someone please explain this to me

here are two remarkably similar conversations i had yesterday:

#1)  woman with known coronary artery disease:

ms. angina:  i've been having chest pains for the last several weeks.
me (among other pertinent questions):  when did you last see your cardiologist?
ms. angina:  last week.
me:  did you mention that you were having chest pain?
ms. angina: no.


#2)  man with history of retinal hemorrhage

mr. bleed:  for the past few months, when i stand up after sitting for a long time, my left eye gets blurry and gray.
me:  have you seen the eye doctor about this?
mr. bleed:  i went last week but i didn't tell him about it.


i have a few theories about this phenomenon:

1)  to tell your cardiologist (or retinal specialist) that you are having chest pain (or blurred vision) is just making it too real.  you don't want to admit you may actually be having a serious issue.

2 ) you thought the don't ask, don't tell policy was really a brilliant piece of legislation (was that legislated?), so you thought you'd try applying it to all areas of your life.

3)  it's a conspiracy to thwart me.

i think terrible thoughts

a big part of getting our electronic health record up and running is data entry - past histories, medication lists, diagnostic lists, surgeries, and on and on. it is a massive project and i am doing most of it myself.  who else could decipher my handwriting? (sometimes even i can't figure out what i wrote.)  down the road, when these patients come back in, it will all be there waiting for me, neat and tidy, in the chart.  future visits will be easier.  that is what keeps me going.  so when i see my 94 year-old patient i think, what is the real return on my investment here?  i'm going to take the time to enter all this data and they might not stick around long enough for me to reap the benefits.  isn't that terrible?  i enter all the data anyway.  what can i say, i'm an optimist.

medical terminology repurposed

anal verge - this is when you are about to refold the towels that your husband just folded, but he did it wrong.  you are on the anal verge.  don't go there!

psoriasis - the look you give your sister or girlfriend when you want her to shut up.  girl, did you just  give me the psoriasis?

abscess - a verb that means to harbor bitter emotions.  don't abscess over that.  better to express yourself.

PEA (pulseless electrical activity) - the eerily quiet sound your hybrid makes at a stoplight.

uvula - okay, i can't think of anything for this word, but i still love to say it.  submissions are welcome!

my gray's anatomy moment

no, this is not a post about steamy call room sex, but i did have one exhilarating moment when, with only the right background music, it could have been a scene straight out of gray's anatomy.

i was on the nephrology consult service.  we were making our afternoon rounds, following up on labs and tests, and checking in on patients.  we came into the room of a young man who had had a biopsy of his transplanted kidney earlier that day.  he was lying quietly in his bed.  he looked a little pale.  actually he confessed, he was having  pain in his left side and it was gradually getting worse, is that normal?  as we helped him sit up to listen to his lungs, he fainted.

the kidney is a hard working but delicate organ, filtering up to two hundred quarts of blood each day, keeping the good and allowing the bad to pass through to the bladder as urine.  i think of it as one of those finely strung fishing nets, the fish stay in and the flotsam and jetsam pass through. or you could think of it as the person in the back of the goodwill, accepting all the donations then sorting through them, keeping the good stuff to display in the store and tossing the rest in the trash.  because the kidney is so richly vascular, a biopsy is a tricky thing.  passing a needle through some one's flank to take a sliver of kidney carries a real risk of hemorrhage.  and that is exactly what our young man was doing.

we miraculously had on the floor a handheld doppler, so we used it to confirm our suspicions.  somehow, as we were pressing the transducer against his abdomen, we realized that with the right amount of pressure in just the right place, he stopped bleeding.  that is where i came in.  we needed to get him to the OR quickly and with the least further blood loss possible.  i was the smallest one there, so i climbed onto his bed kneeling next to him and holding pressure against his abdomen as we rushed him and the whole giant entourage that had now formed to the OR.  we raced down the hall, my hair blowing back away from my face, my eyes bright with just the right mix of fear and determination.  okay i'm making that last part up about my hair and my eyes, but either way, it was quite a sight.  and more importantly, our patient did fine.

and who the heck are you?

every time i see one of my elderly patients, he comments that he can't believe i call him with his lab results.  he says, " i've been going to the doctor for 80 plus years and i've never had a doctor call me.  and then you say  'this is beth'  and for a minute i have absolutely no idea who the heck you are!'  (he also can't believe i use my first name.)

he wants to know why i make my own calls.  first of all, i don't make them all.  if your pap is normal or you don't have strep, someone else will call you. but mostly it will be me on the other end of the line with your results.  what i want to tell him is that it is because i love him, but that is too strange to say out loud.  so i tell him it is because he is my family.  he shakes his head and smiles and i know he is satisfied with my answer.

a peculiar work related misery

most of us have had a pimple in the hollow of our ear before. 
as a matter of fact, they can be quite sore.
but try putting your stethoscope repeatedly into that ear
as breath sounds and bowel sounds you are trying to hear
and you will want to shout, arrrgggghhhhh, i can't take this anymore! 

i believe this has something to do with the rotation of the earth...

despite the fact that the highest elevation around here is about eight feet above sea level, the bike ride i just went on was uphill the whole way.

on a brighter note, being so far from realizing my full physical potential means i have something to work toward.