November 20, 2015

wheel within wheels

This is what I think of when I see companies like 23andme and others claiming they've figured out how to predict your health. My not so insignificant time spent in pharmaceutical research and development also bears out this comic. It's amazining we can treat anything given how complex the human body is. 

November 18, 2015

just the beginning

    Nearing the end of the day, I was checking my lidoderm patches to see how well they were sticking and assessing whether they'd survive the drive home or whether they should just be removed. I then noticed a streak down the middle of my scrubs. The back of my scrubs. I was struggling with the beginning of a bout of gastroenteritis and lets just say things were starting to get raw down there. So I had the brilliant idea to use vaseline to help protect the skin. But it had soaked through to my scrubs. And I wasn't wearing my long white coat either. Great, I had been walking around all day with this streak on my ass and no one bothered to tell me that it looked like I shit my pants. If only that had been the worst of it....

November 10, 2015

design flaw

Other than being funny, this cartoon will make more sense in days to come.

October 30, 2015


This may sound vain, but everytime I physically sign a prescription, a birth certificate, a form, etc and put the requisite MD after my name, I feel a twinge of giddiness. It'll probably take a bit longer for the novelty to wear off as so many of the prescriptions are electronically signed now.

October 22, 2015

my life

     It's a slow night and I can't be more relieved. There is only one lady in labor and delivery; triage is completely empty. The woman was barely contracting a couple of hours ago so I figure it won't be until 2 or 3 in the morning until she delivers. My oncologist calls me to follow up about getting in to see an endocrinologist. During that phone call, the delivery page goes off overhead. I start running down the hall while still talking about my own unknown health. I tell the doc I have to go. Emergency. I run in and the baby just came out. Fortunately, another doctor happened to be in the room while the woman started pushing. I massage her uterus and then start delivering the placenta, collecting cord blood, making sure she isn't bleeding, etc. We count up the sponges and we're one short. Shit. We can't find it. The only remaining place is the biohazardous trash. So while still fully gowned up I'm digging through the trash looking for a bloody sponge while my phone keeps going off as my oncologist is trying to call me back. Did I mention that the trash consisted mostly of feces laden pads as the lady began pushing too early? This is my life. I'm digging through a biohazard trash bin filled with shit while my oncologist is calling me about seeing an endocrinologist. I can't make these metaphors up.

October 17, 2015

pain continued

     It's 4:33 am. The constant barrage of patients streaming into triage all night has abated. My back is fried and I know I will pay for it. But underneath lies a sense of pride in doing a job well done. With every shift I gain in knowledge and experience. The patients are well cared for and I continue to grow. It seems worth the sacrifice. I lie down on one of the triage beds in a room hardly ever used. I intend to go to sleep for an hour or two. But the adrenaline that carried me for 11 straight hours is now depleted and the pain starts to resurface. I lie in the bed on my left side. My lower left lumbar cries out after just a few minutes. I flip over to my right side as lying on my back is a nonstarter. The right shoulder complains just as loudly, the result of a spinal defect combined combined with a football injury decades ago which has left me with a built in barometer. Sleep is not going to happen. I pull out my iPad and bring up Netflix intending on using that age old tested method for treating pain called Diversion. Ten minutes into it, I'm restless and cannot get comfortable. I try getting back up to walk it off. It works for about 60 seconds before the fatigue that caused the pain returns. I lie back down and try meditating. I struggle to control my breath and focus on it instead of the physical pain. I lie there in the dark and the thought arises in my head, "This is what hell must be like. Or, at least some version of hell. To be trapped in one's own body and unable to escape the pain signals it is creating. The pride is long gone and all that is left is physical pain."

October 14, 2015


     The first time I saw the patient, it was for a wellness exam but I sensed an angst that lie below the surface. But it's best to let these things evolve and focus on creating trust with the patient. The second time the patient came back in, the nurse came and whispered to me, "their pulse is in the 110s. I think they're really anxious about something."
     I walked in and asked, "how are you doing?", to which their reply was noncommittal. I set the chart, the pen and my stethoscope down and asked if everything was ok as I sat down. The breaths started coming deeply and tears started flowing. I reached out and offered my hand. They grabbed it and started to try to talk. To give words to the anxiety, to the trauma that created the anxiety. But the words were impotent. So I told them to close their eyes, focus on my voice, take deep breaths in and let them out completely. I instructed them to squeeze my hand as hard as they could with each breath in and relax on the exhale and just keep focusing on my voice. It must've lasted quite some time because the nurse peeked her head to see what was taking so long. One quick look appraised her of the situation and she quickly closed the door. 
     I could begin to tell the patient was starting to turn a corner and the adrenaline coursing through their veins was starting to ebb. I ever so gently slid my hand to feel their pulse as they continued to squeeze. What was that. That was a skipped beat. That happens. Maybe it's nothing. But I continue to feel. Shit. Another skipped beat. And this is not afib. I now have to tell this patient that they likely have an arrhythmia. And now I have to get an ekg. I have to let go of the patient's hand before they are ready. It is incredibly painful for me to do so but it's a necessity. Somehow, I manage to coax the patient to break that healing physical connection and let cold reason dictate my next steps. There is a cost to be bourn by both the patient and myself for this schism.