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?

Tele Neurologist. Specialist On Call.

In a time not so far away, you just brought a friend to the emergency room with symptoms of stroke. Patient has developed right sided weakness and also complaints of slurred speech. ER physician enters the room and evaluate your friend. He recommends that your friend can benefit from thrombolytic therapy. Then he goes on to say that he would need a neurologist to make that call, however, there is no local neurologist on call. You start to get upset and…………….drum rolls…..

………and enters neurologist on wheels, this robot like device is being dragged in to the room by a nurse. On the monitor you see a doctor’s face. “Robot” asks you different questions, examines your friend with certain devices and eventually review your CAT scan of the brain while sitting miles apart. Finally he recommends that he concurs with thrombolytics. He orders it and the nurse administers the lytics. Soon your friend who was unable to speak a minute ago now is talking with you and moving his extremities. Finally you take a deep breath. You know what’s so peculiar about this scenario? THE TIME IS PRESENT, IT’S HERE.

I was invited today to meet with Specialist On Call (S.O.C). They provide expert consultation and evaluation for stroke patients. Their model is telemedicine, where a board certified physician is sitting at a remote facility and evaluates your patient. He makes recommendations appropriately, utilizing most advanced tools available through a computer portal.

This company provides specialty care to those hospitals which lack certain specialties. Like in our program we do not have a neurologist on call for stroke.  So patient who live close to our hospitals are taken to a remote facilities to be treated with thrombolytics.

 Initially I was apprehended by the presentation but after listing to the speaker he was able to answer most of our concerns. SOC was founded in 2005, they are currently working in 105 hospitals around the country and they are (Joint Commission) JACHO accredited. They guarantee a patient–teleneurologist encounter within 15 minutes and are available 24/7. They had 6734 consults in 2009 and recommended 380 thrombolytics. National average for cerebral bleed after thrombolytics is 6 %, they are at 4.5 %.  They recommend collaboration with local neurologist for post thrombolytic care.

Though it seems like a good alternative but it would require a comprehensive protocol before this could be implemented. There is a company in Georgia who is also using the similar device to fill in for nocturnist/hospitalist and so far they have seen good results.

I would appreciate feedback if anyone has been involved with similar projects. 

How Many Times Have I been Sued. Malpractice Lawsuits.

Recently I came across an article by Paul Levy, it mentioned a support system among doctors at Brigham and Women Hospital. This support system is in place to meet the physician who is being sued. They provide counseling and assist in anyway they can. I also received a report from a very good friend of mine, an interventional cardiologist Dr Raxwell about percentage of lawsuits among different sub-specialties.

When I initially moved to Florida, I was asked to meet a hospital chief of staff. During the interview process he asked me how many times have I been sued,  I replied none. He smiled and said “you want to say that you have not been sued, yet”.  

I have seen a large number of doctors struggling with insurance and lawyer issues that they can hardly live a normal life.  A colleague of mine was sued over a lipid-lowering drug by a 75 year old lady,  who had been her patient for over a decade. She asked the lady why? The patient said that she still likes her, insurance was going to award her the money that she thinks would not affect the doctor and …….. She is almost 80 year old and  likes to go to casinos.

Here is the report from AMA physician practice survey.

You should specially look at cardiovascular surgeons, 75% of them have been sued, 56% for the second time, almost 15% in the last 12 months and finally their number of claims per 100 doctors were 297%. WOW….

Knock on the wood, I still have not been sued… as of yet!  So what do you think. 

What If Walls Could Talk?

What if walls could really talk? Would you be scared? Would you really want to listen? What stories would they have. If walls talked would you be appalled, overjoyed or disgusted with their sordid tales. You could hear the resonance of  soft whispers among lovers and their promises to each other.

These fortifications may divulge your stories and secrets, stories about you, things you do not want anyone to know. On the flip side you may hear a hearty laughter from your childhood days.  full of fun as a child, sound of your innocent and pure laugh, not yet corrupted by social obligations.

Maybe you will cover your ears, as you can no longer bear to listen to these atrocious stories. Or maybe you will listen just a tad bit more to satisfy you innate curiosity.  You may not like yourself when it will remind you of the unkept promises and blatant lies. It may show your lack of integrity, gold standard test for integrity is not measured on the basis of our social interactions but by what you do when you are alone.

Or maybe it may remind you how much you are needed and what you have done for others.

 PS: I have been lazy about writing blog lately as I have not been feeling well.

About the picture: Field Museum, Chicago

My Friend With Cancer, Words of Wisdom.

Sun is cherished and romanticized the most at sunrise and sunset, so is birth and death. These are two focal points, which we rejoice and grieve the most, more than anything in between. A friend of mine is suffering from terminal cancer, I previously wrote about this few moths ago.

The last few days have been very turbulent and conflicting for me.  On one hand I have to face the eventuality of this situation and on the other hand I feel guilty because I can not control myself from thinking that what if this was me. I feel a certain bond with him as I have two daughters too of the same age. What would I have done? Would I have shown the same dignity?  I try to distract my self in other things so that I do not have to think about this.

I was sitting next to his bed just a couple of days ago. How do you answer when your friend ask you is there any hope when there is none. It is different when you tell a patient that they are dying, it is quite different when you have to say to a loved one. I held his hand and firmly informed him that this is the end of the road and controlled myself from showing my emotions.

But I am not writing today to tell you about how I feel, as someone said it once, regardless of how bad one feel for the other, you can never feel close to the despair the other person is going through.

This is what he said to me with shallow breaths and teary eyes for almost thirty minutes after I told him what I think. I got his permission to write this and I will try to quote him the best I can.

“One thing cancer has taught me is that the world is not about you. When you turn the world about you, your life becomes very difficult. You have stressful days and you have days of agony. When you decide that your life is about others, about friends, about relationships, your world becomes a lot easier. When you stop focusing on “me”, and start to focus on people and relationships around you, you world starts to get easier. That is tough lesson I have learned from my cancer.

He paused briefly, then continued "I am really into my 2 little girls, just like any father. I had a very touchildhood…. My life long goal was to have a perfect family. And to have kids, and to shower them with parental love more than which I ever got. With this mentality I started my family. If I would have known my life would take a sharp turn like this I would have never done it. I did not know I was going to die this young. Because I can not bear to think that my kids will miss and not look at me in their later lives. I do not want them to wonder where is daddy, when is daddy coming home?

My older one knows that what is going on. My relationship with her has changed. She is more quite. She gives me hugs everyday, the kind of hugs she did not give me before. Before she used to give me hugs which a typical 9 year old gives to her  daddy depicting “I love you so much”, in the past few months she gives me a hug which is more like “daddy I do not want you to go”, for a nine year old to go through this, is heart breaking.

I fight this disease because of my daughters. Your life should revolve around your family. Your should not sacrifice your family”.

Well I just want you to know buddy, the love and affection your girls have already received, very few children get it in their whole lifetime. 

A New blood thinner in 50 years. Dabigatran.

In the history of blood thinners, FDA has approved Dabigatran, a new blood thinner for the first time in fifty years. Dabigatran (Pradaxa) has been approved for strokes associated with Atrial fibrillation. It inhibits thrombin.

Warfarin is one the the best and most dangerous medication we have been using for decades for clot related problems. It requires constant monitoring. Unlike Warfarin, Pradaxa does not require periodic monitoring.  It carries decrease risk of bleeding as its counterpart. It will be available in 75 mg and 150 mg capsules. The cost is going to be an issue. It can be 10 times higher than Warfarin. I think it should be available in the next 6 months.

Well this is as exciting as it gets for us.

About the picture: On top of the ferris wheel at Navy Pier, Chicago. 

Doctors Are In For The Money!

I was recently reading an article at KevinMD, about doctors, that they are in for the money. Well I thought, to give you some perspective, I should list the jobs that I have done in my life, during my transition years.

In Pakistan I already finished my training after post graduation and I was running my own practice. However, once in the US I needed to do this all over again, so I was waiting to restart this process. The problem was that this cycle takes a year before you can get a position. So, I had about 18 months to kill. When I came to America, I did research with Dr. Harvey Priesler and Dr. Azra Raza, two of the smartest people I know in the field of Leukemia and Myelodysplastic disorders. I thoroughly enjoyed the experience but on the flip side the stipend that I earned only covered my studio rent in Chicago.

So I started to look for other jobs. I started my quest, beginning with trying to get off of a forced-vegetarian diet i.e., one of the cheapest meal prepared with garbanzo beans and diced tomato which takes only few minutes to cook. A friend of mine (who is now a high-risk Obstetrician in Detroit) tagged along and we stared to look for jobs. Our first stop was a pizza place. We filled out an application. There was a slot in there about education; we were naive enough to mention our qualification. They turned us down due to lack of relevant experience. My friend tried to argue that if he can deliver a baby, he can deliver a pizza without any problem. We lost the argument when the owner said that this oven works in a different way.

Finally I found a spot at a pizza joint. I delivered pizza for 3 weeks. It was the most stressful job I ever held. I used to park my antique car (my father bought me that car) in downtown Chicago and run up to deliver pizzas. The problem was that I got so many parking tickets that the net revenues were in the negative. After getting mugged and punched in the belly I was forced by my wife to quit that job.

Next stop, Chinese take out restaurant. I think the owner did not appreciate my talent. He kept on asking me to cut the vegetables faster and faster. I tried telling him that you can not be hasty, cooking is an art. He did not agree and I was given a pink slip along with garlic chicken on my way out.

Finally I found a job which I kept for over a year, carpet cleaning. I use to do high tech leukemia research with different clinical protocols in the morning and in the evening I use to clean carpets in the dead winter of Chicago. In fact the job was so “lucrative” that some of my other friends joined in too. One of them is now an Interventional Radiologist in Wisconsin and another one a Critical care Intensivist in Phoenix.  I will let you in a secret; I can still clean the carpets with floor stripping better than many, just do not tell my wife.

As I was diligently doing these two jobs I received a call from a program at Beth Israel Hospital/Harvard about an off cycle radiology position. They asked me to be there in 2 days. The problem was that I only had $280 in my account which would not have paid for the whole plane trip and stay. I told them I am busy for the next 2 days I can be there in 3 days. 

Greyhound used to take 28 hours from Chicago to Boston.  I got in a bus within 12 hours and made my way to Longwood Avenue in 28 hours, changed into a suit at a restaurant at Fenway park. It was a very humbling experience to be cleaning floors one day and standing at Harvard Medical School the next. Finally I got this position, during my stay there I learned so much from Dr. Sughra Raza, Dr. Janet Baum and Dr. Brook Longwood. They all made a significant impact on my professional life. My career started to shape up from there one..... and here I am.

Well so there it is, you be the judge.

About the picture:  Not mine!