So you made a mistake. I know you’re busy beating yourself up about it. I know that after years and years of training in life-saving medicine you’ve also trained yourself to accept the blame for all sorts of things beyond your control. You’re asking, "How could I have missed that," or "Why didn’t I think about that?" You’re wondering why you didn’t give a different drug, order another test or do ...

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It’s hard to put into words the horror we all feel about the events in Las Vegas. So I won’t try. But what I will try to do is point out an often unspoken reality. Which is that those who work in emergency care constantly face terrible things with courage and skill and keep coming back for more. And everyone needs to remember that all those folks society counts on ...

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So I’ve finished up at one job and moved on to another. I was a director for a year, and it was a learning experience. Right now I’m nearing the final approach after working a long run. Last week I had five nights, 12 hours duration each. I stayed in a hotel near the hospital. Then, after two days off at home, I started a run of five days, of ...

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Unless you’ve been living under a rock, you’re well aware that the United States is in the grip of a really big epidemic of opioid abuse.  The epicenter of much of this has been my beloved Appalachia.  My home-town, Huntington, WV, might as well be re-named "Oxycontin," or maybe "Heroinville."  It’s ugly. Enormous amounts of ink have been spilled on this topic, and ...

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I was recently at a meeting where some very influential physicians were discussing a question that I’ve been thinking about for a while: how do we find medical staff for rural emergency rooms and hospitals? It’s a tough question, because, increasingly, it seems that young physicians are trained to work in urban hospitals. Those are also the places these young doctors prefer to practice. Big hospitals and teaching centers in ...

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I used to practice locums medicine; which for the lay person means traveling to different jobs, sometimes several states at a time.   During that time I stayed in a lot of hotels.  But, occasionally, I had more unique accomodations.  Obviously, if you travel enough, you’ll sleep in an airport here and there. No big deal.  I actually like sleeping in airports occasionally.  When you’re stuck, you’re stuck.  Weather or ...

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I know, I know, I spend way too much time ranting about work in the emergency department. But after some recent shifts, my box of rants is full once more. And what I want to point out is the enormous struggle of the mid-sized emergency departments in America today. I know this is a problem; I work in them, and I know and talk with people who work in them. It’s ...

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After years and years of practicing emergency medicine, I’ve seen and treated thousands of children for everything from beads in the nose to leukemia, ruptured spleens to sprained ankles. A father of four myself, I take great delight in interacting with the kids that come through my workplace. I consider it a personal challenge to make them smile whenever possible and to put them at ease. I’ve learned a few things over ...

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I have never wanted to be the medical advice columnist. “Dear Dr. Leap: My feet sweat all the time. I’ve tried everything! What should I do?” Nope, I’m not your guy. Nor do I want to opine on study after study about statin drugs for cholesterol or discuss whether women should take estrogen. There are physicians who love those questions! And I think they’re fantastic. But I’m an emergency medicine ...

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“So tell me why you think you you’re having a stroke?” The nice lady, mid 40s, sat on the ER exam table in work-clothes, an anxious look on her face. “Well, I was working the cattle up in the timber, and when I got back to my 4-wheeler my heart was racing, and I was short of breath. My arms were tingling, and so was my face. I’m concerned it might ...

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