Mind In the Gutter

So a recent incident in town has me rankled. Yesterday, eight youths perished in a fire. The news describes them as “homeless.” Upon deeper research, it becomes apparent that the dead were part of a subculture commonly referred to in New Orleans as “gutter punks.” It is tragic that eight young folks died, and all the more so because their deaths could have been avoided.

“Yes!” I hear you cheer. “It’s a shame that the city isn’t doing more to help these poor, homeless young people!” I can picture you lamenting over your breakfast latte and muffin top. “Those poor people were the victims of an uncaring city!”

No, they weren’t.

Having had many, many interactions with members of the gutter punk subculture, allow me to reveal the real reason of why eight tragic deaths were completely avoidable. Those scruffy, unwashed “homeless” waifs (and their dogs) you step over on the sidewalks of the French Quarter are as far removed from the “homeless” you find at the Ozanam Inn or the New Orleans Mission as those same homeless are from the Southern Yacht Club. They are not down on their luck, impoverished or abused. In twenty years of EMS, I’ve picked up a LOT of gutter punks in my ambulance. The process of running an emergency call and the conversation carried on in the back of the truck affords numerous opportunities to get a pretty clear picture of any particular cross-section of the population. Here are my findings.

Extraordinarily few are local kids. In twenty years of collecting punks from the gutter, I have yet to meet one who was born and raised in New Orleans. Their points of origin are wide and varied, but heavily weighted towards the Northeast. Upon examining their reasons for choosing New Orleans as their preferred destination, apparently it is because New Orleans is well known for the gutter punk “scene” (interesting cycle, eh?). These kids aren’t leaving behind a life of abuse and squalor only to find themselves saddled with a different flavor of abuse and squalor here. No, gutter punks, by and large, come from very affluent, privileged families. And from the information I’ve gleaned, I don’t mean families that are hiding a terrible secret, like incest or beatings or a dead hooker buried in the yard. They come from families where the parents are often still happily married or at least financially successful. On numerous occasions I’ve asked my gutter punk patient “What’s your parents’ phone number?” as part of my report, and the answer was “The phone number to which house? Our house in Manhattan or our summer place in Martha's Vineyard/The Hamptons/Palm Beach?” Upon searching for identification for a patient, I’ve come across countless “platinum,” "diamond” and “black” credit cards (you know, the cards that have no credit limit in sight) with mummy or daddy’s name on them.

So why the “homelessness?” Apparently it’s a big adventure coupled with a rebellious outlook, typical of the teens-to-twenties psyche. Whereas many of us would be happy to fulfill this worldview with a backpacking trip around Europe or Asia, these folks find its fulfillment in living amongst the casual friends, abandoned hovels and handouts that are apparently so abundant in the Big Easy. And apparently there are certain social etiquettes that are required in this culture. The obvious ones are the dirty clothes, unwashed bodies and prevalence of tattoos and piercings. I asked a personal friend, something of a reformed gutter punk, why they eschewed soap and water. Apparently the act of bathing is somehow equated with “the establishment,” which is roundly rejected among the gutter punks. The equivalency of personal hygiene with the mainstream socio-political-cultural image of the general population escapes me, but I’m not one to judge another’s idea of disestablishmentarianism. I merely report. But expand this mentality to fulfilling rent, or doing laundry or (gasp) the evil of paying taxes and perhaps you get an idea of the thinking within those dreadlocked skulls. Surely, though, a comparison could be made to these young folks and the hippies’ communes of the sixties, or even the hobo camps of the Great Depression, which eventually was romanticized in song and screen. “The establishment” seems to be an anchoring phrase between the generations. With such a long history of rebellion against “the establishment,” is it any wonder that today’s young folks choose to conform to traditional non-conformist ways?

Therefore it is pointless to complain that The City That Care Forgot forgot to care. These young folks that chose to brave their way by living on its streets is not a situation for which City Hall can establish an office to “help.” Build all the shelters you want; gutter punks will not come. Offer all the assistance centers you want; the gutter punks’ parents are probably your investors. Those youths want to continue to live out their big adventure, with all its inherent risks and dangers. And I’m not railing against the gutter punks, either; I certainly understand the appeal of going against the system (though I do enjoy a decent shower). But while it is a shame that eight young people died in a fire, please don’t blame it on my city.

Is Christine O'Donnell a Witch?

There's only one way to find out the truth: if she weighs the same as a duck... A WITCH!

How To Be A Pain In the Ass In the Hospital

So here’s a fascinating little tidbit from CBS News: How Not to Die in the Hospital. As a critical care nurse, I feel especially qualified to comment on the hilarity that ensues with the perusal of this article when compared to real life.  Let’s discuss each recommendation step by step, shall we?

The first two pages discuss the terrible possibility that you may die if you’re in the hospital. This is true. I’ve seen patients die unnecessarily myself. No arguments here. The vast majority of complications from hospital stays, however, do not involve death. Most patients have pain or vomiting or diarrhea, at worst. They may have a bad hospital experience, but in the end, they get better. Sorry for the un-fun visit, but you’re better. Mission accomplished.

Page three talks about hand washing. “If you do not see your clinician wash their hands, ask,” Dr. Pronovost recommends. Very good idea, Doc. In all my years as a clinician, I have had exactly two patients bother to ask if I had washed my hands. I had, but was happy to do so again right in front of them. In both cases, the patients who were so concerned with my hands didn’t give a hoot about their family members who came to visit them and touched not only their skin, but the IV’s, central lines, wound dressings and whatever else was attached to them. Big signs that say “CONTACT PRECAUTIONS - DO NOT ENTER THIS ROOM WITHOUT A GOWN AND GLOVES”  and protective equipment located right outside a patient’s room are summarily ignored by the dozens of visitors encrusted in God-knows-what filth they’ve brought from the outside world. Patients don't mind if their visitors slobber all over them after they've just arrived from a cholera party, but God forbid if a staff member didn't wash their hands for the three hundredth time that shift.

On page four of the article I find it hysterical that patients are encouraged to ask if they still need the breathing tube (speaking is a physical impossibility with one). But their point is the possible route of infection from catheters and other invasive devices. Here’s the thing: old people are more likely to be in the hospital. When they get that catheter, it’s like a godsend to them. They don’t have to get out bed to pee, they’re dry & comfy. They beg for the catheter to remain. If the mean ol’ nurse has the nerve to remove said catheter, they still don’t want to get out of bed and pee all over themselves and get bedsores from the constant moisture. So you’re damned if you do, damned if you don’t.

Page five recommends you stay at least at a thirty degree angle if you’re on a ventilator. Agreed, this is very necessary to prevent pneumonia! Can you please explain that to the family members that go all willy-nilly with the bed positioning controls and keep laying their loved ones flat “because it doesn’t seem real comfortable sitting up like that”? 

On page six, they recommend easing anxiety or pain without being sedated. Um, you DO realize that ALL anti-anxiety medications have sedative properties, right? And, um, except for Tylenol and NSAIDS, all narcotic pain meds are sedating to some degree, ya know? Further, rare is the patient who does NOT want the absolute strongest medications in their highest possible dose. Most patients with “chronic pain” have already hardened their nervous systems with constant prescription narcotics at home so that even ridiculous doses that would tranquilize a stampeding elephant have no effect on them. We could shoot uncut heroin directly into their brains and they’d beg for more.

Page seven - the “specialist” page! Lemme tell ya - if you’re in the ICU, you have a specialist. In fact, you probably have so many specialists, that the doctors and nurses aren’t sure whom to call if there’s a question about your care. Did you have a stroke, but now you have an infection? The conversation outside of your room probably goes like this: “Hi, Doctor Smith? The stroke patient in room 6 also has the flu. What do you want to do? Call the Infectious Disease specialist? OK. *Ring* Hello, Dr. Brown, the stroke patient in room 6 has the flu and Dr. Smith asked that I call you... You’re not a stroke specialist? I know...but... what? Call the patient’s primary care doctor? Well, you see, his doctor is in Bumfuck, Egypt and... *Click*... hello? Hello?” Also, with the chronic shortage of beds and staff in hospitals, you may be in the ICU simply because they had an open bed, not because you need intensive care, and with the staffing problems facing hospitals, your nurse (or doctor[s]) may well be right out of school, ink still drying on their diploma. So good luck with that.

Page eight deals with central line infections. Dunno what to tell you about that. Lots of folks have central lines and despite best practices, they still can get infected. Roll the dice.

Page nine and ten are two of my favorite pages. “The Deadly Blood Clot”! Yes they can kill or create a stroke or heart attack. TED stockings and SCD’s (sequential compression devices) help prevent them. Interestingly, about five minutes after the nurse fits the stockings over the patient’s legs and applies the SCD’s, the patient usually starts complaining that they don’t like them and take them off and it makes my legs feel hot and can you take these off... and so on. Explaining their use and the horrible consequences that they prevent falls on deaf or at least unimaginative ears. The theoretical killer blood clod seems far less important than the tight stockings and swooshing SCD’s. If they relent and leave the things on while the nurse is in the room, you can bet your bottom dollar that they’ll take them off as soon as the nurse leaves. If a visiting family member gets wind of it, they’ll hustle to take the things off themselves, then file a complaint that the nurse “wouldn’t listen” to the patient. Interestingly, the patients who don’t even need the TED’s and SCD’s, those folks who are fully mobile and reasonably healthy, are the ones most likely to keep them on.

Page eleven deals with “Drugs Gone Wrong.” Yep, it happens. One of the problems is when nurses and pharmacists have to translate SCJsjdhyt^*%nv[f written in doctor handwriting hieroglyphics into actual words. Think computerized charting will help? Guess again. The patched-together ad hoc code that most medical charting software is written in frequently crashes or inserts errors into medication names or dosages, or medications may suddenly simply disappear from your chart. Thank your nurses, who are diligent to spot errors and excel at doing so, that you actually get the medications to help you get better. So cut them a little slack if you miss a dose of brain heroin.

The last recommendation talks about communication. Ask questions, express your thoughts, get involved, blah blah blah. You want to know what most patients think of as “communication”? “I need more pain meds!” “Why can’t I have some food?” “Nurse! I just shit all over the bed!” "You guys suck!" If you carefully explain why the patient is not due for any more pain meds five minutes after heroin was injected into his brain, or why the patient whose intestines are rotting from the inside cannot have food, the response will be “But ‘they’ said I could have fried chicken/a narcotic fountain/cases of Dom Perignon. You just don’t want to be bothered with me.”

Sometimes, we don’t. We just suck.

Any Retard Can Be a Super-Brain

Ok - I’m amazed. I’m amazed that the media, the locals, university researchers and mega-intellects are stunned at the “disappearance” of BP’s oil in the Gulf of Mexico. I am even more amazed at their shock at finding the missing oil below the water’s surface. The big story this week is the discovery of untold volumes of oil drifting beneath the surface of the Gulf.

“Wait a minute,” I hear you gasp. “Oil beneath the water? Drifting along? Not on the surface?” You apparently are not alone in your astonishment. Super-mega-brainiac Christopher Reddy was equally shocked at the revelation as described in this article from NPR. “Doesn’t oil float?” he asks, echoing your incredulousness as well as that of countless other people with functioning brains.

Well, as we all know, oil does indeed float. So why is this oil not floating on the surface? What mysterious physics have turned our safe, grammar-school imagery of “lighter than water” oil on it’s metaphorical ear?

Now here is the source of MY shock: Virtually since day one of the oil spill, it has been no secret that BP has been dousing the oil with Corexit, an oil “dispersant.” We have seen numerous images of planes flying over the oil spill with tons of Corexit being dispersed upon the oil. Millions of people viewed the live camera focused on the source of the oil disaster, the spewing wellhead of the broken rig. In the foreground of every frame was the nozzle one of BP’s submersibles, spraying an unbroken stream of Corexit directly into the escaping petroleum. Panic along the gulf coast has ensued in recent weeks over the possible toxicity of the millions of gallons of Corexit that accompanies the oil.

Why am I shocked? Along with the common knowledge of the deployment of Corexit since day one, the purpose of Corexit was also announced. Corexit is a “dispersant.” It is specifically designed to make oil sink. I does not make oil disappear; it does not consume oil, it does not neutralize oil in any way. It only makes oil heavier. Any retard with a web browser can research this. Even Corexit’s manufacturer, Nalco, says exactly this. Corexit makes the oil sink below the surface of the water. Granted, it also says that the oil “biodegrades” after sinking. Also true, bacteria and other microbes MAY decide that the oil is tasty enough to feast on, thereby biodegrading it. But the Corexit itself does nothing to promote biodegrading. It merely makes the oil sink out of sight.

Brainiacs, mega-intellects, university professors, media people - WHAT PART OF THAT DID YOU MISS? The oil went nowhere, other than a few thousand feet below the surface. Why are you all shocked that the oil is floating around in the gulf beneath the surface? I can say one thing for BP, they did not lie about spraying Corexit everywhere. Since the first knowledge that the oil spill was developing, they told us, even sent us videos of Corexit fumigating the gulf. The Corexit did exactly what it was supposed to do - make the oil sink, thereby keeping it out of sight and hopefully out of mind, protecting BP’s rainbow-and-unicorns reputation.

I’m shocked and dismayed that so many fell prey to this sleight-of-hand, this tragic subterfuge that BP tried to con us with. It is as if a shell-game street con-artist told us “I’m going to hide the ball up my sleeve,” and you were still dumb enough to guess that the ball was under one of the shells! Now as those millions of barrels of oil make their way throughout one of the most vital ecosystems of the western hemisphere, it makes me wonder how many other cons slip our notice, as well as the tragic consequences in which they will result.

Survival of the Stupidest

If you’ve ever wondered what sort of stupidity medical professionals have to put up with, why they grouse and moan and bitch and complain about the idiocy with which they have to deal, why ambulance workers have such a high burn-out rate and emergency room staff have such a high stress level, this is a perfect example.

http://to.ly/56J3

This little princess shot herself in the shoulder to get “medical care” for some unclear previous shoulder problem. As you watch the video, a couple of things might stand out. How, precisely, will a gunshot wound, in addition to whatever old pre-existing problem is there, make things better? Did you suspect that an emergency department staff will attempt to fix every possible little problem you have just because you walked in the door with a flesh wound?

You complain that you can’t afford medical insurance. Sister, allow me to inquire how much money you spend on cigarettes and tattoos? Seeing as you couldn’t wait for five minutes till the interview was over to light up a fag, I imagine you have a pretty hefty tobacco budget. Here’s a hint- putting that cash toward a medical insurance premium will cover the cost, plain and simple.

Seeing as you’re so concerned with the health of your shoulder, if not the rest of your body, what’s up with leaving two open wounds exposed for every infectious agent to grab a bite? Letting your dog lick it is not exactly the gold standard of antiseptic (as I imagine you let your dog do.)

One more thing - you do realize that everywhere there are free clinics. Just waltz on in, tell them what’s wrong, and you get free care that I have the privilege of paying for from my taxes to keep your stupid ass alive. Ironically, she may serve jail time for the illegal discharge of a firearm, and guess who gets to pay for her medical care in jail? Yep, you, the taxpayer.

Do us a favor sweetheart, don’t shoot yourself in the shoulder. Do it in the head. Real soon.

2010 Hurricane Names & Predictions

2010 Hurricane names & predictions:

Alex (big hooplah, no problems),

Bonnie (tropical storm- who cares),

Colin (fizzle),

Danielle (Keys, watch out),

Earl (Gulf churner, more BP lies),

Fiona (evacuation),

Gaston (tropical storm but scary news broadcasts)

Hermine (Central America problem),

Igor (really? Igor?),

Julia (Wind damage),

Karl (fizzle),

Lisa (watch out - God's answer to the gays),

Matthew (New England) ,

Nicole (Late-season scare),

Otto (fizzle),

Paula (East Coast),

Richard (nobody realizes it exists),

Shary (oh, please!),

Tomas (never happens),

Virginie (never happens),

Walter (never happens)

Since NOLA.com deleted my comment - here it is! (You know it's good when it's deleted!)

Jazz Fest first timers- Bring tons of cash. That's just for the admission.
If you want food or water, have a friend lug tons more cash.
Scope out a sweet spot near a stage and rope it off with constantine wire. Then prepare your insults for the dirty ugly hippies and wannabe hippies that cut down your constantine wire so they could grab your spot.
Make sure to buy some souvenirs - get ugly crap that you wouldn't want your family to find when you die. It won't be hard to find. Also splurge on a poster - only like $150 for a postcard-size print.
Unless you're really, really, REALLY adventurous, poop before you go.
Even if you are that adventurous, poop before you go. (Seriously)
Bring a dictionary or thesaurus so you can find the words to describe the odor of the people next to you.
Check the schedule ahead of time for which washed-up performers who have nothing to do with Louisiana jazz or heritage are scheduled to play their music badly.
Or - find some friends having a crawfish boil or barbecue, head over there and put on some actually good jazz or Louisiana music to hear. Enjoy your friends air-conditioning. Bring beer or cocktails which will be a twentieth of the price as at Jazz Fest. When it rains, lament how you'll miss the only good entertainment at Jazz Fest, people slipping in the mud. Enjoy.

From the Journalism textbook chapter titled "You Can Make Anything Sound Like News"

Plane crash in Russia, 132 people dead including the President of Poland. This is the best news update they could come up with?

The Science of Apathy (Or Maybe the Science Fiction of Apathy)

The Science of Apathy (Or Maybe the Science Fiction of Apathy)

I love sci-fi. I love real life too. It’s always so much fun when I watch sci-fi movies about aliens and space travelers and such. They’re always trying to blend in with their disguises and their shape-shifting ways, only to be foiled by keen-eyed civilians or “the government.” Earth survives another day. Yay.

But then it comes down to real life. I’d love to believe in actual extraterrestrials. But I don’t. Why? I haven’t seen any. Nor have you. Or have we? How many times have you seen someone on the street that was just so ugly or deformed or unearthly beautiful? Did it ever cross your mind that they might be an alien? Of course not. Me neither. But here’s a fun thought: what if they are? I’m sure psychologists would say that our minds simply try to incorporate the unusual into our usual frames of reference. For example, a time-displaced caveman might refer to a helicopter as some sort of bird (remember that movie?). Likewise, we would probably just think of an alien as a different-looking human. We’d just say “Oh, they must just have Down Syndrome,” or “What a an unfortunate birth defect, having a head shaped like the Sydney opera house. She should get surgery for that.”

Which brings me back to sci-fi. Remember when Captain Kirk and crew returned to the 1980’s to retrieve their humpback whales? The Shat ordered his crew to remove their Starfleet insignia. Why? Who would care? Mr. Spock wore that bandana thing to hide his ears. Really? What was the point? (Pardon the pun.) I’ve seen lots of people with weird-shaped ears but it never once entered my mind that they might be an alien. I’d venture to say that you, dear reader, have done the same.

I’ve been a paramedic and a nurse for nearly twenty years. Many, many times I’ve listened to patients’ chests and heard heart tones on the right side as well as the left, or heard breath sounds when listening to an abdomen. Breath sounds in a belly or heart tones on the right side are exactly what you shouldn’t hear. But I never suspected that they might be a timelord like Dr. Who or other such alien with two hearts or otherworldly arranged internal architecture. I just figured that my stethoscope was really sensitive or the patient’s chest was particularly resonant.

The sci-fi show that I think strikes the nail on the head psychology-wise is “Invader Zim”, a Nickelodeon cartoon that only ran for a couple of seasons. In it, Zim is a green-skinned alien with no ears and pink eyes who lives in a freakish house. He goes to great lengths to disguise himself as he plots to annihilate the world. Zim needn’t bother. The only person who believes he is an alien is Dib. Everyone else is convinced Dib is insane. All the rest of humanity is completely apathetic about the unusual happenings surrounding Zim.

That’s pretty much how humanity really is. I don’t think that there are extraterrestrials living among us; which, if you’re an extraterrestrial, is the perfect disguise. The folks that believe in aliens are the “fringe” people, and they proclaim their stories of abduction and insidious alien plots between doses of Seroquel behind the revolving door of their psychiatric facility. What if they're actually right? Like I said, I’d like to believe in aliens, but I don’t. Does that make me as apathetic as the rest of the world? Probably, but I don’t particularly want to spend my days behind that revolving door in a Seroquel happy place.

So is there a happy medium? Can a normal person find a compromise between boring, sane apathy and the men in the white coats? Just for fun, next time you see someone unusual-looking, imagine that they might actually be an alien, instead of an unfortunate soul whose eyes are too far apart or in need of a good plastic surgeon to take care of that tail or proboscis. Just the other day, I saw a man who was odd-looking (I say he was a “man,” but who knows?) His eyes were really far apart and his skin was an odd shade, sort of like you would get by putting too much butter on burnt toast. His ears were odd too, almost star-shaped. My first thought? Some black guy born with fetal alcohol syndrome. My second thought? He could be an alien and no one else realizes, or cares! The second thought, that he might be an alien, was so much more fun than the depressing disease process thought! Try it! Just be careful who you talk to about it.

See you in the asylum!