I was nearing the end of my pediatrics rotation as a third-year medical student when the senior resident asked me to admit a patient to the general pediatrics floor. The only information I had as I headed down to the intensive care unit was that she was a ten-year-old girl who had survived an extensive resuscitation at home. By this point in my education, I was certain that I wanted to ...

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Most experienced pediatric intensivists, myself included, have encountered situations in which we, the doctors, believe continuing to support a child is unethical because it is not saving the life but prolonging the dying; whereas the child’s parents believe the opposite -- that it is unethical to withdraw life support because all life is sacred, no matter the circumstances. Sometimes these situations arise because poor communication causes families to distrust the ...

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Years ago in a 15-bed acute medical-surgical ICU, the nursing supervisor contacted me about a special assignment. Once I knew what it was, I said, “Absolutely.” We were about to admit a patient in his 40s with end-stage AIDS/HIV. He asked to be a DNR, but his MD wanted to admit him to the ICU for close monitoring. But the patient had a special request. Even with IV antibiotics and pain ...

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It’s fall in the PICU, and we just saw our first severe case of respiratory syncytial virus (RSV) of the season. RSV is by far the most common cause of bronchiolitis in infants. To scientists, RSV is a fascinating virus with several unique properties. One of these is its behavior in the population. When it’s present, RSV is everywhere. Then it suddenly vanishes. There are exceptions to everything in medicine ...

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“Doc, you mind switching that to an oral preparation?” our clinical pharmacist inquired during multi-disciplinary rounds as intravenous infusion devices beeped annoyingly in the background.  Taking care of ICU patients can be extraordinarily complicated, so doing it as part of a team helps make sure that all bases are covered. Like many hospitals, ours uses a multidisciplinary model which makes rounds on all patients in the ICU.  An ICU nurse, clinical ...

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“You folks have it easy.” As a resident, it is not uncommon to hear these words on the wards from older physicians. After all, this new generation is spoiled, one could say. At the time when I trained, we had hour limitations and “caps” on the number of cases we could handle as interns on our shifts. Now, that seems to have reversed. Second year was tougher in ...

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I am the “sick” resident this month. Instead of seeing check-ups and doing physicals, I see walk-in patients and triage same-day appointments. When my desk phone rings, the standard greeting in clinic is, "This is Amy — sick." After a few days, I started joking that I am to be called the Well resident from now on. Some people laughed, and many said, "What would that mean?" Somewhere between the 50th and ...

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As Harvey’s devastation raged through Houston recently, the city's mayor was compelled to address rumors that those seeking aid could be deported. In the wake of a statewide ban on “sanctuary cities,” the mayor sought to reassure the Houston area's more than 500,000 undocumented immigrants that they would not be targeted for deportation at emergency shelters. Nevertheless, out of the disaster ...

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How do I tell you who I am in a couple of paragraphs? Well, I was born in 1955, so that makes me 61 years old. My namesake is probably movie star and America's sweetheart Debbie Reynolds. My maternal grandfather was straight from Italy; my paternal grandfather was straight from Ireland. Both crossed the Atlantic and landed on Ellis Island in New York Harbor. It was the promised land. So, that means I ...

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How often have I heard those words or some version of them? The location of the conversations varies. I might be standing outside the curtain of an emergency room bay or sitting on a worn chair inside a cramped waiting room adjacent to the ICU. Possibly on the phone in the dark of my bedroom at some pre-dawn hour. Those words, coming from the mouth of a spouse, a child, ...

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