Sunday, December 27, 2009

Best Christmas Ever

So, imagine that it's Christmas Eve. You're with your wife and 2 grown daughters. They don't live very far, and they've come over for brunch.

Your pager goes off.

Except that you're not a doctor. Or a fire fighter. You're a patient with end-stage liver disease and that pager means a new liver. You call the transplant coordinator, and she tells you that there's a local match. It's time to drive down to the Hospital and prepare for surgery. Good thing you hadn't eaten that brunch yet.

So, after approximately 10 hours of surgery, you got a new liver. It's nearly midnight and your family is in your ICU room. It'll be a few days before you're extubated, so you're going to miss Christmas.

Somehow, I don't think Mr. H will mind. He and his new liver and doing well. He's not out of the woods yet, but the first critical days are going by smoothly. Even though his memories of Christmas 2009 will be foggy at best, something tells me it'll go down as the best Christmas ever.

Thursday, December 24, 2009

"It's been a good experience"

I did some moonlighting today, so I saw some patients who aren't normally mine.

One is a 54-ish year old guy with newly diagnosed lymphoma. He's been in the hospital for a few weeks - he says he was a terrible mess when he came in, but he looks good now. He pointed out that I hadn't seen him back then but if I had it's night-and-day compared to now.

Right now, he's 20lb heavier from water weight - though he points out that he was up 40lbs a week or so ago, so it's improving. Right now, he's yellow. Right now, his liver and spleen are riddled with metastatic lesions, though some of the MDs comment that it's looking better. Right now, his white blood cell count is in the toilet, making him at high risk for infections. He quickly points out that he's not having fevers anymore, so that's an improvement.

Right now, his 27-year-old daughter is at home, having just flown in from DC where she works. She doesn't know how sick her dad is. He has gotten a few rounds of chemo and was deathly afraid of losing his hair. He's not vain, he just wants to ease his daughter into this diagnosis. His nightmare was having her walk through the door to see a yellow, swollen, bald man claiming to be her dad. He called Patient Relations a few days ago and asked them how he can get a hair cut. He wanted it to be short (but not shaved), in case he did start losing his hair. He figured it wouldn't look as bad if it was patchy and shorter.

Whaddya know - Patient Relations called up Al the barber. I didn't know we had a barber. Apparently, Al comes in and cuts hair for those patients who can't leave the hospital. Al's daughter was (is?) a nurse at the hospital and got started doing this awhile back. Al is 82. My patient said that Al did a great job with the tools in his little black satchel, jumping over IV tubing, ducking antibiotic bags, etc. He is really glad his hair hasn't started falling out yet (it might never), and he was extremely happy to have had Al come by.

Mr. T looked at me and said, "You know, it's been a good experience, being in here." I just looked at him - jaundiced, edematous, belly full of over sized organs. His prognosis is up in the air, mostly because his type of lymphoma is so rare there's not a lot of data on it. Mr. T looked at his wife, who smiled, and then looked back at me, "I know that must be weird to hear me say, but it's true. You, the nurses,'s been a good experience."

I wished him a merry Christmas with his daughter and complemented his hair cut. Then I left before I started to cry in front of him.

Tuesday, December 22, 2009

Merry Christmas! You have cancer.

So, Christmas time is great, except when you're sick. And except when you're taking care of the sick people. This past week has been full of not-fun things.

- I diagnosed someone with metastatic cancer
- I watched a family opt to turn off life support
- I told a daughter that grandma won't be able to leave the hospital in time to go on the family cruise
- I can't figure out why my lady with her second organ transplant is back in the ICU
- I handed a man his vomit bucket as he told me hasn't been able to eat in 17 days
- I got the autopsy results from a 33 year old patient, and I'm still not sure why he died

It's been full of little miracles, too, if I think about it.

- Mr. M took his first steps in the 6 weeks since his liver transplant
- Mr. L is going to make it home on Thursday, in time for Christmas with his wife
- Mr. H got his liver transplant a week ago and is sailing along
- Ms. O is home, even though she doesn't have a diagnosis yet
- Mr. K isn't having 18 bowel movements a day since the treatment finally started to work

I guess that's the way life is. Ebbs and flows. Ups and downs. Without one, how would you know the other? Without a low, how could you recognize (let alone appreciate) a high? So, I'll be thankful today for both the trials and the joys. I can learn from the trials, making the joys that much more exhilarating.

Tuesday, December 15, 2009


I was recently asked to talk about one of my favorite holiday memories. I have so many funny family stories. How to pick just one...

Perhaps one of the most memorable occurred about 15 years ago, when my youngest brother was about 10. Being the youngest, he was, of course, the most excited for Christmas. He also wanted to get up at the crack of dawn to open his gifts.

The other siblings and I were in our mid-teens. We loved Christmas, but we also loved sleep. You remember those teenage years when you couldn't sleep enough? That was all three of us. We all had our own room at this point. My other brother was in the basement. My sister and I were down the hall from each other upstairs. The little guy was across the hall from us.

Around 5am, the little guy comes in to my room. He shakes my shoulder until I wake up. He can barely keep his excited voice in a whisper as he tells me it's Christmas. With a sense of urgency, he tells me that it's time to get up and open our presents. "Is Brother up yet?" I ask, my eyes drifting close. He admits that no, Brother is not up yet. "Well, go get Brother, and when he's up, let me know. I'll come right down." The little guy goes skipping down the hall and down, down to the basement.

About 10 minutes later, he comes walking back in. I hear the patter of his feet and open my eyes. "So...?" He drops his arms down, leans on my bed and sighs with the weight of a hundred years. "Brother asked if you and Sister were awake, and when you were both downstairs he'd come up for presents." I just smiled. "Ok, so go get Sister, tell her to go downstairs. Then tell Brother to meet us. Then, come get me." I must have sounded convincing because he left for another round of trying to convince each of us to be the first to get up.

Sister caved first, probably because she was second she is easily worn down by whining. Brother and I held out for a long time, sending the little guy up and down 2 flights of stairs several times. By the time we both agreed to get up (it's probably only 6am at this point), the little guy had separated all of the presents into nice piles for each of us, arranged pillows and chairs near the stacks, and was grinning madly near his stash. Brother and I laughed as we realized we had sent him back and forth no less than 4 times. It was at this point that we learned that the little guy had been up since 4a and had watched an old VHS copy of Scrooged before coming to get us. Watching Scrooged became a yearly tradition for him, and I'm actually not sure if he's outgrown it yet...15 years later...

Tuesday, December 8, 2009

Can I get a liver?

I was recently consulted on a patient who developed acute liver failure of unknown etiology. He was fine until 3 weeks ago when he felt tired and achy. Then someone at the store told him his eyes looked yellow. Two weeks later he was transferred to our hospital because we do liver transplants. Infectious Diseases physicians are consulted to make sure the patient has no infectious contraindications to a transplant as well as to make sure they are on proper antibiotic prophylaxis pre-operatively.

This patient crashed fast. He was intubated, on continuous dialysis, on 2 medications to support his blood pressure, and his heart rate kept plummeting. We had done a bone marrow biopsy on him a few days earlier because his blood cell counts were a little off. As we waited for that result, and many other lab tests, to come back, we were supporting him in every way we could.

Yesterday morning, I was in his room in the ICU when the transplant surgery fellow came in. I've gotten to know him well, since we share a lot of the same patients. The nurse was also in the room. A few minutes later, the patient's wife and a priest came in. The 3 of us healthcare providers took a step back and let the priest pray over the patient. The surgeon's eyes never left the heart monitor, but his lips moved with the Lord's Prayer. The nurse watched the dialysis machine while she made the sign of the cross. I stood, hands folded, and alternated watching the priest and the ventilator.

Then, the priest and the wife left, and we all went back to examining the patient and talking about what we needed to do next. It was a very surreal moment, and it wasn't one that happens often. But, it was nice.

We later found out that the patient had an aggressive type of lymphoma, which rendered him "not a transplant candidate." He died shortly after.

Sunday, December 6, 2009

3 Years Later

I got this amazing email the other day. Before I go into it, I'll need to go back three years. My memory is a little foggy because of a) early onset dementia and b) the sheer number of patients I see in a given day/week/month. I don't always remember details about each of them. Except for Raphael*. Beautiful Raphael. But that's another story for another day.

(*not his real name, of course)

I was doing a rotation at one of the free clinics on the west side of town. I must have had a patient that I saw more than once in that month and that I connected with more than just the normal amount. I remember her name but not why I saw her. I remember she had a brother with leukemia (he was about 22 years old) who was in the hospital. She mentioned to me that his favorite show was House, MD and that he watched it faithfully even while in the hospital. I happened to know people on that show, and I mentioned that to the patient. She couldn't wait to tell her brother. I spoke with my friends and got a signed cast photo, which I then mailed to my patient's brother. I never heard from her again, but I didn't think anything of it. I moved on to another rotation and that's life.

Until this past week, when I got an email from her:
"It has been almost three years since we have communicated. I'm not sure you remember me, but I remember you for the beautiful things you did for me and my brother. I once asked you if you can get me the signatures of your friends who are actors from the show "House". I never got a chance to thank you, but thank you. Unfortunately my brother passed away in October of 2007. We got the news that he was getting close about a year before which was when you mailed us the pictures. My brother loved them! But it has been tough. I hope you can remember me, and not think that I completely forgot about what a thoughtful thing you did.
-M. P."

Wow, did that cause me to pause. It made my day, of course, but it also made me think about all the little things we do every day that someone else doesn't look at as being so "little." The cards we send, the candy bar we give, the CD we make. Those little extra gestures that really make a big impact on someone else. So, this week, I am going to be uber aware of the extra mile I can go for others because just maybe it'll be something that sticks with them forever.

Saturday, November 28, 2009

Three Ladies

I happen to have 3 female patients on my service right now who rock my world.

D is in her mid-thirties and has Down's Syndrome. Her intestine popped a hole in itself and she got a mad infection in her abdomen requiring surgery. She's doing quite well now, though it was touch-and-go for awhile there. She has slowly begun to trust me. Her mom is amazing; she's about mid-60s and is rarely away from D. The mom showed me some drawings D did recently (she is an avid artist). I told her I'd bring her in something of mine, so I sketched a little dog that looks like Muffy, her favorite stuffed animal who never leaves her side. D loved it and said she'll color it. She gave me a big smile and a high five.

Ms. O is close to 60 and has brain cancer. She has fought for 2 years and it recently recurred. Ms. O's younger sister is a saint. She has made the tough decision to not prolong Ms. O's suffering. Ms. O was having fevers to 105 with no identifiable source, so I attributed them to her brain cancer or recent seizures. A few days ago, I told Ms. O's sister that she is amazing for listening to her sister's wishes and making this hard decision. I told her that she shouldn't second guess herself, and that she needs to stay strong in this because that's what the patient wanted. She was tearful, but she thanked me. I hadn't seen the sister over the past few days (it was Thanksgiving), but I saw her today. She thanked me again for my kind words, and said she's at peace with everything now. Ms. O is even having periods of lucency where she tells her sister "thank you" and "I love you." The sister gave me a Starbucks gift card today and said, "Thank you again. Please, use this and think of us when you take a few minutes to yourself." I plan to take my own sister out for coffee with the card. I think Ms. O and her sister would like that.

K is also in her mid-30s, like D. K is a mystery because she seems to have a recurring illness. It's either reexposure to something leading to recurrent infection or a latent infection that comes up from time to time...or it's not infectious at all. It's a strange story, and one that I hope to figure out in the next few days. K and I hit it off, she's a great girl. She has a tattoo, and we got to talking about tattoos. She got hers with a few girlfriends - they all got the same one. She loves it and says she always will, "Because it meant so much to me when I got it." I told her that I was thinking of getting one, but I can't decide on something I'll want forever. She told me to just get one, because it will always be special to me. Today she was reading that book Push, which is what the movie Precious is based on. She said, "Just when you think you have it bad, you can just look at the person next to you." She has a great outlook on life, especially for someone who has been dealing with this recurrent mystery disease for 3 years. Then she said, "You know what? This world is filled with crazy."

She's right. This world is filled with Crazy. Once again, it takes a special patient to remind me to realize how blessed I am to not only survive amidst the Crazy but to flourish here. I love my job.

Friday, November 6, 2009


I have a difficult patient.

Ok, I have many difficult patients. Attendings like to give me the difficult patients. I'm not sure why, but I have a few theories. 1) I'm nice but firm. 2) I'm a girl. 3) I don't complain about it. I'm not sure which of those theories factors most into the equation, but the end result is that I have a lot of difficult patients.

The positive side to my patient panel is that I occasionally make a break-through with a patient. Almost always, my patients at least start to prefer seeing me as opposed to the other fellows (we don't always get to see our own patients, due to scheduling conflicts). So, even if they hate me, they hate me less than they hate the others! Ah, the simple victories.

I have a patient - Mr. S. Mr. S is HIV+ and in an electric wheelchair. I'm not sure why he's in a wheelchair, because he can walk. I haven't dug deep enough in his chart to figure out why he has chronic leg pain. Maybe from HIV neuropathy. Maybe from HIV-associated bone destruction of his hips. I'm not sure.

Mr. S is difficult because he has a lot of psychiatric issues as well as his chronic pain. He gets a lot of narcotics to deal with the pain. He also takes a lot of anti-depressants and other psych meds. As a results, he can be drowsy and not a great historian. He's also a little whiney and demands a lot of attention.

Mr. S has outfitted his wheelchair with solar panels. I had never asked him about the panels, because he was never my patient. Until now. About 3 months ago, he got moved to my patient panel (see the above 3 reasons as to why). So, half way through our appointment, I asked him, "Are those solar panels?"

Long story short, he went into how they work, what they do, etc. Smart guy. They don't power his wheelchair. Oh, no. They power his sound system. Yes. Yes, I said sound system. Mr. S always rolls with music. He has a receiver and speakers that are rigged to an MP3 player. You can always hear when he's arrived to clinic. This week, he entered to Green Day and waited with Jimi Hendrix. He always turns the music off when he comes into the see the MD, though.

Next, I asked him what kind of music he likes. He said all kinds, and he explained that his current MP3 player got run over by his wheelchair, but still seemed to work. Mr. S actually got run over by a car a few days prior, but he still seemed to work, too. Fractured ankle, but doing ok.

He pushed play, and Tupac filled the room, singing about California Love. My favorite. So, I did the rest of his physical exam with Tupac jammin'. At that point I came to a conclusion:

All patients should come with a soundtrack.

Monday, November 2, 2009

Fellow Fellows

I just got back from Philadelphia and an IDSA conference. Nerdy ID docs from around the world come and listen to hours and hours of lectures about their favorite diseases. It was awesome. Really. I had a great time.

I really enjoyed Philadelphia, much to my surprise. I'm not sure why I was surprised. I didn't know much about Philly before I got there. I thought it was going to be dirty and run down. Not so. It was super cute! Lots to do and see. I could see myself living there. It's close to DC... And we all know how much I love DC.

The other pleasant surprise was how well my fellow fellows and I got along. I shared a room with 2 of them - A and T. I find them both hysterical people, very witty, fun to be around, etc. I was hoping we'd still be friends at the end of the trip -- 5 days of living with people you only really know at work could spell disaster. This time, it went great. I haven't laughed that much in I don't know how long. I love those guys.

Some of our adventures:
- 'A' trying 3 times, unsuccessfully, to give away his Ahi tuna leftovers to any homeless person we could find.
- Visiting the wawa store next to the hotel as often as possible for snacks and Diet Coke.
- Watching our 2 flat screens on the same channel in our hotel suite. The TVs were 10 feet apart. Max.
- Coming back, every day, to a room that was at least 54 degrees and still pumping out AC. We're not sure why Nicole, our cleaning lady, was trying to freeze us out.
- Taking a wrong turn on our run past the Rocky steps, making our 4 mile run a 7 mile run.
- Eating our weight in candy over those 5 days.
- Taking pictures of each other falling asleep during the lectures.
- Listening to our pharmacist try to sell 'T' on going out with her friend who "has a great personality" and "isn't hideous looking." He wasn't biting.
- Trying to come up with a clever title for 'T's talk on Neurosyphilis. I offered "Neurosyphilis: the other spirochete." He wasn't biting on that either.

So many more awesome memories. I'm very thankful that I work with 2 wonderful people. I look forward to our next adventure together!

Saturday, October 17, 2009

Weekend Off

This is my first weekend off -- and in town -- since April 25. Holy cow. To be honest, the only reason I didn't sign up for a moonlighting shift was because I had 50/50 planned on going home to Chicago to see my parents and sister. I opted to stay back because I've got a presentation, a grant and a research proposal due in a week and a half.

Wow, April 25. That's so sad. Half of those weekends I was working for my fellowship, but the other half was moonlighting. I don't think people fully understand medical education. You work like a dog in med school to get good grades, learn the material and get to the residency you want. Then, residency is (at first) a lot of overnight call working 24-30 hours at a stretch. When you get to be in your final year of residency, you have less call and more consults/clinics - that means more 8a-6p type hours. So, you start moonlighting. Working extra clinic shifts at night, covering for attendings to make extra cash. At first, it's not a big deal, because you're so USED to working all the time. Now that you have free time, it's easy to give it up for some extra money, because you're not used to having the free time.

Then it's a vicious cycle: you get used to having the extra money, so you can't stop moonlighting, but you're so tired you want to stop, but if you stop you can't pay the new car payment or go visit your folks, etc. You establish a new income for yourself that you can't let go.

Well, I'm taking the weekend off. I'm nearly done with all of my work, and I'm going to have a day filled with no medical stuff tomorrow. I'm going for a long run in the morning. I'm going to enjoy a cup of coffee with my husband. I'm going to church for the first time in a loooong time. I'm going to look for a new satchel for work. I might even go to a cafe and read a book for fun. Crazy!!

I'm getting more and more of the mindset that life is for living. Not for working. If I never see the pyramids in Egypt because I didn't want to work X number of extra shifts, then so be it. I'll enjoy my friends and family right where I am. Life is too short to be living for tomorrow. Time to live for today.

Sunday, October 11, 2009

One Phone Call

On Friday, I had Hepatitis Clinic. I love that clinic. I'm the only fellow that loves that clinic. I'm not sure why it is so hated by the GI and ID fellows alike. I only know that I find the patients interesting, the disease fascinating and the attendings knowledgeable and fun. Most of them.

I had one patient whose wife kept calling his cell phone during our appointment. He kept answering and telling her he'd call her back when we were done. From what I gathered a) she was supposed to come to the appointment with him but couldn't because of some other family situation; b) she was going to be coming to pick him up when he was done; c) she was afraid he was going to die.

Now that last statement is humorous because people don't die of Hepatitis C when they've had it for 20+ years. Death from Hepatitis C comes on slowly as the liver starts to fail. I'm not sure why she thought he was going to die, but she was very concerned about him. On her last call, I took the phone and told her that I would have more information for her after our visit, so could she please wait and we'd call her back.

After we were done and the attending had concurred with my plan, I asked the patient if I could call his wife back. I spoke with her for about 6 minutes. She had a lot of questions, mostly not understanding the chronic nature of Hep C. I took my time and explained things to her, and she was very grateful.

As I walked the patient out to the front desk where he could check out, he said, "You know, thank you for calling my wife. A lot of doctors don't like talking to the family, so it means a lot that you called her. I appreciate that." I remembered back to when my mom had my grandma's surgeon call me regarding her operation and how everything went. How much it meant to me and to my family that he took the time. I said he was quite welcome, and that I was looking forward to meeting her at this next appointment.

It's the little things - one phone call - that can mean so much to our patients.

Saturday, October 3, 2009

New Patient and Correction

During my moonlighting today, one of my patients was a Cambodian refugee. I'm not sure when he came to the US and under what circumstances. He tried to commit suicide some time back, but it didn't work. He's terribly nice, and he currently has an infection that he'll recover from. I've seen him once before, actually, several months ago. I don't remember why.

As I sat with his chart, I didn't really think about his infectious issues. Instead, I kept wondering what he saw in Cambodia. What horrors did he experience? What was is like right before he came to the US? Did he come here first and then seek asylum, or did he try to get it prior to leaving his homeland? Was that his family that just walked out of his room? Did they come with him? Was he scared when he arrived here? Did he fear deportation? What kind of adjustment period did he go through? What lead him to eventually try to kill himself? Is he glad he failed?

So many questions for this soft spoken man. None of them relevant to his current infection, so none of them were asked. I mostly hoped and prayed that he was glad to be alive, and that whatever atrocious acts he saw and experienced were outweighed by the love he gets from his family and friends.

Correction: in my state of overwhelming gratitude (and in the confusion of too many initials) I left out an amazing friend. JS: Where to start! From an random roommate a true lifesaver. Thank you for your support.

Friday, October 2, 2009


I'm feeling very emotional today. Not like I need a box of Kleenex or anything. Just overwhelmed by the wonderful people in my life.

I'd like to take a minute to thank some wonderful people (who may or may not read this blog, but that's beside the point):

AL: You are my glue. Seriously. Doesn't matter how far apart we are. Glue.

MW: Thank you for your wonderful blog which I have just stumbled upon. I still regret that we didn't spend more time together in DC.

JL: You're my rock in LA. Thank you for being there. Oh, I love the lungs, too. Remember that.

LR: My other LA rock. Thank you for trusting me and for being so trustworthy. We'll hike again soon.

RM: Our time at G'town went so fast. Thank you for being a great listener.

JB-C: Leaving stupid voicemails to each other will never get old. No matter how long it's been, when we talk it seems like we never left.

My sibs: You all rock. Thank you for making me a better (and funnier) person. Thank you for loving me through everything, even when I didn't deserve it. Thank you for keeping me humble. Thank you for giving me so much more than I could ever give back.

Remember to tell the people you love how much they mean to you. It'll make their day (and probably their week).

Monday, September 28, 2009

Happy New Year!

It's the Jewish new year. I'm not Jewish, but one of my best buddies is. Inspired by another (non-Jewish) friend, I'm going to use this time to Atone, just like the Jews. Atone, fast, then feast. I'm going to skip the last two. Unless you count a cinnamon chip scone from Panera as a feast, then I've got 2/3.

Things I'm sorry for:

1. Not calling home enough. I live so far away and I love my family so much, you'd think I'd be better at this. Sure, the time change makes it hard to call them. My 'rents and my sister go to bed fairly early. The bro's probably don't, but I don't know. I feel like I'm barging in to their lives when it might not be convenient. But Doc, you say, if it's a bad time, they'll let it ring and call you back. You, my reader, are correct. This leads me to #2.

2. Not giving other people a chance to say no. I never want to bother anyone, never want to burden them and never want to be intrusive. Thus, I never ask people to help me. This is bad, I've realized, for two reasons. A) I often need help and make myself crazy trying to do it all myself and B) People often like to help! I know I like to be helpful. I like to do things for other people, so it would stand that other people would like to do things for me. So, I'm going to try and be less self-sufficient and ask people for help when I need it.

3. Pride. I'm not a terribly prideful person, but my pride definitely gets in the way sometimes (see #2). I'll try to be more humble and if I do something stupid, I'll just own up to it. I need to laugh at myself more anyway.

4. Smell the roses. Metaphorically speaking, of course. I need to take some breaks, not work myself to death. I need to reconnect with things I love to do: drawing, making cards, camping, reading for fun. I do have a life outside of work, I just need to find it again.

A friend of my Jewish Buddy died unexpectedly and suddenly at the age of 31. I new her fairly well. It was a big shock, obviously. So, it's given us both a new sense of what's important in life.

*Do what makes you happy.
*Do what brings you joy.
*Hug the people you love.
*Don't worry who thinks you're crazy.
*Be the best person you can be.

I hope I can work on my shortcomings, and I hope I can live this next year to its fullest. Happy New Year everyone!

Sunday, September 27, 2009

The Other Shoe. Or Foot. Whatever...

So, I awoke a few mornings ago at 2am. Why? Because someone had shoved a hot poker into my upper abdomen. Or so I thought. I have rarely been in so much constant pain. After 2 hours of unrelenting fire, I elected to go to the Emergency Department. Yes. I did.

[aside: I have a few cousins with aortic tears recently, and the pain I felt was not incompatable with that syndrome. I have a bicuspid aorta and may be at higher risk for aortic tears, so I didn't want to bleed out in my living room. Without that history, I doubt I would've gone in for a belly ache.]

It was interesting being a patient. I wondered why, at 4am with only 5 other people in the waiting room, did it take an hour to register me? I wondered why, with only a handful of people in the ED, did it take me an hour to be seen by a physician? Were the nurses raiding the candy drawer like they did every night about this time?

In the end, it was very educational. I had my first CT scan. I drank liquid lidocaine (which worked wonders). I got a not-helpful diagnosis of "epigastric pain" (no kidding, Sherlock). I then diagnosed myself with a stomach ulcer brought on by too many ibuprofens for the tendonitis I just got over. Seems I should follow my own advice of taking those little pills with food.

So, I'm slowly recovering, thanks to my bottle of Mylanta and omeprazole.

Physician, heal thyself. Or at least, don't kill thyself on over-the-counter pain medications.

But, another lesson learned. I'll try to be better at explaining to my patients what is going on and apologizing for the wait. Because while we may be running around behind the scenes, they are just one person waiting in a room, scared, wondering if they are going to be ok.

Tuesday, September 8, 2009

How do you explain...

My patient today is HIV+, has Hepatitis C and is on hemodialysis for his nonfunctioning kidneys.

He would like to be evaluated for a kidney transplant, which you can totally do in HIV+ patients. However, it's his Hep C that may stand in his way. It's really hard to treat Hep C after someone gets a transplant, so we try to do it beforehand. But, it's really hard to treat Hep C in patients on hemodialysis because the toxicities of the medications are so much worse.

You can do it, but the success rate isn't great. There's a new drug that should be out in about a year, but that pushes his (potential) transplant off for a year. And there's an old drug that is being looked at for a new use - Hep C treatment. It's not being tried in HIV patients yet, and he feels slighted. The patient said, "Why do they always leave us out?"

He's right. People with HIV have been marginalized in society and in medicine. However, when researchers are trying out new medications, they want to try them on the people who have the best chance of responding. The ideal patient. Patients with HIV are not ideal patients and so they are excluded from most trials.

How do you explain that to someone who feels neglected and uncared for? Who has lived through the days of Martin Luther King, Jr. Who has watched people die of HIV. Who now lives alone in a nursing home. Who probably feels the whole world is against him. I can't blame him.

I was able to convince the attending to look at the patient's case and see if we can't at least try something. We'll see what happens. Hopefully we can at least try, and if it doesn't work, well, at least we tried. And he is validated that we cared enough to try.

Wednesday, September 2, 2009

No...Thank YOU

I was in clinic today at the VA. It was a good clinic day, despite the air reeking of smoke from the California fires burning not too far away.

My fellow fellow Dr. L and I whipped through the patient list like it was butter. We were ahead of schedule (cue choir singing Handel's Messiah). We were going to leave before noon. I was going to get to my 1p meeting across town on time. Sweet.

My last pt was Mr. P. Mr. P is a new patient with a nasty foot infection. He's been suffering with it for 3 years. It hurts, it's itchy, it inhibits his mobility. He's miserable. He begins the visit by saying, "If I would've known that I would be suffering from this for this long...I would've preferred to have died in Vietnam." Oh, brother, I'm thinking. The hyperbole is a bit much.

Granted, when I looked at his foot, it did look painful. And itchy. And I could see that you might not be playing basketball with a foot like this. Mr. P, now 70 years old, bragged that he used to be very active: "I would play beach side, blacktop basketball all the way until I was 48!"

So, the attending and I concocted a plan for him - some medications, some lab tests, and an attempt to try and get a solid diagnosis for his man. Mr. P said, "I've lived a long life. If you can't help me that's ok. Just please tell me that you can't help me. Don't tell me you can help and then don't. I've lived a good life." After assuring him that we weren't about to put him in a box yet, I told him that he needed to give us more than one visit to get this nailed down. He agreed.

At the end of the visit (time check: 11:40a), he was going to put his zinc oxide cream on his foot and wrap it back up. I asked him what "support services" meant. He has mentioned that he was in Vietnam in the early 1960s, and he went over for support services and recon. He explained that he went to help the scouts gather information and to make sure they had the supplies and equipment they needed to do their job.

He told me a story. He said that he was with a group of men who were trying to move from Point A to Point B. "Like getting from here to Manhattan Beach. On foot." (Note: that's about 30 miles) I expressed shock at this, and he said, "It don't take smarts. If you can read a map, you can do it." I chuckled, because I'm pretty sure that despite my medical degree I could not navigate the jungles of Vietnam for 30 miles - with or without the threat of gunfire.

He said his group advanced to a clearing in the early morning. He felt that it was too light out to try and cross; he wanted to wait until it got dark out. However, the decision was made to go. The first 4 guys crossed without difficulty. The next group went to pass and the shots rang out. Mr. P was not shy in stating that he "was going to do whatever was necessary" to stay alive and protect the other soldiers, but he didn't know who he was shooting. He just knew that it was in a general direction.

He starteds to cut up the gauze to create a pad for his foot. He assured me that at home his dressing change goes much quicker. I assured him that there's no rush (time check 11:50a). He resumes his story.

Things quieted down and it was his turn to cross. Last. He almost made it through the clearing when the firing began again. He was hit, but he made it out. The other soldiers didn't want to leave him. "I told them that they had a job to do! They had to get to the guys that were waiting for us. They had already called in that I was injured, someone was coming. I told them to go on, I'd be fine." He said that they left, and he laid in that grass for 5 days. "They came back for me -- the helicopter, not the other guys...I never saw those other guys..." He teared up and it was clear that not only did he never see his friends again, he wasn't sure what their fates were either.

We went back to getting his wound dressed. I asked him to finish teaching me "proper" wound care. He thanked me. "For letting me bare my soul a little bit back there." He said that I was very nice for listening to him. And then he said something that pierced my heart. He said, "When God comes to get me, I'm refusing to go unless I can bring you with. Now, He can get you on your own time, but I won't let him take me to Heaven unless he'll let you in, too." I was so touched, I was speechless. I mumbled something lame, thanking him for sharing with me and hoping that his foot responded to our treatment. (time check: 12:05p, but I didn't care)

I think he came in frustrated because people weren't listening to him. Not every doctor can give 20 minutes of non-medical time to his/her patient. But, every doctor should be listening to what their patients are saying and acknowledging the pains and itches that they have. I think Mr. P was grateful that I listened, that I saw him as a person and not just a busted-up foot. What Mr. P probably doesn't realize is that I learned a lot from him today. He reminded me of how awesome it is to be a doctor -- how great a privilege it is when someone trusts you to care for them, how humbling it is when they invite you into their personal lives, and how marvelous it is to have someone look you in the eye and thank you for reaching out to them.

Sunday, August 23, 2009


I have one patient who is intubated. He's got a tube down his trachea and the machine is breathing for him. We've given him a lot of sedation so it's not uncomfortable. He's sleeping relatively peacefully.

He's been that way for about 3 weeks.

He's 23 and has H1N1, aka swine flu. He's morbidly obese with asthma, two big strikes against him in this H1N1 epidemic.

I'm trying to remain hopeful that he'll survive, but every day it's harder and harder to imagine him recovering. He'll get a tracheostomy this week - a hole in his neck for the tube to go in, rather than passing through his lips and down his throat. His white blood cell count (a marker of infection / inflammation) is still high. He spends most of the day with a fever of 101-102. He's starting to get bed sores, because it's so difficult to turn him adequately due to his size. I'm not sure if he's infected somewhere else, becaues he is too heavy for the CT Scan (weight limit 350lb).

I'm really hoping that by the time I leave the Zoo on 31 August, our big guy will be off the ventilator and on his way to recovery. I can't say I'm all that optomistic, but we will do our best to support him through this.

Monday, August 17, 2009


A big thanks to my sister for giving my page a facelift! I'm not so good at these technical things, so I'm glad that she stepped in took control.

The Zoo is going along as always. We've had some interesting cases. It's been busy, but things have quieted down a bit this past week. I've got a new attending who is awesome. She's the kind of doctor I want to be. She's amazingly smart and articulate. She's also an extreme advocate for her patients. She will do anything for them. She stands up for them, she pushes for the best care possible, and she doesn't care what their background / imigration status / etc. Each patient is a person, and she works hard for him or her.

I'm looking forward to working with Dr. D and learning from her in every way.

Monday, August 10, 2009

Amazing Case

A friend of mine told me a story about a patient he discharged from the hospital about a month ago.

She's a mid-50s-year-old lady, who had an underlying lung disease, something called idiopathic pulmonary fibrosis. That translates roughly to "scarring of the lungs and we don't know why." She developed a heart condition, possibly as a result of the scarred lungs. She also had renal failure - an unrelated, but equally unfortunate, condition. She had been on peritoneal dialysis for awhile - her heart condition meant that she couldn't tolerated traditional hemodialysis three times a week, because the fluid shifts associated with that caused her blood pressure to drop. In hemodialysis, they remove your blood, clean it, and give it back. Not all at once or anything, but a large enough portion is removed that you need to be able to handle the fluid change. So, she did peritoneal dialysis - she would get fluid pumped into the abdomen every night so that it could clean her blood, and then it was removed at every morning.

Well, she recently underwent a heart-lung-kidney transplant. All three (or four, if you count both lungs)! She got all three organs from a 50-ish year old donor, and they are working great. My friend saw her the last 3 weeks in clinic, and she's doing great! Apparently, she's super nice, and she is so grateful for her renewed energy. She can walk around the grocery store now, she can go with her son to Home Depot to get supplies for a home improvement project...she's a new person. Well, with 4 new organs, she really is like a new person!

It's amazing what medicine can do nowadays. Blows my mind.

Monday, August 3, 2009

Back to the Zoo

So, we didn't win the Lotto. Shocker. So, I'm back to work at the Zoo.

Today was a nice 12-hour day. We are battling a swine flu epidemic. We've had quite a few people admitted with H1N1 (the official name for "swine flu") symptoms. Some have turned up positive. Some are negative, but we still think they have it. And some have turned out to have something else. It's been very educational, learning how to deal with an epidemic. There are interesting questions: Who gets prophylaxis? Who gets screened? Who do you still treat even though the screening test is positive? How accurate are the tests? Who should get the vaccine (when it comes out)?

It's not every day an ID fellow gets to be a part of something like this. So, while it is going to make for a very busy month, I'm trying to stay positive and focus on what a great opportunity it is. And while I'll likely watch my summer tan fade without any hope of seeing the sun for awhile, I know I'll end up in a better position when it's all said and done.

Tuesday, July 28, 2009


So, one of the other fellows and I have taken up to playing the Lottery each week. We put in $1-2 and pick which Lottery we want to play. I'm waiting for that late night phone call to come in, telling me we're winners.

What would I do if I won? Well, of course it depends on how much. But, if we're talking a prize of at least $100k...

Well, I'd like to pay off my med school loans. Those are totaling about $200k last I checked. I'd pay off a big chunk of that, for sure.

I'd stop moonlighting if I had any left over. I am tired of working so much extra. That's probably the first change I'd make.

I'd like a new car - nothing fancy, just a Jeep Wrangler. Not even the Special Edition.

I'd probably hit the outlet mall for a new wardrobe. I'd say >50% of my clothes are hand-me-downs from my well-dressed aunt. I'm super thankful, because they are awesome and new to me! But, it'd be nice to actually choose some different outfits.

I'd give a bunch away. I've got some great charities I'd like to support more. I like Project Angel Food. Doctors without Borders. International Justice Mission. To name a few.

I'd like to open my own clinic. This would only be if I hit it big. Like $10 million big. I'd model it after the CORE Center in Chicago. Create a truly comprehensive place for people with HIV and Hepatitis to come for treatment, social services, dental work, massage therapy, etc. People would pay on a sliding scale. It would be awesome.

So, keep your fingers crossed. The next drawing is tomorrow night. I hope to be writing a new post on Thursday, detailing my trip out to pick up my oversized check. :)

Wednesday, July 15, 2009

Dairy Queen and Popcorn

There are a few things that were staples growing up. Baseball. Summer days at the local (man-made) lake. Sleepovers at the Neighbors. Nighttime snacks.

Nighttime snacks were either ice cream or popcorn. Dad makes the best popcorn - on the stove with oil and everything. We always eat it with cheese. I don't know why, we just do. Bite of cheese, few kernels of popcorn...yum.

Or we'd have ice cream. Sometimes plain vanilla or Neapolitan. Sometimes we'd crush up Oreos or candy canes. Sometimes we'd get the ice cream with fudge swirls or put our own Hershey syrup on top.

I was home this past weekend with all the sibs, and it was awesome. We had a blast together. It's nice to see them and hang out as adults. I really appreciate their unique personalities. I see how my life has been -- and continues to be -- enriched by each of them. I am truly blessed to have such wonderful siblings. We played hours and hours of beanbags. We played games at the kitchen table. We laughed with my niece and nephew. We visited Grandma together. We made fun of each other, exercised together, and made dinner together.

And, of course, we ate ice cream and popcorn.

Friday, July 3, 2009

Movin' Up

So, I'm officially a second year fellow now. As of July 1. Nothing much changes, really. I have more clinic months this year, less in-patient consult months. But, overall, it's more of the same. I know a whole lot more than I did a year ago, which is nice. At least I can give advice without asking the attending every freaking time. Well, usually. There's still a very long way to go.

The new fellows start up on Tuesday - they work with us on the consult service for half a day and then all day Wednesday. We show them how things run, answer questions, etc. Then they are on their own on Thursday! Oh, and if you didn't know already, never get sick in July. Ever.

On a personal note, I'm going home next weekend, which I'm super excited about. I'll get to see all of my siblings (which is a rare event, since we live in the far corners of the country -- literally). I'll also get to see my "new" nephew Noah. He's almost 6 months old, but I'll meet him for the first time in a week. It's going to be a blast!

Saturday, June 27, 2009

Sign Up for More?

I just found out I was accepted into a K30 program. That's an NIH-sponsored program where you learn how to conduct research -- ethics, statistics, logistics of research. I'd do classes during my next year of fellowship, and then I'd do another year of "fellowship" which would be most research. I'd have a class or 2 to take.

Now I have to decide if I want to do the program. It would give me more options. I'm always up for a challenge. I enjoy research. It would provide me a good framework to get an academic position.

It's another year of poor pay. It's another year of instability and "temporary-ness." It's another year of putting off the real world. It's another year of waiting for life to start.

I have 6 or 8 weeks to decide. No pressure. :)

Tuesday, June 23, 2009


Tomorrow the new interns start. Joy.

Now, don't get me wrong, I remember what it was like to start day #1 of intern year. I was on wards. Blue Team. With WW and MC as my co-interns - we had a blast. You form a bond with that first team that no one can take away.

I was very well prepared for my intern year. Georgetown gave us a LOT of responsibility as 4th year med students. We took overnight call, we cross-covered on other 4th years' patients...we were basically interns (we just needed our residents to co-sign our orders). So, my transition to intern year was pretty smooth.

Not so for everyone. Some are overwhelmed by it all. And it is, surely, overwhelming. For the first time, you're being asked to make decisions. You start to think, "Should I give this person Tylenol? Will I throw them into fulminant hepatic failure??" It's a little scary. But, you need to work through it and learn what you know and what you don't know. It's actually more important to know what you don't know, so you don't hurt anyone.

Starting fellowship was a bit like that. People are asking your "expert" opinion, not realizing that you don't know squat about your own specialty yet. But, again, you push through - read a lot, see patients and learn from them. It's a steep learning curve.

Now that I'm nearly done with fellowship (1-2 years left, depending on whether I do that research year or not), starting a new year isn't much different. More of the same. Only tomorrow, it'll be dozens of new, young faces, scared out of their wits. I'm anticipating the next week will be rough with unnecessary consults. See, the new interns start tomorrow, but the R2s and R3s are the same - they've got it down at this point. But July 1 marks a new year for residents -- the old interns are now R2s and the old R2s are now R3s. Transitioning to R2 year is tough, as you're responsible often for running the whole team. So, that's going to me a whole lot of unnecessary consults, with R2s just wanting to make sure they've got it right. [nb: these are the same people who just 2 weeks earlier (as interns) would roll their eyes when their resident wanted an ID consult to treat a simple pneumonia; things are different when you're in charge!]

So, we'll see how the next 2 weeks play out. Should be interesting, to say the least. Hopefully I can impart some knowledge on these newbies and teach them a little about ID and a lot about being a caring, compassionate doctor.

Sunday, June 14, 2009

A Beautiful Sight

This is just a quick snapshot of something I saw last weekend while moonlighting. I wish I could've gotten an actual snapshot, but here's my description.

There was an elderly woman in a hospital gown, walking down the hallway. She had her slippers on, and her shoulders were slightly hunched over. From her left arm sleeve, IV tubing came out and stretched behind her to the IV pole.

The IV pole was attended to by her husband, an elderly gentleman with the same slight hunch. He had his right hand on the pole, pushing it at the exact right pace to keep up with his wife. His left hand cradled the IV tubing, so it wouldn't pull at her arm.

Seeing them together caused me to smile. I'm sure they don't have the perfect marriage, and who knows how long they've been together. Perhaps they're celebrating 50 years. Perhaps they've just recently found each other. In either case, the dedication he showed her was genuine and touching. I hope to be so lucky as to have my partner with me during my time of need.

Wednesday, June 10, 2009

Door #1

Today was a fairly light day, by Zoo standards. We took a trip to the pathology department to try and get some information on a skin biopsy that was done on one of our patients yesterday. "We" is the attending, my resident and myself. I have only a faint idea of where things are in the hospital, so I spend most of the time following closely on the heels of the Attending. He's kind of like a hurricane, in that he's all over the place and often disorganized. However, he's brilliant with more knowledge than I could ever hope to attain. And he's super nice. I like him.

So, he's leading us down to the path department, and Resident and I are following closely behind him, like ducklings in tow. We stop at the first open door on the right - a pathologist is in there, but on the phone. We proceed to the next door, which leads to an empty office. The doctor we passed called out to us, so we go back. He tells us it's the pathologist 2 doors down who has the slides. We rush down two doors and find that pathologist. She tells us her resident is reading the slides, across the hall. In a bustle, we whip around (seemingly as one organism) and Resident and I quickly follow the Attending directly across the hall and open the door. He stops short after opening the door about 24 inches. "It's the restroom..." he says sheepishly, and I notice the "Mens" sign on the door. I stifled my laughter for a good 20 minutes after that. Even now, I laugh out loud as I think about our ridiculous journey.

Sunday, June 7, 2009

Rock Star

So, I've gotten my first taste at what it must be like to be a rock star. Here's a typical day at the Zoo:

- Get paged about 3/hour
- People calling your name out as you walk down the hall
- People waving forms in your face, asking for your autograph
- Being unable to take a pee break or a lunch break because you're so in demand

I'm going to start wearing big sunglasses and a floppy hat to see if it helps quell the masses. Something tells me they'll find me anyway.

I had a sad case of a kid (he's in his mid-20s) who we just diagnosed with HIV/AIDS and an infection in his colon. Given the degree of immunosuppression and kidney disease, I suspect he has had HIV for about 7-10 years. I think he was in a lot of denial about it all. He didn't understand how sick he really was. This weekend, he left the hospital against medical advice ("AMA"). I've been really concerned about him, because I don't think he'll come back to the clinic for follow-up. We need to start antiretrovirals on him. His CD4 count is in the toilet, and it's only a matter of time before he winds up with a very serious infection. He has a higher chance of being dead in a year than not. However, if he'd just come to clinic, we could get his CD4 count up, his viral load down, and he'd have a half-way decent chance of reaching 40. As it stands, I don't think he'll see 29.

Monday, June 1, 2009

The Zoo

So, I will refer to the hospital I'm now rotating through as the Zoo for two reasons. 1) It's a county hospital and is extremely busy and hectic. 2) The name actually rhymes with it's real name. In no way am I trying to disrespect the patients or employees of the hospital. Heck, I'm one.

So, today was my first day at the Zoo. Wow. My pager went off fairly non-stop all day. It's going to be a busy month. It's also going to be a great month, because I'm going to see some crazy, crazy stuff. Already I have a lady with pachy meningitis (I had never heard of it before today), a guy with miliary TB (where tuberculosis is extensive throughout the lung), a young man with newly diagnosed HIV and CMV colitis (a viral infection of the colon causing severe diarrhea and dehydration), and a new mother who likely has herpes hepatitis. And, I just admitted a transgendered male-to-female with a bizarre rash and facial droop.

I'm slowly learning my way around the hospital and the different things I'm expected to know and do. I have a feeling it's going to be 30 days on a steep learning curve. I'll post some updates as I get to know my patients more and hear their stories. I think I'm going to learn a lot - about medicine and about life.

Saturday, May 23, 2009

Homesick and a Patient's Course

Sometimes, as I start to write a new blog post, I wonder if I'm not just saying the same few things over and over. I hope not. However, I try not to go back to reread my posts, as I'm sure I'd be aghast at what I've written and vow to never blog again. As it stands, I will keep writing and naively think that what I'm saying is having an impact on people. :)

I was recently back in the Midwest for a wedding. It was a college friend, and it was a lot of fun. It really made me miss the Midwest. Now, it's not perfect back home, but I miss the simplicity of life there. I also miss seeing my siblings. I'm jealous of people who can drive 20 minutes and hang out with their brother or sister. Not that moving back home would allow me to see them more (since they are equally spread out), but I'd at least be in the same time zone. Well, close to the same time zone.

Fortunately, I'll see everyone in July which will be awesome. I can't wait.

To add a medical side to this post, I saw a patient recently who is HIV+. She is close to 50 and really rebelled against taking any medications for a long time. She weighs about 75lb. Her daughter brings her to clinic every week so we can check on her. We often get frustrated at patients who so blatantly refuse life-saving treatment. I wonder what her daughter goes through. Is she frustrated with her mom's condition, is she tired of spending her entire Thursday at our county clinic? Is she the driving force behind her mom now staying adherent to the regimen? Next time, I think I'll ask her how she's doing. I'm sure her role as care taker is stressful, and we doctors don't do enough to recognize that.

Sunday, May 10, 2009


Today is Mothers' Day. I need to say thanks to my mom for doing an awesome job raising 4 very independent, very ambitious kids.

As I get older and I realize how much my mom really has hit me that I can't adequately say thanks. Not that she'd want that, but I know that there's no way to repay all of the sacrifice, the tears and the headaches. Sure, I caused some joy and laughter. I just hope the good memories outweigh the bad!

So, Happy Mothers' Day - to my mom and all the moms out there.

Saturday, May 2, 2009

When You Can't Move On

I had a patient on Friday in my Hepatitis C clinic who was coming in to be evaluated for treatment. Not everyone with Hep C needs treatment, and it's not an easy treatment to tolerate.

To get right to the point, he had problems with depression before so I asked him how he was feeling. He said that this week marked the 10 year anniversary of his mother's death. He's the 2nd oldest of many many children. His mom had some sort of head bleed and was on life support. His dad was having a rough time of it and was quite elderly himself.

The other children (all grown adults) kept saying that the decision to withdrawal life support was the dad's. This was clearly wearing on the dad, and my patient couldn't understand why the oldest didn't step up and make the decision -- one way or another -- to help the dad out. So, my patient took the burden and stood up for withdrawing care.

He tearfully said that decision has weighed heavily on him ever since. He'll hear of someone "waking up" from a year-long coma and wonder if he did the right thing. I tried to reassure him that a 22 year old waking up from a few months after a car accident and an 80-something waking up after a ruptured aneurysm are very different things. I tried to explain that the young people aren't usually vent-dependent -- they have their brainstem intact, whereas his mother didn't. I don't think I helped him too much.

I hope he can find some peace soon, it's been 10 years that he's been torturing himself with this. I referred him to Psychiatry, where hopefully he can get in with a therapist and make some progress. His Hep C is definitely taking a backseat to his mental health. I hope the next time I see him he'll have been able to move on.

Tuesday, April 28, 2009

Saying Sorry

So, I blew it.

It wasn't the first time, and it certainly won't be the last.

I was in clinic last week, and I greeted my patient who had been waiting about an hour. I could tell he was upset. I would certainly be upset if I waited an hour. Sadly, I can only move as quickly as there are attendings available to hear the case. No attending = I wait to present the case = I get backed up = my patients wait. It's the nature of the beast that is a training program.

Turns out he was a bit peeved at the wait. However, he was mostly upset that I had forgotten to order his labs to be drawn 2 weeks prior to the visit. With HIV patients, you bring them in every 3-6 months to look at their CD4 counts and viral loads. No labs? Nothing to talk about and nothing to do. A waste of a visit.

I could've gotten defensive: why didn't he call in and tell me when he went to the lab 2 weeks ago, so I could've ordered them on the spot? Why didn't he just call that day and change his appointment so we could get his labs done? There were a few ways we could've salvaged things if he had been proactive.

However, the blame was mine: I forgot to order them. I took a deep breath and just said sorry. I told him that he was right, that I had forgotten, that I had wasted his time, and that I was sorry. Contrary to the Movie-of-the-Week, this did not end in hugs and rainbows. He was pissed and left unhappy. But, I heard him and acknowledged the hardship I had caused. He looked a little relieved, which is nice, but ultimately he was going to be upset with me. And that's ok.

Not everything turns out peachy, and I am not a perfect doctor (or person for that matter!). I can only show my patients the respect they deserve by confessing my mistakes and apologizing for them. Hopefully, when he comes back in 3 months, we can have a better doctor-patient relationship because of it. But, if he never wants to see me again, at least I was honest with him. That's the best I could do.

Wednesday, April 15, 2009

Back to Work

So, I've had a light clinic month for the last 2 weeks. No complaints from me! I needed a break after a hellish 2 weeks on the consult service at the VA. I can't talk about, I'll get too angry.

So, in clinic today, I had a patient with PTSD -- Post Traumatic Stress Disorder. He came in to the ID clinic for fungus on his toe nails. What he really wanted to talk about was the horrors of Vietnam. I wish I had more time to dedicate to that for him. As it stood, I did the best I could with my limited amount of time.

He kept coming back to one main theme. He said he was born a Mormon. He studied and went on his mission trip. He then went into the Marines (enlisted or drafted, I'm not sure) and went to Vietnam. He went TWICE. Two tours in the violence and horror that was the Vietnam jungle. He looked at me and said, "I killed 6 people in my first 2 days there. 'Thou shall not kill.' How do you deal with that??" Of course, I had no answer.

He proceeded to tell me that when he came home after his first tour [aside: why do they call it tour, like it's a fun romp around the world?], he was talking with his family. "They were all 'Peace' and 'Love' and 'Jane Fonda.' They didn't want to hear about it. They wouldn't let me talk about it." He was so conflicted about his religious upbringing and the acts he witnessed and committed. He was crying out for help, for someone in his family or community to listen to him and let him purge his nightmares. He got nothing.

No matter how you feel about the Vietnam War, our involvement in it, etc, you can't punish those men that were sent to fight. They were doing a job and often just trying to save their own skins in the ordeal. America really treated those vets poorly when they returned. Thankfully, my patient has a group for therapy that he enjoys. Sadly, he says he lost his first two wives because of Vietnam -- they couldn't take his emotional lability, his voluntary admissions to the psych ward, or his leaving for hours / days at a time. He gets these flashback and then wakes up under some tree, not knowing where he was or how he got there.

I can't say he'd be different if someone would've let him unload back in 1970-something when he returned the first time. I can't say that his PTSD wouldn't be as bad if someone would've given him a shoulder 30+ years ago. I can say that he turned his back on his religion and his God for many years because of that moment. Fortunately, he has found his way back, and he said that getting back to church was one of the best things for him. It's just sad that he was pushed out in the first place.

Monday, April 6, 2009

Where do we go from here?

Ever hear that song by David Essex - "Rock On"? You can see a YouTube video here. There's a line where he says, "Where do we go from here..."

That's how I'm feeling these days.

I'm near the point in my fellowship where I have to decide what I want to do when I'm done. This doesn't sound hard -- I've been training to be an Infectious Diseases, duh, go and be an ID doc! It's not that easy.

There's outpatient HIV work. There's hospital consulting. There's any combination of those two. There's joining a group, starting your own group or (for those who love risk) starting your own solo practice. There's research - many, many different types. There's staying LA (which is a pretty saturated market) or looking out in the 'burbs.

Here's the kicker: I don't know what I want.

I know what I don't want. I don't want to be bored. I don't want to work 28 days a month. I don't want the pressure of starting my own group. I enjoy research and teaching. I am fascinated by HIV and Hep C. I love international HIV work.

Ideally, I want a job where I can do frequent over-seas trips to either do research or direct patient care, possibly some teaching of residents or med students there. I want to do HIV work with some HCV work here. Teach and supervise residents/fellows here. So, I think I need to stay in academics. In order to try and get a job in that competitive world, I think I'm going to need to do a 3rd year of fellowship. This pains me mostly because of the salary. I'll have to moonlight still to make enough to pay off the house and such. But, it's just one more year in the grand scheme of life.

So, I've got some meetings coming up to see where that 3rd year will be and how it will be structured. So many questions still.

Tuesday, March 31, 2009

Clinic #4: Mityana

This was going to be our final clinic, and we knew it. It was a little bitter sweet loading up the luggage of medications for these final two days. Ok, it was mostly sweet, since I know I was darn tired of lifting and pulling 7 bags through the back windows of the bus and lugging them over uneven dirt sidewalks.

The night before our first day, we brainstormed on how to make this one run most efficiently. We had definitely run into some speed bumps along the way. So, we formulated a plan to try and get through all of the orphans and school kids as well as the adults in the community. So, with a plan in hand, we started the clinic early.

Things ran really well. Partly because we finally knew what we were doing. Partly because Joshua and Paul, who run the orphanage, were very capable leaders [in the photo below, Joshua is on the far right, with Paul in the yellow shirt]. We arranged a line of children and the NPs saw them. We arranged a line of adults who saw the nurses for vital signs. Then they arranged in a line outside the door and waited for the PA or me to be free. By this time, we all had our own translator. I worked with Nicholas, a very bright and caring young man who one day will be a world-class economist. However, I was lucky enough to have him as my translator and friend. By the end of our week together, he could diagnose arthritis, give medication precautions for Benadryl and educate people on conservative treatment of low back pain. He was a lifesaver.

We were seeing a young mother who was holding a baby who was about 5-6 months old. All of the sudden, the baby's arms started shaking. Nicholas jumped up and translated for me: "She says this has never happened before - what's wrong with the baby?" I looked at the baby. His pupils were fixed and pinpoint. He was unresponsive to painful stimuli. He was shaking. He had a pulse. I grabbed my sister-in-law, the NP: this baby was having a seizure. {He only seized for a few minutes. Needless to say, we recommended that the mother take the baby to the hospital to get evaluated for a seizure disorder.

We saw about 250 people in 2 days. We were running out of medications at the end of the second day. Mostly over-the-counter things like Tylenol and Omeprazole. But, we did what we could, and the people were very thankful.

It was sad to pack up at the end of the day on Thursday. We said goodbye to the people in the town. We said goodbye to the kids. We eventually had to say goodbye to the translators...our new friends [here's a picture of some of them with some of us]. But, we have great memories and thanks to Facebook we are still keeping in touch, all these miles away. I have no doubt that some of us will go back to Africa, perhaps even Uganda. Some of us will work on helping the poor and under-served right here at home. All of us have been touched by the warm hearts of the people of Uganda, and that will leave a mark on us forever.

Monday, March 30, 2009

Clinic #3: Canaan

For the next two days, the group split up. The 4 providers (me the MD, a PA and 2 pediatric NPs), along with another NP who was running the pharmacy, would go to the orphanage in Canaan. There, we would see the 100 orphan kids along with the 200 kids who come in for school there. Now, that's a lot of kids, but we had a plan. The PA and I would screen the kids with a quick eye-ear-mouth-heart-lung-skin check. Anyone with any issues would go to see the NPs (since they do peds for a living) and get meds from the pharmacy. We'd give worm meds to the appropriate kids (ie, kids with big bellies).

This started out great. We had Paul, our Ugandan friend and translator, helping give out worm meds after we checked the kids. The meds taste awful, so he'd tell them in Luganda, "Be strong!" and make a chomping noise. Then, he'd give them a yummy vitamin to follow it up with. We laughed every time we heard him say, "Be strong!"

Then, at about 10:30a, I noticed that more and more adults were congregating in the big main room. The main woman at the orphanage came over and asked me when we were going to see the adults. I nearly bit her head off. We had 300 kids to see, when exactly did she think we were going to see the adults?? And we had never planned to see any adults, so what would make her think this was part of our day? I asked how many there were, and she said about 27. I said I would start seeing them after lunch. I figured I could see them all in the 3-4 hours after lunch, and let one NP and the PA do the congo line of kids. We weren't sending too many back for treatment.

At 11a, I see a ton of adults now, hanging around. I marched over the lady and saw that her sheet of paper, previously 2/3 full on one side is now full of names, front and back. I'm livid. I just told her that we weren't supposed to see any, and now she's adding on names?!?

"What's going on? How many people do you have?" Before she can answer, I continue. "No more. I will see as many as I can see, but I cannot see everyone. No more." "No more?" she asks. "NO. MORE." I state firmly.

I grab Paul to help me translate; he gives his "Be strong" strategy to Seggy, our main point-person in Uganda.

To make a very long and painful story short(er), I saw 55 adults in 5 hours. We got a 20 minute lunch consisting of Coke and Poptarts. We saw 160 kids. We saw one baby with meningitis that the parents didn't want to take to the hospital. We were exhausted, emotionally and physically.

When we finally got home, dirty and tired, we found out that the other group had a fairly relaxing day in Waka Waka - eating lemongrass fish cooked by Carl the South African, playing with kids at the orphanage, and talking with the orphanage staff about their needs. Granted, they did arrive at the Waka Waka clinic to an angry mob of 100 people who thought they would get medical care (miscommunication). They triaged those people and had about 20 for us to see the next day, as we switched sites. The providers went to Waka Waka and the rest when to Canaan the next day. We didn't get lemongrass tilapia, but we did get to see some monkeys running around Carl's yard. [this is a picture on the way to Waka Waka...Lake Victoria is in the background]

Next up: Mityana.

Monday, March 23, 2009

Clinic #2: Seeta

Our second clinic was in a place called Seeta. Pronouced See-et-uh. There we met Betty, who runs a school for the surrounding children. It's not an orphanage, but many of these children come from vulnerable families and wouldn't have the chance to go to school if not for Betty. Most of the children have classes with her and the teachers in the morning and afternoon. Some of the older kids return to her HOUSE in the evenings for additional classes. (Here's a pic of some kids outside the school.)

There is one building for the school, divided into 4 sections. Each section holds two classes. The classes are divided by a chalkboard -- one teacher writes on one side, the other writes on the other side. The kids face each other, but can't see one another because of the chalkboard. The whole room is about 8x16 feet. Pretty small once you put a chalkboard and 2-3 benches on each side.

We went to the "clinic" after meeting Betty and the students at the school. One of the community leaders lent his house for us to hold the clinic in. We had 2 rooms -- one for seeing patients and one for the pharmacy. Each of us 4 providers took a corner of the room. We put 2 chairs in each corner and a coffee table dividing the room in half.

At this clinic, we learned that each provider needed her own translator. Waiting for one to free up was not working. We became more efficient in seeing patients this way. We also set up our pharmacy with several chairs so people could wait for their medications. We learned that it's essential to have a dedicated translator in the pharmacy.

We saw about 180 patients over those two days. There was some chaos, but overall it wasn't bad for our first real clinic. We had a very dehydrated baby that we mixed up some oral rehydration solution for. We also had a baby with suspected pyloric stenosis versus severe reflux. He would vomit after almost every feeding. He had gained only 1lb in the 2 months since birth. He should've gained over 10. His mother was also have severe pelvic pain after having a C-section.

We arranged for them to go to the hospital. We actually took them ourselves on one of our final days in Uganda. Mom ended up having a severe bladder infection (thankfully nothing worse!), and the baby was going to be checked by a radiologist a few days later to look for pyloric stenosis. I'll have to check to see if we have an update on the little guy.

Seeta was a good way to start things off. We learned how to pack and unpack all of the meds into our 7 suitcases. We learned how to maneuver all of the suitcases on and off the bus. We'd have to do this every morning and every night, so that we could keep the meds safely with us.

The next clinic was supposed to be more low key. Half the group would go to Waka Waka and the providers would go to Canaan. Then we'd switch. Let's just say it didn't turn to be as "low key" as we anticipated.

Saturday, March 21, 2009

Uganda - Clinic #1

Our first clinic in Uganda was in a Kampala Slum. Kampala is the capital of Uganda (see map). There are about 30 million people in Uganda; about 1.5 million live in Kampala. I'm not sure exactly where we were in relation to the rest of the city, but we turned off the main (paved) road down into a dirt road. All around the mini-bus we saw little stands set up. People were selling tomatoes, potatoes, bananas, shoes, etc. Children were running around and people walked, shopping for goods.

We travelled a bit down the main dirt road (which was only wide enough for the mini-bus), when all of the sudden the driver stopped. Apparently we had arrived. The building was made of concrete and, like most things in Uganda, adopted the red hue of the dirt. We piled out and went in. Inside the main room (which stood about 50x30ft), approximately 25 people sat on plastic patio chairs. There were 2 tables in front and some chairs up there. We had carried in the 7 suitcases that contained our "pharmacy" -- medications purchased both in the States and in Uganda that morning.

We were ushered to sit in front of everyone, behind the tables. We introduced ourselves, and Seggy (our Ugandan partner) told everyone in their native Luganda language that we were from the US and here to provide medical care.

We went back to the "treatment rooms." We discovered that this building was probably a type of hostel or dorm. The rooms were small -- about 10x6ft -- with barely enough room for a twin bed. Myself and the PA (who also saw adults) took one room. The two pediatric NPs took the other room. Across the hall from our rooms was a slightly bigger room -- about 15x15ft, with a queen bed. We unloaded the drugs on to the bed and left a 3rd NP and a lawyer to figure out the pharmacy.

The 4 providers looked at each other and got to work. We had enough Purell for a small country, and we used a ton that day. After a few patients, the PA felt comfortable enough to look for another room. Having 4 adults in that tiny space was too much. Thankfully, she found another room down the hall.

We had some translators bouncing between rooms to help with the people who didn't speak English. School is taught in English, so anyone who spent any significant amount of time in a classroom spoke fairly good English. However, most of the people who we saw didn't have much of an education.

The saddest case I saw was Ronald. He is 26, and his English was amazing. He had served in the Ugandan Army and was stationed in Iraq. He sustained an injury to his left eye in 2003 and was sent back to Uganda. He was discharged from the military, but his vision continued to decline. He came to me with a letter from a Ugandan ophthalmologist. She described his eye and the growing pressure that was occurring. She had performed a few drainage procedures, but the fluid kept returning; he needed a definitive procedure if he had any hope of saving his vision. As it stood, he could see light and dark and basic shapes on my exam. He couldn't count fingers in that eye.

The letter went on to explain that there were no doctors in Uganda who could perform the procedure. They hadn't been trained to do it. She asked for help so that this young man could get a place that might be able to help him. My guess is that the closest facility would be in Nairobi.

I introduced him to Julie Clark, the leader for doma. We had travelled to Uganda with doma so Julie could try and figure out how doma could best partner with orphanages and community groups to provide medical care to orphans and vulnerable families. Julie took down his name and contact information, and her hope is that we can raise money to get him to Nairobi for further care. He was very thankful, and he came back to my room twice to express his gratitude. He was hopefully that we might be able to provide some way for him to save his sight.

We saw just over 200 people in 5 hours. We had to turn about 30 people away because it was getting dark, and we needed to be on the road before it got too late. There was such a need for basic primary care -- blood pressure monitoring, nutrition counselling for new mothers, STD testing and treatment -- we probably could've spent all week there and barely made a dent in the population that lives in the slum.

However, we had 3 more locations to visit before our trip was done. Next up: Seeta.

Monday, March 16, 2009

HWC Recap

So, we had a successful event on March 1.

Caitlin rocked the house with an amazing performance. Jesse Spencer on violin and James Denton on guitar provided excellent support. It was magical. I hope to have a video up soon.

Kevin Pereira and Alison Haislip were awesome co-hosts. They put together a video of their experience, which you can find here. I hope you like it! The best part: you can make a donation from the page to support the great work at the Los Angeles Christian Health Centers.

Kevin Parry, of wireimage, did an amazing job photographing the event. You can check it out at the wireimage site here.

So far, we've raised almost $28,000 for the clinic! This is amazing, especially given the current economy. It reminds me once again how generous people are. We had so many people donate auction items, donate their time to help organize the event, and then donate their money via ticket sales and auction bidding.

A big thank you to everyone who came out to support us! Remember: whether you donate to our charity at the link above, to another charity, or whether you give of your time to help those in need, we can all make a big difference if we just take the first step to care.

Saturday, February 28, 2009 only a day away...

The big day is here!!

My brothers are in town, my sister-in-law is in town. My parents come in tonight. My sister and her husband can't come, but they are doing their part as well: visit her blog here to find out how you can win awesome scrapbooking supplies while raising money for the Clinic!

Caitlin is going to be singing. Check out her video here. She is awesome! The song in the video shows her playful side. She is also a very socially conscious singer, whose music really touches your heart. I'll be linking a video of the Clinic done to one of her songs after the event. Stay tuned.

Jesse Spencer from House, MD is going to be playing the violin with her; James Denton from Desperate Housewives is going to be playing guitar. And Jeremiah James is going to be chiming in on bass. It's going to be a rockin' night!

Our co-hosts, Alison Haislip and Kevin Pereira from G4 TV's Attack of the Show have got a great evening planned.

We've got all the auction items accounted for. We've got all the decorations ready. We've got our outfits picked out and waiting. This is going to be a great event!

I hope to update after the event, so be sure to check back in a day or so to find out how it went! Thanks to everyone for their support - financial, emotional, and otherwise!

Wednesday, February 25, 2009


So, the timing is pretty poor, but I've come down with some illness. In my best estimation, I'd say either bronchitis or pneumonia. I hesitate with a simple bronchitis because I have such a productive cough. I even coughed up a mucus plus last night. It was nasty.

Fortunately, I started antibiotics today, and I'm hoping to be in top shape on Sunday. Again, luckily for me, I'm on a lighter rotation, and my attending was fine with me taking a day off. I can remember the last day I took off. It was the Saturday after Thanksgiving, 2005. I had to get someone to cover my clinic because I had a temperature to 102.

I don't like calling in sick. Don't get me wrong, I often fantasize about staying home from work, watching television all day, or going to the beach. However, I feel a strong commitment to my patients that I be there for them. And, I do love my job (most days!), so it's not torture going in. Today, however, I felt I'd just spread my germs around, and we don't need any transplant patients coming down with whatever nastiness I have.

So, I'm taking it easy today. I should have a light day tomorrow and Friday. The Brothers come in tomorrow, so that's exciting. I hope I don't get any of them sick!

Saturday, February 21, 2009

One Week Away

So, the charity is just one week away!

March 1.

Wow. Most of the family is coming, so that's awesome. My sister is home with the kiddies, but the rest of the fam is coming out.

We're benefitting a clinic on Skid Row that has just started diagnosing and testing people for HIV. It's an expensive endeavor, but it's a needed one given the high risk nature of the patients there.

Check out the website for more information:

Friday, February 13, 2009


A few weeks ago, I was in clinic and I met a man with AIDS. This is not unusual, since a meet a lot of people in clinic with AIDS.

The difference was this man was dying. Right before my eyes.

He was in his mid-30s, very pleasant, very grounded. He had been through a lot in his life. He was diagnosed several years earlier, and he had actually started treatment. Then, as he explained to me, he got very angry. "Angry at God," were his words. He stopped seeing his doctors. He stopped taking his medications. He just stopped trying to live. He went back to using drugs. He was transiently homeless.

Then, about a year ago, something inside him woke up. I'm not sure what, and he wasn't really able to explain it all that well. He worked through his anger, and he was ready to really live.

He was admitted to one of our hospitals with pancreatitis and fulmanent liver failure. Our best guess is that it was an extremely rare reaction to one of his HIV medications. He nearly died. For the doctors out there: his Ranson score was through the roof.

He made it through and was discharge, but when I saw him in clinic he was pale and wasted. He started crying as he told me about what he'd been through in his life. He had a glimmer of life in his crystal blue eyes, but it was faint. He had a firm resolve to make it through, but his physical body seemed to say otherwise.

I admitted him for anemia and failure to thrive, a diagnosis usually given to neonates. His housing situation was still tenuous, and he really needed close to 24-hour nursing care. He was barely strong enough to get to the bathroom, let alone stand in a shower and wash. However, with no income and no insurance, finding a place to accept him was going to be a nightmare for the social worker.

The hardest thing was the complete faith he put in us to make him well. His chances of survival are so small. If he does make it, it's purely because of his will to live and his faith in God. Medicine can only do so much for him now. The best thing was the sense of peace he had about his situation. The paradox of his physical condition and his spiritual one still strike me now, all these weeks later.

Saturday, February 7, 2009


So, I ran the Surf City Half-Marathon in Manhattan Beach on February 1. It was quite an experience! I finished in just under 2 hours, and I ran about a 9 minute mile, which is better than I anticipated.

It was quite fun running with all those people around you.

I don't think I'll ever have the desire to run a full marathon, but a 10k or even another half would be fun. For now, though, I'll stick to a few miles around my house for fun. :) I need a break!

Tuesday, January 27, 2009

5 (or 6) Things

I am feeling very grateful today, so I thought I'd write down the 5 things I'm most thankful for today (not in general, just today).

1. I'm thankful that clinic ended early tonight.
2. I'm thankful that we'll soon have an online link to buy tickets to the charity event.
3. I'm thankful for Campbell's soup-on-the-go.
4. I'm thankful for cell phones.
5. I'm thankful that I am married to my best friend.

Ok, I have a 6th one:
6. I'm thankful for Christian Girl, who always makes me laugh, always acts with grace and always comes through in a pinch.

Monday, January 19, 2009

A View of Life

I'm an optimist. Really. Optimists not only see the glass as half full, they see the optimist in everyone. Even the pessimists. That's where we optimists get into trouble -- the pessimists don't want to see that the glass is half full. They'd rather pour the contents over your head and walk away while you're dripping wet, staring at a now fully-empty glass. My blog today is for the pessimists out there:

Are things really so dire? Are the stakes really so high?

Are we so arrogant to think that we are above disappointment and failure and frustration?

Are we so misguided as to think that life is all sunshine and rainbows?

I grew up with more "no"s than "yes"s, with more disappointments than gifts, and with more struggle than easy roads. I subsequently chose a career where I would see death win, tragedy happen and people break down. However, what I have learned through all of this is that we (meaning humankind) DO persevere, we DO fight even when we're losing, and we DO occasionally come out victorious.

I've also learned that you sometimes have to redefine what "victory" means. Sometimes it means your cancer is cured. Sometimes it means you die with dignity. Sometimes it means you finally get that baby. Sometimes it means you grew closer to your dad as you watch your mother die.

Life, I feel, is all about perspective. And we can choose from what angle we want to view things. That starting point is our decision to make, and it will make all the difference in how we look back on where we've come.

Friday, January 2, 2009

A December to Remember

Well, I finished by "31 Friends in 31 Days" experiment. I successfully sent 31 emails to 31+ people throughout December to tell them what they mean to me.

I'll be honest -- I missed a day here and there, so some people got it the day after their assigned day...but they didn't need to know that I was slow on delivering. Besides that little hang up, it went smashingly well.

I learned a lot in this experiment.

1. We don't tell people we love them nearly enough. (I hope to do a better job of this in the future.)
2. People enjoy knowing that they mean something to you.
3. It doesn't take much time to tell people how wonderful they are.
4. When I really looked at my friends and what their best qualities are, I found a lot of similar through lines. Generosity. Loyalty. Sacrifice. It seems that I am drawn to people with these qualities...they certainly make for awesome friends.

So, don't be afraid to tell people what they've done for you, what they mean to you, etc. We shouldn't have to wait for some tragedy to tell people how amazing they are. I think it's awesome to think that perhaps my everyday actions can touch people in ways that mean something. So, when people do that for me, I am going to tell them.

Spread the Love.