Germy

A resident physician's life is broken up into four week chunk. And just like this post, residency seems like it could go on forever. These four weeks find me in the ICU. My fourth year of medical school was spent thinking I wanted to be an intensivist; a fancy term for the doctor who runs the ICU. I was keen on going through an internal medicine residency then match into a critical care fellowship. Many intensivists make their way via a pulmonary-critical care residency. In the ICU, I am reminded why I was so intrigued by critical care medicine. I am also reminded why I am not planning on a career that involves the ICU. Rare is the Family Medicine doc who would manage a patient in the ICU, these days, anyway. It important to see and gain experience managing diseases at all points in the spectrum.  Managing a patient at the beginning of their liver failure journey patient takes on a different urgency once seeing what the ending looks like.  Cancer. Renal failure.

Turned 40 a few weeks ago. Over a month ago, I guess. I mean, basically I may as well be 50. At that point retirement is looming. Golden years.  Do you know many 40 year olds who still have two grandparents around? Well, I do. Both of my maternal grandparents are alive, but this past week almost saw that number halved.  My grandmother had another small bowel obstruction, and from what I've heard from my Mother, there was a suspicion of volvulus -- a twisting of the bowel on its axis. Imagine a tootsie roll, how the ends are twisted, it's like this. You may think, well, big deal, so what if the guts twist around? The blood supply is cut off when this happens. When blood supply is cut off, death is close behind. Gett'n ahead of ourselves, though.  This, the sixth edition of Doctor, Doctor, Give Me The News will address something near and dear to my heart, and that is small bowel obstruction (SBO.)  We'll use this for a jumping off point to discuss how to manage

It was my third weekend working in the Rose Medical Center's Emergency Department in Denver when the call came in. It was a Sunday morning -- often the quietest (oh no! somebody said the "q" word! I actively rally against the silly superstitions that stop us actually enjoying a moment of peace between the storms of chaos. Let the comment on the temporary tranquil present be met with a smile and a nod instead of derision and threats of bodily harm, as they most often are) time in the ED and maybe 8:30 in the morning at the latest.  I was standing close to the phone, leaning on my "COW" (which we were told were to be referred to as WOW -- for Workstation On Wheels, versus Computer On Wheels, as Nancy in HR got offended that one time she was on a clinical floor and heard the doctor tell the scribe to "grab the cow") and immediately was alarmed by the nurse's reaction.  We were a level III trauma, if I remember correctly, with no dedicated pediat

Welcome to the forth edition of an ongoing series built to break down common medical conditions and emergencies so all of us can have a better understanding of just why doctors do what they do. Thankfully I've been overwhelmingly healthy and issue free for my entire life. Good genes and luck more than wisdom and disciplined living. There are some patient presentations that trigger powerful feelings of empathy -- gout flares and osteoarthritis flares, in particular. I've had a couple gout flares -- the worst manifesting in my knee during my first semester of medical school. I didn't know what was going on and the pain was extraordinary. A solid decade of avid skateboarding will teach one to tolerate pain, but that gouty knee was terrible. Gout is nothing more than an acute arthritis caused by purine crystal formation in the fluid of the joint, which look like barbed wire under the microscope. The sharp, powerful sensations of pain do not disappoint, in that barbed wire

In this, the third installment in  Doctor, Doctor, Give Me The News  we turn not to another common medical malady or emergent disease process. Imma gonna try'n decode and simplify the malignant beast that is the American Medical-Industrial Complex. I see it as the largest barrier to our long term health and wellness but, at the same time recognize the success in emergent, dramatic, life saving machinations that we depend on.  The forces that have shaped our healthcare system remind me of another dynamic I've watched play out in our society.   The "right to choosers" versus the "right to lifers."  This truly is not an indictment on either side of the debate -- neither the time nor the place, but just my observations and what it has meant for public policy and politics at large, in this country. Afterall, large swaths of voters vote on this item, and this item alone.  Not hard to imagine that the good ol' polly teeshans understand this an