FYI

healthcare reform

OK. So I just spent 8 mind-numbing hours working in an ER about an hour from The Second-Whitest Town on Earth. I saw people - old and young, sick and well - waiting for hours to be seen. Let me just say this: I have some suggestions as to how we can streamline things. Contrary to popular media reports, the ER is clearly far too nice of a place to spend a Saturday afternoon. I propose sweeping reforms.

1. The seats are way too comfortable. I propose no seats at all. Those in triage must stand. Unless they fall over. Then they can lie down. But be aware that whatever change may roll out of your pockets is fair game for staff. Any attempts to reclaim your loose change will result in loss of collapsing privileges and swift return to the back of the line.

2. No crying out. Not even in pain. If you're currently in possession of all of your limbs, I don't want to hear a whimper. You want something to cry about? I'll give you something to cry about. I'm watching you Timmy. I know you're seven.

3. No runny noses. I don't care if your throat hurts. Can you speak? Can you swallow? Come back when you're seizing. Collapse at the back of the line and wait until I call your number.

4. In fact, from now on, I will only see the following emergencies:

• Heart attack. FYI, if you think you're having one, you're not having one. Go home and take a Zantac.
• Penetrating chest trauma. The closer it is to midline, the quicker you will be seen.
• Anaphylaxis/Epiglottitis. I don't care if you took your "blue puffer" 20 times. Show me your hives or come back when you're drooling.
• MVA's in which the airbag has deployed. Bonus points for being ejected.
• Sepsis. IV drug users need not apply. Why should I fix you if you're gonna ruin all my hard work next week?
• Strokes so long as you've had symptoms for less than 4 hours. Otherwise don't even bother. You're gorked. Don't worry about the drool on your chin. Pretty soon you won't be able to remember the word for chin.
• Perforated bowels. I don't care if you're constipated. It's not the same thing. Try taking the Senekot you have at home. If you tell me you can't take it because it gives you diarrhea I'm going to punch you.
• Massive bleed. This is more than three napkins or a couple tampons. Blood must be gushing/spurting from an orifice (original issue or man-made) in order to qualify. Being light-headed is a bonus but be warned that if your BP is normal you're gonna be joining Timmy at the back of the line.

It's pretty simple. UTI's, coughs, heartburn, scrapes, slivers, diarrhea and anything not on the list can take it somewhere else. But you're in real pain you say? Uh. Uh. Sorry. I don't buy it, crazy. An 8/10 can't form words, let alone ask for water.

5. Finally, instead of local radio, I will be playing this song on repeat at the nursing station. It outta keep things moving briskly.

And that's it for now. Five simple but effective ways for our government to decrease wait times across the province while simultaneously addressing the bed shortage issue. Cue the applause.

Call me a visionary. Call me a prophet. Just don't call me Clooj.

(don't) pour some sugar on me

If you wanted to know what my week looked like, trapped in an endocrine clinic, I could tell you. But a picture says it so much better.

Golden Rules

My boss, who will heretofore be known only as Dr. Oz (due to a striking similarity in looks and demeanor) imparted to me, quite early in my tenure in his office, the three golden rules of medicine. They are as follows:

1. Don't fuck your patients.

2. No matter what you did, you did the right thing, because you were there.

3. Get out alive.

The first is pretty self-explanatory, if a bit obvious. And not much of an issue, given that most of the women in our practice look like Burt Reynolds' stunt doubles.

The second is meant to reassure me and other Officers of the House that when we eff things up in the middle of the night due to a healthy mix of incompetence, exhaustion, and fear, that we couldn't have done any better. And furthermore, that we should be applauded for our mistakes just as loudly as our victories. Not sure how I feel about that one.

The third point drives at self preservation. It used to be that docs were encouraged to forsake all else (family, friends, hobbies) in favor of the JOB. The CAREER. The DUTY. The ART of medicine. It still happens to some. We call those people internists. These are the people who only find their genitalia at the age of forty when they finally notice on one of their trips to the bathroom that they are leaking urine from somewhere and decide to investigate. Already, I've met a couple. The Tortoise, and the Badger. More on them later.

Rest assured, I've safe-guarded myself against burn-out. I'm part of generation now. Being one of the me-first, fuck-you kids who are mostly illiterate and addicted to TV has its perks. I spend most of my days thinking about the car I want to buy next or where I want to build a house.

Six year old girl, acute asthma attack. Audi. S4. The one with the glass roof.

Ten year old boy, post MVA with splenic rupture. No. Maybe a Merc.

Fifty-five year old man, fat as a hog, wheezing and clutching his chest. Should I get an iPad? Are they dumb or cool? How would it look in my new leather bag? Would it even fit?

A voice careens headlong into my train of thought - a nurse barks in my ear. "Doctor! This man needs an ECG now! And some nitro! We can't just do nothing" I slide slowly down in my seat.

Clearly, she's never heard of rule 2.

My Admission Note

Today's date is July 1, 2010. This is Dr. Brown dictating an admission note on behalf of the Walrus for patient "HF" unit number 00678756.

[begin dictation]

Admission Note

ID:

HF is a 28 year old male from home, previously well, who presents to the HOG to begin his residency in medicine.

History of Present Illness:

Patient has recently graduated from the University of Mud where he worked for 3 long years as a runt and has successfully applied to begin his residency as an officer of the House of God. At the beginning of June, the patient drove across the country, unwitnessed, with roughly $2500 worth of IKEA utensils and clothes stuffed into the back of a silver station wagon, all of which he claims belong to him. The journey took him 10 days, of which he actually drove 4. Upon arriving home, he was greeted by two loving parents and a socially-maladjusted cat. In hindsight, the patient feels he should have driven in the opposite direction.

The patient spent the following 48 hours unpacking his car and moving the seven boxes that contain the sum of his possessions into his new apartment, right in the heart of the city's industrial park. Of note, his home is located less than 5 minutes walk from a liquor store and 15 minutes from the city's red light district. He attributes these facts to coincidence.

Despite minimal knowledge and scanty motivation, the house has reluctantly accepted HF into servitude as an officer. He will commence his duties immediately, with the implicit knowledge that neither party is thrilled about the arrangement.

Past Medical History:

Patient has been hospitalized once for query aspiration pneumonitis. At the age of 5 years he appears to have ingested a Lego piece. However, chest x-ray was negative and a space-man backpack was later recovered from the patient's stool.

There is a remote history of asthma. However, there are no documented breathing difficulties and a note from a Dr. Simpson, dated June of 1986, suggests that Munchausen by-proxy be included in the differential for this illness.

Finally, the patient has a remote history of endocarditis. According to the patient, he was culture-positive, for a period of roughly 6 years, with the Talkslika manicus virus. This appears to have caused temporary alienation from loved ones and lost him some serious "street cred." However, following a protracted period of social isolation, it has since been eradicated, the only sequela being transient myocarditis without any significant heart-break.

Medications:

Patient is not currently taking any prescription medications. He is, however, taking 1000mg of caffeine daily.

Allergies:

No known drug allergies.

Social History:

Patient lives alone in an apartment in the Second-Whitest-Town-on-Earth. He is not currently in a relationship, but has of late been to dinner with an emotionally-stunted brat who refers to him as "Doc" while sexting. Patient admits to social drinking, occasionally with stuffed animals. He is a non-smoker who denies any recreational drug use, although patient recently returned from Bolivia with 6 kilos of flour.

Family History:

Family history is positive for an Eating Disorder NYD and workaholism on the paternal side and Generalized Anxiety Disorder on the maternal side. Patient is the youngest of three children, all of whom had a childhood afflicted with Spectacularly Neurotic Parenting Disorder and doasisaynotasidoitis.

On Examination:

The patient was examined in ER. He is a 5ft 7inch male with light brown hair and blue New Balance 420 trainers. He appears older than stated age, yet was alert and oriented times three and in no apparent distress.

Cardiovascular exam revealed normal S1 S2, no S3 S4 and no murmurs. JVP was at 3-4 cm above the sternal angle. Peripheral pulses were palpable bilaterally. Cap refill was less than 3 seconds at the nail bed. Abdominal exam was unremarkable. Despite patient's request, a digital rectal exam was not performed. A brief neuro exam was significant only for a severe bilateral retro-ocular headache with pronounced photophobia. Patient attributed this to a night of drinking. Respiratory exam revealed good air entry bilaterally without any adventitia.

Laboratory investigations were not available at the time of this dictation. Urine drug screen is pending.

Impression:

This is a mildly-neurotic 28 year male who presents to the HOG in reasonable health. He will be admitted for further ridicule and monitoring.

Issues and Plan:

1. Idealism - patient reports a strong belief in the inherent goodness of people. This is expected to pass within several weeks.

2. Hypersomnia - patient reports regularly sleeping as much as 7 hours per night. Patient will be confined to the wards every third day for a period of no less than 24 hours, during which time he will not be allowed to sleep and required to care for GOMERS. It is anticipated this will threaten the integrity of the House and in no way contribute to increasing his competence as a physician.

3. Abstinence - patient has requested contact with easy, hot nurses. I have accordingly assigned him to the ward from the Rocky Horror Picture Show.

Thank you very much for including me in the care of this patient.

Sincerely,

Dr. Brown, R2 dictating on behalf of the Walrus.

[End dictation]

Please send copies of this report to the patient's chart, to the Walrus and to the CPSBC.