Monday, November 30, 2015

November Notes, Day 30


Thank you for joining me over this last month.  I hope I have written something
of interest for you...

I'm not the best frequent blog writer, but I am going to try to post more often...
I hope you'll continue along for the ride...!

And thank you for taking the time to visit my little corner of
the interweb....

Sunday, November 29, 2015

November Notes, Day 29


"She Googled Your Ass"

This photo was making the rounds on Facebook today, and it reminded me of a post I did a while back (2011) on just this subject.  I'm going to reshare that with you tonight:


Excuse the rant, but seriously?

I've seen electronics develop greatly since the time I was in medical school.  I remember getting my first Palm and "synching" programs to help make studying easier with my fellow colleagues.  I remember our brand new auditorium boasting that one day all of the students would be able to instantly download the lecture to their personal laptops.  Wow, how could a medical student afford the $3300 a laptop would cost....?

Fast forward to now where I look up everything from medication interactions, to the latest antibiotics therapies, to calculating free water deficits on my phone.  My laptop is my, almost, constant companion.  And that dream of one day using a tablet-based medical logging system is now becoming a reality.  I, of course, should have patented my App for that.

But, what I find hard getting used to is patients who come in and tell you what their problem is, how they would like it treated, and could you freshen their coffee while you're at it.



I have always advocated for patient rights.  I tell patients it's their responsibility to ask questions of their doctors so that they are well-informed about their illnesses.  But, really?  I've called primary care physicians at home to talk to their patients who come into the emergency department because they don't believe me when I tell them to stop their medications, and that, no, they won't die, well unless they don't stop their medications.  I know what you read on WebMD but that relates to a certain population which you're not a part of.  I know that "Diagnose That" said that because your skin looks green under a full moon you could have a metabolic disorder, but if you read further or did some more research,  the fact that you're still alive at 22 means you probably don't have something where the average survival age is 2.

I read somewhere that a little knowledge is a dangerous thing... just continue to quote the internet to someone who's dedicated at least 12 years of their lives to studying medicine. Mmhmm...

Saturday, November 28, 2015

November Notes, Day 28


I did another painting class...
The beer is for inspiration for this tropical scene which I am painting
in a place far removed from the tropics.


It all begins as a blank canvas covered in red paint,
then a sketch of the dark areas


Then you add in the ocean


Starting to add the wave element


The break point is developing


Add the beach, the trees, some movement in the water


Complete!


Friday, November 27, 2015

November Notes, Day 27


"After Dinner Conversations"

I hope you had a great Thanksgiving.  I went to a colleague's home for Thanksgiving given that I am away from home working in Sacramento for the holiday.  Her family was very nice, and we had a great time eating and drinking.  What I love best, though, are the after dinner conversations.

As physicians, and especially as ED physicians, we get asked all the time about TV shows and how close to reality are they.  We all laughed and shared experiences from our medical school and training and how there are some things you're only going to see on TV... such as that episode on "Grey's Anatomy" where they wear adult incontinence undergarments to surgery so that they don't have to step out and miss something.  This is something my surgical fellow residents and I never even considered.  You ate and drank to a certain schedule, and you made sure your bladder was empty prior to going into the OR.  Even bowel habits became regimented.

We also talked about current politics touching on the Belgium Crisis and cat memes, the refugee crisis and friends that are helping and their stories, and the legalization of marijuana in California and the problem with "trimigrants."  

There were the usual discussions about favorite TV shows, the benefits of Hulu and Roku versus satellite or cable.  What shows were currently available on Netflix and what recent movies were better than others.  We discussed music.  We touched on some decorating tips.  And, we had some nice discussions about travel and places we'd been and where we'd like to go next.

I could have talked all night...   

Thursday, November 26, 2015

November Notes, Day 26


Dear Heavenly Father,
Today we give thanks for the many blessings You have bestowed on us this year.
We thank You for a prosperous year and the ability to serve You through others.
We thank You for our health and family.
We thank You for keeping us safe and free from harm while traveling
and enjoying the splendor of Your Earth.
We thank You for protecting our home and our creatures
that You have placed in our care.
We thank You for this gift of life, may we continue to live it
in appreciation for the many wonders You share with us.
We thank You in Jesus' name
Amen

Happy Thanksgiving to you and yours!



Wednesday, November 25, 2015

November Notes, Day 25


"Baby Huey"

There are a lot of studies on why emergency physicians have such a high burn-out ratio as compared to other specialties.  ED physicians know why we do... we see and treat patients on the worst day of their lives, or on the day they decide to make ours the worst ever.

Like, Baby Huey.  They were morbidly obese... so much so that they measured around about the same amount as their height.  And, they didn't want to do anything for themselves:  
couldn't move themselves from the ambulance gurney to the hospital bed, they actually asked if the paramedics could "carry them over" 
couldn't decide if they wanted to lie down or sit up, so they constantly were yelling out
into the hallway for the nurse
kept asking for: something to eat, something to drink, some ice chips, another blanket,
blanket's on the floor, blanket's too cold, I want to sit up again
and couldn't seem to make it to the toilet to pee although
the toilet was in the room about 3 steps away from the bed.
So they peed on the floor.
When staff came in, they said that they "do that at home"
and the daughter "just cleans it up"
but now "I've wet myself and I'm cold and I need another warm blanket..."

Thank you, Sir, why yes, I will have another...




Tuesday, November 24, 2015

November Notes, Day 24

Another day, another work shift... 
Switching to nights for a couple of days... 
Hope the cold medicine holds up...
Head is too foggy to write, 
so just this little noted.

Monday, November 23, 2015

November Notes, Day 23


"Anywhere But Here"

I caught a cold.  Workplace hazard.  I wash my hands like crazy, 
but it doesn't help when a viral-laden pedi coughs in your face
when you're doing the throat exam or looking in their ears. 
I tell their parents to keep them home, rest, lots of fluids,
follow up with their pediatrician in a couple of days if they're
not getting better... 
And, yet, I can't call in sick and follow my own advice.  
I have to go to work.
After all, those Norco scripts aren't going to write themselves...

Sunday, November 22, 2015

November Notes, Day 22


I really miss having goats.


Sure they chewed up all of my roses,
and they ate my husband's blueberry bushes.


But they were so much fun to have around...

I miss goats...

Saturday, November 21, 2015

November Notes, Day 21


"FOS - or Why I Want You to Eat Your Veggies"

As I was doing a rectal exam on my last patient today, ending up with my hand almost entirely into his rectum trying to get out a fecal impaction (big poop ball from severe constipation), I thought it might be time to readdress one of my "how to stay out of the ED" lectures.  The one about constipation.

The U.S. could save MILLIONS and MILLIONS of dollars if people would just do a little bit of preventative care.... like eating a vegetable-based diet, drinking plenty of water and exercising.  I see so many children (and many adults) with abdominal pain who are FOS (full of s&*^).  Kids that are brought in with "I think Timmy might have a appendicitis" even though the pain is on the left, they're chowing down Cheetohs and Mountain Dew in the waiting room, and they haven't had any fevers or chills, nausea or vomiting.  Or the kids who are brought in at 3 in the morning with the "bad tummy ache" who went to a party the night before where they chowed down on pizza, coke and boxes of Ike and Mikes.  

Yes, I know that appendicitis can present atypically, but let's give it a couple of hours at least.  Or, you could do what my grandmother used to do when I complained of a stomachache... she brought out the fish oil medicine.  That was her test... if you still complained of pain after you were completely flushed out, then something might actually be wrong.  I've given parents the "if they continue to have pain or develop a fever after giving them this laxative then bring them back for re-evaluation" instruction many times, and maybe one or two has actually returned, and neither had appendicitis.

And, yes, you can poop daily and still be constipated because if you imagine 4 feet of large intestine being filled like a sausage casing, only a small amount may come out at a time, but it's still full.  And, that continued fullness leads to other problems... like diverticular disease and when that gets infected then it's diverticulitis.


Basically, if you've seen a blow-out on a tire, that's the same thing that happens inside of the large intestine.  It's trying to move your digested food stuffs, but there's not enough fiber and water to push them through without having to strain, so the bowel wall weakens and you get a diverticulum.  If that gets infected then it's diverticulitis.

Diverticulitis used to be a disease of the elderly, but I recently saw my first 20 year old with the disease who needed IV antibiotics and then oral antibiotics.  Yes, while antibiotics can cure this, complications include a ruptured diverticulum with abscess, and sometimes that means getting a part of your colon taken out.  If the infection is really bad, you get a colostomy for six months before they can reconnect the parts.  Imagine showing that to your date in your 20's, 30's and 40's.

So, let's practice a little preventative medicine shall we?  Eat a high fiber, vegetable-based diet.  Drink plenty of WATER... not soda;  soda has no nutritional value and is bad for you even if it's diet.  Why would you put anything into your body that does more harm than good?  And why would you give it to your child?  And exercise.  The colon likes motility.  We're not rest and digest kind of creatures like snakes that crawl onto a hot rock after a big meal, we're moving on, moving on kind of creatures that should be active.  

***Caveat:  do not sue me.  I'm not telling you to not come into the emergency department or not to bring your child into the emergency department if they are having abdominal pain.  People can have abdominal pain for different reasons some of which can be life-threatening.  I'm here telling you about preventing disease with some simple things that don't cost a lot of money, but can save healthcare a lot of money, and also save me from having to put my hand up your rectum.


Friday, November 20, 2015

November Notes, Day 20


"The Calm After the Storm"

Today was that weird kind of day where all of a sudden there was nothing to do.  I'm back in Sacramento for a week, and our annual party is over, all the work on the house has stopped for a few weeks, and it's that strange kind of let down when you've been running full blast for what seems like weeks and weeks, and the stress is finally over.

I remember experiencing the same thing in medical school.  You'd have weeks of classwork, then weeks of endless nights preparing for midterms, then a solid week of exams with no rest except to grab something to eat to get back to studying... then Friday would come.  Your exams would be over by around noon, and suddenly you were free with NOTHING TO DO.  You didn't feel the need to rush to get back to the books... that was for Sunday night.  And for just a few hours you could relish in the now.

That's kinda how today felt once I finished all the things I needed to do.  I walked outside and stood in the sunshine, feeling the slight breeze, and just enjoyed being in the moment.  Tomorrow it's back to the rush of the ED for a full 5 days in a row, but today was just a chance to recharge and renew.

Thursday, November 19, 2015

November Notes, Day 19


"Camera Ready"

I don't know how much time people of my generation think about how the lives of current generations are so different from when we grew up.  Sure, there are all those memes on Facebook that show an item or two that only "Gen X's" can identify.  But, where you really notice the differences are when you look at old photos... or unpack boxes from your college years (mixed tape anyone..?  or better yet, what can I play that mixed tape on...?)

Take for example this photo that my bestie that was visiting this weekend sent me.  Look at that camera... I think this is a C24 camera that used to take film that came enclosed in its own container.  You popped the film in, advanced the film with a roller, then popped the film out and took it to be developed.  Some people might remember the 110 film cameras and rolls that were a much smaller version of this.

I had one of those too.

We didn't take a lot of pictures back then because film was pricey and developing the film also cost some money.  So our parents paid for it, and they weren't about to spend a lot of money on just a bunch of random pictures, so we had to make every photo count.  Not surprisingly, we didn't shoot a lot of pictures.

I still remember my high school trip to Europe in '85.  I took 10 rolls of film with me.  I would have loved to have taken more, but tried to factor in the cost of developing 360 photos on my measly allowance.  As a comparison, on my last cruise I shot over 2000 photos on three different devices including an SLR digital camera, a point-and-shoot digital camera and my iPhone.  I can promise you that about 30% of those shots are probably throw-aways and only about 40 or so would I ever consider printing.  Not to mention the video captured on the PNS and GoPro.

Kids today will have their entire lives documented and posted online.  I have photo albums.  Whatever happened to those...?  I guess I'll have to look into making a photobook online.  Much easier than trying to weed through several thousand images now on Facebook.  

How do you capture your memories....?





Wednesday, November 18, 2015

November Notes, Day 18


"Addicted"

Do you have a collection of games on your iPad?  I do.  They're a major distraction.  And, just when I tell myself "no more!" I see an ad for another game that looks interesting, and I have a new obsession for a while.

I can't even begin to imagine how much time I've lost playing games.  I can get involved in TSTO, for example, and three hours later where did my afternoon go?  Or, wait, hang on, DH, but I've just got to complete this task and get the other tasks going.... I know, we're late for dinner, but just one... more... minute....

Tuesday, November 17, 2015

November Notes, Day 17


"The Body Detective"

There was a time when I considered, for the briefest of moments, becoming a forensic pathologist.  I don't know why murder and mystery fascinates me as much as it does.  Those of you that have followed my blog for a time, especially while I was in residency, know that during my training I spent some time in the medical examiner's office in Erie County, New York.  But, before that, I did an elective in the medical examiner's office in Milwaukee during medical school.

I actually looked forward to coming in every morning and seeing what the day/night prior had brought in.  All the cases for the morning would be lined up.  Officers from various law enforcement offices would be there to see their case.  And the ME investigators would tell us the stories.  Then the chief medical examiner would divide up the cases, and the work would begin.

I remember one murder case vividly.  The victim was found in a field and taken to a local hospital where they were pronounced dead.  They came the next morning to the ME's office.  I observed the autopsy, and injuries consistent with being struck in the head were discovered.  The pathologist held onto the body, and over the next 3 mornings, we would pull the body out after morning cases had been performed.  Bruising became more evident as time passed, and there was a small lesion I noted on the last day that was photographed and helped to solidify the case against the perpetrator who had apparently chosen the victim at random.

That was such a surprise given all of the leads which were followed up on.  The list of suspects that the victim had known and which were eliminated as suspects.  The review of store footage which helped to establish a timeline for the victim.  And, finally, a couple of weeks later, an anonymous call which led to the perpetrator.  At least, justice was served, and it's a case I'll never forget.

I remember following the path of bullet holes through various layers of clothing in another murder victim.  I remember the victim of a house fire that had to sit in the corner of the autopsy suite "defrosting" for several days.  I remember the tiny murder victim whose organs were so perfect, I wanted to cry.  I remember the disinterred case that was brought back up for analysis in case something was missed on the first autopsy.  And, I remember the suicide case that killed themselves because of having a financial crisis, but who missed the letter that came the next day which would have solved all of their worries.

I remember them as patients that taught me so much about anatomy and physiology, along with teaching me about trauma and pathology of disease.  Like the patient whose heart is pictured above.  They collapsed in their office and their co-workers immediately started CPR, but they never got pulses back.  That brown "glob" in the middle of the blood vessel in the center of the photo is the clot that blocked the coronary artery that lead to their having a massive heart attack leading to their death.  Another mystery solved.

Monday, November 16, 2015

November Notes, Day 16


Funny the things you find when you unpack.
I've had some boxes which had been packed when I
left Buffalo five years ago that I am finally unpacking.
(It's because I finally have my craft room built in my new house.)

And, I had some boxes which were packed even before then.
In some of them, I am finding stamps...
books of stamps...
sheets of stamps...
stamps I bought for the wedding invitations in 2008
stamps I bought for Christmas cards in 2012
stamps, stamps, stamps

Guess I'm going to need to write more snail mail...






Sunday, November 15, 2015

November Notes, Day 15


"Fabric Fanatic"

Spent most of the day today working on organizing my new craft room.  Today I focused on fabric. I've started dabbling in quilt making, and I want to design purses (I love totes) and stuffed bears.  So, I've bought a lot of fabric over the last several years, and finally have a place to store it instead of plastic containers.  Since my bestie is in town, she helped get things organized.  First, we had to do a little shopping...


Then we needed to add a little organization.


Then we started to go through boxes and bags of fabric..


This is only a small part of all the fabric I still have.
There are several UFO's (unfinished objects) in the top small bins,
several small quarter panels assorted by color/theme in the medium bins,
and bear, purse and large quilt fabrics in the largest bins.

Now to get my sewing machine set back up again...


Saturday, November 14, 2015

November Notes, Day 14


"Racing for Home"

This stained glass window now sits at the top of the stairs
leading to our master bedroom.
It was the icing on the cake
topping two stressful weeks trying to get
things done before our annual Fall party.

I sail, and my husband hang glides
so we're both represented here.
I love how the clear glass picks up the color
of the landing really enhancing the sunset feel.

I'll be sitting and staring at this for many days to come...


Friday, November 13, 2015

November Notes, Day 13


My best friend from forever is visiting this weekend.
One of the earliest memories I have of her, 
aside from how we met,
is of her falling down the slide in grade school.

Someone had dared us to go down the slide backward.
I took the challenge and made it down.
N. didn't quite make it.
I think she panicked halfway down and then tried to turn around.
It did not end well.
Scraped face and knee for that year's class photo.

Almost 40 years later we're still friends...
It's great to have people in your life
who are there to be your memory.
We can still find things one or the other 
has forgotten/remembered.
I'm sure we'll be sharing and making many more this weekend...

Thursday, November 12, 2015

November Notes, Day 12

It's been a long five months, including several times when I almost divorced my husband due to a choice of lighting....

but we've gone from this...

To this...


And from this...


To this....


We took this...


Created this...


And now this is one view of our
master bedroom


There are still a few more things to finish, 
(like the stairs on this window seat)
but we are so close to being completely done...
and, I'm still married
despite some lighting choices...


Wednesday, November 11, 2015

November Notes, Day 11


My husband has this thing for old cemeteries.  For as long as I've known him, he's always been interested in them, and whenever we go on a road trip, if there's an old cemetery, he wants to stop and see it.


He says it's because cemeteries are the only place where there is absolute truth.  No lies.  Nothing made up.  Date of birth, date of death, name.  Pretty basic...




I remember one old cemetery in Southern Wisconsin where we stopped.  There was a large mausoleum type tomb to one side.  It was for a man who had about 4 wives.  All buried together, along with some kids.  You just walked around the tomb, and you could see their entire history.  Wife number one died at about 20-something years of age, then wife number two came along and she died at some 30 years of age.  Then there were wives three and four.  A little older and I think the last one finally did outlive him.  A lot of stories on that one tomb.


Even though I don't tell him, I'm sure there's some tombs where the information isn't completely true.  But then, I like to watch a lot of Forensic Files and CSI.... And, I can bet, there's a lot more that those graves would say, if they could only talk, and we could take the time to listen...






Tuesday, November 10, 2015

November Notes, Day 10

"Is Your Personal Life Fair Game?"

I remember the old standard that if you were going to break up with someone, you should do it in a public place so that they wouldn't make a scene.  If they do, however, does someone else have the right to film it and publish it?  Kinda like this article I saw earlier today...


I've taken a lot of plane flights.  And, I'm so happy that you can't talk on your phone during a flight because having heard people's conversations before the flight, immediately upon landing, and waiting in baggage claim;  I wouldn't want to be subjected to 4 hours of the same.  Seriously, what did people do before cell phones made every mundane event in the day something to call someone about?

But given that we're living in an "I as reporter" world where YouTube, Vimeo, and the People of Walmart exist, how can we expect to keep some modicum of privacy when out in public?  When reality TV first started, I think it stimulated that small voyeuristic part of us that was curious about how other people lived and thought.  For the first time we were allowed into other people's homes or lives and saw their interactions with each other, their dress, their choice of dates and what they did on those dates.  

And, I think to some extent, the explosion of reality shows (plus the availability of phones with instant upload to the web) makes it now seem almost o.k. to film or record anyone you see just because it's "out in public and if they didn't want someone to see them or hear them then they should have stayed at home."  Plus you get to make fun of them too along with your friends.


So watch what you do out there, what you say, and what you wear... It's not just Big Brother that's watching...




Monday, November 9, 2015

November Notes, Day 9


"And Jesus Wept"

This wasn't going to be my blog post today, but when I got onto Facebook 
this morning, I saw this in the trending section...


I followed the links to an article in the Economist that discusses
the study.  According to the article, 1170 families from around the world
(US, Canada, Jordan, China, South Africa and Turkey) were studied.  Well, actually,
ONE selected child from each of these families was studied.  About 842 of the families
identified themselves as religious *(see below for breakdown) and 328 of the families stated non-religious or agnostic.



The selected child from each family was then given a choice of 90 stickers from
which they could chose 10.  After they'd made their choices, they were told that
other children wouldn't have time to participate and would they be willing
to give up some of their stickers.  According to the results, non-religious household children
gave up an average of 4.1 stickers and religious household children only gave up an
average of 3.3 stickers.  Other notes:  rich children gave up more than poor children, 
and older children gave up more than younger children.  The families were also given a score of their "religiousness" and that was used in the analysis as well.

The article ended with the quote:
"what it suggests is not only that what is preached by religion is not always what is practised, 
which would not be a surprise, but that in some unknown way the preaching makes things worse."

Taking umbrage with that last statement, and being a woman of science 
(as a physician we have to read journal articles all throughout our training, 
and all throughout our careers), 
I wanted to read the original article in Current Biology where it was published.  
In med school and residency, we were taught to look at all research with a skeptical eye.  I
wanted to see how they crunched the numbers.
I wanted to read how you can justify numbers without a balanced sample (842 versus 328)
and without knowing the age groups or economic status.  Maybe they asked poor 5 year olds
in the religious group and rich 11 year olds in the non-religious group to participate.
Maybe it was simpler:  poor Muslim kids in Turkey value stickers more than
rich non-religious kids in the US who get stickers for just showing up to school
every day and not using their cell phones during class.

So I searched the "interweb."
I couldn't find it.  I found this:


With some fascinating articles such as these listed:





I'd kinda like to read that "Do Bees Dream?" article some time...

But, I digress.  I want to know how the numbers were worked because
what really upset me were the headlines of the trending articles:

The Guardian: "Religious Children are Meaner than Their Secular Counterparts"
EpicTimes: "Study: Atheist Children More Generous than Muslim or Christian Kids"
Disinformation: "Religious Children are Meaner"

Seriously?

I wouldn't usually consider Disinformation as a reliable news source, but given that the majority
of people use the web as their primary source of information, and Facebook is used by millions of people daily, and based on the number of "likes" I saw on these pages, 
I know that probably 80% just read the headline and moved on thinking
"Yeah, that's right, just another justification for not going to church, believing in God, 
having to deal with raising my kids with any religious moral foundation 
given that I don't have one myself or
having to think of anyone other than me... 
does that make me selfish?"

Oh, yeah, wait, being non-religious makes you more generous, that's right...
I read it on the internet, so it must be true...



Matthew 22:39
"Thou shalt love they neighbor as thyself"


*510 Muslim, 280 Christian, 29 Jewish, 18 Buddhist, 5 Hindu