Month / April 2009

by Wanderer

Class Rage

The Rage of the Privileged Class As It Loses Its Privileges — New York Magazine

The populist side of me says, “Hell yeah!  Make ’em pay for the deed they’ve done to us!”, I can’t run a company into the round and expect to be paid for it.  The other side of me does sympathize a little, I mean these folks have had the rug pulled out from under them, albeit in retaliation for what they’ve done, but still.  While I’m for fair compensation for the work one does, sometimes it gets a little out of control and our priorities get severely out of whack.  I found this quote a interesting view that somewhat encompasses how I feel.

Wall Street people are not moral idiots (most of them, anyway)—it’s not as if they’ve never pondered the fairness of their enormous salaries. “One of my relatives is a doctor, we’re both well-educated, hardworking people. And he certainly didn’t make the amount of money I made,” a former Bear Stearns senior managing director tells me. “I would be the first person to tell you his value to society, to humanity, is far greater than anything that went on in the Bear Stearns building.”

That said, he continues, “We’re in a hypercapitalistic society. No one complains when Julia Roberts pulls down $25 million per movie or A-Rod has a $300 million guarantee. We have ex-presidents who cash in on their presidencies. Our whole moral compass has shifted about what’s acceptable or not acceptable. Honestly, you can pick on Wall Street all you want, I don’t think it’s fair. It’s fair to say you ran your companies into the ground, your risk management is flawed—that is perfectly legitimate. You can lay criticism on GM or others. But I don’t think it’s fair to say Wall Street is paid too much.”

But the problem with this is that people do complain.  I think Roberts (and many, many other actors) are far and beyond over paid – see Mel Gibson’s $1 billion divorce debacle, and A-Rod is not much better.  The amount of compensation people are paid should not only be guaged by how hard they work, but by how they impact humanity.  Teachers, doctors, nurses, police officers, firefighters to name a few – folks who actually contribute to society should be making that level of pay, not someone who trades electronic money across the world.

I understand the necessity of free flow of capital, but, these guys managed to find a way to assign a value to something that was essentially valueless, nothing more than paper and electrons.  Feel sorry because they can’t summer in the Hamptons?  Nope.  Feel sorry they have to get rid of the private jet and Bentley?  Nope.  When they come on down to the level of the other 99% of the country lives, walk a mile in our shoes, I might feel a little bit sorry for their meteoric fall, but not much.

by Wanderer

Mmmm, swiny

Oh, that was the bacon.

This whole swine flu panic is making me laugh.  Evidently, the local news has just reported the first confirmed cases in Oregon and are in a complete tizzy, breaking in with cue ominous music “Outbreak“.  You would think it was the end of the world.  Even Google Maps is getting in on the action helping to map the cases that have now spread worldwide.

It’s more hysteria than actual sickness.  It’s the flu.  Yes, it kills, but so does pneumonia, alcohol, red meat and driving.  Yes, it’s communicable, but so is syphilis, the common cold and hepatitis.  So let’s all be smart, stop freaking out, wash our hands and cover our mouths when we cough.  And for fucks sake, stay home from work if you’re sick.

So sit back, eat some bacon, drink a cold, frosty adult beverage and watch the world fall apart around us.

by Wanderer

Delaying Health Care

1 in 5 Americans is postponing health care – Health care- msnbc.com

Um, yeah.  Didn’t need a fancy survey to tell me that.  They forget the corollary however:  because they’re postponing their care, the conditions are much more advanced and worse than if they had gone in when it first occurred.  The folks are sicker, stay longer and need a higher level of care.  That’s the fallout from delaying care.

Case in point:  I delayed a sore tooth for far too long and what should have been a simple cavity repair turned into an expensive multi-part root canal.  I think I learned my lesson this time.  Even though I still hate going to the dentist…

by Wanderer

When You Lose

You get used to seeing your frequent flyers, knowing their idiosyncrasies, learning their stories, sharing in their pain and struggle and once they are gone it almost leaves and empty void.  We lost one of those a couple of weeks ago, and I’m still dealing with it as it hit far too close to home.

Part of that was she was young.  My age young.  My wife’s age young.  With a family, children, hopes and dreams.  Another part was that we had brought her back once before.  The progression of her disease was insidious, things compounding into one another, each adding to the vicious cycle, adding momentum, gaining speed as she careened towards the final dance.  The heart failure brought about due to peripartum cardiomyopathy got worse.   The ray of hope that a heart transplant provided was shut out as her kidneys failed and the transplant folks never accepted her inability to lose those last 10 pounds.  I don’t think they realized that losing weight requires exercise and that it’s near impossible to exercise when your ejection fraction is 15%.

She had been on our floor for some time, then went to the ICU as she was no longer stable enough to be with us.  Dialysis at the bedside, levophed to keep her blood pressure high enough to perfuse the brain and what was left of her heart.  She told one of the aides that she wanted to come out to us, instead of our sister floor, when it was time to leave the ICU.  Her kids would come to visit, family too.  And finally it was enough.  She decided that she was done.  She was done with the fight that she had been fighting for so long.  How much of her youth had been spent dealing with this disease?  How much time away from her family had it robbed from her?  She had spent more time in the hospital this year than she spent at home.  So without telling anyone except the docs and nurses, she stopped everything and slipped away.  Selfish?  Maybe.  Maybe it was the action of someone who was just done.

I came back from time off and noticed that the location was no longer next to her name…never a good sign when someone was as sick as she was.  I asked and learned the truth.  I played with the idea of going to her service, but felt odd about it.  It didn’t feel right to intrude upon her family’s’ grieving in that fashion.  I still managed to say good-bye in my own way.

As a health-care provider, death is around us all the time.  I’ve eliucidated my views on death many times, and believe that it is a part of our journey, but when it happens to someone that you know, someone that you’ve taken care of, someone whose life you’ve saved, someone who is close in age to the wife you love, it hits far too close.  I know that she is somewhere better, freed from the shackles of her disease, resting peacefully now.

by Wanderer

Just Wrong

We had a guy on our floor a couple of days ago who in a fit of confused agitation decided that it would be a good idea to pull out the various tubes he had in.  That included the rectal tube.  With the balloon intact…all 40ml of fluid still in.  And flinging liquid poop along it’s path while he was at it.

As nearly everyone said, “Ow.”  Then, “Ewww.”

Or as one nurse, “That’ll make your buthole pucker just thinking about it!”

Or the other with the completely inappropriate comment of the night, “Maybe he was into fisting when he was younger.”

by Wanderer

Kind of Crunchy

The other night I’m sitting at the desk trying to get caught up on charting while keeping an eye on my dude with hepatic encephalopathy who had been jumping out of bed all night long and was far too unsteady and weak to be doing that.  I had given him a cup of ice cream to keep him busy and distracted enough to stay in bed, for at least 10 minutes.  I look up, see he’s in bed, then do a double-take: he has the call light in his mouth, gnawing on it, like it’s the spoon he had been eating ice cream with.  Not just licking it or anything, but full on in the mouth, gnawing on it like a big ‘ol piece of chocolate.

I walk in and say, “You sure you should be eating that call light?”

He looks up, realizing for a moment what he’s doing and says, “You must think I’m pretty fucked up now, huh?”

“Naw,” I say, thinking exactly that.  “You’re just a little off.  Here’s the ice cream back.” as I handed him the cup that was sitting next to him in bed.

At least he stayed in bed for a little longer after that.

by Wanderer

Yikes!

Sphincter-Clenching Case

via ER stories.  It’s pretty damn awesome.

I seem to forget that many times when you have an inferior infarct, odds are pretty good that there is RV involvement.  I remember having an intern literally babysit a patient on the floor one night because she though he was having a RV infarct and was kind of freaked out about it.  She just hung out at the nurses station for hours waiting for the shit to hit the fan, but it never did.  If I remember right, we did a right-sided EKG and it was benign as well.

What bugs me is that during our unit education/skills validation sessions, it’s all LV infarcts.  Which of course means that using nitro is pounded into our heads, but no one stops to ask, “What about RV involvement?”  Sure, it is relatively rare, but it is something that we need to know about.  Granted, LV infarcts are far more common and we need to know how to treat them (at least to keep them alive until they can get cathed…), but I wish the educators would look a little deeper.

by Wanderer

Ahhh…Spring

After the long gray winter, it is nice to see the sun once again.  Yes, according to the Weather Widget on my desktop, it is a balmy 72 degrees outside.  Part of me wants to go out for a ride to enjoy the weather, the other says, “Ahh, I don’t have to work until tomorrow, gonna’ enjoy being lazy.”

With spring though, the cyclists start coming out of the woodwork.  They’re greasing up the chains, dusting off the bad habits, shaking the mothballs out of the Lycra and heading out.  I’m all for it, some days.  The other day though, epitomized the kind of cyclist that makes the average Joe Public see red.  Hell, I’m a dedicated cyclist and bike commuter and they pissed me off.

After enjoying a nice brunch at a cafe downtown, the wife and I are walking back to our car.  She turns to say something to me and as she does so there’s a “whoosh” of air as a cyclist zips past her, less than an arms breadth away.  In the classic Portland hipster cyclist fashion, no helmet, rolled jeans, day-glo colored fixed gear, she blows the stop sign at the intersection, weaves through the moving traffic on the wrong side of street and continues on her way.  Had my wife gestured wrong, slightly wobbled out of step she would have ended up a road jam underneath the turning wheels.

What makes me mad though is the blantant disregard she displayed towards everyone one but herself.  I’ve been known to run stop signs (usually with a California stop) and go fast in crowded areas, but usually I’m looking out for those around me.  She wasn’t.  For a second as she skated through the intersection I thought she was going to end up as road kill.  Cyclists have image issues in Portland already, mostly a mild form of “us vs. them”, but many regular folks plain hate cyclists due to actions of a small group of folks.  Small groups of folks who act this way tend to sour the opinion of normal everyday folks, which is really the last thing we (normal cyclists) need.

Oh well, karma’s a bitch…

And for all you folks who stayed inside all winter, the real cyclists rode all winter, not just in the fair weather.