New posts are available every Monday and can be read in under 5 minutes.
|
Posted by Alex Lickerman  Print  Email to a friend  Photo: scubadive67 WARNING: The time required to read this post will violate my five-minute rule—by a wide margin. This isn’t so much to punish readers for my decision to read all 1,163 pages of the “Patient Protection and Affordable Care Act” (HR3590) and all 337 pages of the “Health Care and Education Reconciliation Act of 2010″ (HR4872)—known collectively as the health care law—but rather because a shorter post couldn’t possibly do an analysis of it justice (not that a longer post will either, but here goes…). Continue reading…
Posted by Alex Lickerman Print Email to a friend  Photo: Cl@re Bear A few years ago, a patient of mine was diagnosed with lung cancer. A metastatic work up revealed a small mass in his liver that had the radiographic appearance of a benign liver cyst. But in the setting of a newly diagnosed lung cancer, we couldn’t be sure it wasn’t a metastatic lesion, so we decided to biopsy it. Due to scheduling issues, we couldn’t get it done for seven days.
Two days into the seven, he called me in a panic over the possibility that the lesion in his liver was cancer, a fact, if true, he understood would change his prognosis from good to dismal. I offered him a prescription for Valium, which he accepted gratefully, and then suggested a strategy to help him manage his anxiety that took him by surprise: denial. Continue reading…
Posted by Alex Lickerman Print Email to a friend  Photo: Photos8.com Eating right, exercising, avoiding the sun or using sunscreen, moderating alcohol consumption, abstaining from tobacco use, getting mammograms, Pap smears, colonoscopies—almost every measure we’re asked to take to safeguard our future health is difficult. It’s a strange paradox that we have to work in some way, to expend energy, and experience discomfort of some kind in order to gain benefit in life. Wouldn’t it be nice if the most pleasurable things also produced long-term benefit? Continue reading…
Posted by Alex Lickerman Print Email to a friend  “He was just…” My patient groped for the right words. “…pretty great.”
She was talking about her boyfriend—or rather, her ex-boyfriend. He’d recently ended their relationship, and she’d come to me now, several months later, unable to shake herself out of the funk in which she’d been left by his leaving.
Surprisingly, she harbored no ill feelings toward him for breaking up with her. Continue reading…
Posted by Alex Lickerman Print Email to a friend  Every once in a while (or perhaps more frequently than I’d like to admit) I find myself overwhelmed by my own life. Taking care of patients, blogging, writing, maintaining relationships (with my wife, son, family, friends, and co-workers), exercising, practicing Buddhism, marketing my writing, answering pages, answering emails, handling unforeseen crises, cleaning out our cats’ litter boxes—suffice it to say one of my greatest challenges is not only getting all these things done day after day but also finding time to enjoy a few leisure activities, too. Continue reading…
Posted by Alex Lickerman Print Email to a friend  When I was a third-year medical student rotating for the first time on a general medicine service inpatient ward, my team admitted a thirty-year-old woman in acute congestive heart failure. That a thirty-year-old was in congestive heart failure was unusual enough. Even more shocking was the cause: an echocardiogram revealed a tumor sitting on top of her mitral valve preventing the normal flow of blood out of her lungs to the left side of her heart. No one on my team, including the attending physician, had ever seen anything like it. A CT scan revealed widely metastatic cancer throughout her entire body—it looked as if every square inch of her had been splattered with buckshot—with no obvious dominant lesion to suggest its point of origin. Continue reading…
Posted by Alex Lickerman Print Email to a friend  “Maybe this is all from anxiety.”
“You think? I mean, yeah, I am anxious, but it feels more like it’s from the symptom than causing the symptom.”
“Still.”
My colleague and friend—and physician—and I were discussing the sudden onset of intense nausea I’d started to experience roughly three weeks after I’d been released from the hospital, as I detailed in a previous post, Overcoming The Fear Of Death. After a pulmonary embolus I’d been left dealing with a clostridium difficile infection, for which I was taking Flagyl, a drug known to cause nausea. The only problem with concluding that the drug was the cause of mine was that I’d been on it nausea-free for a full week already, not to mention I’d been on it previously without nausea for a full course the first time we’d treated the clostridium difficile infection (I’d relapsed, as commonly happens). Why after a previous full course and then seven days would it suddenly cause this side effect? Continue reading…
Posted by Alex Lickerman Print Email to a friend  Most people who come to see me complaining of fatigue are worried something is wrong with them physically but turn out only to be sleep deprived. Sleep seems to be something we all wish we did more, making us for the most part a chronically and persistently sleep-deprived society. Though studies suggest large differences exist in how much sleep different people need to function normally, the range varying from less than 6 to more than 9 hours, and that short sleepers and long sleepers run in families (suggesting a genetic component for people operating on the extremes of the sleep curve), other studies suggest as many as 33% of us don’t get enough sleep to satisfy our basal sleep need (the amount of sleep needed on a nightly basis to perform optimally). Continue reading…
Posted by Alex Lickerman Print Email to a friend  Photo: robertdx Clark (not his real name) came to see me complaining of substernal chest pain. At first, he said, it had come on only with exertion, but in the last two weeks it had begun to bother him at rest. It radiated to his jaw and was associated with some mild nausea and sweating. He’d been a pack-a-day smoker for 35 years, had hypertension and diabetes, and a family history of premature heart disease. Continue reading…
Posted by Alex Lickerman Print Email to a friend  Photo: Richard0 For a doctor, every patient death is unpleasant. My first thought when it happens to me is always, “What mistakes did I make?” I go back through the sequence of events that led up to my patient’s death and ask myself if, given what I knew at each point along the way, I should have thought differently, acted differently or more quickly, or called for help sooner. Only once I finish this exercise and I’ve thoroughly assured myself my patient didn’t die, or even die sooner than he or should would have, because of me can I then move on to grieve for the person that was lost. Continue reading…
|
|
