So, I took a trip to India recently. I’d like to tell you that it was a vacation, but alas my travels there had to do with much sadder subject matter. In any case it was nice to see the old country after many years. My trip back, saw me delayed in Dubai, so I decided to pick up something for the kids, who are 2 and 3 years old. I had already gotten them some things from India, but I thought they might like a chocolate or something else edible. If you haven’t been to the Dubai airport, well simply imagine a very large mall with gates that allow you to board a plane and you’re pretty much there. Except there’s no shoplifting because they might cut your hand off. Continue reading “Of Lollipops, Happiness, and Being a Doctor.”
Top 5 Trivial Things No One Taught Me in Training.
Since medical school, I’ve gone through an additional 6 years of training, read countless volumes of medical literature, and had the fortune of having some great teachers. Through it all, experience has been the greatest teacher, which I suppose is what training is about. I’ve watched with interest as advice has been hashed out on the web around this time of year to new trainees on all matter of subjects. And much of it is good and useful, to be sure.
Being the helpful person that I am, I naturally want to do my part. What, I thought, could I contribute to this discussion that hasn’t been said already?
To that end I’ve come up with my own list of of trivial and only slightly helpful tidbits of information, based on my own experiences over the last 11 years post graduation. Here I give you my top 5 list of things that no one ever told me in medical training. . .but should have. Enjoy. Continue reading “Top 5 Trivial Things No One Taught Me in Training.”
Should we Deny Insulin to Chocoholics?
I’ve always had a tough relationship with cigarettes and the people who love them. As a lung doctor I hate cigarettes, and I hate that patients I see everyday continue to use them. But I also understand that vilifying smokers seems to be in vogue right now. I figure that if someone does something that is not considered socially palatable, and that does them harm, even as they strive to take treatment for it. . . well it must be a pretty powerful addiction.
Recently I was hanging out with a few physician friends, when the topic of conversation came to treating patients who are smokers. Some contemplated whether patients who smoke should even be prescribed inhalers for breathing disorders. Furthermore, we wondered about whether such patients should be followed up for breathing problems unless and until they quit smoking. Continue reading “Should we Deny Insulin to Chocoholics?”
Marriage and Motorcycles.
Being married to a transplant physician tends to give one a different perspective on life, and in particular, risk taking. For example I’m embarrassed to admit I rarely climb ladders anymore unless it is absolutely unavoidable. Between you and me, the last time I had to change a lightbulb in the garage, instead of using a ladder, I stood on the roof of my wife’s S.U.V. (note to self, need to make up story explaining dent on roof of S.U.V.).
But I must admit, I do have a terrible weakness for speed. And while said weakness has been limited to things with four wheels, I’ve always toyed with the notion of someday getting a motorcycle. I never took up motorcycle riding in my younger years, but now as I see older and older people leisurely riding their hogs, and parking their chrome babies in handicapped designated spots, I wonder; could it really be that risky?
The other day, as we were taking a drive on a minimally trafficked two lane road, a couple of kids went flying by us on sportbikes at near triple digit speeds.
My immediate response; “AWESOME! I WANT ONE!”
My wife’s response; “Young . . . healthy. . . perfect candidates for organ harvesting!”
My desire to ride motorcycles has since waned. Continue reading “Marriage and Motorcycles.”
Lung Cancer Screening: Almost There . . .
In 2011 The National Cancer Institute published results from their study of low dose CT lung cancer screening of individuals identified as at risk for lung cancer. The investigators enrolled those between 55 to 74 years of age who had at least 30 pack years of smoking under their belt (number of packs per day multiplied by number of years smoked). These people were then randomly assigned to either a chest x-ray group or a “low dose” CT scan group, with 3 images over 2 years. There was initial criticism that the authors used chest x-rays as the control rather than “usual care”. However given that the PLCO trial, comparing chest x-rays to usual care, subsequently showed no difference between the two, this would appear to have been a sound strategy.
The study also received some well deserved praise, as it was the largest study of its kind, and demonstrated some very impressive findings, as detailed in the article’s abstract. The most striking findings were:
- a 20% reduction in the risk of death from cancer relative to the control group.
- a 6.7% reduction in the risk of death from any cause relative to the control group.
I cannot sum up how to you how astounding these results were/are to the medical community, specifically to those who are involved as patients, or in the treatment, diagnosis, support, research, and fund raising of lung cancer. Continue reading “Lung Cancer Screening: Almost There . . .”
Be Nice To Nurses. . . Or Else!
– by Scott D. Thompson.
I say this to all of the incoming students at the beginning of the Physician Assistant program where I am often a guest lecturer. This is something I have come to believe that is at times, easier said than done.
After all, our knowledge base is more specific, more scientific, and more deliberate. We make the decisions, give the orders and consider the vast minutiae of the facts and concepts coursing through our brains while doing so. And besides, our time is the most valuable, right?
I consider myself to be, like most of you; a good person with a caring heart that chose a career in medicine. We should like to believe that we are non-judgmental of others, and compassionate about everyone – whether they are our patients or not. Right?
Well, I have to admit that these standards can often slip away during the momentary lapses of reason that take place during the occasional 3:00 AM pages regarding a patient’s CONSIPATION and my often very angry response and corresponding order (e.g. “WHY is this suddenly an EMERGENCY, at THIS TIME OF THE NIGHT?!, now GIVE the patient a soap-suds enema.”). Insert your example here: Continue reading “Be Nice To Nurses. . . Or Else!”
An “Untouchable” Who Became a Doctor, and Touched the Lives of Many.
K. Raghavadas was born into the world on the earthen floor of a meager straw hut on a small parcel of land in a small south Indian village, the youngest of four children. He had the fortune of being born to an industrious father who, through hard work and luck had been able to secure the purchase of that small parcel of land which contained an orchard and rice fields which sustained the family through many lean years. He had the misfortune of losing his father a few years later and, through no fault of his own, being born into the bottom rung of a caste system whose basic premise is that all men are not created equal.
Growing up in a small village in Kerala, he realized early on that his best chance to escape poverty, the low expectations of his situation, and the notion that he should not accomplish anything in his life was to educate himself. Hoping that it might help his chances, early on in his childhood his eldest brother, who was forced to be the head of the family, changed his low caste name to Ramachandran, a name normally reserved for higher castes. And so a young Ramachandran entered into school, worked hard and excelled, enduring an occasional beating by low caste teachers who did not understand why a backwards caste person could dare have an aspirational name. Continue reading “An “Untouchable” Who Became a Doctor, and Touched the Lives of Many.”
A Hindu Doctor in a Christian Hospital
As i enter the hospital in which I work, I am struck by a number of signs that denote that
my place of employment is a Christian hospital, with Christian values, and a Christian ‘vision’ of health care. I don’t have the vaguest clue as to what that means. And I don’t really mind either, it’s not like they’re paying me with Jesus biscuits and Christmas ornaments, nor does it seem to impact the day-to-day routine of how I take care of patients.
As a child of immigrants, I was born and raised in this country. As someone of the Hindu faith, I am quite comfortable living and working in a world in which my viewpoint is usually in the minority. But as I make my way through the routine of my job amongst these often constant reminders, I can’t help but feel different, foreign. It’s a situation that often spurs the mental soundtrack of my workday to begin with Sting’s “Englishman in New York”.
I don’t drink coffee I take tea my dear, I like my toast done on one side You can hear it in my accent when I talk, I’m an Englishman in New York
I Need a Reminder. . .
. . .To Remember All These Reminders!
Walking around the hospital the other day, I came across a notice reminding physicians about documentation requirements. I had seen the note when it was first posted a few months earlier, but it had since faded into the background wallpaper, and I don’t remember noticing it since. It made me wonder about all the notices that go un-noticed around the workplace. So I decided to start looking out for them, and was surprised to find just how many reminders there were. Here a but a few for your perusal.
Restraint Is Hard
Being a Hindu, I have no idea how it feels to give up chocolate for Lent. Also, as I’m a crappy Hindu, I’m not sure how it feels to give up eating meat either. But I imagine it must feel something like this self-imposed writing embargo I’ve placed on myself until mid-November, while I get through a busy spot at work and prepare for board exams, among other things.
It’s been particularly difficult because in the past year so much has appeared to have transpired in the medical (and in particularly the pulmonary, critical care, sleep world) that has me itching to write. From the ethics of EMS services initiating therapeutic hypothermia to the use of CT screening for lung cancer, I have been finding it hard to resist the call of my keyboard. But alas, blogging doesn’t pay the bills (it actually makes ’em), so I’ll keep focusing on what does, and in the meantime, I’ll throw a few recycled oldies-but-goodies your way.