Nothing to fear except …

As a medical professional there are probably quite a few things to fear. Fear of unjust malpractice suit, fear of a just malpractice suit, the possibility that you may be accidentally stuck by an infected needle are just a few of the big and yet routine concerns that are faced every day.

One issue that I had never given thought to was that your patient would overpower and choke you to death. I never knew that my fiancee was in this very situation with her patient. The patient had a couple pieces of bad luck, the first was that he had a multi-resistant bacterial infection and the second was he had multi-farction dementia. Because of infection this patient was in a special separated room with a closed door. The dementia part is reasonably clear, the multi-farction part simply means that it is brought on by a series of small strokes. This meant that over time this otherwise healthy 55 year old wouldn’t remember a thing but would remain fit as an ox.

My fiancee was trying to take blood when he woke up. It really wasn’t his fault that he was confused and in a strange surroundings, but his reaction was to reach out and start choking the medical student who was taking blood. Doctors do have a great knowledge of anatomy, pressure points and all that, yet that would not have saved her from a larger stronger opponent. The thing that did save her was that other medical personnel happened to come into the room at that instant.

The prisoner

He wasn’t actually dumb, well for a criminal. He was in court and to try and prevent or at least delay the inevitable sentence when he pretended to have a seizure. It turned out that this particular “alleged” criminal was an alcoholic and was in withdrawal – which can indeed be life threatening.

His seizures although astoundingly accurate were just simulated. Had they been witnessed by less experienced staff he might have been treated differently. This particular doctor recognized that it wasn’t genuine and simply told him to stop as he wasn’t really having seizure. She must have been pretty commanding as the patient did stop, well, for the rest of the day.

But if it worked once then it might work again, so the patient started to pretend to have more seizures the next day as well. This time he really threw himself into the role. While pretending to have another seizure he forced himself to fall out of the bed, but those beds are actually pretty tall and rather than risk actually hurting himself he did fall out of character. It is the little things such as holding onto the chair so he wouldn’t actually fall, or when asked to stop he would answer the questions of the nurse. This last one is actually a pretty big give away, when having a seizure you cannot have a conversation with anyone.

One of the patients guards was tired of being stuck at the hospital watching the patient so asked if it was possible to take him back to prison. The doctor was just as tired of this situation and called the prison doctor to see what types of facilities they had and would this patient be a problem. Both of them were quite relieved to find out that the this wouldn’t be a problem, and so came the “big” talk.

Doctor Diana told the patient that he should stop this nonsense as he was no longer in danger due to alcohol withdrawal and tomorrow he will be transferred out either to the prison hospital or simply back to prison. The patient must have really known his German law as the doctor was 100% correct there was no choice unless … he said he would kill himself which is exactly what he did in front of the doctor, nurse and prison guard.

This did bring up a new dilemma, as if a patient is actually a threat to himself the rules change slightly. The hospital psychologist was summoned and confirmed that he was actually serious. Yet this was one situation that the prison hospital was prepared for. The patient probably ended up in a very very plain padded cell, which they actually do have in prison.

Helicopter weather

Frankfurt has some small mountains nearby, the Taunus, which are not quite skiing quality but do have a number of narrow and winding roads. A “Helicopter weather” day is one of the first nice Saturday or Sunday after winter. The reason for the name is because a lot of motorcyclists jump on their motorcycle and rush to the hills and inevitably some of them have accidents. Due to the nature of the accident and their location the quickest way get them to medical attention is with the emergency helicopter.

Some people feel they must be in charge if they are know what they are doing or not.

Emergency, get in here

The patient was laying there with the doctor at his head while they were trying to resuscitate him. Imagine the doctor’s surprise when the anesthesiologist burst into the room and pushed him away. Normally the person who is at the patients head is in charge, they coordinate the process and normally it is the doctor. It isn’t important who is at the head of the patient but whoever is must coordinate the rest of the team working on the patient.

Obviously when trying to resuscitate a patient you need to know some little things like what does the pulse look like and is he breathing. Denise, well that’s Dr. Denise, came in and was surprised to see the room was full people so this patient probably receiving grade A care.

No, that isn’t what Denise was thinking. Essentially the room was full of people who were doing the medical equivalent of picking their nose. How can we be so sure that that the level of care was somewhat less top notch? Well, the patient didn’t have a EKG monitor connected to him, which makes it difficult to know when you should stop massaging the chest, so Denise asked that a monitor be brought in.

Yup that is a very serious thing but in this case it wasn’t such a problem as it didn’t take more than a few seconds to see that the patient was breathing as well. It was probably the worse resuscitation ever. The anesthesiologist didn’t do his job, the other medical people also didn’t know what equipment would be needed nor what should be done.

Old time medicine

There are certainly some “old fashioned” medical techniques that never should have been done. If you don’t believe me just ask some of the patients from the middle ages who found out that a “good bleeding” would solve virtually every problem from a headache to a fever.

However, it was a long long time ago that blood-letting was in favor as a medical solution. I was a bit surprised to hear that there are other methods that might fall more into the old wives tales category that were (or are) still being used today.

I was speaking with a colleague who told me that when he was young he had an ulcer treated in a rather unusual way. The solution he used was that he drink vodka but vodka that had been treated so it should not be drunk. How was it treated? Kerosene was added to ensure it was used for its intended cleaning purpose not for extra curricular consumption.

Well, apparently this does make you sick and your stomach hurts but then his ulcer was gone. I am a bit skeptical about that one but he did have one other piece of medical advice for me. I came into work with a red bloodshot eye, which my doctor told me was a viral infection – ie. nothing that can be done about it. My colleague suggested that I boil up some water and brew a cup of tea and when it was cool to then put a few drops into my eye.

My doctor was not exactly horrified but did suggest that in that situation I could take the tea bag from my tea and once it was cold I could put it on my closed eye. The two solutions don’t sound too terribly different nor all that desirable. In the end I just suffered through it and decided I wouldn’t be adding any black tea to my eye or drinking any denatured alcohol.

Its a bird, its a plane its a …

The patient came in complaining of abdominal pains whenever he ate. Just like a certain class of patient he did find a work around for this problem as opposed to seeking medical help. It turned out that if he ate yogurt he would would not have any or many pains.

Yet, treating the symptom as opposed to the problem usually never works long term nor did it work in this case. The reason the patient was in front of Dr. Diana was because even eating yogurt was now giving him abdominal pains. So the patient was sent down to ultrasound to see what if anything was obviously the matter.

With modern technology is it is possible to find out the sex of a fetus which seems to me to be a modern miracle. In this case, the problem was actually much easier to diagnose. The patient was a recovering drug addict and it seems that a few months back, say about nine, he lost part of his dentures.

Oddly enough, he didn’t seem to wonder where they went.

It’s a spreadsheet

I was speaking to a doctor friend of mine who was complaining that their server at work was getting full and was curious what IT was planing on doing about it. He was afraid to mention this to the IT department as he was expecting the answer to be something similar to “delete all of your non-patient related files”.

I was a bit curious, what patient related files that they were talking about. I am used to big banks with large databases that are jammed packed full of customer data. I was more surprised at how the data was being stored.

Each day a graph was generated from another system and saved into an excel spreadsheet for that patient for that day. Of course there were other pieces of patient data that could actually be entered into the sheet as well. What was more surprising was the standard procedure was to take the patient’s sheet from the previous day and copy it with a new name for today and then insert the new graph.

You don’t have what?

I actually remember my first conversation about email, it was in 1989 and it was with a friend who was working at the university. I thought that it sounded really cool, but that could have been the beer talking as I was learning about this technology in the bar. My first company didn’t have this technology but of course the second one did and it was popular enough that I could actually send an email back home to the folks.

In the intervening years email has gotten a bit of a bad reputation due to the spam that inevitably jumped on the bandwagon. Other neat technologies that have since followed was the rise of the Internet, the ability to make phone calls over the Internet and well the ability to use the Internet on your cell phone.

The thing that I barely understand is that a hospital in this day and age without some of these fabulous technologies. It turns out that my wife’s hospital doesn’t have email and apparently part of the reason for this is due to the stubbornness of the doctors who work there. The hospital did want to offer this as a method for some forms of communication but there was a teeny tiny hook. If we give you email you must promise to read it every day.

When I was told that it took a minute for that to sink in, well of course I would read it each day. I would most likely grab a cup of coffee and sit at my computer and read my mail. Well, actually that is what happens in my world, but in this hospital not only don’t the doctors have their own desk, they don’t have their own computer so this does add an extra dimension that I didn’t originally consider. Yet, I can almost imagine it. Each day after doing a certain activity I would go to the computer in one of the departments and read my mail. Not quite the productivity wonder but still it may help communicate with the other doctors but perhaps only a couple of times per day.

Yet, I guess I wasn’t really listening to my wife as when I explained how it might be a good thing she explained that every day meant every day of the year, even if it is a public holiday, even if you are on vacation in the Swiss Alps.

Well, once I heard that I did better understand why the doctor’s didn’t want to get email installed at the hospital. I was still focusing on this when I heard that not only don’t they have email they also don’t have access to the internet. I never asked for the rational behind that, I simply heard that all the doctors use their personal cell phone to “surf the web” if they have a need for something.

I am just glad that last time I went to the hospital with a sniffle they didn’t break out a small container of leeches to get rid of all the bad blood.

The tummy ache

It was Monday morning and I didn’t really want to get up and apparently neither did my son. He did mention that his tummy hurt but that was only briefly and then was ok. Later in the day we had to pick him up early from school.

He seemed fine but slightly less energetic than normal. I set him up on my bed and put in a dvd for him to watch. It was out of character that he fell asleep so when my wife, the doctor came up, she wanted to check out the patient. I watched and she was good, obviously the patient trusted mom, and after a few minutes he was pronounced just fine. It was my favorite diagnoses ever.

“He will be just fine. I have checked and he doesn’t have appendicitis”

Only an internal medicine doctor could conceive that a child with a tiny tummy ache could possibly be appendicitis.

Try it perhaps that will work

Maybe you have met someone whose is really smart but they tend to have a hard time getting their ideas across or perhaps they are just a bit inept in personal situations. Well, in this case there were three doctors who were discussing the situation of their patient. He was non-responsive and just staring into space. They kept trying to speak with him but did not get any response.

One of the doctors suggested that perhaps he only understands English and suggested to the head doctor that they try speaking to him in English as all three of them had very good English. The lead doctor agreed and his opening line was simply “Hello”.

What makes this funny is the specialist who suggested they discuss this in English continued to speak Spanish with her colleagues. The patient didn’t actually respond any better to English, but it was worth a try.

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