ZiyadMD - The Blog

For medical school students, Benjamin Franklin’s ubiquitous remark about death and taxes is particularly apropos. But while taxes will come into play years down the road, death is usually introduced on the very first day in the form of the cadaver you meet in Gross Anatomy. Death becomes more consequential, however, the first time a patient whose care you are directly involved with dies. 

Perhaps you are part of the code team that tries unsuccessfully to revive him or her, or perhaps you simply find out about it after the fact. Either way, it is certain to happen. 

When a patient you have been looking after dies, many emotions may come into play. We as physicians-in-training are trained to cure patients and improve their quality of life and in this context, we may feel that we have failed when someone dies. Patients may often develop a closer bond with us than with other medical staff — as we are able to spend longer time with patients than our attending, and they may confide in us more than others.

That first death, may be difficult, and the only thing you can do is know where to go for help.

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USC medical school professor Dr. Ken Murray has an interesting article titled ‘How Doctors Die’ outlining the difference between how most people die and how doctors die. As he says, “It’s not like the rest of us, but it should be.”

We as physicians are deeply familiar with how people usually die, and the incredible suffering that the medical system sometimes imposes on us. Because we’ve seen a lot more medically-induced suffering, and are more familiar with the limits of medicine in extending life, we as doctors are much more likely to die at home, with little medical intervention. That’s a much better match with most people’s stated preferences — many more Americans say they’d like to die at home (as opposed to in a hospital) than actually do.

How Doctors Die is a moving essay on how doctors choose to die in contrast to the “futile-care” imposed on the rest of the population — definitely a good read.

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

You can read the article in it’s entirety at: How Doctors Die on Zocalo Public Square 

Sometimes I really ponder over treatment problems. I really hate those cases where both options stink. For example, you have an elderly patient in afib.. something I see all the time!

• Choice A: Put them on Coumadin. They don’t embolise but they bleed like stink. Nosebleeds. Head bleeds. GI bleeds. Lacerations that bleed. Dental work that bleeds. I hate it — certainly not an option for those who are a great fall risk.
• Choice B: Don’t put them on Coumadin. Presto! No bleeding! But them they come in one day with a dead leg or a huge hemispheric stroke and end up an amputee or a vegetable.

I guess you just have to decide which bad thing is more likely to occur. I’m not sure what I’d choose if I were the patient — what would you do?

What’s the worst thing you can say in an emergency room? This and other questions are answered in an informal survey of doctors, nurses and paramedics, who offer their own insights into the inner workings of hospital emergency rooms. Every year, the nation’s emergency rooms treat 117 million patients, and the average patient spends nearly three hours in the E.R.

But what really goes on behind the scenes? The magazine Reader’s Digest quizzed emergency health workers about the quirks and peeves of the E.R. Here is some of what they had to say.

“The busiest time starts around 6 p.m.; Mondays are the worst. We’re slowest from 3 a.m. to 9 a.m. If you have a choice, come early in the morning.” 
~ Denise King, R.N., Riverside, Calif.

“People who are vomiting their guts out get a room more quickly. The admitting clerks don’t like vomit in the waiting area.” 
~ Joan Somes, R.N., St. Paul, Minn.

“Never tell an E.R. nurse, ‘All I have is this cut on my finger. Why can’t someone just look at it?’ That just shows you have no idea how the E.R. actually works.”
~ Dana Hawkins, R.N., Tulsa, Okla.

“Don’t blame E.R. overcrowding on the uninsured. They account for 17 percent of visits. The underlying problem is hospital overcrowding in general.”
~ Leora Horwitz, M.D., Assistant Professor, Yale University School of Medicine

“Never, ever lie to your E.R. nurse. Their B.S. detectors are excellent, and you lose all credibility when you lie.”
~ Allen Roberts, M.D.

“We hear all kinds of weird stuff. I had a woman who came in at 3 a.m. and said she’d passed out while she was asleep.”
~ Emergency Physician, Suburban Northeast

“Your complaints about your prior doctor will not endear you to us. The more you say, the less we want to deal with you.”
~ Allen Roberts, M.D.

To hear all 50 insights from the emergency room, read both articles from Reader’s Digest, “15 Secrets the E.R. Staff Won’t Tell You,” and “35 More Secrets the E.R. Staff Won’t Tell You.” And then please join the discussion below.

Got a bum trachea? Windpipe not blowing up to steam? We can grow a new one for you.

Thanks to a new technique where a patient’s own stem cells are grown on plastic scaffolds and differentiated into tracheal cells, it looks like that might be a reality.

More on the Baltimore man who was the recipient of this science magic at the New York Times.

Alcohol is more dangerous than illegal drugs like heroin and crack cocaine, according to a new study.

British experts evaluated substances including alcohol, cocaine, heroin, ecstasy and marijuana, ranking them based on how destructive they are to the individual who takes them and to society as a whole.

Researchers analyzed how addictive a drug is and how it harms the human body, in addition to other criteria like environmental damage caused by the drug, its role in breaking up families and its economic costs, such as health care, social services, and prison.

Neuropharmacologist David Nutt, MD, of Imperial College London, and colleagues rated 20 different drugs on a scale that takes into account the various harms caused by a drug. Drugs are rated on nine harms a drug causes an individual and seven harms a drug causes society.

The scale, developed by a panel of experts called the Independent Scientific Committee on Drugs (ICSD), ranges from 0 (no harm) to 100 (greatest possible harm). It is weighted so that a drug that scores 50 is half as harmful as a drug that scores 100.

“The highest and lowest overall harm scores … are 72 for alcohol and 5 for mushrooms,” Nutt and colleagues calculate. “The ICSD scores lend support to the widely accepted view that alcohol is an extremely harmful drug both to users and to society.”

Alcohol was found to be the most harmful drug to society and the fourth most harmful drug to users. 

The findings should come as no surprise: Alcohol has been linked to more than 60 diseases.

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I apologize for any website downtime. Tumblr (my weblog host) had accidentally suspended my site, without just reason. Upon contacting them directly the content was restored with the site fully intact.. thank goodness!