Posterior anatomy study of skeletal muscle articulations of the body, hands, and feet by Albinus, 1879.

Posterior anatomy study of skeletal muscle articulations of the body, hands, and feet by Albinus, 1879.

How Do You Gauge Your Stress?

Whenever I am stressed, there are some subjective markers I look at. I find myself more tired, I have a harder time concentrating, and I feel less motivated. 

Objectively however, I also have something to gauge my stress level. I have a tendency towards grinding my teeth at night, a condition known as bruxism. It is brought on by stress and goes away in its absence. The more stress I have, the more I grind my teeth. From inspecting my mouth guard every morning, I get a decent idea of how stressed I am.

So how do you gauge your stress level? Let me know in the comments and discussion below.

Hit him with everything!
When we get desperate with a patient - be it a cardiac arrest, a septic shock, or just outright aggressiveness - this is what the escalation of interventions feels like.

Hit him with everything!

When we get desperate with a patient - be it a cardiac arrest, a septic shock, or just outright aggressiveness - this is what the escalation of interventions feels like.

Our Deepest Condolences

One of the very first patients I had admitted was a 50-some year old father of three with a newly diagnosed colon cancer. His case read just like my father’s. Sudden changes in stool caliber. More bloating and fatigue. His wife started noticing that he looked thinner. 

By the time I had approached him in the hustle and bustle of the emergency department, the news had already been broken by the emergency physician. “You have colon cancer,” he remarked on the bluntness of that interaction. It had left him in such shock that he had little to say for most of the day. I took my time to be thorough, answering questions, gathering the history, doing the physical - his moderately ascitic belly and an enlarged liver already hinted at something more sinister. Having already been subjected to one rectal exam, he asked if I needed to double check again. I politely declined to which he breathed a great relief. 

I excused myself to review his CT scan, to get a better understanding of what was driving everything. There, on the black and white screen I saw a liver so large it seemed there would be no space for anything else in that belly. Pocked full of cysts and irregular tissue, it screamed only one conclusion: gross metastasis. 

"A few more tests," I reassured him and then he would go home, to follow up with the oncologist for further management options. I explained that the cancer had spread and that the options will be limited. He digested the news silently, his eyes flickered across the floor as he concentrated. When his wife arrived, I made sure to break the news gently. She wept regardless.

By the time I had sent him home, his belly was flatter once again, having been drained of all of the malignant fluid. The oncologist was to follow up with him within a week’s time. The prognosis was guarded but we agreed that he will be fine for at least the week.

Or so we thought.

It was a surprise to me then that not one week later, I saw him again on call in the emergency department, this time looking worse. He was confused, agitated, and grim - his skin had turned yellow. I quickly texted my attending: “Encephalopathy. Icterus.” The response was immediate: “Shit.”

Because most of the patient’s liver had been replaced by metastatic tissue, his body could no longer bear the burden. The liver had started to fail and with that, his kidneys were beginning to shut down. He was quickly transferred to the ward. 

We rediscussed code status with the family with the end drawing near and it was decided to change his care to palliative. We kept him comfortable until he died a few days later.  

Precipitous multi-organ failure is uncommon to see in someone who is still very high functioning. We never would have expected him to decline so rapidly. It was a surprise to everyone that he could be here one week and gone the next. Given his disease, there would not have been much more we could do medically.

But there are always things we could have improved on. From delivering the diagnosis with care, to advocating for a private room in his final days, to addressing the psychosocial needs of the family. These are areas that we can strive to do better. At the end of the day, this patient was not his colon cancer, he was a person. With a wife and three children. A friend to many. 

These were the pieces, in the torrent of changes that ensued on his second admission, that were lost.

"The patient died surrounded by his loved ones. We are grateful to have been involved in his care and offer our deepest condolences to his family and friends…End dictation."

I am almost a high school graduate and I'm very seriously considering entering the medical field. The only problem is that I've read many articles talking about how difficult and stressful it can all be and I'm worried that I don't have what it takes even though I want it very badly. Do you have any advice? — Asked by Anonymous

Medicine is one of those careers where you will not know if you can handle it until you get your feet wet. There are no words to really convey the mental and physical highs and lows that it puts you through. 

Everything in life that you are passionate about is worth fighting for. I think that if you find yourself drawn to medicine, you find yourself answering the call for something that speaks to you deep within, then I think you should seriously consider it. 

We are all our qualities, from the strengths and weaknesses to the good and bad. The sum of those parts and experiences are what give us the mettle to overcome the challenges we face. Once we believe in ourselves to meet them, we can do wonders. Perhaps the greatest challenge of all is starting. 

We all need to start somewhere in order to get anywhere. That road you take might not necessarily always take you to the original destination you intended. You can always change your mind halfway but that starting momentum is what keeps you moving forward. It allows you to push yourself. 

I would encourage you to take a leap of faith and try anyways if medicine is what beckons you.

124 plays

Luck Be A Lady by Frank Sinatra.

I have spent the past few days on a short weekend getaway with my wife. We enjoyed some attractions, nightlife, and even tried a bit of our luck. In any case, it was a great way to get away from work to focus on us and live a little.

A yawn is a silent scream for coffee.

A yawn is a silent scream for coffee.

Book Review: The Reluctant Intern

Disclosure: I was contacted by the author who provided this book to me without expense. In exchange, I was asked to provide an honest review of this book. I have no affiliation with its author, its publisher or Amazon.

Set in the late 1970s, the Reluctant Intern by Bill Yancey tells the story of Addison Wolfe, a recently graduated doctor who failed to reach his aspirations of working for NASA and instead finds himself in the rotating internship of the University Hospital in Jacksonville. The story chronicles his experience from his first day until his last as an intern.

How the Sun Sees You by Thomas Leveritt.

This is a fantastic video illustrating the power and damage ultraviolet rays have on our skin. This is not to say however that we cannot enjoy time in the sun at all.

Instead, make sure that if you are going to spend any length of time outside, remember to put on some sunscreen, to cover yourself properly, and to be mindful of your skin.

Medical Education, Beware the Hidden Curriculum

The hidden curriculum is taught by the school, not by any teacher…something is coming across to the pupils which may never be spoken in the English lesson or prayed about in assembly. They are picking-up an approach to living and an attitude to learning.

-Dr. Roland Meighan