An EarWorm 4 U

Ghost Tour

I recently watched an interview with Tom Underwood, who shot one of the most compelling videos ever of a residual haunting. I've seen this footage many times, but actually seeing and hearing from the man that shot it, really added to its credibility.

The filming took place just before dusk in October of 2001 on Triangular Field in the Gettysburg National Military Park. According to Mr. Underwood, he and his wife, Delia noticed unusually bright flashes of light in the forest that could not be explained by either fireflies or motorized vehicles. Tom set up his video camera and the rest is ghostie history.



Ghost Theory.com has a brief, unedited interview with Delia Underwood here.

As an added bonus, here's Keyboard Cat Does The Shining...



Click on the label "ghost tour" for all of my ghostie posts and check out Chattering Irma and the Ghost of Mr. H. for my, so far, one and only hospice ghost experience.

TwitterLadies and Introspection

I'm every bit the failure at social networking on the internet as I am in real life. I've no MySpace, no Facebook and I have no idea how to make Twitter "work for me". I played around on Blog Catalog for a while, had a little fun, got bored and left.

There are, however, a few diehards that, in spite of my anti-social behavior, persist in trying to get my attention. That would be the naughty ladies of Twitter (not sure how long that link will remain viable) and those that would like to assist me in the task of enlarging my penis. While flattered by your attention and impressed by your tenacity, I'm afraid that you're all barking up the wrong demographic.

I will admit to having had an enormous "girl crush" on Diana Rigg during her stint on The Avengers. Well, actually, Dame Diana still makes my heart flutter a bit. (I absolutely adore the photo of her above and wish I knew more about it. Anyone?)

Oh, Mrs. Peel...(sigh)

Thinking about this a bit, I suppose I wouldn't be completely averse to a snuggle with Angelina Jolie. We could be in for the night, on the sofa, with a good movie and a big bowl of popcorn. Suddenly, Brad would burst into the room and cry out, "What's going on here!?" and then we'd all have a good laugh and then... Hmm, she is a little too thin for a good snuggle, though, isn't she?

I can give it the old, college try, but the kids will have to stay at home!

All right, now I have it. Nigella Lawson. Perfect. An amazing cook of all things sensuous and the epitome of womanly curvatude. I honestly can't think of any woman more snuggle-worthy.

First things first, Nigella. Did you bring the cheesecake?

So apparently, I'm not as "straight" as I thought. Just very, very picky. The TwitterLadies are really going to have to class it up a lot before they deserve my attention. However, I am standing firm on the whole penis enlargement thing. Go away. Just stop it. I am not interested in a BEEF1ER WE1NER.

10 Reasons I Love the Inter-web

by Insurance Guru

Was able to determine that the ant traps the dogs ate wouldn't kill them.

I can work from home. (i.e. home "cube farming")

Adopted the most recent rescue dog from the Inter-web. Pretty sure no one else would've taken her.

Get to see Bruno and Eminem at the 2009 MTV Movie Awards over and over again.....(warning - butt cheeks ahead)

Google.

Found the unfindable sized bi-fold pantry door for 60 bucks. Delivery included.

Bill pay on the bank web-site.

When I have extra cash, E-bay.

Spending a little time with all of our Gentle Readers.

Courtroom Chaos and Cash

By Insurance Guru

I recently accompanied a friend to a court appearance. The background story as to why she was there isn't really relevant to the goings-on that I witnessed that day. First of all, the court room was jam packed. Apparently, a recent holiday had led to some "over-booking". What the heck - even the airport couldn't beat this place for high, quality people-watching.

First person up to bat was an lady from Armenia. She spoke broken English but declined a translator. Accused of shoplifting, she was given the "misdemeanor speech" by the judge... "up to a year in jail or probation, a fine and other costs, blah, blah, blah. She plead guilty, got 10 days in jail to be served if she didn't complete the year's probation. She also had to pay a $500.00 fine and complete a shop-lifting diversion class provided to the city by Wescalpem Enterprises. Wait a minute....who doesn't know shoplifting is bad? How much of a kickback does the city get for this $250.00 class that my dogs could teach?

Batting second was a young man reappearing for a curfew violation back in 2002. No - that is not a typo. I would've apologized for wasting this young man's time, but no - the judge said he "hoped the young man was staying out of trouble". Excuse me? ...If all I had to show for my mis-spent youth was a curfew violation?

Batting third, fourth and fifth was a trio of Hispanic shoplifters that needed a translator. See same result as batter number one.

Number six was a DUI. This fellow had to pay $1500.00 in fines, serve 30 days in jail with work release allowed for twenty of those days. For the remaining ten days of the sentence he's on house arrest. Of course he had to pay 25 bucks a day for the ankle bracelet and pay for the DUI diversion classes provided to the city by Nobucksforu Inc. I'm pretty sure there were other fines and assorted costs in there, but I couldn't keep up.

Number seven was a young man accused of assault. The funny thing about this is that it had previously been dismissed... twice. According to the judge, the city had a year to continue to bring this up. So they did. There's probably some big bucks to be had from the Hitting/Yelling is Bad diversion classes.

The entire afternoon parade went on in the same manner and my friend's case wasn't heard. It was a standing room only day at court, but what an education in our judicial system.

After watching all this money grabbing going on, my friend "lawyered-up" the very next day. It was expensive, but let's give the bucks to someone doing their job. In less than two weeks time, all charges against her have been dropped without another visit to the cash court. We still have to wait a year to see if they've developed a "Fines are Cheaper than a Lawyer" diversion class.

Routine Site Meter Check... Oh, My God!

Some disgusting perv did the Google search shown below and my site popped up as having the potential for "happy, fun time" for this guy.



Apparently, my story, Drunken Fists of Fury, is what made the connection to his search. It's going to take a while for me to psychologically heal from this.

Arrogance 101

by Insurance Guru


Do they have this class in Med School? Is there a 101 and a 110? Maybe a refresher required every year... 201, 301, 401? Maybe a 510 by instructor approval only? Dethmama's last post made me want to pull my eyebrows out one hair at a time and then I opened my newspaper.... let me just say the eyebrows are gone.

Headline - "As rating sites grow, doctors voice concerns". I use all sorts of ratings sites; the latest "camping castle" is the result of a long search using comments made by other owners. I've never booked a Dethmama and Guru vacation without consulting Travelocity, Orbitz or any other place I could get first hand information. I read comments on anything from the latest skin product I may try to the plumber I allow into my home. I know how to exercise my "skepticism muscle" while doing research. So why is this an issue for doctors? Well - hang on to your eyebrows.

The doctors are worried about the reliability of the reviews and the tendency of comments to focus on "customer service rather than competency." Are they mutually exclusive? Would a doctors head explode if they managed both at the same time? As a patient why shouldn't I expect both? My customers do.

There is also doctor outrage that unhappy customers are more likely to post (duh) and that many of these sites are unmoderated. Reading between the lines, I believe doctors think we are illiterate cavemen that wouldn't know superior care if it saved all the starving children in Darfur. Yet, the bulk of the sites allow doctors to post rebuttals to any comment they feel is inaccurate. Do they? No - what a pedestrian bother that would be. If I'm looking for a dentist, it may be important to me to that they don't have private exam rooms or that an OB/GYN was two hours late for an appointment or that a group of family physicians made someone feel welcome.

Enter Medical Justice, a North Carolina firm that offers a "Mutual Privacy" confidentiality agreement. Look for these, coming soon, in that pile of paper on the clipboard in the doctor's office. They essentially state that you, as a patient, will not post on rating sites that fail to meet Medical Justice' s standards. I didn't find any links to an "approved rating site" on their web page. Gotta be a typo.

This is just another example of the isolating sense of entitlement and arrogance in the medical profession. If I'm sloppy and snippy at work, someone tells my boss and my boss tells me. I don't ask them to leave their free speech rights at the door before I do my job.


Some sites to review:
Angieslist.com
RateMDs.com
Vitals.com
DrScore.com


PS. I have the Guru Crystal Ball out and predict that this will eventually become an AMA issue.

Related articles by Zemanta

• Who's Scared of A Little Online Feedback? Doctors. (bioethics.net)
• Muzzling is not a Social Media Strategy (sexywidget.com)
• Rating your doctor online - is this a good idea? [denialism blog] (scienceblogs.com)
• What's Your Choice - Healthcare Or Free Speech? (plastic.com)

Blinded By Arrogance. Is There a Code For That?

Once in a while, I'll read a couple of unrelated blog posts and they create a singular, powerful, visceral reaction...

Nurse K of Crass-Pollination brought to light one of Happy Hospitalist's blog posts relating an interesting experience he had with a "near code" experience. The following is a partial excerpt from his story:
__________________

Let me give you a story. I was doing my normal daily rounds on a patient when I walked in and just stopped. I stopped and I listened. I looked for signs of life in my 67 year old man who was admitted with abdominal pain. I stood there. Watching. Calmly observing.

It struck me as odd. For a full thirty seconds I saw my patient breath exactly one time. I turned on the lights and noted a remarkable physical finding (another reason to always turn on the lights). Cyanosis. A physical finding in which the skin turns purple due to an increase in deoxyhemoglobin in the capillaries (I will never forget the cause of cyanosis due to my exposure to one of the greatest pimping attendings of all times).

So I calmly walked out of the room, walked to the nurses station and stated calmly:

"One of my patients is about to code. What would you like me to do?"

This is probably the quickest way to get a nurse to jump out of their chair and come bedside to your assistance. I think in retrospect I lost the golden opportunity of a lifetime to pull the code chord and watch every nurse on that floor flock to my room with me standing there saying

"What would you ladies and gentleman like to do about my dying patient?"

___________________

The deluge of comments on both blogs was crazy impressive and made for some really good reading. Nurse K even received this interesting and revealing comment from Happy himself:

Nurse K. The words of distress you express are internally driven. What I wrote was a compliment to the nursing profession.

Your first miscue was to believe that because the drugs where nurse given and not PCA that some how the problem was caused by a nurse. I stated, quite clearly that not every patient responds the same. Contrary to your belief, I think nurses do an excellent job of preventing patients from overdosing and dying in the hospital from narcotics . IV narcotics are used so freely in hospitals these days, it's not a mystery why more patients aren't being knocked every day. It's because of excellent nursing care and evaluations. But excellent nursing care can't prevent every patient from experiencing a side effect. And I made that quite clearly. There is no blame here. It's an acknoledgement that every patient is different and we will never be able to prevent injury in all patients while treating pain in all patients.

This was a compliment to your profession. It's time to accept it as that and move on with your life.

As for your assertion that I should just start bagging, perhaps your experience in an ED clouds your judgement of hospital based protocols. The patient was not coding, nor did I foresee her getting intubated. That would be an astute bedside clinical observation based on my knowledge of the situation.

I did, however, foresee the need to have a team present quickly to assist with her rescusitation. An amazing team of nurses and respiratory therapists that respond to any acute emergency in Happy's hospital

We have excellent protocols in place to make thorough evaluations happen quickly and effortlessly. My asking for assistance from the nurses is an acknowledgement to their abilities to expediate those protocols.

You see, when I ask the nurses what would they like me to do, I was asking for their honest opinion. My first inclination as a bed side physicians after summoning the floor nurses for assistance was to get the patient a quick dose of Narcan and handle it ourselves on the florr. That, I felt would be appropriate.

The nurses suggested I activate the emergency response team due to their excellent evaluation skills.

So I did. I gave Narcan and the ICU team arrived quickly. And that's exactly what I had them do.

The first thing you do when you come upon a patient in arrest or near arrest is call 911. That's what ACLS trains you to do. It is not to start your ABCs. I might suggest you go re review that portion of the protocol

Beings that you proclaim to excel in emergency rescusitation of patients

_(all spelling errors per Dr. Happy)_____

At this point Dr. Happy is so blinded by arrogance that he actually sees nothing askew about calling "911" for a code in an acute care hospital. Okay, so if this isn't having an "arrogance effect" on you, let's try another "code-related" blog topic...

Jay, of Two Women Blogging, wrote an excellent article called Breaking the Code. In this post, Jay discusses a resolution that the AMA considered passing. The wording of this resolution was so shocking to me that I actually thought that this could be a hoax. It wasn't. Here is the resolution in its entirety:

Resolution 710
(A-09)

Introduced by: Michigan Delegation

Subject: Identifying Abusive, Hostile or Non-Compliant Patients

Referred to: Reference Committee G
(J. Leonard Lichtenfeld, MD, Chair)


Whereas, Many patients are becoming more abusive and hostile toward physicians for many
reasons not limited to the economy, increasing co-pays and deductibles, unreasonable
expectations and demands, a lack of instantaneous cure, arrogance and/or the belief that they
“own” their physicians; and

Whereas, There are decreasing numbers of physicians both in primary care and specialties
especially in terms of access; and

Whereas, Increasing noncompliance with treatment can reflect negatively on physicians during
black box audits by insurance companies and oversight governmental agencies; and

Whereas, Abusive, hostile, and noncompliant patients result in increasing office resources
adding to office overhead and added stress on all of the office personnel, which can lead to
potential ill health; and

Whereas, The stress of dealing with ungrateful patients is adding to the stress of physicians
leading to decreased physician satisfaction; and

Whereas, Any complaint to any oversight investigative regulatory body leads to uncompensated
expenditure of time, resources, and monies to defend physicians or the “guilty until proven
innocent” principal; and

Whereas, Physicians need to own the data to simplify patient collection and identification to
defend themselves as well as alert outside investigating agencies to the potential nature of the
patient’s records; therefore be it

RESOLVED: That our American Medical Association ask its CPT Editorial Panel to investigate
for data collection and report back at Annual 2010 meeting: 1) developing a modifier for the
E&M codes to identify non-compliant patients and/or 2) develop an add-on code to E&M codes
to identify non-compliant patients. (Directive to Take Action)

Fiscal Note: Staff cost estimated at less than $500 to implement.

Received: 05/06/09

__________________________

Ho-lee crap! The good news is that this resolution didn't pass. The bad news is that apparently no one in the Michigan delegation saw anything inappropriate about the wording of this thing. What is wrong with you people? Where did this kind of arrogance get its start? Is there a cure?

I'm no psych nurse, but when arrogance has grown to such a proportion that it distorts reality to this extent, I'd think it would qualify as some kind of personality disorder. Is there some kind of DSM-IV Code for this? If not, I think we need a code.

Michael Jackson RIP

by Insurance Guru

I'm going to miss Michael Jackson. He was part of the sound track of my life for the past 35 years. You have to respect his talent and drive while acknowledging the maelstrom of his life.

I was in Barnes and Noble today, the store music was all Michael Jackson and a bit louder than usual. It was interesting to see shoppers, in their 60's, tapping their toes, the teenagers singing along with "Black and White" and the employees all humming along. I'll admit to my share of toe tapping as well. I would've moon walked, if I could.

I hope he is at peace now and his suffering at an end.

Palliative Care Grand Rounds Vol. 1, Issue 6

This month's PCGR is now up at Tim Cousounis' Palliative Care Success blog. My sincere thanks to Mr. Cousounis for his great job and his contribution toward furthering the visibility of bloggers in the field of palliative care.

Now get on over there and start reading!

My New PCP!

by Insurance Guru

Just think of the savings on prescriptions!

O Dethmama, Where Is Thy Sting?

My absence from this site has been related to a sudden, but temporary, aversion to all things "bloggy" and unusually taxing work nights. I've truly felt the need to use every moment away from my hospice duties to tend to my physical and emotional well-being. That being said, let's take a peek at just a few of the events of my last "week" or so at work...
_____________________

The Drunken Tuck-In

I went to a new patient's home to do a "tuck-in" visit. I was let into the apartment by the patient's friend who was putting away groceries that she'd bought for him and she'd also just picked him up from jail where he'd been detained on DUI charges.

My attempt to educate the man on his medications was completely thwarted due to his inability to pay attention to my learned advice. He was passed out drunk on the sofa and any attempts to rouse him were in vain. I notified the hospice of the situation, and predicted that "this new guy is gonna be a handful". For some odd reason, I feel that this is, so far, my Best Tuck-In Ever.
___________________________________

I Still Hate My Hospice's Pharmacy

Had a new admission into the inpatient unit for uncontrollable pain. The morphine drip didn't arrive until three hours after the patient arrived on the unit.
.........
Got a call regarding a patient with intractable nausea and vomiting. The patient's caregiver has used every intervention/medication available to her and nothing's working for this poor man. I contacted our doc and called the new orders into the pharmacy. During my conversation with the pharmacist, I made it quite clear how much the patient was suffering. In spite of this, the pharmacist still asked, "Should we mail this medication to the patient?"
__________________________________

The Nursie Fight

I got into a shouting match over the phone with a nurse at one of our contracted inpatient units. She refused to go look for a patient's medications that had been sent to the wrong floor and insisted that our pharmacy redeliver the meds. Yeah, they were way too busy to look for those meds. So I flipped out.

I told her that I'd be happy to drive the 25 miles to look for the meds myself since her being inconvenienced was way more important than the patient's well-being. That pretty much got her panties in a bunch and she hung up on me... and I happily drove 25 miles to the inpatient unit.
_______________________________

Just Pick Up The Phone. Please.

I've tried repeatedly to contact the Administrator On-Call this week to notify her of potential shit storms and well, "nursie fights". She never answered the phone once.
________________________________

It's Crazy Time

This poor, old woman has had a psychotic break. She's going to kill her son, her hired caregiver and then kill herself. As I speak to the son on the phone, I realize that he wants me to come over to the house. Apparently, he thinks that as soon as I walk in the door, his mother will see my heavenly halo, hear the angelic chorus and all will be well. I tell him to call 911 instead. He does.
__________________________________

Deth-O-Rama

I've attended nine deaths this week.
__________________________________

Drunken Tuck-In Redux

This guy's now in an inpatient unit for symptom control (i.e. keeping the pink elephants at bay). We need to work a bit harder on his situation. He's stumbling about the unit and wandering into other patients' rooms. The nurses are, understandably, not happy about this.
__________________________________

The Death of Michael Jackson

I found out about MJ's death from the 88 year old husband of a patient I visited on Thursday night. I was completely stunned and my arms broke out in goose flesh. The news also made me realize how "out of the loop" I've been for over a week. Okay, need to watch less BBC, more CNN.
____________________________________

Free Pepper Spray With Every Tuck-In

Both the patient and his partner were very pleasant and their tidy apartment was truly a place of sanctuary in this very, dangerous neighborhood. After making sure that the patient was settled in and his partner was comfortable with administering the new medications, it was time for me to go. The patient's partner would not let me leave the apartment, however, without first making sure that I was armed with a canister of pepper spray. Okay, this is officially, so far, the Best Tuck-In Ever.

What Were Your Parents Thinking?

Name FAIL

I saw this a while ago on failblog.org and have, unfortunately, succumbed to the dark side and cannot resist posting this example of extremely poor, parental judgment. I shall just leave it at that... I'm sure that Mike has suffered enough.

Back From the Wild

It was an excellent camping trip. The weather couldn't have been more perfect. There was a good fire every night and I enjoyed the warm company of my childhood friend, I.G., and my foolish pup, Olive.

A most Excellent Camper!

Olive: Finishing the last of a freshly caught hiker

____________________________________
Without giving away too much information regarding our locale, here are a couple of snaps of the view from the tent. Yes, you read that right. In spite of our advanced age and numerous infirmities, we still prefer a tent.




If you can guess the exact location of where we were, from this stingy information, you should get a prize.
_____________________________________
I.G. was most pleased with her ingenious solution for the daily water-hauling duties...


Mind you, that stroller has never known a baby's butt. I.G. bought it just for this purpose only!
_________________________________

Although the camping trip was perfect, the equipment was not always so...

Things we broke while camping.

Oh, my! I just got a text from Insurance Guru. She's just come from Cabela's with a new tent for the next camping trip.

The next Camping Castle. Ooh, lovely!

Goin' Campin'

Insurance Guru, Olive the Pug and I are off to the wilderness for the rest of this week and into part of next. We'll be out of reach of any wireless connections whatsoever. Ahhh...


As much as I detest taking pictures during my vacations, I've made a vow to snap a few and share with you all. See you later!