Medicine Sucks

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When I was doing MICU, I had my 26 year old 2-week postpartum lady die from swine flu. No significant medical history. Had a C-section, caught swine flu that was apparently doing the rounds in that hospital's OB ward, and she died. She was on NO, prone bed, nearly considered Ecmo. Was the hardest thing getting the mother to sign the DNR on the day she was coding. Family had to believe in miracles...healthy 26 yr olds aren't supposed to die 2 weeks after giving birth. That sucked.
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I've diagnosed plenty of folks with cancer in ED...that's really always tough. But to be honest, people just really want to know. Even if you aren't "sure" it's cancer, they still want to know what you think. As a cancer survivor myself, I can tell you - people just want to know. The fear of the diagnosis is often worse than the diagnosis itself.

To other topics...

The one that really haunts me from residency, is an 8 yo GSW to the belly. Initial story was that some guys broke in to his parents house and starting shooting the place up, come to find out it was actually his 7 yo cousin who shot him. We didn't know that at the time. Anyway, EMS carries the kid in and says he need to go straight to the OR...I say, we can't send you up - the surgeons aren't here yet. Let's get started in the trauma room. He's got a sheet covering his belly, I quickly move it and see a large amount of his intestines extruded. Kid is awake and talking, but obviously in shock. He's moaning "My belly hurts, my belly hurts" the whole time. Nurse can't get an IV so I get on a knee and tie his arm off. At that point he looked over at me and said, "I don't want to die." He stared at me for what seemed like an eternity. His eyes still haunt me to this day. Trauma room was a mess. The surgeons took him to the OR but he died about 5 hours later. Uffff....

SIDS deaths are impossible too. Had a 6 month old come in, who was obviously dead. We worked on him for a while but we knew he had been dead for a while...finally called it and went and got the mother. I stayed in the room with her, the pain and grief she was experiencing must have been unimaginable. I could literally feel it. My wife was 8 months pregnant at the time and I had a rough time with the rest of that shift. I decided not to tell her and I never have. Probably never will either.
 
I notice no influx of Christmas-time posts, so I'm hoping that means it wasn't a very abusive one for you guys. Merry Christmas.
 
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loveoforganic said:
I notice no influx of Christmas-time posts, so I'm hoping that means it wasn't a very abusive one for you guys. Merry Christmas.
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Haven't caught up on charting.
Only had to tell 1 family for christmas eve, and 1 family christmas day that they would not be with a family member.
A couple of other bad diagnoses those two days too.
 
Christmas day...young child ejected from a vehicle in a rollover at high rate of speed. Suffered a severe TBI. ICP's in the 60's. Asked to keep him alive long enough to harvest organs. Family in the room crying all night until he was taken to the OR.
 
Yes, I know your baby was perfectly fine when you brought him home, but little babies can get really sick, really fast.

6 days old. Normal pregnancy, normal delivery... now hypothermic, hypoxic, hypotensive and hypoglycemic. And oozing from every needlestick.

Plt 11.
INR of 6.
Ph 6.9
Hgb initally 13. Lab called with a repeat as the chopper crew was wheeling the baby out: down to 4.

I never, ever want to watch fulminant DIC in a baby ever again. There wasn't a damn thing we could do. (And yes, we threw everything and the kitchen sink at this kiddo.)

Baby didn't make it.
Medicine sucks.
 
50 yo guy. Comes in by EMS with complaint of new onset seizure x2. Talking, nice guy, pale but no CP. EKG with lateral STEMI. I went with the patient to the lab to get him on the table faster while cards was enroute. Just as cards got going pt goes into VF arrest. I tubed him on the cath table and cards kept shocking and adding drugs. We threw everything we could at him but nothing worked.

The guy had come in from out of town to help his family get his dad set up on hospice for his terminal brain tumor. The cards and I had to tell his sister and mom that he didn't make it. They were appropriately upset but were very thankful for us trying everthing. Nice guy, nice family, tragic situation.

I had told him we were going to get him fixed up while he was still conscious. I suppose I should be more careful about saying that sort of stuff but I felt like he knew we were doing everything we could for him and he seemed more relaxed. Sh---y case, anyway you look at it.
 
Did a Medevac in the sand box a while back. Called to transfer a little girl to what passes for definitive care in Afghanistan. Kiddo had a bad head injury with a subdural hematoma and pneumocephalus. She was status post surgical intervention and had an IVC in place per a military hospital.

We make contact with an Army helicopter, received report, and do an assessment. Patient is awake and alert and even interacting. Dad had left his rural village to be with the patient. We load up and drive into the city. The accepting facility is a house where a few nurses come and go. We make contact and they refuse to accept. They are more of a halfway house and were told by the military that the patient was stable and just needed a few days of being watched. Not somebody post craniotomy with an IVC in place.

After extensive wheeling and dealing an actual hospital accepts. We arrive in the ER and the doctors throw a fit. They refuse to accept because the father is with the patient. No men can be near female caregivers on the floor. We go round and round with one of our doctors (local doc) attempting to appeal to the receiving doctors. The doctors agree to keep the patient for a day in the ER only and throw the dad out of the hospital in spite of his crying and begging and his daughters crying.

At this point I am angry and yelling. Our doc pulls at my arm saying we are not welcome and it is dangerous, we must leave now for our safety. I left a broken family and a little gril to her possible death that day. The sense of failure and helplessness I felt that day are hard to describe with words.

Tough times. There were a few times where I absolutely despised all of humanity after that experience.
 
I was ill myself and out of work for a month over the holidays.

I came back to work...and took care of a 42 female. C/o of shortness of breath. had a pericardial window, pt then developed a chyle leak, pt went for ct, and bone scan. has stage IV small lung cell cancer, mets everywhere. She was 5-6 weeks at most, that's with aggressive treatment. Husband is refusing to let us aggressively treat her for pain, and is accusing nursing staff of trying to drug his wife or keep her "sedated". Poor woman gets no more than 2-4 hours of sleep at a time at night with IV lorazepam and 1 mg of morphine. Despite education, the woman defers to her husband and will not take pain meds.

Husband has "fired" several nurses because he has left the room and the nurses gave pain meds while he was gone. She has lung cancer, bone mets, chest tube, tumors in her liver/pancreas, and a surgical inc. 1 mg morphine iv q 4-6 hours, and her pain is never below a 7 or 8.

I know he is grieving, but I want to have him removed from the room and take care of my pt.
 
I worked from 0000-0500 on Jan 1, 2010. The first two jobs I was given were two deceased pt's to take to the mortuary. Welcome to 2010. Later that night we had a helicopter retrieval land on our helipad. I was tasked with meeting the helicopter on the helipad.The Pt was DoA, died 20mins away from landing. The Retrieval Dr was in tears when we brought the pt down to ED. Worse part was the pt was conscious before they got onto the helicopter and waved good bye to his family as the loaded him on to the chopper.
 
Nice/sweet eldery woman in mid 70's is a direct admit for our attending's office for some DOE over the past 2 weeks. No prior cardiac history whatsoever, just h/o tobacco use. She's very thin but the initial transthoracic echo doesn't show much, just a possibly low EF. So we do a TEE to get a better look at the valves and there is severe MR, mod MVP, and an EF around 35%. Keep in mind she's compensated VERY well on her own and is very mentally sharp so this was a huge surprise to all. Got CT surg involved and did a cath which showed severe 3 vessel CAD as well.

Sat with her daughter (who happens to work at the hospital) and pt's husband as we told her if we do nothing she may have 6 months, and open heart surgery for her is still going to have around 30% mortality risk. The small contrast load from the cath was enough to push her a little over the ledge to land her in ICU and on 2 pressors. Worse part was watching this all sink in with her elderly husband. Was the first time on rotations when something like this really got to me. Makes it a lot harder when the family is nice and supportive and the pt is nice and sweet, unfair.
 
I figured as long as I stayed in medicine, eventually I'd have my own story to post on here.

57 yo M with h/o stage IV-C SCC of the R submandibular gland (with mets to liver, lung, and multiple distal bone sites) dx in May '09 s/p neck dissection and PEG placement presents to the ED with his wife and daughter for aspiration pneumonia of his tube feeds/vomit. Only other co-morbidity is nice man, nice family. Admitted. Sating well for his 2 day stay on 2L O2; pt removed O2 b/c it was irritating him and he desated with LOC. Became febrile to 102.

Either the pt and his family were improperly informed by his oncologist or they improperly listened and they were under the impression that the chemo he was set to receive this week could be potentially curative and not just palliative. After a frank discussion of his dx, pt decides he no longer wants the O2, doesn't want the abx, and just wants to go home. Wife goes through the 4 of 5 stages of grief before our eyes - denial, anger, bargaining, depression. Says she believes in miracles and knows that just because a doctor says there is no chance doesn't always make it true. Yells at the brother-in-law for daring to say it was the pt's choice. Tells us the only reason he is making this decision is because he is frustrated b/c he hasn't had his tube feeds x 48 hours. Bawls and prays please Lord don't let his happen. All the while my pt is saying "just let me go". After a long discussion, pt is convinced by his wife to not sign DNR/DNI until tomorrow morning after they have discussed it. Several hours later, pt crashes, emergently intubated and transferred to the unit.

It's not as bad as the newborn/peds stuff I've read on here, but it was my first patient that I admitted (as much as 3rd year med student admits a pt, as in I did the initial H&P, A/P, etc) and followed for several days who is dying. First can too easily be the worse since the heart and mind mind have yet to steel themselves against such pain.

I can't stop seeing his sad but mischievous smile. He was cracking jokes when he came in. Now his wife is going to have to make the decision to withdraw care after a painful ICU stay.

Medicine sucks.
 
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I was a rough week for the elderly in Vegas.

95 yo M visiting from elsewhere got up at 3am to go to the bathroom. That never ends well. Hip fx. Was pretty good protoplasm going in but didn't make it. I admitted him and then by coincidence I wound up coding him 3 days later. Family was very nice. A poor prognostic indicator.

82 yo M who had just started the work up for some kind of CA. Came in SOB. Lucid and talking and a really nice guy but sick as Hell. Came in like a PE but turned out to be septic. I tried to tune him up but he crumped. I pulled the wife and gave her the "We're gonna put him on the vent and after that he won't be able to talk. There's a pretty good chance he won't come off this vent so go and spend a few minutes with him 'cause you may never talk to your husband again." speech. They pulled support 24 hrs later. Because he was still holding for a bed in the ED I had to go pronounce him and talk to the wife. Ug.

88 yo F was getting into her car for the drive back home. Wind blew the door into her and knocked her down. Hip fx. Couldn't come off the vent post op. Developing ARDS in ICU. Doesn't look good.

Like I said, rough week.
 
31yo guy, around my age. Comes in with a week of back pain, 2 wks of something hard in his RLQ. and oh yeah, since yesterday, one thigh looks bigger than the other. He had some mass occupying his entire RLQ with spread to every nearby bone and to the bones of his skull. Yeah, I get to tell him he's not going home today because some mass decided to grow and invade everything within a month.
 
24 yo M come in with chest pain. :rolleyes: right? Wrong. CXR shows a huge mediastinum. CT Chest reveals football sized mediastinal mass. Bad news. Nice, polite kid but typical macho 24 yo. Didn't cry when I said the C word but shed some tears. Mom took a deep breath and asked what the plan was. Some of those ghetto moms are just so strong from all the **** life dumps on them. And all this in a bed in the hallway. I so wished I could toss one of the Dilaudid seekers out on their ass so I could get this kid and his family into a room.

A scary thing about this case, the kid had been to another ER 3 months prior with the same thing. He said he was told the CXR was normal then and he was treated for bronchitis and everything got better (he probably got some roids which makes sense). Any one of us would have treated him the same. It probably wasn't even a "miss." The CXR probably was normal. Scary.
 
Obviously not one of mine... but I'm sure you've all dealt with similar things...

Close friend of mine, out on her front lawn on christmas morning. Woman comes driving down the street - is high, thinks my friend is standing in the middle of the road, swerves INTO her, pinning her against a tree.

She was 39 weeks pregnant. Baby didn't make it :(
 
Well, I think this falls under the category of "suck".

A very nice lady who used to teach with my mom just found out that her cancer is back.

It's uterine.

And it's metastasized to her spine, her liver, and I want to say her gallbladder (I know there was another spot, but it's not coming to me right now).

She beat the cancer into remission once, but her doctor is not giving her good odds.

So, this nice lady, who has three kids, is a wonderful teacher and a sweet person? Her odds of survival suck. And yet, the trashtastic drug dealer who is shot six times in center mass will pull through with no complications whatsoever.
 
Apparently G5P4 with vaginal bleeding, +BHCG, L adnexal mass on U/S and empty uterus is not a slam dunk anymore.... pt ended up having adenocarcinoma of the colon that secreted the hormone. I'm glad I didn't have to tell her about all the mets. :(
 
Get a call from a rural hospital about 100 miles away. They want to send an intubated, multiorgan system failure patient who is crumping in their ED. I accept. Helo goes out and picks up the patient. Husband gets in his car and starts heading my way as soon as the helo lifts off. 5 minutes in the patient codes and they turn back. Patient dies in the same ED where she started. The husband has no cell phone so he shows up at my ED an hour and a half later. I have to go tell him his wife died in the helo and she's actually now back at the hospital where they started. He didn't take it well (not violent or angry, just grief stricken and crying). Thank God he had a friend with him to drive him home.
 
docB said:
Get a call from a rural hospital about 100 miles away. They want to send an intubated, multiorgan system failure patient who is crumping in their ED. I accept. Helo goes out and picks up the patient. Husband gets in his car and starts heading my way as soon as the helo lifts off. 5 minutes in the patient codes and they turn back. Patient dies in the same ED where she started. The husband has no cell phone so he shows up at my ED an hour and a half later. I have to go tell him his wife died in the helo and she's actually now back at the hospital where they started. He didn't take it well (not violent or angry, just grief stricken and crying). Thank God he had a friend with him to drive him home.
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I just knew he got in a crash and died. Thank god, like you said, someone was with him.
 
20 yo G1 at 26 weeks with sudden headache and seizes. Pt undergoes an emergent c-section as the initial thought was eclampsia. CT of her head shows a large non operable bleeding mass. Baby doesn't survive. She likely won't. F**K.
 
Found out today that one of the first patients I helped admit (did the H&P and helped work him up as a new MS3 on medicine) has gastric CA w/ mets. We chased it for a bit and I was always excited to present him because of all the cool tests we were running. Then we found out and have to tell him tmrw. I feel ... naive for how much I've joked and laughed with him while pre-rounding for the past 4 days. I knew medicine sucked like this but it's impossible to describe what it's like.
 
coldweatherblue said:
Found out today that one of the first patients I helped admit (did the H&P and helped work him up as a new MS3 on medicine) has gastric CA w/ mets. We chased it for a bit and I was always excited to present him because of all the cool tests we were running. Then we found out and have to tell him tmrw. I feel ... naive for how much I've joked and laughed with him while pre-rounding for the past 4 days. I knew medicine sucked like this but it's impossible to describe what it's like.
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While probably others were rushing around trying to solve the mystery and make the diagnosis (as is the often-necessity for the residents and attendings) you gave him the precious gift of being a human being in a very un-human and sometimes inhumane place. I tend to think that someone who shares sincere laughs with their provider for more than brief moments has a great fondness and appreciation for them. I hope this give you some solace. And I hope you keep this close to you as you progress through your training and your career.
 
coldweatherblue said:
Found out today that one of the first patients I helped admit (did the H&P and helped work him up as a new MS3 on medicine) has gastric CA w/ mets. We chased it for a bit and I was always excited to present him because of all the cool tests we were running. Then we found out and have to tell him tmrw. I feel ... naive for how much I've joked and laughed with him while pre-rounding for the past 4 days. I knew medicine sucked like this but it's impossible to describe what it's like.
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I think J-Rad makes a great point. What you were doing with that patient just sounds like a good bedside manner to me, not a bad thing at all. Sometimes for patients it just makes things more upsetting and frightening when the providers act serious and grim but can't yet tell the patient what's going on. Of course you don't want to be joking around when you have the conversation about the test results and the prognosis, but when you have an appropriate moment to try to make someone who doesn't feel good laugh or smile, take it.
 
docB said:
Get a call from a rural hospital about 100 miles away. They want to send an intubated, multiorgan system failure patient who is crumping in their ED. I accept. Helo goes out and picks up the patient. Husband gets in his car and starts heading my way as soon as the helo lifts off. 5 minutes in the patient codes and they turn back. Patient dies in the same ED where she started. The husband has no cell phone so he shows up at my ED an hour and a half later. I have to go tell him his wife died in the helo and she's actually now back at the hospital where they started. He didn't take it well (not violent or angry, just grief stricken and crying). Thank God he had a friend with him to drive him home.
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I had one of those were I was the flight doc, patient not doing well. Codes as she's being loaded in to the helo. Doesn't make it, I get to fly back and tell family she died.
 
thanks for the support. I know it's just part of medicine, and that the positive interactions we've had so far can only be for good. Still, tomorrow when I walk in; no matter how hard I try to be the same as before, people are incredibly intuitive regarding body language, and after I've asked how he slept and gotten I/O's, he'll no doubt have a lingering suspicion as to where the tests have led.. and that will be the beginning of a very bad day.
 
Christmas Day- Grandma falls down the basement steps bringing up a crockpot. Massive, lethal subdural. Cute little grandpa scoots to her bedside in his wheelchair to hold her hand and tell her he loves her. They were married for 57 years.

Christmas Eve- Rollover MVC female driver loses control on icy road. She's a CNA taking her 2 year old to her Mom's for babysitting so she can go to work. Both are killed. We open her phone to find a picture of her boy in a Santa hat as the screensaver, and call her husband to tell him to come in for the bad news. They had tried for 8 years to conceive.
 
Reviving an old thread because I need a place to vent tonight.

7 month old beautiful little girl. Otherwise healthy. Catches bronchiolitis, breathing 60s. Tuned up and looks better, but chest xray shows incidental posterior mediastinal mass. CT shows likely neuroblastoma. Kid now looks great. Parents look not so great. I almost cried in the room. Hate nights like this.
 
DocVirk said:
Reviving an old thread because I need a place to vent tonight.

7 month old beautiful little girl. Otherwise healthy. Catches bronchiolitis, breathing 60s. Tuned up and looks better, but chest xray shows incidental posterior mediastinal mass. CT shows likely neuroblastoma. Kid now looks great. Parents look not so great. I almost cried in the room. Hate nights like this.
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Recall, though, that neuroblastoma is known, in some cases, and especially in children less than 1 year old, to spontaneously regress - which is remarkable in cancer.

Also coincidentally remarkable is that work on neuroblastoma was done by Rudolf Virchow (same of Virchow's triad), and you are "DocVirk". (Just co-incidental.)
 
59 year old non-drinker. Has GI bleed at home, doesn't want to bother anyone so waits 5 hours to present. Bleeds 10 minutes after entering department, codes, dies. We didn't even have a line on him when he coded. Had a signed organ donor card, but has to go to autopsy.
He was a really nice man. He looked so surprised and confused as the blood poured out of his mouth.
Worst part? Triage mistake made him a 5, so he waited 2 hours to be seen. Someone's getting fired if I have my way.
M
 
3 year old female out playing on the playground with Dad. Suddenly, she screams in pain and grabs the sides of her head. As she comes in to the ED, her mental status tanks. I intubate her & she's whisked off to the CT scanner only to find a large intraparenchymal bleed in the posterior fossa. Parents withdrew life support a few days later. My son was about 2 1/2 at the time. Not a good day.
 
Beautiful 9 year old girl, suddenly falls at home, arrived in mom's car with pronounced R facial droop, R hemiparesis and marked aphasia. She's awake, alert and utterly terrified.

Rushed to CT to find the 3.6 cm interparenchymal bleed. Remembered to sit mom down to tell her (we were all still in the CT suite), got the helicopter and flew her out... but not before she projectile vomited all over me. And everyone else in the vicinity.

The fear in her eyes was just palpable. I cannot imagine. And at 9 years old...

I won't know how she's doing until we call to find out. Kiddos have tight brains... she was still protecting her airway as they wheeled her out. Praying for a miracle...
 
19 yo guy – first person in his family to go to college, on a tennis scholarship – has had some hip pain for a while, it started getting much worse in the last couple of months, but he didn’t get a chance to have it checked out as his dad and little sister were killed in the MVA 2 months ago. Now for 2 days it has gotten so bad he couldn’t walk so he finally made it to the ED – real worried about not being able to play tennis… He turned out to have a huge (25cm) osteochondrosarcoma with multiple lung mets. Nope – you want be able to play tennis after the surgery in which you’ll lose your leg and half of your pelvis. And the chemo you’ll get if you get out of that surgery is not terribly effective, but it might buy you a couple more months to be there for your mother after she just lost a husband and a daughter…
 
alexmtr said:
19 yo guy – first person in his family to go to college, on a tennis scholarship – has had some hip pain for a while, it started getting much worse in the last couple of months, but he didn’t get a chance to have it checked out as his dad and little sister were killed in the MVA 2 months ago. Now for 2 days it has gotten so bad he couldn’t walk so he finally made it to the ED – real worried about not being able to play tennis… He turned out to have a huge (25cm) osteochondrosarcoma with multiple lung mets. Nope – you want be able to play tennis after the surgery in which you’ll lose your leg and half of your pelvis. And the chemo you’ll get if you get out of that surgery is not terribly effective, but it might buy you a couple more months to be there for your mother after she just lost a husband and a daughter…
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Why?

Why even operate? Why the chemo? He'll have a couple more utterly miserable months. It's not like he'll have years and years and years. And his last days will be even more miserable than they need to be. :(

We're more kind to our animals than we are to people. I would never allow a cat to suffer like that.

And I know, we can't just euthanize people. But we can be kind. We could offer morphine and other palliative care. But God forbid that the terminal cancer patient gets hooked on morphine before s/he goes, right?

*sigh*

Sorry. This post really got to me.
 
Kittenmommy said:
Why?

Why even operate? Why the chemo? He'll have a couple more utterly miserable months. It's not like he'll have years and years and years. And his last days will be even more miserable than they need to be. :(

We're more kind to our animals than we are to people. I would never allow a cat to suffer like that.

And I know, we can't just euthanize people. But we can be kind. We could offer morphine and other palliative care. But God forbid that the terminal cancer patient gets hooked on morphine before s/he goes, right?

*sigh*

Sorry. This post really got to me.
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I'm sorry, but that's bull****. Who said the patient doesn't want the extra time? And you may be shocked to know that opiates are in fact used to control pain in cancer patients.
 
Kittenmommy said:
Why?
Why even operate? Why the chemo? He'll have a couple more utterly miserable months. It's not like he'll have years and years and years. And his last days will be even more miserable than they need to be. :(
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Paliative care is a great thing, but it is not that simple. It is a rare cancer with little good data and if the patient (who is 19!!!) is willing to take the chance (given they are realistic about their chances), not only is it their choice, but for a rare tumor like that, without patients actually trying the current treatment we will never get a better teratment for it.

KeyzerSoze said:
I'm sorry, but that's bull****. Who said the patient doesn't want the extra time? And you may be shocked to know that opiates are in fact used to control pain in cancer patients.
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Exactly.
 
KeyzerSoze said:
I'm sorry, but that's bull****. Who said the patient doesn't want the extra time? And you may be shocked to know that opiates are in fact used to control pain in cancer patients.
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This was a little harsh. Kittenmommy isn't in a field involved with patient care (not directly anyways) and honestly with the picture painted I thought the same thing. Why bother with the operations (which with the lung mets likely won't add any extra time)? Just control the pain and try to make what little time left as comfortable as possible.
 
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alexmtr said:
Paliative care is a great thing, but it is not that simple. It is a rare cancer with little good data and if the patient (who is 19!!!) is willing to take the chance (given they are realistic about their chances), not only is it their choice, but for a rare tumor like that, without patients actually trying the current treatment we will never get a better teratment for it.
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You're right.

This is a very personal subject for me, because I watched cancer kill my mother. It was slow and it was ugly.

This kid is basically signing on for two months of hell on Earth. I wonder if he really understands that yet.

atkinsje said:
This was a little harsh. Kittenmommy isn't in a field involved with patient care (not directly anyways) and honestly with the picture painted I thought the same thing. Why bother with the operations (which with the lung mets likely won't add any extra time)? Just control the pain and try to make what little time left as comfortable as possible.
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It comes down to what the patient wants. If this kid really, really wants a shot at this, who am I to deny him? It's his body, his life, and his choice.
 
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I've worked in the bloodbank when those types of surgeries (total sacrectomies, hemi-pelvectomies, etc) are happening and the only thing I can think of that would inspire me to undergo that kind of procedure would be if I had young kids. I respect everyone's ability to decide for themselves, but that is some kind of will to live. we transfused just shy of 100 units of product in one of the first ones i worked during. just wow.
 
Wow. Just... wow.

I've had a string of new cancer diagnoses in the last month... to the point that I've had a partner refuse to sign any more of his patients out to me after I unwittingly discovered a large gastric mass in a "check the CT, if ok, d/c home" sign out. And he was forced to sign out another last week - same sort of thing, although he was pretty sure something was wrong. Yep, more cancer - this time with bulky peritoneal spread. Those two, 2 hilar masses, 1 Pancoast tumor and a large ovarian mass in a 70 yo F. Ug. It's been a sucky couple weeks for my patients.
 
That's pretty sad. To not only have two cancer diagnoses at the same but two advanced cancers would be devastating. It looks like the wife is keeping a blog at http://familybondingtime.blogspot.com if people want to follow their story.
 
Hi all,

As a non-trad pre-med I have seen "alot"; your posts are really rough, but they remind me of why I want to do this for the rest of my life. seeing sick kids angers me to no end.
thus my desire to practice peds anesthesia, and my time spent observing and publishing and researching with some amazing docs and mentors.

Some moments that have stayed with me:

It seems the 3 y/o's who present for a LP for chemo directly into CSF have the brightest and bluest eyes. And the blondest hair.

When the jovial patient with a bandage around her head asks you to "guess" why she's there, don't. Lesson #1. Don't guess. Ever again. She's not going to tell you fell, she's going to tell you she has adrenoleukodystrophy. Why ask me to guess then??!?

The woman who goes in for a diagnostic angiogram really didn't "need" one, she just "feels safer getting them every year" with her history of CAD. This one cost her her life, when the wedge ruptured her PA. I've never seen someone go from chit chatting to bleeding out of her mouth to dead in 45 seconds to a minute. And I'll never forget it.

90 YO M, h/o STEMI and subdural hematoma both years prior, made it through both close calls, CAD, CHF, EF 30%, very sedentary lifestyle, loves hi NY Yankees, Jazz radio, sharp as a tack, crossword puzzles everyday, follows the market as if he were Gordon Gekko. Travels from Miami to PA for granddaughter's wedding, by Amtrak, doesn't fly, never has. Doesn't even drive. The anxious type. After wedding, couple flies to Germany while Gramps heads back home on silver star amtrak express to Miami. Complains of severe abdominal pain. However, in hindsight, family states this is a normal complaint, 90 yo often passes gas. A lot of gas. He's notorious for complaining of belly pain and passing gas. Train stops. ER in South Carolina, checked out, ER says "he's fine," send him on his way. Hops back on train to Miami. In Miami, family regale another gasious episode of a worried patriarch. He lasts the afternoon before calling for ambulance that night in Miami, codes en route to 2nd ER of the day. Abdomen now full of blood. Dies two days later. Three years ago, today. I get to call my sister on her honeymoon in Germany and tell her about our Grandfather. The only grandparent we ever had. She's guilt ridden. Assisted by our father's reminder that Gramps "need not have been put through that long a train ride for your 2nd wedding." Charming. Venting helps. We miss him.

D712
 
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10 month old on vacation with family comes into the ED with a slightly bloated belly, per parents. Not even remotely feeling or acting sick. Constipated, maybe? Nope. Cancer.
 
doctor712 said:
90 YO M, h/o STEMI and subdural hematoma both years prior, made it through both close calls, CAD, CHF, EF 30%, very sedentary lifestyle, loves hi NY Yankees, Jazz radio, sharp as a tack, crossword puzzles everyday, follows the market as if he were Gordon Gekko. Travels from Miami to PA for granddaughter's wedding, by Amtrak, doesn't fly, never has. Doesn't even drive. The anxious type. After wedding, couple flies to Germany while Gramps heads back home on silver star amtrak express to Miami. Complains of severe abdominal pain. However, in hindsight, family states this is a normal complaint, 90 yo often passes gas. A lot of gas. He's notorious for complaining of belly pain and passing gas. Train stops. ER in South Carolina, checked out, ER says "he's fine," send him on his way. Hops back on train to Miami. In Miami, family regale another gasious episode of a worried patriarch. He lasts the afternoon before calling for ambulance that night in Miami, codes en route to 2nd ER of the day. Abdomen now full of blood. Dies two days later. Three years ago, today. I get to call my sister on her honeymoon in Germany and tell her about our Grandfather. The only grandparent we ever had. She's guilt ridden. Assisted by our father's reminder that Gramps "need not have been put through that long a train ride for your 2nd wedding." Charming. Venting helps. We miss him.

D712
Click to expand...

I know he's your dad, but that's a pretty crappy thing to do especially as those kinds of remarks stick for a very long time.
 
3 fatal PEs in patients less than 45 in last few weeks.
Hell, 2 were less than 30.

I'm going to start taking coumadin.
 
VA Hopeful Dr said:
I know he's your dad, but that's a pretty crappy thing to do especially as those kinds of remarks stick for a very long time.
Click to expand...

Thanks VA,

I agree and that's the TIP of the iceberg. He also said he'll be "6 feet under before I ever get my MD," but let me not hijack the thread with my father issues. :rolleyes:

Let's just be happy I'm nothing like him.

D712
 
Dr.McNinja said:
3 fatal PEs in patients less than 45 in last few weeks.
Hell, 2 were less than 30.

I'm going to start taking coumadin.
Click to expand...

Wow...that is tough. I'm sorry to hijack the thread, but what risk factors did they have?
 
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