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My first day as a doctor

Panda Bear, MD (a feisty young blogger) gives some advice to
new medical interns in his recent post.
Internship, for those of you who may not know, is the first year of
residency training.  It is the first time
that a doctor, fresh out of medical school, has responsibility for patient
care.  The intern prescribes medications,
performs procedures, writes notes that are part of the medical record, and
generally learns the art of medicine under the careful watch of more senior

Internship is a frightening time for all of us.  We’ve studied medicine for 4 years, memorized
ungodly amounts of largely irrelevant material, played “doctor” in third and
fourth year clerkships, but never before have lives actually been put in our hands.  We know the expression, “never get sick in
July” because that’s when all the well-intentioned, but generally incompetent
new interns start caring for patients. And so, as Panda describes the experience,
we tremble as we begin the new stage in our careers – applying our medical knowledge
to real life situations, and praying that we don’t kill anybody.

I’ll never forget my first day of internship.  I must have drawn the short straw, because
not only was I assigned to the busiest, sickest ward in my hospital (the HIV
and infectious disease unit), but I was on call that day (so I’d be working for
24 hours straight) with the most hated resident in the program (he had a
reputation for treating interns poorly and being arrogant to the nurses).  As I reviewed my patient list, I noticed that
the sign out sheet (the paper “baton” of information handed to you by the last
intern who cared for the patients – meant to give you a synopsis of what they
needed) was supremely unhelpful.  Chicken
scratch with diagnoses and little check boxes of “to do’s” for me.  I was really nervous.

So I began to round on my patients – introducing myself to
each of them, letting them know that I was their new doctor.  I figured that even if I couldn’t completely
understand the sign out notes, at least by eye-balling them I’d have an idea of
whether or not they were in imminent danger of coding or some other awful thing
that I figured they’d be trying to do.

My third patient (of 15) was a thin, elderly Hispanic man,
Mr. Santos.  He smiled at me when I came
in the door – the kind of lecherous smile that a certain type of man gives to
all women of child bearing age.  I
ignored it and introduced myself in a professional manner and began to check
his vital signs.  I was listening to his
heart, and I honestly couldn’t hear much of anything.  There was a weird very distant beat –
something I wouldn’t expect for such a thin chest.  The man himself looked awful, but I really
wasn’t sure why – he just seemed really, really ill.

My pager was going off mercilessly all night.  I wondered if this was how the nurses got to
know the characters of their new interns – to test them by paging them for
anything under the sun, tempting us to tip our hand if we had tendencies to be
impatient or disrespectful.  But in the
midst of all the “we need you to sign this Tylenol order” pages, there came a
concerning one: “Hey, Mr. Santos doesn’t look good.  Better get up here.”

My heart raced as I rushed to his bedside.  Yup, he sure didn’t look too good.  He was breathing heavily, and had some kind
of fearful expression on his face.  I
didn’t really know what to do, so I decided to call the resident in charge
(much as I was loathe to do so, since I knew he would humiliate me for bothering

The resident appeared in a froth – “why are you paging
me?  What’s wrong with the patient?  Why do you need me here?  This better be good!”

“Um… Mr. Santos doesn’t look too good.” I said, frightened
to death.

“What do you mean ‘he doesn’t look too good?’  Can you be a little bit more specific” he
said, sarcasm dripping from his tongue.

“Well, I can’t hear his heart and he’s breathing hard.”

“I see,” said the resident, rolling his eyes.  He marched off towards the patient’s room,
certain to make an example of me and this case.

I trotted along behind him, hoping I hadn’t been wrong in
paging him – trying to remember the ACLS
protocol from 2 weeks prior.

The resident drew back the curtain around the man’s bed with
one grand sweep of the arm.  “Mr. Santos,
how are you doing?” he shouted, as if the man were deaf.

The man was staring at the wall, taking in deep, labored
breaths of air.  I saw that the resident
immediately realized that this was serious, and he placed his stethoscope on
the man’s chest.

I approached on the other side of the bed and held his
hand.  “Mr. Santos, I’m back, remember
me?”  He smiled and looked me straight in
the eye.

He replied, “Angel.” (in Spanish)  Then he let out a deep breath and all was

The resident shook the man, “Mr. Santos?  Mr. Santos?!”
There was no response.

“Should I call a code?” I asked sheepishly.

“Nope, he’s DNR,” said the resident.

I was flabbergasted.

“Yep, you just killed your first patient.  Welcome to intern year.”

As I thought about his cruel accusation, I was comforted by
the fact that at least, as Mr. Santos released his final breath, he thought he
had seen an angel.  Maybe my presence
with him that night did something good… even though I was only a lowly intern.

This post originally appeared on Dr. Val’s blog at

Gluten-Free Cooking Spree

I’ve been meaning to write about what happened at the
Gluten-Free Cooking Spree event that I attended last week… it was a pretty
funny story.

Gastro Girl and I were invited to a cook off for celiac
awareness – we were told that we would be helping a chef to create a gluten
free entrée on a stage in front of a large audience with CNN’s Heidi Collins
presiding.  There were 7 teams consisting of a chef, a doctor and a reporter.  It
sounded like Iron Chef (with a hint of “Scrubs” since I was cooking).  On the debriefing phone call we were told
that our chef would be provided with all the necessary ingredients (thanks to
Wegman’s sponsorship) and that we only needed to show up 30 minutes prior and
take instructions from our chef.  We had
1 hour to prepare the entrée and our meal would be judged against 6 other teams…

Sounds easy enough… but wait till you hear what really went
down.  First of all, much to the surprise
and amazement of Gastro Girl and me, all the other teams brought sous chefs
from their respective restaurants to the cook off.  Not only that, but they had cooked and
prepared most of their meal in advance, and were using the kitchen time to mix
and heat things.  They were dressed
impeccably in white cooking smocks and hamming it up for the CNN camera crew.  Our poor chef, Chef “Rock” (Rahman Harper)
from B. Smith’s Restaurant, got caught in some heavy DC traffic (this happens
when a motorcade of some ilk appears out of nowhere) and arrived about forty
minutes late.

Now, far from being an Iron Chef TV set, our facility was
actually a real hotel kitchen – steamy hot, grease covered tile floor, one
industrial gas stove, and stainless steel pots and pans hanging on wires
dangling above metal tables.  Gastro Girl
and I had come straight from work, and were wearing business attire, with heals
and the whole bit.  As I slid my way to
an unclaimed table, trying not to fall down in the grease in front of the CNN
cameras, I put my head together with Gastro Girl about how we could at least
find all our ingredients and have them ready for Chef Rock when he appeared.

We were the last team to arrive in the kitchen, and all the
ingredients had been handed out to the different teams… a box of groceries was
left for us in the walk-in cooler.  As we
removed all the items we realized that many of our ingredients were missing (we
were planning to make cheese grits and a sort of spicy shrimp Jambalaya).  In fact, there were only 2 cups of shrimp
(frozen and unpeeled!) in our box… and we were supposed to be cooking for 50
people… near our table was a group of sous chefs from a competing team, with a
large bucket of shrimp, grinning from ear-to-ear as they watched Gastro Girl
and me talking about our predicament.

Our situation was not lost on the organizers, however, and a
very kind lady asked us to give her a list of our missing ingredients so that
she could send someone to buy them for us.
Chef Rock appeared, and allayed our fears – “we can make this work, even
if we need to change the recipe a bit.”

Well, the other teams took up most of the burners on the
stove, and we had to wait until the last minute to cook our shrimp… and with 30
seconds to spare, Chef Rock came through with a gorgeous dish of soul food that
was whisked away to a large judge’s table in a crowd of hundreds.  Gastro Girl and I wiped the nervous sweat
from our brow and followed him out to the booth we had in the ballroom.

There were several presentations made, with introductions of
the various teams (Gastro Girl and I shouted “wooo-hooo” when our team was
announced, and waved to the crowd – we had the best team spirit)… and finally
the winner was announced… it wasn’t our dish unfortunately (coriander crusted
skate won), but several members of the crowd told me that they liked ours best.

And so, the Gluten-Free Cooking Spree was a great success,
raising money and awareness for celiac disease.
The chaos behind the scenes went unnoticed by the participants, and I
felt proud of our little team – having pulled off a near miracle against all

Next year, we’ll be back with a vengeance… Watch out, sly
competitors – Dr. Val, Gastro Girl, and The Rock will be armed and dangerous!

This post originally appeared on Dr. Val’s blog at

The $456 Billion Meme

Many thanks to Dr. Rob at the Musings of a Distractible Mind
blog for tagging me with the 456 billion dollar meme…  The idea of this game is to think of the best
way to spend 456 billion dollars.  Sam at
BlogMD started this meme when considering how the total amount of money spent
on the war in Iraq may have been better spent (he suggests that we could have
cured cancer by giving that money to the NCI instead).  By contrast, Rob’s proposal is rather whimsical, exploring
the number of llamas and goats that could have been purchased for that amount
of cash.

I’m of two minds – part of me wants to be silly, the other
wants to be serious (a tension that is part of Rob’s daily inner struggle)… but
in this case I’m afraid that silly wins.

Silly Val

My apologies to Sam for allowing his noble meme to
deteriorate so rapidly into chaos but what did you expect, tagging a goat loving
guy who blogs about the history of accordions?
It’s not surprising that his pals would wander off into uncharted animal
territory, rather than suggesting solutions that might actually achieve world

I myself have a special fondness for any animal whose face
bears an expression of astonishment, goofyness, or inquisitiveness.  Some animals are just plain cute because of
their whimsical behavior.

Given my recent concern about melamine and pet food tainting
– I suppose the 456 billion could be used to create US regulated, safe, animal
food factories to support the culinary needs of kitties and doggies everywhere…
except in China, of course, where they make pet food but eat pets.  There’s some kind of irony in there somewhere…

Of course, humans are people too… and I also worry about the
safety of the food supply for them.  The
latest food debacles (salmonella in Cadbury’s chocolate bars and in US
peanut butter, as well as the E. coli/spinach issue) highlight the fact that
even the West’s attempts to regulate and monitor food safety have fallen down
on the job.

So… in honor of the culinary medical blog “The Blog That Ate Manhattan” – our Grand
Rounds host this week – I am voting to use the $456 billion on safe food for
pets and people.  Since math isn’t my
forte, I’m not sure exactly how the cost break down will go, but I think it’s
something like:

Cost of creating internationally safe pet food: $50 billion

Cost of creating an air-tight FDA process for ensuring human
food and drug safety: $100 billion

Cost of setting up safe, organic producers of healthy food
all over the world: $306 billion

The cost of a fat, juicy, 100% Salmonella-free wild fish
steak on summer barbeque grill… priceless.

I tag the following bloggers to tell me what they would do
with $456 billion…  Dr. Charles, Dr. Joe,
Dr. Charlie, Dr. Jeff, and Mira Kirshenbaum.This post originally appeared on Dr. Val’s blog at

Globalization Poses Health Risks

The global economy is a mixed blessing – while we may
benefit from access to less expensive goods and services, by using them we rely
on the quality standards of their country of origin.  In an alarming expose, the New York Times
reveals how far behind China
is in the application of quality and safety standards to their food and
pharmaceutical products.

I have voiced concerns in this blog before about the
melamine/pet food scandal and the implications it may have for humans, as well
as the fact that many Chinese citizens trust western medicine over their own
traditional practices for matters of serious illness.  But this latest Times article has further
described the risk that counterfeit Chinese products can pose to the global community:

Toxic syrup has
figured in at least eight mass poisonings around the world in the past two
decades. Researchers estimate that thousands have died. In many cases, the
precise origin of the poison has never been determined. But records and
interviews show that in three of the last four cases it was made in China, a major
source of counterfeit drugs.

“Everybody wants to
invest in the pharmaceutical industry and it is growing, but the regulators
can’t keep up,” Mr. Zhou said. “We need a system to assure our safety.”

… Families [in Panama] have
reported 365 deaths from the poison, 100 of which have been confirmed so far.

When it comes to your health and the safety of the medicines
you use, you’re only as safe as the weakest link in the manufacturing or regulatory
process.  Prescription medications are
carefully regulated in the US,
but there is no such oversight in the herb and supplements market.  So buyer beware…  Check out places like to get
some objective information about safety before you pop those “health pills.”

This post originally appeared on Dr. Val’s blog at

Best of the Blog, Part 2

The best way to cheer
yourself up is to try to cheer somebody else up.
- Mark Twain

In this post we focus on cheerful, positive stories – my favorite
blog theme.

The cookie series

Girl Scout cookies – the story of a little girl who went
beyond the call of duty

9/11 cookies – what some of us did on that fateful day

Baking cookies part 2 – how one man made it back from near

Good can come from

The strength of weakness – Dr. Rob shows how we can turn
suffering into a force for good

Back Pain 911 – my own back injury teaches me compassion for

More than skin deep – a burn victim finds a way to “pay it forward”

Unexpected heroes

Two teen girls take on Glaxo Smith Kline – the ultimate
David & Goliath story

Spider saves man from cancer – a spider bite called
attention to a suspicious nearby lesion

Make a wish – An 8 year old “President” shows great bravery in
his final months

Your mom will always be your mom – and mine has impulse
control problems

My medical heroes – some doctors who are making a difference

Slice of life

Easter exercises – how creative parents get their kids to

An elderly woman assesses her healthcare problems

Understanding introverts – they’re worth getting to know

What the heck is a rehab doc? – my specialty is the least
understood in all of medicine!

Well, there you have it.
My thoughts in a nutshell from the past 6 months.  Stay tuned for more random thoughts… or make
a suggestion and I may blog about it!

This post originally appeared on Dr. Val’s blog at

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