Dec

23

Random Notes

December 23, 2011 | 6 Comments

Competition
It’s a rare Emergency Department that does not advertise some kind of thirty-minute-or-less guarantee and many even have electronic billboards flashing their current wait times into the night like a bug light to attract the casual seeker of late night medical care.   Because we have not yet taken complete leave of our senses the [...]

Dec

1

The McDonald’s Paradox

December 1, 2011 | 5 Comments

Left Without Being Fed
Consider a typical fast food restaurant.  On any given day they are staffed to quickly and efficiently handle a certain number of customers and to this end do their employees, many working at the first job in their life, toil mightily.    It’s hard work.  I’ve done it.
Suppose for some reason; rock [...]

Nov

18

J.G. Wentworth and the Hoveround of Doom

November 18, 2011 | 5 Comments

Wake Me When Our Society Collapses
You’ve no doubt seen those annoying ads featuring smug, entitled Americans demanding in one lump sum the money owed to them for structured legal settlements because it’s theirs and they want it now! Apparently we have become such a nation of legal parasites that it requires an industry devoted to [...]

Nov

11

We Are All Criminals Now

November 11, 2011 | 5 Comments

We Who Are About to Die
I once worked at a hospital where every infraction of the rules was punished by death.  I was somewhat insulated from this because it is a little harder to replace a physician than that guy spooning pseudo-meat into my Chalupa but the nurses lived in a constant sweat of fear [...]

Nov

4

Breaking Your Heart

November 4, 2011 | 14 Comments

Code Blue
It will break your heart.
Somebody’s smartly-dressed, elegant grandmother is comatose.  Hadn’t been to church.  Goes every Wednesday and Sunday.  Found in her kitchen in a puddle of vomit and stool, barely breathing. Had been healthy all her life.  Prognosis very poor.  In profound shock and admitted to the intensive care unit where every possible [...]

Dec

17

Prince of Denmark

December 17, 2009 | 42 Comments

Empty Suit
How’s that Hope and Change working for you?  Had enough?  Still grimly resisting that urge to scrape off the bumper sticker?  It’s all right.  Nobody likes to admit they were fooled even though it’s now painfully obvious that, like many of us warned you, The Sun King Ra-Obama is nothing more than an empty [...]

Nov

21

Money for Nothing, Healthcare for Free

November 21, 2009 | 23 Comments

Jumping the Shark
“My arm was numb after I slept on it funny and my mom says I’m having a stroke,” says my essentially healthy 34-year-old patient to the nodding approval of his indulgent mother sitting by the bed.
“How long did the numbness last?”
“A couple of minutes…it went away after I straightened my arm.”
“So your arm [...]

Oct

12

State of Fear

October 12, 2009 | 18 Comments

Struggling for Rationality
“This patient,” I said to myself, “is going home.” 
I know.  She’s 85 with the dreaded complaint of “Altered Mental Status” described by the family as a brief period of “staring.”  No generalized seizure activity, you understand, and no syncope (fainting), slurring of speech, facial droop, drooling, weakness, confusion, sweating, fever, nausea, vomiting, or [...]

Sep

5

Yer’ Stinking Tax Dollars at Work

September 5, 2009 | 17 Comments

(More questions from real readers. -PB)
What’s the Emergency Department Really Like?
The American College of Emergency Physicians and their bogus statistics notwithstanding, the majority of cases we see are not emergencies.   As I have mentioned before, most of the cases we see probably don’t need to be seen at all by anybody in the medical profession in any [...]

Aug

30

Life or Something Sorta’ Like It

August 30, 2009 | 15 Comments

(Just a few random questions from real readers-PB)
What is your job really like?
As you know, I am an Emergency Physician working in a medium-sized community Emergency Department in a medium-sized hospital in a medium-sized city in a medium-sized state.   A “community” Emergency Department is not a major trauma center and generally sees mostly medical complaints [...]

Aug

15

Pandamorama

August 15, 2009 | 27 Comments

Quick Learner
So I had a drug seeker come in the other day with her usual back pain.  Lately I have been very stingy with narcotics and after refusing to give her a shot of anything stronger than Toradol I explained that I only give narcotics for patients with fractures or obvious acute injuries and never to patients with [...]

Jul

13

Poker and Other Things

July 13, 2009 | 17 Comments

Michael Jackson is Dead and I Don’t Care
Michael Jackson is dead and, God forgive me, I don’t care. I wasn’t a fan and I didn’t like his music. Sure, I listened to it; it would have been impossible not to but I never bought an album, stopped turning the dial at the sound [...]

Jun

14

Bread and Circuses, Water and Sewage

June 14, 2009 | 22 Comments

Customer Disservice
There are days when I explain to the family of a 98-year-old customer, in terror of the the inevitable end, that today is not that day and while the odds of their mother living another month are close to zero, she’s alert, reasonably comfortable, and they have some time to say what they want [...]

Jun

2

Anabasis

June 2, 2009 | 18 Comments

Marching Up Country
(With Apologies to Xenophon)
The campaign draws to a close and will end like many such expeditions do; in a victory of sorts for I have certainly marched into and through the Empire of Medicine with my fellow mercenaries, outwitting the enemy on many occasions, laying waste to his crops and orchards when necessary, [...]

May

22

Edumucation and Other Things

May 22, 2009 | 12 Comments

Perspective
While driving through the downtown of our small but not insignificant Midwestern city (there are corn fields five miles from the city center but we do have the state capital and a handful of miniature skyscrapers) I noticed a fat brown squirrel scampering down a tree and bounding across the street in the halting but graceful manner [...]

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