Wednesday, September 15, 2010


Another perk to my temporary life as a cardiologist is that I don't need to arrive at the hospital before 9 or 9:30, so I've traded gigs with Brian and have been dropping Sam off at daycare in the mornings. We've already developed a weekday routine that involves a morning coffee (for me) and a morning scone (for him). Yesterday as we were walking toward the coffee shop, we passed one of the baristas, empyting the garbage. "Stay in school, kid," he said to Sam. "You don't want to spend your life empyting other people's trash."


Speaking of gratitude, here's a story for you. One aspect of modern medical care that I suspect many non-doctors don't fully appreciate: the log-jam. I recently helped to care for a patient at our veterans' hospital with so many medical problems, it is almost impossible to treat him. Poorly controlled diabetes earlier in his life resulted in kidney failure; a decade ago he underwent kidney and pancreas transplantation. Unforunately, his shiny new kidney was infected with a virus and was subsequently removed and he is now a dialysis patient with permanent vascular access. But his borrowed pancreas still functions, and he remains on immunosuppressive medications. (Note that permanent vascular access + immunosuppressive medications is a bad, bad combination.) He rolled in to our VA emergency department four or five days ago with a high fever and severe back pain. An MRI showed a large abcess in his lower back, tracking along his spine. The next day, his blood cultures grew Enterococcus and an ultrasound of his heart revealed a infectious goober flopping along on his aortic valve. The valve itself is no longer functioning adequately; he is increasingly short of breath and hypoxic as a result. Treatment for an epidural abscess? Surgery to drain the abscess. Treatment for bacterial endocarditis causing heart failure? Surgery to replace the valve. But the heart can't be fixed before the back; can't put hardware in a patient with an active septic focus. And the neurosurgeons are -- how to say this? -- declining the opportunity to operate on this man's back due to his kidney disease and overall clinical instability. "Poor surgical candidate," they called him. ("Poor non-surgical candidate," the medical team noted.) In the meantime, his fevers and rigors continue despite horse doses of antibiotics and all the while he remains paradoxically on medications to suppress his immune system. The whole situation is a complete snarl and the patient is desperately, desperately sick. I'm not sure what will happen for him or to him.

Thursday, September 2, 2010

Cardiologist for a day (month)

This month, I'm on the cardiology service at our veterans' hospital. Among other things, the new rotation means WEEKENDS OFF. My first so-called "golden weekend" (known to non-residents by the common moniker, "weekend") was last week. Brian, Sam and I celebrated by spending the weekend at Lassen National Park. Despite a Bay Area heat wave earlier in the week, it actually snowed in Lassen over the weekend. Snow! In August! Even with the incement weather, we had a wonderful time. On Sunday we hiked to the top of the Lassen cinder cone for a view of the painted dunes and lava beds. It's quite a steep climb and poor Brian carried Sam on his shoulders the entire way. When we got to the top, Sammy announced, "I HIKED!" Um, sure, kid.

I'll post pictures of Sam "hiking" and "camping" (technically, a hotel, but what does he know?) when I can.