Notes on a Physician’s Life discusses the terminology, and deeper meaning, of the phenomenon of Burnout.

If Oliver Wendell Holmes, could, over his toast and marmalade in 1887, say, “… that society is always trying in some way or other to grind us down to a single flat surface. It is hard work to resist this grinding down action”, what might he think of our fast-paced world and how it chews up healthcare professionals and workers in most every other field today?

Dr. Dork Hosts Grand Rounds

Grand Rounds is up at Dr. Dorks place. I submitted my first entry in possible over a year, and it was chosen amongst what sounds like over 120 entries! Thanks Dr. Dork.

It ends with a touching goodbye by our own Barbados Butterfly.

Charity Doc Feeling a Bit Malicious

Charity Doc has some amazing case studies, including a recent clamshell cracked chest in the ED. I hope I have the guts to do that if/when it’s ever indicated. The one time that it WAS indicated, the cheif trauma surgeon called the code on our arrival in the ED, then after the fact offered to let the resident’s put in chest tubes “for practice”. He was a bastard.

Anyway, Charity Doc has had enough and has resigned from his job. I wish him the best and hope my work never gets as rough as his, although I think this is just a glimpse of things to come for all of us.

Isn’t it ridiculously ironic? The hospital is ragging my case for ordering too many tests, despite that they are justified, while a patient is suing me for not ordering enough tests, despite that there were no justification for such. Cystoscopy for a UTI, oh my goodness!

Isn’t there a shot?

I guess this really shouldn’t irritate me, except in light of the fact that we had four sequential codes in the ER today, the urgency of this case escaped me. Basically a nice older lady in a personal care home with 5 minutes of facial droop totally resolved. Physician appropriately called. Patient appropritately transferred to ER for evaluation. Son promptly notified, and informed that the patient is back to normal, even as she sits in her bedroom.

Patient arrives in the ER, smiling, says she feels fine, but basically can’t give any reasonable history, just smiles and entertains her family. Family is kind & patient. Son sees me at the desk writing orders for patient not breathing next door. I explain to them that I could look for a pillow for his mother, but it would delay my evaluation of their mother for another 20 minutes if I go to look for one before coming into the room. He invites me in without the pillow.

So it’s clear she’s had a TIA (transient ischemic attack), in which, by definition, the patient has returned 100% to baseline. “Clot busters” clearly not indicated. I explain to the family my plan for workup, excuse myself to take a phone call and come back to the room.

The son casually asks, “Isn’t there a shot she’s supposed to get?”


It takes me longer to explain WHAT the “shot” is, WHY it’s given, WHY it’s not given, and why it might KILL their mother if I give it.

I’m all for education of the public regarding early stroke warning signs, but get very grumpy when the family wants “THE SHOT” (that might kill her). Please, people. This is my job, this is what we do here in the EMERGENCY ROOM. We have been trained when to reccommend “the shot” and when to not.

For all who are wondering, “The SHOT” is a thrombolytic drug (“clot buster”), that not only prevents future clotting, but DISSOLVES existing clots. Sounds like a good idea until you consider the fact that our body is constantly doing a fine job on it’s own of balancing the clotting process between too much and not enough. One of the real risks of the clot buster, whether it’s for your heart or your brain, is causing a brain or intestinal hemorrhage.

Furthermore, it’s only idicated for people who present within 3 hours, with potentially debiliting symptoms (hand numbness is not debilitating, whereas full sided body weakness is), who do not have any one of a number of absolute and relative contraindications to it’s administration.

What is ironic about this whole story is that while I was explaining to the family why I would not give her “THE SHOT”, there was a patient 3 doors down who GOT THE SHOT, after a tele-consultation with our friendly neighbor neurologist. That’s the first time in my career that I’ve been in the department, let alone had a patient, in whom “THE SHOT” was indicated, despite the fact that I have treated many hundreds of stroke and TIA patients.

Bottom line, if you think you are having a stroke, call 911, do NOT drive yourself to the hospital or call your friend/wife/mother/daughter. Call 911. We’ll give you “the shot” if you need it.

Fish Dream

Fish Dream

Mabye my last post was too morbid or sad to garner any comments.

So I thought I’d share something more lighthearted. Any comments on dream interpretation are welcome. For some background, my dad & I went fishing together for the first time in many, many years about 2 weeks ago. He thinks it’d been about six, but I think it’s been more like 25. I honestly can’t remember the last time we went fishing together, but he’s got a better memory than I do.

Anyway, here’s the dream I had the other night as told to my cousin Keith:

We were fishing for steelhead, only it was in a big meandering stream with a lake like still section. It was dark, the stars were out. I was casting…it must have been north…because I was looking at the big dipper on the skyline while I was fishing. Then it got light out, and all the water went out of the stream, like low tide, except it wasn’t the ocean. I looked around and started saying, “Fishies, fishies!”. There were stranded fish of all sizes everywhere and I was looking for the nice colored steelhead. I found a silvery gray fish that had a big hook in his mouth. I picked him up & took him to my dad to take the hook out of his mouth. Then the water came back into the stream and I let him go, but had to hold him upright for awhile before he could swim away on his own. Then I woke up.

“Gratuituous Fish Pic” courtesy of my cousin KM.