August 11, 2009, 7:49 pm

That Old Mad Season Comes Around

bradyIt’s here!

The pre-season for the NFL starts this week and needless to say, I have my Brady Quinn jersey and my orange and brown pom poms ready to go!  My team resides where my quarterback plays, so right now my team is the Cleveland Browns.

That’s Brady Quinn on the right. That other guy is Derek Anderson, also a quarterback.

I’m sure Derek is really nice and cool and plays a decent game or he wouldn’t be in the NFL, but can I make a teensy-weensy request? Send him somewhere else.

Brady should start for the Browns. ‘Nuff said.



If it’s Tuesday, it must be Grand Rounds, as DrRich at the Covert Rationing Blog takes over hosting honors this week.

It’s another great edition, made even better by DrRich’s unique voice in the commentary!


Here’s a carnival I just rediscovered! SurgXperiences is up at Reflections in a Head Mirror.


It’s that time again.

Time to renegotiate the contract between my hospital and the nurses.

It’s a time of over-the-top threats of take-aways and over-the-top attempts to agitate the nurses.

It’s a contest between good and evil that makes Lord of the Rings look like a segment of Mr. Rogers’ Neighborhood.

It’s a time when the Administration threatens big bad stuff like taking away all funding for the nurses’ PPO health plan and the union counters by sending out an email with the cell phone number of the head negotiator and rallying all the nurses to harass call and make their opinions known.


Now, I’m watching this from the outside in; I’m merely a staff nurse who does not sit at the negotiating table.

And I will say that despite the fact that my union funds are sometimes spent on propositions I do not believe in, candidates I do not support and occasionally actions I do not condone, my working conditions are pretty tolerable (in the ER)  and my paycheck is fantastic. So while I have issues with my union, I have to give credit where it is due.

I actually started to get caught up in the “oh, like hell they are!” mentality.  Adrenaline climbing, “how DARE they!” running through my brain. Hell, there is even a flyer hung in the nurses’ bathroom, three feet in front of the commode exhorting us to come to a “picketing meeting” to discuss the evil Administration!

Then I started to wonder.

Why does it have to be like this?


Why the game playing?

First of all, it’s obvious to anyone who stops to think about it that the administration throws out “No funding for the PPO” type announcements because (a) health care is a hugely emotional topic and (b) it takes the focus off of other things they may not want to talk about, like salaries or work force conditions.

And it sure helps rally the troops from the Union standpoint when they do that! Tally ho! Grab the picket signs! Meet and agitate!


What would happen if the administration came to the table and laid everything out, truthfully and transparently. “Welcome, Union. Here is where we stand financially. Here is where we are hoping to be in 2012. We value our nurses and want to be able to provide the best for them within the budget we have to work with.  What is the best way for us to do that?”

(That sound was 50 union reps having syncopal episodes.)

But it works both ways, too. How about the Union coming to the table in a similar fashion: “Well, Administration, there are certain benefits that our nurses have said are very important to them. We recognize that there are budgetary issues. How can we work together to maintain those benefits within the budget that you have (truthfully and transparently) put before us?”


No, I haven’t been smoking anything.

I’ve worked for hospitals where I was not represented by a union, and they give the very barest minimum they can to keep up with the local unionized hospitals. And I’ve watched Sutter try to decimate the nurses on the other side of the Bay.

So, in the end, I guess it really is all about the Administration wanting to take away everything they possibly can and the union fighting to keep everything we have and add a little more.

Does anyone else find that sad, or is it just me?

August 8, 2009, 11:38 am

A Tail of Health Care…Reformed? puh-lease!

Like the number one reason any woman took Midol was a guy!

We took Midol so our uterus didn’t burst into flames while tearing our guts apart and we didn’t  develop four-plus pitting edema of our earlobes.

This ad is from the ’70s, the era of Women’s Liberation! Who needs a guy – we can take care of ourselves!

I am woman, hear me roar!!!

And had I not taken Midol, you would have heard me.

But it had nothing to do with a dude.

(H/T to Advertising Is Good For You, where I found this ugly guy delightful ad!)


She didn’t eat her dinner Friday night.

By 4: 30 am Saturday, the previously healthy 65-year-old female had a fever and lower extremity weakness. A family member heard her repetitive moaning. The patient got up to void, but could barely negotiate the one step up to the hallway. As she negotiated the hallway, she staggered.

By 5:00 am she was in the ER.


The patient was taken to an exam room. Vital signs were taken and it was noted that the patient’s fever was “extremely high”. The doctor came into the room and the temp was re-taken.  Extremely high.  The patient had no insurance and was not verbal; the doctor discussed options with the family member.

The goal: find the source of the fever and begin treatment. A CBC, Chem 14, a urinalysis, an IV and hydration would be started. No lactate level would be done; the doctor stated it would be pointless to run a test that she already knew would be elevated based on clinical presentation.  Blood cultures would be drawn, but not sent immediately. As the doctor explained, they are expensive and it would take days before the test results would be back.

In this facility, payment was expected at the time of treatment and a detailed estimate was provided to the family. The low end of the estimate was the deposit.


By 8:30 am Saturday, the fever was still raging; the lab tests were normal. The patient was in ice packs with a fan in an attempt to lower the fever. An IV antibiotic was initiated; hydration was on-going. An internist and a neurosurgeon were consulted as the patient was experiencing lower back pain in addition to the profound weakness. The patient was admitted.

Further tests were proposed:  lumbar x-ray to rule out spondylitis and, given the patient’s age, a chest x-ray to rule out occult pneumonia. The pros and cons of each test were fully explained along with rationale and the cost.


The radiographic exams were normal. A loose bowel movement that morning had been blood-tinged. The patient had been medicated for pain. A second antibiotic was started. The next step would be an abdominal ultrasound, as no obvious source for the fever had been found. The rationale for the test and the cost were discussed and the family gave the go-ahead.

The spleen. Enlarged and mottled on ultrasound. A call was made to the family to discuss needle aspiration to rule out lymphoma.


Monday morning the patient’s fever was down. She was eating.  She was voiding. She was still weak, still moved slowly and awkwardly. She would be discharged home on oral antibiotics with the results of her spleen aspirate pending.


It’s been a week now and the patient is acting 100% normally.

The patient was my dog, a 10-year-old, 70 pound Shepherd mix. We still don’t know what nearly killed her last weekend. The spleen aspirate was abnormal, but not lymphoma. The fact that the fever responded to antibiotics (as did the weakness) leaves us with the feeling that it was an infection in such an early stage that the source was not obvious.

I realize veterinary medicine is not human medicine, and a million holes can be found in my attempt to draw a parallel between them. But a few things crossed my mind during this experience:

(a) Tests were not done just for the sake of testing or because a printed standard said they should be. This was not template medicine dictated by any outside organization or government regulations.

(b) The doctor/patient relationship was unencumbered by insurance company approvals, government regulations, billing, coding or the number of patients that had to be seen in a certain time frame.

(c) there was full transparency regarding what each test would cost.

Maybe the human health care system can take a few pointers from what the veterinary world has been doing all along.

(P.S.  I just realized you can read this story from the vantage point of ME being the third-party payer standing between the vet and my dog, deciding what would be “covered”  – i.e. paid for.  Interesting either way….)

August 5, 2009, 12:06 pm

With a Little Help From My Friends

push-lucynurseThe week after BlogHer09 was exhausting.

I had traveled across the country two weekends in a row, and was working 12-hour shifts in-between (and after) to make up the time I had taken off. I was doing some writing and had two articles due on a deadline.

Plus, it was my week to host Grand Rounds. Lots of stuff on my plate and if I wasn’t sleeping or working, I was glued to the computer (not that there is anything wrong with that…).

So on Monday, as I finished Grand Rounds and was ready to hit the sack before working the night shift, I noticed a link had been made to Emergiblog from Grunt Doc. I checked it out and it was a “Happy Blogiversary” note.

Oh geeze – Emergiblog WAS four years old on August 3rd and the date had totally slipped my mind! “Wow!” I thought, along with (a) Grunt Doc keeps track of that stuff? and (b) how nice of him to mention it, I’ll have to leave a comment saying “thanks”.

The next morning I got home and, as is my wont, I hit the computer. The “Google Alert” for Emergiblog was in my mailbox and I opened it. Holy cow! There were a bazillion links! My first thought was “oh geeze, what did I do now?”

Well, they were all “Happy Anniversary” posts (including a video from Mike at Dr. Anonymous and a hilarious post by Dr. Rob!)! I nearly fell over! I guess Shane, official “web guy” of Emergiblog, had mentioned the date to a few bloggers. It was like coming home to a virtual surprise party!

(Confirmation of date confusion: fourth anniversary and the beginning of my fifth year of blogging.)

Many, many thanks to all who posted best wishes! I was touched and had a lump in my throat more than once.

A special thank you to Shane who keeps Emergiblog working smoothly no matter how many widgets I ask him to place (and I’m the queen of widgets!), handles my ads and still answers all my questions after four years running.

It goes without saying that this blog would be a web page in the dark if it were not for the folks who read it, so

For all the support, encouragement, commenting (pro AND con) and reading – thank you!


And now for some fun Emergiblog facts (courtesy of my SiteMeter, you can see it at the bottom): as of today, August 5th, 2009….

Average daily number of visitors: 433

Total visitors over life of blog: 470,516 (some perspective on this: NHS Blog Doctor did 500,000 in six months!)

Number of page views: 1,026,888

Most visits by web page (top three): Crass Pollination, the twitter feed for Bojustbo and Code Blog (thanks, guys! : D You can bet I’m right up there on your reader lists, too!)

Top three search words: “Emergiblog”, “Nurse Jackie” (!), “pain scale 1-10” (I cannot believe “Kasey Kahne” did not make the list…)


Now for just some plain old facts:

My blog fathers: Hugh Hewitt and James Lileks

Number of posts: 805 (whoa, that averages out to .55 posts per day, 16.7 per month, 201 per year!)

Number of comments: 7,068

Number of times comments blocked: once (It was my Nurse Jackie post. I mean, I can only take being called a “turkey-on-a-high-horse” so many times : D)

My first link: Circadiana, by Coturnix (aka Bora!) on August 16th, 2005 to this post (originally posted to my old blogspot site).

Number of lattes consumed during blogging: 4,397,777 (okay, I exaggerate)

Number of times I hosted Grand Rounds: 5 (if I counted correctly, themes have been Wallace and Gromit, the Beatles, Nascar, Starbucks and the Emergency Room)


My totally worst experience blogging EVER: My first Grand Rounds (March of 2006) at the old site (which seems to have not made the transition over to this url). I was almost done. There had to be 70 submissions, at least (I may increase the number every time I tell the story). It was late Monday night.

I lost the post. Suddenly it was gone! It disappeared. Vanished off the face of the internets.

I started again, clicked to save the post and it vanished.

Now I am frantic. One is never late with Grand Rounds. I found out the post was too long for Blogger to handle, but managed to get it up somewhere around 0400 or 0500 that Tuesday morning. (Pic thanks to Rita at Supporting Safer Healthcare! From back in 2006!)

I decided right then and there that I would leave Blogger and get my own domain. I do believe that was when Shane entered the picture and this version of Emergiblog was born after that, with my own domain name and, may god bless, a WordPress format!

And never looked back…..until now.

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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