The Happy Hospitalist was kind enough to invite me to join Google Plus. I haven’t done much with it yet. but I now have a bunch of invites to give out.

If you don’t have one and you want an invite to Google Plus, drop me an e-mail. whitecoat at epmonthly dot com.

The competition was tough, the voting was close, and half of you have your minds in the gutter. After careful consideration, EP Monthly’s editors have chosen the following comments as winners of WhiteCoat Challenge #7:

#3 Ed’s observation that “they have the ‘sickness and health’ clause covered.”

#13 joebob’s morning after question – “Have you passed gas yet?”

#24 ER Jedi’s comment that the bridal party will be catching C.Diff instead of bouquets and that the best man accidentally removed the bride’s catheter instead of her garter belt

Honorable mentions also go to:

# 10 BinkRN’s Reception Menu

# 12 Christopher’s Time Out clause

Winners send your contact information to lplaster -at- epmonthly dot com to get your prizes. Check out www.zazzle.com/epmonthly for your list.

Thanks to everyone for playing along!

I was going to add this story to next week’s Health Care Update, but as I was thinking about it, there were too many smart-alec comments that can be made about this scenario.  See what you can come up with …

Bride gets married in hospital when appendix ruptures on her wedding day.

Here are a couple off the top of my head to get you started:
And you thought the reception hall was going to be expensive …
Hey – they needed something to do while they were waiting to see the doctor …

Top three choices as chosen by EP Monthly editors get either a travel coffee mug or a t-shirt from the EP Monthly store.

Winners chosen next Tuesday.

Leaving for a two day lacrosse tournament, so won’t be online this weekend.

May add a couple of tweets from my phone.

The comments section is hereby open for anyone to post any medically-related questions, comments, or other esoterica. Just remember, no personal attacks.

I’ll try to answer posted questions/comments on Monday. Have a safe and enjoyable weekend … and wear sunscreen.

WC

Any time that I discuss patients on this blog, I randomly change around the gender, the age, the complaints, and any names involved – both to protect the patients’ privacy and to comply with privacy laws. As I have stated in my “About” link:

“If you think there is any similarity between you and a patient I write about, it isn’t you. I may or may not change the age, sex, injuries, or complaints of the patients I write about. The 70 year old grandma with a hip fracture may really be a 16 year old star high school football player who skinned his knee. I may change some of the things that patients say or do for entertainment value. I repeat: It isn’t you.”

One of the patients I have written about in the past came back to the ED for a different issue the other day. The previous post was a funny scenario and I made up names for each of  the other people involved.

The last visit, the patient was alone. This time his family was with him. When I walk in the room, I usually introduce myself to everyone and shake everyone’s hand. When I got to the patient’s father, he introduced himself and told me his name. His name just happened to be the same one that I created out of thin air for the previous post.

I happened to remember the patient and the name I made up for his dad. I did a double take and must have given the dad a strange look when he told me his name, because he then gave me a funny look and tilted his head.

“Sorry, you look just like someone else I know with that same name. You don’t have a twin, do you?”
“No, but if I did, he probably wouldn’t have my name …”

Another reason why from this point forward, all patients will hereby be named Joanne Doroshow.

A quick shout out to a new venture from Emergency Physicians Monthly

Logan Plaster and company have started a new magazine called Emergency Physicians International. They just put out Issue #3 and there are a lot of good articles inside, including articles about laryngoscopy and emergency medicine in Croatia, Japan, and South America, to name a few countries. I found it very interesting reading.

There are over 1000 registered members on the site from 60 different countries.

If international medicine is your thing, you can read all the issues online and join the forum discussions at this link:
http://epinternational.ning.com/

I’m still around.

Unfortunately, the past couple of weeks have been very busy at work and filled with some not so nice things. Dealing with a lot of death – both at work and at home. Death is part of life, but sometimes circumstances make it a little harder to accept.

Have a lot to write about, but just need to set aside some time to do it.

Also, please excuse the breaks within the posts. I added Google ads to the ends of the posts to try to earn “take Mrs. WhiteCoat out to dinner” money from ad clicks, but Google only allows three ads to be shown on a single web page, so ads in older posts at the bottom of the blog cause ads in newer posts not to show up.

Will be back to regular blogging soon.

I hate Top 100 rankings.

In my e-mail box there was another Top 100 solicitation. This one was for the Top 100 most influential people in healthcare.

I deleted it. Then I thought a moment and pulled it out of the trash bin.

What if *I*, humble and pure WhiteCoat the blogger, could be voted as one of the Top 100 most influential people in healthcare?

How would Modern Healthcare handle the fact that an anonymous blogger could be held in such high esteem? What if I could be voted more influential than … Kathleen Sebelius … or … President Obama ?!?

Mwuaaaahahahahaha.

I’ve been blogging for almost 5 years and I’ve never done something like this before … until now.

So here’s my plan:

I’m asking that someone go to Modern HealthCare’s site and nominate me for the Top 100. I’m also asking that you nominate some other people in the medical blogosphere as well.

If any of us are officially nominated, I’ll post an update with a site where everyone can go to get out the vote. Then we can see exactly how influential all of us health care bloggers can be.

Thanks!

1) Nominee’s last name — Coat
2) Nominee’s first name — White
3) Nominee’s title — Health Care Blogger
4) Name of organization — Emergency Physician’s Monthly Magazine
5) Location of organization — Annapolis, MD

Kevin Klauer – Editor-In-Chief – Emergency Physician’s Monthly Magazine – Annapolis, MD
Mark Plaster – Publisher – Emergency Physician’s Monthly Magazine – Annapolis, MD
Rick Bukata – Professor Emergency Medicine – University Southern California, Los Angeles, CA
Greg Henry – Columnist – Emergency Physician’s Monthly Magazine – Annapolis, MD
Kevin Pho – Medical blogger - KevinMD.com - Nashua, NH
Ibee Grumpy - Medical blogger – DrGrumpyInTheHouse.blogspot.com - Grumpyville, USA
Nurse K – Medical blogger – crasspollination.blogspot.com – Montana, USA
T K – Medical blogger – ERstories.net –  Suburban Northeast, USA

By the time we reached the hospital, the parking garage was nearly full. How damn many surgeries do they do at 6:00 in the morning? We ended up getting to the registration desk 15 minutes late.

The presurgical waiting room was dark and kind of musty. There were many antique chairs situated in a maze throughout the room. A large plasma screen TV showed a grid with patient numbers, status, and comments. As we walked up to the desk, we were given a number and told to reference that number in all communications about the patient — me. That number would also be used to track my progress through surgery and into the recovery room.

As we sat down to fill out more paperwork, we walked past a young woman who was sitting in a chair, rocking back and forth, crying, and rubbing the beads on a rosary. That upset my wife and I could see her begin to fidget.

One by one, patient numbers were called, random people and family members stood up, walked to the desk, and then walked out the door into pre-op.

“7126″
“That’s us,” I said to my wife. She just gave me this long sorrowful look that kind of made me feel sad. We took all of our belongings and followed everyone else down the hall to pre-op.

Once inside, there was another maze of hospital gurneys separated by curtains. We were led to one of the “rooms” in the middle of the maze. Hospital staff scurried about with portable computers, entering data as they walked from room to room. On the bed in my room was a garment bag and a gown. I knew the routine. Everything off. Gown with the opening in the back. Hair net to catch all of my flowing locks.
I took off my sneakers, folded up my sweatsuit, and put everything into the bag. I had to wear a sweatsuit to the surgery, because it made me feel as if I was more “healthy” compared all the other people who needed surgery. Also, I figured that if I wore jeans when I left the hospital, they would press upon the surgical site. See? I was thinking ahead.

I sat myself in the bed and pulled the sheet up over my legs. My wife pulled the chair next to me and held my hand. Then we just sat and waited.

A nurse came in and took a history. She confirmed everything that was in the records from my preoperative physical the week prior. Nope. Nothing changed.
Then a surgical resident came in, performed a brief physical exam, and took another history. Same questions the nurse asked. I knew I would have to repeat the same history at least 2-3 more times. That’s just the way things go.

Then the anesthesiologist came by and sized up my jaw. Held my chin in his hand and turned my head from side to side like he was getting ready to sock me. Had me open my mouth. Made sure that I showed him all of my intact teeth. He just wanted to make sure that there wouldn’t be any problem getting the tube down my throat.

Another nurse came in and started my IV. By then, word had gotten around the pre-op area that I was a doctor. One of the other nurses chickened out on sticking me for the IV. The new nurse’s hand was shaking when she came at me with the needle. I felt bad. What’s the big deal? It’s not like I’m going to yell at you. She aced it on the first stick and taped it into place.

For some reason, about 5 minutes later I got very nauseous. Just came up at me out of the blue.

“You better get me a bucket quick – I’m going to hurl,” I told my wife. I was getting that tight feeling in my jaw and my salivary glands were doing double time.
“Did they put something in the IV?” I asked.
“I don’t think so.”

I looked across the hall. There was another guy sitting in a bed staring at me. For some reason, I got irritated.
“Honey, can you close the drape?”
“Why?”
“Because otherwise I’m going to jump out of this fricking bed and go puke in the lap of that dude eyeballing me across the hall.”
“Just relax. He doesn’t have anything else to do. Look at his wife.”
He was just sitting in the bed. His wife was hunched over her CrackBerry texting away and completely ignoring him. Not sure what was so important at 6:30 AM on the day of her husband’s surgery, but my wife was right. Then I felt bad for getting annoyed.
OK, buddy, enjoy the show.

Another nurse came by, ripped open several alcohol swabs and held them up to my nose. “Sniff these, they’ll help.”
I looked at her as if to say “are you kidding me?”
“Trust me.”
So at that instant, I became a “huffer” of isopropyl alcohol. If the odor didn’t help, I could always suck the alcohol out like I’ve seen some patients do in the past.
Damned if it didn’t work.  The nausea didn’t go away, but it did get better.

Then an anesthesia resident came by and gave me some Zofran. Cool. Nausea pretty much gone. He began to give me a second medication when Mrs. WhiteCoat asked what it was. He held the syringe so she could see it but so that my line of sight was blocked by his hand.

Mrs. WhiteCoat’s eyes began to tear up.

I thought to myself “Why the heck is she get….”

Whoa.

Here are links to the other parts in case you get lost:
Part 1, Part 2, Part 3, Part 4, Part 5, Part 6