The student had met her earlier last week. During that time she had been quite charming, quick minded, snarky, but with a compassion beyond belief. She had insisted that the doctor come to her home, once she was discharged, and sample some of her homemade jam recipes. She proudly recalled that she grew her own ingredients and her jars of jams and other treats were the talk of the neighborhood. Her daughter smiled lovingly at her. She was decisively independent in action and thought, but euphoric about her improvement. Traits that endeared her to the student and he hoped that he'd see her again when he returned the next week.
Upon the student’s return he found her in an opposing condition. That Friday she had been planning to go home, doing well and feeling optimistic about her time left, but now she was besieged like a cornered animal, clinging to an oxygen mask as life sustaining gas was pumped through at more than 7 liters a minute. Her eyes were screaming at him: “Help. I can’t breathe. Help!” and he recalled seeing that her oxygen saturations had dropped over the weekend to precariously low levels. The room, once full of euphoria, was now transformed into a dark, humorless, shadow full of dispair and exhaustion. The student felt a unique sense of vertigo, as if his entire world was being lost along with her's.
With this remarkable uneasiness that assailed him from every corner of the room, he examined her. He instantly recongnized the revulsion that had grown up in him and stood as a palpable lump in his throat. He found it hard to talk, even when just telling her what he was doing.
As the student arrived at the abdomen he discovered that the once soft, obese stomach was now a massively enlarged, rock hard, mound with discernible peaks and valleys. He could not appreciate any bowel sounds – an ominous sign. She had stopped producing urine and her eyes were no longer white, but were markedly yellow. His horror magnified as he examined these eyes, noting the distinct despair and cries that were manifested there within.
He knew from last week that she had undergone a major surgery to remove cancerous tissues. They had hoped that there hadn’t been any spread, but clearly the truth was here for the student to behold: The tumor had survived and was assaulting the woman from within; taking control of her body, plaguing her kidneys and liver, and making breathing an incredibly laborious effort. She was drenched with sweat from the effort of living. The student felt the sudden need to leave. He did not know what to do.
The morning rounds consisted of lengthy discussions between the doctor and her residents as well as with the family and the patient. The main topic focused on her sudden and clearly unexpected change. He found somewhere during this time that a party had been for her return and the banners still hung in her living room. "I doubt she'll see them" he had thought.
Radiographic films were viewed with the family in the physician’s lounge and the doctor explained the findings. The student already knew – large amounts of a homogenous, grey material obscured large amounts of the normal anatomy, interspersed with tumor. Her abdominal wall was caked in oppressive and magnificent abnormal cellular reproduction that constricted her diaphragm and reduced the patient's ability to move air.
“Metastasis. Outcome looks bad. Kidneys have begun to stop working”.
The family received these messages with stunned silence; then the daughter, the loving woman whom had been at the patient’s side when he initially met her, began to cry. The student looked away. He was surprised to find that he was fighting back tears as well – tears for a patient he’d only met once. Yet he knew what all of this meant.
In the span of 3 days she had fallen down the potential abyss that many patients navigate unscathed. She had “decompensated” and he knew there was nothing more to be done. She was going to die and he felt the acutely ironic scenarios play out before him.
****
She died later that week - a full code despite the attempts to obtain a DNR. He had avoided talking with the family or seeing the patient since that day unless he absolutely must. The situation was uncomfortable and the interrogations he received or perceived frustrated and confused the student. He didn’t know what to do, nor what to say. The doctor should be doing that. He was angry at the situation and the distinct perception that he was absolutely and completely ignorant of how to proceed. "How is it that after all this time I have no idea what to do"? he would often find himself asking aloud. His mind swam with guilt.
Now, as the student surveyed her lifeless body, tracheal tube still in place, eyes fixed and staring, chest exposed with the disproportions of her abdomen starkly evident, he was disgusted. A sudden and uncontrollable compulsion welled up within him. “I must get out of here!” he thought and he looked longingly at the door and the sanctuary of the nurses station. There he would be safe from the woman’s gaze, from his guilt.
Fighting off this instinct, the student stayed. He stayed when the doctor and residents lefts, he stayed when they cleaned up the woman. He even stayed when the family came in and burst forth in tremendous sobs. He persisted, in spite of himself. He had not been there for them before, but he wanted to be there now. Not so much for them, but for himself. If the student ran from this, then he had utterly failed in his duty.
The day culminated in a total of 20 hours. He had not needed to stay and had been released earlier. Yet he persisted. Wanting to stay and learn from his mistakes he remained and accompanied her to the morgue. He had avoided Death, but clearly it could not be brushed aside. It must be faced, and he had not performed admirably during the patient’s transition.
Though he desired to view her autopsy, he knew that this was an intrusion he could not perform. He had not been there with her during life, surely he should not be there when she was dissected and the tense abdomen exposed - it felt too intimate. He heard the next day that when the pathologist intially began she gushed liters of fluid. Metastatic ovarian cancer with mets all over her body.
At least she’s at peace, he thought. If there is a heaven, then surely she’s making her famous jams. The student smiled, and went about the rest of his day.
Showing posts with label patients. Show all posts
Showing posts with label patients. Show all posts
Saturday, March 1, 2008
Tuesday, January 29, 2008
Trust in Pain
A comment recently received caught my attention. And not so for it’s questioning of my patient attitudeness, but more for this first portion:
Fortunately I received a great lecture on this topic early in my 3rd year that has stuck with me. Yes, there are those people out there who abuse the system and want to have narcs up the wazoo just because they want to get high. However, in anesthesia we do have to be more receptive to the idea that someone’s pain is a 10/10 even though they are sleepy.
The lecture to which I referred earlier was by a doctor who worked with the old and terminally ill. She often gave dosages of pain killers that many other doctors thought would surely kill the patient. Her advice was that pain should never be uncontrolled just to remain within the “standards” of the pharmacopeia.
“The patient will let you know when they’ve received enough. You just titrate out the amount until they are pain free or close to sleep. Then you’re at your boundary.”
In most patient encounters this wouldn’t work too well – not enough staff to watch carefully over the patient as the drugs reach their peak effect. However, in the PACU, where we have nurses who carefully observe and manage patients, we can adjust more readily. They are given orders for pain management by the anesthesiologist, who, by way of observing the patient’s narcotic need intraoperatively, will have a better understanding of how tolerant or labile the patient is towards pain control measures. These can then be adjusted based on pain scales and overall patient physical characteristics.
Addressing the notion that we lack objective tests, certainly during the operation there are physiological parameters that anesthesiologists look for when controlling pain: increases in blood pressure, heart rate, breathing, perspiration, etc. are all items that alert them to a need for increased pain management (this being said, it is important to realize that even though the “body” is responding by reflexive physiological measures, the patient very rarely has any recall). This is a form of acute pain control, often a direct result of a noxious stimulus. Many patients present with similar findings, even when conscious, and allow for more visual confirmation of pain. While easier to understand and treat, we still have people with chronic pain, vague and mysterious, that's often at the heart of these controversies between physician and patient.
Rather than label a patient as a "malingerer" or "druggie" who presents multiple times for low back pain, neuropathic pain, or "flares" we must trust them. And that’s were the catch comes. That’s were so many healthcare providers, who entered medicine wanting to help only to be burned time and again, are now skeptical of most pain complaints. The abuse they've seen and endured, at the hands of addicts and malingerers, hurts more than just the patient - we all suffer to some degree.
Considering the notion that people report pain even after receiving large amounts of highly potent narcotics, you can easily expect providers to write the patient off as an addict. Unfortunately, while true in many cases, some pain cannot be well controlled with medications or is completely untouchable. This leaves the sufferer searching for assistance, help, and relief from the constant agony. Pain specialists are often useful for these kinds of patients, using advanced pain management, through invasive procedures, to help in these cases. A rather lucrative field, I personally have no desire to entertain such thoughts, as pain patients are some of the hardest people to treat, having been "mistreated" so many times.
Many forms of pain are hard to diagnose, treat, or even moderately control regardless of level of therapy. Asking for a quantification (the best known is the 0-10 scale) is often hard to deem accurate as pain is patient specific, based on psychological, emotional, and environmental cues. Someone claiming 10/10 pain may actually have the worst pain they've ever experienced. Just because we've seen people in worse situations shouldn't cause us to feel they're lying to us - it's completely subjective.
A theory postulated by some neurologists and others has suggested that the brain “makes up” pain in order to elicit stress responses that were once normally found – we’ve just become too comfortable and it’s a fall-back mechanism gone awry, kind of like the increased incidence of allergies. I kinda like that idea and understand it – after all, many of the harder to “trust” diseases like Fibromyalgia are more receptive towards medications targeting brain chemistry and function*. Whether I believe it to be a real disease is not the question, the patient believes it and therefore they suffer from it. We need to understand that more.
I honestly feel that we must listen to a patient and assess them truthfully while at the same time the patient must also listen and adhere to physician advice. An overdose of pain medications results in decreases in many aspects important for body funtions, including breathing and cerebral consciousness. If patients are found to be sleepy, lethargic, hard to arouse, disoriented, or having some trouble breathing at a normal rate they shouldn’t receive anything more - regardless of additional complaints. That's were the education comes into play. The physician must acknowledge the limit and be in control of the situation, without allowing emotions or a concern for legal action to influence their decision.
Despite the fact that there is some evidence that pain exists regardless of conscious level (i.e a sleepy patient can still have 7/10 pain) we need to accept that the limits have been met or breached and inform the patient as best as possible. I might still trust that the patient has pain, but my ability to help with more narcotics has been limited. My hands are tied.
*Is it just me, or do those commercials have the crazy patient look down? I look at those ladies, talking about their pain, and just shudder.
I think it is interesting that you have chosen anesthesia as your specialty - the management of pain issues being one of the few areas of medicine where the physician has to simply trust the patient to report their pain since there is no objective test to prove it. Have you thought about how you will manage when a patient reports pain (and i'm not speaking of one of the flat out easy to spot drug seekers) but you feel you have treated them adequately? If you, using your prior experience and all of your knowledge don't feel they need more meds despite what they are telling you - what will you do?
Fortunately I received a great lecture on this topic early in my 3rd year that has stuck with me. Yes, there are those people out there who abuse the system and want to have narcs up the wazoo just because they want to get high. However, in anesthesia we do have to be more receptive to the idea that someone’s pain is a 10/10 even though they are sleepy.
The lecture to which I referred earlier was by a doctor who worked with the old and terminally ill. She often gave dosages of pain killers that many other doctors thought would surely kill the patient. Her advice was that pain should never be uncontrolled just to remain within the “standards” of the pharmacopeia.
“The patient will let you know when they’ve received enough. You just titrate out the amount until they are pain free or close to sleep. Then you’re at your boundary.”
In most patient encounters this wouldn’t work too well – not enough staff to watch carefully over the patient as the drugs reach their peak effect. However, in the PACU, where we have nurses who carefully observe and manage patients, we can adjust more readily. They are given orders for pain management by the anesthesiologist, who, by way of observing the patient’s narcotic need intraoperatively, will have a better understanding of how tolerant or labile the patient is towards pain control measures. These can then be adjusted based on pain scales and overall patient physical characteristics.
Addressing the notion that we lack objective tests, certainly during the operation there are physiological parameters that anesthesiologists look for when controlling pain: increases in blood pressure, heart rate, breathing, perspiration, etc. are all items that alert them to a need for increased pain management (this being said, it is important to realize that even though the “body” is responding by reflexive physiological measures, the patient very rarely has any recall). This is a form of acute pain control, often a direct result of a noxious stimulus. Many patients present with similar findings, even when conscious, and allow for more visual confirmation of pain. While easier to understand and treat, we still have people with chronic pain, vague and mysterious, that's often at the heart of these controversies between physician and patient.
Rather than label a patient as a "malingerer" or "druggie" who presents multiple times for low back pain, neuropathic pain, or "flares" we must trust them. And that’s were the catch comes. That’s were so many healthcare providers, who entered medicine wanting to help only to be burned time and again, are now skeptical of most pain complaints. The abuse they've seen and endured, at the hands of addicts and malingerers, hurts more than just the patient - we all suffer to some degree.
Considering the notion that people report pain even after receiving large amounts of highly potent narcotics, you can easily expect providers to write the patient off as an addict. Unfortunately, while true in many cases, some pain cannot be well controlled with medications or is completely untouchable. This leaves the sufferer searching for assistance, help, and relief from the constant agony. Pain specialists are often useful for these kinds of patients, using advanced pain management, through invasive procedures, to help in these cases. A rather lucrative field, I personally have no desire to entertain such thoughts, as pain patients are some of the hardest people to treat, having been "mistreated" so many times.
Many forms of pain are hard to diagnose, treat, or even moderately control regardless of level of therapy. Asking for a quantification (the best known is the 0-10 scale) is often hard to deem accurate as pain is patient specific, based on psychological, emotional, and environmental cues. Someone claiming 10/10 pain may actually have the worst pain they've ever experienced. Just because we've seen people in worse situations shouldn't cause us to feel they're lying to us - it's completely subjective.
A theory postulated by some neurologists and others has suggested that the brain “makes up” pain in order to elicit stress responses that were once normally found – we’ve just become too comfortable and it’s a fall-back mechanism gone awry, kind of like the increased incidence of allergies. I kinda like that idea and understand it – after all, many of the harder to “trust” diseases like Fibromyalgia are more receptive towards medications targeting brain chemistry and function*. Whether I believe it to be a real disease is not the question, the patient believes it and therefore they suffer from it. We need to understand that more.
I honestly feel that we must listen to a patient and assess them truthfully while at the same time the patient must also listen and adhere to physician advice. An overdose of pain medications results in decreases in many aspects important for body funtions, including breathing and cerebral consciousness. If patients are found to be sleepy, lethargic, hard to arouse, disoriented, or having some trouble breathing at a normal rate they shouldn’t receive anything more - regardless of additional complaints. That's were the education comes into play. The physician must acknowledge the limit and be in control of the situation, without allowing emotions or a concern for legal action to influence their decision.
Despite the fact that there is some evidence that pain exists regardless of conscious level (i.e a sleepy patient can still have 7/10 pain) we need to accept that the limits have been met or breached and inform the patient as best as possible. I might still trust that the patient has pain, but my ability to help with more narcotics has been limited. My hands are tied.
*Is it just me, or do those commercials have the crazy patient look down? I look at those ladies, talking about their pain, and just shudder.
Monday, January 28, 2008
Kids Are to Placebos as Patients Are to...
Little children are placebo happy. If they have a small scratch, bump, or bruise that they can see they want a band-aid and a kiss. As soon as the band-aid is applied, the kiss given, they suddenly feel an instantaneous relief. If they’ve received medicine in the past for an illness they want something for their cough – or just to be like mommy and daddy. As soon as they get it, they’re happy. They're cured.
Patients are a lot like little children - at least the ones who use primary care services or the ER for minor complaints and an overt sense of entitlement. If you tell them that they’re going to be OK and try to send them along their way they get all upset.
“What, you’re not giving me an antibiotic? But I WASTED $25 for my stupid copayment! I didn’t come here to waste my money!” (as if taking up a professionals time and utilizing many years of education and training could be considered a "waste")
So, some doctors give in and prescribe the antibiotic, only reinforcing the patient’s misplaced sense of entitlement. Unlike a band-aid or kiss, this practice is dangerous as every drug has side effects and also increases resistance of normal residential bacteria.
Essentially the patient has thrown an adult temper tantrum, demanding to receive their placebo. Hell, we could give them sugar water with red food coloring and call it an antibiotic and they’d swear that they only get better with drugs.
In fact, my grandmother once told me about one of her friends who will purchase a large bottle of penicillin whenever they travel to Mexico. He then uses them with every subsequent cold he gets. I can't even begin to describe how irresponsible that practice is - I'm surprised he hasn't gotten a severe infection yet. But I'm sure he believes he improves only as a direct result of the antibiotics he takes and thinks his doctor's an idiot.
Patients are a lot like little children - at least the ones who use primary care services or the ER for minor complaints and an overt sense of entitlement. If you tell them that they’re going to be OK and try to send them along their way they get all upset.
“What, you’re not giving me an antibiotic? But I WASTED $25 for my stupid copayment! I didn’t come here to waste my money!” (as if taking up a professionals time and utilizing many years of education and training could be considered a "waste")
So, some doctors give in and prescribe the antibiotic, only reinforcing the patient’s misplaced sense of entitlement. Unlike a band-aid or kiss, this practice is dangerous as every drug has side effects and also increases resistance of normal residential bacteria.
Essentially the patient has thrown an adult temper tantrum, demanding to receive their placebo. Hell, we could give them sugar water with red food coloring and call it an antibiotic and they’d swear that they only get better with drugs.
In fact, my grandmother once told me about one of her friends who will purchase a large bottle of penicillin whenever they travel to Mexico. He then uses them with every subsequent cold he gets. I can't even begin to describe how irresponsible that practice is - I'm surprised he hasn't gotten a severe infection yet. But I'm sure he believes he improves only as a direct result of the antibiotics he takes and thinks his doctor's an idiot.
Tuesday, December 18, 2007
My First Time
I remember my first inpatient experience well. The patient is burned into my mind as a constant declaration of the ignorance that I held entering the clinical aspects of medicine. To be honest I found this person disgusting, repulsive, and inhuman. A perception that I did not wish to have betrayed to my superiors or my patient.
This feeling was uncomfortable and appaling. Over the last 2 years I’d been indoctrinated with the ideals of the “ethical physician” and the “professionalism” I must inculcate before meeting real patients. Despite the many fantastic thoughts and discussions we as a class had entertained, these forums, as well meaning as any, were utterly useless upon this first meeting.
Homeless, IV drug addicted, and crippled with disease, the patient came to us earlier that morning while I oriented to the inpatient wards. Upon entering the room I beheld a haggard, disheveled, and desperate form. Reeking of a filth known only to years of hardened drug use, I realized and withheld the primordial urge to retch and vacate the room.
“A full history and physical.” was the task charged me by my senior resident. "You will need to get a full H&P, write it out, and present it to me later today along with a differential and plan." Considering I'd never done a full blown physical, I knew I would need at least an hour with this patient and was not looking forward to our prolonged encounter.
Even though the intern was finishing up his H&P when I entered, I had to revisit every last detail already procured. The patient, clearly upset over this obvious intrusion, deferred several questions, cursed my stupidity readily, and resisted any attempts at a full physical. The anger inherent in the eyes was penetrating. Trust was not given nor expected, just more hurt, and he wished to inflict it before receiving.
Over the next week and a half “my patient” grew more tiresome. Pre-rounding was endless, useless, and ultimately absurd. The only information gathered was from forcing myself on the chest wall, abdomen, back, and head in order to elicit the heart sounds, breath sounds, and other physical tasks requisite of me after questioning the lethargic night nurses for overnight events.
Once able to hold a semblance of conversation, my patient soon withdrew from everyone and became mute. On one occasion I found my senior yelling in exasperation as she attempted to get consent for treatment. She no longer rounded unless the attending requested – leaving only the intern and I looking after the patient in the early mornings. The hate emanating from those eyes was palpable. We all felt it.
Regardless of the hate, the battles, and the apparent lack of concern about their declining condition the patient did not leave. Eventually a surgeon at another hospital agreed to fix the problem, and they were thankfully transferred off our service.
A month later, while on surgery, I heard a coarse, rough, and demanding voice yelling from a room.
“NURSE!” it boomed out of the darkened room. Despite the days of silence, I still instantly recognized it as my former patient’s.
My first instincts were to walk away and ignore the voice. I was no longer on this service and thus, not responsible for this patient anymore. However, for reasons still unknown to me, I walked into the room.
Upon my entrance I felt the same misgivings I had previously. There the patient was, improved in some ways, but in others very similar. I wondered if the reasons for another hospitalization were due to drug use and thought quickly about the cost of treatment they’d received that would surely never be collected.
I informed my former patient that I was not the nurse, but would let them know they were needed. Then, turning to leave, I said as calmly as I could:
“I hope that you’re doing everything you were asked to get better. A lot went into your care to get that surgery and I don’t think you realize how hard it was to get that taken care of…don’t blow it.”
I then walked out. A part of me felt vindication – speaking out against the wretch who hated those trying their best to improve a hopeless life. However, another piece of me knew that my innocence of doctor-patient politics had been forever lost. The urge to “want to help those in need” had been challenged and clearly weakened. By saying what I did I had only perpetuated its decay, amongst both parties. Despite knowing that I should have remained silent, I felt the need to let this person know were tried for them. We worked hard, against a system designed to hinder progress and I was upset by their seeming displeasure of my team's daily work.
This patient still haunts me. I’ve not seen them since, but I frequently think of them. I did not hate this person, but I entertained such desires at times. In my innocence, as a 3rd year medical student, fresh on the hospital wards, I wanted my patients to want to be helped. Furthermore I hoped that they would appreciate our efforts. Unfortunately I learned that it’s not that simple and patients, like those caring for them, are people first and foremost. Some are just better than others.
This feeling was uncomfortable and appaling. Over the last 2 years I’d been indoctrinated with the ideals of the “ethical physician” and the “professionalism” I must inculcate before meeting real patients. Despite the many fantastic thoughts and discussions we as a class had entertained, these forums, as well meaning as any, were utterly useless upon this first meeting.
Homeless, IV drug addicted, and crippled with disease, the patient came to us earlier that morning while I oriented to the inpatient wards. Upon entering the room I beheld a haggard, disheveled, and desperate form. Reeking of a filth known only to years of hardened drug use, I realized and withheld the primordial urge to retch and vacate the room.
“A full history and physical.” was the task charged me by my senior resident. "You will need to get a full H&P, write it out, and present it to me later today along with a differential and plan." Considering I'd never done a full blown physical, I knew I would need at least an hour with this patient and was not looking forward to our prolonged encounter.
Even though the intern was finishing up his H&P when I entered, I had to revisit every last detail already procured. The patient, clearly upset over this obvious intrusion, deferred several questions, cursed my stupidity readily, and resisted any attempts at a full physical. The anger inherent in the eyes was penetrating. Trust was not given nor expected, just more hurt, and he wished to inflict it before receiving.
Over the next week and a half “my patient” grew more tiresome. Pre-rounding was endless, useless, and ultimately absurd. The only information gathered was from forcing myself on the chest wall, abdomen, back, and head in order to elicit the heart sounds, breath sounds, and other physical tasks requisite of me after questioning the lethargic night nurses for overnight events.
Once able to hold a semblance of conversation, my patient soon withdrew from everyone and became mute. On one occasion I found my senior yelling in exasperation as she attempted to get consent for treatment. She no longer rounded unless the attending requested – leaving only the intern and I looking after the patient in the early mornings. The hate emanating from those eyes was palpable. We all felt it.
Regardless of the hate, the battles, and the apparent lack of concern about their declining condition the patient did not leave. Eventually a surgeon at another hospital agreed to fix the problem, and they were thankfully transferred off our service.
A month later, while on surgery, I heard a coarse, rough, and demanding voice yelling from a room.
“NURSE!” it boomed out of the darkened room. Despite the days of silence, I still instantly recognized it as my former patient’s.
My first instincts were to walk away and ignore the voice. I was no longer on this service and thus, not responsible for this patient anymore. However, for reasons still unknown to me, I walked into the room.
Upon my entrance I felt the same misgivings I had previously. There the patient was, improved in some ways, but in others very similar. I wondered if the reasons for another hospitalization were due to drug use and thought quickly about the cost of treatment they’d received that would surely never be collected.
I informed my former patient that I was not the nurse, but would let them know they were needed. Then, turning to leave, I said as calmly as I could:
“I hope that you’re doing everything you were asked to get better. A lot went into your care to get that surgery and I don’t think you realize how hard it was to get that taken care of…don’t blow it.”
I then walked out. A part of me felt vindication – speaking out against the wretch who hated those trying their best to improve a hopeless life. However, another piece of me knew that my innocence of doctor-patient politics had been forever lost. The urge to “want to help those in need” had been challenged and clearly weakened. By saying what I did I had only perpetuated its decay, amongst both parties. Despite knowing that I should have remained silent, I felt the need to let this person know were tried for them. We worked hard, against a system designed to hinder progress and I was upset by their seeming displeasure of my team's daily work.
This patient still haunts me. I’ve not seen them since, but I frequently think of them. I did not hate this person, but I entertained such desires at times. In my innocence, as a 3rd year medical student, fresh on the hospital wards, I wanted my patients to want to be helped. Furthermore I hoped that they would appreciate our efforts. Unfortunately I learned that it’s not that simple and patients, like those caring for them, are people first and foremost. Some are just better than others.
Friday, October 26, 2007
ER Abuse
Scalpel has been talking about the pain scale and pain-seekers recently. Reading these entries got me thinking about a trip I had to an ER during med school and the lasting impression it left with me.
Between 1st and 2nd year I had a research project that fell through. Since this occurred late in the year I decided to just get a job and work over the summer. I don’t really like research anyways and my Orthopeadic frenzy had significantly subsided so I didn’t feel research was absolutely mandatory at that time.
I returned to work for the company I’d been with prior to med school and was given a job in the backroom where I would stock and pull items for the salesfloor. This entailed some heavy lifting which aggravated my back already damaged from poor weight lifting during high school. I began taking Aleve in the mornings before arriving to work in order to move better and decrease the stiffness I was appreciating in the morning. This seemed to be working well until 4 weeks into the job.
One Saturday morning I awoke with a great deal of pain. I found that I had a significant amount of trouble getting out of bed and walked bent over since straightening caused a great deal of discomfort. Some NSAIDs and attempts to stretch out my back resulted in little improvement. Deciding to rest my back, I laid down for a period of time, hoping for a “miraculous” improvement. Instead my decreased range of motion and pain only increased.
I found that I couldn’t stand up at all. In fact, trying to walk resulted in me crying out briefly a rather nasty curse and falling to the floor. Wife found me crawling on the floor, unable to get out of this position, heading to the living room to sit. She decided that there was something very wrong and that I needed to go the ER. I resisted, thinking it weak and pointless; after all this wasn’t an emergency – right?
She persisted and I finally caved. The ride to the ER was torture, with every bump knifing through my back. In order to decrease the pain I was in the fetal position the whole ride. On arrival I tried to get out of the car, only to fall on the sidewalk from the pain. Wife ran in and found a volunteer who brought out a wheelchair. Humiliated, I again resisted, but eventually had to sit and be wheeled into the ER. They wouldn't let me crawl.
The staff was courteous and quick (not very busy at that time of day), but I continue to feel that they thought me a druggie. I rated the pain a 5/10 since I didn’t want the stigma of being a “seeker” and tried to be as helpful as possible in relating my history, but when everyone who wants drugs mimics this kind of pain I just knew they were talking about the “drug seeker” with lower back pain in room 12. It was frustrating to know that I was in very serious pain, had fought seeking treatment, and just wanted to be able to walk without severe shooting pain, but that because of parasites in society I was most likely considered an addict.
After some x-rays, a perfunctory exam by an NP (I wasn’t even taken seriously enough for an MD to waste his time on), and a shot of narcotic in the ol’ butt, I was discharged to follow up with my doc.
The narcotic and muscle relaxants worked wonders, allowing me some increased motion, but I was unable to return to work. An MRI done later per my PCP showed osteoarthritis of the lumbar spine with small herniations. I was informed that the kind of work I was performing was out of the question with my back and physical therapy was eventually needed for me to regain my normal mobility.
Now, I tell this story not as a lesson to be learned for all ER docs. Rather it is the reason that I find so many of the patients I’ve seen - who claim 10/10 pain, want Lortab or Dilaudid since they have “allergies”, and abuse our system - completely abhorrent.
It is the reason I decided to opt out of Emergency Medicine. I was just too jaded. It is because of patients like these that those who truly need the services of the ER are often initially considered addicts. It's because of asshole patients, cyring wolf constantly, who abuse our system that ER's are practicing defensive medicine. It's the reason I think ER's should get a free pass for all frequent flyers who they don't believe who present with an actual problem. You weren't believed? Too fucking bad!
Between 1st and 2nd year I had a research project that fell through. Since this occurred late in the year I decided to just get a job and work over the summer. I don’t really like research anyways and my Orthopeadic frenzy had significantly subsided so I didn’t feel research was absolutely mandatory at that time.
I returned to work for the company I’d been with prior to med school and was given a job in the backroom where I would stock and pull items for the salesfloor. This entailed some heavy lifting which aggravated my back already damaged from poor weight lifting during high school. I began taking Aleve in the mornings before arriving to work in order to move better and decrease the stiffness I was appreciating in the morning. This seemed to be working well until 4 weeks into the job.
One Saturday morning I awoke with a great deal of pain. I found that I had a significant amount of trouble getting out of bed and walked bent over since straightening caused a great deal of discomfort. Some NSAIDs and attempts to stretch out my back resulted in little improvement. Deciding to rest my back, I laid down for a period of time, hoping for a “miraculous” improvement. Instead my decreased range of motion and pain only increased.
I found that I couldn’t stand up at all. In fact, trying to walk resulted in me crying out briefly a rather nasty curse and falling to the floor. Wife found me crawling on the floor, unable to get out of this position, heading to the living room to sit. She decided that there was something very wrong and that I needed to go the ER. I resisted, thinking it weak and pointless; after all this wasn’t an emergency – right?
She persisted and I finally caved. The ride to the ER was torture, with every bump knifing through my back. In order to decrease the pain I was in the fetal position the whole ride. On arrival I tried to get out of the car, only to fall on the sidewalk from the pain. Wife ran in and found a volunteer who brought out a wheelchair. Humiliated, I again resisted, but eventually had to sit and be wheeled into the ER. They wouldn't let me crawl.
The staff was courteous and quick (not very busy at that time of day), but I continue to feel that they thought me a druggie. I rated the pain a 5/10 since I didn’t want the stigma of being a “seeker” and tried to be as helpful as possible in relating my history, but when everyone who wants drugs mimics this kind of pain I just knew they were talking about the “drug seeker” with lower back pain in room 12. It was frustrating to know that I was in very serious pain, had fought seeking treatment, and just wanted to be able to walk without severe shooting pain, but that because of parasites in society I was most likely considered an addict.
After some x-rays, a perfunctory exam by an NP (I wasn’t even taken seriously enough for an MD to waste his time on), and a shot of narcotic in the ol’ butt, I was discharged to follow up with my doc.
The narcotic and muscle relaxants worked wonders, allowing me some increased motion, but I was unable to return to work. An MRI done later per my PCP showed osteoarthritis of the lumbar spine with small herniations. I was informed that the kind of work I was performing was out of the question with my back and physical therapy was eventually needed for me to regain my normal mobility.
Now, I tell this story not as a lesson to be learned for all ER docs. Rather it is the reason that I find so many of the patients I’ve seen - who claim 10/10 pain, want Lortab or Dilaudid since they have “allergies”, and abuse our system - completely abhorrent.
It is the reason I decided to opt out of Emergency Medicine. I was just too jaded. It is because of patients like these that those who truly need the services of the ER are often initially considered addicts. It's because of asshole patients, cyring wolf constantly, who abuse our system that ER's are practicing defensive medicine. It's the reason I think ER's should get a free pass for all frequent flyers who they don't believe who present with an actual problem. You weren't believed? Too fucking bad!
Friday, October 12, 2007
Your Fault, Not Mine
Some patients seem to think that their doctors – multi and varied from vast specialties – should be solely responsible for their care while they just veg out. Well, I think not.
For one thing it’s not the doc who’s got a bad heart from increased salt intake and fatty foods, bad lungs from smoking 2 packs per day for decades, high cholesterol from too much fat-fried chicken, and the other various diseases that I’m so often seeing. It’s the patient. It's essentially their fault they're in this predicament and they need to take some responsibility with their care, their medicines, and to ensure that every visit is purposeful – not a waste of time for both involved.
Showing up, not knowing why you’re there, not knowing what meds you’re taking other than what they “might” be for, and getting all uppity because we’re asking you what your other docs have been doing or what a test showed is stupid. Just because you think we should have the results doesn't automatically mean we received them, nor does it magically make them appear.
You need to take some effort and ask what was seen, what it means, and what needs to be relayed to your primary physician. Not doing that...well... what kind of care do you expect to get? It’s your life - make an effort to care about it and it makes your doctor's job a whole lot more easier as well.
For one thing it’s not the doc who’s got a bad heart from increased salt intake and fatty foods, bad lungs from smoking 2 packs per day for decades, high cholesterol from too much fat-fried chicken, and the other various diseases that I’m so often seeing. It’s the patient. It's essentially their fault they're in this predicament and they need to take some responsibility with their care, their medicines, and to ensure that every visit is purposeful – not a waste of time for both involved.
Showing up, not knowing why you’re there, not knowing what meds you’re taking other than what they “might” be for, and getting all uppity because we’re asking you what your other docs have been doing or what a test showed is stupid. Just because you think we should have the results doesn't automatically mean we received them, nor does it magically make them appear.
You need to take some effort and ask what was seen, what it means, and what needs to be relayed to your primary physician. Not doing that...well... what kind of care do you expect to get? It’s your life - make an effort to care about it and it makes your doctor's job a whole lot more easier as well.
Wednesday, August 22, 2007
Past
Oh, wait...that's passed! I guess my mediocre education and inability to think beyond what I've read just showed its ugly, narrow-minded, and racist head.
Or so I was told something like that by a stain on American culture patient today and her family. BTW: it's called a shower... take one!
Anyway, just wanted to say that I received my USMLE Step 2 CK results today. I passed. 98th percentile! Remember when I was freaking out last month? God what a waste of energy that was.
Or so I was told something like that by a stain on American culture patient today and her family. BTW: it's called a shower... take one!
Anyway, just wanted to say that I received my USMLE Step 2 CK results today. I passed. 98th percentile! Remember when I was freaking out last month? God what a waste of energy that was.
Tuesday, July 3, 2007
A Different View
I thought I’d show you an alternative version to my most recent post. Dr. J, over at Adventures in Medicine, has studied addiction for a bit and works with people in areas of Canada where, I imagine, addiction is a major social and economic problem. He has a differing opinion of the drug seeking behavior that is in stark contrast to what many physicians would agree with, but it’s one that definitely holds merit.
Personally I’m not saying that drug seekers should be instantly turned away. After all, they are someone’s kid, possibly a parent, and most likely have at least a couple people who love or care about them. Therefore they should not be instantly vilified for poor life choices and neurologic or chemical changes that force them to “seek”. What I was trying to convey in my post, though, is the tremendous amount of resources that are lost on people like this just so that they can satisfy their “Jonesing”. It’s really quite sad to know that someone might lose a bed because a Demerol junkie needed a fix and the hospital caved.
Now, after reading the well formulated post by Dr. J, I would admit that his method seems to be a better way to handle drug seekers at their intial intake: by being forthright with them. Let them know upfront you’re not going to give them drugs, but that you can help them with treatment should they want it. Make it their decision to seek the proper healthcare rather than shuffling them off onto inpatient teams many times over who will spend days and thousands of dollars “treating” a malingerer. It’s a good thought process and I think, as medical personnel, it is essential to always remember that the vagrant, the asshole, the annoying drugged out jerk in bed 3 is still a human being.
Personally I’m not saying that drug seekers should be instantly turned away. After all, they are someone’s kid, possibly a parent, and most likely have at least a couple people who love or care about them. Therefore they should not be instantly vilified for poor life choices and neurologic or chemical changes that force them to “seek”. What I was trying to convey in my post, though, is the tremendous amount of resources that are lost on people like this just so that they can satisfy their “Jonesing”. It’s really quite sad to know that someone might lose a bed because a Demerol junkie needed a fix and the hospital caved.
Now, after reading the well formulated post by Dr. J, I would admit that his method seems to be a better way to handle drug seekers at their intial intake: by being forthright with them. Let them know upfront you’re not going to give them drugs, but that you can help them with treatment should they want it. Make it their decision to seek the proper healthcare rather than shuffling them off onto inpatient teams many times over who will spend days and thousands of dollars “treating” a malingerer. It’s a good thought process and I think, as medical personnel, it is essential to always remember that the vagrant, the asshole, the annoying drugged out jerk in bed 3 is still a human being.
Monday, July 2, 2007
Mining for Gold
“How’s your pain today, Ms. Drugseeker?”
“It still hurts like hell!”
“How’d you rate it?”
“Same as yesterday, a fucking 10! God, why don’t you give me anything?” Her eyes demonstrate a clear desire for pain meds; desperate and conniving as is often seen in connoisseurs of opiates.
“We are giving you pain medications. We aren’t going to increase the dose at this point as you've yet to gain any relief over several days.” I lie to the patient. Really we know she’s full of it and we’re planning on taking her down, giving something for her iatrogenic constipation, and giving her the boot.
I proceed to complete the requisite physical check which includes the patient jumping with “pain” each and every time I touch around her left chest. Oddly enough every test performed to this date has come back negative. Wonder of wonders. She doesn’t have ACS, an MI, or any other problems - except drug addiction and vagrancy. I’ll be glad when she’s outta my hair.
I learned quite early in my 3rd year of training that some patients need a place to stay, some need a bed and a meal for the night, and others just want drugs and use the hospital for these purposes. Things that I knew already, but never quite understood how it was that they were able to manipulate the system so well. I've seen the scams and read about others. Oddly many are very similar, but unique with the person involved.
Ms. Drugseeker will receive a bed because she is middle aged, has abused her physical and psychological health for years, ingests varied amounts of drugs which she obtains by doing unmentionable acts, and has not seen a regular physician since Nixon was in office. An abnormal EKG results and labs will most likely surface, relegating the on-call team to take on this freeloader in a useless search for the etiology.
The patient stays, getting a bed, free food, free healthcare, free drugs, and a place for her hubby to sleep as well while the doctors, nurses, and medical students try to not think about the waste of money this person has become. Hubby remains sedated throughout the process until he hears they're being "evicted". Then he suddenly is concerned about his wife's condition.
Unfortunately for our society this is an all too common occurrence. Many private hospitals won’t take them and will either give a quick drug cocktail and/ or street the druggie. Then the charade plays out all over again, at another ER, another clinic, wasting the same taxpayer dollars; but nothing can be done because god forbid if the constant abuse of heath resources by a parasite might actually lead to the discovery of some illness. Then the lottery is in town.
Hell, we might find gold in them thar hills…so wouldn’t it be a shame to not go looking at the same or slightly varied complaint for the upteenth time while knowing full well that you‘re most likely not going to find anything other than someone who can only tolerate a “D“ drug? That’s what a litigious society has constructed for our kids.
Personally this abuse pisses me off. If we’re going to ever have a healthcare system that has any potential to become universal this exploitation has got to stop. Personally I like the idea that people have a certain amount of points that they can use. Use it up and your done for the month, year, etc. If you’ve been diagnosed with a legitimate disease that will increase your healthcare use then you receive additional points.
This would reduce the overuse of ER’s for minor ailments, reduce the ICU stays with ridiculous attempts to prolong lives already long lost, and might just curtail drug seeking abuse. Of course there's a lot to be desired from this plan; it won't define what an actual "emergency" is, it won't create jobs and decrease poverty/ addiction in many abusers, and it won't take care of the illegal immigrant crisis. But I like it in it's infancy.
Till then the exploitations will continue, the drug seekers shall refine and perfect their lies, the viral URI's will get treated with antibiotics at 3am, illegal immigrants shall continue to invade ED’s for each and every complaint to avoid INS troubles, and my taxes and health insurance premiums will continue to increase.
“It still hurts like hell!”
“How’d you rate it?”
“Same as yesterday, a fucking 10! God, why don’t you give me anything?” Her eyes demonstrate a clear desire for pain meds; desperate and conniving as is often seen in connoisseurs of opiates.
“We are giving you pain medications. We aren’t going to increase the dose at this point as you've yet to gain any relief over several days.” I lie to the patient. Really we know she’s full of it and we’re planning on taking her down, giving something for her iatrogenic constipation, and giving her the boot.
I proceed to complete the requisite physical check which includes the patient jumping with “pain” each and every time I touch around her left chest. Oddly enough every test performed to this date has come back negative. Wonder of wonders. She doesn’t have ACS, an MI, or any other problems - except drug addiction and vagrancy. I’ll be glad when she’s outta my hair.
I learned quite early in my 3rd year of training that some patients need a place to stay, some need a bed and a meal for the night, and others just want drugs and use the hospital for these purposes. Things that I knew already, but never quite understood how it was that they were able to manipulate the system so well. I've seen the scams and read about others. Oddly many are very similar, but unique with the person involved.
Ms. Drugseeker will receive a bed because she is middle aged, has abused her physical and psychological health for years, ingests varied amounts of drugs which she obtains by doing unmentionable acts, and has not seen a regular physician since Nixon was in office. An abnormal EKG results and labs will most likely surface, relegating the on-call team to take on this freeloader in a useless search for the etiology.
The patient stays, getting a bed, free food, free healthcare, free drugs, and a place for her hubby to sleep as well while the doctors, nurses, and medical students try to not think about the waste of money this person has become. Hubby remains sedated throughout the process until he hears they're being "evicted". Then he suddenly is concerned about his wife's condition.
Unfortunately for our society this is an all too common occurrence. Many private hospitals won’t take them and will either give a quick drug cocktail and/ or street the druggie. Then the charade plays out all over again, at another ER, another clinic, wasting the same taxpayer dollars; but nothing can be done because god forbid if the constant abuse of heath resources by a parasite might actually lead to the discovery of some illness. Then the lottery is in town.
Hell, we might find gold in them thar hills…so wouldn’t it be a shame to not go looking at the same or slightly varied complaint for the upteenth time while knowing full well that you‘re most likely not going to find anything other than someone who can only tolerate a “D“ drug? That’s what a litigious society has constructed for our kids.
Personally this abuse pisses me off. If we’re going to ever have a healthcare system that has any potential to become universal this exploitation has got to stop. Personally I like the idea that people have a certain amount of points that they can use. Use it up and your done for the month, year, etc. If you’ve been diagnosed with a legitimate disease that will increase your healthcare use then you receive additional points.
This would reduce the overuse of ER’s for minor ailments, reduce the ICU stays with ridiculous attempts to prolong lives already long lost, and might just curtail drug seeking abuse. Of course there's a lot to be desired from this plan; it won't define what an actual "emergency" is, it won't create jobs and decrease poverty/ addiction in many abusers, and it won't take care of the illegal immigrant crisis. But I like it in it's infancy.
Till then the exploitations will continue, the drug seekers shall refine and perfect their lies, the viral URI's will get treated with antibiotics at 3am, illegal immigrants shall continue to invade ED’s for each and every complaint to avoid INS troubles, and my taxes and health insurance premiums will continue to increase.
Monday, June 25, 2007
Broadband Doctor
This letter is to a certain person who, while at a community function, asked me why I was becoming a doctor. Enjoy:
To Mr. Hair-Plug Extraordinaire,
I find it interesting that you feel a career in the medical field is worthless. Simply because you think medicine is bogus and most doctors don’t know shit. Your love for the herbal remedies and accupuncturist you regularly see amaze me. Maybe you think that being all cool with WOO is the way to go. Maybe you’re a dumb ass.
The fact that you told me about the time you diagnosed yourself with some rare blood disease (which you weren’t even pronouncing correctly - it’s von Willebrand’s disease, not von Winter brand like Wintergreen - it's not gum) after using your high speed internet connection made me feel all warm inside - like I was going to hurl. Oh, by the way, just so you realize how silly you appeared - VWD is NOT a rare disease - it’s one of the most common coagulation disorders out there. And you did not have the disease. Getting bruised while doing manual labor does not a platelet deficiency make.
Perhaps you hold some feeling that you are special. I could sense the narcissism rising during our conversation as you elaborated on the countless ways in which you’re smarter than everyone at the “function” and that all of your doctors have gone away learning from you. You’ve told docs how to treat you and have always been correct. Sure. Whatever.
Maybe it was your own insecurity rising as my eyes could not resist looking at your new hair plugs over and over. God, where did you get those things? I guess with your vast knowledge you probably did the procedure yourself.
Whatever the reason you need to clearly get some help. You’re an asshole. A 40 year old bastard that no one likes. Because I was watching my kids play and was around you does not mean that I was interested in your life choices and feelings. You, my friend, are the reason that I decided against primary care medicine. You’re wrong, plain and simple. Unfortunately you're probably too stupid to know any better.
Regards,
-MSG
To Mr. Hair-Plug Extraordinaire,
I find it interesting that you feel a career in the medical field is worthless. Simply because you think medicine is bogus and most doctors don’t know shit. Your love for the herbal remedies and accupuncturist you regularly see amaze me. Maybe you think that being all cool with WOO is the way to go. Maybe you’re a dumb ass.
The fact that you told me about the time you diagnosed yourself with some rare blood disease (which you weren’t even pronouncing correctly - it’s von Willebrand’s disease, not von Winter brand like Wintergreen - it's not gum) after using your high speed internet connection made me feel all warm inside - like I was going to hurl. Oh, by the way, just so you realize how silly you appeared - VWD is NOT a rare disease - it’s one of the most common coagulation disorders out there. And you did not have the disease. Getting bruised while doing manual labor does not a platelet deficiency make.
Perhaps you hold some feeling that you are special. I could sense the narcissism rising during our conversation as you elaborated on the countless ways in which you’re smarter than everyone at the “function” and that all of your doctors have gone away learning from you. You’ve told docs how to treat you and have always been correct. Sure. Whatever.
Maybe it was your own insecurity rising as my eyes could not resist looking at your new hair plugs over and over. God, where did you get those things? I guess with your vast knowledge you probably did the procedure yourself.
Whatever the reason you need to clearly get some help. You’re an asshole. A 40 year old bastard that no one likes. Because I was watching my kids play and was around you does not mean that I was interested in your life choices and feelings. You, my friend, are the reason that I decided against primary care medicine. You’re wrong, plain and simple. Unfortunately you're probably too stupid to know any better.
Regards,
-MSG
Friday, June 22, 2007
Fat Ambulance
News story about Canada's first "Bariatric Response Team" with an ambulance capable of transporting people weighing anywhere between 400-1000 pounds. Unfortunately when they arrive at the hospital I'd bet they'll still have a hard time finding a CT or MRI machine geared up for their "largess".
http://news.yahoo.com/s/nm/20070622/hl_nm/canada_obesity_dc
http://news.yahoo.com/s/nm/20070622/hl_nm/canada_obesity_dc
Sunday, May 27, 2007
Not For Me
When did I discover it wasn’t for me? Basically a question often asked of me by underclassmen regarding my deviation from Emergency Medicine (of which I’m still VP of the interest group – when are the elections already?). Essentially I can honestly and without delay state that the time was during my Internal Medicine rotation.
I liked IM enough. I figure I could be a rather great internist because of the knowledge aspect and the detective work that goes into managing patients. I really enjoyed that part of Medicine. The problem that I had, however, was that I didn’t like the patients.
And not just the patients, I didn’t like the type of patients we mostly catered to: poor, underserved, homeless, etc. The “scum of the earth” as some might put it. I thought about these patients and how most of them came to us from the ER. I evaluated the prospect that I would have to deal with these kinds of patients on daily basis many times over for year and years. And I knew I couldn’t do it.
It just wasn’t in me. I would have burned out incredibly fast had I decided to enter this field of medicine. Partly because I think many of these social parasites shirk their responsibilities and trust in others to do everything for them while continiuing their immoral behaviors. I can’t remain humble and self-less to people that I can’t even stand to talk to or interact with in some semblance of humanity. For that reason I knew EM was not for me and I believe that these patients would be better off without me as their “primary care giver”.
I liked IM enough. I figure I could be a rather great internist because of the knowledge aspect and the detective work that goes into managing patients. I really enjoyed that part of Medicine. The problem that I had, however, was that I didn’t like the patients.
And not just the patients, I didn’t like the type of patients we mostly catered to: poor, underserved, homeless, etc. The “scum of the earth” as some might put it. I thought about these patients and how most of them came to us from the ER. I evaluated the prospect that I would have to deal with these kinds of patients on daily basis many times over for year and years. And I knew I couldn’t do it.
It just wasn’t in me. I would have burned out incredibly fast had I decided to enter this field of medicine. Partly because I think many of these social parasites shirk their responsibilities and trust in others to do everything for them while continiuing their immoral behaviors. I can’t remain humble and self-less to people that I can’t even stand to talk to or interact with in some semblance of humanity. For that reason I knew EM was not for me and I believe that these patients would be better off without me as their “primary care giver”.
Wednesday, May 23, 2007
Courage
Que Sarah, Sarah is a blog that I read every now and then. I was first introduced to the blog’s author by way of a comment she made about me and my blog’s apparent despicable character at the time on Dr. Couz's blog (I will not link to the post as this is not the intended reason for this post).
Despite this comment and the feelings that I initially felt towards her, I came to enjoy reading her thoughts on a semi-regular basis. I have not read her posts for some time though and was informed by Dr. Couz of her turn for the worse.
Sarah is most likely going to die within the month from malignant melanoma. The cancer has become very aggressive and all treatment options are not helping. Her husband is currently updating her blog as she is no longer capable. It was shocking to say the least.
I urge all of you to please take some time to read her story and learn about this courageous woman. If, for nothing else, than to realize how fulfilling life can be and how someone can take adversity and turn it into triumph. She has been tremendously brave and steadfast through this time and her courage has been awe inspiring. I honestly felt that she was going to be OK.
I wish Sarah and her husband the best with the time she has remaining with the strength needed as they endure this trying time. Despite our first impressions I came to feel like I knew you, Sarah. You are in my thoughts. Find peace.
Despite this comment and the feelings that I initially felt towards her, I came to enjoy reading her thoughts on a semi-regular basis. I have not read her posts for some time though and was informed by Dr. Couz of her turn for the worse.
Sarah is most likely going to die within the month from malignant melanoma. The cancer has become very aggressive and all treatment options are not helping. Her husband is currently updating her blog as she is no longer capable. It was shocking to say the least.
I urge all of you to please take some time to read her story and learn about this courageous woman. If, for nothing else, than to realize how fulfilling life can be and how someone can take adversity and turn it into triumph. She has been tremendously brave and steadfast through this time and her courage has been awe inspiring. I honestly felt that she was going to be OK.
I wish Sarah and her husband the best with the time she has remaining with the strength needed as they endure this trying time. Despite our first impressions I came to feel like I knew you, Sarah. You are in my thoughts. Find peace.
Friday, May 18, 2007
Parasites
The way some people carry-on you think they were royalty. In a hospital that caters towards the indigent and uninsured I see a great deal of unwillingness in patients to help themselves out of their dire situation who will, at the drop of a hat, threaten to leave for a better hospital. They don’t like what’s happening here and they want better care. In short they feel entitled.
But here’s the thing: these other hospitals that these tragic patients want to have their care transferred to won’t see them. They’ll kick their asses straight out the door should they try and walk-in and they sure as shit won’t receive them as a transfer. Why? No ability to pay for services rendered.
So instead this hospital accepts these patients, hemorrhaging money by the millions each year in order to give the extremely poor a place to receive equal and fair treatment. Because of the huge financial pitfalls there are areas where we suffer. We don’t have the newest, most expensive, and most advertised machinery or treatment options. Instead patients receive quality care with methods proven to work. And all at almost no expense to themselves (since we all know they’re not paying for anything anyway).
Despite these efforts and the obvious level of gratitude that should be inherent in these people I often see them ungrateful. Upset at the conditions they “perceive” in a place that’s never out of the red.
“I’m going somewhere else. They’ll take better care of me.”
“You don’t know what you’re doing. Over at (huge research hospital with lots of fancy and expensive new equipment) I’d get this test done. I’m outta here.”
“I’m leaving AMA. I don’t care what you say. Some doctor out there will take me and care for me without insurance and a stable income.”
I hear these lines or variations everyday. Trying to explain to a patient who has not had a job in over 5 years, drinks 12 or more beers a day, smokes like a chimney, and has absolutely no means of paying for services for his congestive heart failure, kidney failure, and rectal cancer that no doctor in town will touch him other than those currently seeing him is just futile. They don’t get it. They don’t want to get it. All they want is a handout and feel entitled to the services and care received by the best insured and wealthiest in society.
I guess it’s the delusional aspect of many of these patients that got them where they are in the first place. Believing that someone will always take care of them, trusting in the fact that Uncle Sam will never stop giving them money or food or clothing. Ensuring that they’re not responsible for their own damn care – ever and behaving like spoiled children with surrogate parents. Why else wouldn’t they think they can get that new drug, fancy treatment, or costly surgery with little to no cost to themselves? It’s how they’ve been living their entire life.
But here’s the thing: these other hospitals that these tragic patients want to have their care transferred to won’t see them. They’ll kick their asses straight out the door should they try and walk-in and they sure as shit won’t receive them as a transfer. Why? No ability to pay for services rendered.
So instead this hospital accepts these patients, hemorrhaging money by the millions each year in order to give the extremely poor a place to receive equal and fair treatment. Because of the huge financial pitfalls there are areas where we suffer. We don’t have the newest, most expensive, and most advertised machinery or treatment options. Instead patients receive quality care with methods proven to work. And all at almost no expense to themselves (since we all know they’re not paying for anything anyway).
Despite these efforts and the obvious level of gratitude that should be inherent in these people I often see them ungrateful. Upset at the conditions they “perceive” in a place that’s never out of the red.
“I’m going somewhere else. They’ll take better care of me.”
“You don’t know what you’re doing. Over at (huge research hospital with lots of fancy and expensive new equipment) I’d get this test done. I’m outta here.”
“I’m leaving AMA. I don’t care what you say. Some doctor out there will take me and care for me without insurance and a stable income.”
I hear these lines or variations everyday. Trying to explain to a patient who has not had a job in over 5 years, drinks 12 or more beers a day, smokes like a chimney, and has absolutely no means of paying for services for his congestive heart failure, kidney failure, and rectal cancer that no doctor in town will touch him other than those currently seeing him is just futile. They don’t get it. They don’t want to get it. All they want is a handout and feel entitled to the services and care received by the best insured and wealthiest in society.
I guess it’s the delusional aspect of many of these patients that got them where they are in the first place. Believing that someone will always take care of them, trusting in the fact that Uncle Sam will never stop giving them money or food or clothing. Ensuring that they’re not responsible for their own damn care – ever and behaving like spoiled children with surrogate parents. Why else wouldn’t they think they can get that new drug, fancy treatment, or costly surgery with little to no cost to themselves? It’s how they’ve been living their entire life.
Tuesday, May 15, 2007
Lovey-Dovey
Thursday, May 3, 2007
Take a Number
“What’s her name?”
This thought crosses my mind as I head towards my patient’s door. It’s 5:45 am and I’m dragging. I don’t want to be here. I don’t want to walk into a stranger’s room and feel them up (not truly, but checking for breast tenderness and discharge as well as vaginal exams seems an awful lot like it – especially at this ungodly early hour).
“Shit. I can’t remember. Can’t go calling her senora 4104 now, can I?”
I head back to the census sheet, taking a few extra moments to talk with my friend. I then head back to the door. Stopping tentatively at the door, hand poised to knock and shatter the stillness within the room.
“Goddammit! What’s her name again!?”
This plays out more often than you would like to think. I’ve read the chart, understood what transpired overnight, know where she and her newborn child stand amongst the new admissions, and know exactly what phrases to employ in order to get my SOAP note complete. I just can’t remember her name.
This is medical education. Patients begin to loose their identities to us as we try and get through rotations alive. The pressures placed on our shoulders, already weighed down by the heaviness of our short white coats overloaded with multiple tools to assist our "brains", lend themselves towards our thought blocking. It's the only defense mechanism we have left.
Patients stop existing as people and become numbers, diseases, diagnoses, and procedures to be added to the ever growing patient encounter log in my right pocket. They’re just not people. That impedes my daily progress. That notion cannot be considered - it will delay me.
Why do you want to be a doctor? I can no longer answer this question without wondering if the reason(s) I had entered medical school have been completely abandoned; lost along the way during the inculcation of my medical knowledge. Maybe next year I’ll pick it back up and patients won’t be just a number. But I fear that this won't transpire. After all, I've got things to do and people (numbers) to see.
This thought crosses my mind as I head towards my patient’s door. It’s 5:45 am and I’m dragging. I don’t want to be here. I don’t want to walk into a stranger’s room and feel them up (not truly, but checking for breast tenderness and discharge as well as vaginal exams seems an awful lot like it – especially at this ungodly early hour).
“Shit. I can’t remember. Can’t go calling her senora 4104 now, can I?”
I head back to the census sheet, taking a few extra moments to talk with my friend. I then head back to the door. Stopping tentatively at the door, hand poised to knock and shatter the stillness within the room.
“Goddammit! What’s her name again!?”
This plays out more often than you would like to think. I’ve read the chart, understood what transpired overnight, know where she and her newborn child stand amongst the new admissions, and know exactly what phrases to employ in order to get my SOAP note complete. I just can’t remember her name.
This is medical education. Patients begin to loose their identities to us as we try and get through rotations alive. The pressures placed on our shoulders, already weighed down by the heaviness of our short white coats overloaded with multiple tools to assist our "brains", lend themselves towards our thought blocking. It's the only defense mechanism we have left.
Patients stop existing as people and become numbers, diseases, diagnoses, and procedures to be added to the ever growing patient encounter log in my right pocket. They’re just not people. That impedes my daily progress. That notion cannot be considered - it will delay me.
Why do you want to be a doctor? I can no longer answer this question without wondering if the reason(s) I had entered medical school have been completely abandoned; lost along the way during the inculcation of my medical knowledge. Maybe next year I’ll pick it back up and patients won’t be just a number. But I fear that this won't transpire. After all, I've got things to do and people (numbers) to see.
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