Friday, December 5, 2008

A new blog, and death

I came across a great blog yesterday, I don't know why it took me so long to find him, it seems as though we read similar blogs. His name is Savage henry. We have alot of similarites in experiences, but our biggest difference comes from the fact that he's more willing to write about military life, and he's an actual writer, I just use this blog to rant and bitch a little bit. After reading all of his blog in the last 2 days I feel compelled to share a little piece of my life that I rarely share.

I don't talk much about my military life, and for good reason. Some things really just need to be repressed. The transition from military life to civilian life was pretty difficult for me, The army didn't help prepare me for life after service, but I can't blame them. I had alot of growing up to do. I didn't know how to make a budget so I screwed up my credit. I didn't know how to control my drinking, and I lost a job. I didn't know how to interact with people, especially without dropping an f-bomb every 2 minutes and being overly demanding. All of these things factored into my difficult transition. What made it really difficult was transitioning from a brotherhood where everyone looked out for one another, because every step could mean life and death, to a free for all civilian world. Deciding to be in the health care field made the transition nearly impossible. How could I transition to caring about the sick when I was programmed to perform a task without thinking about what consequences it might carry.

Several years ago there were three soldiers that returned home from a deployment and all killed their wives at Ft. Bliss, unfortunately I couldn't dig up a story to link to, but I think most of us remember it. I never really knew if it was a premeditated thing, or if it was PTSD.

I happened to be working in the blood bank in the hospital at WBAMC the night this happened. I didn't have much work to do, because they were all dead by the time they made it to the hospital. I was morbidly curious back then and decided I needed to go and see the bodies. I don't know why, the morgue was just around the corner and the guy in charge was a buddy just down the hall in the barracks. In a civilian hospital it's hard to get stories in the lab, in a military hospital, they guy that just perfomed cpr on some poor sap for the last hour just happens to be your roomate or another soldier down the hall. You'll always find out what happens. Anyway, I walked in the morgue and saw 1 clean bullet hole in each head. It kinda freaked me out.

I was deployed after that and dealt with soldiers with limbs missing, and bullet wounds and shrapnel ridden bodies. That never effected me the way those three women did. You can only turn off emotion for so long. Eventually something will get to you. For me, that night was what was a wake up call for me. I've had a hard time adjusting to normal life after that, but I know i'm not the only one with stories like this. In fact most are probably worse. It's not easy to re-wire your brain. but it can happen over time.

I think the Army or the armed services for that matter, need to do a better job preparing soldiers for post war/service life. It's a difficult situation that many 20 something year old kids that enlisted right after high school don't have the tools to deal with. The next time you look at a vet that you work with or interact with, just remember that the things he's had to deal with in his formative adult years, are probably things you'll never even have to imagine in a nightmare. The one's that can make a smooth transition should be given the utmost respect. What would you do with your life post military if your one discernable skill is killing, or teaching others to kill?

Thursday, November 20, 2008

Shady company.

If you've ever seen my blog before you know that I'm always preaching about doing what's right for the patient above all else. Forget the fact that you feel slighted by someone calling you and bitching, forget about extra work it may cause you. Above all else, our responsibility is to the patient. With this said, I now understand a little better why many of the older techs at our hospital are good with washing their hands of any problem and not worrying about it so long as they won't be held responsible.

I was working a night in the blood bank. I think I've stated before that we're a reference lab for many smaller hospitals in the area. On the shift previous to mine, one of the smaller local hospitals sent a sample for a red cell antibody ID. The patient had a FYa antibody. This particular antigen on red cells occurs in about 66% of the normal population so there is about a 33% chance that a randomly selected unit of blood will be compatible with this person. They sent us sample of two units in their inventory to do testing. They needed two unit crossmatched. At a 33% likely hood of compatibility, it's not too likely both of them would be negative.

The tech on the shift before me basically washed his hands of the problem by informing the smaller hospital that they had to call the blood donor center they use and have them do the work since we didn't have everything we needed to help them out. About an hour later I get a phone call from the local blood center, of course it's midnight on a friday night, I'm informed that unless it's a medical emergency they're not coming in. That's fine, It really doesn't effect me. Except, The hospital says We need it tonight, but it's not a medical emergency, I don't get it.

What I find out, is that this gentleman's only diagnosis is anemia and they want to discharge this patient. The Dr. seems to be looking out for his best interest, in terms of cost for the patient, and in hoping to get him out of the hospital to prevent things like nosocomial infections. I can appreciate that. So I agree to have the blood center send me some historically FYa antigen negative units. I'll do the antigen typing and the extended crossmatch and go ahead and send these units on to the smaller hospital. It's alot of extra work, but it should do two things, It should save the hospital money considering this hospital is a satellite hospital and under the same blanket organization. The second thing it should do is enable the patient to receive the units he needs more quickly.

I complete my end of the bargain and send the units on their way. and try to leave an email to the blood bank supervisor about what happened, hoping all the charges can be fixed appropriately. Come to find out, the blood center charged us for the units, then charged us a "consulting fee" of $800 even though the on call tech from the blood center called me. Somehow, they even passed on charges for the work I did, to the satellite hospital.

Basically trying to do the right thing financially effed us, not to mention it caused me a shit ton more work. I easily could have washed my hands of the situation and said that it's a contractual problem between the blood center and the smaller hospital, but nooooo I had to try to do the right thing for the patient.

Frankly, I hope events like these won't cause me to think twice about doing the right thing for the patient. I can see why people are so hesitant to go out of their way to help, in the long run you're just screwing yourself. I hate being a hypocrite more than anything in the world

Sunday, November 16, 2008

Rumblings and grumblings

I haven't really had anything blog-worthy happen lately so I have a list of a few things I just want to get off my chest.

1. I really, really hate having to call positive blood cultures to Docs at 3 AM. Really, I don't like to call anytime but 3 am just sucks.

This happened awhile ago but I just remembered it while I was typing how much I hate calling blood cultures We have a set of Dr.'s at my hospital that are married, one is a surgeon the other is a hospitalist, I think. I had just started at the hospital and was working a second shift in micro. I didn't know that these two doctors were married, and I didn't even realize there were two of them; they had pretty unique Indian names. I had to call a positive blood culture at about five in the evening, so I called the operator and had DR. unique name paged (still not knowing there were multiple Docs.)I get a phone call back shortly and immediately the female doc starts reaming for calling her on a Saturday during her time off for a patient that wasn't even hers. How could I possibly make such an egregious error? I swear to you I spent 10 minutes listening to her bitch. Finally, at the end of it she said you probably want to talk to my husband, here. Her husband took the phone and was surprisingly nice. I was on the phone for about 15 seconds and we were done. How hard would it have been just to hand the fucking phone to your husband in the first place?

2. To my wife; if you're too sick to clean up after our son while I'm sleeping, then you're too sick to play on Facebook. Grow up. I fuck HATE Facebook! If I could ground my wife from it I would. I can't count how many times I've woken up and there she is sitting on the couch while my son has a full diaper and crap all over him and the house is a mess while she's on the computer chatting on Facebook. Facebook, I hope you die!

3. To my boss; Do you're own damned job. Before I took the job I'm in now, I took an entry level position and amounted to me wasting my degree but it was a foot in the door after some hard times. Anyway, because I know this job, I get screwed any time our specimen processer decides not to show up. Recently, we hired a new girl and she can't seem to make it to work. Because of the fact it's impossible to fill that job, she may have to kill someone to get fired. Anyway, my boss grew a pair and put her on probation and gave her a list of things she needed to improve upon if she wanted to keep her job. My boss approached me and said I really needed to take time and try to help the new girl. I needed to not only do my job, but retrain someone else at the same time. Ummmm, no. Do your fucking job and make sure people are trained correctly. I refuse to make my life harder simply to make yours easier. I'm the shortest tenured person on my shift but somehow I'm already the go-to-guy. I don't think I'm alright with that.

I saw a couple of funny quotes posted lately and I wish I could give credit but I don't remember where I read them.
1. "You can't cure crazy or stupid".... so true
2. A positive attitude may not solve all of your problems, but it will annoy enough people to make it worthwhile".

Saturday, November 1, 2008

Powerpoint Fun!

There's a good chance I could be fired on monday.

Last night I called a floor and informed the unit secretary that a protime on a patient was clotted and would need to be redrawn.

Five minutes later a nurse calls me and asks what I did to the specimin and informs me that it was a good draw and looked fine to her. I told her that there was nothing I could have done to MAKE it clot. She replied that she wished the lab would just own up to their mistakes and maybe she wouldn't hate us so much and hung up.

I brushed it off, hey everyone deals with stress and needs a release. She was probably busy and didn't want to deal with the nuisance.

Five more minutes passed and I got a phone call from the nursing supervisor asking if I had "dropped the specimin". I said I hadn't and privately wondered why the hell she asked me that. The nursing supervisor hung up and called back about two minutes later to inform me that we needed to run the protime on the specimen we had and that she'd be writing up a QI report detailing how I refused to accept a good specimin. She went on to say that the nurse is postive it was a good stick and the problem must have happened in the lab.

I knew full well that there's not point in doing a clotting study on a sample that's already clotted, evidently I couldn't explain this to her. Sometimes I wonder if nurses always know what tests are for, or if they simply know if something is out of range, and what needs to be done i.e. call the doc. Either way, eventually I convinced her I wasn't going to run the sample and she had to have it recollected.

Most normal people would let this slide. I knew I hadn't done anything wrong but frankly, if my time is going to be wasted on filling out/sitting through a reading of a QI report, I was going to waste her time.

I decided to spend the rest of my free time that evening creating a power point illustrating how the coagulation cascasde works and how sodium citrate works in binding calcium to prevent the cascade from ever starting. Thereby illustrating how if a sample is collected correctly, nothing I can do, short of adding more calcium would make it clot. This included the dropping scenario. No matter how many times a specimin may be dropped it won't spontaneoulsly clot.

I can't figure out how to post a powerpoint on here but if I ever figure it out I'll try to. I haven't gotten a response to this yet. I'm waiting, probably untill monday but hopefully it's not too bad. Surely my bosses know I'm a smart ass by now.

I'd like to end this post by telling everyone that we're accused of "not getting it". We just don't seem to understand that patients are critically ill and a nurse can't be bothered to redraw a specimen. My favorite line is that we only ask for redraws when we don't want to run something. Let me tell you, I get it. We're all on the same team here and we should have patient saftey and quality of care in the forefront of our mind. There is too much inter-departmental strife that was created because of an "us vs. them" mentality. It also takes me longer to pull one specimin out of my work flow and have it recollected than it would take to just run the sample and send out erroneous results.

I promise I understand that being a nurse isn't easy, I could never/would never do patient care. I also know that nurses are paid much better than we are even though we have similar degrees, ours may actually be tougher in terms of learning bodily processes on a molecular level, and I also know that the squeaky wheel gets oiled. The nurses always seem to be that squeaky wheel. Anyway, I'm tired of being accused of not getting it or just trying to avoid work. Just understand that shit happens. I'm not sitting in the lab making fun of someone for a clotted or hemolyzed sample. Shit happens it's not a reflection on your phlebo skills it's just something that happens, and there's nothing either of us can do to avoid it. I promise I've never had anything recollected out of spite or laziness.

Please pray that I still have a job monday.

Our helpful nurses

This just happened about an hour ago and I don't have any thoughts on it yet so I thought I'd share it with you and let you decide what you think.

We were in the middle of a fire code when a nurse came down to get some blood from transfusion. She comes to the window and says "I don't know if I should pick this up right now, I know he really needs it, but we're not allowed to use the elevators during a fire code and no way in hell I'm walking up 4 flights of stairs.


My Views on gay marriage

Gay marriage is a touchy subject for me. On one hand this is one of the few things I'm somewhat "liberal" about. Our fore fathers set up a system that yes, was to be founded on judeo-christian principles, but above all else was designed to be free. Abraham lincoln was a staunch supporter of the idea that you should be allowed to do anything you want so long as it doesn't hurt the community or another individual. I agree. When did it become the government's place to say who could or could not get married?

I kind of follow in the footsteps of Gov. Jesse Ventura in saying that regardless of whether homosexuality is right or wrong, it's not the government's place to say who can and cannot be wed. It only seems logical that a couple who have devoted themselves to one another be allowed to receive all civil benefits afforded to heterosexual couples.

On the other hand. Homosexuality, in many ways is seen as deviant. Liberals tend to follow Darwin's theory of evolution and prescribe to the notion that only the strong survive in nature. If Humans really did follow this line of thought, then homosexuality could never sustain itself. People would learn that homosexuality prevents reproduction and have no need for it. Although, along the same line of thought, it may prove that homosexuality is not a learned behavior but something coded into a person's DNA. Homosexuality wouldn't exist under darwinism if it were a learned behavior.

What I'm trying to say, is that I really have no idea what is right. Why promote a practice that could potentially be harmful to a community. If homosexuality is a learned behavior and allowed to continue to grow due to new civil freedoms, our ability to reproduce could be hampered, or our available DNA pool limited. I realize I'm looking at a gross view of the subject that may not play out for thousands of years, but I'm just throwing out "what ifs".

Untill someone can convince me otherwise, I agree with Gov. Ventura, once again. I say we should eliminate marriage as a civil union all together. If someone wants to be married and recognized as a couple through church, so be it, let the individual, private churches make those distinctions. We would then simply have civil unions for tax and legal purposes with no hint of the word marriage or definitions for those who can be in a civil union.

Anyone have an argument that might sway me? I'd love to hear people's (non-radical) thoughts on this. I'm a pretty open guy. I just don't know what to think about gay marriage.

Friday, October 24, 2008

I could never work in the ER

This is just another example of why I respect emergency health workers so much. It also illustrates why I could never ever ever be one.

I got a urinalysis on a three year old. The first two things I noticed were the bacteria and squamous epithelial cells. it's pretty clear she had a UTI. A three year old rarely gets a UTI on their own, although there are instances. A good portion of the time it's because of some kind of sexual abuse.

The next two things I noticed weren't so innocent. I saw sperm that was still motile, and Trichomonas. I can't begin to explain how extremely pissed I was about this. If you really want to talk about "never events" this is one that should never ever happen. This girl had obviously been sexually abused and given an STD. It had to have happened pretty recently for the sperm to still be motile.

If I were an emergency care worker armed with this information, I'd go apeshit. I can't imagine the kind of crap that I would do, especially if the abuser was around. I'm pretty sure whatever it would be it wouldn't be pleasant for him. I'm also pretty sure that I'd have a job for all of about two seconds after that.

Unfortunately things like this occur way too often and these emergency workers have to deal with this crap, and the scum of the earth daily. I can't imagine the professionalism and restraint that it takes to deal with this. So emergency workers I applaud you and your professionalism. I certainly couldn't deal with it.

Thursday, October 23, 2008

Cryo, and what it looks like

I took a pretty funny phone call in blood bank last night, it went a little something like this.

Nurse: Ummm, hi this is nurse blobity blob, I just came and picked up some cryo for this patient and it looks like it has a clot in it, there's this goopy white stuff in the bottom, I'm going to need you to set up some more.

Me: ummm, no it's not a clot. That's the actual cryo. The patient, considering her fibrinogen was ridiculously low, needs that "goopy white stuff."

Nurse: No, it's definitely a clot, I've been a nurse for 15 years and I know what a clot is.

Me: Well, you must not be a very good nurse if you don't know what cryo looks like, or even is, for that matter. I'm not thawing and pooling any more, B cryo is expensive and difficult to obtain, I'm not detroying ten units because you don't know what a clot looks like.

Nurse: I need to talk to your supervisor!

The nurse talked to my supervisor and frankly my supervisor is an idiot, She just wanted to appease the stupid nurse and waste a ton of product. It took every single tech working that night to tell her how stupid that was. It really worries me when a nurse doesn't really have any background information about what she's putting into a patient, it's really no different than if she were to push a drug without knowing the side effects or even generally what it looked like, according to the FDA blood products and drugs are basically the same thing.

Sometimes I wonder about these nurses, I don't mean to put down all nurses because our facility has some great ones, but we're also big enough that we have some WEEEETAAAAARDED ones. I hope I never get sick enough to be admitted, I've been a dick over the phone so many times that I know all the nurses would gang up and let me die.

Man I hope I don't have an email from one of the "important people" about this. The last time I had a problem in blood bank it involved a hospital vice-president that they called in at 3 in the morning, boy was that fun!

Tuesday, October 21, 2008

My boss is stuuuupid

I know this is only a small silly example of her stupidity/blind following of pseudo-regulations, but I'll share it with you regardless.

In our chemistry department we have three centrifuges, Two older, larger capacity centrifuges that run for 8 minutes, then we have a slightly smaller centrifuge that runs for 6 minutes. The smaller one is designed to be our stat centrifuge. and because we spent a ludicrous amount of money on it, we are to use it every time we have an ER.

That's all well and good unless your boss is a retard. I walked by the centrifuges to see if I could grab any samples that were just coming down. I see the stat centrifuge running with 5 minutes remaining. I see another ER sitting on top of the centrifuge while the other two weren't being used. I asked if there was a problem with the older centrifuges and she said; "no I just don't have any routine samples to put in." WTF?

I know in the grand scheme of things it only saves three minutes, but seriously, use you're fucking brain. I have a million stories about her that are much worse, but I thought this was the best example of her lack of critical thinking skills. I just don't get her, She was a salesperson for a major reference lab for the last 15 years, yet somehow that qualifies her to be a shift supervisor at a major trauma center that was voted the number 1 integrated health system in America. Who is she sleeping with?

Saturday, October 18, 2008

Blood and Cancer

This is a double post. One rant and one thing I'm actually happy about. Naturally we have to start with the rant.

There are a couple of floor nurses that are about to make me go apeshit. I work a third shift and my night starts at 10. Frequently we have units of blood that will expire at midnight. For years and years and years, as long as it was issued by midnight it was ok for use. The policy remains intact, yet a few nurses have taken it upon themselves to "educate" some of their patients. By educate I mean fill their heads with crap.

These Nurses are informing their patients that the units are going to expire at midnight and that the infusion will probably take longer than that. I don't know when we decided that a patient can pick and choose what unit of blood they want, but I guess these nurses have taken it upon themselves to allow this to be a decision. The expiration dates a largely arbitrary designed to mimic life cycles in vivo. There isn't a time bomb that's going to go off and make the blood suddenly useless or even less effective for that matter, it'll raise you're HCT and your HGB exactly the same way as a unit drawn 2 days ago.

It upsets me because it's a huge waste, at $400 a pop it's no small expense. It's tantamount to allowing a patient to refuse a medication because it expires that night. How ridiculous is that. All because a small group of nurses have decided unilaterally that these patients should be "educated."

We're a pretty large hospital. We have a contract with the local blood center to recieve short dated PRBC due to the high volume of infusions that we have. We're a last resort to make sure someone's donation is being used properly. I now have to deal with returning and destroying these units, and subsequently taking phone calls from Docs asking why it's taking so long to get Mr. so-and-so's blood transfused.

Anyway, The good news that you've all been waiting for.

Working third shift I don't get to stay in one department of the lab like other shifts do. It makes it much harder for me to become really good in any one area of the lab, yet I'm expected to be an expert for the night. Before I came to this hospital the only section I had ever worked in was the blood bank. about 2 years ago I cross trained in hematology. You remember basic stuff from school but it's hard to recognize and remember all kinds of crazy cells that you see from oncology patients.

We have one particular oncology patient that has been in our hospital for about the last year and in and out for the last 5. We save his slides for new employees and for students to look at, basically I've seen every abnormal cell you could possibly have in this patients blood. As I was saying earlier it's difficult to remain proficient in an area working there maybe once a week. During every morning run I do my best to pick this guys slide out of the pile and review it for myself to remind myself what some of these abnormal cells look like. You have to be the person driving yourself to become better at your job I keep up on my own continuing ed by doing things like this.

Yesterday morning I looked for his slide and couldn't find it. The first thing that came to my head, unfortunately, was that he had probably passed away, it's weird that I never new the guy but I felt like I did just because I saw his name so often and I kinda followed how he was doing.

I was doing a little investigating and found out that our system had autoverified his cbc. I asked for a redraw because I was sure it had to be a mislabeled specimin. I started to review his history and his slides had been more and more normal for the last month or so and it turns out it was the correct patient. So congrats Mr. Cancer. It's a big deal when a patient goes from 90% blasts to being within normal ranges so that an analyzer will autoverify your cbc. I'm really happy for this guy that I'll never know beyond a slide with a drop of his blood.

Thursday, October 16, 2008

How to really fix health care

I was watching the presidential debate last night and I came to one realization; either way, healthcare/coverage is going to remain extremely expensive.

Here's my plan to fix our entire system. I know this is an oversimplified plan but it is what it is.

Step 1. Eliminate JCHAO and any other government oversight programs.

There are hundreds if not thousands of private certifying agencies of health professionals in the U.S. For the lab two major ones are the A.S.C.P. and C.A.P. Both of these private/privately funded organizations have the expertise to do a better job of oversight and certification. The added bonus these organizations provide is that they don't use tax payer dollars. The only government oversight committee that would be needed would be a 25 member team that would review each hospital throughout the year and ensure they have up to date certifications from these private agencies.

Step 2. Allow hospitals to reject non-emergency patients with no insurance without fear of lawsuits.

There are far too many people that abuse the healthcare system and there is no good way to prevent them from continuing to abuse the system. We need to allow our emergency health workers, the EMT, the ER nurse and the ER Doc to make educated decisions based on the need for care. If someone comes in complaining of a cough x 2 days, they don't need to be seen let the triage nurse send them home without seeing a provider.

Step 3. Eliminate federal medicaid

Change the medicaid system to a state run system that takes federal money out of the equation. Maybe more people will be up in arms if they really see the abuse that happens and the associated tax hikes that will occur in areas that provide more un-insured healthcare per capita.

As a secondary solution; if you live in a city or near a city with a military hospital and you're uninsured you have to go to these government run facilities. The hospitals can run at a loss and still stay open. there doesn't need to be a profit margin because the workers in these hospitals aren't paid out of any health care based funds. The funds come from the DOD and they pay a brand new soldier much less to do the same job a civilian would do. There's even a possibility to expand the government run facilities and allow them to become specialized care centers. This could also entice the military to expand the education of some of these soldiers.

I can't make a decision to eliminate medicaid because of the fact that people have already put in a lifetime's worth of money before they receive benefits.

Step 4. Larger reimbursements.

With the federal savings from the elimination of JCHAO and other government oversight committees we can afford to offer full compensation for the few uninsured that do make it to local and rural hospitals.

With these larger reimbursements and lowered operating costs that would come from being able to get rid of thousands of middle management jobs whose sole purpose is to ready hospitals for JCAHO inspections hospitals can afford to offer services at lower costs.

5. Have a plan to recoup some of the money that is owed by the uninsured.

The easiest way to do this would be to take money out of any potential tax refund that the unisured may receive at the end of the year. I realize that it does nothing to help with illegal aliens/unemployed abusing the health system. However, if hospitals are given the opportunity to reject care to known abusers of the system these patients can be sent to federal/military hospitals once there, I'm sure something could be done about them being here illegally. If they reject care at one of these facilities our objective is still met. Keeping abusers of the system out of the system. I know the government has the ability to do this, when I got out of the Army I had a military credit card that had a balance of $2.03 that I thought was paid off. The year after I got out of the Army and filed my tax return I got a letter saying these funds would be taken out of my tax return before i would receive a refund. If they can keep track of $2.03 surely they can keep track of thousands that they're owed for health care.

My whole plan is based on trying to eliminate costs that hospitals have to eat, and pass along to patients. If we can lower the actual cost of healthcare services, insurance becomes more affordable/accessible to everyone. This potentially takes many borderline people out of the federal health system. The people I'm talking about are the ones that are close to being able to afford insurance but just can't seem to make the numbers crunch, The people that need help for a short period but are proud, and don't want to be on a free ticket for very long.

If we can start making federal/military/VA hospitals into facilities that can handle these uninsured patients the quality of care in these facilities may go up. If they don't, it may motivate people to find a way to afford insurance. The government isn't going to put up with people using the ER for a cough x2 days. Another benefit could be making some of these hospitals into specialty hospitals that could deal with chronic disease for patients that can't get insurance because of negative health histories. These "specialty" hospitals could also produce more qualified soldiers and soldiers with real specialties that can be more of a help in the work force once they decide to leave the military. The addition of a quality work-force with usable skills that have no student loans could benefit private health systems across the nation in numerous ways.

Tuesday, October 14, 2008

Should you trust your pediatrician?

I was over at Whitecoat Rants and was reading his post about pediatric cold medicines that spilled over into a post about the over-prescription of antibiotics. This reminded me of an older post of mine entitled updates skip down to point number three and it'll help explain where this post is coming from. You really need to read it to understand the rest of my post.

A yeast infection is one thing. Killing a kid with lack of knowledge is entirely different. I'll admit I've tended to blindly follow doctors orders, assuming they knew more than I did, but that all changed about a month and a half ago.

We had a known 11 yr old leukemic patient visit our ER a month or so ago. The kid had a super low platlet count. I think it was 5000 or so. He also had a slightly decreased hgb and hematocrit.

The Er Dr. contacted one of the patients specialists in a larger city about 3 hours away and called me to order an obscene amount of blood and platlet products. I called the E.R. doc and he admitted it sounded like alot but the patient was being admitted so he didn't want to deal with it. Fair enough.

I waited untill the child made it to the floor and asked the nurse to verify exactly what the orders were. I don't know if there was a mix-up in communication or if people just follow whatever protocol they make up, but, she read to me that the Dr. ordered 15 ml/kg of both PRBC and platlets. the kid weighed 50 kg. His hemoglobin was 10. Frankly I couldn't figure out why they were transfusing PRBC in the first place but 750 of PRBC is alot for a 50 kg kid. They also ordered the equvilent of 4 plateletpheresis, which is an ungodly amount. Because of the highly concentrated nature of a platletpheresis product normal protocol is to infuse one unit and perform a platlet count. a more acceptable transfusion ratio is about 5 ml per kg. this ratio should raise the platlet count by about 50,000.

The goal in these scenarios is really just to get the patients platelet count about the spontaneous bleeding threshold of 20,000. The goal isn't to reach "normal" levels again.

I realize I've given entirely too much backstory. So I ask the nurse to please have The Dr. call me to hash out exactly what this kid needed. The Dr. that calls me back is my son's pediatrician. I thought pretty highly of her so I was sure this would be smooth sailing. Not so much. It took me an hour to convince her that giving that much volume to this kid would certainly produce Circulatory overload . I had to fax her an entire chapter in the AABB technical manual to help her make an informed decision.

I'll admit a 50 kg 11 year old with leukemia is a tricky situation not knowing wheter to follow pediatric or adult guidlines considering his weight.

I think I was most troubled by the fact that while I was talking with the Dr. she seemed to sway back and forth and really have no idea what I was talking about. I tried explaining the differences in plateletpheresis and random donor platelets, And I tried explaining that 750 ml of prbc would spike a normal adults HGB about three grams and it would function differently in a 50 kg child.

I understand that as a DR. you can't know everything but It just seemed like this Dr. should have known transfusion protocol for children if she's a peditrician, especially one with leukemic patients.

I just swithced to her because of the whole antibiotic mess, I didn't think she was an idiot, and I hope she's not. I just wonder how much I trust my child's Dr. right now. Pediatricians want to take cold medicines off the shelf because they think parents are too stupid to properly dose their child. In the last year I've had two differnet Dr's make equally stupid decisions. Who can you trust if you can't trust you're child's Dr?

Monday, October 13, 2008

Getting what you earn.

*Disclaimer* This is not unbiased. I have a candidate of choice. Not my first choice, but in this instance definitely the lesser of two evils.

I've been doing alot of research on the health plans that both Sen. McCain and Obama are setting forth.

From What I can understand, the biggest difference is this;

1. Senator Obama supports a system that would provide more government funding/control.

2. Senator Mccain supports a system that is privately run.

My issues/objections to each plan

The U.S. is not a socialist state. It's not the responsiblilty of the federal government to ensure everyone has insurance. It's the responsibility of every individual. At some point and time Americans have lost the attitude that made this nation great. Independece and self-reliance are no long valued. Everyone has their hand out waiting to see what will be given to them.

Sen. Obama's plan to fund another 17 million health care recipients comes from the tax cuts from the bush administration that are set to expire. Many of these tax cuts are for buissness and the wealthy (making over 200,000 per year). So naturally it's okay to take even more from the most heavily taxed bracket, right? to provide for lower income families. This seems like a socialist idea to me. I hardly think it's fair that many lower income families get more out of the system at tax refund time then they put into the system while people in higher tax brackets pay the majority of income tax in america. (I'm not in a higher tax bracket if everyone paid a flat tax percentage that I support I'd actually pay more taxes. But I guess I'm the only one that realizes we all owe our part, and that it's a privledge to live in the U.S.)

Don't get me wrong, I fully support windfall taxes on large companies but I don't think it's fair to overly burden families that have worked hard to do well for themselves. Generating more revenue from this higher bracket with the sole intention of providing (probably sub-standard) care for the poor is not okay.

The obama plan is one step closer to a universal government run health plan that will not be good for patients or health care workers.

The press has gone to great lengths to make people aware of the fact that Sen. Mccain plans to tax health benefits for the first time. He'll then provide a 2,500 or 5,000 tax credit to offset costs. Sen. Biden says the average cost of health insurance in america is about $12,000 per person. I don't know if this is true, personally mine cost about 2,400 for a family of three for just our premiums. I understand that I work for a hospital and I work in a smaller city so my costs will be lower than average. I'm just not sure if 12,000 a year for premiums is a correct estimate.

The government has done similar thing with our income tax for years, allowing you to claim only yourself then at the end of the year claim you deductions hoping for either a refund or a smaller tax bill. They use the money that they collect throughout the year for the operating budget and for investments. Generally these investments have panned out and the government can afford to give some people more than they've put into a system. I don't see the huge problem with the plan to generate extra cash flow without a net increase in taxes for most people.

I don't think universal health care is the answer and I don't think Giving a tax credit on a new tax make a whole lot of sense either. But given the lesser of two evils I pick Senator McCain's Health plan. It puts fewer people on government funded heatlth care and it may give the government a little more flexible cash rather than going with plan A as of late and just printing more money.

I think the answer lies in maintaining privatized insurance with better oversight. The difficult part about this is that I couldn't begin to explain what proper oversight would be. I'm not talking about jchao oversight because those fools have simply made providing good health care more difficult.

I may think I have the answer but I'm probably wrong. I was all for deregulating wall street. Let a free market society work. I can't count how many times I kept telling myself it would all work out, and it will but it'll take some governmental help and oversight which in the past I was all about preventing. I believe in capitalism but every system has it's flaws.

I hope we find a good system for our healtcare. Progress is stimulated by competition and in order to have adequate competetion I believe that the system needs to remain as privatized as possible. Unless everyone out there believes medicare and medicaid have been shining examples of how to run healthcare in America. At some point and time we all need to take responsibility for ourselves and understand that you really do get what you pay for and that we're not entitled to anything free healthcare isn't a right.

My hospital already has policies in place to help offset costs associated with uninsured/medicaid patients. We basically do everything we can within a working diagnosis that we're sure medicaid will pay for. patients will get all kinds of silly workups just in hopes that the volume of tests on a patient will somehow even out the cost, considering how much less medicaid will pay for services.

If I need to explain to you why these are negative things, and how government has screwed up health care I think you should just go vote for Obama's plan that's a step too close to universal healthcare for me.

Monday, August 25, 2008

Yeah, I know I'm a stud

The wife and I took our little boy to the Dr. for his 18 month check up recently. I've officially given up on the idea of him having any athletic prowess. He's in the 80th percentile for height the 20th percentile for weight and the 99th percentile for head circumference.

What this means is that he's going to be a tall skinny bobble head. It's pretty unfortunate. I reserved some hope that maybe he'll be smart with that huge head of his. So far, it's not looking so good. The Dr. says he should be able to say about fifty words. We're lucky if he knows ten. He knows alot of baby sign language but evidently that means squat.

Anyway, The real reason I felt a need to post today, was because I stumbled upon some very interesting news. I was looking up a story on Cael Sanderson, mostly I was trying to figure out why he wasn't wrestling in these Olympics. What I came across was a list of Olympians that had something in common with Cael.

I came across a familiar face. A female basketball player from another country. We met while I was in Texas and she was on scholarship to play basketball, What's significant about this chance encounter, is that I've never been able to claim meeting a celebrity. While she's a small scale celebrity (she also plays professional basketball in Australia) She is a celebrity, and one I've hooked up with, which makes it a little extra special.

When my friends discuss their chance meeting with celebrities, I've always had to shut up and listen. Now, I'm able to rehash my own story, one where I hooked up with said female, and just to make things more interesting, I even hooked up with her Brazilian roommate. It was fabulous. I sure feel studly right now. I hooked up with an Olympian.

Anyway, I live a pretty boring life I'm married with a kid and work in a job where I do the same thing over and over. It's important for me to be able to relive these memories so that I can remind myself that I really used to be cool. I swear.

Sunday, July 13, 2008

Wal-Mart clinics

I've apologized countless times for not updating more frequently, yet I continue to be lazy. I can't really explain it. I really promise this time I'll try harder. I'm working nights now, and assuming people aren't dying I may have a chance to blog a little more often.

The topic I want to discuss tonight is the degredation of my hospitals values. Now you may say Rob Rob the party slob; Every hospital is losing their values, it's just the line of work you're in buddy. There's only so much you can do. I however, still believe in the off chance that some health systems maintain their integrity.

Recently the lab had a town hall meeting with our VP to discuss upcoming events in the hospital, more often than not it's a big pat on the back to administration and a "look at how wonderful we are" meeting. They also need to remind us every so often that two years ago we were the number 1 integrated health system in America and last year we were number 3 so we need to work harder so they can get their bonus checks. For the most part this one was no different, They discussed all the new building projects, and of course how wonderful our new 100 million dollar facility is. Then they dropped a bomb.

We're teaming up with Wal-Mart to open up several clinics inside supercenters, kinda like the fast-food of health care. Where a patient will come in a complain about something random and another even more random PA or nurse practitioner will write a script and send them on their merry way to an oh so conviently located Wal-Mart pharmacy.

I know most of you already realize several of these have already popped up with Wal-Mart's around Atlanta being the most recognizable of these. I guess I really believed that my hospital was above all of this. For the longest time we had our true mission statement on the reverse of our ID badges to remind us that we're here for the sick and the poor, especially the poor.

The Good sisters that opened the hospital have to be turning over in their graves. This might be the final straw for me. In no way shape or form can I justify opening a fast-food health box in Wal-Mart. It goes against everything our values as an organization used to stand for.

After the sister's turned control over to a board, this place hasn't been the same. We've lost touch with our identity. Recently, We've changed our policies on forgiving the debts of the poor. Instead of understanding our function as a not for profit organization that was built to help the poor and the sick, We've become driven by the almighty dollar, just like everyone else. I guess this proves no one is above the influence of Money. We employ laywers and debt collecters to collect money from people that may not know where their next meal is coming from. citing they give money to the free clinic. I understand you need money to continue to operate, and to pay you'r employess, you don't need to build a 100 million dollar facility with plans to build two more just like it at the expense of losing your identity. and now, of course we've partnered with the devil himself, Wal-Mart.
It might be time for a change for me.

Tuesday, May 13, 2008

My Quote of the week

For the few of you who stumble across my blog, I'm sorry I haven't been updating lately. I've been computer-less for the last month and some change. My little boy decided to spill water all over our laptop. Oh well, you can't really get mad at a 14 month old.

"The psychologist is really upset that these tests weren't completed." This is by far my favorite quote of the week. I'll give you a little back story. I got a phone call from our psych unit. The psych tech informs me that several labs were ordered in the E.R. but were not drawn, and therefore not completed. Evidently, Patients coming into the E.R. for psych evaluations have to be medically cleared before being sent to the unit. Part of that evaluation is several lab tests.

The Psych tech informs me that I need to come to the unit and draw this patient NOW!, because the psychologist is very upset. Here is my list of problems with this statement.

1. I don't draw blood, I'm more than willing to transfer you to someone who does.

2. No psych tech is ever going to tell me what to do and when to do it, with any type of authoritative tone.

3. Informing me that the psychologist is very mad about something, is tantamount to telling me that the dermatologist is upset about something. Please explain to me why I care if a fucking counselor is upset about something. A psychologist can't even order lab tests, and There's no way in hell he could even interpret anything beyond a drug level. If someone told me an ER DR. was upset about it, I'd probably take care of the problem. But really, a psychologist?

I guess it's a bit of an ego trip to distinguish between a psych tech / psychologist and a Real nurse/doctor telling me they're upset about something. Oh well, I'll live with the fact that I think I'm better educated than a psych tech, and know more about medicine than a psychologist.

There's a hierarchy in a hospital, and in general I'm at the bottom of the totem poll. We're the worst paid professionals in a hospital. My degree is just as difficult as a nursing degree, in some cases it's tougher, why on average am I being paid several dollars an hour less? No matter how much I hate this little ladder of importance, it exists, but it will be a cold day in hell when a psych tech tells me what to do.

I'm a bit biased to begin with, I really think psychology in general is a crack-pot pseudo-science. And in all honesty, I don't take care of a test as quickly if I know it's just another E.R. visit for a psych evaluation. Why On earth is being crazy a medical emergency? So please don't bring in a crazy retarded adult into the E.R. it just makes it harder for real medical emergencies to be taken care of, besides most of the time people like that don't have insurance anyway, so we're being reimbursed pennies on the dollar by the government. Boy am I glad I didn't take an oath to take care of people regardless of their situation. Boy are docs getting hosed.

Tuesday, February 12, 2008


I've got lots of updates.

1. Heaven's hotties is coming along very nicely I expect to have a beta version soon.

2. Work has banned my site. This kind of puts a damper on my idea to make my blog more of an entertainment center for me at work. This could be very bad. I'm guessing, in a hospital that employs 5000 people my site wouldn't be banned soley based on my usage. Does this mean people at my work are also reading my blog? This could be a bad thing. I say alot of negative things about my job and my co-workers.

3. I'm thinking about switching doctors simply because his nurse is a fucking idiot. I took my son to the Dr. for his 1 year check-up. He was also feeling sick so it was pretty good timing. The Dr. prescribed a broad spectrum antibiotic and called it a day. As some of you know I just happen to work in a microbiology lab so I took advantage and ran several tests on him, on the health system's dime mind you. He came back positive for RSV. By it's self RSV is really no big deal most kids get it at some point. I still needed to call the nurse at my doctor's office for advice on whether or not I should continue to give him the antibiotic. Antibiotics don't do anything for viral infections. As a side note, Superbugs like MRSA are created when people don't finish all of their antibiotics, take them needlessly, or are given the wrong type of antibiotic. I'm not a proponent of giving someone antibiotics just for shits and giggles. Anyway, Back to the nurse. I gave her a ring a ding ding and informed her of my findings and she said she'd get back to me. The conversation we had when she called back two days later went a little like this

Nurse: Hey, this is J from the Dr.'s office. I did a little research and found out that RSV is a virus and the antibiotics probably won't help him very much, well at least that's what the pharmacist tells me.
(No fucking shit. I told you what RSV was, and aren't the worlds Respiratory Syncytial Virus a clue as to it being a virus.)

Me: Well, I knew that, that's why I was calling, should I continue giving him the Zithromax.

Nurse: Well, It might help in case he gets some other kind of infection
(like I said, it's never a good idea to give people antibiotics for no good reason, however, this did make sense for preventing ear infections while his immune system was hurting.)

Me: I guess that makes a little sense. I'll keep him on it.

I think what really pissed me off is that this nurse was unfamiliar with a pretty common pediatric virus. It also bothered me that she seemed proud of the fact that she figured out it was a virus.

My son ended up with a yeast infection because the antibiotics killed the normal flora (the good bacteria) in his body, and allowed yeast to grow uncontrolled.

Never do something because a "Medical professional" tells you it's the right thing. Do you're own research, there are a whole lot of fucking stupid nurses that will tell you to do stupid things like taking antibiotics for no reason, therefore giving you a yeast infection and bacteria develop resistance to antibiotics.

4. My hospital is all about "productivity" it's a rough formula that takes the number and complexity of tests and divides it by the number of hours worked in a particular department. Usually all we do is play with numbers to improve these rates, For instance, if Micro is looking like it may not reach the productivity goal I'll clock into a different department under an alternate rate of pay. So in reality these numbers don't mean anything except to the administration their raises are based on these numbers. Each department this last quarter was at at least 150% which is kind of ridiculous. It either means we're over-budgeting hours or we're working our balls off. Wanna guess which department didn't meet it's goal? Administration.

We also were recently named the number 3 health system in america by Verispan, Wanna know what my reward was? An email. My bosses? a cool 10 grand. wouldn't it make more sense to give that money to the people who earned it by having asinine productivity ratings? Oh well just more motivation to become management right?

Monday, January 28, 2008

Heaven's hotties

My buddy Dave is 40 and single. Recently a few friends suggested he should try meeting a nice girl in church. I think it's a good idea. Who doesn't love a sweet innocent church girl.

This got me to thinking. We researched all of the churches within a mile from his house. What we really wanted to know was how many attractive young ladies attended that church. I could find no such information. So POW! an idea hit like a ton of bricks. a site to rate local churches based on the percentage of attractive young women at each service.

I haven't really hashed out any details. That's where you, my faithful readers come in. I need ideas. How do I compile this information without doing all the legwork myself? I also envision a wikipedia esque format that will allow users who attend those churches to update information at their own church. Any ideas would be great.

Ideally, I could use this site to collect information from all my readers, unfortunately not enough people read my site. That's where you come in. If any of you have bigger blogs with more readers please let people know about what I'm trying to do. I can accumulate stats one reader/church at a time.

I could really see this thing getting huge and extending to schools, and neighborhoods and towns. I just need a little help collecting data. Either send this post to people, link to it, or give me some stats about you're own church. Go ahead fill up the mailbox

Think Trip Adviser for churches, with a little sex thrown in for spice

The retarded policeman

I know this video has been running around he internet for awhile now, and honestly I don't know how I missed it, but I thought you all needed to share in m love of the retarded policeman. Also, my work has recently banned almost anything entertaining. I can't even watch streaming videos. What this means, is that my blog may become a little less about my personal life and more about stuff to entertain me and others at work. Enjoy the retarded policeman.

And for those of you who think it's wrong to "exploit" people with downs syndrome, watch this.

Thursday, January 24, 2008

I've just added a new "Boss" button to the page in the upper right hand corner. If you enjoy my blog at work; all you have to do is click the button and it will take you to a "safe screen". Sure hope it works.

Wednesday, January 23, 2008

The Plaxico Burress of the midwest

Those of you who watched the Giants-Packers game last Sunday will understand what I'm saying a little better than those of you who did not. If you really watched that game you know that Plaxico Burress was the best player on the field that day. Every time New York needed a big 3rd down reception or Eli Manning looked like he was confused, the ball was thrown up to Burress. He is the reason the Giants are going to the Super Bowl.

You may be asking yourself why I'm pointing this out. I'm not a Giants fan, and I'm not even really a fan of Burress. I can, however, relate to him. Sometimes, I feel like I'm the Plaxico Burress of my little world. I'm the Go-to-guy, and I don't know that I want to be anymore. At work, home and even my social circle I seem to be the guy who gets stuff done.

During most of my life I've wanted to stand out. I've wanted people to notice. I'm good at anything I've ever wanted to be good at. Normally this sounds pretty appealing, just not to me. I'm at a point in my life where all I really want is to blend into the crowd. I want to do my eight hours of work, without any extra responsibility. I don't want to feel hurried and overwhelmed because everything seems to get dumped on me one way or the other. I want to be that guy in the cubicle that seemingly has no name. He comes to work on time, finishes his eight hours in peace and walks out the door on time stress free.

At home, I'm basically responsible for everything. I'm the only one bringing in an income, I seem to be the primary care giver to our son and I have to do most of the cooking, and if I want the house to be clean I pretty much have to do it myself. All so the wife can go to school for 24 hours a week at a community college. I just feel as though if I didn't try to do so much, maybe no one would ask anything of me.

I'm tired of being a standout. I want to be another face in the crowd, living my day to day life stress free without having to deal with everyone else's problems. Lord knows I have enough of my own. Do you know how screwed up someone has to be to want to go from being the man (without being paid like the man) to being just another guy? I don't know maybe I have multiple personalities, I sure do write as if I do. I can't seem to make up my mind about who I am. or what I want or what I should be.

Plaxico Burress probably doesn't worry about any of these things. He's paid millions of dollars to play a game I'm sure he loves and most dominant athletes are a type A, go-to-guy personality type. But I wonder if he ever feels like he's carrying the team, does he wonder what the hell would these people do without me there to catch that impossible one handed, tip toeing the sideline, sailing out of bounds pass. What would it feel like to take a game off? unfortunately I don't get to take a game off, or even a play for that matter, but I sure do wish I could.

Monday, January 21, 2008

What I really think Of MLK day

I hate that I always have to preface my posts. I always come off like an immoral jerk, or just a hateful bastard. Nonetheless, I'll do it again. I want everyone to know I support equality, but not having a day reserved to remember one man. I don't have any personal problems with Dr. Martin Luther King Jr. but I do want everyone to know what I think of the day set aside to remember him.

I'll start off with the question that I think of most frequently when I think about MLK. What exactly did he do that was so extraordinary? He was a powerful and eloquent speaker and led freedom marches. Other than that, I don't know what I can say about the man. He believed he was being treated as less than an equal in his community. He stood up for the belief that equality was a intrinsic right. I agree, I believe that all human beings should be treated equally. I also believe I'd stand up for my own rights in much the same way. I don't think it was an incredible feat to bring media attention to the fact he felt he and the rest of the black community were being treated unfairly. I know I would have, and still would, say something if I felt my rights were being violated, I think you would as well.

Alot of pundits like to bring up several moral and ethical indiscretions he may have committed. The indiscretions include adultery, plagiarism, and communist involvement. As much I'd like to be able to say those things don't matter, I have to take a realistic view of the world. When history looks back on my life, will it only remember the good things, or will the world remember all of my faults? I know my faults will be remembered, so why are we so quick to forget his? I can't, simply because mine won't be forgotten. I realize that everyone makes mistakes, but not everyone has a federal holiday to remember their lives. I just don't think we should look through rose colored glasses.

Many people will label me a racist because MLK is seen almost as a demi-God in this country. Nothing can be said in a critical light. To me it's as if the federal government feels as though it needs to appease the black community in some way. I believe that we should have a day that reminds us of the fact that all men are created equally, I just don't believe it should be named after MLK, that it should be something almost exclusively black, or that is should be something done to simply appease a demographic. It should be a true celebration of all Sexes, creeds, races, sexual orientations, or anything else that makes anyone a "minority". We should be remembering that our ancestors didn't have it as easy as we do and that The fight for true equality is NEVER over.

I really just want people to take a step back and really examine the world for a second. Too much is made of the differences between races, when in fact we need to remember all the similarities. We need to remember the struggles of every race and generation. We shouldn't single out a day or a month to remember something exclusively as black history, or black civil rights. We need to remind ourselves each day of everything our ancestors accomplished, and not take that for granted.

For all of you white power jackasses that thought this was going to be an anti black post; Fuck you, and to all the black power jackasses; I wish to lend you the same phrase Fuck you. Just remember that life is a struggle for everyone. Do some research and ask yourself is MLK really worthy of his own federal holiday? Is this a man that did anything I wouldn't have done for my own civil rights? If you come to the conclusion that he does, fine. Just think of how many more bullshit holiday's we really should be recognizing too.

While I don't want to tarnish the legacy of what MLK has been made into, I still feel as though he's overly praised. I also think the "Idea" of MLK is far greater than the man himself. Maybe we need the "Idea" of a civil rights leader more than we need to celebrate the man himself.

Monday, January 14, 2008

Using religion to your advantage.

I want to preface this with the fact that I'm a much nicer person now, than I used to be. My wife, and alot of my friends have a hard time understanding what a dick I used to be. At work, people can see glimpses, I don't like things to awry. For the most part, I'm a big softy. Having a little boy has changed my life. I can't claim to have had any big Epiphany. I just decided to be a different person.

I was living in D.C. and having the time of my life. I didn't make a ton of money but I really only had to pay for my cell phone and dating. I blew money like I had it, and went through women even faster.

I found a little niche in D.C. an untapped reservoir of sexual frustration, Their name; Mormon girls. I've had alot of success with Mormon girls over my lifetime. I think it's because I can act like a nice guy without really being a nice guy. A normal skeptical girl could see through my bullshit, but these Mormon girls were naive. They didn't see game. They still believed in real love, big love. A street smart girl in D.C. would have laughed at my nice guy routine, but they ate it up.

Some small piece of every woman wants to have that one last fling before they get serious about their life. That's something else I had going for me. I was fun, attractive, smart and funny, but not marriage material. I'd be that guy you'd have lots of fun stories about wonderful dates, but in the end you knew you needed to settle down with someone more ambitious. In the case of the Mormon girls, a little more into God.

I met a girl, her name escapes me right now, who was a civilian at the hospital I was doing my clinicals at. She also happened to be a good friend of one of my good friends. It turns out she was Mormon and had a bit of a crush on me. I hung out with her a few times but nothing formal. While I was hanging out with her one night I got a phone call from
Heather and she's wanting to get together. Most people would either tell the other person they were busy or they'd blow the original girl off in some nice way. Not me. I saw the chance to get two girls in one night and went for it.

Things were progressing quickly with the first girl. We were in bed in no time. I wasn't in the mood for "Making love" it was her first time and I'm pretty sure she wanted it to be special. Because this is a family blog I'll leave out all the crude details and tell ya it was a two minute job. I stopped suddenly and told her I felt too bad. I felt like I was taking advantage of her. It just wasn't the right thing to do. I played it off like I hadn't gotten mine, but I did.

I went to see Heather later that night and we had a good time. Not only did I get to spend time with both girls but I got to be the nice guy, the one that respected girls. In the End being completely selfish, getting mine, then leaving turned out great. She told all of her Mormon friends what a nice guy I was and that "respected a girl's boundaries". I ended up being the last fling for at least 20 of the girls in the Chevy chase singles ward in D.C. God really does bless those who use religion to their advantage.