Pain is an interesting thing.  Even more interesting is how different people react to pain.  Somewhere along the way, someone decided that pain should be considered the fifth vital sign, that we need to regularly ask our patients to "rate" their pain on the wonderful 10 point pain scale, and then treat them accordingly. Even better is the fact that this whole "pain as the fifth vital sign" thing has been demonstrated to be useless. But we still stick with it, so you get patients ...

/begin whine As I sit here in the hospital, answering moronic pages about stupid things, my wife is home, sick herself, taking care of a 4 year old and an almost 2 year old who are both puking. Thank goodness for parents who just happened to be out here visiting. Sometimes this whole call thing really sucks. /end whine

Over the course of your intern year, you really learn how to work with nurses.  Some nurse you know will call with the most stupid things.  It just seems they can't think for themselves.  Others, however, only call when it is important.  And when they call in the middle of the night, you better get your butt out of bed. I got one of those calls 1 am Tuesday morning. It was from a nurse on one of the surgical floors who has been doing this for years.  He is fantasti...

Stand your ground, don't back down. Sometimes you have no choice.  Sure, you have to pick your fights, or you will just burn out.  But sometimes you have to fight.  You have to push, pull, coerce and convince.  Sometimes it just ain't right that the patient stays another day.  Case in point: a patient we admitted just the other day. She was a trauma.  Accident on the slopes.  No major injuries, just some bumps and bruises.  But the head CT showed a v...

Rolling over and playing dead. It is a survival mechanism that has been around for centuries.  Convince the predator you are dead, no longer a threat, and there is a chance they will leave you alone.  It ain't survival of the fittest.  It's survival of the limpest.  It's no different in medicine.  With some patients, all you can do is play dead.  Case in point: a patient I had this week.  She had a pretty minor surgery.  It was a procedure that,...

I have previously pondered the subject of pimping in medical education.  As much as I may not like it, I recognize that it is a time honored tradition in medical education.  As such, I expect it, and even respect it just a bit (that is the masochist in me speaking). However, lately I have experienced an aspect of pimping I could do without.  Let me set the stage. I present a patient.  On trauma, many of our patients can be rather complex, as they often have injuries a...

Just over a year ago, after I finished all my residency interviews, I decided to grow my goatee.  Over years, I have had a beard, here and there, for a few weeks at a time.  I thought this would be the same.  But after a while, my goatee grew on me (pun intended). The next thing I knew, it was months later and I still had my little red beard.  Now, over a year later, it was still there, having metamorphosized from a Van Dyck to most recently a pure goatee, with no associat...

Not quite a year ago, I penned some thoughts on being in the ICU, and what it was like to walk with death .  This article is the natural evolution of that. "Dr. Jones, what was the time of death?" There is no need to look at the clock.  I already did.  And at that moment, I firmly fixed in my mind that hour and minute.  I know what time she died.  I was there.  In fact, I was the one who told the nurse to turn off her levophed, vasopressin, and dopamine (th...

Exactly one month ago I wrote a blog about closed doors and open windows.  Well that open window I mentioned?  It's closing. In fact, Friday afternoon, it closes officially, and we will walk away with the keys to our own (first!) house. I am thrilled.  I sat on the couch tonight, looking around our current apartment with such excitement.  It hasn't been a bad place to live, and honestly was exactly what we needed.  Close to the hospital, close to good friends, an...

The trial that is Cardiothoracic surgery is over.  Well, sort of.  I still have to (get to) go back for a couple more weeks this next 4 week block.  I am on vacation coverage for this next 4 weeks, meaning I get to fill in for the interns who are on vacation.  Next week: the ER. And say goodbye to sleeping well. Monday I work a 12 noon-12 midnight shift.  Tuesday I do the same.  No big deal.  But when I get home early Wednesday morning (probably aroun...

Every once in a while, a moment becomes indelibly etched into our psyches.  No matter what happens for the rest of our lives, these moments will forever be crisp and clear, in some cases disturbingly so. The call came early.  4 am to be precise.  Low blood pressure.  Nothing new, nothing too concerning for the most part.  There are lots of reasons a person's blood pressure can drop, some serious, some not too serious.  He was a dialysis patient.  Kidneys are...

I'm a ho.  Really.  I am.  I am a HO. House Officer, that is.  And after 6 weeks of this, I feel like I am sort of starting to get the hang of things.  There is still way too much I don't know, and I don't even know just how much I don't know at this time.  But I am learning every day, and I am getting more comfortable with being a HO. I get dozens of ridiculous pages every day.  Some are from nurses who know better, but have to make the call anyway.&...

They say you are only as old as you feel.  Crap, I must be close to retirement today. I decided that I was decidedly sick and tired of not having time to exercise.  So Saturday I resolved to start riding my bike to work.  I don't live that far from the hospital, only about 4-5 miles.  But heading to the hospital is, well, uphill.  All the way.  One long, uphill ride.  It makes the ride home a lot of fun.  But the ride up, well. . . I'm feeling a bit ...

It is that time of year again. You know, that one day where some people try to make you celebrate that one thing you did all those years ago. That being born thing. Not that I really remember doing anything that day worth celebrating, least of all for 30 freaking years. But oh well. The kids like it, so I play along for their sake. The rumor is they are pretty excited about my cake. Usually I will pick what I want (and it usually isn't cake-I am much more of a pie person), but this year...

Warning: This will be scattered.  Bear with me, or feel free to stop reading. -The move to New Hampshire really went better than we could have even hoped for.  The help from my family was invaluable.  When I think about how hard it would have been had they not sacrificed their vacation to help us, I can't even begin to think about how overwhelming it would have been.  I have a pretty amazing family. -Board scores are back, everything is in order, I start as a doctor on ...