‘Full of shit’or more politically and scientifically correct’ fecal impaction’ 

The patient may not know but this condition can easily be a battleground between nurses and doctors .

As a geriatrician I like to use the gentlest treatment possible which is some times soap suds enema until clear or even tap water enema however they require repeated administration and very gentle hands. In addition I like to add oral miralax.

 Surprisingly , a lot of nurses don’t have time for this . They prefer stronger drugs. The message here is to stay the course even when you are getting pages every fifteen minutes asking you to go the other way. As long as the patient tolerates it continue to ‘do no harm’


My ageism


Yes I suffer from ageism. Time and again I have found that older nurses are better at everything compared to younger nurses .

Experience , just plain skill and the fact that if you have spent twenty year in a field you know you actually love it and not doing it just to get by.

I am actually afraid sometimes when I see younger nurses taking care of my critical patient. I check everything twice or thrice, sometime twenty seven times and never take their words as the final word. Even when it’s something as simple as urine output I go and check the foley bag myself or confirm with the cna’s and other personnel . I know it’s crazy and probably wrong but it’s difficult for me to take the young twenty year old , face booking , latte sipping , planning her hook up in the evening nurse as seriously as a 55 year old with 20 year experience who just sent her kids to college .

I once got a call from a nursing home . A young nurse told me that the patient is having pain in left side of the chest about 2 inch area , worse on coughing and deep breathing . He can point to the area with two fingers and when the nurse tries  to press on it hurts . I told her it’s probably pleuritic or musculoskeletal , she told this to her senior who ws standing behind her . The senior took the phone and said its central chest pain with radiation to the left arm . He can point to it but  its probably not the area of two fingers and he is nauseous. It is worse with coughing and deep breathing but it’s bad anyways. This got my attention .I told them to take the patient to er and sure enough he was having a heart attack.

It may surprise people but a lot of the twenty year olds will not even stay a nurse too long . I am not quoting studies. I am just quoting my experience . I have seen nurses go from being a nurse to stripper , real estate agents ,even a trucker. True story !

Of course the worst part is when they try to impart their infinite wisdom and knowledge to me. Comparing Percocet to Tylenol, telling when the patient need dialysis all the way to withholding Ivf when ordered because they think the patient is wet. Yes it has actually happened . Also holding Coumadin because the patient is on heparin . ( for a heparin window)

So whenever I have sick patients I want my old reliable gray haired nurses to manage them . Sue me if you want .


What’s the worst thing a nurse can say to a doctor when he or she calls to check on their patient .

“I don’t know . I just started my shift”

Believe me we don’t care about your schedule. We don’t care about your love life, your child’s drug problem or your father’s suicide . If you are in the hospital taking care of a patient you should know basic stuff about him. There is such a thing as ‘sign off’and in most cases vital signs are just a glance away.

If you really have issues please get help. Talk to me in your free time.

Let’s say you are a clueless nurse . How can you better serve the purpose of your existence?

Suggestions :”I just started my shift but if you hold on one minute I can get you the information ”

Or forget the shift” I can text / call you with the required information in one minute ” 

Maybe I m a narcissist and want the world to revolve around me but you have to understand that I ,like a moon revolve around the care of the patient atleast until my shift is over and nurses like gravity are the connection between me and the patients.

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 ! 

Sex and  Doctor Sexy MD

Over the course of 15 years I have worked in small  50 beds rural hospitals to big  million bed city hospitals and everything in between but for some strange reason nobody in the hospital has ever wanted to have sex with me .
Nobody ! No nurse , no doctors , not even the cleaning ladies!. Not even the nymphomaniac on the psyche ward.

 I have decided that the problem is me . I definitely  need to work out more and get a stylist or something because I am sure , based on all the hospital tv shows that a good lay is just around one of the hospital corridor and almost inside every closet.

Even the Ph.D. Doctors on tv seems to be getting illicit sex everywhere .

In my case every closet I open turns out to be the  janitor closet with the big burly janitor inside and even he is not interested.

Maybe I need to develop a Ptsd or some complicated past love life or perhaps find the one Doctor in the entire universe who paid for medical school by working as a lingerie model.
Or is there a slight chance that the hospital tv shows are wrong. Nah that can’t be!