Well, so what the hell do I expect? I need to sleep, I want to sleep, therefore I can't sleep. Talking about yesterday, of course. This sort of thing is getting so common with me that it's completely unremarkable.
Well, OK, there is nothing that I won't remark about, for all practical purposes.
Yesterday evening was very busy until about 19:00, then the radiography part dropped off... and suddenly I had five CTs to do. And, naturally, I was the only one there that could do CTs...
Two of them were appendix studies... they are generally kind of fun diagnostically but not technically. If a patient is suspected of having an appendicitis, but don't quite fit the picture for some reason or another with either their symptoms or their lab results, it usta be that the only real way to know was to give them to the surgeon, and if they got in there and found a normal appendix, why, they would just rumble around in there until they found the patient's problem.
Or didn't, as this was normally what happened.
Now, we have a CT procedure that will show the appendix most of the time if it's done correctly. Most patients feel that it's a better alternative than the knife, and I'd have to agree with that.
On the technical side, the patient has to be given an enema of water-soluable contrast material and the head of that contrast column has to reach the cecum, which is where the appendix lives. The problem is that the cecum is way over on the right side... it's the beginning of the colon.
So, the patient is turned on the left side and about half of the liquid is given, then they're rolled over onto the right side and the rest of it's allowed to flow in. The contrast material is heavier than water, so it goes down... jiggling the patient's belly while this is going on is imperative.
Also imperative is that the patient has to retain the fluid... not let the enema tip slip out. Most people don't have a problem with this, but we get patients who are 1) in a lot of pain, and 2) drugged up pretty good sometimes.
Anyway, after the contrast is all in, a series of slices is done through the cecum, and either the appendix will show up filled with contrast or it won't. Either way, if the cecum is filled, the radiologist is usually able to make a diagnosis. Well, most of the time.
One of the ER docs claims that the exam is very reader-dependent, but I sure haven't been able to correlate that... it seems that the rate is about 75% for false positives, but I don't always know the outcome. False negatives are much harder to correlate, of course...
The second appy study was on a lady that was 86 years old, and she did great, all things considered.
Anyway, the gist of the story is that I didn't get out of there until 23:00, and I was bushed, both from working and from having very little sleep. I was in bed by 00:30 and went right to sleep.
And I woke up at 07:00. I wanted to sleep at least 'til noon, dammit!
But I did get quite a few chores done today... another round with the drywall, I think that I might get done with it before xmas, but don't count on it.
And Drew is staying with us tonight, Andy and Karla were going to KC but decided not to but Drew wanted to come over anyway. He likes being with his grandma, and he tolerates me pretty well too.
Karen and I went to the store, and she started talking about wanting to go on a diet again... she said that she misses her dad, who would always get on her about her weight, and that she knows that I don't really care.
And that's a fact, I really don't. She will always be Karen, and I love the woman, not the body. However, I did take the hint and made some rather mildly cutting remarks about her weight... just filling in for Charlie, y'understand....
And boy-o-boy did she get upset!
So, consequently, I am going to quit listening to her when she indicates that she wants me to speak disparagingly about her. She doesn't know what she's talking about, and I'm not that stupid.
Well, I won't be that stupid next time...
And, speaking of next time... more tomorrow.
But, back to last night. The first patient was a lady about my age, but she wasn't able to retain the enema tip, and I had to repeat the enema the second time worked very well, I got the images that I needed. However, I couldn't get the lady to come out of the bathroom after the exam was done... it took her about 25 minutes, and I had other patients waiting.