American Idol 4

My predictions for the top 4:

Nadia Turner -- odds of winning: VERY HIGH, if she remains consistent. Gorgeous young lady with a devastating stage presence. Cross between Beyonce and Tina Turner. Best performance so far: her rock / R&B / disco cover of the usually sedate ballad Try A Little Tenderness ( also featured on Michael Buble's latest album ). My jaw dropped. :)

Mario Vasquez -- odds: ALSO VERY HIGH, if he doesn't screw up. Another good-looking contestant with lots of sex appeal. Beautiful smile. Awesome showmanship. Best performance so far: How Do You Mend A Broken Heart at the most recent show. It literally broke mine. :D

Anthony Fedorov -- odds: MODERATELY HIGH, but could get higher if he loosens up a little. Constantly compared with fellow bespectacled power vocalist Clay Aiken, and described as "sweet" and "a very nice guy" by none other than Simon Cowell. Fantastic voice, capable of belting Jon Secada, Richard Marx and Marc Anthony numbers. Best performance so far: Hold On To The Night on the first semi-finalist episode. Gave me goosebumps!

Anwar Robinson -- odds: MODERATELY HIGH, but set to rocket past everyone if he plays his cards right. The reason I say this: he's got TWO great performances so far, and I can't even choose between them. First, his fantastic rendition of Moon River, and second, his amazing cover of Louis Armstrong's simple yet poignant What A Wonderful World. He dazzles just that little bit more with each passing week. If he keeps this up, he'll win for sure. Plus, he's also been described by Simon as a very nice person, and he's a music teacher who used to coach a school choir. What more do you need to be an American Idol?! :)

P.S. The female contestants suck. Except Nadia, of course.

Work Issues

A little disturbing sometimes. And I don't mean the patients.

Can someone please tell me if a positive Murphy's sign has any value anymore? A person, who shall remain unnamed, told me the other day that a fever MUST be present in order for acute cholecystitis to be EVEN CONSIDERED. So a strongly positive Murphy's in an afebrile patient = DEFINITELY NOT ACUTE CHOLECYSTITIS.

Since when?

SP, since you read my blog and are well-placed to answer such a question, perhaps you can provide some answers? Thanks. :)

In the book, The House Of God, by Samuel Shem, the protagonist's stint in the ER mentions prominently his attempts at being a Wall, aka a Gatekeeper, who tries his darnedest to prevent the wards from overcrowding with gomers and other assorted unwanted or unwarranted admissions.

I tried to be a good Wall the other day.

Elderly man, just discharged 4 days ago for pneumonia. Perfectly well at home until that morning when he was brought to the hospital for a blocked urinary catheter. Found to have a very low-grade fever <38 degrees. Chest Xrays and urine combo negative. Just completed a course of Augmentin. Sitting on the bed and grinning at me. Tells me he's okay and keen for home. Family also wants to take him back.

The niggling temperature bothers me a little, but I didn't want to subject him to an unnecessary inpatient stay, with all its nosocomial infections. So I decide to do a simple full blood count to assess his total whites. If it's significantly elevated, he has to stay, no question about it.

Patient and family agreeable and happy with above plan. Besides, he has a clinic followup in just 3 days' time. I draw the blood and put him in observation. Only thing is, I'm going off shift, and need to hand the case over to a fellow colleague, who shares a similar rank, but has a few additional years of experience on me.

I tell him about the case, and when the FBC is mentioned, my colleague suggests I admit the guy immediately, BEFORE the results are back. I explain that the patient's problem was NEVER a fever, but the ?blocked catheter, which has now resolved spontaneously. We debate the issue for a few minutes, and at one point, I ask ( a little loudly ), "You mean you WANT to ADMIT the patient?!"

Not sure how that came across. I wasn't being rude or disrespectful, just simply shocked. I didn't think it was justified. But my colleague was being insistent, and try as I might, I couldn't give in. Perhaps if HE wanted to admit the patient, HE should go tell the patient and his family that, and leave me out of it.

Silence for a few seconds, then he relented. Okay, we'll wait for the FBC. Not sure what happened, since I'm off today. But I'd like to think I had good reason to at least wait before taking up another bed in an already busy hospital.

And if the colleague in question does read this, please don't take my reaction the wrong way. He's a good guy, and I enjoy working with him. But doctors often disagree, and I was only trying to present the merits of my case. After all, I was the one who saw the patient and spoke extensively with his family, who swear that he's absolutely fine at home.

The 3rd issue: Referrals to a certain department ( or more specifically, certain junior members of that department ) are being mismanaged. To put it nicely. People getting admitted to other disciplines because this one regularly rejects them, then being referred again after they're sent up to the wards. Diagnoses made late. Treatment delayed. Outcomes not very good in some cases. Then the ER docs get blamed in "closed door" meetings. C'mon... don't any of you have a conscience anymore?

All hell breaks loose tomorrow. Monday morning, and I'm on shift. Sigh.