In the dark lecture room, I watched the neurologist's shadow flicker across the only source of light -- a projection of the New York City subway map. He pointed at Times Square station. If the subway system were a brainstem, then Times Square would be the pons, transporting vital signals like breathing, speaking, and swallowing. He likened the station's abrupt destruction to a stroke producing locked-in syndrome. Writer Jean-Dominique Bauby describes ...

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Physicians are accustomed to seeing patients at the end of their lives.  It is difficult to let families know they may lose their loved one.  Clinicians are often accepting of patients DNR orders before family members are ready.  This story is about a time where the health care team was ill-prepared, yet a parent made the difficult decision to discontinue intervention.  It taught me an unforgettable lesson. During the first ICU ...

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It's field trip season in middle school. Which means that all over the country young adolescents are headed to memorials and museums. In New Haven, Connecticut, field trip season means the 8th graders are going to the World Trade Center in New York City. Which means that at my kitchen table, my daughters and I are discussing how safe it is to be at the World Trade Center. Two of us think it's one of the ...

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During our dermatology section in medical school, a classmate recounted having had Henoch-Schonlein purpura as a child.  Over a holiday break, he visited his primary care physician and asked if he could review his records out of curiosity.  His family physician pulled out the index card that served as this man’s medical record.  Yes, you read that correctly.  It was not a chart or computer printout; rather a 4 x ...

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voluntary The American Board of Medical Specialties says “board certification is a voluntary process, and one that is very different from medical licensure.” This is echoed by my board, the American Board of Pediatrics, who says, “Board certification is a voluntary process that goes above and beyond state licensing requirements for practicing medicine.” Over the past few years, the definition ...

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To the suicidal transgender teen I had the pleasure of meeting, I have been thinking about you a lot recently. I have been thinking about your struggle and how to support your transition into a healthy and happy adult who feels like the world is a safe place. I have been thinking about how to best help alleviate your fears about being ridiculed, discriminated against, bullied, threatened, abused, assaulted, or killed. I have been ...

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At 6 a.m. one morning, I was playing tennis at our local athletic club a few months ago.  Sam, working at the front desk came running down onto the courts.  “There is an emergency and a woman on the phone says she needs your help.” I will be honest; I panicked a little.  My husband was home asleep as were my four children.  My thoughts as I raced up two flights of stairs ...

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It's the beginning of October, it's Sunday, and it's been an uneventful shift thus far. However, in exactly seventy minutes, a patient that I've just seen -- one that I think has nothing more than an upset stomach -- will collapse and begin a fight for her life. I'm at the nursing station scribbling on a chart when a lanky man leans over me, a toddler in his arms. He's looking at the ...

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A reader writes: “Grunting baby syndrome. Is this really a thing? My 6-week-old son grunts, strains, and writhes from approximately 3 to 6 a.m. every night. Most of the time he sleeps through it. My GP suspects reflux but ranitidine has not helped. Also, he’s very happy/calm all day rarely fusses or cries. My Google searching came across grunting baby syndrome. Is that a real thing? When do babies grow out of ...

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There are over 400 pediatric intensive care units (PICUs) in the USA, as most recently estimated by the Society of Critical Care Medicine. These units vary widely in size, from 4 or 5 beds to fifty or more. The smaller units are generally found in community hospitals; the larger ones are usually in academic medical centers, often in designated children’s hospitals, of which there are 220. Given this size range, it ...

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