Dissecting Grey's Anatomy

Let’s Get Morbid

ricklambert — Wed, 14 Oct 2009 00:02:17 +0000

I like to cruise CNN.com and therefore you get to privy to all the “important” people that die all over the world. I think it’s fun to try and dissect some of the mumbo jumbo that we doctors like to say to confuse patients and their families and let us quietly rake in millions of your dollars.

That being said, one of the singers of Boyzone died. I have no idea who this guy is and I haven’t ever knowingly listened to a Boyzone song. According to the article he died of “natural causes” and they said pulmonary edema was the cause.

I don’t consider pulmonary edema to be a natural cause. I guess it’s a natural cause if you consider a knife in your back or falling off a building to be natural. But this is not a natural way to die for a 33 year old guy.

He could have been poisoned. Or shot up some bad drugs.

Interesting fact: The bioterrorism chemical, ricin, once used on a japanese subway, causes pulmonary edema as a side effect (or intended effect).

Suspicious indeed. I’d ship his body to someone I trust and have the autopsy repeated.

Be glad you are still breathing!

Cheers,
Rick

One awesome thing about being a doctor…

ricklambert — Mon, 12 Oct 2009 02:02:06 +0000

Is that you can make a total ass of yourself at weddings and no one blinks an eye.
All that schooling really was worth it!

Rick

The ten month count down

ricklambert — Sat, 10 Oct 2009 18:48:02 +0000

The final year of my residency is here. What this boils down to is that I have about ten months to learn everything there is to know about illness. I will be expected to know causes, symptoms, pathophysiology, treatment and prognosis of every disease known to man. I exaggerate some, but not by much.
If this sounds scary, imagine how scared I am. My license will be riding daily on my ability to care for people in “a manner consistent with a physician who has a similar level of training.”
I have heard it can be pretty daunting to go from the resident that no one listens to, to the end of the line physician.
To be truthful, I’m not sure any amount of training could prepare for the coming months. It boggles my mind that internal medicine is one of the shortest residencies. I heard it is 5 years long in other countries. That wouldn’t fly in the States as training length seems to correlate closely to salary and internists are already paid at the lower end.

Who knows maybe I won’t have to worry about this in the end, maybe I won’t get a job!
New physicians have an approximately 50% chance of leaving their first job within 2 years according to some people I’ve talked to. I’m not sure if I’m more afraid of accepting the wrong job or not getting one.
I’ll keep y’all updated.

Cheers
Rick

Patrick Swayze quick shot

ricklambert — Sat, 19 Sep 2009 18:53:58 +0000

So I haven’t blogged in a bit because of vacation but I figured I could say a brief thing about the death of Patrick Swayze.
Now I knew he was gonna die. As soon as they said on the news that he had pancreatic cancer he was toast.
Pancreatic cancer is bad news. The reasons are several:
1) You don’t usually have a lot of symptoms. Your pancreas is buried deep in your upper abdomen and you don’t often feel a mass there. Subsequently you get diagnosed late in the course
2) your pancreas keeps close company to very important organs. Namely, your liver. You can get along with only one kidney or part of your stomach or part of your pancreas but you only have one liver. Another reason why alcoholism is so deadly.
3) Surgery to resect a pancreatic cancer is incredibly difficult as a patient and a technical standpoint. The surgery is called a pancreatoduodenectomy. I’ve been told it’s like “trying to sew together moonbeams and flatus”. I think it takes some twelves hours. Imagine taking out a moderate sized chunk of every abdominal organ then sewing the chunks back together again and hope they don’t leak.

Prognosis for pancreatic cancer is less than 5% at 5 years. In other words almost no one achieves cure or even lengthy remission.

See. The cool things you learn in med skool.
Cheers
Rick

As it turns out, I was right

ricklambert — Sun, 30 Aug 2009 05:16:38 +0000

The coroner has ruled Michael’s death a homicide. Not really a surprise. I’m not sure, however, what constitutes crossing the line between malpractice and homicide. Sounds more like manslaughter to me, if anything. Then again I’m not a piece of shit, oops I mean I’m not a lawyer.

According to the “experts” that consult for CNN, the drugs used that killed Jackson are for clinical use only. Duh. I guess that makes me an expert. Or… it’s fucking common sense.

Cheers,
Rick

Michael Jackson’s Autopsy Results Released

ricklambert — Thu, 27 Aug 2009 04:32:18 +0000

The preliminary results are out and it looks like Michael definitely had some help going to either heaven or pedophile’s hell (depending on who you believe).

Let’s take a look at what Dr. Murray did that evening:

“– At about 1:30 a.m., Murray gave Jackson 10 mg of Valium.

– At about 2 a.m., he injected Jackson with 2 mg of the anti-anxiety drug Ativan.

– At about 3 a.m., Murray then administered 2 mg of the sedative Versed.

– At about 5 a.m., he administered another 2 mg of Ativan.

– At about 7:30 a.m., Murray gave Jackson yet another 2 mg of Versed while monitoring him with a device that measured the oxygen saturation of his blood.

– At about 10:40 a.m., “after repeated demands/requests from Jackson,” Murray administered 25 mg of propofol, the document said.”

Now lets break down this cocktail:

1) Valium (generic: diazepam) 10 milligrams – this size pill is the largest that it comes in. This class of drugs, known as benzodiazepines, are habit forming. Valium are quite popular on the street.

2) Ativan (generic: lorazepam) 2 milligrams – Notice that it says INJECTED. So this means, most likely that Dr. Murray had started an IV on him and then pushed a pretty damn big dose of Ativan. The biggest dose that I’ll usually use for anxiety/sedation in a patient is 1 milligram. Dr. Murray gave twice that after Valium.

3) Versed (generic: midazolam) 2 milligrams – This is the THIRD benzodiazepine that Jackson received. This medication does not have an oral formulation. This was more than likely given IV as well. Once again at the upper end of a usual dose.

4) Another 2 milligrams of Ativan to bring the total to 4. Dude, seriously?

5) Another 2 milligrams of Versed to bring the total to 4. Gah.

6) Diprivan (generic: propofol) 25 milligrams. A sedative as I had discussed before. Interesting to now know the dose that he gave. It usually burns in the veins so Dr. Murray gave it mixed with Lidocaine (the same thing that dentists use to numb gums) but also happens to be an anti-arrhythmic cardiac medication when given IV. I get the impression it was given via a drip (ie slowly) but I’m not sure it wasn’t given in one big shot. This was given at a moderate dose for what we use to TOTALLY KNOCK PATIENTS THE FUCK OUT.

Per the report Michael finally went to “sleep.” Or as I suspect he fucking died.

So it sounds like Dr. Murray is guilty as hell. Here is why:

1) You are a cardiologist trying to “wean” Michael from what you think is “propofol addiction.” – this is way out of your scope of practice. Go listen to some hearts. Don’t think that you are an addiction specialist + an anesthesiologist.

2) What the hell are you doing giving Michael three drugs from the same class? Let me tell you something, if ONE didn’t work, MORE IS NOT BETTER!

Ugh. I’ve written too much. We’ll see if I revisit this issue as more stuff comes to light.

Cheers,

Rick

What to do when patients don’t want to leave

ricklambert — Mon, 24 Aug 2009 20:26:38 +0000

You may find this hard to believe but I’ve had a number of patients refuse to leave the hospital. It’s really not hArd to believe when you realize that you get a warm bed, warm showers, three warm meals and all the drugs you could ever want.
“But what about the cost?” you say.
Well, if you have no plans on paying your bill then a thousand dollar medical bill is the same as a ten thousand dollar medical bill.
The majority of my patients or hotel guests as I sometimes call them are homeless, addicted to drugs, trying to avoid going back to prison or some combination of the three.
I joke among my colleagues that the best way to get these people out of the hospital is to change all of their medications to intramuscular injections or administer them rectally. Order that all temps be taken rectally and to start ordering painful diagnostic tests. I’ve never done it but with some patients who are abusive to staff and blatantly abusingthe system, I’ve considered it.
(Un)fortunately we just have to deal with it for a day or two, sometimes getting risk managment and other administration involved and culminating in getting security called to the room and “escorting” them to the curb.
Seriously, get the hell out. You are eating up health care dollars and occupying a bed that can be used by a real sick person.

Countdown to health care crisis… 5…4…3…

Cheer
Rick

Bad Breath

ricklambert — Thu, 20 Aug 2009 04:44:45 +0000

Many of you may not have had the pleasure and opportunity to do direct patient care on your average down-and-out person. One of the hardest things for me to deal with is the ass-mouth phenomenon. The ass-mouth phenomenon is where a person’s ass smells better than their mouth.

This is brought into painful reality when you are examining a patients mouth or auscultating their heart and lungs and suddenly you are hit with this HORRID smell.

“Take a deep breath,” I say. Unconsciously I begin to hold my breath and try to aim all my mucous membranes AWAY from where they are exhaling this foul air.

The worst breath, I find, are patients with bad tooth. Notice I didn’t say “bad teeth.” I didn’t say it because the rest of their teeth have rotted out of their faces and all they have left is one black, necrotic tooth that blows in the wind every time they talk.

The thing about patients with bad breath is that it rarely improves while they are in the hospital. Brushing your teeth is kind of like leaving your room to smoke a cigarette. If you are well enough to go smoke, you are probably well enough to be discharged. Thus patients are usually too sick to get out of bed and thus they carpet bomb my sensitive nose with their stank ass breath.

This is something you’ll never hear about on Grey’s Anatomy.

Ugh, I’m gonna go floss.

Cheers,
Rick

Obama’s Health Care Plan

ricklambert — Sun, 16 Aug 2009 18:20:02 +0000

Now many of you may not realize just how many American’s do not have insurance. The people who do not realize this, are the ones RAGING at Arlen Specter. (You have to give the guy credit, though. Most politicians would shy away from the opportunity to get yelled at by people.)

I see so many uninsured people every day and unless you are on the front lines you may never realize how desperately things need to be changed. I don’t know WHAT we need to do to change things, but the status quo is not working. SOMETHING needs to be done. Anything would be better than the current system.

There was even a high level insurance company exec who left his job to fight for the uninsured.

What is gonna happen, is that insurance companies will do enough scare mongering to stop any legislation from being pushed through. Then we will continue downward and downward until we reach a HUGE FUCKING CRISIS and then we will do a number of bailouts and patches and we’ll be screwed.

I’m almost at the point where I could care less. We’re going to reach a point where I have to turn every uninsured patient away and as long as I get paid I’m probably just going to go with the flow.

The end is near.

Cheers,
Rick

Diprivan (Propofol) evidently widely abused

ricklambert — Fri, 14 Aug 2009 04:55:34 +0000

So after a little digging, I’ve discovered that propofol is actually abused quite frequently. It’s not widely available so you can guess who abuses it: doctors.

This is news to me because I didn’t think that it would be very attractive as a drug of abuse. As far as I know it does not cause the same euphoria that opiates like morphine, heroin, oxycodone, or fentanyl. It’s really an anesthetic. In other words, it just puts you to sleep.
If you want to just get knocked out, it’s the way to go. And some sources are saying that some doctors get their start when trying to self treat their insomnia. It has been described that propofol can cause “euphoria, sexual hallucinations and disinhibition have beendescribed on recovery of propofol anaesthesia.”
Interesting. Perhaps the cause for Michael Jackson’s abuse is that it let him have wet dreams about little boys?

Evidently, propofol can be a drug of abuse. The details of Michael’s use will hopefully become clearer with release of details from his autopsy.

Cheers,
Rick