Gerty

There's a 95 year old woman dying in the intensive care unit in a community hospital about 20 miles from here.  Her body is a withered shell, a mere 60-70 lbs of bones and loose, bruised skin. Her mind, however, is vibrant, joyous, and sharp. When I walk in the room each morning and ask "how are you doing?" she invariably responds "I'm feeling better," even as she hacks up increasing amounts of thick phlegm. Equally invariably, she turns to me and squeaks out, "how are you this morning?" She says it with all the sincerity she can muster. She reaches out her feeble, skeleton-like hand while I talk to her about her ailment. Each morning, I take her hand in mine and she clasps her hand tightly, as if clinging to life itself. I lean in close to her--as her 95 year old ears don't hear as well as they used to-- and there we sit, chatting about her sons and her lifelong passion for football. I don't have the heart to tell her that I don't care much for the sport. Her mouth is dry and cracked, so each morning I swab her lips with a moistened sponge on a stick, and my mind drifts to the vinegar held to Jesus' lips in his last moments. After the sponge, I dab her lips gently with a tube of moisturizer, and I think how much more pleasant the cross would have been with some lip balm. Yesterday I was watching her breathe during her sleep, noting how her entire body seemed to gasp for air. She awoke, opened her eyes slightly, and turned in my direction. "Am I going to make it?" she asked. Suddenly my chest was in a vice, and the vice was squeezing me so hard that my eyes welled clear and full. I answered feebly, something about doing our best. Her hand squeezed my own. We smiled at each other, and she went back to sleep.

The Washington Patch

Many thanks to Brother Wrider for the brilliant idea. Allowed me to check out some new single track near my house. Perhaps not the smartest thing to do on a 1 dollar makeshift patch.

The Central Line

A "central line" is a type of intravenous catheter that is inserted into one of the larger veins of the body, typically the superior vena cava, which can be accessed by either the internal jugular vein or, more rarely, the subclavian vein.

A "central line" is also a great cause of fear and trepidation for many med students and junior residents. I recently successfully placed my first central line under with ultrasound guidance and close supervision on an intubated patient. Placement of the line requires inserting a 3-4 inch needle into the neck or chest while avoiding any of the following scenarios:

1) Nicking the carotid artery and watching your patient spurt blood from his neck like a cheap zombie apocalypse flick
2) Puncturing the lung (more likely with a subclavian line) and causing a pneumothorax in which the lung collapses as its surrounding negative pressure space fills with air.
3) Stabbing the heart itself with the long guidewire over which the catheter itself is slid; this is a particularly undesirable possibility as large hunks of raw meat typically do not respond well to poking and prodding. Ask any cow.
4) Failing. In this scenario you can't get your needle in the vein and the patient either dies or (and possibly more dreadfully for many individuals) a more senior medical staff has to save your incompetent derriere.
5) Incurring the wrath of a sickly patient who does not take kindly to being treated as a pin cushion; in this scenario the patient may run the risk of breaking the sterile field by squirming, spitting, swinging fists at your petrified face, or possibly snatching the needle from your trembling hand and attempting to place a central line in YOUR neck.

Polo

 New mallet.

 Tapped the end so there's no need for a bolt through the side

 See

 Teip and BBor

 Polo

 The coveted Joust

 Bbor with his new ride

To what end do we save lives?

The end is the same, despite our lofty pontifications and costly interventions. We save lives for the sake of the individual, despite the impact on the herd. We save lives to postpone the tears and nose-blowing of loved ones, despite the knowledge that no tears or hankeys are ever spared. Death is a zero sum game.

We save lives because, for some inexplicable reason, we intrinsically value life- however harsh it may be. We value time. Time on this spinning rock. Yet, ironically, we don't value our own lives enough to quit drinking, quit smoking, quit McDonaldsing, quit winding up in the damned hospital. And we don't value our time on this spinning rock enough to value the spinning rock itself.

Ode to Veterans Affairs

Beards, beards, and beards galore; welcome to the VA. Missing toes, missing eyes, missing the bus to Battle Creek. COPD, PTSD, straight black coffee; welcome to the VA. Diabetes mellitus, old man who yells at us, abscesses full of pus. Delirium tremens, estranged family makes amends, all vets are old friends, come once you'll come again; welcome to the VA. Cirrhosis, thrombosis, please help us. Tote your guns, smoke for fun, terr'rists go'n run, 'Merica's next to none; welcome to the VA. Yessir, Nossir, thankya Ma'amy, firm shake your handy, spank the nurse's fanny, ain't this life grandy, pass me the brandy; welcome to the VA. Fought in war, decub sore, hate Al Gore. Nicest folk you'll ever meet, missing teeth and missing feet, live in trailers live on the street, laughing joking tender sweet- in terms of patients, you just can't beat...the VA.

"Comfort Care": Euphemism of Euphemisms

Mrs. P went comfort care over the weekend. Died a few hours later. She was puffy, swollen, pumped full of a myriad of unforgiving antibiotics and crystalloid solution, a plastic tube jammed down her throat with dried blood at the corners of her mouth. Unconscious, unable to breathe, unplugged, and now unalive.

Her husband, from whom she was separated, was at the bedside soon after she passed- distraught, he prayed with the clergyman assigned to Mrs. P.  He wept openly. A broken marriage and a wife stripped of white cells and stripped of life. Which part was he weeping for?

 He found no comfort in comfort care. I find no comfort in comfort care. Here's hoping Mrs. P had some comfort with comfort care.