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reviewing my timesheets and realizing the client has been underpaying me for 3 months.

Reading list

Currently intaking:

The Lexus & the Olive Tree. (T. Friedman)
The World is Flat (T. Friedman)
The New Paradigm (G.Soros)
A Briefer History of Time (S. Hawking)
Getting it Done (R. Fisher)

endless UpToDate articles
AASLD HCV Tx guidelines

Latest tunes:
Linkin Park. New Divide.
Mogwai. Autorock.
Global Deejays. One Night in Bangkok.
Nina Simone w/ Felix da cat. Sinnerman.

Sports:
Monday Night Football. NFL
Thursday Night Football. NCAA
Saturday Football. NCAA
Sunday Football. NFL
NBA preseason.
MLB playoffs.

Food:
PF Chang's
Sesame Chicken
Mongolian Beef
Panda Express
Orange Chicken
Beijing Beef
Ruth's Chris
Filet mignon
Prison Kitchen
Swiss on Sourdough grilled cheese w/ crispy fries

Firsts
Swore about a patient's care.

Uptime: 0400
Downtime: 2000

over & out

NCAA Football

Today was an all college football day. Great games. Thanks to justin.tv I could watch any game in real time for free. While watching I could IM friends thanks to Yahoo mail and e-mail others concurrently. All this while listening to Stephen Hawking's audio book, A Briefer History of Time.

Life is good.

The potential bleed out at work ended up being an error by the nurse making the lab draw Friday afternoon. The patient has a port-a-cath and the nurse sent the first draw to the lab instead of the second. This resulted in my ordering Vitamin K that could have killed the patient. Luckily, it is standard practice to recheck abnormal labs. (And thankfully, the ER nurse completed a physical assessment which she called in as normal without petechaie or ecchymosis.)

My Gators came through and beat LSU much to the dismay of my Cayenne loving friend in the central valley. He may have gotten his Arkansas victory but Beamer at VT chalked up another win. I hope Beamer passes Bowden, that academic cheating supporter. I wonder if the NCAA would accept dementia as an excuse. Or maybe that academic honesty hadn't been invented when Bobby was in school.

The SNL Obama skit about doing nothing was more humorous since he won the Nobel Peace Prize. The humor increased when the Daily Show led with the story that Obama delayed meeting with the Dalai Lama, another Peace Prize winner, in order not to anger the Chinese. I wonder if the Chinese are angered that a Guantanamo maintaining, Afghanistan war escalating, trade protectionist, Olympic bid losing President will meet with the Lama at all. (For the written record, I am pro-Obama.)

Tomorrow I go gun shopping since I can now basically by a firearm the same day.

Pew-pew.

bleeding out

I'm taking call for Friday night for a medical staff member who is deciding whether he has appendicitis or not. Doctors make the worst patients. Instead of going straight to an ER, he is monitoring the evolution of his symptoms over 16 hours. (I've done the same.) For no medical professional wants to be the one to misdiagnose him or herself with the false "hot abdomen." (Needing emergent surgery.) I wonder if bartenders ever avoid drinking in excess in public places to avoid having the server tell them, "Sir, I think you;ve had your limit."

At 0400 I receive a stat lab result, INR 17.
This is one of those "Huh?!" results where one asks the nurse to repeat what she says three times during the conversation.
"Okay, when was his last dose? When and what was his previous INR? And what was that INR today again?"
As if hoping to catch the nurse in misreporting. Wistfully wanting a, "Oh, doctor, I'm sorry. I misread the lab. His PT was 17!"

A PT of 17 needs more coumadin. An INR of 17 needs less.

I've been thinking of getting an online fax service so the nurses can fax me the reports so I can see them myself. (How untrusting you may think.)
That's what I'm thinking, "How untrusting."

This early call better not interfere with my early Panda Express run.

transpo

So after getting up at 0030 to drive O to prison, I slept in and was able to awaken to the sun rising over the mountains...

I arrive at work and have an e-mail waiting from O's Iphone...

The initial plan called for O to accompany an oxygen dependent inmate on a 14 hour transport...

The transport ended up being for two inmates, the original to the south and a psych/crazy inmate to midstate...

Each transport vehicle only has two cells...

O rode with the psych inmate in the middle.

He said fought to stay awake all morning...

not wanting to fall asleep locked in a cage with a Level 4 psych patient.

also...

there were no bathroom breaks for the entire trip.

So 14 hours later, the officers dismount the vehicle and go back and unlock his cage...

allowing him out to see his wife, who is the Chief Medical Officer.

He earned 3 thousand dollars.

Which he is going to spend on his mother-in-law.

Who forgot to pay her electric bill and had her power shut off.

PG&E came to the home but the electric box was very old and rusty.

The utility men stated it would need to be replaced before they could turn the power back on.

Estimated cost: 3,000 dollars.

Biggest fear on the trip:

(that we all shared at work)

There would be a car accident where the officers would be knocked out and the responding law enforcement would think O an inmate.

And he would be hauled of to jail for processing.

With the other inmates who know he's staff.

His ass would be worth a pack of cigarettes exchanged in under 5 minutes.

Chase Car

Today I receive the call from admin asking if I would be willing to follow a colleague to the airport to drop of his rental and drive him back to work. I would be paid full pay for the drive time.

The state is transferring a patient 14 hours away. The patient uses oxygen and would need an ambulance with paramedics to transport. This is expensive, so the state realized a normal transportation vehicle could be used if a medical provider traveled along.

So I followed the provider to the airport, we went to PF Changs and returned back all on the state's dime. This saved the state around 10,000 dollars. That's a win-win.

new hire

so i was invited back 0800 Friday am.
my lay-off lasted < 20h

now back on call until tuesday.

You've been terminated

Received the call to stop seeing patients today around 1200.
The Chief Medical Officer called to say she wasn't sure she could keep paying the registry staff and we were to stop providing care.
So tonight I'm packing up and going to do a little road trip.
Been wanting to travel.