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A Meth Lab, The ER, Judgment And Grace

Last week a trailer less than a mile from our house experienced a small explosion. Trailers, which seldom explode on their own (without undiscovered volcanoes or CIA drones with missiles) was concealing a meth lab.

What can you say? If I weren’t an emergency physician I’d say, “Shocking! Ghastly! Unbelievable!” But I do what I do so I say, “Huh, how about that.”

I’ve lost much of my capacity to be shocked. I have seen meth users, and probably meth dealers. I’ve known and enjoyed the company of alcoholics and Valium addicts. I’ve cared for murderers and the murdered (albeit briefly in the case of the latter). I’ve been involved in the evaluation of sexual assault victims, car thieves, drunk drivers and child abusers. A meth lab is, in its own way, kind of small stuff.

What does it say about me? I don’t know. It may suggest that I’m cynical. Or it may mean that I’m cold. Or it may mean, as I suspect it does, that I’m just realistic. I know the world is full of drugs and brokenness. The ER, where I work, is just the place where all of it arrives in its fermented, fully concentrated, “contents under pressure” form. Read more »

*This blog post was originally published at*

A Song About Ending Up In The Emergency Department

Somebody at Apple likes Goldfrapp. They’ve used her latest album for this tutorial and the sublime Seventh Tree was pictured on the first Apple descriptions of the Remote app. It’s nice when a monolithic institution shows a little personality. Of course, my interest in Goldfrapp is mostly professional: Who else has sung as well about ending up in an emergency department?

*This blog post was originally published at Blogborygmi*

A Little Old Lady’s Power In The ER

Here’s my column in the August edition of Emergency Medicine News. A person who seems powerless may hold an entire emergency room hostage!

Magic Words: ‘I Have Chest Pain’

Propped in her bed, frail and weak, the little grandma sighed. Her complaints were legion: weakness, poor appetite, poor sleep, joint pain, cough, dry mouth. Her daughter, eyes rolling, was trying to balance three reasonable emotions. She desperately wanted to go home and rest after spending the day in the ER. She truly wanted to avoid her mother’s admission to the hospital, and she was, graciously, sympathetic to the physician who brought the bad news.

‘Mrs. Adkins, I know you feel poorly, and I’m sorry. But I have to say, I can’t find any reason to admit you to the hospital. You’re right as rain. Isn’t that great?’

‘You mean, I’ve been here all this time, and had a gallon of blood drawn, and all them x-rays and a CAT scan, and there ain’t nothing wrong? I can’t believe that. I feel terrible.’ When she said the word terrible, she smacked her lips and looked away. She propped her hands on her lap and intertwined them; and she managed a subtle, but expressive, sniffle. Read more »

*This blog post was originally published at*

Emergency-Palliative Care: “We Can’t Save You”

An alert reader alerted me to this related piece in Slate: “We Can’t Save You: How To Tell Emergency Room Patients That They’re Dying.” An excerpt:

The ER is not an easy place to come to these realizations or assess their consequences. A handful of physicians are trying to change that. Doctors like Tammie Quest, board-certified in both palliative and emergency medicine, hope to bring the deliberative goal-setting, symptom-controlling ethos of palliative care into the adrenaline-charged, “tube ’em and move ’em” ER. Palliative/emergency medicine collaboration remains rare, but it’s growing as both fields seek to create a more “patient-centered” approach to emergency care for the seriously ill or the dying, to improve symptom management, enhance family support, and ensure that the patient understands the likely outcomes once they get on that high-tech conveyor belt of 21st-century emergency medicine.

Emergency medicine and palliative care-certified? That’s an interesting mix. We have a great palliative care service where I work (in fact, it just won the national “Circle of Life” award.) It makes a lot of sense to have a palliative care nurse stationed in (or routinely rounding) the ER, though. I think I’m going to suggest this to our hospice folks.

*This blog post was originally published at Movin' Meat*

An Emergency Medicine Myth?

Eyebrow lacerationI’ve internalized all the dogma of medicine, for good and bad.

When I was an EMT, green as a twig in an ER, I learned the basics: For any wound with hair employ the razor, and get the hair away from the laceration so the doc could do a good closure.

So, employment week #3: Eyebrow laceration? Shaved that sucker clean off. ER doc freaked out, and I learned some medical dogma: Don’t shave eyebrows, they don’t grow back. Heard it later, too — all the way through training, in fact. Read more »

*This blog post was originally published at GruntDoc*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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