I think they just want my money

(I have not edited this yet, so hopefully there are not too many spelling and grammar errors.)
It's been a long while since I've posted on this pointless blog . . . . . so . . .here it goes.
I'm approaching finally getting a real medical license after all these years of education, and I just can't believe how much every little fee is now. I have all of my previous debt and now work very long hours for pay averaging less than an experienced person at Taco Bell, along with a wife and kids. And then "they" just throw hundreds of bucks of bills at me like I have wads of money in my sock drawer. So, how much has is cost thus far I've been thinking today . . . . . .

College: Very blessed and I was actually paid for each semester after my grants and scholarships were tallied up -- so that part was sort of a free 5 years of work. Initially I thought the couple grand applying to med school was costly, but I sure didn't realize back then how small of a chunk of the real pie of fee's that would be.

Med school: Well, this cost us over $200, 000, and the interest is literally increasing by the minute, which is a bit disturbing and I have to just try and not think about it or I just get more gray hairs.
Then come some of the tests
USMLE Step I board exam: $505 (1 day computer exam) after 2 years or med school
USMLE Step IIa board exam: $505 (1 day computer exam) a year later with the next test
USMLE Step IIb board exam: $1075 (1 day simulation with humans exam), PLUS you "get" to fly yourself to one of 5 places that actually give this test -- so I had to get myself to California, stay for a hotel, cab, and get back home again, all of course with no additional school loan money to somehow fund any of the over $2K in tests .

Then one graduates from medical school. . . only to realize that they spent about $5-10,000 more applying to and flying around the country interviewing at a dozen places to make sure they had a residency job after the M.D. is attached to the name. (All of which are on new private loans for most folks.)

Then you have a job as a resident, which is the first fulltime job in several years, so it's very nice to have some income that you actually earned, rather than borrowed from a bank, to pay for your beans and rice. Then a few more fees have come my way this past year.
I had to pay $705 to take USMLE Step 3 board exam (the last one), a 2 day test.
So sweet! I've finally finished all my main exams, I can now legally put a sign above a shop and call it a doctor’s office . . . oh wait, I mean . . . I have to pay others more money to let them make sure I really did everything above, which they have already been watching me very closely do.

So here I am now, needing to get state approval to use my stethoscope or treat an individual.
Here is what they now need, from what I have thus far figured out.
$16 to have myself put into some other database that keeps track of me
$48 for a fingerprint card fee
$50 to have my scores shipped from one agency to another of the above tests.
$52 background check fee (about the 10th one thus far, but I'd rather them check everone than not of course)
$205 initial license fee
$295 to pay a company to keep track of which fee's I've paid and to hold the paperwork for the main company
$500 application fee, just to top it off!

Then, if I actually want to be able to give that poor guy with a new kidney stone, or the lady with belly pain, or the kid just hit by some drunk driver some pain meds, I need a DEA number, which is a few hundred more bucks I get to fork out.

But wait -- I'm not even "board certified" in my career path yet, I'm only an M.D. but not a specialist yet in anything. After all of the above, and after finishing an approved residency training program, I then get to pay $385 to first apply to take the test in my Emergency Medicine specialty, which then costs $115 for an "in-training exam" then $895 for a "qualifying exam" then $1,125 for an oral exam. Then I'm sure there are some more to just top things off. All this just to let you actually treat your first patient . . . . who may very well just call the 1800Ididn'tLikeTheMD.com line when they get home and file a lawsuit . . . . on the guy who just worked for over a dozen years to try and help you to begin with. Did I really sign up for this???? Why????
Sometimes I wonder.

Yet, I still love my job as an ER resident, and somehow still have a great wife who has stuck by me (in our 10th year now), which I'm very grateful for, and we have 3 incredible kids, who make all the whining above well worth it!!!
______________________
Sorry for the ranting, I'm just feeling the burden right now. I know, I know, I'll be sending out the bills to those that have much less than I have ever had soon enough, and I'm just a scum sucking doc that somehow has some alternative motives for the workup I do on my patients that come to the hospital, but really, I'm just a guy like everyone else, trying to be the best I can at what I have been blessed with to be able to do and I really did just go into this to try and help folks out and have a job that I enjoy. In the end, it's our families that matter.

Someone always has it worse than you do . . .

I recently had a middle aged patient who a few years ago was diagnosed with Kidney cancer. He had the kidney removed that had the cancer and he was followed up for about a year, but then stopped follow-ups due to inability to afford his health insurance. This patient has no parents alive, no siblings, no children, no spouse, no cousins and no close friends. He's not a freak or anything, just a quiet guy. This guys apartment caught on fire and burned down about a year ago due to a neighbor leaving something on in his apartment. He lost everything. Then, about 3 months ago, after working full time for a company for over 20 years, he was laid off due to downsizing. He still gets a check from them, but apparently not much. This guy came in feeling week so he was admitted and was under my care. We sadly had to find that this poor relatively young man had small cancers throughout his liver and lungs and spinal cord. He had back surgery to have the entire middle of his back bones removed so that the cancer would have room to grow rather than pushing on his spinal cord making him paralyzed in the near future.
Life may be extremely busy at times, but I had to spend some with with this guy and let him vent some tears. He has NO ONE to vent to or to help hold his hand as he not only is very sick with advanced metastatic cancer (his kidney cancer that apparently was elsewhere but they just never knew it, they were too small back at this kidney surgery time) and just had extensive back surgery, but he also now has been laid off and limited possessions since the fire. It became so apparent how much we take those close to us for granted at times. Those times I can just come home and vent about frustrations can be so helpful, or as Lindsay babied me during the holidays when I was down for the count for a couple days was a life send. This guy has no such person and I am just even so much more thankful for my incredible wife and for my great family and friends. I strongly encouraged this guy to make sure his few friends understand how sick he really is. I hope he does ok.

Elder Joseph B. Wirthlin

Talk about being out of the loop down here in Florida.
Three days ago Elder Joseph B. Wirthlin apparently passed away at age 91. I had no clue and only found out because it on some random website I ran across today.

Information HERE

We will miss him. What a life of service and an example to us all.

You can't make this stuff up!!!

A guy came in with some significant Left eye pain. He was very drunk, and rude, and stated that he was hit in the eye with a blunt object, possibly a bat or fist.

Well, we couldn't really examine his eye because there is a ridiculous amount of swelling around/on it and the guy was very combative. We get a CT ("Cat Scan") of his face, and there is nothing that looks like a normal eyeball in the eye socket. We tell the guy that his eye looks like it's toast (in more politically correct terms) and that we'd like to take him to the OR to see if we can save the eye or any vision. He agreed.

Well, in the Operating Room . . . it's very strange. There is NO eye at all in the socket. Not even the thick gel-like substance that is in the eye. In fact, there is not even part of the optic nerve, including the 2.5 cm of neve that's in the eye socket before it gets to the eye. Something isn't right with the guys story.

We wake him up and then tell him that something doesn't fit and ask him if his story is any different. Well, just like one of the rules of being an EM doc (Emergency Medicine), the stories tend to change over time. The patient then stated that he was really just playing a board game with his uncle, who suffers with some apparently pretty bad PTSD since the Vietnam War. Well, the uncle was not very pleased with now the game was going, so he reached up and literally ripped this poor guys Left eye out. Yup, ripped the eye and nerve, right out of the guys face. Thankfully for the patient, he was very intoxicated, so it hurt a little less. Pretty sick huh? Well, the story gets even a bit worse-- there was so much L eye nerve damage, that it affected all of the crossing fibers from the R eye (1/2 of the total R eye vision) that cross to the L -- so this guy now has no Left eye and he can only see from the left half of the world out of his right eye, the other 3/4's of his vision is forever gone.

Pretty messed up huh? And guess what game they were playing -- "Sorry"!!!!

A sad case . . .

So sometimes work just sends you home depressed. Here is what arrived one day ---
You send your 2 1/2 yr old little guy down the street with your sister to pick up some bread. On the way back, just outside your house, your 2 yr old decides to randomly dart out into the street for no apparent reason. Your standing on your doorstep, too far away, but you see the truck just a moment away --WHAM -- your kiddo is smashed by the truck, then he somehow fits under it . . . as the truck drives away, never stopping. Your child is not breathing and is bleeding from all over his skull. Not good! A part time paramedic is working across the street as a construction worker and heard the screams and immediately came over and started CPR. The kiddo got a pulse and started breathing again. EMS brings him to our hospital where he codes again -- but again, his heart comes back, and we have now intubated him (put a breathing tube in).
Well, he sustained about a dozen skull fractures, and his femur was sticking out, and he had some other broken bones as well.
Needless to say, something like this coming in sure makes for a crappy day. How depressing. There is no awesome ending, it just sucked. This little guy is now home after a long critical care hospital stay and multiple surgeries. He is breathing on his own, but pretty much completely unresponsive to anyone around him -- in a coma. Will he ever get better? I don't know, but I sure hope so.
The horrible person that didn't hit the brakes . . . well, he got home, and after an hour or so it was really bothering him, so he told his wife what he accidentally did, but that he didn't stop. She called 911 and he was arrested, with the poor kids blood on his bumper.
Well, ever since this day, Hattie, who is 2 1/2, is even more very closely watched when we are on our walks taking Sophie to and from school and during the almost daily trip across the semi-busy street to the pool.
What a nightmare and I sure shared some hugs with this poor pt's mom and sister. May this, or anything like it, never happen to any of you.

Gustav --- it's projections over time

Gustav as of Sunday PM:


Gustav Sat:
Despite this stating it's a category 3 hurricane, it's already a 4, and about to slam Cuba. 78 have already been killed.


These are not looking good for our already previously beaten coastline. Those Spaghetti lines sure are not leaving much room for doubt of where this thing is going to go.

Gustav as of Thursday Evening: Not lookin' good for the folks of Louisiana -- hopefully no catastrophes!

Spaghetti Models:

Gustav as of Noon Tues:



Below are the initial estimates:


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Below is the final map and course of our old Fay threat. It left a large path of destruction, tons of flooding and multiple lives have been lost. Thankfully, it turned just before it's track for our home and we were essentially completely unscathed by it here in the Tampa area.

Our First Hurricane -- dead on track for our house. . . and Tampa General Hospital.

It's not looking to good for us here in Tampa -- we're projected to be slammed by the eye of the to-be Hurricane Fay. I'm on at the hospital all the night that it's expected to hit, responsible for over 100 patients while "on call" (AKA: frantically running around the hospital taking care of anything that happens to any of the pt's) -- it's not going to be a very fun night if the place turns into a disaster area --- which is expected and the state has already launched everything as a national disaster zone.
Since I'm also an ER doc, we have the responsibility of trying to carry the load of any disasters and all of the messes that may occur -- so I may be at the hospital for several days. My poor wife, alone with the kids -- that's my real concern. She'll be fine, I hope, but it will sure be a bugger if the power goes out and the house ends up at 100 degrees with 3 kids. Wish us the best. Gracias!

I'm now an even older fatty

At 5:20pm, Australia time, marks the uneventful event of me coming into this world.

I have two incredible parents, one of which starts his mission today (congrats Dad!!!)and the other is doing her missionary work up above. I love my parents and they have have had to put up with a lot with me in my less-old-fart years.

Now I've got an amazing loving perfect and beautiful wife who has to put up with my onery whining and sarcastic nature. I love her with all my heart and despite her best efforts, I would not in any way let her get away with any kind of party today. I even blocked her bringing a big cake to the ER last night. Yippee!!!

We will be taking the girls to the Aquarium today, so, pending that I'm able to stay awake since I worked all last night, it should be cool and fun for us all.

If ya can't tell -- I started my own Blog

So -- since Lindsay has to hear me blabbering about hospital stuff or just about me whining all the time -- I thought it was time to start my own, completely useless, blog. I have no idea what will become of this, but I'll try it out and see how it goes.

I may only whine on here or I may post cool and/or crazy stuff from the ER I work in -- who knows . . . ?

Later-- James

For fam and friends -- our family blog, that Lindsay much more professionally does -- is at http://docbartlettfamily.blogspot.com/ and if you don't yet have access -- drop me an email at dr.bartlett@yahoo.com and I'll make it available. We just don't want psycho's stalking our adorable kids.

Trying to find a time to get the lawn mowed

I've been trying for 15 days to get the dang lawn mowed and this is what happens EVERY single time I'm home and it's not night time already. This suddenly started the moment I took the mower out of the garage. Geeze!



Yesterday I was extremely exhausted after a night shift and some kids came to the door, obviously noticing the length of the lawn, and the offered to mow it for 10 bucks. I agreed. I still can't believe that I paid some kids to mow my lawn! How pathetic, but I was so tired and it desperately needed to be done. Since I don't yet own a trimmer, they got off the hook and only had to mow. Oh well -- it still looks much better than it used to.