The funny is HERE

What I did on my day off. . .

I vandalized multiple police cars - for credit.

I took a vehicle extrication class with the city. I broke multiple windows. I took a whole door off with the Hurst tool ( Jaws of life). I helped do a dash roll with a hydraulic ram.

It was awesome.

I friend asked me later, "As a doctor, when could you be called upon to used those skills?"

Oh I totally won't be! But wouldn't you go hit police cars with hammers and fire extinguishers and crow bars if you could?

Mourning, and yet not

One of the nice things about emergency medicine is that it's hard to get attached to your patients. The ones that are going to die, generally die before you have a chance for much emotional investment. Maybe that's harsh but it's how I cope. I did poorly with patients that I talked to and laughed with for weeks before they died suddenly on my service. That being said, I do have the tendency to pick up pets, emotionally speaking. Patients who I'm attached to in some way or for some reason. They were really nice, had something really awful, or really minor and I spent time with them. Whatever. I have a drunk that I'm partial too even.

One of my pet patients died the other day. I mourn his passing. He was a nice man.

The ironic thing is, the last thing I did for him was to get him admitted. . . so that he could die.

I met him a couple of months ago. He came to the ER for leg pain. It sounded to me like clauducation. This is a condition where the blood vessels can't keep up with the demand of a muscle for blood. In the heart it's a heart attack, or chest pain. In the legs, it's clauducation.

During the first few minutes with him, I noticed that my patient was skinny, wasted even. I found out that he'd lost a lot of weight over the last year. I mean A LOT.

I ordered a chest x-ray. One of the more basic tests that I order daily. He had a really big mass in his lung.

Cancer is a tissue diagnosis, as one of my colleagues recently pointed out. Dr. D told me that it was patently inappropriate for an ER doc to tell a pt that they have cancer without a tissue diagnosis. Nevertheless, I ordered a CT scan and told my patient that it looked like he might have cancer. That with his studies, and his smoking history, and his weight loss that he should really follow up with the cancer doctors. I left before his CT was read, and turned over his disposition - home with Oncology follow-up for biopsy. Oh, and he has clauducation and it's uncomfortable, he should see a vascular surgeon.

Two weeks later, I came into a night shift and got this on turnover, "Older man, transfer from Big Hospital Across Town with Cancer Center Ads on TV, CT today shows new lung CA. Needs work-up. Get some studies and call Medicine." No sooner did I sit down to write just those orders than I saw his name.

This man does not need more studies, I told my staff. I diagnosed his cancer two weeks ago. Look, I can show you his x-ray, I still know his name and number. I prepared to discharge him, because, no way was medicine going to admit this man for sub acute cancer work-up. He gets Zofran for nausea, Percocet for pain and sent home with follow-up in Oncology clinic.

I went in to talk to him as I was doing this and his family said, "What about his right arm weakness? You know he's had strokes in the past." I did know that.

"Right arm weakness? You didn't tell me about that! What's this about?"

"Oh, yeah, well, you know...I don't have it now, it's not a big deal....they're being silly" he tells me.

I had felt bad about my disposition. I wanted to have this nice man, who was one of my sweeter patients, admitted and biopsied. I knew that with a mass the size of his that his prognosis was dismal. But I wanted him to have an answer, and a real doctor who would follow him. Not just me. Not just some ER intern who happened to be on twice.

I nearly did a dance when they told me about his strokes. I finally had something iron-clad, something medicine couldn't balk at. They HAVE TO admit stroke or maybe-stroke patients. I got a CT of my patient's head. Strokes in the past was really swiss cheese. The man was missing most of his left hemisphere. Sweet, but not so much bright anymore.

I went in to talk to his family about being able to bring him in. It turns out that he never told them that he probably had cancer. All he was ever worried about was the leg pain, and the medicine I gave him for that made him throw up. So he didn't bother them with the whole cancer thing.

I found my friendly neighborhood Medicine team's intern, a guy I've known since Junior High. I told him straight," This guy is a lot of soft calls. He doesn't have any real symptoms now. The stroke thing is just convenient for me. Please, bring him in. This guy needs a biopsy and to be worked into hospice. He's already fallen through the cracks here. Help me out? Admit my patient." He did.

When I checked up on his progress in the computer, I found him still admitted a week later. On questioning the medicine team told me that the mass was biopsied and showed cancer, yeah, but also tuberculosis. Weird. So he was worked up for "what if those 'mets' are really TB?" Which they really weren't, and he was discharged with hospice. My initial request.

I read his obituary in the paper the other day.

He was 61 years old. Father of H Jr., K, S, S, R, W K, D F, K M and the late T K. Beloved son of the late Z and Ms. B K. Brother of Y, I, J, D, L, B, P, L, Z and D. Also survived by 28 grandchildren, 1 great-grandchild, and a host of nieces, nephews, aunts, uncles, other relatives and friends.

It made me sad that this nice man, this pet patient of mine was gone, but pleased at the life he lived and the host of people who loved him. We should all be so lucky.

Pride

I fixed a guy's lip the other day.
Through & through lip lac from the bottom of his nose straight down the filtrum. He had a brand new cleft lip. It was pretty horrifying.

All of the other suturing that I've done has been pretty two-dimensional. Not this. I was silently greatful for my years of art class and sculpture and crafting that let me think in 3D reconstruction. This is a very nice illustration of how to sew a lip.

By the time I was done you couldn't tell that he'd been split from the door of his room. 3 internal sutures to approximate the muscle. Some dozen or so simple interrupted with buried knots for the superficial. It took me something like 2-2.5 hrs.

I was really pleased with my results.

I saw Mommy coding Santa Claus. . .

Truly.

My attending is preggers. My patient looked like Santa. He had pink frothy crap coming out of his mouth. He was having a widowmaker MI. Our door to balloon time was excellent. Santa got stents. Christmas not canceled.

That is all.

News from the pit

Hi every-body.

I'm in the ICU this month. I'm on call every third day, which means that day A = 7a-12p, day B is 7a- until 12p on day C; Repeat.

Ergo, no posting from me.

Today was an "A" day. I went to vote after work today. I did my civic duty after only 3 hrs in line.

Here's hoping it makes a difference.

The Butcher's Bill* for this month is 13. That's a lot. 11 of those were in the first 14 days of the month. For some it was sudden and surprising. For others it was the best thing for them. For one it was too long in coming. 2 who we have now would be better off if they could go. 

I find myself strangely, or not so strangely reflective as I near the end of my month in the ICU - and my thirtieth birthday. Reflecting on this town, the country, life & death, and the things that one is supposed to have done.

As my husband is wont to point out, sure I'm an overachiever, but am I enough of an over achiever? As I approach 30 - I've graduated from college, a master's degree, and an MD program with degrees to show for all three; I married a doctor; I have a job;  I live in a house in the 'burbs; I'm training my dog to do search & rescue in my copious spare time; my car is paid off; I'm of fairly sound mind & body.

What do I have to bitch about, right? I'm right about on track, I guess.

For any of you who are wondering - of the house, white picket fence, and 2.5 kids - we're checked off on the house, fence is black iron, not kids - dogs and I'm working on it.

*In the war against Napoleon, when Admiral Nelson wanted to know how many people were dead, he'd yell to his orderly, "What's the butcher's bill for today?"

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