Rants from the Crib

An Ob/Gyn gone mad

Archive for the tag “hospital”

Take Your Vitamins

Most of you are familiar, I believe, with the concept of vitamins. They are compounds that are essential (or at least damn useful) to the physical well-being and development of the organism taking them. Many of us take vitamins. Some take them religiously. They have been seen as possible cure-alls for almost everything. My husband superstitiously takes magadoses of Vitamin C whenever he feels like he is getting sick, which I think is a crock, but it probably won’t hurt him. The problem is, when I feel like I might be getting sick, he tries to foist them upon me too, and he becomes indignant when I refuse to take them. My dad, in the past, has dabbled with mega-doses of various vitamins and minerals. Usually when you take hyperdoses of vitamins, your body takes out what it needs, and dumps the rest into the toilet, wasting your investment

I will stand on my Doctor Soapbox for a moment, and remind my gentle readers that it is actually dangerous to take excessive doses of the ADEK vitamins (a mnemnotic for vitamins A, D, E, and K), which are the fat soluble vitamins, and they can actually hurt you in excess. It has been discovered that Vitamin E, taken in dosages higher than recommended, can cause heart problems.

Among other things, excessive vitamin A can cause birth defects in a fetus who is conceived when Mom is on megadoses. The acne medicine Accutane is actually a form of extremely high-dose Vitamin A, and they medically recommend abortion if you become pregnant while taking it – it often results in babies born without brains, which, needless to say, is an extremely undesirable outcome. Physicians are required not to prescribe Accutane for a female of childbearing age unless it is verified that she is on a reliable form of birth control. Accutane has been linked to suicide in some users. I don’t like Accutane. It is nasty stuff.

Then there are “medical vitamins”. These are not actually vitamins, but are very useful medications. Anything we medical types jokingly call “Vitamin” is usually a drug that gives immediate results, typically for a patient who is anxious, in need of immediate intervention, or a pain in the ass.

Vitamin K is a good one. There is an anesthetic drug out there called ketamine. Some of you may know of it. It was initially used as a veterinary anesthetic, because when they tested it on humans, it caused pretty intense hallucinations. It is seeing more widespread use now in people. My specialty uses it frequently to boost pain control in an awake patient who is having some discomfort during her c-section with a poorly functioning epidural. This results in the patient saying some pretty darn amusing things. I was actually given it during my c-section, because I had a hot spot in my epidural and was in a lot of pain. I watched the anesthesiologist squeeze something into my IV really fast and then I was out. When I awoke a few minutes later, the pain was gone, but all I could see were blue brains. Fortunately, I am not easily rattled and pretty much realized they had just dosed me with ketamine. The blue brains turned into blue triangles, and then I realized it was just the blue surgical drape that was placed over me. I couldn’t remember what I was doing for a minute. “Oh,” I thought, “I’m having a baby. Is it a normal delivery? No. It’s a c-section. What’s a c-section?” We also use it to quickly sedate uncooperative patients who need to undergo anesthesia. We hit them with something called a ketamine dart, usually in a sneak attack on the shoulder. Most typically this is used for patients who are unable to understand or cooperate, or who may be outright combative. I have a fairly large group of patients in a state facility who need annual pelvic and breast exams, but they may be violent or scared and unable to be awake for them. They are brought in, given a ketamine dart, and then their IV is placed after they are asleep. In one particularly funny episode, we were sedating a large and dangerous mentally handicapped female patient who struck fear and respect into everyone she came into contact with. She is missing one eye, and legend has it that she is so mean, she removed it herself. At any rate, she bites, spits, and hits anyone who comes near her, and she packs a mean wallop. Our anesthesiologist danced around her like a prizefighter, trying to sneak up on the side of the missing eye to administer the ketamine dart. She caught sight of him anyway, and administered a massive blow before he could duck away. She was finally successfully sedated, but not without a lot of expletives from the nurses and the anesthesiologist. Ketamine is also a street drug, prized for both its general anesthetic and its hallucinatory properties. On the street it is known as Special K.

Vitamin A is Ativan, which is a drug in the same class as valium and it works great on addled little old ladies who are in the hospital and causing a fuss. Typically the anxious patients are placed on this medication, or others in its class, as outpatients, to calm nervousness and the bad habit of calling the office daily with imaginary problems.

Vitamin H is Haldol, which is less commonly used, but extremely useful in the case of a violent or psychotic patient as it is a rapid acting antipsychotic and has an almost immediate sedating effect. We will frequently call for “a butt full of Haldol” for an out-of-control patient, because they aren’t going to cooperate with any pills given them, and pills wouldn’t act fast enough anyway. The key is to, well, corral them enough to pin them down and administer the aforementioned Haldol Butt Shot.

Vitamin V, or Versed, is also an antianxiety drug that is extremely potent. It is used for situations where a patient needs to remain conscious but sedated for a procedure, and combined with a good pain med, it keeps them calm and comfortable. Vitamin V is used routinely in the OR holding area, where the patients waiting for their surgery are almost certainly anxious, whether they seem so or not. Versed also has a powerful amnestic effect – that is to say, once you are given it, you will almost certainly not remember what transpires in the next few hours. This is handy, because the patients will not remember the ride back to the cold OR, the positioning on the table or preliminary and potentially frightening discussions about instruments or other such. Best of all, should a patient have an extremely rare consciousness experience under general anesthetia, which I understand is terrifying, they will probably not remember it. Having been given Versed myself, I can testify that the stuff is AWESOME.

Watching a patient being given Versed is a wonderful thing to see. At the bedside, in preop holding, your patient is trying to hold it together but it is obvious that they are tense and aprehensive. After your preop chat, where you address any final questions or concerns, it is nice to be able to then say to the patient, “Anesthesia is going to be coming in a couple of minutes, and they will be giving you the equivalent of at least 3 margueritas in your IV. Once you get that stuff, you will be grinning and telling me that you’re so psyched, you’re having surgery!” They look at you skeptically, and you hang around because it is so merciful and fun to see that stuff kick in. When anesthesia arrives with the syringe of Versed, you tell the patient, “Here come your margueritas!” They will eye their arm apprehensively and watch as the needle pushes the medicine into the IV. Then, about 30 seconds later, you can see them visibly relax, and almost sink into the bed. A lot of times they will look at you out of stoned eyes and slur, “Thish shtuff is AWESOME! I’m having Shurgery! YAY!” Gives me a kick every time! And a lot of times, they will tell you some REALLY funny things. One patient, after her Vitamin V, became convinced that the handsome CRNA was a doctor whom she needed to seduce and make her sugar daddy immediately. She pinched his ass repeatedly, making him yelp and jump every time he tried to check her vital signs. She kept offering him fascinating sexual favors, some of which are only available online, and he was so embarassed that he turned bright red, which was hysterical because he is normally an obnoxious and non-embarassable person.

My husband has a very funny history with Versed. After we married, for the first several years, he seemed to need a surgery almost every year, usually in November. For his first ever surgery, I accompanied him to the holding area because I am a doctor and I can. I also had some concerns. My husband, in his right mind, is a blabbermouth who cannot keep a secret even if he really means to, and has very little internal filter regarding whether something might be inappropriate to say. He has mortified me on numerous occasions. Rarely, I have seen him drunk, and am surprised he has not been arrested (or at least had the shit beat out of him) for some of the things he says. He loves women and doesn’t have any problems with discrimination against women, near as I can tell, but what he thinks is subtle sexual innuendo, out of his mouth, can be freaking AWFUL. No filter. Then he brightly looks around and says, “Oopsie! Was that my out loud voice?” I maintain that it is his out loud OINK.

At any rate, I had concerns about his behavior under the influence of Versed. It was entirely possible that he would began to disseminate details of our intimate personal lives, or the last awesome video he saw on YouTube, all of which would render me humiliated and my colleagues confused as to what kind of person would marry someone this awful. So I was there to police him, at least until he was wheeled back to the OR. Well, Vitamin V knocked him on his ass. I somehow kept him on track until they wheeled him back, but I am still worried about what he may have said on arrival to the operating room. The problem is, it may have been embarassing enough that my colleagues would not report it to me. I will never know.

After the surgery, my husband waxed lyrical about the amazing stuff they gave him on the way back to the OR. “I never understood how anybody could crave or be addicted to drugs, but I could sure see wanting more of THAT stuff!” He did remark, however, that he found it extremely disarming that he could remember nothing after the injection was given. That could be disturbing for a bona fide control freak, which he most certainly is. At any rate, despite that, he found the stuff quite enjoyable.

A year later, we were back in the holding area, getting ready for another surgery. My husband had told me that he was psyched, because he was looking forward to the Vitamin V, but that this time, he was DETERMINED not to forget events that followed its administration. I told him that was probably not possible. He insisted that his superior intellect would absolutely make memory of the event possible. I found this immensely reassuring, because, distracted by the work of recalling all events with his “superior intellect”, he would be unlikely to say anything inappropriate, because he would be focused on remembering everything around him. I also found this extremely amusing, because a fiendish plot was forming in my mind.

Prior to the administration of the Versed in the holding area, I pulled the CRNA, who is a friend of mine, aside. I explained to him the whole dislike of forgetfulness and loss of control thing, and about my husband’s determination to use his “superior intellect” to beat the amnesia. My friend, who is my friend because he catches onto things very quickly, smiled a sneaky Grinch-like smile at me. “I’m doubling the dose.” he told me. This did not concern me as it would not harm him – he was about to be put all the way to sleep. It would, however, be wicked funny as hell.

Sure enough, my friend loaded up enough Versed to drop a rhino and pushed it through my husband’s IV. He was WHACKED. I watched him ride back to the OR, pointing at objects on the way back to the operating room and slurring, “I’ll remember you DOOR and I’ll remember you WINNOW and I’ll remember you LADY and I’ll remember you DESK…”. Awesomesauce. Never laughed so damn hard in my whole life.

After the surgery, I asked him how his memory was. He was indignant, because somehow, the drug had overcome his superior intellect. He couldn’t understand it. Of course, at that point, the final stop in my plot arrived – I told him I had arranged to have him DOSED and he couldn’t have remembered his name if someone had asked for it at that point. He was downright incensed. And then he laughed. And laughed. Because he loves a good joke, even if it is on him.

So as a medical person, I must say, it is essential to remember your vitamins! And not just the ones that come in expensive bottles at the GNC…

Things That Men Say

Let me preface this for those who do not know my by saying that I am an OB/Gyn – a doctor that takes care of women, doing, you know, women stuff like baby birthing, hysterectomies, icky periods… yeah, that stuff. Because I care for women for a living, I get to spend a lot of time with their men, frequently under bizarre circumstances like childbirth, or a really icky pubic rash. Shhhh… I’ll tell you a secret. OB/Gyns have a saying: “All women are different, but all husbands look alike.” Their men are a constant source of amazement, embarassment, stereotypical behavior, sweetness, and hilarity, planned or not.

I made a previous post about things that patients say that amuse me. This one’s just for the guys! Here’s to you and thanks for all the laughs (and muffled sobs)!

1. When you do her hysterectomy, can you get the mean out of her too, doc?

2. Hey doc, while you’re sewin’ that up, can you throw in a couple extra stitches, just for me?

3. You mean that thing’s an extra nipple? Babe, you’re a FREAK!!!

4. Only YOU would ask the doctor for something like that, Princess.

5. I thought she’d go back to normal after the baby came out.

6. We both dug around and looked for it, doc. Just can’t figure out where the damn thing went!

7. Are you gonna stick that duck thing in ‘er?

8. I’m leavin’ the room. I don’t wanna see this.

9. Oh, my God, what’s THAT?

10. What’s that brown stripe in the middle of her belly for?

11. Hey, if you’re gonna do that to her, you oughta at least buy her dinner first!

12. I dunno, doc. She got off your scale and just started cryin’.

13. What do you mean, she got pregnant in April? I wasn’t here in April!

14. What’s THIS for?

15. Is it OK if we keep the litter box in the kitchen?

16. Don’t worry, doc. I ain’t gonna pass out. It’s just like guttin’ a deer, right?

17. If it’s a girl can you put it back?

18. If it’s a boy, you only got one dick you gotta worry about. If it’s a girl, you’ve gotta worry about ’em ALL!

19. She caught that somewhere else.

20. I AM payin’ attention, hon. You just keep pushin’!

21. I’m just gonna sit over here.

22. I feel a little…. THUNK!

23. There ain’t another un in there, is it?

24. You swear it ain’t twins?

25. Does that hurt, babe? That looks like it hurts! What do you mean, shut up??

26. OW! You’re gonna rip my fingers off!

27. What do you mean, this is all my fault? You was there too!

28. My wife is hurtin’! Fix that Goddamn epidural thing, NOW!

29. She done broke her water all over my truck upholstery!

30. What do I do? What do I do?

31. Damn, Babe! You’re big as a frickin’ HOUSE!

32. Is she gonna be OK?

33. I am NOT drunk!

34. Can’t you just grab its ears and pull?

35. Why’s his head all pointy? Is that gonna go away?

36. What do you mean, you don’t want my mom in here?

37. Some things a man just shouldn’t have to see.

38. What do you mean, she can’t just have it now?

39. Can you just spay her?

40. Damn, I can’t even look at her but she gets knocked up with another one!

41. What do you mean, we can’t have sex til the baby comes?

42. Seriously, what do you mean, we can’t have sex until the baby comes?

43. How long do we have to wait to have sex?

44. Tie her tubes? Cut ’em the hell out, set fire to ’em and STOMP ’em!

45. Semen analysis? Hell no, doc, I know it ain’t ME! Ain’t nothin’ wrong with ME!

46. How soon can you do a paternity test?

47. Where’d the red hair come from?

48. She said it was a alien probe! That’s funny Babe! Ain’t that funny?

49. I can’t wear one ‘a them things! Like taking a shower with a raincoat on!

50. It can’t just get lost up in there, can it?

51. Damn, looks like you’re stickin’ your whole HAND up in there!

52. Oh my God! I shouldn’t’a looked down there! Oh, CRAP!

53. What’s that stuff comin’ out of her now?

54. That is just so GROSS!

55. Gawd, doc! How’m I gonna compete with THAT thing?

56. She told me she couldn’t get pregnant.

57. Can you give her somethin’ to make her wanna, well, you know… ?

58. Why’s she squallin’ like that?

59. Damn, her boobs got BIG!

60. Her nipples look like dinner plates!

61. Her boobs are bigger than my kid’s HEAD!

62. That thing makes her look like she’s on a milkin’ machine! OW, Babe!

63. I can’t pick him up. I don’t know how to hold his head.

64. COOL! He blew poop out his diaper right up his back! THAT’S my boy!

65. What do you mean, I get to have the next one?

66. I swear I didn’t think that thing’d get stuck up there.

67. Oh my God! Why’s that woman next door SCREAMIN’?

68. Did you really have to go into labor right in the middle of the Iron Bowl?

69. Do some jumping jacks, Babe. We need to have that thing this year – we need the deduction.

70. Can’t tell if she’s walkin’ or rollin’.

71. Why does she still look pregnant?

72. She can’t have the baby Thursday. I can’t get off work then.

73. She cain’t have the baby on Halloween – he might be a WITCH!

74. What the hell’s a onesie?

75. If her mom don’t leave I’m gonna go nuts.

76. No, you can’t buy all new shoes if your feet spread.

77. How come you need your toenails painted? You can’t even SEE ’em!

78. Stirrups? You mean like on a horse?

79. Why’s she so grouchy when she’s on the rag?

80. Oh my God! That needle is huge!

81. Don’t worry. I’ll make her take her pills.

82. Damn, girl! Your Tweety Bird tattoo’s done turned into Big Bird!

83. Is she gonna have to take that piercing out?

84. Looks like he’s a little alien tryin’ to crawl out your belly.

85. What’s that cut for her c-section gonna look like?

86. She doesn’t want an epidural. You don’t want an epidural, hon. We want an all natural birth.

87. Just breathe, hon. You’re not breathing the way we practiced. What do you mean, shut the hell up?

88. What the hell do you want me to do??

89. Why are all the magazines in here for women?

90. She’s a MILF in training.

91. I forgot the camera.

92. This wasn’t in the birth plan.

93. You’re not the doctor we’ve been seeing.

94. How can you stand looking at this stuff all day? Why’d you decide to do this?

95. Don’t you feel weird looking at women’s crotches all day?

96. Will she still be a woman if she has a hysterectomy?

97. Will she still be mean when her periods go away?

98. You gotta do something, doc. She’s rippin’ the covers off and freezin’ my ass off every night.

99. I told her I was coming in with her to make sure she addresses this issue.

100.Thank God I’m a man. That’s all I’m gonna say.

Orientation Fun

 

Rapid City Regional Hospital Credit: Flickr Creative Commons – Emilio

 

I started a new locums travel doc adventure in Rapid City, South Dakota yesterday.  I was to report to the hospital for my “orientation”, a word to those in the know as “soul shattering meaningless tedium”.  My schedule was as follows:

0645 – 0701:  Lean up against the wall opposite the Medical Staff Office where I was supposed to report at 0700.  Watched 3 (count them, 3) employees come up, unlock the office and ignore me totally, despite the fact that I was obviously the new doctor who was getting processed (much like the beaks and assholes that go into luncheon meat) and that I was holding up a wall in the hall out of sheer sleepiness and boredom.  I did manage to get a picture of Traveling Guck sitting under the Med Staff Office sign, post it on Facebook, and email it to my daughter.

0701:  They actually stick their heads out and open the door for me.  Apparently they take the 0700 start time very seriously.

0701 – 0707:  Introduction to the 3 dickheads who left me standing in the hall.

0707 – 0720:  Taken to get a photo badge processed.  When I asked them if they needed ID verifying my identity, they said no.  Apparently they don’t mind issuing medical staff badges to random strangers.  I was of course lined up against a blue wall without opportunity to inspect my hair, and allowed one deer-in-the-headlights shot with no Mulligan.  I was told to go do something else; the badge was processing.

0720 – 0735:  Taken to IT to get computer passwords and immediately change them.  Since they wouldn’t tell me the criteria for the passwords (I swear, they didn’t know whether I needed capitals, lower case, special characters or numbers), I had several do-overs until I found a password that the freaking computer would accept.

0735 – 0740:  Back to pick up ugly badge. Future spoiler:  they set it up wrong and it didn’t open any of the doors that I needed it to.

0740 – 0815:  The ultimate in mind boggling tedium.  This is the same standardized spiel you are given at every single hospital that you work in:  it is dictated by OSHA and JCAHO and a few other acronyms.  Therefore I have heard this 3 times in the past 3 months.  It involves:  Hospital Mission – a retch-inducing phrase or two about Service, Teaching, Health Promotion and Other Grandiose Bullshit, Fire Procedures – seriously, who doesn’t know about RACE and PASS?, Infection Control – a list of all the nasty bugs floating around in the hospital and the special antibiotics used to treat them, if you are lucky and they can be treated at all  (Flesh-eating bacteria included), HIPAA – letters stand for “you’d better not give anyone any information about any of your patients and it we find out you did, we will fine you, fire you and set fire to you”, Code of Conduct – they now must produce a written list about how not to be an asshole (official name:  disruptive physician) because people apparently don’t have the sense not to be assholes and must be given a specific list of asshole things not to do,  Peer Review – we will be watching you, new doctor, and auditing your charts because you are probably incompetent, and Software Use and Access – the passwords never work.

0815 – 0830:  Ridiculously long-winded talk from the head pharmacist, who has a way overdeveloped sense of importance, and who gave me 8 (yes, 8) business cards of pharmacists who I would probably not encounter were I to work at the hospital for 10 years.

0830 – 0930:  Computer training.  This seems to follow a basic pattern – taken to a dark room where a pasty antisocial individual is hunkered down,  sat in front of a computer and given a mouse to click on various things without explanation.  This is all punctuated by, “oh, I don’t know why that’s not working – it usually works”, from the IT person who seems to have no idea about real-life applications of the material they are teaching.  An hour of, “Oh, let’s back up, oh, no, no, no, we didn’t want to go there, OK, try clicking on that” where really, I would have done just as well playing with the damn program myself.

0930 – 1000:  “Do we have anything else for her to do?  I’m not sure, do we?  Did she see the pharmacist?  Oh, I guess we should try to show you the hospital.”  Remember that I must see Medical Records for instructions for record dictation.  Meet with sourpuss from Medical Records.  Receive incomprehensible instructions and dictation cards.

1000:  Phone call from the doctor who is already turning call over to you, explaining that you already have a labor patient to take care of, despite the fact that you haven’t even seen Labor and Delivery yet.

1000 – 1020:  Taken at a gallop past the OR, doctor’s lounge, ER, radiology, and finally, Labor and Delivery where you are kindly intercepted by the chief MD of the Ob/Gyn department, who gives you an actually civivlized and useful tour of the area.  You are introduced to at least 25 people, none of whose names you will remember.

1020 – 1030:  Shown where the locker rooms, scrubs and break rooms are.  Both the MD call rooms are occupied, so no place to sit there.  Insructed to throw backpack on the floor in the nurse’s lounge.

1030 – 1040:  Locate and change your scrubs to their scrubs, because the ones you have on (although perfectly functional) do not belong to this hospital and are thus assumed to harbor awful bacteria.

1040 – 1500:  Sit around on Labor and Delivery because the patient in labor is having her third baby and it should come fast.  It does not come fast.  Chat with nurses (who are too busy to chat) and a Family Practice resident who is waiting to do a delivery and who is hoping you will let him do yours.  You don’t want to let him do your delivery, because you don’t like how anyone does deliveries except for the way you do them, but you have to be a good sport, because that was how you learned back in the day, and people have to learn, don’t they?

1500 – 1530;  Actual delivery of the baby.  You let the resident do it.  He does OK except for the suturing part, which is so slow and fumbling and incompetent that you want to kill yourself.  You would have finished 20 minutes ago.  The nurse is uncertain whether the stitching job is adequate.  It is adequate and you politely tell her to bugger off.

1530 – 1600:  Attempt to take care of strange paperwork and computer work, none of which functions the way you were shown by the creepy IT person in the basement.  Swear under breath.  Repeat.

1600 – 1615:  Use Google Maps (which totally rocks, by the way, and it’s free) to find your way out to Bumfuck where the Ob/Gyn clinic is located.

1615 – 1700:  Meet the doc you are working for and her office manager husband, who regale you with how awful and unfair the politics at the hospital are, and how they hope they will not make you suffer too much.  Yippee.

1700-1715:  Find way back from Bumfuck to the hotel using Google Maps, which by now has used up the battery on your phone.  Pray that you get to the hotel before the phone dies and you are stranded forever.

1715:  Collapse on the bed with the stuffed duck and eat an Atkins bar.  Plan TV watching.  Sulk because tomorrow the patient that delivered wants her tubes tied, a procedure you hate doing and you will have to get up early to do it.

The Doctor Is The Patient

CT scanner, from aestheticdoctorsingapore

I became a patient instead of a doctor last night.  The day before yesterday, I flew home from North Dakota for a few days at home before going on a trip to South Dakota.  Yesterday, I experienced sudden left calf pain for no reason at all.  I hadn’t had a cramp, nor had I injured the leg in any way.  Sudden unexplained calf pain can be a sign of a DVT, or a deep venous thrombosis, which is quite dangerous as that blood clot can be thrown into the lung, which in severe cases can result in instant death.  Travelers are at high risk for a DVT because sitting for long periods of time can impede blood return from the legs to the heart, and with the blood pooling in dependent areas, it can set up as a clot.  I am also over forty years old and am on estrogen in the form of birth control, which increases my risk for DVT even more.

I considered the pain for a while, and I could think of no plausible reason for it to be there.  And knowing I had another plane trip in two days, it would seem very foolhardy to hop back on a plane and risk throwing a clot at 30,000 feet up, where there is no medical care available.  So I made the decision to take myself to the ER, as they would need to perform a number of tests, most of which are not available at an outpatient clinic.

I arrived at the ER, in my own hospital where I have worked for ten years, and signed in.  I was recognized immediately and was signed in.  Membership does have its privileges.  They instantly brought me back to triage, before an entire waiting crowd of people, had my vitals done and they whisked me directly to a bed.

They immediately drew bloodwork pertinent to the diagnosis of a DVT.  Everyone who came into the room recognized me and chatted with me.  The lab tech came in and said she’d drawn bloodwork a million times with my name on the order slip, but had never drawn blood on me.  She confessed she was a little intimidated.  I told her not to be; I have amazingly beautiful veins and I told her she would have no trouble accessing one.  Indeed, I was an easy stick.  While we were chatting, she told me she was pregnant, and that her doctor was my former partner, who is a great person, so I told her I was happy for her.

Next the ER doctor came in, and he is one of my friends, which was great.  He’s also brilliant, by any standards, which is also great.  He’s also qute eccentric, which I enjoy.  He was always calling me when I was on call, and he always starts his explanation with “I’ve got this girl here…”.  Doesn’t matter if the girl is twenty or eighty.  So he came in and chatted with me about what the problem was, and he checked out my leg and checked pulses and all that good stuff.  Then he ordered leg dopplers and headed back out.

The doppler tech came in, and I know her too, so we started chatting about all the crazy things going on in the hospital, and about how everyone is so scared for their jobs, because they are slowly shutting the hospital down.  She scanned the leg, and everything turned out OK.  Several years ago, I had contacted the CEO regarding equipment that they needed for the vascular lab and weren’t getting.  I asked if she ever got the equipment.  She smiled and said she got it the next day.  It was good to see her.

The RN came in to see if I needed anything.  We chatted too, about the job situation.  She’s a former EMT and firefighter, and she has maintained her certification in both so she may have more options than some.  She adjusted the thermostat for me and got me tucked in to wait on lab results.

The doctor came back in the room.  My clotting labs had come back abnormal.  He wondered if I had already thrown a clot from my leg into my lung.  If it was a bad one, I would have died already, so I would likely be OK.  But the abnormal lab meant I needed a chest CT to make sure there was no clot in my lungs, because if there was, I was going to have to take blood thinning medication to get it to go away and prevent future ones from happening.  I knew the CT would be done with contrast.  I’ve had a CT before, so I knew how weird it feels when they push that stuff into your vein.  You get a massive hot flush from your head to your toes, and a cough reflex when it hits your lungs.  It’s not a lot of fun.

That means I needed an IV.  The RN came back into the room to start it.  She too confessed that it was a bit intimidating to start an IV on a doctor.  I told her number one, I am not at all intimidating, and number two, I have beautiful veins and she would have no trouble getting one.  As advertised, she nailed it on the first try.  I didn’t even feel it much.  She told me I would have to keep my arm straight as it was at the bend of my elbow.

They came to pick me up for my CT.  I was wheeled down the hall, and the CT tech informed me that this contrast would be twice and much, and pushed twice as fast as the contrast I had had for my previous abdominal CT.  Great.  He also told me that the chest CT was the equivalent of 300 chest x-rays.  Double great.  We laid me out on the table and he did one pass without the contrast dye.  Then he rolled me back in and BAM I felt that stuff hit my body, a mile a minute, head to toe.  I was in the breath holding phase of the scan and the urge to cough when the stuff hit my lungs was almost impossible to control.  But I made it through, and it wasn’t even as bad as I had remained.  It gave me a really weird afterglow feeling in my privates for a minute or two though.  Then I was wheeled back to my room to wait for results.

The results took about forty five minutes.  I laid on the bed and kept my left leg straight because it hurt, and the right arm straight because there was an IV in it.  Then the doctor came back into the room and told me there was no clot in the lung.  Thank God!  Now I could travel to my next assignment and not have to be stuck in the hospital.  There were some other weird findings on my chest film though.  There were some areas that looked like I might have had TB, which as far as I know I’ve never had, as I am tested for it every year since I started med school.  Another possibility was histoplasmosis, which is common in the South and many people carry it asymptomatically in their lungs.  It only reactivates if you are somehow immunosuppressed.  Hopefully that will not happen.  Also, my blood sugar was a little high, and my blood pressure was a lot high, which kind of worried me.  Now I will have to go see my primary care doctor and have all these things worked up.

I didn’t get home until after midnight.  Hubby and daughter were passed out in the bed.  I was very relieved I didn’t have a blood clot, as I leave for South Dakota for work tomorrow.  My husband wondered in the morning why I didn’t wake him to give him the news when I got home.  I reminded him that he has insomnia and if he was asleep, I wanted him to stay that way.  So when I get back, I’ll be following up with my regular doctor to explain all these adjunctive findings that we came up with while ruling out the DVT.

First Day Craziness

Wow.  Holy crap!  What a day!

I arrived in North Dakota yesterday, in preparation for a 3 week stay as a temp doc (known as locum tenens).  I have never been to North Dakota before, I don’t think.  My parents did a lot of traveling when I was a kid, so maybe we went to North Dakota and I just forgot.  I have definitely never been here in February.

My first day of work was today.  I had to arrive at the hospital at 7:30 AM to start my hospital orientation.  Even though my hotel is like, five minutes up the road from the hospital, I got up at 5:30 (ouch) to make sure I had time to shower, dry hair (so as not to become a docsicle), put on makeup (which I rarely do, so I wasn’t sure how long it would take), eat breakfast, deal with any ice situations, and find my way to the hospital on time.

I got to the damn hospital 45 minutes early.  I hope they were impressed with my punctuality.  Tomorrow I’m sleeping later.  It was supposed to snow 3 inches last night, which was part of why I got up so early.  Instead of 3 inches, there was just some loose snow eddying in the wind in the parking lot.  I was unimpressed.

The lady who was to meet me at 7:30 was actually already at the hospital when I got there, so we went ahead and got started.  I was photographed, rephotographed, processed for a badge, guided through several hundred pages (a somewhat abridged version, but still) of the hospital rules and regs, given a crash course in the hospital computer system, which I must say the IT girl had an alarmingly low understanding of, taken to medical records for dictation numbers and instructions, and given a full out tour of the hospital.

As I have no sense of direction, I have no idea where anything is.  They took me to the clinic where I will be working at about 11:00.  My first patient wasn’t until 1:30.  I met the nurses, and some of the doctors, and became aware that the system is pretty much chaos.  They have so many temporary doctors coming in and out of there, there are hardly any permanent ones.  Maybe because, hmmm, it’s North Dakota?  Actually, it’s because this place is a boomtoom.  Hundreds of people are pouring into this little town because they are now fracking full steam ahead.  I will have no office – I will just work out of whatever area they have available for me with whatever nurse they have available for me each day.  It’s crazy.

Now here’s where the serious craziness comes in.  Since I didn’t have any patients for a couple hours, I started asking questions.  At the time I finished my residency and was looking for my first job, I interviewed with a woman who was a very strict Catholic.  She informed me that she could not condone tubal ligations or basically any other form of birth control.  So I thought, well, surely since we’re in the twenty-first century, that would no longer be the case, but this hospital is a Catholic hospital.  So I asked.  Holy crap, Fertile Woman!  They don’t tie tubes.  They don’t do IUDs, or Implanons, or Depo Provera shots.  If you give a prescription for birth control, you pretty much have to establish a medical reason for it.  Other than just not wanting any more babies, which appears not to be a valid reason.  Shit, when I was working in Alabama, I put everyone on birth control.  Seriously, I made sure my teens, and my patients without insurance, and my patients who wanted no more babies had birth control and plenty of it.  Isn’t that kind of a big part of the job of an Ob/Gyn?  BUT NOT THIS PLACE!!!!  (Yes, I am screaming here).  How can I be an Ob/Gyn and not help with birth control?  WTF?

So I chewed on that bit of craziness over lunch.  By time for clinic to start, I was pretty well convinced I wanted to go home and never see the place again.  But once again, the patients won out.  I saw some great patients, and after a little conference with the nurse taking care of me, I established that I could, in fact, prescribe birth control.  We just don’t install it.  So if they want a shot, or an implant, or an IUD, we send them somewhere else in town.  So there are options.

By the end of the day, I was feeling better.  The nurses were nice, the patients were nice, and I was learning a few things about how to get along in the clinic.  I felt sufficiently energized at the end of the afternoon to go home and read and write a little and had a lovely Atkins dinner of eggs and cheese.  And Mom called to see how my first day of work went, so I filled her ears with all the details of my first day at work.  And now I’ve filled your ears (or at least your eyes, since you’re reading) and feel much better.  And soon I’ll have a little Skype with my husband and sweet little daughter, and I don’t need to be in clinic tomorrow until 10:00!

Tune in tomorrow for more fun-filled North Dakota escapades!  Beadstork OUT!

Paper Towel Holders

Our hospital recently demonstrated the great efficiency, logic and money conservation that is inherent in any health care system.  We have great need of many things.  For example, the phone in my work area is nonfunctional.  A physician really needs a phone within reach.  We have requested that phone I don’t know how many times.  For a while we had to wait until JCAHO came through.  Now, I don’t know what the excuse is. 

However, we had perfectly functional, perfectly normal paper towel holders that were not causing a bit of trouble.  On a list of things we need, new paper towel holders would be at the absolute bottom.  In fact, they would not be on the list at all.  So what did the hospital do?  They came through the ENTIRE HOSPITAL, all the clinics and inpatient and replaced ALL THE PAPER TOWEL HOLDERS.  Perfectly good paper towel dispensers.  Replaced for absolutely no reason.  Even better, the new paper towel dispensers SUCK.  They are one of those paper towel holders that have dire messages all over them:  “Pull with BOTH hands” and a dramatic x’d out picture of a single hand pulling a paper towel.  Because, God forbid we try to pull a towel out with one hand.  They are marked about as dramatically as land mines.  And the thing is, those signs make me WANT to pull out paper towels with one hand.  In fact, every time I use the damn things, I pull with one hand, just to spite the paper towel makers.  Sometimes they rip, and I expect a flashing buzzer to go off.  “Warning, warning!  Back AWAY from the towels!  They were pulled with one hand, oh my GOSH!” 

Most of the time I can get them out in one piece by pulling with one hand, and that is a personal triumph.  At any rate, I still don’t have a working phone, but by George, I’ve got “fancy” new paper towel holders!

Barfing Girl

At the hospital where I work, about 5 or 6 children’s drawings were selected with a hospital theme.  Every day when I walk down that hall, I see the paintings and one in particular jumps out at me.  There is a girl’s head, and her mouth is open, and she appears to be barfing white stuff all over the bottom of the page.  Every day I question why on earth the hospital chose this disgusting picture to put in the hall.  My husband came to eat lunch with me and as he walked me back to my office, it occurred to me to point out the picture of the barfing girl.  “Can you imagine?” I asked him.  “Putting up a picture of a little kid throwing up?”  My husband glanced at it.  “Look closer,” he said.  “It’s a white gloved hand holding a white tongue depressor.”  Why, so it was.  My DH was extremely amused.  “You must have thought it was some diagnostic technique that you’d missed out on.  ‘I’ll hold out my hand and you barf in it.’  But in your line of work,” he continued, “You’d hold your hand down under their crotch and tell them to barf.”  “Ewwww, gross,” we both said.  He’d grossed us out pretty good.  He’s mighty good at that.  But I must say, it is a great relief that the hospital did not post a picture of a barfing girl, just a girl getting her throat checked with a tongue depressor!

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