You just gotta keep livin' man, L-I-V-I-N

Hospice

noreply@blogger.com (Pseudo_Doctor) — Thu, 26 Jan 2012 02:56:00 +0000

http://www.kevinmd.com/blog/2012/01/doctors-delay-hospice-referrals.html

From Kevinmd.com

"This is a response to Deb Discenza’s article requesting a one page informational sheet informing a patient about hospice or palliative care.

This would allow the patient and their family to make decisions regarding end of life care before it becomes a necessity. I am a crisis care hospice nurse. I am the one who comes to your home, whether it is a million dollar beachfront mansion, or a single wide mobile home with 20 cats, to care for your loved one when the decision is made to stop treatment and go home to live out their last days.

We are the nurses that come when the caregiver is worn out. We stay for 12-hour shifts 24 hrs a day until we get the issue resolved or the patient passes away. Our organization‘s average time with a patient is 11 days. This is a shame to our current medical system. A patient can be on hospice care when a doctor says if an illness runs its normal course; the patient would most likely die within 6 months. You can remain on hospice care for years, in fact, once a patient decides to stop medical treatment they often start feeling better."

Please go to the link for the full article.

ER DRUG SEEKER NOTICE

noreply@blogger.com (Pseudo_Doctor) — Fri, 16 Dec 2011 01:33:00 +0000

Taken from MDOD who took it from Craiglist but hilarious and true

"OK, I am not going to lecture you about the dangers of narcotic pain medicines. We both know how addictive they are: you because you know how it feels when you don't have your vicodin, me because I've seen many many many people just like you. However, there are a few things I can tell you that would make us both much happier. By following a few simple rules our little clinical transaction can go more smoothly and we'll both be happier because you get out of the ER quicker.

The first rule is be nice to the nurses. They are underpaid, overworked, and have a lot more influence over your stay in the ER than you think. When you are tempted to treat them like shit because they are not the ones who write the rx, remember: I might write for you to get a shot of 2mg of dilaudid, but your behavior toward the nurses determines what percent of that dilaudid is squirted onto the floor before you get your shot.

The second rule is pick a simple, non-dangerous, (non-verifiable) painful condition which doesn't require me to do a four thousand dollar work-up in order to get you out of the ER. If you tell me that you headache started suddenly and is the 'worst headache of your life' you will either end up with a spinal tap or signing out against medical advice without an rx for pain medicine. The parts of the story that you think make you sound pitiful and worthy of extra narcotics make me worry that you have a bleeding aneurysm. And while I am 99% sure its not, I'm not willing to lay my license and my families future on the line for your ass. I also don't want to miss the poor bastard who really has a bleed, so everyone with that history gets a needle in the back. Just stick to a history of your 'typical pain that is totally the same as I usually get' and we will both be much happier.

The third rule (related to #2) is never rate your pain a 10/10. 10/10 means the worst pain you could possibly imagine. I've seen people in a 10/10 pain and you sitting there playing tetris on your cell phone are not in 10/10 pain. 10/10 pain is an open fracture dangling in the wind, a 50% body surface deep partial thickness burn, or the pain of a real cerebral aneurysm. Even when I passed a kidney stone, the worst pain I had was probably a 7. And that was when I was projectile vomiting and crying for my mother. So stick with a nice 7 or even an 8. That means to me you are hurting by you might not be lying. (See below.)

The fourth rule is never ever ever lie to me about who you are or your history. If you come to the ER and give us a fake name so we can't get your old records I will assume you are a worse douchetard than you really are. More importantly though it will really really piss me the fuck off. Pissing off the guy who writes the rx you want does not work to your advantage.

The fifth rule is don't assume I am an idiot. I went to medical school. That is certainly no guarantee that I am a rocket scientist I know (hell, I went to school with a few people who were a couple of french fries short of a happy meal.) However, I also got an ER residency spot which means I was in the top quarter or so of my class. This means it is a fair guess I am a reasonably smart guy. So if I read your triage note and 1) you list allergies to every non-narcotic pain medicine ever made, 2) you have a history of migraines, fibromyalgia, and lumbar disk disease, and 3) your doctor is on vacation, only has clinic on alternate Tuesdays, or is dead, I am smart enough to read that as: you are scamming for some vicodin. That in and of itself won't necessarily mean you don't get any pain medicine. Hell, the fucktards who list and allergy to tylenol but who can take vicodin (which contains tylenol) are at least good for a few laughs at the nurses station. However, if you give that history everyone in the ER from me to the guy who mops the floor will know you are a lying douchetard who is scamming for vicodin. (See rule # 4 about lying.)

The sixth and final rule is wait your fucking turn. If the nurse triages you to the waiting room but brings patients who arrived after you back to be treated first, that is because this is an EMERGENCY room and they are sicker than you are. You getting a fix of vicodin is not more important than the 6 year old with a severe asthma attack. Telling the nurse at triage that now your migraine is giving you chest pain since you have been sitting a half hour in the waiting area to try to force her into taking you back sooner is a recipe for making all of us hate you. Even if you end up coming back immediately, I will make it my mission that night to torment you. You will not get the pain medicine you want under any circumstances. And I firmly believe that if you manipulate your way to the back and make a 19 year old young woman with an ectopic pregnancy that might kill her in a few hours wait even a moment longer to be seen, I should be able to piss in a glass and make you drink it before you leave the ER.

So if you keep these few simple rules in mind, our interaction will go much more smoothly. I don't really give a shit if I give 20 vicodins to a drug-seeker. Before I was burnt out in the ER I was a hippy and I would honestly rather give that to ten of you guys than make one person in real pain (unrelated to withdrawal) suffer. However, if you insist on waving a flourescent orange flag that says 'I am a drug seeker' and pissing me and the nurses off with your behavior, I am less likely to give you that rx. You don't want that. I don't want that. So lets keep this simple, easy, and we'll all be much happier.

Sincerely,
Your Friendly Neighborhood ER Doc"

Fellowship or another residency?

noreply@blogger.com (Pseudo_Doctor) — Tue, 06 Dec 2011 04:06:00 +0000

Still totally up in the air at this point on what to do after nxt year. Pretty much have narrowed it down to Critical Care vs ER residency. Confused yes I am too...

New Sternal Rub

noreply@blogger.com (Pseudo_Doctor) — Wed, 16 Nov 2011 16:14:00 +0000

Had someone tried to fake apenic epsiodes leading to someone calling a code. Person was a young kid with psych issues. Instead of sternal rub she nipple twisted em. Boy did that person wake up fast. I propose this become a new protocol to all druggies, psych patient and just obnoxious attention seekers.

Overheard in the OR

noreply@blogger.com (Pseudo_Doctor) — Thu, 03 Nov 2011 03:35:00 +0000

The following is a press release from the book Overheard in the OR by Dr Gelber. Just FYI i was given a free copy to read for full disclosure.

FOR IMMEDIATE RELEASE

CONTACT: Elaine Krackau | PR by the Book | 512.501.4399, x 704 |elaine@prbythebook.com

Overheard in the OR

A look into the mind of a surgeon and his operating room

HOUSTON – The medical drama Grey’s Anatomy has been a ratings hit for six years. Before that, ER became the longest-running primetime medical drama in American television history.

Programs like these have taken viewers behind the closed doors of the operating room, asking us to imagine: Do doctors really discuss their love lives in the middle of surgery? What goes through a surgeon’s mind in a crisis?

Dr. David Gelber is a General and Vascular Surgeon who answers those questions and more in his newest release, Behind the Mask: The Mystique of Surgery and the Surgeons Who Perform Them (Ruffian Press, August 2011).

Drawing on his 30 years of surgical experience, Dr. Gelber offers a behind-the-scenes look at the operating room and the surgeons who practice there.

Equal parts memoir, textbook and philosophy, Behind the Mask reveals surgeons’ innermost thoughts as they evaluate the sick and injured as well as what happens before, during and after surgery. He even lets readers in on some operating room conversations.

“I wanted to paint a picture of surgery unlike what you see on television and convey that there is a sense of order and purpose even in the most dire situation,” says Gelber.

Using anecdotes about his own patients to illustrate the bond between patient and surgeon, Dr. Gelber candidly discusses what it’s like to make high stakes surgical decisions – and the calculations that have to be made in a millisecond, in order to save a life. On the flip side, he also reveals a side of the surgeon most of us never see: The emotional pain of losing a patient, and what it’s like to break the news to a family.

Readers also meet Dr. Gelber’s most colorful patients in Behind the Mask, and get to know the unsung heroes of the OR and ICU: Nurses, who can have a life or death effect on a patient.

DR. DAVID GELBER is a General and Vascular Surgeon, who has been practicing in Southeast Harris County in Texas since 1990. He is also the author of two science fiction novels, Future Hope, ITP Book One and Joshua and Aaron, ITP Book Two. He lives in Houston, Texas with his wife of 25 years, Laura, and three teenaged children.

For more information, please visit: www.davidgelber.com or the author’s blog, “Heard in the OR:” www.heardintheor.blogspot.com.

To schedule an interview, please contact

Emily Bond at emily@prbythebook.com | 512.501.4399, x 705

Vegas

noreply@blogger.com (Pseudo_Doctor) — Wed, 24 Aug 2011 01:19:00 +0000

Going to be in Vegas this Friday to Sunday. If any bloggers are going to be around let me know

lessons

noreply@blogger.com (Pseudo_Doctor) — Tue, 08 Feb 2011 02:01:00 +0000

Its sad but sometimes your most memorable cases are the ones with tragic ending leading you to really learn from the endeavor. All of medicine seems to be based on experience however it usually at someone else's expense. I'm pretty sure medicine is the only profession by which this is deemed "okay".

Quality of life vs quantity

noreply@blogger.com (Pseudo_Doctor) — Fri, 04 Feb 2011 22:18:00 +0000

One of the hardest decision we struggle with is quality vs quantity. We have the ability in this day an age to extend life so far to the point of is it really worth it? Granted I'm not saying I have the ability to judge what "worth it is", it is up to each individual, however quality in my mind does not consist of being bed ridden unable to talk or hear while being in pain. The biggest problem with having such great medical advancements in technology is not with the life we extend, but with the lives we extended at what cost.

Recently I came across a patient with pancreatic cancer w/mets to brain, liver and lung. I wont say his age but for those who don't realize the direness of just pancreatic cancer five year survival is less then 5%. That is just with pancreatic cancer were not even talking about metastasis. The poor patient who's quality of life consists of lying in bed writhing in pain for the last six month was admitted by a family who felt he was getting worse and insisted on being a FULL CODE. The patient unable to answer questions instead just sleeping in bed while the family fed off each other like a group of vultures seeking out for the best interests of themselves instead of the patient. This is reoccurring theme I'm starting to see over and over again to the point of making me sick. I have no qualms about helping a patient who wants to be helped but I've also come to know when patients are in such situations palliative care is a great option. You only need to read studies like this to know the great work these people can do.

End of life care is a tortuous subject with families. I still remember my first case of the year fumbling over words converting a patient from full medical care to palliative care. Using phrases like morphine for "air hunger" at doses of hourly felt like waving the white flag. Now however having had many of experiences transitioning patients it has gotten to the point where I'm comfortable doing it not because of the end result, but because I know its the right thing to do. I wish sometimes families would realize this too.

Randy Pausch also had pancreatic cancer which took his life but he turned his disease into something millions could relate to. Make sure to check out his book as well "the last lecture"

Shout out to Socrates...

noreply@blogger.com (Pseudo_Doctor) — Sat, 29 Jan 2011 02:41:00 +0000

One of the struggles of intern year is learning how to start balancing your knowledge base with what you don't know. Believe me just because you are six month in ( and you realize how little you knew six month ago) start's to make you realize just exactly how little you still really know. I always hear this is time where intern's are the most dangerous because our confidence has increased along with our knowledge. Don't worry I understand exactly.

"The more I learn the more I learn how little I know"

-SOCRATES

OSU miley impersonation

noreply@blogger.com (Pseudo_Doctor) — Wed, 26 Jan 2011 18:47:00 +0000

Another disappointing thing from the state of Ohio...

Professional Dampening

noreply@blogger.com (Pseudo_Doctor) — Tue, 14 Dec 2010 01:53:00 +0000

Its something you start to develop without even realizing it. However telling a nice 70+ year old person whom you had suspected for an underlying malignancy has squamous cell carcinoma, dampening just isn't possible. It's true the nicer the guy the worse the diagnosis. Btw he had a 60 year smoking history. Five year survival is prob less then 15-20% depending on staging. Smoking is not cool.

CPR on an airplane and Futility

noreply@blogger.com (Pseudo_Doctor) — Wed, 17 Nov 2010 23:29:00 +0000

http://www.nejm.org/doi/full/10.1056/NEJMp1006331

An interesting NEJM article about CPR on a plane and futility. Definitely a must read

3 months of wards done

noreply@blogger.com (Pseudo_Doctor) — Mon, 15 Nov 2010 00:06:00 +0000

Medicine is starting to get fun again....maybe its because I have a light rotation for six weeks coming up being geriatric medicine and surgery..

Poker is fun sometimes

noreply@blogger.com (Pseudo_Doctor) — Tue, 09 Nov 2010 00:33:00 +0000

***** Hand History for Game 25390662937 ***** (Full Tilt)
$200.00 USD NL Texas Hold'em - Monday, November 08, 07:26:48 ET 2010
Table Manion (6 max) (Real Money)
Seat 2 is the button
Seat 1: VIEZERIK ( $315.85 USD )
Seat 2: KireevEvgeny ( $257.05 USD )
Seat 3: zomgROFL ( $377.05 USD )
Seat 4: rspr41 ( $283.65 USD )
Seat 5: DntFCUKWivMe ( $60.00 USD )
Seat 6: DrUPSWING ( $513.45 USD )
zomgROFL posts small blind [$1.00 USD].
rspr41 posts big blind [$2.00 USD].
** Dealing down cards **
Dealt to rspr41 [ Jc 9c ]
DntFCUKWivMe folds
DrUPSWING folds
KireevEvgeny folds
zomgROFL raises [$6.00 USD]
rspr41 calls [$5.00 USD]
** Dealing Flop ** [ 5s, 5d, 9s ]
zomgROFL bets [$8.00 USD]
rspr41 calls [$8.00 USD]
** Dealing Turn ** [ 9h ]
zomgROFL bets [$18.00 USD]
rspr41 calls [$18.00 USD]
** Dealing River ** [ Th ]
zomgROFL bets [$37.00 USD]
rspr41 raises [$105.00 USD]
zomgROFL calls [$68.00 USD]
rspr41 shows [Jc, 9c ]
rspr41 wins $273.00 USD from main pot
zomgROFL doesn't show [Td, Kd ]

Playing for the first time in months

Google Maps like to Jet Ski

noreply@blogger.com (Pseudo_Doctor) — Sat, 06 Nov 2010 01:29:00 +0000

‎1) go to google maps
2) go to get directions
3) type in start point japan
4) type in end point china
5) scroll down to number 43

make sure you buy your jet ski's first

Residency life

noreply@blogger.com (Pseudo_Doctor) — Wed, 03 Nov 2010 00:02:00 +0000

Had a dream last night in which I was woke up in the middle of the night from being on call only to wake up and realize I was actually on call....

Crushing

noreply@blogger.com (Pseudo_Doctor) — Sat, 30 Oct 2010 00:24:00 +0000

Responded to a code recently where the patient wasn't a patient but it was actually a co-worker. Nothing worse then coding one of your own. The hospital is a crazy place.

Speechless

noreply@blogger.com (Pseudo_Doctor) — Tue, 19 Oct 2010 19:17:00 +0000

After we finished discussing the plan on a obese patient with BLE edema who needed his scrotum elevated along with increasing the loss of free water, one of the attending states, "sounds like my weekends"

Too funny

Hypothermia inductions can save lives

noreply@blogger.com (Pseudo_Doctor) — Fri, 17 Sep 2010 17:49:00 +0000

Found this article today on the today on msn.

"Little Gore Otteson toddled around the TODAY show set Friday morning, rosy-cheeked and rambunctious. Pretty normal for a 2-year-old — except that Gore has made a miraculous recovery after apparently drowning in an irrigation ditch earlier this summer.

The toddler was submerged for 25 minutes, and his heart stopped for an hour. When he was pulled out of the frigid water, pale and lifeless, his mother thought he was dead. Doctors at a Denver hospital told his parents that Gore had less than a 1 percent chance of survival — and even they can’t totally explain his amazing full recovery."

For full article please click here.

Watermelon meets women on Amazing Race

noreply@blogger.com (Pseudo_Doctor) — Wed, 15 Sep 2010 16:17:00 +0000

Talk about getting it in the kisser!

My first call as an intern....

noreply@blogger.com (Pseudo_Doctor) — Sat, 31 Jul 2010 01:25:00 +0000

Everything really does slow down in a moment of near chaos. You can almost see the seconds tick off the clock like in a move. The pager went off (and it's the one you don't ever want going off) meaning you take a deep breath, trying to stay calm even though you're tackacardic in anticipation of the rollercoaster about to unfold. You actually wish you were on the set of a movie because a director yelling cut would be a blessing. However this is real life. You've just run your first real code on a young patient. To make matter's worse those two little letter's, M.D, give you that responsibility of talking to the family. Try breaking the new to a wife and his little daughter by saying I'm sorry we did everything we could. To which she says," I don't understand we had our whole lives ahead of us". But that's the life we've chosen in the medical field. You really never realize what residency is like until you start it.

Conundrum

noreply@blogger.com (Pseudo_Doctor) — Tue, 27 Jul 2010 03:04:00 +0000

How do you manage a patient with a possible ICH, an INR over the normal limit of 3 and a mechanical heart valve? Do you try to correct the INR with FFP and vitamin K while holding warfarin? And if you do aren't you worried about the patients mechanical valve clotting up?

Just another day with answers you don't know and not much literature to support a decision either way. Welcome to residency.....

Iphone vs HTC EVO cartoon hilarious

noreply@blogger.com (Pseudo_Doctor) — Fri, 23 Jul 2010 19:22:00 +0000

New McLaren yes please

noreply@blogger.com (Pseudo_Doctor) — Sun, 04 Jul 2010 18:50:00 +0000

Looks amazing

Tips for Intern Year Day #1

noreply@blogger.com (Pseudo_Doctor) — Thu, 01 Jul 2010 23:40:00 +0000

What I learned from my first day:

1) Everytime your pager goes off you die a little inside.
2) When you hear a pager go off and everyone is looking at you, its probably yours
2) Learn to use the deer in headlights face to get help. It totally works
3) People expect you to know absolutely nothing and be inefficient early on. Use it to your advantage. Remember you want to set the bar low so you can shine later.
4) When a nurse asks you to change medications just say SURE NO PROBLEM and thank you
5) When txt paging consults write THANK YOU at the end of the page
6) You only have about one week to ask stupid question since you are new to the system's so make sure to ASK DUMB QUESTIONS, the window is closing.
7) I dont remember what learning to walk was like but if it's anything like your first day on wards it sure must have sucked
8) You know that feeling where you feel as though you did something wrong but have no idea what it is or when someone will find out and scold you. Yea well get used to it.
9) Just remember you asked for this. You can't blame anyone but yourself unfortunately.

July 1st the day that everyone dreads in the medical profession because a new flock of ducks are anointed into the medical community. Sure they all look like everyone else that you might see in the hospital. Shiny clean white coats, check. Brand new scrubs, check. Unscathed name tag, check twice.

What you don't realize is that these new flock of intern's are clueless to the rhythmic dance that goes on to the beat of bureaucratic paperwork. Sure the EMR's have made our jobs easier by allowing shortcuts (that are frowned upon but totally necessary) such as cutting and pasting notes but at the end of the day there is TON of paperwork to be done. If my keyboard hasn't painted you enough of a picture yet imagine Scrooge McDuck swimming in his vault through paper instead of gold coins.

So I was starting to get the hang of this whole medicine thing on my first day. I arrived bright eyed at around 6am to get acquainted with my six patients from the team before. After about an hour of staring at labs, names, drugs, and histories I had absorbed nothing. Not only do you have no clue what to do but you really have NO CLUE what to do (No the two and half months off definitely doesn't help). Yes I've graduated from four year's of medical school but as I turned to the intern beside me and asked, "what the #@#$ am I supposed to be doing" he cracked a smile and replied, "I have no idea. I've been staring at the computer for an hour and am still lost on what I'm expected to do." That made me feel much better. I knew this was about to be a long long year.