AwwS

A somewhat depressing sentence from my cardiology review book:

No waiting is necessary to have sex after [a heart attack]. Sex does not significantly increase the risk of [another heart attack], because neither the duration nor the intensity of exertion is sufficient to provoke ischemia in most cases.

Good news! But sad at the same time.

I know . . .

. . . this is supposed to be funny.

But my, how much trouble it would save us:




And we need all our energy to panic about swine flu.

In swine-flu-related news

At pediatrics clinic, we've come up with a cute little nickname for the H1N1 virus that's a little easier to say and less likely to panic people.

I think it's adorable.

But we've been causing a bit of concern with the patients when they hear us asking the nurse for a
"hiney" exam.









Heehee, hiney.

It's here!

I've spent the past six months with my head buried firmly in the sand, insisting that all this swine flu silliness was just going to blow over, that it's exactly like any flu, really not a big deal. Totally shrugged off any discussion of it. I figured it was going to be a total nothing. If we had to deal with anything at the hospital, I imagined it would just be a steady stream of worried well trying to stockpile antivirals.

But over the past week or so our hospital has been pretty firmly whomped with a steady trickle of very early and very severe flu cases, and a fair number of them are H1N1.

Now I do have an inexplicable passionate love affair with horror movies, and most especially those of the viral apocalypse variety. Nonetheless, I am not at all excited about the prospect of my first ever year as a doctor being the year we all die of the flu.

(Mostly because I'm just not sure my uterus is up to the task of repopulating the world).

I may have felt a tiny tingle of excitement as I snapped the elastic of my respirator behind my ears and headed down the hallway to see my first verified H1N1 patient. But as we tried to tease out who might have been exposed and how many high risk contacts he had and whether he needed to be admitted and whether he met the criteria for antiviral treatment and whether his one month old baby with a fever and runny nose needed treatment, I just thought oh no.

I may not be getting very much sleep on call this winter.

brand new pet peeve #1

Doctors (and it's always doctors) who push the blue handicapped wall button to open every single door in the hospital. Every single time.

Adult critical care vs. Pediatrics

Two not-so-exaggerated interactions.

Peds clinic (after 4 minutes with the patient):

Me:

"Patient Baby is a healthy one year old who presents with a birthmark on his head that has been previously diagnosed as a sebaceous nevus by two pediatric dermatologists who recommend removal between age 8-11.

My assessment is that this child has a sebaceous nevus that should be removed sometime before adolescence."

Staff pediatrician:

"Great job! Exactly right! I agree! Excellent presentation and clinical instincts! Woo-hoo! You've been working so hard, that's your second patient, right? Go take a coffee break."

Adult Critical Care: (after literally 12 overnight, sleepless hours of being in the patient's room every 10-15 minutes while juggling pages about literally, yes literally, 43 other critically ill patients)

Me:

"Good morning Dr. S! Patient W has significant history of every cardiac pathology imaginable (which I then listed in chronologic order including details such as systolic function, dates of hospital admissions, and cardiologists consulted) as well as end stage renal disease (presented in similar detail). He presented in vtach cardiac arrest and was found to be febrile.

I literally saved his life by performing three rounds of CPR including epinephrine, shocks, intubation, central line placement, aggressive fluid and electrolyte management, antibiotics, and blood transfusion. He proceeded to code two more times, requiring initiation of an antiarrhythmic drip, and subsequently developed pulmonary edema while remaining hypotensive, requiring a dialysis consult and initiation of pressors. I've arranged for dialysis this morning, cardiology consult, ordered all necessary labs and diagnostic testing for this morning and patient is currently clinically stable."

Staff:

"Well, doctor, (somehow impregnating a Colbert Report season's volume of sarcasm into that one word) I notice that his [random irrelevent electrolyte like manganese] was checked at oustide hospital and is slightly low. Did you miss that? Were you planning on fixing it anytime soon? And what supremely esoteric fungal infection observed only in a 1 mile subtropical region of latin America might you have considered and covered for? And what is his exact troponin level to the third decimal point. . . .? "

Me: [reflexes are slow at hour 29 awake] ::long pause::

Staff: I highly suggest, doctor, that you know your patients before presenting them. Now why don't you get to work at fixing this? ::walk away::


I'm currently on the peds side, by the way, and going through pretty significant negative reinforcement withdrawal. I keep waiting to get yelled at and it keeps not happening. Makes me nervous.

Oh and did I mention

Dr. S actually laughs with the sound "Mwa ha ha ha ha." (This laughter is usually occurring at the expense of someone else, most likely a patient). It bears a striking resemblance the count on sesame street mixed with the evil witch of west but with about 71% more evil. Bone chilling.

So appreciated

7:01am

Dr. S: Why is [other resident] not here yet?
Me: She's across the street at Starbucks, it was her birthday yesterday, she's probably a little tired.
Dr. S: She didn't mention her birthday yesterday. Why didn't she mention that to me??
Me: [pause] . . . . .
Umm, sir, she wasn't here yesterday. It was her day off.
Dr. S: Oh. I never really notice if my interns are here or not unless I end up
having to do extra work.

Code blues and parsnips

One of my favorite on-call joys is perking up my ears while we're in the middle of a code and listening to the random sideline conversations that take place at the moment of someone's passing.

I find it both amusing, the topics that come up! and kind of touching or poignant sometimes.

Occasionally there's radio playing 80s hits at one of the nursing desks. Last night two respiratory techs were talking about the best time of year to plant parsnips. There are always a handful of nervous interns and medical students milling about, chit chatting about other patients, and secretly hoping no one asks them to do anything important.

It's just such a striking reminder that life really really goes on.

I suppose it could be seen as irreverent or disrespectful to the moment, but I kind of appreciate it. And we can't just fall apart every time a code happens, that would do a great disservice to our living patients that we'll have to get back to in a few minutes. I mean, if I was dying I sure wouldn't want every doctor in the place standing around in reverential silence. Or crying. I think I wouldn't mind so much overhearing one final conversation about parsnips.

An actual lecture slide today

Strongyloides geographic distribution

-Developing countries
-Regions where fecal contamination of water is prevalent
-Kentucky


p.s. Hundreds of these buggers were found inside one of my patients! Neato!