Me

Six Courses

My wife and I have been together for a decade. She decided to take us to dinner as a celebration. We went to a six course meal, which I had never done before. The meal was prix fixe, and consisted of six courses, each paired with a wine selection by a professional sommelier. Each course was small, which was a good thing, since there were six of them.

We arrived at the appointed time and were served a welcome cocktail while we waited for the other diners. The cocktail was simple syrup, mint leaves, and champagne. It was intended to be a light, refreshing palate cleanser.

We sat down at the appointed time and were served our first course. It was the appetizer course. Scallop Carpaccio paired with an Italian Pinot Grigio. The scallops were sliced thinner than a sheet of paper. It was fairly good. This is the plate:

The soup course was second, and it was a Smoked Tomato Soup that had been cooked for six hours. It was paired with a white wine from Napa Valley that was pretty good.

The third course was the salad course. It was made from butter poached lobster, hearts of palm, pineapples, and cilantro with a vanilla dressing. The wine pairing was a Sauvignon Blanc from New Zealand.

The fourth course was the fish course. It was a roasted branzino with zucchini, peppers, lemon, and a pesto. It was hands down the tastiest course of the night. If it had not been such a fancy restaurant, I would have been tempted to lick the plate. This course was paired with a Chardonnay from California.

The fifth course was the beef course. A grilled filet mignon with truffled potato puree, asparagus, and bordelaise sauce. It was delicious, but I have to admit that I was getting pretty full at this point. This course was paired with a Cabernet from Napa Valley.

The last (dessert) course was a chocolate sphere that they poured hot caramel over, revealing a peanut butter ganache, chocolate mousse, and a caramel gelato. It was good, but I was so full at this point, I only ate about a third of the dessert. It was paired with a Salted Caramel Espresso Martini. The martini was so good that I had two of them.

The meal was superb, but I have to admit that I ate so much that I didn’t eat at all the following day. I had two of the martinis, and that turned out to be a mistake. First, there was so much alcohol served with this meal, that I was pretty drunk after the three hour dinner experience. Second, I woke up in the middle of the night to pee, and my heart was racing at about 120 beats per minute. I am guessing the espresso had something to do with it.

We had a great night, and this meal was an appropriate celebration of ten years together.

By Divemedic, ago

Finally Rented

It took 5 weeks to get my rental home repaired from the damage done by the previous tenants. The total repair bill came to over $9,000, and I still need to replace the flooring in the entire house because their dog ruined it in spots by peeing on it.

Anyhow, we listed it 28 days ago, and our new tenants signed the lease to move in soon. That’s one project off my plate.

Now I have to work on selling our old house. It’s always something, and I am always busy.

By Divemedic, ago

At Work

At work this week, a couple of noteworthy patients.

The first was a woman who brought in her year old baby because the baby had a purple spot on her tongue and about a dozen red spots on her body, just isolated 1mm red dots. The baby’s tongue looked just like this:

This is called purpura, and the ones on the skin are called petechiae. It can be genetic, or can be triggered by a virus that causes the immune system to misbehave and attack the patient’s blood. So I went to go tell the doctor, who ordered a blood test. Sure enough, the baby’s platelet count was 3,000. It should be between 150,000 to 450,000.

The disease is called thrombocytopenia. It can be caused by a number of different things, this will require more testing. No matter what, it isn’t going to be good news. We transferred the baby to a children’s hospital.

The second one was a fine example of how people abuse the system. A woman came in telling me that she had called in sick to work so her and her boyfriend could spend the day smoking weed. She had no medical complaints, but wanted a doctor’s note for work so she wouldn’t get fired for calling in again.

We ( the nurses and doctors) were offended, but the doctor wrote her note. Why? Because payment rates for the hospital for all patients are set by satisfaction scores, according to Obamacare.

On the business front, we began showing the rental finally. There have been two people by to look at it, but no one has put in an application yet.

By Divemedic, ago

Blame the IRS

Posting is delayed this morning because I am in the middle of doing my least favorite chore of the year- closing the books on 2023, and preparing my taxes.

Feel free to curse the IRS during this most difficult time.

By Divemedic, ago

Why I am tired

Got to work, got my room assignment. took report, and all three of my patients seemed easy. After an hour of just sitting there, watching patients who were not really any trouble, I started thinking that I was going to have an easy shift for a change.

I was wrong.

I discharged a patient and wheeled her to the front door. When I returned to my little slice of the ED, there was an EMS crew waiting there for me with a patient. They told me he was normally on oxygen at home, and was coming in because it was taking more effort than usual to breathe. They hadn’t bothered to try for an IV, because they didn’t think it was needed. On 6 liters, his SpO2 was 88%. It got worse from there. So I called a respiratory alert. The respiratory therapist was busy, so never came. The doctor decided that the man was septic and ordered antibiotics. I gave them and went next door to the next patient.

I heard yelling and went back to see what the problem was. The patient was having an anaphylactic reaction to the antibiotics. Yep, turns out that he had an allergy that he didn’t know about. I had to do an emergency override for Epinephrine, steroids, and Benadryl. That was when the patient next door decided to desaturate. Then I had another EMS truck come in with a cardiac emergency. In the middle of that, the charge nurse came in and told me that I was getting a fourth patient.

All while the joint commission was there.

Fourteen straight hours of that. So that’s why I didn’t want to post yesterday.

By Divemedic, ago

No Plans

I worked last night and it was quite a busy night. For those of you who are in health care, you will understand- the Joint Commission was in the hospital yesterday, which means that the administrators were everywhere, getting the vapors and micromanaging everything. On top of it, we had an unusually busy night.

So the tank is a bit depleted right now.

By Divemedic, ago

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.

By Divemedic, ago

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.

By Divemedic, ago

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.

By Divemedic, ago