Dialysis 

“Why do you not have an arterivenous fistula , that’s the stands of care . Why do you get dialysis with a catheter ”

I asked the  somewhat attractive 50 some year old woman laying in the bed 

” I don’t plan to stay on dialysis that long” she said without much emotions

“What do you mean ” I asked

Now her eyes teared. 

“I  been sick for 15 years . I don’t want to continue dialysis . I hate it ”

If she hates dialysis that much why start it in the first place.

She read the question in my eyes

“My parents are still alive.  They are in their 90’s. I have to wait”

Now it all made sense . 

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My ageism

http://cliparts.co/

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 .

Trump

I admire trump. He has shown the world what Americans really are .  Thousands of documentaries cannot capture what the world see when people rally behind him and cheer him on. 

Does it remind anyone of the hitler adresses they show in black and white grainy newsreels.

Hail Drumpf

 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.

Joint aspiration 

We were talking in a group of people , not all of whom were in the medical field .

I told them that I do perform joint aspirations often and actually like them because they make life easy for me. I don’t have to guess stuff . I of course was talking about diagnosing gout ,septic arthritis , rheumatoid arthritis etc.

A girls from accounting looked puzzled 

‘You mean like ,In a couple situation ‘