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Tag Archives: Random Thoughts

Flat WhiteCoat

Dear readers, I have a favor to ask. My youngest daughter developed on obsession after seeing a project from my middle daughter’s class. Remember “Flat Stanley”? Well middle daughter’s class was doing a “Flat Stanley” project and youngest daughter wanted to be involved. So youngest daughter made her own version of a “Flat Stanley” drawing and wanted to send him on some adventures. We had a couple of people that we thought about sending her “Flat WhiteCoat” to visit, but then she actually got sad because none of our relatives are particularly adventurous. I thought that some of you might be able to help her on her project. A picture of Flat WhiteCoat with a restrained patient screaming Black Sabbath lyrics will only go so far. If you have the desire and would be willing to double click on the picture and print out a copy of Flat WhiteCoat, take a picture of him on an adventure – G-RATED ADVENTURES ONLY – or at a famous place and e-mail me (whitecoatrants at g mail) a short story about the picture, my youngest daughter would be most excited to hear your story. Once the project is finished, I’ll post all of the pictures and stories together into a .pdf file that everyone can download. Thanks! And in case you were wondering, the doll is not a replica of me. I still have all my teeth, I have a nose, I have opposable thumbs, my mouth is not typically full of blood, and I am much more muscular than this doll.  

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Dear Diary

It’s been a long few weeks since I last wrote. I’m going to file this one under “serentipity.” My son’s wrestling season is over. He didn’t make the cutoff to qualify for states, but he still had a great season. There was something strange that happened as he prepared for the tournaments, though. In our region, there is one kid in my son’s weight class that is an excellent wrestler. He’s strong. He’s quick. He literally throws kids around the mat. He did an illegal slam on my son a couple of years ago and ever since, my son is scared to death of him. As we got closer to declaring weights for the regional tournaments, my son decided that he wanted to diet down to the next lower weight class so that he wouldn’t have to wrestle this kid. We discussed how everyone is beatable and how we can’t run away from our fears, but he wouldn’t listen. So for the week prior to the weigh-ins, he cut back on his food, ate popcorn and vegetables, and exercised a lot. The night of weigh-ins, he had almost lost the four pounds he needed. So he skipped rope in a sweatsuit for a half hour at the weigh-in site to sweat off the last six ounces. He weighed himself on the check-in scale and he was 2 ounces under the limit. Phew. Then he ran inside to have his official weigh-in. On that scale, he was two ounces OVER the limit. He lost it. He just burst out crying. His coach demanded that he be re-weighed. Same weight. He was going to do some more exercises, but once the official weight is declared, there are no changes. His coach demanded that he be weighed on the check scale. Everyone went back outside – he was still two ounces over. Junior was heartbroken. Not only would he have to wrestle this monster kid, but he would have to do so weaker than his usual. He worried all night. Didn’t get a lot of sleep. We got to the tournament the next day and found out that the monster kid cut weight and was in the bracket below my son. Those extra two ounces kept him out of monster kid’s bracket. I kept reciting the quote from “Kung Fu Panda” – “one often meets his destiny on the road he takes to avoid it.” My wife kept saying that an angel must have stepped on the scale. In the end, my son wound up placing fourth in regionals and sixth in sectionals. Monster kid won the state tournament in his weight division, leaving a path of destruction in his wake. My middle daughter got sick. Initially, it looked like she had influenza, but then she started complaining of back pain. Then she had a high fever. Then she got shaking chills. We checked her urine and it was full of WBCs and bacteria. By that time, she was vomiting. We tried to give her nausea medication and antibiotics, but she kept vomiting them. So Mrs. WhiteCoat got some IM antibiotics from her office to begin treatment. We drew up one dose and were ready to give it … then Mrs. WhiteCoat asked if I smelled anything funny. No, I have a cold. She thought the medication was bad. So she drove to her office and got another vial. I smelled it this time. Had an odor of used cat litter. Called pharmacy. Nope, shouldn’t have an odor. The following morning, called manufacturer. Nope, shouldn’t have an odor. Recalled the whole lot of ...

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How Time is Spent During an Emergency Department Shift

During one shift last week, I felt as if I was spending too much time doing computerized charting, computerized order entry, and computerized admit orders [contractually required to write them – don’t ask] and not enough time with patients and their families. This week, I decided to account for every minute of my time during a 12 hour shift in a moderately busy emergency department where I was the only physician working. I had to scrap the first time I tried it because I kept forgetting to write things down. The next shift, I put the notes where I wouldn’t forget – right next to the computer keyboard with portable clock sitting on top of them. There is a little bit of overlap between categories when I was multitasking. For example, if I was speaking to a doctor on the phone while charting, I counted the time as only speaking to the doctor. Out of a total of 720 minutes in the shift, I calculated that I spent the following amount of time performing the following tasks: Seeing patients: 247 minutes Time on computer: 365 minutes including … –Charting/entering orders and labs to be done: 219 minutes –Looking up old medical records: 42 minutes –Entering discharge instructions/prescriptions: 41 minutes –Entering admit orders/completing transfer forms: 63 minutes Discussions with other physicians: 69 minutes Researching medical issues: 13 minutes Eating lunch: 5 minutes Personal phone call: 4 minutes Miscellaneous down time: 12 minutes Sign out to oncoming physician: 5 minutes Longest time between patient exams: 47 minutes Involving: 24 combined minutes charting patient’s condition and entering orders, 13 minutes discussing the patient condition with three physicians, 10 minutes completing transfer documents and giving report to medics I probably write more than most docs on my patient charts. Even so, more than half of my time was spent making sure that the charts were documented sufficiently to satisfy hospital administrators, to please governmental payors, and to smite plaintiff attorneys. I’ve had some nurses tell me that I spend too much time with patients. My shift averaged 7-11 minutes per patient, with a few outliers. In total, I spent only one-third of my 12 hour shift with patients and their families. That’s too much? Kind of disappointing to realize how the practice of medicine has “evolved.”

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Vaccinate Now?

Flu season is late, but it is upon us. Is it only my experience, or does it seem to be the following: 1. Those patients and parents who most vehemently refuse influenza vaccines are the same ones who complain the loudest about their symptoms and their childrens’ symptoms when they actually come down with the flu. And I wish I had a dollar every time I hear someone say they don’t get vaccinated because “I get sick from the flu shots.” Since the virii in the shots are dead, getting sick from the flu shot is highly unlikely. But hey, enjoy your fever, headache, cough, and muscle aches for the next week or so. 2. Entirely too many people think that the “flu” is vomiting and diarrhea. It isn’t. The “stomach flu” is a misnomer. Symptoms of influenza are fever, cough, runny nose, sore throat, headaches, muscle aches, and fatigue. 3. People whose insurance does not cover Tamiflu demand amantadine even though amantadine doesn’t work on the circulating strains of influenza. In other words, people would rather take a free medication that doesn’t work at all rather than pay for something that could conceivably help them. And while I’m on an influenza rant, remember the 26 million treatment courses of Tamiflu that the US government stockpiled? Yeah. That’s all past its expiration date now. At about $100 per treatment course, that’s $2.6 billion that the government can now flush down the crapper. I’m sure that there was bulk pricing for the government’s stockpile, but even half that amount of money is a lot to be throwing away.  

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We Now Return to Our Regularly Scheduled Program …

The web site went down for some reason last evening. Had to restore everything from a backup copy, but lost the past few days’ worth of posts and comments. Posts were saved to computer, so I just restored them, but the comments are permanently lost. And just when things were getting good. :-/  

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RIP – Weird Nursing Tales

From Tex … After nearly 20 years on the internet, Weird Nursing Tales passed away. Weird Nursing Tales died on February 7, 2012 after it was reported to Administration that the true author was an employee of the Hospital. Yesterday, February 7, “The Author” sat in a conference room in the Human Resources department with his Administrative Director and the Vice-President of HR to discuss this “discovery.” After a brief, 15 minute meeting, the plug was pulled and Weird Nursing Tales died, without so much as a gasp. Family was at the bedside. Weird Nursing Tales is survived by an only child, “ED Sing-a-Long.” Weird Nursing Tales may be gone, but Tex is still out there. Deep sadness. Tex was the only person who ever dedicated a song to me. Goes to show that even when you’re anonymous, you’re not as anonymous as you think. Hopefully not the last we hear from this great blogger.

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