Calorie

“I am prescribing you this new medicine for your high blood pressure/ diebetes/heart disease / cancer/bipolar disorder/bigheadedness/split ends/hang nails etc”
” will it make me fat”
” not if you step away from
the table before filling up to your throat”

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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. 

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 . 

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