My spry, 90-year-old patient decided she had a urinary tract infection two weeks ago. She had difficulty urinating and the constant urge to void with no fever, no chills, no back pain, no bloody urine. She was advised to come in for an appointment the same morning, but this didn’t suit her. The alternative choice was to see her urologist who made time available that same day. She decided this …
Why Medicare cannot stay solvent: a case study
It’s hard to put into words the horror we all feel about the events in Las Vegas. So I won’t try. But what I will try to do is point out an often unspoken reality. Which is that those who work in emergency care constantly face terrible things with courage and skill and keep coming back for more. And everyone needs to remember that all those folks society counts on …
My heart goes out to all of the first responders
The emergency department is a place of unpredictability. Some days are a whirlwind, others drag, but both can be interesting. On a calmer day, I found myself, a fourth-year medical student, working with a physician I will call Dr. Smith. We discovered that we shared a common love for music, and between patients, we discussed everything from opera, to banjo, to Indian music. I am a composer and amateur classical …
A place for music in the emergency department
Text message:
Me: “Mom you alright? I just heard that there was an explosion at the Pepsi Center.”
Mom: “What are you talking about? I am fine, everything is OK over here.”
Earlier that day:
It’s the first day of my first ER rotation as an intern.
I had endured months on medicine, neurosurgery and the medical ICU. I am finally home back in the ER. I am hoping that today will be a somewhat …
The first day of my ER rotation is one that this doctor will never forget
This is a letter I wrote to my wife’s grandfather for Veterans Day back when he was still alive. He was pretty proud of it, and that made me smile because I knew that if nothing else, he deserved to be proud of what he did for America. When he died a few months ago, I was able to muster up the fortitude to read it at his funeral. Here …
Recently, a video went viral when a woman complained about the lengthy wait time at a clinic. On video, we see the physician asks if the patient still wants to be seen. The patient declines to be seen, yet complains patients should be informed they will not be seen in a timely manner.
The frustrated physician replies, “Then fine … …
Do physicians deserve our mercy? #silentnomore
So I’ve finished up at one job and moved on to another. I was a director for a year, and it was a learning experience. Right now I’m nearing the final approach after working a long run. Last week I had five nights, 12 hours duration each. I stayed in a hotel near the hospital. Then, after two days off at home, I started a run of five days, of …
Emergency medicine can be exhausting. Here’s what this doctor does to unwind.
A father and a son are in a car accident. The father dies instantly, and the son is taken to the nearest hospital. The doctor comes in and exclaims, “I can’t operate on this boy!”
“Why not?” the nurse asks.
“Because he is my son,” the doctor responds.
How is this possible?
***
I first saw this riddle in a Washington Post article in October 2016. I was four years out of residency, and for the …
No female physician should have to feel that her gender is a factor limiting her success
Las Vegas: 59 dead, 500+ injured. I worry about our medical colleagues who will suffer tremendously while treating the injured; they will be wracked with guilt for the patients they could not help and false back to the horror of that night and the ensuing days and weeks caring for the living. We must find ways to support each other help them cope as well as looking for sensible solutions.
My …
After Las Vegas: What is the change that needs to occur?
Unless you’ve been living under a rock, you’re well aware that the United States is in the grip of a really big epidemic of opioid abuse. The epicenter of much of this has been my beloved Appalachia. My home-town, Huntington, WV, might as well be re-named “Oxycontin,” or maybe “Heroinville.” It’s ugly.
Enormous amounts of ink have been spilled on this topic, and …
How the pain scale and patient satisfaction leads to death
As Harvey’s devastation raged through Houston recently, the city’s mayor was compelled to address rumors that those seeking aid could be deported.
In the wake of a statewide ban on “sanctuary cities,” the mayor sought to reassure the Houston area’s more than 500,000 undocumented immigrants that they would not be targeted for deportation at emergency shelters.
Nevertheless, out of the disaster …
Anti-immigrant policies put people at risk during Harvey. And that’s just the beginning.
The ice storm of 2013 in Atlanta, Georgia made headlines for weeks described as “snowpocalypse” and “snowmageddon.” It looked like something from a sci-fi movie — the end of the world, an alien invasion. It was the subject of social media memes and discourse for quite some time. In the midst of all that human frustration, there were ice-trapped cars, parents who struggled to reach children trapped at elementary schools.
Physicians, …
5 ways doctors can cope when natural disaster strikes
When I meet a new person, and they find out I am a pediatric ER doctor, the most common response is a variation of: “Oh, that must be hard,” accompanied by a sympathetic frown.
The statement is well-intentioned, but I wonder — is their view of medicine closer to “Grey’s Anatomy” or “Scrubs?” (Hint: “Scrubs” is a better show and a more accurately reflects life in medicine.)
I imagine they think my …
A strategy for working in the ER: Serenity now, insanity later
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Social norms are not the norm in the ER. Things that are regarded as gross in the real world are an everyday occurrence. Our ER especially lived in a special universe where all social graces were stripped away, and the rawness of humanity is what remained.
I begin my night shift. I hadn’t taken a solid nap before my shift, and I am now headed into round 3 of 4. Nights …
Social norms are not the norm in the ER
The young woman was curled up in a ball. She was sweating and shivering from pain. As she answered my questions — all my many, many questions — tears fell silently from her eyes.
I was a third-year medical student, and the resident I was working with had asked me to evaluate this woman. She had …
An episode of racism in medical school. Did it affect her care years later?
I was recently at a meeting where some very influential physicians were discussing a question that I’ve been thinking about for a while: how do we find medical staff for rural emergency rooms and hospitals? It’s a tough question, because, increasingly, it seems that young physicians are trained to work in urban hospitals. Those are also the places these young doctors prefer to practice. Big hospitals and teaching centers in …
How can we solve the rural clinician shortage?
Fatal police encounters can engender PTSD in non-white communities and forever impact interactions with police. In the last few years, we have witnessed in horror the erosion of trust between public servants charged to protect the community and the non-white communities they serve. The killing of Philando Castile and Charleena Lyles compounded the horror, as their violent deaths were witnessed by their young children, spouses and, for Philando, social media. …
Philando Castile, Charleena Lyles, and PTSD: The consequences of fatal police encounters
As many was in the health care world, I was shocked by the unlawful arrest of nurse Alex Wubbels. In health care, there is a brotherhood and camaraderie between our law enforcement officers and health care workers, especially nurses. We all are literally on the front line of public service on a daily basis, making this story even more disturbing.
Although the situation initially happened on July 26, …
Here’s how the unjust arrest of one nurse inspires all nurses
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 57-year-old woman is evaluated in the emergency department for an episode of hematemesis that occurred 1 hour ago. She had previously felt well except for a recent knee injury, for which she has been taking ibuprofen. She currently is experiencing lightheadedness and weakness. Medical history is otherwise unremarkable. She does not …
MKSAP: 57-year-old woman with hematemesis
Health care is falling apart. We all know it, we can feel it, but it’s hard to say why it’s happening or even what is happening, we just know that it is true. And as bad as it is for patients, it’s even worse for providers. We know that there is something wrong. We want to help people. We are busy all day long seeing patients. Why doesn’t it feel …
Physicians have the power to save our health care system
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