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Crosses to bear

Although these 3 stories are incredibly sad, they serve to
illustrate the realities of this imperfect world – and how heavy some “crosses”
are for people.  We should count our
blessings when things go right for us, and reach out to those who are suffering
in unimaginable ways…

From Hallway Four:  A
40 year old woman was seen for difficulty breathing and eventually diagnosed
with pneumonia and fluid-overload secondary to need for dialysis.  This
lovely lady had been diagnosed recently with kidney cancer of her right kidney
and had undergone nephrectomy (removal of the diseased kidney).
Ordinarily, this would still have left her with one good kidney, which is all
you need.  But, as luck would have it, this lady had donated her left
kidney to her ailing sister three years prior.

From Charity Doc: A father of a 7 y/o little boy brings him
into the ED last night reporting that his mother’s boyfriend had beaten him
black and blue with a belt, an assertion that the mother did not deny. The couple had
been divorced for a little over a year. On physical exam, the little boy had
indeed not been spared the rod at all. His buttocks and back were ecchymotic,
black and blue with scattered scabbed marks from numerous whippings and
beatings. It was unbelievable.  [Child
protective services ruled that the child should go home with the mother
because] the mother has legal custody of the kid and we can’t send him home
with his father.

From a story relayed at a Rehabilitation Medicine
conference
: A set of conjoined twins were born fused at the hip.  They were sickly, sharing a circulatory
system that was insufficient to serve both of their needs.  The doctors had to make an educated guess as
to how to dissect the two apart from one another – there was only one set of
male genitals, and three legs.  They
carefully studied the anatomy and decided to part the twins, giving the
healthier appearing one two legs and the genitalia, leaving the other with only
one leg and no genitals.  Several weeks
after the surgery the first twin (with the 2 legs) died.  The second twin is still alive, is in his 20’s,
and has been in and out of jail for drug trafficking.

Makes our own problems seem pretty trivial, doesn’t it?

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

Kitty Rescued From Fire

Thanks to GruntDoc for posting a link to a heart warming story of a cat rescued by an EMS team in Britain.  Firefighters and ambulance crews were called to the scene of a house fire, and fortunately found no people inside.  They did, however, find the family pet – suffocating, wet and terrified – and brought the poor cat out to the street where they administered some oxygen.  Unsure of next steps, the crew asked for permission to transport the animal to the nearest 24 hour veterinarian hospital.  Being that there were no humans in need of the ambulance at that time, they were given permission to call ahead to the animal hospital and hand off the kitty to the vet team, who proceeded to save her life.

Let’s hear it for the compassionate EMS team who took the time to be kind to all creatures great and small…This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

2 Medical Blogs Shut Down

Superstar medical blogger KevinMD calls today (May 16, 2007) “Black Wednesday” – the day when two of the Internet’s most popular blogs were officially closed.  Both Flea and Fat Doctor were forced to shut down their blogs due to privacy concerns.  The two bloggers had been posting anonymously – in order to protect themselves and the privacy of the people they wrote about.  It seems that Fat Doctor was outed by a co-worker, and Flea… we don’t know what happened exactly, but he was in the middle of a malpractice lawsuit, and was revealing the unsavory details of how the trial was going.

And this news is timely, coming on the heels of an interview I did with USA Today about blogging and patient privacy.

This seems to me like a wake up call for medical bloggers – there is no such thing as true anonymity.  Your identity can only be hidden for so long.

I have never blogged anonymously – and I recognize that anything I post can be read by anyone, anytime, anywhere.  This knowledge has resulted in extreme caution in posting information that could even remotely be linked to a real patient.  And yes, I have also refrained from blogging about issues and events that I sure would have liked to because of the associated risks.

It may be time for us medical bloggers to create and adhere to a code of conduct to protect ourselves and our patients from harm.  I had actually proposed this to Dr. Rob a few weeks ago…

What do you think?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

The wounds of childhood

I was reading a touching post in Fat Doctor’s blog about her
son – how she wanted to protect him from mean kids who would inevitably hurt
him at some point along his school career.
She spoke about how painful child vs. child cruelty can be, and how some
of us carry those wounds and insecurities into adulthood.

I was a bookish little girl, pudgy with pale skin, freckles
and braces… unathletic but enthusiastic.
Our gym teacher liked to begin each class by appointing two team captains
and allowing them to choose teammates one after the other until everyone had
been assigned a team.  So whether we were
going to play softball, floor hockey, basketball, or any other sport, it always
began the same way, two captains vying for the top athletes to build a team
that could crush the other.

The outcome was predictable.
The top “jocks” were usually selected as team captains, and they
proceeded to invite their favorite friends to their team, followed by the
mediocre kids, and finished with the chubby or clumsy kids at the end.

I was usually chosen second to last.  But there was one little girl who finished
last every time – Tina Appleberry.  She
was book smart like me, but although she wasn’t chubby, she had poor eyesight
and thick glasses and was rather uncoordinated and fearful of balls.  Most kids didn’t like Tina because she was awkward
and unattractive.  And I used to watch
her facial expression as she listened to the reticent team captain calling her
name last… because there was no one else to call.

Tina was a sad girl, and the years of being selected last
for sport teams had taken a toll on her.
She lacked self confidence, she was easily embarrassed, and she fully
believed that she wasn’t worth much at all.
I felt so badly for her… and shared her pain.  Being second to last wasn’t that much easier
– and I loathed gym class.  I would try
to get my parents to write as many excuses as I could think of to get out of
it, so I didn’t have to suffer the humiliation of my peers testifying in unison
that I was nearly the worst person in my grade at sports.

One day we had a substitute gym teacher.  She clearly had no idea who the jocks were or
what the pecking order of kid selection was supposed to be.  I was putting on my sneakers in the corner,
wishing that I could be invisible, when she walked up to me and announced that
I would be a team captain that day.
There were sighs and snickers as I followed her to the middle of the gym
floor and stood next to the class’s top jock, Johnny Tanner.  The rest of the class lined up in single file
in front of us so we could see our range of choices.

The teacher told me to choose first.  I surveyed the children lined up against the
wall, eyes fixed on me, eager to see who I’d pick first.  I paused.

“I call Tina Appleberry,” I said.  And you could have heard a pin drop.  Tina almost fell over in astonishment.  She slowly walked towards me to stand by my
side, lopsided pigtails and all.  I
smiled at her, she smiled back.  The
other kids didn’t know what to make of my choice – some thought I was stupid,
others thought I didn’t understand the rules (that you choose your favorite kid
first).  But that day I knew that I had
won a small victory – a victory that outweighed the sum of all gym game
outcomes in grade school.  And I can only
hope that Tina remembers that she was not always chosen last –and that her childhood
wounds are a little less deep because of that day.

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

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
physicians.

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
him).

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
silent.

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 RevolutionHealth.com.

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