On my last shift, I had a pair of chonky 3-month-old twins come back to our department because one of them had suddenly developed rapidly worsening stridor; when they were seen initially, they both had fever, cough, and nasal congestion. Unsurprisingly, they were COVID+; unfortunately, this quickly evolved into croup for one of the chubby beans. He was crying and barking away while his twin slept completely unawares; he struggled to breathe and was so upset, making it harder for himself to breathe because of how upset he was… the classic moderate croup-er that was just too young to be soothed with words and distraction alone.
Of course, when the beans are this mad/anxious and working this hard to breathe, there’s no way you can get them to take any oral medications. My nursing colleague and I attempted to decrease his stridor in whatever ways did not require him to swallow–I put him face-down in my arms with his chubby little cheek smooshed against the lateral condyle of my elbow, rocking him and patting his little diapered butt. Eventually that calmed him enough to stop crying, and his stridor improved enough for my nursing colleague to get him to take a few puffs from an epinephrine MDI. His stridor got a bit better still and now could be heard faintly as the chunker dropped off to sleep, probably exhausted from crying and breathing so hard.
Unfortunately… we already knew this little guy would start screaming again if we moved him, and he was now too sleepy to actually swallow any oral meds… so we weighed the options with his caregiver and opted to give his steroid medication as an intramuscular injection, since then we could at least ensure he received the whole dose. Predictably, the little guy was NOT happy to be poked while he had finally nodded off, so I resumed rocking him and patting his little butt.
Maybe twenty minutes later, after all his medications were in, I arranged the little bean in his mother’s arms in the same prone position as he had been in mine; he protested stridorously for a few minutes before settling back to sleep. (During this transfer over to mom, we all became acutely aware of the string of drool from the beany bean’s face down my elbow and reaching literally all the way to the floor… I was honestly kind of impressed.)
Thankfully, the steroids kicked in as expected and when I checked back in the next few times our little chonk was fast asleep in his carseat with no stridor and no work of breathing. Eventually he and his brother were discharged with an anticipatory dose of oral steroids in case his brother developed similar symptoms, and instructions to come back if those symptoms returned or worsened. The babies’ poor caregiver looked so exhausted (but relieved).
Unsurprisingly, I woke up the next morning after this shift with very sore arms… I guess soothing chunky chunkers is actually good weight training…?
If there aren’t any kiddos in your life, you may not have realized this, but kiddos love pressing buttons. You know that visceral satisfaction you feel when you get to pop some good bubble wrap? For the little beans, every button, no matter how mundane it may seem to us, is like bubble wrap.
The other day I got on the elevator and a mom rushed on behind me, pushing her stroller with one hand and carrying her little bean in the other. I had my finger on the “door open” button to ensure they could get on, and I saw the kiddo’s wide, curious eyes trained on my hand at the button pad.
“Could you press the button for me?” I asked her, indicating with my finger which button I needed her to press. She nodded and squirmed excitedly in her mom’s arms until her mom brought her over. I stepped out of the way so she could press my floor button. She squealed with delight, giggling and beaming at me behind her tiny teddy-bear print mask. Her mother chuckled and showed her which button to press next for their destination, and she very excitedly mashed that button too.
The little peanut was just so happy by her opportunity to press buttons (and come to think of it, a lot of kiddos also just enjoy elevators for some reason) that she couldn’t stop grinning and wiggling in her mom’s arms. When we arrived at my floor I waved at her as I stepped out of the elevator, and she chirped, “Byeee!!!” and continued to wave at me until the elevator doors closed.
Children experience life and joy in a different way than adults; we are simply privileged that their experience is so willingly and enthusiastically shared.
Had the amazing opportunity to write a small scene for the Netflix series ‘Black Mirror.’ If you haven’t checked out ‘Arkangel’ in the new season, be sure to give it a look!
JUST HIT 25,000 FOLLOWERS!!! I love each and every one of you. I’m sorry I don’t post as much on here anymore but I post almost daily on my instagram account if you would like to follow me there! @doctor.dustin
Make your own magic. The LA-based purveyors from Spellbound Sky join us this week at the Whitney Shop with their inspired stone, quartz and crystal accessories.
“We found love in a hopeless place” -Rihanna. I mean, we all know dating within the residency program is a risky move, but people can’t stop falling in #love.
I wanted to capture my feelings as a doctor in training who has been bludgeoned by the Covid-19 pandemic the last year and a half. But I’ve been too burned out to write about burnout.”
This article captures the emotions that have kept me from trying to write anything substantial about the pandemic, the massive systemic failures involved, and the social selfishness/ignorance it has revealed.
Translating the numbers. COVID. What do extra beds mean.
It’s another pet peeve I have with media and government bodies, whenever they go, we have X number of extra beds or we can flex up to this many beds.
It does not mean the beds come out of thin air. Or that COVID staff have magically appeared as “extra staffing” in addition to regular hospital beds.
It’s just not how it works. even if you have extra physical rooms and beds, training staff takes years.
It means regular hospital beds are being converted and staff are being transferred from whatever departments they were previously in to staff the COVID wards.
They could be surgeons, anaesthetists, physicians etc. trained to do other jobs, now being re-purposed or re-trained to temporarily staff ICU or COVID wards.
It means, less timely care and beds for other diseases that while not life threatening, are no less significant. No one casually goes to hospital for a cold for instance. Even those really sick with COVID needing hospital admission, are in terrible shape, it’s not like a bad case of the “man flu.”
I’ve seen entire public hospitals re-purposed to cater solely to COVID and it means other patients get re-diverted elsewhere where staff may not know long term patients with complex conditions or staff are not used to caring for some of them. This can lead to higher medical errors or worse long term outcomes than normal. For example, we have expert units in Cystic Fibrosis, organ transplants etc., not all hospitals or generalists are going to be as highly skilled in looking after them. Entire stroke wards have been dissolved or amalgamated with internal medicine units, so some staff can be re-purposed for COVID. There is no one size fits all in medicine, not all the time.
Healthcare agencies have already come out halted elective surgeries. This is needed during a crisis, but what are elective surgeries? Why is this term being thrown around? These aren’t superfluous necessarily, like a tummy tuck or hernia repair. Elective can refer to surgery to determine if someone has the early stages of cancer. We are going to see an influx of advanced cancers which means, higher mortality, more destructive therapies to control it versus the very early stage. And this isn’t solely limited to cancer, it’s also relevant to a host of other chronic diseases. We really take for granted the care we were providing previously. And we’re going backwards in the care we provide by years, possibly decades. I can’t imagine what this means for developing countries already under resourced and behind.
My other pet peeve is when politicians in particular and journalists, come out and go, we’ve known for 18 months or 2 years blah blah why were we not better prepared for the 3rd, 4th, 5th peak? It can take 10 years + to train a doctor. Med school can be 4-6 years depending on where you are in the world. Then you add residency etc. Nurses also need years to adequately train. We can’t just pull doctors out of a hat or from other countries - it’s a global pandemic.
Our healthcare systems were already operating at capacity before the pandemic. Why on earth would anyone think it would magically meet the challenge of the pandemic without repercussions? Where do you think the extra beds come from?
I wish the media would stop reporting extra beds as something we just pulled out of thin air when we didn’t. It’s providing a false sense of security and relief. Right now, we need to continue to encourage vaccinations and appropriate pandemic restriction measures, whatever they may be.
So I haven’t posted on here in ages though I do occasionally page through others posts. Anyway - just wanted to let you all know I’ve accepted a fellowship position!
I can’t say what in because- well it’s a small world and there aren’t too many Polish FMG docs but I wanted to tell you. I’m still getting over the shock of getting a residency and specializing is more than I could have ever hoped for!
Thank you all for being there for me through med school, residency, and now fellowship. It’s been quite the journey!
Has anyone ever acquired torsades de pointes by drinking too much tonic water???
There’s no studies on it that I could find and inquiring minds want to know.
So I was wandering through the depths of tumblr and stumbled across this post and oh my god guess who knows the answer to this ancient question
Had a patient with malaria recently and there was no quinine to be had in my city so out of curiosity I calculated the dose in tonic water:
In the US, quinine in tonic water is limited to 83mg/liter, and since the dose per the CDC is 650mg PO TID, the patient would have needed to drink 7.8 liters of tonic water 3 times daily.
If a patient who was drinking a lot of modern tonic water developed torsades, I’d recommend evaluating for hypomagnesia and hypokalemia due to volume status before looking at the quinine as the cause.
I realize that you’re a lot further in your career now and you already realize this about tonic water. I just got excited that I could answer this random drug question from your student era.
Sometimes it feels like there’s too much random trivia in the brain and you’ve gotta let it leak out, which is why we’re on tumblr.
And this is why I give up an call pharmacy half the time when it comes to the crazy stuff. Because you guys always have a way of knowing how much of something is in something else and viola! Magic!
I haven’t thought about this in ages!!! Thanks for the info!!! =-)
Had a patient on service for 36 days. For three weeks he had been 90% fiO2 on vapotherm 35 LPM. THREE WEEKS. We tried everything short of intubating him to fix his lungs. Family didn’t want to intubate or CPR if it came to it. They didn’t want hospice either and except for being encephalopathic and on way too much oxygen and being unable to get out of bed he looked okay.
The family kept telling us that what when G-d wants him, he’ll take him.
We decided a week ago to try and get him to a long term acute rehab hospital. Family couldn’t decide. Keep in mind there was literally nothing more we could do and despite crazy high oxygen nothing had changed in weeks. Today we spent 45 minutes on the phone with the family and got them to agree to the transfer.
An hour later the patient became brady and died. The whole ICU was shocked.
Please consider supporting thee Santoro School for Comics Book Makers drive to build the Comics Workbook Rowhouse Residency. Come live and work in Pittsburgh PA . CHECK OUT THE AUCTION OF RARE COMICS HERE.
I scored some rare minis and a sammyharkham original through Frank’s auction! Sammy’s comic Poor Sailor first convinced me of the power of this medium and I’m so excited to have an original from him! You, too, could glimpse into the minds of your comics heroes through some of the items that Frank is auctioning off.
I have tapped out my resources but you could win some awesome stuff AND support a very interesting future opportunity for furthering the comic arts.
Well guys, this is it. We are finally (almost) there.
We submitted the application for his Temporary Graduate Visa in August, and have been waiting for approval.
A few weeks ago we were assigned a case officer (CO), who requested additional documentation that we couldn’t provide at the time of application (his Skills Assessment). We were given a month to provide the assessment, otherwise an decision would be made. We were freaking out because we were still waiting on TRA to approve his Skills Assessment.
Well, within a matter of 2 days, they came through and gave him a positive Skills Assessment, and we sent it off. We are now playing the final waiting game. I can’t wait for this be over!
