Kari’s feet on a kayak in Halong Bay, Vietnam. Photo taken 5/16/16.
Several months ago, Gary came to my hospital complaining of weakness. Gary was 72 years old, so weakness was a pretty common complaint in his age population. While lying in bed, Gary told me that this morning he could not move his feet. Since then, the weakness has gotten progressively worse and traveled up both his legs. At presentation, Gary said that he could not even lift either of his arms or legs. I lifted up one of his legs, and let it go. The leg dropped like a dead weight. In addition, Gary said he recently got over a cold. Gary also told me he had a similar illness over ten years ago. He said at the time he was hospitalized for 3 weeks with over 10 days connected to a breathing machine. Essentially, what he had ten years ago was the same as what he had at presentation.
A couple of months ago, this short 70-year-old Chinese lady with a 6cm lump on the corner of her left jaw sat across from me and the attending. Sue was here for follow-up after completing her radiation treatment. Sue has a rare cancer of her salivary glands. The cancer invaded her jaw, so we couldn’t simply take out the cancer. Therefore, we had to treat her with radiation to decrease the size of the tumor so she can go to surgery.
In the emergency department, I saw a 52-year-old female that was here for a flare up of her systemic lupus erythematosis (SLE). Let’s call her “Lupe.” So Lupe has been in and out of the hospital for the past several years for different reasons. One time it was for severe back pain. Another time was low energy from anemia. The most recent time was for acute lupus nephritis (kidney failure) which required for her to start hemodialysis every other day (hemodialysis is a method of purifying the blood when the kidneys aren’t working properly).
Lupe was here this time for a lot of critical lab values found on her blood work – a poor sign for those with kidney failure. SLE is a devastating disease, and it can affect almost everything in the body. If kidney failure is one of them, it’s usually a poor prognosis. I felt sorry for Lupe because she was so crippled from this menacing illness.
On my last day on the ICU rotation block, one of the patients went into an irregular heart rhythm called ventricular tachycardia. He was a 60-something year old guy with multiple medical problems and connected to a breathing machine. All of a sudden, he became unresponsive and hypotensive and had a heart rate of 150+ beats per minute. As we all rushed into the room, we systematically ran through the ACLS algorithm. We initially evaluated him, checked for pulses, started CPR, established the airway, monitored blood pressure, identified the rhythm, and gave a dose of treatment. We repeated the process until the patient was stable. It was efficient, it was effective, and most importantly it was routine. It was a checklist that was used around the world and saved many lives.
Surprisingly, in my past month in the intensive care unit (ICU), I spent more than half the time talking to family members about goals of care. In a previous post, my attending had a great quote about survival in the ICU. If one-third of your patients survive the ICU stay, you’re doing hall of fame work. So if only one-third of patients are surviving on a good day, then why am I spending most of my time speaking to families about goals of care? Shouldn’t I be spending more time treating the patients?
The other week, I had an 18-year-old guy who came in unresponsive after overdosing on Xanax and Tylenol. We stabilized the patient, and when he woke up, I asked him why he did it. He told me that he was just doing some dumb stuff with friends. However, when I asked the father later, he told me his son has been more depressed lately and attempted suicide just last month by cutting his wrists. They didn’t seek help at the time for a variety of personal reasons, and it’s fortunate that the patient’s suicide attempt failed the second time. Fortunately, I haven’t seen a lot cases like this at my hospital, but still, he was so young. The patient had so much to live for.
Sunset in 2012 from my medical school campus, St. George’s University.
In the ICU, we had to perform a bronchoscopy on a patient to rule out excessive bleeding in the lung. It might have been my attending who was in a good mood or the fact that I was just sitting at the computer responding to WordPress comments, but whatever it was, he asked me to do the bronchoscopy. For those of you who don’t know, a bronchoscopy is a procedure where you take this thin tube with a camera at the end of it to visualize the inside of someone’s airways. The procedure looks like this. Gross, I know. I’m not much of a procedure person, but as I was standing there holding the scope in my hand and looking down this guy’s trachea, I came to a realization. Bronchoscopy is a type of endoscopy, and endoscopy means to look inside.
One of the greatest assets of the human race as a whole is our ability to communicate with each other. This ability allows us to exchange great ideas, solve difficult problems, and express various amounts of emotion. In this post, I’m going to talk about how to communicate and a 5 step formula on how to win others to your way of thinking.
Thanksgiving is my favorite holiday. Although it’s once a year, we should be giving thanks everyday. Why? In this post, I will share with you why being grateful can change your life. Also, I’ll give you four ways on how to be grateful right now.
Sunset view from my apartment in Grenada during Thanksgiving