Three Things You Want In Future.

 Today was a very special day. I have been invited for talks before but this was the best.

I went to my daughter’s class to talk about what I do. The teacher has invited parents to come to the class and talk about what they do for a living.

When I arrived at the school there were 17 children eagerly waiting. I talked about what Hospitalist are and what hospital medicine is about? I also informed them about wound care and hyperbaric medicine. I asked for any volunteers with any “boo-boo” for demonstration. One 7 year old volunteer with an ant bite came forward,  who I readily discharged from my service after prompt therapy.

All in all it was a lovely experience.

In the end I asked them if there were any questions or comments, here are some fine examples;

• “My sister kicks me at night, can you do something about it”.
• “My granny has a metal in her hip. Does she need any thing?”
• “Do you also treat cats and dogs?”
• “I know how you become a doctor, you go to med school”.

 The best thing is my daughter thought I was awesome! You  can’t beat that.

  

Blog You Later.

About the picture: My 6 year old daughter was asked what three things you want to do in future.

So if you look at the picture, she scratched 1- Fly 2- Talk to cars. Before what she wrote above. 

Monro-Kellie Doctrine And My Father.

Alexander Monroe hypothesized in 1783 that brain resides in a confined box. Total volume of the brain remains constant and it is incompressible. Any time there is an increase in the volume of this box it will directly increase intracranial pressure and will compromise either one of the three contents; brain, cerebrospinal volume or blood.  Later George Kelly confirmed this observation in 1824.

Our memory is like that too. We only have a finite memory, our recall is limited. We only remember the most pertinent things. Stress plays a major role in memory loss, sustained stress cause damage to hippo-campus, which is essential for learning and memory. When we forget essential details during stress, that is due to Cortisol, which may also cause confusion in trauma and crisis. Maybe after delivery mother's develop some short term memory loss.... otherwise women may never want to be pregnant again.

My father taught me so many things. He practiced Medicine for almost 50 years, a very astute clinician.   When I was growing up, I had to wear a tie even in 1st grade. It took me a while to master the knot properly but he never gave up on me. My parents were visiting me some time ago and we were going out  for dinner. My mom came to me and asked me to help my dad. I went to his room and I found him standing in front of the mirror holding a tie with a look of confusion. I asked him what is wrong. He said I don't know how to tie a knot. I looked at him and remembered all the times when I had the same look when I was young. I tied his knot and we went our way.

They are visiting me this month. When I look back, I wish I be as caring and a good father as he has been to me all my life.

Blog you later,

About the picture: Still going through the museums.

Empowered Patient, Myself.

I was watching a news report on CNN the day before, titled The Empowered Patient. There was a story about a lady who was misdiagnosed by a doctor which almost cost her life.  I occasionally come across these situations in my professional life. But the story I have for you is more personal and involves my then 3 year daughter.

We just moved to Tampa around that time. We were sitting on a new sofa which we recently bought, watching a late night TV show. My 3 year old daughter was doodling something on a paper at the same time chewing on a pencil. After a while she tried to climb the couch, as soon as she came up she fell down, face first with the pencil in her mouth. She started to cry and I saw a speckle of blood at the corner of her mouth. I immediately examined her mouth and I noticed a small amount of blood at the palate. My wife who is a physician too washed her face, gave her some cold water to drink and everything seems to be alright.

Around 11 pm my daughter started to fuss a little more and complained of mouth pain. I decided to take her to the ER after my wife insistence. In the ER she was examined by a familiar physician. He examined her ear, nose and throat along with a chest X-ray. He diagnosed her with middle ear infection and prescribed her codeine and antibiotics. I was perplexed; I could not fathom how she would develop an ear infection after this kind of injury. He assured me she must have an underlying problem which is manifesting now. He added “Irfan, you are analyzing things like a father rather than a physician”. I was confused, but there was nothing else to do. After his repeated reassurance I brought her home around 4 AM with instructions to restart feeding with milk and food.

Her condition at home started to deteriorate, around 5:30 AM she started to develop shortness of breath and became lethargic. My wife looked at me and said “We need to take her back to a different hospital; my motherly instincts are telling me that there is something terribly wrong here”.

As we were putting her back in the car I got a call from director of the ER. He said “ the other doctor missed a finding on the chest x-ray, you daughter has pneumomediastinum”. I felt like being kicked in the chest. Knowing pneumomediastinum is an air collection (mostly after a trauma) in the space between the lungs, this space is in the middle of the chest (the mediastinum). Basically the pencil penetrated her throat, made its way into the space in the middle of her chest. This created an opening between the throat and the chest. We had been feeding her milk, a perfect medium for bacteria. Infection with pneumomediastinum has a very high mortality rate.

We literally ran to a different hospital where she was seen by an excellent ENT and ER physician. She had few procedures, couple of tubes and she was admitted to the ICU for a week. She recovered without any residual problems and we brought her home. A happy ending.

There are certain concerns though. To err is human. But how do you deal with your mistakes. Full disclosure would help in most cases. I never got a call from the physician who was involved, he never explained what happened even after we met; considering this could have resulted in a disaster if we were even an hour late. A sincere explanation would have sufficed. That is where transparency comes in.

On the flip side systems puts in place for patient safety helped us save her life. Any X Rays read by ER physicians are read again by the radiologist, which decreases the chances of error. I am glad that this system of checks and balances exist, as this improves the safety of our patients.

About the Picture: At a lake nearby.

Cut, Burnt and Poisoned.

“I have been cut, burnt and poisoned” said a friend of mine who has been recently diagnosed with esophageal cancer. He has gone through surgery, radiation and chemotherapy.  He is merely 40 years old. He has lived a very good life, successful in his career and married with two little daughters who are my daughter’s age.  I can relate to him on so many levels because of   many similar traits in our personalities and among our families.

 

We used to go out a lot before he was taken by this ailment. We have shared some good laughs and enjoyed some great times. I remember going out once for a snorkeling trip. There were at least fifty or so people floating around us.  So here we were snorkeling up and down the river, we would come back up to our canoe and move to different spot.  It started to rain and we continued to do what we were doing. After a while I come up and notice there is no one in the river any more. My friend realized it too. I asked him where did everybody go. He said possibly because it is raining and, after a pause he said ……lightening too. We suddenly realized that we are sitting in an aluminum canoe. Moment of panic struck us at the same time. It was an open invitation for a lightening bolt to strike us. We both paddled for our lives and reached the shore on record Olympic time. Once we were safe we laughed at our stupidity for a very long time….. We still do.

 

We would also meet on the weekends where my 6 year old daughter would go for karate class. His daughter was just too good despite being the same age as my daughter. I was afraid she may break someone’s arm or leg. One day he told me how he taught her daughter to throw a perfect punch, I envied him because even I don’t know how to throw one. I thought well maybe I can teach my daughter not to throw a perfect tantrum.

 

Sometimes I wish we can have that time back. I wish he can get better like this has never happened before. I asked him how come he is so brave, I would tap out so fast. He replied I am as brave as any father would be. I am doing this for my daughters.

 

After he received his first cycle of surgery, radiation and chemo he waited for a month before the CT chest and abdomen were repeated. He was very optimistic, doing everything right and embracing any therapy available for this disease. He was even getting imported Japanese herbal tea which can help with cancers. Then came the results of the CT scan which showed that there was no remission, in fact there was progression of disease with lymph node involvement.

 

I remember the day when I found out. I had a tough time sleeping that night.  But he did not flinch and started the process again with chemo. I asked him how it feels. He said “It is like you prepare for your tests and work really hard, you sit at the day of test and do really well. But when the result come out you find out that you got a F. That’s how it feels like”. I was speechless.

 

His courage, dedication and strength is inspirational. We met few days ago and during our conversation he told me casually that he sold one of his cars just in case if he is not around things would be simpler for his wife. To come in terms of one’s mortality is not an easy thing to do. His wife who is a physician too puts up an act so convincing that it is hard to figure out what is going on behind this veil of bravado.

 

I read a book The Last Lecture by Randy Pausch, a computer professor who stood in front of 400 people at Carnegie Mellon University in Pittsburgh and frankly talked about his fight with pancreatic cancer with few months to live. Later in the lecture he did some push ups followed by a lecture about how to achieve childhood dreams. He writes in his book “We cannot change the cards we are dealt, just how we play the hand”.

 

I think my friends have played it well. Sometimes I feel guilty that in the game of life the dice coughed out the wrong numbers. Sometimes I have trouble looking straight in his eyes thinking he may discover that I fear for him. But there is never a time when I don’t envy his strength. I wish I could have been a better friend.

 

Anyway my friend I just want you to know we are here for you always and I hope we are stupid again to snorkel during thunder and lightening soon.

 

Blog you later.

 

About the picture: I took this picture at our house but my daughter provided me with the ketchup.

PS: This is a follow up.