Sunday, October 14, 2012

From Poop To Nuts

     It's raining nuts around here, literally and figuratively. I'll try to explain. I live in the former library of a very old elementary school that's been converted into lofts. The library is separate from the rest of the school building: 2500 square feet of open space, 14 foot ceilings with exposed ductwork, huge windows, polished concrete floors, and a metal roof with two large skylights, a visionary repurposing of otherwise ugly industrial materials.  When we found this place back in January, the karma was almost too good to be true. Aside from being the perfect place to start life as a writer, this old schoolhouse is located in an uber-cool East Atlanta neighborhood, one that's currently undergoing the process of gentrification. It's trendy, but still replete with original ghetto charm.
     For the last week, the acorns from the oak trees in the schoolyard have started plummeting incessantly across this metal roof in a maddeningly nutty hail that shows no sign of letting up anytime soon. With the acorns have come the squirrels, whose thunderous rooftop scampering has jangled my last nerve so badly that I'm thinking of taking up residence with any of the mixed bag of human nuts that populate our neighborhood. Let's see...there's the angry sweaty lady with the big hat and pendulous belly who, when she isn't wandering around observing telephone poles and recording her findings in a black notebook, parks herself out on our front stoop, giving F-bomb filled Sunday sermons any given day of the week, completely oblivious to the dog-walkers, bike-riders, and parents pushing baby carriages passing her by. Another lady wearing a hair net rides around on her bike, yelling and screaming into her cell phone, which I'm not sure even has a person on the other end. There's the young guy with dreadlocks and a trucker hat who can be seen either standing on the corner with a baby, or pushing a grill or an empty stroller up and down the street, stopping you on a regular basis to ask for (crack) money. Then, there's the drunk middle aged woman, decked out in Tennessee Volunteers attire, who amuses herself by barking at our dogs.
     I've had my hands full of nuts the last few days, and I'm not referring to the ones here in the 'hood. A couple of weeks ago, I had a patient who presented 30 minutes after her scheduled appointment for esophageal endoscopy and colonoscopy, due to a complaint of abdominal pain. She seemed to be of reasonable intelligence, but come to find out, appearances can be deceiving. In order for a colonoscopy to be performed successfully, one's bowels have to be clean as a whistle. Makes sense, right? It's self-evident that a colon full of poo will obscure a camera's view. Patients are given explicit verbal and written instructions for prepping the colon, which involves a two day ordeal of clear liquids, various cathartics, and enemas. For 24 hours prior to the procedure, there is to be no intake of solid food whatsoever. Doesn't leave much to the imagination, now, does it? After denying that she'd eaten the day before, we took this patient back to the procedure area, got her sedated, and placed the scope in her throat, only to be greeted by an esophagus full of undigested pasta. The procedure was immediately aborted, given the fact that a full stomach in a deeply sedated patient is a potentially lethal combination.
     Because sedation and anesthesia impair the protective gag reflex which prevents food from being upchucked into the lungs where it can cause catastrophic aspiration-induced respiratory failure, NPO (nil per os or "nothing by mouth) guidelines are strictly enforced. Unfortunately, many patients don't seem to take them very seriously. It's almost as if they think they're pulling one over on us, but what they don't quite grasp is that we're going to be looking right into their gullets and bowels with a video camera where all will be revealed. In other words, if you've consumed anything other than plain Jello, apple juice, or broth, we're going to see exactly what you've been eating! Needless to say, upon further questioning, the patient admitted to having eaten a Lean Cuisine the night before. Her inability to comply with simple instructions could have cost her her life. Once again, this patient was given clear and concise instructions for repeating the bowel prep, and this time, she was placed on a clear liquid diet for two full days prior to her rescheduled colonoscopy to ensure that she'd be extra clean. On Thursday, she returned for her procedure, forty-five minutes late. This time, she admitted up front to eating peaches and cream of mushroom soup the day before, so she was immediately cancelled. Whatever belly pain she's been having obviously wasn't sufficient enough motivation to keep this Holly GoLYTELY from indulging in breakfast at Tiffany's (or Waffle House), ruining her second chance at a diagnosis.
     On Friday, I checked into my blogger forum where there's always sure to be an interesting discussion taking place. Medically-related posts never fail to catch my eye. I don't consider myself a censor per se, but with all the nonsense floating around on the internet which lay people misconstrue as science, I feel a bit of responsibility in busting the myths that routinely complicate my clinical practice, the primary example of which is Michael Jackson's illicit use of propofol. Every single day, I'm confronted with some anxiety-riddled version of, "You're gonna give me the Michael Jackson drug?!" I explain that propofol didn't kill Michael Jackson--his own addiction and his doctor's negligence did. I then reassure the patient that propofol, which is an intravenous anesthetic, not a sleeping aid,  is safe when administered by anesthesiologists and anesthetists in a monitored setting. These conversations tack an extra two or three minutes onto my pre-op assessments, time that could be better used in other ways. Thanks a pantload, Michael Jackson!      
     Anyway, I was trying to get my mind off of work, when I noticed a discussion entitled "What Good Is A Cortisone Shot?" Without going into details, it was a wealth of misinformation regarding steroid epidural and joint injections by a Hitler-obsessed conspiracy theorist claiming that patients are misled into thinking cortisone shots are beneficial, when it's really "cocaine derivatives" producing the analgesic effect. I'd never seen this author on the forum before, so I wrote a reply clarifying that although local anesthetics are sometimes used diagnostically in these injections, none of those currently in use are derivatives of cocaine. This guy is a great example of a little bit of knowledge being a dangerous thing. Although some of what he said was valid, namely that the long term use of corticosteroids is associated with immunosuppression, bone demineralization, and derangement of intrinsic hormone homeostasis, his conclusion that these injections have no clinical utility was based on an incomplete understanding of steroid synthesis and pharmacotherapeutics, as well a frightening arsenal of evangelical paranoia-fueled pseudoscientific propaganda. After realizing that he was just another disturbed nutcase, I left the conversation. My guess is that anyone who follows his blog is probably as bonkers as he is, too brainwashed by hogwash to question the verbal diarrhea he's spewing as the truth.
      From poop to nuts, it's been one of those weeks. I'm emerging from a funk of aggravated frustration, heavily infused with snark, which I have to admit I've rather enjoyed indulging in. I'm tired and grumpy, but at least I feel validated. For now, the acorn showers have abated, and the lunatic fringe is strangely quiet, like a knife cutting through peanut butter. Sometimes you feel like a nut, sometimes you don't. Neighborhood eccentrics are whimsical and endearing, militant fanatics and NPO violators, not so much. Life's already a tough enough nut to crack, isn't it? I think I'll be much better off without further help from the peanut gallery.

20 comments:

  1. loved it .. and yeah, nuts are there in abundance either because of squirrels who forget where they have hidden them or because of people who forget the rubber :P
    - simplysud.com

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    1. Thanks, SimplySud! So glad you enjoyed it.

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  2. It would have been amusing if your patient's oesophagus had contained nuts. :)

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    1. Robert, you have no idea how much your response made me laugh! So funny! Yes, wouldn't that have been perfect?

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    2. Robert, thats what I thought she was about to say. lol
      I was thinking that when they put that women to sleep low and behold there was a darn nut. lol

      Kris, loved the title to this post.
      I don't understand how some people wouldn't listen to what they are supposed to do especially knowing they are about to go under.
      Thats just insane!

      AND I saw that discussion you're talking about I figured he was just high. Who knew?

      Acorns are out of hand at my place. I have TONS of them everywhere.
      In fact during this season it always sounds like a hail storm at my place as I have 28 oak trees all around my house. You can't even go outside without them knocking you over the head.

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  3. I suppose even in Atlanta, things aren't so vastly different from the patients we see! Sounds like my week VERBATIM....I love the types of patients you speak of nearly as much as those who rip off the blood pressure cuff during readings, or who almost dislocate my elbow when I prick their finger to find a glucose calculation because "it hurts". Have a good Sunday afternoon with the crack seeker, pole yeller, and Tennessee fan!

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    1. I know, Emily, right? I remember many patients like that over in the outpatient surgery center!

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  4. I'm wondering if you're living in the library of an old school or that's just what you were told so you'd be willing to buy in a former mental institution. Maybe you better check it out.

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  5. Aw, nuts! Sounds like you haven't gotten much peace lately. Hope things calm down soon. As for colonoscopies? I still remember how awful the night before my husband's was. That last glass of what was supposed to taste like lemonade was the hardest thing he's ever had to drink. Still, I get why they have to do it. I can't believe that lady was trying to pull a fast one on you.

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  6. Kris, Bob has been an intermittent visitor to BC over the years, popping in from time to time to spout his eccentric theories about Hitler, the Bible and the malevolent purveyors of the medical and psychiatric professions. He's quite brilliant in his own way, quick of mind and sharp of wit, with masses of facts and opinions about everything. I get the feeling that's he's quite accustomed to being sneered at and has secreted a good, hard shell of obliviousness around himself to keep himself well-protected.

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    1. Thanks for letting me know, NP. Had never seen him before. He is obviously bright, but has a lot of things confused because he picks and chooses bits of information and then, strings them together in his own weird way. I like your hard shell metaphor, too.

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  7. Kris, thanks for this. It's a terrifically written and important post.

    I know of the blog forum discussion of which you speak. I'm certain of very little in this world, but one thing that I am certain of is that this world will, regrettably, never run out of either poop or nuts. (Of course, I mean both in the rhetorical sense. I hope I'm not permanently constipated and I enjoy eating nuts of the food variety.)

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    1. Joel, thanks for your feedback. That discussion will go down as one of my all-time favorites. And you're right, we're not likely to run out of poop or nuts anytime soon.

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  8. Kris you did an excellent job here today. Always my pleasure to read. Here I thought I was the only one the acorn storm bugged. Bet its brain deafening with a metal roof. It is good to know that there are people who still care about dispelling non truths and hitler stylized commentary. Sometime people just don't know when to stop. I am probably one of those people. Anyway, great post!

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    1. Thanks, Steven! Good to know I'm not alone in my distaste for acorn storms. Re: dispelling non truths, Bob actually told me that Hitler died in 2001. He would have been 112. WTF?!

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  9. A great read again Helena, and I've learnt something very important about eating before surgery etc. I have been the stupid one that actually snuck a bit of food down me before a procedure when there was a clear sign saying 'nil by mouth' over my hospital bed and despite being told not to eat by the hospital consultants. Thought I'd got one over on them for making me wait so long.
    BUT after reading your post, I've realised just how serious it could have got if things went wrong. I don't feel so wise now.

    Wow, those acorns must really be driving everyone mad, and those squirrels running wild everywhere. What a per-lava, especially if it happens every year for long periods.

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  10. Lots to love here.

    1. Your apartment sounds great (sans the squirrel percussion)
    2. Your neighbors don't sound that nutty to me but then, I live/work in Manhattan :)
    3. It's too funny (and yes, possibly deadly) to think you can lie to someone who will be putting a camera INSIDE you... and
    4. I saw that blog catalog forum post. When it reached Hitler, that was beyond my nut-capacity so I left. But I feel safe revealing the truth here. The true value of a cortisone shot is that it hurts so much, you think the original pain is not so bad.

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  11. I love the descriptions of the characters outside your home and find medical situations fascinating. Thanks for a great post.

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  12. Kris, you certainly have colorful neighbors in your ‘hood and I love the way you described them! Love the post and the title too. Other than the colorful neighbors (and squirrels!), your home sounds exactly like the kind of place I’d love to be. I hear ya on the colonoscopy. My husband just had one this week, no problems just routine recommended by the dr, and he faithfully (although not without complaint lol!) followed the entire process for clearing yourself before the procedure. Sure does make sense that a colon full of poo will obstruct the camera view! I can’t believe that woman didn’t realize that and then she does it 2x. Some people. Btw, my husband was given propofol, no problems, all went smoothly. And he’s had cortisone shots in the past that have really helped his back. Good for you for trying to clear up the misconceptions. Nutcases are all around us! :)

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