Straight Talk from the Stanford ER

Cecelia is Crying

2009-01-08T15:49:00.000-08:00

It’s 3 AM. Only 3 hours left. It’s about time for one more cup of coffee. Suddenly the calmness of my overnight Pediatric shift is broken by the wailing of a crying baby. The family walks past me-looking exhausted, feet dragging, bewildered, holding a screaming child. They are quickly registered, and the chief complaint flashes on the computer screen before me: 4 month old female, “crying.” Ah,...

Let pain be your guide

2008-11-30T22:50:00.000-08:00

As a resident, I am constantly learning. And, I think, so are most of the attendings that help guide me. Every so often there comes a case that is as startling as a splash of cold water. The dangerous disease lurking behind the benign presentation can keep the hairs on the back of your neck erect for months. Something very similar happened just yesterday. In room 7 waited a 54 yo man with a...

Taming The Jealous Mistress

2008-11-16T13:24:00.000-08:00

“Medicine can be like a jealous mistress if you are not careful Sean….” These words were spoken to me 10 years ago by a much older, and at the time, possibly wiser Orthopedic Surgeon. The man was in the waning days of his career, and at 65 years old was currently working on his third marriage and had a 3 year old son. I listened to his words, but I could not fully appreciate the gravity of my...

Desert Halloween

2008-11-01T06:57:00.000-07:00

Today is Halloween and I am celebrating it with a costume made of bandages. One roll of elastic tape can make you look like the mummy, a creature from Pans Labyrinth or just Robin. I am also celebrating it with over one hundred competitors from the race. Sometime between yesterday at 10 p.m. and today at 2 p.m., they finished a 54 segment of the race. That makes four marathons and one...

The Roaming ER

2008-10-29T21:01:00.000-07:00

It appears that life is more than blisters and foot care. Though that is an important part of a race that keeps people pounding their feet in 100 degree weather for most of the day. In my travels, I've noticed a need for medical care in the villages and for locals. Here, in the Sahara Desert, the Bedouins comprise most of the population and are isolated from the major hospitals in Cairo. At our...

Blisters and More

2008-10-28T09:13:00.000-07:00

Day Two from www.racingtheplanet.com and I'm still practicing emergency medicine. Today's topic is the subungual hematoma. Another way to describe that is a bruise under the toenail. You might not have seen it if you haven't dropped a rock on your foot or ran two back-to-back marathons with five more to come. To highlight this affliction of long-distance runners, a particular, sweaty Englishman...

The ER is Wide Open

2008-10-27T16:19:00.000-07:00

Emergency medicine became an easy choice for me once I learned how big emergency rooms could really be. The best example is my current shift. At this moment, I am writing an email from a satellite-enabled laptop in the Sahara Desert. Finally, I feel like a real blogger, connected to the internet, even on the road. This email is sent from the site of racing the planet which is a race I am...

Music to the ER

2008-10-14T01:35:00.000-07:00

Stravinsky composed the Rite of Spring with innovative asynchronus chords to the appreciation of many fans. Without nearly the same fan base, the emergency department plays a mash-up of Stravinsky records scratched by DJ Qbert. In room one there is constant beeping, every 0.5 to 1 seconds coming from two different sources, the highly resonant sounds cut through the voices of nurses talking, and...

Brain Bucket

2008-10-01T20:42:00.000-07:00

The mild temperature and cloudless sky last Saturday lured people outside onto their bikes, horses, motorcycles and basketball courts. Unfortunately, even the most careful sports enthusiast can suffer an accident and several men and women wound up visiting our ED for a variety of bruises, lacerations, broken bones, and worse. By early afternoon, a motorcyclist with a lacerated spleen, truck...

Heroic Measures

2008-09-14T23:29:00.000-07:00

ED thoracotomy is as far as we ever go to save a life. In fact, it is sometimes so far away that we now have rules to to prevent us from getting lost while performing this procedure. By that I mean, we do not do it unless there is at least a remote chance of saving a life so that we do not waste hospital resources and time when there is not even that distant chance of life. In essence, the...

Divine Intervention

2008-08-24T07:36:00.000-07:00

It was a humid night as a storm quietly crept along the Santa Cruz Mountains. A soft, sultry steam seemed to float along the Emergency Department floor. I remember it being hot; I think the air conditioning was broken. Beads of sweat rolled down my Attendings forehead...It was that kind of hot. The chants had grown incessantly louder from her room. A young lady in her native garb was surrounded...

The Rustling Beneath The Sheets

2008-06-15T13:43:00.000-07:00

“Sean, you have a new patient in Room 8…and there is something moving under the sheets,” stated the Nurse. I noticed she looked quite pale. I paused…”Okaaaay…..did you say something moving beneath the sheets?” “Yes,” she replied. “Do you know what it was,” I asked? “No but they were large, there were a lot of them, and they were moving….” “Did you look,” I asked with a look of bewilderment, and...

One Stop Shop

2008-05-06T13:53:00.000-07:00

I went into emergency medicine because I wanted to be able to help any person and do it anywhere. The field offered a body of knowledge I could use to help any patient that might enter the emergency department. Of course, it did not take long to realize how much my ED care relied upon other specialists, nurses, medical devices, and the vast resources of the hospital. In a neighboring blog Paul...

Beyond Recognition

2008-04-02T14:21:00.000-07:00

She came to the Emergency Department, burned beyond recognition. She arrived in complete anonymity, and that is how she remains. I had just finished seeing a patient one early morning, when I heard the Paramedics enter the Emergency Room. I smelled her charred flesh, I heard her wheezing for every breath. This patient was supposed to be a "minor burn," as announced: they wheeled her past me, I...

Shot in The Dark

2008-03-01T19:00:00.000-08:00

“There is a sniper out there,” the paramedics stated matter of factly as they wheeled our patient into the trauma bay. “This is Jose, he is 25 years old, he was walking to the store this evening when he heard a loud ‘pop’, and felt a sting on the left side of his neck. He is bleeding from a small puncture wound over the lateral portion of his neck, and there is noted swelling. He denies any...

Attack of the Zebras

2008-01-30T15:40:00.000-08:00

An 80 year old mentor, and Physician once told me, “being a good doctor is not understanding the typical presentation of uncommon disease, but rather the atypical presentation of common disease.” I have tried to keep these words close as I have journeyed through Medicine…but it is difficult. We naturally want to gravitate, especially in Emergency Medicine towards the “Zebras,” or those disease...

Leap of Faith

2008-01-15T09:58:00.000-08:00

“Oh my God!” I exclaimed to my wife as we neared the restaurant. A nice day out with the family, driving to lunch, abruptly changed by our gruesome discovery. Our route had been rather fortuitous: I missed one turn, made another wrong turn, got stuck in traffic, then finally we neared the restaurant. I looked over casually…and there he lay, completely by happenstance: Half on, half off of the...

Why?

2007-12-09T15:16:00.000-08:00

“We should have known he was dying,” my Attending said to me with a somber look on her face. “These young guys always fight you when they are getting ready to die,” and that’s exactly what Rodney did-he fought us. One minute the picture of perfect health, the next, gone-his only memory the steady beep of a heart monitor, a trail of blood leaving the trauma bay. Rodney died in the operating...

Superman Sean

2007-12-06T23:53:00.000-08:00

I am using this title not only because I think Sean is one of my favorite and most impressive people to work with but also in an effort to instigate Sean into writing about his recent experience as a first responder to a trauma in downtown Palo Alto. In a sad turn of events, someone jumped from a building and landed right next to him. I'll leave that story for him. However, I do have my own...

Coming Soon: the Trauma Center 1.2

2007-11-15T15:44:00.000-08:00

We'll be hosting the next issue of the Trauma Center here next Tuesday, November 20th. The Trauma Center is a new blog carnival covering all aspects of emergency medicine. To be included, please send an email to lshevchik at healthline dot com by 12 midnight PST Sunday, November 18th.

A Stroke of Luck

2007-11-12T10:58:00.000-08:00

Last night, John was enjoying dinner with his wife. Suddenly he dropped his fork, a pain seared through his head. His right arm went limp, he tried to talk, but only incomprehensible slurs emerged. John at just 55 years old had suffered a massive, debilitating stroke. When he arrived at the Emergency Room a team of doctors and nurses had to quickly calculate if John was a candidate for a...

Too Many Chefs

2007-11-06T23:47:00.000-08:00

I am now in Los Angeles visiting my sister and her newly born daughter. Immediately after work I drove straight for San Jose and Southwest Airlines to see the first new member in our small family. The stark transition of my last two hours in the emergency room to the joy and hope I immediately encountered in the delivery room has left my head spinning. The ER blog about boarding brings me back...

The Trauma Center, 1.1

2007-11-06T13:32:00.000-08:00

Welcome to the inaugural issue of the Trauma Center, a blog carnival covering emergency medicine. I received an overwhelming number of submissions for our first time out and would like to thank everyone who sent in a submission. So without further ado, I bring you... Fat Doctor gives us a crash course in Japanese in this moving post about the benefits and limitations of virtual critical...

Part II: Where Do We Go from Here?

2007-10-31T16:07:00.000-07:00

...I prescribed Frank a potent steroid cream to help with the inflammation, as well as a moisturizing cream, and wrote down strict instructions as to how to care for his diseased skin. We gave him a list of free clinics in the area where he could be followed for his condition. “Frank, these medicines will cost about $30 dollars, but should last you for a couple of months….” “Thanks Doc he...

Where Do We Go from Here?

2007-10-14T10:52:00.000-07:00

Frank is an uninsured patient. I have seen him 4 times in the past 12 months for his chronic psoriasis-an autoimmune disorder which causes a thickening and irritation of the skin. His feet and hands are thick gloves of matted, cracked, peeling skin, which bleed and cause him a tremendous amount of pain. Even individuals with the best health insurance may have a difficult time dealing with this...