Medical Musings

For some reason the NYT is all about neck injury lately. In yesterday's discussion of a possible chiropractic induced injury, Russell asked: But given all the other stresses people put on their necks, from accidents such as headbumps, from purposeful athletics such as whacking soccer balls, and from just craning one's head in odd positions when performing various kinds of mechanical labor, it puzzles me that the risk from a chiropractor would be much greater than the risks from these other kinds of use/abuse. Of course, this is not excuse for the chiropractor, who is imposing that risk,…

A few years ago I was walking through a local mall with my daughter and saw a kid about her age wearing a backpack and holding hands with a young woman. He was a gorgeous little boy, with black hair and huge black eyes. His eyes reminded me of my daughter's. There was a name tag on the backpack. The last name was unusual but one that I recognized as that of a guy I grew up with---and this little boy looked just like him. So I politely asked the woman if she was D's wife. She laughed and introduced herself as a family friend. My friend D and his wife were in California getting her cancer…

The great Dr. Sandy Templeton once asked his pathology class, "Why do people go to the doctor?" People came up with all sorts of responses, but to each he gave his best British, "No, no, no, no!" Then he would tell us, "They come to the doctor because they don't feel well and they want you to make it better!" So obvious. So simple. And yet, so complicated. As physicians, we have a number of ways of helping patients, only some of which make the patient feel better. Primary and secondary prevention of disease don't necessarily make people feel better in the short run, so they can be…

The young resident presented the patient in the usual dry terms we use for such things. "The patient is a 42 year old woman recently hospitalized for cirrhosis due to alcohol use. Her cirrhosis has been complicated by esophageal varices, encephalopathy, and refractory ascites." In other words, the woman has drunk herself nearly to death. "Is she still drinking?" I asked. "She says not. She says she stopped about six months ago when she first got sick." "What did GI say? Did they refer her for transplant evaluation?" "No," she said, a bit disappointedly, "they said she wasn't a candidate…

Recent discussions around here reminded me that it's time again to talk about what it's like to be in a hospital, and how to survive the experience. But first, as we move into the last two weeks of our very-successful Donors Choose challenge, I'd like to invite health care professionals in particular to participate. Gifts are tax-deductible and help out needy Michigan school kids with specific, vetted projects that are often useful for several years. Micro-donation is a great way to go. While big gifts are great, even a couple of bucks add up quickly, especially on challenges with Gates…

I was one of those crazy folks who loved medical school---not just the clinical years, but the pre-clinical sciences as well. The transition from pre-clinical to clinical can be rather unnerving (picture learning how to do a pelvic exam on paid models). One of my first clinical experiences was in our physical exam class. Much of this was done on each other (not the pelvics), but we were also paired with attending physicians who would take us to see---gasp!---actual patients. The guy I was paired with was old---impossibly old. I wondered to myself if he still had a jar of leeches in his…

On July 4th at 5 a.m., I'm loading the family into the car and driving very far away, where cellphones, pagers, and most critically the internet, do not work. Blogging has been very hard for me lately. I love writing, but due to work and family mishegos it's been hard to keep up with the posting. I'm hoping a stint up in the woods providing medical supervision to 400 souls will be rejuvenating. While I'm gone, I'll leave you with some of my favorite posts about the human side of medicine. I hope you enjoy reading them again, or for the first time. --PalMD Urinary tract infections (UTIs…

On July 4th at 5 a.m., I'm loading the family into the car and driving very far away, where cellphones, pagers, and most critically the internet, do not work. Blogging has been very hard for me lately. I love writing, but due to work and family mishegos it's been hard to keep up with the posting. I'm hoping a stint up in the woods providing medical supervision to 400 souls will be rejuvenating. While I'm gone, I'll leave you with some of my favorite posts about the human side of medicine. I hope you enjoy reading them again, or for the first time. --PalMD I met this beautiful woman the…

On July 4th at 5 a.m., I'm loading the family into the car and driving very far away, where cellphones, pagers, and most critically the internet, do not work. Blogging has been very hard for me lately. I love writing, but due to work and family mishegos it's been hard to keep up with the posting. I'm hoping a stint up in the woods providing medical supervision to 400 souls will be rejuvenating. While I'm gone, I'll leave you with some of my favorite posts about the human side of medicine. I hope you enjoy reading them again, or for the first time. --PalMD Mr. D. is one of those guys who…

On July 4th at 5 a.m., I'm loading the family into the car and driving very far away, where cellphones, pagers, and most critically the internet, do not work. Blogging has been very hard for me lately. I love writing, but due to work and family mishegos it's been hard to keep up with the posting. I'm hoping a stint up in the woods providing medical supervision to 400 souls will be rejuvenating. While I'm gone, I'll leave you with some of my favorite posts about the human side of medicine. I hope you enjoy reading them again, or for the first time. --PalMD I can't tell you the number of…

On July 4th at 5 a.m., I'm loading the family into the car and driving very far away, where cellphones, pagers, and most critically the internet, do not work. Blogging has been very hard for me lately. I love writing, but due to work and family mishegos it's been hard to keep up with the posting. I'm hoping a stint up in the woods providing medical supervision to 400 souls will be rejuvenating. While I'm gone, I'll leave you with some of my favorite posts about the human side of medicine. I hope you enjoy reading them again, or for the first time. --PalMD I love fountain pens, but I'm…

On July 4th at 5 a.m., I'm loading the family into the car and driving very far away, where cellphones, pagers, and most critically the internet, do not work. Blogging has been very hard for me lately. I love writing, but due to work and family mishegos it's been hard to keep up with the posting. I'm hoping a stint up in the woods providing medical supervision to 400 souls will be rejuvenating. While I'm gone, I'll leave you with some of my favorite posts about the human side of medicine. I hope you enjoy reading them again, or for the first time. --PalMD I am often the bearer of bad…

This is a piece from last year that is kinda resonating today, so I'm gonna share it with you.  --PalMD As I've written before, I love my work. You really have to love medicine to do it, because, contrary to popular belief, it's a lousy way to get rich. I'm not starving or anything, but there are dozens of easier ways to make a much better living... I'm sitting here in my robe, drinking coffee, getting ready to go out for a birthday party. I'm drinking coffee because at 2:38 a.m., the E.R. called me to tell me a patient of mine was being admitted--to oncology. "So, why are you calling me?" I…

Yesterday, a fellow medical blogger suffered a blow most of us cannot imagine. She goes by the name "drsmak" and was a great writer before her son fell ill, but when her son fell ill, her document of the struggle showed us how good the blogosphere can be. She allowed us a view of what it is like to love, and how that love is sometimes distilled into a painfully small elixir. Drsmak did us all a great favor---she showed us how it is possible to survive the unsurvivable, and she has done it with great dignity and art. The blogosphere owes her a debt. And you can help memorialize Henry, and…

And I breathe a sigh of relief. Working nights my schedule is a tad goofy, but I wake up today to see this guy describing the changes in the new budget: This is Peter Orszag the new director of the Office of Management and Budget. He is a nerd and I instantly like him. I was not surprised to find he used to be a blogger. It was especially refreshing because for too long our government has been run by this guy: In particular I agree with their emphasis on health care as a necessary element for creating a viable modern economy. America has to compete with other countries that provide…

This is an essay from several years ago, but with so many WWII vets dying, I thought I'd keep this little bit of oral history around. About an hour before my patients begin to show up, I sit at my desk and enjoy a cup of coffee while looking over the charts for the day. On my list was a new patient for the 9:00 slot. I opened his computer chart and saw that he was not new to the VA, only to me. He had been to a series of doctors over the years, and was noted to be hostile and dissatisfied with each. This is often how people seeking help become labeled as "bad patients", and are even "fired"…

In 1999, during my intern year, Hurricane Mitch struck Central America. As stated below, I wanted to become involved. The program director of my residency was kind enough to view this as a worthwhile educational experience. This is my diary from the trip. Part IV is here. Leaving Our final evening in Juticalpa saw the reunion of the medical teams that had been sent to the outlying countryside. Our friend Jeremy returned essentially unscathed but with a few stories from the hinterlands. His group was lodged in a small house in a distant village. They bathed with buckets of river water from a…

In 1999, during my intern year, Hurricane Mitch struck Central America. As stated below, I wanted to become involved. The program director of my residency was kind enough to view this as a worthwhile educational experience. This is my diary from the trip. Part III is here. After Hours We returned each night over the route we came, waving to our patients along the way, occasionally stopping to say hello or take a picture of the cloud-shrouded mountains. Our first stop was always the bodega, to drop off our gear and resupply for the next day's work. Afterward, we retreated behind the gate of…

In 1999, during my intern year, Hurricane Mitch struck Central America. As stated below, I wanted to become involved. The program director of my residency was kind enough to view this as a worthwhile educational experience. This is my diary from the trip. Part II is here. Zopilotepe; the Clinic We loaded our supplies and our tired but excited selves into a jeep and headed out to the highway. Shortly after leaving town we turned down an unremarkable dirt road that threaded through bean and corn fields. The rough-hewn wooden fences were covered with purple and pink morning glories. As we wound…

In 1999, during my intern year, Hurricane Mitch struck Central America. As stated below, I wanted to become involved. The program director of my residency was kind enough to view this as a worthwhile educational experience. This is part II of my diary from the trip. Part I is here. To Juticalpa As we left Teguz, we crossed one more bridge and began to climb into the hills that surround the high valley in which rests the city. Thin dogs wandered along the roadside sniffing at the animal skulls lining the road. Women and children crowded into ravines to wash clothes in the river which was both…