Archive for the ‘Random Thoughts’ Category
Wednesday, March 14th, 2012
It’s been a long few weeks since I last wrote. I’m going to file this one under “serentipity.”
My son’s wrestling season is over. He didn’t make the cutoff to qualify for states, but he still had a great season. There was something strange that happened as he prepared for the tournaments, though. In our region, there is one kid in my son’s weight class that is an excellent wrestler. He’s strong. He’s quick. He literally throws kids around the mat. He did an illegal slam on my son a couple of years ago and ever since, my son is scared to death of him. As we got closer to declaring weights for the regional tournaments, my son decided that he wanted to diet down to the next lower weight class so that he wouldn’t have to wrestle this kid. We discussed how everyone is beatable and how we can’t run away from our fears, but he wouldn’t listen. So for the week prior to the weigh-ins, he cut back on his food, ate popcorn and vegetables, and exercised a lot. The night of weigh-ins, he had almost lost the four pounds he needed. So he skipped rope in a sweatsuit for a half hour at the weigh-in site to sweat off the last six ounces. He weighed himself on the check-in scale and he was 2 ounces under the limit. Phew. Then he ran inside to have his official weigh-in. On that scale, he was two ounces OVER the limit. He lost it. He just burst out crying. His coach demanded that he be re-weighed. Same weight. He was going to do some more exercises, but once the official weight is declared, there are no changes. His coach demanded that he be weighed on the check scale. Everyone went back outside – he was still two ounces over. Junior was heartbroken. Not only would he have to wrestle this monster kid, but he would have to do so weaker than his usual. He worried all night. Didn’t get a lot of sleep. We got to the tournament the next day and found out that the monster kid cut weight and was in the bracket below my son. Those extra two ounces kept him out of monster kid’s bracket. I kept reciting the quote from “Kung Fu Panda” – “one often meets his destiny on the road he takes to avoid it.” My wife kept saying that an angel must have stepped on the scale. In the end, my son wound up placing fourth in regionals and sixth in sectionals. Monster kid won the state tournament in his weight division, leaving a path of destruction in his wake.
My middle daughter got sick. Initially, it looked like she had influenza, but then she started complaining of back pain. Then she had a high fever. Then she got shaking chills. We checked her urine and it was full of WBCs and bacteria. By that time, she was vomiting. We tried to give her nausea medication and antibiotics, but she kept vomiting them. So Mrs. WhiteCoat got some IM antibiotics from her office to begin treatment. We drew up one dose and were ready to give it … then Mrs. WhiteCoat asked if I smelled anything funny. No, I have a cold. She thought the medication was bad. So she drove to her office and got another vial. I smelled it this time. Had an odor of used cat litter. Called pharmacy. Nope, shouldn’t have an odor. The following morning, called manufacturer. Nope, shouldn’t have an odor. Recalled the whole lot of medication. Don’t know if there was any contaminant, but just makes me wonder what would have happened if my wife wasn’t there to catch the odor. Another angel moment. By the way, did you know that liquid morphine smells like rotten eggs? That’s the whole “sulfate” thing in morphine sulfate.
Three of my four kids are filming parts in movies. They were extras in one Hollywood movie a year or two ago, but these are student and indie films. It’s neat watching them do their thing, but it is also so frustrating watching them do the same scene over … and over … and over … and over. Spending 6 hours to catch a 3 minute scene? You movie directors and all the behind-the-scenes people (sorry I don’t know all the technical names like “gaffer”) can keep it. The experience does make me appreciate how much work goes into making a movie, though. I have to admit that seeing the final product is rewarding. But I also have a problem watching a 23 year old kid who is supposed to be playing a high-school senior putting his hand on the rear of my daughter who is 14. And for some reason, I felt uncomfortable watching a movie scene with my youngest daughter where another actor was playing a father and kissing her on the forehead while she hugged him. I wasn’t jealous, but it just felt surreal – like I was a spirit or something looking in at what my kid’s life would be like if I wasn’t around.
Today was busy.
First, I don’t think I’ve ever complained about the heat in the middle of March. It hit 81 degrees here today.
I also had multiple encounters with the legal profession today. I had to drive into the big city for a deposition as a treating physician. Much better than driving into the city to be deposed as a defendant. After reading through the medical records and listening to the questions that the attorneys asked, it became fairly obvious that both sides were either consciously ignoring issues detrimental to their cases or weren’t aware of issues detrimental to their cases. One attorney tried to get me to “defer to the diagnoses made by subsequent treating physicians” based upon injuries she sustained and for which I treated her. When I saw the patient, I specifically asked her if she injured that part of the body and she denied it. Apparently another physician who saw her several months later stated that she had sustained the injury during the accident. Um no, she didn’t. Wouldn’t I admit that the other doctor has more experience in diagnosing these injuries? No I wouldn’t. The opposing attorney started getting mad. Sorry. One of the cardinal rules of litigation is “Don’t ask a question unless you already know the answer.”
I scheduled the deposition today because there was also a hearing in the malpractice suit in which I am involved. Yes, I am keeping notes. But the kicker is that I saw an old acquaintance in the halls of the courthouse. He was talking to some other lawyers and he had gained some weight, but I recognized him by his teeth. It was The Grinch! I’m not sure if he remembered me. He did kind of watch me as I walked toward him in the hall. Can only imagine what was running through his head.
Lots of other things going on, but this entry is already getting too long. Will write more later.
Posted in Random Thoughts | 7 Comments »
Tuesday, March 6th, 2012
During one shift last week, I felt as if I was spending too much time doing computerized charting, computerized order entry, and computerized admit orders [contractually required to write them - don't ask] and not enough time with patients and their families.
This week, I decided to account for every minute of my time during a 12 hour shift in a moderately busy emergency department where I was the only physician working. I had to scrap the first time I tried it because I kept forgetting to write things down. The next shift, I put the notes where I wouldn’t forget – right next to the computer keyboard with portable clock sitting on top of them.
There is a little bit of overlap between categories when I was multitasking. For example, if I was speaking to a doctor on the phone while charting, I counted the time as only speaking to the doctor. Out of a total of 720 minutes in the shift, I calculated that I spent the following amount of time performing the following tasks:
Seeing patients: 247 minutes
Time on computer: 365 minutes including …
–Charting/entering orders and labs to be done: 219 minutes
–Looking up old medical records: 42 minutes
–Entering discharge instructions/prescriptions: 41 minutes
–Entering admit orders/completing transfer forms: 63 minutes
Discussions with other physicians: 69 minutes
Researching medical issues: 13 minutes
Eating lunch: 5 minutes
Personal phone call: 4 minutes
Miscellaneous down time: 12 minutes
Sign out to oncoming physician: 5 minutes
Longest time between patient exams: 47 minutes
Involving: 24 combined minutes charting patient’s condition and entering orders, 13 minutes discussing the patient condition with three physicians, 10 minutes completing transfer documents and giving report to medics
I probably write more than most docs on my patient charts. Even so, more than half of my time was spent making sure that the charts were documented sufficiently to satisfy hospital administrators, to please governmental payors, and to smite plaintiff attorneys.
I’ve had some nurses tell me that I spend too much time with patients. My shift averaged 7-11 minutes per patient, with a few outliers. In total, I spent only one-third of my 12 hour shift with patients and their families. That’s too much?
Kind of disappointing to realize how the practice of medicine has “evolved.”
Posted in Medical Topics, Policy, Random Thoughts | 45 Comments »
Sunday, March 4th, 2012
Flu season is late, but it is upon us.
Is it only my experience, or does it seem to be the following:
1. Those patients and parents who most vehemently refuse influenza vaccines are the same ones who complain the loudest about their symptoms and their childrens’ symptoms when they actually come down with the flu. And I wish I had a dollar every time I hear someone say they don’t get vaccinated because “I get sick from the flu shots.” Since the virii in the shots are dead, getting sick from the flu shot is highly unlikely. But hey, enjoy your fever, headache, cough, and muscle aches for the next week or so.
2. Entirely too many people think that the “flu” is vomiting and diarrhea. It isn’t. The “stomach flu” is a misnomer. Symptoms of influenza are fever, cough, runny nose, sore throat, headaches, muscle aches, and fatigue.
3. People whose insurance does not cover Tamiflu demand amantadine even though amantadine doesn’t work on the circulating strains of influenza. In other words, people would rather take a free medication that doesn’t work at all rather than pay for something that could conceivably help them.
And while I’m on an influenza rant, remember the 26 million treatment courses of Tamiflu that the US government stockpiled? Yeah. That’s all past its expiration date now. At about $100 per treatment course, that’s $2.6 billion that the government can now flush down the crapper. I’m sure that there was bulk pricing for the government’s stockpile, but even half that amount of money is a lot to be throwing away.
Posted in Random Thoughts, Vaccinations | 10 Comments »
Friday, February 17th, 2012
The web site went down for some reason last evening.
Had to restore everything from a backup copy, but lost the past few days’ worth of posts and comments.
Posts were saved to computer, so I just restored them, but the comments are permanently lost.
And just when things were getting good. :-/
Posted in Random Thoughts | 1 Comment »
Thursday, February 9th, 2012

From Tex …
After nearly 20 years on the internet, Weird Nursing Tales passed away.
Weird Nursing Tales died on February 7, 2012 after it was reported to Administration that the true author was an employee of the Hospital.
Yesterday, February 7, “The Author” sat in a conference room in the Human Resources department with his Administrative Director and the Vice-President of HR to discuss this “discovery.”
After a brief, 15 minute meeting, the plug was pulled and Weird Nursing Tales died, without so much as a gasp.
Family was at the bedside.
Weird Nursing Tales is survived by an only child, “ED Sing-a-Long.”
Weird Nursing Tales may be gone, but Tex is still out there.
Deep sadness. Tex was the only person who ever dedicated a song to me.
Goes to show that even when you’re anonymous, you’re not as anonymous as you think.
Hopefully not the last we hear from this great blogger.
Posted in Random Thoughts | 14 Comments »
Friday, January 27th, 2012
I made the statement that “I’m glad I’m a doctor” in one of my posts, but when I went back to link to the story behind the statement, I couldn’t find it anywhere. So I pulled up the story from the archives and have posted it below. Still holds true today.
When I was a student, one of the attendings on my ICU rotation told me a story that I still have not forgotten.
When I was in your position, I thought it was cool to be a doctor because you got to have a pager. Everyone wanted you. You were the “go to” guy. If someone needed help, they called you. Then I wore a pager for a couple of days and found out that being wanted 24 hours a day wasn’t very much fun. In fact it caused me so much stress that I didn’t want the pager any more. But by then, it was too late.
As I went through my training, I thought it was cool to be a doctor because you’d make lots of money. I’d be rich and could retire at the age of 40. That idea came to an end rather quickly. I got a hard lesson in economics. College loans. Medical school loans. Malpractice insurance. Lawsuits. Taxes. Licensing fees. You make more money because you work more hours. Sure, your paycheck is larger, but your expenses are unbelievable. There are a lot of easier ways to become wealthy.
Now that I have settled into practice and I have my nice little house with a picket fence, I know the real reason I’m glad I became a doctor. Helping people is great. Making money is good, too. But being able to protect yourself and your family in a medical crisis – that is something that no one from any other profession can do for you.
Posted in Random Thoughts | 3 Comments »
Thursday, January 26th, 2012
Never finished describing what happened when we got back from our vacation … three weeks ago. Dang does time fly.
When we walked in the house, the first thing we noticed was that it smelled like cleaning products. There were a mop and a bucket sitting in the wet room by the garage.
The fishtank in the kitchen was a ruddy brown color. We could barely see the fish. One fish was floating. Half of a large can of fish food that we had just bought was gone.
Instead of coming home to relax, we came home to a CSI scene. We began to explore further.
One of the things that I noticed was that our coat rack had been moved. It was sitting to directly block the view through the windows by the front door. I also noticed that there was a piece of tape over the side of the kitchen window. Our neighbors told us that all the window shades were pulled. Our kitchen window doesn’t have a shade. I’m sure that something was taped over it.
Two of our security cameras were unplugged and the third one was pointed at the ceiling.
Something big happened here.
We paid the kid to walk the dogs. We were gone for more than a week. We had just purchased a package of doggie doo bags before we left and we had put a brand new roll in the holder on one dog’s chain. Not one bag had been used.
The girls came down from their rooms upset.
“Someone went through my drawers and messed my clothing all up.”
“Someone rearranged all the clothes in my closet.”
We went downstairs. There was a hole in the wall from one of the legs of a bar stool. The house abuser had said that one of the dogs knocked the chair over while playing catch with a tennis ball. The angle of the hole made it clear that the trajectory of the chair was from up to down – as if someone was holding the seat and forcing the chair downward. An Ansel Adams print hanging on the wall had the glass broken.
There was a run in the seam of the basement carpet and the carpet had been unraveled. Looking closer, there was a stain on the carpet all around the seam. A pair of my youngest daughter’s underwear was hanging off the barbell sitting on my weight bench.
We called the kid’s mother. She brought her son over to see what we were so upset about.
I brought him down in the basement and asked him what happened. He stuck to his story. The dog knocked over the stool and put the hole in the wall. I asked him about the stain on the carpet. The dog urinated on the spot. He cleaned it and then the other dog urinated there again. I told him it seemed that he spent an awful lot of time cleaning. He said that he just wanted us to come home to a clean house.
Like we left the house in that much of a mess?
Oh, and he was concerned about the Ansel Adams print.
“Was that cracked already? Sometimes I get clumsy and don’t remember falling into things.”
“Yeah, it was broken when my son’s friend whacked it with a baseball.”
“OK, good. I mean I’m glad that I didn’t break it.”
We walked back upstairs. It was then that I heard house abuser’s mom tell Mrs. WhiteCoat that we were overreacting. After all, there couldn’t have been that many kids over and if we had just called her, she would have taken care of it.
Whatever.
The next two days at home were spent cleaning up the house that our house abuser had so thoughtfully cleaned for us. We also tried to taken an inventory of the things around the house to make sure that nothing was missing. The only other thing I noticed was that the house abuser cleaned out most of the soda and all of the Red Bulls in the refrigerator in my garage. However, there wasn’t a single can in the garbage or in the recycling bin. Why was that? We soon found out.
The following day, Daughter WhiteCoat banged her head on a dresser and I went to the freezer to get an ice pack. The house abuser just got busted. A bottle of whiskey was buried in the ice maker. And we don’t drink whiskey. A little while later, my son brought up a “Rolling Rock” bottle cap that was in the seat cushion of his official Xbox 360 chair.
This weasel and his buddies were boozing it up in our house while we were gone.
House abuser’s school has a policy that all athletes must sign. Get caught with alcohol or get caught at a party where there’s alcohol and you’re off the team instantly.
We called back his mother and asked her if she wanted to come and pick up his whiskey and beer cap or if we should just drop it off at the school for him.
Thirty minutes later, he was ringing our doorbell. When we opened the door, his dad threw him inside by the scruff of his neck.
His first words were “I want you to know that I’ve lost everything.”
Never really got around to saying he was sorry. Never really admitted having a party. Just said that some of his “so called friends” took advantage of him and were drinking here when he wasn’t watching.
His dad said that he had “misgivings” about letting him watch the house and that junior let him down again.
Would have been nice to know about that before we gave junior the keys.
We were still going to go to the school about the alcohol, but figured that we’d let things go and move on with our lives.
And for the first time in three weeks, we can see through the fish tank again.
Next time we leave, we’re taking the dogs with us.
Posted in Random Thoughts | 22 Comments »
Wednesday, January 25th, 2012
Daughter WhiteCoat’s reading is going well. In keeping with the previous posts on the topic, she continues to learn about the adventures of Dick and his family and she still can’t understand why mom and dad laugh at her as she reads her workbook.
I bet the teacher sits in her class every morning just chortling away at this book.

Posted in Random Thoughts | 5 Comments »
Tuesday, January 17th, 2012
I almost had an ironic picture to post from this week’s wrestling meets. Almost.
There was a parent in the stands several rows in front of me. She was cheering on her son, which we all do.
Her son was 13 years old and weighed 229 pounds. I know because wrestlers have their weights written on their arms in magic marker after they weigh in.
The lady easily weighed 300 lbs. She was cheering loudly and bouncing up and down on the stands.
Then her son won his match.
She stood up and put her arms over her head and cheered. Fair enough. We do the same thing when our kid wins.
In the woman’s left hand was a partially eaten doughnut. In the woman’s right hand was a partially eaten peanut butter and jelly sandwich.
There she stood jumping up and down cheering while jelly dripped down her hand.
I did a double take and then unzipped my backpack to grab my camera.
But as luck would have it the evidence was eaten before I could get the picture.
That will teach me once again.
In photography, timing is everything.
Posted in Random Thoughts | 4 Comments »
Saturday, January 14th, 2012
So Jr. WhiteCoat is back to wrestling.
During one match, he is winning 11-0 and the kid he is wrestling flings his head back and hits Jr. WhiteCoat in the mouth. He gets a little cut on the corner of his lip and his lip started bleeding.
Referee stopped the match. It took about 45 seconds to get the bleeding to stop. During that time, there was a medical time-out. If the medical time out lasts more than 2 minutes, then the wrestler is disqualified.
Started wrestling again. Then the referee notices blood on the back of the other kid’s uniform. No further bleeding from Jr. WhiteCoat’s mouth, just a couple of spots of blood that the referee hadn’t noticed before. He stops the match again for a medical time-out. Trainer has to come over and use soap to wipe the kid’s uniform. Another 50 seconds.
Referee tells coach that if Jr. WhiteCoat has any more bleeding, that he will be disqualified.
Coach gets upset, turns to me and Mrs. WhiteCoat on the sidelines and yells “this ref is a friggin STROKE!”
Mrs. WhiteCoat gets excited and yells out “What?!?! He’s having a stroke?!?!”
Coach rolls his eyes and yells back over his shoulder “yeah, we should be so lucky.”
[cue half of crowd on south side of gym cracking up]
Posted in Random Thoughts | 8 Comments »
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