With Mother. She is sleeping more. Her intake and output is diminishing. She is not in pain or anxious. The aides and nurses from hospice have been wonderful.
I received a call today from E. E worked with me on nights for many years. She retired and enjoys her life. She has had some health concerns and we had a good conversation. She advised me that I should follow my heart and head in deciding how to adapt to the rest of my career.
In the day, there was E and L, an aide and me. Our friend S was our night x-ray tech and our friend D was in the lab. E had trained at the world's best pediatric hospital and her partner L was an experienced critical care nurse. E reminded me that even in those quieter times I could be a PITA. She reminisced how she or L would give me a verbal or physical smack upside my head when necessary.
Two years ago E called to tell me of some disturbing symptoms. She correctly diagnosed her own disease and I arranged for one of my partners to treat her in the ER. An recent alarming visit to an ER where she lives during the winter, was precipitated by chest pains and severe hypertension. She was treated and is doing well.
Last week I cared for two patients with intracerebral hemorrhages (ICH). The first patient was 61 years old. The family found the patient on the floor with evidence of having vomited and unresponsive to voice or touch. The paramedics did a great job of entubating and stabilizing the patient. A CT scan revealed a large ICH that was distorting the normal brain anatomy. I stabilized the patient's blood pressure and transferred her to a tertiary care hospital. The family told us that the patient had been complaining of a headache for a couple of days. The patient had no medical history, but had seen a doctor regularly for check ups. The prognosis is not good.
The second patient was an octagenarian who walked in with symptoms of an episode of confusion and possibly some slurred speech. The patient complained of a worsening headache for a few days. The patient was on coumadin for an irregular heart beat. CT scanning and labs were ordered. The INR was above the therapeutic level and the CT showed a small ICH. There was no evidence of a shift of the normal brain structures. Arrangements were made to transfer the patient to a tertiary care hospital and I started medication to control her blood pressure and gave fresh frozen plasma to reverse her clotting abnormality. The prognosis is good.
My brother-in-law has arrived and we have the golf tournament on the TV. Mother was an avid golfer. Her father and husband were also devoted to the game. She told me that they were disappointed, when I began dating their daughter, because I had no interest in golf. The sounds of the tournament brought a smile to her face.
In the near future I will be enbarking on the next stage of my career. The world's oldest ER doc will become a part timer. Shorter hours, a less busy ER, and fewer or maybe no nights are my goals. I think that with this change I can make it to 40 years in emergency medicine. For now I will enjoy spending time with the extraordinary woman who I am fortunate to have as my mother-in-law.
Saturday, March 26, 2011
Thursday, March 24, 2011
C'est La Vie
It's Life! The founder of the Brotherhood Of Nocturnal Emergency Room doctors has made a decision. It is time to get off nights. I am at peace with the decision. The lack of sleep, the volume of patients, the constant stress has effected me mentally, physically and emotionally. The nursing staff has rightly complained about by surly and disruptive behavior. Patients who wait hours before seeing a physician or PA do not care about an old and tired ER doc's problems.
As I write this posting, I am waiting to find out my fate. Will I be allowed to stay at the hospital where I have worked for 29 years, or will my unprofessional actions send me on a job search? Retirement is not an option. A less stressful work situation is in order. Another physician in my group has been advocating for 8 hour night shifts for years. My fellow B.O.N.E.R. doc, Zorba and I have stubbornly clung to our 10 hour nights. Pride, arrogance, and hubris all contributed to my insistence on maintaining my schedule even as my health and interpersonal relationships suffered.
My problems are trivial compared to the fate of my mother and mother-in-law. Nearing 92 years of age, my mother has settled into her life in a nursing home. The facility is clean, well staffed and maintained, and Ma is safe and secure. That doesn't totally free me of the guilt of only seeing her once a week. My schedule and the distance between my home and the nursing home makes once a week visits all I can give. Ma is pleasantly confused. Her short term memory is impaired but she knows her family and friends and enjoys visitors, phone calls, and activities.
The exotic woman of indeterminate age, who is my wife, has a equally extraordinary mother. I met my mother-in-law some 40 years ago. She was intelligent, attractive and strong willed. My Dad advised to check out the mother of the women I dated. His words of wisdom proved fateful. Mother has lived a life of honor. She loved and cared for her husband as he became disabled from a progressive neurological disease. She loved her children and grandchildren. She and my wife travelled together, saw shows and had a wonderful mother-daughter relationship. Mother gave love and support to her sister, niece and nephew, friends and coworkers. She was still working in retail 32 hours a week when she was diagnosed with pancreatic cancer.
Mother has survived breast and uterine cancer with attendent surgeries. She had one hip replaced twice and the other hip once. Osteoarthritis became another challenge to overcome. She kept in touch with old friends and made new friends as she moved and worked in different locations. Impeccably dressed and coifed, she exemplified class.
Since the last paragraph, I have left Starbucks and my meeting with the director of my group. I am sitting a few feet from Mother. She is resting comfortably. She smiled when I arrived and gave her a kiss. She wishes to die with dignity. She left the hospital for the last time and is home with hospice care. She is surrounded by her familiar belongings including furniture, pictures and her beloved collection of elephants. Her family will be with her until the end and honor her wishes.
Our family will continue our lives. We will be bereft but inspired by Mother's life.
The world's oldest ER doc will eventually get off the night shift. I will remain a B.O.N.E.R. doc in my heart. B.O.N.E.R. doc emeritus.
As I write this posting, I am waiting to find out my fate. Will I be allowed to stay at the hospital where I have worked for 29 years, or will my unprofessional actions send me on a job search? Retirement is not an option. A less stressful work situation is in order. Another physician in my group has been advocating for 8 hour night shifts for years. My fellow B.O.N.E.R. doc, Zorba and I have stubbornly clung to our 10 hour nights. Pride, arrogance, and hubris all contributed to my insistence on maintaining my schedule even as my health and interpersonal relationships suffered.
My problems are trivial compared to the fate of my mother and mother-in-law. Nearing 92 years of age, my mother has settled into her life in a nursing home. The facility is clean, well staffed and maintained, and Ma is safe and secure. That doesn't totally free me of the guilt of only seeing her once a week. My schedule and the distance between my home and the nursing home makes once a week visits all I can give. Ma is pleasantly confused. Her short term memory is impaired but she knows her family and friends and enjoys visitors, phone calls, and activities.
The exotic woman of indeterminate age, who is my wife, has a equally extraordinary mother. I met my mother-in-law some 40 years ago. She was intelligent, attractive and strong willed. My Dad advised to check out the mother of the women I dated. His words of wisdom proved fateful. Mother has lived a life of honor. She loved and cared for her husband as he became disabled from a progressive neurological disease. She loved her children and grandchildren. She and my wife travelled together, saw shows and had a wonderful mother-daughter relationship. Mother gave love and support to her sister, niece and nephew, friends and coworkers. She was still working in retail 32 hours a week when she was diagnosed with pancreatic cancer.
Mother has survived breast and uterine cancer with attendent surgeries. She had one hip replaced twice and the other hip once. Osteoarthritis became another challenge to overcome. She kept in touch with old friends and made new friends as she moved and worked in different locations. Impeccably dressed and coifed, she exemplified class.
Since the last paragraph, I have left Starbucks and my meeting with the director of my group. I am sitting a few feet from Mother. She is resting comfortably. She smiled when I arrived and gave her a kiss. She wishes to die with dignity. She left the hospital for the last time and is home with hospice care. She is surrounded by her familiar belongings including furniture, pictures and her beloved collection of elephants. Her family will be with her until the end and honor her wishes.
Our family will continue our lives. We will be bereft but inspired by Mother's life.
The world's oldest ER doc will eventually get off the night shift. I will remain a B.O.N.E.R. doc in my heart. B.O.N.E.R. doc emeritus.
Friday, March 11, 2011
Clusters
The world's oldest ER doc has survived another winter. Too much snow, leaking roofs, freezing temperatures and no Caribbean vacation made this a particularly onerous winter. The continuously rising ER census added to my SAD.
My beloved wife booked us for a three night escape in VERMONT. It snowed 12 inches the day after our arrival and I had extreme flop sweat driving home in an ice storm. We returned to the hacienda to find 6 inches of wet heavy snow. We did discover the joy of snowshoeing but a beach in Puerto Rico would have been oh so therapeutic.
What does this have to do with clusters? Nothing, I just needed to vent. Before getting to clusters, she, who is an exotic woman of indeterminate age, made a scheduling conflict. This deprived me of my one excuse to take the tuxedo out of mothballs. We missed the black tie charity ball. The upside was that our grandniece, along with her mother, grandmother and grand aunt, got to enjoy a sophisticated night of dinner and "Mary Poppins".
Epidemiology is the study of the spread and control of diseases. A cluster is a "pocket" of a disease or condition that is statistically aberrant. A person of my acquaintance recently pointed out that her neighborhood had a large number of young people with learning disabilities and or mental illness. The cause was not evident to her but she suspected that neurological Lyme disease might play a role.
The incident of a disease in a population can be easily enumerated. One in a hundred or one in 10,000 are derived from the number of cases of an illness in a given population. The geographic distribution of these cases may not be even, i.e., clusters. Clusters of cases may represent a local factor that contributes to the disease or be totally random.
Bacterial meningitis has a definable incidence in the US. The clustering of cases in military installations and college communities is real and represents the grouping of large numbers of potentially susceptible people in a small area.
When an an unusually rare disease suddenly appears in a narrow population, there is often a specific cause. Clear cell carcinoma of the vagina began to appear in young women back in the sixties and seventies. An epidemiological examination revealed that all the young woman had been exposed to DES in utero. Diethylstilbesterol was given to women at risk for miscarriage in the fifties and sixties. It did not prevent miscarriage but did induce abnormalities in the genitourinary tracts of the exposed children.
The virus that caused HIV was found after the disease AIDS was recognized. Unusual pneumonias, rare cancers, and early deaths sparked the epidemiologists to uncover the roots of the AIDS epidemic and led to the successful isolating of the HIV and the treatments that have prolonged the lives of these patients. Our blood supply is constantly being screened for transmissible diseases, thanks to the work of medical sleuths in epidemiology and medical research labs.
A disturbing trend among well intentioned parents, is to not vaccinate their children. The rationale for this dangerous decision is the belief that vaccines may cause autism. The facts are that the incident of children diagnosed with autism is climbing. There are any number of reasons for this rise in cases of autism. Better knowledge of the variety of conditions in the autism spectrum by physician and the general public accounts for some of the increase. The miasma of chemicals in our environment from PCB's, phthalates, hormones fed to animals, and industrial and agricultural run off, may all cause damage to developing nervous systems. There is no evidence that the MMR or other vaccination causes autism.
The human brain looks for patterns. Seeing the image of Abe Lincoln in a potato chip illustrates this phenomenon. The danger lies in not remaining scientifically skeptical in the pursuit of seemingly significant clusters of disease. Don't believe everything you read on the internet. This blogger tries to be accurate. I use information from peer reviewed scientific literature, not Wikipedia.
Stay informed, be skeptical.
I saw my first robin yesterday, and I heard the congaree of the redwing blackbird last weekend. Spring is here. Rejoice!
My beloved wife booked us for a three night escape in VERMONT. It snowed 12 inches the day after our arrival and I had extreme flop sweat driving home in an ice storm. We returned to the hacienda to find 6 inches of wet heavy snow. We did discover the joy of snowshoeing but a beach in Puerto Rico would have been oh so therapeutic.
What does this have to do with clusters? Nothing, I just needed to vent. Before getting to clusters, she, who is an exotic woman of indeterminate age, made a scheduling conflict. This deprived me of my one excuse to take the tuxedo out of mothballs. We missed the black tie charity ball. The upside was that our grandniece, along with her mother, grandmother and grand aunt, got to enjoy a sophisticated night of dinner and "Mary Poppins".
Epidemiology is the study of the spread and control of diseases. A cluster is a "pocket" of a disease or condition that is statistically aberrant. A person of my acquaintance recently pointed out that her neighborhood had a large number of young people with learning disabilities and or mental illness. The cause was not evident to her but she suspected that neurological Lyme disease might play a role.
The incident of a disease in a population can be easily enumerated. One in a hundred or one in 10,000 are derived from the number of cases of an illness in a given population. The geographic distribution of these cases may not be even, i.e., clusters. Clusters of cases may represent a local factor that contributes to the disease or be totally random.
Bacterial meningitis has a definable incidence in the US. The clustering of cases in military installations and college communities is real and represents the grouping of large numbers of potentially susceptible people in a small area.
When an an unusually rare disease suddenly appears in a narrow population, there is often a specific cause. Clear cell carcinoma of the vagina began to appear in young women back in the sixties and seventies. An epidemiological examination revealed that all the young woman had been exposed to DES in utero. Diethylstilbesterol was given to women at risk for miscarriage in the fifties and sixties. It did not prevent miscarriage but did induce abnormalities in the genitourinary tracts of the exposed children.
The virus that caused HIV was found after the disease AIDS was recognized. Unusual pneumonias, rare cancers, and early deaths sparked the epidemiologists to uncover the roots of the AIDS epidemic and led to the successful isolating of the HIV and the treatments that have prolonged the lives of these patients. Our blood supply is constantly being screened for transmissible diseases, thanks to the work of medical sleuths in epidemiology and medical research labs.
A disturbing trend among well intentioned parents, is to not vaccinate their children. The rationale for this dangerous decision is the belief that vaccines may cause autism. The facts are that the incident of children diagnosed with autism is climbing. There are any number of reasons for this rise in cases of autism. Better knowledge of the variety of conditions in the autism spectrum by physician and the general public accounts for some of the increase. The miasma of chemicals in our environment from PCB's, phthalates, hormones fed to animals, and industrial and agricultural run off, may all cause damage to developing nervous systems. There is no evidence that the MMR or other vaccination causes autism.
The human brain looks for patterns. Seeing the image of Abe Lincoln in a potato chip illustrates this phenomenon. The danger lies in not remaining scientifically skeptical in the pursuit of seemingly significant clusters of disease. Don't believe everything you read on the internet. This blogger tries to be accurate. I use information from peer reviewed scientific literature, not Wikipedia.
Stay informed, be skeptical.
I saw my first robin yesterday, and I heard the congaree of the redwing blackbird last weekend. Spring is here. Rejoice!
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