Thursday, August 29, 2002.
Watching: K-pop
singer Jini (a.k.a Theresa, not the blonde)
on the Video
Music Awards tonight. Yeah, you heard me.
K-POP SINGER. (link from Dave)
Inevitability Index: 57 dead (at least).
WEST
NILE STORY
A Saturday afternoon not too long ago, in the ER.
ER DOC: "Forty-four years old. Worst headache of her life. Fever. Vomiting. Looks like meningitis. I doubt it's West Nile but you never know."
ME: "Sounds interesting."
I'm lying. Nothing "sounds interesting" at work on a Saturday or Sunday.
Later, with the husband and his wife, the patient.
HUSBAND: "Are you a doctor in training?"
ME: "I'm done with my training. I'm one of the doctors who trains the doctors in training."
HUSBAND: "Oh, sorry."
ME: "Don't worry about it. (To wife) You've got meningitis."
WIFE / PATIENT: "Ahhh… BLURGHGGHGHGhghghrgrghh…."
ME: "Let me get your nurse."
ME: "I know you're worried about West Nile virus. We're sending tests, but we really don't think you have it. We're going to treat you for everything, regardless."
HUSBAND: "What if it is that virus?"
ME: "It doesn't have a specific treatment. We just watch her until she gets better ...."
I leave out the "or worse" part.
ME: "Do you think she has West Nile?"
INFECTIOUS DISEASE DOC: "I doubt it. But the fluid test results are screwed up because of the antibiotics she got before coming to the hospital."
There's always something that screws up everything else in Medicine. Almost always. It's uncanny.
A couple days later,
PATIENT'S MOM: "Why is she still vomiting, doctor?"ME: "Well, it could be the infection still, but she should be getting better by now. It could be the antibiotics that are making her sick. Or the narcotics we're giving for the headache. There's not much more we can do right now. Do you have any other questions?"
PATIENT / WIFE: "Blgrhghrghhrghh…."
I tap the nurse button. That wasn't a question.
HUSBAND: "Have the virus tests come back yet?"ME: "Not yet. We had to send it to an outside lab. They're being flooded. You'll probably be home before we get the results back. Because of the antibiotics she got at home, we might never know what caused the infection. We're treating everything we can anyways."
At least I'm honest.
ME: "How are you feeling?"PATIENT / WIFE: "Better … blghrghr…."
Tap. Tap. Tap.
After a week of much illness and nurse-button tapping, she finally got better and went home.
The next day,
ME (answering a page): "Scott. Paged."
Years of answering pages all day have reduced my phone greetings to all but the most essential syllables when I answer a page.
PHONE: "Hi, Dr. Scott. This is The Lab. Your patient, Alma Achinghead's tests came back positive for West Nile virus."
ME: "…. Really? Am I supposed to call the NIH or CDC or something?"
PHONE: "No, hahaha, they already know."
*insert X-Files music here*
INFECTIOUS DISEASE DOC: "Yeah, we called her. That's what we suspected…."
(Suspected my ass. Save it for your American Co11ege of Physicians poster, haha.)
INFECTIOUS DISEASE DOC: "… After her case, we've been inundated with a dozen West Nile confirmed cases at this hospital alone. She's one of the first few cases in Michigan."
I guess I was wrong before about not knowing any famous people. First the Stanley Cup passes within my disinterested grasp and now this - one of the first cases in Michigan. I've already heard the news anchors talking about it with a gleam in their eye. Kidnapped baby stories are getting old.
Oh, and Crazy Creepy Guy was in the newspaper the day after I posted my entry about him. The newspaper article gave a lot more information about him than I did in my entry. They actually used the word "horror" to describe the whole thing. I didn't have to.
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Some West Nile info: Usually, posting public service announcements bores the hell out of me. I mean, I could post a public service announcement every hour of every fucking day until it killed me. Then I'd be able to post a public service announcement stating that posting too many public service announcements at one time can kill you.
Anyways, West Nile virus comes from mosquitoes (who get it from birds, the dead bird sign). Mosquitoes give it to people. People cannot give it to people. You are not contagious to your granny or your baby or anyone.
How do you know you have it? Well, you can't know for sure, really. But the symptoms are the same as most viral mengitis or encephalitis pictures -- unrelenting headache, often worse with standing up; confusion; nausea/vomiting; oftentimes a brief rash initially; body aches. Younger people tend to get over it or never know they had it. Older people (>70 years) and people with major medical illnesses are most at risk of dying. There's no real treatment other than 'supportive management' which means watching you and giving pain or nausea meds and I.V. fluids or possibly ventilatory support. How to avoid it? Stay away from mosquitoes or use repellent.
The Center of Disease Control lowdown is here.
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YOU KNOW YOU'RE A REDNECK WHEN ...
I actually have a patient who took Valium and Methadone at once (and he was not trying to kill himself by the way) and then fell asleep in his pickup truck. For over twenty-four hours.
He's been in the hospital for over a month now with a huge gangrenous infected ulcer in the middle of his ass that literally stenched up the entire room, and was tracking up underneath the skin of his back.
He's a fairly young and nice guy. But after the surgical excisions he's had, you can literally rest a basketball into the crater where his buttock crease use to be.
MR. CRATER ASS: "The older surgeon said it was the worse case of gangrene he'd ever seen."
WOUND SURGEON: "That's ... not good."
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LIKE KIM BASINGER IN BATMAN. NOT.
When you are morbidly obesely huge, imaging your internal organs becomes a problem. The x-rays look all white and hazy from so much flesh density. Ultrasounds just can't see through that much fat. CTs and MRIs often have a 300 pound limit.
Ms. Pannus was so huge that her belly literally covered the amputated stump of a leg we were trying to look at. We couldn't move her or her belly, in fact, because she was quite short and very weak.
ME: "How much do you weigh? We need to know for the CT scan."
MS. PANNUS: "Two fifty eight."
ME: "Are you sure? You look like you weigh more than --"
NURSE: "Kilograms."
ME: "Oh. Cancel the CT scan."
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HABITS I'VE PICKED UP BEING A HOSPITAL DOCTOR
1. Answering the phone as "Scott. Paged." Even when I wasn't. Even if I called first. Even outside the hospital.
2. Writing an indecipherable signature, often with my legible 4-digit pager number after it. Outside the hospital.
3. An inescapable need to be doing something else while on the phone like paging someone else, or looking up test results or writing a note.
4. I look for a nurse-call light whenever ... The LIGER! throws up. (I end up cleaning it myself of course. Someone actually thought ... The LIGER! was our baby! It's our cat!)
5. Greeting elderly people by feeling their pulse and checking their ankles for swelling. (I actually did this when I met my Corean granny. She looked so frail, I wanted to make sure she wasn't in congestive heart failure or something.)
6. Identifying people at bars who have clear signs of cirrhosis and probably less than six months to live. I've seen two so far. (We don't go to bars but some of the cheaper restaurant/bars we've been to have them.)
7. Occasionally looking at my stool to see if it is "black and tarry" or "bright red and bloody." (It hasn't been.)
8. Using the word "stool" or "BM" when most people say "poop", "poo", "crap," or "shit."
9. Always looking at my urine color to determine if I am tanked with enough fluids or a little dry.
10. Removing my wedding ring whenever people aren't around due to a fear that I will become bloated and comatose and have to get either my ring or my finger sawed off while I am paralyzed on a ventilator in the ICU. (Happens more than you want to know.)
11. Poking Amy in the ass when she's not looking. Oh wait. I don't do that because I'm a doctor. I do that because I'm Corean.
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DESTROY ALL MONSTERS!
China has created the ultimate arch-nemesis to our Corean feline hero known only as ... The LIGER!
They call it ... The TIGON!!
They talk about ... The TIGON!! and ... The LIGER! here. And you probably thought I was making up the word "liger" all this time.
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