Thursday, May 27, 2010


The nurses named the baby "Jezebel." I hope her mom, even with her limited English will give her a name today. Yesterday, the mom, brought to the hospital by an ambulance, was too sick to name her. Growth restricted by her mother's hypertension, "Jezebel" only weighs 5 pounds even though she is full term. Her mother had been on medications for the high blood pressure but felt these medications were not working so she did not go back to the clinic for more. I am hoping in three days with my limited Spanish and the translator, I can help her understand.

Mom has many reasons to stay healthy. A single mother with two other children to feed, clothe, and get to school every day (one is elementary age, the other middle school), Jezebel's mom was working cleaning houses until she got sick with feet and hands too swollen to work and a terrible headache. I am just happy someone called the ambulance before a stroke or a seizure occurred. I also feel pretty good about the fact that Jezebel's blood gases and Apgar scores at birth were good. Now, I only have to worry about how to convince mom that her blood pressure is a problem even when she is not pregnant. How do I know? I appears she has the early signs of kidney disease probably secondary to her long standing, untreated high blood pressure.

I am remembering I live in that great land where we pay for care if you are in renal failure and need dialysis but we don't cover patients who are not pregnant with hypertension that could cause renal failure. At least not yet. I hope, as a country we are at least getting there.
JezebelSocialTwist Tell-a-Friend

Sunday, May 23, 2010


subspecialist - def. In medicine, someone who makes more money by doing less work.
SUBspecialistSocialTwist Tell-a-Friend

Monday, May 17, 2010

The babies

While most of my stories end with the birth of the baby, when I was in private practice, I always enjoyed seeing my patients' children grow. Because of this, I cannot resist visits to the neonatal intensive care unit (NICU) to see the babies. Occasionally one will celebrate a 1st birthday there. Usually the stint is much shorter. After graduating to intermediate care and "rooming in" with the parents over night to allow the parents to adjust to the machines such as the apnea and bradycardia monitor which checks heart rate and breathing, these kids will go home.

This morning, however, I am thinking about Megan. This is not her real name but she is a real baby. Born in early January, she weighed slightly more than a pound. She is now almost six pounds and her mother is now 18. Megan's mother rarely visits I am told. Megan is very fussy and the non-pediatrician that I am, I thought this was due to inattention. I ask to hold Megan and I noticed she gets quiet for a few seconds but then she is fussy again. The respiratory therapist explained the fussiness is due to air hunger. That is right, even with oxygen on, Megan struggles to breath. She is off the ventalator in an effort to get her stable enough to move to intermediate care.

For those of you out there who have had the opportunity to sit with someone afflicted with emphysema, air hunger is what makes these adults so restless. Every nerve connected to respiration is firing, pushing the muscle cells that control respiration to work harder and faster. When this doesn't work, more catecholamines are released, making other nerves and muscles twitch.

Perhaps you arrived at the conclusion of this story before I did. How is a mother who was 17 when this baby was born going to deal with these health problems in her daughter? This mother did not seek medical care when she was pregnant and she did not follow medical advice when she was in premature labor. Yes, social services is involved. And yes, there are days that my prayer is one of thanks that I do not have that job.
The babiesSocialTwist Tell-a-Friend

Sunday, May 16, 2010

Redefining "health care"

When I cease to be amazed, I will be dead.

Today I am sure of this. "Abortion foes capitalize on health care law" is the title of an article being carried this morning by the Associated Press. It does not surprise me that abortion opponents are using federal law to beef up their state provisions prohibiting abortions. This is something I could see coming from the outset of the debate as "pro-life" and "pro-choice" congressional leaders sparred during the health plan debates. What I did not see is the fact that private insurance companies will now regard "elective" abortion as beyond the scope of health care. In other words, "You want it. You pay for it." Which means the rich people will and the poor people, even those with jobs and health care coverage, will not likely be able to obtain safe, affordable abortions. There will be even more unwanted children. There will be even more young women in the emergency room with infections, bleeding, and uterine perforations. Some of them will even die.

I am not "pro-abortion" and I don't support abortion as a means of birth control. Yet, I cannot see how we as a nation can continue down the path we are on. A truth that was lost in the health care reform debates is this: The insurance companies are huge businesses with one goal in mind, making as much money as possible. If you don't believe that, look at the salaries, benefits, and bonuses their CEOs receive. Current health care legislation did almost nothing to restrict these companies abilities to make unconscionable profits. If fact, when I read articles such as the one today, I wonder if we didn't give these companies ways to increase their wealth at the expense of the very people we were trying to help.
Redefining "health care"SocialTwist Tell-a-Friend

Saturday, May 15, 2010


"I'm pregnant? I can't be pregnant! I mean I have had a period every month." Ducking her head to avoid my gaze, she thinks. "Yes, every, agh.." The next contraction takes hold and she has to breathe and then she is overwhelmed and tries to push.

"We have to get to labor and delivery'" I declare as the ER nurse calls report on her mobile phone. Unlocking the bed, I make sure the patient is completely covered before we start the journey that is about a city block of corridors and a short elevator ride. I have never understood why anyone, even a hospital architect would allow so much distance between the two departments.

We do make it to labor and delivery. The patient is thirty-two weeks pregnant. Labor stopping drugs, tocolytics, are used to get steroids, which aide in fetal lung maturity, on board along with antibiotics to protect the baby against infection. Her urine drug screen is positive for cocaine and marijuana and the baby delivers a day later despite our best efforts. She has a rough start in life, weighing just over three and a half pounds.

Even more challenging is the fact that this mother will leave the hospital with a three month contraceptive shot. She will not get any follow up care even though it is free and she willcontinue on the same behavior which got her here in the first place, unless and probably even instead of the fact that she may be put in jail for a short period of time. This mother has a parole officer and a 20 month old son. The 20 month old son is in foster care, taken away because of her drug habit. I suspect this baby will end up in foster care also.

I have already thought about this scenario too much. How does one change this pattern? Where will it all end, for this young woman and for her children?
SurpriseSocialTwist Tell-a-Friend

Tuesday, May 11, 2010

In my prefect world...

...children are not allowed out of their parent's sight until they are self supporting.

...low rise pants cause temporary sterility.

...all ovulating women, regardless of age, develop an aversion to drugs, alcohol, and tobacco. If impregnated, this will last until the off-spring's 18th birthday. in basic household finance, child psychology and development, and human nutrition are required for high school graduation.

...there is a fail safe birth control device which can be implanted at puberty, is safe, effective, and some how encourages abstinence until the individual is mentally, physicially and emotionally ready for parenthood.
In my prefect world...SocialTwist Tell-a-Friend

Monday, May 10, 2010

Early morning ramblings

It is 3:38 AM. I can't wait until 7:00 AM. I usually do not get so involved at watching the clock but I am having crazy thoughts. I think it was the drug addict I just saw. She was busy telling me her 18 month old was "just fine." This was after I had looked up her admission from his birth to see that she was using cocaine and marijuana the night he was born also.

I no longer ask why Child Protective Services doesn't do something about this mother. How can they do something about a population so large it would fill one of the suburbs. These women sell themselves to support their habit so there are usually from one to four sexually transmitted diseases to treat also. No one takes care of their children. And no one cares all this is going on. After a year, I understand why. It is too exhausting to deal with the drug addicts except when you must, which is usually when they are in labor. Two days ago we were able to arrange for a patient to go to a rehab institution that accepts Medicaid only to have the patient refuse and leave the hospital against medical advice. I suspect the baby will go to her mother who is responsible for raising her other three.

I am not saying this to be funny but this job is going to make me a Republican. There is no way the United States can support the drug habit of all these people. While I will never be a fundamentalist of any kind, I must admit that I am coming to believe in a kind of natural selection Armageddon. Why? When I look around me at 3 AM, I know there is no way this country can sustain herself with such a large population of marginalized individuals. I wish this were just a nightmare. Then all I would need to do would be just wake up.
Early morning ramblingsSocialTwist Tell-a-Friend

Sunday, May 9, 2010

Another day

Just as I am getting a cup of coffee and declaring, "What I like about this job? The fact I am never bored." In comes a patient obviously laboring, claiming it is her third baby and she is due. Her other two were born at Major Medical Center but she receives her care at Local County Hospital. Interestingly, Dad looks like he could be her father.

10 minutes later the baby is out. And she is just fine until I look at the hands. Next, the nurse checks the feet. They are webbed also. There is a cleft in the palate and a loud heart murmur. This is Apert syndrome, occurring in one out of 70,000 births, it is much more common when the father is older. This is the first case I have ever seen. Well, I said I was never bored.

Another daySocialTwist Tell-a-Friend

Saturday, May 8, 2010

The game

To be a doctor, you must get up really early. Yes, because you need to make rounds at the hospital before the patients are awake. That way they will not be able to ask you any questions, which will take up too much time and make you late for the office. Of course you must also get to the hospital before the nursing shift changes. Otherwise the new shift of nurses will be waking the patients for vital signs. Then both the patients and the nurses taking care of them for the day will be waiting for your.

Once you arrive at your office, it is important to stay one step ahead of the patients by ordering as many expensive and sophisticated tests as possible. This will not only impress your patients but if you can own or lease the machines that preform these tests, it will increase your revenue.

Also, be sure you employ plenty of physician extenders, nurse practitioners, physicians assistants, technicians, and the like. Those who can preform services that have CPT codes are the best. You can bill for these services as a source of additional income. These extenders are especially helpful when they can work in your office while you are not there. This being the case, you will generate revenue while you are away from the practice, thus helping the practice pay of itself while your office space would otherwise be idle.

Finally, get an electronic medical record with voice recognition software included. This way when you have spent 5 minutes with your new patient, you can say something like, "insert my usual review of systems" and a five page printout will result, making it possible for you to bill for a comprehensive evaluation where limited would be the case if you were taking the time to write out what you could remember discussing with the patient.

It is no secret that I played this game poorly. As frustrating as it may sometimes be, I enjoy tackling the patients questions, listening to their answers to mine, and trying to ferret out a diagnosis from the signs and symptoms as I pondered which tests might be useful and which were a waste of time (and money.) I also loved knowing the names of their kids, where they were going on vacation, and what books they would read when they got there.

After a year, it is now apparent to me why it takes me more than an 80 hour week to do what many of my colleagues consider a part time job. I hope I can always practice some type of medicine simply because I enjoy it.
The gameSocialTwist Tell-a-Friend

Thursday, May 6, 2010

Beginning the book

"If I wrote a memoir many would not believe me and a few people, who thought they recognized themselves would probably sue. If I wrote a book and called it fiction, most would say the stories were based on my own experiences. This later plan seems more safe some how, so that is what I will do...."

I am looking for a place to put all of the experiences, thoughts, ideas that I cannot but in this blog so my writing energies are elsewhere as I have found it is difficult to have a following and remain anonymous.
Beginning the bookSocialTwist Tell-a-Friend

Tuesday, May 4, 2010


Every so often, usually once a month or so, I think about looking for a new job. Sometimes I even go as far as searching Internet sites to see what is available. Once I went to look at a hospital, clinic, and the surrounding area. That was in the middle of the winter, a particularly difficult time, as I was spending even my days off indoors.

Last week was a particularly awful week in terms of outcomes. Cancer in a pregnant woman can be devastating, so I don't understand why I expect something different. I can still remember a post mortem C-section I did as a resident on a young woman with advanced cancer. One of the nurses who cared for this woman told me she got a card with a picture of the baby each year for several years. The woman's parents raised the child and had become so bonded with the hospital staff, they wanted to share the good which came from this tragedy.

There are many situations where those working in this hectic world of artificial light and air never see any good. We are left to wonder what keeps the sun coming up, the moon rising, the seasons changing. Thankfully it is spring.
SpringSocialTwist Tell-a-Friend