signout | February 11, 2007This morning, I was writing in a patient's chart on a general medicine ward when I felt the energy around me shift. Everyone seemed to suddenly be walking faster and talking louder--something was obviously wrong.
I overheard snippets of conversations swirl around me while disaster built: "patient is unresponsive," "don't know what to do." There was a team of doctors already in the room, and I didn't want to be intrusive. I just watched and listened from in front of my chart until I overheard a nurse say, "Maybe we should call a code."
When I got into the room, there were eight people crowded…
signout | February 7, 2007Grand Rounds 3.20 is up at Tales from the Emergency Room. The focus this week is on the people behind the medicine. (If you ask me, the medicine should watch out, because the people is probably planning to give it an unannounced rectal exam.)
signout | February 7, 2007I'm always a little restless the night before a new rotation. Sunday night was no different, and I laid awake in my bed for longer than I'd hoped to, worrying about leaving behind the intensive care unit (the ICU) and switching to the general medicine floors.
At about six o'clock Monday morning, I walked into the room of a 91-year old guy admitted with antibiotic-related diarrhea. "How're you doing?" I asked. "Anyone I can get my hands on," he said, and cracked a little grin. Instantly, I was back.
What I worry about most prior to starting rotations is whether anything in the new place will…
signout | February 2, 2007A few days ago, I posted here about a recent ICU admission of a patient with pancreatic cancer. Her admitting diagnosis was septic shock, and I'd initially included some detail about septic shock to help illustrate a clinical dilemma in her treatment. Although that portion was ultimately edited out, this is how a snippet of it read:
In septic shock, the blood itself is infected, and byproducts made by the infectious organisms cause the blood vessels to become dilated and leaky. The danger of septic shock is poor perfusion of important organs, like the brain, the heart, the kidneys, and the…
signout | January 31, 2007At about 8 a.m. today, the code bells sounded. ("I love the smell of chaos in the morning," said a nurse nearby.) I ran to the code, but because I had to schlep over from the intensive care unit (the ICU), I was late, and I didn't make it into the room. Scowling, I trundled downstairs to get back to pre-rounding.
Half an hour later, the ICU fellow came and tugged on my sleeve. "The code upstairs? She's here, and she needs lines." I jumped up, gathered supplies, and went into the room.
The patient was lying in bed, her eyelids stained violet as if with makeup. I began to announce myself…
signout | January 28, 2007Back in October, I admitted a patient to the general medicine service with a three-week history of abdominal pain and progressively yellowing eyes. She was a large, pleasant, quiet black woman who was almost always accompanied by her husband, a broad man with laughing eyes and a white beard who wore an old-fashioned train engineer's cap. Her history was suspicious for pancreatic cancer, as was the flurry of radiologic studies and biopsies that followed her admission.
On a Saturday morning shortly before I finished the rotation, I had a long conversation with the patient and her husband.…
signout | January 23, 2007At about this time last week, I asked for bloggers' thoughts on the interface of scientific evidence with health and health care. In an unscientific poll of the blogosphere, about 40% of you gave this theme the finger, while about 60% of you found it interesting to the point of arousal. To the first group, I say, I hope we can still be friends. Meanwhile, the second group should sit quietly and think about what it has done.
I sure have. There's great variety, great thought, and great effort evident (heh) among the entries in this week's collection. I hope you will find it as thought-provoking…
signout | January 21, 2007Don't forget: The deadline for submitting to this week's Grand Rounds is midnight tonight.
Please note--as addended at the bottom of the original announcement--that although there is indeed a theme for this Grand Rounds, non-thematic posts will most certainly be given careful consideration.
Plug away!
signout | January 17, 2007For those of you new to Signout, I'm a first-year resident (i.e., an intern) in a medical residency program in the United States.
Medical education is different all over the world. In the U.S., we spend four years getting a bachelor's degree (which doesn't need to be science-related); four years getting a medical degree (in which we take a standardized group of courses in medically related sciences and clinical medicine); anywhere from three to seven years training as a resident (all clinical, all the time, and standardized according to the requirements of the field in which the training is…
signout | January 17, 2007Further proving the existence of God (just kidding! Hi, neighbors!), I am now writing under the ScienceBlogs umbrella. This is terribly exciting for me, and I look forward to being part of this formidable community of thinkers and writers.
To those new to Signout: Hello. Welcome. Have a cookie, or maybe a nice piece fruit. Thanks for visiting. The archives are coming.
To those new to ScienceBlogs: Hello. Welcome. Thanks for following me here, where I plan to keep doing whatever it is that I do. Please, check out my amazing neighbors.
Yes, you may also have a cookie.
signout | January 16, 2007Next week's Grand Rounds will be hosted here at Signout on Tuesday, January 23.
Every medical student takes courses in physiology, pathophysiology, histology, and pharmacology. A new science has recently been added to this basic battery: evidence-based medicine, the science of critically searching and reading the scientific literature. Finding proof for our daily practice as doctors has begun to play an enormous role in patient care, and it shows in medical education and in the dollars (euros, yen, et al.) committed to research, both in industry and in academic institutions.
The formidable…
signout | January 13, 2007I just finished a rotation in pediatric hematology and oncology, where almost all of the kids I was taking care of had cancer. Most had leukemia or lymphoma with prognoses that were varying degrees of good. A few had other, highly curable solid tumors. Only one kid--a boy I've written about here twice before--had a bad cancer. But boy, was it bad.
His tumor, called a neuroblastoma, is a cancer of the sympathetic nervous system. Its prognosis can vary significantly with the age of the patient it affects and with characteristics of the tumor itself. This boy's problems had started at the age of…
signout | January 7, 2007There's a 3-year old kid on our pediatric hematology-oncology service who has a high-risk, stage IV, disseminated neuroblastoma: a bad cancer with a terrible prognosis. The mass in his liver is huge, and distends his abdomen way out of proportion to his limbs. He is otherwise a truly beautiful child, with big, blue eyes and an open, winning smile.
I went in last night at about 3 a.m. to examine him because he had spiked a fever. When I laid my hand flat on his belly, he opened his eyes and said, in full voice, "Don't hurt me!"
In my training, I do both adult and pediatric medicine. However,…
signout | January 3, 2007For several weeks in December, I worked with an adolescent medicine doctor who was like magic. Watching him massage our spectacularly manipulative patients into compliance was like watching someone fit a greased elephant into a cigar box. His motto was, as he told me repeatedly, "Every behavior that persists is being rewarded on some level."
We had a patient for a time, an 11-year old girl I'll call Precious. Precious had previously been diagnosed with lupus, a chronic and very real illness, but had been admitted this time for abdominal pain. Shortly after her admission (and her extensive…
signout | December 30, 2006And again, I point you to this week's Pediatric Grand Rounds. There's a great series on vaccines mentioned there, if you're into that sort of thing (and I know you are).
signout | December 26, 2006Now up: this week's Grand Rounds, into which I've again managed to squeak. This week: bloggers' best-of.
signout | December 25, 2006I'm an M.O.T., so for me, Christmas, meh. It's just kind of another day. I'm neither especially cranky about having to work nights through the holiday, nor is my heart filled with the dazzling light of yuletide joy.
But last night, a colleague reminded me of something that brought home the true meaning of Christmas: today, I am exactly halfway through my intern year.
Hallelujah!
We even had our own Christmas miracle: we got a kid with a huge neuroblastoma in his liver down to the CT scanner at 2 a.m....and he wasn't bleeding into the tumor. (The real miracle is the first part.)
Huzzah! I…
signout | December 22, 2006Yesterday, I discharged 5 patients from the hospital. Today, I feel dead inside.
For patients, hospital discharge is a happy moment. Leaving the hospital means leaving behind the unflattering gown, the interrupted sleep, the food that does not resemble itself, and the constant parade of people poking and sticking and looking at your business. Most inpatients eagerly anticipate discharge from the moment they are admitted.
For residents, hospital discharges are a little different. Patients leaving the hospital require instructions, follow-up appointments, outpatient testing, prescriptions, and…
signout | December 19, 2006Most of you know I'm not the only one writing about the medical profession out here in the blogosphere. This week, I'm honored to be in the company of many excellent medical bloggers at two weekly, appropriately named anthologies: Grand Rounds and Pediatric Grand Rounds. Please have a visit and view the greatness that surrounds me!
I also made it into Wordpress.com's A-Blog-A-Day column the other day. They called me "interesting," which, as I recall, is fairly synonymous with "not interesting." Whatever. It's exposure.
But enough about me: anyone with an interest in verse should get their…