Thursday, July 10, 2008

This Star

Curieux, n'est-ce pas? What serendipity to check in at PostSecret, and find this -- by which I mean that the extraordinary challenges faced by workers in the field of emergency medicine seem lately to have found a widespread expression. Be it in the form of this anonymous postcard, be it in the form of a seemingly hateful rant in the blog of a caring EMT, nurse, doctor...
I cannot let my mind go, cannot let my mind's eye imagine what she has seen.
What are the things that one sees in the course of the practice of these professions that shake even a firm faith? Can you tell me? I would like to know, and promise simply to receive the information.
Obviously, my experience only comes from the intersection of my personal emergency with the health care system, and it travels the continuum from near sainted people who did nothing less than save my life to people who delighted in causing me pain. Emergency medicine is far from the sole field in which human nature is so exposed -- raw in its depravity, surprising in its splendor -- but its practitioners seem to feel proprietary, and cling to the resulting pain and awe as their own peculiar reward, or punishment.
It's almost an impossible conversation to have but God bless them for their willingness to try, to begin, and to muck around in the mud trying to translate it all for the rest of us.
Much easier, I know, to interpret an EKG or tally the I & O, bust a clot, stabilize a blood pressure, usher lives in, guide them out...

Wednesday, July 9, 2008

Emergency Department Blogging

After an arduous day. La Belle Bianca is enfin abed. Il est à souhaiter qu'elle y reste, *silente*.

Now, with my cup of tea -- in mismatched, crackly-glazed bone china -- I am ready to face this expanse of white, thinking it cool, thinking it calm, thinking it the balm my body needs. What a foolish person (though I do like my pluck).

At issue are my reading habits: The list of tangential blogs and websites to the left of the page needs judicious editing.

I enjoy reading medical blogs -- the snarkiest and most amusing tend to be derivative (HIPAA, huzzah! HIPAA, huzzah!) of experiences in emergency medicine. The bloggers are, for the most part, terrific story tellers, with a few not-so-talented moralists interspersed for local color.

Ach! A bump in the writerly road. I am, essentially, free associating and have been brought up short by my use of the term "local color." It's not a term that I groom and keep ready on my short list of lit crit terms.

That's my field, you see, kind reader: literary criticism and the sacrifice of said organizing principle to the development of superior critical thinking skills in the 18-24 year old population of francophones within a given academic enclave. Rarefied air? Cannot get your breath? Run along to the Emergency Department -- they will take care of you!

Local color can also known as regionalism -- and is most often, these days, code for Southern
Antebellum Literature (SAL), most often code for a not-so-secret smugness in which to dress up racism, classism (all yer basic -jizms). A world apart is the later movement of the early 20th century that hoped to shore up the notion of a core, almost antediluvian (way before -bellum, even), southern identity -- a unifying movement toward definition as straightforward as movements come. Still, there's an undeniable desire within the region's -izm for goshawks -- for falconry, filial crests, and the Old World tapestry of heraldry in general.

It's all about words, and how you use them, the dialect you adopt, the dialectic that ensues.

These incredibly fascinating blogs relating to the world of emergency medicine? They are couched in extremes of local color and regionalism.

The blogosphere: "It is the perception that blogs exist together as a connected community (or as a collection of connected communities) or as a social network."

Local color. Secret code, paternalistic assumption over the power of dialect. There are moments, even, of affected "Ebonic" dialect, a whole new venue for shucking and jiving. There are many approximations as to what the Undeserving are Entitled.

Regionalism. The assertion of a special geography, say? Local color may stand alone, indeed, and demand special attention, determined to stand out. But the regionalism of these medical blogs arises from several generally unacknowledged peculiarities and disparities that mark the ED as a very different locus in the medical sphere. Perhaps a free-standing building, perhaps connected to a main hospital by tunnels; Perhaps, a vital, irreplaceable buffer between outside (health management) insanity and the inner torpor of the hospital ward. The general presumption that the patient not perfectly defined by an established clinical picture (trauma, a surgical abdomen, a classic MI) is likely from the dregs, a despised bottom feeder -- either seeking drugs, a free visit, sympathy, or some other gain -- all this unwieldy presumption makes for easy derision, a quick shift into high-handed morality and a degradation of dialect.

But how do I expect medical professionals to perform under the many pressures of insufficient means (of space, hands), misuse, abuse, fated failures? (How dare I have any expectation of them at all is probably the better question! Easy, mes chers, I have come to like your writing and all that shines through.)

And now I find that I don't want links to some of these blogs to originate from my blog -- the seething resentment and anger being that bothersome. In a highly scientific crap shoot, I read 10 entries "at random" from ED-based blogs linked here, as well as those in my private Favorite's List, and each time easily found the rancor to which I am referring.

They've every right and cause for rancor! I want to assert that their life-saving work, filled as it is with perversion of their good intent, ought to allow for almost any expressions of frustration -- because I believe that I do GET IT.

I want to assert that, because as I said, I get it, but I can't. It is not about getting their pain, understanding their problems.

No, ultimately we are each stripped of out local ism, our local color, our regionalism, and asked only to be good and fair companions of the road.

Right now, these blogs are fascinating, in and of themselves, as small ecologies of inbred, insular, jealous, and competitive communities.

Enrico over at Mexico Medical Student put up a post entitled EM Blogger "Hate": Nature or Nurture that I found a rational, reasoned, and calm assessment of the increasingly disturbing dispositions coming out of Emergency Departments. Enrico opens with a reference to a post by Sid Schwab:

<<Sid Schwab posted an entry the other day about EM blogs (I’m including nurses in what I write here) and their penchant for not only being right-of-center politically, but “vitriolic." [....]

EM has been corrupted by being made into the PCP of the disenfranchised and uneducated, as well as the pressure valve for inpatient floor inefficiency as admitted patients crowd the ED, further straining things. I get it.>>

He gets it, too. Really, you'd have to be fairly thick not to... so why the overt resentment, meanness, anger? Have a read, and see if these two gents don't do a fine job of teasing out the reasons.

And I will wait to cull the URLs à gauche.

Grosses bises!

Tuesday, July 8, 2008

Bianca Bites the Big One

Sacré bordel! Holy whorehouse!

The medical saga continues. I saw my most excellent doctor last Tuesday, and it so happens that I was having one of my "bad" days. It turns out that this was a fortuitous encounter, as my bloodwork has returned showing signs of major infection, and the rather generalized aches and pains and fevers that I had been dealing with became more focused. Stress-dose steroids can mask infections, so I had been admonished to keep an eye out for just such an occurence.

Et ainsi de suite... et puis... yadda!

Yesterday, when all of this ought to have been reported and plans made -- my chart was misplaced.


So I am out the door with the Fredster -- Bianca is threatening to belt out show tunes; She cannot handle the stress of probable hospitalizations. We are ruling out an infected prosthesis -- one of my three artificial joints.

I am febrile, exhausted, sweating, tachycardic, and in severe pain.

Would I even *consider* presenting to the Emergency Room? No way in hell. So I hope there are no more snafus with charts and telephone calls.

X-rays and a bone scan, although no one is heeding me -- a bone scan is a ridiculous idea that will supply no useful, specific information. I light up like a Christmas tree, just on principle.

Please think a good thought.


Sunday, July 6, 2008

Forrest Griffin, Champ!

Oh, Happy Day!

As I sit propped up in bed, watching Nadal take the first set of the Wimbledon (or, in these parts: "Wimpleton") final, I rejoice in other sporting news.

[....Last night], at the sold out Mandalay Bay Events Center, [Forrest] Griffin took all the ‘buts’ out of the equation, overturning the odds and pounding out a thrilling unanimous five round decision win over Jackson to win the 205-pound world championship and etch his name in the history books.

“This is the greatest night of my life,” said Griffin, the first winner of The Ultimate Fighter reality show and now the second TUF winner to earn a world title, following former welterweight boss Matt Serra. “I want to thank Quinton Jackson. It was close and I think we’re gonna have to do it again.”

“He whupped my ass,” said a gracious Jackson. “Sometimes you win, sometimes you lose. He deserves it.”

Scores were 48-46 twice and 49-46 for Griffin who engaged in the front runner for 2008 Fight of The Year with Jackson.

And this one will be tough to top.

Griffin took the fight to the champion immediately, working behind his jab and some quick kicks to the head and legs. The challenger’s hand speed was impressive early, catching Jackson off guard. When the two would exchange at close range though, Jackson was in his element and he was able to land with more consistency, and with under three minutes left he was able to jar Griffin briefly with a left hook. The challenger recovered quickly and flurried back, but a right uppercut by Jackson with a little over a minute left dropped Griffin. Jackson pounced on his foe, but Griffin got his wits back and fought his way back up, where he continued to move forward and engage until the bell rang.

Continuing to be the aggressor, Griffin opened the second with more leg kicks, this time buckling Jackson’s left leg.

“He jacked my leg up,” said Jackson. “I’m not that good at acting. He knew he hurt me.”

As the champion staggered backward, Griffin moved in, clinching and landing knees at close range before trying to sink in a guillotine. Jackson escaped that trouble but wound up in more as the bout subsequently moved to the mat, with Griffin working for submissions and grounding and pounding Jackson steadily for the remainder of the round....

* * *

All day long I had been a regular fussbudget, worrying about poor Forrest getting beat to a pulp, a real bloody mess, by Quentin Rampage Jackson.

All of that scar tissue on his face, just waiting for an evil elbow, or the well-placed glancing blow off that beautiful brow.

Fred, however, was optimistic, reminding me that Forrest was developing a ground game, that he knew how to move out of range, that he was, in essence, "a big boy now." Harrumph. Fred has the most annoying habit of being right. Plus his Muay Thai is very sharp, and he keeps getting me in a clinch. Giggle. Imposing his will, as it were. Swoon.

Bianca Castafiore sat ogling various MMA fighters and their respective torsos. She was whistling, in the bright annoying way that a tea kettle whistles. "I wish everyone looked as good as Georges St.-Pierre in his tighty-whities," she yelled. Bianca always yells.

I whipped out a few spare rosaries and hailed Mary like a maniac. Despite my fame as a former international Vale Tudo champion, there's not much that still goes anymore. Hence, religion.

Marmy bowed her furry head, swished her bushy tail, cried "Ack! Ack!" and did her best imitation of Tank Abbott.

Sam-I-Am, just back from a stint at the Gracie Jiu-Jitsu Academy in Rio de Janeiro, fell asleep on his back, legs splayed, guard wide open.

Dobby, my little idiot, took his usual over-the-top approach, trying to slap a flying arm bar on the increasingly distracted Bianca. She was, by then, rocking back and forth, murmuring, singing, and it wasn't that damned Jewelry Aria, either. At least, not entirely. She can't help herself.

"Booooom! Bonjour, mon cher! O là là! You’re gonna get pinned.
Booooom! Voici un joli air! You’re gonna get knocked out.
You’re gonna feel it -- this is the ultimate -- moi! moi! moi!
Si belle... dans ce miroir!"

* * *
There is no substitute,
for the ultimate is what's in store.
Bear witness to the fitness
of the modern warrior!
And they go boom --
another hit is landing --
Boom another hit is landing --
There's nothing to stop
but the strike of a viper.
They're training to challenge
the ultimate fighter.
You're gonna get hit.
You're gonna get knocked out.
You're gonna feel it.
This is the ultimate...
* * *

Way to go, Forrest! Congratulations, Champ!

Much Love,
The Retired Educator
Bianca Castafiore
and The Felines