The hospital gowns at Lonnie are thick, warm, flannel. What a concept: patients are warm and comfortable (to say nothing of the convivial atmosphere of having beds spaced about 2 feet apart). They remind me of the terry robes that I hear are provided at nice hotels - I wouldn't know for sure. I bet the simple change from thin, chilly cotton gowns to thick, warm, flannel would be worth about 1.75 Press-Gainey point (Hearken well, Bruce).
Here's a weird one: for some reason that totally escapes everyone that I've asked, there is a governmental restriction on parenteral thiamine. A page of multiple blanks to fill in and sign - with no apparent reason, if you'd like to use IM or IV thiamine instead of oral. WTF???? Took a while to get the paperwork done and sent off to pharmacy so that one gentleman with unfortunate social habits, and with a wee bit of Wernicke's could get treated.
I had a guy with pneumonia sent down from a hospital at St Mary's (because of rising creatinine - although, since they had no imaging, they didn't know that he had the pneumonia as a cause for his fever and vomiting) - on the East Coast, about 2 hours away. I sorted out a few things and got him fluffed up a bit and appeared that he could be managed at a small hospital - and we were experiencing 48+ hour delays in getting people admitted from the ER (one guy spent about 4 days). I talked with the Doc at the little hospital, and at some length with the patient's wife - who happened to be the nursing supervisor of the hospital. 2 reasons for not sending him back: more flooding was going on and the road had been closed. More interestingly: the hospital is 8 beds. 1 is the ER. There is no imaging, and no lab. Each of the last 4 years they've requested an I-stat machine so that they could do simple stuff. So, since the issue that had prompted the transfer was worsening renal status (they do a blood draw, and send it to Lonnie and get the results a day later) it seemed unwise to send him back even though I was confident that his renal status was just inadequate volume replacement.
18 year old girl sent in from another little rural place. 12 weeks since last menses, had 1 home and 1 clinic positive urine pregnancy test about 8 weeks ago. Presented to little hospital with 12 hrs severe abdominal pain, one episode of heavy bleeding, and BP's in the 80's but with pulse only 90. They gave her some fluids and shipped her. We took a quick look on arrival with our 1950's era ultrasound (2 of the 3 better machines in the hospital were out for repair, and one was in use) - she had a normal uterus and a 5.5 cm complex cyst and no free fluid. But, then when she gave us urine had a negative urine pregnancy test, and 90 minutes later we had our Quant which confirmed zero. Since we have no doppler on our Ultrasound there was no way to look at flow in the cyst to make any guess as to whether the pain was torsion, or was due to what appear to be a hemorrhagic cysts (wavy little curlyQ's within the cyst). And, no hope of getting a formal US for another 12 hours. Sooooo, hopefully just a hemorrhagic cyst. Any theoryies out there in listener land as to what the scenario was? 12 weeks by dates, with positive UPT early on, but not now? Pure false positive? Early fetal demise? Of an IUP? Of an ectopic? Beats me. Somebody must know something. Hellllllp!
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