The power of an apology

I recently treated two college freshman who had concocted this homemade brew of nutmeg and poppy seeds. The reason for the poppy seeds is fairly obvious, but the addition of the nutmeg puzzled me a little. Until I called Poison Control and found out that nutmeg has fairly potent anticholinergic properties--tachycardia, dry mouth, vomiting, hallucinations---aaahhh...that's it--hallucinations. Our two little scientists had come up with a brand new concoction that was totally legal and available at your local grocery store.

Well, since the safety of this brew hasn't been as well established as some of the more commonly used drugs we see all the time (crack, meth, marijuana, etc), we were obligated to give these guys charcoal, which they inevitably vomited all over the place (why didn't I put in an NG tube???) For non-medical folks, charcoal vomiting creates a mess that no commercial stain remover is designed to clean up. This mess then tied up not one, but both of our night nurses for a good hour. We then had to call the social worker to come see them in the middle of the night and arrange for their ICU admission.

The thing that makes this story unique (besides the novel use of nutmeg) is that towards the end of this, one of them tells me "I'm really sorry about all of this." Huh? You're sorry? I was speechless. Sure, patients have said this before, but it's usually the little old lady who's so sorry to be bugging everyone about this, but she's concerned about this tearing sensation in her chest that turns out to be an aortic dissection. It's never the people that really should be sorry.

But you know what? The two words "I'm sorry" made everything--the charcoal mess, the tired social worker, the ICU admission--a little better for everyone. I guess it's because we've all done really stupid things in our lives, things that create bigger problems than a little mess on the floor. Thank goodness for the words, "I'm sorry."

Last night, I discovered the world of medblogs, and now I'm hooked. (Thank you internet, for stealing yet another day of my life.) Some of my favorites:

M.D.O.D. www.docsontheweb.blogspot.com
Musings of a Highly Trained Monkey www.highlytrainedmonkey.blogspot.com
Scalpel or Sword www.scalpelorsword.com

It got me wondering about what I'm writing this for, who I'm writing it to, etc. The idea of writing a medblog is appealing in a sense. I could use an outlet for venting--try as she might, my wife just doesn't always get it. I also work in a single-coverage ER for the most part, and I sort of miss having other docs to talk to. On the other hand, I spend enough time at work, that when I get home, medicine is often the last thing I want to think or talk about.

I want to write about what I'm thinking, which more often than not is not related to medicine, and may or may not be all that interesting. I would love for my friends to stop by and read a few posts, but most of my friends aren't in the medical field and aren't the blogging type, if there is such a thing. And with such a lack of direction, I'm not sure I can count on any consistent audience of strangers out there.

So, I guess I'm settling on this blog being for me. Well, me and that faceless stranger I'm talking to in these posts who always cares what I have to say, no matter the subject, and is intensely interested.

For anyone else who happens to wander by this blog, deal with it.

Oh...and feel free to leave a comment...

Tired

Just finishing a week of 12's--2 nights followed by three days. As any ER doctor knows, a 12-hour is really a 13-hour shift by the time things get all wrapped up. So, it's a 65-hour week. I used to pull those all the time in residency--I'm getting soft.

I'm not so much tired as I am annoyed. For me, annoyance with patients is my first sign of burnout, a sign that I need a break. I caught myself several times getting bored as the patient is talking to me, wondering in my head, "why in the world are they telling me this? Do they really think I care? Why on earth is this relevant?" Which is sort of dangerous, because on more than one occasion, a patient has volunteered a detail I never would have asked about that's been the key to their diagnosis. The problem is, for every one of those facts that saves your butt, you have to wade through 20 ramblings about a patient's tingling sensation in their left pinky.

It's flu season, which adds to the fatigue. Besides having to listen to the same constellation of symptoms over and over (and over...), I end up having to tell them that despite the fact that they're absolutely miserable, there's really nothing I can do that they can't do for themselves by a quick walk through the pharmacy. And even after my lengthy explanation that their illness is due to a virus, they inevitably ask, "Are you going to write me for something?" Yes, "something" means an antibiotic.

Did you hear a word of what I just said? YOU DON'T NEED AN ANTIBIOTIC. I don't care if your doctor gives you a Z-pack whenever you get this. You could take a pack of jelly beans and get better just as quickly. Here...I'll even put them in a pill bottle for you.

As you can tell, I'm not very good at the kind doctor comforting thing. It's actually much more tiring to me telling 20 people they're fine (without ticking them off) than treating 20 MI's. Wow...it's really a good thing I switched residencies.

Good news, I have a good week ahead. Only two shifts. Such is the beauty of 12's.

The strike must end!

My favorite shows:
1) The Office
2) (a very close second) Scrubs
3) 30 Rock
4) My Name is Earl
5) A bunch of others - Pushing Up Daisies and Big Bang Theory are recent finds that are pretty good.

Guilty pleasures - So You Think You Can Dance, Biggest Loser

Show that must die soon...
American Idol. How does this show get 4-5 hours every week?

The writers' strike needs to end. If I miss the final season of Scrubs, I'll be ticked.

Mitt wins Michigan...pandering

So Mitt Romney won Michigan last night. I'm glad--I like Mitt and I think his abilities and accomplishments outshine anyone from either party. I also think he hasn't been treated very fairly by the media, and it's always nice to see them eat their words. It's funny--this victory was treated as a resuscitation to his campaign, despite the fact that he was leading in delegates going into Michigan.

BUT...he has this nasty habit of pandering. The media has picked up on this and run with it, and he hasn't done much to discourage it. Joining the NRA, claiming he's a lifelong hunter, reminiscing about watching his dad march with MLK, denying that he called McCain's immigration policy "amnesty", "changing [his] mind" on abortion...the list goes on and on. Now he's telling Michigan voters that he'll fight to get their auto manufacturing jobs back.

Uh...they're not coming back. And Mitt knows it. You can't pay a high school graduate 100K+ to bend a piece of sheet metal all day and expect to compete. So, exactly how is he going to fight for those jobs? Did he change his mind about unions too?

The irony is that he didn't really need to do any of this. He's smart, charismatic, well-spoken, and has a great record. Why open himself up like this? It'd be really nice if the Mormon candidate was the one known for being straightforward and honest, and not the guy that'll say or do anything for a vote.

Interesting quiz online to help you decide who to vote for: http://www.gotoquiz.com/candidates/2008-quiz.html

Chelsea's top candidate? Hillary Clinton.

Hehehe.

My first post...

I recently finished a book by Patricia Grimes called "Just Trying to Save A Few Lives", or something like that (it's funny...I remember the author's name but not the title of the book--maybe she should have just titled it "Grimy stories"), and it gave me the idea that I need to start keeping track of these encounters for....something (posterity? book deal? sanity?). So, at risk of becoming the third wheel at Chelsea's female blogging club, I'm going to interject here and there.

But now that I'm typing, I'm sort of at a loss as to where to begin. I get the request for a story all the time when I tell someone what I do, and I seem to always be at this same loss. The problem is that nearly all of the stories that come to mind either are either really morbid/tragic or involve objects inserted into bodily orifices where they shouldn't (and you would often think--couldn't) fit.

Well, there's the Thanksgiving that I spent in the "thumb" of Michigan where I sent home a little girl who had a cold with her mom and older brother, only to see her come back by ambulance with her mother 45 minutes later, brother decapitated in a car accident, mother with a displaced elbow fracture and screaming "Where is my son? What happened to my son?" (do I tell her? or do I just sedate her so she doesn't permanently wreck her arm?) , and little girl trying to act brave through it all, and then having to contact the divorced father across the state to tell him his son is dead, all this with one nurse and six other patients wondering why I'm taking so long to get to them...

Sort of a conversation killer.

I don't want to have the reputation of "the weird doctor who works at night all the time and pssst...I think it's gotten to him." So, while I'm sure I'll hit the "slipped in the shower and happened to land right on this hairdryer" stories, I would like to record some of the everyday entertaining encounters that make me love my job.

But I really don't know where to begin. The story I really want to tell, the one that's timely and hilariously funny (as opposed to just funny), falls into that second category and will probably make everyone wonder just what kind of guy Chelsea is now stuck with forever. I'm sure I'll get around to it in a few weeks when everyone has learned to skip my posts, but it's really not a good icebreaker. So for now, it's a slow Tuesday morning shift (the kind I rarely get as the low guy on the totem pole) and maybe something will walk through the door and give me something to talk about.