Lola the Leaking Basset Hound

Rather than write my own version of the night, I’ll just post this group poem that was written the next day.

Once upon a midnight dreary
There I pondered, weak and weary
About a hound named Lola
Covered with bumps of curious lore.

When all at once I heard a knockin’
Lee-Ann cried, “Shazam! This dog is Talking,
About an oozing bloody mass that’s
Spewing pus upon her fur!”

Then the puss soaked, slimy rustling of each fur
Sickened me-left with a queezy feeling never felt before
My Soul grew stronger, hesitating then no longer
“L-A I will help you ferry, and in the process make more merry
The journey to the vet, to ensure the health of the ‘lords pet
Route 8 and nothing more,

Now Dasher, Now Dancer, Now Prancer, Now Vixen.
On Comet, On Cupid, On Doner, On Blitzen.
Grab a cat leash, your pal Shazam and jump in the CRV
Wait we do and patiently.

We arrived upon the clinic so dark
and pounded on the door,
“bark, bark!”
The entrance swung open slowly
and creaked a lonely sound.

We entered, females three,
Lee-Ann, Lola and me.
And lamented that there were only
two humans to laugh out loud.

When suddnely the door swung open,
“CARL!!!” Shazam shouted with emotion.
The waiting room got quiet and all eyes
darted from the floor.

On the road they had phoned, explained and bemoaned
and dreams of ice cream roused him twisting turning speeding toward them
Deep in the darkness came a beac’n not without a certain reak’n
Eat n’ Park!! was the source to spurn this man upon his course
surrounded by “smiley” faces awaiting patiently his bounty
Twas 3 shakes. Who could ask for more?

Text at 11, replies of fright,
“a leaky bassett hound you say?”, not such a delight
but how, but when, but why, you might ask?
no explanation given, just focus on the task
poor lola the bassett, she can barely see
but rest assured in better hands she could not be….

Upon his arrival, barging through the doggy door
There erupted from a patron a heartfelt gutsy roar
Joyous their reunion, cold and creamy their communion
cheery banter filled the air , those around tried not to stare
who are these interlopers disturbing their morbid lair.
Shakes by Jamaal and nothing more

Deep in the darkness, the talk turned to canines, cycling, appendix, cogs
lawyers, patrons, friends, hats and puss filled dogs
A feline hit by a car, and a Husky too drugged to walk far
amidst the downcast faces surrounding them in these morbid places
They found laughter and sun- the clock steadily approached one
350$. Nothing more

A funny thing happened while I was googling “patcher1048”

My laptop is crazy slow, so I began cleaning up the harddrive…uninstalled programs I no longer use, running CCleaner, etc.

Some of the files that were deleted had the directory string

“C:\Temp\Patcher\Patcher1048\PBSLocalizedStrings\PBSLocalization\es_ES\PBS.zdct 5.88KB”

There were hundreds of these…what the heck are they?

So I googled “patcher”, and got millions of hits.

Then I googled “patcher1048” and got ZERO hits.  That’s right, zero.

So try googling “Patcher1048”.

If I’m lucky, I’ll be the only result.  I wonder how many people search for patcher1048?

Is My Mother in Imminent Danger?

I was trying to quickly wrap up my patients for the afternoon, since I had someplace to be at 6pm (a bike race to be specific), when  the nurse taking care of the woman in room F told me that her son had some questions for me.

I sighed.  I always want patients and family to understand what is happening, but sometimes I feel like i explain the same thing over & over again (because I do, most of the time).  But this time the questions were different.

“I need you to be frank with me,” her son stated solemnly, but peacefully at the same time.  I actually felt soothed by being in the room with the woman whose blood pressure was 88 systolic and her pulse ox was 85%.  “Is my mother in imminent danger of dying?” he asked.

I wasn’t quite sure how to answer his question, so I probed further in to why he was asking.

She was a “no code”, “Do Not Intubate”, “Do Not Resucitate”, etc.  Generally, I know what that means, but far more important than what boxes are checked on the “DNR” form is what the patient wants from their quality of life.  I feel that it is the onus of the physician and healthcare team to determine what “boxes” to check, based on the patient’s and family’s stated wishes for end of life.

After discussing his mother’s quality of life, I gave him my recommendations.  I didn’t feel comfortable withdrawing all care until he had the opportunity to talk to his sister in North Carolina, and to talk to his mother’s physician.  While I was flattered that he asked for my opinion, I explained to him, “I’ve only known you and your mother for less than two hours.  I don’t feel comfortable telling you stop all treatment right now, but I will give you my advice about what you should do tonight.”

I suggested that we continue fluids, antibiotics and humidified oxygen through the night to maintain her present state of health, and possibly improve it.  This evening he could discuss the case with his sister and in the morning talk about it with his mothers physician. I told him that there was nothing that we were doing tonight that could not easily be stopped in the morning and this would give him and his sister time to discuss her care.

Was it a cop out on my part?  I don’t think so.  I’ve recommended to families that they stop all treatment in the past, especially when it’s clear what the patient’s wishes are.  I wasn’t certain that this lady would die tonight if all treatment were stopped…I was pretty sure she would linger for days to weeks, getting progressively worse every day.  I wanted him to at least enjoy her company for one more night.

She said to her son just as I was leaving, “Matthew…I’m not very good company right now.  Why don’t you go home.”  Matthew didn’t seem to mind just sitting there in his mother’s room.  Enjoying her quiet serenity one last time.

Matthew didn’t mind it at all, and neither did I.  It was better than the bike race would have been.

Demented Man Fights Off Ex-Boxer in Midnight “Attack”

This poor old man with dementia was in a fist fight with another resident.  So the staff tried to commit him to the psychiatric hospital. I got the same basic story from both the patient and the staff.  Apparently, another resident went into his room, and the patient was afraid that he was being attacked, so he took care of the situation and fought back.

I felt bad for the little old guy, but was more irritated at the nursing home staff.  There is a misconception that all they have to do is fill out the committment papers, and it’s a done deal…the patient gets admitted to the psych hospital against their will.

It’s basically the same as putting someone in prison, and has legal ramifications that are similar.

The problem was, that this wasn’t a psychiatric problem, it was a medical problem and a social one.  His aggressive behavior is part of his dementia.  Couple that with an ex-boxer resident walking into his room, and sure enough, he’ll fight back.

I declined the involuntary committment and sent the patient back with instructions that the staff is required to keep other residents from wandering into his room.  I mean, it’s the only right he has left…his right to privacy.

Extensor Tendon Repair in Honduras- Part 3

Extensor Tendon Repair in Honduras- Part 3

This is  a 3 part series
Read Part 1 Of Machetes and Snakebites
Read Part 2 Preparation Meets Opportunity and Betadine
Now Reading Part 3 Extensor Tendon Repair

We created the best sterile field that we could and numbed up the laceration with as much lidocaine with epi as was safe to administer.  We had run the hand under running water to disrupt the clot, and then irrigated with sterile saline.

The distal tendons popped into view easily by simply extending all of his fingers flat against the table. They popped out like little white worms and just sat there.  That was easy.  The hard part was finding the proximal ends.  I gently dissected the tissue back towards his wrist, grasping the overlying skin & fat in forceps then cutting the skin with a scalpel.

I was shocked when I saw a small whitish object hiding under the retinaculum.  I quickly grasped it with forceps and pulled it out, placed a stich through it and kept it in sight.  I tugged on it and his forearm twitched.  We proceeded to suture the 3rd distal and proximal tendons together.  While it wasn’t the prettiest knot, it was functional, and what’s even more important, his finger worked again!

THen I set off to find the 4th & 5th tendons.  I had luck in only finding the smallest proximal tendon and I’m assuming it was the 5th.  So I placed sutures through both the 4th & 5th distal tendons and sewed them to the 5th distal tendon.

In the end, I had a pretty three sided laceration…one side formed by the machete, and the other two formed by me looking for the proximal tendons.  I pulled the two sides up and placed a red rubber catheter drain in the lac, and we created an ulnar gutter splint for him.

We fed both he and his brother dinner (tortillas, rice & beans) and the two set off towards home.  We offered them a place to stay for the night, but they insisted on walking back home, 5 hours, in the dark.

The boy came back to the clinic 5 days later, after we were gone, to see the nurse.  We received an email from her saying that the wound looked good, non-infected, and she removed the drain.

Hopefully in 6 months he’ll come back to the clinic to show us how well his fingers are working.  It wasn’t the best tendon repair, but it was the best one he could get at the time.

Everytime I go there, I learn more, come back & study more and am better prepared.  I can’t wait for my next machete wound in Hondura!