Thursday, January 12, 2012


      It's been a sad-ish few days around the old parsonage, dear reader.  I've not been able to write - turned out Laptop's condition was far more serious than originally thought.Indeed, in the end - well, not the VERY END - the doc, breaking with standard protocol, made a house call.  And he wasn't alone.  Rather, as he is also on staff at the School of Teckie-ology, he had asked - before setting out in the ETS (Emergency Technician Savior) bus, whether he could bring an intern-in-training along.  Of course I dared not object.  Firstly, (and my apologies if that is not a word) you know/should know that I am a champion of clinical experience in the education process.  And - the honest albeit selfish motivating factor - Laptop's condition was deteriorating.  I had already prepared Desktop for the worst when I was with him fetching email. Thought it best.  And now a fledgling healer would be exposed to his first challenging emergency.  What could I do?  You know what they say, "Man proposes, God disposes.". (You remember "They", the users of phrases like, "when I was 'coming up'".  Goes to show this group of pundits can also, on occasion, be profound.
      (You know/have no way of knowing, when I studied - at Georgetown U., I was always struck by the choice of words used by its membership when describing - anecdotally or on patient data templates - the patient/patient's condition. Twenty years later, when one of our daughters matriculated through the very same program, two significant changes prevailed: Four credits of Statistics was required - Color me grateful to be a living anachronism - and "patient" was taboo, "client" now the politically correct terminology -Color me in black avec veiled chapeau.
       By way of example, the patient was not "having" or "in" pain but rather "complains of pain" (c/o).  At the outset, then, our hapless, suffering patient is pre-cast as 'The Complainer' who whines, bitches, demands - runs the gamut of demanding/inappropriate modes of expression EVEN if he's an above-the-knee-amputee who is unable to 'run' at all.)
      Laptop had not been running well for a few weeks.  It had been showing ("presenting with") signs and symptoms ("sxs and sxs") which this observer intuitively associated with pain - displaying prompt after (p) prompt, attempting to 'install' tray applications, only to fail at the task for lack of required disks (CD-ROM) during the start-up process; (I quickly learned to cancel the attempt as soon as I saw the prompt.  I mean, why re-enforce an obviously ailing Laptop's experience of failure?) a fiendish memo informing me that "Microsoft Office 2003 is corrupted", also during start-up and, the most humiliating/damaging sx for Laptop as well as the most eviscerating sx for me - the inability to access the Internet.  Laptop had been exiled from the fold;  I had been cut-off from family, friends, business associates, clients (LAW clients - I no longer practice the art of nursing which deals with patients.) and potentially important updates as well as definitely important help in curing this pathology.  And, I might add, (you knew I would) during ALL of this trauma, not a 'peep' from Laptop.  Never complained; 'sucked it up', as they, our new comrade-in-penning, say. Sadly, this would be the intern's (his name is Christian) first exposure to an on-site attempt at resuscitation.  And even though his mentor, Mike's, skills, knowledge and experience are without equal, Christian was unwittingly about to be launched to the lions.
      (Of course, there was a class of medical nomenclature which was benign in addition to having the same Druidic security encoding as the malignant.  I give you "PND" - which I interpreted as 'post nasal drip' on my first in-hospital cardiac patient assignment.  I quickly learned via my clinical instructor's acuity, that it meant "paroxysmal nocturnal dyspnea" or intermittent attacks of difficulty breathing during the patient's sleeping hours; "SOB" was was not what I was thinking with attendant embarrassment, but rather 'shortnes of breath'; "ataxia" referred NOT to how the patient arrived at the hospital, but problems with balance and coordination; "Hx" was the patient's past medical history, NOT a poorly-scribed prescription; "appy" - NOT the patient's pet.  He'd had an appendectomy in the past; "PAT" - NOT his wife but 'paroxysmal atrial tachycardia (as chatted up in today's TV ads by the doctor/actor in the white lab coat). 
      The heart has four chambers - two upper, the right (R w/ circle around it) and left (L w/ circle around it) atria or chambers and two larger lower, the R and L ventricles or chambers. Our heart rate - incorrectly dubbed 'pulse' - is generated by a pacemaker, an in situ electrical impulse generator, located in the R atrium.  When things are jake, it sends impulses down via the intersection of A and V, to the ventricles which, being healthy, well-mannered  soldiers, OBEY and pump or squeeze in response to each impulsive command - roughly 70 - 80 times a minute.  BUT.  If the patient suffers from the abnormal condition of PAT, gangs of little reprobate pacemaker wannabees start a rumble in the R atrium.  "And the winner is. . . . .THE FASTEST!".  So, as the obedient ventricles will follow the fastest pacemaker, they squeeze their myocardial muscle strands - THE TEAM - OVER AND OVER, FASTER AND FASTER.  Sometimes, for plain old capability reasons, they can only execute every 2nd or 3rd order.      
      Now, we have the mayhem scenario of rebel-controlled atrium trying to beat 350 or so times a minute and winding up just looking silly; the ventricles pumping away with impressive regularity at some 'bad-for-your-health rate; a decrease in blood flow because, let's face it, when you're racing THAT fast, who's got time to fill up at the pit?  And the patient is feeling a funny fluttering - or not or just scared or dizzy.  SO.  It was really a giant step in my learning curve when the cardiologists' lecture took the patient's "wife" out of MY notes.  Now I I could look for those sxs and sxs of PAT & act, with something along the lines of ,"HELP!".)
     When the ETS van arrived, I immediately (STAT) told Laptop that help had arrived.  Mike (Attending) proceeded directly to Laptop - who hangs by my bedside table, directly above the router on the floor below.  Perched on the bed - with Christian at his side, Mike turned Laptop on and watched with furrowed brow as his fingers fluttered over the keyboard assisting him in aborting all of those 'intall' attempts.  Laptop looked - and I KNEW - he was in 'good fingers'.  Noticing the red 'X' on the 'internet access' bars, Mike asked for the password - which I thought was the WEP key & could not locate.  We all trundled downstairs to elicit the password/key from Desktop's router.  (If you need a break, dear reader - go ahead, take that cruise.  "They' will take notes.) 
      Back at Laptop's bedside, Mike swiftly re-stored Internet access.  But things remained dicey with the 'install' rascal.  He couldn't ID it so couldn't stop it.That ole 'Druidic Security'. I shed a few as Mike and Christian carried Laptop out to the van, thence to become an in-patient.
      (What I have indicated as malignant nomenclature in medical terminology covers a broad spectrum.  I guess a soupcon will have to do.  "Patient denies pain" - totally uncooperative;  "admits to smoking" - currying favor with forced confessional info; "reports bloating after eating dairy products" - the kind of bloke who would turn ANY body in, even his mother, especially if she's called 'Elsie'; "refusing assistance with ambulation" - showboating, probably to his own detriment.  Note to BRAIN: Get a psych consult.; "says zero Hx of HTN" - this according to a patient who we KNOW denies.  Of course, he may CONFESS if someone just told him that HTN means high blood pressure;  his "affect is flat" - you want grins from a sick man?;  his prognosis is "poor" - no surprise given he won't play nice;  the outcome borders on "grave" - forget serious, disastrous even.  "grave" has JUST the right imagery baggage.)
      The good news is that Mike tells me Laptop can come home today.  Makes it all worth it.  I'll get right on those notes to the kids and they, in turn will shower me with lols, BTWs, FYIs, smiley faces - their entire arsenal of evocab for which we spent twelve plus years and close to $200K.  So what?  I'll be able to write, the sun will probably rise tomorrow, Christian's a happy camper with all that extra teckie-knowledge bang for his buck and - at least last time I looked, we humans are still biodegradable.  Later, Lorane. . . .