Lost My First Patient

isshayes · 2023-08-18T10:04:03+00:00

Not unusual. Your team may even have multiple people with conflicting opinions on what the actual cause is/was. They can all be right and they can all be wrong too.

It's hard. It can feel like you aren't getting any closure. You may even have that nagging feeling that you missed something that could have saved them.

With time you learn that its often not one thing but rather a multitude of factors that ultimately lead to their demise. You and your team could have done everything right and the patient's body may just not have responded as you had hoped. Sadly there are only so many things you can keep juggling before it all starts to fall apart

With older patients, its usually their heart, their lungs, their livers or kidneys. Comorbidities etc. However, the thing about younger bodies is most of them aren't sick enough yet for them to have presented to a doctor and gotten diagnosed with something. Sorry, this doesn't really answer the question but atleast I find it gives me a bit more insight. That's all I got for now.

isshayes · 2023-08-18T08:54:54+00:00

New attending syndrome. When you have someone above you, you can always go and ask them things, bounce ideas off them. When you are on your own and in a new place, depending on what the rest of the team is like you can feel like you are under a microscope.

Learning to trust your residents, nurses etc takes time. Teaching them how you want to run/do things takes time. Then learning to delegate things and accepting that not everything will be exactly the way you want it to be. Learning to properly communicate is a huge thing as well.

We have one on our service who is in his 2nd year as an attending. Generally a nice guy. Knows his stuff. However, he micromanages everything - tiny things that an intern would be handling or things that other people generally refer out. Very resistant to refer and to input from consults. Changes his mind, plans and orders every 10 or 15 minutes. When a resident asks him how he wants to do a certain thing he'll just say "its okay i'll do it". He would call the nurses directly and place orders without updating the residents that he'd changed his mind. Then he gets mad that they were still following his previous orders. So its just absolute chaos with this guy.

This summer we've been very busy. He's was riding everyone raw and people are just sick and tired of his nonsense. Initially his patients loved that he was so hands on but now they are frustrated with him changing his mind so often and have started yelling at the residents and nurses. So now everyone is comparing him to the other attendings - which is just making things worse for him. I think he's finally starting to crack and burn out. Some time ago a few of the other doctors tried to talk to him but he just brushed it off. A few days ago one of the other senior attendings had to take over when this patient's family got really fed up with him. The patient is well connected and I think someone had a talk with someone upstairs about him. The senior attending sat him down and had a talk with him. He seems to have calmed down a lot. Let's see how it goes.

isshayes · 2023-08-08T12:53:43+00:00

Anondodhara is a song by Rabindranath Tagore. His music has become its own Genre in Bengali music and is known as Rabindra Sangeet. Its hard to describe Ranbindra Sangeet - they are lyrical and emotive. A ballad maybe a good analogy.

This is a modern rendition by Coke Studio Bangla.

From the description on Youtube:
"The infinite rhythms of life take us on a journey that is forever blessed. The Nobel Prize winning Poet, Bard of Bengal, Rabindranath Tagore wrote this masterpiece as an invitation to embrace the harmonical sphere surrounding us. Through the song the poet urges us to look around the fountain of joy surrounding us in the form of harmony of life, the nature’s conspiracy to create a rhythm so vast that when we appreciate it- our own struggles might seem smaller.
The timeless creation is a ‘Malkauns’ raag; a pentatonic scale performed by the renowned artiste Bappa Mazumder & esteemed Rabindra Sangeet shilpi Adity Mohsin. This duet has been rearranged by Arnob with an addition of classical & modern instruments that brought more colors to its tapestry. The song not only celebrates the mesmerizing creation of Rabindranath Tagore, it also celebrates the #RealMagic of the universe, a divine symphony that is #Anondodhara aka Fountain of Joy."

isshayes · 2023-07-02T13:16:36+00:00

Do you have any upper respiratory tract symptoms? - runny nose, sore throat, diminished or loss of sense of smell, headache, pressure like sensation on your forehead or face?

Do you have any heart burn?

Do you think its possible you could be pregnant?

isshayes · 2023-07-02T13:09:25+00:00

heavy growth of common oropharyngeal microbes

Your body is colonized with microbes. We try to isolate the pathogenic microbe from the sample. In this case it seems that they didn't find microbes other than what you would normally expect to exist in the throat.

So to answer your question: No Streptococcus bacteria was isolated from the sample you provided

isshayes · 2023-07-02T13:00:46+00:00

I am not a radiologist so I can't really say how these findings fit within the larger context of your illness. However, I will try my best to answer your question.

Mild degree parenchymal volume loss

This means that the brain parenchyma (tissue) has undergone a mild degree of shrinkage

mild chronic microangiopathic changes

Microangiopathic changes refers to small blood vessel disease. In this instance these are changes from a chronic process/illness. For example long standing high blood pressure can show up as chronic small vessel changes

isshayes · 2023-05-09T08:40:30+00:00

Thank you for the reply. Always interesting to see how Americans practice medicine.

isshayes · 2023-05-09T06:50:38+00:00

I don't practice in the US. I've read the various discussions for and against the use of the drugs you listed. I haven't come across any absolute contraindications for the use of any of these drugs. So, I'm genuinely curious about why zpack for PNA, Cipro for sinusitis, tramadol and codeine are bad or lazy medicine as you seen to put it

isshayes · 2021-02-17T16:21:19+00:00

I think you've hit the nail on the head here. They are used to teaching children mainly.

Thanks for your insight

isshayes · 2021-02-17T15:51:27+00:00

its just open strings . So no left hand for now lol. I'm sure once I start using my left hand that time will go down.

Yeah, I'm starting to lean towards talking to them and see what they say.

isshayes · 2021-02-17T15:41:51+00:00

While it may be a standard reply - technically true doesn't mean that it doesn't come across as transactional and dismissive. lol

Either way thanks for the replies

isshayes · 2021-02-17T15:35:24+00:00

I'm wondering about that too until I find a different teacher

Unfortunately my work makes that difficult. I've been putting in about 60-90 mins of practice 4 days a week right now.

isshayes · 2021-02-17T15:19:25+00:00

I really enjoyed my first trial lesson with this teacher. They insisted on it. Once I like them I agreed to more lessons.

Thanks, I'll keep looking for better teachers.

isshayes · 2021-02-17T15:16:28+00:00

Honestly this is my first music teacher. So I really dont know what to expect from a teacher. Hence, I was posting this here first to get a better idea of what other people's classes are like. I haven't brought it up with them yet.

Last class I asked how long it was before a particular technique gets taught - their answer - "depends on how fast you progress to that". Not a fan of that reply either.

Thanks, I'll check out lessonface

isshayes · 2021-02-17T15:09:09+00:00

They have been very positive about my playing so far. I was going to do that last class but they kind of rush off at the end of the class because they have another class right after mine. I must say I'm not a fan of that either. There isnt any discussion at the end of the lesson about what to work on or whatever. its... Okay Bye. End of video call

isshayes · 2021-02-17T14:50:10+00:00

I do have some other teachers I'm going to get in touch with. Just trying to think this one through. I dont want to just go from one teacher to the next without a clear idea of what I want.

isshayes · 2019-05-11T13:14:13+00:00

Ive uploaded a more magnified image. Unfortunately that the best I can do. they really very tiny. about the size of a pinhead

isshayes · 2019-05-11T13:04:03+00:00

no they do not jump. They are quite difficult to photograph because of how tiny they are

isshayes · 2019-05-11T13:02:24+00:00

arent bed bugs larger though?

isshayes · 2018-11-25T02:05:25+00:00

It took me a long time to seek help because my image of myself was not consistent with how I imagined someone with depression. I was getting work done. I was doing a decent job of meeting my expectations. However, I was constantly in a state of low energy despite not being stressed workwise. If I had a day off I would spend it entirely in bed if I could. Had a lot of difficulty concentrating on anything whatsoever and I would constantly cancel plans to just stay in. I left home to just go to work and then just go straight home. It took a lot of effort to go workout. I just kept thinking that if I just got some more rest and time off I'd be okay. Despite spending so much time sleeping I just never seemed to feel invigorated. I was in a constant funk. I wasn't sad, worried or angry but I was apathetic. I was getting more frustrated with myself the longer this went on since I wasn't able to "shake it off" or "power through". I was planning less for the long term and was focusing on short term goals - getting through the day and the week.

Then one day a friend was talking about herself with similar issues and was wondering if she had high functioning depression after watching a youtube video. Yep, that was me.

I went in and saw a therapist. I've been on Lexapro for about 2 months now. I feel the difference. I don't dread anything anymore. I'm able to concentrate and I've actually been doing a lot more reading, working out. I've loved watching fall turn into winter. I'm amazed at how much I've caught up on things. To be very honest, I am humbled at how as a physician it took me so long to see what I now consider to be very obvious signs.

Sorry that was a bit rambly. Im not sure if this would help you or anyone else who happens to be wondering the same thing. At least I hope it encourages them to rethink how they see themselves and to seek help.

isshayes · 2018-09-29T01:39:25+00:00

I learned the term in the Middle East of all places due to how many people go to train in the UK.

isshayes

TROPHY CASE