Perhaps the most commonly asked question I get from nurses either verbally or implied is why their medication takes so damn long to get to the floor. In the interest of full disclosure, I feel it is my duty to fill you in, Ms. RN, on why your medication doesn’t instantly appear in your hands as soon as you read the order. Let us look at the following example. We will assume all other meds ordered on this new admit are mundane PRNs and it’s these two items you are after:

Protonix gtt at 8 mg/hr
Zosine 4.5 gm IV q6h
Dr. Doctor #0000

I get the order scanned to me five hours after it was written. I ignore the fact that Zosyn is spelled wrong and notice it is not on the mandatory antibiotic form. The pharmacy does not stock Protonix IV and does not have an automatic therapeutic interchange for IV Proton Pump Inhibitors (those are for upset tummies). I page Dr. Doctor to change Protonix to Nexium and to fill out the antibiotic form. I then call the floor to obtain a height and weight for the patient which was omitted on the admit sheet. The HUC tells me she will tell the nurse and hangs up in my ear.

Three hours later, after hearing no response from Dr. Doctor or receiving height and weight, you call down asking me where your meds are. I explain what’s wrong with the Zosyn and Protonix and inquire about the height and weight again. You sigh loudly, claim the HUC never let you know, and tell me that height and weight isn’t important and to just put the meds in anyway. I explain that height and weight is required in the pharmacokinetic calculation of creatinine clearance that will determine the estimated kidney function of the patient and will ultimately allow me to ascertain the appropriate dose of all renally cleared medications including Zosyn. You tell me that is dumb and a waste of your time but put me on hold to get the height and weight. Five minutes later you tell me the height and weight and hang up in my ear.

After not hearing from Dr. Doctor for three hours I get a call from him a few minutes after hanging up with you. He tells me he’ll fill out the antibiotic form and to just make the Protonix whatever it has to be to make it right. I assume this means Nexium gtt at 8mg/hr and write the telephone order.

I’m interrupted by a phone call from one of your colleagues who requests the timing of a patient’s simvastatin be adjusted by 1 hour. I ask her to please fill out a MAR correction form, which she tells me is dumb and a waste of her time. Five minutes later after explaining the policy and why a one hour time change for simvastatin is clinically irrelevant, she hangs up in my ear.

I complete writing out the telephone order and see that the antibiotic form was scanned. I start to calculate the patient’s creatinine clearance and am interrupted by another one of your colleagues who demands to know why her Pyxis machine is “all messed up.” Tempted to ask for more details, I think better of it and transfer her to a technician.
I enter the Nexium drip into the computer, but my printer is out of labels and the IV technician is on a smoke break.

Before I can fix the issue, the phone rings and it’s another one of your colleagues requesting a new MAR because she spilled coffee on the last one.

I get the printer working, but now must print another label for the Nexium. After that, I finally complete the creatinine clearance calculation and notice the Zosyn dose should be decreased to 3.375 gm iv q6 hours. I begin to fill out the Pharmacy Dosing per Policy form to adjust the dose, but am interrupted once again by the phone.

This time it is you asking me why it’s taking so long to get your medications.

I complete the form, and enter new Zosyn dose. By this time, the tech has gone into the very expensive and sterile IV room, taken the proper sterile procedures per USP 797 policy, and completed the Nexium drip. After ungowning, she brings it to me for verification. I check it off along with the pre-snapped Zosyn and have the tech send the Zosyn, Nexium, telephone order, and pharmacy dosing forms up through the tube system.

Fifteen minutes later you call me asking what my problem is and why it’s taking so long. I inform you everything has all ready be tubed up. You tell me I’m lying and hang up in my ear.

Ten minutes later you call back and say you found the forms and the Zosyn but not the Nexium drip. Considering they were all in the same tube and you probably had to lift the Nexium drip to get to the Zosyn and forms, I ask you to double check. You tell me that’s not your job and you hate me. You then ask for new more IV maintenance fluids for another patient. I ask you to demand it through the computer system, but you claim you’ve never heard of that and neither has the HUC. I agree to remake the Nexium and demand the IV fluids for you.

As I am about to do so, Dr. Doctor calls and asks a legitimate and involved drug information question. Not knowing the answer off the top of my head, I tell him I will look it up and get back with him shortly.

As I’m researching the answer, a nurse from another floor calls and asks me to replenish the toilet paper in the bathroom.

I go back to researching and upon finding the answer, page Dr. Doctor, who is readily available when needing something from me and calls back immediately. After the conversation, I go back to demanding your IV fluids and reprinting your Nexium drip.

You call me asking me where your meds are again.

Just as we are about to tube them up, you call me again saying that you found the Nexium drip from before but you still haven’t gotten your fluids yet and demand to know why.

Now imagine this wasn’t you but the person who scanned their orders twenty minutes before you and you’ll start to have an idea why your medications take so damn long to get to the floor.

Am I the only one who doesn’t really give a shit about Haiti? See that picture above? That is before the earthquake, not after…and you couldn’t even tell.

Now, don’t get me wrong. I’m not pro-destruction, I don’t root for natural disasters, nor do I hate Haitians (or foreigners in general). But this is kind of like if a tornado took out all the alleys where homeless people live. They had terrible, miserable lives before this earthquake, and not one seemed to care then. Sure there were a few missionaries down there trying to meet their Jesus conversion quota and some medical staff buffing up their resumes, but there weren’t Haiti telethons a few weeks ago.

Now all of a sudden it’s this cool, sexy, trendy fad to donate money to Haiti. It’s like breast cancer awareness month on steroids. I think this is what gets me most. I support helping other in crisis (as long as its not me), but the fact that it has become the latest fashion trend is just absurd. Donating to Haiti is the new black.

What I don’t understand is why didn’t the California earthquake get hot? They had a 6.5 (Haiti had a 7.0) a week before and no one really seemed to care.

Time to get philosophical. What if the same earthquake occurred in Afghanistan? It affected the same number of people in the same way. Assuming no American soldiers were injured, would we give the same relief effort? We are in a war with Afghanistan (sort of) so would we be happy so many people died? Would we be dishing out money via text messages to help all the little Afghan babies with no mommies? I would say not. But why not? Aren’t we all humans? Shouldn’t we all help each other and Tweet about it?

Good news for Red Cross though. The economy was hurting their business for a while. I even read somewhere a couple months ago that they cashed a check for tens of thousands of dollars that bounced. Nothing like a good internet meme to replenish the stock pile.

Oh, and this just in. George Bush doesn’t care about Haitians either.

There are all these rules when you are behind the wheel that I don’t really understand. Lawmakers feel they can prevent wrecks by incorporating all these policies for motorists, but in realilty, most are equivalent of 4th grade teachers banning whatever became popular in school. Let’s begin:

• Several states have gotten on their high horse and outlawed the use of cell phones while driving. Seriously? It’s not that dangerous. I can even text and drive, but I could see an argument against that. Sure there are people who can’t handle it, but there are also people who can’t walk and chew gum at the same time, but the last time I checked it’s still legal to munch on gum and perform any activity you please.

  Lets say there was a massive catastrophe. Lets say some schuck operating a piano lift was chewing gum and out of uncoordination, dropped the piano on a crowd of people killing 2 and injuring 5 on the streets of New York. Would this justify banning chewing gum and doing manual labor?

  It’s not illegal for one armed man to talk to his passenger while driving. What’s the difference?


• It’s illegal to wear headphones while driving. Why? What sounds are so important that you have to hear in order to drive safely? Amublances? You know what I think about that. Police cars? I think you’ll know if you are being pulled over. Most policemen don’t even blast their siren for routine speeding tickets anymore anyway.

  I vividly remember several cases of playing outside as a kid and hearing some punk teenager’s radio blasting as he drove by on the highway 1000 feet away. There’s no way he could hear himself think, much less a horn honk from the car behind him…yet…that’s legal.

  It’s legal for deaf people to drive. What’s the difference?


• Did you know you have to wear shoes when driving? Barefoot driving will get you a ticket. This one may be the best of them all. Who gives a shit if you’re barefoot? If anything, you would think it would enhance your driving skill by giving you a better feel of the gas and brake pedal. It’s like making quarterback wear a glove on his throwing hand in football. It just makes no sense.

  The only time I’ve ever felt a bit unsure of my driving skill when it comes to pedal sensitivity was when I wore cleats. The extra few inches between my foot and the pedal kinda threw off, but surprisingly, I figured out.

  It’s legal for a man stricken with frostbite on his foot to drive. What’s the difference?

I know it’s the law. I know you are supposed to jump your car on the nearest curb, or yard, or embankement, or ditch when you see an ambulance coming. At the very least you are supposed to stop. But can we please use some common sense?

If you are driving along a road with a median and an ambulance in driving toward you in the opposite direction, there is no need to stop. The ambulance isn’t going to get all Fast and Furious by doing a flip over the median.

Really, the median doesn’t even have to be there. Sure, there are a lot of turn ins on your side of the road, then by all means, stop until the ambulance passes, but if there is nowhere for it to go and no reason to come to an immedate top, jack a sharp 90 degree turn, and get over to the grassy patch on the side of the road, then there’s no reason to stop.

Perhaps it’s ok to slow down a bit, but not really. The only reason I slow down in situations like these is to avoid those cars in front of me who deem it necessary. Then again, it could be one of those off-roading ambulances.

Compeletly off topic, but everytime an ambulance does pass me I listen for the Doppler Effect. Wow. I can’t believe I just admitted to that.

It was Wednesday evening. I had just completed a glorious week off where I had spent my time between lying on the couch and stuffing my face with popcorn. It was now time to start yet another work week. As I trudged down the long, barren, hallway toward the pharmacy I wondered to myself who I would be working with during the evening shift. As I opened the door, I was devastated by who would be with me for the next couple hours: Delilah.

Yes, the Delilah on the radio. She has evidently accumulated the popularity of Elvis and Cher and been christened into the “I am known only by my first name” club. However, just because she has 7 million listeners, doesn’t mean she has any place in a pharmacy. It’s simply not safe.

As a case in point, let’s look at this particular Wednesday night. I sat down to begin work with Delilah talking my ear off in the background. During an attempt to enter a host of admit orders, a caller got on the air and droned on about how the love of her life left her after three months.

Yes, three months. I’ve eaten nothing but Taco Bell for longer stretches of time and I hardly consider the chicken quesadilla with soft taco combo meal the love of my life. This woman was an emotional wreck, though, and who does she turn to for relationship advice? Delilah Rene Luke. (That’s her full name, by the way) The single mother of 8 kids (5 adopted) who has been married and divorced twice. I’m not saying there is anything wrong with that, but I wouldn’t take beach volleyball lessons from an Eskimo.

How could I function as a professional and competent pharmacist with the radio blaring this kind of stuff just 15 feet away? Matters got worse when Delilah’s only remedy was to pick out a sappy, depressing, dismal song to play just for her. I’m sure the caller felt much better after 3 minutes of musical sorrow, but I, on the other hand, could not get any work done because I was too busy beating my head against the counter. I can only hope that the work I did manage to squeak out during this time period was accurate.

The bottom line is that Delilah could cost people their lives. I’m not just talking about the lack of relevant advice she gives to her gloomy callers. I’m talking about secondary influences such as patients in hospitals, the kids at the dentist’s office, the construction workers on tall buildings, or anywhere else there is Delilah in the workplace. Save a life. Turn the dial.

Today, I had an epiphany. A good one at that. I was walking by an employee on lunch who had brought in chicken wings. At first sight of them, I gave a noticable cringe. I’m not really the biggest fan of wings…in fact I would say I’m not a huge fan at all.

The reasons are simple. First off, in general, they are hot. I don’t really do spicy food. Second, they are covered in sauce and require you to eat with your hands. WTF? Who came up with this idea? The usual idea with finger foods is that your hands don’t get all nasty when you eat them. If there exists a food that get your hands nasty, then you use silverware. Hell, it’s probably why the fork was invented in the first place. The creator of the chicken wing through that idea out the window, though, and said, “Screw it. I’m going to make the messiest edible substance I can imagine.”

Really though, it’s not the actual messiness factor that really gets me. It’s what comes with it. So there you are. You have eaten one wing and your fingers are all ready covered in viscous sauce that is apparently made with skin adhesive. Do you go for the napkin at this point or do you go in for another wing? The two biggest dilemmas are when and what utensil you go about wiping the sauce off your fingers.

There are so many options of when. Do you wipe after every wing? Every 2 wings? Every time you go for a drink? Wait until you finish all the wings? The major problem with the latter is that you look like a Downs Syndrome child if you grab your drink using just the palms of your hands.

What about the method of wiping? There’s the conventional napkin. There’s always lick/pop your fingers. But when, if ever, is there appropriate? You’ve also got the the moisty naps, but I can never tell if those are strictly for post meal use or they can be used throughout. It’s all very confusing for me. Even after all that, it still takes three days worth of showers before you completely get all of the sauce out from between your fingernails.

Then I realized how much I’ve eaten wings in my life, and wondered why. I think it’s a man thing. There are several things classified in the “well it’s just a man thing” category that men do/have done regardless of their personal preferences. For example, bench press is one of these. Even those who don’t work out or have never worked out on a consistent basis, have probably bench pressed at least once in their life. I would say most guys can quote you the most weight they have ever done. 250, by the way.

Another man thing would be driving a standard, or manual transmission. (I didn’t want to just say, ‘driving a stick’) Most people would agree, outside of the “coolness” factor, driving a standard is a pain in the ass over time, but most guys are able to at least do it. Even if they have never tried driving one, they will claim they are able to in fear of losing any man points.

One final man item off the top of my head would be wearing boots. Not cowboy boots, necessarily, just boots in general. Maybe for some, boots are not comfortable or give you bunions, but I betcha anything, they’ve got a pair in their closet. They won’t throw them out either. Every man’s gotta have a pair of boots, whether they wear them or not.

Back to wings, I will make a guilty confession now that I am out of Winchester and will probably never live in a town where the primary attraction is Buffalo Wild Wings. I really only went there for the beer and Stacker machine. There. I said it.

I feel better all ready.

Ever since I started Blogosis, I’ve yearned for hate mail. Just once, I really wanted to get under someone’s skin and induce boils to the point where their only remedy was to send me an electronic message. Finally…my dream has come true.

It was a comment, and not an email, yet equally as effective. Of course, it comes on one of my more controversial posts, “Why black people love me,” but hey, you have to start somewhere. Here is the comment from Mr. Polite:

Mr. Polite says on June 3rd, 2008 at 2:32 pm edit:

Your attempt at humor fails. Not because of the subject matter, but because you’re unfunny. Thats right… you, are the _opposite_ of funny. You make funny things unfunny, and really funny things downright tragic.

And kids…what’s the best part about hate mail? The rebuttal! Of course! So, Mr. Polite, take off your hat and put your napkin in your lap, because here we go:

I am first going to make a couple of assumptions. One, you’re black. I’m taking this from the fact that you were apparently offended by my “Black people love me” entry, as well as your avatar is of a black man with stud earrings on your linked website. Granted from the surface, it would appear this post has a racist undertone, but after further looking at it, you should easily see that the whole post is a farce making fun of white people who actually think along these lines. This is also evident from the link I put at the bottom of the site, but I also assume you didn’t check that link out.

You also claim that I’m not funny, “not because of my subject matter.” Well, considering this was the only post you commented on, you’re probably black, and obviously didn’t think about it very long, I’m going to assume this is the only post you read. That would make your judgment entirely based on subject matter. Also, this was post from February 2008, over 3 months ago. I’m guessing you just found this through some type of Google search, and didn’t bother to read any of my other posts…posts that don’t involve race, yet equally as funny (or even funnier).

Ever consider people have different types of humor? You should know that from obviously being the distinguished, politically correct person you are. All people, regardless of age, sex, race, and sense of humor are created equally, right?

Because, and I know you’re gonna be shocked to hear this, people do consider me at least somewhat humorous. It’s true. Hard to believe, I know. It seems that from not understanding ONE of my nearly 300 posts, you think I am “unfunny…the _opposite_ of funny.” By the way, 1998 called and wants its underscores back. I am curious to see though, what “funny things I made unfunny,” and what “really funny things I made tragic.” Considering this was probably the only post you read, I am trying to get out what “really funny things” you could have found in that post. Please, Mr. Polite, come back and clear up this confusion.

Nice name too, by the way…Mr. Polite. Don’t you mean, “Mr. Subtle, Passive Aggressive stab at the fact that I am a good person and you are the scum of the earth”?

Well once you browse around my site and realize that it actually is more humorous than cynical…although at times cynically humorous, please drop me off an apology comment. Email works too. Until then, continue ridding the world of unfunny bloggers.

Sincerely,
Dr. Humor

For a long time I considered carnies the lowest form of human life. This is, of course, outside the obvious categories such as hobos, gang members, and prisoners. I’m talking about people with jobs. For those of you who may not be familiar with the term “carnies,” I’m sure you have had a run in or two. Carnies, or “carnival workers” for the lay can be found hustling you out of your money with rigged games at small town carnivals taunting you with grand prizes like a gigantic stuffed purple lion.

Although after just typing out the job description, I now hesitate to declare my newest low man on society’s totem pole, but at the very least, they run a close second.

These pillars of the community steal your money and then grab you by the balls while maintaining all of your personal belongings and then laugh: Moving company people. Call it a bad experience, but the move from Virginia to Phoenix was miserable, and I blame it entirely on the moving company people. (I include the car moving people in this category as well)

You quickly realize that the moving company people could give two shits less about you. Then you find out they sub contract out the work to a different moving company whom you have never spoken with, and they could care ten shits less about you. I gave you a brief synopsis of my pickup day (that was 3 days late by the way) and the way they tore up my apartment. Somehow, they managed to leave a bigger mess than when there was actually furniture in the place! It honestly looked like a rottweiler dog had just mutilated a two story cardboard statue filled with tape. This was a Thursday.

So I make it to Phoenix the following Tuesday. My stuff was scheduled to be there Wednesday or Thursday…at the latest on Friday. Of course…nothing doing. After getting several run arounds on the phone, I get up with the actual driver of the truck carrying my stuff on Friday. He tells me he’s in Tennessee. Remember, this is 8 days after the pickup. “I’ll probably be there Sunday.”

On Monday (now almost a week late) he rolls in and bitches about the apt complex not having enough room for the truck. He jacks the price up $500 for having to rent a U-Haul and because my place in on the third story. Bastard. On top of that, I never got my desk chair. I’m sure some little Mexican boy has it in some pueblo somewhere across the border. I’m putting it as a tax deduction for donation to charity.

This was the highlight of the move. Then comes the car people. Holy shit. This was the worst. They also sub contract out to some other company who I make a certified check out to for payment upon deliver. It’s scheduled for a (just like the movers) a Wednesday/Thursday delivery. I call Thursday, and I get a, “oh…probably tomorrow.” I call Friday…”It will be Tuesday.” I call Tuesday…”It will be tomorrow or Thursday.” NO NO NO NO NO NO! I gave this guy hell. I gave the others hell as well, but this guy got it pretty good, and its not in my nature to verbally abuse random people. I held back previously both because working in retail pharmacy has thought me a lot of patience when I’m the customer, and because they still had my car which was pretty much the equivalent to having a firm grasp on my testicles.

Also from working in the pharmacy, I am fully aware that time estimations can be wrong sometimes. Hell, I’ve been wrong several times, and sometimes twice to one customer. But NEVER, have I ever been wrong 4 times. That’s just piss poor. Not only that…I got no discount or anything even after insisting. Screw the discount, I didn’t even get an apology.

To top it all off, when the driver delivers it, I find out this was ANOTHER subtracted company! Third generation, if you will. He wants me to get a new certified check with his company’s name on it. He’s lucky I wasn’t a rottweiler and he wasn’t a taped up cardboard statue.

He was gonna have to figure it out for himself. Not taking anything else for an answer. I took my keys and drove off, and pondered what kind of blog I would write ripping moving companies to shreds. So I did what was the lowest form of insult I can think of, and likened them to carnies. Those dirty, money grubbing, smelly, toothless, bathless, greezy, God-forsaken, miserable excuse for human souls, carnies.

But all in all…I’m starting to like it here.

After a year of going through rotations, I learned a thing or two. For those of you just beginning rotations or who will one day partake, I offer you my humble advice from my short, but lengthy, somewhat cynical experiences.

1: Watch out for long hallways in the hospitals. Perhaps the biggest awkward dance you can do during rotations is during the long approach towards someone in one of the hospitals many long hallways. I imagine that flys, gnats, and dustmites alike line up along the wall and laugh their ass off everyone’s awkward looks as they approach down the hallways. If you’re a little confused about what I’m talking about, let me break it down further:

You are by yourself on some mission to save the world, or at least stall from having to do it. Some other someone is doing the same, but walking towards you…but really far away. Common human courtesy suggests two things: one, you acknowledge them as they pass, and two, you don’t stare at them. This obviously presents a problem when in a long hallway. You learn to casually look down, look at the wall, look up to see how close they are, look back down, look at your watch, glance toward the ceiling, back down to see if they are close enough to give a head nod. They aren’t. Shit. Eyes back to the floor…oh, wait, an open door, look in acting like you care about whats inside, back to the opposite wall…are they close enough yet? Ok…one more glance down and they will be. You can then mumble some sort of greeting. Mine was usually a mix between, ‘hey,’ ‘howdy,’ ‘how ya doin’?', or ‘hi’. It usually sounded like, “heh.” This is of course followed by a sigh of relief by both parties that the long approach is finally over.

The situation I just described is true of most every type of hospital ambulator including physicians, nurses, patients, and office personnel. However, the one group that changes this stereotype is black people. They, once again, amazingly, are able to defy social norms and get away with it, and even be funny and/or cool in the process. Housekeepers and Dom (homeless facility) patients at the VA who were black would often sing loudly down the hallway by themselves as they approached you. If you are a hot girl, they will stare, and make it obvious. Correction…scratch the word hot in the last sentence as this is not a necessary component. You’ll then get a whistle as you pass or shortly after. I usually get a “Hey, doc!” Damn white coat. I usually only get a head nod with half smile in for black people out of fear of saying anything too white and nerdy. But it’s ok, because black people love me.

2. Never, ever, ever, say you are doing a residency. I don’t care if it’s your last rotation and you already found out you have been accepted. Once preceptors find out you are doing a residency or even considering it, your workload triples. It’s an effort to “better prepare” you, but in reality, it’s just more busy work.

3. Don’t guess. You’re probably wrong and you’ll twice as stupid than if you just say, “I don’t know.”

4. Act busy…even if you’re not, as you’re bound to get more work. This is unless you are around a preceptor with a history of letting you go home early.

5. Be normal, talk, and don’t suck.

Good luck with it…especially those long dreaded long hallways.

Every superhero has a weakness. Growing up, our dads were the most real super heroes outside of Superman, Batman, and the Green Lantern. But just like kryptonite sent Superman to his knees, dads too, have a weakness.

If your dad was anything like mine, he was an expert driver. Any kind of parallel parking, backing up on a hill, or traffic jam was no match for the cunning wheel techniques employed by my father. I once saw him drive all the way to California…backwards…with no mirrors. It must be another one of those inherent dad skills that boys will not obtain until they too reproduce…like understanding insurances, boating, and light fixtures.

However, I was about 12 years old when I discovered what cripples a dad…and it comes when he is driving. We were coming back home late one night from a trip. I was looking around for a quarter I had dropped in the front seat, but it was dark, and I couldn’t see. So I did it…I reached up and turned on the overhead light.

At that point, my dad went into an absolute frenzy as if the light was actually a glowing green rock from the planet Krypton.

“Ah…GAW…son! The light…can’t see…get your quarter…hurry…turn the light off…AHHHH!”

This, obviously, scared the living piss out of me. Without regard to my wayward coin, I immediately pressed the light off and with wide eyes, curled back in my seat to see if I was too late. After a few heavy breaths from Dad…order was restored to the universe.

I tested the weakness periodically throughout the rest of my life, and sure enough, each time the light went on, it yielded the same reaction. I’ve talked to several other people over the years and they have confirmed my suspicion that my dad is not the exception. Dad’s across the nation fall victim to the harsh glow of the overhead light in a car at night.

If you weren’t aware of this weakness, I dare you to try it out. Next time you’re in a car with your dad, or any dad for that matter, just flip it on. See what happens. Get back with me.