Happy Thanksgiving

It's been trying the last few months. We've been constantly exhausted because of the baby (though she is sleeping better the last few weeks). Work has been busy but yet it's been a fiscally difficult time for a variety of reasons. In the last few months we've lost friends, some dear patients.

But it's easy sometimes to forget that despite the challenges life may throw at us, we have much to be thankful for. So perhaps it's timely, that today's Thanksgiving and it gives me a moment to reflect.

Yes, I have much to be thankful for. But by far, family comes to mind. Having wonderful parents and siblings though they are far away. A gem of a wife and two darling girls. And for having our health.

Happy Thanksgiving folks.

Hope your turkey turns out great tonight!

(mine's sitting in the brine. Secret to a juicy bird)



Safety of Energy Drinks?

http://www.cnn.com/2012/11/15/health/energy-drinks-fda-investigates/index.html?hpt=us_t4

Perhaps this was a timely article on CNN on the safety of energy drinks.

'Under investigation' however is not evidence of guilt, as they say. But I'm certainly cautious of things myself because of a recent case with a patient (and as they say, anecdotal evidence should carry as little weight as stories of bigfoot sightings, so caveat emptor!)

Mr. P was a 56 year old man with diabetes and hypertensive nephrosclerosis. I saw him for his usual visit and drew some routine labs. As always, his hemoglobin A1c was well controlled. The electrolyte panel, however, takes a few hours to be resulted. I saw him at 3PM. The lab calls me at 5:30PM to inform me of his critical potassium of 6.7, with his creatinine being as it's always been- slightly elevated but not too bad. I verified that it was a clean, unhemolyzed sample. I then called him up suggesting he gets his butt to the ER for urgent workup.

His labs were repeated in the ER at 8PM (I suppose 'urgent' to him meant after a nice dinner with his wife)- back down to normal levels. They sent him home and I called him the following day to follow up on things.

It was puzzling- there had been no medication change and he had been asymptomatic. No change in health status to explain the spike in potassium.

And then he shares, "Say, I was tired in the afternoon and took one of those energy drinks an hour before the labs were done...."

Now, this clearly is far from cause and relationship. And it's possible it was an erroneous result. But these days, especially in my renally impaired patients, I advise caution.

 

Here today, Gone tomorrow

I was reminded of the fragility of life today. I was oncall for the hospital, and had been seeing consults. Amongst them, Mr. L who was scheduled for a coronary artery bypass graft. He also had type 2 diabetes and was on several medications including insulin and so the cardiac surgeon wanted me to help out with his program.

As I was wrapping up the consult, I shook his hand and wished him well. And said he'd see me again in 2 days, after he was off the vent and extubated.

Unfortunately, it was not meant to be.

A few hours after his surgery, he went into ventricular fibrillation, and had to be resuscitated. Though they brought him back, he went into cardiogenic shock, and had to have an intra-aortic balloon pump inserted. When I saw him post-op, it was clear the prognosis was pretty grim.

A few hours after that, he went into another episode of v-fib. This time, despite coding him and then cracking open his chest again, they could not bring him back.

It was almost surreal to me. To have met this man for the first time just yesterday and to have shared some moments with him. And today, just like that, he was gone.

It's a reminder that one never knows what might happen.

And it's a reminder to me to not take things for granted, and to not sweat the small stuff.

Little Pleasures

Perhaps some timely reminders after my last post, of the simple things I enjoy in playing a doctor.

I saw Mrs. D for follow up of her thyroid cancer. Really, it wasn't an issue anymore; she had a subtotal thyroidectomy for her papillary cancer 8 years ago. Her thyroglobulin markers had been unmeasurable for years. So, it was just a routine annual visit. But, at that 720AM appointment, I sensed something was bothering her, and asked her if she wanted to share anything.

And so, for the next 10 minutes, she bawled. She told of her husband who was losing his job. Of her daughter's troubles with the law and her substance abuse issues. I just listened; she came early so I had plenty of time. At the end of the visit, she seemed better after having vented. And I was reminded of the privilege we doctors sometimes have- having our patients share their troubles with us. Though there was little I could do for her medically, it felt good being able to listen to her.

Later this morning, I saw Kara. I got to know her when she first presented for management of her uncontrolled type 1 diabetes. Her hemoglobin A1c was 11.9%. And she was also 9 weeks pregnant.

Several times over the next few months I was worried she was going to lose the baby. Her diabetes was uncontrolled, with wild fluctuations between hyperglycemia, to hypoglycemic seizures. And yet, she persevered, and brought her A1c down to 6.3%. She came back today for her first postpartum diabetic follow up, and brought baby Isaac. He appeared to be healthy, with the most beautiful blue eyes. When I walked her, Kara and her mother gave me hugs. And then she let me carry Isaac for a few moments, before my hordes of nurses whisked him away and ooh-ed and aah-ed at him.

Sometimes, we all need days like these, to be reminded of the simpler pleasures of work.

Burnout

Probably much to share on a public site, but here's the truth: I'm feeling burnt out.

Yes, one might be anonymous online, but over the years many of my readers have gotten to know me personally, so that's always a risk you take with blogging. But that being said, a blogger starts to feel a certain connection to his readers. Hence, I feel comfortable sharing that statement. "I'm feeling burnt out".

• Perhaps it's the feel that I work harder than what I feel the rewards are worth
• In large part, it's also the feeling that I'm not helping patients. The longtimers who come in with a sheepish smile, no glucose logs, and a persistent hemoglobin A1c of 14 while they're just 2 steps away from dialysis. Seriously, why the hell are you even coming to see your doctor, if you won't take the time to help yourself?? True, you might make me richer, but it certainly makes me feel no better not being able to help you.
• And then, it's the loads of people who come to me expecting that I'll be able to help them lose weight, or feel better, less depressed, more horny, have a longer, more erect penis, have more/less hair, sleep better. Just because they "just know it must be related to the hormones". Believe you me, I take very little pleasure in billing a consult for something that I cannot treat. I hate ordering tests that patients ask for that I consider unnecessary, even if it makes me more money. In fact, a large part of me feels that I shouldn't even be seeing these people. But the powers-that-be dictate that we shouldn't be turning away potential revenue.
• Maybe it's from some recent events, people I know or care about who met their demise in an untimely manner. Maybe it's gotten me thinking that life is short, and if work feels like work, maybe I should be doing something else.
• Or maybe it's just from exhaustion and sleep deprivation of chasing around 2 kids.

The truth is, of late I've taken very little pleasure out of work. My only joys seem to be when I come home and see my wife and 2 kids. When I prescribe eskimo kisses, or give out hugs, or get treated with smiles and embraces.

I think we're reaching a crossroads of sorts in the next 12 months, and some career decisions might need to be make.