Vanguard: A Miscellany

Good Morning!

This is how the day started:

TIME OF PRESENTATION: 0515.
I was called to the 4th floor for intubation. The patient had a left thoracotomy for empyema. She had been having hemoptysis. The rapid response team was called, and they found her in severe respiratory distress. I was called me for intubation. On arrival, she was having difficulty breathing-- coughing up clots. Then she
literally stopped talking, faded away, and appear to be occluded. She was given etomidate at that point, so I could suction her out. She was suctioned thoroughly. The airway had large amounts of clots in the trachea
and the pharynx. The trachea was thoroughly cleaned and then intubated with an 8.0-French ET tube with good bilateral breath sounds and positive CO2 monitor. She had a bradycardic cardiac arrest with loss of pulse, rate dropping to the 30's. She was given epi and atropine with no response. After about 1 minute of CPR, the ET tube was clogged with clots, unable to suction it out or flush it out with saline; therefore, the ET tube had to be removed and replaced with an 8.5-French ET tube. It was noted after removal of the 1st tube that there was a large clot at the end of the ET-tube. The 8.5-French ET tube had good bilateral breath sounds. It was placed deeper this time with only breath sounds heard on the right side to try to avoid the left lung which appeared probably to be the site of bleeding. She had good response with no clogging of that tube. She was ventilated and given repeated doses of epi and atropine. Her pulse rate decreased down to
asystole. She had no response to CPR or ACLS therapy. The CO2 monitor was positive. She remained refractory to ACLS therapy and had no response. She was coded with CPR from 0528 to 0543.

CLINICAL IMPRESSION: Acute cardiac arrest secondary to severe hemoptysis
and respiratory arrest.

PROCEDURES:
1. Cardiopulmonary resuscitation.
2. Endotracheal intubation.
The patient was pronounced dead at 0543 hours.

The good thing is that the day could only get better.

Dos and Don'ts

I see a lot of people. A. Lot. Of. People. Especially recently. With one doctor on vacation and another on jury duty, I'm in charge of my 2,000 patients as well as the temporary cumulative 4,000 of the other two doctors in my suite.

And as the average twenty-five to thirty patients file into and out of my examination rooms daily, I see them. The whole variety of them. And nothing surprises me. They come in all shapes and sizes and all manner of dress and grooming.

The men with the mohawks. The completely bald. The neatly trimmed. The shag. The fro. The Hitler. Black, brown, red and blonde. I see them all and none surprise me. Until today.

He looked funky. It looked like a bald ZZ Top, completely shaven on top with a long, never before been trimmed beard. The hairiest balls ever. It was the weirdest thing!

You do know I'm talking about pubes, right?

Best Laid Plans

Sometimes it's best when shit isn't planned.

Like Saturday. All day Saturday all I could think of was that night's party. My sister Virna has a friend BTI (Big Tittied Italian) who had insisted that I go to a party with her. She's got a lot of gay friends and one of them was having a birthday party. She's sweet like that, always trying to hook me up. And nowadays, I need all the help I can get meeting the gays.

So much so that I even turned down the invite to hang out with Razor Burn, Guido, Sunshine and a handful of other friends. Besides which they couldn't get their shit together to figure out what they were doing by the time I left work at 5:00. And after a long ass six day work week, I was way too tired to make any suggestions. So big old gay party it was.

Only it wasn't. By 8:00 Virna called and told me she was still waiting for BTI to call. Apparently we'd have to go pick up a bunch of other people as well since she'd invited eight other people to this little shindig. And it became all too clear that Virna was not feeling this party. I let her off the hook. Besides I was tired. I could always use a night of doing nothing.

One phone call from Razor Burn and a half an hour later, however, I found myself polishing off two vodka Rockstars at Guido's with R.B., his new girlfriend Robot who I totally fucking love, Guido and Dirty Sanchez. We didn't stay too long, and fifteen minutes later we were at the home of two of Guido's friends drinking a couple of beers before once again heading out.

First stop, a Hollywood bar called The Well. I'm starting to realize I may actually drink a shitload. I had a vodka Redbull and then was introduced by Guido's friend to my new fave drink Jaegermeister Redbulls. Yum. I had two there and another at our next stop. Some dance club right on Hollywood Blvd. None of us remember the name of the fucking club, but it was fun as hell. Our last stop was the Avalon.

I'm not exactly sure what it was. Maybe the completely unplanned sequence of events. Could've been that the light rain made it all a little surreal. Quite possibly it was the introduction of Robot and getting a chance to hang out more with Guido's friends and getting to know them. More than likely it was the fact that the dynamics of that group made for one of the funnest nights I've had in a long time.

Fuck all that. What made the night is the fact that one of Guido's friends was smart enough to have bought four extra tickets to the now sold out Howie Day concert at the Hotel Cafe! Yeah that's definitely it. Whoo hoo!

Week In...'08.08

2/16 - It was the beginning of a three day weekend. Unfortunately, mine was only two days. Had to work at job #2 on Saturday, but that evening, the mantra was "Go big or go home." Razor Burn and I met up at Guido's. Here's the thing with Razor Burn and me, over the last few years we have become amazingly close. Despite the fact that he's straight and I'm gay, we really do see eye to eye on just about everything, and this night it was painfully clear. As we got rid of our blazers to settle in for a few drinks, we just started at each other in our jeans, our thick cuff bracelets, and our Monarch t-shirts--the exact same fucking one.

Anyway, after a few drinks, we met up with a few friends for dinner at Chan Darae, ending the night with bottle service at Vanguard. Yeah, Vanguard went clubbing at Vanguard. Didn't get home til three, and I was the one who left early--well me and my straight, Caucasian twin.

2/17 - Didn't really do too much until I met up with Dutch. We were supposed to catch one of the Oscar nominated movies, but that went out the window, and we ended up going out for drinks, first trying Here, then the Abbey, Eleven, and East/West. All dead, and we finally settled on Baja Cantina, home of twinks galore.

2/18 - It was nice to actually have a day off. I don't remember doing anything but working out with my trainer. He says my body is looking better...then again I'm paying him money, so whatever.

2/19 - American Idol. Big Brother. Nuff said.

2/20 - Man actually this week is sort of a dull one for me. Went and had another training session. Got my ass kicked again. Then hung out with Grey Shorts for another not dinner date.

2/21 - Here's the thing about traffic in my part of town. During rush hour, the two mile drive to the freeway onramp took an hour. Yes, an hour. So Razor Burn and I decided to fuck the conference we were slated to attend and instead went out to a Vietnamese restaurant. We hung out at my place afterwards to try to wait out the traffic.

Still it took forty minutes for me to get down to O-Bar to meet up with the crew.

2/22 - So glad to be done with the fucking work week. I was the only doctor there since one was on vacation and the other was on jury duty. So my panel for the week went from 2000 patients to about 6000 patients. In the middle of what has been the worst cold and flu season I can remember since starting my career.

I was happy to get down for my third training session of the week and blow off some pent up aggression. After, I went over to the Farmer's Market and met with a Spanish girlfriend of mine who introduced me to a group of Spaniards who meet there regularly. Really nice group of people. Really nice to be able to practice the language on a conversational basis. And I've realized that I think straight people are far more impressed by me than the gays. Sad.

Crazy

Here are the signs that he's crazy:

1) He's gone to lengths to get in contact with me. He contacted a friend of a friend, knowing absolutely nothing of me, having only seen me in a crowded theater.

2) He addressed the email to my friend as "Dear Mr. ______," Formal much? I mean, who does that? Unless it's a business thing, who doesn't start e-mails with anything more formal than "Hey" or "Hi"? It's like that "Dear Mr. ____," thing should be followed up by something like "I regret to inform you that your gonorrhea test was positive."

Who does that?

But the formality doesn't end there: " Please pass this e-mail message along to him, if you would please."

"if you would please."?!?!?!?

3) He's frighteningly excited. Exclamation points everywhere! The email ends:
"Have a Great Day! [capitalized Great and capitalized Day]
Thanks for your assistance!"

I imagine sitting across him at a dinner table in a romantic restaurant cringing at the impending end of every sentence during which he feels the need to Yell. To emphasize his Point!

4) Besides the formality, his choice of words seems a bit antiquated. I can't remember the last time I've described someone as "handsome".

5) I've used his email address. I've used his full name. I've searched under the contacts of the friend of a friend, and nothing. Not on Connexion. Not on Myspace. Not on Facebook.

It's kind of like "if a tree falls in the woods and no one is there to hear it..."

If a fag wants to go on a date, but doesn't have a stalkable profile...

6) For the sake of blogability, (since today does mark the first day of my fifth year of doing this and I'm running out of stories), he decides to respond to a persistent, formal, overexuberant, anachronistic, untraceable admirer despite many reservations.

And yes, first day of my fifth year...seriously. That's probably the craziest part, right?

Gay Seinfeld

Gap Boy was 34 year old who was a law school drop-out who ended up working for the Gap. Peter Pan was the other 34 year old with a bunch of issues the least of which was that he didn't drink because he just didn't like it, but also didn't like that others chose to partake. Dr. Jekyll and Mr. Hyde was sweet, almost too sweet, to me, but a dick to everyone else. With Injun, I just couldn't get past the HIV status.

There were others--Yellow Fever, Good on Paper, Goldilocks, Nervous Nelly. I'm sort of the gay Seinfeld. I mean, how could I have not made it work with the C.I.A. guy whose second job was as a personal trainer?

So I was determined.

Here was this guy, this very cute Latino guy with whom I had been flirting for years. He liked me. He stroked my fragile ego and made me feel desirable. And the conversation was engaging. And after years of missed connections and poor timing, the stars were aligned. We were finally both single. We were both clearly still mutually attracted. Perfect!

Except it was not.

It was over before it even started. He was young. And not just chronologically. He asked me out after finding out my relationship status. He was determined to take me out. And hell yeah I was flattered. We'd meet for dinner on a Tuesday after I finished at work and after he finished classes. He even told me he had the perfect shirt for the event. It was sweet.

"So where are you taking me?" I asked.

And that's when it ended. He was going to take me to El Torito.

It's just never going to work is it?

Week In...'08.07

2/9 - Saturday...and it was a long day at work. Long. But after that, after getting done at 6:00, this seventh week started out quite good. I went home, had a nice dinner, did laundry and rested. I know. Weird, right?

2/10 - For the first time in months, I went to the beach and got in some volleyball. Again, a nice quet nice at home.

2/11 - Hard day at work. Went to the trainer. Home.

2/12 - Harder day at work. Went for an hour run. Home.

2/13 - Even harder day at work. On call. Got only three hours of sleep.

2/14 - With the sleep deprivation, work sucked. I was tired the whole half day. Except it wasn't so much a half day. The last guy not only came in late. The last guy not only was scheduled for a 15 minute appointment. The last guy not only neglected to come in for routine check ups for a year, but the last guy had his diabetes so poorly controlled that between the fluids, the IV medications and the testing, I left two hours later than expected.

So I went home and took a nap for half an hour, waking up just in time to get on the road for my Valentine's date. So here's the thing, I can never ever figure out L.A. traffic. I left my apartment at 5:00 and the ten minute drive to the freeway onramp took thirty minutes. So fucking late! I barely made it to Razor Burn's house on time for us to leave to get to Universal City Walk for the Jill Scott concert.

And let me say this, Jill Scott is fucking amazing. Amazing! Beautiful singer and wonderfully entertaining. But just like the Molotov concert we'd been to last month, I was again the only yellow guy there. And likely the only gay guy there. It was fun.

2/15 - After the previous two days and nights, I was fucked! I dragged the whole day, well as much as I could drag when I was scheduled to see thirty two patients. Fuck me! All I wanted to do was blow off some steam and have my trainer kick my ass. I powered through the day, seeing all my patients and still able to leave by 4:45 (I told some patients to come in during my lunch break).

Traffic had other plans however. I was stuck in traffic for an hour and a half, fifteen minutes after I was supposed to be at my trainer's. I. Was. So. Fucking. Pissed! But he still kicked my ass with a truncated work out.

I finished at 7:15 and hauled ass to go see a friend perform, as I had promised. Again traffic, but made it on time...sort of.

And now, here I am, ready to start it all over again. Ugh.

Happy Valentine's Day 2

So, I've got a little surprise. This year, I actually do have a Valentine. And honestly I'm pretty psyched.

Everything is set. I talked to him today. I'll meet him over at his house after I get done with work. He said we could have a couple of drinks there before we go off to dinner. After dinner, we're going to a concert. Jill Scott. We both love Jill Scott. As it turns out we have a lot in common. So I'm psyched.

Now if only Razor Burn was gay...and I didn't already think of him as a brother, that would make a good Valentine a downright hot Valentine. Well see about next year.

In the meantime, Happy Singles Awareness Day.

Happy Valentine's Day

Seeker

"Dr. V, he says he's going to kick your ass. If you don't refill his meds, he's going to kick your ass."

Shit....

Really?

I don't understand these motherfuckers and their fucking ghetto attitudes. I mean, really! Really!? He wants me to refill his fucking Vicodin, and he tries to convince me by threatening bodily harm? Whatevah, biotch.

Lemme break this down, Bobby Brown. This dude is sixty five years old. He's got hepatitis C from previous IV drug use. From the hepatitis C, he also has cirrhosis. Besides all that, he's got arthritis in his shoulders and hips and knees for which he takes Vicodin. Yeah, this dude was going to kick my ass.

Not so much.

I saw him through the tiny window in the door that separated the waiting room from the nurses' station and examination rooms, glowering with his bullshit bravado, like he actually thought he had a chance of kicking my ass. My ass. If he comes back for a regular appointment I need to remember to write him a fucking prescription for crazy pills.

I stared back through that window with a look that any sane person would know to stay the hell away from. As always, my day was busy as shit, and I was not happy that I now had to deal with this bullshit as well. Not happy. At all. I wanted to bust through that door and just get into it: "I hear you want to kick my ass, old man. Let's see you try."

Of course I wasn't going to do that. I'm a professional. But lemme tell you what I was going to do, and the reason why this guy and this type of anger management issue is just plain stupid. Once a patient threatens physical harm, it is for physicians a get out of jail free card. With my office staff as witnesses, I could drop this fucker's ass quicker than a two dollar witch's tit. Wait, that analogy seems off, but you get what I mean.

"My nurses tell me that you threatened to kick my ass. I'm sorry but I don't tolerate that behavior. Not at all. I will give you one month's worth of Vicodin, and in that one month's time you will have to have found another doctor."

But...well, here's the deal. I'm a pushover.

I went into the waiting room which, at the time was empty except for the drug seeker. And I was prepared to read him the riot act. What came out of my mouth, however, well it was a disappointment.

"Mr. Seeker, here's the deal. I understand that you have pain. I know. You've been my patient for years now, and I've given you Vicodin. You've told me that you only take one a day, and I've given you that. When you had the pharmacy call for a refill, yes I denied it. Because you were refilling too early. For the third month in a row, you were refilling way too early. You know you have cirrhosis. Your liver is shot. You know that the Vicodin can mess up what's left of your liver. Your pain has been stable. Nothing's changed. So I have to question why do you now need more?"

He yelled for a bit. Even as another patient, a younger thirty-something man, walked in staring at all the commotion. He had no qualms about talking about his Vicodin use, about yelling about how he needed more, about his previous drug addiction, blah, blah, blah. He even looked over to the thirty-something guy with a little nod of acknowledgement.

Finally, we came to an agreement. And we shook hands.

And here's where the story gets good. Yeah after all of that, this is where the story gets good.

As I walked back to the security door, Seeker walks over to the younger man: "Hey, how's it going? I know you, right?"

The other man shook his hand and replied, "Yeah, man. Of course I know you. I've arrested you about half a dozen times."

Yeah, that is just my kind of patient.