The Other Side of Medicine: Big M

It lasted maybe 5 minutes but those minutes stretched in my mind to hours as I sat there listening to our baby cry knowing I was an accomplice in his pain.

I was ecstatic!  My wife and I had waited to have a baby until I was in my last year of residency.  When she told me she was pregnant, I was over the moon.  We later found out it would be a boy and this was icing on the cake.  I had always wanted a boy first.  The pregnancy had the normal ups and downs including morning sickness and enduring a hot summer.  He was finally born in October.  Eek! Cough, cold and flu season! But I wasn’t worried.

We had decided early we were not going to be the parents that would let their baby keep them from doing normal activities.  When he was only a week old, we went to a pumpkin patch with family.  He was a big boy at 9 lbs 2 oz and had quite the appetite.  I’ll lovingly refer to him as Big M. We were up every 2 hours feeding him from the beginning (and this lasted through the 1st year), but we enjoyed it because he was such a wonderful gift. We had all of our friends come by to see him and they were gracious enough to bring us some meals while we adapted.

At about 2 weeks old my wife informed me that she thought Big M felt a little hot.  I felt him and he was warm but it didn’t alarm me.  I quickly forgot about it until the evening when my wife called me into his room concerned.  This time he felt hot.  I got out the thermometer and, knowing the only way to get a true temperature was rectally, I placed the thermometer in his bottom.  Even this small act was hard.  I watched as the numbers on the digital display slowly rose.  I kept hoping for it to slow down as it approached 100 but it kept going.

It finally stopped at 101.5 and the beeping from the thermometer sealed our fate.  I knew what we had to do but I was in denial.  Every fever in a newborn under 3 months is to be taken seriously and requires a thorough workup.  We needed to go to the ER.  I called his doctor to try to find a way out but he confirmed that we needed to go in.

At the ER things went quickly.  They confirmed Big M’s fever with a temperature that was even higher at 102.1 and quickly gave him some Tylenol to try to bring it down.  He was 2 weeks and didn’t realize what was going on but he knew something was wrong judging by the irritability he was displaying and crying that was difficult to console.  This only worsened when they took his blood and placed and IV.  We couldn’t watch as they place a tiny needle into the vein on the back of his hand. He let out a horrendous squeal that chilled us to the core.

My wife had already just about lost it.  She was crying watching him go through this torment.  Being a physician I knew this was all leading up to an even more distressing finale: a spinal tap.  One of the diseases we worry about when a baby has a fever is meningitis. The best way to diagnose it is by placing a needle through the vertebra in the lower spine into the outer space of the neural tube to obtain some fluid.

They wanted me to hold him.  “Are you serious?!” I thought.  There was no way my wife could do it as she was already emotionally drained from the IV placement.  I knew what this entailed and wouldn’t put her through it.  The procedure for doing a spinal tap (or lumbar puncture) in a baby is to lay them on their side and make them flex their spine while making sure they don’t flail or arch their back.  The only way to do this was to have me hold Big M rolled up in a ball.  He would fight back and I would have to restrain him. 

I had done this procedure dozens of times before but I couldn’t look.  This was different.  This was my son.  Tears escaped as I had to fight his tiny wiggling body as the ER doctor completed the procedure.  It lasted maybe 5 minutes but those minutes stretched in my mind to hours as I sat there listening to our baby cry knowing I was an accomplice in his pain.  The doctor completed the procedure and I was allowed to hold him and soothe him as he finally calmed down sniffling into my wet sleeve formed from his tears.  I held him up to my cheek and our tears mixed and ran as I told him I loved him.

He was started on IV antibiotics and was admitted.  We stayed in the hospital a total of 4 days.  Blood and cerebrospinal fluid cultures returned negative.  The final conclusion was that it was a virus but he was sent home on some oral antibiotics to cover for anything else.  You wouldn’t know it happened now.  He is 6 and healthy and energetic (sometimes too much).  

Things are different when you’re on the other side of medicine as a patient or a parent of a child who gets sick.  I couldn’t think straight.  I would have been useless as his doctor. This was flesh and blood. The experience did help me understand the helpless feeling that parents have when caring for their sick child.  I can now empathize and feel I am a better doctor because I have been in their shoes.  These experiences make us who we are.  The good and the bad.  Don’t suppress them.  Use them to empathize and help someone you know going through the same situation. Sometimes you are the only one who truly understands where a person is at or coming from.  

Make your Summer a Safe and Healthy One

My best advice to ensure a safe and healthy summer

Summer is here! And with it comes all sorts of plans to take advantage of it! With kids out of school, longer daylight and warmer weather, I’m sure you already have your calendar packed full of activities. At this point you’re envisioning a fun and exciting summer, but I want to make sure it’s safe and healthy as well. Below you’ll find my best advice to ensure this happens.

    1. Get out and be active!
      Summer is the perfect time to get out and start exercising. Since the weather is typically superb, you can do just about anything outside. Whether it’s hiking, biking, running, canoeing, kayaking, or swimming, it will be good exercise. It may be as simple as starting a morning routine of walking. If you can get in at least 30 minutes of activity daily, you’re doing great. If you can get more, even better!
      You can also start up some recreational sports. Your local Recreational District likely offers individual or team sports for free or a small fee. A quick perusal of our local Recreational District website shows exercise classes, summer camps, and sports such as bocce ball, pickleball and softball. This is a great way to support your local community and meet new people. You can also take advantage of parks in your area for a nice walk or bike ride.
    2. Wear sunscreen and a hat
      While summer is a great time to get out, with it comes the warning to protect yourself from the sun. We often underestimate how little it takes to get a sunburn. For fair skinned individuals this can be as little as 10 minutes. Sunburns are mainly due to UVB but also a little from UVA exposure, so make sure you get a broad spectrum sunscreen. Your sunscreen should be at least SPF 35 and water resistant. I use Banana Boat SPF 50 Sport Performance Broad Spectrum Sunscreen (because I’m quite fair skinned).  There is a little confusion about what SPF means so I’ll clear it up here. SPF is the multiplication factor for how long it will take to get sunburn. So if it typically takes 10 minutes to burn, an SPF 35 sunscreen will ideally protect you for 350 minutes (35×10) with perfect application. Despite this I recommend reapplying sunscreen every 2 to 3 hours to be safe, possibly even more often if you are in the water or are a heavy sweater. Timing your activity is also crucial. If possible, try to plan activities before 10 AM or after 4 pm where the UV index is the lowest. Wearing a broad brimmed hat that protects your ears and sun protective clothing are also smart if you are out on a hike or long walk. Prevention is always the best way to handle sunburns but if you get one you can use aloe gel and cool packs (not directly against the skin) for relief. The burn should heal in 2-3 days.
    3. Stay hydrated
      It’s sometimes hard to gauge how much water you need to take to stay hydrated. For those who are active and in the heat it has been estimated that you should take in half of your weight in ounces of water a day (I weight 190 lbs so that would be 95 ounces a day). Holy waterlog batman, that’s a lot of water! Most people will not get hot enough or exercise enough to need this much. When it’s hot outside you need to stay in front of drinking water or else you can get dehydrated quickly. The best way to check is with your urination. If you are properly hydrated you should be urinating every 2-4 hours and the urine should be clear or very faint yellow. If your urine is less frequent or looks dark yellow or orange, get some water in you quickly. For just about everything you do during the summer, straight water is adequate and electrolyte replacement (in the form of gatorade or other sport drinks) is not needed.
    4. Watch out for bugs and other summer creatures
      With the warm weather also comes a host of bugs to watch out for. There are many different issues that can come from insects and spiders including bites, transmission of disease and infection. The big diseases to look out for are Lyme disease from ticks and West Nile from Mosquitoes.  Bites or stings from arachnids and insects can also create infection or an allergic or local reaction. The best way to keep insects off of you is with a repellent containing DEET (N,N-diethyl-meta-toluamide) such as Off! Deep Woods Insect Repellant.  I use this one because it contains enough DEET to deter mosquitos while not having a harsh smell. Prevention is again the best medicine here but if you do get a bite or sting and start to have a reaction, see your doctor immediately!
      If you are out in nature you should also be aware of any wildlife that you may encounter. This varies on where you live but the big ones to watch out for are bears, mountain lions, and snakes to name a few. For the most part, wildlife does not want anything to do with humans so if you give a wide berth and don’t invade their territory, you will be fine. Stick to paths that are easily visible and avoid traveling alone.  If you happen to spot anything, back up slowly and call for help if needed.
    5. Take a vacation!
      I know everyone will love this one. Summer is the perfect time to go out on the road in an RV, travel to a tropical island, or just get away. If you have kids, they will be out of school so there is nothing to hold you back. I recommend taking at least one vacation during the summer for your mental health. Getting away from the hustle and bustle of work is relaxing and allows your mind to get the downtime it needs and restorative rest required to avoid burnout from being overstressed. If your employer asks why, just tell them that it’s doctor’s orders.
    6. Stay Safe
      Summer is usually packed full of adventures which can be fun and exciting but through all of this, you should always think about your safety. Basic safety measures should be followed to assure you don’t get any serious injuries. You should always wear a helmet when on just about anything with wheels and no safety enclosure. This includes (but is not limited to): bikes, rollerblades, skateboards, scooters, motorcycles, and quads. You should also wear a helmet whenever you are participating in an activity where you could fall on your head or be hit by falling debris such as wake-boarding or rock climbing. Always wear a lifejacket when on a body of water where you cannot touch the bottom. And always wear a seatbelt when driving or riding in a motorized vehicle.

This is not an exhaustive list, but if you adhere to this advice you will more than likely have a fun, safe and healthy summer. I invite any further ideas in the comments. You can also share your summer itinerary and how you plan to stay safe. If you feel this will benefit your friends please share it. Stay safe and healthy!

Disclaimer: The links contained within this post are affiliate links where I will get a very small return for any purchase.
Photo Credit Jeff Dickerson

Vasectomy Hilarity

Sometimes life brings us smiles and laughter. Sometimes we augment it by adding valium.

Depending on your gender and possible life experiences, vasectomies can bring about feelings of pain and loss but in my case they produce great stories.  Fortunately, I have always been on the performing end of one of these. When I was an associate faculty, I even taught them.  For some reason, during these procedures many hilarious things tend to happen.

Take Bill, a 32 year old who had 3 children and did not want any more.  The procedure started with the usual banter and inappropriate jokes including , “just a little off the top” and “We’ll be done in a snip.” The prep was then completed including “sterilizing” the surgical field with some antiseptic.  

For those who have never been through or seen a vasectomy, the procedure is quite simple.  The patient is numbed up with some marcaine.  (In this case telling the patient they will feel a “little prick” is completely appropriate)  An assistant and I then isolate the vas deference (the tube the sperm swim through on their journey to meet an egg) and make a small opening to bring out the vas.  No scalpel is used and once out, the vas is cut in half, cauterized and then a thin layer of tissue is sewn over it.  The procedure is done on the other side completing the procedure usually taking about 30-45 minutes.

Before the procedure the patient is given a dose of valium which acts like a few beers and relaxes him, allowing for an easier procedure.  This brings us back to Bill.  He decided the best way to make it through the procedure would be to sing… THE WHOLE TIME!  My first impression was that this was impressive.  He must have had a classic rock collection he had listened to enough that he had memorized it.  No joke it was like we had started a playlist and there was only about a 3 to 5 second delay before the next song ensued.

Now I am usually a fan of classic rock but this detracted from my typical enjoyment of Bon Jovi, Kansas and Journey.  It started out fun and I even sang along, but it got old.  The surprising thing was how he didn’t miss a beat, even when he felt the poke of the needle or a tug of the vas.  On these occasions he didn’t miss a beat but did go up an octave when he felt pain which made for an entertaining rendition of Carry on my Wayward Son.

I didn’t know until later that he was loud enough to attract a crowd of giggling nurses and medical assistants around the door of the procedure room.  It made for an entertaining day and a fun story.  Bill was none the wiser and the procedure was successful allowing him to shoot blanks without fear of having another child.

I even got laughs when I was not performing the procedure.  I alternated with a few other doctors who also performed the procedure.  One day I was performing my typical clinic duties while one of my partners was doing vasectomies and running late.  My workstation was directly across from the room where the next victim (ur… patient) waited.  It had been over an hour and we could hear laughing and other precarious sounds coming from the room.  Keep in mind that this guy had already taken his valium.

He must have been a light weight.  Eventually the door opened and his wife walked out.  She wore a look of frustration like a wrinkled blouse. “Do you know how long it is going to be?”  She asked.  My medical assistant said she would look into it and I walked her back to the room. I opened the door and was not prepared for what I saw.  Her husband (happily intoxicated on valium) was gleefully dancing around the exam room…. wearing nothing but boxers… on his head.  I couldn’t take it and laughed out loud.  Through a continued grin I calmed him down and reassured her it wouldn’t be long.  

Sometimes life brings us smiles and laughter.  Sometimes we augment it by adding valium.  I smile as I write this thinking about the joy that telling this story has brought me and I hope it brings you joy and laughter too.  Look for the fun and funny things in life and don’t be afraid to laugh.  They say it’s the best medicine.

The Fight Inside

Every good book needs a hook, right?  You know, that short story or scene that draws you in and makes you unable to put the book down.  The same is true for blogs.  Consider this entry that post.  While the names have been changed, this story is true.  It begins in my residency…

I was on call for obstetrics.  After a long day of welcoming babies to planet earth, I finally was getting a rest.  I retreated to the call room to get some sleep.  The call room was basically a closet with a cheap discarded hospital bed and a phone. Despite this, when it’s 2 in the morning and you’re beat, the mattress feels like a Beautyrest welcoming you into it’s comforting embrace.  I settled in and drifted away.

BEEP!  BEEP!  BEEP!  My pager… letting me know the sandman had been scared away.  I checked the number and knew it all too well… the ER.  I fought obscenities as I dialed the number.  Dr. Scott picked up and quickly filled me in.  A pregnant woman had come in for abdominal pain and he wanted me to check it out.  I hung up, grabbed my white coat, took a swig of the Monster energy drink and was on my way.

She was in room 4 and judging by the screams, she was in pain.  I did a quick assessment and called my preceptor, Dr Peters.  I quickly filled him in with the fast no-nonsense medicalspeak, “This is a 32 year old G12P9 female at 25 weeks here with abdominal pain.  Labs show an anemia and she is having vaginal bleeding.  Ultrasound shows a placenta previa. She’s likely having an abruption.”  Translation: this young woman was on her 12th pregnancy and had delivered 9 babies.  This pregnancy was at about 5 months.  The placenta which nourishes the baby was connected to the uterus over the cervix and was starting to come up off the inside of the uterus causing bleeding.  He advised me to admit her and check on her through the night. Good plan, I thought, maybe I’ll get some rest.

I started writing orders and was interrupted by the nurse running out of her room yelling for a crash cart.  Her blood pressure had dropped and she needed resuscitation.  She was revived and a repeat bedside ultrasound now showed that there was blood collecting in her abdomen.  I again called my preceptor who immediately said to prepare an OR and he would meet me there.

Not more than 10 minutes later, Dr. Peters slid the razor sharp scalpel across the patient’s lower abdomen to gain access to the abdominal cavity.  We were met with blood.  The anesthesiologist was pouring in O neg and fluids to keep her stable while we started the process of finding where the bleeding was.  The uterus had burst open and 3 quick clamps over the arteries stopped the bleeding. We both had suction removing blood and were reaching in to remove clots that had formed.  Dr. Peters was on her right side and was reaching in with his arm all the way up to his elbow to remove blood from around the liver when he shot me a wide eyed look.  I saw it in his eyes, something was wrong, and just as quickly he said it, “You’re not going to believe this.”

I looked down and followed his arm as he slowly removed it revealing a tiny leg the size of a GI Joe’s attached to a 5 month old fetus.  He removed the baby and quickly handed it off to a waiting anesthesiologist who started CPR.  We finished removing the blood and completed the operation.

The baby didn’t make it.  The woman got an involuntary hysterectomy after we tried to repair the break in the uterus unsuccessfully.  Of the previous 9 deliveries, 6 were C-sections and those surgeries had healed over and over making the front of the uterus paper thin.  This caused the current pregnancy to break open after only 25 weeks and made it impossible to stitch back together.  The uterus had to be removed.  She recovered well and returned to her normal health.

I didn’t sleep that night.  Not because it continued to be busy; things actually quieted down.  I was trying to reconcile the feeling of sadness for the baby with my duty to calmly complete the operation.  The internal struggle ensued but eventually I suppressed the sadness and continued working.

Perhaps we all fight this.  We fight against something that is an integral part of who we are or what we do that challenges us to question why we should go on.  Do we continue and compartmentalize or live in the moment and allow the emotions to affect our behavior and performance?  I chose to compartmentalize and now I regret it.  It allowed me to work without feelings, which translated to success, but it spilled over into my relationships and personal life.  I was unable to enjoy my son’s first birthday party as much as I feel I should have.  I had to work to recover from it.

I’m still not there. I still suppress feelings so I can be objective and make the best decision.  But I’m getting better.  You can too.  It starts by allowing yourself to cry.  Allowing yourself to laugh.  This opens the world to your emotions and opens you to the scary world of vulnerability.  But it’s worth it!  Start with family.  Cry with your brother over his divorce.  Play tag with your kids and just laugh when they inevitably tackle you.  Weep with your wife over her miscarriage.  Let your heart feel the warmth of a hug or embrace.

I invite you on this journey towards discovering emotions and enjoying life.  I invite you to cry with me!  Laugh with me!  I invite you to live.