My, what a nice eye you have!

So I've sacrificed two hours of sleep just now to go admit a patient in the E.D. (Emergency Department is supposedly the more correct term, as most E.D.'s are more than one room. As for the apostrophe in the previous sentence, discussion will have to wait.) This elderly 95 year-old lady, who moaned every time we touched her with our icy-cold hands, presented with obstipation and a gigantic abdomen. She'd already had two enemas, so we're sending her down in the morning for a hypaque enema...this should do the trick! In the course of the interview, however, I made the faux pas of referring to the white-haired man in the room with us as her husband. It was her son!

Well, the payback for missing sleep is what awaited me in room 3. One of the attendings told me to go do an eye exam. I'd already caught wind of a fake eye, so I was expecting the usual well-made prosthetic globe that looked and moved like a real eye, only with no response to light. This model, however, was a little different. The prosthetic included the eyelid, eyelashes, and skin around the eye in the distribution of the orbicularis oculi. And it was attached to her glasses, coming off when she removed the lenses! This is more or less what the prosthetic looked like:

A little morphine along the way...

So I guess I'm getting back into the swing of wards... Today was filled with conferences: EKG/Cardiology conference, 1 1/2 hour teaching conference, and then noon conference. Somewhere in between I rounded, and then from 1:00 PM until 11:00 PM was spent admitting patients and fielding multiple cross cover calls.

One of my patients--who happens to be deaf and hispanic--only speaks in Spanish sign language. (And here I'd thought it was an international language! Maybe not when you have to spell words.) He also has cerebral palsy. Anyway, a good part of my history was obtained by guessing his miming and my writing Spanish phrases on a note-pad to have him point to what he wanted to say. This was challenging!

I trooped over the cancer building with my resident to check in on a patient with metastatic breast cancer, placed on hospice today. This was by far the most meaningful part of my day, as the family was all in the room to say goodbye to their mother & grandmother. My resident doesn't expect this patient to live through the night, but she's being kept comfortable--though somewhat sedated--with morphine.

It's been said that sometimes easing suffering hastens death. I used to not understand this, until I saw situations like this one. Rather than have this patient be in pain, she is kept comfortable with morphine, which depresses her respiratory drive and keeps her more sedated and hypoxic. While her organs shut down, her drive to breathe becomes less and less...

This is a good side of medicine to see, the side that walks with the person to the very end, whether or not the disease has been conquered. This is practicing the art of medicine, when healing is a higher goal than cure.

Hilarious story!

Okay, so I've already piddled away a good 30 minutes since my last post. But I did discover a well-written blog written by a medical student. In one post from this summer, he relates this story which has me laughing still!

A glorious October day

Autumn in New Hampshire

Autumn has finally come to this corner of Texas! Although I'm back on the internal medicine wards for the month of October, I happen to be off today. (I'm particularly happy about this, as I especially enjoy Thursdays.) Mixed with my aspirations to make the most of the day was my desire to sleep, and so my day began lazily at 0730. A quick trip downstairs to pick up a newspaper was my first taste of the refreshingly cool autumn air that crept into town overnight. I opened all the windows to the apartment to let in the 61-degree air and spent the next hour purusing the paper at the breakfast table.

What to do with the day?!? So many possibilities! Here are a few:

• Vacuum the apartment, tidy up my room--these chores will help me feel productive and enjoy my room more, though I've gotten pretty good at ignoring the small pile of paperwork hidden behind the armchair in my room.
• Buy new running shoes. My old ones were purchased in September 2004, and I'm sure have traveled well over the recommended 200 miles for a good pair of running shoes.
• Go running on the trail near my apartment.
• Read a chapter or two in my anesthesia book.
• Read an issue of the New England Journal of Medicine.
• Purchase and pot some fall plants for my balcony planter-box.
• Consider going to the symphony tonight (which is performing the Copland Clarinet Concerto--a great blend of jazz and classical music)

Walter Mondale would have been a good guess...

Here's another anecdote from my brother's experience in the middle school classroom. He was teaching logic to seventh graders and gave an example of Ronald Reagan's using a red herring to his advantage. When asked in a presidential debate if his age might be seen as a disadvantage, Reagan responded that he certainly wouldn't, for political purposes, take advantage of his opponent's youth and inexperience. (see interview)

Around that time, my brother paused and asked the class, "Wait, do you all remember Ronald Reagan? What year were you born?" These kids were born in the early nineties. And then he asked, "And whom did Reagan defeat in 1980?"

After a pause, one girl timidly raised her hand. "Adolph Hitler?"