Throat Ca-chunk

Ok - try this: Take a drink of water. Do you hear a noise in your head when you swallow? No? Try it again. Bend your neck to the right, to the left, down, across. Yes? You can hear a noise?

THAT'S NORMAL!!!!!!!!!!!

I did a video swallow (dumbest exam ever, next to VCUGs) today on a 30-something woman with the history of: chunking noise in head when swallows.

Yes. Really.

What did the Rad. tell her?

He said, "Huh, yeah I have that too. You're not crazy, there really is a noise. It's the cartilage in your neck. (Thank you for your money, have a good day.)"

She also had foot weakness, post-nasal drainage and sinus pressure. Really? A video swallow? Why?

Well, I like my job (and money) so come on crazy faker patients. Can't you think up any other imaginary symptoms?

~On a side note: I randomly picked up the optical space age thermometer today and took my temp. It was 100.1F

And I felt fine.........but I had a fever, so I had a perfectly good reason to go to the ER.

I took it a couple more times and it was 100.0 and 99.8

Oh, well I had better things to do than sit in the ER waiting room for 3 hours.~

In Control

I think it's strange that 3 months ago I sat sweating, praying, on the edge of my seat, waiting for my interview in a new department AND NOW I'm in control of that department.
I worked my first 4 day week-end by myself. Thurs. to Sun.
I'm not following anyone around anymore.
It was interesting.
Very, very busy.
Exciting.
Boring.
Gross.
My very first patient on Thurs. painted the walls, floor and x-ray table with vomit.
It smelled like hamburger.


I had this funny little conversation with a nurse on Sat. night. The ER was packed and I was working on one patient and a nurse brought over another patient. The computer was slower than a 92 year old on ice. I'm trying to work fast and get done with the first patient, so the nurse can go back to the ER with him, but the computer is Too Slow!!
She's breathing down my neck.

Then she starts walking around looking for something and she finally comes back to me and says: Are you here all by yourself?
Me: Yeah.
Nurse: Well, that's strange.
Me: Uh, on a Sat? Evening? I think there's usually just one person.
Nurse: Yeah, but don't you need a license or something to run the machines?
Me: Uhhhh.......I've been a tech. for 5 years.
Nurse:...............oh, never mind.

Should I be insulted?

Wiped Out

Thursday (today) we did 18 fluoro/interventional pts. I was doing or assisting in almost every case. PLUS I did 3 In pts, 2 girls from a MVA and 4 other ER pts. All 7 of the ER pts were on backboards, so everything was cross table. Knees, c-spine, l-spine, ect. Ugg.
And 2 of the in pts were kids. So sad....little cancer kids with bald heads.

I'm having a hard time letting the students do stuff. It's really tough. Either I end up jumping in and doing everything or I let the student do it, but I forget that I'm supposed to stand there and watch them. I end up walking away to do some paperwork or answer the phone. Then I run back when I remember that they're "just" students. Aaaaaaaaa!

Some of the techs are really rude to the students. Even though they're students they're still HUMANS! Do unto others as you would like done to you.
Please.
It's embarrassing to watch them belittle the students. It just makes them look incompetent.

Well, I've collected a couple really juicy, grusome stories during this last week........... but I'm waiting for people/media to forget about them. No HIPPA lawsuit for me thanks very much!

X-ray Poem

I took a little artistic liberty(!) with the Statue of Liberty poem, The New Colossus, by Emma Lazarus.

Radiographer's Poem

Give me your tired, your poor,

Your huddled kyphotic masses yearning to breath free, without COPD,

The wretched refuse scooped from off the floor

Send these, the homeless, tempest-tossed half-drowned to me,

I lift my x-ray beam inside the lead lined door.

Here's the original poem:

Not like the brazen giant of Greek fame
With conquering limbs astride from land to land;
Here at our sea-washed, sunset gates shall stand
A mighty woman with a torch, whose flame
Is the imprisoned lightning, and her name
Mother of Exiles. From her beacon-hand
Glows world-wide welcome; her mild eyes command
The air-bridged harbor that twin cities frame,
"Keep, ancient lands, your storied pomp!" cries she
With silent lips. "Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore,
Send these, the homeless, tempest-tossed to me,
I lift my lamp beside the golden door!"

I love my job! This week has been really, really good in x-ray land. I did an awesome cross table knee on Tues. The pt was unconsious, but the films looked like they were done on a walkie talkie. X-ray rocks!

Happy March

Happy March!
I turn 25 this month. Boo.

It's depressing. If I live to be 100 (ha,ha, not likely) 1/4 of my life is already over.

But really, I should look at it as 1/3, because statistically I'm more likely to only live to 75.
Sad.

I thought this article about hormone related side effects was interesting. I see anecdotal evidence of this when I'm doing mammograms on women that have taken HRT in the past. Their breasts are very firm and hard, so it's much more difficult to get adequate compression. We all hate doing HRT pts.

However, the worst are women with breast implants. We draw straws to see who has to do those.
One woman came in to the dept. and was suprised at how difficult her mammogram was now that she had breast implants. Her surgeon told her that mammograms would be easier now that she had the implants, because there 'wasn't as much breast tissue'. -Not true!

As you can see from these pictures.
First, standard mamm views are taken with moderate force to the breast and implant.



Then, implant displacement views are taken. The implant is pushed back against the chest wall and the breast tissue is pulled forward and compressed. Imagine a half empty tube of toothpaste. Just like pushing the toothpaste toward the cap, we push or squeeze the implant toward the chest wall. There are double the views(x-rays) = more time and more times compressing the pt.

Time Waster

The hopital admin. are instituting another time wasting protocol.

It's called SBAR. Anybody use that at their hosp.? Did it work?

SBAR stands for Situation-Background-Assessment-Recommendations

Basically, as they've discribed it to us, the pt's nurse fills out a 'ticket to ride' every time the pt needs to leave the floor for a procedure. The questions that they fill out are like,

Wheelchair? yes/no (duh, every pt gets a wheelchair ride)

O2 y/n

Circle O2 level: 1 2 3 4 5 6 7 8 9 10 12

circle one: pt stands alone, two person lift, pt immobile

Location of pt pain?:

Level of pain:

Does pain move around?:

Pt confused/disorientated?:

IV: y/n

IV Location?:

IV taped in place? y/n

IV gauge?:

Multiple IV tries?

If so, are repeat IV locations bandaged?

Pt wearing any jewelry?:

Pt provided with slippers and robe?

RN/LPN to sign:

RN to sign if pt changes noted:

OK this is silly!

Sure I want to know if the pt is on O2 or if they're confused. I also would like to know if they are a 2 man lift(so I can bring the strong man we keep in the hallway closet ha,ha), but I can ask the nurse these questions!

Also, I can, instead of reading a piece of paper that was filled out the night before, by the previous shift, talk to the nurse or aide or whoever and tell them, "Oh by the way I'm taking 314 for their x-ray. Do they need O2? Are they combative?" Ect.

That way they won't freak out when they see an empty bed and think the pt. has escaped!

It's not like we are a huge hospital - there are 21 beds in med/surg, 4 in Ob, 4 in ICU, and 15 in the locked mental health ward.

It's just one more piece of paper the nurse has to fill out.

And our hospital is supposed to be paper-less!

Why don't they put this info into the digital chart?

Then before we go to pick the pt up off the floor (sounds bad) we'll know that they need O2 , ect.

Work Here

Hey!

Need a job?

Work with me!

We have openings for : RN-med/surg,

RN- med/surg,

RN-er,

LPN,

EMT,

a pharmacy manager

and ortho surgeon!

We really, really need a pharmacy manager ASAP. They're offering $63 an hour. (Is that a good wage for pharmacy managers? IDK) And you would only have to work every 4th week-end!

If you are an ortho surgeon- consider working here because:

Low crime rate (good place to raise your kids or retire)

Newly remodeled OR (move in date Jan.'09)

Admin. will buy any equipment you want

(or use the $600,000 of equipment the last guy

left behind after working for 5 months - he moved to

CA-not our fault)

Fresh Air

Wide open empty spaces

New Wal-mart

(where old people trip every Sun. and break their hips)

Local skiing (see above)

Many drunk drivers(broken arms/legs ect.)

Metal foundry (back pain/crushed limbs)

9 months of ice and snow(multi fx)

Come work with the best!

JACHO what

In the last few days I've read a lot of posts on other blogs about JACHO.
I know they are a farce and a pain, but let me tell you about working in a non-JACHO facility.

The state, EPA and other government bodies check us out once a year and we always pass with flying colors.
However, they never check things like air return/ventilation.

The air flow in my dept goes like this -
1. Vent outside the hosp., where smokers stand, sucks in air.
2. Air flows down past the cafeteria picking up the scent of fried onions and charcoal burgers
3. Air then passes into Radiology.
4. Air stays in Radiology, becoming muggy and holding the scent of home-less woman's armpit.
5. Same air still in Radiology.
6. Ambulance idles outside ER.
7. Diesel fumes overwhelm cigarette smoke,onions,charcoal and home-less armpit.
8. Radiology dept. workers gag, fall on floor and die.
9. Phone rings 49 times in silent dept.
10. Angry Dr.,looking for x-ray report, finds dead technologists.
11. 2 hours later Dr. remembers rad dept is dead (after calling again for a report) and complains to administration that rad dept is lazy.

Stir Fried

I stayed inside this week-end and cooked. It's -15F outside with a windchill of -35F. At that temp. any exposed skin freezes in about 15 minutes. I hate winter.
I watched The Day After Tomorrow at work last week.
In the movie first there are terrible tornadoes that kill hundreds of people.
Then the oceans rise and finally a deep freeze covers the northern hemisphere.
In the movie, living where I live, I would be frozen dead.
One thing that bothers me about the movie: the temp gets down to -135F and humans freeze instantly, unless they're standing next to a fire.
Question: Would a fire burn at -135F? Wouldn't all the oxygen be sucked away from the fire?


Well, that's what I've been thinking about this week-end. Freezing and dying.
This is a pic of some tofu I marinaded and then baked at 500F. It comes out of the oven salty and crispy on the outside and creamy soft on the inside.

My mom used to make this for me as a special treat.
It's my second favorite snack.
I guess some people think of mac&cheese or chocolate pudding as comfort foods, but this is what I like.
My favorite meal is really weird. Nobody outside my family likes it.
It's fried onions, bean thread noodles, textured veg. protein, mushrooms, and soy sauce.
It's cooked like a casserole. Mmmmmm. Yum yum.

This is a pic of the stir fry I made. I love baby corn! And jasmine rice.

This is a pic of the egg bread I made today. And a radish sandwich.

Eggy bread,butter, and radish. Mmmmmm.

And then I made some molasses cookies.


I slept for hours and hours this week-end. Work on Friday really tired me out. I worked a morning shift after working a shift the night before. Then I was on CT, on a Friday, always exhausting. People always try to get in on Friday for pain they've had all week.
But what if it gets worse over the week-end?
True.

Secretly, I don't really mind. I can do an Abd/Pelvis CT in 15mins.(they're scheduled every hour) and a head CT in 5 mins.
I've made it sort of a game.

Also, one of my co-workers (we'll call her Talky), who is six months younger than me(as opposed to everyone else who are: 35,45,47,57,64 years old) was working and we always have a lot of fun.
We have our own inside jokes and we can complain about other people.
It's fun.
After working for 3 years with people as old and older than my parents, it's nice to have someone closer to my age to work with.


And I can boss her around sometimes.
Because she is younger than me.
But sometimes she talks too much.

Rice Fire

I love Indian food!
Dum Aloo is my favorite. It's potatoes in a semi-fiery tomato sauce with lots of good spices. Mmmmm and samosas and naan.

I wish I could find a recipe for the red relish that's often served in Indian restaurants for an appetizer. I think it's made out of finely chopped onion and lemon juice, but what makes it red and gives it such a great flavor? Cumin? Annatto?-that would give it a bright red color. Hmmm. I guess I'll keep looking.

So far today at work I have done ONE, yes, count it, one Abd/Pelvis CT on a chemo pt.

My boss asked me today if I would be interested in working from 2pm to 2am x 3 days a week without week-ends and NO CALL!!!!
This seems like a pretty good deal to me. I'll have to see if it works out though. I don't think I would be interested if I still had to work week-ends.

I wish I knew what kind of shifts other x-ray depts. worked.
As I've just passed my Mamm boards (in Dec. score of 98, thanks very much!), it would kind of suck if I didn't get to do mamms at all. They only schedule mamms until 3pm, because there's only a staff of one(me!) in the dept after 3:30pm.
Ho Hum, have to see how it goes.

Groin Shot

An ETOH man came into the ER last fall, during hunting season. He was obviously drunk-slurred speech, stumbling, passing out every few minutes, smelled like a bar floor. He was triaged into a low priority trauma bay.

His friend (also drunk) had driven him to the ER, because the pt had some pain when he tried to go pee. The Dr. looked at him 'down there' and he had a few red bumps on his thighs with visible BB's underneath the skin. She decided to order an abd CT, before she started poking around and pulling out BB's.
I did the CT.
The ER was busy and it was a Sat., so I was all by myself.
This guy was really drunk and really, really heavy. I had to move him from the cart to the CT table (and back again) by myself. It wasn't a problem, while he was passed out (thank you inventor of slider boards!!), but about every 5 min. he would wake-up and try to punch me and drunk-cuss me out.
Did the CT and !!OH MY WORD!! He had BB's throughout his groin and into his abd. It looked like he'd shot himself on purpose in the crotch!!
I can not imagine how this happened - Did he do it to himself? Did his 'friend' do it? Did the gun go off accidently?
We'll never know, because they were drunk.
One BB was in close proximity to his abd aorta (and in many,many other places), so they air-lifted him to a bigger hospital for surg.
But - can you imagine how painful it would be for him to pee? With a groin full of buckshot?

Say Quiet

Med-eo's (see glossary) are a lot like actors. They are very superstitious.

Just for fun walk into an ER and say the word 'quiet'.

I dare you.

It's like walking into a theater and saying 'MacBeth'. The word doesn't kill you, but the people that hear you say it sure will.

We have a woman, Ruby, that works nights at the front desk.

Let's just say, not all her bulbs are lit. Every single week-end that Dr. Cutie (he's cute) works she says to him, "Well, I hope that you have a quiet night." And every single time he cringes and tells her 'Not to say that word!!' And then he gets avalanched on. A full ER -all night.

I feel really sorry for him, because #1 he's so hot. #2 I usually have to do some work too.

I start a 24 hour shift tomorrow. Yeah........

Today my EE, Lavender, layed her first green egg and my Sebright, Pippa, also layed her first egg.

From Lt: Pippa's egg, Lavender's egg, Med. store bought egg, Zela's Jumbo egg.

Surgery Sucks

I am soooo tired. I had to work a morning shift today. Last night I got off work at 11pm, drove home 30 mins., and then got up again at 5am and to drive back to work.
Started the day off with a mammogram. Did an awsome job - as always - nobody gets more breast tissue on a film than me! I get chest wall everytime, on every film.

At 9am I went up to surgery. The first case was a foreign body removal and the second one was a gallbadder. Easy-peasy, 2 hours tops, Right? Wrong! I was in surg. for four hours!!

Four hours wearing about 20 lbs. of protective lead. apron, thyroid shield, ect. Plus the ever stylish blue hair net and yellow face mask.

The for. body was a kid that was burning garbage, someting exploded and hit him in the cheek. Dr. T. dug around and around in the boy's cheek for like hours. Seriously, if anything happens to my face I'm going to a cosmetic surgeon. No scars for me! Thanks very much.

They usually use a magnet to suck for. bodies out of incision sites. The magnet looks like metal toilet paper holder with a metal tip on either end. They stick the metal tip end into the flesh, squish it around a little bit and sometimes that's all it takes. The for. body sticks to the magnet and sclushp it's out.

But not today. It wasn't ferrous. So it wouldn't stick to the magnet. And it was stuck it a chunk of tissue, so Dr. T just had to dig it out manually.
My job in Surg. is pretty boring. I stand there and push the C-Arm in and out of the surgical site. When the Dr. says x-ray, I press a button and take an x-ray.

The gallbladder took forever, because the Dr., thinking it was an artery, clamped a duct off and then tried to inject contrast. "Hmmm, the contrast isn't going anywhere?" "Maybe it's the big stain-less steel clip you just clamped there."

Most of the time I really like Dr. T.
He's quiet and he doesn't swear at me.
A+ Dr.!!