September 29th, 2007 by Dr. Val Jones in Quackery Exposed, True Stories
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As some of you faithful readers of Dr. Val may know – I’m a huge fan of massage. Consider it my
addiction, I suppose – it could be worse! And so it may come as no surprise that I had a massage every day of my vacation (7 days in Southern California – sorry I haven’t been blogging as much lately). Yes I’m well and truly tenderized from head to toe. But I have to say that some of the therapists’ chatter was quite amusing to me. I was unsuccessful at completely removing my doctor hat during the experience, and tried not to look quizzically at them as they explained what they were up to and what I needed.
Those of you with healthcare backgrounds may especially appreciate this dialog:
Therapist (scrutinizing my back as I’m face down on a
table): have you seen a chiropractor recently?
Dr. Val: Um, no. Why?
Therapist: Well, two of your ribs are out.
Dr. Val: They’re ‘out?’
Where did they go?
Therapist: A chiropractor can put them back for you so your
muscles won’t pull in the wrong direction.
Dr. Val: Will a chiropractor be able to fix this
permanently?
Therapist: No, you’ll have to keep going. (Adds some eucalyptus lotion). This will bring your red blood cells to the
surface, and the cooling brings white blood cells to the area.
Dr. Val: (considering what a collection of white blood cells
actually do – yuck). Hrmph. That’s a nice massage technique. What are you doing?
Therapist: I’m using my elbows to stimulate repair cells.
Dr. Val: Ahum…
Therapist: You have lactic acid build up in your shoulders
so we have to flush the toxins out with special oils. You should also drink a lot of water.
Dr. Val: What sort of toxins?
Therapist: Like, dirt and metals and stuff that you’ve been
exposed to. You might have eaten fruit
with pesticides on it. Do you eat
organic food?
Dr. Val: Sometimes.
Therapist: Oh, you should only eat organic food. Then you won’t have as many toxins built up.
Dr. Val: How do I know how many toxins I have in my body?
Therapist: Well, your shoulders are really tight and your
ribs are out so I think you probably have a lot. You’ll need a lot of massage and you need to
see a chiropractor. The oils I used on
you will have a calming effect, though.
You’ll probably sleep really well tonight.
Dr. Val: I see (inhaling, exhaling). I hope I do.
** 15 minutes post massage – back at the hotel room **
Husband: You smell funny – like an almond.
Dr. Val: That’s “the calming oil that flushed the toxins out
of my body” today. I have to drink
water.
Husband: Well we’re driving 2 hours up to L.A. so don’t drink too much or we’ll have to
stop along the way.
Dr. Val: The therapist said 2 of my ribs were out and that I
need to see a chiropractor.
Husband: There’s nothing wrong with your ribs. Don’t be silly. Why do you keep getting these massages?
Dr. Val: They feel good.
Husband: I could give you a back rub for free.
Dr. Val: It’s not the same, though.
Husband: Why, because I don’t tell you your ribs are out of
whack?
Dr. Val: Well, they have a proper table…
Husband: I don’t understand you.
Dr. Val: But you like almonds (hugs him).This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 15th, 2007 by Dr. Val Jones in True Stories
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Physicians see horrible things, tragic injustices caused by unexpected disease and circumstance. We do what we can to remain compassionate – to be emotionally “present” and yet to keep the professional distance required for our survival and success. It takes courage to set a bone, crack a chest, to do painful procedures to save lives – there must be no hesitation when minutes count.
And I suppose that our saving grace is that the majority of the patients we meet in tragic circumstances are not personally known to us. We appreciate their humanity in a general sense, but are not pierced and incapacitated by a family tie or bond of friendship. We are pained by their suffering – but we can cope.
That is, until we’re confronted with a loved one who is thrust into tragedy. Two days ago, a dear friend and former coworker called me to say that she had been diagnosed with colon cancer that had metastasized to her liver. She had just given birth to her first child at age 41. Her only symptom? Post-partum fatigue.
My friend is a health nut and athlete – she has lived the “gold standard” life from a preventive health perspective. I always wanted to be more like her – eating lots of veggies and running regularly. She has been at her target weight all her life, has the occasional glass of wine, and spends much of her free time in community service projects and charity work. She has no history of cancer in her family – they are all hardworking, clean-living types who enjoy long, productive lives.
So when she told me about her advanced disease I almost fell off my chair. How could this happen to her? She is too young! She doesn’t fit the right description… Why didn’t I catch this sooner? Did she ever give me any hint of a warning symptom?
She told me that after having her baby she just felt really tired and was unable to bounce back as quickly as expected. I was worried about post-partum depression, and she eventually decided to see a family physician about her fatigue. He was unclear as to its root cause, and ordered a broad range of general blood tests – including liver function tests. They turned out to be abnormal, and he inquired as to whether my friend might be a drinker. She denied any such tendencies, so he scheduled an ultrasound. The ultrasonographer noted the appearance of metastatic cancer – she had a CT scan and a colonoscopy to confirm the diagnosis of colon cancer. We were both in shock.
And now as my dear friend faces likely surgeries and chemotherapy, I am witness to her journey – the same one that I’ve observed in strangers – but this time I have no professional defenses. I will watch as her body is wracked by the disease’s treatments, I will understand the individual circumstances behind her bravery, I’ll know and feel everything in a personal way that I can’t control.
I am about to join the millions of cancer patients and their families on the other side of the examining room. This time I’m not the doctor, I’m the close friend who rages against a disease that is not fair. And I am ready to fight.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 10th, 2007 by Dr. Val Jones in True Stories
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I was having lunch in a DC garden hideaway with some colleagues from Revolution Health when the subject of 9/11 came up. We all agreed that it was one of those events that everyone remembers vividly, no matter where they were in the world at the time. Each of us took turns telling the others where we were and what we were doing on that fateful day. Each person’s account was moving and personal. My story follows… [insert fuzzy dream sequence graphics here]
I was getting off a night shift rotation at a hospital in lower Manhattan, sitting in morning report – my eye lids sticking to dry corneas, my head feeling vaguely gummy, thoughts cluttered with worries about
whether or not the incoming shift of residents would remember to perform all the tasks I’d listed for them at sign out.
And as I dozed off, suddenly our chief resident marched up to the front of the room, brushing aside the trembling intern who was presenting a case at the podium at the front of the dingy room. “How rude of him” I thought hazily, as I shifted in my seat to hear what he had to say.
“Guys, there’s been a big accident. An airplane just crashed into the World Trade Center.”
Of all the things he could have said, that was the last thing I was expecting. I shook my head, wondering if I was awake or asleep.
“We don’t know how many casualties to expect, but it could be hundreds. You need to get ready, and ALL of you report back to the ER in 30 minutes.”
I thought to myself, “surely some misguided small aircraft pilot fell asleep at the controls, and this is just an exaggeration.” But worried and exhausted, I went back to my hospital-subsidized studio apartment and turned on the TV as I searched for a fresh pair of scrubs. All the channels were showing the north tower on
fire, and as I was listening to the news commentary and watching the flames, whammo, the second plane hit the south tower. I stared in disbelief as the “accident” turned into something intentional. I remembered having dinner at Windows on the World the week before. I knew what it must have looked like inside the buildings.
I was in shock as I hurried back to the hospital, trying to think of where we kept all our supplies, what sort of injuries I’d be seeing, if there was anything I could stuff in my pockets that could help…
I joined a gathering crowd of white coats at the hospital entrance. There was a nervous energy, without a particular plan. We thought maybe that ambulances filled with casualties were going to show up any second.
The chief told me, “Get everybody you can out of the hospital – anyone who’s well enough for discharge home needs to leave. Go prepare beds for the incoming.”
So I went back to my floor, recalling the patients who were lingering mostly because of social dispo issues, and I quickly explained the situation – that we needed their beds and that I was sorry but they had to leave. They were actually very understanding, made calls to friends and family, and packed their bags to go.
And hours passed without a single ambulance turning up with injuries. I could smell burning plastic in the air, and a cloud of soot was hanging over the buildings to the south of us. We eventually left the ER and sat down in the chairs surrounding a TV in the room where we had gathered for morning report. We watched the plane hit the Pentagon, the crash in Pennsylvania… I thought it was the beginning of World War 3.
The silence on the streets of New York was deafening. Huddling inside buildings, people were calling one another via cell phone to see if they were ok. My friend Cindy called me to say that she had received a call from her close friend who was working as a manager at Windows on the World. There was a big executive brunch scheduled that morning. Cindy used to be a manager there too… the woman’s last words were, “the ceiling has just collapsed, what’s the emergency evacuation route? I can’t see in here… please help…”
That night as I reported for my shift in the cardiac ICU, I was informed by the nursing staff that there were no patients to care for, the few that were there yesterday were either discharged or moved to the MICU. They were shutting down the CICU for the night. I wasn’t sure what to do… so I went back to my apartment and baked chocolate chip cookies and brought in a warm, gooey plate of them for the nurses. We ate them together quietly considering the craziness of our circumstance.
“Dr. Jones, you look like crap” one of them said to me affectionately. “Why don’t you go home and get some rest. We’ll page you if there’s an admission.”
So I went home, crawled into my bed with scrubs on, and slept through the entire night without a page. The disaster had only 2 outcomes – people were either dead, or alive and unharmed – with almost nothing in between. All we docs could do was mourn… or bake cookies.
What were you doing on 9/11? Join our forum to share your stories.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 22nd, 2007 by Dr. Val Jones in True Stories
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Dr. Sid Schwab recently wrote a wonderful blog post about what doctors feel when they treat patients who remind them of their own kids. For example, he describes how it makes the physician want to run home and hug his/her kids out of gratitude that they’re ok. His post reminded me of an experience I had in the pediatric Emergency Department where I came face to face with memories of my own childhood trauma.
I was bitten in the face by a neighbor’s dog when I was about 4 years old. It was unprovoked and completely unexpected. The dog had no history of viciousness and I had no history of tormenting the creature. I was standing in the hallway, eye to eye with the dog (we were the same height) and I reached out to gently pet him when he attacked me. My parents freaked out, blood was pouring out of my face, and apparently it initially looked as if he’d gotten my left eyes since it was covered in blood. I was rushed to the local hospital where a family physician cleaned me up and put stitches in my cheek, eyebrow, and corner of my eye. It was hard to sit still for the numbing medicine and I was crying softly through it all. I don’t remember the details of the event, but I do still have the scars on my face – scars, I am told, that would be less noticeable if a plastic surgeon had closed the wounds.
Flash forward 30 years and I’m working a night shift in the pediatric ED. A father carries in his young daughter, crying and bloody. She had been mauled by a dog – and had sustained injuries to her face only. I escort the little girl to an examining room and begin flushing her wounds with saline to get a sense of how extensive they are. Dad goes to fill out paperwork while mom holds the girl’s hand.
It was eerie – her injuries were very similar to my own. I figured she’d need a total of 15 stitches or so, all on the left side of her face. There was no missing flesh so I knew that the cosmetic result would be good. I explained to her mom that we would be able to stitch her up nicely – and that she’d likely have minimal scarring. The mom asked for a plastic surgeon – and I agreed to call one for her right away.
That night I had a new appreciation for what my parents must have felt when I was bitten. I could see these strangers’ concern – how they hoped that their little girl wouldn’t be permanently disfigured, how they wanted the most experienced doctor to do the suturing, how they held her hand as she cried. It was really tough – but we were all grateful that the injuries weren’t more severe… and I was glad that I didn’t have to do the suturing. I showed the girl my scars and she seemed comforted by how they had turned out. This experience reminded me how personal experience can add a special dimension to caring for others, and that sometimes having been a patient can make you a better doctor.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 14th, 2007 by Dr. Val Jones in True Stories
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This story is from my intern year diary. It’s a quick snapshot of a patient who had overdosed on heroine, coded, and was resuscitated. I think about him sometimes… especially when I read about the rampant drug abuse problem in the US.
—————
I poked my head into the 4-bed communal room on the sixth
floor. The nurse had called to say that
one of the patients was agitated and required restraints. I was asked to assess the situation.
It was immediately clear to me which of the four patients required
my attention. In the far, right corner
was a pale young man, stark naked and thrashing about in his bed. He was babbling something about Ireland and how
he needed to get home. I had gathered
from a quick review of his chart that he had overdosed on heroine, was
resuscitated after coding in the E.R. and transferred to the floor for
observation as he detoxed from the overdose.
I approached the flailing body tentatively. “Hello.
I’m Dr. Jones. You appear to
be quite distressed. What seems to be
the matter?” I said as I pulled a sheet up from the bottom of his bed and
placed it over his genitals.
The young man, barely in his twenties, lay very still as I
spoke to him. He stared at my face with
bulging eyes, speechless for a full 10 seconds.
“Are you alright?” I asked.
“Where am I?” asked the man in a quiet voice.
“Where do you think you are?” I asked, using the opportunity
to assess his mental status.
“I’m somewhere in Ireland,” he said, head turned
towards the window with a view of the Chrysler building.
Seeing that his reasoning was not intact, I replied kindly,
“Well, actually you’re in a hospital in New
York City. You
took an overdose of heroine and your heart stopped…”
“Wow, that sucks,” said the man, sincerely surprised by the
news.
“We were able to resuscitate you in the emergency room,” I
added.
“Cool,” he said, as if the event had transpired in another
person’s life.
“So right now you still have a lot of drugs in your system
which is why you feel confused,” I said, “I think it will take several days
until you return to your normal state of health.”
“Sounds good,” nodded the man.
“Do you know where you are right now?” I asked, suspecting
that his short-term memory had been completely lost.
“I’m in Amsterdam,”
he said, undisturbed by his delirium.
I sighed as I realized that nothing I said to him would
register for longer than a second or two.
“Such a young person, what a waste,” I thought.
The man started to thrash about in his bed again.
“What are you doing?” I asked.
“The back stroke,” he said, surprised that I didn’t know.
I glanced at the man in the bed nearby. He was watching our interaction with some
amusement. He had been reading the New
York Times with a book light. He was a
private patient on a heparin drip for a deep venous thrombosis behind his right
knee. I nodded at him and shook my
head.
Weeks later I heard that the young man’s thoughts were no clearer than they were that night, and that he was transferred to a nursing home for long term care. The brain damage that he suffered from his drug use (and lack of oxygen during his cardiac arrest) had caused permanent, irreparable damage. Another tragic victim of a brain on drugs.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
