March 19th, 2011 by Bryan Vartabedian, M.D. in True Stories
Tags: Death, Doctor Patient Relationship, Doctors, Gastroenterology, Mitochondrial Depletion Syndrome, Pediatrics
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This week I lost one of my patients, Cooper. He was a feisty 4-year-old with mitochondrial depletion syndrome. I began looking after him as an infant when he wouldn’t stop screaming. I saw him through surgeries, diagnostic rabbit trails, and ultimately helped with the painful decision to undergo small bowel transplantation. Inexplicable symptoms and strange complications defined his short life. While he spent his final days in considerable pain, his lucid moments were spent throwing marshmallows at his siblings. It sort of encapsulates who he was. Great spirit.
Independent of the circumstances, a child’s death is always brutally difficult to process. It’s counterintuitive. And facing Cooper’s parents for the first time after his passing was strangely difficult for me. When he was alive I always had a plan. Every sign, symptom, and problem had a systematic approach. But when faced with the most inconceivable process, I found myself awkwardly at odds with how to handle the dialog. In a hospital my calculated clinical role has a way of sheltering me from a parent’s reality. At a funeral it’s different. Read more »
*This blog post was originally published at 33 Charts*
March 18th, 2011 by Emergiblog in Humor, Opinion, True Stories
Tags: 911, Customer Service, Emergency Medicine, ER Abuse, Nursing, Online Booking, Real Emergencies, Reservations
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This is so wrong.
You can’t make this stuff up.
It seems an emergency department in Memphis, Tennessee is now taking online reservations for their services. Yes, you heard that right, you can now hop online and select the time you would like to be seen for your “emergency”. Just pay $15.00 and you can give your chief complaint, your medical history and your list of medications ahead of time, saving you time and trouble when you pop in with your pesky problem!
What if the problem is serious?
The computer won’t let you register and flashes a “Call 911″ sign at you.
But wait! There’s more!
If you are not seen within 15 minutes of your scheduled time, you money is cheerfully refunded!
I’m not kidding. Read more »
*This blog post was originally published at Emergiblog*
March 17th, 2011 by Shadowfax in Health Tips, True Stories
Tags: Crepitus, Dermatology, Elderly, Emergency Medicine, Flesh Eating Bacteria, Geriatrics, Mental Status Change, Necrotizing Fasciitis, Physical Exam, Radiology
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I’ve remarked in the past how rarely I ever learn anything useful from physical exam. It’s one of those irritating things about medicine — we spent all that time in school learning arcane details of the exam, esoteric maneuvers like pulsus paradoxus, comparing pulses, Rovsing’s sign and the like. But in the modern era, it seems like about half the diagnoses are made by history and the other half are made by ancillary testing. Some people interpreted my comments to mean I don’t do an exam, or endorse a half-assed exam, which I do not. I always do an exam, as indicated by the presenting condition. I just don’t often learn much from it. But I always do it.
The other day, for example, I saw this elderly lady who was sent in for altered mental status. There wasn’t much (or indeed, any) history available. She was from some sort of nursing home, and they sent in essentially no information beyond a med list. The patient was non-verbal, but it wasn’t clear if she was chronically demented and non-verbal or whether this was a drastic change in baseline. So I went in to see her. I stopped at the doorway. “Uh-oh. She don’t look so good,” I commented to a nurse. As an aside, this “she don’t look so good” is maybe 90% of my job — the reflexive assessment of sick/not sick, which I suppose is itself a component of physical exam. But I digress. Her vitals were OK, other than some tachycardia*. Her color, flaccidity and apathy, however, really all screamed “sick” to me. Of course, the exam was otherwise nonfocal. Groans to pain, withdraws but does not localize or follow instructions. Seems symmetric on motor exam, from what I can elicit. Belly soft, lungs clear. Looks dry. No rash. Read more »
*This blog post was originally published at Movin' Meat*
March 14th, 2011 by AnnMacDonald in Health Tips, True Stories
Tags: Ann MacDonald, Be Prepared, Bystander CPR, Cardiac Distress, Cardiology, Cardiopulmonary Resuscitation, Chest Compressions, Harvard Health Blog, Harvard Heart Letter, Harvard Medical School, Harvard University, Havard Health Publications, Health Writer, Heart Attack, Heart Health, Lifesaving Techniques, Medical Emergency, Preventive Health, Preventive Medicine, Sudden Cardiac Arrest
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While I was browsing the produce section of my grocery store the other day, the sound of a panicked voice coming over the store’s loudspeaker made me jump. “Does anyone in the store know CPR? Anyone? CPR? We need you in baked goods!”
I froze. In theory, I know how to perform CPR — cardiopulmonary resuscitation. I took a two-hour course on it nearly 25 years ago. But I hadn’t given it much thought since then and I certainly hadn’t practiced what I learned.
My mind started whirling as I tried to remember the sequence of steps. They’d changed the rules a few years back — I knew that much — so I wouldn’t have to do mouth-to-mouth resuscitation. But where exactly on the chest was I supposed to push? Should I form a fist and push down with my knuckles, or use the ball of my hand?
Suddenly, sirens wailed outside the store. The rescue squad had arrived. Too late, as I learned afterward, for this man, who was a victim of a sudden cardiac arrest. This type of heart attack strikes so fast that there usually aren’t any warning signs. You might see someone grasp his or her chest, collapse, twitch and gasp a few times, and then lie deathly still.
At that point, every minute counts. Enough oxygen remains in the person’s bloodstream to nourish the brain for several minutes — but a bystander has to circulate oxygenated blood to the brain and other organs by pushing down on the chest hard and fast, mimicking the heartbeat.
I’m a health writer. I knew this intellectually. But until those agonizing moments in the grocery store, I never really understood on a gut level just how important every minute is. Read more »
*This blog post was originally published at Harvard Health Blog*
March 13th, 2011 by KerriSparling in Better Health Network, True Stories
Tags: Blood Sugar Control, Blood Sugar Low, Bolus, Diabetes and Motherhood, Diabetes and Parenting, Diabetes Management, Diabetic Mommy, Endocrinology, Family Health History, Insulin Regimen, Kerri Morrone Sparling, Living With Diabetes, Six Until Me, Type 1 Diabetes
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After a tough low this morning:
I want her to know that she was wanted so much, well before she arrived, and that her parents went to great lengths to make sure her arrival was as safe as they could manage.
I want her to know that those moments when she has to wait while I test, or while I bolus, or the times when I have to set her in her crib and gulp down grape juice while she stands there with her big, brown eyes staring at me while her mouth tugs into an impatient smile, that I love her and I just need to deal with diabetes for a few seconds so I can be the best mommy I can.
I want her to know that if my eyes don’t get better, it’s not her fault. It’s not my fault, either. The fault lies with diabetes.
I want her to know that the reason I’ll sometimes frown at a soggy diaper or a voracious pull from the bottle isn’t because she’s being “bad” or doing something wrong, but because I’m worrying.
I want her to know that just because I have it, and because some of her best buddies have it, doesn’t mean that she will have it. But I also want her to know that if a diagnosis of any kind ever touches her life, we’ll manage just fine and take the best care of one another that we can.
I want her to know that when she smiles at me, it’s like a thousand online communities inspiring me all at once. That the hope of her was once the biggest incentive to improve my health, only to be superseded by her arrival in my arms.
I want her to know that regardless of what she may hear about this “diabetes,” her mommy is going to be just fine. Just fine.
*This blog post was originally published at Six Until Me.*
This week I lost one of my patients, Cooper. He was a feisty 4-year-old with mitochondrial depletion syndrome. I began looking after him as an infant when he wouldn’t stop screaming. I saw him through surgeries, diagnostic rabbit trails, and ultimately helped with the painful decision to undergo small bowel transplantation. Inexplicable symptoms and strange complications defined his short life. While he spent his final days in considerable pain, his lucid moments were spent throwing marshmallows at his siblings. It sort of encapsulates who he was. Great spirit.
