Chuckles

Another after work post.  Not tired enough to fall asleep but not awake enough to do much so why not recall a story?

My last patient today was a high school senior who dislocated his shoulder, I'm calling him Chuckles.  All things considered he was handling it well, making jokes and laughing with us in our attempts to help him feel better.

It just looks painful, I need something just looking at this....

Doc comes in and we tell him we're going to administer some meds to help him relax and sleep a little while we pop it back in (shoulder reduction for those requiring medical terminology).  Doc administers Etomidate so we can perform the reduction.

Etomidate is a short acting anesthetic we administer to perform the procedure.  The process is called conscious sedation (they aren't fully under sedation but gone enough that they don't care and won't remember).

Chuckles passes out mid sentence shortly after administering the medication.  Shoulder is reduced without any problems, less than 10 minutes later the Chuckles is almost back to his baseline.  

When he wakes up he is stoned.  He laughs at everything, asks his mom to record him so they can remember, etc.  He calls his girlfriend, all the while laughing at everything (that's why the nickname).

Trying to see how oriented he is I ask him to give me his birthday.  His response, "I'm 18, you do the math."  I explain to him that I am not being quizzed, he is and needs to give his birth year.  So he starts counting backwards until he gets to his birth year.  

For being as stoned as he is he does a good job problem solving.

I point out to him that he is stoned.  He yells out, "I'm not stoned, I never do drugs!"

I responded, "Dude, I gave you the meds.  You're stoned because of me."

He replies, "Oh.  Man that's some good stuff, you should think about selling it.  You'd make a fortune."

Chuckles is funny.  Eventually he is discharged and asks to be taken to the vending machines.  The next time I see Chuckles he is still in the wheelchair (too dizzy to stand up by himself) inching himself around using his legs and trying to keep all the honey buns from falling to the floor (and failing miserably).

Honey Buns, snack of choice for a post shoulder reduction

I must say, Chuckles made my night.

Fish

On my 8th birthday (around that time) I got a goldfish.  I was so excited for my very own pet.  They even got me a bowl.

Yeah, like this except no gravel and no grass, just Goldie, water and the bowl

I wanted to prove to my parents I could take care of this fish all on my own, that I was responsible and they wouldn't have to help me.  As soon as they let me I ran upstairs and filled the fishbowl with water.  Goldie was happily swimming away, I fed it some food (all part of my birthday present, wow such a wonderful gift!)

The party finished, everyone went home and I went upstairs to check on the fish.  Bedtime was approaching and I wanted to make sure it was OK.

It wasn't moving.  I was devastated.  I pulled it from the fish tank and put fresh tap water in the tank hoping it wasn't too late.  Apparently in my haste to give it fresh water I turned on the hot water (my sister pointed that out a few decades later), sealing it's fate.

Sobbing I took the fish to the front yard and buried it.  I don't know how long I cried that night, mourning the loss of Goldie (I actually don't think I named it, that's what I'm calling it now).

See the gas can? That's where Goldie is buried.

After almost 30 years I still remember the fish funeral in the front yard digging the grave with my hands, the only light I had was from the porch.  I'm pretty sure my parents were behind me, I don't recall.  Very traumatizing for a young mind.

Fast forward to today.  My 8 year old daughter and 7 year old son both wanted fish.  My wife claims the water from the fish tank will help the humidity levels in their rooms (which is great, the boy has some serious allergies).  I'm thinking it should be cheap to get things ready, only need a bowl, a tank, and some water.

We go to Petsmart, start looking for tanks and fish and I learn that one goldfish needs 10 gallons of water to grow.  Crap, the cost of the fish just increased exponentially.  I also learn that the water needs to be conditioned for a few days to make the water safe for fish.  

Wow, everything I thought I knew about caring for fish (water, food and you're good) went right out the window.  Suddenly I realize that the hot water on my fish probably didn't do it in but the fact that I used untreated tap water (and I definitely had a bowl that was too small for that fish).

I wanted to give my kids a better chance at keeping their fish alive than I had so we grab the water treatment and everything we need to keep them healthy.

We buy the fish, 5 neon tetras for the boy and 6 guppies for the girl.  We were told the transition for the fish is extremely stressful and some may die in the process.  My kids seem prepped for this and as far as I could tell the expectations that they may lose a few fish were understood.

Two days into their new environment and all seems great.  We get home the afternoon of day two and we see one of the guppies struggling.  We bring my daughter upstairs and tell her what is going to happen.  She seems to understand.  The tetras were doing fine, all 5 of them.

We leave and run some errands, come back just before bedtime.  We go upstairs to feed the fish so we can start our bedtime routine and notice the guppy is belly up.  My daughter loses it.  All I can think about is my experience almost 30 years ago.

You teared up, you know you did.

We go check on the tetras, we need to feed them anyway.  One is dead and one is missing.  Crap, 3 dead fish after only a few hours away.  My son, handling it better than the girl, also starts crying.  

One hour before bed and we have 3 dead fish, 2 sobbing kids, and 2 parents doing the best we can to help soothe them, and one happy German shepherd (oblivious to the turmoil, just glad we're together as a family).

My kids went to sleep in much better moods than when we got home.  If this is how they are when they lose fish they've owned for 2 days, I hope I can prep them when it's time to bury our cats or dog.

Uhhhh....

I get an ambulance (my last patient of the day), a young female with abdominal pain.  She is obviously in pain, screaming in a shrill high pitched voice "aren't you going to help me?".

Shift change for the doctor's is only 10 minutes away, I know the doctor that is getting ready to leave won't see her so I order a few ATPs (advance triage protocol, the doctors in our ER have agreed on certain tests that can be run if they present with certain symptoms such as abdominal pain).

After putting in the orders I go in to assess the patient so I know a little better what is going on and where.  When assessing the abdomen it is protocol to listen for bowel sounds with your stethoscope before palpating (follow the link to hear bowel sounds).  If you palpate (examine by touch) before listening you can agitate the bowels and hear bowel sounds that may not have been there.

Because of the continuous shrill screams from the patient I knew I wasn't going to be able to hear anything through the stethoscope so I skipped this step and went to the palpation to determine where the pain was located.

I wish all patients had a flat belly like this...

The abdomen is divided into 4 quadrants.  As long as you listen and palpate all the sections it doesn't matter where you start.  I usually start away from where they claim their pain is located.

Tonight my patient had pain in the left upper quadrant (LUQ) so I started palpating on the right side.

She wasn't too patient with my assessment and decided to grab my hand and show me where her pain was located.

Unfortunately (for me) she placed my hand right on top of her naked, sagging breast.  Being the professional I am I moved the breast aside and palpated the belly underneath.  My brain, on the other hand, was screaming.  This is in no way ideal.  Nasty.....

Clint Eastwood's face sums up how I felt after "palpating" her mammary...

My Day

Today my day started with a few minor hiccups.  Nothing big.  My daughter forgot her lunch on the counter and I burned a couple of tortillas for my breakfast sandwiches.

Nothing I can't handle so far.  I have a personal goal of reading the scriptures daily so I started while I was eating breakfast.

I read in the Book of Mormon in Mosiah chapter 2.   In this chapter King Benjamin, who is also a prophet of the people of Nephi, is giving his final sermon.  King Benjamin talks about service to his people and when you are serving your fellow man you are also serving God (Mosiah 2:17).

I find it fitting because the night before we had the Mormon missionaries over and we discussed our prophet President Thomas S. Monson who teaches regularly about serving your fellow man (and woman, and children, etc).

I clean the kitchen, shower and get ready for work.  Sometime after the kids got on the bus it started snowing outside.  Nothing bad, barely any accumulation.  As I head out to my car I'm in a good mood.  I have plenty of time to drop my daughter's lunch off at school and go to work.  I turn the key and nothing happens.  Turns out my battery is dead.

Panic starts to settle.  How am I going to get to work on time?  I call and tell them the situation and I'll keep them posted.  I could always call the ambulance and have them take me in but then I'd be stuck at the hospital with no vehicle to bring me home.  I'm prompted to call the local repair shop.  They can easily jump my car but it'll be at least 30 minutes before they can get to me.

Crap, so much for my time frame of doing everything before work.

Having some time to kill (and needing to calm myself down) I decide to read a magazine publication from my church.  The main message is given to us by President Dieter F. Uchtdorf to keep your focus where it needs to be.  He quoted the New Testament, Matthew 22 verses 36-40.

I feel like there is a message that is trying to be pounded into my head at this point.  I'll just sum it up as service.  I personally think I'm being told I need to do better in serving others both at church and in my personal life.

Continuing with my day I manage to get my car jump started, drop my daughter's lunch off and get to work only 15 minutes late.  A minor miracle considering when everything (and going 90mph on the interstate helped, definitely glad there were no cops).

I try to keep this in mind as I help the different people who come to the ER, love and serve others.  Fortunately the people I interacted with were not complete jerks, they were all pleasant.

All throughout my shift I'm in a good mood, I personally don't feel like I was brought down by the negativity that surrounds some of my coworkers.

Still in a good mood I get to my car at the end of the shift.  The technician who gave me a jump in the morning claimed my car would be fine and I shouldn't have any problems starting my car later.  My car is dead when I get there.  Freezing rain coming down (crazy weather, snow in the morning and freezing rain at night, 18 degrees Fahrenheit when I leave home and 34 when I clock out) I find my coworker who I walked to her car and ask for a jump.

Even though my shift started and ended in a manner that was not planned I feel blessed.  Things could've been a lot worse but the situation played out well.  I'm glad I was able to get home and safely.  I still feel good about the way today turned out, praying tomorrow will be good too.

And in case you're wondering about what freezing rain is, follow this link. The first time I heard of freezing rain I was beyond confused.  It's beautiful to see all your plants and trees covered in this devilish creation.

This is what coats everything including the roads and sidewalks.

What would you do?

Hypothetically speaking what would you do with your toe if it was amputated in the ED?

Personally I think I would not only get the tattoo shown above but I would probably try and pickle it and put it in a jar.  Or even better (and probably a little less crazy of a conversation point) bury it in the flower garden and make a nice headstone dedicated to the piggy who went to market.

Lego Death Star

I got what I wanted for Christmas, the Lego Death Star.  I admit half of it is technically my son's but I've been talking about it for a long time.  I saved up some money for it but realized the best way to get it is to have part of it be for me.  It's the only way I could justify the purchase (at $500, wow...)

Because my son got many other Lego gifts this was my project to put together and it took me forever.  I timed it because I was curious how long it would take me to put together the 4016 piece beast.  It took over 1115 minutes to complete. Wow, is that right?  So the second time I did the math it came up at 960 minutes.  Ok adding it up the third time I got 1055 minutes (I'm watching Gabriel Iglesias after 2300 on about 5 hours of sleep while attempting to do math, obviously it's not working).  So it takes me somewhere in the ballpark of 960 minutes at 1115 minutes (and maybe a little longer, I'm distracted the entire time watching Frozen Planet, Blue Planet, True Blood if the kids aren't around, helping the boy put his Legos together when he's stuck which isn't very frequently, etc).

WOOHOO! Lego Alderaan beware!

So opening the box was very exciting for me, of all the Star Wars toys I owned growing up (original toys here back in the early 80s) I never had a Death Star.  I dump out the box and there are 3 smaller boxes in the giant box along with several bags and a 320 page spiral bound book of instructions.

Whoa...Alderaan may have to wait a while...Let's hope Jyn doesn't show up

This jumbled mess came out of the box.  I quickly realized this was going to need a bit of organization.  If you've ever put large Lego sets together you know they come with numbered bags to be opened at a certain time in the instructions. (Side note, my niece didn't know this, opened 4 bags worth of Legos and color coordinated them on a different set, took me forever to find everything).

An organized plan, just how the Emperor wanted.

So after the organizing I realize that yes there are numbered bags but as you can (hopefully) see in this picture there are multiple bags per number.  Instead of one bag #1 there are 3 bags. #2 has 5 bags to go with it, #3 has 3 and it goes on and on with 2 bags without numbers on them.  When you open these bags there are even smaller bags inside with the extremely small pieces (the one piece, etc).  Now you're starting to understand a bit why it took me some time to finish.

This is the cutest Dianoga ever! Watch out Luke!

*Pew, Pew, Pew*

I was going to show the completed stages as I finished the Death Star but I decided to cut to the completed project.  I have no clue how to format with this many pictures so hopefully it's not too confusing.  They show the different sections of the Death Star, many moving parts (closing walls in the Trash compactor, trap door in the prisoner cell that drops to the trash compactor, etc).  I look forward to doing more Lego Star Wars projects in the future.  Maybe Boba Fett's ship, the Slave One (hint, hint).