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Maybe 2 months ago had a guy in his 20s came in for “stroke alert”, we’re all thinking WHaTeVeR lol
Comes in. Obviously moribund. Intubate. Huge hypertensive bleed , BP +++/200, NS puts a ventric in the ER, he goes off to icu. wife shows up and says usually the kids let one of us put them to bed but they were really insistent that we both tuck them in tonight .. gives me chills even now.
He self extubated and went home intact 😁
Had a guy working on my home for some minor repair things yesterday (joys of 1 year warranty with a new build). I was talking to my daughter in Urdu, so he asked If we’re working on getting her bilingual. Anyway, we got talking and he said that he was working on learning American Sign Language since his 1.5 year old was deaf. And that they were trying to teach their 3 year old ASL as well so he could communicate with his younger brother. Apparently the only issue is a malformation of the TMs and the inner ear is completely fine - to me that sounds fixable surgically. Though what would i know.
He talked about how his pcp referred them to somebody and they are basically getting the run around, being referred from one place to the next, and still haven’t been to an ENT. I basically called the mothership peds hospital in the city, figured out who the person is who does the most work with cochlear implants, implanted hearing aids, and congenital deformities etc, and just set them up with an appointment. Took me about 5-10 minutes, so not bad.
The guy was so happy and appreciative. Kinda felt nice.
Sounds nice working at a place that allows for that amount of time to spend on other things besides dispo. To be fair, I'm compensated well for the grind, but I worked an overnight last night where I saw 27 patients, intubated 1, sent 4 to the ICU and was more or less in "put out fires" mode for the full 9 hours.
The most recent highlight I can remember was a patient who punched a couple of cops and came in "altered." Seemed maybe psychotic vs just an ahole. Was going to be in obs for psych to see but several hours later a group of US marshals strolled in, briefly mentioned something about federal gun trafficking charges, and simply plopped the patient in a wheelchair and rolled her out the door. That was kinda great.
The most recent highlight I can remember was a patient who punched a couple of cops and came in "altered." Seemed maybe psychotic vs just an ahole. Was going to be in obs for psych to see but several hours later a group of US marshals strolled in, briefly mentioned something about federal gun trafficking charges, and simply plopped the patient in a wheelchair and rolled her out the door. That was kinda great.
You need a new job.
Probably the only positive patient outcome that came out of my STICU rotation.
20ish male, jumping from one side-by-side to another at speed, no helmet, misses and smashes his head on a rock. Gets flown in from BFE West Virginia with a massive head bleed. Gets a craniectomy, mannitol, all the pressors, ICP Bolt, winds up on an Arctic Sun from hyperpyrexia, Then a second crani, you name it. I'd round in the AM, write my notes, and then park a chair in the corner of the room and watch all the monitors and pumps until it was time to round with the team. To be honest, I had written him off after the 1st week. I had gotten to know the family that visited daily, prepared them for the worst but was hoping for the best. After 2 and a half weeks, we managed to get him extubated, following commands, speaking, and to the step-down unit. By the end of the month, PT had him up walking with a walker. I saw him a couple of months later in the ED after he had tripped walking on his own at home and hit his helmeted head on the ground. Still had some retrograde amnesia to the event, but was expected to make a pretty decent recovery and regain a lot of function.
Most of the time in the ED, I'm happy for the little meaningful things or making a real connection with a patient. I work in Ohio, but had a conversation with a patient last shift who lived near where I grew up in Arkansas. Talking towboats with a Captain who had a TIA while at work on the Ohio River. The patient that tells me "Thank You, I feel so much better" after a GI cocktail or a Lidocaine patch.
20ish male, jumping from one side-by-side to another at speed, no helmet, misses and smashes his head on a rock. Gets flown in from BFE West Virginia with a massive head bleed. Gets a craniectomy, mannitol, all the pressors, ICP Bolt, winds up on an Arctic Sun from hyperpyrexia, Then a second crani, you name it. I'd round in the AM, write my notes, and then park a chair in the corner of the room and watch all the monitors and pumps until it was time to round with the team. To be honest, I had written him off after the 1st week. I had gotten to know the family that visited daily, prepared them for the worst but was hoping for the best. After 2 and a half weeks, we managed to get him extubated, following commands, speaking, and to the step-down unit. By the end of the month, PT had him up walking with a walker. I saw him a couple of months later in the ED after he had tripped walking on his own at home and hit his helmeted head on the ground. Still had some retrograde amnesia to the event, but was expected to make a pretty decent recovery and regain a lot of function.
Most of the time in the ED, I'm happy for the little meaningful things or making a real connection with a patient. I work in Ohio, but had a conversation with a patient last shift who lived near where I grew up in Arkansas. Talking towboats with a Captain who had a TIA while at work on the Ohio River. The patient that tells me "Thank You, I feel so much better" after a GI cocktail or a Lidocaine patch.
One of the things I’ve learned to enjoy as I got better at this job, and frankly didn’t need to take as much time with hx/PE (you guys know what I mean, 10 seconds in the room and you know dx/tx/dispo), is to just shoot the **** with patients. what do you do for work, what do you do for fun, whats your hobby, what’s the best book you’ve read in the last year, what are you listening to right now, whatever.
Some people suck, but most are pretty neat. If I’m lucky I find a neat patient/family and just BS with them for 10-15min at the end of my shift instead of finishing charts. Its midnight, what does it matter if I’m home 15 minutes late. Sometimes I steal the lac repair from the PA so I can have a decent conversation with someone. Heck, its one of the decent things about spending 5 minutes doing POCUS, chat with someone and show them pretty pictures of their insides.
This doesn’t make every interaction magical, and this job still sucks souls out of those who perform it, but I get some joy-from-the-mundane with this one simple trick…
I’ve also become much more content with the urgent care things I CAN fix being real and meaningful and nice. Sure nothing beats a complex resus, but there is joy at pointing at a toe, saying sir that is THE GOUT and boy can I make your toy feel better!
Some people suck, but most are pretty neat. If I’m lucky I find a neat patient/family and just BS with them for 10-15min at the end of my shift instead of finishing charts. Its midnight, what does it matter if I’m home 15 minutes late. Sometimes I steal the lac repair from the PA so I can have a decent conversation with someone. Heck, its one of the decent things about spending 5 minutes doing POCUS, chat with someone and show them pretty pictures of their insides.
This doesn’t make every interaction magical, and this job still sucks souls out of those who perform it, but I get some joy-from-the-mundane with this one simple trick…
I’ve also become much more content with the urgent care things I CAN fix being real and meaningful and nice. Sure nothing beats a complex resus, but there is joy at pointing at a toe, saying sir that is THE GOUT and boy can I make your toy feel better!
Oh god that is nice.
I can see some docs be like "Yea...ummm....M-TAL-???" and US Marshall responds "F**k that. I dont give a s**t and you shouldn't either."
"Yes sir! You bet I don't! Please come by again! All the time! Beds 3,4,6, and 8 are all stupid, f**ked up PD med clearances by the way. Take em"
Yup. I had a 35 yo woman bring in her 6 mo boy for a cold. 10 yo sister was there too just helping (not a patient). I spent 30 seconds on the kid and 20 minutes talking to Mom about her life. She has 12 kids. I asked the 10 yo sister can you name all your brothers and sisters in order? She said yea and immediately rattled off 12 names. Mom was happy and regularly tired. She never cooked and Dad did all the cooking. One meal for the family, 12 kids and 2 adults, at Chik-fil-a is $180 bucks. McDonalds "is cheaper like $150". Most of the kids do chores around the house. Mom smiled the entire time.
And she just learned she's pregnant with #13 on the way.
I had a pilot who came in for "tripping over a suitcase"- he'd been hiding etoh use for his whole career. Called him out on it (kindly) and encouraged him to find treatment. Scared but relieved, I think. It's a hard secret to hold onto. Felt extra special that none of his other docs had noticed.
Sometimes I get thanked by grateful SDNers for giving them advice that helped them either get into or through medical school.
I tell them, "Every now and then I justify my existence."
Having been on the receiving end of emergency care with a positive outcome (ditto the wife), all I can offer to you after reading this thread is that you guys justify your existence every minute, every hour, every day.
As my mother used to say, "God should bless you."
I tell them, "Every now and then I justify my existence."
Having been on the receiving end of emergency care with a positive outcome (ditto the wife), all I can offer to you after reading this thread is that you guys justify your existence every minute, every hour, every day.
As my mother used to say, "God should bless you."
One of the things that sucked about being a clinical lab scientist was not really seeing or knowing patients you might have helped. Most of the crazy blood bank management that we did were for cases that didn’t end well, you’d find out things went bad when printer would start dc’ing all the orders after midnight when patients died. There was a little baby in from birth to 4 months who had a really rough go of it, and we’d get so excited when orders would come through cuz it meant he was still with us.
In grad school I volunteered with the student run free clinic. It was nice have some interaction w/patients. We saw lots of homeless folks, ppl with disabilities, vets, mentally ill, etc. I only did about one shift a month as a community health worker but still got to know the regulars. One older lady came in, a regular. It was cold winter out and she was bundled up but looked sweaty. She had a bit of a speech impediment so it usually sounded a bit like slurring, but it seemed more pronounced that day. She sat down in the waiting room and I processed other folks but kept my eye on her. Every few minutes she’d get up an drink some water, odd. Then our research folks went to talk to her, her speech was definitely not her normal, she was more confused than usual. I asked the others if they noticed it, but they hadn’t.
I went and got the supervising MD to come check her out. Turns out her glucose was <40. They got her squared away. She said her glucose meter was broken. They checked it out and it just had dead batteries. Felt like a decent half win.
In grad school I volunteered with the student run free clinic. It was nice have some interaction w/patients. We saw lots of homeless folks, ppl with disabilities, vets, mentally ill, etc. I only did about one shift a month as a community health worker but still got to know the regulars. One older lady came in, a regular. It was cold winter out and she was bundled up but looked sweaty. She had a bit of a speech impediment so it usually sounded a bit like slurring, but it seemed more pronounced that day. She sat down in the waiting room and I processed other folks but kept my eye on her. Every few minutes she’d get up an drink some water, odd. Then our research folks went to talk to her, her speech was definitely not her normal, she was more confused than usual. I asked the others if they noticed it, but they hadn’t.
I went and got the supervising MD to come check her out. Turns out her glucose was <40. They got her squared away. She said her glucose meter was broken. They checked it out and it just had dead batteries. Felt like a decent half win.
i hope he did not trip over that suitcase while on the job.
because you encouraging him to find treatment and leaving it at that seems inappropriate.
I'm walking through the hall to see a patient. Sitting in a chair in the hallway is a patient from about a year prior. "Hey doc!" he said loudly, "Thanks for everything."
"You're welcome," I said, not remembering any particular reason he should be thanking me.
"If it wasn't for you, I wouldn't be able to walk," he said.
Gratitude Can Be Scarce, But Means A Lot When Given
My Father-In-Law comes over to visit. He says, "When I told the security guard at the gate of your neighborhood that I was coming to your house, he said, 'You're going to visit the best doctor in the world! Dr. Birdstrike saved my life! I'd be dead if it wasn't for him.'"
For years, every single time anyone came to visit me in my neighborhood on that guard's shift, he'd say that to whoever was coming to see me. This was all because this 40-year-old male came to see me on an ED shift for 'back pain.' Something told me it was more than musculoskeletal back pain. I did a cardiac workup that was normal. I did a second EKG which was normal. I called the hospitalist to admit him and fielded a turd-storm of insults for doing so. A third EKG was normal.
The hospitalists finally relented and agreed to admit him. He ordered one more EKG, which showed an acute ST elevation MI. He patient went to the cath lab. He lived. If I had blown him off and sent him home in a hurry, he'd be dead.
Although he no longer works in my neighborhood and I've lost touch, that guy was the most loyal giver of thanks I've ever encountered in my many years in Medicine. He relentlessly and religiously told everyone that visited me I "saved his life" for multiple years to a near embarrassing level. But it was super cool. I miss him.
Thanks Mr. Security Guard, wherever you are. Thank you for saying, "Thanks."
My Father-In-Law comes over to visit. He says, "When I told the security guard at the gate of your neighborhood that I was coming to your house, he said, 'You're going to visit the best doctor in the world! Dr. Birdstrike saved my life! I'd be dead if it wasn't for him.'"
For years, every single time anyone came to visit me in my neighborhood on that guard's shift, he'd say that to whoever was coming to see me. This was all because this 40-year-old male came to see me on an ED shift for 'back pain.' Something told me it was more than musculoskeletal back pain. I did a cardiac workup that was normal. I did a second EKG which was normal. I called the hospitalist to admit him and fielded a turd-storm of insults for doing so. A third EKG was normal.
The hospitalists finally relented and agreed to admit him. He ordered one more EKG, which showed an acute ST elevation MI. He patient went to the cath lab. He lived. If I had blown him off and sent him home in a hurry, he'd be dead.
Although he no longer works in my neighborhood and I've lost touch, that guy was the most loyal giver of thanks I've ever encountered in my many years in Medicine. He relentlessly and religiously told everyone that visited me I "saved his life" for multiple years to a near embarrassing level. But it was super cool. I miss him.
Thanks Mr. Security Guard, wherever you are. Thank you for saying, "Thanks."
I share that concern for public safety. But where would one report such an issue? FAA? Employer? I wouldn’t know where to go and if HIP laws prevent such disclosures.
You are right it is a difficult situation and beyond what I am qualified to do as a physician. Is there a duty to warn here? Is there an imminent risk to public safety? I don't know.. if he was impaired at work as a pilot then he is putting the lives of hundreds of people at risk.
I would talk to social work or legal / risk management at the hospital to determine what would be appropriate next steps to take.
A little over five years ago I read your post on reinvention for the non-trad and executed hard for a couple years. I'm wrapping up third year at an amazing MD program now and am lucky enough to feel like I'm drowning in opportunities and decisions.
I tell haters and administrators that I wouldn't be in med school without SDN and really it goes back to your simple plan. Thank you for what you do.
