hypocaffeinemia

It’s two in the morning right now; I am at work. Took a long vacation last week– first one in years, actually. Having difficulty readjusting to night-shift due to my wonky schedule this week. I’ve basically been up since 6 am yesterday. This whole week is a total yin and yang with some super-duper-freakin’ awesome moments punctuated by some freakin’ horrible lows.

Tonight one of my patients died. Not unexpectedly, mind you, but it sucks all the same. Especially because the patient’s progression and the patient’s loving family mirrored that of my wife’s grandmother who is currently very ill at a nearby hospital. I’m seeing a lot of grieving families today: my patient’s and my own.

And yet I feel strangely disconnected from the reality of either at the moment. Like I’m a disinterested third party watching a documentary of it all on an old CRT TV with poor vertical stabilization. I feel guilty for this. I will now blame it on my lack of sleep.

That wraps it up for now. I’m in the temporary lull between a discharge and the inevitable admit.

I’m testing out a post on my new palm Pre. I’ve found that I’m often not near a computer when a thought I wish to perserve strikes me. If this works well I might just have to start blogging more!

I’m having a bit of trouble internalizing my accomplishments, recently. I feel like I have a bit of imposter syndrome every time I put initials after my name. It’s a good but awkward feeling.

Tonight, Scrubs ended. While it may return in some altered form next season, the show I’ve loved since I first saw the promo in the fall of my freshman year of college is over.
It’s ending coincides with the ending– for now– of my education. Over the past eight years I’ve been in and out of school working on various degrees, but I finally am at a point of stability career and education wise. Much like J.D., I also have a young son and have grown significantly in maturity over the last eight years.

The episode tonight, for these reasons, was bittersweet. Not only does it mark an end of an era of great comedic and dramatic storytelling, it marks the end of one chapter of my life and the beginning of the next chapter. As J.D. fantasized about what his future would hold, I am reminded that my future is a blank canvas I hold the brush to.
Thanks to Bill Lawrence and the cast and crew of scrubs for their wonderfully human story I’ve been privileged to watch and connect with.

This whole “Swine Flu” pandemic thing has officially jumped the shark. Now schools local to me are closing over “probable (?) cases”. How they determine the cases are probable when the symptoms are…wait for it: identical to the normal friendly endemic influenza strains that kill 36,000+ stateside annually, I’m not sure. Especially when labs are being overwhelmed with samples from everybody and their mother (and their father and their siblings…) that shows up to the ER or the doctor’s office with so much as the sniffles.
Unfortunately, one of the local school closings is about half a mile from my hospital. I haven’t walked by our ER (their lobby is literally a prefab building in the parking lot now), but from talking with some of my esteemed colleagues down in the trailer park (ha!), there’s at least a dozen people with masks and “flu-like” symptoms showing up on any given shift at the moment.

I think the way this entire thing is being handle is particularly egregious. While the WHO and CDC are just doing their jobs by tracking stuff (”pandemic” doesn’t speak of severity, mind you), the way the media has picked up the ball and ran with this is a special sort of stupid. There are plenty of viruses out there to be feared- viruses with high transmission rates, high morbidity, and high mortality- but swine flu isn’t one of them. The very premise of calling it “swine flu” when it’s nothing more than a recombination of several extant Orthomyxoviridae strains– a retrovirus we already well-known to us that mutates so quickly we need annual immunizations just to keep up with its changes– is nearly as criminal as yelling “fire” in a crowded theater.

And so over 25,000 kids across the country are missing school due to a few suspected cases of a new strain of a disease so endemic in our population that most people aren’t even aware of the fact that it kills more people than auto accidents annually.

Of course, no school would ever think of shutting down November-April even while hundreds of children are affected annually. Case in point: My wife’s a teacher. One week this January, roughly 11% of the student body (total pop = 1100) was absent due to a similar GI illness. The district didn’t shut the campus down; the media was not alerted; the CDC did not quarantine our town. Why not? It was easily as severe and as dangerous as the worst of swine flu. It just lacked the hysteria only the media is able to generate.

An interesting trend has emerged from the far right, convinced that the country has gone to hell in three short months. Or rather, cognitively dissonant of the fact the right got us to where we currently are.

Rick “Good Hair” Perry, Texas Governor:

Texas is a unique place. When we came into the union in 1845, one of the issues was that we would be able to leave if we decided to do that,” Perry said. “My hope is that America and Washington in particular pays attention. We’ve got a great union. There’s absolutely no reason to dissolve it. But if Washington continues to thumb their nose at the American people, who knows what may come of that.”

Chuck Norris, Black-belted buffoon:

That need may be a reality sooner than we think. If not me, someone someday may again be running for president of the Lone Star state, if the state of the union continues to turn into the enemy of the state.

Glen Beck, Spastic hysteric:

“Does the state have any right anymore? And I know, because I’ve heard it from all of the conservative, uh, you know, uh, the historians and scholars and everything else, but you can’t convince me that the founding fathers wouldn’t allow you to secede. The Constitution is not a suicide pact. And if a state says, ‘I don’t want to go there because that’s suicide,’ they have a right to back out. They have a right. People have a right to not commit economic suicide.

“I believe it was Davy Crockett, that as he was standing there in the well of the Senate and they were all yelling and screaming at him, he said — he looked them right square in the eye and said, ‘Hey, you know what? You can all go to hell. I’m going to Texas.’ About time somebody says that again.

“You’re telling me that states can’t say ‘Washington, we’re not going to commit suicide with you’”?

Now, during the looong eight years Bush was president, any and all criticism of the direction of the country was met by the very same bunch as “anti-American”. Dare I say, however, that actively advocating for states to secede is, by definition, anti-American.

Rough illustration of the anti-midazolam mob

Over the last year, I’ve noticed and interacted with an interesting group of folks at allnurses.com and around the ‘net. There seems to be an underground movement against the use of midazolam (Versed®) or any sedation at all while undergoing procedures such as colonoscopy.

It’s an interesting if not quite articulate group: They infiltrate medical boards such as allnurses and start quasi-professional  sounding pity party threads seeking out sympathy from nurses and, presumably, trying to maximize their google exposure for future patients.

Here’s an example from today:

The nurses in the room the first time tried to force me to take Versed (I had it once before and it has ruined my life totally, memories are gone…years of memories, and I was left with PTSD from the incident, stopped breathing and almost died.) I wear a medic alert bracelet now at all times stating that I’m allergic to this poison that should be banned for use on humans.

Poison that should be banned for use on humans?!

Hyperbole, much?

There is no reasonable discourse path to take with such people. Each and every single one of them will claim that midazolam causes irreparable retrograde amnesia and post-traumatic stress disorder (discounting that midazolam and related drugs are actually used to treat PTSD), and significant chunk of them will claim they nearly died.

Other, less dramatic members of this society will claim that they think a drug that causes any amnesia is dangerous– there goes essentially all the benzodiazepines.

The particularly odd part about it all is that the story always seems the same: The patient either requested no sedation or some other drug, and was lied to and given midazolam without their consent, leading to a whole array of negative consequences. A quick google search for versed will yield many more such stories, too.

It goes without saying that no drug works perfectly in all patients across the board, yet something is fishy about those claiming one of the most-utilized drugs in the country is secretly an evil poison that causes people to forget their children growing up (actually claimed!).

One of my biggest pet peeves is use of the so-called “Appeal to Nature” fallacy. I dare say its has conned and confused more suckers than any other marketing gimmick in the last decade.

As a was driving into work this morning, I heard an ad for Poyz Calming Dog Treats that went above and beyond merely claiming to be “safe, all-natural”  like typical marketing.

Here’s what they said:

Our product is all-natural, so you know it’s safe and non-addictive!

All natural and safe, just like atropine and digitalis, right?

All natural and non-addictive, just like coca leaves, opium poppies, tobacco, and ethanol?

Point made, hopefully.

I just ran across a blog entitled Adventures in Cardiology. It details the experiences, from the husband’s viewpoint, of a cardiac nurse undergoing RF ablation for atrial fib.

It is, simply put, a must read for anyone who truly cares about patients. Pam’s experiences can fill a textbook in what NOT to do from both a medical and nursing standpoint.

Thanks, Dan and Pam, for being courageous enough to write about your experience. I hope things are now going well for you both.

As for me, I think that I have learned much by seeing this unique and unfortunate viewpoint.

Clearly thinking of the Children

Link

Here’s the quote from the douchebag State Senator representing Colorado Springs:

“This stems from sexual promiscuity for the most part and I just can’t go there. We do things continually to remove the consequences of poor behavior, unacceptable behavior, quite frankly. I’m not convinced that part of the role of government should be to protect individuals from the negative consequences of their actions.

. . .

What I’m hoping is that yes, that person may have AIDS, have it seriously as a baby and when they grow up, but the mother will begin to feel guilt as a result of that. The family will see the negative consequences of that promiscuity and it may make a number of people over the coming years … begin to realize that there are negative consequences and maybe they should adjust their behavior.

He is against opt-out HIV testing of pregnant women. For those not in the know, with detection and proper treatment mother-to-infant transmission can be brought down to less than 1%. He hopes that more kids will grow up with AIDS to set an example to others about the negative effects of promiscuity.

My thought: if he wants to set an example to society regarding AIDS and promiscuity, he should volunteer himself. Perhaps the people of Colorado can vote on that.