MedWorm: Emergency Medicine Doctors

Wendell berry a socialist? yes, it's libertarianism vs agrarianism again

Glorfindel of Gondolin — Tue, 07 Oct 2008 01:59:22 +0100

An argument has broken out in an obscure part of the blogosphere between libertarians, paleoconservatives, and agrarians. You may think you don't care, but I'd like to suggest that arguments like these tend to be more substantive than the typical democrat vs republican swill we're treated to on blogs like Kos and Instapundit. Libertarian David Gordon wrote a piece critical of Rod Dreher and the "crunchy cons", which provoked responses from Jerry Salyer in the paleocon magazine Chronicles, and from Daniel Larison at Eunomia. I've talked, briefly, about libertarianism before, and dismissed it as a one-size-fits-all ideology that ignores local realities. I should probably admit that I'm not the best critic of libertarianism because I dismiss it as childish -- an overly simple and simplistic ideology. But this disagreement between Gordon and his critics gives me the chance to bring up one point that I didn't before. Agrarianism's chief conviction, it seems to me, is that we must take responsibility for what we do. Its arguments for localism are toothless without this conviction behind them. As Wendell Berry points out in many of his essays, the modern, industrial, global economy prevents us from adequately taking responsibilty for our actions because we can't even see what the consequences of our actions are. As I wrote in a previous post:Our non-agrarian society makes it very difficult to take full responsibility for what we do. According to the agrarian writer Wendell Berry, "When there is no reliable accounting and therefore no competent knowledge of the economic and ecological effects of our lives, we cannot live lives that are economically and ecologically responsible." [Berry, "The Whole Horse"] Berry thinks that in modern society there is in fact "no reliable accounting," and "no competent knowledge" of what we are doing. "We are thus involved in a kind of lostness in which most people are participating more or less unconsciously in the destruction of the natural world, which is to say, the sources of their own lives. They are doing this unconsciously because they see or do very little of the actual destruction themselves, and they don't know, because they have no way to learn, how they are involved." [Berry, "Two Minds"] Localism is desirable for agrarians because it helps us to learn what the consequences of our actions are, and limits our destructiveness when we make mistakes. Given, however, a global society like ours, we need some other ways of learning "how [we] are involved." And this is just where libertarianism fails, and why it ought to be rejected. The unregulated free market beloved of libertarians, far from educating us about the consequences of what we do, tends just as often to obscure them. It reduces all the complex history of an item to a single number, the price. But even mainstream economists acknowledge that the price frequently fails to reflect even quantitatively (much less qualitatively) much of the "costs" that we pay as a society for the goods we produce. This is, of course, the problem of externalities. The most common example is the price of a gallon of gas, which fails to account for the environmental damage caused by its extraction, refining, transportation, and consumption. Short of moving towards a local economy, the best way to account for all of the externalities that the market price fails to reflect is... government regulation, in the form of strict penalties for destructive behavior, subsidies for less destructive behavior, mandatory disclosures, and the list goes on. Libertarians reject all of this, and in so doing set themselves up as obstacles to achieving the kind of responsible society agrarians want. But enough of that. Larison's and Salyer's answers to Gordon are interesting and I recommend them. Given the economic events of the past month, though, Dreher makes the wittiest riposte:In the meantime, can I just say how much I hate that Wendell Berry and all the farmers for bringing the entire US economy and global financial system to the edge of the abyss with their financial recklessness. If only we'd had less regulation of the moneymen, like fundamentalist libertarians want, why, we wouldn't be in this fix. Right? (Source: Glorfindel of Gondolin)

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Code blue

Ten out of Ten — Mon, 06 Oct 2008 22:23:04 +0100

Plenty of people out there abuse ambulances, calling for colds, hangnails, and other similarly trivial stuff. Then there’s ambulance anti-abuse, where people don’t think to or choose not to dial 911 even as they are actively dying. Like the family of my patient who watched him clutch his chest and collapse to the ground. More than a time to dial 911, really this is the time to dial 911. But for whatever reason they didn’t, instead they loaded him up in the back seat of their car and drove him frantically to my ER. It’s not very often that someone shows up unannounced in cardiopulmonary arrest. Usually they come by ambulance and since they radio ahead to us it gives us a little time to prepare. All of us I would imagine have our little rituals. I like to check the equipment — make sure the suction works, make sure the lightbulb on the laryngoscope is good — while sort of visualizing in my head how the code will go. I used to run down the ACLS protocols in my head, but really by now I have these down cold. Instead I focus on the finer points of a resuscitation: making sure breaths aren’t given too fast, making sure the chest compressions are the appropriate rate and depth, etc. Showing up unannounced makes the process more ragged, especially in the beginning. Initially unaware of what was going on down the hall, I was with another patient when the nurse pulled back the curtain and said with strained calmness “we need you in room 1 now.” I pretty much knew then what I’d find, getting interrupted means it’s serious and that tone meant it was really serious. Room 1 contained what seemed like every nurse and tech in the department, all surrounding this newly dead person. Pretty much everyone in the room knows the protocols and therefore how to run a code, but with so many different people involved and multiple tasks to be done there has to be someone in charge giving instructions and doling out responsibilities. That job belongs to the ER doctor, and while I’ve never excelled at this since I don’t have anything resembling a take-charge kind of personality I still understand my role in the process. So I walk in and take charge as best I can, telling this person to start compressions, this person to get the pads hooked up to the chest, that person to get the bag connected to the oxygen, and off we go. After awhile the dramatics of his entrance wear off and now it’s just another code and we settle into a code rhythm, the techs switching out every so often as they fatigue from the compressions while some med or another is given every five minutes or so. One of the nurses cracks a joke and it’s funny so some people laugh. This happens partially to relieve built up tension, but mostly because for us there’s no sadness attached to what we’re doing. If it was a kid that would be different, a kid’s death is always tragic but this is just the latest in a long line of middle to older-aged people whose time on this earth happened to run out while we were on shift. Still, I softly remind the nurses that this patient’s family members are just a few feet away, separated from us only by a thin curtain. Their faces fall and they immediately feel bad. Even though it’s not sad for us we all understand it’s horrific for someone else and the importance of remaining professional out of respect for the unseen family is instantly remembered. The patient died but I felt good about the code. We were taken by surprise but quickly got organized. I got the tube right away, and the nurses immediatedly established the IV’s. We gave him every chance we could to regain a pulse, and that’s all we have control over. Whether or not his body starts working again is out of our hands. As usual, I didn’t feel sad until it was done and I had to tell his family memebers that he had died. Our chaplin came in from home fortunately and was much more comforting than I could ever be. I don’t have that kind of time to spend with families anyway, this was exciting and somewhat draining but now it was over and as always the next patient was waiting to be seen. (Source: Ten out of Ten)

Death of reaganism

Glorfindel of Gondolin — Mon, 06 Oct 2008 19:24:53 +0100

We can't tell yet just how painful this economic crisis will eventually get, but it's fair to say that there'll be some of us who suffer pretty badly. There's going to be plenty of bad news, so I'd like to start concentrating on the silver linings in this economic cloud. When Rep. Darryl Issa opposed the Paulson bailout plan last week on the grounds that it would put "a coffin on Ronald Reagan's coffin," he was pointing out something we all should cheer: the death of Reaganism. Reaganism describes the political climate that I've lived in ever since Ronald Reagan took office in 1981, at just about the time that I grew old enough to become politically aware. I think of it as a mix between right-wing economics and a "sunny optimism" that (a la Walt Disney) has little to do with reality. It's a mix of neoclassical economics and infantile consumerism. Ever since Reagan, the idea that government intervention in "the free market" is harmful has been the default ideological position that politicians have had to genuflect toward in order to get elected. Republicans have been the dominant political party in the age of Reagan because they embraced the free-market orthodoxy most energetically. Bill Clinton was a Democrat, but he won elections by telling us that "the era of big government is over" and governed as a welfare-cutting, NAFTA supporting center-right politician. Whatever else has happened over the past 30 years, we've repeatedly rewarded politicians who've told us that tax cuts and free trade would make us prosper. We've ignored calls for raising the minimum wage, watched without much interest as unions decayed, embraced the Wal-Mart business model of low-wage, part-time jobs in exchange for cheap merchandise imported from China, and wimpered ineffectually at the inevitable consequences of a health insurance system placed in the hands of the market -- namely, rising premiums and a growing number of people without health insurance. As we continued to send Republicans and free-market Democrats to Washington, we didn't pay much attention to the fact that year-by-year the regulations that governed the financial industry were getting scaled back. "Voluntary regulation" was advocated so often that we forgot how oxymoronic a thing it was. At the same time that we were dismantling the protections of the regulatory state, we were taking huge risks by living beyond our means. Our real wages weren't going up, but dammit, we weren't going to do without -- especially since our politicians always seemed more worried by slowdowns in consumer spending than by declines in the household savings rate. We refinanced homes to go on vacation or buy that new SUV; we ran up credit card debt, we spent everything we made and then some. As our households went, so did our government: running deficits almost every year and piling up trillions of dollars in debt. No politician who would actually raise taxes or cut spending was allowed to survive. When George W. Bush decided to take us to war, he told us to go shopping. More household and government debt accumulated. The specific etiologies of this credit crisis weren't all foreordained, but how could we have avoided a serious correction when housing prices were so out of control? (Via angry bear.) Reaganism was unsustainable because the free-marketeerism and consumerism that it was based on are not grounded in reality. Free markets on a national or global level aren't self correcting, and they are disruptive:We are now learning what countries across the developing world have experienced over three decades: unstable and inequitable neoliberal economics leads to unacceptable levels of social disruption and hardship that can only be contained by brutal repression. Add that to the two other central charges against deregulated capitalism: first, it may create wealth but it does not distribute it effectively; and second, that it takes no account of what it cannot commodify - neither the social relationships of family and community nor the environment, which are vital to human wellbeing, and indeed to the functioning of the market itself. Ultimately, neoliberal capitalism is self-destructive. Consumerism is built on irresponsible hedonism -- both for CEOs with golden parachutes and for hockey moms with plasma-screen TVs bought on home equity loans. Now that reality has caught up to us, we can forgive Darryl Issa for sticking to his conservative principles in opposing the bailout, and rejecting the modern Republican principles of socializing the risk while privatizing the benefits. Was the bailout a good idea? Depends on whether you trust the Bush/Paulson/Frank leadership team (I remain suspicious). We're probably in for a lot of pain, but thankfully, Reaganism is now dead. (Source: Glorfindel of Gondolin)

Excuses

Scalpel or Sword? — Mon, 06 Oct 2008 14:59:00 +0100

Expanding on the previous post, here are some of the reasons people give for not wanting to be admitted to the hospital, along with my replies:1) I don't want my (family member) to worry about me.How worried will they be when they find your cold dead body in the morning?2) I need to feed my dogs.Who is going to feed them after you're dead? Call them.3) I have a big presentation tomorrow.This is what sick days are for. A heart attack is an excused absence.4) I'm flying to ______ in the morning.It's not safe for you to fly. 5) I can't afford to be admitted.You can't afford not to be. (Source: Scalpel or Sword?)

Things to do

Scalpel or Sword? — Mon, 06 Oct 2008 05:31:00 +0100

Two patients in the aftermath of the hurricane both had problems with perspective, and both produced the exact same quote.The first had suffered a minor laceration and was in a big hurry to get back to her un-air-conditioned powerless home."How long is this going to take? I've got things I need to do."Yeah, I had a few things I needed to do too, but instead I came to work on my day off so you could get on with your life just a little bit sooner. You're welcome. And no, I don't think I can get a plastic surgeon to come put three stitches in your leg, sorry.The second patient appeared to have suffered a stroke earlier in the day, but she refused admission. She also had some things she needed to do. I hope she finished them all. (Source: Scalpel or Sword?)

Alaska, part 2

Collective Contemplations — Mon, 06 Oct 2008 04:00:00 +0100

More pictures from my recent Alaskan trip: Pink salmon, about to die after spawning.Silver salmon, hung out to dry in one of the villages. I went fishing (for the first time EVER), while I was doing a four-day village stay to do annual check-ups and medication renewals. I didn't actually catch anything, but by the end of a couple hours, I was no longer casting into the weeds. The best part of (Source: Collective Contemplations)

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Cubs lose

Glorfindel of Gondolin — Sun, 05 Oct 2008 21:44:23 +0100

The Cubs, true to form, got swept out of the playoffs again. To the LA Dodgers: you're welcome. I suppose I'm lucky this year. Living in Chicago, it was impossible not to notice the buzz around the Cubs, and many times I was tempted to get on the bandwagon and pour my heart into the team like I did back in 1984. I was thirteen then, and the Cubs were up 2-0 in their best-of-five series with the Padres. Only one more game, and the Cubs were in the Series. But the Cubs lost three straight and I learned what it was like to be a Cubs fan. It was painful. And the pain wasn't worth it. Why did I have to feel so bad about a stupid baseball team that I wasn't playing for or employed by in any capacity? Stupid Cubs. I've been a very distant Cubs fan ever since. Because of that, I haven't felt the pain of 1984 again -- the agony of 2003 and the five outs was visited on the hard-core fans, and not on me. I didn't need to spend a month recovering, all because of the stupid Cubs. And again this year, it's not me that's writing paragraphs like this:Pathetic. Nothing short of pathetic. I hate this team. I hate every player. Every single goddamn one. I have never in my life been this disgusted with a Cubs team. This is not the lovable losers-they’re just a bunch of fucking losers. I’m tired of this wait until next year crap. All of you on this team can shove it. Now, I know that I'm running a risk by being a very distant and lukewarm fan. When the Cubs finally win the World Series, I won't share in the ecstatic joy that the hardcore fans will bathe in. I'll miss all that. But hey, I'll probably grow old and die before the Cubs ever win the Series. Heh, heh. You can't hurt me, stupid Cubs. (Source: Glorfindel of Gondolin)

"...the duality of man, sir"

Latest entries from bloodletting.blog-city.com — Sun, 05 Oct 2008 17:16:00 +0100

Being a former Marine, and, in fact, still practicing martial artst, sometimes there are very interesting juxtapositions which occur in clinical practice. I would like to share one with you now.I recently started training again in martial arts. By th (Source: Latest entries from bloodletting.blog-city.com)

Interesting lawsuit

Glorfindel of Gondolin — Fri, 03 Oct 2008 23:58:07 +0100

Read all about this 7-1/2 year pregnancy. (Source: Glorfindel of Gondolin)

Friday cat (and doggie) blogging

Glorfindel of Gondolin — Fri, 03 Oct 2008 21:53:29 +0100

Here's Big Frank taking a little nap, high above it all. And here's Little Pele hanging out on the deck in Colorado. (Source: Glorfindel of Gondolin)

The right wing blogosphere

Glorfindel of Gondolin — Fri, 03 Oct 2008 21:42:58 +0100

Crises like this are the best time to visit the far-right blogosphere. It's fascinating to see what effect reality has on the opinions of true ideologues. Apparently, no effect at all. That's why they're called "ideologues." Take the Biden-Palin debate, for instance. Most of us think Palin's answers were incoherent, or at best, weak. However, people like this guy say that "Sarah Palin drove another stake in the heart of those fuddy-duddy reactionaries that constitute our mainstream media. Going toe-to-toe with a senator with decades of experience, she more than held her own, giving lie to the media constructed narrative that she was an inexperienced hick from nowheresville Alaska." My question to Mr. Simon is simply: how poorly would she have had to perform for you to say that she lost the debate? What is your standard? How about drooling? Would you reluctantly admit she lost only if her responses had been limited to silent drooling? I'd like to ask similar kinds of questions to people like Hugh Hewitt, who believes the solution to our economic crisis is to -- drum roll, please -- cut taxes! [McCain's] simple, closing message ought to be that the world is threatened by terrorism, and the global economy is threatened by rising taxes, chains on productivity, pressure on trade, and corrupt, self-dealing political elites at home and abroad.McCain needs to declare that he's been around a long time, and he's seen all the big mistakes made and all the costs paid, and that he isn't going to stand for it now.McCain should pledge to be John McCut from day one in the White House:He'll cut taxes on new businesses and construction to jump start a flat economy and invigorate employment;He'll cut federal spending to make sure we have the resources for those that need it and not those who have gotten fat off of subsidies;He'll cut the chains that government has put on productivity, allowing builders to build and energy companies to explore and producers to make;He'll cut every trade barrier he can find and commit to an export economy that will surge the growth in American production of the goods and services demanded around the globe;He'll cut the corrupt culture of self-dealing that allowed Freddie and Fannie to pump hundreds of billions of bad loans to over-their-head borrowers and into the economy and thereby infect our financial system to the point of collapse.... Question: If our economy weren't threatened by a credit crisis, but instead by, say, big furry mice, would you still say it was threatened by rising taxes? What kinds of economic threats do you think exist, other than taxes? I'm sure the far left is just as nutty in their own way. Question for them: How high would taxes have to be before you'd advocate for a smaller government? 100%? The fact is, though, that ever since the Reagan Revolution, the political "moderates" have been much closer to the far-right nutjobs than to the far left nutjobs. Communism is dead; no one seriously supports that ideology any more. Liberalism has been a toxic political label for thirty years. No one who supports "protectionism" or "pacifism" survives as a viable politician for very long. The only influential wingnuts are the right wing ones. So it's both amusing and scary to see how tightly they cling to their beliefs in the face of a reality that demands something different. The good news is that most people aren't ideologues. If they can be induced to pay enough attention to form their own opinions, they'll realize that most of today's problems spring from too much right-wing ideology and not too little. While a little Reaganism might have been good for the nation at the end of the 1970s (debatable), it's certainly toxic now. We're suffering from too much Reaganism, and we've been doing so for a long time. That's why, if the people pay attention, it'll be fun to tour the right-wing blogs again after John McCain loses this election. My question for the Hugh Hewitts then will be: How massive a landslide would Barack Obama have had to win by before you'd admit that the reason McCain lost was that the voters just didn't want him to be president? (Source: Glorfindel of Gondolin)

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Thought for the day

The KnifeMan — Fri, 03 Oct 2008 11:44:00 +0100

You can't make war in the Middle East without Egypt and you can't make peace without Syria. HENRY KISSINGER (1923-) (Source: The KnifeMan)

Flu shot

Ten out of Ten — Thu, 02 Oct 2008 22:33:55 +0100

I got my flu shot today. Have you gotten yours? Last year 40,000 people in the US tested positive for flu, half of which I’m pretty sure I saw in my ER. 83 kids died last season of the flu or resultant complications. Actual numbers, as always, are even higher. The flu shot is basically a syringe full of dead flu virus. It’s not alive. We won’t do CPR on the flu and bring it back to life before you get the vaccine. You will not get the flu from the shot, cross my heart. Your doctor can hook you up with the vaccine. If you don’t have one try a Walgreens or CVS, or you can always visit your local health department. Here’s a link to the American Lung Association’s on-line flu shot locator. The flu is pure misery. Do yourself a favor and get vaccinated. (Source: Ten out of Ten)

My new favourite quote

The KnifeMan — Thu, 02 Oct 2008 19:54:00 +0100

There are, in fact, two things, science and opinion;the former begets knowledge, the latter ignoranceHippocratesBorrowed from Trick or Treatment, by Simon Singh and Edzard Ernst. I commend it to you. (Source: The KnifeMan)

Why i love tech...

The KnifeMan — Thu, 02 Oct 2008 09:31:00 +0100

A pox on iTunes, which took it upon itself to delete several of my Floyd and Stones albums; and no they weren't backed up.... (Source: The KnifeMan)

Panhandling

Ten out of Ten — Wed, 01 Oct 2008 10:22:13 +0100

A patient left his room and started hitting up other patients for change. We told him sorry but no panhandling in the ER. (Source: Ten out of Ten)

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A sort of open reply

The KnifeMan — Wed, 01 Oct 2008 09:02:00 +0100

If only because some good points were made, and, if I have mis-represented myself, then explanation should be public.I want to apologise for over-egging the pudding, suggesting that No-One, from the aforementioned NotDrRant laid all the blame at the foot of the docs. And I concur, there are indeed some truly awful docs in the system, and rooting them out has been, and remains, difficult.I don't object, by and large, to swearing. I swear vigorously myself at any given opportunity, and the example I gave may have given the impression that it was an indirect dig, or slight, aimed at No-One. Not so. My complaint was more in general, and I freely admit that No-One has indeed not named any specifics. But sites do exist where people can, and do; and the lack of a right-of-reply remains. My own experience of this is acute. Where patients want something from the health service, often for a relative, that it cannot provide, their anger often vents at the nearest professional, rather than the system. Sometimes this is justified, sometimes not. Some of my patients seem to think it acceptable to call me a "cunt" to my face, to suggest that I obtained my degree "from the back of a cornflakes box", and then complain about how poorly they were treated....Anyway, if you wanna swear, swear on. I meant no criticism.On a more general note... will giving all the power to the patient solve the problem? I doubt it. Just as Doctors weren't meant to be administrators, neither were the bulk of patients. Yes, they can vote with their feet; but turning it truly 'private' might have a few unexpected side effects. Are we, the medics, afraid of having our snouts displaced from the NHS trough? Maybe. Bevan, after all, only swung the agreement of the Consultants in 1948 with a promise to choke their throats with gold.For me? Makes no odds. I work in Emergency. Voting with your feet is rarely an option, and I expect I'd make more money if you paid for service. I'm all for patient power, but it has to be tempered with the knowledge that, just occasionally, I might know what I'm doing, might know better than you what the best treatment is. Currently, I have no financial stake in how you're treated.Will I give you better care if I do?(The answer's "no", by the way...) (Source: The KnifeMan)

Best chief complaint of the night

Mr. Hassle's Long Underpants — Wed, 01 Oct 2008 07:25:12 +0100

I was just finishing my shift when I saw this chief complaint pop up on the triage list… “Privates sweaty and bothersome” I finished up my last dication and ran out the door! (Source: Mr. Hassle's Long Underpants)

Bill whittle's kidney stone

Scalpel or Sword? — Wed, 01 Oct 2008 04:27:00 +0100

You know you're a political junkie when..."Do you want to know what my honest-to-God first thought was when the pain got manageable enough to be able to hold a thought? I tell you: I thought of John McCain. And I’ll tell you what hit me the hardest: not his pain lasted for five years when mine lasted for four hours. But to add to that raw fear, lying in filth and knowing that those footsteps in the hall would bring not relief but more pain . . . my God! When I think about those men on those fields from Bunker Hill to Baghdad, lying there for hours, awaiting rescue and relief that often simply never came . . . I end up — and I don’t expect any of you to actually believe this — I end up grateful for those few hours." (Source: Scalpel or Sword?)

Brain bucket

Straight Talk from the Stanford ER — Wed, 01 Oct 2008 04:00:00 +0100

The mild temperature and cloudless sky last Saturday lured people outside onto their bikes, horses, motorcycles and basketball courts. Unfortunately, even the most careful sports enthusiast can suffer an accident and several men and women wound up visiting our ED for a variety of bruises, lacerations, broken bones, and worse. By early afternoon, a motorcyclist with a lacerated spleen, truck... (Source: Straight Talk from the Stanford ER)

Folk music re-'imagined'

The KnifeMan — Tue, 30 Sep 2008 18:42:00 +0100

Buy the album, see them live... do it. You know you wanna... (Source: The KnifeMan)

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Internet addiction

All Scrubbed Up — Tue, 30 Sep 2008 16:49:00 +0100

And you think it isn't true...(SA Doc says: Where your world meets mine!). Har. Har.Check it out...I do like the bit about seduction:The Internet itself is a neutral device originally designed to facilitate research among academic and military agencies. How some people have come to use this medium, however, has created a stir among the mental health community by great discussion of Internet addiction. Addictive use of the Internet is a new phenomenon which many practitioners are unaware of and subsequently unprepared to treat. Some therapists are unfamiliar with the Internet, making its seduction difficult to understand. (Source: All Scrubbed Up)

Odds and sods

The KnifeMan — Tue, 30 Sep 2008 15:47:00 +0100

Ruminations...Struggle on, trying to finish some work related research, revise, generally live my life. It goes slowly; I think I'd be good as a sloth. Although not sure I'd pass the entrance exam.La Belle Fille continues to understand, which is good of her; spent the weekend hanging out, which is good for the soul; I also had the pleasure of seeing possibly the world's biggest round of cheese at the local French market. God love the French.A brief flag for NotDrRant. This blog has a very different spin on the NHS; a patient's view, and not a complimentary one. I'm in favour of free speech, so you should feel free to check them out, tho' I don't hold with their take on the causes of the faults ( to whit, it's all the doctor's fault. ) That having sad, the author doesn't seem to have been served very well by the NHS.It raises at least one interesting point. (For a certain value of the word 'interesting') While patients can, almost without fear of censure or repercussion, write what they want about the medical profession, or indeed specific members therof, the medical profession has little, or no, right of reply. So, there is little to stop Mr Smith naming me as, for example, "a cunt", for all the world to read. But if I name Mr Smith as, for example, a wife-beating kiddie-fiddler... the Law has me by the balls.On balance, I'm in favour of confidentiality. Publishing lists of naughty people all too often results in hysteria, and Paediatricians having their houses shit-bombed; but shouldn't there be some sort of quid pro quo? As a medical professional, I must be completely transparent; I accept this. I must also be inscrutable; I accept this, too.But should there be some sort of checks and balances to stop my being compared to reproductive anatomy? (Source: The KnifeMan)

Catnap

Scalpel or Sword? — Tue, 30 Sep 2008 15:18:00 +0100

I've got my board examination coming up very soon, so the light blogging will likely continue for a bit longer. (Source: Scalpel or Sword?)

Surely shome mishtake...

The KnifeMan — Tue, 30 Sep 2008 15:17:00 +0100

You are a Social Liberal(75% permissive)and an... Economic Liberal(21% permissive)You are best described as a:Socialist Link: The Politics Test on OkCupid.com: Free Online DatingAlso : The OkCupid Dating Persona Test (Source: The KnifeMan)

Bloke in a dress

The KnifeMan — Mon, 29 Sep 2008 16:45:00 +0100

Casually, and swiftly, photoshopped by a good friend of mine. I should add that the Shroom does not consider kilts to be dresses, skirts, or, indeed, anything other than manly clothing, especially whn worn 'Highlander', as both I and the Groom were. I also have nothing against blokes wearing dresses. All power to all people, that's what I say. In fact, it's quite liberating, as long as yo remember to keep your knees together, and avoid scaring children / being placed on the sex-offenders register... (Source: The KnifeMan)

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Nonpolitical pictures

Scalpel or Sword? — Mon, 29 Sep 2008 16:12:00 +0100

She's not a kitten anymore. (Source: Scalpel or Sword?)

Gratuitous 'skirt' shot

The KnifeMan — Mon, 29 Sep 2008 14:32:00 +0100

(Source: The KnifeMan)

Uh

Scalpel or Sword? — Mon, 29 Sep 2008 04:41:00 +0100

via IMAO (Source: Scalpel or Sword?)

God's dandruff

The KnifeMan — Fri, 26 Sep 2008 22:00:00 +0100

Continue in low mood; it is what comes of spending long days alone, at home, ruminating on my own inadequacies.My impending exam - the Fellowship, the exit exam, the big one... what it takes to be board certified, I think, if you're one of my Colonial brothers or sisters... dwells heavily on my mind. I've spent the last year pretending it was an age away; and know it isn't. I'm not sure where the last year has gone; it seems to have slipped away from me.There must have been something on my mind (at least for the last 6 months).Caught a programme on the Beeb a few days ago, about the birth of the NHS. 'Twas interesting, if only to hear the concerns of the (largely) middle class docs regarding the State control of medicine. That the doctor would no longer work for the patient, but for the state. That there would be no autonomy.That we would be told what sort of medicine to practice. Told what we could do and not do, say and not say.While the GPs were against it, Bevan swung opinion through the influence of Lord Moran, President of the Royal College of Physicians; not by much mind - he only won re-election that year by 5 votes.It wasn't clear what role Surgeons had in all this, but I'm guessing that they too were amenable to having their throats stuffed with gold...The objections seem to mirror those I see expressed by my Colonial brethren today, when threatened with Socialised medicine, and indeed they would seem to be (at least partly) valid... what was prophesied has indeed come to pass.Is the NHS a good thing?Fundamentally, yes it is.I can't not believe that. People don't die because they can't afford to see their doctor anymore, childhood disease is a shadow of it's former self, and is only really coming back because of the gullibility, stupidity, superstition of certain sections of the populus, encouraged by the media.Is the Continental system better? The American system? I suspect the practitioners thereof would tell you "yes", but, and I think there's some evidence out there to support this idea of mine, I'm not sure they offer better results per unit spent.But maybe all that proves is that spending more equals better care... up to a point - see the way China works. But maybe I just don't know any better.And a man can become little more than the sum of his ideas, his obsessions.Get it right, and you're a genius. Wrong, a crackpot. We need to be careful about being defined by our own horizons, our own experience.Consider the American tourist visiting the Bodleian Library in Oxford. Much impressed, she enquired of one of the Security Guards: "This place looks so old. Is it pre-war?"With a haughty sniff, the Guard drew himself up, puffing out his chest."Madam", he replied, "it is pre-America..."Does that fit a pre-conception? Should it? Is there any mileage listening to the ramblings of a man who thinks the height of comedy is a Gorilla drumming?Thank you for bearing with, constant reader. Sometimes I just need to let the mind wander.More sense soon.(Or possibly just a picture of me in a kilt...) (Source: The KnifeMan)

Friday random

The KnifeMan — Fri, 26 Sep 2008 08:37:00 +0100

If there's a better way to advertise chocolate, I don't know what it is... (Source: The KnifeMan)

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Nights drawing in

The KnifeMan — Wed, 24 Sep 2008 21:04:00 +0100

I continue in low mood; the 'Black Dog' and I always seem to end up struggling about this time; I suppose if I wanted to, I could call this Seasonal Affect Disorder. It always seems to coincide with the shortening of the days... but, not only do I dislike what I consider pointless labelling (see: IBS; CFS; Fibromyalgia...), but I actually enjoy this time of year; I enjoy the cold, crisp nights and mornings; I'm not quite so keen on getting up, and going home in the dark, but...I think it is just overpowering nostalgia. Some of my happiest memories are rooted in these months; and I think it just serves to remind me how far I've travelled from them. I miss my friends and my family increasingly these days, and all the more so at this time of year. This year, my mind is troubled with impending exams, and the amount of work I haven't done - some things never change, I guess.I think this is especially hard on La Belle Fille, who works as hard as I do, for less money and with considerably more organisation; so she finds it hard to see why I should be so stressed, and hard to find ways to help me. And she finds it hard to put up with my bleak moods; the stress isn't good for our relationship, which already labours under the constraints of both our jobs. I know she reads from time to time, so hope she'll manage to put up with my increasingly monk-ish behaviour over the next few months.Name in lights... (Source: The KnifeMan)

....with terror and slaughter return

Latest entries from bloodletting.blog-city.com — Wed, 24 Sep 2008 16:47:00 +0100

A h/t to the smallest minority for this link to Jerry Pournelle's blogThe more I read Kipling, the more I love his work. I think this is due in no small part to wisdom accrued at dear cost through the injuries and insults of experience. So, havin (Source: Latest entries from bloodletting.blog-city.com)

How affirmative action damaged our economy

Scalpel or Sword? — Wed, 24 Sep 2008 07:34:00 +0100

"The mortgage bubble was essentially a bet on the purportedly increased creditworthiness of the bottom half of the American population. After three decades of the home ownership rate stalling at around 64 percent, a series of federal initiatives to increase minority and low-income ownership helped push the rate up to just below 70 percent. The housing bubble ... never made much sense. The lower half of American society, where the new homeowners had to come from, isn’t getting better educated, is not settling down to more stable family structures, and is not developing a more rigorous code of honor about paying debts.Nor was the government doing much of anything to help the bottom half earn more in order to afford home ownership. Indeed, by not enforcing the laws against illegal immigration, the Clinton and Bush Administrations were flooding the country with unskilled workers who competed down the wages of blue-collar Americans.It turned out, not surprisingly, that contrary to the assurances of the Great and the Good of both parties, many of these marginal homebuyers should have continued to rent."Read the rest. It's a long article, but well worth reading. As you will see, the Clinton and Bush administrations share much of the blame for this mess. (Source: Scalpel or Sword?)

Manto's liver

All Scrubbed Up — Tue, 23 Sep 2008 15:46:00 +0100

Spotted on a Times blog...“The Medical Association of South Africa (MASA) herewith informs the Minister of Health, the Honourable Manto Tshabala-Msimang, that should she resign, now, with her 11 Cabinet colleagues, she would not be obliged to return her liver.”Some humour following the chaos in South Africa today... (Source: All Scrubbed Up)

Ever wondered why they called him "god"?

The KnifeMan — Tue, 23 Sep 2008 14:09:00 +0100

The sax solo ain't too shabby, either, but nothing beats Eric's guitar face.... (Source: The KnifeMan)

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Things that make you go 'why?'

The KnifeMan — Tue, 23 Sep 2008 13:59:00 +0100

Hat-tip to Kal at TQ.Further details to follow, especially involving La Belle Fille, who was heard to complain that her 'character' appeared to have been written out...I could survive for 1 minute, 22 seconds chained to a bunk bed with a velociraptor (Source: The KnifeMan)

Picture of the day

Scalpel or Sword? — Tue, 23 Sep 2008 08:16:00 +0100

No, that's not really 911doc. It's from a really funny website I just found. (Source: Scalpel or Sword?)

Famus lines...

Latest entries from bloodletting.blog-city.com — Tue, 23 Sep 2008 06:02:00 +0100

...spoken by yours truly in the emergency department.One of our young, hotshot pulmonologists overheard me say this to a minimally responsive patient with pinpoint pupils while he was evaluating an intubated patient in the next curtain: &n (Source: Latest entries from bloodletting.blog-city.com)

I'm not bitter, i'm blessed

Scalpel or Sword? — Mon, 22 Sep 2008 20:34:00 +0100

from the NRA, via Hot Air (Source: Scalpel or Sword?)

Blogging buzz killer

Scalpel or Sword? — Mon, 22 Sep 2008 15:44:00 +0100

ALBUQUERQUE, N.M. — Two University of New Mexico Hospital employees have been fired for using their cell phone cameras to take photos of patients receiving treatment and then posting the images to a social networking Web site.Director of Public Affairs Sam Giammo said Sunday the photos — mainly close-ups of injuries being treated in the Albuquerque hospital's emergency room over the past few months — were posted on an employee's private MySpace page.Giammo said he's never heard of a similar incident at the University of New Mexico Hospital or any other hospital.The patients in the photos could not be notified that their pictures had been taken because their faces and personal identifying features had been removed from the photos, Giammo said.Giammo said the MySpace page could only be accessed by the employee's online friends, not the general public.Chilling. (Source: Scalpel or Sword?)

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A not-so-average shift

Latest entries from bloodletting.blog-city.com — Sat, 20 Sep 2008 23:56:00 +0100

Last night was one of those nights were I got worked hard, and put up wet, but was actually had a Hell of a time.It was hard, demanding and stressful work, but I actually felt like I was 'living the dream.'To give you an idea of what it was l (Source: Latest entries from bloodletting.blog-city.com)

Quote of the day

Scalpel or Sword? — Fri, 19 Sep 2008 13:40:00 +0100

"In the concerted effort to destroy Sarah Palin, her husband, and her children, we've seen the progressive blogosphere and professional media adopt the no-holds barred, street-fight viciousness of a community organizer fighting for scraps. The petty brutality has trickled down from the man they idolize, a man cool enough to befriend and use aging terrorists and racist ministers as they can help him, and callous enough to discard friendships decades old if it suits him, without a backward glance.For all his eloquence behind a teleprompter, Barack Obama is still at heart a thug, and his disciples learned well from their master."- Confederate Yankee (Source: Scalpel or Sword?)

Alaska, part 1

Collective Contemplations — Fri, 19 Sep 2008 04:00:00 +0100

I am not sure I can summarize the whole 4-week rotation and vacation in just a few entries, but I am going to try. My rotation was through the Indian Health Service, and it took several months of filling out paperwork and waiting for a temporary resident permit to get the thing set up. I chose to go to Alaska, partly because some residents the year before me had gone there and had a great time, (Source: Collective Contemplations)

The best medicine

Ten out of Ten — Thu, 18 Sep 2008 06:54:54 +0100

I almost never laugh at work. I’m too focused on the task at hand, particularly when it’s busy — I’m pretty much all, well, business. If it slows down I’ll lighten up a little, joke around some with the patients and staff but it’s rare for something to just out and out crack me up. The other day was ridiculously busy to the point where I broke some kind of personal record by seeing 21 patients in the first 4.5 hours, which basically resulted in me walking around like this. After a brief timeout to mutter and get some coffee I went and saw patient #22, who turned out to have the first break dancing injury I had ever seen — a college-aged guy who dislocated his toe. It needed to be numbed so I placed a digital block by sticking a needle in the webbing surrounding his toe. I’ve seen a lot of different reactions to these blocks but he had a new one: he held his breath and slapped the gurney while I pushed the lidocaine, and when it was done he threw back his head and let loose with a long, slightly crayzee fit of laughter. It was the most contagious thing I dealt with all night and I started cracking up too and then he said “wow, that s— hurts” which just set me off again. So thanks break dancing dislocated toe dood. I needed that. (Source: Ten out of Ten)

Picture of the day

Scalpel or Sword? — Wed, 17 Sep 2008 11:14:00 +0100

Medical clinic reopens on the West end of Galveston Island.via the Houston Chronicle (Source: Scalpel or Sword?)

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A letter to a cliché

Scalpel or Sword? — Tue, 16 Sep 2008 14:24:00 +0100

Dear Mademoiselle:I'm so sorry that your visit to our storm-ravaged ER was less than satisfactory to you. I must admit that working for 20 hours straight in a facility without air conditioning might have made me slightly less than optimally compassionate, therefore I was not inclined to repeat my explanation to you why you couldn't have a fifth round of intravenous narcotic for your "migraine."A delicate migraineur like yourself obviously ravaged by pain to the point that you "almost threw up" once and bearing such a tortured expression when I would enter the room to interrupt your cell phone conversation obviously needed much stronger medication more frequently than I was willing or able to provide to you. Our nurses definitely got the message because you were hitting that call bell like an enthusiastic xylophonist. Well played! Unfortunately mon cherie, as I explained to you already, your extensive list of allergies to non-narcotic medications made treating your condition rather challenging. You are living proof that narcotics are ineffective for treating migraines. Merci!Complain about me then as you wish, my delicate little cheesepuff, but understand that welfare recipient drug seekers like yourself aren't entitled to unlimited narcotics any more than you are to unlimited recitations of my gentle GTFOOMER speech, and that on your next visit your reputation will precede you.Oh, and that "bloating" in your abdomen? It's called fat. Might I suggest avoiding the crepes and that obviously uncomfortable thong?Bonne chance,Scalpel (Source: Scalpel or Sword?)

Lessons from ike

Scalpel or Sword? — Tue, 16 Sep 2008 10:00:00 +0100

1) The generator I was thinking about buying a couple of months ago? That would have been nice to have. And maybe one of these too. If I had to choose between water and air conditioning, I'd choose air conditioning. One more night without power and I'd have slept in my car with the engine running.2) When there is no electricity, ice is the next best thing. Ice is worth waiting in line for several hours to obtain. 3) If you have a headlamp, then you don't have to hold a flashlight in your teeth when you pee.4) Despite the tragedy and inconvenience of hurricanes, I still enjoy them. As an extreme weather junkie, I feel energized by their awesome power. The aftermath of a disaster helps us to view (and live) our lives with a new perspective. Sitting in a dark hot room listening to a radio by candlelight makes me appreciate the simple conveniences I usually take for granted. I especially enjoy watching the community come together to help their neighbors afterward. With the political climate heating up, it is refreshing to see people unified for a change. The weaker trees were blown down and will be replaced by new ones, while the stronger growths survive another season. Similarly, many of the dilapidated old buildings were washed away; some will be replaced by new construction, and some areas will perhaps not be redeveloped at all. Despite their destructiveness, hurricanes ultimately make many things better. (Source: Scalpel or Sword?)

My promises are nearly kept

The KnifeMan — Mon, 15 Sep 2008 23:18:00 +0100

Saturday was unbearably busy; Sunday just unbearable. It was busy, I was irritable. The SHOs are hard working, God love 'em, but have a deal to learn about the appropriate time to strap on in Emergency Medicine. I'm not sure I helped much.The tone was set, not so much by Drs Greene or Carter, but by two patients. The first, a young man with his own version of a biological clock; his aorta distended, over-ripe lay swollen and pregnant within him. He knew it was there and had had the 'full and frank' discussion with his surgeon. Weighed the odds of success against the chance of failure and the consequences inherent therein. He had, he thought faced his demons, made his choice, and defended it. The ultimate act of self determination.Funny how circumstances can change a body's perspective. Each man faces death alone, and sometimes it hurts. He faced death in the company of us all, and asked for one more roll of the dice. We gave it gladly, some less calm than others, but we stood by him.Snake eyes is still snake eyes, no matter how many hands help roll it.Number two had other gifts, unknown, only now bearing fruit; spoiled and rotten; foul and terrible. Still I bore them, my words harsh even under the bright lights of the ED. My words, short, to the point, still have the power to bring tears.Still, the next will be better, eh? (Source: The KnifeMan)

Knifeman's blues

The KnifeMan — Sun, 14 Sep 2008 18:18:00 +0100

Shall I whisper to thee of the nights I have seen...My nights are full of coffee and hope; hope for a quiet life, and yet hope for a chance to show off and do my job. It is an interesting dichotomy - I enjoy seeing the big cases, treating the really sick guys and gals... but it means someone has to be sick...Quiet? Or busy? I know which I prefer, but it's for selfish reasons.Shall I tell thee of the ways the nights begin?Heading to my car, I realise it's dark, and with a slight chill in the air; I have blinked and missed summer. Actually, the last year has been something of a blur, but I was counting on summer. Driving to work, I feel cocooned in my car; isolated. I try to use the time to prepare for the joy that is too come. Sometimes it works.Shall I tell of the tells we see?The first is the ambulance bays. If they're full, and especially if there are plenty of Police jostling for position, it bodes for an... interesting night. Resus is next; I see it as I come in the ambulance bay doors. Last night it was humming, full of eager doctors, jumpsuited road warriors and coppers. A stabbee and the stabber all in a messy package. The first 3 people I see advise me to turn about and run, before it's too late. The next is the Charge Nurse - he asks m to start early - 'becaue we're a bit fucked'.It's going to be a fun night. (Source: The KnifeMan)