signout | March 28, 2007For the past week and change, ScienceBlogs has been nerdily (and happily) hosting the Science Spring Showdown. It is Signout's distinct honor to host the Sweet Sixteen match-up between HIV and Phylogenetics. (Please see the SSS Press Center for details of previous rounds' results.)
As a microorganism, HIV is dazzlingly cunning and elusive; as an epidemic, it is insatiable; and as a PR campaign, it is straight-up sexy. In the past, if you wanted to talk about condoms, prostitution, anal sex, and men who have sex with men, you'd have to go to a shady bar, or maybe a Democratic convention. Now…
signout | March 24, 2007The first phone call came about a month ago, on a day I wasn't in clinic. The phone nurse had left me a message: Rosie's mother wants to know why she keeps turning in circles."
I had never met the 10-year-old Rosie, but looking through her old records, I found that she has a non-specific kind of global developmental delay--something we used to call MRCP, for "mentally retarded/cerebral palsy." I also found that this wasn't the first time her mother had called with concerns about Rosie's circles--over the last five years, there had been at least as many calls with the same question, and Rosie…
signout | March 24, 2007This week's Change of Shift, a collection of nurse blogging, is up at codeblog.
signout | March 21, 2007Yesterday, I got tagged with a meme by the inimitable Dr. Flea, of whose recognition I am totally not worthy. Although normally, memes, meh, this "Thinking Blogs" meme gives me the opportunity to give props to several excellent thinkers and writers who routinely send my tiny brain into spasms of glee.
I'd have tagged Flea himself if it hadn't been he who tagged me. That not being an option, here are five other bloggers I adore:
1. I Blame the Patriarchy. My daily dose of radical feminism since 2004, this blog has done nothing less than give me a new vocabulary for thinking about human rights…
signout | March 18, 2007On Friday, I did something I never thought I'd have the guts to do: I looked a patient in the eye and told her I was not going to treat her pain. It was hard.
She had been admitted the previous day with nausea, vomiting, and epigastric pain. Although she had some marks of a drug seeker--she was rude and demanding, she had a long history of vague chronic pain syndromes, and she had a habit of switching doctors--her initial bloodwork showed an indisputably real and concerning abnormality. "Even crazy people get real disease," said my upper level resident, and we offered her the diagnostic…
signout | March 14, 2007This is maybe my favorite and/or the most aggressively nerdy thing on ScienceBlogs so far: it's smoking hot, one-on-one, science competition in the abstract, with brackets and everything. Way more interesting than stupid college sports.
Obviously, I'm most interested in the life sciences bracket, but other flavors of geek should have a look at the other brackets.
Defense! Or whatever.
signout | March 13, 2007This week's Grand Rounds is up at Scienceroll. You read, you like!
Addended 11:20 pm:
I keep forgetting to post about the excellent Change of Shift, a biweekly (I think) carnival of nurse blogging.
signout | March 12, 2007It's a very exciting week for residents all over the country. This Thursday, at exactly 12:00 EST, we find out who next year's chumps are--for this Thursday is Match Day.
It is a spectacle most powerful for the sheer simultaneousness of the reactions it elicits. The vindication for some, the crushing devastation of ego for others--I still shudder when I recall the faces in my medical school's big auditorium on Match Day. Words cannot express how happy I am to not have to sit in that sea of dread again, nearly sick to my stomach with hope.
It's a very different feeling, waiting to see the list…
signout | March 11, 2007A new Pediatric Grand Rounds is up at Blog, MD. And I'd say that even if I weren't included, if I remembered.
This edition contains some interesting parent perspectives, as well as lots of thoughtful, quality writing from the usual stellar suspects.
signout | March 8, 2007"I'm a 70-year old basket case," he said.
He was right. He'd been admitted a month before for workup of what was thought to be a relapse of a malignant melanoma--an aggressive cancer. His chart told a story of overwhelming chronic anxiety and depression dominating his adult life and resulting in a near-total inability to care for himself. His mental illness featured prominently in his hospitalization; most mornings, when I scanned his chart, there were notes from the nursing staff about him crying out in the night, and notes from the chaplaincy service about the previous day's existential…
signout | March 6, 2007The next issue of Pediatric Grand Rounds will be hosted at a blog I love, Blog, MD, on Sunday, March 11th. If you blog about anything related to pediatrics, send contributions to PGR by e-mailing them to samuel (dot) blackman (at) gmail (dot) com by Friday, March 9th.
signout | March 6, 2007"He's just a drug seeker." This was my signout from Dr. Dispo, an emergency medicine intern. He was going home, and I was taking over the care of any patients of his that still needed disposition, whether to the inpatient floors, a short-stay unit, the psychiatry department, or home.
This last patient on his list was a "frequent flyer" in our ED, a guy who is in all the time with abdominal pain. He'd been last hospitalized the week before with a suspected small bowel obstruction, and Dr. Dispo was sure he just wanted more painkillers because they got him high. "Just get him out of here," he…
signout | March 1, 2007I know about 50 people who should enter this contest, wherein mere mortals submit t-shirt designs with a "science is culture" theme and win fabulous prizes.
You know who you are. Get cracking.
signout | February 26, 2007For weeks, our emergency department (ED) has been "red," meaning that--theoretically, anyway--it is no longer accepting patients. Of course, sick people who come to the door are not turned away. Ambulances, however, are instructed to take patients not requiring high-level trauma services to other emergency departments in the city, and our triage staff works extra hard to redirect people who don't really need emergency care.
The other day, I walked into the main charting area of the ED and smelled pizza. This worried me, as food odors in the emergency department are, more often than not, early…
signout | February 21, 2007A few weeks ago, I wrote about a woman I met in the intensive care unit after she was successfully resuscitated with ACLS. Serendipitously, she ended up on the medicine service I switched to shortly thereafter, and I've been taking care of her on the general medicine floors for a few weeks.
Today, on my way out of her room, I let on that I'd be switching services in a few days. "What?" she said. "You come back here." From her mouth poured forth a torrent of words, mostly good ones: "You're great, but you're a little rough around the edges. You're a go-getter. You know what needs to happen,…
signout | February 18, 2007I just talked to a regular reader of this humble blog, a good friend doing his residency in another institution. He brought up the code I mentioned here, and was appalled by the fact that procedures were still being done on a patient long after he'd died because the practitioners needed practice. "I've got some ethical issues with that," he said. "People donate their bodies to science so we can practice procedures on them. That's not what happened here."
I've got news, people. When you make yourself a full code in a hospital--namely, when you elect to have full cardiopulmonary resuscitation…
signout | February 16, 2007I love this*:
To the left, next to "Paediatrics," I'd add, "Hates adults and children and self" > "Med-Peds."
*Courtesy of the British Medical Journal.
signout | February 15, 2007Oh, that hospital.
Yesterday was SO romantic. The hospital woke me up early with a big, sloppy kiss and had me all packed off to work by 6:00 a.m. An hour later, it gave me a code--a guy with a busted heart chamber. Get it? A heart chamber? On Valentine's Day? So thematically appropriate! I did chest compressions for days after he was dead because the cardiologists wanted to practice doing pericardial windows. It's a good thing the hospital prefers its ladies musky.
I discharged two patients to nursing homes before noon (nuts to those sad, old single people, ha ha!), and after my upper level…