doc2010

Sometimes they don't need it;sometimes they do.

2005-02-19T01:35:00.000-05:00

Everyone's familiar with patients who arrived at the ER in an ambulance, but didn't really need to be brought in that way. All they suceeded in doing was generating a $350.00 useless charge, because they spent hours sitting in the same waiting room as the folks who drove themselves in. The ones I do wonder about, though, are the ones who really did need an ambulance, but made it in somehow on their own. It seems like the ER was full of those kind tonight.

The first one was a young lady, two days post-op, who was totally unresponsive when I ran outside to see what all the commotion was about. She was spralled across the passenger seat, wearing nothing but an adult diaper (which was overflowing) and her husband said, "I think she's a little dehydrated." Fortunately, her father had gone to check on her an hour earlier and insisted that she be taken to the ER. Unfortunately, even that wasn't fast enough. Can you say sepsis? Hours later, the husband was still insisting that she "shoulda had some more water."

Number two was brought in (begrudgingly) by her son-in-law. "She says she's having an asthma attack," he says, "but she has them ALL the time." A little later, I overheard her grandson (Little Johnny) on his cellphone. "We'll probably be here a while...Dad says she's really putting on an act this time," he related. I could have approached it as a learning experience: "Hey Johnny!" I could have said, "can you spell V-E-N-T-I-L-A-T-O-R ? Why? Because that's what grandma's using to breathe right now. Instead, all I said was, "I don't really think she's faking it Johnny."

Third was a lady who drove herself to the hospital. Even though she had wrecked her other car a little earlier, she didn't appear to have a whole lot wrong with her at first. Five hours later, though, she looked awfully pale when someone finally noticed her. Now on a normal day things might have gone a little differently. Patients in the triage waiting area are supposed to have their vitals rechecked every two hours. But today, eight people called in sick, and that just didn't get done. It was kind of chilly today and she was all wrapped up in a sheet-- she could have been any other patient who waits for hours with big toe pain. Fortunately, someone did happen to notice her, and one transfusion due to a huge GI bleed later, she might just be OK. I wish I could say that for the other two, but I can't. We only batted .333 today. That's good for baseball...but bad for ER.

I don't know...

2005-01-29T11:22:00.000-05:00

"I don't know" must be the stock answer of teenagers these days. Last night an eighteen year-old walsks in the ER:

"What's going on?" I asked.
"Well," she replied, "I'm from out of state but I go to college here. Is it OK if I'm seen here?"
"Sure it is," I said, "we take anybody, any time. What's the problem?"
"I'm pregnant and I was spotting last night, so I thought I'd come in today"
"How far along are you?"
"I don't know."
"Do you have any idea?"
"Well, I guess maybe...oh...three months or so."
"Did you doctor tell you when you are due?"
"Oh...well..I haven't actually been to the doctor yet...but I'm here now."

Thinking back on the past 20 years I realized that things haven't really changed that much after all.

"Will I have to wait long before I see the doctor?" She asked, meeky waiting for my reply.
"I don't know."

The Preacher Man

2005-01-29T11:14:00.000-05:00

When he was rolled into the ER, he was wearing the preacher's robe...and that's all. That's exactly the way the policemen found him when they arrived at the scene of the church break-in last night. Patient X had been told by "the Lord" that he needed to spread the Word. So, he broke into the church, undressed, stole and donned the robe and preceded to the pulpit. According to the arresting officers, he was preaching "one helluva sermon" up there, prancing around like he was on fire. Did I mention that "the Lord" had also told him that he had no need for the cast we had applied to his broken leg a few days earlier, so he had removed it himself. When I left for the night, he was still in the acute adult pod and had been rather heavily sedated. I'll bet he's in a different pod today-- no doubt he's still spreading the Word.

Who's to Blame for Healthcare Costs?

2005-01-09T13:18:00.000-05:00

Who do we blame for the cost of healthcare? I've got a few ideas.

You could probably say the government started it back in the 1940's if you wanted to. At a time when wages were frozen by the government, someone came up with the idea of paying for health insurance to lure in prospective employees. They couldn't give them more money, but they could give them benefits. Suddenly, any job worth having offered health insurance. People simply got used to this benefit and began demanding it, because they were somehow entitled to it. To this day, one of the first questions asked of prospective employers is, "What kind of health plan do you have?" Can you imagine what would have happened if they had decided to pay for your car insurance or house insurance back then as well. You can bet that people would still be demanding those benefits today. I wonder how much they would cost now.

Of course, the health insurance benefit wasn't a big problem at first, because people still had to pay a fair sized deductible and probably 20% of the charges after that. But, it covered catastrophic damages that they never could have covered on their own. You could blame the government again for their interference in the 1960's if you really wanted to. The decade of Medicaid is surely one that changed healthcare forever. Do you remember when the government said, "Why should you doctor's worry. We don't want to change the way you practice; we only want to pay the bills for the elderly. Why should you care where the money comes from?" Of course, we all know what happened next. People really decided to take advantage of this free healthcare and in no time the government couldn't afford to pay for it anymore; not without controlling what services took place and how much physicians would be paid. You couldn't tell the people to stop having those elective surgeries that the government volunteered to pay for, because, by then, the older people had a right to free health care, didn't they?

I guess you could blame the HMO's for the next phase of problems, or maybe you could still blame the government again, because it was really the government's price freezes to combat runaway inflation that brought HMO's to prevalence in the 1970's. I'm even guilty of overusing them myself. The first job I ever had paid for my health insurance, but I still couldn't afford to go to the doctor, because I had to meet a $250.00 deductible first. When they finally got and HMO plan, with a $10.00 co-pay, I went to the doctor every time my nose ran and still didn't spend $250.00 in a year. It was a godsend. After that, no other kind of plan was any good. After all, I was entitled to the cheapest plan, where I could pay next-to-nothing and still get quality healthcare, wasn't I?

So, I sit here now and look at the escalating costs and wonder whose fault the current situation is. The truth, however unpleasant it may seem, is that it's me. I'm responsible for the problem, and so are you. Why? Because of our attitudes. We have somehow come to believe that free healthcare is a right in this country. We still have catastrophic insurance on our houses and cars, but we know that regular, routine maintenance is up to us. Yet, we demand free regular and routine maintenance of our healthcare plan. We got greedy with Medicare too. We were not willing to give up our newly acquired rights to any procedure we desired, even if the government couldn't afford it, but someone had to pay for it. Guess who that was. It was we...We the People of the United States of America who don't seem to care where they money comes from, as long as it's not from our own pockets. The only problem with that theory is that it's exactly where the money does come from...eventually.

One Malpractice Solution is...

2005-01-08T14:20:00.000-05:00

Maybe it will provoke a few nasty comments, but since the debate is already as nasty as it gets, I won't lose sleep worrying over it. What's the real problem with malpractice lawsuits? I think it's the incentive lawyer's have to file cases-- specifically the financial gain. Let's just say you were a lawyer. If four potential clients walked into your office one day, three of them obviously wronged by a horrible physician, but there is little chance of collecting a financial reward, and one of them with a so-so case, but a big opportunity for financial gain, which case(s) would you take? Most of you are going to pick the one where you might get the big bucks, right? It makes sense to do it that way. Face it, the "lawyering" business is just like any other business (physician included); if you can't make money at it, there's no reason to do it. Thus, there is a potential for a lot of legitimate cases never getting filed, but plenty of so-so cases being taken to court.

The lawyers have said a few things that make sense. They put up the money for these big cases, spending their own hard-earned dollars while taking a gamble that they will win. If they lose, they get nothing. So, shouldn't they expect to get a big part of the windfall? The problem as I see it, is the gambling thing. If they want to gamble their money, I'd much rather see them put it in the stock market. Then, they could take the cases that really do deserve to go before a judge. Unfortunately, the current system allows them the possibility that they might make millions. Take away that possibility and you take away the incentive for lawyers to choose cases based on possible large financial gains. The one thing that you don't take away, though, is the financial gain of a legitimate victim.

So, just how do you do that? Never let it be said that I didn't bitch and moan about something without proposing an alternative. Each possible case should be brought before a panel consisting of one judge and two medical professionals. Those that have merit will be assigned to a court-appointed attorney, and they will be reimbursed at a rate to be determined by the state. The courts must also approve expenses for each case (including expert witnesses, etc.). All lawyers will be required to serve in this capacity at some point in time, as will all physicians. It will be considered a part of their duty to their fellow man. Cases will still be tried, witnesses called, juries convened, and awards made. But, the financial incentive to pick cases based on money, rather than justice, will be eliminated.

Now for the last point-- before you get all huffy and start screaming about how silly this is, how it could never happen, and condemning it for its faults-- why not propose your own solution? It's easy to scream about how awful someone's proposal is; it's a lot harder to bring one of your own.

No Good Way to Tell Her

2004-12-18T09:17:00.000-05:00

It must have been troublesome, all that waiting and not knowing, while folks in the background tried to figure out a good way to tell her just what had happened. It was busy, you see. Lot's of trauma on Friday-- the trauma bays were fulls, the rooms were full, the waiting room was full...but she was only there because her husband needed some blood drawn. She would have been back on Monday, though, because her husband was scheduled for surgery then.

Unfortunately, his time ran out. Somewhere between "ball up your fist" and "you'll feel a little stick now" his heart decided to stop cooperating. It's a little unusual to hear a code called from that part of the building, and the response was fast, but by the time he got to the ED he was long gone. Meanwhile, his wife fluttered around, passed from one employee to another while folks behind the scenes scrambled to "set things up." You see, you just don't walk out into hallway with the "We did the best we could do" speech like you see on TV. We have to put the family in a nice little room, filled with councilors and shoulders to cry on, but...all of those rooms were already taken. So, it took a good forty-five minutes to find an unused space and set up some new place for the family to go. To top it all off, this woman was a hospital employee-- not from the medical side, but a "big whig" in the accounting department. So, the entire administration wanted to be on hand, offering their condolences. That means it had to be a a nice, big, and politically correct place as well. The whole thing started getting so big that I would not have been surprised if they had ordered in some food and waited till that got there to tell her. And all that time she sat lonely and afraid, tears streaming from her face, wondering why on Earth no one would tell her anything. I felt a little like the desk clerk at the hotel, because I wanted to say, "I'm sorry ma'am, but your room's not ready yet."

How to make your life easier...

2004-12-12T13:41:00.000-05:00

Four exams, three papers, a lab report and two Powerpoint presentations in one week...of course I avoided doing the laundry, because folding shirts just took much too long. I had even started putting everything on hangers, (yes, even the t-shirts) because it took less time. Unfortunately, my closet was getting way too full. What could I do?-- Then...I found this:

http://www.albinoblacksheep.com/flash/fold.php

Viola!!! All my concerns were over in a flash. Now, laundry time is my favorite time of the week. Unfortunately, it doesn't last long enough now and I sometimes have to wash clothes twice a week. Who'd have ever believed it!

The "Regulars"

2004-11-25T10:59:00.000-05:00

They're the "regulars". You know them by name. You know their illnesses. You even know what day of the week they are likely to arrive, and during the winter, they visit you more and more often.
Mary [not her real name] lives forty miles from the ER. She works weekends as a prostitute, but doesn't have transportation into the city, where the johns are, so she uses the next best thing...the EMS system. On Friday mornings, she inevitably has a sickle cell crisis, and calls EMS for transport to the city. After several hours of moaning and groaning, when it gets near dark, she heads out to the streets and hooks for the weekend. Then she gets a ride back home-- sometimes from her grandmother-- but if it's been a good weekend, she'll hail a cab. Did I mention that Mary is still a teenager?
Bobby [another fake name] comes in on Fridays as well. He tries his best to get admitted for the weekend, but he's more than happy to sit in the back hallway waiting area and watch TV for a day or two. IN fact, he has his own dedicated seat. He's used it so often that it is molded to shape of his butt, and no one else can sit in it comfortably. But, to Bobby, it's fine. And if he doesn't get admitted he still gets to eat, because someone is always jumping up when there name is called and forgetting the last few bites of his bacon double cheesburger. Nevermind...because Bobby will finish it up for you, and throw away the wrapper. You see, he doesn't like his room to be messy. I'll bet he's been like that since he was a kid.
BTW, what is it with food in the ER? All you have to do is make someone wait for fifteen minutes in the ER and they get incredibly hungry:

PATIENT

How long before I'll be seen? Do I have long enough to go get a taco salad, with sour cream and extra hot sauce?

I think the doctor would probably prefer you didn't.

PATIENT

You know I've been throwing up for two days, and my stomach hurts really bad. Don't you think food would help that?

Now, I've been on the other end of the ER once or twice too, as a patient. Trust me, the last thing I ever wanted was food!

We're not a pharmacy...

2004-11-25T10:28:00.000-05:00

So, it's Friday night in the ER and it's busy as usual. The Triage rooms are filled, the waiting room is filled, and there's a line of folks fighting to get through the revolving front door. In walks a 50-ish year-old man:

In a formal voice: What is the nature of your complaint, sir?

PATIENT

I need to get my prescription filled.

Ummm...did you go to the pharmacy? There's one right across the street.

PATIENT

I'm on out-of-state Medicaid. Greyhound lost my luggage and they won't fill it. They said you would.

OK...Fill this form out for me and we'll start checking your vital signs in a few minutes.

PATIENT

I just need my prescription filled. That's all.

I'm sorry, but it doesn't work that way in the ER; you have to see a doctor first.

PATIENT

How long will that take? Can't you just take my prescription back to him and have him give me some pills?

No, sir, I can't do it that way. Like I said before, you have to see the doctor before you can get any medicine...and it might take a while.

PATIENT

Well, where is he? I can just go see him now. Is he in the back? [starts walking down the hallway, ignoring me] I'll bet I can find him and he probably just get me the pills, right?

---

10 minutes pass

---

PATIENT

Where'd you say that doctor was? I need to get my prescription filled.

Do you remember any of the conversation we had earlier?

PATIENT

What?

Do you remember when I told you that you have to fill out this form, see the triage nurse, then wait to see a doctor before you'll ever get any medicine? I'm sorry that Greyhound lost your luggage, but in the ER it works this way.

PATIENT

All I need is my prescription filled. If you''ll just quit giving me the attitude and give me my pills, I'll be out of here in five minutes...

...and for the next five hours this same conversation occurred-- every ten minutes. We finally got him through triage, but the wait at the level-one trauma center on Friday night is pretty long for folks who just need their prescription filled. I was never so glad to see midnight as I was then. There were a few times that I started to lose my cool. Such as when I told him, "What part of 'we're not a pharmacy' don't you understand?" and "No, Greyhound will probably find your luggage before you ever see a doctor here." Nights like those, I'd rather be in Pod7 (the pychiatric ward), because even in a crisis, most of those patients are reasonable.

Pokeberries in Peds

2004-09-25T18:09:00.000-04:00

The whole family came in at one time... Mom, Dad, and five children, ages 2 to 6. It seems that the kids had run across a pokeberry/pokeweed plant on Sunday afternoon. Unfortunately, they were hungry. ScienceU.com talks about the pokeberry:

"The red stems of the Pokeweed slightly resemble Rhubarb, especially in the Spring, but Pokeweed likes to grow into a tall tree-like plant. The purple berries shown here are its most distinctive feature. They will dye almost anything purple, but they are very poisonous."

The scene was just as chaotic as it was hilarious. Of course they ALL blamed the two-year-old, who seemed to have eaten the most pokeberries, and was also least interested in drinking the charcoal. Now, I've never tried drinking charcoal, even with the added cherry flavor used in Peds ER, but most of the kids didn't mind drinking it...until one of them discovered that smearing it on your face left stains. Thus, smearing it on your little brother's face would be exceptional fun, especially if he didn't want you to do it. The four-year-old was a Michael Jackson fan as well. He danced around the hallway with his charcoal screaming "Beat it!", over and over, at the top of his lungs. I couldn't help but wonder if this scenario is normal at their house. Does the same thing happen when they go shopping, or when they go out to eat?

This story normally wouldn't bother me, because I work in the Adult ER, but my fiance insists that she wants four kids. I have this fear that I'll be on the other side some day, my own kids raising all the havoc. So, I went home and put attention into cutting my grass. I found some pokeberry plants in my yard too... and I burned them.

What was I Supposed to be Doing?

2004-09-16T22:21:00.000-04:00

You were supposed to be wearing a seat-belt, that's what. I wouldn't have even noticed you, but the drink machine in our area was out of order, so I was on the way to the cafeteria. You were waiting patiently in the hallway outside x-ray. Of course you were pretty much out of it-- lying there on the gurney with a sheet pulled up to your neck. Patches of blonde hair were missing where it was shaved in spots, and your once-pretty face was stained by antiseptic and had more stitches in it than a baseball.

Later that night, actually the next morning, I was sitting in the parking garage-- cranking up the car-- and I strapped myself in really tight. I was thinking about you then too. So, I pulled a little tighter on the buckle, and shifted into reverse.

24 Weeks

2004-09-16T22:00:00.000-04:00

That should have been the title of last Friday's shift in the ER, because it was the most common phrase that rolled from my tongue that night. I don't really remember how many times I called up to the fourth floor for L&D (Labor and Delivery) but it seemed like hundreds. Unfortunately, these "twenty-four-weekers" were all having problems-- thus, they show up at the ER.

But, I'll probably never know what happened to any of them, because anyone over twenty weeks goes straight to L&D. Oh I'm usually nice about it... I call ahead. I like to push 'em up there in a wheel chair too, because you get to go through the coolest elevator. One side opens in the ER, but the OPPOSITE side opens on the fourth floor. If you didn't know what was going on, you might get in the elevator, turn around, press the button, and wonder why the door didn't open again when you got there-- until the breeze from the door opening behind you hits you in the back. Sometimes on break I'll just ride up and down on that thing, over and over again. For some reason I never seem to get tired of it. At every stop, though, I'll wonder what's going on with the "twenty-four weekers".

Not long ago, Michelle Au posted about a 23 1/2 week premie that was doing pretty well in her hospital. She wrote:

"I could talk about the baby in the NICU that I'm taking care of, who was born at 23 and a half weeks for various and sundry reasons, and who I basically thought was going to die within hours because she was basically a fetus, all transparent skinned and fused eyes and tiny labored breaths. But the parents wanted everything done, and despite some ethical reservations, we acquiesced and the kid surprised all of us by not only not dying, but doing unbelievably well on minimal support."

I don't think I'll ever lose my sense of amazement over how well modern medicine can take care of people, people of ALL ages. My older sister died when we were both young. She was born with a heart valve defect that is very commonly fixed these days. If she had been born a few years later, she might have survived. I don't feel so bad, though, knowing that she was a "practice" patient-- a guinea pig for the surgeon's at Duke-- because quite a few folks that are alive today are alive because she gave the ultimate sacrifice. I still think about you every day Suzy, I really do.

He's Only Seventeen...

2004-09-16T21:20:00.000-04:00

Actually I didn't see the "seventeen year-old" when he first walked up, hand wrapped in bloody towel, because I was telling the "body pain" lady that she would have to wait a little longer. When "body pain" lady first walked up to the ER, she filled out the chief complaint section as if it were a grocery list:

"head pain, neck pain, leg pain, vaginal pain, and stomach pain"

It looked like not too many body parts were working well for her that day. In fact, the reason why I was talking to her at all when the "seventeen year-old" showed up was that she wanted me to know that she had developed some more pain, and also wanted to know if she needed to fill out another form. She was still there when I left after midnight, but I suspect she was on her way to Pod 7. You'll need to guesss what goes on in Pod 7.

Anyway, the seventeen year-old must have gotten tired of waiting, and dripping on the floor, because he started screaming about being shot in the hand. It didn't take long for me to drag him into Triage 4 after that. The physical damage, as it turns out, wasn't too bad. There was a lot of conjecture about exactly HOW he got shot in the hand, but the real story didn't come out until two police officers showed up and tracked down the mom. It looked like they were pretty familiar with each other, and I'll admit to a little eavesdropping, but it seems as if the "seventeen year-old" had been shot in the neck only a month earlier. Mom seemed more worried about her son's future and so did the officers. I think I agree too. If quite a few things don't turn around really soon in this young man's life, he might not live to be the "eighteen year-old."

MCAT Prep

2004-09-05T18:45:00.000-04:00

Another day, another solicitation from the Kaplan folks who certainly seem interested in improving my MCAT score-- or is it that they want my money? Am I being to cynical?

In any case, only about thirty weeks remain until the April 2005 edition of the MCAT testing session. While I've been studying for several months now, it seems like the time is growing very short and my study sessions are growing more structured.

I am taking Organic Chemistry and Physics for the next two semesters, so I'm not really worried about those two subjects-- they should still be rather fresh in my mind. I just finished two summer sessions of General Chemistry, so that is pretty fresh right now, but I have a few weeks set aside in December to do refreshers.

Biology? Yes I'll have a couple of Biology classes in the meantime, but I've also set up a study schedule based on the "Topics for Biological and Physical Sciences Sections of the MCAT" page on the MCAT homepage. Thirty weeks remain, so I've divided the subjects into 28 sections and I'll be studying for each of those just as if it was an additional class I was taking. The subjects are:

1- ENZYMES AND METABOLISM
2- DNA STRUCTURE , FUNCTION, REPLICATION
3- REPAIR OF DNA, RECOMBINANT DNA
4- GENETIC CODE, TRANSCRIPTION, TRANSLATION
5- EUKARYOTIC CHROMOSOME ORGANIZATION, GENE EXPRESSION
6- MENDELIAN CONCEPTS, ANALYTIC METHODS
7- FUNGI, VIRUS STRUCTURE AND LIFE CYCLE
8- PROKARYOTIC CELL: STRUCTURE, BACTERIA
GROWTH, PHYSIOLOGY, GENETICS
9- NUCLEUS, MEMBRANE-BOUND ORGANELLES
10- PLASMA MEMBRANE, CYTOSKELETON
11- MITOSIS, MEIOSIS
12- NERVE CELL, MUSCLE CELL, OTHER
13- HORMONES, MECHANISMS OF HORMONE ACTION
14- NERVOUS SYSTEM STRUCTURE AND FUNCTION,
SENSORY RECEPTION AND PROCESSING
15- CIRCULATORY SYSTEM
16- LYMPHATIC SYSTEM
17- IMMUNE SYSTEM
18- RESPIRATORY SYSTEM
19- SKIN SYSTEM
20- DIGESTIVE SYSTEM
21- EXCRETORY SYSTEM
22- MUSCLE SYSTEM
23- SKELETAL SYSTEM
24- REPRODUCTIVE SYSTEM
25- EMBRYOGENESIS
26- DEVELOPMENTAL MECHANISMS
27- EVOLUTION
28- COMPARATIVE ANATOMY

In addition, four weeks in December and January (no classes to attend) will be spent reviewing General Biology and General Chemistry, as well as a couple of practice tests. I plan to take two more practice tests in the last two weeks (remember I said a total of thirty remain) of the spring.

Yes, I left out a few things-- like the reading comprehension and writing sample-- but I have strategies for those too. That, however, will have to wait for another time.

Abusing the system

2004-09-05T16:20:00.000-04:00

You know, it's fairly easy to recognize the "frequent flyers" in the ER-- they seem to know the system very well. The first trip is just like any other, but they have a learning curve reminiscent of a toddler. But, the ER fights back as well. For every bit of new information learned by the "frequent flyer" a new solution is created by the ER.

I work in triage on Fridays from 3PM to midnight. Everyone who doesn't come in via ambulance or helicopter goes through triage. The first step is to fill out the little pink form on the clip board. Unless you are experiencing chest pain and SOB (shortness of breath) you have to wait to see the triage nurse-- especially on Friday evening when MVC's (motor vehicle crash) rule. The truly observant patient, however, will notice that chest pain/SOB's go straight through the triage door-- not into the waiting room.

The triage door, though, is only the first step. In most cases, when the triage nurse finishes, the patient goes back into the waiting room until a slot in the pod opens-- unless they need immediate help. Last Friday, one enterprising young woman decided that after 2 hours of waiting her chief complaint had changed. Not only did her ankle hurt, but she now also had chest pain/SOB as well. Someone either told her that chest pain/SOB was never ignored, or she gleaned it on her own, but I shipped her straight into triage two and strapped her up to the pulse-ox monitor. When Will (not his real name), the triage nurse, looked at the 100% saturation, he thanked her for her time and sent her back to the ER waiting room. Yes, she succeeded in getting into the triage room quicker, but she was no quicker getting into the pod. I can't be sure, but I think that Will shuffled her records to the back once or twice to make her wait a little longer.

Some patients, however, have learned that they can bypass triage entirely-- simply by showing up in an ambulance. Once on board, the EMT's call ahead on the radio and the head nurse assigns a pod room in advance. The most critical go to Pod 5 or 6. Pods 5 and 6 each have about 10 rooms and pod 5 is also home to Trauma 1 and 2 and Trauma W (waiting). Less critical patients go to Pod 9. Really less critical (frequent flyer and hypocondriac cases) go to Pod 5 Hall. Yes, it is simply a place in the hall. There they wait until an actual room is empty, and the wait there can be just as long as it would have been if they had gone through triage in the first place-- except they have no TV to watch, no snack machine, and can't have visitors.

Who's guarding the jail?

2004-09-05T15:50:00.000-04:00

I only ask that because Friday was obviously Prisoner Day at the ER. Being the Level One trauma center for 16 counties can have it's advantages at times, but it is also the place where every prisoner within the 16 county area, who has more than the sniffles, is treated. That means that at least two correctional officers make the trip as well-- and there is no "special" treatment. They wait just as long as the guy whose chief complaint is "my leg kind of hurts."

The only difference with the prison population is that they don't wait in the ER waiting room. They get to wait in the triage hallway. I guess the reason for that is to make the place look "nicer." Little do most people know that just behind door number one can be 6 to 10 convicted felons doing 6 to 10 years of service behind bars. Especially after 8:30 PM, when visiting hours end, because the main hospital doors close and EVERYONE has to enter through the ER. It just wouldn't do to have bleeding men in chains taking up the lounge chairs and monopolizing the remote control.

The only thing that really puzzled me was the one inmate who came in around 4PM. The officers usually bring in any medical records, x-rays, etc. and then fill out the short paper form listing the chief complaint-- manacled patients have a problem doing this on their own:) Mr. 4PM's chief complaint was stomach pain. Following protocol, I directed them through door number one and passes the form to the clerk. Another potential client was stumbling through the door, so I went to help-- totally forgetting about Mr. 4PM. An hour later, while trying to explain to a dishelveled mom that it is not irregular for parents to actually beat the ambulance containing their child to the hospital(especially on Friday at 5PM), that Mr. 4PM was already in surgery. Glancing at the computer screen I noticed that the chief complaint had been changed to "stab wound" and a little detective work allowed me to discover that said "stab wound" had occurred one week prior. I wondered why he had not been brought in sooner, and discovered that he had complained quite a bit and that an x-ray (taken today) showed that he had part of an "object" still imbeded within his abdomen. By now said object had obviously caused a few more problems, and having missed the "golden hour" complications were sure to follow.

Strangely enough, I never even wondered what he did to be sent to prison. It never really dawned on me until I was talking later to my sister and told her about the number of prisoners I had seen in the ER that day. "Wonder what they did?" she asked. I had no clue, but I knew that even if it had been murder that each and everyone of them deserved adequate medical care. Not free, mind you, but adequate. Good medical care is one thing. Free medical care is another.

Been Browsing Blogs...

2004-08-18T15:07:00.000-04:00

I don't know what happened but Blogger lost some of this post the first time, so off I go to try to recover it...
I needed to get my daily dose of alliteration out of the way, and I guess the title says it all. This particular one delt with consonance, but I've often been told that my real specialty is in assonance.That's not really what I wanted to talk about, though. It's a really slow day, between semesters, and I decided to search for some med-school or pre-med blogs out there-- one's that I haven't read before. Unfortunately, many of the bloggers seem to give up before very long.
I was really interested in Bunneeblog at first, because she seemed to be an older pre-med, and I was dying to hear about her adventures. Unfortunately, only five entries in three months (none since December 2003) and that just isn't good enough for me. Where are you Bunnee? Are you ever coming back?
Tamika started off with a bang at MyBlog Journal, with 38 posts since January' 04, but it all ended in April. At least she informed us that it was her last post. If it had been April 1, instead of April 8, I might have thought that it was all just a joke. But, no posts since then, so it really, truly must be over. Will you ever become an OB\GYN Tamika?
Arzhang's Medicine Blog is fairly new, and he just began year one at UW medical School. With a name like Arzhang, how can you go wrong? Will you keep us informed of your journey, or will your blogging fall by the wayside as you devote more and more time to your studies?
If you really want to get the most bang for your buck, check out Non-traditional Student Doctor Journals, where you can get six for the price of one. Check out guy on the far right. Does he look like your doctor? Actually he reminds me of Gonzo on the short-lived Trapper John, MD TV series. I wonder if he lives in a motor-home in the hospital parking lot too?
I guess that I should apologize in advance, in case anyone takes my subtle attempt at humor today too seriously. I just needed to find something constructive to do, and all my actions are absolved, I hope. Now, that's alliteration... almost.

How good are sports analogies?

2004-08-18T11:34:00.000-04:00

A really good sports analogy covers just about anything, doesn't it? Maybe it's because of human nature-- that we are all so competitive-- that they always seem to work. I've seen so many posts about defensive medicine lately that I wondered if sports analogies were appropriate there as well. I don't know about this in the scheme of life, but in the scheme of sports a good defense will keep you in the game, but it rarely wins in the end.
Think about it...with a great offense it doesn't matter how many touchdowns the opposing team scores. As long as you score at least one more, then technically you win. But, at what cost to the team? Is the victory just as sweet when your own defense was solidly beaten to a bloody pulp?
Now, if your defense is good enough, no one will ever score on you. That's good too, but if you want to win the game it's not good enough. You also need at least a fieldgoal to break a 0-0 tie. Of course it's possible tat your defense is soooooo good that it will manage a few interceptions per game and run them back for a touchdown-- you could win that way, but probably not very often. What is more likely to happen is that your defense makes a terrific interception at the opponent's five yard line, but your inept offense is still unable to score. Or, even worse, they turn the ball over and the opponents run the length of the field for a touchdown. If the offense can't score, you can't expect them to know how to tackle either, can you?
Does a great defense ever help? Sure it does! The way it helps the most, though, is to keep the score within reach. So, if you have a half-way decent offense, you have a chance to put a few points on the board. Maybe, just maybe, you'll have enough points to win if the defense keeps the score low. Of course, if you're also playing against the best defense in the league, you're going to have problems scoring anyway... unless you have the best offense in the league. We've all seen the great defensive battles-- a 1-0 baseball game, a 3-0 football game, a 35-30 overtime win in basketball. The common factor between them all is that they are usually boring.
You know, the more I think about it, the more it seems like a vicious, unending circle. How could you possibly expect to win unless you have both the best defense and the best offense in the league. Besides, winning isn't everything, is it? Except when someone's life is involved.

Starting Med School...Does it matter where you live?

2004-08-17T19:33:00.000-04:00

You might think that there is just a little too much time between summer classes and fall classes when you find out what I've been doing today. Perhaps I'm overly fond of statistics, but I value having the information that I need at hand to make my choices. Some folks would just call me anal, I guess.

Anyway, I was looking at the statistics for Med School applicants at the MCAT homepage. I wondered how may state (South Carolina) compared against the national average as far as applicants who actually matriculated into med school. Considering the national average was 47.54% in 2003, the 50.90% in South Carolina (226 of 444) seemed to be pretty good.

Then, it dawned on me. Is there any correlation between where you live and how many matriculates there are? So, I copied the tables exhibited there to Excel and added a few columns of my own. Using the data from the 50 US states and the District of Columbia, you can find some interesting information. As the information was already broken up into 4 regions, I tabulated those results first.

What percentage of applicants matriculated by region?
Northeast 51.82%
Central 49.72%
South 46.15%
West 45.25%

What then were the top five states?
New Hampshire 59.21%
West Virginia 56.98%
Rhode Island 54.79%
Vermont 54.55%
Kentucky 54.46%

OK, so what were the bottom five states?
D.C. 35.53%
Colorado 37.41%
Alaska 39.13%
Washington 40.29%
New Mexico 40.32%

I wasn't really surprised too much by the individual states, since the northeast was ahead overall. Kentucky and Kentucky surprised me a little, though, because South Carolina (at 50.59) was next closest to them. Actually, they included Oklahoma as a "southern" state, and if you do that, it was really third at 51.09%, but I don't think that a lot of Oklahomans claim to be from the south...do they? There were a few other things that I disagreed with in the "southern" column, since they included Puerto Rico (54.02%) and Other US Territories (33.33%). Perhaps I'll have to take the states and divide them up in my own way. Check out the link here if you are interested in seeing the results from your own state, or e-mail me for the full list.

Between Classes

2004-08-14T20:16:00.000-04:00

No, I guess I haven't spent a lot of time blogging lately, but I have spent an awful lot of time going to class, to lab, and running errands. This past week kept me busy with a chemistry quiz, lab final, and the cumulative ACS chemistry exam. Between those events, and the accompanying study sessions (keep in mind there were two-hour lecture sessions everyday as well), I spent ooboodles of time working in the yard (I'm still keeping that new lawn mower well-used), cleaning the house, getting ready for the fall semester, and it was time for the annual TB skin test.
The last one probably took a lot more time away from studying than it should have, but I chose to volunteer my services with a hospital 65 miles away from home. Why? Because that's where the level-one trauma center is. One of the things you need in order to get into med school these days is some clinical experience. Someone said that it used to be a lot easier to get into med school many years ago, but very hard to get out. These days, the "weeding out" process begins long before you ever think about AMCAS. Some med school applicants have ample opportunity for clinical experience these days. Many have been nurses or EMT's, for example, but others of us still rely on the volunteer route. Sure, there's a level-three trauma center 5 miles away from home, and there's a level-two trauma center 25 miles away, but I just had to be there for the "worst case scenarios" and this place certainly fills the ticket. Oh yeah, and I could have had the tests performed locally and just sent the info to the volunteer coordinator, but I might have actually had to pay for that-- not the choice of the starving college student.
Then, I was really looking forward to relaxing this weekend and teaching an adult CPR class on Saturday. Wrong again! Hurricane Charley stopped that from happening; the class was cancelled due to "possible" inclement weather. The ironic part is that I live just far enough from the South Carolina coast that nothing happened in my area. We didn't even have to open evacuation shelters (Red Cross Disaster Services operations is my other big "hobby" after teaching First Aid/CPR classes), so the class needn't have been cancelled after all. Plus, it's just wet enough that I can't even cut the grass-- nothing to do with my time this weekend, I guess, except blog.

Do Patients Really Understand?

2004-07-30T19:40:00.000-04:00

I've mentioned what my Friday mornings are like these days. With no classes on Friday, a trip to Bojangles for breakfast (where the local contingent of retirees hangs out) makes me feel young again. My dad goes there six days a week. He'd go on Sunday too, but his wife won't let him.

As I would have expected there was a hot and heavy debate going on about the Democratic Convention, and with South Carolina being pretty much a solid 'Bush' state, there was plenty of Kerry bashing going on. While I waited at the counter for my sausage biscuit and coffee, the conversation drifted to a local infomercial that has been playing on the NBC station from Columbia for a week or so, describing how doctors in South Carolina were beginning to leave their practices "just like some of those yankee doctors already have," [Keep in mind, some of these old guys don't realize the war-between-the-states is over yet:)] and heavy bashing of Edwards took off next.

Things calmed down a little as I took my seat, and the conversation eazed into medical topics, as it usually does whenever I sit down. Old folks love to talk about their ailments, and they love better having someone with even the slightest bit of medical knowledge around. I keep reminding them that I'm not a doctor yet, but in truth, I love talking about medicine-- to anybody. That's just one of my reasons for wanting to become a doctor.

Timmy (not his real name-- only in the South are grown men still called Timmy, Billy, Bobby, Joey, etc.) had just returned from time in the hospital where he had two stints inserted, and he couldn't wait to ask me a whole pile of questions. He wanted to know about the procedure, about how long it would be good for, and why he wasn't supposed to drive for a month. (That one ticked him off the most). I asked him if he had asked those questions to his doctor. He said that he did, but the doctor was really busy and didn't have the time to explain it to him very well. I asked him about what they told him when he was discharged. He said that they said a whole bunch of stuff, and he didn't really understand it, but they gave him some papers with stuff written down on it and a number to call if he had any questions. It made me wonder how many patients really don't understand the things their doctor tells them. I see the same thing in class every day.

Professor: "Does everyone understand that?"
Class: "Yeah, sure."

Moments Later...

Student 1: "Pssst. Did you understand any of that?"
Student 2: "No way, dude!"

Is there some reason that when people don't understand things, they still nod their heads in agreement, acknowledging the information, and acting like they have it filed in long-term memory. It brings another question to my mind: Do physicians, for example, need to go to extremes in order to ensure that their patients understand things? Maybe it's not as important when the plumber says that you need to replace that ring around the toilet or you're going to have a leak. But, when the doctor says that you need to take this medicine or your blood pressure will never come down, do people really understand that?

Then, the really meaty part of the Friday discussion began. An article tiltled 'Hospital errors may be U.S.’s No. 3 killer' appeared in The State newspaper a few days ago. To the old folks, who are probably a lot closer to death than I am anyway, this was a big concern. I was surprised, though, at how many of them thought that there must be something wrong with the story-- the writer had a grudge, for instance. (There is a conspiracy theory in every corner in a little town like mine). We had a long, fruitful discussion on how "failure to act" was considered a medical error in the study. Surprisingly, they all said that they understood, but did they really?

Democrats and Fetal Stem Cell Research

2004-07-28T15:52:00.000-04:00

Since I am a Republican, how do you think that I would feel about fetal stem cell research? I'm obviously for it. "Wait a second," you might say, "the Democrats are caiming that Republicans are against it, aren't they?"

I don’t like to comment on political topics very often, because they can stir up a lot of negative emotions between people, but I just have to say something about the current debate on fetal stem cell research. Why? Because the Democrats have turned it into a truly political argument, but it shouldn’t be. It should, instead, be a scientific argument. Does anyone really believe that allowing Ron Reagan, Jr. to speak at the Democratic National Convention was anything but a blatant attempt to capitalize on the death of President Reagan? Liberals seem to believe that a coup has occurred, because the son of the father of modern conservatism believes in fetal stem cell research, but modern conservatives don’t. Democrats would have you believe that the Republican Party (thus George W. Bush) is against the research. They fail, though, to point out that President Bush is the only president ever to publicly fund fetal stem cell research. Bill Clinton never did it. At this moment the federal government is paying for fetal stem cell research because President Bush OK’d it. The only caveat is that new lines not be used.

Some scientists believe that fetal stem cell research may lead to a cure for Diabetes or Alzheimer’s, so the liberals have implied that President Reagan would have been for expanding new lines of fetal stem cell research since he had Alzheimer’s himself. After all, aren’t his wife and son for it? Most people, though, don’t seem to recognize that Ron Sr. and Ron Jr. were polar opposites for most of their lives. In his spare time, Ron Sr. liked to ride the ranch on his horse and thrilled to the great outdoors; in his spare time, Ron Jr. liked to ballet dance. Ron’s brother, Michael, even acknowledges that Ron Jr. was so liberal that he did not even vote for their father when he ran for president. It is any surprise that they would have different opinions still to this day?

Let’s consider the status of fetal stem cell research at this point. You can’t even say that it is in it’s infancy, maybe not even that it has reached the fetal stage itself, because it is little more than a pipe dream at the moment. Some scientists say that this might be the cure for all ills. Some of these same scientists have been working on a cure for cancer for 50 years, and have failed. Have they now given up and gone to a new cause? No one at all believes that any practical value will come out of fetal stem cell research in the next one or two years, or ten years, or maybe even 50 years.

Still, I believe that the research is a good thing, and I don’t think that its current status will last forever. In the meantime, investors have the ability to pour all the money they want into new stem cell lines. Why should the federal government be the one to spend all the research dollars and a few private individuals be the ones who end up gaining the patents and making all the money? That's the way the system works right now. At some point, more people may be receptive to new lines,and government funding of new lines, as their attitudes surely change. Remember that many people thought organ transplants were the work of the Devil in the 1960’s. The extreme views that many of my fellow parishioners had, however, have changed over time. Organ transplants are no longer the sins of the Devil, they are gifts from God. Some people, though, still object to any form of medical science because of their religious beliefs. The courts are full of cases where the prosecutor’s claim that parents murdered their children by denying them medical care. It’s not hard for me to believe in these extremes because I was raised as a Southern Baptist. While not all churches were as extreme, I was taught that failure to repent for picking on a younger sibling would condemn you to an eternity of burning in Hell. Believe me, I spent a lot of time repenting.

So, let’s get the facts straight. The Republicans do believe in fetal stem cell research, otherwise the Bush administration would not have been the first one ever to give federal funds for it. We do not, however, know that anything good will ever come about because of it. If the Democratic Party really believed that fetal stem cell research was such an important election issue, they could ask George Soros and Steven Bing to stop using their millions to fund the illegal moveon.org advertisements. Why not use that money for fetal stem cell research? Any other position is simply political rhetoric.

First in Line...

2004-07-26T19:38:00.000-04:00

Actually, wouldn't 'Top of the Class' be better than 'First in Line.' Sure, but how do you get there? How do you make the grades necessary to be the one at the top? Well, the word 'study' comes to mind, but there's a whole lot more to it than that. It really comes down to both 'how' you study and you're 'purpose' in studying, because if your 'purpose' is just to do well on the test, then you're really wasting your time. If your 'purpose' is, however, actually trying to learn and understand the material, then you have a chance to be the top man/woman on the totem pole. It would be a little boastful (OK, a lot boastful) to say that I will be there when the graduation ceremony takes place, but I actually do have a chance. Why? Because I have developed a pretty good method for studying over the years that helps me 'learn' the material, and in doing so, I usually do pretty well on the tests too. What follows is Doc2010's study methods:

1) Never study a single subject for more than an hour at a time.
Any more than that tends to confuse your brain. Actually, I prefer to limit it to about 45 minutes at a time. Then, switch to something else-- another subject. If you don't have another subject to study get up, walk around, answer some email, throw out the garbage-- just do something to break it up. The next time you get back to it, your mind will work better.

2) Spend at least 30 minutes a day on every subject.
Wait! I had class today and don't have this subject again for two days. Can't I wait till tomorrow to work on it? No!!! At a minimum, read over those notes while it's still fresh in your mind. It will help reinforce what you discussed in class. You don't have to study that subject first, though. You can save it till last.

3) Take good notes.
Even write down the stuff you already know. Most professors will cover the really important stuff more than once. If you look at your lecture notes and realized that a particular idea was covered it three (or more) times in class, you can bet that it is a really, really important thing to know. Remember that I'm not advocating you study just for what's on a test, but if you cover it two or three times, then you can bet it'll be on there.

4) If problems are assigned, do them.
Then do some more, and some more, etc. Because the best way to learn the mathematical component of a subject is by repetition. If you see something often enough, you will remember it much more easily.

5) Use the Web site.
Most textbooks these days have a web site that explains questions, has practice problems and tests, and even flashcards to study by. Many have a CD-rom included as well. Use these things, because they point out the major concepts of every individual chapter. If you understand those concepts, then you will do well.

6) Note cards.
The best way to study. Make note cards for lecture notes and for your textbook reading assignments. I like to phrase them in the form of a question-- the question on one side and the answer on the other. Example- (On the Front) :What is the process called when water diffuses from the leaf through the stoma? (On the Back) : Transpiration. Put all the cards in a stack. You can use either side of the card as the actual question-- learn them frontways and backwards. When you know the answer on a particular card, toss it out of the stack. No need to carry around bulky textbooks or notebooks, you can cary these cards in your pocket or purse and pull them out any time you have a minute or two, when you're feeding the pidgeons, or when you're stopped at a particularly long stop light, anytime.

7) In the absence of note cards, re-write your notes.
One of the other bonuses of making notecards is that you are re-writing the information you discussed in class, and that helps to re-emphasize the subject. Some people have found that all they need to do is just re-copy (and maybe re-organize) their notes into another notebook-- making them more clear and precise. I think that this probably only works if you have a super memory. At forty years of age, my memory just isn't that good anymore.

8) Make friends.
Especially make friends who will be able to get together in group study sessions. Maybe you understand everything pretty clearly, but one little thing bothers you just a bit. Chances are that someone in the group understands that particular topic better than you, and can explain it to you. The best part of study groups, however, is when you get to teach someone else about a particular topic. I'm convinced that teaching a subject is really the best way to learn something, because you really have to understand it in order to teach it. Chances are that if you didn't know it well before you started teaching it, then you will know it well afterwards.

One final note. You don't have to do all of these things, but do all that you can. The more you do, the better you'll understand. And, of course, the better your grade will be in the end.

On a Need-to-Know Basis...

2004-07-24T15:07:00.000-04:00

So, what do I need to know to get into medical school? I thought a lot about that in the period of time just before I went back to college. The answer, though, seems to vary depending on the medical school you wish to enter. Since only two of them exist in the Palmetto state, my search for answers was greatly reduced. Many schools don't really have a requirement as far as particular course work goes these days. That surprises me a little, but I think that most folks are still going to go by the average requirements at least. I know that most pre-med advisors are going to do their best to get students from their colleges in, so they seem to follow a basic set of rules.

MUSC (at Charleston), one of the two state med schools doesn't have a set list of prerequisites per se, but my advisor's recommendations follow (almost exactly) the requirements of the University of South Carolina (at Columbia) Medical School regardless of whether or not you have a preference for which school you would rather attend. [In case you are wondering why I am concentrating on just these two schools, not out-of-state ones, keep in mind that only about 20 students that matriculated into med school last year from South Carolina went out-of-state. I still plan to apply to some out-of-state- schools, though.] The following are the minimum requirements from USC's academic bulletin:

English composition and literature
Two semesters or three quarters.
Mathematics
A minimum of college algebra. Work in statistics or biostatistics is recommended. Work in integral and differential calculus is suggested. Two semesters or three quarters.
Biology* with laboratory
Work in general biology, general zoology, or botany is acceptable. No more than four semester hours may be botany. Two semesters or three quarters.
Physics* with laboratory
Two semesters or three quarters.
General inorganic chemistry* with laboratory.
Work in qualitative analysis, quantitative analysis, or physical chemistry is acceptable. Two semesters or three quarters.
General organic chemistry* with laboratory.
This course work should include studies of aliphatic and aromatic compounds. Two semesters or three quarters.
*All science course work must be acceptable for continued study by department majors.

Notice that there are a couple of suggestions in there as well. Seems to me like a good idea to heed their advice and take those as well, and my adviser concurs.

So, it seems like just about anyone, with any major, can get in. Yes, but it still makes sense to me to do the Biology major/Chemistry minor thing, because you have to take all of those courses, but you will also be taking courses that you will be taking in your first two years of med school as well. I really would like to take that History of the Old South course, but I may have to skip it to fit in Immunology and Biochemistry.

So here I am in the middle of summer school and enjoying my second semester of inorganic chemistry. Summer school is a little strange, though. There was that shock in the transition from high school to college when I realized that what you do in one week of high school, you do in one day of college. They even expect you to spend 2 to 3 hours of self-study for every hour spent in class. In summer school, though, you spend one day on what you would spend one week on during the Fall or Spring terms. Add in 8 hours of lab per week and it can become busy rather quickly. The people I fell kind of sorry for, though, are the few folks in my class who are taking the MCAT in August and just wanted to brush up on something they had not seen in a while. Unfortunately, during the summer, not a lot of actual teaching goes on-- you either get it or you don't, with no time for questions.

Some subjects, though, I think are even harder in summer school. Take English 200 for example. My university requires two freshman writing courses (with a writing lab too), a sophomore writing course, and a sophomore literature course with intensive writing. I tutor these kids in the Writing Center during the Fall and Spring semesters, but we don't have enough money to keep the center open during the summer months. In a summer session of English 200 (five weeks), students are required to write six essays, research and write a term paper, fill a minimum of twenty journal pages, and take two essay exams. That's a lot of work in five weeks. I don't know that I could do it. Well, I certainly wouldn't want to do it.

A Chance to Cut...Grass

2004-07-24T11:17:00.000-04:00

I adapted that title from a general surgeon's blog that you should check out when you have a chance. I don't think that I'll ever make it as a surgeon. You should have seen the animal carcasses I slaughtered in organismal biology. Granted, the starfish was in pretty bad shape to begin with, but the clam, the grasshopper, the frog, etc.-- well, they all started off looking pretty good, for dead things anyway, but the results...

Anyway, back to cutting about the only thing that I cut well-- grass. And that's only because I bought a new lawn mower yesterday. And, I've already got my money's worth out of it, complete with blisters. Actually it's the first new lawn mower that I've ever had. Oh, I've had hand-me-downs, but it's not like a hand-me-down pair of jeans where your older sibling just grew out of them. They are usually still in relatively good condition. But a hand-me-down mower has usually bee poorly maintained, looks like crap, and runs even worse. After all, why would the previous owner be buying a new one unless the old one really sucked?

Since it was Friday, and no summer school on Fridays, I went to eat breakfast with the other old men at Bojangles. They're all 60 or over, so at 40, I feel like a spring chicken-- not like at school during the week when I'm surrounded by 20 year-olds. Then, it was off to search for mowers. Walmart, K-mart, Lowe's-- all had cheap mowers for sale, only they didn't have any in stock. No, we can't sell the floor model, but you can get a 5% discount on the more expensive ones. This is not an investment, I thought, just a lawn mower. So, off I went to Sears. They didn't have a model as cheap as the others did, though. Their least expensive (notice I didn't say 'cheap' this time) model was a Craftsman model that fit the bill. No, I didn't buy the extended warranty, but it came with a free bottle of oil, so in no time I was in business. Too bad the warranty isn't quite like their tools. You ever break one of those, send it back and get a new one for free. I once new a gut who mad a comfortable living going to yard sales, buying old, broken Craftsman tape measures, returning them for newer models and re-selling them. Of course, he lived with his mother so he didn't have a lot of expenses anyway.

I learned a lot about mowing in the last two days. I learned that I need a ginsu blade. Do you remember the old commercial on TV where the ginsu knife would cut through an aluminum can and still slice a tomato like butter? Well, this mower won't even cut through the can very well. But in the scheme of things, mower vs. can, the mower still got the best end of the deal. Thanks to the internet, though, you can buy the famous ginsu knife set pretty easily. It used to be that if you missed the address and 800 number on the commercial, or unless you visited the As Seen on TV store at Mall of America, you were out of luck. Now that Mall of America is another story...best saved for later.

The other main thing I learned about mowing is that the insects can get really upset. Let's face it, not only are you cutting through the high grass, but you're also taking their food and shelter and ripping it into shreds. The bees, being spatial learners, will never find their way home. The spiders, however, I really don't care so much for them. Maybe I should...but I don't.