A picture’s worth a thousand words a second…
Ramblings of an Emergency Physician in Texas
A picture’s worth a thousand words a second…
Very cool. Good for all involved.
A Formula One fan has had his wish of a new bionic hand fulfilled after a plucky letter to boss of the Mercedes GP Petronas team, Ross Brawn.
I have a few things I really like. Vacation trips to SoCal (nearly always to Disneyland), silly and trivial but fun events there, and a nearly Holy Grail trip to In-N-Out Burger are some of my favorites. I’m easy to please, really. Attainable fun and gastronomic happiness in one trip. Bliss.
(I’m not an expert on pleasure. I’m the weirdest extrovert you’ll meet, in that I will include everyone very happily in my public life, and by that I mean I have a blog, I tell people about all the superficial things in my life (I just had my pond filled in, and I have bored everyone at work with that), I’ve blogged a lot of things people know about, and I keep my private life and friends private. You might be surprised that things happen I don’t blog. You might not. It depends on what you know of me.)
Therefore, things I like I tend to Really Like. This explains why I go to the same places for fun. I’m sure there’s a psychological problem/answer there.
As if by magic, one of the forbidden SoCal-only objects has been deposited in my world: In-N-Out has come to Mohammed. (I’m not Mohammed, it’s a metaphor, no bombings please). My anticipation, thrill really, was shared by the family. To say we’ve followed the construction and timeline of this Parthenon of Patties would be an understatement. Never in the history of our collective, extended family has one fast food joint focused our attention so meatily.
I had the Forbidden Burger tonight! And, it was a burger. Away from its normal surroundings, the pseudo-exotic locale, it was a decent burger, average fries, and a good milkshake. (My choice is not for the calorie conscious).
I felt like I finally had a date with the Prom Queen and found out she’s a shallow, dumb person who also isn’t into me. (I’m not personalizing this intentionally, except it’s personal). I could taste the disappointment. Pun intended.
My title isn’t quite right. I wanted it, I got it, and the failure was mine. It was a good burger, perfectly adequate, served with a smile, and as close in taste as a 1,500 mile breach can be. It’s that it wasn’t eaten There, in The Place. And therefore it wasn’t right. Dang it.
Now I’ve diminished something I liked, a lot, and have learned the big lesson. Don’t screw up the things you like, and where you like things is a huge component as to why they’re liked.
I’ve lost something I’ve loved, and now at best I can like it again, in its rightful place, someday. Context matters.
That would have been a better title. I just had to work through it.
Seems like a lot to get into a tweet. I’d cut the guy some slack on that…
When Gov. Rick Perry emerged from back surgery on July 1, he tweeted that his “little procedure” — a spinal fusion and nerve decompression designed to treat a recurring injury — had gone “as advertised.”
The possible presidential contender didn’t reveal that he’d undergone an experimental injection of his own stem cells, a therapy that isn’t FDA approved, has mixed evidence of success and can cost upwards of tens of thousands of dollars.
He defends Marines and sailors with love and tenacity, protecting them as any Marine would protect a brother-in-arms. He is the epitome of man’s best friend, shielding service members from the enemy while providing companionship and camaraderie. His name is Willy Pete, and he’s a warrior, a protector, a friend. He’s also a dog.
If you needed to find an example of government action designed to make citizenry cynical and disillusioned look no further than this story, from WFAA:
DALLAS — Dallas will keep $2,000 found by a teenager in a parking lot last February.
The money will go into the city’s general fund — not back to Plano high school student Ashley Donaldson, who found the cash in an envelope at the Pavillion Shopping Center in North Dallas.
This after being told she’d get it if nobody claimed it. I found this story on Hot Air, who described it as wall-punching material. They were correct.
So, how much is $2,000 to the city of Dallas? (Hint, their 2010-11 budget is $2,795,393,655 (it’s in the 2011 .pdf file) Two Billion with a B.) 2000/2795393655= 7.15×10-7, or, 0.000000715%
So, you can see they need the money. Certainly means more to the City of Dallas than a 15 year old girl.
An astonishingly unserious look at the budget problem.
Sen. Susan Collins (R-Maine.) said Friday that she will not support the 2012 budget passed by the House last week.
“I don’t happen to support Congressman Ryan’s plan but at least he had the courage to put forth a plan to significantly reduce the debt,” Collins said on “In the Arena” a program on WCSH 6, a local NBC affiliate in Portland, Maine.
Collins, who is one of several centrists in the Senate Republican Caucus, did not say specifically what she opposed in the House GOP plan, but she did say that she would like to begin moving the government towards solvency by eliminating ethanol and farm subsidies as well as funding for an extra engine for the F-35 fighter jet.
“There are lots of opportunities to consolidate and save money,” Collins said.
I’m not a policy wonk, but I know BS when I hear it.
The Ryan plan proposes to reduce 10 year deficits by 5.8 Trillion, so 580bn/year for 10 years (as an average).
Senator Collins’ proposal: kill off farm subsidies (20bn/yr), Ethanol subsidies (best number I could find was 6bn/year) and kill off the GE ‘second engine’ for the F35 project. I couldn’t find hard numbers for that cost (I suspect there aren’t any that are founded in reality), but found one site that said just futzing with the consideration was costing someone a million a week. Crummy assumption, so let’s say it’s costing that much every day rather than every week. It’s a place to start, so, $365M/year, as a low-ball number, before production. All these numbers may be way, way, off, but let’s use them for illustration.
So, 26.365Bn/yr x 10 years = 263.65 Billion dollars. Which is only 5.537 Trillion short of the Ryan plan goal. Or, to look at it another way, this would knock 4.5% off the Ryan 10 year total. Leaving another 95.5% of the total to be discovered elsewhere.
Perhaps she has a whole lot of consolidating in mind. Maybe she’s going to write a check to cover the balance. Whichever, this statement is politician speak for ‘I’m not going to be the naysayer without a plan, I’m going to point out the things I’d cut as a way of showing I have some ideas, too’. But it’s patronizing when you run the numbers, and discover she’s not the least bit serious.
I’ve been reading about our financial problems, and the idea that we can kill off government checks to NPR and Foreign Aid and we’ll be fine is nuts. It’s not that they’re not worth doing, but it’s such small change that it’s barely even a start. There are no easy answers.
Everyone’s ox gets gored before this gets fixed, and pretending we can cut some fluff or a program that only directly affects a few isn’t serious.
Very neat. Via @CardioNP on Twitter.
3 April 2011. Also: Fukushima Daiichi Nuclear Plant Hi-Res Photos 2:
From a High School friend who went the Navy path, and keeps in touch: RadGuy in West Texas…
My background in nuclear power. I completed 6 years in the US Navy’s nuclear program. I qualified at the Nautilus (S1W) prototype in Idaho, and was assigned for several years to a nuclear power guided missile cruiser. My last year in the Navy was spent planning and performing repair work on submarine, cruiser and carrier nuclear plants. As a civilian, I spent 5 years doing inspection and testing in the engineering department at one of the largest (1250+ megawatts per unit) nuclear plants in the United States. I ended up with a reasonable amount of knowledge enlightened by a great deal of practical experience.
Why is this on a medical blog dealing the Emergency Medicine? The EM system has evolved in a way that the nuclear power industry has not. In EM, many trained technicians have been added over the years; ranging from EMS first responders in the field, to the various techs in-house in most EDs. Having a group of people trained to perform specific tasks not only speeds care, but it allows those dealing with the most serious problems to act with greater focus.
The nuclear power industry has not evolved in a similar manner. An irrational fear of nuclear energy has left power plant operations to be a great mystery, and made outcasts of those who run the plants. This has left us with a very small number of operators run massive plants. Typical coverage might be 4 or 5 operators in the control room, and a similar number out in the plant. In my civilian career, that would be perhaps a dozen per unit, on a two unit site approaching 10,000 acres. Yes, there are more than a thousand other employees, but only around slightly more than 20 on site that are trained and allowed to operate equipment. The high level of engineering and verbatim compliance with written procedures allows this to work. Highly trained people do certain things in a pre-planned certain order.
In Japan we have seen a large, multi unit plant hammered by a huge earthquake and a tsunami. The earthquake was of a severity far beyond what the plant was designed for. All power was lost, and bad things started to happen that could not be coped with by the onsite staff.
The immediate need was for power, and circulating water. A group of trained responders should be available to provide these things from self contained equipment they bring with them. A modern nuclear plant is built on a truly vast scale. Careful modification will be needed so that these crews may begin to provide the needed services without help from the plant operators. The task is to arrive, hook up the needed services, and let the trained plant operator operate the needed equipment inside the plant.
All the equipment should be of a size to be carried in or behind standard size vehicle, say a large pickup or van. The equipment must be self contained, and be simple to operate. These units should be sized to be contained in a large pickup, or towed in a reasonable sized trailer. When needed, they should be suitable for air transport.
A fair standard would be 300 hp class diesel engines, attached respectively to generators, pumps, and air compressors. These should be of a robust but ordinary commercial design. Fuel tanks sized for around 24 hours of operation.
On the plant side, design must allow vital systems to be accessed from outside, with ordinary hand tools. I propose color coded and number steel access plates on the outer walls of various plant buildings. Crews can unbolt the cover plate, expose connections, and hook up the appropriate service.
In Japan, the first need was a power connection for each unit. Assume that first responders begin to arrive around three hours after the initial event. Whether they arrive by road, air, barge or train does not matter. The first units to arrive connect to the first power panel for the assigned unit. This power is not to run plant equipment, but rather to provide power for instrumentation, control and communications. For each unit, this is well within the capacity of a single portable diesel.
Once there is power for communications, and more direct intervention can begin. As additional power units arrive, they can be attached to single plant loads, those deemed most vital at the time. Examples might be a small number of pumps, or even a single large pump. It could be power for a single set of motor operated valves. The power units would be attached under the direction of the operators for each plant. These could be emergency feed pumps, fire pumps, isolated HVAC systems.
Besides power, there may be a need for cooling water. From photographs, it appears the circulating water intake structure in Japan was badly damaged. If the systems are intact, portable power can run some of the pumps. With damage such as occurred in Japan, connections similar to standard dry standpipe fire systems should be provided for in an individual basis for vital loads. This could be heat exchangers for cooling anything from the plant emergency generators, to decay heat removal systems. Single fire engines, or trailer mounted pumps can then provide water for individual loads.
These small interventions will provide time for other needed repairs, and for more trained plant operators, engineers and technicians to arrive. From the available information from Japan, perhaps a dozen such portable units would have allowed things to progress much more slowly. Indeed, with timely intervention and a bit of luck fission products would not have been released.
It is time to accept nuclear power as a part of daily life. The communities that use the power from these plants can also provide support in emergencies. Truly, we are all in this together.
Okay, I’ve been passively watching, safe in my relative geography. Then today I read that there are TWO Fukushima nuclear plants.
It’s F1 that’s having all the problems, reportedly F2 is shut down and cooling off.
When I’m confused about geography, my current go-to is Google Earth.
There are two Fukushima nuclear plants, you ask?
AUSTIN — Texas medical regulators on Friday placed on probation a West Texas doctor involved in the unsuccessful prosecution of two nurses who complained anonymously that the physician was unethical and risking patients’ health.
The Texas Medical Board technically suspended Dr. Rolando G. Arafiles Jr. but allowed him to continue to practice medicine while on probation for four years if he completes additional training.
Welcome to the Donation Page of
Join me in my efforts to support Tragedy Assistance Program for Survivors (TAPS)!
On March 27, 2011, I will be participating in the Dallas Rock ‘N Roll Half Marathon in support of the Tragedy Assistance Program for Survivors (TAPS). TAPS provides direct support to families who have been impacted by a death in the military regardless of geography or circumstance.
I wrote about her late husband, an ED Nurse colleague, after his untimely death here. I’m glad Kate is helping others, and TAPS sounds like a terrific program.
I gave to her goal, and hope you’ll consider doing the same.
I’m in one of those phases where feeding the blog is a) not a priority and b) a potential liability, so it’s one of those things.
It’s not that I don’t like all 9 of you readers, I do. It’s just that with the repeal of the 24 hour day I have less time to get work/family/TV/CME/all that other stuff in. 2/3 of my kids have been home for a while, it’s been terrific, and tomorrow I go down to 1/3, keeping the lawyer. Go ahead, tick me off, and find out what having a temporarily unemployed lawyer at the other end of a complaint feels like. He’d like me to tell you that’s a joke, so it is, because he says it is. That’s what a decent legal education gets you.
My medical practice is smooth, and I’ve given a couple of talks to groups recently, so that’s fun. I talked for medical CME about whether non-contrast of the abdomen is ready for ED use (short version, no), and it was decently well received; yesterday I spoke to a nursing CME conference, ditto.
If you’re an ED doc and you haven’t at least looked at how to manage patients who come to your ED with a ventricular assist device, catch up. They are no longer locked up in the CCU, they’re now being sent home with them. This wouldn’t be a problem except they break a lot of rules… like no CPR if pulseless, etc, and some of these are designed to be pulseless. You can see the problem.
As for the liability, I’m getting more leadership/responsibility roles, but middle management types can’t blog those. Paul Levy can, as a CEO, but nobody in the middle can, and it makes sense to me. Lacking amazing stories of management (and I wonder if there are any), nada to blog about. Hold your breath for the reports from my addition to the hospital Bylaws Committee. Yeah, crazy stuff.
On a professional note, I’d like to alert all me ED colleagues that apparently a) jeans are no longer pre-washed before sale b) adolescent females don’t wash them before wear, and c) you’ll see patients in the ED with inexplicably warm yet blue extremities. Connect the dots, win a prize. I’ve picked up 3 of these recently (that have seen other docs who haven’t connected the dots), and have added alcohol-preps to my skin exam in select cases. Awkward diagnosis, and rewarding. (The key is warm, blue extremities but the skin discoloration skips the ‘between the digits’ areas).
I’ll be here. Thanks for checking in.