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| Wednesday, May 16th, 2012 | |
drgrumpyfeed
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5:55a |
Huh?
http://drgrumpyinthehouse.blogspot.com/2012/05/huh.html Dr. Grumpy: "Have a seat and let me look at your chart... So I saw you last week and started you on Mariokart. I'm surprised to see you back in less than a week. Was there a problem?"
Mrs. Copay: "No, I haven't even started it yet. But at the appointment you said I could take it in the morning or at night, and I said I'd like to take it at night. I've been thinking about it, and I'd rather take it in the morning. Is that still okay?"
Dr. Grumpy: "Yes... Was that all?"
Mrs. Copay: "That was it. Thank you!" (leaves office)
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status
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2:51p |
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status
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2:08p |
LiveJournal administrators are aware of issues with updated content not immediately appearing, or appearing and then disappearing temporarily to reappear again later, and are working to resolve this problem as quickly as possible. We appreciate your patience while we're working on this. |
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devpant_feed
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4:00a |
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someposifeed
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11:42a |
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girlgenius_feed
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4:00a |
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| Tuesday, May 15th, 2012 | |
schlockrss
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9:58p |
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| Wednesday, May 16th, 2012 | |
dilbertdaily
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12:00a |
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skzbrust
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2:29a |
Scalzi’s Latest: But I didn’t get MY say!
John “Breathtakingly Brilliant” Scalzi has made another breathtakingly brilliant post. At 800 comments and late at night, he finally said “Enough,” especially because everyone was repeating himself (and anyone who didn’t notice the non-sex-specific “he” in that sentence might have problems with this conversation). Point is, I had something to say about it, and, after reading all 800 comments, no one said it. So I will say it here.
First, please read his post.
Okay, when I say it is ‘breathtakingly brilliant,” I mean it, because it has beautifully redefined things for me. It was a classic case of, “You’re bothered by this metaphor, so let me give you a new metaphor without the emotional baggage, so that, just maybe, we can discuss the actual issue.” It worked.
And, in so doing, it highlighted my problem with the whole, massive bundle. My problem can be stated thus: All of this effort put into either a) How do we make the game more fair, or b) At least making us aware of how unfair the rules are, makes it that much harder to focus on what is, to me, most important: THE FUCKING GAME SUCKS.
I don’t want to play it, I don’t want to be forced to play it, I don’t want strangers to have no choice but to play it; I don’t like smug assholes “dropping out” to live in the woods and then claiming they aren’t playing it.
The game needs to go. It needs to be replaced by a game that doesn’t have a wealth stat, or an education stat, because those things are just always maxed for everyone. It needs to be replaced by a game in which the stats are different talents, and the only thing to put points in are interests and passions.
John calls his game real life, and he’s right, it is. But I passionately, deeply believe it isn’t the only choice for what real life can be. Most people will believe my desire here is unrealistic, and dismiss it; but we must not forget that many of these people believe (or believed) that voting for Obama made a difference, so exactly who is unrealistic is open for debate. In terms of material wealth and capacity for wealth production, there is, at present, enough to create the game I want, or at least get pretty close. In order to concentrate on changing the rules for stat setting, you must believe the game is always going to be there, more or less the same.
I will never accept that.
Originally published at Words Words Words. Please leave any comments there. |
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questionablerss
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3:49a |
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sillygoosegirl
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12:11a |
Double Shift
The trouble with working 16 hours in a day is simply this: my next meeting is in 8 hours, and while I am exhausted, I am pumped rather sleepy. And I probably need a shower, not to mention a meal or two and a massage. The work itself was fun and interesting today. When it isn't, I can't make myself work that long in one stretch. Posted via LiveJournal app for iPhone. |
sinfest_mod
[ just_you_wait ]
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2:07a |
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xkcd_rss
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4:00a |
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| Tuesday, May 15th, 2012 | |
schlockrss
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10:00p |
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| Wednesday, May 16th, 2012 | |
portableapps
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2:07a |
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| Tuesday, May 15th, 2012 |
jerseyjess
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9:33p |
...but I'd be lying
I was attempting to dig a nail out of a guy's wrist last night while on call (more on this later) when my pager went off from the ER. The orthotech answered it because he was assisting me and apparently there was a guy with an open elbow and an open knee fracture. So I was stuck in the Hand Room, attempting to do this stupid hand procedure (and really, it was not going well at all) and now I have an orthopedic emergency. I told him to tell them I would see it as quickly as I could but for the moment I was dealing with the patient in front of me. Fair enough, I'm not sure what else i could do in that situation. The pager went off again from Dr. Jameson (attending on call), asking me if I had heard about the patient yet. I said I would see him as soon as I could and he said he had already booked the OR so get everything ready down here. I was starting to feel the push when the trauma surgeon on call, Dr. TraumaFem, walked into the Hand Room and asked me if I was planning on taking Open Fracture Dude to surgery that night. Me: i haven't even seen him yet! Dr. TraumaFem: He has an open elbow and open knee fractures, there's communication with the joint, and there's gross contamination. Well, each of those is a reason to go to the OR STAT, so the combination of those really means you have to move your ass. I asked the orthotech to suss out the situation and he came back and said "oh yeah, based on what i can see, you're definitely going to the OR." Fortunately, I finished with my hand job about 5 minutes later, checked out the xrays on Open Fracture Dude and noticed he had a comminuted patella and olecranon fracture, and went to see how badly they looked. Dr. TraumaFem came in the room with me. Me: Hi, I'm Dr. Orthochick from the orthopedics department. They asked us to look at you because you broke your knee and elbow. I need to take these bandages off so I can see if there's any bone sticking out, because then it becomes an emergency and we have to go to the OR tonight. Patient: Naw, nothing's sticking out. So I peeled the curiously non-bloody bandages off and discovered, lo and behold, the patient was right. Nothing was sticking out. He had an abrasion on his knee, but the words "open," "intra-articular extension," or "gross contamination" did not come to mind. The word "boo boo" did. Me: Am I going crazy or is that not open? Dr. TraumaFem: No, that's definitely not open. Me: Uh... Dr. TraumaFem: I didn't want to look at it because i figured you would and that way we only had to do it once. Me: Well, let's look at the elbow. We repeated the process with the elbow and this one was even less of a boo-boo. It might have been a scratch, on par with fingernails. Me: OK, well, we don't have to go to the OR tonight, I guess. I called Dr. Jameson to report to him before he rushed in to the hospital. Me: Hi, it's jess orthochick. Uh, he's not open. Dr. Jameson: What's not open? Me: The guy with the patella and the olecranon. He's definitely not open. He's got some abrasions, but he's not open. There's no communication. Dr. Jameson: What? Are you sure? Me: Trust me on this one. Dr. Jameson: Are you sure about this? Me: If I'm wrong, you can petition to fire me from residency. Seriuosly, how can so many people be so convinced of something without having looked at it? I mean, I heard from the ER, the nurse, the trauma surgeon, and the orthotech that a patient had obvious intra-articular gross contamination of an open fracture, and as far as I can tell, none of them had actually looked at the guy. Dr. TraumaFem admitted she hadn't looked, the orthotech later looked at the guy and said 'I don't think he needs to go to the OR, that's not open' (way to change your story, buddy), and I don't know what the ER's excuse was but I'm sure they didn't look either. I'm guessing EMS called and said they were bringing a guy in with open fractures and no one bothered to see if they were right. And really, I'm not bashing EMS, but they're wrong all the freaking time. They once told me a guy had bilateral open tib fibs but was neurovascularly intact. The guy had a knee dislocation, no lacerations or even abrasions over the tib fib, and was not neurovascularly intact. But come on! If you're going to call a consult, especially one for an emergency, look at the freaking patient. Or hell, even listen to the patient. He's the only person who told me he didn't have any open fractures. I then got a consult for a lady with a tibia fracture. The ER resident told me she had a laceration but the fracture wasn't open. What he should have said was the laceration was right over the fracture and communicated with the fracture, so yeah, actually, it was open. So that one did have to go to the OR that night. I think by that point Dr. Jameson was trying to figure out what the hell was going on so he said he would just meet me in the ER already and to sit tight. I got the decided feeling he didn't believe me about either patient but hey, I'm not really known for being one of the brighter residents so he's allowed to feel that way. He saw Open Fracture Dude and started laughing. He saw Open Tibia Lady and called the OR. So yeah, it wound up being a busy night on call. Current Mood:  bouncy |
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portableapps
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9:22p |
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portableapps
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6:09p |
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portableapps
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6:00p |
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portableapps
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5:56p |
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phdcomic
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11:49a |
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jerseyjess
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5:16p |
the best I've ever had
So my polytrauma dude from my marathon day was doing a little better. Not "better" in the kind of way where he was alert, oriented, or making any purposeful movement, but better in the way where his intracranial pressures were no longer suggesting that his brain was herniating. It's the little things. I will say though, his family has been pretty incredible. Every time I go in there in the morning, there's a different family member. And they've never given me crap about anything, they always say they're very happy he's getting such good care, occasionally they'll ask me a question but if I say I don't really know the answer they don't get mad, and everything I do tell them they say they really appreciate. I have spent a not insignificant amount of time around families of trauma patients and these people are probably up there in top 1% of nicest.*** Which is too bad because the patient has a horrible injury and the family doesn't understand the extent of it. Or they don't want to. Or I"m not helping the situation because this morning the mother asked me if he would be more likely to need a hip replacement because of his hip fracture-dislocation. The answer is, yes and no. Yes, he is, but no, I don't think he's going to make it that long to get to the point of post-traumatic arthritis and he's not going to be putting weight on that side so it really won't be an issue. I didn't say that, though. I said he would probably start showing signs of arthritis in that hip around age 40. He's 27 now and I'm pretty sure he's never going to get off a vent so if they keep him on it for another 13 years and we get n xray that shows posttraumatic arthritis, well...I'll replace his hip for free then. So he was scheduled to get a repeat debridement of his open fracture site and an ORIF of his ulna yesterday. The debridement was starting to get kind of emergent because he's had visible muscle sticking out for the past week (It's covered, but that's just not a great idea), the ulna can wait but if you do it after 2 weeks, it's a much more complicated surgery. That being said, for how much he's using his arm right now, it can probably wait a little bit longer. Anyway, Sunday night he totally crashed. No idea what happened, but his intracranial pressures shot up into the 40s (good is 0--15) and he started having non-convulsive status epilepticus, which is where in your brain it looks like you're seizing but you're not actually having a seizure, clinically. So they put him in a pentobarb coma, which is one step up from the drug-induced coma he was in before. I am actually not a huge fan of the term "drug-induced coma" but the other day I was trying to describe the patient's status to my mom and she asked if he was in one, so it's a pretty mainstream idea. I dunno, that one pisses me off. Like 'life support machine.' I really hate that term. So surgery got put on hold. Which meant I had to stick a wound vac on him at bedside. OK fine, if there's one procedure I feel very comfortable doing by myself, it's putting on a wound vac. Granted, I had never actually done it by myself, but I spent most of intern year changing them on the M-W-F plan, and seriously, those things are idiot-proof. The plastic is numbered so you know which piece to peel off first. The hardest part is turning on the machine and figuring out how to put it on 125mm Hg continuous. So I told Dr. Grandpa I had no problem doing it and wrote an order to have all the patient's stuff at bedside. Here is the part that drives me crazy: I wrote a sign and stuck it on the patient's door that said "STERILE PROCEDURE IN PROGRESS. DO NOT ENTER. THANKS!" I did not think this was a particularly confusing or misleading sign. In fact, I'm not sure how I could have made it any more clear. But I had a freaking revolving door of people in and out of the room. I guess maybe I should have put "BORING STERILE PROCEDURE" so that no one would think I was doing anything cool, but still. Plus, since it's a seizure room, the room is videotaped at all times, so you could stand outside and watch me put on a wound vac. Which is totally not an interesting procedure at all. Nor is it uncommon. If you're really interested, just call the wound&stoma (ewww) nurses and hang out with them for the day. They're very nice. They have to be because their job involves two of the grossest parts of being alive. (stomas? yuck.) And, of course, everyone had to comment. Since i couldn't do a full irrigation and debridement, I had grabbed sterile betadine sponges from the OR so I as scrubbing his muscle down with that and you would not believe how many people commented that i was hurting him. Dudes, he's in a pentobarb coma. He's on propofol. He's on a fentanyl drip. He has a bolt going into his head. I'm not saying he wouldn't feel this if he was awake, but for right now, his vitals aren't even changing because he's on so many drugs. Move away from my sterile field and quit criticizing me. You know what really hurts? Infected muscle, sepsis, endocarditis, and kidney failure. Also, I had asked the trauma attending if I needed to bolus the guy with anything beforehand and he laughed at me. He was right to do so. It was a dumb question. I kept on asking everyone please leave, which meant they left and came back, which is even worse than just standing there because you're opening and closing the door. You'd think ICU people would know this since it's not like they have to worry about spreading infection or something like that. At the very end when i was hooking up the vac, the patient's nurse said to me, "who are you? Do you work here?" No, I"m some random person who gets off on exposed muscle. Carry on. As you were. ...and now i have to do this every M-W-F for the foreseeable future, although I might just dump it off on the wound care nurses after a week or so as long as everything looks good. But I might say something to the trauma surgeon tomorrow. Because I was really trying to maintain a sterile environment, I was all gowned and gloved and the patient was properly prepped and draped, and it's really hard to do that when you have people walking in and out. I get that no one respects me, but I'm scared of half of the trauma surgeons at this hospital so hopefully they'll be better than me at getting everyone to leave me the hell alone when I'm trying to do a stupid wound vac. ***The other day I was trying to describe the TCU shuffle to Mim. (TCU=Trauma Care Unit) It's where a young person is involved in a trauma and the family sits in the waiting room and every now and then a new person joins them and they all stand and hug. TCU shuffle. I'm probably going to hell for coining that term. Current Mood:  annoyed |
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status
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7:19p |
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portableapps
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4:05p |
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portableapps
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2:25p |
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