<strong>THE FAT MAN, MOVING DOWN THE WARD</strong><br/><br/>The Fat Man stroked his chin and nodded quietly as he heard out Markum and Boss.<strong>"Thank you, I'm starting to hear some good suggestions from you both, and I'd like to stop you right there,"</strong>he smiled at both. He acknowledged Mox with a grin and a wave.<strong>"You're absolutely right, Markum. We've only recently extensively examined Mrs. Staudemeyer and come to the conclusion that she is, in fact, an old lady with the usual symptoms. The best treatment for most of them is to do nothing. It's very easy to make things worse."</strong>The resident doctor pulled on a pair of rubber gloves and ran a finger over the skin of the patient's forehead.<strong>"And Doctor <em>Boss</em>, you're right that uremia is one of the most usual and obvious geriatric conditions. So, we make sure her catheter's in right, the pee bag isn't full, and maybe give her some Lasix to increase the flow."</strong>He added a large dose of Lasix to the list of prescribed medications in her chart, and passed them on to the interns to take a look at. Then he lifted the covers and showed them how a catheter was meant to stick out of an old lady's urethra. Jackson gritted his teeth at the sight of the grayish octogenarian vulva. He sighed softly with relief when the Fat Man lowered the covers again.<br/><br/><strong>"Mrs. Staudemeyer is what we know by a technical term as a GOMER. Or rather, a <em>gomère</em>, the feminine version. GOMER stands for Get Out Of My Emergency Room. It's what you say when one comes in from the nursing home at 3 a.m. It means an elderly, senile patient who continuously shows emergency symptoms, gets treated, made a little better, then shows emergency symptoms again, then gets a little better. With the miracles of modern medicine, we can keep a patient like that alive forever. Eventually, the patient stops seeing the point, but not the finance honchos cashing their insurance checks. It's the First Law of Medicine. LAW ONE: GOMERS DON'T DIE. <br/><br/>The idea with this kind of patient, as with any other, is to treat anything dangerous as mildly as possible, so we can continue doing nothing and they can get better. Proper healthcare consists of bedrest until complications arise. Write that down."</strong>Jackson was already taking notes.<br/><br/>Turning around, the Fat Man gestured towards the empty bed beside Mrs. Gomere. Now he was in the flow of Breaking In The Terns, he gushed with enthusiasm, speaking quickly with grandiose hand gestures.<strong>"Now for quick demonstration and guided tour of the beds we use, folks. And say hi to Dr. David Harris, "Mox" as they called him back in 'Nam, he'll be helping me supervise you. Looks like he's already closely supervising Markum and Montero. There'll be time for proper introductions later. You see these rails on the side of the bed? They keep patients from falling out, but don't help much. That's unfortunate, but takes a lot of gomers off our hands and makes them someone else's problem. LAW TWO: GOMERS GO TO GROUND. They fall out of bed, often break bones, and have to be TURFed out to Orthopedics. Don't be afraid to TURF as soon as a patient isn't your problem; a good doctor makes as little work for himself - or herself,"</strong>he added with a wink at Markum and Montero,<strong>"as possible. This is what we call the Orthopedic Height, and sometimes you'll have to lower it."</strong>He quickly demonstrated how to raise and lower the bed; the patient could be lifted up to six feet high.<strong>"This is what we call the neurological height, because a fall from up there is an instant TURF to Neuro for a cracked skull. Avoid that TURF if you can."</strong><br/><br/>He moved the team along from the empty bed to the next patient along, a Mrs. Vanessa Golding, as marked on the bed. A young woman who looked tired and confused, as well as in some discomfort due to the tube sticking out of her chest and slowly dripping into a bag.<strong>"Montero, your turn. Check Mrs. Golding's charts. As you see, she's had the chest drain in for two days."</strong>Her chart and the bag of milky-clear fluid on the end of the tube supported this.<strong>"What do you think we should do next?" </strong>he asked, moving over to stand between Cliff and Bob with a gesture to the side of the patient's bed.<br/><br/><br/><br/>