December 1, 2016

communion


Time is a rarified commodity for me. Such is the nature of the beast of training to be a physician, both in the aspect of the hours demanded but also in the aspect of trying to stave off death for the patients. Caffeine and adrenaline are well known tools to any in the trade. Even relaxing involves an element of hurry. Hurry up and get home to furiously decompress. Always balanced against fatigue. Before it is time to go back and do it all over again. So even my beloved task of writing often takes a back seat to other more pressing matters, usually sleep. But one commitment I have kept is giving blood. I always make time for it. It has become a sacred ritual of remembering. It is a communion in the truest sense of the religious term. A communion with memories, motivations, unanswered questions, struggles, sufferings. Do this in remembrance.

November 12, 2016

pagers

There are few devices that trigger a more negative Pavlovian response than a pager.  At 3 am.  When you've been asleep for 30 minutes.  Because the last page was at 2:30 am.  When you are already sleep deprived.  And running on empty.  Apparently, there is no training on what is deemed a good, or appropriate page, what can be resolved with common sense or what can wait until the morning.  The hospital isn't Walmart.  You can't just walk in and get whatever you want.  At least it shouldn't be.

Good Page with Appropriate Response
"Doctor, the patient's heart rate is in the 130s and they are having shortness of breath."
"I'm on my way."

Bad Page with Forced Appropriate Response
"Doctor, the patient is requesting mucinex."
Silence..........."Mucinex?  At 3 am? Ok"  Click.  The patient wasn't congested when I saw them at 9 pm and asked them if there was anything I could get them for the night.  Again, not Walmart.

Worst Page with Restrained Response
"Doctor, I see you put in a prescription for lowermybloodpressure.  But I am looking at the patient's blood pressure and this is normal for them. Do you still want to give it?"

What I don't say, "no, a systolic of 180 is NOT normal NOR good.  And let us not forget another nurse, perhaps someone you may know since you're both caring for the exact same patient, paged me not 45 minutes ago to tell me about the elevated blood pressure.  Perhaps she can educate you about the dangers of elevated blood pressure since she seems to know more about it than you."

What I do say, "Yes.  It's ok to give the medication."
"Are you sure?"
"Yes.  I am sure that I want the medication I ordered to be given."
"What is your name, doctor?"
"It's the one on the order."  Click.

November 9, 2016

best line

Best line in clinic from a patient all week, hell all month.

"I'm gonna be your black mama.  Give me a hug."

November 3, 2016

last resort



I walk in. Walk being the operative word. As I glance furtively about the waiting room, wheelchairs with their occupants of varying degrees of physical humanness sit close by their care giver. I don't belong here, here being TIRR. The Institute for Rehabilitation and Research. Or, THE Institute, I should say. When the congresswoman Giffords from Arizona was shot in the head, she was flown here for rehab. A bit of a reality check sets in as an internal dialogue begins. 
"I can walk."
"But some days, not so well."
"Yeah, but I'm not this far gone."
"Do you have a better idea?"
The voice is silenced as I truly am out of ideas. As are my other physicians. This pain management physician came highly recommended by my colleagues and friends in the palliative specialty of all places. How's that for dark humor?