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    After my last diary, I was somewhat discouraged. So much so that I was going to give up writing diaries for a while. Then I done went and watched afternoon cable television news yesterday and, well, here I am. Pissed off again. I suppose if I were to diagnose myself I'd say it's not unlike the joke where the guy runs up to the doctor and says, "Doctor! Doctor! It hurts every time I do this!" usually doing some motion with his arm. The doctor turns to him and says, "Well then stop doing that!" So why would I bother with another diary? I suppose it's something that gives me the allusion that I'm actually doing something good with all that rage.

     Believe you me, I've done enough navel gazing lately to fill an encyclopedia with my thoughts on this matter, (Encyclopedias were the way mommies and daddies used the internet back when dinosaurs roamed the Earth.) I'm constantly asking myself why I feel driven to write these stupid diaries lately.  I try to write like over a million viewers will see what I have to say about the ignoramuses that populate the Right Wing of the Republican Party. I realize I may be kidding myself, but I gotta believe here. I have to write, it seems, because I feel like the last time I just sat back and let a bunch of stupid Texan redneck fucks railroad this country into a war,  it cost me very dearly. I won't rehash that whole issue. If you want the details, go back to one of my diaries from last August. I explain it in more detail there. You'll forgive me if I don't rehash it here. Suffice it to say it's a sad story.

     But, I'm moving forward and trying to learn from my own mistakes. So what was it today that has purpled my nerple? Was it the cable news networks orgy of obsession with Michael Sam's PDA with his boyfriend after he was taken in the seventh fucking round, of the NFL Draft? (When he shouldn't have gone any later than the second! And shame on the concerted efforts of the NFL, NFL Network, ESPN and every other commentator out there that publicly downplayed Sam's abilities to give cover to the fact that the NFL is homophobic at its core. But see, if they don't draft the SEC defensive player of the year because he sucks, well then that's OK. Who's the one needing a beard now NFL.) Surprisingly no. Was it something The Five (Combined I.Q. Points) said today on their show? Perish the thought! Was it Rush's latest bigoted rant that he regurgitated all over the nation's amplitude modulated airwaves today? Not even that was enough to raise my ire. Nope, It was Florida's own Marco Rubio lecturing us (well, the smart people in the GOP refers to us as norms,) on Global Climate Change, but then again you'd know that if you read the title.

Dateline Knob Noster

Disclaimer:    I'm about to do something that I've tried very hard not to do throughout my medical career. I'm about to start heavily using medical jargon. I do so not in an attempt to obfuscate nor to aggrandize myself to seem smarter or by lording any knowledge I may have over anyone. I suppose I'm comfortable enough in my own skin to not to have to put anybody down in order to build my own ego up. Every job has its own jargon, medicine's just raised it to a Zen like art form. Believe it or not, I'm just trying to make a larger point unrelated to the jargon. And no fair for you doctors, nurses and sundry other medical professionals out their to ruin the fun for everybody else.

     Perhaps a bit of perspective is needed first. We have Marco saying on This Week with George Stephanopoulos

Q: Let me get this straight: You do not think that human activities production of CO 2 has caused warming to our planet?  

Rubio: I do not believe that human activity is causing these dramatic changes to our climate the way these scientists are portraying it. That's what I do not...And I do not think that the laws that they propose we pass will do anything about it except that it will destroy our economy.
Marco Rubio, This Week with George Stephanopoulos, ABC News, 11 May, 2014

And possibly an even more aggravating line produced by one who can nary afford to risk coming across as a wee bit on the stupid side. amateur
But what I think from the left, I get a little tired of is this idea that, the sanctimonious idea that somehow science has decided all this and so therefore you can't have a view.
Jeb Bush, Cavuto (or whatever he calls his show, who cares), Faux "News" August 23, 2011
    Let's face it, everyone in that sack full o' assholes who think that they want to be the GOP's nominee for the 2016 Presidential race, have, at one time or another, expressed the notion that they know more about catastrophic global climate change, or evolution, or any other field of scientific knowledge than do the scientists who actually study it. And where's their fig leaf coming from for this little fashion show in Stupid Town? Why from the same sort of assholes that provided the very sane fig leaf for the Tobacco Industry. The one that they used to deny, with a straight face, a connection between smoking and cancer, heart, lung and circulatory disease for years. These are unscrupulous little fungal balls that sell their alphabet soup of degrees that they have behind their names in order to pick up a big payday spouting whatever male bovine fecal matter that their puppeteers back at corporate want them to say. And why not? You get to travel first class (business class at least.) You get to go on television a bunch because when you're in that big of a minority, you're opinions are sought out. I don't know why, but TV just loves assholes that have the gall to go before the American people and tell obvious boldface lies to the public's face. Go figure.

     So to that end, let's try a little experiment here to illustrate just what these guys are doing, so...

     A sixty three year old white male presents to the emergency department in obvious distress c/o UM quadrant and midline c.p. He is also c/o lower back and "scrotal" discomfort. The pt is diaphoretic and tachypneic at present and is c/o SOB. He had an admitting RR of 24 bpm, temp 39.1° C, and bp of 160/110. Despite the pt's c/o's he is alert and oriented X3, although he speaks in shortened halting sentences. HR is tachy @110 but he is in SR at this time. SaO2 is 91% on NRB mask, PEARL, some JVD on the R side, with no bruit noted. Upon auscultation of the chest, diffuse moist rales and rhonchi were heard t/o both lung fields of the chest with some possible crackles heard t/o both bases and the RML. Upon auscultation of the heart, there was a lateral displacement of the apical beat noted and a marked splitting of the S2, a pronounced S3, and a possible Grade 3 murmur was also appreciated. There is a distinct rub also heard in both bases bilat. Some tenderness was noted in this area as well although this might very well be referred pain. The pt's c.p. does not appear to be pleuritic in nature and is unrelieved by the administration of O2 therapy or sublingual nitro. The trachea is midline with no shifts or deviations noted. The pt has a moist, but so far, largely N/P cough. What little sputum there is, is pink and frothy with no frank blood seen in the sample. A specimen was collected aseptically and was saved for a possible later C & S. There was some noted pitting edema in both lower legs bilat.

        AP & lat CXRs shows vascular congestion t/o both lung fields and distinct cardiomegaly  Kerley B lines were also seen on the film. Some medisteinal widening was also seen on the AP view. There is obscuring on the film of the costophrenal angles. ABGs shortly after admission were pH 7.21, CO2 52, O2 57 (on 5 lpm n/c), HCO3 18. B.S. 158. Other labs were ordered and results are pending. EKG on admission showed a sinus tachycardia, rate 110 bpm, with some possible ST-elevation seen predominantly in leads II, III, and AVF. Precordial leads show a pronounced left axis deviation, most probably due to previously undiagnosed LVH. There is some widening of the QRS complexes. UA shows a concentrated dark straw sample with sugar and protein leaking which is consistent with the pt's admitting BS and possible undiagnosed DM II. Other labs are drawn and pending at this time.

     The patient was transported to this department by ambulance and states that he's a veteran of the Viet Nam war. He is presently without housing and denies having seen a doctor since dismissal from the armed services although he had been attending AA meetings and was on a waiting list for substance rehab services. He also denies any serious medical problem until earlier today when pain, that he states started in his lower back and pelvic region, later progressed into his chest and upper abdomen.  He was no longer able to conduct his ADL's and was later reported to the police who in turn had him transferred to our facility. The pt admits to being a 45 pack/year smoker, and is waiting treatment for EtOH abuse through the VA. He claims to have had aprox. one fifth of gin earlier in the day and prior to development of symptoms. Otherwise he denies any other substance abuse in the last 24.

     Now Dr. Rubio, Dr. Bush, get to it. You guys are the ones who think your so God Damn much smarter than all them thar "si-in-tests" what with all theys dang high palutin' book learnin' and all. Comin' 'round chere, puttin' on all they's airs, actin' all high and mighty and such.

     Get the fuck on it you guys! Tell us all what's wrong with this poor sap who's unlucky enough to get you two amateur assholes for doctors. Tick fuckin' Tock guys. Get up off your asses and diagnose this guy! You both thought you knew more than climate scientists about global climate change, how 'bout saving this poor vet. I gave you both all the information to at least point you in the right direction. I'd give ya partial credit for just calling in the right consult. Does this guy need a cardiology consult. Does this guy need to go to the cath lab STAT, or do we need to call in a thoracic surgeon, anesthesiologist  and perfusionist to set up? Or, do we just need to give this guy some Tums and send this malingerer on his way? This guys life might very well depend on what you do now you assholes. And, maybe more important to you two douches, quite a bit of money will be spent depending on the professional decisions you two numb nutz make right here, so what's it gonna be? Do we chop him open? Slice and dice? Or, do you want more tests run. Can you sit on him long enough to even get those results back? Will his symptoms abate given time, or do we start him on some sort of chemotherapeutic regime and if so, what. Or do we just transfer him to the local VA and let him die from neglect since you guys luv veterans sooo, so much?!  Do you see him as just another GOMER (Get Outta My Emergency Room?) Come on you dicks! You don't mind pretending to be climate scientists! How's this scenario any different, other than if you make bad decisions on this guy, you're only killing one person and not dooming millions. So Jeb, what's your "opinion"? God knows I would be eager to hear your opinion since you nonscientist republicans have things so wired. That you could do my job better than I could do yours. Who knows, maybe your right. Then again...

     I suppose I let myself get a little too excited about such things. After all, where's the harm if we let the GOP play OTJ scientists for a while. As John Oliver said this last Sunday, you could have an opinion on which number is bigger, 5 or 15, but if you pick 5, you're just wrong.

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