Today

Trying to decide what sort of day today is...

Pros:

• Found my favorite ballpoint clicky pens at the store

Cons:

• Woken at 08:30 to tractors flattening a dirt pile outside my apartment
• Couldn't get back to sleep, get out of bed at 10:00
• Have to work tonight, and couldn't catch a nap all day
  
• Eye exam shows my eyes are worse than before
• After being told my insurance was accepted at Wal-mart, I get the exam and buy two packs of contacts - and then am informed that I'll have to submit my claim since my insurance actually isn't accepted
• Where's my cell phone?
• I have one of those super painful under-the-skin zits on my jawline
  
• Work tonight is night one out of three
  

So what's the verdict?

...

And it's clicky pens for the Win! I choose to have a good night tonight despite the Fail start! Carpe Diem, my friends!

Limits

So many people think that discussing end-of-life care with their doctors is tantamount to those doctors deciding to cut the life support on all the old people just because they're old.

That couldn't be farther from the truth.

I think those of us who work in hospitals understand - being old and being old and sick are two very different beasts. You can be 85 and in very good health with a sound mind. Or you can be 70 and demented, incontinent, bedbound, and doomed to a nursing home.

I can't even count the number of nursing home transfers we get in the ER where the patient is so far gone mentally and physically that I'm not sure how they made it through the night, yet their paperwork clearly states "Full Code." Translation: break Granny's ribs during CPR, put her on a ventilator she'll never come off of, pump her full of drugs her already failing organs won't be able to handle, and send her to the unit where they'll feed turn and water her every day for a month until she dies of sepsis.

So much of the outrageous cost of heath care comes from this futile care. Just because we can keep someone alive, does it mean we should? Where does the line get drawn? When can the doctor step up and tell the family that she'll die either way? When do I get to explain to the family that if Granny had severe dementia before, this little 45 minute CPR battle most certainly isn't going to bring back any mental function?

I think that right now there is no hope of setting limits in health care. Too many people will decry the "death panels," call them doctors who play God and presume to hold the key to life and death. Lawsuits will rain down on those who try to set limits by those who have no understanding of what it is to watch futile care being performed.

Perhaps the only option is to face this head on; to sit down and talk with our doctors over what we want done when we're close to death. Death is never pretty, but it doesn't have to be agonizingly drawn out. I for one will never be a Gomer hooked to a ventilator, drips hanging into IVs, with no hope of recovery. If I've lived a full live, I will make sure everyone around me knows to come say their goodbyes and then let me go peacefully.

I think if we talk about this enough, maybe people will understand.

Here's a start to the talking: a solid Newsweek article titled The Case for Killing Granny. Read it, please. And then go share it.

Shock

I couldn't believe it. This just never happens. I mean seriously, this never happens...

Very elderly man comes in with a legit complaint. When I ask him to describe his problems to me, he concisely and excellently describes his issue, along with how long he's been bothered by it and when exactly he noticed the changes start.

I ask him for his meds, and he gives me a detailed list with every single med, dosage, and frequency.

I ask him for his allergies, and he shows me his allergy bracelet with his true allergies. He then says "there are a few meds I don't like to take because they make me feel like I will get ill, but I'll take them if I have to because that's not really an allergy."

I ask him who his PCP is, and he promptly names his PCP, along with his cardiologist and pulmonologist.

And if all that isn't enough, he then goes, "and I know this isn't a life or death visit, so I'll understand if you have more sick people you need to take care of. I'm in pain, but you take care of the sick people first."

W. T. F.

I had to scrape my jaw off the floor. And then I wanted to give him a hug.

Why can't every person on the planet be as awesome as that guy? I want to set him up in a seminar in the waiting room, and have his old ass lecture every single person that comes through the doors. Man, he was awesome.

I did not invite The Todd

Three reasons why I love Scrubs:

1.


2.


3.


Enjoy, suckahs.

Ambulance worthy, for sure

Last night I sat at the computer next to the syscom-central phones, which meant I got to receive most of the ambulance reports. At about 0200, we got a call from one of the city crews....and it was a good one.

"18 year old male, was smoking pot tonight and felt disoriented and groggy, and he saw a police car go by so he called for us. Told us he thinks it was laced with something else. Patient was awake and alert on our arrival, but is now sleeping on the stretcher. Requesting no further interventions, we'll be there in three."

I asked if they offered him any snacks.

There was static for a few seconds, then the voice came back with, "nah, we didn't think it nice to wake him up."

Sigh. If only his friends had given him a twinkie and tucked him into bed, I wouldn't have had to look at this knucklehead and try not to laugh directly at him.

The worse part about this isn't that his friends will think him a pansy for calling the ambulance, and it won't be the $1000 ER bill...no, it's that his parents will get that bill in the mail after sending their dear sweet boy off to school for the first time with visions of overachiever in their heads. I don't want to be anywhere near him when that happens...