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Medical Humanities Section Newsletter - May 2010, Vol 6, #2


circle_arrow From the Editor
circle_arrow From the Chair
circle_arrow Wherefix
circle_arrow Skit for holiday party
circle_arrow I Hate My Beeper
circle_arrow Novice Skier Table
circle_arrow Starting a Fire
circle_arrow Teeny and Martha
circle_arrow Great Aunt G
circle_arrow Flying Tortoise Klismos Chair
circle_arrow Learning German in my fifties
circle_arrow Luigi Galvani
circle_arrow To Comfort Food
circle_arrow The Coffee Wars

Newsletter Index

Medical Humanities Section

MUSE – Winter/Spring Edition 2010 – Whimsy, Humor, Daydreams & Castles in the Sky

From the Editor
Peter Paganussi, MD, FACEP
Falls Church, VA

As we shake off the fading remnants of what was a very tough winter in most quarters, we look to lighten our step, brighten our mood and perhaps actually heighten our senses with the coming of spring. The promise of warmer and longer days can make the mind wander in the general direction of more self-indulgent pursuits. They may range far afield, or can be as close and personal as simple daydreams. This issue of the ACEP Section of Medical Humanities Newsletter is dedicated to this very ideal and to the proposition that all daydreams, and flights of fancy, are not created equal. There is definitely a lighter side to life and unfortunately some of us have to look harder for it than others. For those who fit that description think of this newsletter edition as a roadmap to the side of life where you can find flights of fancy that leave every minute, on the minute. For those who need little prodding into this mode, this edition will be just enough of an appetizer to get you ready for a proper main course. This analogy is appropriate as you read and gaze forth. You will note some common themes: food, caffeine, and a deep-seated sense of the ironic. These are all items that remain central to the very core of an emergency physician and to our practice.

Our work in medicine often exposes us to the darker side of human existence. On virtually every shift we get exposed to the seamy underbelly of life. There is homelessness, drug addiction, abuse, neglect, traumatic injury, and the lot for our psyche to absorb. This is to say nothing of the strokes, pneumonias, heart attacks, fractures, miscarriages, and more common daily woes that plague our species. It is a never-ending cycle of illness and misery. Thus, with this issue, the Section of Medical Humanities collectively implores our colleagues, in full chorus, to:

"Wipe off that "full of doubt" look,
Slap on a happy grin!
And spread sunshine all over the place,
Just put on a happy face!"

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From the Chair

Edwin Leap, MD, FACEP
Tamassee, SC

To the section,

My boys and I have a new hobby (not because we didn't already have five or six of them). We've taken up blacksmithing. Once each month, we travel to a guild in Tryon, North Carolina, and there spend the day with master smiths, pounding on iron around 2500 degree coal forges, trying desperately to make something beautiful, or useful, without burning it to pieces in the fire.

I love doing things like that. I never could build anything with wood, but I can twist hot iron, and I can hammer on a lovely, gray anvil. My children barely let me help them, "no papa, let me hammer it!" We've made arrowheads and leaves, horseshoes into the shape of horses, small devices to flip steaks and most recently (and treasured of all by boys), knives made from railroad spikes.

As I write this, my shoulders and hands still hurt from helping all of the kids who recently went with me (my three sons plus three more boys), as each made a knife. It's a wonderful combination: an art that leaves the body aching and the mind hungry for more knowledge, searching for more ways to turn iron into something more than simple gray hunks of metal.

So, it's with the forge, hammer and anvil in mind that I write to you and encourage you. Every art that we engage in is its own kind of guild, has its own tools, its own fire, its own masters and beginners. Every painter has had some guidance by someone who knew how to do it, and who desired to pass that knowledge on to another generation. Every writer who has written with passion, and has taken a risk, has experienced the hot fire of rejection. Every musician has tools, beautiful, melodious instruments on which to shape note and beauty and project them into the air. The metaphor extends to every art in which we find ourselves engaged.

Of course, as physicians in busy emergency departments, we bring a whole different kind of raw material to the arts we practice. Into the fire of our art goes laughter and suffering, thousands of conversations, millions of images of the body, and thoughts of the lives that inhabit those bodies. Into it goes loss and struggle, triumph and hope, exhaustion, anger, miracles and every other conceivable experience and emotion that we have stored in our mind's eye.

As you practice your art, be proud of what you bring to it. Use those things you know, those things you have in your mind and heart and hands. Cast them into the coals and pull them out; shape them, turn them, mold them. Sometimes the product will be burnt, or inadequate, or will look unlike anything you imagined at the start. But with time, and patience, with practice and guidance and a few burns, your art will be a thing both solid and beautiful; sometimes utilitarian, a thing that will outlive you by centuries. Sometimes a whimsical thing, light as a fairy, that will encourage someone or make them laugh; if only for a day. Like this issue.

Whichever it is, be proud. And don't give up. Like all of the different tools I'm learning to use by the forge, you each have a special gift to offer the world of medicine and the world of the humanities.

We look forward to the work you hammer out, not just for the humanities section, but for humanity.

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Gary Morneau, MD, FACEP


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Skit for holiday party 

Jeannette Wolfe, MD, FACEP
Springfield, MA

Emergency departments can be very stressful places. The overcrowding, high acuity, and long wait times can just make people downright cranky. Wouldn't it be nice to have a little something to help you out with all that chaos and those hot-blooded tempers? And face it- don't we all need a little extra help with those pesky little patient satisfaction surveys? Well, we are proud to announce a revolutionary new product that will help you take back control of your runaway ER. CAFFAMINE.

Caffamine starts with an organic fair trade coffee handpicked by fully vaccinated Columbians who volunteer all their free time to teach indigent school children proper hand washing techniques and advanced robotic surgery. Next we supplement the coffee's nutty aromatic full body taste with just the right splash of medicinal grade ketamine. It takes just an average of 2 sips, or approximately 10 cc's, for a hallucinogenic naive patient to become serene and appreciative.

Let's take a peek on how Caffamine performs in a real ER.

Patient Frank Sueyou presents to the ER after deciding to remodel his kitchen with a chainsaw after a busy night drinking at the Mardi Gras. Although he has a dangerous radial artery injury thus far his care has been greatly impeded by his inability to play well with others.

Skit (all done silently)
Joe is a pissed-off patient with bandage around his arm; he is starting to gesticulate in angry movements, swinging his beer can.

Howard goes over, attempts to examine him and then tries to calm him down; when Joe continues to escalate he blows a whistle.

Patient advocates (me and Jolie) come running over in blue coats with tray and coffee
Joe takes a few sips of coffee and lies back blissfully/smiling.

Howard smiles satisfyingly as well and then begins to unwrap his bandage and gets to work.

Notice that it just took a few sips of freshly brewed Caffamine to deescalate Frank Sueyou and allow Dr. Smithline to rapidly assess and treat him. Caffamine not only takes patients like Frank on an express train to their happy place but also helps doctors maximize the number of patients seen per hour and their departmental billing. This in turn facilitates excellent annual reviews resulting in high quality of life scores for over 80% of our customers with a full 75% also commenting on improved sexual prowess and regression of male pattern baldness.

Now although Caffamine has been clinically proven to have an immediate effect on 90% of the population there does appear to be two groups of outliers: 1) patients who have tolerance from a long history of hallucinogenic drug abuse; and 2) Arrogant and entitled consultants.

For these special groups we have developed a new product line called Caffamine PF. It contains our same base Caffamine product plus a specially formulated 24 pack of propafol-laced creamers.

Let's see how it works.

Dr. Bowtome has been asked to consult on one of his patients who appears to have a wound infection after an unnecessary surgery. He arrives to the ER irritated that one of the interns has parked in his designated parking space and upset that he might miss the second part of Miami CSI.

Skit: Bob is standing and really upset, looking at his watch, has chart in hand. Howard comes over to talk to him and within a few seconds Bob starts hitting Howard with chart; cowering Howard blows his whistle.

Patient advocates come running over with tray and coffee and makes dramatic deal of adding cream to coffee to hand to Bob.

Within a few seconds, Bob is blissful/smiling, patting Howard on his back and sort of swaying like one would in a pub with a beer mug (with his coffee cup).

Yes, amazing isn't it. These unbelievable results can happen in your ER too. Now, isn't it time that you took control back of your ER? Just call our friendly operator Peg Lynch now and we'll send you a trial pack of Caffamine and Caffamine PF for three simple payments of $199.99, which translates into just one hour of critical care billing.

Caffamine and Caffamine PF: Make a visit to your ER worth a trip.

(Matt talking in rapid fire- during this time skit below is happening)
Caffamine and Caffamine PF are not for everyone. Talk to your doctor before using if you have consumed more than 4 cups of coffee or approximately a Starbuck's grande mochacappucino in the past 24 hours. It also should not be used in patients with high intraocular pressure, head injury or seizure disorder. Caffamine PF should not be consumed by patients who are allergic to soy, peanuts or eggs or who know the entire dance sequence to the Michael Jackson Thriller video. Patients who have enjoyed our products should not operate heavy machinery until they can correctly identify their right hand from their left and they no longer believe they are at a Grateful Dead concert.

Caffamine and Caffamine PF- Make a visit to your ER worth the trip.

While Matt is talking, Bob (or Aaron as additional consultant if he is going to the party) snaps out of it and starts acting like a jerk again, Howard blows whistle, patient advocates come running over but Bob throws contents of coffee cup handed to him in the air. At this point patient advocates grabs him in half nelson and the other patient advocate squirts coffee into his mouth from the camel back.

End with Matt saying Caffamine, Because shouldn't a visit to your ER be worth the trip?

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I Hate My Beeper

Andrew Jacques, MD, FACEP
Akron, OH

I hate my pager. Not in the playful, joking sort of way, but in a deep loathing, "I want to throw you out the window and see you smash into hundreds of tiny pieces," kind of way. The shrill chirp of the beeper attached to my scrubs is enough to make my heart sink in an instant.

It didn't used to be this way. When I was in high school before cell phones became popular, beepers were so cool! Your friends could beep you and you'd call back. What could be better? Through college beepers were the things I saw doctors wear. My insatiable desire to become one of them made me covet the rectangular pieces of technology. In medical school, having a beeper meant you were a part of the team. Your senior could beep you to do an admission or to find out where you were so you could meet up with your team. Even my first couple of months as an intern when I did emergency medicine propagated the myth that beepers are cool. I wore it around like a beacon declaring my physician-hood, attached to my scrubs, ready to go off at any moment. Of course, it never did. No one beeps you in the emergency department, you're always right around the corner. At worst you'll be paged overhead if there's someone on the phone for you.

After spending months outside the emergency department and having heard my beeper chirp at me from 7:00 AM in the morning until noon the next when I'm on-call, I'm more than happy to exclaim my deep disgust of my beeper. It's not even the calls that bother me. Usually the matter is remedied quickly with a simple verbal order. On the occasion that I have to examine and assess a patient, they're usually sick and need attention or reassurance. I'm more than happy to provide both of those things for my patients. It's the incessant chirping of the bugger that nags at me.

So here's the positive side of the story. I'll only have a beeper for another two-and-a-half years. After that, working in the emergency department won't require being beeped. On one of my calls last month I received a 3:30 AM trauma call for a gunshot wound to the thigh. My curly hair was matted from an all-too-brief two hours of sleep, and my attending physician asked me if I was in fact awake. I responded with a tired yawn and the truth, "No." The patient had of course been minding his own business when someone shot him in the leg for an unknown reason. He left against medical advice when he learned that he would not die, had not broken any bones in his wounded leg, and simply needed to be washed out to cleanse the wound. I'm so glad my career choice has ensured that I'll have no 2:00 AM "Can I give this patient Tylenol for their fever?" beeps. And I couldn't be happier. Soon enough I'll be able to sing in the words of Pink Floyd "No more teachers, no more schoolbooks, no more crayons or erasers, … teachers leave those kids alone!"

I was watching TV a couple of days ago when a commercial aired with an alarm clock that sounded identical to my beeper's alarm. Needless to say, I won't be buying any yuletide fresh-roast Folger's decaf coffee anytime soon. Here's to you my beeper. Your execution by being flung from the helipad of the hospital has been stayed another 913 days.

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Novice Skier Table

Novice Skier Table, 1996, painted steel
Lee Robbins, MD, FACEP
Cooperstown, NY


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Starting a Fire

Jay Kaplan, MD, FACEP
San Anselmo, CA

Starting a Fire

starting a fire

 the question arises

            not when 
 to do so requires
            that which is to be burned
            the igniting spark
            air the feeder of the flame
 once lit
 it takes time for all to work together
 to catch and self-perpetuate
            creating comfort

so in me

 the stage is set and
 it is not I who is mixing the ingredients just right
passion is my fire
            hoping to bring spirit
                        a sense of possibility
                        a deep recognition of being loved
                        and beautiful and unique 
            to those (including my self) who come to sit around its light and warmth
 I ache
to truly belong in this world
to feel more fully than I could possibly imagine
that is my kindling
my pain at the speed at which I often move
the busyness of my most common day
the blandness of meeting all of the demands of everyone else
            not the desires of my own heart and soul
that is what now initiates the blaze
and breathing through my fear
keeps it going and nourishes it
what is burned
            perhaps bridges from the past
            visions of the future
            many present moments
            and the ripe imagination which fills each experience
            with sparkling intensity and vivid color
sitting in front of the fire
            now bright and full

it enjoying itself

and I myself

I am thankful
            grateful for this gift
                                    this moment
that the fire is being stoked


Fireworks in the distance
            sparks of light piercing the darkness
      failing to notice
            have I been so busy that the life light
                  inside is smoldering 
                          caught in the in-between

not in the darkness of the unknown
       exploring by touch the next steps
            pushing through the paralysis of being blind

nor in the fire of creative passion
      burning up
            feverish with feeling

Cannot always be in the one wished for

But to be in neither is to be dead     
even if the heart still beats

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Teeny and Martha

Lee Robbins, MD, FACEP
Cooperstown, NY 


When I was denied my earned sabbatical in "the era of managed care," I sublimated my frustration going to blacksmithing school in Santa Fe in 1996.

I now run Flying Tortoise Forge Studio in Hartwick, NY.

The tortoises on the horizon at the fair, Teeny and Marth,a are accompanied by my sculptures in resin also at the fair (I paid for med school selling resin paperweights and keychains to Bloomingdales and Neiman Marcus in the '70s). The mounting tortoises are in my driveway now and I was informed that the school bus monitor asked that I take them down due to comments daily as the school bus passes. Who'd a thunk?

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Great Aunt G

Kathryn Hall-Boyer MD, FACEP
Atlanta, GA

Great Aunt G

A couple months ago I was in California visiting my mother. She related a story to me and my son, Garry, a software engineer at Google. My Great Aunt G was never seen at home without a glass of water. Everyone in the family knew what she called "water" was spelled V-O-D-K-A. Apparently Aunt G was having some trouble with balance and consulted her doctor. He told her, "What you have, we call ATAXIA." To this Garry responded, "I thought when you were drunk, you should always call A TAXI."

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Flying Tortoise Klismos Chair

Lee Robbins, MD, FACEP
Cooperstown, NY


Flying Tortoise Klismos Chair, 2009, forged, cut, mig and tig welded and inflated steel

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Learning German in my fifties

Frank Edwards, MD, FACEP
Sodus, NY

Learning German in my fifties

I imagine myself in a real Bavarian restaurant
Sitting across from the sweetly crisp-voiced Fraulein
Of the language cassettes I studied for a year in the car,
Confident I can ask where the bathroom is,
Request a menu and consider the schnitzel,
Skilled enough even to inform her that it rains and snows a lot
Back where I come from,
And last but far from least
To order us a bottle of good red wine.

She, in turn, can inform me that her profession is that of a teacher,
And that if I drive straight ahead and go right at the light
I will find the post office on the Mozartstrasse,
And I will smile in complete understanding.
But much beyond that
The silences would grow like shadows.

I'd look out the leaded panes of thick old German glass
At the Bavarian peaks
And remember the softer Vosges Mountains
In Southern France
Where I'd wandered once,
Staying in an old Inn and waking at dawn
To an astonishing foot of snow
Fallen during an April night,
How I'd left my young wife
To her dreams in the deep bed
And hiked far uphill along a tiny brook
Where the stems of yellow cinquefoil
Were trapped in plates of ice.

I would turn from the window then,
Catch the gaze of the lovely Fraulein
(Those eyes like lilting umlauts)
Wishing to tell her of this
In her mother tongue.
But I could no more call it up
Than I could have fought the pull of earth that day
As back down the snow-covered slope I ran
In skidding leaps,
The distance between poetry
And directions.

I think I shall let her choose dessert.

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Luigi Galvani

Luigi Galvani – (1737-1798 Bologna, Italy) – The Father of Bioelectricity
Peter Paganussi, MD, FACEP
Falls Church, VA


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To Comfort Food

Edwin Leap, MD, FACEP (Section Chair)
Tamassee, SC

Multi-trauma, fall from height
'scuse me while I grab a bite!
Pain pills, nerve pills, work releases,
think I'll order several pizzas.
Transfer forms, administrators,
I love deep fried green tomatoes!

On call back up, what a joke!
Where the heck's my Diet Coke?
Suicidal, taking crack,
pick me up a Jumbo Jack.
Man in shock, has a STEMI,
great big cup of Southern sweet tea.

IV, airway, heart-rate low,
salsa, chips and warm queso;
partner sick, I'm staying late,
honey, bring a dinner plate!
To get me through, make me smile
and comfort me with food a while.

If I'm not home in bed a'sleepin',
the next best thing's to here eatin:
Subway sandwich, pretzels salty,
doughnut, hummus, edamame,
sushi, egg-roll, shrimp lo-mein
fried-egg sandwich (on whole grain).

Chicken nuggets, blt
all bring joy (and mass) to me,
'cause when this job is dark and wacky,
inevitably I feel snacky.
However hard the days and nights,
I'm happier with every bite.

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The Coffee Wars

Peter Paganussi, MD, FACEP (Newsletter Editor)
Falls Church, VA

The Coffee Wars

Port-Of-Call, Baranquilla, Colombia: Pablo and Javier are loading canvas bags into a large shipping container. They are both dripping sweat on this horrifically humid night in the southern tropics. It is 3 a.m. and they are working quietly, all the while looking over their shoulders nervously. The docks are mostly quiet now and they have paid off the night watchman to "look the other way." One hour ago they gave a bottle of tequila and a carton of American cigarettes to the two young dock attendants who are now passed out drunk on some banana bales behind them. Pablo and Javier still have great fear of the government authorities, La Policía Nacional de Colombia, who may pounce at any minute. Their eyes meet. There is fear and then a newfound sense of urgency as they begin to work faster. Soon the container is full of the canvas bags. As they stuff the last two in, they swing the metal door shut with a sense of relief and finality. Stenciled on the back are the words, "Medical Supplies…USA." The bill of lading lists the receiving port as "Port of South Louisiana."

Pablo leans back against the container and smiles. He reaches into his pocket and pulls out a weathered pack of cigarettes. He offers one to his associate who nods, accepts the smoke, and mutters "Gracias." Pablo runs a wooden match across the back of the metal container and lights their cigarettes. They both draw in deeply. Pablo blows a big smoke plume up and into the steamy night. Javier seems to hold his a few seconds longer, then slowly exhales through his nose looking not unlike that maniacal bull from an old Bugs Bunny cartoon. He flashes a gold-capped tooth that seems too bright for such a dark place.

"Say a prayer today amigo, that we can get this shipment past those hijos de putas, otherwise we're out a lot of cash," Pablo declares.

"Don't worry colega, my faith is in el Jefe. There is too great a need for our "product"…there is no farmacia in the States that can provide them with such quality…" Javier's voice trails off for a moment, "…or quantity."He finishes with a soft chuckle.

"What do we do with the others?" asks Pablo.

"I almost forgot about them." Javier begins to walk around to the other side of the container.

As they round the dark corner two seated figures and a muzzled burro, on its side with legs tied, come into view. They are all bound and gagged. They appear dazed and disoriented, especially the burro.

Just then an electronic chirping sound pierces the dark stillness. They both jump and Pablo nervously waves an Uzi that he quickly pulls out of a nearby backpack.

"Dios mio, amigo…it's my cell. I forgot to turn it off," says Javier fumbling for the phone.

"It's el Jefe. Silencio!" Javier pauses and listens intently over the phone. He looks around once with a scared and worried look on his face. He swallows slowly and looks at Pablo and rolls his eyes. He motions to the prisoners.

"Si, Jefe they are here. The lady Mrs. Folger and that man…what's his name…ValdezSi, Jefe...Si… and the burro too. I will make sure they arrive safely. Yes we have switched the containers. You will get la material. It will all be there. No one else will be able to get their hands on any. You have cornered the global market Jefe. Soon those idiotas will be begging you to lift the ban. Then you will have them by los conojones." Javier's voice trails off. "Si Jefe, we will make you proud." He closes the phone and motions desperately to the bound prisoners, "Quickly Pablo, let's get them on the boat…and I'll make sure the containers go to the right places…Vamos, colega."

Almost a hemisphere away, in a suburb of Chicago known as Oakbrook Terrace, a dark figure closes his cellphone with a flip and places it in a bottom drawer of his heavy wooden desk. He locks the drawer with a key he keeps on a rather sizeable silver chain around his neck. He looks around and glances nervously at the clock above the door. He reaches across his desk and punches a button on the intercom.

In a wheezy, raspy whisper, the figure speaks towards the machine, "Dante, hold all my calls."

"Yes Mr. Phisto" comes the reply.

Marcus Erasmus Phisto (aka M.E. Phisto) was sitting in his palatial office at One Renaissance Boulevard in Oakbrook Terrace, Illinois and nervously tapping his long, sinewy fingers on his ornately carved mahogany desk. He hoped this shipment would be routed properly through the Port of South Louisiana. He would make sure there were trucks there ready to transport the ill-gotten cargo north up to the Chicago area.

Marcus thought, "Even I can't believe how cruel this scheme is. Of course there was The Inquisition, but I never thought I should be held solely responsible for that one…" His thought trails off as he fumbles around looking for his coffee mug. It was right behind his black eight ball, a toy he loves dearly. His coffee mug is red and has "The devil made me do it" scrawled on the side. He takes a long draught off the cup. A touch of the dark brew slithers down from the corner of his lip. It heads for his chin. He doesn't bother to wipe it away.

M.E. Phisto, Esquire had recently staged a corporate coup and somehow managed to become C.E.O. of The Joint Commission (TJC, formerly known as JCAHO). He had by some diabolical means cast a kind of a strange "spell" over them at the last Board of Directors meeting. They then unanimously elected him C.E.O. No one really knows, or remembers how he wormed his way into TJC. Rumor had it he had been V.P. at Enron, but no one could ever substantiate it. Despite all this, things were just peachy at TJC. Hospital Administrators cowered in fear at the mere mention of the acronym. TJC has always wielded ungodly amounts of power over the health care industry. Their power and reach seemed to be growing every day. Since the arrival of M.E. Phisto the TJC employees have never seemed happier or better cared for. It was all just as he had planned, and now, well, now he stood on the brink of the ultimate coup. All the pieces were in place and the game had begun. The board was in play and he would see this deadly and devilish game to its conclusion. He was hell-bent. He chuckled at his appropriate analogy.

For you see, using the cover of TJC, and the organizations' edicts, M.E. Phisto was slowly cornering the worlds' market of coffee beans. Ever since TJC put forth its "recommendation" that no hospital personnel, in sight of a patient(s), should be seen eating or drinking…anything. The eating part most ER Docs could understand, but the drinking? This was a bit over the top, and certainly could wreak havoc with the US health care infrastructure since it is largely held together by that dark Colombian brew.

Well, thanks to Mr. Phisto, the edict had the desired effects. Hospital personnel across the country were wandering around, aimlessly, with glassed over eyes and far-away stares. Emergency departments everywhere were floundering. Emergency physicians all across America were said to be muttering and drooling, at least more than usual. The wait times were becoming ridiculous. Nerves were beginning to fray. Even Katie Couric was talking about it on the Evening News. The health care safety net of the United States was shredding and giving way. Soon Phisto would have the grandmotherly Mrs. Folger, the supercilious Juan Valdez plus his famous little burro and they would be preparing the coffee for the workers at TJC…and only for TJC. Only TJC would have coffee, all the coffee and the coffee makers as well. Soon the health care system would be at its knees, begging for mercy…begging for coffee to refuel and stoke the fires of progress again.


In a dark parking structure, about 2 clicks east of TJC Headquarters, a small group of emergency physicians gather. They are dressed in black scrubs, wearing black wool-knit caps, and have lamp-black smeared over their faces. They each have a coil of garrote wire protruding from their back pockets. They are kneeling in a circle and looking at an architectural schematic of an office building. There are a variety of grappling hooks, coiled ropes, and mountaineering equipment scattered about. These brave warriors are members of an elite team of dedicated emergency physicians whose mission it is "To Promote and Protect the Interests of Emergency Physicians and the Patients They Serve." They are a crackerjack mercenary squad from Quantico, Virginia representing Virginia ACEP. They are preparing to storm the TJC building, free Mrs. Folger, Juan Valdez, Bobaloo (the burro), and perhaps more importantly, they are here for the coffee. But something, or more pointedly someone, is missing. They are waiting for their leader. As good as they all are, they need someone to galvanize them, someone who has experience in such things, someone who has the skills and leadership necessary for such a dangerous mission.

Suddenly, dropping from the ceiling like a stealthy ninja comes their anxiously awaited leader. He lands right in the middle of their convened circle. He looks around at each of them as he slowly scans the circle nodding in both approval and encouragement.

They all intone simultaneously "Thank you Chuck Norris!"

"No…thank you VACEP!" comes his husky reply. "Now let's go get some coffee."

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This publication is designed to promote communication among emergency physicians of a basic informational nature only. While ACEP provides the support necessary for these newsletters to be produced, the content is provided by volunteers and is in no way an official ACEP communication. ACEP makes no representations as to the content of this newsletter and does not necessarily endorse the specific content or positions contained therein. ACEP does not purport to provide medical, legal, business, or any other professional guidance in this publication. If expert assistance is needed, the services of a competent professional should be sought. ACEP expressly disclaims all liability in respect to the content, positions, or actions taken or not taken based on any or all the contents of this newsletter.

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