There’s a war being waged on one of America’s most revered institutions, the emergency room. The ER, or emergency department (ED for the sake of this post) has been the subject of at least a dozen prime-time TV shows. What’s not to love about a place where both Doogie Houser and George Clooney worked? Every new parent in the world knows three different ways to get to the closest ED. It’s the ...

Read more...

I wish I could share the photo of my 4mm boomerang shaped kidney stone.  I labored for 2 months, back in early 2009 to pass it, the second stone in 5 years. During my ordeal with these stones, I had the following health care encounters, tests, medicines, lab and imaging tests.

  1. at least 5 sets of blood work, with CBC and chemical profiles, parathyroid studies
  2. several urine tests, including urinalysis and urine culture, ...

    Read more...

“If you insure them, they will come.” Those words might as well be the mantra of hospitals across the country, because they can expect an onslaught of customers thanks to the expansion of health insurance under Obamacare. A recent study published in Science showed increased emergency room use among people in Oregon who became eligible for Medicaid, compared to others who, literally by the luck of the draw, were not chosen to ...

Read more...

The clock read 9:30pm and in front of me was dozens of notes, PowerPoint slides, and practice exams to review before 8am. The all-too-familiar finals week all-nighter beckoned, and though I’ve had my fair share of experiences with studying until the sun rose, I decided to forgo the typical mug of coffee and take some over-the-counter caffeine pills instead. My friend proclaimed that they would help more than any energy ...

Read more...

A mission trip to Kenya: Challenge, success and heartbreak A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Mission must have always been in my blood, but it took me a while to discover it. I considered going on a mission trip to Bungoma, Kenya, in 2009, but the timing coincided with one of the major conferences at the New York State Society of ...

Read more...

Who watches the watchers?  It’s an old Roman saying from the poet Juvenal, and it had to do with infidelity. But over the years it has been applied to politics as well.  It means, "How do I know that the people guarding me are worthy?"  It has also been translated, "Who guards the guards?" But it seems to me that it applies to medicine quite appropriately.  Who watches those watching physicians?  We ...

Read more...

She looked like a whipped puppy that had had a garden hose turned on it and slunk off to a far corner of the yard to dry out in the sun. She sat there, wizened but hard, thin and wiry, dressed in standard issue blue emergency room scrubs, thin tanned face, long stringy, wet prematurely gray hair falling limply around her shoulders. She looked down at the floor, but when her ...

Read more...

Today, a patient attacked me. A nurse got kicked. Another punched. I was gouged to the point that blood was drawn. The patient was neither intoxicated nor psychotic. Rather, she was a meek 92-year-old grandmother, and she was terrified. It took five of us to hold her down, as she summoned the strength of a woman fighting for her life. Linda is an elderly woman with moderate dementia. She is blind ...

Read more...

It was recently Nurses Week in early May and there were a lot of adulations being offered on social media and throughout hospitals regarding the appreciation we have for those among us who have chosen to be on the “front lines” of caring for us when ill or injured. As an emergency physician I could speak about the many times a nurse has grabbed me and pulled me into a room ...

Read more...

Another backboarded body rolls in. I slip from my perch at the computer and greet the emergency medical technician. “Seizure. Lasted a few minutes, done by the time we got there. Fell and cut his face.  Vitals stable. Sugar fine. Oriented but postictal.  Didn’t take his meds.” Approximately my age, the backboarded man’s chin bears a ribbon of red laces. “Dammit,” he says. A glance at the cardiorespiratory monitor shows me suitable hemodynamics, ...

Read more...