Technological change and mental health: How will the workforce of the future cope with the fourth industrial revolution?

Conditions
June 19, 2020

Work is a necessary part of life. More than simply a means to a paycheck, work gives individuals a sense of dignity and accomplishment. Feeling as though one is participating in meaningful work, whether it is contributing to a massive project or an individual artistic pursuit, allows one to feel as though they have a purpose.

While this urge to create or work appears to be a universal human trait, the …

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Technological change and mental health: How will the workforce of the future cope with the fourth industrial revolution?

There’s a code for pain, but what’s the code for suffering?

Conditions
June 16, 2020

Opiates relieve pain and can transport people to their apparent happy place. So does marijuana.  Lyrica, the seizure-turned-pain medication, caused enough of a buzz in early study participants that it became a controlled substance. The anesthetic ketamine is now used for treatment-resistant depression.

Years ago, we had to be very specific about the location and classification of our patients’ pain. When pain then became a self-reported vital sign and chronic opioid …

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There’s a code for pain, but what’s the code for suffering?

We need improved mental health care for physicians

Conditions
June 11, 2020

In 2014, an emergency medicine resident opened a personal email and was shocked to see it briefly mention the death of another resident physician from a different training program. Unofficial group chats ensued amongst her co-residents, discussing the vague email. Suspicion arose that the resident has died of suicide. His particular death was never addressed outright in a formal or public manner at the hospital, department, or residency level. All …

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We need improved mental health care for physicians

Why this anesthesiologist has a problem with monitored anesthesia care (MAC)

Conditions
June 11, 2020

I have a major issue with MAC.

To be more specific, I have a major issue with how we communicate the concept of MAC to our patients, anesthesia care team members, and proceduralist colleagues.

MAC stands for “monitored anesthesia care,” and we tend to throw it around and use it interchangeably with a lot of other terms:

  • Sedation
  • Procedural sedation
  • Conscious sedation
  • Twilight anesthesia
  • Light anesthesia

The fact is, these entities are not …

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Why this anesthesiologist has a problem with monitored anesthesia care (MAC)

I am an ICU nurse. We are drowning.

Conditions
June 9, 2020

I am an ICU nurse. I love what I do; It’s not just a career: It’s who I am. No other job could offer me the intimate opportunity to support and guide a total stranger through the worst (and occasionally best) days of their life. Nowhere else would I leave feeling humbled by what I do every day. Nothing compares to that. Simply put: You don’t find that sense of …

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I am an ICU nurse. We are drowning.

3 enemas? For a man without a colon?

Conditions
June 5, 2020

“Three Fleet enemas?” I ask the nurse. She isn’t much interested in a conversation with me about anything. She is busy.

“This man, so far as I understand it, does not have a colon.”

It looks to me like they want to reconnect his colon,” she says as if I hadn’t said what I just said.

“I am not a doctor,” I remind her, “but I don’t see how that is possible. Too …

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3 enemas? For a man without a colon?

The social worker and a patient’s homicidal thoughts

Conditions
May 31, 2020

“Howard wants to go to the hospital. He knows he isn’t doing that great. He says he is having homicidal thoughts.” This from my supervisor, Linda.

Homicidal thoughts on the part of any client get our attention, especially so with Howard, because years before, he killed a man with a gun. I believe it was in a fight.

“He wants you to take him to the hospital, Ray.”

“Sure,” I say. “You think …

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The social worker and a patient’s homicidal thoughts

The new words from the coronavirus pandemic

Conditions
May 28, 2020

With any new illness comes metaphor. It is humanity’s attempt to incorporate the mystery of disease into our own stories. We like to personify illness, give it human characteristics as a way of visualizing it. We name its actions to help lessen its unpredictability. Tuberculosis consumed. Syphilis punished. AIDS invaded. Cancer grows. COVID-19 quarantines separate and spread fear.

How long does it take for a disease or illness to become a …

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The new words from the coronavirus pandemic

Ventilator rationing is guided by rules that could worsen health inequities

Conditions
May 28, 2020

Imagine there are two individuals who have been admitted to a hospital due to COVID-19, and both desperately need ventilators. One is a 60-year-old with a heart condition, and another is a 63-year-old with chronic kidney disease. Because of resource constraints, you have to decide which patient will be able to receive a ventilator. Both patients’ families are looking to you to help their loved one through this illness. With …

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Ventilator rationing is guided by rules that could worsen health inequities

Cause unknown: the burden of diagnosis

Conditions
May 22, 2020

Around three weeks ago, my 72-year-old patient, Mr. J., woke up feeling severely short of breath. He felt unusually tired, noticed a dry cough, and felt achy in his arms and legs. Suspicious of COVID-19, he and his wife called an ambulance and went to the nearest New York City emergency room.

At first, the doctors too thought it was COVID-19. However, a chest X-ray, CT scan, and a series of …

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Cause unknown: the burden of diagnosis

Charting in uncharted territory: Scribing during COVID-19

Conditions
May 21, 2020

On Friday, March 27, 2020, California went on lockdown in the face of the COVID-19 pandemic. It changed every Californian’s life, including my own. As the newly appointed chief scribe, the possibility that I would be jobless by the time Monday rolled around, was the last of my worries. What would happen to the patients who depended on our care? Or the physicians, nurses, and administrators that kept the center …

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Charting in uncharted territory: Scribing during COVID-19

Don’t drink the COVID conspiracy Kool-Aid

Conditions
May 16, 2020

Drinking the Kool-Aid

Across the USA recently, demonstrators wielding, “Stop the madness! It is just a cold virus!” and “Let me work” signs, chanting “Freedom now” and “Fire Fauci,” dangerously demanded an end to social distancing and stay-at-home orders.

In Italy, we would assume such demonstrations were fomented by the Mafia. In America, the provocateurs are right-wing extremists, Read more…

Don’t drink the COVID conspiracy Kool-Aid

Alfred Hitchcock, COVID-19, and the MacGuffin

Conditions
May 14, 2020

The last couple of months in a world with COVID-19 have felt absurd, incomprehensible, like something out of a movie.  Most of us hunker down in our homes and wear masks whenever we’re out.  Those who work in patient care settings try to limit risk, both of becoming infected, or perhaps worse, unknowingly infecting others.  How can this really be happening?  Everything seems to have changed overnight.  The paranoia, fear, …

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Alfred Hitchcock, COVID-19, and the MacGuffin

What John Snow and cholera tell us about the COVID pandemic

Conditions
May 13, 2020

It’s hard to imagine that someone could die from diarrhea. If you live in America today, you’ve likely never heard of anyone with cholera, and certainly never of anyone dying from diarrhea. Yet, in the middle of the nineteenth century, it was fairly commonplace. Medicine just wasn’t advanced at the time. Amputating limbs of fully-conscious human beings was only recently falling out of favor with the discovery of ether as …

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What John Snow and cholera tell us about the COVID pandemic

Everyone agrees nurses are heroes. Why aren’t we treating them that way?

Conditions
May 11, 2020

It’s been said that history doesn’t repeat, but it does often rhyme. And as we’re learning during COVID-19, lessons from the past can be a guide to help us navigate a modern pandemic — if we listen to the rhythm of history.

For a little more than two years in the middle of the 19th century, Great Britain, France, the Ottoman Empire, and Sardinia fought the Russian Empire for …

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Everyone agrees nurses are heroes. Why aren’t we treating them that way?

I’m a new doctor, and I’m scared about the other threat to my colleagues’ lives

Conditions
May 2, 2020

In late March, on what is known as Match Day, graduating medical students like myself found out where we would continue training as residents. This has always been an exciting but stressful time. This year it is more than that. On top of the countless challenges of starting residency, we are becoming doctors on the front lines of a pandemic.

How …

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I’m a new doctor, and I’m scared about the other threat to my colleagues’ lives

The parallels between basketball and pandemic medicine

Conditions
May 1, 2020

Michael Jordan. Kobe Bryant. Yao Ming. These are the biggest names in the basketball world, and all three were my superheroes growing up. Even though I’d never had the chance to meet them, to see how they carried themselves on and off the court-inspired me to push myself, to find out what my limits were physically and mentally, and to constantly create new goals for myself after accomplishing what I …

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The parallels between basketball and pandemic medicine

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