ERthang

a work thang, a food thang, a shake your groove thang

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But people themselves alter so much that there is something new to be observed in them forever.

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the lady without any mcgrrrrrit

I found myself somewhat upbeat about the day.  Not sure what it was— maybe the extra sleep, maybe an unconscious excitement for the start of my adventure in 8 days (!!!!), or maybe the sun’s guest appearance today.  Who knows? Anywhos, I started out the day just right— with a good mood and some delicious tea in my favorite office.  It was busy as ushhh filled with the same well-deserved praises of “ohhh you’re the best!”, “you did such a great job”, ” you came highly recommended” and on and on and on until the giant sinkhole of death came into the office. 

She sat in her normal sunken position with a book of puzzles and crosswords and sudokus sprawled out across her lap.  Her face was wrinkled with disgust as we entered the room and it was obvious in her contempt in speech that her expression was directed at us.  It was nothing surprising though, or out of the norm. We’ve been the easy targets of her anger since day one—even before she knew or we knew that she had breast cancer. I always wonder what it’s like being this woman’s wife, being her child.  I would hate life and all people.  Where does this anger even come from?  She has to be a huge bitch to deal with on a daily basis; even more-so now with cancer at her side.  It’s evident too in her husband’s demeanor and snotty replies that you are the company you keep. 

I realize that the bitch factor is her way of dealing with the shitty things in her life, which, to be that outwardly angry, must be quite extensive.  But it also made me see how pathetic she is.  Most patients come in because they want to have this taken care of and with today’s medicine you can be treated— and she can be treated.  Instead, she cowered into the pages of her puzzle book and pencil, ignoring our (RIGHT!) recommendations, ignoring the very fact that someone was talking to her.  In the rare occasion that she did speak, it was as if she was questioning the doctor, like he had no idea what he was talking about or even that he had the place to tell her that she has cancer and that it can be treated.  She just refuses to believe that anything can help her; that medicine is all some huge hoax; and that tomorrow she’ll probably be dead.  “You don’t know what you’re talking about and uhhh, you suck” was really what she was trying to say.  Her husband acted as her spokesperson and decision maker.  He was a perfect extension of her— evil and conceited and ugly.  Seems about right though, those damn USC bitches. 

I’ve never seen someone so hopeless EVER; and I’ve seen people who were basically told that death is the only outlook with more hope than she does.  It just disgusted me to see how hopeless she was in an actually hopeful situation.  I don’t even feel bad for her; she’s bringing all of this bad karma upon herself, which makes her being angry with the world make sense!  Alls I can conclude from this, is she sucks and don’t be rude and have hope for life, even in the most hopeless of situations.  Your outlook can really have a positive effect on your life and in the lives of the people you interact with.  Lucky for me, despite the deep, dark shadows of her black hole of hopelessness and bad everything, my good mood stuck!

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Saw a cardioversion in the ED today.  I’d heard of the procedure before, however, have never seen one done before or even really knew what it entailed.   Our 50 yo male pt had entered atrial fibrillation at 05:00 this morning.  He has hx of frequent a-fib episodes; associated palpitations and diaphoresis.  He takes Sotalol to treat for his irregular rhythm and is compliant with his meds; still continues to convert into a-fib.  He notes spontaneous cardioversion with rest.  However, since October 2011, he has been having episodes of a-fib w/o spontaneous return to regular rhythm and has since had to be cardioverted each time. Today was no different and the cardiologist and anesthesiologist consulted on the case.   Propafol (yes, the michael jackson drug) was injected into the pt.  He was immediately sedated and it was cool watching him quickly go from conscious to unconscious within the span of just a few seconds.  It was at this time that the defibrillator was used to shock him back into regular rhythm.  Defibrillator is at a lower voltage than when used in pts in cardiac arrest.  After the first shock, the pt immediately returned to regular rate and rhythm; EKG confirmed this at 63 bpm, NSR, no evidence of ectopy and normal intervals.   Also learned that when pts get kidney transplants they place the new kidney in the anterior abdomen so as to be able to monitor any changes easily (aka any development of abdominal pain/tenderness etc).  Pt we had today had transplant in LLQ abdomen; no change seen but I never knew this before.  

Saw a cardioversion in the ED today.  I’d heard of the procedure before, however, have never seen one done before or even really knew what it entailed.  

Our 50 yo male pt had entered atrial fibrillation at 05:00 this morning.  He has hx of frequent a-fib episodes; associated palpitations and diaphoresis.  He takes Sotalol to treat for his irregular rhythm and is compliant with his meds; still continues to convert into a-fib.  He notes spontaneous cardioversion with rest.  However, since October 2011, he has been having episodes of a-fib w/o spontaneous return to regular rhythm and has since had to be cardioverted each time. Today was no different and the cardiologist and anesthesiologist consulted on the case.  

Propafol (yes, the michael jackson drug) was injected into the pt.  He was immediately sedated and it was cool watching him quickly go from conscious to unconscious within the span of just a few seconds.  It was at this time that the defibrillator was used to shock him back into regular rhythm.  Defibrillator is at a lower voltage than when used in pts in cardiac arrest.  After the first shock, the pt immediately returned to regular rate and rhythm; EKG confirmed this at 63 bpm, NSR, no evidence of ectopy and normal intervals.  

Also learned that when pts get kidney transplants they place the new kidney in the anterior abdomen so as to be able to monitor any changes easily (aka any development of abdominal pain/tenderness etc).  Pt we had today had transplant in LLQ abdomen; no change seen but I never knew this before.  

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70 yo male presents for evaluation of left axillary swelling and redness that began 3 days prior to presentation in the office; symptoms quickly became worse in the 3 days prior to presentation with developing warmth around the area.  The definite cause is uncertain however the pt states that he thinks a spider bit him.  An I&D was performed in the office and bloody purulent fluid was removed; the pt was prescribed abx and instructed to return to the office in 1 week for wound care and re-evaluation.   Upon examination 1 week later, the pt has a gaping hole in his pit!! If I can remember correctly, it was a 5cm diameter ulcer with 2.5cm depth.  This was definitely not the extent of the incision 1 week ago.  Necrotic tissue was also debrided from around the site.  Given its presentation and the development of an ulcer and necrotic tissue, this was most likely due to a brown recluse spider bite. SUPER GNARLY and I hope I never face one of those brown recluse daddies because they sure do seem like assholes.  

70 yo male presents for evaluation of left axillary swelling and redness that began 3 days prior to presentation in the office; symptoms quickly became worse in the 3 days prior to presentation with developing warmth around the area.  The definite cause is uncertain however the pt states that he thinks a spider bit him.  An I&D was performed in the office and bloody purulent fluid was removed; the pt was prescribed abx and instructed to return to the office in 1 week for wound care and re-evaluation.  

Upon examination 1 week later, the pt has a gaping hole in his pit!! If I can remember correctly, it was a 5cm diameter ulcer with 2.5cm depth.  This was definitely not the extent of the incision 1 week ago.  Necrotic tissue was also debrided from around the site.  Given its presentation and the development of an ulcer and necrotic tissue, this was most likely due to a brown recluse spider bite. SUPER GNARLY and I hope I never face one of those brown recluse daddies because they sure do seem like assholes.  

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Only 54% of doctors say they would choose a career in medicine again...

jayparkinsonmd:

Just 11% say they consider themselves “rich” — and 45% agree that “my income probably qualifies me as rich, but I have so many debts and expenses that I don’t feel rich.”

And a pediatric oncologist made an excellent comment:

With regard to the compensation bit, it is important to recognize that the student loan burden is enormous. Not only are you carrying over the loans from college, but your loans from medical school, and all of these tend to be held in limbo (“forbearance”) where they continue to earn interest that is capitalized/principalized, because during residency and fellowship (3-6 years beyond medical school graduation for medical specialists and 5-9 years beyond medical school graduation for surgical specialists) you’re making only $50K or $60K a year for your 80 hours a week work.

But I think one of the hardest bits is that during your school and training there’s never enough money to set aside, and certainly no 401(k) or pension, for retirement savings. So many of us start our “financial adulthood” in our 30s or even early 40s with a huge hole to fill - the need to save for retirement, to pay off the student loans, and at the same time, the need to start living like an adult (kids, house, non-disposable furniture, reliable transportation). And you start to get tired. When you’re 20-something or even in your early 30s, you can do the up-all-night/up-all-day thing, but when you’re in your early or mid 40s, it just gets really hard.

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DRACO (malfoy)

So maybe Draco really isn’t an ass.  DRACO (aka Double-stranded RNA Activated Caspase Oligimerizer) is a new pharmaceutical development that may one day be used as a broad-spectrum anti-viral.  It is impressive in that this synthetic drug is able to specifically target long ds-RNA (which are typical only of viruses) and use caspase to initiate apoptosis within the affected cell.  It is therefore selective for infected cells, leaving healthy cells alone.  In its early stages of experiment, its results are promising within tissue cultures and rat models; it has yet to be tested within a human model.