I have to admit it. They can tell you so ridiculously much about a hidden organ. And they're so simple. I mean, really really low-tech. I had a patient with prolonged QT. That means that inside his heart muscle, the cells were taking longer to repolarize (get ready to contract again). And we could tell that by sticking little tapies to his skin and recording the electricity that moves across the skin on a little tracing and voila! Long QT. It can mean: drug interaction, familial syndrome, ischemia, electrolyte imbalance...but the EKG gets us started.
I have an old EKG of my own (from the time I passed out while working in the ER, hit my head, and accidentally bought the Workman's Comp system a lot of tests). That EKG is dog-eared and fuzzy on the edges from wear. I have to say that I can learn about quirks of physiology in a book forever, but there is an emotional punch to receiving a much-sought lab on a patient whom you've gotten to know. When I know what someone's high school sport was, the names of their kids, and their first job (things I usually find out in a patient interview), I CARE what their white blood cell count is. Because high WBC's could mean an infection that I am (a little bit) responsible for protecting them from.
A point of personal growth: I have never trusted my ears one little bit. I don't trust them to hear my kids when they're whispering upstairs, not to discern the nature of the ruckus outside my home, not to differentiate Schumann from Schubert. But tonight I was the first person to diagnose a heart murmur! This was AFTER a senior doctor listened and missed it! (It's easy to miss because it's the kind of murmur that radiates to the lateral chest wall, so you have to be really thorough to hear it way over there.) I got confirmation from a third person. Go, EARS! (It's probably mitral regurgitation - the patient has too much else going on health-wise for the diagnosis to matter a hill of beans to her in the long run).
Work hours have been right at 80/week on internal medicine at the VA. Today (Saturday) I worked from 7 til 9, and that's how almost every day has been for the past week. I work again tomorrow starting at 6 a.m. Today, Richie took the girls to get a new mattress (Vivian was literally hanging out of her toddler bed which has a crib-size mattress). He made tater tots for dinner, the aroma of which hung in the air when I arrived home tonight. Ahhhh, cold tater tots! I like tater tots so much that (don't tell) I have gnawed away at them in their frozen state. I'm getting slap-happy in a public forum, and so will bid the internet Adieu...to you and you and you!
One last thing: I have a patient with tattoos that label his nipples "hot" and "cold." You'd think this would be scrawled or written in Victorian parlor font, but it's actually in clean architectural lettering. I found this among the more odd and interesting of the tattoos I've seen. I won't mention the more profoundly disgusting tattoos I've seen, but Mr. hot/cold is, I think, fairly PG. I always want to ask people about all their tattoos. Less "what the heck were you thinking?" (although some may feel that's appropriate), and more "What does that piece mean to you?" Dr. Gillespie, the psychiatrist who leads our psych module, mentioned that approach and I liked it. I've only asked about specific tattoos a few times (not Mr. Hot/Cold), and I learned about peoples' loved ones who have died and about their military service. One must work that question in artfully, preferably after the initial interview...maybe during the physical exam. I don't know. But I certainly don't lead with that question.
Almost all my patients are nice people. People who are addicted to things have, in my experience, been among the nicest ones. I think they usually feel pretty sheepish about their reason for being in the hospital. I have seen a lot of really physically miserable, crying, shaking detoxing alcoholics who were the most contrite people on earth. I don't know. I know when I meet a patient, I initially feel standoffish (really just like when I meet any new person), but it takes about 2 minutes to warm up to each other and then I just really love them (usually). Even if they don't smell so good and I want to give them a buzz cut and a shave so bad I can't stand it. I wonder if there is a role for hospital grooming consultant. I think people wouldn't fare nearly so badly in life if they only had short hair. Okay, now I've really got to sleep. But I think short clean hair is always a step in the right direction.
In the hospital, people have access to showers, but I think that in some cases they've forgotten that hygiene is important. I think street culture is like camping only without the gear and without the wildlife. And without the s'mores and the thermarest and a good deal of other things. Nonetheless. I think some people get so far into street life that they literally need re-teaching. Maybe an 8 1/2 by eleven sheet that says something like: "In our culture, it's important to bathe. If you've been on the street for a length of time, it's easy to forget what you need to do to fit back in to non-street culture. Even when you can't smell yourself, other people will begin to smell you after a day or two of not showering. Bathing also helps rid your skin of germs that can make you sick. It gives you a chance to examine your entire body for any changes that may have occurred. It's easy to forget places like feet if you keep them inside socks or boots all the time. You may not always be able to get to a shower, but we have one here for you to use, along with this complimentary soap. If you have any questions or if you need any help that we have not provided, please ask. Go ahead and shower - your body will thank you!" And then one for haircuts and shaving. I really don't mean to be flippant or simplistic. I feel for these people, and I think that the urge to keep clean simply acculturates right out of them. I have wanted to have this talk about a dozen times in the past month, but it's tricky territory. I have had some patients who have detoxed in the hospital, and then we let them go looking and feeling and in the same clothes as when they came in (only not drunk). I feel like a haircut and a shave and set of clothes that fit well would go a long way toward helping them stay clean substance-wise, too.
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