Recently, a former NFL football player, Phillip Adams, murdered Dr. Robert Lesslie, his wife, his two grandchildren ages 5 and 9, an air conditioning appliance man, and critically injured a second man. The NFL player had gunned down these innocent people. And then, he left and went to his parent's house (who lived on the same road), and after hours of the SWAT team begging this man to surrender, he ...

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"It is not enough to say we are anti-racist; we have to modify our systems to recognize that we have placed individuals of color at risk of poorer outcomes.  Lack of insurance, lack of finances, or even the presence of certain diagnoses may reflect less about the person and more about our ...

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The triage note noted that my next patient had an oxygen saturation in the 70s and was short of breath. He was exposed to a COVID+ contact several weeks ago. I put on my gown, mask, face shield, and gloves and walked into a room where the patient sat on the edge of his bed, bare chest heaving. He wore a blithe smile on his unmasked face. I glanced at the ...

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"I am grateful that I work in a small rural hospital that is like a family. I am grateful that my organization has done everything in its power to protect us… but I hope we can do better. I hope medical workers have enough left within them to give their all ...

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The differential diagnosis is a cornerstone of the profession of medicine which epitomizes physicians’ critical thinking skills. It is not an antiquated tradition of by-gone eras. The practice of medicine has been positively impacted in the past century by revolutionary scientific advancements, standardization of medical education, and transformative societal changes. Its overlap has provoked some unfavorable changes in the practice of medicine with the business of health care. The differential ...

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Our lives are stories, and we are the narrators. The stories we tell have an arc across our lives as the plot, characters, and climax unfold. These narrative arcs are expected, for the most part, to follow a linear path defined by time. I’ve been thinking a lot lately about how time flows through life and how we measure our life in relation to time. We have no grasp of ...

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A patient once told me, “I sit on the side of the road asking for change. People look right through me like I’m invisible. Food stamps aren’t enough. I can’t afford to exist and I want to die.” A man is dying of poverty -- this is an emergency, but not one I have been trained to fix. I am an emergency medicine physician; I care for people on the ...

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The emergency department is fast-paced. Full of chaos. Incredible suffering. Frustration. Disappointment. Screams, tears, smiles. Reassurance. Good news. Bad news. Diagnoses. Failure to find a diagnosis. Getting a last-minute cardiac arrest coming in at 650 a.m., ten minutes before the end of your 12-hour, overnight shift – you have the energy and wherewithal to do the task, but to process the life that was lost? To truly realize the dead ...

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An excerpt from 50 Years in the OR: True Stories of Life, Loss, and Laughter While Giving Anesthesia. We were notified one cold winter’s afternoon in February that a farm accident victim with a bad leg injury was coming in from a small town twenty-five miles west ...

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An excerpt from 50 Years in the OR: True Stories of Life, Loss, and Laughter While Giving Anesthesia. Chronic long-term alcoholism causes many health problems, not the least of which is cirrhosis of the liver. In advanced cases of cirrhosis, the liver becomes full of ...

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The emergency department. A haven for cardiac arrests and gunshot wounds and respiratory distress and overdoses and auto accidents and children’s sniffles and fever and coughs that won’t go away. The ED was easy access to many. And at times, it was an easy fix not to pay the bill upfront or to be anonymous with your problem. As much as I loved emergency nursing, it was always the children that left ...

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The attending physician knelt next to the stretcher to repeat his opening line. “Hello, sir. What brings you to the emergency department today?” The man looked around in a daze, his lips quivering as if he was on the verge of crying. “The demons! The demons, they’re everywhere! Help me. Please, help me. I can’t stand it ...” As the medical scribe, I stood next to the doctor and typed the note. ...

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Over the past year, we have experienced massive organizational change at an unprecedented pace. Traditionally, we could spend weeks planning how to best make a change in our workplaces, but COVID-19 was anything but traditional. Our emergency department at Saint Barnabas Health System in Bronx, NY, needed to pivot on a daily and even hourly basis, and to do so took planning and effort. In general, change is difficult, and ...

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"My own dream-induced pain started at the same time this child was mowed down. Then and there is when and where my faith in God died because God, the higher power, had allowed this unspeakable nightmare to happen. My hope for the future evaporated, all while helplessness chewed through my guts ...

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I was an assistant nurse manager (ANM) in a 24 bed ICU in my younger, energetic years. Before that, I was a manager in a very small emergency department. I must say, I loved it. I loved the thrill and the challenge. I was able to work with the Joint Commission; I ordered EKG monitors and defibrillators, any equipment needed for the emergency department. I worked with the health department ...

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She shook her head no, eyes brimming with tears, chin quivering with emotion. Again, I told her that without further care, her son would never have use of his arm and possibly would die. Her voice trembling, she told me her husband would beat her if she returned home without the boy. She placed her son on their horse, his newly bandaged arm in a make-shift sling. I gave her ...

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“We have met the enemy in medical education, and he is us!” My paraphrase of the “philosophy of Pogo” is pertinent to today’s crop of graduating medical students. We have inserted them into the most toxic environment for learning medicine, ever. Dr. Michael Halberstam once stated that the most powerful treatment the ER had to offer (after CPR, of course) was “the sight of your own doctor at the bedside.”  Yet look ...

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On a recent trauma call, we had a busy night, culminating in a horrific motorcycle trauma that came in early in the morning. The patient had devastating injuries and ended up dying. The detectives finally tracked down the patient’s family. I cleaned myself up, put on my white coat and had the family sit down in a private conference room. I entered with my trauma attending and a consulting specialist, ...

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Drip. Drip. Drip. It’s 8:00 p.m. I’m staring at the IV tubing. We forgot to stop the fluids. I’m standing in the resuscitation room alongside the naked, broken body of a teenage male. Unable to break my gaze on that dripping IV line, thinking, We’re going to flood him. But it doesn’t really matter. Somewhere in the background, muffled yelling comes through the doors. “Sounds like they found the family,” remarks a nurse. The tech is putting the young ...

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Christmas Eve 1990, Saudi Arabia, a few miles south of the Iraqi border - it is cold and dark as I lay on my cot, my sleeping bag around me, the constant hum of the generators in the background. I am listening to Pachabel’s Canon in D minor on my cassette player. Rain pelts the tent I share with nine other Army doctors. The sides move rhythmically with the wind, ...

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