A Swollen Arm, Radical Mastectomy, And Becoming A Doctor: How To Overcome Failure

Holly, a 68-year-old woman, came in with a red, hot, and swollen left arm. On presentation, her left arm was at least twice the size of her right arm. She’s a thin lady, so the contrast was remarkable. She told me that the arm blew up 2 days ago. Her left arm felt extremely hot. She chronically gets arm swelling because she had a mastectomy of her left breast about 5 years ago. This type of swelling is a common side effect of the surgery. Lymphatic ducts in the arm cannot drain the fluid correctly, thus congesting and blowing up the arm like a water balloon. Ever since the surgery, Holly tells me that her arm keeps on swelling up, but never this big. Normally she goes through her physical therapy very religiously; she never misses a session. She’s frustrated that her arm is infected, but she states she’s not going to let this stop her.

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Beach Ball Abdomens, The Ars Moriendi, And Why I Want To Be An Oncologist

Pam was a 62-year-old female with pancreatic cancer who first came in due to abdominal pain and distension. She said she was diagnosed with pancreatic cancer this past January and was going through chemotherapy. She was admitted to the hospital because her abdomen was the size of a beach ball. Several family members were with her at bedside. Although Pam looked weak, she was laughing and making jokes with her family. In fact, she jokingly remarked “Doctor, I look like I’m pregnant!”  I asked her if her husband knows. She asked me, “Know about what?” I pointed to her stomach and said, “the baby.” She broke a smile and the other family members in the room sheepishly chuckled. I told her we were going to run some tests and figure out what’s going on.

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Coconuts in Bien Hoa, Vietnam. Imagine a really big one of these in your belly. That’s probably how Pam felt. 5/12/16.

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A Flood and Fiesta For The Common Good: How Family Might Save U.S. Healthcare And You

Over the past three weeks I have been traveling throughout Asia including Vietnam and Philippines. I don’t speak any of the languages, but it didn’t take much to see the culture of community and family.

On one particular day in Biên Hòa, a suburban area one hour away from Saigon, a storm flooded the street. As I stood at the doorstep of the place I was staying at, I watched cars and motorcycles trudging across the high water. I looked at the stores around my area and saw people helping each other put their belongings away, move their scooters inside, and even push cars through the torrent. There was hardly any hesitation in any of their actions – a firsthand example of working for the common good.

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Flood one hour away from Saigon, Vietnam. 5/12/16

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Paralyzed Breathing and 2 Simple Steps To Be Happy Now

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Kari’s feet on a kayak in Halong Bay, Vietnam. Photo taken 5/16/16.

Several months ago, Gary came to my hospital complaining of weakness. Gary was 72 years old, so weakness was a pretty common complaint in his age population. While lying in bed, Gary told me that this morning he could not move his feet. Since then, the weakness has gotten progressively worse and traveled up both his legs. At presentation, Gary said that he could not even lift either of his arms or legs. I lifted up one of his legs, and let it go. The leg dropped like a dead weight. In addition, Gary said he recently got over a cold. Gary also told me he had a similar illness over ten years ago. He said at the time he was hospitalized for 3 weeks with over 10 days connected to a breathing machine. Essentially, what he had ten years ago was the same as what he had at presentation.

Gary had Guillain-Barré Syndrome.

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How To Think Big: Taught By A Small Chinese Lady

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A couple of months ago, this short 70-year-old Chinese lady with a 6cm lump on the corner of her left jaw sat across from me and the attending. Sue was here for follow-up after completing her radiation treatment. Sue has a rare cancer of her salivary glands. The cancer invaded her jaw, so we couldn’t simply take out the cancer. Therefore, we had to treat her with radiation to decrease the size of the tumor so she can go to surgery.

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Ventricular Tachycardia, Bomber Planes, And Checklists: How To Decrease Cognitive Load To Be More Productive

On my last day on the ICU rotation block, one of the patients went into an irregular heart rhythm called ventricular tachycardia. He was a 60-something year old guy with multiple medical problems and connected to a breathing machine. All of a sudden, he became unresponsive and hypotensive and had a heart rate of 150+ beats per minute. As we all rushed into the room, we systematically ran through the ACLS algorithm. We initially evaluated him, checked for pulses, started CPR, established the  airway, monitored blood pressure, identified the rhythm, and gave a dose of treatment. We repeated the process until the patient was stable. It was efficient, it was effective, and most importantly it was routine. It was a checklist that was used around the world and saved many lives.

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Goals Of Care, Family Meetings, And The 80/20 Rule

Surprisingly, in my past month in the intensive care unit (ICU), I spent more than half the time talking to family members about goals of care. In a previous post, my attending had a great quote about survival in the ICU. If one-third of your patients survive the ICU stay, you’re doing hall of fame work. So if only one-third of patients are surviving on a good day, then why am I spending most of my time speaking to families about goals of care? Shouldn’t I be spending more time treating the patients?

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“20% of our efforts leads to 80% of our results.”

 

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Too Much Xanax, Depression, And What To Do About It

The other week, I had an 18-year-old guy who came in unresponsive after overdosing on Xanax and Tylenol. We stabilized the patient, and when he woke up, I asked him why he did it. He told me that he was just doing some dumb stuff with friends. However, when I asked the father later, he told me his son has been more depressed lately and attempted suicide just last month by cutting his wrists. They didn’t seek help at the time for a variety of personal reasons, and it’s fortunate that the patient’s suicide attempt failed the second time. Fortunately, I haven’t seen a lot cases like this at my hospital, but still, he was so young. The patient had so much to live for.

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Sunset in 2012 from my medical school campus, St. George’s University.

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Chronic Disease and How to Influence Others

One of the greatest assets of the human race as a whole is our ability to communicate with each other. This ability allows us to exchange great ideas, solve difficult problems, and express various amounts of emotion. In this post, I’m going to talk about how to communicate and a 5 step formula on how to win others to your way of thinking.

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Misha convincing me to walk her more.

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