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Geriatrics and Palliative Care Medicine

November 18, 2012 By Leave a Comment

That’s what this month has been all about.

Ok, so I did get a week of vacation at the beginning of the month, but after that I have been dealing with senior citizen patients, quite a few of whom are hospice care patients.

It has been strange — the palliative care side of things, that is. I feel like I have spent the last few years preparing for a career in which I do everything I can in order to help someone get better. And on occasion, we must get out of nature’s way and allow death to happen. However, this month I feel like that model of medicine has been flipped upside down — that my role has now shifted.

I feel like so many of the patients I see are desperate for help. They crave to die with dignity and with peace. And for that, they look to us.

It is different when the family members of patients come looking to you, not for hope in a recovery, but for hope in a peaceful passing.

I have a great deal of respect for physicians who choose to go into palliative medicine. I used to look at the specialty of Oncology/Hematology as the “saddest” of specialties. Yet it seems the field of Palliative Care is grimmer still.

Perhaps I am just not used to it.

But maybe I don’t want to get used to it.

Filed Under: My Life, Residency Tagged With: , , , , , , ,
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Medicine & Death

January 31, 2011 By Leave a Comment

I just found this quote by Dr. Atul Gawande and I wanted to share it:

The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And, in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and how to surrender when he couldn’t, someone who understood that the damage is greatest if all you do is fight to the bitter end.

Filed Under: Other Tagged With: , , , , , , , ,
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Dreams

December 30, 2009 By Leave a Comment

Just woke up from a strange dream. It was a pretty convoluted “storyline” that started off with me running away from the “authorities” in some old-time setting. And by old-time setting I mean a couple hundred years ago. At least that’s how it felt because the people who were chasing me were doing so with swords.

Anyhow, the dream ended in a modern day setting where I was at a party. There were movie stars and I was some new person to the “scene.” My manager was worried about me and the press coverage.

Suddenly one of the ladies at the party started flying. But we knew she was on some sort of harness and it was all part of the entertainment. Something went wrong, though, and she slammed into a wall and dropped like a rag doll. I rushed to her side and started assessing the situation.

We didn’t want to mover her.

I believe I managed to intubate her.

It was a blur, and a flurry of action because along the way some good-natured person slipped her a pill while she was unconscious in hopes of helping her. I’m not sure when this happened but it must’ve been while I was otherwise occupied. This pill was causing her airway to close up and the reason I had to intubate her.

I just had to write this up because it seems like dream-me is progressing through my medical education faster than real-me. Which is alright, I suppose. Because at least real-me doesn’t have to run away with armed guards equipped from swords.

Filed Under: Medical School, My Life Tagged With: ,
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Change The World

December 24, 2009 By Leave a Comment

I’m not in the habit of adding music to my blog posts. So this is a special occasion — or just an opportunity for me to hunt down and try out a new plugin for my blog.

Yesterday I drove back to Loma Linda (from San Fernando) to get my H1N1 vaccine and to pick up some other things. This vaccine was the main reason. I received an email a couple weeks back saying that all students at Loma Linda University would be required to have the vaccination in order to register for Spring quarter. Last week (during exams), I received an email from one of my deans stating that I had not yet received mine and they wanted to know why and when I would get one. So, taking advantage of Christmas break (a time when the I’ve-got-to-study-every-minute-I-can feeling is slightly diminished), I decided to get my shot.

On the drive back I selected shuffle on my iPod and placed Apple in charge of my driving music. I frequently download music, add it to my library, and never listen to it. So there are plenty of songs that have a zero play count. But eventually I do get to hear some of the songs when my iPod shuffles to it.

Somewhere around Pasadena this song started playing (lyrics below). I think it was the first time I’d ever listened to it.

As the chorus played I thought about medicine — about the practice of it. I thought about the current healthcare reform debate. I thought about the seeming futility of trying to make a difference. I thought of all the practicing doctors who started out hoping to change the world but who have since become filled with cynicism. And I thought about Loma Linda University’s motto: “…to Make Man Whole.”

Can we make a difference on a grand scale? I don’t know. Through the optimistic lenses of my medical student glasses I’d like to hope that we can. I want to believe it’s possible.

But at the very least, we can start on the path towards changing the world by making a difference in the lives of one patient at a time.

Hope everyone has a wonderful Christmas.

If you’re a medical student, or any other student, I hope you get well-rested, refreshed, and ready to attack a new quarter come January.

If you’re out of school and working, I hope the office Christmas parties will have made you smile at least a little — even if it was to laugh at the foolishness around you.

And if you are a bum, I hope the chaos of the season will not be too overwhelming for you.

Change
Performed by Carrie Underwood
Album: Play On

What’cha gonna do with the 36 cents
Sticky with Coke on your floorboard
When a woman on the street is huddled in the cold
On a sidewalk vent trying to keep warm
Do you call her over hand her the change
Ask her a story ask her her name
Or do you tell yourself

You’re just a fool
Just a fool
You believe you can change the world
You’re just a fool
Just a fool
You believe you can change the world

What’cha gonna do when you’re watching t.v.
And an ad comes on
Yeah you know the kind
Flashin’ up pictures of a child in need
For a dime a day you can save a life
Do you call the number reach out a hand
Or do you change the channel call it a scam
Or do you tell yourself

You’re just a fool
Just a fool
You believe you can change the world
Don’t you listen to them when they say
You’re just a fool
Just a fool
You believe you can change the world
Oh the smallest thing can make all the difference
Love is alive
Don’t listen to them when they say
You’re just a fool
Just a fool
You believe you can change the world

The worlds so big it could break your heart
And you just wanna help
But not sure where to start
so you close your eyes
Send up a prayer into the dark

You’re just a fool
Just a fool
You believe you can change the world
Don’t listen to them when they say
Youre just a fool
Just a fool you believe
You can change the world
Oh the smallest thing can all the difference
Love is alive
Don’t listen to them when they say
You’re just a fool
Just a fool
You believe you can change the world

Filed Under: Medical School, My Life Tagged With: , , ,
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MSNBC.com: Sleep-deprived docs told to drink 6 cups coffee

September 18, 2009 By Leave a Comment

Article Link: MSNBC.com:Sleep-deprived docs told to drink 6 cups coffee

um… yeah.. very good example of patient care focused on patient safety… (Sarcasm. I hate that I have to put this, but I am paranoid that if I don’t, this Internet post is going to come back and bite me in the future.)

I thought US Resident Physicians had it bad with our 80 hour/week cap (which isn’t as strict as some would like). But 80 hours of work without rest? That’s just downright ridiculous!

Maybe the guys in charge down under think that their doctors are super-human…

Ok, ok… so they admit that there is a doctor shortage. And they need more doctors. I guess it’s a good thing for foreign graduates who have an interest in working there.

Personally I have thought about working there in Australia after I finish training here. But I would not want to have to do an Australian residency in addition to my US one…

Filed Under: News, Other Tagged With: , , , , ,
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Science-Based Medicine

July 10, 2008 By 6 Comments

This year I had a course called Evidence-Based Medicine. The point of the class was to educate us on how to use the medical literature to determine the best treatments. Medicine has definitely come a long way from bleeding patients as a form of treatment. Now, we have evidence to lead the way.

But I recently overheard my parents talking about drinking EPSOM salt as part of an alternative to surgery for removing gallbladder stones. The treatment involved drinking fresh-squeezed apple juice for a number of days, drinking a 1/2 cup of Virgin Olive Oil, and then drinking an EPSOM salt and water mixture.

The treatment is supposed to flush out your liver/gallbladder and cause gallstones to be excreted with your stool. The site Curezone.com has a page dedicated to this treatment with a list of the various different “recipes” for the treatment. (Click here to see the liver flushing page.) Oh, and for all the skeptics, the pages come complete with pictures of gallstones people removed from their own stool!

Well I was a skeptic. I realize I’m just a medical student. But the idea didn’t sit right with me. Then I found a website called Science-Based Medicine that contained an article titled “Would you like a liver flush with that colon cleanse?”

The author, a surgeon, rips apart this treatment. If I were to paraphrase him: The treatment is absolutely ridiculous. You can check out the details at his post.

Even in this day and age, there are still plenty of strange treatments that are blindly followed without any evidence to support it. My parents heard about this treatment from a church member who was told that she had gallstones and needed a surgery to remove them.

I wish we could educate the public. Maybe a course on evidence-based medicine should be taught at the high school level. I mean, reading a site like the one listed above (Curezone) can be very convincing. You see all these testimonials by people who have “flushed” their livers. You see pictures of these supposed gallstones that were fished out of the toilet. And you think, hey, that’s proof it works!

I guess this was one moment where I saw the value of my Evidence-Based Medicine course — a value I failed to appreciate at the time I took it.

Filed Under: Medical School, My Life, Opinion, Other Tagged With: , ,
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Wal-Mart and Healthcare

April 28, 2008 By Leave a Comment

I’ve been hearing a lot about these quick-stop clinics staffed by nurse practitioners. I hear about them in the news or read about them online. They seem to be on the east coast or midwest. Or maybe I’m just not paying any attention to them here locally.

As someone going into a medical career, this is somewhat discouraging. I don’t see how a family physician can compete against an NP based solely on costs. It seems like the scope of nursing just keeps getting expanded more and more. I’m sure the nurses are elated about this. And their paychecks continue to rise as they get more specialized.

I don’t think we need to go back to the days were the doctors were kings of their wards and nurses stood whenever one came in the room. But I do think that scope of practice of nurses and doctors cannot overlap too much. Because let’s face it, the nurses will always be able to offer their services at lower costs. And, more often than not, they (nurses) have less debt coming out of school.

Amy from RNCentral.com sent me this post titled 20 Surprising Ways Wal-Mart Clinics Will Affect US Healthcare. It’s a good read discussing the pros and cons of Wal-Mart entering the health service industry by opening up clinics at their stores.

Filed Under: Opinion Tagged With: , ,