So, the reason I am quiet right now is that I am eyeball deep in studying for my boards. I am a horrible test taker, so I need to do everything I can, and maybe...*maybe* I'll pass.

No bloggin'

R/S,
-doc

It turns out that Napolitano is trying to "deflect a wave of anti-muslim backlash" following the Ft. Hood shootings.

Well, maybe she should have tried addressing the muslim threat instead of sending out memos about the threat of returning veterans .

R/S doc

I had actually started this as a comment at Grim's Hall, but I should put this up on my own site.

Seething rage does not illustrate my feelings right now.

I want to go after his family. Now that I know that he is alive, I want him to receive weekly care packages of pieces of his relatives that have not decayed, (and are still fresh so that he knows that they are still alive and suffering) for the next twenty years. I want this so that he will know the pain that his loved ones are suffering. I want to hurt them in order that I might hurt him. I want him to know anguish, and I want it to last him for the rest of a long, long life. I want him to beg for death and be denied. I want to drive him mad with grief. Then, after he has grown too old for pain, I want his carcass to be fed to pigs so that all that is left of him on this planet is pig shit.

None of this shall come to pass, but I want it to.

Never trust a Muslim.

I can no longer consider them to be human beings after this. If a muslim is killed, I will bear no witness against his murderer, and I will acquit his murderer if charged. This is the rules that they live by, and this is the rule that I shall give them.

Yes, there are some muslims who I like, but as much as I enjoy their company, I would gladly give it up for all eternity as long as this is never able to happen again.

Maybe I will feel differently about this later, but right now, this is where I stand.

Respectfully Submitted,
-doc russia

So, this Halloween was a lot different from the ones that D-6 and I went through in previous years. We had, over many years gotten into the habit of only buying a nominal amount of candy for Halloween, and then having no trick-or-treaters. We lived in not so nice neighborhoods, so people did not trick-or-treat. This year was *completely* different. There were lots of kids in this neighborhood, and they *all* came by. In fact, judging by the appearance of kids who didn't speak english, I am fairly certain that parents drove their kids to our neighborhood instead of trick-or-treating in their own. It was very nice to see all these young kids dressed up as who-knows-what greedily grabbing for sweets. There was this one kid who was about 5 years old, who I thought his hands were so small, he wouldn't be able to grab a golfball single-handed. Well, his hand went into the basket, and came out with a tether ball sized fist of candy. I was shocked. There were also a cute set of twin girls who had huge costume ears, and I couldn't recognize what they were. The Harry Potters, Luke skywalkers, Princesses, goblins, and all were easy, but I had to ask the girls what they were.

"Blood elves"

In stereo.

I did not ask for explanation. I just opened the basket, and let them pilfer away. Whatever blood elves are, they do not sound very pleasant, and inappropriate for cute little girls. Still, at least theyweren't dressed like hookers or Brittney spears (though I repeat myself), soI just will let it go.

Anyway, I have to get back to work!

Respectfully Submitted,
-doc Russia

Yes, I have been quiet as of late. I have been doing another tac med course. This one took more hours each day, and had more PT going on. I am getting to the point that I think that the best program would be one which had a certain amount of classroom instruction, but would rely largely upon scenario and force on force training for driving the lessons home. I think that PT is of marginal usefulness in a two week course, and of even less worth in a one week course. I think it is far better to understand the physical demands of being an operator by doing scenarios which require physical fitness. Running around in formation does not teach the importance of PT nearly as well as dragging an injured patient (mannequin) out of a dark corner corner by crawling on your belly with a gas mask on.

Just my thoughts.

Anyway, I have to go to work, so I am going to go get ready for another shift.

Respectfully Submitted,
-doc Russia

So, last night's shift was pretty benign. Workups and dispositions on patients were pretty straightforward. No real diagnostic dillemmas. Just kind of moving meat, and actually having a lot of fun doing it. These off-service interns scare me every now and again. they do funny things like neglecting to mention that the patient they think is a nothingburger is tachycardic. Or that there is an afferent pupillary defect. Or, that there is snuffbox tenderness. Still, no big deal. I mean, they are 'terns, and that is what they do. I don't berate them or scream and yell; there is simply no need. Missing an important finding and being notified about it is usually enough of a bad feeling in these adults. They get the deer in headlights look, and then I explain to them why that little nugget of information was important to drill down on. Had a good crew, nurses included. Things went smoothly.

Until the last 30 minutes.

30 minutes before the end of the shift, a young patient rolls in who had been involved in a house fire. I go over with the resident (2nd year), and find myself nervously hovering over her like a helicopter parent while she does the intial exam. I am nervous because we may have a rapidly closing window of intubation, and I am anxious to know her findings. She calls the airway clean, but I know by watching her that she didn't get a good look. I grab a tongue blade and check myself. Sure enough, there is carbonaceous sputum (Spit made black from soot) in the back of the throat. I call her back and show it to her. I then ask her what this means, and she stammers a bit,unsure. "Do you think this might warrant intubation?" I ask her. She guesses so. "Your G-Damned right, it does."

I call for the RSi kit, and ask her what other orders would be indicated at this time. She rattles off the CBC, BMP, ABG. I tell her to also *always* get a carboxyhemoglobin in possible smoke injuries. Done. The burns fellow shows up and we start chit-chatting. He does not recommend intubation at this time. The guy has no burns, or indications of burns- he's a straight smoke inhalation injury. poorer outcome if we intubate him unnecessarily, he says. The patient starts coughing, and has another "spell." I figure out later that they are seizures. The birns fellow is now unsure. Recommends observing the patient and intubating as needed later. He's hoping it won't be.

Hope is not a strategy.

I order the intern to tube him. He's crying and scared. I do my best to reassure him. I don't tell him the bad stuff; he's altered and acting goofy. I need him calm. I quiz the resident while this is going on about what meds she wants to use for the RSI (rapid sequence intubation). Smart girl, gets it right, and opts for the rocuronium. Low probability that this patient has a high potassium, but the risk is there, and liberating more by using sux will anger the gods and put the patient in a likely lethal cardiac arrest. The drugs are pushed, and the patient stops crying. He relaxes. I'm holding cricoid pressure as the meds reach full efficacy. The resident takes a look. She's having trouble, but I let her continue while the patient lies still, unable to breathe. After longer than I like, she asks for the tube. I feel it go in. Took her a while, but she was successful. It was probably a surprise to her to try to hit vocal cords that are soot-stained amongst blackened tissue. tough, but she did it, and grew that little bit stronger as a physician by the challenge. 

More informatin from the paramedics. Fire started in the bathroom. Lots of plastics.

I ask the resident (who by now must feel like I am riding her ass just to be mean) what we should be considering in a patient removed from a fire who suddenly loses consciousness. 

Blank look.

I add on that there was a lot of plastic burned.

Blank look + shaking head.

I ponder for an instant if I am being too hard, or expecting too much, because I kind of thought she should get this one.

"Cyanide" I say.

The light goes on, and I have her fetch the antidote kit.

I never actually used one of these before. Hell, I don't think that I have ever seen one of these before.

Still, the mnemonic I made up in med school to remember the order that the amyl nitrate, sodium thiosulfate and sodium nitrate should be given in somehow leapt back to my forebrain.

It was shift change, and suddenly the nurses disappeared.

I started drawing up syringes from ampules, and went to work. Bypass the first medication due to formulation constraints. Give the second one slow, and the third one fast right behind it.

I told the resident to page toxicology and also ordered some additional labs that I thought would be useful. Tox came back with recommendations, but I had guessed right, and they were already done, labs and all.

By now, the patient is tubed, lined, loaded, sedated and restrained. He still looks dusky. I wonder what the Hell will happen to him and grab a sticker to find out later.

My boss shows up, he had been watching. He asks the nurse a few questions. gives me a thumbs up, and leaves.

I, in turn, talk to the resident. Now that the stress of the moment is over, and the patient is stabilized, she is energized by the case.

I'm tired.

It was her first patient of the shift, and my last.

I try to make a few points and pearls, but mostly I am spent.

I write a nice note trying to capture the essence of what I did and why I did it. Can't write "decided to go big or go home" so I wrap it up in that nice, sterile and intentionally understated medicalese which makes it seem like the decisions were clear cut, and based on solid information, when the truth is that they were largerly judgement calls based upon spotty and/or inaccurate information.

I sign out and then I punch out. 

Less than an hour later my pregnant wife is barefoot in the kitchen making me some eggs as I tell her about the case.

And then I sleep. I sleep like I earned it.

Respectfully Submitted,
-doc Russia

So, the big news is that I closed on our house the other day!

I am so happy about it. I got a great deal on a great house. Couldn't be more pleased. I also just changed all of the locks, and now onto the other security upgrades.

Domestic-6 and I have been living in apartments with second hand furnishings for so long that I am almost having a hard time believing that we will be living at a house, the same house, for the forseeable future. We aso have enough money set aside to buy some pretty nice furniture. New furniture. Not hand-me-down thriftstore stuff. So, on Saturday we will be shopping for a mattress and a bed. I actually care more for the mattress than the bed. I want absolutely the best mattress that I can get. Sleep is very important to me, and a good mattress is going to be a key part of that. The bed? Well, Domestic-6 has all the fashion sense in our marriage, and I have complete faith in her ability to choose something that looks great. Of course,unless it is really lousy, I probably can't tell the difference between the high end and the mid-range. So, first comes the bedroom set and mattress. Then comes the breakfast set. Next comes the living room. Then I guess that the dining room and office are next. Along the way, we need to create a crash room. Actually, that my come along way early. I guess that the first thing I need to do is to get some exterior shutters. Then I need to get a day bed to use. A small table for the alarm clock, and then everything else is just extra.

Alright, I gotta go; there's tons of paperwork to wade through.

Respectfully Submitted,
-doc Russia

So, one of the things that I enjoy doing is martial arts. I think that it is a great way for me to get in shape, and it also works well with my self-image, identity, all of that. I don't like it for it's beauty, or for "the competition." I like it because it is a great workout, and because of my past history of fisticuffs (although even that has been a looong time since) it might actually be useful. I especially like fighting styles which are very reality based. For these reasons, I fell into Krav Maga, which I am sure that I have mentioned previously. While in Detroit, I trained at Krav Maga Detroit with Pawel Cichowlas , who, I must say,  runs an absolutely first rate school.

Well, now I am in the North Dallas/ Ft. Worth area, and I am starting to really get that itch. I need to get back out there and start training again. I am getting soft and fat and slow, and all of those things that come with being in your mid thirties and inactive for weeks at a time. Looking around at the training schools around, I have really come to appreciate and miss the training that Pawel gave me. It was so good that I don't want to step down to a lesser school, or a lesser system, and undo the training that I have picked up. I don't see any schools around which appear to really be that good. Worse yet, I want to get into crossfit, but I can't seem to find any gyms real close by which carry it. 

Maybe I have become something of a workout snob, but after years, or even decades of working out, I have gotten to be set in my ways, and I know what I like. I like functional fitness. I like combative oriented martial arts, and I want to continue them. I don't like wearing a gi or other special uniforms for martial arts, or any where you train barefoot. I do not walk around barefoot on the streets of Texas. If I get in a fight, and I kick someone, I am going to stomp their face in with a boot heel. 

Anyway, I say all of this because I am casting a net out there to see if anyone knows of anything in the North D/FW area which might be good. Are there some schools out there which are not run by the "North American grand master" of some obscure fighting style which nobody ever heard of. The other problem I have is the krav maga schools I have seen are kind of... mediocre. Not very vibrant. Run more like a business than a discipline. Maybe I am just spoiled.

In the meantime, I may just sign up for a crossfit gym for six months, and see how it goes with 30 minute drives. When I was doing it on my own in Detroit, it seemed to be pretty good as far as physical conditioning goes. It's also endorsed by a lot of military operator types, which is a huge plus in my book.

Anyway, if anybody has any recommendations, then please leave them in the comments.

And if you are near North Detroit, you may want to check out Krav Maga Detroit. That school has my full and unreserved endorsement.

Respectfully Submitted,
-doc Russia

No, I did not take my recently earned paycheck and go shootie shopping. No, I deposited it. I did, however, decide that a month was too long without sending some lead downrange, so I went to the range near work, and shot off a box of .45. Just maintainance shooting. Knocking the cobwebs off. I discovered that I have started to ride the safety. I am not sure where that comes from. After a couple of mags, I heard the unmistakable sound of a rifle going full auto. It turns out that there was a guy a few stalls down from me who had an SBR AR with a giggle switch. Sort of like this:

I asked him if I could shoot it, naturally. He told me that he wanted ten bucks to cover the price of ammo for a magazine.

I gave him a $20 and put the wallet away.

So, I shot a very sweet little rifle. It was so much fun, it was illegal. Okay, it wasn't illegal, but to have more fun you need whip cream, chocolate, a trapeze setup and a Dallas cowboys cheerleader plus or minus pom-poms.

The proud owners first comment was "I can see that you have done this before."

Then, as the thing got completely fouled and overheated, it started to jam, and he was impressed with my obvious familiarity with clearing an AR.

(Thank you, magpul dynamics.)

Next thing you know, we are talking about Class III firearms, and so we just kind of hit it off. 

Here's the thing, though...

This guy does not, as far as I can tell, frequent blogs. He never heard of Kim DuToit or the Mad Ogre, or anyone else.

But he is expecting that money is going to get tight, and is planning accordingly. He has laid aside ammo by the pallet from what it sounds like.

I don't know where he gets his information, but the fact that we both are gun nuts, and our paths have never crossed, and we don't even know of people in common, but are concerned about the same economic pitfalls approaching.

Well, it means something, I am just not sure what.

We parted as fellow pilgrims, and I will have to ask him at the next gun show (should I see him there) about getting a giggle switch. 

Respectfully Submitted,
-doc Russia

And for the record.... I *HAVE* done that kind of thing before.

Today in the mail there arrived the usual odds and ends. However, in one very thin and innocuous looking envelope was something special.

My first paycheck.

I have been through a lot to get to this point. If you want an idea, read through this blog, all the way back to the beginning. Read about the endless hours of studying, the grief, the sorrow, the stress, the sacrifices, and then realize that it represents just a fraction of what I have gone through. Having gone through all of that, I finally earned my first paycheck. By itself, it does not come close to even an idea of what I would have gotten flipping burgers for this time, but you know what? I EARNED it.

And it is five fu*&ing figures!!

YEAH, BABY!!!!

 I realize that there are a lot of people out there who are scraping by from paycheck to paycheck. I get it. I have lived a lot of my life that way. An awful lot of my life. Years and decades of living in falling apart housing with cockroaches because it's what I can afford. More meals than I care to count scraped together from whatever could be scrounged out of an embarrassing cupboard.

Yeah, I've been there. 

So, while things are tough for other people, and I still have a *ton* of student loans, I am not ashamed of what I have earned. 

Hell, no. 

My first impulse is to go out and buy a nice gun. Something beautiful that will be around long, long after I am gone. My second impulse is to buy something beautiful for my long-suffering wife. She deserves to be wrapped in beautiful things, and I have not been able to do that for her very much.

This money will go towards paying off loans, and buying our house. In short, it will go to discharging my responsibilities, and that's just fine with me.

But damn, it feels to good to look upon that sum and to know without guilt or doubt, that I earned it.

Respectfully Submitted,
-doc Russia

....okay, maybe I will buy myself something small.

Oh, yeah; Happy B-day, Mom!

So, sunday night I took a break and watched into the wild .

I think that this man's story is exactly what happens when a dirty hippie thinks that the world is all lightness and ice cream shitting unicorns prancing on rainbows. Seriously; this kid, according to the flick,did not think that things like borders, police, parents, park rangers and helpful old men were useful constructs.The short story is that a young man, after finishing college in the early nineties, decides to destroy all of his material wealth, and wander around on his way to Alaska.

Dumbass.

While the true reasons for his abrupt break from society are never explained, the voiceover of his sister interjects that he was, at his core, upset about his family dynamic, specifically his father. Apparently, mom was dear old dad's young mistress, and his previous marriage was hidden from the children.

So, his first mistake was thinking that his dad was a jerk because he denied a previous family. I suppose this punk would have been just peachy if his father had done what most unfaithful husbands do when they get their mistress knocked up, and pull an Edwards, and try to deny the relationship or the offspring. I think his dad was a jerk for cheating on his first wife. Had he just divorced her and moved in with little miss thing, it would have been something less than horrible to do.

Anyway, that was his first mistake. His second mistake was to think that he could write a few notes on wilderness survival and be all hunky-dorey. No, I take that back; his next mistake was to think that the wilderness has any sort of kindness or understanding about it. Despite having almost been killed by shooting some rapids on the Colorado without any training, he sees this not as a non-fatal error, but as proof that he doesn't need stuff like training, preparation, or local guides. It's the old "you will understand more if you look upon the world with the eyes of a child, and filled with wonder" shtick. It's also horribly false. So, he hitchhikes and rides rails. He gets the crap kicked out of him by some railyard security type. If he had taken that as a sign that maybe, just maybe, relying upon divine providence is not a tack that an atheist should take, maybe he would not have continued to make errors.

He also thinks that having listened to someone telling him about skinning an animal, and taking notes, that somehow he will be ready to skin a moose when the opportunity arises. The opportunity arises, and he screws it up. Then he feels guilty about killing the moose for nothing. Dumbass. First off, he dumped the mag from a .22 into it (according to the movie), which means that he was lucky that it didn't run off wounded and die miles from him, where he couldn't get to it, anyway. He also didn't ever practice doing this skinning and smoking a carcass before trying it on a moose. Ever hear of walking before you run, pal?

Let's see, he has a bag of rice, and he draws a line on it to show the level below which he should get concerned. Of course, having a "danger" line is one thing, and having a plan for what to do when you cross it is another. Guess which part he forgot? That's right; the planning. Other mistakes; shooting off his rifle in frustration that there are no animals about. Because we all know how much deer can'thelp but to be drawn to the sound of rifle fire. He also, in his hunger, scarfs down a bunch of wild plants. Naturally, not having practiced gathering skills, he ingests some poisonous tuber and almost dies right there. This whole failing to plan and practice thing is a recurring theme. He doesn't plan to practice, and he doesn't practice planning. He just makes shit up as he goes along.

So, about fifteen minutes into the movie, I realize that things are not going to end well for the protagonist. It's based on a true story. A true story of a true dumbass. Of course things are going to end badly. I spent the rest of the movie watching this train wreck build up. I felt kind of bad when he died of starvation at the end. But here's the thing. Stupidity kills. In fact, it could have and probably should have killed him sooner. He kept on doing dumb hippie things until he pretty much forced the wilderness of Alaska to kill him. 

So, if you want to see what happens to hippies when they really try to commune with the earth, it may be a good flick. It's like that Grizzly Man flick. I want to ask their souls when we meet on the other side this single question:

"What did you think was going to happen?"

Starting shifts in a new EC tomorrow, so I have the usual butterflies in the stomach. It's  like the minutes before a rugby match, or the minutes before a martial arts match. There is great excitement. The pain of the contest is a certainty. The victory is not. I just need that first sting of the battle. the first punch in the mind as diagnostic uncertainty rears it's head, when catastrophe threatens. the first elbow to the face, the first scrum, in all of it's snarling, grinding struggle to get my motor really running.

I am reminded of what a SWAT guy once said (I am going to absolutely abuse artistic license and totally paraphrase here to the point that the original quote is unrecognizable, but the sentiment is true).

"For most people, the roar of battle cows, confuses and subdues. For them, the rattle of the sabre imprisons them in fear. Not for us. For us, it is the jarring clash of arms that sets us *FREE*"

Respectfully Submitted,
-doc Russia

I was shocked and delighted to discover that Matt Burden is running for office . The first thing I thought was "He's crazy." The next thing I thought was "He must have lost a bet." Something like "first one to pass out has to run for office." Finally, I thought that if he didn't lose a bet, he may just be Chesty Puller reincarnate. For those of you who are unfamiliar with this most famous of Marines, he was recorded as having said, upon learning that his unit was surrounded "That simplifies out problems; We can attack them in any direction! Those Bastards won't get away this time!"

Naturally, Matty, who is s self-described Reagan conservative, is running for office in Illinois. Head over to his site, and send him some money .

Those bastards won't get away this time!

Respectfully Submitted,
-doc Russia

So, while my wife was expressing her concerns about taking care of a child, I responded with "well, we could trade her for a dog......"

Which, under any other circumstances would be grounds for a week on the couch, but having been said in jest, she gave me the "you stinker!" look, and tried to hold in her laughter, but failed miserably. The best part about it is that from this day on, I can always whip that reference out.  when Domestic-6 complains about how tiring taking care of a baby is, I can just say "Hey, *I* wanted to trade her for a dog." When our lovely daughter does something to upset me, I can turn to her and say "you see... *this* is why I wanted to trade you for a dog." Of course, she will run to mommy and whine that Daddy said that he wanted to trade her for a dog, and she'll ask my lovely wife if that was true, and there will be just enough of a pause as Domestic-6 ponders how to answer that question for her to wonder for a moment if it's true.

Now, while this may seem cruel and heartless (two of my specialties), the sad fact is thhat I do not think that I can raise my daughter as anything besides a tomboy, and that means giving her a thick skin. You see, the boys I see growing up maturing in her cohort today are not being raised (for the most part) as men. No, they are something else entirely. So, I must raise a daughter under the presumption that there will be few men (classical men, I should say) available to her. This means no helpless little girl. No delicate little flower. Don't get me wrong; I do want her to be feminine, well-groomed and beautiful. It's just that she is going to have to be the kind of woman who has to make sure that she doesn't mix up her Chanel No. 5 and her Hoppe's No. 9.

In other news, the house is inspected, and was, to paraphrase "appears younger than stated age."  On to the next step, and I don't even know what it is. work tomorrow. Another day spent learning the ropes doing cool prehospital work. Last meeting like this introduced me to a couple of people who I hope to train with a *lot* in the future. One belongs to a tactical TLA (three letter agency), and the other is TX guard. I really like what I do. 

I note that there was a recent bill passed in response to Wilson's counter-accusation which now prohibits members of congress from calling people liars or hypocrites. I am sure that all of congress passed that one with much relief and little debate. it would appear to me that they fear the first ammendment even more  than I thought. 

Oh, and Pelosi; Since I *will* call you a hypocrite, let me point out that you can cry me an effing river as you weep about the incivility going on. You should have thought of that when you called people who don't like your statist policies 'Nazis.'

Bite me, you ugly, botox-assed, lying hypocrite.

Thatisall.

Respectfully Submitted,
-doc Russia

So, the reason I am not blogging much is because I am working everyday, and juggling a new house, a baby on the way, and a new job. I might be able to post something useful in ...

...May.

Respectfully submitted,
-doc Russia

So, we have yet to close, but we have an agreement in principle.

I am totally stoked! I really like the house that we were looking at. It was a good house in a good neighborhood, and for a good price. 

Oddly, the first thing that occurred to me was that this will be where my daughter grows up.

 Funny, that.

Respectfully Submitted,
-doc Russia