Ahhhh, at last. I started this blog back in September of 05. Back when I was a young, handsome, single resident living the good life in Seal Beach. I let the blog slip, but over time I've found myself thinking fondly of it. So, I just completed transferring and updating all the posts.....and this is my first post of a new era. The intervening un-blogged months have been good to me. Of greatest note: I have a baby. And another on the way. i won't write much, now, but will include this little work exploit. At 0430 I was kind of loafing my way through a Sunday night shift. All of a sudden someone yells from the ambulance ramp "We need help! She's having a baby!". Well...usually this is bogus, a 20 weeker who is having some Braxton-Hicks contractions or whose water broke, etc. But, better safe than sorry, so I grab my goggles and a pair of gloves and jog outside. Ominously, there is a Plymouth parked out in front of the ED with a pair of legs sticking out the passenger door. Hmmmmm....I yell things about gurneys and calling L&D and run over to the car. There is a (surprise) young Hispanic girl laying across bench seats moaning and kind of weakly pulling at her pants and panties. On her face is a wan look of distress and between her legs if a round hairy crown of baby head. Ah-ha. This one probably isn't bogus. I'm no doctor, but this is probably the sort of thing that can't be blessed, tossed on a gurney and sent to L&D. I think "Well, I'd better deliver this baby," and I say "We're going to deliver this baby"--really more to convince myself than to impart any important information to the team around me who have already figured it out. I whip her pants off, kneel down between her legs, and realize that the front seat of a Plymouth, at 0430, between a woman's legs it is a dark, dark place. (Travis--I assume you already knew this....) One of the techs has enough good sense to flag down the next car that is driving into the ER lot and wave them over to shine their headlights on me and the "field". She's at eight months and obviously ready to go, so I put a hand on the baby's head and ask her to "empuje". The head eases out and a jet of fluid splashes all over my pants. I put my hand down to feel the little guys face and slide a finger around the neck to (not) feel a nuchal cord. So far so good. A couple more pushes and the shoulders are out and then the little guy slips on out and into my arms. I think "Don't drop the baby, don't drop the baby, don't drop the baby, don't drop the baby....." I flip the kid around, the tech who had the presence of mind to arrange my light also suctions the kid's nose and mouth, and then with a little stimulation the kid starts to cry pretty robustly. We dry him, put him on mom's chest, and I clamp and cut the cord. The little guy is fine except--horrifiyingly--appears to be missing his penis! Kid goes into the ER on the gurney to be resuc'd and mom goes in on the next gurney with a cord and clamp still dangling between her legs. I check on the kid and she looks pretty damn good--pink, breathing well, with a kind of philosophical look on her face. Thoughfully, I've left her a good eight inches of umbilical cord. Mom is also fine, but very tired. L&D comes down and they say: a) Hey, nice work! This must have been pretty hairy out there... b) Great work. Mom looks good, baby looks good. Perfect score. or....c) What were the APGARs? What you don't have a one minute APGAR?! Sheesh.....mumble mumble mumble "ED Doc" mumble mumble "incompetent" mumble mumble "eight inches of cord" mumble mumble muble, etc. What was the one minute APGAR?! Are you fucking kidding me? How 'bout I stick this clamp up your ass, lady? So I thought the mom might ask me to help name the baby--I would have chosen "Misty"--but instead she went with Dessiray Miracle Angel Jimenez, which would have been my second choice. I billed for 35 minutes of Critical Care time. Though of course that is fraud because the patient wasn't in the ED for 35 minutes and really I can only bill a level 3 (for $45 of Medi-Cal "reimbursement") since I was deficient on my history and physical. Rest of the shift was very anticlimactic and I got out on time.

Sunday, July 02, 2006 Lately I've been feeling like a real ER doctor. I've had a few good days in a row. A couple of days ago at the D I had a nice CVA. The guy came in 1 hour after the onset of symptoms. I bullied the CT tech into doing a STAT CT Head and pushed this guy hard. The highlight of it all came when we hijacked a critical care team en route to the ICU and forced them to take our biy instead. The guy had a huge bleed and was way, way, way not a TPA candidate. I called the local community hospital and expedited the shit out of him. This guy came in, was worked up and was on his way out in 1:45--that's some good fucking Emergency Medicine. It felt good and I let the nurses know that I was ready to put my wallet where my orders were (forgive the incredibly awkward phrasing) and buy the department some pizza or Starbuucks, whichever they preferred. And today I was CPR boy. We had a lady come in in full arrest. She got coded up and somehow we pulled her back and saved her for a agonizing family agony-fest that resulted ij her husband kissing her good-bye and telling me to stop the pressors and let her die. In the meantime I got called to the floor and ran a code up there. Holy shit. Floor nursing is the biggest scam in medicine. These people are idiots and thanks to the beauty of the nurses union they make the same miney that actual real honest to God competent nurses make. Running a code with these idiots was unbelievable. I would have been better off with a troop of high achieving cub scouts. I kept on telling myself "Stay calm, be polite. Stay calm, be polite. Stay calm, be polite...." Somehow, even with Strike Force Idiot on my side we pulled the guy back. The med students were impressed. I was reminded of the time when I was awed by this stuff. When reaching into death and pulling people back made me wax philosophical and (honestly) stand in awe at the momentousness of it all. Now the wonder of it all is gone--I run the codes and sometimes they live and sometimes they die. I fill out the billing form and go on. I got an email from my Bro. He nailed the F'ing LSAT! 99%! How's that for some strong fucking work! Good to have a lawyer on team 561. Strong work, Bro. Strong work. U-561