Tuesday, February 22, 2011

Rank List

Spiff and I finalized the ol' rank list yesterday, submitted it to the authorities, and decided not to tweak it or worry about it anymore. Not a moment too soon, either, since it is due by tonight. Here are the top six:
1. Mayo in Rochester, MN
2. University of Michigan, Ann Arbor, MI
3. Dartmouth, Hanover, NH
4. Wash U, St. Louis
5. University of Utah
6. University of Wisconsin, Madison, WI

There are several more programs on the list, but we're hoping for at least somewhere in the top six. There are also transition year programs ranked, and it is very possible that we will be in one city for a year and another city for the remaining three years of anesthesia. There has been a lot of thought and prayer that went into ranking these programs, and we're trusting the Lord that we will be where our family needs to be for the next four years. Three weeks until Match Day sounds like a long wait.

Saturday, February 12, 2011

Emergency Medicine

I have just finished a rotation in the emergency departement. As a child I never went to the emergency room, due in part to the fact that I never broke any bones or had any major accidents, but also because in my mind the emergency room was for people in extremis, those having heart attacks, strokes, car wrecks, etc.. St Louisans do not, however, harbor any such notions regarding emergency care. Here are some vignettes to illustrate the abuse and waste found in the medical system.

44 year old african american male presenting to the ED complaining of chest pain. Upon further questioning he actually has heartburn. He asks for Maalox. When asked why he came to the ER instead of buying a $4 bottle of Maalox at Walgreen's, he replies "the ER is cheaper".

21 year old African American female who was in the ED 2 days ago for heavy vaginal bleeding. She was given a script for medroxyprogesterone and an appointment today with an OB. When asked why she came to the ER instead of the OB, she said "I'm still bleeding, they told me to come to the ER". When the OB is queried, she replied "that's ridiculous, she can come to clinic, we never told her that". I love being lied to.

59 yo caucasian female with history of coronary artery dz, diabetes, hypertension, and depression comes in with "high blood sugar". Apparently she ate a bag of cookies, checked her glucose which was 486 (pretty high, but not astronomically so). Took 5 units of insulin, didn't re-check her sugar, and then called EMS. Came to the ED. Sugar in ED: 187. Patient unable to understand instructions regarding sliding scale insulin, and discharged home. This patient visits the ER weekly.

34 year old lady with heartburn, came to hospital via EMS.
Multiple drunk folks admitted to ED to sleep off their booze.

21 year old with severe asthma who snorted cocaine. Cardiac arrest, died.
45 year old cardiac arrest after doing cocaine. Died. (well, technically came to ER dead, we just coded her for a while. Same with the cocaine-asthma guy).

24 year old with history of 22 (!) intubations in past 2 (!) years for asthma exacerbations. Comes in after smoking (!!!!!) a cigarette and now wheezing like an accordian. Statistically speaking, this person will die within another 2 years from asthma. The only people in our day who die of asthma are those who insist on smoking.

21 who is "constipated" and hasn't moved her bowels in 1 day. Explained normal bowel movements to an adult.

33 year old man with heartburn. Describes classic timing after meals, positional nature, sour taste in mouth, relief with antacids. Not exacerbated by activity, no history of coronary disease or angina, no hyperlipidemia. Yup, another dude with GERD coming to the ER.

21 year old male whose girlfriend told him she had chlamydia, so he wanted antibiotics. When asked why he didn't go to any one of the numerous free clinics in town, he replied that it was cheaper and more convenient to come to the ER. This was after a 9 hour wait in the waiting room.

44 year old who was bumped in the knee by a motorized wheelchair who was upset when I ran out of his room when the cocaine-cardiac arrest lady coded. Sir, your utterly non-emergent mild knee pain is going to have to wait while we try to resuscitate this woman.

UTI count: 7.
Pyelonephritis: 2
Viral upper respiratory illnesses (colds): 5. Folks, the sniffles ain't emergent. No fever, no chills, no vomiting, no diarrhea,no abdominal pain, no chest pain, no shortness of breath = NO COME TO THE ER! See, a cold is a virus, so berating me for antibiotics is not going to work.

I'll post more stories of waste and abuse later when I can recall them all. Some of these are obviously not abuse of the system, but rather failings of the system as a whole. Why the diabetic lady who probably has an IQ of about 70 is giving herself insulin is beyond me.

Thursday, February 03, 2011

Two and Half Weeks

At this point in having a new baby, I feel like if someone were to offer me the choice between a million dollars or one full night of sleep, I wouldn't hesitate before throwing on my pajamas and jumping into bed. This realization came to me last night while we were struggling to get little Hobbes to sleep. He seemed to be having some intestinal distress (at least that's what I think it was), and he couldn't settle down. After I did the whole feed/burp/change/feed/burp routine for the millionth time, I would put him down in bed, and all he would do was grunt. All. Night. Long.

Grrrrrrrrrrrrrrrrrrrrunt. Rrrrrrrrrrrrrr. Grummmmmph. Grunt. Grunt. Grunt.

I can't tell you the number of times I finally lay down, only to get up again to burp, rock, or try again to feed the ever-grunting little man. We finally kicked him out of our room. Spiff rolled the bassinet into the kitchen at 4:00 this morning so that we could get some sleep. I think Hobbles eventually fell asleep, too. And then he had a mighty poop at one point this morning, so I'm really hoping that that's what his problem was last night. We all really need to get some sleep tonight. Pray for us, please.

Also, Gunner woke up this morning with a cold. I'm pretty bitter about it. We haven't gone anywhere for days and days, thanks to the weather. The only place Gunner has been in the last week is church on Sunday. I guess he must have brought it home from that. And now I'm terrified of him passing it onto the baby. I have us all on a strict hand-washing regimen before touching Hobbes, but as Spiff pointed out, it's probably too late at this point. Oh, but I'd really rather not have a sick baby. Please.

On a side note, a really nice friend from our ward brought us dinner the other day. However, she didn't just bring us dinner. She brought some homemade scones for breakfast the next day and some delicious banana bread that Gunner and I have been enjoying for several days. She brought Gunner his own special little sack lunch that he was so excited about that I swear he thought it was Christmas again. She also brought a couple toys she had lying around her house that she didn't need. I pulled one of them out today, on the third straight day of being indoors and the first day of his cold. He loved it and ended up taking his new cars to bed with him. This friend really went above and beyond with this act of service, and it has been a life-save for us this week. I will have to remember these special things she did and pay it forward soon.