I saw this on another blog, so I figure I'll try it. Request week: Anything you want to see a post about? Put it in the comments and I'll see what I can do. Tempted to say I'd also take requests for a video topic, but I'm not sure anyone except my family is really watching the videos (and maybe they're not either), fun as they might be to make.

Patient comes in, high blood pressure, BMI of 47.

"I don't know why I keep gaining weight."

"You need to exercise and eat better."

"I don't have time to exercise."

"What hours do you work?"

"8:00 until 11."

"Fifteen hours is a long day."

"No, not 11 at night. 7 until 11 in the morning. I work the breakfast shift."

"And what do you do the rest of the day?"

"I sit on the couch and watch TV."

"All day?"

"I'm lazy."

"And you're wondering why you're gaining weight?"

"This is what I've always done."

"And now it's catching up to you. You definitely have time to exercise. You need to exercise."

"How about starting this summer?"

"How about starting today?"

"I don't want to."

"I don't have a lot of answers for you if you're not willing to try exercising and eating right."

"Diets don't work."

"But we can try and find a plan that can work specifically for you. It needs to start with more movement though. You can't sit on the couch watching TV for 12 hours a day."

"I go to bed by 9."

"Okay, for ten hours a day."

"I'm old."

"You're 39. That's not old."

"It feels old."

"It feels old because you sit on the couch all day, and you weigh almost 300 pounds."

"What if I make it a New Years Resolution?"

"For next year? It's only March!"

"That'll give me time to used to the idea."

"You need to start changing things now."

"I don't want to."

"Then there's not a lot that I can do."

"I told my friends you wouldn't do anything."

"What did you expect me to do?"

"I don't know. Nothing. Doctors are useless."

"What would you like me to do for you?"

"You tell me."

"I don't have any answers if you're not willing to change your lifestyle."

"I'll think about it."

"Okay, at least that's a start."

DISCHARGE SUMMARY

This 136-year-old female from the nursing home was admitted by her overbearing family for no particular reason. She arrived complaining of leg pain caused by her 102-year-old daughter dragging her into the car to come to the hospital. There was also evidence of the patient's breakfast on her face and clothing.

Intravenous fluids and antibiotics were administered in the ER after she was confused with another patient with a similar name. She was transferred to the OR for a gastric bypass procedure by mistake. The procedure was a success and the patient has thus far dropped from 109 pounds to 67. Her post-operative course has been unremarkable.

An echocardiogram performed for no apparent reason was misread and the patient was transferred to the telemetry floor. She was inadvertently left in the elevator for sixteen hours. A urine sample was collected from the floor of the elevator. It was positive for everything.

The patient was intubated seventeen times after being mistakenly wheeled to the medical student skills lab and switched with a cadaver. After being extubated for the final time, she was dropped on the floor. Structural testing on the floor revealed no damage. However, a CT of the brain revealed contusion of the frontal lobe along with evidence of leftover medical supplies from the gastric bypass which had apparently traversed the blood-brain barrier.

The patient underwent brain surgery to remove the medical supplies. We are currently unsure who performed the procedure; neurology claims no knowledge and the records have been misplaced. Nevertheless, the procedure was deemed a success. The patient remained clinically stable for thirteen minutes until she was accidentally lit on fire by occupational therapy.

The fire was extinguished using the patient's lab results, which had not yet been reviewed and cannot be located on the computer. We operated under the assumption her lab values were entirely abnormal and started her on a course of everything.

In a separate incident, patient's left cornea was removed due to a clerical error.

After a psych consult, patient was transferred to an empty closet on the 14th floor for three days. A urine sample was collected from the floor of the closet. It was positive for everything.

The patient expired on the morning of 3/25/11 from acute respiratory failure caused by accidental smothering. The patient was pronounced once again alive on the afternoon of 3/25/11 after we realized we had inadvertently recorded the death of the wrong patient. After being returned from the morgue, the patient underwent a preoperative workup and clearance for a cardiac transplant before being correctly identified and returned to her room.

Patient was discharged on 3/28/11. Discharge instructions were sent home with a different patient, but we have given him the patient's phone number and instructed him to swap paperwork at their earliest convenience.

DISCHARGE INSTRUCTIONS

She may shower but not bathe. She may eat but not swallow. She needs to keep her wounds wet. She needs to follow up in my office in 1 week for postoperative evaluation, and every week after that for continued insurance billing and maintenance. She is instructed to call for any problems of breath, lack of breath, breath sounds, bowel sounds, chest pain, no pain, any temperature greater than 0, foul-smelling drainage from her mouth, redness or swelling of the liver, or unexpected hearing loss.

DISCHARGE MEDICATIONS

The patient was given scripts for Assorted Medication Grab Bag #3.

EXPECTED OUTCOME

Outlook not so good. Concentrate and ask again.

Inspired by events this past weekend... What a resident thinks about while a guest at a wedding:

** Isn't it amazing how all of these people are able to stand up without assistance?

** I wonder how many of the guests have cancers that haven't yet been diagnosed.

** Wow, no one has fallen yet on the dance floor!

** Those obese people should probably stop eating so many hors d'oeuvres.

** Do I really have this whole weekend off? I should probably check the schedule again, just to make sure.

** Was that a sneeze?

** Based on his toast, and what I know about how the bride and groom actually met, the best man seems like he would be a poor historian if he were a patient.

** I wonder if that pregnant woman is of advanced maternal age.

** Should I have ordered an MRI for that patient on Friday, and was I just cutting corners because I wanted to start my weekend?

** All these flowers... are probably harboring scores of bacteria.

** I hope no one chokes. Or, if someone does choke, I hope no one remembers that I am a doctor.

** And that makes six identified neurological problems, just at that one table!

** It's amazing how easy it is to forget that some places don't actually smell like the hospital.

** Bad dancing, or essential tremor?

** Hey, that guy with the drink in his hand is showing signs of liver failure!

** Oh, wait, I can actually touch this bathroom door without feeling like I'm going to give myself a staph infection.

** I wonder where the nearest trauma center is, and how many patients it can accommodate in case of a disaster between now and the wedding cake.

** I bet the bride would need stitches if she accidentally cut her finger with the cake knife.

** Speaking of the cake, are we sure the frosting was properly refrigerated?

** So if eighty people flew in for the wedding, and the average flight was two hours long, how many of them have a DVT?

** That woman definitely had a stroke. I should tell her.

** If I were working tomorrow, I would have had to go to sleep four hours ago.

** This white wine looks like the color of healthy urine.

** The red wine does not.

** The guy next to me is going to the bathroom so often he should probably be tested for diabetes.

** Those flower girls are going to grow up in a world where they have a life expectancy shorter than their parents.

** I'm glad that now the groom can be on the bride's health insurance plan.

** I am the least fun person here.

I'm counseling a clinic patient this afternoon about obesity and her high cholesterol, and as we're talking she reaches into her purse...

And pulls out a hot dog.

Wrapped in foil, but still... a hot dog. And she unwraps it and starts eating. While we are talking. About her eating habits.

"I'm sorry, you can't eat that in here."

"I didn't get a chance to eat lunch."

"I'm sorry, you just can't. This is an office that a lot of doctors share, and there's a very strict rule against food. Plus, you can't eat a hot dog while we're talking about things you should and shouldn't be eating. You just can't."

"I didn't get the french fries. I'm trying."

"I know you're trying, but you really have to put that away. You really can't eat that in here."

"I'll be neat."

"No one's neat. If we let people eat in here, the office would be a mess. And it can't smell like hot dog in the doctor's office. It really can't. I don't know what else to say except that I have to cut the visit short if you don't put that away."

And then she stuffed the entire thing into her mouth, chewed it up, and swallowed.

"Okay, all done."

"That was not the right answer."

"You didn't give me much of a choice."

"I can't believe that just happened."

"Don't tell me you don't like hot dogs."

"I'm sorry. I have to go... check something... in the chart...."

"I have something else I want to talk to you about," said my clinic patient, a little angrily, as we were finishing up.

"Sure. What's the problem?"

"Do you not like me?"

"I like you just fine. Did I do something wrong?"

"Yeah, I want to know if you told them to give me Dr. [Jones] last time."

"I was working in the hospital last month and didn't have any clinic hours. I'm sorry I wasn't able to be the doctor who saw you. It was nothing personal. I just didn't have any clinic hours."

"Yeah, that's fine. No offense, but I don't really care if I see you or I see someone else. I just want to know if you told them to give me Dr. Jones."

"No, they assign based on availability, if your usual doctor isn't going to be there that week."

"Because Dr. Jones was terrible. And I thought maybe you were trying to punish me."

"I'm sorry you had a bad experience with Dr. Jones. He's another resident in the program with me, and I have no reason to think he's anything but a terrific doctor. The note in the chart said the visit went fine."

"Yeah, I didn't like him."

"I'm sorry to hear that. You can definitely request not to see him when you make your next appointment."

"Yeah, can you write it in my chart?"

"They're not going to look in the chart when you make the appointment. The easiest thing to do is just to request not to be assigned to him when you make the appointment."

"Yeah, I just thought you were punishing me for something."

"Even if I had a reason to, that's not something we do. It's our job to deal with everyone the same way, whether we like you or not. And I'm not saying I don't like you, I'm just saying your doctor should never be punishing you for anything."

"I thought maybe you figured out I wasn't taking my pills."

"Wait, you should be taking your pills."

"So you didn't know I wasn't?"

"No, I didn't. You need to tell me these things. You need to take your pills. Why aren't you taking them?"

"I forget."

"Do you forget other things?"

"No. I forget to refill them when I run out."

"You need to do that. And you need to put them in a place where you'll remember, and make it part of your routine. Take them at the same time every day. I can give you an organizer to put them in, so you can keep track of whether you've taken that day's pills."

"I didn't want to tell you I wasn't taking them. I thought you would punish me."

"I'm just trying to help you stay healthy. I don't want to punish you. I want you to be healthy and not need to come to clinic and see me. Can you promise me you'll take the pills?"

"I'll take the pills."

"Good, because if you don't, I'm going to tell them to assign you to Dr. Jones."

"Doctor, I'm telling you, I have bad kidneys."

"Your kidneys are fine. The tests came back normal, there's no problem with your kidneys."

"But I have pain here." [he points to a spot on his upper thigh]

"That's not where your kidneys are."

"Mine are there. I have bad kidneys."

"Not your kidneys. You have leg pain."

"No, it's my kidneys. I take special pills from Venezuela for them every day for three years."

"Wait, what kind of special pills?"

"This is the name:" [he says a name I've never heard of]

"Hold on, let me look that up." [I Google to discover it's some kind of antibiotic that we don't sell in the U.S. and that probably no one should be taking for three years.]

"You should not be taking that, you don't need that. You have leg pain. Did you hurt your leg?"

"It is not my leg, it is my kidneys."

"Your kidneys are not there, and your kidneys are fine. Just tell me, did you hurt your leg?"

"It does not matter if I hurt my leg, this pain is not from my leg."

"But did you hurt your leg?"

"No, it was not a big deal, did not cause my kidney pain."

"What happened to your leg?"

"I was hit by a car. But that is not the problem with my kidneys."

One nice thing about the outpatient service is that sometimes your patients don't show up.

I don't mean that to sound so negative. But when you're in the hospital, you are virtually *always* busy. The to-do list is always full, there are always labs to check, there are always things to follow up on, families to call, patients to visit, tests to order, consults, interns and students to check in on, new admissions, discharges... the entire day is a battle to keep up. From the moment you walk in, you're fighting a losing battle to leave at a reasonable hour.

And then there's the outpatient service. Where, barring something astonishing, you see a handful of patients and then the clinic closes for the day and you get to go home. One patient doesn't show up, you surf the Internet for twenty minutes, do some reading, whatever. Two patients don't show up and you get to catch up on e-mail, maybe chat with an attending. Three patients don't show up and they probably give you someone else's patient to see, but then it's almost like you're doing someone a favor. You can actually end the day feeling like you helped someone out and didn't just try to tread water in your own little bubble.

Sure, it's probably different when you're not a resident and you're actually in practice-- and whether your patients show up determines whether or not you get paid, and a no-show means you're wasting a block of time in the office for no compensation. But on salary, I don't know, it's hard to feel so terrible about it.

So if you go to a clinic for your medical care-- do your doctors a favor. Make appointments when you don't need them, and then don't show up. They'll thank you for it.

Okay, maybe that's not quite the advice I should be giving out...

I start getting two-day weekends and suddenly posts don't get written. A few days into my month of outpatient and I can actually see daylight. How about that? I can even plan activities outside of work. I mean, in theory. In practice, I'm still catching up on sleep and trying to finish a book I started reading in December. Or was it November? Or July? Who knows. I don't even know what I'm reading anymore if it's not medical. I have dreams about chronic urinary tract infections. Not mine. Patients. Patients' chronic urinary tract infections.

Last week was Match Day, where fourth-year med students found out where they're going for residency. The hospital sent out a list of everyone who'll be starting in July. A couple of people from my medical school. Didn't know them. Hard to know people two years below you. They're having a celebratory dinner tomorrow night for med students in the area who got into our program. We're urged to go if we're on outpatient. It's a free dinner. I'll probably go. Part of me wants to scare them. Now that they're stuck and everything-- no turning back. "Oh, the hours are great-- you thought we were maxed at 80 a week? No, that's just for dermatology. We do 125." "Nurses? Nope, no nurses. We have to do everything ourselves. Including medical billing. An entire month of billing. It's a great rotation."

Just made a new video. I don't quite know why, but they're fun to do. This is #6 in the ongoing series. "I Do Not Like The Taste Of My Mother's Medication." Check it out.

Patient's daughter: "Can we give my mother [other drug] instead of [drug she's on]? I used to be a drug rep for [other drug]."

What in the world is the correct answer to a patient's daughter asking if we can switch her mother's medication because she used to be a drug rep for a competing pill?

I mean, besides, "no."

Or, "actually, we make drug decisions based on the drug we-- your mother's doctors-- think will be most effective, not based on who manufactures the drug, because, frankly, I don't even know the trade names of most of the stuff we provide, and who makes it, and don't care."

Drug reps get a hugely bad rap, and I really can't speak with any expertise about them, because they're banned and we never see them, they're a non-factor for residents. But for a patient's daughter to think that having been a drug rep for a certain drug is a reason why we might switch her mother's medication-- that's bizarre to me, and a completely off the wall request.

Not that we don't get off the wall requests all the time. "Can you do that later? We're currently visiting," is a common one. I understand it, sort of-- you come to visit your family member, and, sure, it sucks if a doctor comes in to wheel him away for a test. But they're here for tests, they're here to hopefully get better, and there's no way we can coordinate a schedule around the visitation of family members. He needs an MRI, the MRI is available, he's getting the MRI, even if his twelve kids just flew in from Antarctica to visit. He'll be back, don't worry. He'll be here all night. But the MRI technician won't be, and that's the priority. And yet people act like we're being horrible if we insist on getting the patient to the test. Or if we insist on interrupting the family visit to take blood, or give medication. Guess what? If you stop arguing about it, it'll take two minutes.

Okay, this post sounds angry and I don't mean it to sound angry. It's just frustrating to have to keep explaining to people that what we're doing is important, needs to be done, and will make their family member better (we hope). We're doing it for their benefit, not ours. And it's so hard to get the MRI scheduled-- too hard, absolutely, and I don't entirely understand why it has to be as hard to manage these schedules as it is-- and I don't want to lose the day, nothing good can happen from being pushed to the next day and having to start the process all over again, for any of these things. And it's hard when families don't understand, even though I sympathize with them wanting to see their family member, and not having all day to visit, and traveling distances and being squeezed by their real lives. But at the end of the day, I have to believe that they would rather their visit be cut short and their family member get better than they get all the time in the world to visit a dead person. That sounds harsh, and it is, and I don't mean it to. And of course it is better for family members to visit than not visit, and we shouldn't make it harder than it needs to be for them to visit and get to spend time with their family member. It's just hard to balance 15 patients, their families, the specialists we're dealing with for each of them, and the techs actually doing all of the tests, that's all.

But, regardless, no, being a former drug rep for a competing drug to the one your mother is on is not a reason for us to switch drugs. Sorry.

Quote of The Day:

"I like dealing with ICU patients because they can't talk back."

Tell me you don't want that guy as your doctor, right?

People will go to great lengths to deny that their loved ones are demented. The other day, I asked a patient what year it is.

"1970."

"You sure?"

"Yep."

Checked his chart, no indication he'd ever been diagnosed with dementia. So I swung by his room when his wife was visiting. "How long has your husband been having trouble with his memory?"

"Oh, he doesn't have any trouble with his memory."

"He told me this morning that it was 1970."

"He just gets confused in the morning sometimes. But his memory is fine."

Not to oversimplify, but, you know, it's a binary thing. Either you have dementia or you don't. Non-demented people don't get confused at certain times of the day. Non-demented people remember the people they've met, and have a pretty good idea of what year it is. Non-demented people know if they've eaten breakfast yet.

The worse part is that it's not that his wife is lying to us-- she isn't. She's just in complete denial-- she genuinely believes that his memory is in working order. Which is a problem, because he tells her things about what's going on in the hospital that simply aren't true.

She had me paged this morning. "You know, I should report you and your entire team. My husband said he asked the nurse to help him to the bathroom, she said she would, and she never did."

I checked with the nurse. She said she helped him to the bathroom. Twice.

"And he said he's been here all day and hasn't gotten anything to eat."

Nope. Not true.

"And he never got his MRI."

"Well, I have his results."

"Then I guess you didn't even take the time to explain to him what kind of test he was getting, because he does not remember getting the MRI."

"He doesn't remember because he is unfortunately suffering from dementia."

"He is not. He takes care of himself just fine at home."

Just wait until he lights the house on fire, or leaves the house and can't find his way back. His primary doctor is a cardiologist. The cardiologist isn't necessarily going to diagnose dementia. People need primary care doctors. I called social work-- he can't be on his own when we release him, his wife needs to get help for him. But she won't, because she thinks he's fine.

Until he doesn't remember who she is, and then maybe she'll realize. Or maybe she won't.

You read about the possibility that a patient can vomit up their own feces, but you don't really believe it until you see it for yourself.

Today, I saw it.

And believe me, it's something you don't want to see.

Thanks, surgical service, for dragging your feet on agreeing to take the patient, long enough for his problem to go from "oh, we'll get to it" to "oh, gosh, is that his feces spewing from his mouth?"

Why, yes. Yes, it is.

"Why is this happening?" yelled his daughter, as she wiped some of her father's feces from the side of her neck.

"We're going to get him transferred to surgery."

"Could you help me clean up first?"

"No, first I'm going to get a surgeon on the phone so we can get this taken care of, now."

I just yelled at a med student.

I don't yell at med students. I don't yell. Some people yell. There are a fair number of residents who yell. I've had some of those residents. I'm not saying I'm better or worse, I just don't have it in me. I don't like to be in a work environment where everyone is walking on eggshells. I don't want the people under me to hate me. I don't want to hate the people above me. I want things to be friendly and civil so that spending twelve hours a day here isn't torture. I've had very competent interns and med students who do good work, who make the job a lot easier, who are certainly better than I was at that point, and who I genuinely enjoy being around, despite the work. And I've had interns and med students who work slowly, or make mistakes, and the attending teaches and I teach and we make it work and try to figure out what's causing the problem. And there's no need to yell. Everyone's trying, yelling won't accomplish anything. Even my med student who was making dental appointments in the middle of the day and telling me he had to leave in the middle of a rapid response-- we had a conversation, I tried to explain he needs to take on more responsibility-- I didn't yell.

Until today.

I don't know if this guy is taking lessons from the patient's wife who I wrote about in the last post, or what-- because it's pretty much the same story, only worse because this is a soon-to-be-doctor.

We have a patient who's not eating-- can't eat. It's not useful to explain any details, but it's a malnourished patient who needs to be eating and can't eat, and we're trying to nourish her in other ways but she's rapidly destabilizing. We had to move her to the ICU. We happened to move her right as they were coming around with the dinner trays. We get her out of her room, and my med student turns to me and says:

"I could probably steal her fruit cup, right?"

Then, off my look: "What? Too soon?" he says.

And I grabbed him. Okay, I probably didn't actually grab him, but I made it clear that he should follow me. And I took him into the stairwell, because we don't have private spaces, because we're prisoners, forced to be here for what feels like days at a time.

"This patient might die."

"Oh, I was just trying to make a joke--"

"Yeah. This patient might die. Do you understand that? We just moved this patient to the ICU because this patient might die. This patient, who we are supposed to keep alive, might die. Today. She might die today. And you're making a joke about her fruit cup?"

"I'm sorry. I--"

"I don't care. There is nothing you can say to justify it."

And I left him in the stairwell to deal with himself. Look, I don't know if I'm a hypocrite. There are patients who say stupid things, there are patients who are frustrating to deal with, there are families that are frustrating to deal with, we all cope in different ways. I'm not one to talk, given this blog. We sit in the call room and talk about the patients, we sit in clinic and talk about the patients, stories get around, not everything that is said is appropriate. But hopefully there is a difference, and there's a line. Death is real. You come in and complain about a "new cough" you then say you've had for the past thirty-three years, making a joke about that in the call room is one thing. But you watch us wheel out a patient who's clinging to life and may not survive the day-- and then you want to make a joke about *that*? I hope there's a difference. I think there's a difference.

Hard day. We lost a patient I'd come to really feel connected to. It's not that it was completely unexpected, but it was unexpected it would happen in the hospital, and certainly that it would happen today. We wanted to get him home. We thought we were going to be able to get him home, and we couldn't. Too many issues, one on top of the next, and it all went downhill very quickly. I'm beating myself up over things I could have done differently, but intellectually I know it was a losing battle, I know that even in a best-case scenario it was a difference of days, and maybe not even. I'm not cut out for inpatient care. It's one thing to know a patient is dying, or to know a patient has died. It's another thing to quite literally watch them die. To see the numbers on the monitor, to see the patient's pH dropping, to see the patient's very last breath.

As they wheeled him out of the room, I overheard the wife of the man in the other bed talking to her husband.

"They're moving him out. Now you'll get the window."

In a comment on the last post, someone asked about my personal life. I could give the party line about how it's one thing when it's 6 days a week and 10 hours a day, it's another thing when it's 6 days a week and 14 hours a day, and that there's no way anyone who's not already married can have a personal life-- and even the ones who are married, there are more than a couple of rumors of assorted kinds of trouble.

But the truth is, there's time if you make time. And I don't make time. And I should make time. But I don't make time. Look, fortunately no one asks about my personal life, no one asks about anyone's personal life, and if you don't bring it up, no one's going to question you about it except for this one resident who keeps trying to match people up, but unfortunately she hasn't gotten around to asking me yet and I'm not quite bold enough to say I'd sort of like her help.

Hey, a beacon of light from today's New York Times. Hard to feel bad about the work you do when you read stuff like this. An article (link here) about a psychiatrist who has stopped providing talk therapy because insurance companies won't pay enough, and now all he does is 15-minute visits to write prescriptions for meds.

It's an appalling article, not so much because the doctor feels conflicted about the limited service he's able to provide in order to make a living-- but because he doesn't really seem to be very conflicted at all. At least he's aware that he's turned his practice into a medication mill. His wife (and office manager) seems to lack any compassion or self-awareness entirely, if her quotes are representative.

Some bits from the piece:

"He now resists helping patients to manage their lives better. “I had to train myself not to get too interested in their problems,”"

He could have accepted less money and could have provided time to patients even when insurers did not pay, but, he said, “I want to retire with the lifestyle that my wife and I have been living for the last 40 years.”

[Y]ears ago, he often saw patients 10 or more times before arriving at a diagnosis. Now, he makes that decision in the first 45-minute visit. “You have to have a diagnosis to get paid,” he said with a shrug. “I play the game.”

“The sad thing is that I’m very important to them, but I barely know them,” he said.

I get some of this is necessary-- or at least necessary if you want to make as much money as you can-- but at least feel ashamed of yourself, right? Being a doctor isn't the same as being a guy who pushes paper in an office, it just isn't. You can't process a patient the same way you can process a tax return. Yes, there are things about the system that suck. And residents are sheltered from the concerns of insurance companies and reimbursement. But how can you not feel profoundly ashamed of yourself to be a psychiatrist who refuses to listen to his patient's problems and won't even try to squeeze someone in when they're having an emergency?

If you want to be rich, be a specialist. Perform procedures. Align your practice with the kinds of work that insurance companies pay for. This way you can serve your patients and at the same time make the kind of money you want to make. But I don't think it's fair to your patients to become a psychiatrist and then decide that the competent practice of psychiatry won't make you rich enough, so you have to cut corners.

Maybe this is a naive reaction to the article. I mean, I feel like I'm usually inclined to sympathize in the other direction and then deal with commenters who say I'm proof that doctors are terrible. So if I'm feeling like this guy is a joke... I'm guessing you have words even harsher in mind.

My biggest question though-- why did he agree to this interview? Can anyone possibly read this article and think, hey, I want *THIS GUY* to be my doctor! It's like he's *TRYING* to sabotage his practice!

Enough from me. Read the piece. Tell me what you think.

Oh, and while I'm at it-- I threw that Facebook "Like" button up on the right-hand column of the blog a while back and can't tell if anyone has ever clicked on it. If you like the blog, do me a favor and click on the button if you don't mind. I don't know quite what it does, but I figure it might be neat to find out. Thanks.

Rapid response this morning on one of my patients.

The son comes running out of the room.

"My father's turning blue."

And, sure enough, his oxygen saturation is way down, he's literally turning blue...

"What happened?"

"Nothing. I just gave him a piece of my cookie."

"Your father can't swallow."

"I just thought he'd want some cookie."

"He has a feeding tube."

"He seemed hungry."

"He has a feeding tube and can't swallow. He's choking on the cookie."

"Can't you fix it?"

"We're trying."

And so we're working to dislodge the cookie... and we're working, as the guy's father is literally turning blue...

The son's phone rings. He takes the call (!) and then turns to me.

"Yeah, I'm really sorry, but that was my ride. I have to go."

"Your father--"

"Yeah, I hope you can save him. But I really have to go before my ride leaves."

And he leaves.

We got his father stable again, fortunately, but, uh -- what????

Loyal readers will note this is not the first patient who couldn't swallow who's been fed food by family members. Hey, you know what? If your family member can't swallow, don't feed them anything. Better yet, don't feed them anything, period. I'm not saying the hospital food is awesome, but the hospital food is (hopefully) what they're supposed to be eating, with the right consistency, the right amount of salt, etc. Liquids-only, purees, whatever some doctor has said they need. Your cookie, not on the list. Ask a doctor first.

I just made a new video. I am sort of embarrassed by it, but I am just trying to have some fun. What if Charlie Sheen visited my clinic? Enjoy.

Elderly patient comes in after falling at home. In the course of admitting him, we check his labs, and some of the values are way off. We ask about his medication, to make sure he's been taking it, he says his wife's in charge of that. We talk to the wife, she says she's on top of it, he never misses a pill. Okay. Wife is taking notes, very involved in her husband's care, they live on their own, lovely couple.

Fast forward two days to today. They've been model patients. The wife has repeated a couple of stories she's told me, but I'm not thinking much of it. They're delightful.

Her husband's doing well. We're thinking about discharging him. I go in to talk to them. The wife gives me a blank look.

"I'm sorry, have we met?"

"Uh, yes, I'm Dr. Whoever, we've talked a few times since your husband came in."

"I don't remember you."

I turn to the husband. "You remember me, right?"

"Sure I do."

Okay. So the husband can't physically take care of himself, and the wife-- who's in charge of his medication, and I presume in charge of everything else-- seems more and more like she may have some kind of dementia. And so I'm not sure I still believe he's been taking all of his medication.

Sort of a dilemma though. Because she's not the patient.

We can't feel good about discharging him to go home to a situation where one of them is physically capable and one of them is mentally capable, and it's not the same one. But we can't keep someone a prisoner... we can try and get the family to help, we can get a visiting nurse to make home visits and manage the medication... we can call social work and hope they help but, I don't know, it's a hard situation and I don't know that there are any good answers.