Poker and Other Things

Michael Jackson is Dead and I Don’t Care

Michael Jackson is dead and, God forgive me, I don’t care. I wasn’t a fan and I didn’t like his music. Sure, I listened to it; it would have been impossible not to but I never bought an album, stopped turning the dial at the sound of his falsetto voice, or really followed his career except that it was part of the cultural noise of our age. I don’t worship celebrities and entertainers either and am completely indifferent to their lives. Oblivious, actually. I’ve been listening to Pink Floyd for thirty years and I can’t name any band member, differentiate who among them is living or dead, or tell you anything about any of them. Don’t know, Don’t care. It’s not important.

Of course I watched Michael Jackson’s opulent funereal. How could I not? I couldn’t tear myself away from this sad commentary on our silly and insipid age where a mincing creep, a pedophile, and a middle-aged man who spent the treasure of a small nation to satisfy his bizarre urges is buried like a pharaoh while better and braver men who sweat and bleed every day are rewarded with nothing more than a flag-draped coffin and the barely concealed derision of the perpetually chattering classes.

What a freak show it was. A parade of Jacksons you never heard of and flocks of B-list celebrities come to preen and feed on entertainment carrion under a grisly sun. I think it’s weird and freakish how the black community has embraced embarrassments like Al Sharpton who delivered the most embarrassing eulogy of the day. What a low-life, likewise flapped in from lonely media desolation to feast on the dead body that seemed hardly enough to feed a couple of washed up singers let alone the small country’s worth of celebrants descended on Los Angeles. Was it some miracle, feeding the multitudes I mean?

The ongoing news coverage was disgusting. North Korea will be lobbing nukes at us pretty soon, the economy is still in free-fall, and everywhere rough beasts, their hour come, slouch towards Bethlehem so you’d think there would be a lot to discuss on serious news outlets but based on four or five obvious facts that were a revelation to no one and only surprising to those who have been living in caves for the last twenty years we were treated to solid, 24-hour coverage of nothing and less than nothing about a guy whose life was really not that complicated and whose death was mundane by celebrity standards…save for the revelation that Diprovan, an induction agent for anesthesia and medical paralysis, is now a recreational drug.

About the only real interest I have in the whole affair is whether and when Michael Jackson’s doctors are going to jail.

You’ve Got to Know When to Hold ’em

As many of you know I am done with residency and am back in Louisiana working as an Attending Physician in a small but very busy Emergency Department. We have a lot of casinos in our fair city which got me thinking that Emergency Medicine is a lot like high stakes gambling. We are dealt a hand with every patient and after glancing at it, must figure out what kind of cards the patient is holding; whether the guy with chronic back pain really has an epidural abscess or whether he is bluffing, and make our workup and disposition judgments accordingly. We can’t admit everybody, we can’t run every test on everybody all the time, and as this is still a rational world (but getting more insane every day) eventually the majority of patients will be sent home where a certain percentage of them will have a bad outcome from something that we missed because it never occurred to us or from something that we anticipated as a possibility but about which the patient decided to eschew follow up as directed.

I mention this because I actually send people home with no lab work or imaging studies whatsoever which is something I probably only did a handful of times as a resident. I had, for example, a young boy brought in by his father for intermittent abdominal pain for the previous two days, particularly while playing sports, but who presented with no complaints whatsoever and a normal physical exam complete with a benign abdomen, normal testicular exam, normal digital rectal exam negative for occult blood, normal vitals, normal, normal, nothing, nada, zilch.

Could he have had something? Functional abdominal pain? Gastritis? Intermittant testicular torsion? Sure. But he had excellent follow up, reliable parents, and no complaints whatsoever brought in mostly for parental concern and because it was a Saturday and their pediatrician wouldn’t see them until Monday. I felt it was safe to send the kid home because, and maybe I’m wrong here and I will be bombarded by dire warnings from my colleagues to the effect that I am playing with fire or I will change my practice habits the first time I am sued (but did I mention the kid had no complaints and a stone-cold normal and extremely comprehensive physical exam?), on some level our job has got to involve using a little common sense. In this case understanding that the kid was not sick, was in no danger of dying, had vigilant parents who lived only a mile from our hospital with access to a phone, and really had no business being seen in the Emergency Department except that most Emergency Departments are now mostly after-hours clinics with some really sick patients thrown in three or for times a shift to slow things down and keep the waiting room backed-up.

With that being said, I still admit the usual patients with vague complaints who meet certain criteria for age, comorbidity, or reliability. I’m not stupid. But I’m trying, like I said, to use a little common sense.

We have the usual variety of patients but, while we have much less trauma than at my residency program, many of our patients are actually quite sick. I have run quite few codes, intubated often, and have done a lot more procedures on a daily basis than I did as a resident for the same number of patients. I’ve had, for example, quite a run of febrile infants with Fever of Unknown Origin requiring lumbar punctures and several of them panned out as meningitis.

Procedures are a lot easier as an attending in a non-residency hospital. I tell our most excellent nurses what I am going to do, they get all of the stuff ready (the most time-consuming part of most procedures), and they don’t even let me dispose of my own sharps after I am done because, as the charge nurse told me, “Don’t you have some patients you could be seeing?”

A resident’s time is not worth much, in other words, but they aren’t paying me now to hunt up gloves and syringes. We are incredibly busy most of the time and like residency I work non-stop for my entire shift.

My first patient was a woman with vague abdominal pain and an elevated white count who I did actually send for a CT scan (normal of course) but eventually sent home with instructions to return in twelve hours if not significantly better. My second patient was a young lady on oral contraceptives and a smoker with a month of worsening breathing difficulty, chest pain, and “cellulitis” of her calf a month before. Wouldn’t you know that her EKG showed the classic strain pattern (“S1Q3T3”) that you never are actually supposed to see and I naturally started her on Heparin (an anticoagulant) almost as soon as I got her history, being rewarded shortly with an angiogram that showed exactly what I thought it would: big pulmonary emboli (clots) in the arteries of her lungs.

The family thought I was a genius but this one was obvious, an incredibly easy (but very satisfying) diagnosis that in our age of vague complaints presenting far in advance of any classical signs and symptoms is something of a rarity. It’s the minor complaints that really give me fits.

17 thoughts on “Poker and Other Things

  1. You are right about Michael Jackson. It is really disgusting how people treated him like crap before he died and now resort to fawning, praise, and generally acting like sniveling sycophants after his death.

    If you really, truly, loved and cared for someone, shouldn’t you respect and appreciate them while they were alive rather than after the casket is buried? Apparently in Hollywood, dying is actually a valid and respectable career move. Jackson’s physicians should be tarred and feathered.

    Loved the throwaway Yeats reference.

  2. Ditto on the dead child molester of questionable race and gender.

    ..and Al Sharpton was, is, and evermore shall be lying, slimy asshole.

  3. You know, I see all these references to where others have emailed you… and yet, it seems I am not as clever as those people, for I cannot find an email address at which to contact you.

    If I promise (nay, SWEAR) not to email a completely ridiculous question/comment, will you get in touch?

  4. I love sports, music, and movies but I will never praise people participating in these. Everyone thinks that these professional athletes and musicians are doing us a favor with their amazing talents, when in fact, we are doing them a favor by paying for their huge mansions, nice cars, and beautiful women (because let’s face it, some of these guys would be losers without their money). They, like Michael Jackson, have never done anything that will make me worship them.

    As for Michael Jackson, I find myself asking why are so many people mourning his death? I cannot find a reason except for the fact that many of these people like to make things more dramatic than they really are, because they need some excitement in their lives. Also, the drama is contagious and it just flows throughout the country because most people are followers.

    Like you pointed out, we have American soldiers giving their lives everyday to keep us and even foreigners safe. These men and women are the real people we should be honoring and praising. Los Angeles should be paying one million dollars for the funerals of the soldiers who gave their lives for us.

  5. Thanks for speaking up about Michael Jackson – I’ve been thinking exactly the same thing. I’ve never understood the FAN (not fan but FANATIC) mystique from his followers. I’ll grant that he was a trendsetter – back in the mid80s, with nothing new since then, and he was all about the high pitched “whoo” with a crotch grab, tippytoes and flashing lights. I saw him as a freak and a pedophile. He was loaned zillions of dollars to indulge fantasies we can’t even fathom, and I’d prefer not to. And I don’t even know where to start about the drugs, much less the propofol.

    So, if I didn’t care about him when he lived, why wold I care about him when he died? There’s a worldful of other, MUCH more important news that’s so much more relevant, but that’s been drowned out by bubblegum idiocracy

  6. PB we miss you. Please scrape together some time and crank out a beautiful piece of art when you can. Thanks so much.

  7. Panda, good luck on the new gig.
    In light of Michael Jackson’s death, I’d like to add to the Pandictionary. Labeling requirements for propofol should now include “terrasomnolence” as an adverse reaction (iow, dirt nap).

  8. I am sorry he died… but I just did not get the 24 hr non stop news coverage… particularly with the Korean nukes and other stuff now escaping my tired brain at the moment.

    I was especially irked when someone stated it was racist to bring up the drugs. What? How is stating facts racist? It may have been Sharpton.. not sure. They said we wouldn’t do it with Elvis? what? They all talked about his needing drugs to sleep, wake up and everything in between, peanut butter sandwiches, weight gain and dying on the toilet.

    I really hate when that racist card is played and I believe incites/perpetuates racism or is a convenient excuse to create a diversion of the facts.

    I didn’t watch the funeral. I did watch some of the initial stuff and did enjoy watching him dance and I even put up a Youtube and small post. But…I do not understand..why the media covered it like he was a president, etc.

    Ditto on not following celebrities. no one would want me on their team for celebrity trivial pursuit… because I don’t care and rarely pay attention. I enjoy the performances… but not a groupie at all… well except for Grey’s Anatomy.. but couldn’t tell you much about the stars in real life.

    Congrats on your new job.

    I enjoy your writing. 🙂

  9. Panda, I’ve just recently found your blog as I’m about to begin medical school and have found it both informative and extremely entertaining. Your wit and “no-bullshit” attitude have really inspired me to write about medical school myself. Best wishes for your new job.

  10. PB, I’m glad you were finally able to get out of the northern wastelands and back to the good ol’ south. Nice catch on the PE, too. And like someone else said, please start updating more regularly. I miss the fresh batch of refreshing entertainment that used to greet me at least once a week on this blog.

  11. Any hints on which of this great state’s cities you are currently residing in? Any chance those of us at Tulane will get to pass by you on a rotation? Congratulations on your new job in any event.

  12. How about another post? I’m sure the current state of health care reform would provide plenty of fodder.

  13. A very refreshing opinion! I was beginning to feel like I was the only one in the world saying “I don’t care Michael Jackson is dead.” Michael Jackson (pedophile, lest we forget) has been nothing but a joke for the last 10 years- I just don’t understand why, with his death, he’s suddenly a superhero again.

  14. glad your doing well back home. feels nice to practice w\o an attending telling you what you have to do, is’nt it. things are same here.
    as far as mikey, mcdonalds has a new burger to honor him. 50 yo meat between 12 yo buns….see ya!

  15. Well said. It disgusted me that Farrah Faucett, who was a positive role model, advocate for cancer & lost a long, brave fight with the disease had her death upstaged and pushed aside by the death of a drug-addicted, freak-show pedophile who died from a drug overdose. Where was Farrah’s televised funeral? I’d be surprised if the day Jackson died or his bday isn’t soon made to be a national holiday.

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