Survival of the Fittest

November 19, 2015

An observation that I and many of my emergency medicine colleagues have made about vacations: we need them. We need them for wellness, to recharge, to recover. Great saves, terrible tragedies, we witness it all and it can wear on you. Unfortunately, when vacation plans are made, it is not uncommon to find oneself working even more shifts before the break to offset our absence on the schedule, making the time away absolutely critical by the time it rolls around.

And so after ten shifts in thirteen days, I find myself exhausted, unprepared, nervous, on a hot, humid bus that is supposed to be taking us to the dock but instead slows unexpectedly. A land iguana, a golden brown ancient dinosaur, creeps off of the road into the side brush. Piling off the bus, we are directed toward a concrete platform adorned with huge lounging marine iguanas. I gather my belongings and catch myself from stumbling, nearly stepping on an iguana’s whiplike tail that seems to have appeared right next to me. It spits salt water at me in retaliation but does not move. Sally lightfoots scuttle along the jagged shore, red as the lava the rocks once were. When I ask which boat is ours, I am interrupted by shouts of “Blue footed boobie!” causing me to forget the question I just asked. This is the first hour in the Galapagos.

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Physician (un)Wellness and the Passion Paradox

July 23, 2015

When it comes to physician wellness, I’m type A noncompliant. That realization struck me midway through my last vacation, which was notable because I didn’t travel anywhere, and the most extraordinary activity involved sleeping through the night.

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It’s Time for a Tune-Up

May 19, 2015

If I’m to take fashion advice from Maureen Dowd’s March 3 column, “Stroke of Fate,” a take-down of emergency medicine disguised as a recovery narrative of her niece, then I should exchange my white coat for grease-stained overalls.

In her column, a Harvard neurology professor who specializes in stroke describes the brain as the Rolls-Royce of the human body. When it comes to acute stroke care, he is quoted as saying, “would you run your Rolls-Royce into the local gas station?”

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Train Wreck

May 5, 2015

I run down the tracks between metal rails that converge on my goal, a distant pile of wreckage, barely visible. Nothing moves around me. On either side the flat grasslands of North Dakota lie broken only by a lone oil pumpjack, like a huge skeletal bird at the horizon. I am diminished by the sky. Behind me the massive passenger train idles, arrested suddenly on its westward pursuit. I can just make out the shape of a crumpled truck lying half off the track where a country road crosses. “I think it’s bad,” the conductor had said. I expect to find a crushed body in the twisted metal.

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Have You Hugged Your EMR, Lately?

April 21, 2015

Seeking to provide balanced discourse and to recognize marginalized voices at the gooey center of healthcare, I kindly ask that you find a seat in the Captain’s Room of the Hilltop Motor Lodge for the inaugural meeting of Physicians for the Liberty of the Electronic Health Record, where founder and president Dr. IM Klickhffor starts the proceedings with this plenary talk.

Thank you, thank you. Many of you are using this weekend to catch up on your charting. To raise your hands from the keyboard and clap so generously fills my heart with a JOY template. This weekend wouldn’t be possible without the generosity of the IT companies crowding the exhibit hall, the motel gym, and the less humid corners of the indoor pool. But any conflicts of interest on my part are entangled more with the contradictions that make us human.

Why are we here? I’d argue it’s because medicine is in desperate need of a new orderset, and it’s called EMRpathy. Physicians must value electronic medical records, EMRs, and the larger enterprise of electronic health records, because they possess intrinsic worth. This complex, vulnerable and sensitive software shouldn’t be tolerated for their financial incentives and then insulted for destroying the doctor-patient relationship.

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Confessions of a would-be nocturnist

February 19, 2015

“Hope it’s not too busy.”

I smile and kiss my well-meaning husband goodbye, the man who has just cursed my night.

In fact, I was swamped all night. It was the equivalent of the “Q word.” First rule of the emergency department: never talk about how “quiet” it is. We all know too well Newton’s law of the ED: for every moment of calm, there is an equal and opposite hellfire of activity. Straight out of Field of Dreams, if you acknowledge it, they will come.

I have been working nights for one year now, full time. To be fair, it was at my own suggestion, borne from a need to stabilize my schedule with a nursing baby at home and two more kids in school. If I work nights, I reasoned, I can set my schedule, make dinner, go to school functions, have regular date nights with my husband, and see my children every single day! In short, I can do it all! Never mind one small but critical detail — I have to stay up all night to do so.

I have a confession: working nights has made me a little crazy.

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The Red Circle: Sex and Gender Make Center Stage

February 12, 2015

“Male cells?”

I stood on that red circle at a recent TEDx Providence event Sex Matters in a Medical Emergency and noticed the faces in the audience transform into looks of shock and wonder. They truly did not realize that medicine, science and research have been based upon the male model. That human research subjects are men, animal research is performed using male mice, and even molecular studies are conducted on male cell lines. One hundred years of insight and knowledge gained by experimenting on men has been applied to both men and women.

In fact, the assumption was that if you set aside obvious differences in reproductive systems, men and women were nearly identical. As a result of this, women’s health began to be defined by breast and gynecological health. This “Bikini Medicine” view seemed status quo until the past decade as more and more questions kept being raised. Why are so many FDA approved medications withdrawn from the market due to unacceptable side effects on women and not men? Why are women more likely than men to develop unusual fatigue and shortness of breath when having a heart attack? The lack of data on women perpetuated the convenient principle that men and women were the same. An informational vortex of mounting evidence that ultimately led us astray.

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The leaf blower/CT scan quandary

December 14, 2014

To critics who admonish emergency physicians like myself for our excessive use of CT scans, I’ll ask them to consider the leaf blower. I’m sipping my morning coffee on our front porch, a bright, idyllic autumn day in New England, the tranquility ripped apart by the landscapers across the street. For many jobs, a powerful leaf blower might prove superior to a rake or broom. But in my neighborhood known for smaller yards, the humble rake and broom would work as well, if not better.

I’m not a leaf blower person. Raking my yard takes hours. It leaves my muscles knotted and hands calloused. Not so the speedy landscapers, nonchalant with technology strapped to their backs. Laughing and screaming over noise that assaults my eardrums, they bully grass clippings and leaves into a dancing cloud that swirls onto the street, often finding refuge on my lawn.

Why should the status of lawn detritus, or my serene coffee moment, concern them? They’re responsible for my neighbor’s lawn, not the yards nearby. And if leaf blowers improve the speed and perhaps the quality of their work, why wouldn’t they take advantage of the opportunity? Imagine the following argument from a landscaper-philosopher: “What is a leaf blower anyway but a push of air, like a strong wind? You have a problem with the wind?”

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Duly Noted

December 8, 2014

If Kurt Vonnegut had been a physician, would his phrase “and so it goes” have ended each section of his clinic notes? Would a patient history written by Charles Dickens wax poetic and verbose over the orphan’s plight, no matter what the patient’s chief complaint? Perhaps Ernest Hemingway’s charting would be spare with impeccable narrative development.

No, they would have wanted nothing to do with medical documentation—bastard child of the biography and the legal brief. Like the physicians who author them, medical notes are hobbled by too many conflicting functions, both banal and profound. Yet they also reflect a physician’s voice, and, under the technical jargon, a story always hides. Read the rest of this entry »

In This Life

November 24, 2014

“Mom!  Mohhhhmmm!  MAMA!”

I’m on a deadline. I work the overnight shift tonight. And I’m presenting M&M at our staff meeting first thing in the morning. My powerpoint is nearly finished.

“WHAT, honey?”

“Well . . . what are you doing?” He’s rocking his head back and forth, something he has done out of comfort since he was a baby.

“I’m working on a presentation for work.”

“What’s it about?”

“It’s about a man who was very sick. He died. He had a heart attack. I have to talk about it with the other doctors.”

His head stops rocking. Maybe I shouldn’t have told him he died. Have I ever explained a heart attack? He looks into my face. Here it comes. How do I explain this to a six year old?

“Was he very special to the world?”

My breath catches. Read the rest of this entry »