My Answer

Let’s say that you go to the ED with a complaint that could be an infection. The team is going to evaluate you to see if you meet sepsis criteria. I posted about that back in August right here on this blog. If the patient meets sepsis criteria, the nurse will enter a standardized set of orders for tests. Those tests include tests for lactic acid, a CBC, CMP, and if appropriate, COVID/Flu tests, urinalysis, and other tests. If the patient has a lactic acid level of 2.0 or more, they are going to get IV fluids. Lots of them, like 30mL per kilogram of body weight. If you weigh 100kg, that means 3 liters of fluid. The lactic acid level will be checked and rechecked until the level is below 2.0.

So think about this when you consider the cost:

  • The triage nurse and their team briefly evaluates you and assigns you to the appropriate nurse.
  • You then become one of the 3 or 4 patients that nurse is caring for. You get a full evaluation, including an EKG, an IV line, along with blood and urine tests. This nurse has years of education and years or even decades more experience.
  • The lab team then runs the tests, the X-ray team shoots your pictures, a radiologist reviews them and sends the results to your nurse.
  • The ED physician evaluates all of that information and, in cooperation with your nurse comes up with the treatment plan. Then he orders the medications.
  • The pharmacy reviews the patient’s previous medications, condition, and the ordered medication to ensure that this is a safe course of medicine, then releases it.
  • The nurse then triple checks everything and gives the medicine.

In all, a visit to the ED involves no fewer than 12 specially trained medical personnel, who perform tests and treatment across no fewer than 9 different specialties. Each of those people is college educated from a 2 year degree to full on doctors. Most of them have a decade or more of experience. That doesn’t count all of the other people involved from the hospital’s chief nursing officer, the administrative people, janitors, security, and others involved in running a large business.

Now consider that Americans demand flawless health care on a 24/7 schedule, and want to be seen and leaving the hospital in less than 3 hours. Sometimes, we actually meet that deadline. Most of the time, we come close, but there are too many patients there for too many silly complaints. I had a patient this week who came in for constipation and was demanding to know why we were so understaffed that he had to wait an hour and a half to see the doctor.

So if you want to know why it costs $10k for an ED visit, that’s why. The old saying is that all businesses offer one of three services:

  • Good
  • Fast
  • Cheap

You can only get two- if it is cheap and fast, it won’t be good. If it is good and cheap, it won’t be fast. If it is good and fast, it won’t be cheap.

We as a nation demand good and fast. That means it won’t be cheap. On top of it, the patients want to be pampered like they are in a day spa. My patients are frequently more concerned with what I am going to feed them than they are in the quality of their care. They expect to be cured in an hour for a problem that has been years in the making: you are a long term smoker, a diabetic, are 100 pounds overweight, and have high blood pressure, then expect to come in and be cured of your shortness of breath in an hour so you can make it to half priced wing and beer night at your local watering hole. Then you blame the health care personnel when it takes too long.

Another of my patients came in and the first thing he said to me is that he wanted a sandwich followed by a cup of coffee brought to him every hour. I told him that I was holding him without anything by mouth at least until we were done evaluating him, so he demanded to see my boss. When the boss told him the same thing, he told us that we were inhumane for denying him food, then stormed out.

That’s my rant.

It’s Over

My regular readers know that my mother passed away in early December. She left a mess of things by not keeping her will up to date. I told my brother, who was taking point on this, that he needed to hire a lawyer to handle the estate. He poo-pooed my advice and said that no lawyers were open during the Christmas holidays, and he would take care of it after the New Year. He was busy trying to track down Mom’s assets.

He paid a retainer to a lawyer in mid January, and had his first meeting during the following week.

That wasn’t what my mother’s widower and his daughter did. It turns out that they knew where all of Mom’s assets were. They hired a lawyer less than a week after mom died. By the time of my brother’s meeting, the hearings had already been finalized, and all of Mom’s assets had already been distributed.

My brother dropped the ball. Even worse is that Mom’s husband has dementia. All of this was orchestrated by the man’s daughter and ex-wife. I am sure that Dad, when he left Mom all of his assets, did not intend for all of that money to go to that man’s daughter and ex-wife. We aren’t even sure how much they wound up getting. We know it was at least $150k.

Even worse, this is the first time in more than 2 decades that my mother didn’t call me on my birthday at the exact time I was born to wish me a happy birthday.

Still Busy

I got the floors looking as well as they can be, cleaned up all of the mess left by the tenants, repaired the holes in the walls, replaced the burned out light bulbs, and replaced the screens on the lanai. I remulched the flower beds and trimmed the trees. I took yesterday off because I have COVID for the third time, and decided to spend the day napping on the couch in a fog of Nyquil induced sleep.

Today’s project is re-plumbing the kitchen sink, fixing some water damage in one of the bathrooms, and replacing a towel rack that was torn from the wall. After that, all I need to do is paint the garage walls and the white trim in the house, and I think we are ready to list it for rent again.

I will be running on cough medicine and Sudafed today.


My tenants moved out a couple of weeks ago. I have been spending every spare minute trying to get the place ready to rent again.

  • The countertops needed to be replaced at a cost of $4,000.
  • The lawn is dead because they turned off the sprinklers in a bid to save money.
  • They glued mirrors to one of the walls with construction adhesive. The entire wall will have to be ripped out and replaced in order to get them out of there. I will do it myself, but a contractor would charge $3,000 or so to get it done.
  • There is a large amount of filth in the place. I found sausages under the stove, and it looked like no one had moved any of the appliances to clean behind or under them for the four years they were in there. There are bits of food stuck to walls, ceilings, and some of the light fixtures.
  • Most of the light bulbs needed to be replaced. Of the 42 bulbs in the house, 24 of them were burned out.
  • There were over 200 nail holes in the walls, a hole in one of the doors, and numerous pushpins in the ceilings and walls.
  • The lanai screen needs replacing after someone/something pushed it out of the frame.
  • The screen door from the lanai to the back yard has to be replaced.
  • They painted a bedroom that has to be painted back to its original color.
  • The laminate floor in three different rooms has liquid damage from what appears to be pet urine. I’m not going to replace it now, but reflooring the place will likely cost $6,000 to $7,000.
  • The stove and refrigerator need to be replaced. The glass cooktop on the stove was shattered.

All in all, the damages come to about $20,000. There is no way that I am giving this guy his deposit voluntarily. He is claiming that, since I am doing most of the work myself, I can’t bill him for anything but materials. He claims that since the appliances were more than 5 years old and depreciated, I can’t bill him for that, either.

This is why landlords need to charge so much. This is wiping out a large chunk of the profit from the past four years they were renting from me. This reduces my ROI to about 2.5 percent per year. I would do better putting that money into a high yield CD. The only saving grace here is that the property has increased in value, so when sold I can pull some profit out.

I am seriously thinking about selling now, but the wife likes the passive income and wants to try to find another tenant. So for that reason, I am spending most of my free time getting it ready for the next tenant. Then once that is done, I have to get the other house ready for sale.

For the next couple of months, I don’t have a lot of free time.

This Hit Me in the Feels

I have watched my parents get older, more feeble, and finally die. It’s been two months since Mom passed, and Dad died 19 years ago. Time makes it easier, but it still is a difficult part of growing up that you don’t spend much time thinking about when you are young.

Getting Things In Order

Long day yesterday. I had a Dr appointment, then I had to meet with the cabinets guy to replace the countertops in the rental house. That’s gonna cost me about $3800. Then I had to run to the hardware store and get the stuff to install our water conditioner.

The story there is that I had a slop sink and a water conditioner that I needed to have installed. I called a plumber, who came out and estimated $600 for the sink, and $900 for the water conditioner. WTF.

The sink was easy. It cost be $50 in parts to install this:

The water conditioner was a bit harder, but this is what the completed underground plumbing looks like. Service line through the wall to the water conditioner, then from there back out to the connection that goes to the house.

As you can see, we didn’t finish until 8:30 or so, after it was dark, but we got it done. Like my Dad used to say, you only need to know a few things in order to be a plumber:

  • Hot’s on the left
  • Cold is on the right.
  • Payday is on Friday
  • Shit won’t flow uphill
  • Payday is on Friday

That’s it. The only casualty was the loss of my cordless drill. The gearbox was destroyed because I was too cheap to buy a $200 hammer drill. The drill I broke was 9 years old. I ordered a new one.

Long day yesterday, which is why this is the first post of the day…

Inheritance and Deception

As my readers will recall, my mother passed away a little over a month ago. When we initially went to the funeral home, her husband told us that he didn’t have any money, so my brother and I covered the costs associated with the cremation and other expenses. Over $3000 worth of expenses. At the time we paid, we designated my sister as the point of contact for the family. We paid for the cremation, 4 certified copies of the death certificate, and urns to split the ashes. (The Husband wanted some, my sister did, too. My brother and I didn’t get one, we just got the free container, because it’s our intention to bury Mom’s ashes in the grave that her and Dad already paid for.)

Once that was done, he asked us to provide him with one of the copies of Mom’s death certificate, and he also said that Mom didn’t want to be buried with her late husband (my Dad), but instead wanted to be buried with him (the widower). He asked us for another 10 large to cover the costs associated with a plot for the two of them, again claiming that he was broke. That was one thing that we weren’t going to pay for. Not my responsibility to pay for the burial plot for a man I barely knew.

He and mom were married a little over two years before her death. At that time, mom disposed of most of her stuff somehow, and moved in with him. Mom’s husband asked us to come over to his house and clean out Mom’s belongings. We agreed, because we were trying to find out what happened to a house full of expensive furniture, as well as the whereabouts of 150 thousand dollars in retirement funds.

Mom didn’t leave a will. Or so we thought. While we were cleaning out the detached garage, we found $4000 in cash and a copy of four wills. The first three were from when Dad was still alive. The fourth was interesting- it was less than 10 years old, named my brother as being the executor of the estate, and even though it was from before she remarried, it was the most current will. My sister handed the cash to the husband and his daughter before my brother and I could stop her. As a reader here, you would know that my sister is kind of stupid like that. She is also a Democrat, which explains why she doesn’t understand money, the law, or most other things of practical value.

WE contacted Mom’s stock broker to trace the money. What we didn’t know was that the husband and his daughter had taken Mom’s death certificate and a copy of their marriage license to the bank and had them cut the husband a check for the money. Not only that, but we found out that the husband had given Mom’s car away to his ex-wife. It turns out that the husband and daughter knew where the funds were the entire time, but neglected to tell us. They are deliberately hiding her assets.

When we pointed out that the estate hasn’t closed yet and they couldn’t be spending the money and giving away her possessions because things like funeral expenses needed to be paid from that estate, the daughter said “You aren’t expecting my father to pay for all of those things for your mother, are you? That’s HIS money now, because YOUR mother was planning on using that money to buy my dad a house. Her cremation expenses are your problem.”

My brother is PISSED. So am I. We are now paying an attorney to sue his ass and enforce the will. I don’t care if I don’t get a dime, but that asshole and his greedy twenty something daughter aren’t getting a penny more than the law says that they have to.

Folks- have a will. Keep it current. Don’t make your relatives deal with this sort of bullshit.

People Trying to Help

We closed on the house, which wound up taking all day. The reason it took so long was that the woman at the title company took it upon herself to “correct mistakes” that she thought that she had found in the financing paperwork. This caused a cascade of issues that added four hours to the time needed to close, and required a personal visit from the President of the mortgage broker’s company to fix. As a result of her mistake, it added $200 to the closing costs, which I refused to pay, so the finance company was forced to eat it.

My original plan was to spend a couple of weeks getting the place ready to move in, then we would spend another couple of weeks actually moving. There was a lot that needed to happen before we started moving in. I had to:

  • Change the locks. I don’t care if it’s a brand new house, I always change the locks so I can be sure that I know who has keys to my place.
  • I bought commercial concrete paint and sealant. It takes three days to apply and another three days to cure, but gives you a very professional looking, durable, slip resistant floor that won’t absorb things spilled on it, such as motor oil. It wasn’t cheap. Enough to do a three car garage cost about a thousand bucks. The floor looks great, though. I paid it because you only get one chance to seal a new floor.
  • I had to install four televisions on the wall, six ceiling fans, and replace 12 light fixtures. The light fixtures that came with the house were the cheap ones because I didn’t like the choices that they had, so I bought my own. The lighting looks great.
  • I installed a whole home sound system, the home network, added some power receptacles in the garage where my workbench will be, because I wasn’t willing to pay the $140 per extra outlet that the contractor charges to add them. I added 4 outlets for about $100.
  • I paid movers to move the furniture, and a locksmith specializing in safes moved the gun safe. We moved everything else. The movers took care of every single piece of furniture that my wife didn’t place off limits because the pieces were fragile or very valuable. For example, I have an antique AM radio that uses tubes. It used to belong to my grandfather, and my dad listened to the old radio programs on it as a child. I won’t plug it in, but it looks great in the man cave.

So that was the plan. The plan died when my wife’s family came over to help. They decided to do a lot of stuff while I was working, so it put things into overdrive. We wound up moving the entire household in only 8 days. Now I am sitting in my house, surrounded by dozens of boxes, trying to organize and put things away. I still have to get a plumber to come over and install the water softener, and I will need to spend a couple of weeks getting the old house ready to either rent or sell.

Normal blogging to resume today.

On a side note, my shower in this new house is pure indulgence. Three showerheads, it’s like showering in a car wash.