T called and told me about a miserable case he had. Ruptured AAA that came in. The ER doc did everything right and because of the failure of California Emergency Medical system the guy was left to die, slowly, over the course of several hours, in front of his family's eyes. Total system failure. But because the deaths and human misery are considered a) par for the course or b) physician incompetence or c) both--the system will not be fixed.

I deal with it every single shift. Sick, worried, pained people wait five or six hours to be seen. Ridiculous.

The Biscuit is proving herself to be wonderful. I scheduled myself to work during the second half of our honeymoon. Once she overcame her stupefaction and astonishment she dealt with it with remarkable grace and forbearance. I picked a magnificent woman.

Last night I was called up to the floor for a "Come up here before we have to call a code." Well, there you go--what does that mean? I went up to find out. An old guy laying in bed with a heart rate of 177, diaphoresis, chest pain. Getting a little info from the nurses the possible history of WPW arose. Hmm...The guys QRS interval was 120ms, right at the edge of normal. I decided this was most likely ortho-dromic conduction and....you know what, this is too much inside baseball. suffice it to say that the gy needed Adenosine promptly and I gave it to him and the situation settled down nicely.

Two things stand out for me: One, I like being the guy that is called when bad things are happpening and something needs to be done. Two, there was another doc there, waiting for me to come up and deal with the situation, and I am SO glad not to be that guy. Of course, isn't that what just happened last night when I called anesthesia for a tube I couldn't get? Interesting....Another win for humility in medicine. Competence and humility--those are what you want in a doctor.

Photos:

I've been away for a while, but I have not been idling away my hours. I got married and went on a honeymoon--a pre-honeymoon really--to Japan. Pictures to follow.

Last night at work I got called up to the ICU to intubate a guy. Fine. The patient big COPD/sleep apnea guy who was grunting to death on CPAP. I ordered up the meds and examined the intended target oropharynx. I was out of my league. Thick neck, no jaw excursion, zero thyro-mental distance. Fat tongue and, for that matter, pretty clenched. I realized that if I put this guy down there was no way I could get the tube in. A sure cric, and with that think neck a certain death. I pulled back, called for anesthesia, and let them make the attempt.

I'm really happy with the pull-back. I could have really hhurt that guy; I'm glad I realized it before going in.
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