I worked at a new place. An extra shifts that offered experience, a chance to work with residents and a little money on the side. It's good to work at new places--it stretches me. Two things stand out. First, the tech working the front desk felt sick. He had a fever and some abdominal pain. The PA he was working with chatted with him and it turned out the abdominal pain was right lower quadrant abdominal pain. Hmmmm.... So, labs were drawn and an ultrasound was done (at the desk where this guy was working!) and, Tah-dah!, appendicitis. The surgeon is called, the OR is scheduled, and....this guy keeps working. He stops working when the OR becomes available and at that point he hops into a wheelchair and lets the OR tech wheel him off. How's that for employee of the month! What a work ethic! There's no substitute that sort of personal integrity! I wrote a letter to his boss. Also, had an infuriating encounter with a radiologist. As ER docs we have a certain professional suspicion of Radiologists--their hands are so clean, their hours are so mysterious and flexible, and they have this superbly convenient screen (me) between their decisions and their consequences. So, to continue, I had a preganant woman in a motor vehicle collision. Minor, but she had real back pain and real tenderness. Also pelvic tenderness. I wrestled with the issue of radiation to the fetus and finally committed myself--a chest XRay (shielded), a knee film (shielded) and a head on Lumbar Spine film and Pelvic AP. Shooting radiation right into that baby. It felt creepy, but I had the facts on my side and I knew it. The radiology techs refused to do it. I felt the anger rising inside me (somehow I interpreted their refusal as a slur against my decency and medical judgement). I readied myself to beat on them with the power of my MD and dress them down. But I realized that was inappropriate and shitty. I eased myself down and after agreeing with them that it felt creepy (it did) I said we should go to the radiologist and have her explain the risks and benefits. I was confident I knew the risks and benefits, but thought this was a good way to deal with the potentially combustible situation. So we went to Dr. Sutter and....she didn't know shit. It was as if the idea of a pregnant woman ever needing XRays had never been addressed in the history of medicine. She knew nothing. And she was proud of it. "That's way too much radiation" she said of my plan. What was acceptable, I asked. No idea. Well, how much radiation in each of these studies? No idea. "That's something a phycisist would know." she said. Well, I am a physicist, I have my BA in it and, let me me assure you, physicists don't know shit. They sure as hell don't know ionizing radiation tolerances for 32 week fetuses. You know who does? Competent radiologists. Unfortunately we didn't have one. So, I knew I was right on this one, I got some supporting documentation, and on my authority it was done. Arrrggghhhh! Infuriating. Okay...in other news, told MA about the Biscuit situation. Her advice is no, no, don't propose in the plane. Wait until you land...she'll want to hear what you say. Hmmmm, I'm not sure I have anything clever to say, but there it is. I'm not so foolish to ignore the advice of a good female friend on a matter of such a delicate nature. I'm in count down mode--ask her Mom Thursday and fly out that night (less time for her chatty mom to spill the beans). Or maybe Wednesday....we'll see. U-561