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.

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Oncologist 

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 .

7am

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.

Suicidal

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.

Open marriage

so a patient , a good looking blonde woman in early forties sat in front of me complaining about her husband.

They had been in an open marriage for probably more then ten years but now there was trouble in paradise.

Both the spouses had been my patient for many years . As usual I never cared about what and who they did In the bedroom.

“He fucks her behind my back. Never even tells me about it ”

Remember it’s an open marriage .

“I thought you were ok with this”

“I was ok with this when I was younger, when I could get as many men as he could get girls”

“well”

“we invited this girl to a threesome a few times , she is young and hot and now she is fucking him all the time ,all the time”with more emphasis

“hmm”

“She is a bitch”

“I understand”

“How do I stop him ”

“Hmm. I see the problem”

“I can only get old guys now . He can get any girls he wants”

What I wanted to say was 

“Well,you should have thought about it when you brought a younger and hotter girl to a threesome”

Or

“Sorry about the current double standards which persists in our society, but perhaps it’s time to let your husband know you don’t want an open marriage or any marriage”

Or  what I really wanted to say 

“How is this my problem. The guy still in waiting room may have a ruptured appendix and I am sitting here talking to you about your crazy love life”

My residency program director voice hammered into my head .

“You don’t have to like your patients , but you still have  to take care of them to the best of your abilities”

Therefore what I really said was.

” I feel sorry for you. This is indeed a bad situation , perhaps I can refer you to couples counseling and maybe we can find a solution for this problem”

I hate you Sir for being my teacher.

 

 

 

 

Paging

So I get a page . I am in a patients room . I get out and answer the page . A nurse from 12th floor is looking for me but she is with a patient so I am put on hold . After 5 minutes I break the connection and go up to the 12th floor . The nurse is still busy . Another nurse gives me a paper I need to sign . I sign it, ask if they need anything else and go back to my work.

Get a page again. The same nurse. I am put on hold . Five minutes later she come on the phone . She can’t find my orders . I explain to her where they are. Then I am back to work.

I started with 18 patients and have got 9 new ones. No lunch. I have planned my day down to each minute. Basically I am on roller skates.

Get a page again. Same nurse but of course she is with a patient so I have to hold . This time for close to 10 minutes.

I thought when somebody pages me they need me . Why would they page me if their issue can wait. If you want me , talk to me.

Is it too much to ask of a nurse to page a doctor only when you can talk to him. And God forbid if you get angry. Heavens will move if you ever express your unhappiness.