Ameda Purely Yours Breast Pump – Carry All Amazon Price: $172.51 List Price: $287.00
	Ameda Breast Pump Spare Parts Kit Amazon Price: $16.95 List Price: $19.99
	Ameda Custom Breast Flanges M/L – 28.5 & 30.5 mm Amazon Price: $9.79

With this pump, you do not have to carry a bag as it does not come with any. It is suitable for those moms who find carrying bags are a liability wherever they go. In addition to this, the breast pumps are affordable and easily available since you can find them in many of the malls around.

If you keep traveling every now and then, and you need a pump that has a variety of ways in which it can get powered, then you do not have to search any longer. The Ameda Purely Yours electric pump can get powered from three sources, which are easily available. You can use the pump while you are driving as it can get powered by a car adapter.

The Ameda Purely Yours breast pump can be powered by 6 AA batteries, and this is efficient as you can use it while you are in the rural areas where there is no electricity or there are no vehicles around. It is important, since you can use the pump while you are away from home. You just need to carry 6 AA batteries with you.

The final power source is the AC adapter which is obviously the commonly used. You can charge your breast pump using alternating current directly from the socket. For those of you who keep moving from one place to another, and you need to carry the breast pump with you, then you are safe now as the Ameda Purely Yours breast pump is easily portable since it is light compared to other breast pumps.

	Medela Pump in Style Advanced Breast Pump with On the Go Tote Amazon Price: $239.00 List Price: $349.99
	The First Years Breastflow miPump Double Electric Breast Pump Amazon Price: $70.74 List Price: $79.99
	Philips AVENT BPA Free Twin Electric Breast Pump, White Amazon Price: $154.99 List Price: $199.99
	Medela Symphony Breast Pump Amazon Price: $1,199.00 List Price: $1,599.00
	Ameda Elite Electric Breast Pump with 9ft Cord Amazon Price: $699.99 List Price: $931.95

One thing moms should be assured of is that your milk will remain pure as they are. No foreign materials can find their way through the pump. The Ameda Purely Yours breast pump has a diaphragm barrier that keeps air and other foreign materials from getting their way into the pump; this is effective as it prevents air from coming into contact with milk.

Therefore, you as a mother will be guaranteed that you are giving your baby pure milk free from any germs. Since there is no air that gets into the pump, there is no need of cleaning the tube. This ensures the milk stay pure all through. When using the electric pump many moms enjoy the fact that you can adjust the speed of the pump depending with how fast you want the milk to get pumped from your breasts into the pump. The Ameda Purely Yours breast pump is easy to use, and you will always get an instruction manual in the package, for assistance if you have any problem using the pump.

	HT Massage Chair iJoy-2580 Massage Chair, Espresso Amazon Price: $739.99 List Price: $1,099.00
	iJoy 250 Human Touch Massage Chair BLACK FR Amazon Price: $899.00 List Price: $999.99

It offers a variety of programs and three massaging options. You can choose to massage your back, and this will be useful for those involved in tiresome jobs that stress their backs. You can choose to massage your shoulders and neck, and this will greatly help to improve the circulation of blood. You can also choose from the three available options, if you prefer to massage your lower back. If you want deeper and penetrating massage, you can use the removable pad.

Rickets can lead to tremendous pain in the spine when the bone actually bends without breaking. The use of long strokes will greatly help to reduce the bending effect. Good massaging procedures would help you lose weight and facilitate normal growth. Proper use of a massage chair will greatly help in maintaining your health.

It has a cup holder to allow the user to have a drink during the massaging process. This is aimed at stimulating your nerves as well as refreshing the body. It is located in a place where you can comfortably place and pick up the cup while still enjoy massaging without interruption. It also has an auxiliary power outlet for controlling of the chair.

	Forever Rest Premium Massage Chair w/body scan, BUILT IN HEAT(TOP OF THE LINE) 10yr. Warranty (Black) Amazon Price: $1,369.99
	Inada Massage Chairs HCP-10001A(CW) Sogno Dreamwave Massage Chair, Cr?me Amazon Price: $8,499.00 List Price: $8,799.00
	Osaki OS-4000 Executive Massage Chair Zero Gravity Recliner Shiatsu 32 Air Bags – Powerful 11 Motors & Intelligent 4 Roller System New Amazon Price: $2,895.00 List Price: $3,995.00
	Shiatsu Arm Hand Massage Chair with Jade Heat Therapy, Human Body Scan, Mp3 Synched Massage, 69 Air Bags + More Amazon Price: $1,698.00
	HT Massage Chair HT-5040 Massage Chair, Black Amazon Price: $1,999.00 List Price: $2,599.00

The Human Touch iJoy-2580 massage chair features a power recliner which allows a user to choose the suitable angle necessary for massage procedures. They can be used in your home as seats for your guests. It comes with various colors. You can always find one that matches the color of your room. It has a wide base which helps to increase stability of the chair. The weight is concentrated near the center of the sitting part to lower the level of gravity, so the chair is more stable. It features functions to erase any underlying stress very fast, and this greatly assists to improve the health of the individual.

The Human Touch iJoy-2580 massage chair has another great feature. You can easily reach the control panel and use it to change settings of the massage process without interrupting the massage procedures. Strength of the individual and muscle tone will also be improved by the percussion aspect of the chair.

Black & Decker CCC3000 18-Volt Cordless Electric Lawncare Center Amazon Price: $199.97 List Price: $199.99

Those who have never used a cordless trimmer possibly cannot easily figure out how the cordless feature of Black & Decker string trimmer is bound to make work easier. The best way to evaluate the effectiveness of a cordless trimmer is to figure out that you do not have to worry about your trimming path and the distance that you are covering. Having a cordless trimmer will definitely ease your mind of the taking care of trimming paths. You will not have any cables lying on your yard, especially when you are working an extensive area.

One major issue that has been lingering in the minds of many potential clients is the time limit of the batteries used to power the trimmer. Most reviews concerning Black & Decker CCC3000 string trimmer show that one can use the batteries for about five hours without recharging although this is dependent on the task being carried out and the kind of vegetation being trimmed. Even when using the Black & Decker CCC3000 string trimmer for heavy-duty activities, it is always more efficient than using electrically powered trimmers. It takes a very short time to charge the two batteries of the trimmer. This is because this trimmer has two separate charging ports, which are used to charge the cells independently which simply means that the use of two rechargeable batteries on this trimmer will not end up doubling the charging duration.

Another feature makes Black & Decker CCC3000 string trimmer a better option is the fact that it has a hard sweeper. It can be used to clean up the litter after trimming the yard. This will save the user other tasks involving cleaning up the litter, and thus it is a great time-saving machine. One can also use it to clean the little from the walkways in the yards as well as sweeping driveways. Its effectiveness is equally comparable to the performance of vacuum cleaners not forgetting that it acts like a cordless vacuum cleaner.

Most of the clients have also expressed their gratitude to manufacturers of Black & Decker CCC3000 string trimmer because it has minimum noise pollution, which makes them quite comfortable throughout the activity. This Black & Decker string trimmer has been designed in a way that its engine runs smoothly and quietly, and the blades have been set well set to minimize collisions with other parts of the trimmer which would otherwise lead to noise pollution. You do not have to use ear muffs as you do the trimming because the kind of noise that Black & Decker CCC3000 string trimmer produces is bearable.

	Black & Decker LST220 12-Inch 20-Volt Lithium-Ion Cordless GrassHog Trimmer/Edger Amazon Price: $127.98 List Price: $237.74
	Greenworks 21212 13-Inch 4 Amp Electric String Trimmer/Edger With Telescoping Handle Amazon Price: $49.99
	Black & Decker NST2018 Grass Hog 12-Inch 18-Volt Cordless Electric String Trimmer with 2 Batteries Amazon Price: $74.99 List Price: $191.66
	Black & Decker NST2118 12-Inch 18-Volt Ni-Cd Cordless Electric GrassHog String Trimmer/Edger Amazon Price: $83.50 List Price: $180.82
	Greenworks 21052 15-Inch 5.5 Amp Electric String Trimmer/Edger With Pivoting Head & Telescoping Handle Amazon Price: $49.90 List Price: $59.99

Hitachi CG22EASSLP 21.1cc 2 Stroke Gas Powered Straight Shaft Grass Trimmer (CARB Compliant) Amazon Price: $199.99

Use of electrically powered string trimmers makes it difficult to use the machines with ease because they are not easily carried to all the corners of the lawn. This machine is also very safe to use because it does not use iron blades. The iron blades can cause injury to the user if not properly handled. The term string trimmer was actually coined from the fact that this machine has string controllers on to the head and blades rather than metallic controllers.

By using Hitachi CG22EASSLP String Trimmer, you will never feel any vibration nuisance when carrying out trimming activities. This feature made this trimmer to be the most preferred trimmer after people realized that it is designed in a way that it absorbs all the shock and vibration produced by the machine during the trimming activity. Nobody likes the feeling of vibration all the way during the activity.

It is even sad to note that some of the machines produce strong vibrations, which make the user suffer from headaches. Some of the users also suffer from muscle pain because the stress impacted by the machine on the body cause physical stress on the muscles. You will also enjoy the light-weight nature of the trimmer which will facilitate portability of the trimmer when using the machine.

It has a very powerful engine. This is the major feature which has made Hitachi CG22EASSLP string trimmer users like this gadget. This ensures the trimmer to handle any kind of vegetation. It is not like other trimmers, which are not able to trim grass overgrowth or dry grass. The blades are well set in a way that they manage to cut any kind of vegetation on your yard. It has a double stroke engine which has been specifically designed to adjust its fuel consumption level by itself.

When you are working on tough vegetation, this Hitachi string trimmer will be automatically adjusted to perform the task. When you get to softer vegetation, it will automatically resume back to lower energy consumption. The Hitachi CG22EASSLP String Trimmer has also been designed in a way that you can work with it at all edges of your yard. It is easily adjustable to get the right trim even to the inaccessible corners of the yard without much difficulties.

It is an advisable product at any time, if you need to buy a trimmer. The Hitachi CG22EASSLP string trimmer should be the best choice for you. It has a powerful engine, safe to use features and string controllers, which would make you feel quite comfortable while using it.

	Black & Decker LST220 12-Inch 20-Volt Lithium-Ion Cordless GrassHog Trimmer/Edger Amazon Price: $127.98 List Price: $237.74
	Greenworks 21212 13-Inch 4 Amp Electric String Trimmer/Edger With Telescoping Handle Amazon Price: $49.99
	Black & Decker NST2018 Grass Hog 12-Inch 18-Volt Cordless Electric String Trimmer with 2 Batteries Amazon Price: $74.99 List Price: $191.66
	Black & Decker NST2118 12-Inch 18-Volt Ni-Cd Cordless Electric GrassHog String Trimmer/Edger Amazon Price: $83.50 List Price: $180.82
	Greenworks 21052 15-Inch 5.5 Amp Electric String Trimmer/Edger With Pivoting Head & Telescoping Handle Amazon Price: $49.90 List Price: $59.99

	Polaris 9300 Sport Robotic Pool Cleaner Amazon Price: $1,075.00
	Polaris Vac-Sweep 280 F5 Pressure-Side Automatic In-Ground Pool Cleaner Amazon Price: $361.34 List Price: $723.77
	Polaris ATV F7 Premium Suction Side Automatic Pool Cleaner Amazon Price: $408.99 List Price: $685.22
	Polaris Vac-Sweep 380 F3 Pressure Side Automatic Pool Cleaner for In-Ground Pools Amazon Price: $526.80 List Price: $1,087.79

The Polaris robotic pool cleaner is not complex in assemblage and thus very easy to use and brings about all the smartness required. You can easily regulate the running pace of the device desired to give a thorough cleaning of the surface. The simplicity of the machine allows simple maintenance practices, which do not require trained personnel to do it for you because you can comfortably learn this using the provided manual. Manufacturers are now concerned about the long cable which may at times interfere with the running of the machine when the speed is high. It is hoped that new designs are being manufactured that will solve this problem.

The other advantage of the Polaris 9300 pool cleaner is that it is very fast and efficient in operation. This is the excellent cleaning equipment that will remove even the microscopic organisms such as bacteria completely without even a single one remaining behind. It is good to know that the machine is easy to set up and to use. This allows its usage by a large number of people even those who have never used it there before. It has a robotic function which pulls the lid out and up and then a hose from inside is used to blow the debris out from the outside.

The Polaris 9300 robotic pool cleaner has well designed high-quality wheels, which roll smoothly on the surface and this helps to move the machine from one point to another without using your hands. This simplifies the movement of the equipment. The machine offers extraordinary suction, which facilitates efficiency in removing dirt from the pool. Technology is part of this machine, and it uses patented vertex technology, which includes a vacuum. The vacuums are large enough to hold very large debris. The process involved in the release of debris after suction procedures involve removal of canisters, which is done is a swift manner.

The hand-operated buttons help you to quickly control the machine, and you can have this done even by using a remote. Remote connectivity allows the user to control the machine from the comfort of their seat without necessarily moving along with it. You cannot forget to note the great and marked agility of the Polaris 9300 pool cleaner. It features an advanced navigation system, and this helps to determine the direction to which it is running towards. It has an automatic stitch off button, which helps to cut off the power supply whenever the running time is more than required. This aims at reducing costs for fuel and saves time.

	Aqua Products APRVJR Aquabot Pool Rover Jr. Robotic Above-Ground Pool Cleaner Amazon Price: $268.99 List Price: $329.00
	Hayward RC9742 SharkVac with Caddy Robotic Pool Cleaner Amazon Price: $599.99 List Price: $749.00
	Aquabot Turbo T4RC Robotic In-ground Pool Cleaner with Remote Control Amazon Price: $1,549.00 List Price: $1,899.00
	Aquabot ABTTJET Turbo T Jet Robotic In-Ground Pool Cleaner Amazon Price: $579.99 List Price: $699.00
	Dolphin Triton Robotic In Ground Pool Cleaner Amazon Price: $889.99

How’s that Hope and Change working for you?  Had enough?  Still grimly resisting that urge to scrape off the bumper sticker?  It’s all right.  Nobody likes to admit they were fooled even though it’s now painfully obvious that, like many of us warned you, The Sun King Ra-Obama is nothing more than an empty suit who if he is in fact filled with anything it’s the shopworn doctrinaire leftism that has been such a disaster for most of the planet and apparently needs to be tried again and again because…well…because the purpose of leftism is not to improve the human condition but to ensure, as Orwell warned, that a boot is stamping on the human face forever; in this case the boot is an over-reaching and out-of-control government intent on bludgeoning you into submission with a big brick of government cheese.  President Obama and his cabal of like-minded Barons in the House and Senate don’t want to help you, they want to solidify their own power, putting the boot in your face forever.  If they have to lay waste to democracy, free enterprise, initiative, personal responsibility and every other virtue that made America exceptional than so be it.

The sad thing is that you voted for the guy because you are a afraid; afraid to be an American and act like an American and have instead embraced the notion that the Mammary State will nestle you in it’s benevolant bosom if you only give up the liberty that is your birthright and accept the domination of an unelected, multi-tentacled bureaucracy in every part of your life. 

What the heck.   All you’re going to give up in exchange for never having to pay a dime for even the most routine medical care is the ability to be anything but a serf, a comfortable serf for now but the time is coming when the West, finally become nothing more than a crappy nursing home full of drooling, entitled imbeciles, producing nothing and standing for nothing; a civilization reduced to petulance and craven apologies for the cherished values that in distant times American boys stormed impregnable beaches to defend, will collapse from the overwhelming weight of its own folly and short-sightedness.

Then my friends, the World will burn.

Wonderful, Wonderful Copenhagen

Let me get this straight:  The economy teetered on the edge last year when billions of dollars invested in imaginary assets evaporated into thin air.  In Copenhagen, the President, the Democratic Congress, and the parasitic global bureaucracy propose to set up vast markets trading in Carbon Dioxide, a naturally occurring gas which forms a vanishingly small percentage of the atmosphere, and that this entire multi-trillion dollar market in which your pension funds and other financial instruments will be inevitably intertwined will be based on some pointy-headed Eurocrat allocating permission to burn fuel…and you think this is a good idea?

What on earth is wrong with all of you?  Have you taken leave of your senses?  Who thinks up this kind of crap and more importantly, didn’t they get the memo that Global Warming, the Rock upon which the Religion of Global Bureaucracy is built, the Shining Promise to the Ruling Class of Make-Believe Jobs Now and Forever and To the Ages of Ages, is a hoax and nothing more than a shabby and now increasingly transparent attempt to put the unruly American spirit in its place?

If the magnitude of the duplicity involved in the hoax of climate change (now warming, now cooling) is not apparent to you now then you are either blind or willfully intent on destroying as much of our personal freedom as you possibly can.

“My arm was numb after I slept on it funny and my mom says I’m having a stroke,” says my essentially healthy 34-year-old patient to the nodding approval of his indulgent mother sitting by the bed.

“How long did the numbness last?”

“A couple of minutes…it went away after I straightened my arm.”

“So your arm went to sleep and now it’s better?” I ask.

“I guess so.”

“You know that just walking through that door costs you four hundred bucks?”

“It’s okay,” interjects his mother,”He’s on disability and don’t have to pay a dime.”

And there, in a nutshell, is the problem with American medicine and why the looming government solutions are insane.  Don’t you all realize that when a healthy young man can walk into an Emergency Department because his arm fell asleep and be seen by a doctor, a doctor who will dutifully diagnose him with transient paresthesias or compression neuropathy or God forbid initiate an expensive and highly unnecessary work up; when a patient can present with nothing and less than nothing and run through your money with as much concern as I have for swatting a fly…don’t you all realize that when this kind of patient can leave without being arrested for fraud that American medicine has jumped the shark and making it even more accessible at even less cost to a growing population of supremely entitled citizens will result in nothing but an exponential increase in the baseline ridiculousness of it all?

Pill Pusher

The Emergency Department is the center of a thriving drug trade that would make an Afghan Opium Warlord gulp in amazement.  A truly staggering amount of narcotics leaves here every day and I am sorry to say that, even though I am trying to prescribe less of them, I have had a major part in this.  It’s not that I don’t believe in appropriately treating pain.  Cancer?  Major trauma?  Kidney stones?  No problem.  But every person with back pain, even if they were legitimate patients and not the drug seekers that many of them are, does not need thirty Lortabs…if they’re not allergic to Lortab that is as most of our narcotic connoisseurs eschew the slow onset of pills for the instant rush of Dilaudid (doctor prescribed heroin).

The problem is two-fold:  First, there are some patients who are in pain and have a legitimate need for narcotics.  You can’t withhold them because other people abuse the system and consequently it is necessary to give people the benefit of the doubt even if you know you’re being scammed most of the time.  Second, there is tremendous pressure bureaucratically to make the customers (formally known as patients) happy lest Press-Gainey scores suffer and some imaginary harm come the bottom line as customers who probably don’t pay for their medical care anyway threaten to take their business to some other, more accommodating drug entrepot.

So I’m sending a lot of people out on Motrin and occasionally Valium as a muscle relaxer and reaping the whirlwind of bad feelings and complaints.  If you’re in a minor automobile accident and walk in a day later without any injuries this is completely appropriate and why a little fender-bender in which no one was hurt and EMS were not called should be the prelude to a narcotic holiday is not clear.

That many patients lie to get drugs in an incontrovertible fact. I work at two Emergency Departments in town and I have had the same patient on two different days with two different descriptions of the same wreck.   I also occasionally get calls two weeks after the prescription for Lortab was written  for a minor motor vehicle accident claiming that the pharmacy lost it and could I please write them another prescription?

I have discovered from several of my more straightforward ex-drug seeking patients who now come in occasionally for minor but legitimate complaints (and refuse anything but tylenol or Motrin) that at one time they were selling their Lortab on the street for ten bucks a pill.  Apparently you can make a decent living scamming your Emergency Physician or, as the Pharmacist put it, “Hey Doc, did you know that Mr. Smith just filled a prescription for 150 Percocet two days ago?”

No.  No I did not.

It would be unfair to characterize the country as a whole from the self-selected few who have formed a symbiotic relationship with the Emergency Department.  But just like every medical problem is not an Emergency, every little pain does not need treatment and there was a time, I assure you, when people just took a couple of aspirin and called their doctor in the morning.

Jumping the Shark II

“You know I’m not a pediatrician,” I say to the mother of a well-looking, very healthy baby brought to the Emergency Department for a little spitting up and an inability to obtain an instant appointment with the child’s pediatrician.

Incredulous look.  Thinks I am some kind of on-call pediatrician.

“You know I’m not a dermatologist,” I say to a otherwise well man with a faint rash on his neck that started a few months ago.

Disbelief.  Anger at my referral to a dermatologist (who I called after coming up with nothing in my dermatology atlas) who will see him in three weeks but unfortunately will probably ask for money up front.

“I want to see the dermatologist now!  That’s why I came in.”

Good luck.  Heard muttering on his way out that he wanted his co-pay back because “that fucking doctor didn’t do shit for me.”

“You know I’m not your primary care doctor,” I say to the well-appearing woman with a complaint of “I want to be checked for sarcoidosis.”

Scornful look.  “Oh, my doctor isn’t doing anything for me,” although I suspect from a cursory review of her online medical records he is as he has at least ordered all of the appropriate lab work.

Somewhere, sometime…I don’t know when…the public has dropped even the pretense that the Emergency Department is anything other than an all-hours urgent care or some kind of one-stop shopping for all of your real and imagined medical problems.  It it this impatience, the medicalization of all aspects of life, represented by patients demanding instant treatment for things that thirty years ago would be shrugged off that ensures our health care system will bankrupt us, especially when it is free.

“This patient,” I said to myself, “is going home.” 

I know.  She’s 85 with the dreaded complaint of “Altered Mental Status” described by the family as a brief period of “staring.”  No generalized seizure activity, you understand, and no syncope (fainting), slurring of speech, facial droop, drooling, weakness, confusion, sweating, fever, nausea, vomiting, or any of the other symptoms or combination of symptoms upon whose fulcrum are levered mighty weights of flesh into the processing mill that is your local hospital.  In fact, this very pleasant lady felt fine and even the family admitted that she looked normal.

“And I’m not going to spend $20,000 proving she’s fine either,” I continued to myself as I screwed up the courage to throw out the rule book and guide my clinical judgement by history and physical exam.  After four years of medical school and four years of residency training I can do that can’t I?  Isn’t that what my professors, comfortably barricaded behind the litigation-proof walls of the State Charity Hospital told me I should be doing…especially as my history and physical exam confirmed the diagnosis that seemed obvious from reading the triage note and talking to the the paramedics on their way in? 

But then the fear gripped me.  That smouldering dull fire in the gut that can only be quenched by a deluge of unnecessary lab tests and studies. 

And I paused.

My computer glowed seductively.  It would have been easy to click here, click there, and then call the tired hospitalist to admit the patient.   We admit for this kind of thing all the time, slipping the patient in behind a smokescreen of irrelevant data; leveraging confusion, convenience, and sloppy medicine into countless unproductive admissions that discover nothing we didn’t already know, treat nothing that we weren’t already treating and, if we are lucky (because the hospital is a cess-pit of infection and risk) leave our most excellent and trusting patients no worse for the ordeal except for some familial inconvenience.

Reaching deep for my last reserves of courage my hand bypassed the keyboard going to the phone instead to discuss this very gracious and patient lady being treated for Parkinson’s disease with her neurologist and to arrange outpatient follow-up for the next day.  

Maybe one day I’ll tell you about the Bell’s palsy patient I sent home with no lab work or imaging of any kind.

I am a thrill-seeker.  Too bad I’m going to get sued one day and decide that my financial well-being is more important than being a good and faithful steward of your treasure.

America

This country has changed, even in my lifetime.  It used to be a place where people worked and were proud of it as we were proud of out heritage as a pioneer nation, a place were prospectors, inventors, roustabouts, gamblers, swindlers, preachers, cowboys, investors, soldiers, pioneers, farmers, and every variety of people striving for their livlihoods could succeed or fail by their own skills and on their own merits, allowing always for the confounding hand of fortune that sends the river to wash away even the best-tended plantation.  It was a country to which my father came with nothing, expecting nothing except opportunity, and for which he had a great love that he instilled in me.

And now we are to be nothing but Belgium.  A lot bigger but Belgium just the same.  Nothing but another decrepit European social welfare nursing home whose sole pre-occupation is now to become the incessant struggle for money to support a growing class of people who have been seduced by the Obamatariat into giving up uncomfortable and often treacherous liberty for the long, government-cheese induced nap of the nanny state.

It should bother you.

My New Ride

As some of you know, I am a mountain-biker and I just thought I’d share a picture of my new ride.  It is a Specialized FSR XC Expert.  My first mountain bike was a 1992 Bridgestone MB-4 and while I recall it was a really nice bike, this one has front and rear suspension, hydraulic disc brakes, and weighs less than many top-of-the-line road bikes did back then.  There are no mountains in my state.  Nevertheless we have plenty of trails, ranging from smooth beginner level to heart-in-the-mouth-take-your-eyes-off-the-trail-and-you-die technical stuff.   I tend to ride a combination of paved roads, dirt roads, and the occasional rough terrain and since I can lock out the suspension for hills and really smooth roads this bike suits me well.  Yeah, the guys in spandex pass me all the time but they can’t really go off the road much so I don’t mind.

I used to run but got tired of it.  Twenty miles on bike is more fun than five miles on foot.

What’s the Emergency Department Really Like?

The American College of Emergency Physicians and their bogus statistics notwithstanding, the majority of cases we see are not emergencies.   As I have mentioned before, most of the cases we see probably don’t need to be seen at all by anybody in the medical profession in any capacity.  I saw 34 patients last night and half of them were for nothing more than cold symptoms, symptoms that at one time in our nation’s history rational people just accepted without feeling the need to seek medical attention.  Today of course where everything is a friggin’ Emergency and medical care is absolutely free for the asking I walk into many patient’s rooms to find a tattooed, well-looking white chick and her less-tattooed mother waiting angrily to be seen by The Fucking Doctor Who Was Just Standing Around Typing On His Computer While They Waited Three Hours who then breathlessly spin a dire tale of a little bit of a sore throat and a little bit of a cough that is really interfering with the daughter’s two-pack-per day habit or whatever it is she does to lead a fulfilling life.  Either that or it’s a little bit of gas pain or some faint twinge or spasm in the back that has caused a slight discomfort that must be addressed immediately.

That’s a particular species of patient that knows no geographic boundaries, by the way.  Even here in the South where people are an order of magnitude more polite and well-behaved than in Yankeeland we still have the ubiquitous fire-plug of a mother escorting her wan daughter, both of them at various corpulent stages on the road to morbid obesity, who insists that not only is something wrong with the daughter but that every single test and study known to medicine must be ordered to ferret out the problem.  After taking a history, doing an appropriate exam, and telling the mother that her daughter has a chest cold and is going to do just fine, like clockwork comes that cold-as-fish look of disgust and the inevitable, “We want to see another doctor.”

Either that or, “My sister had the same thing and the doctor over at the Quickie Clinic gave her a shot.”

“Madame, the doctor at the Quickie Clinic works at the Quickie Clinic because he’s an idiot.  You’re in the big leagues here and I don’t just give shots.”

Of course I don’t say that. 

One patient opined that he could get served at MacDonald’s in five minutes so he didn’t understand why it took four hours to be seen, evaluated, and discharged.  He was an otherwise reasonable guy and really very pleasant but that sort of highlights the problem with Emergency Medicine and most Emergency Departments, namely that they are largely highly expensive, completely understaffed Quickie Clinics in which some real medicine is practiced from time to time; the twenty percent or so of patients who have real emergencies or legitimate complaints and are part of our core function in the community ironically causing so many delays for the other eighty percent who should have stayed home that, in our insane and upside down world, the various quality “metrics” used to rate how good a job we’re doing are entirely dependent on the satisfaction of irate people who didn’t need to be seen and did nothing but waste either their own money or the taxpayer’s.

There is, as you guessed, tremendous bureaucratic pressure to decrease waiting times and subsequently to increase patient satisfaction which is one of the most important contributing factors to the so-called crisis in Emergency Medicine, a crisis which wouldn’t exist except that there is money to be made in the high volume business of trafficking in minor complaints and very little incentive not to.  Most of our patients, after all, have some kind of insurance and taking money from the government to do what is essentially a well-child exam on a slightly febrile but otherwise healthy-looking toddler is like stealing candy from a baby which is sort of what we are doing (and why the Children’s Health Insurance Program is such a colossal waste of money and a harbinger of what is yet to come when the Sun-King, Ra-Obama, by one gesture of His Mighty Legislative Hand, turns us all into Medicaideurs).

So you can hardly blame the patients.  They come because they are encouraged to come-witness one billboard in town showing a comfortably sleeping baby proudly proclaiming that they are a “Pediatric All-NightER” never mind that it verges on child abuse to drag your healthy looking baby into the Emergency Department at two in the morning to share Cheetos with the crack whores-and they come because there is nothing to discourage them; no obstacle except a little bit of waiting and we have never chased anybody away who had a minor complaint for any reason so mundane as an unwillingness to budget some cigarette money for medical care.

Why is it, by the way, that while I have had many people complain of being unable to afford low-cost antibiotics, inhalers, and blood pressure medications I have never, and I mean never, had anybody cry poverty when presented with a prescription for pain medication?  I could write a wino living under a bridge for three months worth of Lortabs and he’d accept the prescription without demur.   A prescription for Penicillin for his dental abscess?

“Come on, Doc, I ain’t got the money for that.”

So what’s an Emergency Department like?  In reality it’s a little like a miniature hospital onto which has been grafted an STD clinic, an Urgent Care, a psychiatric ward, and a small intensive care unit.  At any time and within ten feet of each other you can have a critically ill dialysis patient being kept alive by pumps and ventilators, a genteel dowager having The Big One, a teenage girl with some vague menstrual cramps, a smattering of varying kinds and degrees of abdominal pain, several people in “Just To Get Checked Out,” and lots of kids and adults with nothing, apparently just in for the novelty of watching a different television and having a nurse at their command.  The only thing we don’t have is an operating room but can the time be too far off when irate patients will opine, angrily, that it’s been three hours and they still haven’t got their appendectomy?

What is your job really like?

As you know, I am an Emergency Physician working in a medium-sized community Emergency Department in a medium-sized hospital in a medium-sized city in a medium-sized state.   A “community” Emergency Department is not a major trauma center and generally sees mostly medical complaints as opposed to the big urban Emergency Departments that see mostly medical complaints with a varying amount of stabbings, shootings, and other acute medical problems that are the inevitable sequelae of Standing On the Corner Minding Your Own Business.

My hospital was purpose-built a few years ago to sit astride the major nursing home trade routes and commands this commerce for many miles around.  There are twenty or thirty nursing homes of varying quality within a quick ambulance ride of the place and, as you can imagine, a large percentage of our patients are the warehoused elderly who present with a varying quality of complaints ranging from the sublimely ridiculous (Altered Mental Status in a demented, contracted 92-year-old who hasn’t moved in two years except when indifferently rolled and slopped by the surly hired hands)  to the legitimately dire (septic shock in an otherwise healthy elderly lady).

We also get the usual general medical complaints, most of them incredibly minor, most of which barely rise to the threshold of needing medical care at all much less both barrels of the Medical Safety Net. We address ‘em all however although in my role of community educator I do counsel people on the appropriate and inappropriate use of Emergency Medical Services.  I understand that some patients don’t have doctors but a rather large percentage of my patients have doctors and either didn’t want to wait for an appointment or were too lazy and irresponsible, despite having insurance, to inconvenience themselves in the slightest to schedule one.

Eczema, for example, no matter how itchy, is never a medical emergency and don’t expect me to apologize for making you wait five hours to be seen.  And standing at the door to your room glaring at me while I work on your fellow citizens who are actually sicker than you won’t make me see you any quicker although I admire both your stamina and your absolute commitment to not walking across the street and getting some skin lotion from Wal Mart, an enterprise that would have taken you ten minutes and was helpfully suggested by the triage nurse.

And for the one thousandth time, fever in an otherwise healthy toddler is not an Emergency either.  It’s 3 AM, for Christ’s sake, and you will pardon my incredulity as I look at your playful, active, rambunctious child stuffing Cheetos in his mouth.   Oh, and just because we didn’t order any lab work or imaging doesn’t mean we “didn’t do anything.”  From start to finish you had some high-powered talent working on you.  Your nurse has a college degree and years of experience and assesed you child perfectly in triage.   I have a ridicuous amount of training and education and if between your nurse and me we decide that your kid ain’t that sick he probably ain’t that sick.  Did you notice the thoroughness of my physical exam?  I’m not just pretending to look in his ears, you know.  Surely the history and the exam are “something.”

The major difference between this job and many other typical jobs is the pace.  I saw 42 patients in twelve hours last night and never stopped working for the whole time. Emergency Physicians don’t get breaks per se.  We are usually scrambling to keep things moving and when things get a little slow we try to catch up on our charting, a task made extremely difficult in my particular hospital by The Worst Emergency Medical Record System In The Entire Universe, a little nightmare called Medhost that apparently got its start as a restaurant order and billing system and has not progressed much from there.

But I digress.

We try to keep people moving in and out, either admitted or discharged, but inevitably something comes up and people start waiting for disposition.  Part of this is my fault as I am still learning how things work in a real Emergency Department where the process of evaluating, treating, and dispositioning is substantially different than it is in the academic world.  On the other hand a couple of critically ill patients or an inexplicable run of ambulances can back up the department for hours, distracting us from our true mission of treating your child’s ear infection at 2AM because your appointment with his pediatrician in ten hours was just not soon enough.

I enjoy my job even if I am glad to leave when my shift is over.  It’s not really too stressful.  The most aggravating thing about it are the long stretches where every patient seems to be “Otherwise well child, active, playful, with a low-grade fever.”  The critical and otherwise actually sick patients are a relief.

What do You Think About Ted Kennedy?

Don’t get me started.  First of all, I will never understand the fawning adulation lavished on our corrupt hereditary ruling class by the press.  Mr. Kennedy was a voracious parasite on the nation whose appetite for power was only checked by his inability to keep his head in a crisis and his utter unwillingness to dive into the cold waters of Chappaquiddick to even attempt a rescue one of The Little People, a throwaway citizen who was just a hired mourner in the long dirge of the Kennedy odyssey.  Mr. Kennedy never held a real job as far as I can tell, never produced any useful good or service, and lead an entirely privileged life out of which he felt comfortable pontificating to the rest of us about Good Citizenship, Duty, Honor, and what constitutes a good life in our now completely insane nation.  He was a senator for as long as I have been alive and the web of corruption and influence peddling he spun is the best argument I can think of for term limits.

But isn’t that the problem with American politics; that it is full of people who have done nothing and know nothing about anything but politics and yet feel confident and, what’s worse, divinely entitled to solve complicated problems that are well out of their scope of experience?  That’s why President Obama is such a failure and going down like your prom date:  Having been sheltered in academia and government for his entire adult life, he doesn’t know anything about the real world, not even enough to know what he doesn’t know.

So sing your paeans and bow your heads.  Wax sanctimonious about the passing of your paper mache great men. I don’t mourn the passing of tyrants.