Ladies and gentlemen...

Meet the new executive chef at BLT Steak, Los Angeles!

(BLT is not Bacon, lettuce, and tomato.. it's Bistro Laurent Tournadel) ;)

Noah News!

Very exciting time for Noah who is being flown to NYC to do a tasting/interview for a big chef who is opening a restaurant in Los Angeles. He has to prepare four courses for the chef this Friday. I'm sure he'll do great and this would be a really great opportunity for him! I'll keep you posted!

Bad hairstyles..

Inspired by Mrs. G at derfwadmanor.blogspot.com I decided to post my half Rick Springfield, half Joan Jett (I wish) haircut from back in the day. I have no shame!

Happy Pickling!

That's what my mom said to me when I got off the phone with her after asking her advice on pickling. I decided it would be fun to make my own pickles. As everyone in my family knows, I had quite an obsession with pickles for awhile. One morning, when we lived in Alaska, my dad was in charge of getting us off to school. He had made our lunches (mine included two plastic wrapped dill pickles) but when the bus pulled up in front of our house he realized he hadn't fed us breakfast. "The bus is here, Dad!", I yelled. His answer? He handed me a pickle. So I ate a pickle on the bus, then ate two pickles for lunch. At recess, it was raining lightly, (as it does in Alaska, everyday pretty much) and I realized my hands were swelling up so much I couldn't bend my fingers! I went to the school nurse and she told me to cut down on my pickle consumption. Wow, digital edema secondary to sodium consumption!

So I pickled today and had lots of fun! I promised my mom I would post the photos: I did pickled beets, one with blood orange slices and one plain, pickled green beans with garlic, and two types of pickles, sliced and quartered. They should be ready for cold storage in three days and to eat in a week! I can't wait! I'll try to ration my pickled meals to avoid any unwanted bodily effects...

My Super!

Happy 35th birthday to you, Noah!












Incredible chef...











Sexy surfer...













Wonderful uncle...














and loving husband! Here's to the next 35 years!

ER Schmee-are...

Another busy day today... Had a poor 4 1/2 year old come in after falling off a top bunk of a bunk bed. (I understand the space needs of homes but this is my second horribly broken arm on a young tot from a bunk bed in two days..). Such an incredibly nice family. His arm was visibly deformed above the elbow. We knew he was a surgery candidate right away. The orthopedic surgeon who specializes in pediatrics was called and came in right away. Our only problem: our hospital does not operate or admit pediatrics! How was this poor family supposed to know this as they rushed to the nearest hospital in distress. Our options were to transfer him to another nearby hospital or have them sign out AMA (against medical advice) and drive 8 blocks to UCLA. I was a fan of the latter. Let them know the legistics and allow their son to be treated in a hospital that specializes in pediatric surgery. Our wonderful doc who was in charge got on the phone and started making phone calls. I called our house supervisor and told her the situation. It turns out we can operate on pediatric patients but they cannot be "admitted" to the hospital. The doc felt this was the best option for the kid. He's already here, lets fix his arm, and send him home after the surgery. Okay, great, but the kid had eaten dinner at 6pm and you have to wait at least 6 hours to do the surgery after a meal. The operating room is open only to dire emergencies at midnight. So this wonderful family had to wait until 7am for the surgery. I give props to the orthopedic surgeon for bullying the OR staff into pushing all their other scheduled surgeries back so this kid could get in first. Meanwhile, we were managing his pain and fear, and the fear and worry of the parents. I continually try to imagine that it is my nieces in these predicaments and give the optimum care that I would want for them. I also give props to the ER doc that kept every option open (even the "controversial" one of letting them go AMA so they could take him to a pediatric hospital) if that would give him the fastest and best care. I am amazed at times of the caring and "fuck the system" attitude of ER doctors to try to get the best care for patients within the constraints of the health care system. I did not notice what kind of insurance this family had. I don't think I'm going to last long in health care if I dwell on it.. I know there are problems but I don't know what I can do except keep patients informed of their choices...

I also learned a lesson in humility (and not overstepping my scope of practice) the other night. A patient came in who I recognized. She was making a big scene in the waiting room, moaning and yelling. I got her into an exam room and I realized I recognized her from several previous visits. I immediately labeled her as a "drug seeker". Her behavior was typical for drug seeking and her visit history was at least 15 visits in the past 3 months for various pain complaints: headaches, back pain,etc. Her behavior was always over the top and she always demanded strong pain medications by name. This visit she was complaining of abdominal pain. We started an IV and gave her a small amount of morphine. She insisted on more and could never exactly tell where the pain was located. She would say "All over" when asked where her abdominal pain was. I doubted her and told the doctor "If she has an acute appy (appendicitis) I will run the halls naked!" Luckily, the doctor believed her and not me. The CAT scan report revealed and inflamed appendix that needed to come out that night. The doctor is still asking me to pay up on my bet... (Yeah, right!) It is sad for me to realize that I have become so cynical towards patients that I don't recognize a real emergency. At least the doc backed me up by saying "She still is a drug seeker. She is displaying the over-the-top behavior. She just actually has a medical condition".

It is hard when so many people come into the ER "crying wolf" or over-exaggerating their problems. It's easy to become cynical. I'll try not to. But it's hard..

Other fun things in the ER..

So please read my last blog to appreciate this one: I was dealing with a patient with a finger amputation. It doesn't matter how busy you are, the patients keep rolling in.. A twenty something girl came in a few minutes after our poor guy who was losing his finger. Of course, she didn't know this. Her complaint was " a big, deep cut". She had a TINY cut on her wrist that you and I would not walk into an ER for. I wanted to walk her into the amputee room and tell her, "THIS is a big, deep cut!!!"

Tell me, would a nurse hotline be helpful to people? A way to avoid the ER $$$ for possible practical advice? Let me know..

Got good insurance?

I was actually going to post a more graphic photo and then decided this would be more appropriate...
I walked into work the other day at 11am, my scheduled time. It is when our department opens although an LVN (licensed vocational nurse) comes in a half hour before to do all the opening bullsh*t. As I walk in, the charge nurse from the main ER strides in with a syringe in one hand and a man following her who has his left hand elevated above his head and wrapped in bloody gauze. Right away I know this is not an ordinary patient. Rarely does the charge nurse from the ER get upset or excited about anything. "Bring him into room 4", I tell her, not even knowing what to expect. The story is this: a spanish speaking only construction worker (I'll call him Jose) was working with a skillsaw and "got" his fingers on his left hand. I knew right away, without even looking at his hand, that he was going to be prepared for surgery just by the presence and attentiveness of the charge nurse. I called the physician's assistant in as I started an IV and drew blood. The poor guy was pale and scared. Luckily he had his brother with him who spoke fluent english (I think!) and translated for us. The hand surgeon was called and showed up in 5 minutes. He took one look and told the patient his options. This is where it gets tricky.. Insurance. Wow, you would think that someone who's middle finger is hanging on by a piece of skin would get the best treatment available. But no. There are two hospitals in LA that specialize in "replantation". Our hand surgeon called them and they both denied him. I don't know the details on why but the bottom line is that they refused to accept him as a replantation candidate. Our hand surgeon, (who wonderfully had been making all the phone calls himself), had to break the news to the patient that no experts in finger replantation would accept him as a patient. By this time, his amputated finger was no longer viable and his only option was to go to surgery at our facility, for an amputation. Very sad. This man is a construction worker. He needs all his fingers. We all need all our fingers. Any normal person would think that if they cut off their finger and went to a hospital, that they would get all possible help. Nope. A finger that could have been saved was lost because of insurance. I find no fault with the hand surgeon that came in because he did everything he could to save the finger. The patient insisted to be transferred to a transplantation hospital (like we all would). The poor patient just didn't know that he would be rejected based on insurance. What can we do about this? This is not right! What next? We can't save your eye or your ear or your leg because you don't have the right insurance??? I'm very upset...