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.

F

‘Full of shit’or more politically and scientifically correct’ fecal impaction’ 

The patient may not know but this condition can easily be a battleground between nurses and doctors .

As a geriatrician I like to use the gentlest treatment possible which is some times soap suds enema until clear or even tap water enema however they require repeated administration and very gentle hands. In addition I like to add oral miralax.

 Surprisingly , a lot of nurses don’t have time for this . They prefer stronger drugs. The message here is to stay the course even when you are getting pages every fifteen minutes asking you to go the other way. As long as the patient tolerates it continue to ‘do no harm’

Doctor

Doctor cranky” so you were trying to kill Yourself  , again”

Patient “Yes”

Doctor cranky “With the same old medicines”

Patient”yes”

Doctor cranky” why don’t you guys learn. You know how much money and effort you have cost all of us who are trying to save your life. I really  wish you stop doing this . This is crazy. You are young. What could be so bad?”

Patient  “well..my girlfriend hates me because I don’t bring any money, but it’s not really my fault. My license is suspended on DUI . And thats because I have four children from four different women and they all keep calling me for money . I have to take some medicine and a drink now and then to calm me down . The worst thing is  I play call of duty at lest 10 hours a day and I keep dying in that too . All this nagging and bitching keeps me from concentrating ”

Doctor Cranky “you do know there is a train track which goes right through the town”

Blood

The movies are right . The books are right . If you are a doctor sooner or later you will see blood and sometimes a lot of it.

From small injuries  to epistaxis to motor vehicle accidents and surgeries . Blood is everywhere . Ubiquitous is the word I think.

Believe  me I am as scared of blood as my five year old daughter ,maybe more. Still I do biopsies , lines , intubations if needed and all the usual stuff.  I pray I never have to see car wrecks or gunshots again and in my field I probably won’t but in my training I did, as all of us do.

So what to to if you are scared of blood but want to become a doctor . Well! fake it till you make it . (Courtesy Steven Tyler)

A jock friend of mine fainted the first time he saw a drop of blood . In our physiology lab we had to one out and each other’s finger for some lab work. Don’t remember what was the actual assignment . He literally fainted . Dropped flat on the floor with a bang. Now he is an anesthesiologist working in OR everyday.

Ii know girls who ran out of dissection hall and quit medical school  and I know the ones who ran out but did not quit medical school. Guess what ! The ones who did not quit did alright and the one who did quit did alright too.  But the one who did not quit got to be doctors , something they all wanted to do in the first place.

one word of advice for new residents and medical students . The blood you see is less then you think it is . A 100 ml bleed can look like a an entire pint of blood when it is spread flat on a surface . I m not telling you to be ruthless and careless. However if you placing a line or doing a biopsy don’t let a little bit of blood scare you into not doing it.  I would worry more about pain. Your procedures should be as painless as possible . Use that lidocaine.

One the other extreme is the daily labs . Almost no patient need daily labs but almost every one admitted in the hospital gets them.  If you have to get daily labs use pediatric tubes. Most of the blood that is collected is discarded. I know it’s only 5 ml in one tube but 5 of those tubes everyday for a week in an elderly severely ill person can take its toll. Because we as a doctor don’t actually see those tubes we don’t think about them. So next time you order daily labs if you absolutely have to , please order them to be collected in pediatric tubes.

I can go on and on on blood and may be I should. Some other day.

 

 

 

A to Z 

To come out of hibernation I have decided to write blogs alphabetically. No particular theme except alphabets . So here goes

A: arsenic . Still happens . I have seen one patient in a rural town who got arsenic poisoning from the wood he was using in his fireplace . For some strange reason the wood was treated with arsenic . Perhaps an unhappy wife or a jealous lover . He did not think so .

Why did I order the test ?Because he had weird neurological symptom and labs ( looked like Lyme but the history , demographics and serology  did not fit ) . Neurological Imaging was pretty much normal .

Of course it took me unfortunately almost a month to get to arsenic but once we found it we fixed it.

Not saying it’s common but if you don’t think of it you won’t find it. 

Also if your wife is not happy with you don’t let her near the firewood.