30 Something Baby Doc

When I was a resident , I worked on the Gynecologic Oncology ward as part of my training. This service mainly dealt with woman who unfortunately had various cancers of the female reproductive tract. (ie. ovarian, uterine and cervical cancers). While on the service we would perform surgeries, and manage the patients after surgery. We also admitted patients for chemotherapy and radiation therapy. Occasionally we would admit a patient for hospice care after they had exhausted all possible treatments for their cancer.

We admitted a patient, Mrs Smith, for hospice care while I was on the service. She was dying of ovarian cancer. She was only to receive supportive care in the form of intravenous fluids and pain medications. She therefore had a PICC line in place to receive fluids and medications. Mrs Smith fought for 3 days but eventually lost her battle with cancer and died. I was on call for the service the night she died therefore I stayed late talking with her family, signing the appropriate paper work and charting. Later that night when I was home asleep, I received a call from the nurses stating that Mrs Smith's PICC line was still in place and the funeral home needed it removed before they would take the body. Patient care policy clearly stated that nurses were not allowed to remove PICC lines therefore, they asked if I could come in and remove it.

I told the nurses that they had my blessing to go ahead and remove the PICC line themselves and if Mrs Smith complained in anyway, maybe we shouldn't be sending her to the funeral home???????

I was at the gas station downtown pumping the usual 5o bucks into my SUV. As I was standing at the pump I was approached by a thin female in her late 40's . She was holding a cigarette in one hand and a cup of coffee in the other. She quickly walked to within 1 foot of my personal space and exclaimed," Hello sir, I'm a Christian , I won't hurt you!" I smiled and immediately replied, " I'm also a Christian and I won't hurt you either."

She proceeded to tell me that she was homeless and it was a very cold evening. I agreed (in regards to the weather). She said that she needed 8 dollars in order to get a room at the local homeless shelter. I asked her if she had tried the W. Mission which I donate to several times a year. I explained to her that they require no cover charge and supply men and women with good meals and warm shelter. She told me that she had tried and they were full. I had my cell phone with me and told her I would call and see if something had opened up. She repeated to me she that she had just checked and I should trust her word as a Christian. I explained again that something may have become available since she last checked. I got the number of the W. Mission via information and called. A very pleasant man answered the phone and said they had several beds available and that has been the case all week. I tried to explain the good news to the homeless lady, and she call me a "Fucking Liar!!". There goes my good deed for the day. Maybe I should have just given her the 8 bucks?

No, not actually. But I am addicted to my body's own endorphins. I noticed in college that when I worked out really hard , I would subsequently have this weird feeling of euphoria that would stick with me for several hours. Of course in medical school and during residency I turned into a fat slob and stopped working out. After I graduated from residency, I started training for a half marathon. I would run 4 to 6 miles every other day. I noticed that feeling of euphoria was even more pronounced (Hell Yeah!).

After a stressful day at work (and I do mean stressful). I would run 3 - 4 miles and lift weights in order to bring my blood pressure down. I have a horrible family history regarding hypertension. The vigorous work out in the evening would really mellow me out. But I needed to figure out a way to avoid getting stressed out in the first place.

A vigorous workout in the morning was the answer. The only catch, I had to be at work by 7am. The answer: wake up at 430 am and work out at 5am. I works!!! Studies estimate only 10% of individuals get a runner's high, I'm content to be one of them. Don't get me wrong, I hate running, it sucks, I would rather be sitting in front of the TV drinking a Bud Light, but that post exercise feeling rocks. I need it. To quote Pookie (Chris Rock's crackhead character from New Jack City) when he was describing his addiction to crack cocaine, he states ," I tried to kick it man, but the shit keeps callin me, it just keeps callin me"

I saw a bumper sticker this weekend that said " JESUS IS LORD, NOT ALLAH", It was attached to a large pick up truck with the NASCAR inspired number "3" also displayed in the side window.

I would hope that 911 and the subsequent Iraq war does not change our tolerance of other religions and cultures.

When has racial, cultural or religious tolerance ever been a problem in the good old USA?

There are over 7 million Muslims living in the US. Many are are from various racial backgrounds and highly productive citizens in our country. Thousands of Muslims currently serve in the armed forces risking their lives for our freedoms (including religious freedoms). Therefore a bumper sticker like that is offensive to many Americans, both Muslims and non-Muslims alike.

What's worst ?

1) fragmented sleep (ie waking up every hour or 2) ?

or

2) no sleep at all ?


It seems, I'm a lot crankier when my sleep is fragmented compared to no sleep at all.

Update on a parasitic twin in Egypt. Let's pray that she'll come thru this healthy and happy.

Of course you would! That's a ignorant question, right? Then why do so many HIV positive pregnant mothers do nothing to aid in the prevention of HIV in their unborn child. Analysis of data from fifteen studies in more than 8500 non-breastfeeding mothers and their children demonstrated that elective cesarean section prior to labor decreased the likelihood of prenatal HIV transmission by about 50 percent. The combination of elective (planned) cesarean section and therapy with ZDV (an antiviral medication) (ie, during pregnancy and labor and in the newborn) reduced HIV transmission by approximately 85 percent when compared to other methods of delivery and no administration of antiretroviral agents.

Several times a year pregnant mothers who have been previously diagnosed with HIV show up to our hospital in labor without any prenatal care whatsoever. Many of the women know the risk of vertical transmission (from the mom to the baby) can be reduced significantly but still make no attempt to seek appropriate prenatal care.

When HIV positive patients present to us in advanced labor like this, it then becomes necessary to perform and urgent C/S (cesarean section) to decrease the transmission risk. A C/S under these rushed circumstances increases the chance of a needle stick or blood splashing and places the providers under greater risk. A planned and controlled C/S before labor in a women receiving appropriate prenatal care and antiviral medication would be the optimal situation.

How should we respond to these patients that knowingly avoid intervention that could prevent HIV in their newborn child? Should we treat this situation as we would if it were maternal drug abuse in pregnancy? Is this a form of child abuse and neglect? Should we involve child protective services and separate the child from the mother? Should we encourage criminal prosecution of the mother in these situations? I wish I had the answers to a situation I unfortunately see more often than I would like.

I work in a teaching hospital therefore training resident physicians is part of my job description.
Our training program offers considerable autonomy to the residents. They often perform uncomplicated major and minor surgery without hands on assistance from attending staff (myself) . I went through similar training as a resident and felt this to be a tremendous confidence and skill builder. My biggest challenge in teaching is deciding when to intervene and assist the residents. Of course it's rare that residents would ask for help during surgery (esp. near the end of their training) as they fear others would perceive it as a sign of weakness or incompetence. In the past, I've seen major bowel and bladder injuries occur because residents were hesitant to notify their staff when they had encountered difficulties during surgery.

We were doing a cesarean section yesterday for a patient at term (37 weeks pregnant or greater) with a breech presentation ( infant was feet first) who declined an external cephalic version (thank God). I allowed the chief resident and third year resident to operate alone. I know these residents well and have confidence in their surgical skills. I simply observed without scrubbing (slang for hand washing, gowning & operating). We called the pediatricians to attend the C/S (cesarean section) just because breech delivery's even by C/S can be particularly traumatic to the infant requiring immediate resuscitation.

The surgery was going well, the incision was made in the uterus (womb) and the 3rd year resident located the infant's feet and was delivering by a breech extraction (delivering the infant by pulling it out feet first). The resident delivered the infant up to it's head and then had significant difficulty delivering the head thru the incision. A minute or 2 went buy (In these situations , minutes seem like hours). I asked the Cheif resident to take over, and he also had difficulty delivering the head . I noted that the amount of traction on the infant's neck was significant and this was increasing risk of injury . I suggested several maneuvers to aid the young surgeons in delivering the head but they were still having significant difficulty and the chance of additional hypoxic injury (neurological injury due to lack of oxygen) was increasing for the infant. My heart was pounding at this point. I immediately grabbed a pair of sterile gloves ran to the operating table without a gown and performed a * Mauriceau maneuver. The poor diligent medical student jumped out the way and nearly fell on the floor. The infant's head delivered with an almost audible pop and the infant cried immediately. I had faith in my residents and they would have delivered it eventually but time was a factor and patient safety at that time was outweighing medical education. The infant did very well except for a little facial bruising. I allowed the residents to take over from that point and they did an excellent job closing.

* Mauriceau maneuver, a method of delivering the aftercoming head in cases of breech presentation: the infant's body rests on the physician's palm and forearm with the index and middle fingers over the maxilla to flex the head while the other hand is placed on the infant's shoulders to apply traction. Called also Mauriceau-Smellie-Veit m. and Smellie's method.

I don't like intervening because part of the joy I receive from teaching is the feeling of accomplishment and pride I see in the residents when they succeed without help. But in the end , I'm the one that is legally responsible for the patient's well being. I have a friend who stated it simply......" It's the patient's neck that's on the line and it's your ass that's on the line"

Good Point Chris!

I was finishing up a busy day in the office and grabbed the last chart to preview before I went into the examining room to see the patient. The appointment seemed easy enough, the chart indicated that the patient was there for her yearly pelvic exam. My medical assistant pre-warned me regarding what I was in store for by pointing to the patient's weight on the chart . "525 pounds plus"! Why the "plus" you ask?........Because 525 pounds is the maximum capacity of our office scale. Sometimes ignorance is bliss. I took a deep breath and walked into the examining room. The patient was a very pleasant well groomed obese woman in her late 30's. The exam was very difficult as to be expected but I able complete it without significant discomfort to the patient or myself. After the examination, I had a lively discussion with the patient concerning her increased sexual activity and birth control. She had just started a new relationship and wanted to be responsible. She had a wonderful personality and she was gearing up for Valentines day. She obviously had self-confidence and self-esteem that her slightly increased weight could not dampen and her partner obviously was able to see beyond the physical into her inner soul. I wish we all had that ability to see past the physical and see what truly makes an individual beautiful. Happy Valentines Day everyone. Be careful out there.

It was a busy day on labor and delivery and I had admitted a very pleasant and intelligent WF in her mid 30's for active labor. The patient was multiparous (Having given birth two or more times) and this was her 4th pregnancy. Her husband was on his way to the hospital and she was very excited. Her cervix was dilated to 4 centimeters when I admitted her from triage to the labor and delivery unit. I addressed all of her concerns and explained that she could have a epidural when she felt she needed it. She believed she could wait a little longer. She showed me a few pictures of her 3 children that were very cute. I was busy writing orders for the patient when the nurse called me to her room 30 minutes after her admission stating she was feeling pressure. I examined the patient and her cervix completely dilated and she ready to deliver. I happily explained to the patient she was ready to deliver and could therefore could start pushing right away. I also sadly explained is was too late for an epidural given her proximity to delivery. The patient peered at me sternly, immediately put her middle finger in my face and yelled " Fuck You, You Motherfucker". It's nice to be appreciated. After only 2 pushes she delivered a healthy baby boy. Mom and baby did fine. She apologized to me for her abrupt behavior after the delivery. I wondered if her husband was intentionally tardy?

After much thought, I've decided to give up the television for Lent, that includes premium and non-premium channels. I'm curious to see how it affects my productivity, esp. completing my case list for my Board Certification. I can't give up the VH1 soul channel though (it's like listening to the radio) , I'll also tune into ESPN Sports Center occasionally just to know what going on with March Madness that way I won't look like a punk in front of other guys .

Make sure you guys cover your tracks and don't let this happen to you. Here's what caused the uproar. Enjoy and be careful out there.

I would like to digress from medical blogging with a fresh batch of Yo Mama Jokes that I found refreshingly entertaining:

Yo Mama so stupid, I told her drinks were on the house...so she went and got a ladder...

Yo mama so stupid, it takes her two hours to watch 60 Minutes.

Yo mama so stupid, when you were born, she looked at your umbilical cord and said, "Wow, it comes with cable too!"

Yo mama so stupid, she asked for a refund on a jigsaw puzzle complaining it was broken.

Yo mama so stupid, she once attempted to commit suicide by jumping off a curb.

Yo mama so stupid, I found her peaking over a glass wall to see what was on the other side.

Yo mama so stupid, she asked me what Jeans I wear. I said 'Guess' and she said - 'Wrangler???'

Yo mama so stupid, when I asked her to purchase me a Colour TV she asked me...'Which colour?'

Yo mama so stupid, It takes her an hour to make Minute Rice.

Yo mama so stupid, She went to a movie and it's rating was "No one under 17 admitted", so she came back with 18 more people.

Yo mama so stupid, She thinks bacteria is the back of the cafeteria.

Yo mama so poor I saw her kicking a can down the street and asked her what she was doing she said moving.

Yo mama so stupid, she took a ruler to bed with her to see how long she slept.

Yo mama so hairy, when u were born u almost died of rugburn.

Your mama so old, someone told her to act her age and she died.

***************** 6 Hours of Nite Call Left:-) *********************************

I was in the middle of another busy day in the office and seeing a 25 year old woman for her routine annual exam. I typically interview patients after they are completely undressed and gowned because it saves valuable time and I can proceed straight to the pelvic exam. (I would prefer to interview the patient fully clothed because it's less intimidating but my schedule is too hectic to allow this)

I interviewed the young woman and she was very pleasant. I then proceeded to place her in stirrups for the pelvic exam. She appeared to be wearing black lace underwear, so I informed her she would need to remove them for the pelvic exam. Imagine my embarrassment when the patient exclaimed she had already removed her underwear. My medical assistant had to bite her bottom lip during the exam in order to keep from laughing in front of the patient.

Imagine being a stranger in a strange land. You're ill and go to a clinic where the health care professionals don't speak your language and you don't speak theirs. It happens every day here at our hospital and across the nation. The Hispanic population in our state alone has grown over 110% in the last decade. The population of Hispanics in our city has tripled in the same decade. In our hospital the shear numbers of Latino patients is overwhelming its capacity to provide bilingual services. Interpreters are truly underpaid and over extended. Telephone translation services are cumbersome and inefficient. Very few physicians and nurses are bilingual. Other healthcare professionals are rapidly becoming frustrated, believing that our Latino patients have the sole responsibility of learning English if they want to live and prosper in this country. I feel the responsibility lies with the providers.

My 4 years of high school Spanish Sucks!!!!!!! It helps me to create more problems than I solve. I currently researching Spanish classes for health care professionals at the local university. My goal is to becomes adequately proficient by the summer. Hold me to it guys. Adios