Tuesday, August 28, 2007

Arnold's Nerve

(This is the nerve in the external ear canal that causes you to cough when it is stimulated with a Q-tip, car key or other foreign body) I am in the ER waiting to take a case up to the or for an active bleed desperately wondering what I can use to scratch the itch in my ear.

The ER is such an interesting place in the middle of the night. I often thought that anyone who the judge gives community service to should be forced to serve it in the ERs third shift. You get to see such a diverse picture of the community and see what is really going on in the world. There is the beligerant drunk with the facial lacerations spitting on the nurses in the first room, the 90 y/o lady with shortness of breath asking to go out to smoke, the drug addict in acute opiate withdrawl, several fractures, a stab wound to the chest and the r/o MI's. In the peds hall there are the acute asthma exacerbations in children who parents smell of pot who demand that their children get scripts for codeine, the newborns with FUOs lined up for their spinal taps. Outside, the EMTs and Police are resting waiting for another call and catching a cup of coffee. There is the smell of old vomit, rubbing alcohol and blood that has made it through the gi tract wafting though the halls when the ambulance bay doors open. Occaisionally the radio alert will go off and report that another ambulance is enroute nonemergent with a patient with uncontrolled fever of 98 degrees or someother taxpayer wasting adventure while the ALS Unit is flying in with a patient in asystole.

The or calls and is ready, the blood is coming from the blood bank, off we go through the double doors to the elevator. Suddenly its quiet except for the sounds of respiratory bagging the patient. Doors open right into the OR corridor and straight into the room. My ear still itches.

Friday, August 24, 2007

Hooters' Sign

We had a bad cancer case that took for hours and my neck and back was aching. I went to reach for my Bextra which had really worked well and all I had was some old Vioxx samples. Of course my brain went ito a rant about lawsuits. I hear all the time about the Vioxx lawsuits and can't help but remember Dow and breast implant cases. It sure seems that there is a race on for attorneys to sue Merck before the science debunks the case. In the case of the breast implants, how come if a jury finds a person criminally guilty but later science (say DNA) shows that he is innocent, he is freed, but in a tort case if science shows the jurys screwed up the plaintiffs dont have to repay the defendent? I mean after it is all said and done, silicone implants are back and the only major complaint about them that has been proven is that many patients wanted them replaced because they were to small.

Blue Screen of Death Sign

This is what happens to your hospitals electronic medical records while the hospital is getting ready for a Joint Commission inspection. I always wondered if the morbidity and mortality of a hospitals census goes up before a JACHO inspection? It seems that just before the inspection everyone is running around trying to make sure yet another form is filled out and filed correctly that has nothing to due with patient care except to make sure that there is no nurse left to take care of the patients.

The latest is the form that shows that we have approved all of the patients home medications on admission whether we are having them take them or not and then the form that has us approve all their home medications on discharge whether we have prescribed them or not. I have decided to scribble N/A on all of them. I will let you know how it works out.

Munchausen by Proxy Syndrome

Finally made it back. Boy have I been terrified lately, it seems that every new patient that I have seen has had cancer. Luckily, we can help most of them. But I digress. I have often thought that the best way to fix our tort system was for the attorneys to start to feed on themselves and last week I got my change to help it along.

A local attorney has helped a group of people bring suit against their employer for disability due to noise induced hearing loss. When the plaintiffs had their hearing test, they all showed evidence of malingering. Apparently, their attorney did not know that an audiogram is very good at picking up fakers and in fact can often prove it. He had advised his clients to feint greater hearing loss for greater value in court. When the plaintiffs were confronted with the evidence that they had tried to rig the test, they uniformly reported that their attorney had advised them to do so.

Presently the issue is now before the judge, the defending attorney has moved to have the case dismissed, and the prior plaintiffs have retained an attorney to sue the original plaintiffs attorney for malpractice. It is all quite interesting.