1. Tell us about your loved one: What brings them in? What’s their baseline? What changed today?  But don’t speak FOR them, unless they can’t. That gets us worried. That’s what abusers often do. 2. Talk to us about your their code status (what should we do if things turn bad,) and leave us a phone number. 3. Pay attention to them. If things change – if they get worse, if they ...

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If you ask people if there is evil in the world, a lot of them will smile politely at such an obviously Medieval (or Neanderthal) view of the world.  Which, of course, is a bit of an insult to both groups who were from all evidence quite intelligent folks. Some might rattle off some examples of evil.  Things like intolerance, racism, sexism, homophobia, transphobia, Islamophobia, and assorted others.  Disregard for the imminent ...

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In October of 2016, I returned to Bernard Mevs Hospital in Port Au Prince, Haiti. Hurricane Matthew, a category 4 hurricane, had touched down near Jeremie only four days prior. Hurricane Matthew caused significant devastation with over 2 million people directly affected, and over 500 reported deaths.  As local health care facilities in southwest Haiti had limited capabilities to care for pediatric trauma patients, Bernard Mevs had arranged transport ...

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There’s always so much to write about, and there’s never any time.  I work too much; it’s become evident recently that I need to cut down.  I have started noticing that things affect me much more than they ever did; there are days I hide my tears, and days I show my tears, when before the tears would have waited for the occasional (yes, occasional) shower.  This is a function ...

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One of the more common complaints that I hear from medical practitioners in jails and prisons (especially new practitioners) is, "These manipulative patients are driving me crazy!" Well, to be honest, I ran into a lot of manipulative patients when I worked in the ER, as well. But it is true that many of our patients in jails are especially ...

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Being a medical student is tough, applying for a competitive residency spot is tough, and being a new mother is also very tough. I am one of the lucky women to do all three at the same time. I had my child early August of my fourth year of medical school. The fourth year of medical school is a great time to become a new mother. The schedule is more ...

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A gray-haired emergency medicine physician once provided the most succinct view of ED efficiency ever uttered. He said, “Sometimes they ask us to dig a ditch. Then they give us spoons with which to do the job.” Though cynical, it is the view of many. There really is only one problem and a single solution to ED efficiency. The problem is variation. The answer is scale. Biologists understand variability best. Biologic ...

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The eulogy of a profession should be a relatively uncommon undertaking. And yet, the death of the physician appears to be such a fait accompli that one feels late to the wake. It has been a long and lingering death, like the proverbial frog in the pot, and but there are moments, increasing in frequency in my day-to-day clinical practice when it seems so sudden, unexpected and even surreal. This ...

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1. Bipolar disorder 2. History of postpartum psychosis 3. No custody of her children 4. In treatment for cocaine abuse 5. Regular smoker I digest each of these facts on the computer screen in rapid succession, progressively cementing the picture of Renee Pryce, a 28-year-old woman in her final months of pregnancy. I'm a first-year resident in a large urban county hospital. In the course of my training, I've learned that some people (mostly older doctors) ...

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Two years ago, something happened that — not to be overly dramatic — changed my life, including my everyday experience of my job as an emergency specialist. My older brother, Martin died of a rare and aggressive form of non-Hodgkin's lymphoma that spread despite every treatment that was thrown at it. When he was dying, I managed to unleash in myself a raging anxiety, which caught me by surprise. In the year ...

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