Archives for October 2006

Don’t choose your hospital by your room desires…

While taking a history recently, I asked the patient why they hadn’t availed themselves of Hospital Y, where their doctors are, much closer to home.  (Usually it’s ‘we like this hospital better’, but consultants ask when called).


“They don’t have any private rooms there, so I want to be admitted here.”


I chuckled a little inside before giving my reply: ‘We’re out of space in the hospital, and if admitted you’ll be in the ED all night, or in a hallway upstairs’.  (True, we were stuffed to the gills).


So, don’t assume anything in hospitals anymore.

MedBlogs Grand Rounds 3:6; Dr. Hebert’s Masterpiece


There have been some entertaining presentations for a Grand Rounds (myself, I’m Joe Friday), but this is a masterpiece: Halloween Grand Rounds


37127957_8f5f102020.jpgAnd now, without further delay, and with apologies to Edgar Allen Poe, I present to you

The Intern

Once upon a midnight dreary, while I rounded weak and weary
Stomach hot and rumbling, I came bleary and a-stumbling
For a cup of hot caffeine through the doctor’s parlor door.
On the sofa lurked before me a shadow breaking silence with rumbling snore.
‘Tis some visitor, I muttered, slumb’ring loudly, bell’wing out that roar.
A sleeping Intern, nothing more.
Ah, distinctly I remember twins delivered last September
Sadly recalled by the Fat Doctor, a patient that she had before;
Or maybe Ghosts the Tundra froze, that living were Yupik Eskimos.
I steeled myself – made no fuss, recalled a day on the Singing Bus
Traveling happily through Uganda, Borneo Breezes dancing
           on the wooden floor.
Simply this, and nothing more.

Holy Cow.  It’ll be a while before I volunteer to host again.  A Bravura performance!

‘Sperm-stopping’ male pill hope

No doubt to be marketed side-by-side with the morning after pill is:

‘Sperm-stopping’ male pill hope: “Scientists are developing a male contraceptive drug which stops the development process of sperm.”

“Yeah, baby, I’m on the pill”. Are there actually going to be takers for that line?

Radiology Grand Rounds 5 up

Here: Sumer’s Radiology Site: Radiology Grand Rounds-V.

Parade Magazine and ‘Surviving the ER’

In today’s Parade magazine (bundled with the 3 pounds of newspaper delivered each Sunday) the headline article is:

(as of right now their site is screwed up, so I’m going from memory)

I read it, mostly out of a sense of curiosity, and their highlighted items make sense to me.


  • have a medication list, up to date
  • know your allergies
  • know your doctor’s name
  • have a copy of your EKG (if you’re a heart patient)

And all that makes sense to me.  The other thing they recommend, and which I cautiously endorse, is ‘get staff attention when something changes or it’s been a long time since re-eval’.  Once a year this really pays off for the patient, and it’s appreciated, which is why I cautiously endorse getting attention.  What I would caution, however, is that after you’ve made your concern known, and the complaint has been addressed, most likely nothing is going to change.

It’s a long wait because the resources are limited, no there’s not a bed upstairs yet, and screaming for more attention (as I had to deal with recently) doesn’t make a bed magically appear, it just keeps us from doing anything but listen to your self-important carping.  So, make sure you’re not forgotten but don’t expect that to change anything most of the time.

Nice article about the US Navy Corpsman

I served with a lot, and respected them for the hard work they did.

There’s a nice write-up about Corpsmen at the Atlanta Journal-Constitution.

Knowing too much

Being a physician is a blessing in many ways, and I won’t bore you with the details.  Getting to this point was a lot of work, but it’s been (overall) worth the effort.

And, it’s a mild curse.  A close relative says “I have a headache” and it’s twenty questions with a lot of exam thrown, in, and a modest desire to get a CT.  Yeah, it’s a non-focal exam, and no it’s not a sudden-onset headache, but if anyone presented to my ED with this headache they’d get a CT before they left.

I expect it’s “just a headache”.


But, I’ve seen too much.


And I know too much.

Overdoses in the news

Why is it that death by (illegal) drug overdose is always protrayed in the news as a “tragedy”?


It’s not a tragedy, it’s a preventable death.  Not taking the drug is the prevention.


Yes, I’m square (cubelike, really) but I don’t get it.  Sad, yes.  Tragedy, no.

CPR class proves valuable for pair of Midlanders

And gives me a soapbox to rant about training recurrence:

logoMonday, Howard, making her way through produce, fell to the ground, split her head open and stopped breathing. And Preston responded.

“I thought ‘I can’t let this lady die,'” Preston later said. “I got up by her head and started doing CPR.”

And so Preston, 47, summoned a skill she learned approximately 25 years earlier when as a mother of two in Andrews and took CPR classes.

“You don’t ever think you will use it,” Preston said. “I never dreamed I would ever have to use it at all.”

“She was not breathing at all,” Preston said. “I thought of my mom and dad, and if it was my mom and dad, I would want someone to do everything they could.”

Howard, 69, started breathing again, and Preston remained at her side when paramedics arrived prepared Howard for her trip to Midland Memorial. At the hospital, Howard underwent surgery to insert a pacemaker. She was released Tuesday and is in good spirits…

So, 25 years after her training, Mrs. Preston was able to save a life (and good for you, Mrs. Preston!).

Why, then, do the CPR cards expire?  Knowledge lives as long as the giver lives.  I’ve been taking CPR classes since 1981, and except for some minor details, it’s been the same.  Oh, a few fewer breaths, a little more pushing, but it’s the same within the realm of reality.

Long lives to all.  Take a CPR class, and then eat the card.  Expiration dates come to all of us, and it’s not the knowledge that expires.


I’m not dead, just dead-tired.  I get a break soon, and it’ll pick up here then.


Until that time, here’s some things that are completely unconnected.

Read about the trial and conviction of an ED doc in USA today.  Oh, actually, he’s just tried and convicted in the paper.


A story: a bitter divorce is finally concluding, and the soon to be ex-hubby (h) calls the soon to be ex-wife (w) as such:

h: I’d like to come over tonight, and we can divide the wine collection in half.  (Big, expensive collection).

w: Okay, come over after 5.

It’s after 5.

h: okay, let’s divide them

w: I already have – (points to a room)

In the next room are all the wine bottles, uncorked.  Next to each is an unlabled mason jar, with 1/2 of the bottle poured into it.

w: your half is in the jars.



KRLD: Mavs Doctor hopes to raise $1 million to put AED’s in schools

DALLAS (AP) A group headed by the Dallas Mavericks team physician said Wednesday it plans to raise $1 million for at least one automated external defibrillator in every Texas public high school after a recent mandate requiring the device.

The donations would help solve how some cash-strapped school districts will afford the life-saving heart stimulator, also known as AED, which costs about $1,200.

The University Interscholastic League voted last week to require that all 1,300 public high schools have at least one AED on campus but did not address how schools would pay for them.

The Texas Sports Medicine Foundation has already raised about half its goal and will give priority to rural school districts with smaller budgets, said Dr. T.O. Souryal, the group’s founder.

“We’re the safety net,” said Souryal.

Putting AEDs on high school campuses vaulted to the forefront of the UIL’s agenda after a recent rash of students who collapsed with suspected heart trouble, including three teenage football players who died in a 10-day span in Houston.

At least 600 high schools in Texas already have the devices in place, and most large school districts own several for their many campuses.


MedBlogs Grand Rounds 3:5

I link to a lawyer:

Ohhhhh . . . Tuesday Morning . . . feels like a hangover. I’m finally coming down from the caffeine buzz of last weeks Grand Rounds hosted by Kim at Emergiblog. I’m in withdraw after a week of working on the incredible submissions for this week’s edition of the best from the medical blogosphere. Actually, I’m looking more like Ground Round! I should have heded Kim’s advice – but you know it’s difficult for lawyers to take advice.

Another marathon Grand Rounds!  (Which I much prefer, thanks). Iraq lacking in emergency medicine


Iraq lacks facilities and expertise in emergency medicine

Bassim Irheim Mohammed Al Sheibani, lecturer physician1

Iraq has a population of over 26 million and more than 180 hospitals, but only a handful have emergency departments. As the violence escalates, and we attempt daily to deal with the devastating effect of multiple deaths and severe injury, the reality is that we cannot provide any treatment for many of the victims. Emergency medicine in Iraq has never developed to meet such unprecedented demand. Emergency departments are staffed by doctors who do not have the proper experience or skills to manage emergency cases.

Read the rest.  Grim.

Headed for medical meltdown

That’s the title of a nice rant/op-ed piece at the Houston Chronicle’s online effort,



Once upon a time, health care was a matter between you, your doctor and the chicken that you used as payment. Then it became a matter for you, your doctor, your employer, your health insurance company, the doctor’s malpractice insurance company. The list goes on …

I am a doctor. Although not old enough to have personally experienced the days of the chicken, I am old enough to be alarmed by this trend. It was out of a desire to learn, “How do we get back to the chicken?” that I left my emergency room in Houston for the U.S. Senate.

I wish I could say that I came away from the experience heartened by the dedication and attention that our leaders are lavishing on the “health care crisis,” confident that bold solutions are just around the corner. Unfortunately, my time on Capitol Hill left me less optimistic than before.

I thought it was from a field-trip, but apparently not:

Bacal is a physician with specialty training in emergency medicine, aerospace medicine, and public health. A graduate of Baylor College of Medicine’s Medical Scientist Training Program, she has worked on health policy for the U.S. Senate as a Robert Wood Johnson Foundation Fellow.

I know nothing of the New Zealand solution mentioned; can anyone enlighten me?

Both Military and Civilian Families Unprepared for Disasters

More from ACEP in NOLA:

American citizens are unprepared for a terrorist attack or natural disaster, and there are no significant differences among military, retired military and civilian families regarding preparedness for disasters, according to a new survey released during the annual meeting of the American College of Emergency Physicians (ACEP) in New Orleans.

Drs. Richard Dagrosa and John McManus, both emergency physicians in the military, surveyed people in San Antonio, Texas, including patients in two military hospital emergency departments. The survey results show no significant differences among military, retired military and civilian families in regard to having a disaster plan, designating a meeting place or having a disaster kit. Only half the families in the survey had prepared any kind of disaster plan, and only one-third possessed a disaster kit.

This surprises me, a little.  We have all of the above, and I wonder why anyone wouldn’t.