Dr. Cranquis' Mumbled Gripes

cranquis:

“Like a bomb went off. ”  That’s the only way that I can describe what we saw next.  Patients were coming into the ED in droves.  It was absolute, utter chaos.  They were limping, bleeding, crying, terrified, with debris and glass sticking out of them, just thankful to be alive.  The floor was covered with about 3 inches of water, there was no power, not even backup generators, rendering it completely dark and eerie in the ED.  The frightening aroma of methane gas leaking from the broken gas lines permeated the air; we knew, but did not dare mention aloud, what that meant.  I redoubled my pace.

This is chilling, thrilling, and just WOW.

Reblogging this on the 1-year anniversary of the Joplin tornadoes. The piece is still goose-bump inducing. Thankfully, the people of Joplin have recovered amazingly well from this tragedy.

medicalstate:

As a humorous slide at the end of our male reproductive anatomy lecture, we all had a good laugh out of this one, especially after the dense and draining material of neuroanatomy of the previous week. It is a little low brow perhaps, but amusing.

The Industry has been looking for a generic name for Viagra.

After consideration by a team of government experts, it recently announced the generic name of mycoxafloppin. Also considered were mycoxafailin, mydixadrupin, mydixarizin, mydixadud, dixafix, and of course ibepokin.

Pfizer Inc. recently indicated that Viagra will soon be available in liquid form and be marketed by Pepsi Cola as a power beverage suitable for use as a mixer. Pepsi’s ad campaign claims it will now be possible for a man to literally pour himself a stiff one. Obviously we can no longer call this a soft drink. This additive gives new meaning to the names of cocktails, highballs and just a good old fashioned stiff drink. Pepsi will market the new concoction by the name of Mount & Do.

THE PUNS! ALL THE PUNS!!

This article reminds me of a situation when a patient’s primary care physician (PCP) and myself colluded to not tell a patient about a suspicious x-ray finding — for a little while.

Behind the Medic: The TSK of when Cranquis Paternalized a Patient.

I’d seen 50-something “Bob” in the urgent care, and he was in bad shape. As far as I could tell, his stomach pains and nausea were due to gastritis, secondary to a mixture of excess NSAID use for his chronic pain + his recent resumption of a heavy alcohol habit (He was back to drinking a fifth of vodka every night, after being sober for 3 months — “There’s so much stress in my life right now, doc. My mom and I have been fighting, and I couldn’t stay sober and deal with the stress.”). The only reason I did a chest xray as part of his workup was because his lung-sounds were suspicious for fluid around the lung bases (a possible secondary effect of “abdominal ascites,” fluid collecting in the abdomen after liver failure).

The labs and xrays looked ok for him to go home instead of being admitted to the hospital, and he was happy about this because he didn’t have health insurance and was already stressing about the cost of that day’s Urgent Care visit. But I arranged for him to see his PCP early next week, and admonished him to start cutting back on his alcohol in preparation for getting off the sauce again. He said all the right things: “I’ll go to AA tomorrow morning, my brother will drive me home and stay with me for a couple days,” but it was hard for me to take him seriously. After all, I’d felt the metal flask in his cargo-pants pocket while I was examining his stomach.

The radiologist’s report came in the next morning: “Chest film shows a small irregularly-shaped density in right lower lobe, concerning for soft-tissue malignancy vs overlying chest-wall abnormality, cannot rule out old rib fractures in this area.” 

Oh great. What am I supposed to do now? Follow my usual routine — call the patient, inform them of an irregular finding on the chest xray, and arrange for ASAP follow-up with their PCP? This would just give Bob even MORE stress, which would shoot down any attempts he might be currently making to cut back on the alcohol use.

When I spoke with his PCP about the situation, he agreed with my hesitancy: “Bob’s anxiety and alcoholism can’t handle this extra piece of stressful news right now. I’ll call and remind him to keep the appointment on Monday, and break the news to him then and order a chest CT.” I felt relieved that Bob’s PCP was going to take over and handle it, but I felt a little dishonest at not notifying the patient of his results myself immediately, as I usually do with any tests that I order. But there was more at stake here than just “being transparent and honest” and “upholding the patient’s autonomy.”

Were his PCP and I being paternalistic? Yeah, a bit — but I hope that it was in the best sense of “behaving as a father”: making a hard decision on his behalf, a decision which would protect him from carrying increased (and out-of-his-control) stress during a difficult moment in his life. Bob was hurting, and he was striving to hide the hurt in a way which was killing him. He couldn’t even turn to his mother for peace, since she was one of the major causes of his stress. What he really needed was a Father, but the best I could offer him was my own fatherly instinct.

(Note: The chest CT came out clean, but as of Bob’s most-recent visit with his PCP, he’s still drinking.)