Training

I suppose it's appropriate to say a bit about my background. I was a "non-traditional" med student, having worked as a professional drummer and then a medical technologist in previous careers. I did med school at the University of Kentucky, and my residency in Appalachia. By this point I already recognized that dealing with the public tends to temper one's respect for most of humanity. Even this didn't prepare me for Appalachia.

I recall three specific cases. The first was my very first patient I saw in clinic. I was taking a thorough history and asked him his occupation. He says, "I draw". I say, "Oh, yeah"? He replies, "Yes -- my wife draws too". Then I go, "Wow, that's cool. You guys are artists"! He says, "No, no! We draw disability"! This was my introduction to a popular occupation in Appalachia, closely followed by dealing prescription drugs.

My next memory involves a fellow resident who was working ER. A family brought in Bubba, who had severe skull fractures & a broken leg. It seems he'd been helping the family move a piano and he dropped his end, fracturing his thigh bone. Writhing on the ground, the pain was so intense he cried, "Knock me out! Knock me out! I can't take the pain"! Whereupon his obliging relatives grabbed some convenient two-by-fours and cudgeled Bubba into nitey-nite land, and also a helicopter ride to University Hospital for a trip to the neurosurgeons, to fix his broken crown. One can't make this sort of stuff up.

Finally, the first time I moonlighted as a resident, a 19 year-old couple came in with their week-old baby. "Our baby's constipated", they said. So I say, "Well, when was his last BM"? "This morning", they said. I go, "OK. Was the BM soft, or hard"? "Soft", they reply. I ask, "So why do you think he's constipated?", and Mom says, "We think his butt looks swollen!"

More later. Maybe.


-- Post From My iPhone

Hi.

I don't know why I'm bothering to start a blog. It's going to be about Urgent Care Medicine and its denizens. Anyhow, the blog name I wanted wasn't available. And, I just finished 13 hours of a 12 hour shift chock-full of whiny people, like an 88 year old lady bitching about not being able to walk. Well, she'd busted her hip. She fell down and snapped the head of her left femur plumb off. In fact, there were a bunch of fractures in today's patient load. Since the term "gomer" is taken (which stands for get out of my ER), I'll henceforth use "gomuc" to describe my dear little patients, since I work in Urgent Care.

Anyhow, the 88-year old gomuc was an issue because she came to our Urgent Care, which is affiliated with one of the two competing hospital systems in our town. But she was now going to have to be transferred for surgery to a hospital affiliated with the other hospital system. Now it's a nightmare because we have to call the ER doc at the other hospital and beg him to accept the patient. Ever hear anything about the Hippocratic Oath, collegiality among physicians and so on? Well, all that stuff goes out the window in the real world, because there's money involved. And power. It's like this:

Me: This is Dr. Zzyzz, from ABC. I have a patient I'd like to transfer.
Him: Wait a minute. Isn't ABC with System A? We're System B!
Me: Yes, I know. But her insurance only covers System B for hospitals and she has a hip fracture, so she'll need surgery.
Him: Well, I don't know. We're awfully busy. We may have to go on diversion.
Me: But she needs surgery and post-op care and they can't pay cash to come to a System A hospital. I'd really appreciate your help on this one. And it's actually to your hospital's benefit financially...
Him: I know that, God damn it! But this is MY ER and I say who comes or doesn't come here!

...and so on. So we finally get him to accept her, get her loaded onto the ambulance and then my partner comes in. Earlier, he said he'd take one for the team, and went in to see a grumpy and foul-mouthed 68 year old man I'd noticed earlier, hobbling about the Urgent Care clutching his back and moaning. It turns out he had misread the label on his blood pressure medication and had been taking a double dose daily for three days. Then tonight he passed out, fell, and hit his head and his back. He was now complaining of horrible back pain. He told my partner, "The only thing that helps it is if I put my hand on it -- see?" So he takes his hand off his back and goes "OOOWWWW!!!". He puts the hand back and promptly stops moaning. My partner could hardly keep a straight face. Anyhow, all X-rays were negative but we turfed him to another ER doc who'd been an asshole to us earlier in the day. Honestly, when they pick up the phone to take our call, they should say, "How can I not help you today?", or, "How can I piss you off today?", because that's the mindset.

It's late so I'll close. I'll be back later. Maybe.