Posts filtered by tags: Critical Care[x]


 

My battle against the nurse’s cap

Florence Nightingale was among the first nurses who started wearing a nurse’s cap. The cap was derived by nuns and represented those caring for the sick. Hair was neatly tightened into a bun and covered by the cap. Back then becoming a nurse was typically seen as a female profession, but men were allowed to […] Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more.
Tags: Health, Policy, Nursing, Florence Nightingale, PA NP, Critical Care, Public Health & Policy, Hospital-Based Medicine, CRNA


A story of treatment failure and end-of-life decisions

Part 4 of a series. By the time my father’s metastatic prostate cancer was diagnosed, he was already experiencing symptoms of poor appetite and weight loss, which grew progressively worse following his first hospital admission. As his nutritional status continued to decline, the protein level in his blood decreased, causing significant fluid buildup in his legs […] Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more.
Tags: Health, Conditions, PA NP, Critical Care, Oncology/Hematology, CRNA


A lesson in never giving up

Jim Henson, creator of the Muppets and Sesame Street, died at the age of 53. His diagnosis was toxic shock syndrome/streptococcus pneumonia — a deadly bacterial infection. We were on vacation when we heard the news: The genius who opened the imaginations and hearts of our children … maybe you too … was gone. We […] Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more.
Tags: Health, Infectious Disease, Jim Henson, Conditions, Pulmonology, PA NP, Critical Care, CRNA


Your first 24-hour shift

How can you work for 24 hours in a row? My friends outside of medicine ask me that often. What is it like? I wondered the same thing the night before my first 24-hour shift or “24.” I lay awake worrying, ironically, that I should have gone to bed earlier to rest up for the […] Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more.
Tags: Health, Physician, Pulmonology, PA NP, Critical Care, Hospital-Based Medicine, CRNA


A change in a patient changed us all

It was another simmering-hot Texas day, and the AC was faltering in the family-practice clinic where I worked as a family nurse practitioner. Most of our clients were poor and spoke only Spanish. My nurse, Eliza, approached, wide-eyed. “There’s a new patient — a woman named Maraby. She seems really angry,” she murmured. “She’s the […] Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more.
Tags: Health, Texas, Infectious Disease, Eliza, Conditions, PA NP, Critical Care, CRNA


Go quiet into the night

I know what you’re thinking: She’s cold-hearted, cruel, and unkind. But am I? Or are you? Grandma Lilly is 87-years-old and in the ICU. She’s on a ventilator with her wrists restrained to the side of the bed. Grandma can barely see because her eyes are puffy: scleral edema. And her heart races: 140 beats […] Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more.
Tags: Health, Nursing, Lilly, Conditions, PA NP, Critical Care, CRNA


Treating the patient’s body is not synonymous with treating the patient

We recently had a patient who arrived on our service in the intensive care unit after a complicated surgery. The surgery left him close to dying, and he was immediately put on life support and given heavy sedatives. Ventilators breathed for him. Special drugs kept his heart beating. A continuous pump acted as his kidneys, […] Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more.
Tags: Health, Education, PA NP, Critical Care, Hospital-Based Medicine, CRNA


What a kitten taught me about critical care

I recently read an article entitled “The family said, ‘Do everything.’” It described the case of an elderly patient at the end-stage of life. The article concluded that “If your loved one has reached an end-stage of life, do the right thing. Let them die peacefully.” While I agree with this author’s intent, recent experience […] Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more.
Tags: Health, Surgery, Physician, PA NP, Critical Care, CRNA


The evolution of the stethoscope

The stethoscope. Nothings says “I’m a doctor” more than the stethoscope in a pocket or draped around the neck. Forty-five years ago when I got my first one, a gift from my physician-father, the former was more common. Then we were more likely to wear coats — white coats or suit coats — and pockets […] Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more.
Tags: Health, Physician, PA NP, Critical Care, Hospital-Based Medicine, CRNA


Your greatest role as a doctor? Storyteller.

There are medical honors so rare you don’t even know they exist. When you’re trudging through the slog of PBK/AOA/other — ultimately meaningless — letters, these seem to be the definition of distinction. Just like every other lesson, a patient taught me what real prestige is. Well, it wasn’t entirely that Oslerian, it was the patient’s nephew.* Carl paged me on an ordinary day — a fellow physician, he once saved my family’s life with the silent, brusque wave of a pen. His aunt, Sharon, had been ...
Tags: Health, Carl, Sharon, Physician, Critical Care, Hospital-Based Medicine, PBK AOA


A physician loves the adrenaline surge

Have you ever felt so cold? I mean bone-chilling cold. I don’t mean the same kind of cold that northern winters can leave you feeling. I am talking about working in a hospital that is climate-controlled, and you are undoubtedly shivering. I still remember my first day on the job as a neonatology fellow. I was anxiously walking to the operating room to attend the delivery of a 25-week infant. As my teeth chattered, I assured my chief fellow that I was ready to lead the resident and nurse practiti...
Tags: Health, Pediatrics, Physician, Critical Care


HELLO AGAIN

I’d like to explain why I haven’t been posting here, and why I hope to be back soon. On August 18, my daughter, Sophie, who was getting ready to start college, developed a sudden and severe autoimmune disorder. She was hospitalized in the Critical Care unit, and began an aggressive course of treatment, to which she gradually responded; she then began intensive physical therapy. After 40 days of hospitalization, she was able to return home. She’s now in outpatient rehab, and is steadily doing bet...
Tags: Michelle, Sophie, Critical Care, Dave Update


Sometimes the most I can offer is to be present with people

I’m sitting in the ICU team room, staring at the computer, trying to look like I’m writing a note. But my head is pounding. As an internal-medicine resident doing my first month of residency, I’ve found the ICU of the bustling county hospital a jarring place to start my training. Although I’d anticipated the clinical challenge of caring for very ill ICU patients, I was unprepared for the emotional burden of having to deliver devastating, life-altering news to them and their family members. Faint...
Tags: Health, Burton, Physician, Critical Care


With every hardship comes ease

“Where is my baby?” I awoke upset that my belly, which hours before was bulging through my doctor scrubs, had surprisingly been flattened. No one had asked for my permission to deliver my baby. They told me he was delivered emergently — at 32-weeks gestation — to save both our lives. I was a third-year pediatric resident, the senior for the pediatric ICU, on the night of my son’s birth. My overnight call had just started with an admission of a 12-year-old in pain of a sickle cell crisis. As I be...
Tags: Health, Pediatrics, Physician, Critical Care


Delirium is a serious and common outcome of treatment in hospital intensive care

Since intensive care units (ICU) were created in hospitals more than a half a century ago, there has been a steady decline in death rates for individuals who are critically ill and require life support. That’s significant and meaningful progress, and it’s thanks to the pioneering work of many doctors, nurses and researchers who have discovered better ways to liberate patients from life support so that they can leave the hospital breathing and functioning on their own. But as a neurologist who pr...
Tags: Health, Neurology, Conditions, Critical Care


Sepsis awareness: Should there be different awareness goals for the young and the old?

Sepsis, the body’s self-destructive inflammatory response to severe infection, is the leading cause of death in U.S. hospitals, particularly among the elderly. It starts as mild sepsis, advances to severe sepsis, and all too frequently blossoms into septic shock.  More than 250,000 die of the illness. One in three patients who die in a hospital have sepsis. 62percent of survivors are re-hospitalized within 30 days. Over 90 percent of cases start in the community. Understanding the critical role...
Tags: Health, Time, Infectious Disease, Conditions, Critical Care, Hospital-Based Medicine, Sepsis Awareness Month Organizations


Burnout in pediatric intensive care physicians

Burnout has been a descriptive term for years, but lately, psychologists and others have assigned it specific characteristics with a view toward being able actually to study and measure it. One common definition of burnout is a state of chronic stress that leads to physical and emotional exhaustion, cynicism, detachment, and feelings of ineffectiveness. The PICU environment is often one of high stress, so it’s a place where this can happen. We’ve known that informally for a long time. The best m...
Tags: Health, Practice Management, Physician, Critical Care Medicine, Critical Care


Doctors should let their patients’ religious beliefs shine

On one of my first days of medical school, I shuffled into a lecture hall surrounded by professional looking individuals as we had done the days before. This similar routine persisted for a few days as we became oriented to our new school. Leadership had indoctrinated us with professionalism, administrative staff had terrified us to the point of avoiding any patient information for fear of being sent wherever they send HIPAA violators, and the resident financial guru helped us slide into the rea...
Tags: Health, Education, HIPAA, Critical Care, Hospital-Based Medicine


When you here these words from an experienced clinician, believe them

Anyone who has worked in medicine for a long time well understands the power of the statement coming from an experienced person: “This kid looks sick.” That person could be a physician or nurse. Years of experience does tend to give one a sort of sixth sense for when to worry something serious is going on that just hasn’t shown itself fully yet. Seasoned parents can often provide the same perspective. A fascinating recent article pertaining to this appeared in Critical Care Medicine, the journal...
Tags: Health, Madonna, Christ, Pediatrics, Conditions, Carracci, Christopher Johnson, Critical Care, Hospital-Based Medicine, Society of Critical Care Medicine, Annibale Carracci


When you hear these words from an experienced clinician, believe them

Anyone who has worked in medicine for a long time well understands the power of the statement coming from an experienced person: “This kid looks sick.” That person could be a physician or nurse. Years of experience does tend to give one a sort of sixth sense for when to worry something serious is going on that just hasn’t shown itself fully yet. Seasoned parents can often provide the same perspective. A fascinating recent article pertaining to this appeared in Critical Care Medicine, the journal...
Tags: Health, Madonna, Christ, Pediatrics, Conditions, Carracci, Christopher Johnson, Critical Care, Hospital-Based Medicine, Society of Critical Care Medicine, Annibale Carracci


Never underestimate the power of a smile

He was a young patient with AIDS and Pneumocystis jiroveci pneumonia (PJP). Maybe that should have scared me from the start, but it didn’t. In hindsight, I keep wondering when the fear really set in. But downstairs under the glaring lights and the swooshing bustle in the ER, I only remember that he looked slightly bored as he took shallow, quick breaths. There was no blood, no screams of pain. No alarm bells rang in my head. He seemed calm at first. But with each passing day he asked the same qu...
Tags: Health, Infectious Disease, Conditions, Critical Care


Caregivers have the power to prevent medical error

What if it is your parent? Your spouse? Your child? Imagine supporting a loved one through a journey of serious illness. You go to all the appointments, know all the medications, almost feel the aches and pains as if they were our own. You repeat the same thing over and over again to one doctor after another making sure nothing slips through the cracks. Did somebody write this down? Isn’t this important? As a clinician, you are busy, overworked. Most days, you don’t have time for lunch. The last...
Tags: Health, Patient, Critical Care, Hospital-Based Medicine


Am I the cold and detached physician?

It’s 9:30 a.m. on a Wednesday, I get on the elevator, and I hear a man in his 40s, having a conversation on his cell. He says: “He had a brain bleed yesterday, and they had to put a breathing tube in, they don’t know how much damage his brain has suffered at this point.” He gets off on the adult ICU floor. I quickly think “that sucks” and carry on. A little bit later that day, as if the theme for the day was brain injury, I walk by a woman standing on the street. She speaks on her cell phone and...
Tags: Health, Physician, Critical Care, Oncology/Hematology


Don’t go to the hospital alone

Very many years ago, as a medical student, I remember caring for a twenty-something-year-old in the intensive care unit (ICU) with a very severe infection that resulted in her being in the ventilator for months. Let’s call her Jane. Her hospital course was complicated: re-infections, loss of digits, muscle wasting. The ICU was closed to families during morning rounds which is when all the doctors in their white coats gathered and went from bedside to bedside discussing each patient in turn. Most...
Tags: Health, Jane, Physician, Critical Care, Hospital-Based Medicine


The man with the fedora in the ICU

I visit him in the ICU day in and day out. It’s the man with the fedora. I see him every day because he is not going anywhere. The metastatic cancer has ravaged his colon, bones, liver, and lungs. His oncologist is willing to try more chemo — but not now — maybe someday “when he is stronger.” The man has already failed several other regimens. The oncologist hasn’t seen him in a while. He’ll see the patient in clinic when he is discharged. He thanks us for keeping him updated. Every day as I log ...
Tags: Health, Infectious Disease, PICC, Physician, Critical Care, Hospital-Based Medicine


How to deal with devastating criticism

“Why don’t you just get a shotgun and blow his brains out next time? Better yet, next time stay the hell away from my patient!” I was frozen, and the ICU attending wasn’t even talking to me. My co-intern had barely started her presentation when she met damnation. Mind you — there was a senior resident, a pulmonary fellow, and a team of nurses caring for the patient also. Yet the intern bore the brunt of the criticism. Health care is often like this and can feel like a dog-eat-dog world with a ri...
Tags: Health, New York, Education, Critical Care, Hospital-Based Medicine


The best time to practice compassionate, attentive care is today

The ICU nurse positioned the mirror in front of my face. “You look more like yourself now, Dr. Berk,” she said. She was right! The nurse, whose name was Meghan, had just shampooed, dried and brushed my hair. Clean and coiffed for the first time in over a week, I appeared normal — except, that is, for the tubes sticking out of my left nostril and my mouth. It was 2009, and my eighth day in the intensive care unit. I’d had a serious bicycle accident that resulted in a spinal cord injury at C3-4, i...
Tags: Health, Neurology, Meghan, Berk, Physician, Critical Care, Hospital-Based Medicine


When someone is not dead but not alive

May lay in a hospital bed, her wrinkled skin covered with sensors that monitored her every breath and heartbeat. Her husband sat at her bedside gently stroking her withering gray hair as her chest moved slowly up and down accompanied by the soft whoosh-whoosh of the ventilator that breathed for her. He stared expectantly at her face as if at any moment she would rise and free herself from the multiple tubes that sustained her. Her adult daughters sat and stared blankly at the floor, waiting for ...
Tags: Health, Daniels, Palliative Care, Physician, Critical Care


How I saved my daughter from a medical error

We had no choice in becoming the “crazy” family that left a hospital against medical advice. Our four-day-old daughter was completely helpless, her condition deteriorating and the staff was ignoring our concerns. I carefully turned off the blue lights, removed her from the isolette, placed her in a car seat and eloped from the pediatrics unit. As a hospitalist, I constantly obsess over medical errors. The majority are more subtle than the headlines (wrong-sided surgery). They are things like del...
Tags: Health, Pediatrics, Physician, Critical Care


A different kind of Mother’s Day

Multiple strokes, respiratory failure. Cardiac arrest — twice. At first glance, I thought that I was reading the medical chart of an elderly person or at least one who had some other predisposing medical conditions to explain her current state. But I was staring at the body of a 28-year-old woman. She had a youthful face and frizzy hair from being propped up on the same static-charged pillow for the last few days. The nurses had painted her fingernails with red polish and slathered Vaseline on h...
Tags: Health, Physician, Critical Care