Happy Birthday, Marines!


I post this every year, and I still enjoy it…
original poster from: stores.ebay.com/WONDERFULART

Happy Birthday to our youngest, latest in a series (and an Aunt!)

Happy Birthday, sweetheart! We wish you all the best.

Here’s a nice throwback birthday post:

We love you a lot! Your life has progressed in the last seven years (see the following post), we’ve been happy to have raised you (so far), and we wish you the best. First year out of the teens. Congrats. Still can’t drink.

Looking at the blog I found this trip down memory lane turned up this ‘gem’ from several years ago:

Today’s the first day of teendom for my littlest girl. She still talks to me, and that’s encouraging, but usually only about horses, or how much she loves horses, or how I should get her a horse.

Tonight we were eating TCBY, and I commented how tall something was. “It’s about 13 hands” was her reply. Horse crazy.

However, no horse this year, and she’s OK with it (though secretly resentful, in the way I still am that I didn’t get either an airplane or a motorcycle for my 13th birthday).

Happy Birthday, sweetheart

Happy Birthday, honey, from all of us. You are loved more than you can know.

It’s also the birthday of one of my Aunts, so Happy Birthday Aunt Sue!

birthday girls

How ER docs actually process what we do

A remarkably good blog post from Seth Treuger ( @MDaware on twitter).

The classic model of history, physical, testing, diagnosis & treatment does not apply to us. I think we do 3 things in emergency medicine:

  1. Resuscitation
  2. Risk stratification
  3. Care coordination

Resus is the fun sexy stuff that we stay up late at night having twitter arguments about. As much as I love ketamine, I can go a number of shifts without using it, and very little of what we do is resus. Most of what we do is risk stratification and care coordination.

Read it. It’s good.


When healthcare is literally legislated

Hint: it’s not good. A terrific article from Weingart and Faust.

If the drafted CMS measure goes into effect, we are hosed. Because data will be collected retrospectively, hundreds of patients will be deemed severe sepsis who were never actually sick.

Government organizations do not invent this stuff. Behind every measure there is, somewhere, a group of physicians that made it happen. Just as medical malpractice would not exist without plaintiff witnesses, these measures would not exist without us. Let’s fight back before it is too late.

Hint: it’s too late. Enjoy the people who wrote the tax code legislating your care.



I’m not a book reviewer but when I read one I want to share I’ll tell you about it. 

This is one for a small audience, those who are space junkies who don’t know a ton about the U.S. Mir space missions. It’s very well written and well sourced, the author having gotten a lot of access to NASA and Mir astronauts  and the myriad people who support them. 

I’m told by a friend who’s briefly mentioned in the book that the author began as a rah-rah angle but soured on NASA and that probably explains the more than warts and all presentation.  It’s not a hatchet job but it’s not a recruiting too either. It reads quickly, and the quirks of astronauts of both countries are very interestingly laid out. 

Oh, did I mention they had both a fire and a rapid decompression while NASA was aboard?

Well written, reads well. Recommended. 


Nursing Homes are restarting the ‘don’t send the MAR’ game

For a primer, from 2007, here.

Another patient, another absent MAR (if you don’t know that acronym, you didn’t read the lead in article!). Usually they send when we call, but not recently. Here’s an amalgamation of some cases:

Calls are made by the nurses at my behest. The MAR Will Not be Sent.

Per nursing, whom I work with daily and trust implicitly, here are the objections proffered:

1) It’s illegal to send our signatures
Really? No, it’s not.

2) It’s our policy not to send MAR’s
Good luck with that policy. It’s going to get you in trouble.

3) You don’t need that.
As it’s a patient who has a) gotten meds from you and b) that timing is a question and c) we don’t know what the timing is, yeah, we and the patient you sent to us need that.

4) We sent you a med list
Yes, you did. That’s a List of Meds, but we don’t know what’s scheduled, PRN, given, held, parameters, etc. That’s a dodge.

Allow me to quote me:

This is outrageous. A chronically ill patient is sent to a higher level of care for an acute problem, and without a complete information base; but not just that, information crucial to the care of the patient that’s being intentionally withheld.

It is a situation that makes me, frankly, nuts. When did intentionally withholding critical patient care information become acceptable? Seriously, have these people not learned from history? The coverup is always, always worse than the crime, and is looked upon less favorably and punished more severely that any original offense. You could ask Nixon, but he’s dead.

Send me all the info you have, and our patient will live or die based on their problem(s); withhold information I need, and it’s on you, Nursing Home nurses.

– See more at: http://gruntdoc.com/2007/06/nursing-home-mars-sent-to-the-ed-with-all-times-removed-a-new-and-horrible-trend.html#sthash.k1mXnxiK.W4zJDG1c.dpuf

And if you’re from the Texas NH Regulatory agency that emailed me after the first posting, please recontact. I’m ready to send you some facility names going forward.