Lawyer

I was at the gym a few days ago. Somebody had pooped into the pool and we had to wait till the pool was cleaned. 

I started talking to the person sitting next to me. Found out he was a personal injury lawyer who had sued many doctors .

“So why does get the doctors sued”

“It’s mostly when they don’t follow up ”

That make sense

”  if surgeon does a surgery and something goes wrong, he usually is not in trouble if it’s a recognized complication but if he misses that on follow up then he is in trouble”

” I can see that ”

That does make sense, I thought

“Or if there differential diagnosis is not broad enough”

I pondered over this .

” the bottom line is, dont be afraid to order more tests, the more test you order the safer you are” the lawyer offered his sage advice.

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Hunting season

Few things make people crave for disabilities as much as hunting season. When hunting season come all of my able bodied patients suddenly develop bad arthritis, leg pains and sometimes even heart conditions ,all to let me write them a letter saying they need to use cross bows instead of regular  compound bows and that they be allowed to hunt from vehicles. 

It staggers me to see that so many people who love and live to hunt ,so desperately want to have that extra advantage over the little deer.

I mean he already has nothing to defend himself with . All he can do is run and hide. Be a man and atleast sit in a frozen  deerstand or walk in the  cold ,but play fairly . And when I say play fairly I realize that these fair play rules are not necessarily created after dialogue with the deer . Some wise  Men just decided that these rules are Somehow fair to deer.

I have to say though that I am a hunter myself.   However I have two self imposed rules which not everybody may agree with . I shoot only once and that is to kill. I never ever injure an animal, or to put it more correctly I take all precaution not to injure an animal. I mean have you ever had to track an injured animal. It is painful for both the hunted  and the hunter. 

It’s cold ,dark and usually damp  and you are looking for small drops of blood ,scared all the time that deer may realize he has antlers and decide to use them to his advantage. You want to pee but you don’t want the deer to smell you, meaning you are not only walking but also dancing. Your flashlight is half dying and today the sun just refuses to come up all the way . lastly, The dirt you just touched while looking hard for blood drops turns out to be bear poop. Disgust and fear rolled into one diffuses through your head and yeah,remember you got to pee. 

That means I let go many more then I actually shoot . In fact  I only fire one or two shots the entire season and they have to be perfect shots by my standards . There have been many mornings when I just walk around in the woods and come back empty handed,smug and proud that I did the right thing.

 Second I don’t hunt anything which is even near the protected species list , meaning no bear, cats of prey or wolves. Again it may have more to do with self preservation then my generosity towards the animal kingdom and the study of zoology in general .  I have never been to Africa but I have read Hemingway and according to him it can be dangerous. 

Still for strange reasons that’s the newest pastime for Americans . All Americans want to kill Cecil. Since American don’t really kill anything that has even the slightest chance of killing them (We don’t go to war unless the odds of our winning are atleast a million to one in our favor, Russians can do whatever they want , We will look the other way)I am sure hunting lion has become safer then it was in Hemingways  time. Still I would rather not take a chance.

I just met a couple of nurses , both in their fifties who are going to Africa coming spring and hunt lions . I mean those lions are not even Muslims , or black or even Mexican. Why does Americans hate them so much. Did Trump announce a vendetta against the lions too which perhaps I didn’t hear about .Those guys are barely out of extinction , thanks to the great white hunter, and now Americans wants to push them back to the brink. I don’t think I trust the African nations to be able to manage lion population as well as American DNR does deer. For 50 000 dollars they will let anybody hunt their lions to extinction.

 On that note, these nurses are rich ! 

Dying 

 I remember a patient who was admitted to ICU during my critical care rotation . I was an intern then. He had no legs and one arm( can’t remember for sure if he had one or two arms but he lost both eventually).

He came in shock from a nursing home. Further investigations revealed that he had been in a vegetative state for several months . No family , a state appointed guardian and of course the physician assigned to him. The patient was a full code, meaning an attempt for cardiopulmonary resuscitation had to be made regardless of clinical scenario . 

The man was pretty much dead when we saw him . 

In three days he was coded three times. We, the ICU team wanted to make him DNR since we could not figure out why we were saving him again and again.

He lost his last remaining limb because of repeated lack of pulse and underlying diabetes and peripheral vascular disease.

It was an open ICU , meaning the primary doctor was still in charge .

His primary Doctor simply stated that according to his (the doctor’s ) religious belief life had to be saved at all cost. When we called the guardian She decided to let the primary doctor make that desicion. 

We saw the patient everyday of course  . Tubes stuck in every orifice. Mucous and phlegm being suctiond every 10 minute or so. The ICU  doc repeatedly attempted to change the patients code status but could not without the guardian or the primary doc’s approval.

The patient developed some intrabdomianl catastrophe . Needed to have surgery. We asked cardiologist for cardiac clearance . I still remember the expression on the cardiologist face when he came to see the patient. He looked at the patient , sat down ,shock and disgust showing on his face , deep in thoughts and said ” yeah, do the surgery , we haven’t stopped yet , why should we stop now”

‘Is he cleared for surgery’

The cardiologist stared at us with a grim face 

“You really want me to do an angiogram to clear him?” 

The worst thing was that we were not sure if  the patients was ‘locked in’ or in persistent vegetative state . If ‘ locked in’ He probably still could feel , see and hear everything but was unable to communicate .

It is much harder then people realize to determine if somebody is locked in or in a vegetative state. For example you ask them to blink their eyes and they do ,you make the diagnosis of locked in and feel you have achieved something. Now come back in 10 minutes and ask them again ,they don’t blink their eyes and suddenly your diagnosis is uncertain . Do it about twenty times and you remain with three possibilities . 

1 either the patient is locked in because he blinked his eyes initially

2 he is in peristent vegetative state because he is not blinking now and the earlier response may have been automatism or reflex.

3 he is mad at you for bothering him repeatedly.
My rotation ended . I found out later that the patient did develop some further complications a few weeks later and was finally unable to be  resuscitated.

Each month the patient lived the doctor and the guardian received a check . Not a fat one but nonetheless a check .  I wonder if that had anything to do with anything.

Fire exits

Is it only me or have other people been stuck out of fire exits too?  Seems to be only me because nobody I ever complain to ever tells me their fire exit story  . They all smile at me just oh so politely as if they just heard mentally challenged person tell them that he just shit in his pants.
“Stuck in fire exits ? Oh no ,not me , never . I am not stupid”

Anyway it has happened to me several times . In Chicago I once found myself in bitter cold ,walking in a snow without a coat because while talking on the Cellphone I had opened a door nonchalantly and walked out  to the back garden of a hospital . Of course the door was a fire  exit and could only be  opened from inside .

Another time I found myself walking down fifteen floors of a stairwell because I wanted to use the stairs for health reasons and decided to walk up from 14th the to 15 th floor of a hospital. Each and every door refused to open from the firewell except of course the ground floor. I didn’t quite understand why but even going down 15 floors can make you tired to the point that you have to drink a sugary coffee and say a vehement goodbye to all healthy intentions . The funny thing was that I was not the only lost soul in the firewell. I found two other people just like me.

And that’s another thing . Whenever I am in the firewell I do find other  people who have stumbled into and gotten lost but God knows where does all these people go away when I am out of the stairwell  because every time I mention my stairwell stories , well, its just me who seems to be stupid enough.
Another time at a university hospital I discovered I had ventured into the basement labyrinth while trying to go down stairs . Was stuck for several hours until another person who was just a tiny bit less lost then me came along . Both of us together managed to find a fire exit and were actually happy to walk into a dark, dreary and wet street outside. Anybody who has ever been stuck in the basement of an old hospital would agree that even pouring cold rain is welcome after that. As expected the fire exit was atleast two block form any other entrance or the carpark therefore my companion has to listen to many choice words emanating form my mouth without me even realizing it. The combnation of fire exits, cold rain and lack of jacket seems to have that effect on me .

Another memorable incident was when I locked myself up on a rooftop . Now that was actually a little stupid . That was during my training . We were not suppose to go to the rooftop but of course that didn’t stop me. I was looking for someplace in the hospital all my own. A place to hang out with me or people close to me . Of course th door turned out to be a some kind of secure fire door . Opens form inside but would need a key once you are out or you would need to climb down an outside fire ladder. Since the whole operation was a secret I did not want to climb down the open-to-everyone fire escape . Result ; stuck on the roof for almost an hour until I could wave to a friend who thankfully understood the situation and rescued me, of course while   laughng like a maniac the whole time .

Cat

Somebody asked me what is the most bizarre thing I have ever seen in my career. It made me think about the cat.

At one point I covered a half way home for troubled youngsters and adults . Once I went there for a routine visit . A 19 yo girl came to me with scratches all over her, even  around her genitals.  I immediately called the nursing supervisor to investigate  what had happened 

The nursing supervisor pointed to the huge male housecat. Apparently the seduction of the cat by the girl had not gone as planned. 

The girl confessed . In addition to the cat she had apparently had sex with a door knob, various plumbing tools and had tried of course her charms on fellow boarders . Unfortunately because of the strict no-sex policy she had to finally resort to the cat.

She was started on ssri and the cat was saved.

There is nothing wrong with 19 year olds having voracious sex drives but the reason sex was not allowed on the premises was because literally everybody living there was either a victim of abuse or a perpetrator and in many cases both.

A lot of them were people who even the homeless shelters would not accept.

The girl’s sad background was that she had been abused repeatedly as a child and had even been pimped  by her own parents for petty sums of money. Now that she was older she had become an abuser  herself. 

She was initially taken in by authorities for protection . She later developed a history of repeatedly trying to molest younger children. The transition is far more common then normal people realize. She stayed in children’s homes and then finally this place.

They were all under the care of psychiatrists , and I am sure the psychiatrists were doing their miracles . 

I still wonder how many of them got unbroken.