Day 12 - I Hate Everyone

Some days, this is my theme song for work.

When the never-ending stream of patients

keeps coming in the front door so that I can

"make sure this blister isn't infected"

"refill my script for pain pills that my girlfriend stole"

"find out why my side's been hurting for the last 3 months"

or so I can have 15 year old try to scam me for

narcotics for their "slipped disks."

When the chronics come in complaining of "increasing pain"

that is not relieved with their prescribed doses of narcotics and benzos.

And who tell me right off the bat that

"I need more than the usual dose because most medications

don't work on my pain"

&

"oh, by the way, I'm allergic to everything except for dilaudid."

When the borderline patient tells me to "*&^% myself"

as they're being brought in by police and EMS.

Don't yell at me when you're the one who "tried to kill themselves"

by taking an extra dose or two of your medications.

As I stated in a previous post,

if you really meant it, you'd take a LOT more medication.

Who's wasting whose time..?

Ok, let's breathe in with the blue

breathe out with the green...

and drink alcohol,

lots and lots of alcohol...

Day 11 - When Grannys Go Boom...

From cinemagay.com

There's a scene from "30 Rock" which I can totally relate to.  It's from the third episode of the first season where Liz Lemon is set up on a date with Gretchen Thomas.  They have a phone conversation about the fear of dying alone in their apartment and being found by the neighbors weeks later when a dog "smells them from the hallway."  Gretchen comments that "ever since I turned thirty every time I get in or out of the bathtub I think I think in my head “Careful…careful…”

I thought about this scene several times tonight during my shift as I handled the multiple patients who came in with falls.  From the teenager who challenged the laws of gravity to the elderly fall victim who dislocated their hip.  We see falls often.  And, it always scares me to think of falling because of all the injuries we see.  From simple lumps and bumps to serious head bleeds and broken extremities.

So just keep thinking, "careful... careful..." and stay safe out there.

Day 10 - My Hero

I can't remember a time growing up when you weren't there.

I can't remember a time when we didn't go fishing.

When I went away to college, you came to visit and we established

our yearly ritual of going fishing for Father's Day.

When I got accepted to medical school, I still came home

every June just so we could spend the day together.

You died in May during my Intern year, 

just a month before our next scheduled trip.

I miss standing at the rail of a boat, heading out to sea,

excited about the day.

I miss the boasting and competition about 

who's catching the first fish,

who's catching the biggest fish,

who's catching the most fish.

I miss arguing about politics.

I miss playing chess.

I miss you... every day...

especially on your birthday...

Day 9 - Squirrel Talk

In case you haven't noticed, I have a thing for squirrels...

Like my blogs all have/had "squirrel in them"

California Dreamin' Squirrel

Buffalo Squirrels Won't You Come Out Tonight?

Are There Squirrels in Buffalo?

Not quite sure why... just do...

I'm thinking of getting a personalized plate that says

DRMSQRL

I had my own little squirrel army when we lived in Minnesota,

I loved watching them playing around the yard...

I feel like they're wearing little grey onesie fluffy pajamas.

Sigh, I miss having squirrels in the yard....

Day 8 - Resurrecting an Oldie but Goodie

I was trying to think of what to write about today, and I came across a posting by Heather who writes "The Waiting is the Hardest Part."  She participated in "Resurrection Blogfest III" yesterday where her fellow bloggers brought back a post from the last year.  I thought I would borrow her idea and repost one of my favorite posts from the last year.  Seriously, I tell patients this on a daily, so I am resharing this blast from the past... well, from 2/10/14 anyway....

A Healthier Lifestyle: Just My Opinion

 As an Emergency Medicine physician, patients frequently ask me what to eat when I am in the process of giving them instructions for discharge.  Especially when I tell them to "lose weight, " stop smoking," and get maintenance check ups from their primary care provider.  It's funny how often it seems I am the first person to address their health and eating habits.  

They are surprised when I tell them to stop smoking because it cuts oxygen supply to their blood vessels by about 50% every time they light up.   They seem sincerely amazed that I recommend exercising in a pool when they tell me that because of their chronic back/knee/hip pain they can't follow the simple walking plan I lay out for them. (And, it is very simple:  15 minutes three times a week, then increase to 30 after several weeks, then add a hill, then try to go farther faster, then the possibilities are endless.)   As for seeing their primary MD;  well, isn't it easier just to come into the ED when I need something?  I'll save my answer as fodder for another post.

But, let's get on to  the, ahem, meat of this.  To eat right you just need to follow three simple rules:  nothing in a bag, nothing in a box, nothing in a can.

Nothing in a bag:

Bags include fast food, snack foods, any prepackaged food.   Top Ramen anyone?  This goes to the ideals also set out in Michael Pollan's "Food Rules:  An Eater's Manual."  You should only eat things you can pronounce.  Lower ingredients = healthier eating with a goal of 1 for everything.  The more the food is in its natural state the better.  I follow a mostly raw food diet and have never felt healthier and with more energy.  On one of my allowed "cheat days"  I was craving McDonald's french fries.  I honestly tasted every molecule of rancid oil along with several flavors I couldn't quite identify.  After about 2 or 3 fries, I threw the rest of the pack away and went to the grocery store for some kale and jicama to make into an awesome salad later that night for dinner.

Nothing in a box:

Again, think prefab foods.  Now, I know it's so much easier to get a Lean Cuisine and throw it into the microwave than to take 20 or 30 minutes to prepare something healthier (one of my mixed salads can take almost an hour to prepare.)  Not to mention, I had to run to grocery store about 2 - 3 times a week, because when you eat healthier, you need to maintain a large stash of fresh ingredients rather than a collection of boxes in the freezer.  Also, boxes generally mean breakfast cereals.   Even Special K cereal contains rice, whole grain wheat, sugar, almonds, wheat bran, then "2%  or less" of other ingredients including maltodextrin and BHT "for freshness."  I don't know about you, but I've never seen a maltodextrin tree, and what is BHT? 

On the other hand, meusli contains a mix of rolled oats (uncooked), wheat, rye, triticale, barley, and usually nuts like almonds, sunflower seeds and walnuts.  Some include some fruit like dates or raisins to add a little touch of sweetness.  Add some coconut or rice milk and have a healthier, low glycemic index breakfast.  I usually cut up a banana for added fiber and potassium.

Nothing in a can:

Before you start jumping all over me about things like tomato paste or canned vegetables, this is a place to read the label and remember my argument about the fresher the better.  How much healthier for you are green beans that come off the plant and to your grocer's display than a can of green beans that is packaged in some kind of liquid, usually with some kind of salt preservative;  that have lost their crispness, broken down their fiber, and taste like the can?  And, at the risk of sounding too "green," think about trash and recycling.  Fresh vegetables come in their own packaging.

Cans also include sodas.  Other than tasting good, sodas have no nutritional value.  And, you have to think about the sugars, phosphates and caffeine that they contain.  Caffeine is a diuretic (it makes you pee more.)  As it is, most people don't drink the recommended gallon of water a day they should be drinking.  (Eight glasses of water = 8 x 8 oz = 64oz = 1 gallon or four 16 oz bottles.)  Add a diuretic and now you're at a water deficit.  Your body needs water to perform many vital functions especially digestion.  And, we're seeing changes in patient profiles because of it.  Whereas diverticulitis used to be a disease of the elderly, I'm now seeing diverticulitis in 30 year olds.  The disease comes from not having a high fiber diet and increased pressure on the colon to expel the digested food stuffs.  Lots of water helps.  And exercise... just saying.

So, there you have it.  I can usually give this talk to my patients in about 5 minutes, answer all their questions and send them off to, hopefully, lead healthier, happier, and more flavor-filled lives.  Yes, I know it costs more.  Yes, I know it takes longer to do.  But then, isn't anything that's worthwhile worth doing right?

**I have no financial ties to any of the companies I've mentioned.  One of the best books I read on the raw food movement is "Raw Food/Real World" by Kenny and Melngailis

Day 7 - Chocolate? Only if It's Swiss...

I really am not a sweets fan.  I don't have a sweet tooth like some people.  And, while I don't consider myself a chocoholic like several of my friends (my DH included), I do occasionally crave a piece.  And, trust me, when I say a piece, I mean like one piece can keep me satisfied for several weeks.  Drives my DH crazy because I'll buy us a candy bar and his will be gone about five minutes after I give it to him while I'll slowly eat mine over the next week.  That is if he doesn't eat it before I finish it.

Regardless, I had the day off and nothing of interest to write about until we went into town for lunch, and I stopped at the local candy store to get one of my favorite chocolate candies... I'll let you know which one as we count down my favorite chocolates:

#10 - The original Lindt Almond Bar

I first had this candy in Switzerland.  We had just crossed the border from Italy, and we stopped at some kind of travel stop.  I remember the brightly colored bars and I grabbed one with almonds on the label.  It was the richest and creamiest chocolate I'd had to that point, and I was glad I had bought more than one bar.  I had also grabbed two gift boxes of individually wrapped chocolates with scenes of Switzerland on them.  It's a wonder I made it home with the boxes intact!

#9 - Trader Joe's PB and J

I don't know what it is about this chocolate bar, but I love it!  I think it's because it's raspberry jelly, and I love that stuff.  Whatever, it's seriously tasty.  Of course, you'll find that three of my favorite chocolate bars are a combination of chocolate and peanut butter.  As an aside, Chubby Hubby by Ben and Jerry is my favorite ice cream... I think that has chocolate, and, um, peanut butter too!!

#8 - The Original Snickers Bar

Still one of my favorites.  The combination of peanuts and caramel really is "satisfying."  I think one of the best parts, too, are the commercials.  I really am a diva when I'm hungry...!

#7 - See's Victoria Toffee

I didn't realize that See's candies are mainly a California thing until I moved to Wisconsin.  I can't remember a Christmas that went by when I didn't get my favorite Victoria Toffee.  I know that most people are into the Nuts & Chews combination, but I still enjoy taking my time and slowly working my way through this toffee, chocolate, and peanut slice of Heaven.

#6 - Ghirardelli's Dark & Sea Salt Caramel

I have to be honest, I am not a fan of dark chocolate.  There's something about the combination of salt and caramel, especially with that full flavor of Ghirardelli chocolate that makes this combination especially good.  The Ghirardelli factory is in San Francisco, and even the milk chocolate has a fuller, deeper flavor than most chocolates.  And, their hot chocolate is oh, so good too!

#5 - Peanut Butter Snickers

What can I say?  It's got chocolate.  It's got peanut butter.  And, it's a Snickers....

#4 - Sweetness and Light Moo Bar

This little local shop produces some mighty fine chocolates.  But, I especially love their Moo Bars.  Soft, fluffy marshmallow layered on top of almonds with a creamy caramel base and coated in creamy milk chocolate.  I find myself craving these, and as I said before, I do not have a sweet tooth.  They're located right next door to the post office, and it's such a temptation to go in there when I go into town when I pick up the mail... but, I do control myself.  Except for today.  Today I splurged.

#3 - Lindor Peanut Butter Truffle

So Lindt also makes Lindor chocolate truffles in many flavors.  Obviously, I like the peanut butter ones.  Already covered in rich and creamy milk chocolate on the outside, the inside is also rich and creamy.  Seriously, peanut butter and chocolate is a match made in heaven.

#2 - Teuscher's Champagne Truffle

I thought I'd had good chocolate until I was introduced to these bad boys.  I worked in an art store and the owner went to NYC on shopping trips.  She brought back a box of these to share, and I was hooked.  Whenever I get to NYC, I stop at Rockefeller Plaza and pick up a box or two.  And, whenever friends go to NYC, I direct them to the store.  And, I ask them to bring me back a box, or two.  They are so worth the price.

#1 - Lindor Milk Chocolate Truffles

Don't get me wrong, Teuscher truffles are the best, but when it comes down to it, if there's one chocolate candy that I can just eat until I make myself sick, it's these Milk Lindor balls.  I hate when Christmas comes around because it seems like these things are everywhere!  I love these things.  If I see one, I will grab it... along with another one... and a friend to keep them both company.  It take my full effort of willpower to not grab a tub of these when I go to Costco.  Silky, smooth, creamy on the inside;  I just let the thing melt in my mouth.  MMhmmm.....

Day 6 - Persona Non Grata

There are a certain number of patients who come to the Emergency Department that automatically illicit an audible groan from the staff as soon as their name appears on the patient board, or when you hear an EMS radio call out to a familiar address.  We certainly don't mention certain patient's names, as in "gee, I wonder what happened to So and So," because of the superstition that, like Beetlejuice, mentioning their name will conjure up the person.  These are our frequent flyers.

Some of them are drug-seeking.  Some of them are homeless.  Some of them are non-compliant with their medications.  Some of them are a combination of the three.  Some of them are simply pathetic.  And they don't die unless they die hard.

We've had these patients on the brink of death;  metabolic derangements, heart attacks, massive trauma, hypothermia, drug overdoses.  They get ICU care, or are flown out to specialty centers, spending days, weeks, months away.  And, then they come back.  They always come back.  Sometimes a week or so after arriving back home.  Sometimes a day or two after being released from the hospital.

I've always been respectful of my patients.  I call them Mr. or Ms.;  never by their first name.  Except for the regulars.  They're called by their first names.  "Ok, John, what's going on today...?  Did you run out of your meds?  Did you do a little drinking last night?  Did you make it to the doctor's appointment I set up for you a couple of days ago?"

What's scary about the frequent flyers is that we often bump them, sometimes repeatedly, to the bottom of the list.  They're the ones that get to sit out in the waiting area for hours and hours.  Some just leave and then come back later.  Some of them are patient knowing that if they make it to the back, they'll get the drug, prescription, turkey sandwich, taxi voucher they've been waiting for.  And their waiting is what can be problematic.  Because they're like the little boy who cried wolf.  That every-single-time-crying-screaming-dry-heaving cyclical vomiter might actually have a true medical emergency, and one of these days we're going to miss it.  He'll crash and burn and get admitted or transferred out of the area not to be seen again for a while.  They'll still come back though... they always come back.