Saw a patient with bladder cancer who and his wife swears to me that he is cured . He is admitted with acute kidney injury and is being rounded on by oncologist and urologist daily. I reviewed his charts and found not only the cancer is still there but he also has several metastasis in spine .

What’s  going on here?

Has the oncologist not been able to break the news 

Has the urologist not been able to break the news

Is The patient and family in sweet denial.

Unfortunately this is not an uncommon scenario .

Sometimes the Doctors are not able to say words like “death” and “incurable”, especially oncologist . Sometimes the patients and their families tune out such words.

Being an oncologist is tough and being an oncologist who does not mince his words is even tougher . Still ,this patient needs a clear and open statement.

I guess I will have to be the bad guy .


Insurance train

A nephrologist walks into a patient’s room in ICU . Patient is admitted with a potassium of 7.5. Potassium has a very narrow range 3.5 to 5.4 . Above 6.2 it can potentially stop the heart in diastole , basically mid beat.

Kidneys excrete potassium and if kidneys don’t work and potassium go high people call nephrologist (kidney doctor )to fix the situation.

The nephrologist had already prior to seeing the patient  instructed the ER Doctor and Hospitalist about some emergency measures and the potassium subsequently had come down to 6.6.

Now in the room, after  the nephrologist introduced himself and the reason why he was there the patient asked.

“Who called you”

Unexpected question.

“Your main Doctor . The Hospitalist and the ER Doctor ”

“He did not ask me”

“Well, perhaps because the situation was emergent he decided to get things going before he comes and talk to you”

“I don’t want people to keep hopping on my insurance train. Just because I have insurance you are here ”

Most Doctor will agree ,more then  half of the patients we see in hospital on an emergency basis are uninsured or underinsured . In Most of these cases we don’t see any money. 

Depending on how critical your field is , more pro bono you are going to work . Like ,a cardiologist ,trauma surgeon and an ER doc probably will do more pro bono work then an orthopedic surgeon or a cPulmonary/critical care Doctor and an orthopedic surgeon possibly more then a nephrologist and obviously a plastic surgeon who specializes in boob jobs will Likely never be called for an emergency. Except of course if a porn stars implant burst open during athletic sex.

In this case , as usual the nephrologist had not looked at the patient’s face sheet before rushing to ICU . Like always doctors don’t look at insurance Cards before responding to emergencies. I m not saying we don’t care about money , of course we have families and dreams too but when somebody calls , we go.

 Potassium greater then seven puts an automatic spring in your feet.

“Well your potassium is high . It’s better then before but it  a still high. It can potentially kill you”

“It’s won’t. It’s getting better and it will get better when we check the next time ”

“Do you not want to see a kidney Doctor ”

“I don’t ” the patient replied resolutely.

And the nephrologist had to leave the room.

True story .


What’s the worst thing a nurse can say to a doctor when he or she calls to check on their patient .

“I don’t know . I just started my shift”

Believe me we don’t care about your schedule. We don’t care about your love life, your child’s drug problem or your father’s suicide . If you are in the hospital taking care of a patient you should know basic stuff about him. There is such a thing as ‘sign off’and in most cases vital signs are just a glance away.

If you really have issues please get help. Talk to me in your free time.

Let’s say you are a clueless nurse . How can you better serve the purpose of your existence?

Suggestions :”I just started my shift but if you hold on one minute I can get you the information ”

Or forget the shift” I can text / call you with the required information in one minute ” 

Maybe I m a narcissist and want the world to revolve around me but you have to understand that I ,like a moon revolve around the care of the patient atleast until my shift is over and nurses like gravity are the connection between me and the patients.


Doctor cranky : why do you want to kill yourself

Patient : I don’t want to kill myself . I just want to go home today

Doctor cranky:  today is Monday , you are in the hospital with overdose , you almost died . Last Tuesday you were at another hospital with same thing . The Friday before you were at yet another hospital with overdose and you almost died at that time too. Three overdoses in less then 10 days . That looks pretty  suicidal to me 

Patient : it’s not a crime to take your medicine 

Doctor cranky : dude you are either very  suicidal or earth shatteringly stupid or it could be both, but you are not leaving the hospital. Unfortunately I can’t let you kill yourself under my watch,intentionally or otherwise.  I will get psyche involved. If you are lucky they may let you go home in a few days and  perhaps you will either stop or figure out the proper  way to do it.