Defining moment for our generation

On the anniversary of 9/11, I thought about where I was when the towers fell and it came as if it happened yesterday- I was in clinic as a resident, and it just did not make sense why something like that happened or why it happened. Later, much later that night we went to the local Wendy's because we were just not able to think straight and looked at the people around and wondered what had gone wrong.
I am so glad today is a national day of service what a great way to remember....

I know exactly what he is talking about...

I was just browsing websites today when I came across this article and it really nails the problems with pain mangement. I think, pain management is very challenging and sometimes, I do not get things right- between expectations of patients, limits of the pharmacy coverage and my own biases/ thoughts regarding diagnoses. This gave me permission to say that I am not always going to achieve great pain control for every body that I see with chronic pain. I feel ready to manage therapeutic expectations of both my patients and myself.

Early Monday morning...

I really should be getting to bed- Labor day tomorrow, the kids are at home, I have to be at work, try to keep the apples in the air...but whatever, I am so glad, and greatful that I have a job where I can, and do make a difference, where I am forever learning. Later on today, I will be pleased to be at the hospital and "laboring" on Labor day.
Power to all the working people- the world depends on us!

How to be a part of a community

I recently went to the summer session of ACP at SFO. I have not been to a medical meeting in the past three years, so I really wanted to find out if there is any benefit to going to one of these meetings and as of now, it seems there is a benefit at least to me. I thought medicine through out the two days. For every one of the sessions, even the one on pneumonia ( surprise, surprise) I learnt something. For each of the sessions, I could relate the information to one of my patients.
The other benefit was meeting folks who practice all over, one of my new friends was a lady who is the only internist in her town in Minnesota, her scope of practice is much broader than mine but her problems are similar to mine. It was good to know that I am not alone.
I am so pumped to learn more, practice better and be more enthusiastic in my career choice. As an additional benefit, I met up with an old high school friend that I have not met in over two decades.

My cure for the Healthcare problem

Take profit away from the practice of medicine- it is absolutely unethical to make money off of sick people, I can understand making a living out of caring for people but profit- that is the real crux of the problem.
For a more balanced approach check this out.

My CD, my remote.....

My two year old has taken to carrying broken Cd's along with him- all the time. Sometimes it falls from the case and we have to rush to get it back- otherwise its the end of the line for the kid and an end to our ear drums. Some weird fixation, when will it end and what is it supposed to mean?

Hospital Rounds

Taking a page from DB's med rants this is a list of conditions I saw during rounds and need to think about carefully-
1.Hyponatremia
2.Pericardial effusion
3.Aspiration Pneumonia
4.Pleural effusion
5.MRSA cellulitis and abscess formation
6.Hypercalcemia
7.Renal cell carcinoma
8. Acute myeloid leukemia chemotherapy complication
9. Renal failure with multiple myeloma
10. Palliative care- patient with metastatic cancer, unknown primary who did not want any investigation.
What a rich source of learning.

Changes, changes, changes...

I will be doing more hospital medicine soon- two weeks out of every eight weeks. I am going to enjoy the contact and hopefully, the intellectual satisfaction of working with housestaff and medical students; but I wonder what it will do for my access. I am sure I will find out soon enough, but the opportunity to work close to home, at least for a fortnight was too good to pass up.
And talking about acess, all my patients can probably see me the day they would like to see me and that is not the case for my son's pediatrician; I had to wait a month for a well child appointment and it took him about two hours to see my kid and I was more than happy to see the nurse practitioner that was offerred. I cannot believe how much I dislike going to the pediatrician- not very good for my kids.

Control Issues

My two year old has taken to carrying an old remote with him- all over the place. He even sleeps with it. As he is walking around, he asks me,"you want to watch this?" and clicks. It is as if clicking the remote will change his reality and the way things happen around him.
I can see he would like to control things around him and a remote, to him at least is a good way to go about it- gosh, his father does it all the time!

How the economic crisis affected me today

My usual, rather hackneyed question to my patient is- "How are you doing today?"
His response was "I just lost my job- I work at the senior center as a driver for the day care center and they let me go, as they have lost so much funding".
My usual second question is "How can I help you?" "Hire me- I am a good jack- of- all trades".
He will be living out of a car with a wife that needs insulin for her diabetes.The insulin needs refrigeration, how will they manage?

Missing a Diagnosis

My first patient of the day was a young woman who is undergoing chemotherapy for recurrent ovarian cancer. After I had examined her and dealt with the medical issues that I- as a Primary Care doc- needed to take care of, she starts telling me about when she was first diagnosed with ovarian cancer. It seems like her belly started swelling, so she went to her doctor and told him that she thought something was wrong with her. He said- you really need to exercise- so, she did. Then she started having bloating, felt short of breath as she lay down in bed, she went to him again- again nothing was done. Finally, in desperation, her mother took her to the ER, where she had a ascitic tap and got admitted for further work up.
I asked her - did this physician ever examine you? She says I cannot honestly remember.
Wow! What's happened to us- what do we do with our patients? My take home point is- always examine the patient in the best way you possibly can. Their life depends on it.
Here is a review of ovarian cancer.

songs

During my seemingly interminable commute, I came upon this hauntingly beautiful song that I have to share with you, its from Bagdad Cafe.
This is just one of those songs that keeps haunting you- makes me want to go to see the movie which is a cult hit, I was told.
Then I went on to listen to Jeff Buckley who is am amazing artist- wish you were here.
A nice, atomospheric sort of weekend for me, but one which makes me ask- am I going through a mid-life crisis?

slumdog and others like it

Disclaimer- I have not yet seen Slumdog Millionaire.
People have been constantly mentioning Slumdog to me (probably,because I am Indian)- even patients I see in clinic want to know if I have seen the movie,and if I liked it. Most people say they thought it was great. I, obviously, do not know what to think about it. All I tell folks is that it is not really an Indian movie, financed by the French, brought about by a British team but it is Indian in that it was shot on site at Dharavi and it did have an Indian crew.
I am pleased that it makes people think about poverty, which we have plenty of, in India. It brings attention and that is good, just as "Smile Pinki" does. It may make us do more and that is all good.
Amongst the category of Indian films, sort of at least, which are Oscar winners is another documentary called "Born into Brothels". I have seen this one and it is probably one of the more hopeful documentaries/docudramas that I have seen. It made me appreciate the human spirit and not to take things at face value, as all of us sometimes do. See it, if you can.

"Keep calm and carry on"

I was driving to work one day and I heard this on NPR; it seems there is this poster from the World War 11, which has becomes seriously popular in these diificult times. This really resonated with me at that particular moment- I was driving to the outpatient clinic which is about 25 miles away from the hospital where I had rounded on a few seriously sick people and while on my way, I was called to let me know that my two year old had high fever.
I repeated to myself- keep calm and carry on....it did seem to help a little.
Check this out for the real thing .

men are from mars....

I feel it diminishes the human being when we talk about the differences in the sexes as being so important.I also think gross generalizations are not useful and do not help us, as people, to do better in our life.
But, this is a rant against the unfairness of life. I was talking to my husband, and just casually mentioned that I told somebody at work that I was really happy I could make it to my son's school for a pizza lunch when he has an early closure. He started off by chiding me...its not good to be so openly personal at work, I really should not be talking so much about my children and especially, going off to see my son when I am doing lunch.
It got me thinking of the ridiculousness of the whole situation, he can talk about his children, even down to discussing how our two year old has been difficult to wean off the breast- that just shows the world that he is a stable, family man while if I do something similar I may be painted as undependable.
I am still seething....