TV Time

Since it has been rather warm lately, I’ve been holed up on the couch watching TV.   It’s not the best use of my time, but I do enjoy it so.  Besides, I’m just preventing heat stroke by staying inside with the AC running.  Am I right?

Anyway, I have reignited my love of BBC America.  Before it was Dr. Who, then all things Chef Ramsey (F Word and Kitchen Nightmares), even before that it was How Clean is Your House and How Clean in your Colon (You Are What You Eat).  But now, I am unabashedly a fan of Torchwood: Children of Men.

In a time where American TV is chock full of the same reality shows (another season of Big Brother?) and lacking in any sort of shows other than stupid sitcoms or crime dramas, a great science-fiction story is a breath of fresh air.  Tautly written and paced, and easy enough to get a grip of (hello Lost, are you listening?) it is a good story, good characters and fine acting.  While I have 2 more shows to go, I’m hooked.

I know there are good shows out there.  There has to be.  We invented the bloody machine afterall.  Isn’t TV the great American invention of the last century?  But it is so much easier to gather a bunch of half-wits, chunk them into some sort of competitive situation and film the hijinks.  Rinse, repeat, profit.  Unfortunately, this spills over into movies, where it has become far easier to either write numerous formulaic sequels or re-make movies from the past (Karate Kid I’m looking at you…).  C’mon Hollywood, earn that money for hookers and blow, give us something to think about, something to delve into, something that can stand up to the giants that went before.

American entertainment has become stale.  To often the cycle of mediocrity is repeated and we’re all the suckers for buying into it.  All hail medicority, the American Way!

Maybe I’m kidding.  Maybe not…

Can’t Put it Into Words

We had a code the other night.  It was by far the “best” code I’ve ever been privy to.  No yelling orders, no standing around waiting, no egos, just a concerted effort to save a dying (well, dead) patient.  The resident running the code was calm, cool and collected.  As we did our interventions he worked through the H’s & T’s trying to figure out if we could fix anything.  Outside of my ACLS megacode, I’ve never seen that.  But moreso, he asked the staff if there was anything that we thought he had missed.  And before he called it, he aksed if anyone else had any objections.  Truly it was a team effort.

But for some reason I can’t seem to shake it off.  I had no real connection to the patient, other than being the charge nurse.  They weren’t one of our frequent flyers.  But something reached ahold of me and won’t seem to let go.

Maybe it was the fact we found her already down in her room.  Or the fact I felt the ribs snap under my palms.  Or it was that we did CPR on her for 30 minutes, rotating between 2, then three of us.  Or that we threw everything in the code cart at her, and some things that weren’t,  but nothing seemed to help.  Our CPR was some of the best I’ve ever seen/felt.  We shocked her a total of 9 times.  She got tubed incredibly quick.  But it didn’t seem to matter.

For the last couple of nights, I’ve laid awake and thought about it.  Re-running it over in my head, which then sparks memories of other codes and then to the memory of running in to see them performing CPR on my little girl.  For some reason, this one cracked my shell.  Like the title says, I can’t put words to the feeling.

Maybe though, it re-affirms that I am human and that I do care, something that I’ve been feeling a great distance from.  Maybe I’ve grown cold over it all- something my wife mentioned in passing not too long ago.  Maybe this nagging sense of malaise over this event is me re-examining myself over this coldness and cynicism and the realization that I’ve moved that direction has left me a little out of sorts.  More than anything though, it serves as a reality check, a visceral reminder of what we do as nurses when things do go south.

I know with time this angst and malaise over it will fade.  I’ll make peace with the way I feel about it, but like all the others, I’ll never forget.

Chart Bloopers

It’s fun when doctors commit a gaffe in writing, but really, they’re only humans with a vast array of knowledge and learning at their disposal, and somehow cogent thoughts that the rest of us can understand don’t always come out. What’s more fun is when a non-medical medical person, in this case a case worker, does much of the same thing. Actual quote:

During this admission the patient was started on Plavix for treament of depression

I guess allowing greater blood flow to the head could make one less depressed…

It’s Hot

Hot with a capital "F". It was in the high 80’s on my way to work last evening, edging it’s way to 90. Sure I spent my time in the desert, so I’m not unfamiliar with heat. But this was killing me. Guess I’m not as used to it as I once was.

But there is something about the heat here in Oregon. First, it seems hotter than it really is. We’ve got nothing on humidity compared to such places as the Deep South, but it still gets humid. Second, everyone seems to get stupider. I know that it is shock from having to ditch our North Face parkas and stumble out into the bright sunlight, but c’mon. I encountered so many idiots on the roads, head in the clouds, not paying attention, that I lost count. Even the docs are in on it as well. Had one document that the patient had "insulin controlled hypertension." Third, it just isn’t us. I moved here and love it here because we stay away from the extremes. We are the definition of mild, and I like it that way. When the temps climb into the 90’s it just makes me (and everyone else around here) cranky.

I know though I’ll be missing this when I’m riding to work in the dark, in pouring rain, with a nasty crosswind in the middle of December. But hey, I’ve got to bitch about something. Right?

En Route: A Review

I was browsing in Barnes & Noble awhile ago and was captured by a bright red wrapped book.  Sure enough, it was AD’s book, En Route: A Paramedic’s Stories of Life, Death, and Everything in Between.  I’ll admit it:  I’m a fan.  Love his writing, his particularly jaundiced view on humanity and the ability to live vicariously through him in situations I will not be finding myself in anytime soon.  In reality, would love to buy him a beer, just to pay him back for the entertainment he has provided (that said, if you’re ever in my neck of the woods…).  So I almost felt obliged to pick up a copy.  Consider this my donation into the “Keep AD in guns, ammo and beer fund”.  And I’m glad I did.  Here’s my review.

Kelly Grayson, otherwise known as AD by his adoring fans worldwide took a collection of his tales, polished them to a high-gloss sheen and wrapped a cover around it and out comes a book.  It’s entertaining, comical, serious, sad and often sobering look at life as a paramedic.  Squeamish of blood and guts?  Probably not the best choice for you.  Can’t handle rude and crude language?  Look elsewhere (he is a scribe of the people folks).  How about a story about a green as grass rookie medic getting urine on himself?  Sit down and enjoy the read.
Odds are, if you’re reading the book you’re already a fan of his blog, A Day in the Life of an Ambulance Driver, so many of the stories come direct from the blog, so it is replete with a sense of deja’ vu as you read.  While not a true narrative, it loosely traces his journey.  Life, love, loss, a hefty dose of snark, he paints us a picture of his experiences on the “bolance” that draws you in.

I think there are better tales on his blog, but I’m a huge fan of easy, no battery portability and this is nearly as good.  So if you’re an EMS junkie, AD groupie or just someone is search of a good tale from the seat of paramedic, there’s worse places to look for sure.

Who is the AMA?

OK, maybe not really, but somedays it sure does feel like it.

At any rate it’s just plain funny.  Best quote?  “If you’re not sick, we’re not doing our job.”

Dr. Wes: Prasugrel and Dronedarone: Rough Roads to Approval

Dr. Wes: Prasugrel and Dronedarone: Rough Roads to Approval.

Precisely when these drugs will be available to the general market is uncertain, but I suspect you’ll know when meals start showing up in cath labs and offices again.

Now that’s just plain funny right there!

These sound promising but with new drugs comes new costs and you know these ain’t going to be cheap.  Plavix already strains the budget of many cardiac patients as Sanofi Aventis/BMS managed to evade it going generic for some time now, so I can’t begin to imagine how a newer version is going to make things any easier on those folks.  One can hope that docs will weigh these issues when deciding which drug to put folks on, rather than going with the newest, most shiny toys on the market.

WHO Not Worried About Drug-Resistant Pandemic Flu — Yet – ABC News

WHO Not Worried About Drug-Resistant Pandemic Flu — Yet – ABC News.

Subtext:  It’s still OK to sling Tamiflu at it and hope it doesn’t fully mutate into a resistant strain.

Subtext Part 2:  Stop asking for meds and just ride it out.  Stay home, drink fluids and practice good hygiene when you get sick.

Subtext 3:  Antibiotics don’t work on the flu virus, so stop asking.

Just because you’re smart

Doesn’t mean you get to be a dick.  Case in point happened the other night.

My friend and co-worker pages the on-call doc and when he calls, the following conversation ensues:

Nurse: Yes, I’m calling about Mr. Jones, a 55 y/o male admitted today with hypertensive urgency related to changes in medication to his intra-thecal pain pump..

On-call Doc: interupting His what? already pissed off

Nurse: Intra-thecal pain pump.  They’ve been tweaking his clonidine dosing.  His blood pressures have been running anywhere from 200s over 110’s to 180’s over 90’s.  Right now, after 200mg of Toprol XL he’s still at 188/105.  He has a history of a AAA repair less than a year ago and I’m a little uncomfortable having him run so high.  All the Toprol did was drop his heart rate.  He’s also been having episodes of chest pressure that’s been relieved…

On-call Doc:  You’re uncomfortable?  I’m OK with that pressure.

Nurse:  Even with the AAA repair and his increasing episodes of chest pressure?

On-call Doc: smugly Well it sounds like we need to modulate his angiotensin system then.  Do you know what drugs do that?

Nurse:  Isn’t that your job?  It’s why I’m calling you…

On-call Doc: breaking in again It’s enalapril.  Do you need me to spell it for you? A-N-A-L-I-P-R-I-L. nurse repeats aloud 10mg, PO BID, 1st dose now.  Good night.  hangs up

Nurse: to me Don’t you mean E-N-A-L-A-P-R-I-L?  Dumbass.  Too bad he hung up.  That was fun, maybe he could have been a litle more condescening…

Ahhh, smug docs.  Always a favorite.  Especially when they do or say something truly stupid.

Hmm… patient got analipril (snerk), his pressure went down and his chest pressure magically went away.  I love it when you note you’re uncomfortable with a patient’s assessment/orders and the doc says, “I’m not.”  All I can ever think about, but never say is, “Of course you’re OK with that.  You’re not here to deal with it when they go south.”  But I guess when you’re “smart”…