H1N1

What you should do if you think you have H1N1.

First, calm the fuck down.

After that, calm the fuck further down.

H1N1 is the flu. The flu is unpleasant. Most healthy people will not die from H1N1, but you wont hear about those people on the news. You'll hear about the ones that die.

Here is a flu survival plan:

1) Get vaccinated. If you didn't get the seasonal flu vaccine you're already failing yourself. If you haven't gotten the H1N1 vaccine, go stand in line and get it. Had H1N1 hit a little earlier, it might have made it into the seasonal flu vaccine. Don't be any more afraid of this vaccine than the regular flu vaccine

2) If you do get the flu or have flu like symptoms (FEVER, chills, cough, nasal congestion, sore throat, body aches) remain calm. If you have no medical conditions such as diabetes, asthma, cancer, kidney problems, liver problems, pregnant, etc (Hypertension DOES NOT count) then you have nothing to worry about. If you do have any chronic health problems, if you're under the age of 2 (shame on your parents for letting you read my blog) or over the age of 65 you should go see you're doctor, the sooner the better. Otherwise, move on to step 3.

3) buy the following medications: Naproxen or ibuprofen, acetaminophen, claritin D (loratidine/psuedoephedrine), and mucinex. Take them as directed. Stay in your house, don't go to work, don't go play with young children or pregnant women. THE MAJORITY of the people that get the flu will not need specialized medical care.

4) DISCLAIMER. If at any time you suffer from severe shortness of breath, altered mental status, seizure, prolonged headache and neck stiffness, become unable to eat or drink due to nausea or vomiting or have any other concerns that you feel are urgent, you should see a doctor. Do not use this blog as your only guide for seeking medical attention. Please see http://www.cdc.gov/h1n1flu/sick.htm for more information on when you should seek medical care.

Obama's Healthcare plan.

Ok, give me half a second. The American healthcare system is broken. Obama's solution: use tax money to buy more people into the broken system. WHAT THE FUCK.

And since I'm bitching. I saw a clip where Obama said, more or less, "we need to start paying doctors to treat diabetes. Right now they would rather cut off a leg and make 30, 40, even 50 thousand dollars to cut off a leg."

HOLY SHIT. Can I sue Obama for malpractice? First, doctors do get paid to treat diabetes and we do it pretty well. The problem is not with doctors aggressively treating diabetes, its with diabetic patients being compliant with the prescribed treatment. Oh, the actually payment to the surgeon (HILARIOUS because surgeons cut people, they don't really treat diabetes) for cutting off a leg is 700 to about 1100 bucks which includes the post operative care.

So how do we fix healthcare?

1) Get rid of insurance. As long as the "it only costs me $20" mentality exists healthcare costs will be insane. People must be unblinded to the cost of the care they receive. Unfortunately, our society is leaning more and more towards a mentality where we should get what we want and someone else can pay for it. Another problem with insurance. They take the biggest chunk of the healthcare profits and they provide he least actual service. Free up about 20% more profits to distribute to hospitals, doctors, and nurses and you will drop the amount of money those entities charge (in theory, never underestimate human greed). Also, insurance companies consume a large amount of dollars in their operating costs. Get rid of all those corporate executives all the way down to the people working in the cubicle and you free up another large amount of money. Remember: health insurance providers make money. That means we are flushing money somewhere when we pay those premiums.

2) We must, as a country, redefine our expectations of medicine and its ability to make us immortal. When an 85 year old has a massive stroke, there is no reason to spend 3 million dollars in ICU care to extend their life by months. Exactly where we draw the line will take a lot of discussion, but it has to happen somewhere.

3) There must be some motivation for people to stay healthy. The majority of the people reading this blog are probably disgusting fat fucks. You probably eat like shit. Some of you drink, some of you smoke. And why not? There is no motivation in this country to stay healthy. I wont say how we impose the penalty errr motivation, but I think personal responsibility for ones health has to come to call at some point.

4) Encourage saving. WE MUST as a society get over the idea that we will pay for everything with money we will make in the future. This goes for everything. People making 60k a year purchasing 500k houses is insanity. The same goes for medical care. People should be encouraged to "self insure" or save money that can only be used for healthcare. Tax incentives, whatever. But we need to find a way.

5) Tort reform. Fat chance. Obama has all but said he has no interest in tort reform. Imagine that, a lawyer not wanting to regulate lawyers...

These are just starting places. Doctors need to change too. No more appeasing patients requests for expensive medicines, lab tests, and imaging unless they are absolutely indicated. Drug companies shouldn't be allowed to advertise to the public. There is no need and it adds to he cost of the drug. SO MANY PLACES TO TRIM THE FAT and all we hear about is public options.

Obama is failing this country. I don't care if you like the guy or not. Don't settle. Don't allow people to vote for a bill that is long to the point that no one really understands whats in it. We must reign our politicians in and make them answer to us, their bosses.

Does anyone read this shit?

Sometimes I make these posts and I wonder who the fuck is reading this shit, and of the people that do read it, how the fuck did they find it.

Anyway, lemme tell you a little about life. Its fucked up.

Lemme tell you a little about life two weeks ago. It was even more fucked up.

In medicine people refer to call schedules like the way you would write a prescription. For example, 1 tab P.O. q6hr = 1 tab by mouth every six hours. Its Latin and stuff. Anyway, people say, "Yeah, I'm q4." which would mean you're on call every 4th day. Example. On call Monday, your next call day would be Thursday.

The most hardcore thing you can legally do in a residency these days is be "q2." That means you would be on call Monday, post call Tuesday (which means all you can do is sleep) and then on call again Wednesday. Or, put differently, you can accumulate 60 our of 72 hours awake and at work.

The point of this is I had 5 calls in 12 days. So, 5 q2 calls AND IT FUCKING SUCKED. So for all you bitches that can't stop bitching about the cost of health care and the greed of doctors I have one question: How many 80 hour weeks have you worked in your life? Ok two questions. How many weeks have you worked over 100 hours and made barely over minimum wage for it while sitting on six figure debt that the interest is running on.

The end.

I See You

The ICU is a horrible place, full of suffering. A place of weeping and gnashing of teeth. A place tainted by the stench of defeat and blessed far too infrequently with the perfume of triumph. It is a parasite that feeds on your soul. It grinds on you daily physically. It grinds on you daily emotionally. It grinds on you daily intellectually. If the ICU had its way, it would leave you as ashen and hollow as the bodies left by those that pass their final breathe there. It is a zombie, wantonly seeking brains only to leave a wake of pestilence and apathy.

As you can imagine, its can be quite an unpleasant dish. Especially when it’s served with sides of early mornings, call every third day, and only 4 days off out of 32. The piece de resistance, for me, is partaking in this smorgasbord of despair during Christmas.

While my wife, who is 716 miles away, opens gifts and plays Rock Band I get to gather a family and tell them we’re out of options. Their father is dying and there is nothing we can do to stop it. On Christmas day.

Today was an especially vigorous beating. The particularly beautiful sunrise left me optimistic that, despite having admitted seven new patients yesterday and discharged only one, Christmas day would be a day of celebration. I’ll spare you the details, but when I left this afternoon the overcast sky, sidewalk, and façade of the hospital were a pallid infinity of melancholy befitting of the events that unfolded in the interim of my arrival and departure.

My drive home was filled primarily with thoughts of Glenlivet and napping—an indifferent repose punctuated briefly by moments of terror related to esoteric diagnoses and outlier lab values that gradually submitted to rationalism. It was with this mindset that I crested the pass and saw, of all things, a rainbow. It was so cliché.

I’d like to tell you the rainbow engendered some epiphany and offered me the strength to carry on and fight the fight one more day. But it didn’t. It was just pretty to look at. The reality is I will fight the fight only because I’m forced to. It comes to me, and I either surrender or fight. That is the poignant reality of the ICU, which for me has become the allegory of life itself.

Dying Miserably.

Death is a funny thing. Well, not really funny “ha ha”, but peculiar. The afterlife is a topic addressed by every major religion. The Buddhist even wrote an entire book dedicated to guiding the recently dead from this world to the next. It’s a dilemma all mankind faces. I talked to a mentor who works in hospice. He told me that there are three kinds of people: those that die joyfully, those that die with indifference, and those that die miserably. The indifferent believe they die, go six feet under and that’s it. It’s final, which lends some comfort. The joyful believe in an afterlife, a Heaven and Hell, and know they are going to Heaven. The miserable are the ones that interest me. They fight for weeks, teetering on the edge, go with restlessness and have much fear of dying. These people believe in an afterlife, but don’t know where they are headed. My interest isn’t morbid or malevolent—I don’t enjoy suffering. My interest is because of an experience I had as a young man of 19 years.

It was a hot May evening. In Texas May is already hot, the two weeks of Spring passed months ago and the Summer’s oppressive heat is on full force. A week before I received my EMT-B license, something I got on a whim because it sounded fun, plus, it looked cool from what I’d seen on TV. I figured it would help me pick up chicks too! I went in to see if my local EMS provider was hiring and got, “Can you start tomorrow?” in response. This was my mindset that May evening. My job was an exciting TV show. It was voyeurism at its finest. And so I sat, on Medic 58, waiting for the commercials to give way to the action of the show.

Imagine my joy when, “Medic 58, five-eight, copy call,” crackled over the radio. “Priority 1 respiratory problem. Unknown age male caller states he can’t breath and hung up after requesting ambulance.” We were in the poorest part of the city, an area legendary amongst the veterans for drive by’s and death. Imagine my disappointment with a banal asthma call, a common affliction of the predominantly African American population.

We made the eight-block response in under 45 seconds. Barely over 2 minutes passed from the time Dispatch answered the phone to the time we checked “on scene.” I was the third man on the truck. That meant I was in the “hazing” phase of my training. For me, EMT really stood for “extra man on truck.” My job was to carry the gear. All of it. On every call, even if it was a stubbed toe. When I got to the patient I was then to take a blood pressure and start getting demographic data. My partners were at the door when I came waddling up with an ED’s-worth of gear. I could hear someone pleading, “Help I can’t breath!” It was like his mantra. “Ok, but first you gotta unlock the door, guy!” my partner pleaded half-heartedly. He too was disappointed with the Trauma Gods afflicting us with this medical patient. The mantra is all he got in response from the patient. In this part of town, everyone had bars on their doors and windows. Most didn’t have AC, so cast iron doors were locked with the wooden door open to allow ventilation with the 100 degree humid Texas air. This was our dilemma: we could see our patient, a black teenager, on his knees bent over with his chest on a couch not more than eight feet away. As we debated what to do, we noticed a coffee table pushed to the door with a key conspicuously placed at arms reach. We were in.

“Ok, calm down, lemme check you out, guy,” my partner said matter-of-factly as he turned the man around and sat him on the couch. “Shit. Damnit! He’s shot, get the fuck out!” Strong moments require strong language.

I stared at a still smoking gunshot wound. It stared back, like a big eye in the middle of his chest. More like a black eye, due to the large powder burn around it. This guy had been shot recently and at point blank range. I turned around and put my nose in someone’s chest. A big someone. Dressed in black. I could have made diamonds from coal in various parts of my body, but especially my ass cheeks. Every muscle clenched in an effort to ward off the bullet that was about to strike me.

“Whatcha got guys?” asked the oak-tree sized cop. The cops automatically get dispatched any time someone calls 911 and hangs up.

“Shot.” is all I could squeeze past my vocal chords, still locked down under the control of a near lethal amount of fear-induced epinephrine. That was the day I developed infinite respect for cops. That guy routed around that entire house, lit only by a 20-watt light bulb, gun drawn and ready to take life if he had to, by himself. He put himself in imminent danger so the scene could be declared safe and we could do our job. He put his life on the line for some kid he knew nothing of. Way cool, in my book.

Well, we worked this kid over. Darted his chest, started an EJ, we were even debating pericardiocentesis but decided bouncing around at high speeds in the back of an ambulance wasn’t the best place to try our hand at this one. At the ED, they cracked his chest downstairs in the trauma bay. Gave him cardiac massage, hit him with the internal paddles. I watched his lungs inflate—outside his body. This was the coolest job ever. The only thing that kept it from being perfect TV was that the kid died.

A few hours later we returned to the same ED with a boring CHF exacerbation. Bad television. As I took the stretcher back to the ambulance I passed a large group of screaming black people, all hugging and weeping. “Whats up with them?” I asked the triage nurse incredulously.

“Oh, that’s the family of that gang banger you guys drug in,” she replied casually.

It was like someone unplugged the TV. Suddenly the weight of reality crushed me. I imagine it would feel about the same as having the oak-tree cop standing on your shoulders. The suffering that surrounded me in the ED was for the first time exposed to me, uncensored for TV. No more was it a “great call.” It was now a kid, who was begging me to save his life, who I watched die. I was there for the last miserable, begging moments of his life. He died miserably.

That was the moment medicine became more than a TV show, more than a pay check. That’s when it became someone’s baby. Someone’s baby brother. The uncle that would never give their nephew a Christmas present. That kid could have been me had life gone differently. My job was life or death.

To this day, I take my work very seriously, if nothing more than out of respect for the babies, the brothers, and the uncles—the family—who’s lives and futures become my job. I wish I could have told that kid the effect his death would have on me and on the lives of those that I would treat in the future. Maybe he wouldn’t have been one of those that died miserably.

Cheatin' the Reaper!

Very, very rarely do people that lose a pulse recover it. And when they do, its only for a short time and they eventually die or are left in a state where death might have been better. But every now and then, shit falls in line and you can walk in the room, point at the Reaper standing in the corner and say, "NOT ON MY WATCH, BUDDY!"

The other day just so happened to be one of those days. I was in the hall outside the guy's room when he went pulseless, I knew what was wrong with him and what I needed to do to fix it, and I was able to get the resources mobilized quickly.

The reaper put up a nice fight though--like hiding all the ET tube styletes forcing me to intubate with a flaccid ET tube. I also liked when he made the blood bank delay sending my blood up because they thought I wanted crossed blood instead of O neg.

However, in the end, I wrestled that mofo into submission and the reaper hung his head in shame and dragged his scythe down the hall.

So with that in mind, I leave you with the words of Sir Winston Churchill.

Victory at all costs, victory in spite of all terror, victory however long and hard the road may be; for without victory there is no survival.

THE WAR IS OVER!

I'm declaring my war on nurses over! I know, its crazy!

The nurses I work with are some of the nicest, most respectful nurses I've ever worked with. They don't hate me, they don't try and (purposely) sabotage me, and they aren't complete bitches. Its pretty cool.

The other day my attending told me "get this guy out of the ED." I assumed that meant in a timely manner, not discharge him w/o any work up. So I ordered some stuff. When he realized I ordered some stuff he came to try and put his foot up my ass. I just kinda stood there and did the fight club thing where I go to the ice cave and slide around with the penguins. Just then, this nurse steps up and says basically says that she ordered it. The attending laughs and walks off.

That is just one of several cool thing nurses have done for me.

To be fair, some of them have accidentally fucked me. Like the one that kept pulling my nasal tampons out of this guys nose making it re-bleed and eventually requiring an urgent surgical consult and a transfusion. Or the other that "spaced" and forgot to check this guys blood sugar. When I was getting ready to intubate him later it was suddenly brought to my attention is sugar was 18.

Shit happens, and I'll gladly let it slide. Seriously, props to my nursing staff.