The Girl and the Hot Dog

She came in wearing a baseball cap decorated like a wedding veil. Only two nights of freedom left before she tied the knot. 6 of "the girls" went to a Friday night baseball game -almost the end of the season.

Laughing, cheering her team on, she was excited about her upcoming nuptials. Suddenly, the hot dog was stuck. Right in the middle of her chest. She could feel it. Totally weird, because she could breathe fine. Swig beer. Nothing. Swig beer again only to upchuck without warning. Try as she might, nothing would go down past her manubrium. Her maid of honor, a life guard long ago, decided to try the heimlich manuever. One, two, three, four, five. Nothing, nada, zip.

In the "olden days" some of us would try Nifedipine sublingually. Others tried warm Coca Cola and a few would give them meat tenderizer. Sometimes these worked, sometimes not.

Now, I try Glucagon. Twice. Then I try Nitroglycerine. Nothing, just big headache and now the poor woman can't even take tylenol. "Call GI", my consulting doc advises. "She just needs scoped" he says.

2am. GI doc says "fine, admit her". "I'll see her in the morning".

"Please, can you do it as early as possible". "She is sweet, she is getting married on Sunday, she has good insurance", I beg.

"I'll see her in the morning". Click.

She is sobbing, mascara running down her cheeks. She is getting married in less than 48 hours. No time for an endoscopy on Saturday. " Please, can't you just shove a stick down my throat", she begs.

Hello, Good Buy

I love Target. You can get some cute stuff and good deals there. Target makes my patients appreciate me.

Every night I send Target at least 10 patients who lack health insurance. 300 great drugs I can write for a mere four bucks.

Skip that daily Grande' White Mocha Light Frappuccino just for one day and heal thyself.

All night I write for Triamicinoline, Atenolol, Hctz., Amoxicillin, Doxycycline, and that good old MRSA fighter, Bactrim DS. All night. Just some tried and true generic meds - - ones I know backward and forward.

THEM: Doc, how much will it cost? I don't have insurance.

ME: I told you, I am not a doc. Go to Target. (pronounce "Tar-shay" to elicit a smile) Don't worry, it is only $4 there.

THEM: $4? FOR ONE PILL?

ME: No, all the pills. Just $4. If you go to Target.

THEM: Do I have to say anything? Is there a card I have to show?

ME: Nope, it is for everyone. $4. Go, hurry, before they close.

THEM: Hey, thanks Doc. Thanks a lot.

ME: I told you, I am not a doc. Quit smoking too.

I know, I know, Walmart has the same $4 drug list and in fact Walmart initiated the program. But I don't do Walmart (don't get me started) and I like Target's funky red medication bottles.

So, yeah, I guess I am a Target Whore and I think some of my patients are too. Good buy, Good buy....

IO, IO, Off to work I go...

No veins and circling the drain? Have no fear, a new, improved IO is here.

Use the trusty powerdriver to insert that bad boy right into your leg bone, or even better, your arm bone. Great little tool and just seconds until Grandma has a pathway to her brain and heart.

It will take the RN longer to flush the IV tubing then it does to put one of these little lifesavers in your leg.

Rex and Maude

I transplanted Rex and Maude to bigger pots today. Rex is a 4 foot staggering Dieffenbachia. Maude is a short, stout Prayer plant. Rex has grown against all odds. He nearly died when I inherited him and so I rooted him in a big vase of water. He just shot up as long as I kept Maude nearby. Maude has never really grown. She maintains her own, sometimes nearly dying if I forget to give her water. She is picky, sort of old looking. Not real colorful, sort of dull.

The "Real Rex and Maude" were patients of mine. I met Rex initially in a internal medicine office I worked at. I soon developed a liking to him and began to make house calls nearly weekly to see his reclusive, obstinate, practically deaf wife. Maude had horrible never a smoker COPD in addition to Rheumatoid Arthritis, severe Osteoarthritis with a dowagers hump,anxiety, depression and agoraphobia. Maude was the love of Rex's life. He was tall, regal, handsome even in his 80s, smart and frugal. He would stock up the house with Ben Gay cream when it was on sale because Maude was addicted to it. He had metastatic prostate cancer himself but no chronic diseases like Maude. As the cancer spread into his spine he grew weaker and had to hire home health aids to care for the two of them. Rex's biggest worry was that Maude would be taken care of if he went first.

Rex died first and Maude hung on for another year. She did OK without Rex but you could tell she was hurting. Andre', an only child, would make frequent 5 hour journeys to see her, handling her affairs, making her the exact same dinners Maude herself used to prepare for the family. Andre' still deep in grief over the loss of his beloved of over 30 years.

Andre' gave me the plants ---- cleaning out his parents home - filled to the brim with loving memories and plain old crap. Both plants still alive but hurting, just enduring three deaths in one year.

And today, on this beautiful September afternoon, I promoted the two of them to bigger pots.

Rock on Rex and Maude, rock on!

Duo of Big Lips

Some fat lipped kids showed up tonight --- one charming 9 year old Filipino girl and one sullen, rude 15 year old Latino boy.

Both kids with some awesome Angioedema of the lips. Lips only. Cutie Girl has had it three nights in a row, just at night. She looked like a duckbill platypus, her lips were so big. She kept taking out a pocket mirror and making faces at herself in it. Giving me a very detailed account of the event.

Rude Boy wore a face mask given to him at triage. Mortified to have to take it off in front of his mother and sister - quickly looking at the floor. Happens to him every year when he starts school. Goes away after a few weeks. This time he had enough – he wanted those lips back to normal before morning – his first day of school. This was absolutely uncool for the first day of highschool.

I told him women pay good money for lips like that. He was not amused.

Johnny, I'll miss you

Johnny was well known to me – 51 but looked 75. Had that rough, tough, bad boy look - the kind that mom would have warned you about - aged and hard, but still sort of attractive. A true Marlboro man.

Used to have a decent job, a local school custodian. Somewhere along the line Johnny pretty much lost everything including his family and an ok life. An adult son with some serious mental issues that took a toll on Johnny. He with degenerative disc disease of the spine and a penchant for Vicodin and tobacco.

Johnny was “found down”, brought into the ER intubated. Spent some time in PEA and after taking a needle to the heart was deemed “critical” and waiting in line for his CCU bed but probably brain dead.. Urine tox screen came back positive for meth, cocaine and barbiturates. No Vicodin??? Johnny, what have you done?

You would visit me at the free clinic for your monthly quota of Vicodin. Charming me to convince me how much you needed them for your back. Always a smile, inquire about how I was doing. When I was dealing with a raging lunatic one busy Monday - you came out of your exam room to make sure I was ok. You so gallantly "saved me" when you saw me on the road, walking my bike with a very flat tire in 90 degree heat - givng me a ride to the hospital. I am so sad, I really did like you. I wanted so bad for you to be one of the few that "get better". I will miss you, Johnny.