psycho tiller

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About psycho tiller

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    Anarchist

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    On the floor, I've fallen and can't get up.
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    Not the floor

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  1. psycho tiller

    Stay the fuck out of the ER unless you're having an emergency

    So glad trump sidelined and muzzled Fauci too. Fauci, the guy who's served as the NIH infectious disease doctor since 1984 under both republican and democratic administrations. The guy who according to wikipedia: "From 1983 to 2002, Fauci was one of the world's most frequently-cited scientists across all scientific journals." The guy who In 2008 President George W. Bush awarded Fauci the Presidential Medal of Freedom, the highest civilian award in the United States, for his work on the AIDS relief program known as PEPFAR. And not to mention (though looks like I'm about to) for many years was also the first author of THE source for internal medicine "Harrisons Principles of Internal Medicine". Harrisons is similar to what google is to search engines, it's widely considered the most complete source. All you have to say is 'Harrisons' and anyone in every field of medicine will know exactly what you're referring to. Not only was Fauci first author but he also wrote the chapter on infectious disease. So Fauci actually DID write the book on medicine. Too bad that Fauci guy turned out to be such a loser, thank sweet baby lord jebesus trump was able to see what no other administration could see over the last 36 years. Fauci is a loser who doesn't know anything. I mean, he's not even first author of Harrisons anymore, just a lowly 2nd author.
  2. psycho tiller

    Pro start on watch?

    Putting my early request in for special 'DFL and OCS warning technology' where you'll hear the unit say "You may ask yourself how did I get here" "And you may say to yourself My God, what have I done?"
  3. psycho tiller

    Stay the fuck out of the ER unless you're having an emergency

    I've always been fascinated with Vancouver and moving there was a serious plan B during the election! Licensing could be a hassle but I'd never say never. Legally I think the terminology of the EMTALA law is we're obligated to provide a "medical screening exam" by a physician or PA. "Medical screening exam" is open to interpretation and about 15 years ago the University of Chicago Med center ER tried something similar to what you're describing. Patients were briefly seen by a provider and if it was determined to not be a true emergency they were given an appointment in an outpatient clinic within a couple days or so. It was a great idea but they apparently got in a lot of trouble for doing what seems entirely reasonable and were forced to go back to the old way of doing business.
  4. psycho tiller

    Pro start on watch?

    Velocitek has yet to confirm but rumors have it every second for the first 9 seconds you'll hear Chuck D say "Fight the Power" and at the start signal you'll hear Flavor Flav say "Yeeaaahhh Boi!!! Next years unit is rumored to play NWA's song 'Straight Outta San Mateo"
  5. psycho tiller

    Stay the fuck out of the ER unless you're having an emergency

    Bit of a rambling response below, settle in or just walk along to the next topic. Must be the Thanksgiving turkey tryptophan settling in. For most people Urgent care is definitely the best way to go for a covid test. Many (most?) areas also have county or state run drive through sites. Unfortunately right now in my area and probably many other places it's getting so busy the UC's and the county testing sites are at capacity and turning people away so they have nowhere else to go if they need a test except the ER. When those places aren't able to take anymore patients they tell everyone to go to the ER, or in Monkey's case when there wasn't anywhere else to get tested. This is a perfect example of everything that's right and also everything that's wrong with the ER. We're simultaneously a safety net and a dumping ground. By law we aren't able to turn anyone away in the ER and in many cases that's a good thing. If you're having a heart attack, stroke, life threatening infection or as the TV ad says "an erection is lasting longer than 6 hours" but don't have insurance or a penny to your name you deserve to not die or have your dick fall off, and in some cases despite yourself . I don't get paid a single dime for saving your life (or your dick) but that's just fine, it's part of the job and I'm happy to help. But once again the road to hell is paved with good intentions. With our legal (and moral) obligation to see everyone what's happened is we've also become the dumping ground for not only society but the entire medical community. You call your primary care doc and he can't see you because his schedule is full or it's 2am or he doesn't know how to help you or he just doesn't like you because you're a pain in the ass, guess what he or she will say? "Go to the ER". If you don't have insurance, money or a primary care doc but you have a cough or your blood pressure is high the ER is unfortunately the only place you can go. When the cops get a bunch of calls about a drunk guy passed out in the bushes pissing on himself in front of your favorite French restaurant they dump them off in my ER too. The problem is until we see you we don't know if you're having a life threatening emergency or not so we have to assume everyone is having an emergency until proven otherwise. So, when a new patient comes in and I'm in the middle of seeing a guy with a heart attack we need to take time away from that guy to make sure the drunk is really just drunk and not having a massive hemorrhagic stroke. Unfortunately you can be both drunk and suffering a hemorrhagic stroke at the same time too. Although it's not common, being drunk and having a stroke (and similar situations) happens more than you'd ever think possible. The other problem is that sick people are often the most quiet and easy to miss. They don't complain if they've been waiting too long. They feel so shitty they curl up in the corner and don't say anything. Think of a time when you were at your sickest, maybe even just a really bad case of the flu or similar. Did you have enough energy to complain or did you just want to curl up in a ball and die? Most people want to curl up in a ball and die and they don't say a word. But you can bet the person with a common cold or the person who's in the ER to get their narcotic pain meds refilled is bitching and complaining because it's taking too long. I have a friend who's also an ER doc, he had really bad abdominal pain when he was out of town and went into an ER. They sent him home, he knew something wasn't right but he felt so shitty he just wanted to get the hell out of there, go home and curl up in bed. He ended up going back the next day and it turns out they failed to diagnose his appendicitis and by the next day it ruptured. This isn't an editorial about the lack of care he had because shit happens and even just common human pathology can be incredibly complicated at times. Any ER doc (any physician for that matter) who says they don't have some skeletons in their closet is either on their first day or lying. Those skeletons can psychologically eat you alive for years too. The worst thing to ever hear from one of your partners is "Remember that patient you sent home the other day?" Think about the comparison of the ER model of business with a restaurant or any other form of business. You don't need reservations, you don't have to pay and they can't turn you away no matter how busy they are. And if you're really hungry but there's no tables and the kitchen doesn't have time to make your meal or ran out of your favorite dish? Too bad, they better figure out how to make it happen and mistakes are not allowed. One of my partners said it best, "In the ER we see normal people having their worst day ever and the worst people having their normal day" I agree, but it's going to be an absolute mess and complicated for the first few years. There will be thousands and thousands of people looking for primary care doctors but there aren't enough and they don't grow on trees. Once again they'll all end up in the ER looking for primary care that we can't really provide and take our time away from the sick patients. Over time this will hopefully correct itself but for a few years it's going to be an absolute mess. Still worth it in my opinion but many others would disagree raising some valid concerns.
  6. psycho tiller

    Stay the fuck out of the ER unless you're having an emergency

    Those too! Apparently old habits die hard. What people put in places where they don't belong is limited only by the imagination. I once pulled out an apple. Apparently an apple a day keeps the doctor away didn't quite work out in that case.
  7. psycho tiller

    Stay the fuck out of the ER unless you're having an emergency

    Apologize to everyone for my very salty original post, went on a bit of a rant there. I feel better now though so I'm back to dick and fart jokes for the time being. For most of us it sure is. My surly attitude doesn't come cheap! Unless you have federal insurance due to low income like Medicaid or Medi-Cal, then it's free which leads to a problem with some people abusing the ER for convenience. Like most good ideas and good intentions a small percentage of people take advantage of the situation. That's a whole other debate and complex problem though...
  8. psycho tiller

    Pro start on watch?

    Flavor Flav came up with a work around for this in the 90's. Not sure if he's still on Sailing Anarchy though.
  9. Probably just pissing in the wind but going to attempt a PSA from your unfriendly neighborhood ER doc. Don't come in to the ER just because you want to get tested. All known positive covid as well as unconfirmed possible covid patients get placed in the same part of the waiting room known affectionately as 'covid corner'. You know what that means? If you came in thinking you might have covid but actually don't you've just been exposed to about 10 other people who actually have it. Go back to start, go home and quarantine for 2 weeks because you've just been exposed to multiple people with covid even though your test today was negative. Fuck it, don't quarantine because even though you should I know you won't and you'll go out and probably unknowingly spread it to a bunch of other people. If you actually are positive and you come in for stupid shit you've just exposed a whole bunch of other people, including your neighborhood unfriendly ER doc, nurses, other patients and everyone else, including the 4 nurses in my ER who tested positive in the last 2 days and the local primary care doctor who caught the rona a week ago. That same primary care doc came in last night in respiratory failure and is now in the ICU. If you feel like you can't breathe and are worried you need to be hospitalized and need supplemental oxygen come in and see us. If you just want to know if you caught the rona go somewhere else like a drive through testing center. I can't speak for anywhere else but in my area I think we're a day or two away from falling over the covid cliff. To put it in strict medical terms we're fucked. I've been doing this job for a while now and I've seen some shit. Like all ER docs it takes a lot to make me nervous because I'm burned out, callous and don't give a shit anymore (I'll always do the right thing medically for you, just don't expect me to smile and be nice). Covid has blown up so bad in just the last week I'm now officially and seriously afraid of what is inevitably about to happen. I have no idea how we're going to handle the surge of patients that's about to come because our hospital and the others in our area are already full. It's inevitable at least one of us ER docs is going to get it and I have no idea how we're going to cover his or her shifts when that happens. This is as bad as I've ever seen it and I see no answers coming in the next few months. Never thought I'd say this but I yearn for the days when I only had to worry about how to pull another dildo out of some idiots rectum. Another free PSA: It's easier if you wait for the batteries to run out before you attempt removal.
  10. psycho tiller

    what’s missing? on front page

    Every. Damn. Time! The only thing worse is when I'm getting my assed kicked and I wrongly assume it must be an E bike only to find out it's not and I'm once again reminded I'm not getting any younger, prettier, skinnier or stronger.
  11. psycho tiller

    what’s missing? on front page

    My time in that particular E-bike Anarchy forum was very short lived. Apparently 'fuck off newbie and show us some tits' doesn't go over so well in other forums. Weird, I always thought that was a universal greeting. Guess I need to get out more and stop listening to the juvenile delinquents around here
  12. psycho tiller

    what’s missing? on front page

    Not in races (yet) but there's definitely some controversy as E-bikes become more popular on bike paths and mtn bike trails. Your question was likely rhetorical but some interesting parallels nonetheless. Can't say I'm a big fan of sharing my mtn bike trails with E-bikes when I'm huffing and puffing as I peddle my fat ass uphill only to be passed by someone smoking a cigar on an E-bike. Especially as the trails become more crowded and overtaken by them. Not to say E-bikes arn't really cool but where they belong is yet to be sorted out. If someone could kindly point me in the direction of E-bike Anarchy I'll let myself out.
  13. I agree with everything you wrote. There's also a lot of value in bringing on a newbie crew member to a team. You can teach them to do things exactly the way you like it done and they'll typically be very loyal to the team for a long time. In this specific case and thread I think some of the animosity is being driven by the fact that this is the 2nd time he's showed up and posted a video then disappeared. Although it's just based on assumptions which could be wrong it seems fair to read into that as someone who's here for click bait YouTube fame and really has no interest in learning anything. Putting that in a real world analogy it's a little like someone saying they really want to learn to sail so you take them out on your boat. But then every time you take the time to teach and explain things they just walk away, take another selfie on your boat and post it on social media. Then once you get back to the dock they just walk away without saying anything. The first time they do that you might just brush it off and let it go. Then they come back a 2nd time and do the same thing.
  14. And the follow up to that: "Me and my dad bought a nuclear reactor, here's our attempt to put out the fire after it suffered a melt down."
  15. Darn, hard to ignore the facts you bring up and I sense we're on the edge of a classic SA revolt. Hoping I have enough popcorn for this one.