Not Dead

Seems like the blogging is DOA.  Hopefully I'll get back to it and have some actual content/complaining soon.

I picked the name of this blog for a reason.

Old People Die

It happens.  A lot.  If you're in the field of inpatient medicine, you will see lots and lots of old people who die.  It's just what they do.  I don't mean to sound callous or cold, but your odds of surviving even simple things go dramatically up as you age.  I've had pretty healthy 70ish year old patients come in with simple pneumonias who end up dying.  More often than not, it's grandma with 14 medical problems and 28 medicines who's suffering from some dementia who doesn't end up making it.  I don't like it, but that's what happens.

It doesn't happen to healthy 20 year olds.  Or it shouldn't.  It did this week however.  A healthy, slim 20 year old who exercised regularly and had no discernible bad habits was admitted to my service with what is normally a straightforward simple diagnosis and ended up dying.  I took this one very personally as did other physicians involved in the case, and that's not like any of us.  We're all used to death.  This one was just different.  This wasn't supposed to happen.

I've probably been doing more thinking about this than is healthy.  I don't know if that's normal or not.  I guess I'm supposed to find some deep meaning to this like, "Live every day like it's your last".  All I'm really left with is a feeling of guilt for not being able to do more, confusion as to why life is so random at times, and great sorrow for the family left behind.

They didn't teach me this in medical school.

Stereotypes

Here's something most people don't want to hear.  Stereotypes exist for a reason.  It's a human behavior that allows us to look at large amounts of information in a simple way and easily categorize things.  Or at least I think that's what one of my college professors taught me.  We all do it on varying levels.  Most of them allow us to more easily go about our lives.  Some are detrimental to the ones doing it and the ones on the receiving end.

Soooo, when you walk into the room of your 90+ year old ICU patient, what do you do?  I tend to assume that they're hard of hearing, maybe a little demented, and not generally all that interactive.  I don't mean to, but my experience tells me that this is a pretty safe assumption most of the time.  When I speak normally I usually get, "What?" as a response if I get any at all.

And sometimes those same folks are Ivy league educated PhD's who are wondering why you're yelling in their direction.  It happens.  :)

I am not your Pez dispenser

Some patients never fail to amaze me.  I will start this by saying that I have absolutely NO PROBLEM giving pain medications to appropriate patients.  If you've had your hip replaced, you get pain meds.  If you have been sliced and diced by a surgeon, you get pain meds.  If you have cancer, you get pain meds. 

So where does that leave my patient with a "raging headache" from excessive coughing?  I'll also add that her coughing is from bronchitis which is a direct result of her smoking like a chimney.  The answer to the question is wanting more and more Dilaudid.  She's not getting it of course, but she sure wants it.   The "I'm allergic to every pain med except the ones that start with D" sign was readily apparent in this person when she basically refused to go home from the ER.  Being a good little hospitalist, I admitted the patient for observation (babysitting/shifting the responsibility/whatever you call it) and pain control.  Now we're coming up with a new symptom every day in an effort to garner more pain meds and testing.  I spend 20 minutes a day explaining why Dilaudid isn't appropriate for her headache and is probably making it worse.  On principle I should just discontinue it completely, but I do live in the real world.  If that happens, I (or my partners) get paged incessantly by the everchanging covering nurse for "intractable pain" better known as patient whining excessively.

Again, none of this has anything to do with the legitimate pain patients.

I also love when patients figure out a way to know who's on call at night and act accordingly.  It's inevitable that in the first hour or so I take call for my partners I will get calls about patients I don't know with complaints of "intractable pain".  Generally they've been weaned off of their big gun narcotics and just want them back.  I'm sure we get nasty comments about our "lack of compassion" or similar BS because the answer is almost always no.

Or maybe I'm just a jerk.

Some days medicine is fun

For all the drudgery (see the name) and general BS involved in being a hospitalist, it really can be rewarding at times.  Just when you think you've seen enough "I'm allergic to morphine" and "We can't take care of grandma" anymore, you get some patients whose lives you actually save.  It's not all this ER garbage where every code is successful and you get to yell "Clear!" just before one successful jolt of juice brings back granny.  It's ordering tests that others question.  It's going with your gut and being right.  It's having somebody look at you and say, "I knew there was something just not right" and you believed in them enough to follow through with their feeling and your gut.

Today was one of those days.

I'm sure tomorrow will bring back the Dilaudid vacuums and Vicodin/Soma/Xanax ladies.

First post

So I've been spending lots of time recently reading various medical blogs and figured I'd join the fray.  I can't promise that I'll always been entertaining (or ever depending on your tastes).  It's really more of a way for me to vent and share things that go on on a daily basis at work.  Maybe I'll be the only one reading it.  Eh, I can live with that.