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Medicine Can Be A Taunting, Vicious Profession At Times

By Birdstrike MD   Not too long ago, I was busy at work seeing patients. The secretary yelled, “Dr. Birdstrike, there’s a phone call for you.” “Alright,” I said. “Transfer it over.” I answered the phone. “Hello, Dr. Birdstrike, this is ***** ****** from the ****** State Medical Board,” said a jabbing, deep military sounding voice. “Uh…hello,” I said. I felt a jolt of electricity in my chest. This wasn’t a phone call I expected nor wanted. The state —-ing medical board? What, the…? “I’m calling to notify you, we’ve received a formal complaint about your medical practice and I’ve been assigned as the lead investigator.” At this point, the adrenaline was pumping through my veins, and my heart beating fast enough, that I didn’t hear much of what he said after that. He might as well have told me I had brain cancer and had 6 agonizing weeks to live. Although I have been sued before, though never convicted by a jury, of medical malpractice, I’d come to realize that whole process was more about one group of lawyers fighting with another group of lawyers, to get money from an insurance company, with a doctor and a patient as mere pawns in the game. It’s a game that can feel very personal, but ultimately isn’t, and is mostly about the trophy hoped for by the plaintiff’s attorneys: Award money. But a complaint from the medical board? It’s honestly something I never thought I’d have to face, having been someone that’s always performed at a very high level during my career, at all of it’s stages, not every having faced any significant concerns regarding my performance. Also, in my personal life, I am, for lack of a better word, a rule follower. After, the initial shock dissipated, his words gradually faded back into the ear of my consciousness. He gave me the name of the patient and the stated complaint. I remembered the patient, but I didn’t remember any particularly bad outcome, or any negative interaction or administrative complaint at the time. The accusation appeared out-of-place and baseless. He explained the process: I was responsible for providing a written response to the medical board within 15 days. After that, there would be an investigation. After an undetermined period of time, the complaint would either be dismissed outright, dismissed with a non-disciplinary letter of warning which would go in my medical-license file, or if neither of those, then I’d have to go before the medical board for a hearing. A licensing hearing? The entire thought of any of this was horrifying. News headlines of doctors who had lost their licenses for egregious and horrible misconduct flashed like shocking, intrusive, strobe-light banner-notifications across the home-screen of my brain. I did nothing wrong. Why is this happening to me? This is insane? What the —-? Am I going to lose my license? No way, I’m going to lose my license. I did nothing wrong. Nothing even happened. Wait, what happened? Did anything happen? No, nothing did. But what if I get some rogue medical board or the case is reviewed by someone with an axe to grind or from a totally different specialty? Miscarriages of justice happen all the time. Don’t they? Questions bounced around my brain like a silver pinball. I slowed my breathing down. I logged into the medical record scanning through charts and reports like a DVR player on fast forward. Wait….They have no case. THEY.   HAVE.   NO.   CASE. I started to get angry, very angry. Just like my lawsuit, where I was falsely accused of malpractice, ...

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The Drowning

By Birdstrike MD   “You want them to see you, like they see any other girl” -Against Me!   I head to work at my new locums job on the California coast. Summer 2015 is going to be a great one, I think to myself. I make the turn into the hospital parking lot and a rusty old Trans Am cuts me off. I slam on the brakes to the soundtrack of screeching tires. Geez, I think to myself. It’s my first day at this job and they’re already trying to kill me. I drive on, and I pull into my parking space. My headache is starting a little too early for this shift, I think to myself. The sun is out, the sand is hot, and it seems like everyone must be at the beach but me.  The humid heat is as thick and soothing as suntan oil.  I leave it and walk into the cold and clinical hospital. Out of the EMS radio and through the air crackles, “ELDERLY FEMALE CARDIAC ARREST…DROWNING…INTUBATED…NO PULSE…45 MINUTE DOWN TIME…ETA 5 MINUTES.” Jane the nurse looks at me.  “This one’s yours,” she says with a wink. “You got it,” I answer. Way to start off with tragic one, I think to myself and take a deep breathe, shaking my head. “Boom” goes the grinding, mechanical sound of the automatic doors as EMS rolls the stretcher into my ER. In they wheel my patient, while feverishly sweating and performing CPR and bagging air in and out of the patient, one breath at a time. With my back against the wall, they wheel the head of the bed up to me. I see a large, elderly female, dressed in a bright orange one-piece women’s bathing suit. I grab my laryngoscope and look to make sure the ET tube is in the airway. Her face is bloated and purplish-pale except for the mess of pink lipstick smeared around her mouth, likely from EMS attempts at placing the tube. I check the tube and it’s okay. “45 minutes with no pulse at any time? Drowning?” I ask EMS. “Yes sir,” responds one of the burly EMS guys. “We got the tube in right away, started CPR, gave epi per protocol, and…..nothing.” “Did you see any of her family?” I ask. “No family. She was with a big church group at the beach for a picnic, with a bunch of kids. Youth group, or something,” says the EMT. “What?! Doc. Look!….” says Nurse Jane who had just cut off the patient’s bathing suit, pointing at the patient’s groin. There, no longer covered by the woman’s bathing suit, is a penis and testicles. I look at Jane, I look at the two EMTs, and they look at me. “I’m just as confused as you doc,” says the EMT, looking at me wide eyed as he raises his hands. “What’s the patient’s name again?” I ask. “Let’s make sure we have the correct patient and correct name.” “We’ve got a driver’s license and the picture matches. Pat ——, female, is what’s on the ID,” says the EMT. “So, the friends that are here, know, or don’t know? Help me out here.” “I have no idea, doc. Her friend, who looked like a little old church lady, referred to her as ‘she.’ That all I know,” answers the EMT. “Okay, thanks. Regardless, we have no pulse, over 45 minutes of downtime and zero chance of survival with a warm water drowning. Time for me to call the code and notify the family. Time of death 17:01.” CPR stops. I’ve declared the ...

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Letter To Doctor That Lost A Patient

By Birdstrike M.D. We all went into medicine to save lives. Deep within even the most cynical of us, is still that pre-med hopeful that believes we can and should restart each non-beating heart, make the non-breathing breathe and fill with blood those who’ve bled, filling them back with life. We expect that a patient’s condition will improve while under our care, or at least not worsen. Intellectually, we know we’ll not be successful every time. None of us became doctors to helplessly watch others die. Yet, we know there will be times, that no matter what we do, nor how perfectly we do it, that’s exactly what we’ll be forced to do, though not for lack of trying. Ultimately, regardless of what any of us says, you’ll go over the case ad nauseum to determine “What could I have done differently?” Ultimately you may conclude you could, or couldn’t have, done something different. But the crux of it, is that the answer to that medical question is irrelevant to the what is ultimately a human experience we can’t fully control. As medical as we try to be, it hurts to watch someone die. And the thing very few understand is the tremendous emotional risk we take as physicians, in having to be part of that, while at the same time charging ourselves with the responsibility of not allowing it to happen. Ultimately, we set ourselves up to fail. Some we can save. Many we can’t. Uniquely, we bear that emotional burden. The hospital CEO doesn’t feel that. The insurance adjuster who pays (or refuses to pay) the hospital claim doesn’t feel that. We share the burden with the family. I’ve seen fellow doctors, grown men, cry over patients lost. What you have to do, after you’ve done the analysis, ultimately are two things: 1-You first have to give yourself permission to be, and forgive yourself for being, human. You have to have compassion, not only for your patient and the family, but allow some for yourself. 2-You have to remind yourself, regardless of whether or not you ultimately decide you could/should have done some thing different, that by your being there, you took a large risk (an emotional one) and by doing so gave your patient a much greater chance of surviving, than if you hadn’t taken that risk. Even if the outcome wasn’t what you or the family would have hoped, you took a great emotional risk by choosing to be there if and when that patient would need you, and increased their chances much greater than if you weren’t there. Sometime their chance was never more than zero, but you did what the rest of the world didn’t have the courage, ability, or desire to do. You placed yourself there and were willing to risk taking the emotional bullet. Why? Because you’re a good human being and you care. I don’t know if that helps, but either way, I can assure you I’ve been there. I have cases that I think about years later; not all the time, but when something, or nothing at all, triggers the vivid memory. For what it’s worth, I feel your pain.   “Midnight, our sons and daughters, Were cut down and taken from us, Hear their heartbeat, We hear their heartbeat.” -U2 (Mothers of the Disappeared)

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I Remember You

By Birdstrike M.D.   I walk out of the patient room.  My eyes stare at the computer screen.  I’m behind, way behind.  I roll my head on my neck.  My neck feels tense, and I have a headache.  It’s been a long week.  I need a vacation.  Hurry up, click-click-click this computer, I think to myself.  Dammit, is this EMR really freezing up again? I look up.  A man walks out of a patient room across the hall.  Our eyes lock.  I quickly look away.  Ouch, my neck.   There are patients waiting. I need to get moving, or I’ll never get out of here, I think to myself.  I put my head down and turn to walk away. “Doctor.  Doctor.  Are you Doctor Bird?” he calls to me with urgency. Crap, I think to myself.  I’m never going to get caught up.  He does look familiar.  I hope he’s not mad at me.  Who is this man?  He probably wants to sue me, or maybe he’s angry I didn’t prescribe him those pills he wanted.  Man, my neck. “Yes?” I answer, hesitantly. “Did you work at —– —– Medical Center about 10 years ago?” he asks. He looks so, so familiar, but I can’t place him. “You won’t remember me, but you took care of my son,” he says, with a faint, but warming smile. Right then, it hits me, like a ton of bricks. “My son had cancer,” he says. “Brain cancer,” I answer, and right then my mind goes back 10 years at warp speed, back to room 10, during a chaotic shift at my first job out of residency.  I’m looking at a 12-yr-old boy laying in bed.  His eyes are sunken and gaunt, skin pale, hair blond. He’s dying of cancer and all treatments have failed.  I had never seen a child so sick, so ill appearing, yet still alive.  He looks like he’s in terrible pain.  There’s nothing left to do, but to try to make his last few days, hours and moments as painless as possible. He needs IV fluids, some pain and nausea medicine and needs to be made comfortable.  In a chair next to him is his father, dying inside.  My heart sinks.  “I remember you, and I remember him.  I even remember the room you were in.” “He died shortly after that.  But I still remember you.  You really took the time to ease his suffering, if only for a short time.  That meant a lot to me.  Most of all, you seemed to actually care,” he says. I felt a little dizzy.  I felt like I was having a flash-back of the PTSD sort; so vivid and real. I remember the chaos of the shift.  Walking down the far hallway, walking in the room and closing the door.  As the door closed behind me, the noisy chaos behind disappeared, and it was stark quiet.  I remember feeling the heart-wrenching sadness of this man sitting next to his dying son, so helpless.  I felt equally helpless.  I remember thinking, I don’t care how many patients are waiting.  I don’t care how long the wait is, or what chaos is swirling outside that door.  I need to pause and try to at least listen, if only for a short time.  I need to at least acknowledge what this boy, his father and family are going through.  I need to try to find some way, no matter how small, to make things a little better, or a little less painful for both of them, if I can.  At the very least, I need to ...

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A Medical Malpractice Attorney Tells It Like It Is

By Birdstrike MD Below is conversation between an Emergency Physician and a medical malpractice attorney. It was originally posted on Student Doctor Network by an anonymous poster that goes by the handle “TrumpetDoc.” It has been reprinted and edited with permission of the original author. If you have any thoughts or experience regarding medical malpractice, from either the plaintiff or defendant side, I’m sure you’ll find it quite interesting. ……………………………………………… Recently I [TrumpetDoc] had a discussion with a local medical malpractice plaintiffs’ attorney at a social gathering. Since I have been hearing often from my former group’s lead MD/JD and influential leaders in Emergency Medicine, that increased medical testing never protected anybody, I asked his thoughts on the subject. His comment was, “That’s Bull—t! When there is a bad case or outcome, and I see an upstream doc that had the chance to make the diagnosis with a test or procedure, I smile every time. I can get an expert from any specialty to debunk a doc’s thought that his/her exam and thoughts are good enough these days. And if we go to trial, I have a pretty set script here. To the effect of ‘so Doctor, you just didn’t care enough about my client to order this test?’ Or ‘so my client was just a statistic, just a percentage to you?’… [Juries] love that stuff!” He went on to explain that the medical malpractice environment will be getting worse for us doctors and he was extremely bullish on the med-mal business in the coming years. He continued on, “You guys are being hung out to dry. So are hospitals. There is already starting to be a contraction on spending and ‘costs.’ This is just awesome for me. There will be a lot of bad discharges, refused admits, procedure delays, diagnoses delays, all in the name of ‘costs.’ Your societies and hospitals are masking this as evidence based practice, etc. But I can get a jury to see that very differently. A lot of physicians will be paying out before long, as will hospitals…Testing is what makes diagnoses, saves people.” I rebutted by explaining that malpractice cases are best prevented and defended not by practicing “defensive medicine” but by documenting in the chart our thought process, differential diagnosis and rationale, using the concepts of clinical acumen, experience, and evidence and that our own experts could and would defend our actions. He responded with, “But that is in your world; people live in mine… juries live in mine,” with a smug smile and chest tapping. I had to restrain myself. He continued on, “If a patient is in the ER and wants to be admitted…you better just pray nothing happens in a reasonable time frame after if you discharge them against their wishes.” I asked about defensive medicine protecting from us suits and he said, “To a point, it does. Will you get sued? Sure. Will I be less inclined to take a case that had a complete workup? Yup. If you appear to me like you cared and did everything you could, you certainly more protected.” To him that equals ordering tests such as labs, CTs, and MRIs in the ED and admitting patients to avoid risk. He went on to say, “Nurses will hang you. EHRs [Electronic Health Records] are awesome! And nurses chart everything they freaking think of while in the ER with a patient. They are there to cover their butt, and often it is very helpful to me. It is so common that there are discrepancies in the medical record, and now they are so easy to find.” Regarding Choosing Wisely, he said, “This will ...

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Cat Lady

By Birdstrike MD   “She talks to angels, they call her out by her name.” – The Black Crowes. . . The radio crackles alive, “County General…we’ve got a 20-something female……just picked her up…..bagging….we’re at your back door…” Boom! They slam through the double doors, and roll into room 8.  Lying on the stretcher is a young thin woman.  Beneath the mask over her face is a full head of golden wavy hair.  I get to the head of the bed, and get ready to intubate her.  I grab the bag and mask and start bagging her myself.  “What have you given her, so far?  Any narcan?  D50?” I ask. “No,” the paramedic says.  “We just scooped her up and had just enough time to get her here and pop an IV in.  Just lost pulses a few seconds ago.  PEA.” “Okay, give her some narcan and D50, while I get ready to intubate.  Resume compressions!  Etomidate, sux, scope…” roll off my tongue.  I look down at the patient’s face again……blond, so young, hair and face like a movie star, except for the pale-bluish dying hue.  She reminds me of Cat Woman from the old Batman comics.  She’s just about dead and much too young to die.  I don’t think I can handle another young patient death this week.  I’m filling with dread, not from anything that has to do with the medical “case” in front of me, but because somewhere out there is an unsuspecting mother, husband or child that I’m going to have to tell that she is dead.  There’s no way to candy-coat that news, and no matter how many times I do it, it still gives me chills. The nurse has just given narcan.   She starts to move.  Is she trying to breath?  I look at her face, it’s pinking up.  Did we restrain her before the narcan?  Damnit….we didn’t! She VIOLENTLY sits up, blasting upwards towards my head, ripping the mask off her face, ripping out her IV and heaves forward.  I’m looking straight at the back of her head and torso and she’s heaving forward violently grabbing at her own neck, making an awful guttural noise, contracting rhythmically.  That noise, what’s that noise?  I’m hearing my cat, she’s trying to vomit.  Is this lady trying to gag up a hairball?  Cat Lady. “Blahhhhaaaaaacghck…..blaaa…..ughggh!” I look beyond her and the nurses are staring back mortified, at the patient.  “Ahhhhhh!     Ahhhhhhh!    Ahhhhhh!” this Cat Lady is screaming.  “I’m dying here!  Help me!!!  Oh, the pain, s—t, the pain!!!” I step around out from the head of the bed to the front of the patient to see what the nurses are looking at, and on the patient’s lap is a big, gooey, mucous-covered ball of something on her lap.  Whatever it is, this patient was choking on it, it almost killed her and now she’s alive and well, though ready for vengeance. Why the heck is she screaming, now?  This thing, whatever it is, is out of her, and she’s awoken from the dead. I pick up the ball of goo and examine it.  I start picking it apart.  Why do I have to do this, this is disgusting?  I should’ve been an accountant.  Hairball, I think to myself, laughing a little bit inside.  Just like my cat.  It seems like a ball of wadded up plastic.  What the heck is this thing?  There’s writing on the plastic.  What is it? Is that an “F—–, Fe—“? “Fentanyl!  Fentanyl!” yells one of the nurses looking over my shoulder, who can obviously read through bloody mucous much better than me.  Fentanyl ...

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