A couple of weeks ago we had an afternoon lecture/demonstration with an ENT (Ear, Nose, & Throat) surgeon. I walked in late and they were doing laryngoscopes (looking at the voice box through the nose) and I asked him how bad my deviated septum was. He asked me to plug my right nostril and try to breath in through my left nostril. Nothing. No air movement at all. He took a look at my nose and about 30-45 seconds later he was on his phone with his nurse setting me up for surgery.
As an aside, I haven't been able to breathe right out of my left nostril for probably 15-20 years. Likely this is from some bonehead move when I was in high school or college. Now, this is nothing that I would pay out-of-pocket for, but if my insurance will cover it and we've already met our deductible and a surgeon is offering it to me...I'm gonna take it.
There are some interesting things about being a doctor and seeing what happens on the other end of surgery. We don't really get called until the patient in on the OR table and getting ready so when the surgeon comes in the room they are ready to cut. That means that I got to the hospital 2 hours early, proceeded to tell each nurse that came in the room that I was a doctor so they could skip all the inane questions (I didn't really say that last part, but wanted to). That means that I got to sit in a very small and flimsy hospital gown nearly naked for 2 hours and read my book that I had the foresight to bring.
We then went down to the OR and I remember moving to the operating table (and probably mooning a couple people in the process), lying down, feeling something cold go in my IV, look back at the anesthesiologist who told me it was Versed and then...nothing. I honestly don't remember a thing. Very weird. Who knows what gibberish I might have been spouting off. That happens to be one of the properties of Versed...amnesia, not spouting off.
The post-op for me was actually pretty uneventful. I was wondering what it would be like to take narcotics, but I didn't really need any, so I didn't get to find out. Alas. For just a septoplasty the recovery entails some pink/red nasal drainage like you have a runny nose and a sensation of TONS of sinus pressure from these small plastic splints they had shoved up my nose. A part of me (a small part of me) wishes that it would have been more involved so I could get a real sense of what surgery is like for my patients, but I'll take the glimpse that I got and be glad for the easier breathing.
Friday, December 30, 2011
Sunday, December 11, 2011
Old School Medicine
Much of modern medicine now relies on tests. When someone comes into the ER they almost always get blood work to one degree or another and then if the diagnosis isn't clear, they get some imagining (CT scan, Ultrasound, etc). Often the physical exam portion of the interactions is perfunctory and really only done for billing reasons. That being said, there are some times when something on the physical exam is more important than imaging and blood work.
I had a patient come in to the ER the other night and we were called down to admit her to the hospital for abdominal pain. Abdominal pain is really difficult to work with because there are some many causes for it. You have the pancreas, stomach, small intestines, large intestines, liver, gall bladder, and appendix. If you're a woman then you also have the ovaries and uterus as well as pregnancy that could be involved in the list of things we need to look at. This lady was a 22 year old lady who was pregnant, had a previous C-section (meaning she had abdominal scarring added to the list), and had a previous umbilical hernia (more scarring). Added to the mix is that she lives at the Salvation Army with her husband and child, is adopted from Vietnam and still speaks with an accent. She has been seen a LOT of times in the last year by both the ER, Obstetrics, and our Residency Clinic.
Anyway, I get down to the ER and start talking to her. She has a very very strange style of interaction. She would just sit there and look straight ahead and mumble answers. Her husband would answer some of the questions, but she just wouldn't make eye contact and just gave off a weird vibe. But one thing I learned from my public speaking class is that people are very uncomfortable with silence. So I would ask her a question and then just wait for her to answer. 30-40 seconds doesn't sounds like a long time, but try sitting in a small room at 10:30PM staring face to face with a doctor answering questions and it becomes a very long time. After a couple of questions and some very long pauses she eventually broke down and started talking with me. Essentially she has had this pain prior to her C-section and Hernia repair (hence not scar tissue, and the duration points away from it being her organs as they usually present more acutely) and although heating pads have helped somewhat, mostly just not using her abdomen has been the most helpful. She said it was worse with movement. All of her lab work was perfectly normal as was her baby.
Still confusing.
However, on physical exam I had her lie down on her back and then do a straight leg lift while I tried to push her feet down. This was very painful for her and perfectly elicited the pain she has been complaining about. Eureka! My conclusion was that it was some abdominal muscle strain that hasn't resolved because she has continued to use it with her job. She needs some Physical Therapy and a little bit of strengthening exercises and she should be good to go.
Most of what I do that is particularly memorable usually involves some sort of tragedy. It was really nice to finally do some sleuthing that changed course from what could have been a big work-up and potential surgery to something simple and easily fixable all because of a simple physical exam.
I had a patient come in to the ER the other night and we were called down to admit her to the hospital for abdominal pain. Abdominal pain is really difficult to work with because there are some many causes for it. You have the pancreas, stomach, small intestines, large intestines, liver, gall bladder, and appendix. If you're a woman then you also have the ovaries and uterus as well as pregnancy that could be involved in the list of things we need to look at. This lady was a 22 year old lady who was pregnant, had a previous C-section (meaning she had abdominal scarring added to the list), and had a previous umbilical hernia (more scarring). Added to the mix is that she lives at the Salvation Army with her husband and child, is adopted from Vietnam and still speaks with an accent. She has been seen a LOT of times in the last year by both the ER, Obstetrics, and our Residency Clinic.
Anyway, I get down to the ER and start talking to her. She has a very very strange style of interaction. She would just sit there and look straight ahead and mumble answers. Her husband would answer some of the questions, but she just wouldn't make eye contact and just gave off a weird vibe. But one thing I learned from my public speaking class is that people are very uncomfortable with silence. So I would ask her a question and then just wait for her to answer. 30-40 seconds doesn't sounds like a long time, but try sitting in a small room at 10:30PM staring face to face with a doctor answering questions and it becomes a very long time. After a couple of questions and some very long pauses she eventually broke down and started talking with me. Essentially she has had this pain prior to her C-section and Hernia repair (hence not scar tissue, and the duration points away from it being her organs as they usually present more acutely) and although heating pads have helped somewhat, mostly just not using her abdomen has been the most helpful. She said it was worse with movement. All of her lab work was perfectly normal as was her baby.
Still confusing.
However, on physical exam I had her lie down on her back and then do a straight leg lift while I tried to push her feet down. This was very painful for her and perfectly elicited the pain she has been complaining about. Eureka! My conclusion was that it was some abdominal muscle strain that hasn't resolved because she has continued to use it with her job. She needs some Physical Therapy and a little bit of strengthening exercises and she should be good to go.
Most of what I do that is particularly memorable usually involves some sort of tragedy. It was really nice to finally do some sleuthing that changed course from what could have been a big work-up and potential surgery to something simple and easily fixable all because of a simple physical exam.
Sunday, October 16, 2011
Psychosis
One of my most interesting rotations last year was Inpatient Psychiatry. This involved patients on a locked ward for a variety of reasons. The most common was depression with thoughts of suicide, but we had our fair share of psychotic people as well.
Modern society has taken it to mean many different things, but here is the actual definition
Modern society has taken it to mean many different things, but here is the actual definition
"A mental disorder characterized by symptoms, such as delusions or hallucinations, that indicate impaired contact with reality."
One of my favorite patients regarding this was a 38 year old African-American lady with some interesting psychoses. When you would ask her about the day she would seem perfectly put-together and answer all your questions appropriately. But, if you asked her about her past and how she got here; hold on for a ride.
She told me that she is actually almost 100 years old and used to teach special education kids until one day they rose up in rebellion and beat her up (which is why she is black now) and pulled out all her hair (which is why she now has "nappy" hair). When she was white she looked like Pamela Anderson and men would stop in the street when they saw her, "riots would break out" when she was around. She also took a train to India where she used to be a doctor. She was also married to Shawn Kemp (former NBA basketball player) who also was much older than he looks. Oh yeah, she also used to be a pink alien at one time. The most interesting thing about these interviews was how she was deadly serious. She didn't laugh or wink or smile or anything. This was her reality.
One of the most interesting things I learned from this is that our brain has all sorts of filters in place. People with this type of mental illness can often have thoughts/ideas/sights/sounds bypass these filters. One part of their brain is telling another part of their brain that it is experiencing something. They are, in one sense, actually experiencing it. As you can imagine it's sometimes very difficult to tell them that these things aren't real. It's like me touching someone on their arm and then telling them that I'm not actually touching their arm. They have felt it, they know it's real, and then they are told that it's not real. Unfortunately for them, it's usually not something as benign as a touch on the arm, but can be "command auditory hallucinations" (where they hear a voice telling them to do something), or telling them people are watching, or that they used to be a fantastically good-looking white lady. Although the stories are fantastic and very interesting, overall it's very sad, because this type of thing doesn't get better very easily. The real story behind this African-American woman is that she had a mental break where she became psychotic all of a sudden and left her 3 young children in the department store that they were in, eventually getting them taken away by Child-Protective Services.
One of my favorite patients regarding this was a 38 year old African-American lady with some interesting psychoses. When you would ask her about the day she would seem perfectly put-together and answer all your questions appropriately. But, if you asked her about her past and how she got here; hold on for a ride.
She told me that she is actually almost 100 years old and used to teach special education kids until one day they rose up in rebellion and beat her up (which is why she is black now) and pulled out all her hair (which is why she now has "nappy" hair). When she was white she looked like Pamela Anderson and men would stop in the street when they saw her, "riots would break out" when she was around. She also took a train to India where she used to be a doctor. She was also married to Shawn Kemp (former NBA basketball player) who also was much older than he looks. Oh yeah, she also used to be a pink alien at one time. The most interesting thing about these interviews was how she was deadly serious. She didn't laugh or wink or smile or anything. This was her reality.
One of the most interesting things I learned from this is that our brain has all sorts of filters in place. People with this type of mental illness can often have thoughts/ideas/sights/sounds bypass these filters. One part of their brain is telling another part of their brain that it is experiencing something. They are, in one sense, actually experiencing it. As you can imagine it's sometimes very difficult to tell them that these things aren't real. It's like me touching someone on their arm and then telling them that I'm not actually touching their arm. They have felt it, they know it's real, and then they are told that it's not real. Unfortunately for them, it's usually not something as benign as a touch on the arm, but can be "command auditory hallucinations" (where they hear a voice telling them to do something), or telling them people are watching, or that they used to be a fantastically good-looking white lady. Although the stories are fantastic and very interesting, overall it's very sad, because this type of thing doesn't get better very easily. The real story behind this African-American woman is that she had a mental break where she became psychotic all of a sudden and left her 3 young children in the department store that they were in, eventually getting them taken away by Child-Protective Services.
Monday, September 5, 2011
The Magic of modern medicine
I'm currently doing my cardiology rotation over at the other hospital in town (they have a Cardiac ICU with a lot more cardiac patients than my hospital). Given that we live in America and particularly in the State of Wisconsin there are a lot of people with risk factors for heart disease and we see A LOT of heart attacks in people. One of the standard treatments that everyone gets on is a medicine called a statin (Crestor, Lipitor, etc) for lowering cholesterol as well as some medications for lowering blood pressure. I was talking with a patient, who was only 55, about changing his diet and exercising after a heart attack and mentioned that we would be starting one of these medications for him. His response was, "Good, then my cholesterol is covered." As if he could now eat what he wanted and the medication would take care of the rest.
Sorry folks, no such luck.
Here's the quick and dirty...the risk factors that brought him to the hospital with a heart attack will continue to be risk factors for future heart attacks, and he will likely have another heart attack in the relatively near future (years time frame, not necessarily months).
There is something in medical research called the "number needed to treat (NNT)". Basically it means that if we take 100 people on a certain medication to prevent a future outcome, how many of those people who take the medication will actually benefit from it, or in other words what is the number of people we need to treat to prevent one bad outcome (heart attack, death, stroke, broken femur, whatever). Unfortunately, a good NNT is 20 or so. Many medications or interventions have much higher NNTs, like 100. Meaning that only about 5% of people at best are helped with our interventions. Not terribly impressive for our vaunted medicine.
Now if I could reduce my risk of a heart attack by even 5% with a largely benign drug that only costs $4 per month, then it's not much of a choice. However, if that drug costs $200-300 per month what would I do. What about a couple thousand dollars per month, what about tens of thousands of dollars for a major surgery? Suddenly it's not as easy as all that.
In the end, I think people put too much stock in what modern medicine does for them and not enough in stuff that is harder, slower, but has much more far reaching effects; exercise, a diet based on fruits, grains, and whole grains.
Sorry folks, no such luck.
Here's the quick and dirty...the risk factors that brought him to the hospital with a heart attack will continue to be risk factors for future heart attacks, and he will likely have another heart attack in the relatively near future (years time frame, not necessarily months).
There is something in medical research called the "number needed to treat (NNT)". Basically it means that if we take 100 people on a certain medication to prevent a future outcome, how many of those people who take the medication will actually benefit from it, or in other words what is the number of people we need to treat to prevent one bad outcome (heart attack, death, stroke, broken femur, whatever). Unfortunately, a good NNT is 20 or so. Many medications or interventions have much higher NNTs, like 100. Meaning that only about 5% of people at best are helped with our interventions. Not terribly impressive for our vaunted medicine.
Now if I could reduce my risk of a heart attack by even 5% with a largely benign drug that only costs $4 per month, then it's not much of a choice. However, if that drug costs $200-300 per month what would I do. What about a couple thousand dollars per month, what about tens of thousands of dollars for a major surgery? Suddenly it's not as easy as all that.
In the end, I think people put too much stock in what modern medicine does for them and not enough in stuff that is harder, slower, but has much more far reaching effects; exercise, a diet based on fruits, grains, and whole grains.
Sunday, August 28, 2011
Doc, I've got this rash
One of the things that my medical school friends would joke about from time to time would be people trying to get free medical advice from us. Of course, then it was easy because we genuinely didn't know anything. As they have chosen to get into more specialized fields, I'm sure their requests have become more infrequent. This is something a doctor in, say, Urology or Neurology, doesn't really have to deal with, but we in Primary care frequently deal with. As a general rule, when I'm able to answer these questions in a couple of seconds or a minute it means that it's not that serious and I saved them a doctor's visit. I'm happy to do this, as I know how expensive a visit to the doctor can be.
One wrinkle to this has been getting medical advice questions from my family. To date I've gotten questions about infant bowel movements, a couple of sick children, and questions about whether someone is in labor or not. There has also been random other things of a non-serious nature from other siblings.
This is actually very fulfilling for me. I love primary care because we can have the longest impact on peoples' overall health and have a wide range of influence. That said, it is nice to be able to help someone out in the short term who happens to be someone in my family. And as my brother said regarding why he called me instead of the nurses line, "You're going to give me more of a straight answer" as opposed to their always telling everyone to come in and be seen.
I anticipate this to continue as the years and nieces/nephews multiply, and I'm looking forward to it.
One wrinkle to this has been getting medical advice questions from my family. To date I've gotten questions about infant bowel movements, a couple of sick children, and questions about whether someone is in labor or not. There has also been random other things of a non-serious nature from other siblings.
This is actually very fulfilling for me. I love primary care because we can have the longest impact on peoples' overall health and have a wide range of influence. That said, it is nice to be able to help someone out in the short term who happens to be someone in my family. And as my brother said regarding why he called me instead of the nurses line, "You're going to give me more of a straight answer" as opposed to their always telling everyone to come in and be seen.
I anticipate this to continue as the years and nieces/nephews multiply, and I'm looking forward to it.
Sunday, August 7, 2011
TOBP
Part of my job as a Family Medicine resident includes delivering babies. (Quick lesson on the different specialties; Internal Medicine = Adult medicine, Pediatrics = kids, Obstetrics = delivering babies, Family Medicine = all of the above). Overall I really enjoy this. People are generally excited (even if it wasn't planned, which is 50% of pregnancies in the US!!!), generally healthy, and generally things go smoothly. That being said, there are a number of people that I see who are social disasters and have multiple problems outside of being pregnant that are magnified by being pregnant.
I have one such lady that I just delivered. She is 21 years old, this is her 5th pregnancy and 3rd child. She has little education, her husband is a truck driver and a little rough around the edges. Needless to say, the Labor and Delivery ward is a safe place for her and she visited often, starting when she was about 30 weeks along (2.5 months before her due date). She came up probably weekly and saw me in the clinic at least once per week in addition to various other visits to other doctors/residents. She would have the usual "contractions" and back pain all without being in labor, "bleeding" with no evidence of it when she came in, and "seizures" that the Neurologist doesn't really believe are real. But by far my favorite was when she came in the middle of the night because her "water broke". Now, there are some tests we can run on pregnant women to see if they have indeed their water has broken. We don't do this on everyone especially if 1) their clothes are wet, 2) they are very reliable, and 3)are full-term. She met only two of those three criteria (guess which one she didn't meet) so we went ahead and tested her for amniotic fluid: negative. So what happened? She had actually peed her pants, went home to change clothes, and peed them again! She got the diagnosis of TOBP (Tired of Being Pregnant: A benign condition) and sent home. Definitely one of the more interesting stories I've had.
The ending of this story is that she went into labor the same day as Melinda and I delivered her an hour before Melinda in the room next door.
I have one such lady that I just delivered. She is 21 years old, this is her 5th pregnancy and 3rd child. She has little education, her husband is a truck driver and a little rough around the edges. Needless to say, the Labor and Delivery ward is a safe place for her and she visited often, starting when she was about 30 weeks along (2.5 months before her due date). She came up probably weekly and saw me in the clinic at least once per week in addition to various other visits to other doctors/residents. She would have the usual "contractions" and back pain all without being in labor, "bleeding" with no evidence of it when she came in, and "seizures" that the Neurologist doesn't really believe are real. But by far my favorite was when she came in the middle of the night because her "water broke". Now, there are some tests we can run on pregnant women to see if they have indeed their water has broken. We don't do this on everyone especially if 1) their clothes are wet, 2) they are very reliable, and 3)are full-term. She met only two of those three criteria (guess which one she didn't meet) so we went ahead and tested her for amniotic fluid: negative. So what happened? She had actually peed her pants, went home to change clothes, and peed them again! She got the diagnosis of TOBP (Tired of Being Pregnant: A benign condition) and sent home. Definitely one of the more interesting stories I've had.
The ending of this story is that she went into labor the same day as Melinda and I delivered her an hour before Melinda in the room next door.
Sunday, July 17, 2011
Life's tough and then you die
I had an interesting patient this week that has given me a lot to think about. The brief explanation of what brought him in will help illustrate what my thought process has been like. Here goes.
He's an 87 year old guy with some dementia and his daughter is his Power of Attorney (makes medical decisions for him now because he can't). He has been getting weaker for the last 6 months, eating 2 meals a day for the last month and 1 meal a day for the last week. He comes in for this weakness and in the course of his testing it's found that he has a golf ball-sized tumor on his lung and another one in his small bowel. This one in his stomach causes him to become totally blocked up. At this point there are really 2 decisions that could be made.
1- Get a very large surgery.
or
2-Get some palliative care and go home to die there.
From a medical standpoint, here is what I see.
Option Number One: If they choose option one you are faced with the reality that his cancer has already spread and has done so a while ago (as evidenced by the tumor in his lung). This is a very poor prognosis for anyone, meaning the surgery that is being offered is not curative, it will only help with the symptoms of an intestinal obstruction. He will likely do poorly after the surgery because of his declining health and poor nutrition and will spend a week or two in the hospital and likely at least a couple of months in a nursing home/rehab facility before going home at all. Remember this hasn't cured him and he will likely die relatively soon from this cancer. It is also important to remember that there will be significant (read: excruciating) pain with the surgery that will slow healing and slow down return of bowel function prolonging hospitalization. Because of any surgery and hospitalization there is the very real possibility that he will have a complication such as infection. Finally, not to crude, but there is the very real situation of finances. The average day in the hospital costs $1000 a day and a stay in the ICU can be $10,000 per day. Not to mention the cost of a nursing home for weeks after being discharged from the hospital.
Option Number Two: A small bowel obstruction is not a fun way to go. Your stomach still makes gastric juices, the bacteria in your belly still make gas all of which can't get past the obstruction and this is very uncomfortable. This also means that you can't eat anything and you will likely die in a matter of weeks. We can put a tube down your nose that can vent these gasses and suck out the juices, or we can put a tube through your skin to your stomach to do the same thing to make you more comfortable. We can do many things for pain control to make you comfortable at the end. Eventually you will die, but you will be at home, reasonably comfortable and surrounded by the people you love in the place that you love. Also, not to be crude, but this option is much cheaper than the previous option.
What would I want if this were me? Take me home and let me die. People spend a fortune, experience so much pain, and endure procedures that ultimately won't buy them more than a couple of weeks at best. All this and 75% of people die in hospitals or nursing homes when an overwhelming majority of Americans want to die at home. Part of this is due to a separation from death and people not seeing the natural process of it. Part of this is due to the belief that we can somehow buy a new lease on life. This last part is partially true, but often not for any meaningful length of time and at tremendous cost physically, emotionally, and monetarily.
I had hoped that this family would have taken their father home and used what little time they have left just being together. That would have been a "good death". Unfortunately he chose the surgery and is now in a great deal of pain recovering from a 6 hour surgery. At this point I just hope that he recovers well from this and the benefit is worth this cost to him.
He's an 87 year old guy with some dementia and his daughter is his Power of Attorney (makes medical decisions for him now because he can't). He has been getting weaker for the last 6 months, eating 2 meals a day for the last month and 1 meal a day for the last week. He comes in for this weakness and in the course of his testing it's found that he has a golf ball-sized tumor on his lung and another one in his small bowel. This one in his stomach causes him to become totally blocked up. At this point there are really 2 decisions that could be made.
1- Get a very large surgery.
or
2-Get some palliative care and go home to die there.
From a medical standpoint, here is what I see.
Option Number One: If they choose option one you are faced with the reality that his cancer has already spread and has done so a while ago (as evidenced by the tumor in his lung). This is a very poor prognosis for anyone, meaning the surgery that is being offered is not curative, it will only help with the symptoms of an intestinal obstruction. He will likely do poorly after the surgery because of his declining health and poor nutrition and will spend a week or two in the hospital and likely at least a couple of months in a nursing home/rehab facility before going home at all. Remember this hasn't cured him and he will likely die relatively soon from this cancer. It is also important to remember that there will be significant (read: excruciating) pain with the surgery that will slow healing and slow down return of bowel function prolonging hospitalization. Because of any surgery and hospitalization there is the very real possibility that he will have a complication such as infection. Finally, not to crude, but there is the very real situation of finances. The average day in the hospital costs $1000 a day and a stay in the ICU can be $10,000 per day. Not to mention the cost of a nursing home for weeks after being discharged from the hospital.
Option Number Two: A small bowel obstruction is not a fun way to go. Your stomach still makes gastric juices, the bacteria in your belly still make gas all of which can't get past the obstruction and this is very uncomfortable. This also means that you can't eat anything and you will likely die in a matter of weeks. We can put a tube down your nose that can vent these gasses and suck out the juices, or we can put a tube through your skin to your stomach to do the same thing to make you more comfortable. We can do many things for pain control to make you comfortable at the end. Eventually you will die, but you will be at home, reasonably comfortable and surrounded by the people you love in the place that you love. Also, not to be crude, but this option is much cheaper than the previous option.
What would I want if this were me? Take me home and let me die. People spend a fortune, experience so much pain, and endure procedures that ultimately won't buy them more than a couple of weeks at best. All this and 75% of people die in hospitals or nursing homes when an overwhelming majority of Americans want to die at home. Part of this is due to a separation from death and people not seeing the natural process of it. Part of this is due to the belief that we can somehow buy a new lease on life. This last part is partially true, but often not for any meaningful length of time and at tremendous cost physically, emotionally, and monetarily.
I had hoped that this family would have taken their father home and used what little time they have left just being together. That would have been a "good death". Unfortunately he chose the surgery and is now in a great deal of pain recovering from a 6 hour surgery. At this point I just hope that he recovers well from this and the benefit is worth this cost to him.
Thursday, June 2, 2011
The tough part of my job
Overall I really love my job, but there are parts of it that I really don't enjoy. On Sunday morning I was on call at the hospital and I was called down to the ER to admit a patient to the hospital. She was a 42 year old lady who aside from being a little overweight was otherwise pretty healthy. She had been seen by her Primary Care Doctor a couple of months ago and felt overall very well. In the next two months she started to develop some digestive problems that weren't terribly worrisome to her as she's had some similar problems in the past that cleared up. These waxed and waned a little, but in the last 3 weeks she's also developed nausea and vomiting and had trouble keeping anything down. She has seen the Gastrointestinal Doctors and they took a look from the top and bottom and didn't find anything. She was set up for a CT scan of her belly set up on Tuesday, but the nausea got so bad that she came in early to get one in the ER on Sunday. She ended up being told by the ER doctor that she had a mass in her pancreas and liver as well as other places and then handed off to me. All cancer is bad, but pancreatic cancer it is almost always a death sentence and almost certainly with metastases like she has. So I have to walk into this room where I have to explain to this previously healthy 42-year old woman, her fiance, and 3 of her siblings that she will most likely have weeks to months to live. Pretty much the worst thing I've had to do as a doctor
Saturday, January 29, 2011
My heart is still pounding
I had an experience last night that had my hands shaking for a good 10 minutes afterward. A little background is needed for this. I'm in a Family Medicine residency which means we do adult medicine, pediatrics, and OB/GYN stuff including delivering babies. Anytime patients come in to be evaluated I see them, come up with a plan, run it by an attending physician (teaching doctors) and then go ahead with the plan. When its close to delivery the doctors come in and stand next to me while I'm delivering the baby. I've had 15-20 deliveries this year and it's usually a very fun experience for everyone (once the baby is out, that is).
Last night I'm on the phone with one of the teaching doctors for a patient when I get interrupted by one of the nurses who takes the phone from me and says, "you need to get in that room right now!" The doctor of this other patient had just recently gone home because the patient wasn't really dilating that quickly. Well, she dilated in a hurry and as this was her 5th child, things moved pretty quickly from there. Before the other doctor even make it to the hospital, and before I even had time to get anything on but some gloves, I'm catching a baby. (Delivering a baby is pretty messy business and usually I have a splash gown for...splashes, and some booties on to cover my shoes). Talk about getting your heart pumping.
Part of the reason that this was so heart-pumping was that 2-3 weeks before residency started I had a dream that was similar to this. Some lady was having a baby right then, and the surrounding crowd asked if anyone was a doctor. I proudly raised my hand and they said I needed to delivery this baby. Then the panic set in because I didn't know what I was doing and this was stressful enough to wake me up out of sleep (for those of you who don't know how hard I sleep, that's sayin' something). I am pleased to say that I have learned much since then, and everything went smoothly with this delivery, but my hands were shaking for a good ten minutes afterwards.
Last night I'm on the phone with one of the teaching doctors for a patient when I get interrupted by one of the nurses who takes the phone from me and says, "you need to get in that room right now!" The doctor of this other patient had just recently gone home because the patient wasn't really dilating that quickly. Well, she dilated in a hurry and as this was her 5th child, things moved pretty quickly from there. Before the other doctor even make it to the hospital, and before I even had time to get anything on but some gloves, I'm catching a baby. (Delivering a baby is pretty messy business and usually I have a splash gown for...splashes, and some booties on to cover my shoes). Talk about getting your heart pumping.
Part of the reason that this was so heart-pumping was that 2-3 weeks before residency started I had a dream that was similar to this. Some lady was having a baby right then, and the surrounding crowd asked if anyone was a doctor. I proudly raised my hand and they said I needed to delivery this baby. Then the panic set in because I didn't know what I was doing and this was stressful enough to wake me up out of sleep (for those of you who don't know how hard I sleep, that's sayin' something). I am pleased to say that I have learned much since then, and everything went smoothly with this delivery, but my hands were shaking for a good ten minutes afterwards.
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