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?