Gather round kids! Let Grandpa Doctor Leap tell you a few things about the old days of doctoring in the emergency room: Back in the good old days, medicine was what we liked to call "fun." Not because it was fun to see people get sick or hurt or die, but because we were supposed to do our best and people didn’t wring their hands all the time about rules and ...

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Alfred is 95 years old, and sits quietly in his wheelchair, rocking back and forth.  His strength is gone, and his veins and tendons bulge through fair, translucent skin, stretched over muscles of long lost size and use.  His greatest foe is gravity, which holds his lithe, bird-like form in the chair enough to cause sores on his hips, but only barely.  It looks as if he might float away. He remembers little, but ...

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I remember the early trials of thrombolytics; not for stroke but for MI. During my residency, we were still comparing tPA with streptokinase. It was pretty incredible stuff. Now we’ve moved beyond that positively "medieval" method of treating heart attacks and have advanced to incredible interventions in coronary and cerebrovascular disease. Furthermore, we are able to rescue more and more people from the brink of death with advanced medications and with ...

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One of the terrible things about being a physician who has spent his adult life working in emergency rooms is that you have a certain terrible clarity about the dangers of this life. It’s why we’re forever pestering our loved ones with phone calls and texts: "Are you there yet!" Or telling the children, "Be careful! After midnight there are too many drunks on the road!" Met, of course, with ...

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It’s August. I’m looking out the windows of our log house and across the immense variety of green leaves, on oak and birch, mountain laurel and sycamore, magnolia and honeysuckle. It’s a rain forest here. Indeed, after a long dry spell, we’ve had days and days of soaking rain, with breaks in the clouds so that the sun raises steam from the earth like water coming up in the garden ...

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I’m in the midst of a run of shifts in the emergency department. I’m doing locums away from home. Last night, I left work at about 3:30 a.m. (My shift was 6 p.m. to 2 a.m.) It was busy — not "crazy busy," just "normal busy." I finished my last note, wrapped up the information about the one patient I was leaving behind with the valiant night doctor and headed ...

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Some dear friends of mine, at Busy Community Hospital, are having a momentous day.  Today is the "go-live" for their brand new, shiny EMR. For those of you outside the hallowed, creaky halls of medicine, this EMR is one of the most widely used electronic medical records systems in America.  It’s big, it’s expensive, it captures lots of data, integrates ERs, hospitals, clinics, labs and everything else.  (Probably your cat’s shot records too.) The problem ...

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I well remember being bullied on the school bus. On many cold, wet mornings (a large portion of the year in West Virginia, by the way), I found my junior-high self sitting in front of high school juniors and seniors who turned their class rings upside down, then used them to hit lesser life forms on the top of the head in a whipping motion. Turning around in pain and ...

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I was working a 6 p.m. to 2 a.m. locums shift a few months ago and was preparing to leave. There were about 15 patients in rooms and 15 waiting to come back. I asked the lone night physician: "Hey, do you want me to stay a while?" Her answer, defeated, was this: "No, don’t worry. It’s always like this." I packed my bag and headed to the hotel, still feeling guilty ...

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These days, I work most of my shifts about 45 minutes from my "house on the hill." At one of those jobs, the day shift starts at 6:30 a.m. Which means I’m rising from my bed at 4:30 a.m. in order to get on the road in time. I’ve started waking up at four, spontaneously, as if it were the most natural thing in the world. I lay out my clothes ...

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