Hate

A doctor is taking care of a Pacific islander. The man is on dialysis but since his immigration status is not legal he cannot get medicare, Medicaid or any kind of insurance to pay for his dialysis. I don’t know the details. It was not my own patient but some how he had come to United States  without the right papers. The Pacific islanders usually find immigration easy compared to Mexicans, South American and South Asians but  he had not signed the right stuff.

The doctor to the case manager, ‘ Is there anything we can do?’

‘No, not really. He can come to Emergency room every three days and get dialyzed.’

‘That’s crazy.’

‘It is, in California there may be some options, Of course he can go home. He will have better luck there. At the least it will take a few months.’

The doctor goes to talk to the guy. His whole family is there visiting him.

Now this is Trump era life, so every brown person is scared.

The daughter who has never seen the doctor before asks before he has time to say anything.

‘Where are you from.’

‘You mean where I was born?’

‘Yes.’

‘I am from Pakistan.’

‘Osama!’ collective sigh from several family members. This is several years after Osama was killed. Trump and Bannon are presidents. Osama is history but evidently not for them.

‘You muslim?’

‘Yes.’

‘We dont want you as my dad’s doctor. We are christians.’

‘OK.’ The doctor turns around and leaves.

My ageism

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Yes I suffer from ageism. Time and again I have found that older nurses are better at everything compared to younger nurses .

Experience , just plain skill and the fact that if you have spent twenty year in a field you know you actually love it and not doing it just to get by.

I am actually afraid sometimes when I see younger nurses taking care of my critical patient. I check everything twice or thrice, sometime twenty seven times and never take their words as the final word. Even when it’s something as simple as urine output I go and check the foley bag myself or confirm with the cna’s and other personnel . I know it’s crazy and probably wrong but it’s difficult for me to take the young twenty year old , face booking , latte sipping , planning her hook up in the evening nurse as seriously as a 55 year old with 20 year experience who just sent her kids to college .

I once got a call from a nursing home . A young nurse told me that the patient is having pain in left side of the chest about 2 inch area , worse on coughing and deep breathing . He can point to the area with two fingers and when the nurse tries  to press on it hurts . I told her it’s probably pleuritic or musculoskeletal , she told this to her senior who ws standing behind her . The senior took the phone and said its central chest pain with radiation to the left arm . He can point to it but  its probably not the area of two fingers and he is nauseous. It is worse with coughing and deep breathing but it’s bad anyways. This got my attention .I told them to take the patient to er and sure enough he was having a heart attack.

It may surprise people but a lot of the twenty year olds will not even stay a nurse too long . I am not quoting studies. I am just quoting my experience . I have seen nurses go from being a nurse to stripper , real estate agents ,even a trucker. True story !

Of course the worst part is when they try to impart their infinite wisdom and knowledge to me. Comparing Percocet to Tylenol, telling when the patient need dialysis all the way to withholding Ivf when ordered because they think the patient is wet. Yes it has actually happened . Also holding Coumadin because the patient is on heparin . ( for a heparin window)

So whenever I have sick patients I want my old reliable gray haired nurses to manage them . Sue me if you want .

 Alcohol

Believe me , I like most alcoholics. They are generally nice , mellow people who would rather hurt themselves then other people . The problem ,they sometimes stop being nice.

Maybe it’s the time of the year or what but lately I have seen several patients with alcohol intoxication either to the point of killing their own selves or to the point of killing other people .

The ones who try to kill other people end up at psyche or jail but the ones who are killing themselves end up in ICU and under my care.

A 28 yo man drank himself to the point of coma . He stopped breathing for an unknown length of time . When he came to us he had diffuse brain ischemia including the frontal lobes. which is where our personality and executive function lies. Frontal lobes makes us humans . He needed to be intubated , started on pressers , and dialysis. Two weeks later he was still the same except being off pressers. Because of the brain ischemia we had a long discussion with his family which included a girlfriend . Btw he is an illegal immigrant whose parents were unable to come to USA so far . We did provide them the papers for visa etc.  The girl friend cried    throughout the meeting ,telling us about their two year old daughter and how they believed that he will recover completely and walk out of the hospital. Apparently they had been praying hard too . I could not help but ponder over the possibility that the daughter must have existed two week earlier too . I mean it’s a fair conclusion that the girlfriend and daughter were existent at the time of his inbibement of copious amount of alcohol.  Now of course me or the other doctors will not do anything which the family does not want but the patients prognosis is basically zero and we are spending millions of dollars and thousands of hours to keep him alive in a vegetative state .

There is another patient who has pancreatitis from drinking alcohol. He is in his twenty’s.

 His family is really remarkable . They tell me that the patient is basically a superhuman as far as his tolerance of alcohol is concerned . Therefore when he kept drinking to stupor everyday for two , three weeks they did not think it was a problem . He had done that many times before . “His father was like this too”

” Is his father alive ”

” no , he passed away”

“Okay”

Perhaps the family was confusing him with a certain kryptonian prince. Anyways , this time he ended up with severe pancreatitis and multi organ failure . Intubated , on dialysis and on top of everything ,in delirium tremens. We have no way of judging his mental status unti he comes out of dt’s but atleast his CT brain does not look as bad .

Of course he has three little girls and a wife.btw this one is a white dude who I think owns his own business, so this problem does not restrict to non whites.

THis reminds me of another pancreatitis patient who left against medical advice from ICU , continued to drink alcohol and came back to hospital next day just to die. Now, I have a problem with patients dying under my care. But Of course there is no problem which a couple of drinks can’t fix. No I didn’t say that. 

That patient left with his family , fully coherent and alert, probably bought vodka on his way home and drank till he could Not . I know sometimes you cannot stop a guy from drinking but maybe you, the family member need to try harder, especially when somebody just walked out of ICU .

Another Patient I saw I during my training . A young girl who came in with alcoholic fulminant liver failure . Her family swore that her boyfriend has given her some poison , though they agreed that she does like to drink a lot “but not too much “. Any ways we never found any poison but her blood was pretty much pure alcohol . She died too inspite  of emergent dialysis and everything possible which could be thrown her way.

So what is it with alcohol ?This drug kills more people every year then all the illegal drugs combined . Is it because people don’t think it is as dangerous . Is it just some Darwinian process.

Fire exits

Is it only me or have other people been stuck out of fire exits too?  Seems to be only me because nobody I ever complain to ever tells me their fire exit story  . They all smile at me just oh so politely as if they just heard mentally challenged person tell them that he just shit in his pants.
“Stuck in fire exits ? Oh no ,not me , never . I am not stupid”

Anyway it has happened to me several times . In Chicago I once found myself in bitter cold ,walking in a snow without a coat because while talking on the Cellphone I had opened a door nonchalantly and walked out  to the back garden of a hospital . Of course the door was a fire  exit and could only be  opened from inside .

Another time I found myself walking down fifteen floors of a stairwell because I wanted to use the stairs for health reasons and decided to walk up from 14th the to 15 th floor of a hospital. Each and every door refused to open from the firewell except of course the ground floor. I didn’t quite understand why but even going down 15 floors can make you tired to the point that you have to drink a sugary coffee and say a vehement goodbye to all healthy intentions . The funny thing was that I was not the only lost soul in the firewell. I found two other people just like me.

And that’s another thing . Whenever I am in the firewell I do find other  people who have stumbled into and gotten lost but God knows where does all these people go away when I am out of the stairwell  because every time I mention my stairwell stories , well, its just me who seems to be stupid enough.
Another time at a university hospital I discovered I had ventured into the basement labyrinth while trying to go down stairs . Was stuck for several hours until another person who was just a tiny bit less lost then me came along . Both of us together managed to find a fire exit and were actually happy to walk into a dark, dreary and wet street outside. Anybody who has ever been stuck in the basement of an old hospital would agree that even pouring cold rain is welcome after that. As expected the fire exit was atleast two block form any other entrance or the carpark therefore my companion has to listen to many choice words emanating form my mouth without me even realizing it. The combnation of fire exits, cold rain and lack of jacket seems to have that effect on me .

Another memorable incident was when I locked myself up on a rooftop . Now that was actually a little stupid . That was during my training . We were not suppose to go to the rooftop but of course that didn’t stop me. I was looking for someplace in the hospital all my own. A place to hang out with me or people close to me . Of course th door turned out to be a some kind of secure fire door . Opens form inside but would need a key once you are out or you would need to climb down an outside fire ladder. Since the whole operation was a secret I did not want to climb down the open-to-everyone fire escape . Result ; stuck on the roof for almost an hour until I could wave to a friend who thankfully understood the situation and rescued me, of course while   laughng like a maniac the whole time .