Archives for July 2012

Clostridium difficile colitis and you, a video tutorial

Learning can be fun!

Just say no to antibiotics you don’t need.

The ultra-awesome

Karen -The bus monitor-Final donation tally

Lets Give Karen -The bus monitor- H Klein A Vacation! — Indiegogo.

In case you don’t recall, this is the nice elderly lady who was working as a bus monitor when she was verbally abused by some feral children who thought it would be a good idea to video the attack and post it to YouTube.

One good guy started this donation page to raise $5K ‘to send her on the vacation of a lifetime’. They raised $703,833. That’ll make for a very nice retirement fund, and she can vacation when she wants.

Good for Max Sidorov for doing this (and for indiegogo for having a platform to make it happen).


Happy Birthday honey!

Somehow I won the marriage lottery, and got the best mate I could have. I cannot be more serious: nobody else on earth understands me better, and still accepts me. Win.

As I said, win.

Happy Birthday, Honey!

A ten year doc’s advice to newly graduated EM residents…

Recently, I blogged about being at my new job for 10 years. It was a wonderful experience to blog about stability. It’s also illuminating I’ve been here for 10 years and still call it my new job.

Not long after the blog post went up, I got an email from a soon to graduate Emergency Medicine resident who was curious as to what techniques I have used to stay at the same job for 10 years. This caused me some consternation, as I don’t think I really had an actual plan to be at the same place for this period of time. Emergency medicine practitioners are not known to stay in the same place for a long time, so blogging about a 10 year stay is something of an anomaly.

When I was a resident the common knowledge given was that it was important to serve on hospital committees, and to otherwise do a good job and you would be recognized and your life would be fine. This may or may not be true for everyone. I did find that I was on hospital committees, but it was after I’d been here for more than eight years and was interested in serving on them. One of the unusual things about my group is that there is extraordinary longevity, and I’m still basically middle of the pack having been here 10 years. I realize this is atypical for emergency medicine, but I think it will become more normal to have more job longevity as the emergency medicine field matures, and as there are more graduating residents.

What you’ll find helps you in the long run in emergency medicine is being a good colleague to the medical staff. This is somewhat antithetical to the way we’re trained, which is this low-level combat between departments, but ultimately the rainmakers talk to the hospital President, if your group isn’t making it some other group will. This does not mean you have to be a doormat but it does mean that when a consultant calls and asks you for a favor if it’s not unreasonable you should do it. This isn’t bad medicine, this is actually good medicine because you’re helping a smart colleague help out their patient. This service does not go unnoticed. In fact, if you want to stay in your place for a long time, be known to be helpful.

Being competent, you’d think, would be a given; you’d be wrong. Being competent in your job, and collegial with the nurses and staff, goes a long way to being accepted as one of the group and being one of the group means you get to stay.

Nobody wants their doctor to be having a bad day. Nobody who works there wants the ER doctor to be having a bad day. It doesn’t matter that your cat threw up in your shoes, or that your underwear is too tight, you have to try to get along. I’m not going to lie to you and tell you that I’m all roses and sunshine but I’m trying every day to get better at this.

Your reputation is set early, take advantage of that. I have a reputation for always being early; these days I’m about on time. For the first six months, I was about 10 to 15 minutes early for every shift. But, since I was always early initially, my reputation is set. On the same theme, as a colleague says, two minutes late is not on time, it’s very very late. When you’re working your tail off, you don’t want to be wondering when your relief is coming in. You’re very important; so is every single person you work with. Never forget that.

New grads are always interested in, and worry about, hospital politics. Here’s the short version of hospital politics in your first two years of practice: don’t make the directors’ job hard. That’s all you have to do. Just show up, work, practice good medicine, and don’t make the director’s job hard. The director is in that position for a reason; as a matter of fact, they’re so smart they hired you, so you should give them the benefit of the doubt when the iffy call comes out. They don’t want you to bother a certain specialist after a certain time; there’s a reason for that, and you should have a conversation behind closed doors, not at the nurses station.

And, when you do finally step in it, and make the mess that’s going to show up on the directors desk sooner or later, you need to be the one that has the conversation with the director first and they don’t need to hear about it from anyone else. This is basic leadership and you need to get on board with it. If they have the facts, and have your side of the story good or bad, they can help you; if they get called on the carpet and have to defend you not knowing your side of the tale, you will not come out the better for the experience. This is just the way of the world, it’s been the same way since you got punished for your brother knocking over the lamp. Help the guy who’s got to help you.

Also, when you show up, you’re going to be full of new knowledge. This doesn’t mean you’re smarter than the group, this just means you got out of training more recently. Use your new power for good and not for evil. And as you’ve probably guessed, there are about 30 ways to skin a cat, and you got trained in two. Keep your eyes open, and learn from your colleagues. They want to help you, let them help you.

Finally, have a life. Don’t spend all the money, put some away, as you may be like me and have to change jobs the first year. It happens. It happens to a lot of us; this doesn’t mean you’re bad it just means it was a bad fit. Keep trying.

Most of that was platitudes; sorry about that. The realty is if you’re a good person, do a good job, and play well with others you’ll be fine.


This was written with the new Mountain Lion operating system for the iMac; it was dictated and now you know that I don’t speak well.


Skydiver Fearless Felix jumps from 18 miles up

Skydiver “Fearless Felix” Baumgartner has done it again.

On Wednesday, Baumgartner took another stratospheric leap, this time from an altitude of more than 18 miles – an estimated 96,640 feet, nearly three times higher than cruising jetliners. He landed safely near Roswell, N.M. His top speed was an estimated 536 mph, said Brian Utley, an official observer on site.

via News from The Associated Press.

His goal is to beat the 1960 record of Capt. Kittinger of 19.5 miles up.

If you have a few minutes, read about Captain Kittinger’s life. Amazing fellow.

My First IDPA; a request for information

I plan to attend my first IDPA match this Friday. Hopefully (I haven’t heard they have a new shooter spot yet).

For those uninitiated: IDPA stands (in this case, there are other acronyms using the same letters) for International Defensive Pistol Association which describes itself thusly:

The International Defensive Pistol Association (IDPA) is the governing body of a shooting sport that simulates self-defense scenarios and real life encounters. It was founded in 1996 as a response to the desires of shooters worldwide. The organization now boasts membership of more than 17,008, including members in 50 foreign countries.

The link is here, but you must agree to indemnify me if your eyes are harmed after following the link. It’s not a pretty web site.

I mention this as I’m not interested in showing up and looking like an idiot. I have the requisite gear, and have shot a little (ahem), but always like to be prepared and hate looking like an unprepared person.

So, for those who’ve been before, what should I take beyond the minimum, and what should I anticipate that reading the FAQ doesn’t prepare me for?

iowahawk: You Didn’t Build That

You Didn’t Build That

Readings from the Book of Barack

1 In the beginning Govt created the heavens and the earth. 2 Now the economy was formless and void, darkness was over the surface of the ATMs, and the Spirit of Govt was hovering over the land.

via iowahawk: You Didn’t Build That.

I try not to be non-medically political here, but this is inspired.

Congrats Youngest Daughter

Our youngest graduated from Chapman University in Orange, California a couple of weeks ago.

Aged 20. With Honors.

Yes, a Disney Graduation hat. Not worn at the actual graduation.

We are very proud of her, as you might imagine. And she’s in California, so employment awaits. And awaits.

This does not in any way detract from our manifest pride in her accomplishment (and my thanks for graduating a year early…).

She’s bright with a similar future. Here’s to Her!

C-17 Globmaster fun

Yesterday a C-17 landed safely. It was also pretty spectacular, as it was on a 3,000′ general aviation strip 5 miles short of the McDill AFB runway.

Okay, but can they then fly it out?

From here:

Ottawa ankle rules and me

[blackbirdpie id=”223480429871767552″]

This reminds me of my experience with the Ottawa Ankle Rules in the Navy.

USMC Infantry is designed to generate ankle sprains, and recurrent ones. Initial sprains as young athletic hard chargers are required to carry big loads over unimproved terrain in the dark, plus seemingly all the time not in direct training was spent running.

The larger problem, and one I was educated on by a fellow BN Surgeon (who was a physical therapist prior to med school) while in Okinawa is that there’s no ankle rehab after a sprain. As soon as you can run on it you do, despite having torn stabilizing ligaments and not having done the training and exercises to get the ankles’ accessory stabilizers up to speed. Then, another sprain. The story of how our medical department got this fixed later.

Sick Call was musculoskeletal city with daily ankle sprains, which by that time in the Marines were usually recurrent. About a year into my assignment, out came the Ottawa Ankle Rules. After a year of negative x-rays, finally, a clinical tool to cut down on useless imaging! I used it in practice, taught it to the Corpsmen (who also found it usable and liked it) and our x-ray utilization dropped hugely and AFAIK we didn’t miss any significant fractures. I was proud.

I was moonlighting (for free, I was that bored) in the Camp Pendleton Naval Hospital ED, and mentioned my new practice and how I was proud to have made an impact.

The response: Please stop doing that. Now when they get off duty they drive down here to get an x-ray”.

Humbled, we backed off a little, but not much.

My response to the above tweet (which I now think I recall as being an @nickgenes original) was “Canadians get exams, Americans get x-rays”, which sums it up nicely.


BLS Jobs By Industry Treemap

BLS Jobs By Industry Treemap.

Follow the link to a very neat, interactive map of where the jobs are (and aren’t) according to the Bureau of Labor Statistics. Then play with the time scale on the left.

Very fun and educational tool! Interestingly, Healthcare has been pretty resilient throughout the last 10 years.

via @AceofSpadesHQ

Japanese parliament report: Fukushima nuclear crisis was ‘man-made’ –

Wow. I’d bet our culture would have a hard time admitting that culture is an impediment, as we have a pretty wide ‘criticize everyone’ outlook; this must be shocking inside the Japanese culture:

The report’s authors — led by Kiyoshi Kurokawa, a former president of the Science Council of Japan — attributed the failings at the plant before and after March 11 specifically to Japanese culture.
“What must be admitted — very painfully — is that this was a disaster ‘Made in Japan,’ ” the report said. “Its fundamental causes are to be found in the ingrained conventions of Japanese culture: our reflexive obedience; our reluctance to question authority; our devotion to ‘sticking with the program.’ ”

via Japanese parliament report: Fukushima nuclear crisis was ‘man-made’ –

IMpressed at the critique, and the nerve it took to write; let’s hope it’s heeded.