Welcome To The Jungle, indeed

The Fake Doc has a lovely and amusing post on the ecosystem of the hospital jungle, and the creatures one is likely to encounter there. You should read it, and then return to this post, because in the spirit of blatant theft appreciative reinforcement, I think I can offer a couple more animals one might spot:

Carpenter Ants (ER Techs): Constantly busy, able to lift several times their own weight, and frequently unnoticed by the other creatures in the jungle, the Ants take care of things that would be problems, if they were allowed to go unchecked. Ants can be annoying at times, but one should be careful about wishing them gone: if they really were to disappear, disgusting remnants of the daily work of the jungle would litter the landscape in a matter of moments. A wise Grizzly, Hedgehog, or other larger creature will cultivate an alliance with the Ants, because at times of need, the greatest help can come from the smallest of sources.

Otters (unusually competent MS4's): Otters are impressive and comical, all at the same time. They work nearly as hard as the most skilled of Beavers, and have an ability to get along with Beavers that too many other creatures lack. They are almost as quick as Hedgehogs, and only slightly less cute than full-on Bunnies. They are not nearly as powerful as Grizzlies, but what they lack in killing power they make up in agility. Sometimes an Otter can be doing well enough to be mistaken for a Hedgehog; when moving at full speed, the blurred shape of the two creatures is remarkably similar.

Wolves (Physician Assistants): Wolves can function very well alone, but by nature they travel in packs. You will usually find at least one Wolf in each of the busier areas of the forest; sometimes the wolf will be doing the exact same thing as the Bears, Badgers, or even Otters, side-by-side with them. Sometimes the Wolf will be silently stalking something the other animals haven't noticed yet. You may see the odd flash of violence as a Wolf works quickly and efficiently, but more likely the Wolf will simply appear to come and go with no discernible pattern. Often faster, more cunning, and more deadly than the larger, more powerful predators, Wolves will occasionally swoop in and take a tasty bit of meat from the other forest creatures; nothing is more amusing than a Grizzly Bear rumbling up, fully expecting a meal, only to find that the Wolf has already taken care of it.

There are undoubtedly more where those came from, too.

I refuse to accept the evidence that I am old and sad.

Because CASPA not only needs to know everything about my academic history, but needs to know it from several different points of view, I took a little tour yesterday. It was harrowing and disturbing, so naturally it's a story that needs to be told here.

I've gone through my own copies of all my college transcripts and entered every college course I've ever taken; this sounds like no big deal unless you know that I basically drifted around for several years, studying nothing in particular. The idea was to knock off basic requirements like English, Math, and Social Sciences, and to an extent it worked. However, when I went back to the U at the age of 25, finally getting somewhat organized, I had taken a full four years' worth of coursework, and only about a third of it was accepted in transfer.

All in all, the listing on my grad school application has four colleges, spanning 27 academic terms, and 77 courses. This may change slightly as I clarify whether the English course I took while a high-school senior should count. I got U credit for it, so yes... but on the other hand, that would mean I've been in college, on and off, for over 18 years. That just ain't right, because last time I looked, I am not a wealthy and esteemed neurosurgeon.

Yesterday compounded and focused the agony, because I had to arrange official copies to be sent to CASPA, together with the official CASPA form. Not wanting to dick around with faxing or mailing documents, this meant a drive up memory lane. Actually revisiting the various community colleges I attended was pretty hellish; who wants to bask in the misty memories of the C they got in Geography of Western Europe at the local ju-co? And how much worse if it was so long ago, you can't actually remember all that much about being there in the first place?

Long story short, somewhere among the current crop of freshmen at Anoka-Ramsey, there is almost surely someone who would have been born when I was a freshman at Anoka-Ramsey CC.

Breakfast: awesome :: Standardized tests: not

Back in the day (i.e., two months ago) my neighborhood greasy spoon was the Blue Benn, a diner famous in diner circles.

Now that I'm ensconced downtown, my new neighborhood greasy spoon is the Band Box. Awww, yeah. I think it's fair to say that your pal Feb has the gift of awesome breakfast joints.

Best of all, the BB is truly in my neighborhood. I can walk there in minutes. And as much as I rock at cooking breakfast my own damn self, I can't touch the home fries at the Band Box. They're made the right way, which is time-consuming and annoying unless you're cooking on a commercial grill, in bulk.

It's a damn fine thing to be able to get off work at 7am, walk to a holy shrine of bacon n' cakes, and then walk home with a full belly to sleep the day away.

The latest snag in my little plan to lead the perfect life would be this little thing here:

Name: [ febrifuge ]
Program: GRE TESTING
Exam: GRE-GREAM-GRE GENERAL TEST
Appointment Date: 11-Aug-2006
Appointment Time: 12:00 (12:00 PM)

Cue the dramatic music. Dun dun daaaaaaah...

You can't spell 'egregious' without G-R-E

Because the admissions deadline of the Best School Evah(tm) is so much earlier than the deadlines of most of my other potential schools, I've had to think a little about whether to turn on the juice and get ready for the test in time for BSE's deadline, or just let them go and concentrate on all the others as a group.

And then I started studying for the thing.

Hey, you know what? It's going to be okay. Sure, there's a boat-load of math for me to review and/or learn, but the GRE is more than anything a test of a person's ability to take standardized tests like the GRE. And I'm starting to think I could be very good indeed at that skill, just now in my little personal adventure.

So I'm doing it. I'll take the test in a little less than four weeks, is the plan. The worst that can happen is a really, terribly, awfully lousy score. In which case I can take the thing again, a month or six weeks later.

Green warrior needs food. Badly.

It was halfway through the shift, and I had just a few minutes before switching over to another area of the ED. Things had been completely nuts in the acute-care area; out of 16 beds, 13 of them were people waiting for admission to the hospital. The other day, I'd helped some fresh new 3rd-year med students find the library, and when I said I'd see them sooner or later down in my department, they commented that all their patients came from the ED anyway. Today, this seemed like it might be literally true.

Before I leave an area, I always ask "so, before I go, is there anything I should take care of as a last-minute thing?" This makes me kind of a dork, I know, but it's the kind of thing I'll encourage when I'm giving orders to techs. Because this day was pretty bad, I wound up with two assignments to take care of in one fell swoop: take a patient upstairs to the cardiac short-stay area, and run over to another building to the radiology department, where the ED's "big boy chair" -- the extra-wide wheelchair -- had been somehow left. No sweat. Since I'm going to be running all over hell anyway, I thought, why not make a detour and come back with the chair? All it takes is some forethought and planning, plus some good decision-making along the way. So I brought the patient up, and got her situated in her room...

6th Floor, Green building - elevators
You are standing in the elevator lobby of the Green building. An empty patient cart is with you. The cardiac unit is behind you. To the left and right are parts of the hospital you don't care about right now. The elevator doors are in front of you. The elevator doors open.

> Push cart into elevator

Elevator (6th floor Green)
You are in the elevator. The doors you came through are behind you. There is a second set of doors ahead of you. There is a bank of buttons on the elevator wall. An empty patient cart is with you.

> Push button

You must specify which button you wish to press.

> Push 5R

Elevator (5th floor Red)
The elevator doors ahead of you open.

> Push cart out of elevator

5th floor, Red building - elevators
You are standing in the elevator lobby of the Red building. The elevators are behind you. To your left is a hallway that leads to offices. Ahead is a long hallway. To your right is a row of high windows that look out on the city. An empty patient cart is with you.

> Push cart forward

5th floor, Red building
You are walking down a long hallway. Behind you is the elevator lobby. To the left is another set of elevators. To the right is the Purple building. Ahead there is a set of locked doors. An empty patient cart is with you.

> Walk forward

5th floor, Red building
You are standing at a set of locked doors. Behind you is a long hallway. An empty patient cart is standing in the hallway. There is nothing to the left. To the right, there is a door to the stairs.

> Stairs

Do you want to walk up the stairs, or down the stairs?

> Down

4th floor, Red building
Behind you is a door to the stairs. To your left is a long hallway. To your right is a set of locked doors. There is nothing ahead of you.

> Left

4th floor, Red building
You are walking down a long hallway. Ahead of you is the elevator lobby. To your right is another set of elevators. To your left is the Purple building. Behind you is a set of locked doors.

> Left

4th floor, Purple building
You walk down a long, narrow hallway. At the end, there is a set of locked doors. To your left, there is a bank of elevators. A sleep-deprived resident is shuffling by. He takes no particular notice of your presence.

> Open door

You need an ID badge to open this door.

> Inventory

In your pockets and on your person, you have:

Trauma shears
A DRG PureTone Classic stethoscope with SafeSeal diaphragm and gel-filled earpieces
Two sets of purple non-latex gloves
A cheap ballpoint pen
Your hospital ID badge

> Use badge on door

The ID reader blinks from red to green, and then back to red, rapidly. Your ID is not coded to open this door.

> Resident

You look blankly at the resident, and before you can speak he looks at you through half-lidded eyes and says, "it's locked. You have to go around."

> Slap resident

You can't do that here.

> Kick resident

You can't do that here.

> Defenestrate resident

You can't do that here. Also, there are no windows nearby.

> Left

4th floor, Purple building (elevators)
You are facing a bank of elevators. To your left and a little behind you is a set of locked doors. There is nothing behind you. To your right is another set of doors.

> Right

4th floor, Purple building (Radiology doors)
You are facing a set of doors that lead to the main Radiology area for the hospital. At this hour, the department appears to be deserted. You can see the wheelchair through the glass portion of the door.

> Open doors

You need an ID badge to open this door.

> Use badge on doors

The ID reader blinks from red to green, and the doors open.

> Forward

4th floor, Purple building (Radiology)
You are in the main Radiology area for the hospital. At this hour, the department appears to be deserted. A large wheelchair is here.

> Take chair

You get behind the chair and wheel it in front of you.

> Thank Jeebus it's about damn time

You can't do that here.



(Yes, my dear sister in KC, that title is a shout-out to you.)

Today's Splash of Brilliance

The Webtender

This handy Web site has every drink recipe its users have ever heard of, plus many (too many) they have supposedly created themselves. Back circa 1997, when I was transcribing Ortho Surgery clinic notes and discovering this wonderful new WWW thing, I found a site devoted to bringing back cocktails (and to criticizing "shots," which the authors found to be a cancer on the esteem that civilized drinking had spent so much time building up, a growing blight that needed eradication, and soon). That's where I came across the Delilah, my all-time favorite hard-liquor drink:

• 1.5 oz Gin (pref. Bombay Sapphire)
• 0.5 oz Cointreau (triple sec will do)
• Juice of one half lemon, freshly squeezed

Add to shaker filled with ice. Shake hard; serve up.

By the by, if I were to adopt a motto for my life, I could do a lot worse than "shake hard; serve up."

The Webtender does indeed have Delilah listed, and gets the recipe right. This was a cocktail popular in the 1930's and 1940's, as best I can recall, and I see today it's also known by the name White Lady (named after a poisonous spider, if Wiki is to be believed). One site says Delilah "is basically a Sidecar, but with gin instead of brandy."

Yeah, okay, and by that same token, Minneapolis is basically Seattle, but in the Midwest rather that the Pacific Northwest. There are three frickin' ingredients, caballero. Of course there are things that go with gin as well as brandy; you know how much similarity that brings to the two drinks? To quote Douglas Adams, "none at all."

Perhaps the handiest, yet most-flawed feature of Webtender is the "In My Bar" section, where you can select from a pick-list of ingredients. Highlight everything you have on hand, and the Webtender will tell you what you can make with it.

Like many Web-based tools that rely on user-submitted info, this nifty app is a long way from perfect. There are way too many recipes that use, say, Crystal Light. There are too many duplicate listings (okay, a true Cuba Libre has diet cola, but do we seriously care whether we have one brand of ginger ale or another?). One gets the idea that a team of intrepid editors could turn this sucker into something mighty, though.

And as many combinations as there must be, nobody saw this coming: I'm drinking banana liqueur and cream soda... and it's not only pretty tasty, it's not listed. Maybe I'll call it "fuzzy monkey" or something. It's good, but not good enough to be called "the Febrifuge;" for that I'd need to fine-tune those Blue Curacao things I was making the first time I was in college.

* If anyone knows what that pro-cocktail, anti-shot site was, and whether it's still in existence, please let me know.

jack of all trades

Just some random things, from recent shifts:

• I disconnected and flushed out an IV in a dude's frickin' external jugular vein.

It turns out you look extra-hard for air bubbles when you're eight centimeters away from the brain. I know, I know: like all veins, the jugular goes toward the heart and therefore away from the brain. In the moment, though, you sort of question everything, and imagine this could be the one guy in 10,000,000 who has some weird anatomical variation, and it might actually be in the artery. And if you've seen enough made-for-cable movies, you know: you can totally kill a dude like that.

• I got to be an auxilliary foot-rest for a paraplegic patient.

This takes a little explaining. See, the patient came in via ambulance, so his own chair wasn't there. The transport company sent a guy with the lamest chair evah, one with no foot-rests at all. So rather than the patient suffering the indignity (and possible injury) of having his feet tucked under and dragging, I just walked backwards in front of him, looking for all the world like a mobile shoe-shine boy.

It was hella stupid, from the point of view of "send the right equipment, ya losers." The patient was annoyed that I had to deal with it, and I was annoyed that the patient had to deal with it. We concentrated our mutual hate on the dude who brought the chair, and that was sort of cathartic. I like to think he, in turn, learned a valuable lesson about life, and therefore everyone wins. If not, then screw the company he works for. Bahhhh.

• I was a carpenter.

I love how we have all this high-tech stuff, and when somebody needs to go home with a cane, we grab one from the Ortho closet, and adjust it to size. Ahhh, but why should that be strange, you ask? Well, they're regular, old-school, wooden canes. Which means we grab the cane, then grab the hand saw hanging right there, and we go on in to see the patient.

Which means you have a choice; you can talk to the patient beforehand and tell them what you're doing, or you can be evil and just stroll into the room with this SAW in your hand. I was my usual gracious self, so the patient had been forewarned. I entered the room and said, "yep -- that leg will have to come off," but he just laughed. Sometimes I am way too easy on people.

UPDATE 7/11: Two canes in two days. I guess my job is merely that odd. There's nothing special about busting out the saw at all.

I do find it kind of charming that someone took a marker to the wide part of the sawblade, and in big block letters wrote "ORTHO." As if we would use it anywhere else. Even better, though, is that a second person's handwriting added "Cane Saw" nearby. I am fighting the temptation to write on the other side, "AMPUTATION SAW" or "OL' RUSTY."

moving up in the world

The perks of being a full-time ER monkey are pretty sweet. To wit, today I picked up (and took home and washed, because I'm like that) my three new sets of scrubs. Paid for by the hospital.

That's right, kids! Not only do I never have to wear a tie, not only do I get to wear what are basically pajamas with handy cargo pockets, but I don't even have to buy them myself.

I mean... well yeah, I have to pay to park, when I work afternoon/evenings. And yeah, I get no discount whatsoever at the cafeteria, much less get my ID badge charged up with fun bucks like the residents do. No, I can't just waltz away with suture materials to practice with, and speaking of the ID badge, I have to use it to leave some areas, and to get into others. But here's how much fun I'm having, knowing I'm committed to being in this environment: the scrubs thing feels as though it makes the rest worth it.

I'm not unrealistic. Any job, no matter how cool, will sometimes feel like a job. If you're lucky, it feels like good work. If it doesn't feel like work at all, then either it's not that hard a job, or maybe you're just not doing it right. In my experience, if it doesn't feel like work, it doesn't feel like fun, either. Anyway. I have had a sufficient number of shifts back in the ER since my glorious return that I have been reminded of how it's work for the full eight hours. But also of how much I love it.

I get paid a pretty sad pittance, really, but I get to see and to be a part of some very cool moments. I've done the thing where I count to three and then a bunch of people move a person. I'm nerd enough to still think that's cool. I get to witness how awesome some parents are with some kids, and see the good in people when they help one another.

And I get to reinforce the idea that the people who do the EM-doctor job are people just like me. By personality, if not by education and training, I could have been either one of the people in this little exchange:

ER Doc: This guy seems like he should be okay to go to detox, right?
ER Tech: Ehh... [indicates a specimen cup full of urine with a scary red tinge]
ER Doc: D'oh!
ER Tech: Yeah.