Sunday, February 26, 2012

The Ultimate Upgrade

This appears to be a very clean and tidy hospital room, ready for the next patient to fill its bed and utilize its healing equipment. I happened to come across it in the early morning hours on my way to see a patient assigned to my service, a patient who had occupied this bed less than 24 hours earlier.

The Morning After

I knew from the previous day that my patient was struggling to survive his declining medical condition and that it would only be a matter of time before his body decompensated. It just didn't occur to me that this particular morning would be the one I found his room void of active recovery. I was rather surprised when I passed the door mentally preparing myself to review his chart for daily rounds. This was not a novel experience for me, yet it was reason for pause in reflection of a life ended, that taught me in during his struggle to survive. Despite the frequency with which this happens, it resonates as a moment of appreciation for the health that I currently possess.

In medicine, we grapple to preserve life and health. Death is not failure in that equation, yet it is the antithesis of our goal. In fact, it may be the expectant end to the story, but our attempts at prolonging its arrival are the reason we prepare for years to work in healthcare. Sadly, it is something we have to accept as an outcome and become comfortable with despite our best efforts to thwart its occurrence. It happens and the morning I stopped in to see my patient, I could not think of a better scene than his empty bed with the light of the sun filling the corners of his room. It was serenely peaceful and appropriate. 

Question of the Week
An elderly woman, diagnosed with Parkinson's Disease, is very combative with hospital staff, refusing treatment except from her own family physician. Which of the following stages of death is she most likely experiencing?

A. Denial
B. Anger
C. Bargaining
D. Depression
E. Acceptance

Answer & Explanation

Sunday, February 19, 2012

The Match Results Are In

Sleeping the night before was not as hard as I expected it to be, but the day of the match results (February 13th) I woke up early. Before I even made it out of bed, the email shown here greeted me with very good news! In just a few months, I will be joining Arrowhead Regional Medical Center's newest team of emergency medicine residents!

Residency Here I Come!

Like many of my colleagues, I had no idea that the match results would be emailed so early in the day. Social networks were abuzz from classmates and peers around the country celebrating and spreading the news. For some it was a time of joy and for others one of disappointment that they either did not get the program they wanted or none at all. It was the major topic of discussion; sometimes surprising and often times expected. Fortunately, in the osteopathic match we do not have to wait a number of days before knowing the results, they are given in the same email. For those attending allopathic schools, they learn that they have matched and wait a few more days before learning where to and in what specialty.

I feel so very fortunate to have matched with a strong institution replete with diversity and opportunity. With the news, I can start looking for housing arrangements and vacation opportunities before everything begins. It's a relief I thought would never come when I was starting out more than three years ago. Now the looming realization of being responsible for someone's health is setting in. For now, I am just going to enjoy knowing that things are going to work out just fine.

Question of the Week
Where did you match and into what specialty?

Answer & Explanation

Sunday, February 12, 2012

Infectious Disease

One of the perks of emergency medicine, OBGYN and surgical rotations is wearing scrubs to work. Between these specialties and vacation it has been a year since I last wore a dress shirt and tie on my rotations. Despite being a little less comfortable, it brings a different sense of professionalism to the game.

Avoiding Disease

Currently rotating on a medicine specialty, infectious disease, I am learning more than ever before, the importance of antibacterial, antifungal, antiviral and antiparasitic medications. I knew there was a lot to know before, but I am now reminded of that fact where it counts, at the bedside. Every day we round on patients who have serious infections including tuberculosis, HIV, meningitis and more. When the patient's infection fighting army can no longer handle the battle, we are called in to bring the reserve armory. Donning special masks, gowns and gloves protects both the patient and ourselves from the exchange of harmful bugs during discussion and examination.

Washing hands is a necessity and stethoscopes are cleaned routinely on this service. If we are not careful, we can be the source of somebody's newest infection at which point it doesn't matter what your tie looks like -- keeping it secured is not a bad idea so it's not dragging through the patient's wounds and dressings. Medicine is a lot like figuring out a good puzzle, both in making a diagnosis and providing the right treatment regimen. Infectious disease aims to find the perfect medication for the job so we are not firing shotguns at thumbtacks every time building resistance to the arsenal we have available. It is a thought provoking field that can have a significant impact on patient outcomes as long as we don't let the disease bug them too much.

Question of the Week
Which of the following drug classes is responsible for both nephrotoxicity and ototoxicity?

A. Carbapenems
B. Penicillins
C. Tetracyclines
D. Aminoglycosides
E. Quinolones

Answer & Explanation

Monday, February 6, 2012

Words of Encouragement

Running towards the finish line, this blog post comes as the 200th, a point that seemed so far away when I hit 100 and even farther when I started writing here. As medical school comes to an end, it seems there are many things to celebrate among board exams, graduation, residency placement, friendship and family.

Fatherly Thoughts

Like a cheer from the sidelines, my father recently wrote me:

I am reminded that you are at a point in your career akin to that moment when a roller coaster crests on its ponderous first climb -- a tipping point with amazing views; where the 360 degree view is the best and breathtaking. For once, maybe only once, you find yourself at a vista point looking behind you (if you have that clarity of mind and the inclination), but especially checking out with breathless heart-pounding anticipation what's about to come. Stretched before you is a winding and precarious-looking path. You can't see it all or how it resolves itself, but you comfort yourself knowing that people survive it every day.

It's a rare defining moment where the natural course of gravity grabs the baton from a methodical and clacking power that lifts you ponderously. Gradual. Ploddingly precise. Unaffected in its destiny, but tension-inducing nonetheless. Then, in the next heartbeat, it happens. Kinetic energy takes over with free abandon with its all too familiar "here we gooooooo" careening dive. You're on a course zooming into the still-unknown hope, happiness and fulfillment on a ride that is sure to thrill and keep you on the edge of your seat.

Buckle up. Be proud. Take in the fleeting moments. Don't forget to breathe. Don't forget to cheer. Don't ever doubt that you are on the right track. And keep coming back for more of what thrills you.

It's interesting to explore the extent of the memories of your program and the interviews. For me the beginning of it all when you were young and had an eye on a frog. Heck! The entire run of you growing up and becoming Dr. Batt.

Thanks for being there for me and the family, for being the person you are and especially for the hundreds and even thousands of people who you will uplift, comfort and heal in the future.
Thank you, Dad.

Question of the Week
A 54 year old male was hospitalized for a pneumonia and placed on broad-spectrum antibiotics for 14 days. Subsequently, he developed diarrhea, fever, and crampy abdominal pain. What is the most likely diagnosis?

A. Diverticulitis
B. Colon cancer
C. Melanosis coli
D. Pseudomembranous colitis
E. Familial polyposis syndrome

Answer & Explanation

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