(Dis)Comfort Measures

November 10, 2014

Close to midnight and Tonya is somnolent, lying on an emergency department (ED) stretcher and not in her own bed at home. The change in location alters the fairy tale quality of the word somnolent from sleepy or drowsy to one that’s more sinister and worrisome. Especially when Tonya is dying of brain cancer, a single mother of thirty-four, a hospice patient now situated in the ED; a space powered by a rescue instinct when faced with a patient with rapid breathing and a sinking blood pressure.

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A Doctor Points a Finger at Himself

October 27, 2014

It is time that we had a frank discussion about rectal exams. Just so there is no confusion here, I am referring to the act where a physician inserts his or her index finger into a patient’s anus and rectum and gleans a piece of clinical data that will be used in the care of said patient. This tidbit of information may be the palpation of the prostate, a search for a rectal tumor, a test of anal neurologic function or to test for bleeding. In my practice a rectal exam is as essential to the care of my patients as listening to the heart. As a patient myself, however, with a looming physical exam by a new primary care doctor, I am apprehensive about its role in my care. But can I put my trust in a doctor who is so cursory as to omit the rectal exam? Suddenly this disconnect between my role as a doctor and my role as a patient is headed for an existential collision!

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Side Effects of Sleep: The Perils of Treating Chronic Intoxicants in the ED

October 2, 2014

The glass doors to the emergency department (ED) part, and in rolls Mr. W, who was discharged only hours before. “Guess who’s back?” remarks EMS (Emergency Medical Services). It’s Mr. W’s third visit in the last twenty four hours, his sixth visit in two days, all for the same chief complaint: ‘alcohol intoxication.’  In the first half or 2014 alone, his list of ED visits fills three computer screens. He’s homeless and chronically intoxicated, and yet, his drunkenness works as an acute medical problem worthy of EMS transport.

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