Home for the Holidays

Being in the hospital days before Christmas it was clear that patients really didn't want to be there. It's not their bed, their decorations or their roommate. They likely don't feel well and simply would rather be ill on their own terms in the comfort of their own home.

Deck the Halls

It was sad to see so many who were aching to be discharged from our care to be sent home for the holidays. They understood their illness was severe enough to warrant continued medical care, but like Dorothy said, "there's no place like home." For what it was worth, the halls were decorated with sparkling ornaments, holiday wreaths were hung near each door, and festive music echoed for those close enough to hear. The hospital staff were directly influenced by the trimmings and hopefully some of their holiday spirit spilled over into the patient rooms.

It made me reflect on the importance of relationships among friends and families. Being surrounded by strangers that have only known us for a few hours or days is in no way as fulfilling as family members and good friends. Cherish good health and loved ones because it is too easy to take them for granted. Despite being hospitalized, I hope those patients felt the holiday spirit even if it was briefly shared by a nurse, house keeper, medical student or other provider. May you and yours have a festive holiday season.

Question of the Week

A 26-year-old HIV-positive woman is brought into the emergency room after she is found lying unresponsive in the street. She has no recollection of what had occurred. She reports sensing a smell "like burning hair" and then blacking out. A medical history reveals that she has had a fever and a headache for the past week. An MRI of the brain shows multiple ring-enhancing lesions. Which of the following is the most likely cause of her symptoms?

A. Cryptococcus neoformans
B. Cryptosporidium
C. Cytomegalovirus
D. Pneumocystis carinii
E. Toxoplasma gondii

Answer & Explanation

Holiday Festivities

(Click image to view Doctor Fizzy's medical cartoons)

Just in time for the holidays is the spread only a physician could love. Textbook descriptions of anatomical abnormalities may not be a popular thing to talk about, but somehow they always seem to make it to the dinner table. For an explanation of these rare delicacies consult your local medical student or physician.

Holiday Cheer

Medical students usually dream of this special time when they get extra time to sleep in, experience a comatose state in front of the television, or just simply not think much at all. That is of course if you are in your first two years of medical school. The clinical years are not as relaxing; resembling something closer to a paid profession. We work all the way up to the holidays and sometimes on those special days just chugging along trying to keep pace. It continues to be rewarding, but does it really help in the long run to have one extra day of clinic...really? The break would probably be better for us mentally than stressing about a few hours of scutwork.

The cartoon depicts the feast well and I could imagine a dessert platter offering the following: cafe-au-lait spots, peau d'orange, cherry hemangiomas, or berry aneurysms. As long as you don't have any of these questionable entities yourself, your holidays are already off to a good start. So whatever your plans this holiday season, elaborate or simple, I hope you take some time to enjoy the finer things in your life - even if you have to work on a supposed day off. I hope you all enjoy the beauty of the season and stay in good health. Bon appetit!

Question of the Week

A patient is admitted to the hospital with shortness of breath and found to have a pleural effusion on chest X-ray. Thoracentesis is performed and the fluid is sent for laboratory testing. Results of the fluid analysis are: pleural protein 8.0, serum protein 6.5, pleural LDH 500, serum LDH 100. Based on these findings, which of the following is the most likely etiology of the pleural effusion?

A. Bacterial
B. Congestive heart failure (CHF)
C. Cirrhosis
D. Nephrotic syndrome
E. Pulmonary embolism

Answer & Explanation

The Choice is Mine to Make

I couldn't help but notice the mirror overhead displaying the converging intersection with an obvious "Check Out" sign. The exit always seems to be the easiest choice, because the others lead to more work, challenges and upward climb.

Uphill Both Ways

No, I'm not "checking out" of medical school, but I cannot deny the difficulty of making progress...all the time. The ascent to the finish line is steep and unrelenting. Just when you think there might be a nice little plateau ahead to cure the fatigue, you reach the bend and see the next peak in the distance. Emotionally it becomes hard to keep pace and trudge along.

This month's Internal Medicine rotation has been interesting but demanding: early morning paperwork and patient interviews to prepare for rounds, in-house nights on call, and weekend shifts. I'm still trying to squeeze in enough time to study every day and maintain some essence of normalcy. The long and early hours keep me exhausted and always looking for an opportunity to recharge before facing the next big hurdle. Driving to the hospital in the dark, rounding while the sun is out, and driving home in the dark somehow makes the days seem longer than they really are. Somewhere between sunset and sunrise, I find the needed rest to start all over the next day. Fortunately, my back continues to face the exit and my feet lead me forward despite the challenges ahead.

Question of the Week

A 58 year old man with a past medical history of hypertension presents with a cough. The medical team suspects that the cough is due to one of his anti-hypertensive medications. Which of the following is a characteristic of the best alternative drug for this patient?

A. Interference with binding of Angiotensin I
B. Interference with binding of Angiotensin II
C. Reduction of serum Angiotensin II levels
D. Decreased production of a key enzyme produced in the lungs
E. None of the above

Answer & Explanation

Regularly Irregular

Looking back, jobs with some regularity are quite nice. In a short matter of time your body gets used to the internal and nightstand clocks. The schedule can be set and forgotten as there is little variation. Medical school is not regular in terms of scheduling, not at all.

Getting Shut-Eye

Being a medical student seems to be one occupation that has regularly irregular sleeping habits. Whether there is an exam coming or a night on call at the hospital, it seems that the sleep schedule is the first thing to go. Sacrificing sleep to get an extra hour or more of study is the norm. It's no wonder caffeine is such a hot commodity among students. Now on clinical rotations I find myself sacrificing sleep so I can see patients at the hospital before rounding with the doctors. As it turns out, this is usually for my practice and there is little effect on the patient's care from my efforts. That is a nice thought to accompany the five o'clock wake up call.

Soon enough I will be sleeping at the hospital to fulfill "call" assignments. Of course it is all in the name of medicine. Certainly the culmination of stress, lack of sleep and lack of exercise is costing me to lose years from my life expectancy. How is it that a career so focused on health can be so detrimental to my own? Oddball hours here I come. I'm just crossing my fingers that when my head hits the pillow at night I can put all my thoughts behind me and actually sleep soundly until the beeper or alarm sounds the reveille.


Question of the Week

Among physiological changes in the elderly, alterations in sleep patterns are common. Which of the following best describes changes in the sleep cycle that accompany aging in the elderly?

A. Decreased REM sleep and decreased slow wave sleep
B. Decreased REM sleep and increased slow wave sleep
C. Increased REM sleep and decreased slow wave sleep
D. Increased REM sleep and increased slow wave sleep
E. Increased REM sleep and no change in slow wave sleep

Answer & Explanation