"Deeper compressions! Deeper! Make sure you get that recoil!" I push harder and lift off higher. I'm starting to sweat. My stethoscope is banging around my neck. I should have taken it off, I think. My hair is flying around my face. I should have tied it up. I'm on tiptoe; my legs are cramping. I should have stood on a step stool. "All right, she's getting tired. Next!" Embarrassing ... I only ...

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I read Samuel Shem's House of God twice — once in my late college/early med school years and another sometime during my pulmonary/critical care fellowship. The first time, I recall thinking it was drop-dead hilarious. I eagerly shared it with friends and family. Absorbing the wisdom of the fat man, the catchy vocabulary, and the cynicism of the narrator made me feel somehow like an insider wise to the game ...

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For what seemed like an hour, I stood staring at the flat lines scrolling endlessly across my monitor in the OR. The once pulsatile waves, rendered useless and flat due to the absence of a beating heart. After a frenzied six hours of pouring blood into the patient while it poured back out of her just as fast, the surgeons drowning in blood in their attempt to sew the new ...

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All of us nurses and physicians in the ED and ICU knew him well. He was a young, 21-year-old. A smart, articulate guy who kept going from one hospital to the next. He had a system down ... almost. This young man was a drug seeker. He knew all about seizures and how an Ativan IV push felt during the "seizures" he allegedly was having. Even though he had several identities and different ...

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“I just don’t know what to do, how to help.”  My patient’s wife was slumped in the plastic chair by her husband’s side, fatigued and beleaguered.  She had been there for hours, days, as we waited for antibiotics to start fighting back against the infection that had overwhelmed his body. “What sort of music does he like to listen to?” “Depends on what he’s doing.  Zeppelin to work on the car.  Jazz ...

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Perfect nurse. Perfect manager. Perfect puppet. An ICU physician once told me: Nurse managers have a life cycle of a mosquito. Fast and furious And then gone. Deleted until the next one shows up. It was the perfect ICU. Twenty-five beds. Dynamic intensivists. Phenomenal. And they respected us nurses and collaborated with us. We had perfect cerebral perfusion together. Experienced ICU nurses who knew what to do like clockwork — teaching the younger new nurses. Teaching them the facts of ICU. ...

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We had just exchanged "I love yous" about 15 minutes before the intercom blared: "Code blue." Just like that, my sister was gone — all from what seemed like a simple knee surgery. Simple in the fact that the type of surgery my sister was supposed to have had that fateful morning was an open reduction and internal fixation (ORIF). Thousands of these surgeries have been performed every day. But something ...

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I recently had the pleasure of participating in an administrative law judge (ALJ) hearing. Novitas, the Medicare administrative contractor had denied the E/M code 99291, critical care. The case was appealed to the qualified independent contractor, who also believed that the care, in this case, did not meet the CMS and CPT definitions of critical care. Subsequently, the case was appealed to the administrative law judge. The encounter occurred in an ...

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Our 20-bed ICU finally captured 10 intensivists — all board-certified in critical care medicine. We were fortunate enough to have one of these doctors in our ICU 24-7. Of course, they all practiced professionally with expertise. But I remembered this one the most: Dr. Jason McKenzie (name changed for privacy). He easily became our friend and "go-to" person. Clocking in at night and finding out that Dr. J was our doc, would give me ...

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Halfway into my four-week hematology consults elective at the county hospital during my fourth year of medical school, I was surprised that one of my patients was a 25-year-old woman from Romania — exactly my age. This was highly unusual, as most of the patients I had seen on this service were not this young, especially with a malignancy. What was even more unique was that she had just arrived from ...

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