Dr. K and Cardiology

I had an awesome cardiology Rotation, where I was able to see a lot of aspects of the care of a patient with and without cardiac issues. While I was there, my preceptor and I would often wax philosophic and he told me about the book, “The House of God” (which I have yet to read), and how there was an attending in that book with ten laws. I re-wrote them for Dr. K, in his honor, and thought they’d be funny to post.

Laws of the House of Kazienko

1. Crapsults are cardioprotective – the more a patient is consulted, the less likely they are to have a cardiac event.
2. Crapsults never stop
3. At a Code Blue, the first procedure is to find out who called it
4. ER Docs don’t diagnose myxomas, they trip over them.
5. Echos never come first.
6. There is no heart cavity that cannot be reached with an esophageal ultrasound or a catheter — and a good dose of sedatives
7. Digoxin is like holy water, a little bit never hurts.
8. (Age + HR) * 0.01 = Dig Bolus
9. The only good Crapsults are from real cardiologists
10. If you don’t order a stress test without symptoms, you wont find obesity induced dyspnea.
11. Show me a BMS going into GP who can understand a differential of CHF, and I will kiss his feet.
12. If the ER doc and the medical student both see raised troponins in the ER, then there can be no MI happening.
13. The delivery of good cardiac care is to do as much nothing as possible and keep the old timer GPs from doing more than that.
14. Your soul belongs to Jesus, but your heart belongs to me.

David S Keith, OMSIII, MSPH (Now DO, MSPH)
Thanks Dr. K

Diseases teach us in many ways

I was at the Opthomologist with my daughter for her to get an exam. Next to me was a sweet older woman who noticed my daughter, and commented on her beauty. She also noted that daughters are precious, and in the next 15 minutes, I came to learn that she had lost her daughter in the Polio epidemics in the mid-nineteenth century.  She lost her husband 6 months later from cancer, and had been alone ever since.  She told me her daughter had stayed for a year at Shriners of her day, was placed in an iron lunch, and that they were only aloud to see her for 1 hour every Sunday. They would bring her a gift every week and talk with her.  She didn’t live more than a year. 

I would never have known this by just looking at her. But I learned a lot about a condition I had just learned the day before had revolutionized what we knew about ventilating patients.  It was the beginning of what we cal l ICUs, and started us into intensivist medicine(medicine for the seriously ill and in need of ventilation management and multi-organ treatments).  Also, it was a time when medical philanthropy was started to blossom, as it was expensive to have an Iron lung and harder to get to them. 

It was a disease that has been recorded for millenia, and that when we started to become a more sanatized society, we actually decreased the exposure for children, and made them more succesptible to the disease’s devestating effects.  Hence the need for immunizations.

Poliowas a devastating disease and it killed a lot of people.  It affected millions and killed thousands.  If you contracted the disease, you were most likely to get better, but many had debilitation limb issues, and few lost the ability to breath or move.  Amazing how such a small thing could cause so much change-societal and personal.

From: Doctoring: the Nature of Primary Care Medicine

“A common error in thinking about primary care is to see it as entry-level medicine…and, because of this, rudimentary medicine — for mostly (say) the common cold and imaginary illnesses. This is a false notion. Everyone knows, however, that knowing when you don’t know require sophisticated knowledge…From the perspective of training physicians and the knowledge bases required for adequate performance, the higher we go on the scale of a specialist training, the less complex medical problems become.” Eric J. Cassell, MD

Man I love that quote! Very well put!

It is humbling…

It is very humbling to feed a young woman her breakfast because she is too autistic to tell you she’s hungry, but functional enough to sometimes be able to use a spoon. It is humbling to watch a spirit, “trapped” in a body that wont allow her to communicate all she feels, so only pure emotion and frustration surface. When she is not understood, or cannot get her needs met, she strikes her own head–her ears bearing years of scars and healing in the form of large keloid scars.

It is humbing to think, that something as simple as telling another human, I think I am tired, do you mind letting me rest? or I am very sad, and I cannot seem to be comforted, will you love me? Can never be said by some who need it most. A very humbling thing to watch.