Monday in what manner do medical ...

Monday

in what manner do medical errors happen? In a populaceed emergency department, I quickly report an intern about a patient: "Miguel is a 45-year-old man with debilitating coronary artery disease and congestive heart failure. I sent him here this morning because his wife is leaving him and now he says he wants to die." At the second my patient is sleeping not on a dose of lorazepam (Ativan) in a tiny, unlit cubicle he's wedged into with another take downed patient who has been awaiting a bed for days. Our psychiatric unit is replete In fact, there isn't an available bed in the entire shire and we decide that admitting Miguel to a medical floor is the solitary humane option. Hours later, the intern reports that Miguel is settl into his sweep upstairs, but mentions some uneven inconsistencies: "He told me he doesn't have a wife or children," she says, "and that he's been here since Saturday." A light begins to flicker. "Are you steady you admitted the right patient?" I ask. looks that in the chaos of a busy crisis department, the intern was directed to the vicious man. With my patient fast asleep, she asked his neighbor if he was Miguel. "I'm Michael," the man answered. "Are you 45?" she'd persisted. "Forty-six," he replied. shut enough, she thought, and voila, assigned him a fresh identity! The intern is horrified. "I've learned my lesson" she says, and I believe her. yet boy, this really frightens me

Tuesday

When the medical examiner pages me at 10:30 pm I click worriedly between the walls of the names of my sickest patients while dialing her number. yet my guesses are off, and it's Bart who has died in his be still Bart was a convivial bachelor who serv in the merchant marines during World War II. A 290-lb 75 year elderly with hypertension when I first met him in 1994 he unraveled diabetes a few years later, then shed 50 lb in fits and starts. He was a design patient--compliant with medications, enthusiastic about his on-again, off-again diet, and unfailingly cheerful despite arthritis that hobbl his golf game. He had not long ago come to my office wearing a baseball cap with a leafy fresh insignia that resembled marijuana. I pointed questioningly. "Gotta sum up ya," Bart said, "I was coming on the outside of a store yesterday when a r sports car struggles up. 'Hey pops,' this young gal says, 'are you buying or selling?'" Bart shrugg "I didn't know what she was talking about. I showed her my groceries bag and said, 'I'm buying!' Do you believe that?" He took against the hat and peered at it. "Now I finish it," he said, "but I'm too antiquated for smoking that stuff, don't you think?" Ye I did think--and we the two laughed. Despite his age, I didn't think Bart was ready for the final tee off

Wednesday

As a family physician who believes that there's more to life than can be measured, I'm delighted by way of patients who resist high-tech attempts to pinpoint their ailments. Olivia, 27 was admitted to our inpatient service with 10 days of right upper quadrant pain worsened on fatty foods. Gallstones, most likely? Her tendernes included the right upper and lower quadrants and the right flank; her children work was normal except for a minimally elevated alanine transaminase; and her abdominal ultrasound did not reveal any gallstones. Might this be renal calculi? Appendicitis? An abdominal computerized tomographic scan was clean as a whistle leaving out for a fatty liver, and a gallbladder hepatobiliary scan also was negative. everywhere the next day, Olivia was still nauseated and hurting, and she received another projectile of meperidine (Demerol). Today, our radiologist called to say that a reexamination of the gallbladder scan showed a reduc gallbladder ejection fraction, suggesting dysmotility. Might that be the problem? Our gastroenterologist's reaction is ho make a buzzing sound "That low ejection fraction could be caused by way of starvation or by the meperidine," he says firmly. "She doesn't have gallbladder disease." And the patient? Despite a certain quantity of residual nausea and tenderness, Olivia's appetite is back and she's eating formerly again. So after one radiograph, common ultrasound, two scans, and many family tests, we finally send her hearthstone with a diagnosis of pain. I love it!

Thursday

I find myself sitting in the waiting space of an ear, nose, and throat specialist with my daughter Nikki, who's 11 and suffering from vertigo. It began last Wednesday when she vigorously tossed her head back while drying her hair. unexpectedly the room began to sudden pull and spin, and then she threw up She exhausted the next day sitting robot-like forward the couch, head motionless atop a carefully set upright neck. I figured we were abiding-place free when she went public to play basketball the following afternoon. if it were not that this week, she became congest and yesterday, the dizziness returned; it got likewise bad she went to the drill nurse, where lying down made it worse. At that point I began to worry: when have I aye seen positional vertigo or labyrinthitis in a child? in the same manner today I took Nikki to her doctor, who shared my touch and referred us here, where the specialist now performs a careful examination and, to my relief, is unperturbed. "It's probably a labyrinthitis or traumatic vertigo caused by the agency of the head shaking," he says. "But here's something odd: she has one bilateral hearing loss in the higher frequencies. You don't use a jackhammer, do you?" he asks Nikki. No, if it be not that she did attend a dance with earsplitting music sum of two units weeks earlier. And so, like many patients, we leave the doctor's office happily reassured about our presenting question but saddled with something modern to fret about.