DocTalk

Re: DocTalk at your service

Blog access is still being updated on www.MDdirect.org (a programmer in Japan is hard at work), but stuff happened. I waited until the story was reported in the local press this morning before I would comment.

Emergency Medicine is pretty straightforward stuff. People come in with injuries and illnesses, you address their concerns, fix them (or not) and either admit them to the hospital for further care o r send them on their way. It’s also a specialty for those who enjoy immediate gratification from their work. I’m uncertain if I could be a family practice doc. I keep a patient’s blood pressure under control and they don’t have a stroke 40 years in the future. I presume that the satisfaction comes from the journey with the patient. In my world, a patient comes in with a laceration, I fix it, it looks pretty and I’m feeling good. Another comes in with a heart attack and I keep them alive until they get their heart fixed and I feel pretty good as well.

Unfortunately, as in every walk of life, there are times when you would rather not do the work, almost like not wanting to cover a story. You know it’s going to start bad and end worse. Wednesday evening was like that in our department and as it turns out, the people caught in the downward spiral were our poor nurses.

On a cold, slippery evening, a minivan crosses the center line and gets crunched by a semi. There is debris strewn everywhere and it takes forever for the van driver to be extricated. The roof needs to be removed and he is pinned under his wife, who is later declared dead at the scene. He is brought to our ER, where he is resuscitated, stabilized and ready to be admitted to ICU. Now comes the hard part. He is told about his wife (terrible) and now the rest of the world descends upon him (worse). The police want a blood alcohol test, the coroner wants an interview and the final straw, the transplant folk want to know if he will allow his wife’s organs to be harvested (worst).

It is difficult to ask family members, in their time of grief, about organ donation, but can you imagine being critically injured and being placed in that situation. From my perspective, the emotional and social trauma that occurs in the ER is often far greater than the physical damage that is evident on the surface.

And I pity and admire the nursing staff. From my perspective and one that I share with my patients: thank the nurses, because they do all the hard work; I just stand around and visit.

 

Re: DocTalk at your service


That's rough, Doc.

 

Re: DocTalk at your service

Ace,

Every profession has its moments, but I am reminded that it isn't the job that is tough but rather the tangential issues that intrude.

For journalists, it is hard to stay focused on breaking news if there is a personal association. Dealing with tragedy is never easy. Keeping distance is harder.

 

Re: DocTalk at your service

There is no blush font, but please spread the word about my services. For most of them, they are fee-free.

 

Re: DocTalk at your service

Good news. The blog feature is ready to go, but no special insights on medicine and sports to make posting worthwhile.

On the other hand, my workday ended up on a difficult downbeat for me. And if it was bad for me, think of how my patient and his family felt. 60 year old guy, seen by his family doc for sharp chest pains in his left side only when he takes a deep breath, has an abnormal blood test (a d-dimer that helps screen for blood clots, but is notoriously unreliable in the face of other underlying conditions) and is sent to the ER for further care. My evaluation is pretty easy, since the patient is stable and not in extremis. A chest CT scan is done and shows lung cancer having already spread to bone and other organs. Spending the time to break bad news is not what I remember signing up for...and you can't fit it into the 45 minute script allowed for ER or House.

I also appreciate that many of you on the board have to write the stories and routinely visit with families and victims of tragedies. Condolences to all of us for having to endure that.

 

Re: DocTalk at your service

Not that the insights are any more special today, but the latest entry on www.mddirect.org has been posted. As usual, I would appreciate the feedback of my colleagues on the board.

And to those of you who have already contacted me about medical issues, I hope that I have been of some help.

 

Re: DocTalk at your service

Hey, Doc. What do you recommend for a sinus infection? I don't really have time to see a doctor right now to get antibiotics. Is there any other remedy?

 

Re: DocTalk at your service

For sinus fullness, I would try Afrin nasal spray twice a day fro three days max (longer than that and you can develop rebound, where the fullness gets worse, like your sinuses get addicted to the stuff). I would also use Ocean nasal spry, which is a salt water nasal spray that can help moisturize and humidify your midface. Drinking plenty of fluids and humidifying the air would also help.

As for antibiotics, they are recommended rarely, but there should be physical evidence of infection: fever, tenderness to percussion of the sinuses, upper teeth pain, pussy nasal drainage. Some infectious disease guys recommend a limited CT scan of the sinuses to prove presence and extent of disease. The drug of choice is Amoxicillin 1 gram three times a day for a week. For penicillin allergic people, Biaxin or Zithromax are options.

 

Re: DocTalk at your service

OK. I guess I better stop with the nasal spray then. This is my fourth day. I figure it's an infection because of the dark-yellow, almost orange color. I won't go into anymore description than that for the sake of the board. Thanks for the help, Doc.

 

Re: DocTalk at your service

Holy smokes. That's awful.

I don't know how you do it. I admire you for it.

 

Re: DocTalk at your service

BYH, I can whine, but appreciate that the patient has to go home to face the consequences, the nurses and social workers have to deal with heartbreak after I leave the room and the family physicians and cancer specialists have to be there in the long run. The upfront telling is the easiest part of the story. I don't envy all those who have to follow.

 

Re: DocTalk at your service

Amoxicilin is evil. It causes me to get hives.

I hate being allergic to antibiotics.