Tuesday, July 26, 2005

Disturbing...

I wish we could take all of the money from PETA,

the money people spend on pet CPR,

and any of the excessive amounts of money we spend on pets

and use it to fix this crap,

to rehabilitate these kids,

and to punish those responsible...

...this is a bit graphic

http://newsok.com/article/1561355/?template=home/main



...just sick.......saddening..........maddening




There have been a couple of news segments where I have seen CPR courses for pets, and pet ambulances. I am bothered by this. While I think pets are great, this is getting ridiculous. It should be a policy that anyone who wishes to be certified or trained in pet CPR should first be required to learn and be certified in human CPR.

PETA...People for the Ethical Treatment of Animals...I really wish they would concern themselves more with the ethical treatment of humans. It may actually help their cause, since one of the signs of an abuser could be the way that they treat animals.

Monday, July 25, 2005

Back on the Blog

...I'm tired, not that I'm overworked. Just not sleeping soundly lately. And the stomach's kinda upset.

...Let's see--what has been going on lately?...Been working in the ER more. Had a few night shifts in a row.

...Had another incident where a patient was brought in all shot up, died, and I went home to learn more about it on the news.

...I did a lumbar puncture (spinal tap) for the first time. This involves placing a long needle into the lower back between two vertebrae and drawing out spinal fluid into tubes to check for infection. Actually did it pretty well. This kind of thing makes me think, what right do I have to be doing this to someone? What right do I have to do a rectal exam? Why do I get to/have to do a pelvic exam to look for koochie critters? What have I done to earn this right?...I went to med school, got an MD...paid out the wazoo for it too. And the people need me to do this to them in order that they get better. That's what you get in return for an education. It's just funny to me. Getting in is the hard part. Once you're in med school, it's just a matter of passing a crap load of tests. Then you get to do some crazy stuff to strangers.

...There was, however, one crazy guy on Saturday who refused the rectal exam. No bother.

...S...A...T-U-R...D-A-Y........NIGHT!!: A man came who was shot in the testicles. Worked overnight on Sat...kinda crazy. People are out and about on Saturdays, gettin' drunk, gettin' sad and close to suicide, passin' out on sidewalks, playin' with knives, shooting each other in the nuts.

...For some reason, we have grown too accustomed to violence in this world. I swear, someone is murdered here every day. People are scared for their lives in some neighborhoods. That must explain the need to carry a gun or a knife at all times. Where I came from, people got in fights, some nastier than others. But they would eventually be broken up, and the two boilers would simmer down, battered and bloody as they may be. But too often, someone ends up in this situation, and a gun is drawn or a knife is wielded, and people get killed. It's crazy. It's not in my mind to even think about carrying a gun around to protect myself. I'm not keen right now on the idea of having one in the house to protect the family (I'd rather spend tons o' cash on a super-duper alarm system). What has happened? How do these people afford the gun, the bullets? Priorities are out of whack. It makes me think that, in some places, having a gun is equally as important as having, say, cable television or a microwave oven. Sad.

...Also attending my service on Saturday was a guy who kept throwing up blood. You know, it sucks to throw up, but it must REALLY suck to throw up blood. I think I have a friend (is it Jerry?) who claims to have a ridiculously long streak of years of not throwing up. On Friday, I treated another someone whose body was ridding itself of all contents through the in door and the out door, out of both chutes. The ultimate act of defiance from your body. The body's saying, "WHAT THE HELL?!?!?...WHAT THE HELL DID YOU JUST PUT IN ME???" It's a wonder I haven't caught it...or have I?...I say that because my belly has been bothering me lately. Paranoia?

...Female doctors can be interesting studies. Not all, just some. From what I gather, nowadays close to 40-50% of doctors are female, quite a change in the last half century. Yet in the face of this, there are still some overly sensitive female doctors out there. Countless stories are told of female med students who round on a patient in the hospital only to be asked how long they have been in nursing school. (Two completely different things, if you didn't know.) Oh, how this gets under their skin! "Are you a nurse?" OH!...how insulting!........For some reason, some female docs get quite upset when a person makes this incorrect assumption, as if it's an insult. I say, take it easy. Probably 90% or more nurses are women. It's just a mistake of generalization, not a commentary on the proper place of women in society or an opinion on the ability of women to obtain professional status. Most certainly, it's not a personal attack on that person. It's just silly.

...Along those same lines, female med students (now doctors) who I went to school with would often bemoan their lacking dating life. No guys are asking them out. What's up with that? Well, the girls would often theorize that the guys they were meeting were intimidated by the fact that they were in medical school. That once they spilled the beans on their chosen occupation, the guys would become disinterested, as if the girl had just told them that their herpes is flaring up or something. I find all of that erroneous. I really can't see that many guys that I know being put off by a girl being in medical school, especially if he's interested enough to talk with her or approach her. Perhaps--I'm sorry--he's just not interested in asking you out. It has nothing to do with your being in medicine. It's actually more to do with chemistry or something. Okay, let's say it is true in some cases, that perhaps some men are shy of the female doctor due to some cause, be it earning potential, intelligence, etc. Even so, if he is put off by it, you don't want him around anyhow. He's probably a meat head, and that's not what a smart, gifted, driven, and entitled woman wants.

...Why does my Vornado spew air that smells like overused, hot electrical equipment? Has smelled like that from day one.

...Finally getting some of my wall hangings on the walls. Maybe I'll actually move in fully to this apartment, unlike my last one.

...Came home before lunch today. I was stopped by a news reporter and camera man as I was walking in to my apartment building. News reporter asks if I would like to speak on camera about the building next door that was torn down and how the contaminants were taken care of. I said I didn't know anything about it. Camera guy says that's the problem--no one does. I declined. Maybe that's why my stomach hurts.

...Good to hear from the OKC folks in the last two days. I've gotten two phone calls and an e-mail.

...My nephew knows my name. Well, my nickname--Tio, which is Spanish for "uncle." That's what he calls me. When I go to visit and I walk in the door, he starts running around saying, "Tio. Tio. Tio. Tio." Sometimes he'll run to the window, see my car and say, "Tio's truck." The other night, my brother Jake and I were playing with him. Caden says, "Ride Dada," and he climbs on Jake's back before being bucked onto the couch. Then he says, "Ride Tio," and I do the same, except instead of bucking, my limbs give out. He's lovin' it. "Ride Dada." "Ride Tio." It's nice to be known by this little guy. That evening was topped off by a beautiful smile from my 1-month old neice, Emery.

...Almost done with my first month. August brings new responsibilities. I begin work in the ICU at another hospital for one month. And I turn 29 next month...hmmph. I'm getting to be a grown-ass man.

Tuesday, July 19, 2005

Music, lately

Soul Coughing...They've been broken up for a little while now. The lyrics are often nonsense/artsy/beat poet kind of stuff. But they're smooth. I love the way they were recorded. The drums sound great at times. And the bass is most often an upright bass. The keyboard sounds are unconvential, to my liking.

Morcheeba, Portishead, Tricky, Massive Attack...With Napster, I can create a 4 hour playlist of music that is related to artists that I like. So what I'll do is select those four and see what comes up. These are my favorite slow-beat, trip-hop artists. Slower than the music blaring from Banana Republic. But just as urban hipster.

Elbow, Elliott Smith, Shins, Doves...just another plug for these folks.

BTW...uncovered an old song by a group called Talk Talk called "It's My Life." It started playing, and I swore I recognized it. Turns out that No Doubt did this song--it's actually a remake. I liked the No Doubt version. The original by Talk Talk is done by a British dude. A well done remake by No Doubt.

Friday, July 08, 2005

Changing Vision

As I was driving from work yesterday, I passed a car driving in the opposite direction. The driver, I noticed, was stopped at an intersection with a passenger next to her. The driver’s left eye was covered with a bandage. The passenger had nothing obstructing her eyes.

*****

I stopped later at the grocery store to pick up a few things. Walking from my car to the store, I saw a tall, high-waisted man, suspenders traveling over his plump belly supporting his forest green pants, with a navy blue based plaid shirt and a black, mesh cap on his head. He walked out of the store, turned to his right to enter the parking lot. I saw, in the corner of my eye as I passed him, his arm suddenly flail in a ballistic way as he nearly lost his balance after knicking his toe on a bit of sidewalk jutting only an inch from the rest. Arms extended, he was reaching for anything to catch himself. Fortunately, he caught himself.

*****

In the grocery store, I retrieved a shopping cart and headed inside. Obstructing my path in the entry aisle was a man wearing a white sweatshirt, white baseball cap with long brown hair flowing from the back…and knitted, white cotton gloves, gently searching with his hands through the greeting cards.

*****

Everyday things begin to take on new significance when you’re in medicine. What immediately entered my mind as I saw the man trying to prevent his fall was the beginning of the recitation of his medical history.

“…66 year old man is here today with a complaint of ‘hip pain.’ He was brought to the ER after he fell in the parking lot of a grocery store. He reports that he fell on his left side and felt immediate hip pain. He denies any light headedness or dizziness, stating that he tripped on the sidewalk. Denies loss of consciousness. Has history of diabetes, high blood pressure, and arthritis. Smokes 1-2 pack/day of cigarettes…”

He was, in my mind, a potential patient. A bit unkempt. Typical dazed look on his face. Odd shaped body. Does not really know what medications he is taking, but takes them all every morning.

The lady driving, in my mind, was the patient who just left the clinic, who has been satiated for her eye trouble, but does not let anything change what she does. She listens to discharge instructions, but doesn’t follow them. She gets only 2 of the 4 medications filled that she was prescribed. She’s gonna continue smoking, even if her eye problems are a direct result of it. When you give her all these instructions and have reasonably soothed her pain, she seems to be gracious and willing to abide. But she doesn’t…and she’ll bitch to her friends and family that the doctor tried to fix it but it didn’t work.

The guy with the gloves brings home the fact that the patients from the psych ward are all around us. The ones who stopped taking their psych meds, leading to relapse of psychosis, leading to exposing himself to a school bus full of children as instructed by “Paul,” leading to his one month hospital stay, which leads to his stabilization, leading to his release from the hospital, back to his home, where he eventually stops taking his medications again, and the first sign is that he’s wearing lots of white and knitted white cotton gloves to cope with his obsessive-compulsive disorder in my grocery store. They’re all around.

Don’t get me wrong…I believe in the validity of mental health illnesses as just that—something that can be treated.

But…they’re all around.

Thursday, July 07, 2005

Emily's Word World #4

Naming this string of posts in honor of the beautiful Emily, though earnest in intent, does not do her justice as a monument to what I think of her. If i was a early pioneer or explorer, I would name a hill or a mountain or a river, or an extensive expanse of scenic landscape after her. Alas, she gets the Word World--a tribute to the inner nerd in all of us, and the inner nerd in her that I love dearly.

mnemonic

mne·mon·ic (n-mnk)adj.
Relating to, assisting,
or intended to assist
the memory.n.
A device, such as a formula or
rhyme, used as an aid in
remembering.

This word was mispronounced this morning by my boss during her lecture (a very helpful lecture, mind you). She pronounced it "noomonic."

This I can understand in light of her being a medical professional, as our lexicon includes many words beginning with the prefix "pneumo-," referring to "air," or "lungs." But I think I've heard it elsewhere, whether that was in medical arenas or not--I don't recall.

(FYI: "pneuma" is the biblical greek word for "spirit," as well. So all of our references to air and breathing are rooted in the idea of a spirit. Think also of breathing in as "inspiration," breathing out as "expire." Death, in medicine, is recorded as "time of expiration." The idea of "spirit" as "air," related to each other by having to do with breathing. For all you Christians, this is an interesting way to listen to the song that begins with, "This is the air I breathe...Your holy spirit/living in me.")

Of course there are certain procedures of pronunciation to remember with silent first letters, as we have here with the leading "mn-"...which reminds me of yet another medically related mispronunciation...or actually, incorrect assumption of pronunciation.

"Dyspnea," is a medical word used to described difficulty with breathing. Note the "pnea," portion which is related to the above "pneumo-/air" discussion. When you speak greek, a word like "pneuma," is pronounced by forming the "p" with your lips, and then saying "neuma." You don't say, "pa-nooma." It should sound more like "nooma," but by simply forming the "p" with your lips, you achieve the subtlety of its pronunciation. The greek equivalents of "p" and "n" in greek are "pi" and "nu"--two separate letters, unlike "psi," the first greek letter, like in "psychology."

Anyway...So, this supervising doctor of mine in med school who was a pulmonologist (lung doctor) corrected one of the residents pronunciation of "dyspnea" while on rounds one day. The resident had said it as, "disp-nee-a." She told him that it should be pronounced, "diss-nee-a," because it should be just like "pneumonia" (when spoken fast, sounds like "noo-moan-ya").

But the resident was right, according to what I learned about greek in college. It's not so much a silent "p" as much as it is a subtle "p" sound. Certainly, it shouldn't be left out, in my opinion.

I will allow for exceptions. I will not go around using the subtle "p" before "psychiatry," or "pneumonia." I'd get laughed at...and I'm a tender little guy.

Back to "mnemonic"...the error was saying "noomonic," and not "nemonic." Using the subtle "m" in this case would be correct, but I will not insist upon it.

That is all, class...

Signed,

Sam's Inner Nerd

Wednesday, July 06, 2005

Li'l bits...

...Today I attended a class about neonatal resuscitation held a room called the "Youngblood Conference Room."...terrible.

...Latest music on the PC via Napster: lots of Elliott Smith; the Shins; Son Volt.

...Watching local news the other night & found out my apartment building was burglarized 3 days after I moved in. Two individuals broke in through the front door, went to the club room, and stole 2 computers. Of course, I didn't hear a word about this except from the news.

...Speaking of news, Kansas City seems to be a high crime city. Or the news here is too sensationalized. They love car wrecks. There have now been 60 murders this year.

...Speaking of car wrecks, saw on the news today a blip about an unsolved hit & run on Sunday night that left a man with critical wounds. Guess who was in the ER where he was taken?

...Why am I watching so much local news? I have forsaken cable TV in lieu of cash savings. Network television sucks. Especially when you're watching in bed trying to get sleepy. Channel surfing is more like boogey-boarding.

...Happy to be in a baseball town. Went to a Royals game on the 4th--by myself (see "Introversion"). Had a nice time. Nice park here. Looking forward to Buck Night, where hot dogs, peanuts, and small Pepsi are each $1. Too bad the team is reheally bad.

Tuesday, July 05, 2005

Emily's Word World #3

I must now archive an instance when I was corrected by the lovely and intelligent Emily.

Liberal v. Conservative

This is a post from another website written by a college friend of mine by the name of W. Clayton Nunnally:


One thing that bothers me is when people apply either of these two labels inappropriately or when they mean something else but for some reasons use one of the two labels.

I bring this up today because the supreme court ruling re: immenent domain provides a great example of the actual meaning and the difference between the two. And because Tom Friedman, a fantastic author, uses the term Liberal interchangebly with 'progressive' (and that bothers or confuses me).

I have the impresssion, valid or not, that conservative or liberal applies to one's opinion on how much government (generally federal) should be applied. I can only see this meaning in reference to something else, i.e. "economically liberal/conservative". My understanding would be that a conservative thinking person would believe the government would be better with less "knobs" on the nations economy, a liberal thinking: more knobs.

Then people throw these terms around and automatically attach 'conservative' to the adjective 'Christian' when there is no need for it.Friedman calls Islamic fundamentalist in Iran "conservative" when they actually have knobs on every goddamn aspect of a society. And he speaks of 'liberals' in the same place when he actually means 'progressive'.

Even more generally, people who think they are liberals use the word 'conservative' when they want to say 'bad'. And vice versa with 'conservatives'. Conclusion: The learning of definitions of words "second hand" or by inapropriate context leads to an avalanche of inappropriate usage. This also leave many people misrepresenting thier political ideology because they attribute false meaning to these two terms.

And yes, this is along the same lines as my problem with the usage of "Literally". I hope you notice both cases of misusage from now on.


Well said. Oddly enough, this misuse was the basis of the first communication problem I ever had with the beautiful Emily. She was trying to correct my usage of the terms, along the lines of the above writing. I became frustrated 1) because I was wrong and felt foolish for being inaccurate for all my adult life, and 2) she was right and very sure of it.

Saturday, July 02, 2005

Emily's Word World #2

peripheral


She's seething now as she reads this posting, because, for all of the glorious orthodoxy with which my lovely Emily speaks the English language, she regresses to the masses with this one. I have been coaching her on it, too. However, she's not to blame, since this may be one of the most used misspoken words I hear.

per IFF er all

NOT: per IFF ee all

When spelled, the second version should be "periphial." However, note that "peripheral" is not spelled, "periphial."

per IFF er all

Things lie out in the "periphery," not the "peripheeeey."

That's all. And you know I still love ya, babe.

First Day

Okay…so today was my first day as Dr. Caire, officially. I worked from 10am to 6pm in the emergency department, where I will be working this first month.

My day began with a workout downstairs in the gym, followed by a “working” breakfast, where I was eating and getting all of my stuff ready for the day at the same time—kinda like how all those people act in commercials about products that are “time-saving.” I got all my pens in my pockets. My new Zire handheld device. My cell phone in new clip. Strapped on my new scrubs and took my new long white lab coat off the hanger. Got my lunch together. Grabbed a few pocket references, my new courier bag (man bag), my keys, and I was on my way.

What’s your big fear on the first day?...being late. Well, I got to the campus at 9:38 and promptly found the parking garage. I wound my way over to the hospital though the walkovers and mazes of hallways and realized I didn’t really know where I was in the hospital. So now I’m sweating, because I really wanted to be there a little early, but that wasn’t going to happen. Fortunately I bumped into a security man, and he directed me to the ED. I set my stuff down, and put my coat on, and entered the ED to begin my career…with sweat on my brow, at 9:53am.

It was a bit weird, my entry into the ED. I’m one of the doctors, the head honchos. I’ll be making things happen here. Yet none of the nurses, staff, or even my fellow residents or attendings know who I am as I stroll through. They don’t recognize me yet. But I’m about to be working side by side wih all of them to start some healing.

Dr. "B" was my upper level today. He appears to be at home in this job. He has learned multi-tasking, as he was able to write patient notes, look at chest x-rays, and explain to me how to find past calcium levels and ECG readings on the computer all at the same time. I’m guessing I’ll learn that, too. After he had oriented me to how things would operate, I had my first patient.

I haven’t interviewed or examined a patient since March—over 3 months ago. I introduced myself for the first time as “Dr. Caire,” which so tremendously self-assuring I cannot explain. I stumbled through the history and physical, ended up ordering some x-rays, wrote prescriptions, all of which required my signature and approval—once again, as “ORDERING PHYSICIAN: SCaire.” Hmph…kinda neat…I have arrived…somewhere, at least.

Today was a good day. They have lightened our patient load while we acquaint ourselves with the system and the way things work. I felt pretty confident near the end of the day, but that’s somewhat false, because one of these days I’m gonna get nailed by a case that stumps me. That’s expected. But today felt good. My attendings were helpful, and I think I’m gonna be all right.

I had just discharged my sixth patient of the day when my shift ended. No patients left over for the next shift from me. And then I left. No attachments. Time to go home and relax for a little while. Kick back and enjoy the fact that it was a good day. Now, I’ll have to improve on my pace some more. But it was a good first day…and I have very much to learn.

Friday, July 01, 2005

Introversion

So I’ve got the day off. This is one of those days that I’m gonna have to get used to now that I’m here in KC. I haven’t directly interacted with more than maybe 3 people. I have talked on the telephone with a few, but person to person contact has been limited to less than three. On recollection—a girl at the coffee shop…........maybe that’s it. I worked out this morning…nobody else was in the gym downstairs. I worked on the computer for most of this morning, nobody else in the apartment. (howling dog next door noted) I went to the coffee shop around 2pm to do some studying. I left there, came home, and have been here since. Planning on staying here, too—more studying to do. What’s funny is that I’m not miserable at all. Perhaps a touch—I do miss my Emmy. I am lonesome enough to notice my nearly complete isolation, but not sad about it. It’s Friday night, and I note that only because, since I’m below 30 years old, I should probably be out and about tonight. But I don’t have any friends tempting me to get out there to go to a bar or anything else. Doesn’t really bother me. I know some people who could not stand a day like I’ve had today. Likewise, I have a low tolerance for a day when I’m around people from sunrise to sunset. Tomorrow is highlighted by work, where I will reacquaint myself with the human race.