Another Vaccine Rant

Both stories are mostly true. But one of these stories, indirectly hurt way more people than the other.





The truth is there are horrible stories that go with both vaccines and the diseases they protect against.  Guess what, we've done the research and far more horrible stories pop up when we don't vaccinate.  Ya it sucks, occasionally people ARE harmed by vaccines...but diseases ALWAYS harm people...ummm... that's why we call them diseases and not immune system calisthenics.

Which is more likely, hundreds of thousands of smart, well-intentioned doctors and scientists are in a giant conspiracy to make money and hurt people while doing it versus a few people are unusually and illogically polarized against something they don't fully understand (or understand at all).

Newbie Doc

Death, Taxes, and Ignorance

I remember when the last election came out and Palin went on a rant about "death panels". Honestly, I haven't read exactly what that specific piece of legislation entailed. I can't say whether it was wrong or right, because I didn't read it. But I know Palin has never stared down at a child that has spent the last year on a breathing machine with bedsores, infections, and eyes so consistently wide and dry they look more like prunes than eyes, if she had her pontifications would have been a little less polarized and "anti-death".

One thing I see time and time again is how poorly educated american politicians are about medicine, they are isolated from it. Whether it's the media clouding the picture or it's just laziness on the part of the politicians, they have no empathy or understanding for the less fortunate. It's sickening to watch a political debate on a major news channel about medicine, especially when no medical expert is involved, they throw statistics around that they have no comprehension of...some they actually had to have made up. My one piece of advise is that when medicine becomes a political debate again, as it always will, close your eyes and cover your ears. Go online and look up the stats, decide for yourself, understand the issues from objective sites, hell read wikipedia if you have to, but do not listen to what either side has to say about the issues in question, you'll be getting your opinion from someone little more educated on the matter than a picking a random man off the street.

Newbie Doc

Residency

Just FYI, if you have any love of your self image, medicine isn't the greatest for you. In one year of residency I've gained 20 pounds and people have gone from telling me I look Brad Pitt to telling me I look like Elton John...what a difference a year makes. Bubububu Benny and the Jettssss.

Elton John :/

Happier Notes

On a happier note, I was walking in to clinic the other day and I ran into the mom of my friend from "A Real Goodbye".  Despite all probability, he's actually doing really good.  His MRD is 0 already, (that stands for something like mean residual disease, which is the residual cancer left in the body after chemo).  Having responded early is a great sign, although he isn't out of the woods yet, it's looking a lot better than it did. I went by and saw him on my lunch break (he was receiving transfusions), he looks tired and the steroids have put on some weight in the last month, but all things considered he looks really good.  I guess that's a lesson for me to stay positive.  I always wondered how so many of the heme-onc docs can stay positive when they here prognosis like his and maybe it's because it's not up to the statisticians and docs who lives and dies, whether you believe it's a cosmic coin toss or a God up in the sky looking down, something else does.

Newbie-Doc

Happily Dreaming

Chelsey is a little 7 year old girl with a chromosome abnormality. No one has seen this type before, it's new and unknown, and as such hard to treat. She experiences periods of apnea (where she stops breathing) for no known reason. For these spells she requires a tracheostomy so that when she has these periods they can easily hook up the breathing machine for her. I'm vastly simplifying her condition, but given all her other complexities and her quality of life, which is poor, her parents have decided to sign a DNR or do not resuscitate order for Chelsey. While she hasn't had another apnic spell yet, the next spell will likely be her last.

I met her at a very special respite house, which my city has been blessed with. Many states are without anything like this for children and many of those that do are put to shame by this "house" which I found myself at. Imagine going to live in a small cottage filled with people and things that were there to make your last days, happy days, that's what this respite house is to the children. To the parents of these chronically ill children, this is a break, an oasis in the middle of a life spent up caring for their unfortunate loves. If a child qualifies, the child can stay there a total of 30 days, used any time during the childs life. If the child is placed on hospice with a DNR, they are allowed an unlimited stay.

I was to meet a nurse there for home visits today, but because she didn't have any, I got to participate in Chelsey's Wish. While at the house the children get to ask one wish that they would like granted, some ask for movie stars to visit, others ask for smaller simpler things, but this house and it's staff go out of it's way to make it happen. Chelsey's wish was to be a nurse when she grows up at this specific respite house.

Today when she awoke, she was given badges and scrubs to wear. She checked in at the clock and she had her first day ever as a nurse. I can't describe how amazingly happy she was as we traveled around to patient rooms interviewing patients with her notepad and listening to them through the stethoscope. When she'd had her fill, we took her to the family room which had been redone as a triage center. Gurneys and wheel chairs filled with large stuffed animals were found scattered through the room. In the corner a large camping tent had been made out as her nurse/doctors office and we'd set Carl the Gorrilla at a desk outside as her nursing manager. Inside the tent, a makeshift cot for a patient was made up. One side was stacked with nursing supplies from thermometers to IV kits. Something like this may sound so mundane to anyone else, but to her she stepped out of her illness for a day and was a kid in a kid's dream. One by one, I brought her the patients who were lined up outside to see her. We treated everything that morning from an abscessed tooth to splinting a Alligators broken tail. Although her condition leaves her chronically fatigued she "worked" tirelessly until all of our patients had been seen...I even asked her once if she needed a break, to which she replied, "More patients!" Every patient she sent away healthy, with a hug and a sticker...some with splints, some with bandages, all with imaginary smiles. We ended it all watching her favorite movie "The Lion King" surrounded by all the patients that she had helped, during the movie I heard her quietly state to herself, "This is the best day ever." I left her with a big smile and a bigger hug. I was told later that night, she quietly passed away. I'll never forget how happy she was, it was a great privilege to have been present for that. I like to think that she died just as she lived, happily dreaming.

I Save Lives?

Just a quick post on saving lives.  I always thought it would be a regular occurring thing where someone was rushed in and we brought out the paddles, after a few jolts the person would be back from the dead.  Things like that do happen with car crashes, really bad infections, ect. but the majority of "life saving" goes on without you realizing it, unless you stop to think about it. Such as the kid with really bad diarrhea whom you give fluids to by IV. It's second nature to do so and really not a big deal...but he would likely die without it.  Or the little baby who was born early and doesn't have the "stuff" in his/her lungs yet to breath...we just intubate for a quick second and pump in the stuff...no big deal...but kids would also probably die without that...or the last one, mentioned in my previous post, vaccinations.  It's a simple shot that, if you haven't seen the actual diseases, SEEMS like a slight inconvenience to the patient...but again those shots are saving lives.  I guess the point of my post was that sometimes I get caught up in the automatism of what we do and forget what a huge privilege it is to have an effect on so many.  I'm NOT saying I'm special, these kids would likely get saved without me and a good deal would survive without these treatments, just that when you think about it medicine has gotten really good at saving lives without most people realizing it, even the people who are doing the saving.

Newbie-Doc

Vaccinations

Vaccinations are kinda of a sore spot for pediatricians. The media often portrays it poorly and as a result we often find ourselves explaining that vaccines don't cause disease..."they prevent disease!" we explain in exasperation. FYI Don't listen to this if you are easily offended by the F word (i think it says it once.) But it's very informative, medically supported, and entertaining.

So I watched it again. It says it twice. Sorry not the most tasteful way to get the point across.

Continuity

So I haven't written about outpatient very much, for the simple fact that I wasn't doing much there. I saw three to four patients every tuesday afternoon last year, most of which I didn't feel comfortable "doctoring" on my own, so I would have my attending come in after I had seen them. Halfway through last year they "graduated" our class and gave us the option of seeing patients on our own if we felt comfortable with doing it. Since then my enjoyment of outpatient has grown in leaps and bounds. Since that time I've been slowly growing a base of "my" patients not just anybodies patients. Although I don't plan on staying here and growing a practice I am relieved to see that I am capable of sustaining myself and of holding my own against even friends of mine who I feel are superior doctors, it's a huge ego boost. Yesterday, I had a clinic schedule full of patients that were there to see me. I even had some walkin's (those that aren't scheduled) that were there to see me and when they were told that I was full and they couldn't see me, they re-scheduled! Two weeks ago I had a couple with a new baby request me after one visit, thought they have extensively delt with residents through two other children who had chronic conditions. I know this is in no way a comment on my medical skill, but non-the-less I take it as a huge compliment, that whether by my affect or by my treatments I am doing something right. It's at the same time scary that I have people expecting a certain standard from me and I honestly don't know what I'm doing different than anybody else. I guess as always I'll stumble and bumble and somewhere in there I will find my way.

Newbie-Doc

I Want a Danger Meter

Have you ever had an occasion where you've been really poisonous, almost to the point where you knew there was something wrong with you. There are times when I am "grumpy" and I know why I'm that way. But since becoming a doctor, there have been times when I come home and I am nasty to everybody around me.  Today, I was like that.  It wasn't till later when I was talking/apologizing to my wife that I finally struck upon the anger that was fueling all these toxic feelings.

There was a 1 month old I examined who over it's short life thus far had suffered several rib fractures, a skull fracture, currently had several bruises, and several breaks of his long bones. While questioning the mother about this I was perfectly polite. It wasn't until several hours of picking on my family and myself after work, that I wondered why I was so angry...and then when I thought of her again I exploded...I wanted to kill her...her indifference to her child's condition, the way she could smile in the face of it all...I don't know if my mind was trying to protect itself while I was with her by closing my mind off to the conclusions that I should have naturally come to, but as soon as I thought about her at home it was like my mind had a poisonous bubble of puss growing with increasing pressure and as soon as I thought about it I popped it and all that hatred and anger came rushing out.  She is either too stupid to know her child is being beaten or she is protecting those who have done it to her son or she herself is doing it and trying to get away with it.  In either one of those cases I hate her.  I know I'm supposed to remain objective and be the "doctor" that non-judgmental ideal...but I can't all the time, the worst part is I don't even know when I'm doing it, it just starts building up...I wish I had a danger meter on my forehead and somebody would just be like, "Hey Newbie-Doc, You better purge man, you're building up to dangerous levels."  I hate my job sometimes.

Newbie Doc