Things that have happened since November 25th

1) I found out that I knocked up the missus

2) The Patriots blew a playoff game against an inferior Denver team

3) X-Box 360 still is not available

4) President Bush made his 5th annual speech about "alternative fuels" (read: "We can keep giving billions to the oil companies if I say we'll stop 20 years from now, nudge nudge, wink wink")

5) They shot the Allstate insurance spokesman - stupid writers...

6) Someone renamed April January - what the heck happened to winter?

7) My least favorite show (and unfortunately, the missus' favorite) American Idol is back on the air.

8) My cats are still crazy, meowing at the ceiling, and chasing invisible creatures up and down the stair

9) We found a good Italian restaurant in Philly (finally)

10) I finished my heart failure rotation... twice.

A brief description of the heart failure rotation: 80% of my patients had hearts that pumped out 5% of their volume with every contraction. For those of you in the non-medical realm, that's bad. Hard to walk across the room with that. What is impressive is that half of them were under 50 - we have a pretty big transplant service, so it is a lot of young people waiting in the hospital for new hearts. On of my patients that got a new heart 2 weeks ago had been sitting in the hospital with an artificial heart pump since October.

The Death of a Legend

I know that I haven't posted in a while (and the missus lets me know about it EVERY day), but something I read today on my headlines really hit me hard. Noriyuki 'Pat' Morita died today at age 73. Morita, better known to the rest of us as Mr. Kesuke Miyagi and sensei to Ralph Macchio, brought joy to millions with his deep philosophical phrases such as "wax-a-flooar", "paint-da-fence" and "you best karate still in side, daniel-san... now time let out".



He is survived by a wife of 12 years - she told the media he died of "natural causes". Yeah, right. Natural causes knocked off Mr. Miyagi? I think it was Martin Kove, aka John Kreese, Cobra Kai Sensei, who finally got back at the little man for honking his nose. I bet it went something like this...


[Pat Morita, elderly asian man using a motorized wheelchair to travel to the store to buy some Depends, stops on the corner of the street. John Kreese, scuzzy mullet man, approaches using his cane, having broken his hip in Karate Kid XII when trying to kick an I-beam in half]

Morita: Kreese
Kreese: YOU! You ruined me, Morita! Before you, I was in such memorable films as "Blood Tide" and "Trouble in High Timber Country". No one believed me as a tough guy anymore after I was repeatedly beat up by little Arnold from Happy Days.
Morita: You didn't have to be in the movie.
Kreese: I had no idea I'd look so silly. But it looks like I have the advantage now, old man. I can push you into the street and you wouldn't be able to get up and walk away.
Morita: You wouldn't kill and old man!
Kreese [going into a trance like state]: We do not train to be merciful here; mercy is for the weak. A man confronts you in the street he is your enemy. An enemy deserves no mercy

[Kreese wacks Morita in the head with his cane but becomes unbalanced. Both fall to the ground. As they strugle to get away, a lincoln continental driven by a 96 year old man that refuses to give up his lisence drives up and runs Morita over, catching only Kreese's mullet and ripping it off, scalp and all]

Kreese: My Hair!!! My beautiful Hair!!!

Why the cover up, you may wonder? I think it is shame. Mrs. Morita didn't want the world to know that Kreese finally got the best of him.

Things learned at the halfway point in the ICU

1) People do recover from the craziest things: had one old guy go comatose from a brain infection, then have a stroke, then have seizures, then get intubated for one week for respiratory failure, and right now he is sitting up in a chair in the hospital getting ready to go home

2) Never getting to sleep can make you really tired: I don't get to sleep anymore. Every third night, I am on call, meaning no sleep whatsoever. I get every sixth day off. My last day off, I slept 13 hours. Jam... good. Meat... good. Sleep.... gooooooood.

3) You don't see your friends or family as much: I'm told I'm married. There is a woman that cooks me dinner from time to time, and she does seem familiar to me.

4) Doing procedures can be scary: My first central line (a big honking tube you stick in someone's big neck or shoulder veins) was a subclavian line. The procedure for a subclavian line is that you feel where the patient's collarbone bends (about halfway out), jab a needle into it pointed at the sternum, and then literally push down on the needle until it slips under the bone. Scary things are down there, like big arteries and lungs. The first one I did the needle slipped a bit once I got under the collarbone and slid forward about an inch more than I wanted. Luckily, I had a clean pair of underwear in the call room.

5) Vets don't die: I've had three veterans under my care at this point, all three I was sure would die, and none of them have. You can't kill a vet.

6) Young people die: two of my sickest patients so far were a 37 year old that died about 18 hours after coming into the hospital with a heart infection, and a 17 year old kid that came in yesterday with a little flu bug that progressed over 24 hours to a multilobar pneumonia (infection all over the lungs). He got intubated. This was a 17 year old freshman in college, who had no other health problems. Kinda freaky.

7) Cases are only really cool when you don't have perspective: The forementioned 37 year old was a fascinating case. He got a bloodstream infection that set up on his heart valve, then shot off to his lungs, and then just crumped. We were pumping him fully of fluids and different meds, playing with the vents; we got echo upstairs and stared at a massive vegetation on his heart valve. It was all really cool, until the father came into the room crying, and we had to tell him that his son would probably die that day (he died about an hour after the conversation).

8) The nurses have definitely saved my butt a few times. They are pretty good up there in the ICU. Not like the first floor nurses at my medical school.

9) I am a medical god. Just call me Dr. Daman (just checking if you were still reading)

10) Did I mention I miss sleep?

Fun with surgeons

Almost finished now with my two week stint at the community hospital, then off to the ICU. It actually has been pretty good thus far - the nurses draw their own labs, which is nice, and when you order an MRI you can actually get the scan done in your lifetime.

The thing that has been most aggravating, actually, has been my interaction with the surgery department. Seems they enjoy turfing their patients to us and then complaining about the ins and outs of the care we give their patients. They even change the orders we put in. I had a patient with a small bowel obstruction (a problem that can be cured only by cutting it out) because they wouldn't take care of her. They "consulted" for a few days, changed my orders and bitched about the meds, fluids, tubes (you name it), and then finally realized "hey, this lady has a surgical issue" and took her to the OR.

That would be kinda interesting if I could refuse patients when I didn't feel like admitting them. Having a heart attack, Mr. Jones? I want to make it home to go watch a football game. Go see your orthapedic surgeon. I'll "consult" if anything comes up.

Root, root root for the home team?

The missus and I are sitting here watching MNF right now - it's Atlanta v. Philadelphia. We are both big Patriots fans, but since we live in Philly, and they are in the NFC anyway, we figured we'd root for them too.

I realize, though, as I watch the game something important that affects that plan. I really don't like the Eagles. TO is a dick, and Donovan McNabb always bothered me a little bit. I think it's the way he said "Hmm... Good.." in that Chunky soup commercial - he let his inner retard out. His fake mom was a little demonic, too. I can't cheer for a retard with a fake devil mom and a big dick.

I've decided to settle for indifference.

Blessed Quiet

The missus and I were at a wedding over the weekend - I was a groomsman, she was a reader. I noticed she was sounding a bit cracky/coarse the day of the wedding and while reading there were some volume difficulties. Well, we had a good time over the evening, but when I woke in the AM, I could no longer hear my wife. Yep, that's right, she's got laryngitis.

For those of you that don't know her, her normal volume is about 10dB louder than anyone else talks (or really wants to listen to, for that matter). The day of the wedding she was at normal. Today... well... when I ignore her today it isn't on purpose.

Bush's thoughts on the toilet

Hmm... How can I help those people down in Louisiana...

I know! We'll build boat. A big boat. Like an ark. And we'll get everyone on in pairs. Yeah, that's a good idea. I'll go ask Dick if that's ok. And they said I needed to quit vacation a few days ago to come back and help efforts. Definitely no rush to get congress back, though - it's not like anyone's feeding tube is being removed.

Maybe I can tie this in to the war on terror... or maybe I can use this to change environmental regulations to allow more pollution in the name of gas prices (oh, I did that already)... or maybe I can get my approval ratings up by visiting the area and looking sympathetic... We'll schedule that for tomorrow. Let's practice my faces - first, stupid shitass grin for "we're gonna send down help" , then sad face for "I'm so sorry that you (poor people, democrats, non-aryan) people are dying". Yeah, that looks like I care.