Dentist.

Maybe it is me but I am just not too crazy about dentists per se, do not take me wrong I am not too crazy about other doctors too when I have to see them as a patient. Anytime I go to a dentist (no names), I come back with a new problem.

So this time I saw him for a regular cleaning. I spent a good fifteen minutes with a dental technician and after she was done I saw a glimpse of my new dentist through my peripheral vision as he was always on my side. If I see him on the street I probably would not recognize him..... unless I see him from the periphery.

I found out soon I was in a precarious situation, I may loose all my teeth in the next 30 years, if I won't get my cavities filled out. Now 30 years is a long time. I was injected with five vials of Novocaine, which I think was a lot and still I was having pain. I was informed that the reason I am still having pain is because "certain Indian and Pakistanis have dual nerve supply". I was not sold with that idea because with that amount of Novocaine, the whole population of India and Pakistan could be anesthetized.

Anyway I was finally done with instructions to come back for some more...... I have more sensitive teeth now as compared to what I presented with but still I have to go and get all this mess fixed up or else......

Please tell me I am not the only one with this problem.

Death Valley.

A friend of mine Dr Rippe recently visited Death Valley, California. He shared this picture with me.  It is a strange. So I did some research this is what I found out.

It is favorite place for tourist, somehow this place has evaded me so far. It is a spectacular geological site. Strange and mysterious with melted rocks scattered around.  Pretty hot there with temperatures over 110 at times. Its favorite attraction is Racetrack Playa, known for moving rocks. There are these rocks which moves leaving behind tracks. 

For centuries people have not been able to figure out how these rocks move. Some theorist suggest that it is because of the rain, some say it is because of magnetics. Considering it is so dry no one really knows. It is a strange site and quite a mystery. 

If you know of any better theories do let me know. I found one explanation here. 

About the picture: Credit goes to Dr Rippe, thank you for sharing.

FCCS. Fundamental Critical Care Course.

For the past couple of days I have been busy taking a FCCS (Fundamental Critical Care Support) certificate course at Tampa General Hospital. It was a great experience in many ways. This course is directed towards hospital physicians who are non intensivist. The goal is to emphasize what needs to be done for patients who are in a critical state and what kind immediate critical support they need for survival in the first few hours when a critical care physician is not available. Dr Luis Llerena, a trauma surgeon conducted this course. His way of teaching was excellent and I would strongly advise other colleagues to attend his courses. 

This is specially helpful for our group which is moving towards a 24/7 scheduling and with plans to be available for code blues and rapid response situations. I believe that in the next 5-6 months we should be able to provide this service. As I mentioned before in a previous post, that is is a natural progression of hospital medicine otherwise hospitalist would be glorified internist.

The picture above shows an algorithm based on a study Dr Emanuel River, dealing with goal directed therapy in the treatment of sepsis, published in New England Journal of Medicine. This study gives a very simple protocol for a very complicated problem. There are numerous times we see patient being treated for severe sepsis with vasopressors alone with intravenous fluid boluses. 

All in all it was very educational and informative. 

Droid In The Room. Autonomous Mobile Robot.

When I was growing up I use to tag along with my older brother who was a big time Star War fan, we use to watch all kind of Star Trek episodes together. I realized later, that in the process I have been transformed into a Trekkie and technology enthusiast. 

So as I was starting my rounds today I had a Star War moment. I saw a R2-D2 like character from Star Wars roaming our hospital corridors. I shot this video earlier today of this contraption, AMR (Autonomous Mobile Robot) going on its merry way. This  is along the same lines as my post earlier regarding Tele-Neurologist. This robot is crafted by a company Swisslog, which creates solutions for logistics automation. So make way to your next generation carrier. By the way, I think my amusement overwhelmed its handlers today. 

This robot carries digitally locked boxes containing various materials. You push a button and it will carry the samples to the lab or carry medications to different units from pharmacy. You can call it to your station by pushing a button. It can open doors, get into an elevator and may even has a capacity to carry medications to patient rooms. Our hospital just started using this robot, it is not operational, at least as of yet, but soon it would be. It will assist in all kind of logistics and distribution jobs around the hospital. 

Everything has its pros and cons. This carrier does not require a 401 K plan nor does it require any benefit plans. Nor it would take smoking breaks or stop on its way for a chat. However, all automated devices come with their own problems. Hey I have an idea, why don't we combine AMR with Tele-Neurologist technology to provide automated service. Anyways be aware,  soon you may find my replacement entering patient's room fully charged and on four wheels with an Apple logo....... here enters IAli,M.D.

So if you have any doubts, tomorrow is already here today. 

Baby Crying.

I saw a patient recently, she had a fetal demise. I came out of the room in our OB part of the hospital, I could hear a baby crying at a distance along with other people chattering away. As I started to tell the nurse  what my plan is, she gently interrupted me and asked "did you close the door behind you" I said no. She said "No problem I will, it is just that I do not want her to hear the baby crying". 

It took me a second to realize her sensitivity to this situation., it takes a certain personality to be so kind. 

I wonder what other things we do without thinking everyday?

Snowbirds.

Yes they are almost here, they are coming in cars, trucks, planes and …… ambulances. They come from Maine, Canada, Massachusetts, Michigan … pretty much everywhere where the temperature is sub zero. I often kid around with my doctor friends from up north that whatever they do with their patients all year, we have to fix it in a very small amount of time. (I am sure they probably say the opposite).

Population of our city triples during winter. You can not beat the sunny weather of Florida neither can a hundred thousand people who swarm from every where.

On my way to the hospital you see tens of RVs jamming the road and people trying to move into RV camps. I had a patient once who was 93 years old, he drove all the way from Maine, and here I am, not even half his age and I try not to drive to the other end of the town.

Winter season has some very interesting dynamics. Especially patients who come from Canada, some of them get conned into buying travel insurances which get them nothing here. On the other hand some Canadian insurance would send a chartered plane with flight crew to pick their patients who need only a colonoscopy or even a cardiac catheterization.

You see a significant increase in your census; I realized finally that we are in the “season” when I ended up admitting 14 patients just last night and at least 35 pages. I have a love hate relationship with my pager; can not live with it and can not live without it.

Not so long ago some physicians in this area used to go on long extended vacations each summer, they worked as seasonal workers.

Anyway,  so for the next 5 months life is going to be very interesting....

  

Lemon Tarts.

She is in her late twenties very energetic and compassionate. She is always bouncing around from one patient room to another, along the way “trying” to boss around all the physicians.

The amount of energy she has is infectious, but looking at her you can never tell she had an open heart surgery just a few years ago. When you think about open heart patients, twenty year olds do not come to mind. It is one of those medical mysteries where we have no answer why she had coronary artery disease at such a young age.

Now she has a new lease on life. She is now married and has a young son. She says that she meets her son everyday like this may be the last day of her life. She has a very positive approach towards life. She thinks she had this ailment for a reason. She believe that through her people find strength and hope, when they see a person living a normal life despite going through this major surgery, they feel they can go through it too. It is true people can associate more when they have some thing in common.

There is no rhyme or reason as to why life has dealt these cards. You can sulk and make your life miserable. It is your choice to be a passenger or be a driver of your life

As they say if life hands you lemons, make lemonade or be smart make lemon tarts. 

About the picture: I am keenly aware that this picture is neither a lemon nor a lemon tart. But I should get credit for it being yellow.

1928 Cell Phone?

We are close to the weekend now, so I will try to keep it light.

I saw this clip on Youtube. CNN also ran a story about this. This clip is from "Circus"

a Charlie Chaplin's movie from 1928. 

You will notice a lady walking in the background while she appears to be talking on a cell phone.

The only problem is that there were no cell phones in 1928. So what is she doing? 

Hearing aid or time travel?

What do you think?