“there is nothing pseudo about a pseudoaneurysm except that it is not actually an aneurysm.”
i know a bit about ballistics. it's more practical knowledge. i've seen enough gunshot wounds to pick up something here and there. the high velocity ones wreak havoc inside. the more usual 9mm doesn't compare but a well placed shot is still devastating. and then you get the exceptions. ricochet shots can be confusing. they tend to take strange paths through the body, sometimes following dissection planes (like surgeons) and causing less damage than you'd expect. and then you get the tumbler……….
……….Ruminating on the case, I became enlightened as to how the "new math" is done in Gaza. I'm reminded of Milo Minderbinder, a character from my favorite book "Catch-22." The character is a mess officer during WW II who turns the war into a lucrative business. He buys eggs at a high price and sells at a low price and still manages to make a profit in a dizzying transfer of goods all over the Mediterranean. This Gazan did the same thing, except with his life……….
Bongi recently had a post about an experience getting stuck by a needle while operating on an HIV positive patient. It reminded me of a time during my residency I had forgotten………. There was something powerfully existential and substantive about it all. Rarely do we visit those dark places of the soul where our ultimate weaknesses are exposed. Rarely do we acknowledge our ineluctable mortality. It's too much. It throws us off our fragile equilibrium. There's too much to do in the here and now. But the time will come for all of us. The day of reckoning is unavoidable……….
Whenever a patient says that my wariness increases a bit. It's doctor-superstition, I suppose, but it's been said that when patients have a feeling they're going to die, it's because...they're going to die. But I was hoping this was just her extreme nervousness talking rather than an actual sense of impending doom.
Normally, getting asked to do an intubation in the ICU is one of the most satisfying parts of my job. I feel like I'm being asked for help….. and the task is potentially life-saving. …..But this one made me terribly sad…………We felt our hands were tied.Chris and Drew, Pallimed, have written a nice post -- "Brain Death 40 years on"
Bruce, Reflections in a Head Mirror, writes two thoughtful posts. The first speaks to the "interval between the biopsy and the report".My leading candidate for headline of the decade is "Are You Brain Dead? Depends on the Hospital." It is from a news article reporting on a study in Neurology (one of the few studies in the entire medical oeuve of 2008 that we have not blogged on)………But variations in the definitions and use of "brain death" in an era of increasing demands for organ donation raise important ethical, legal, and practical questions. Last year Christian briefly blogged on organ donation after cardiac death. According to the Economist.com article, cardiac-dead donors is the fastest growing proportion of donors……..
There is a time of limbo in Medicine that begins when the procedure is completed and ends when the patient learns the results. It occurs millions of times each year after everything from major surgeries to blood tests. Although it was not the point of her essay this week in The New York Times, Dr. Paula Chen touched on these moments as a friend's father waited for the results of a pancreatic biopsy.Dr Pauline Chen writes about The Dance Before the Diagnosis and says “The diagnosis was in their body language.” Also, check out her blog here.
Bruce’s second post addresses the "naked truth about tonsil cancer".
“Doctor, I should not have cancer! I never smoked! I am only 45 years old! It doesn’t make sense!” The patient and his wife sit stunned and frightened.Also check out this NY Times article transplant surgeon Dr Pauline Chen wrote (via Kevin MD) – The Choices Patients Make.
My new patient is absolutely correct … he does not fit the traditional profile of patients with cancer of the tonsil.
There are certain choices patients make that I have never understood, choices that from my perspective as a doctor seem to undermine their very chances for survival. Or at least undermine the efforts doctors, nurses and even complete strangers make on their behalf. ………..
I asked Ms. Silverstein about how she had dealt with such pressure.
“There is no question that I am eternally and profoundly grateful for life and for my good fortune in receiving a donor heart just in the nick of time,” she responded. “But my heart transplant life is a mixed bag, a miracle with a flip side: a wonderful, awful, amazing, terrible existence.”
Then she added, “I have not lived a well day since my surgery — not one — and this is a difficult truth to bear. And sometimes, on the very rare occasion, it wears me down to the point of wondering if the illness and struggle are worth it.”…………
Prompted by Dr Val’s guest post at other things amanzi, i’m reminded of a story my surgical professor recently told us, during his tutorial on fluids and electrolytes management in surgical patients.Quite some time ago, a patient was in the hospital had a percutaneous endoscopic gastrostomy (PEG) tube in for some reason or other…………..
It didn’t make me any more enthusiastic that the picture I got from the chart before going into the room was of a patient seeking pain medication. Sure, she had a couple genuine chronic conditions with biopsy documentation of their existence; but she was on a lot of narcotics, plus some valium thrown in. She had been on disability for years, even before this most recent, serious problem cropped up.I was in for a surprise……….
"Did you reduce it?!"Also, check out this one in which Dr B states never -- not once until yesterday
"Reduce...? It looked less swollen and better, so I sent him home."
You've GOT to be kidding me. That is what I wanted to scream into the phone, but I kept my composure.
I am not proud. I am, in fact, rather ashamed. But the other emotions I feel are anger, distaste, and, quite frankly, dread.
I took the gentleman from this post to the OR last week... last Monday, to be exact……….
Driving a car is a lot like learning to be a surgeon. No matter what you might believe, you begin by being completely incompetent; neither driving nor surgery is intuitive. You learn incrementally and develop skills. You find out how to get out of jams and tight spots. You learn to anticipate what might happen and make adjustments. You develop the ability to to plan three or four steps ahead.
Like I said previously, I intended to keep track of my experiences this year, so it’s time to play catch up.I started the clerkship on June 30 and ended on September 19. I worked with several groups: pediatric surgery, ENT (ears, nose and throat = otolaryngology), the surgical consultation service (mostly hepatobiliary surgeries), and the dedicated hepatobiliary service……………….
After watching this surgery, I am CERTAIN I want to be a surgeon. It was amazing in so many ways. It requires high levels of visual and physiological knowledge, and a level of intricacy and skill that can only be gained through lots of experience and talent. You have to be able to know the human body on an instinctive level, using intuitive knowledge to navigate the viscera as if it were the back of your hand. Surgery is an AMAZING art and it seems to require the usage of the left and right brain, which I think is the best way to stimulate the mind. I love it because it's a high level skill set, which makes the field really special, it's not something everyone can do. I think I fit into this field because I'm a very visual-spatial thinker and it's a field really based on using that sort of talent to develop it into an expertise. The surgery was 4.5 hours, which felt like 30 minutes
scanman Med/Surg/Nursing-twits Check out this article and the accompanying videos for the technique of US-guided hydroreduction http://is.gd/3vVU 06:48 AM October 04, 2008 from twh
One of the peculiarities of the USFDA process during silicone implant reintroduction in 2006 was the labeling on the devices recommending routine MRI surveillance of implants for rupture. When you step back and look at the proceedings and "unique" American history with breast implants, you can see that this was more a political concession to the anti-implant activist lobby then evidence-based medicine.The FDA labeling currently suggests MRI's at 3 years post op and then every 2 years subsequently. It will be interesting with the coming form stable "gummy bear" implants whether or not this recommendation is still maintained………….
This is the story of how I ended up working as a medical photographer. It’s not a very long, but quite winding road, that turned out to come almost full circle.
MR guided focused ultrasound is truly a “Star Trek” level medical breakthrough. The first questions in my mind were: will insurance companies pay for such therapy? Can people actually have access to this technology? The answer to both, as you might expect, is “no.”
As you may recall I was lamenting on Monday about not getting any trauma or on call action. Here's how my other night went. Phone rings at 2150 hrs.
Would you like to assist on an ex-lap for blunt trauma?
Of course I would because that is what I live for.
We got a call this morning: a new liver for Annika.
That needs an exclamation point, but I'm too nervous.
Please please please keep her safe.
Please please please send peace to this donor family.
Karl Merk, 54, a German farmer, lost his arms six years ago in an accident involving a combine harvester.