The hospital can be disorientating, to both the patients and its workers. We commonly witness ICU psychosis, a form of delirium that the elderly frequently spiral into while being in the intensive care unit. Several factors contribute to this state, with sensory deprivation being a common culprit. Sensory overload from the multitude of pumps, monitors, and alarms also lend to the confusion.

Unfortunately psychosis isn’t limited to the elderly. Patients of all ages “misbehave”, especially at night. Combine some pathology with an Axis II diagnosis, and you will have a perfect combination of pain. Last evening, I was called to reason with a young woman with lupus who was admitted for renal failure (likely nephritis). She had just undergone a renal biopsy earlier in the day, and we were also slugging her with steroids. She demanded to be discharged. She also had a record of noncompliance with medical advice. When I saw her, it was obvious that she lacked insight to her disease. She had already signed a hospital waiver stating that she understood that she may die if she left the hospital. I attempted to review the consequences of premature departure from the hospital, which included death. She nodded to me, and walked out. Por qué los pacientes castigarme?

Soon afterward, a patient going through alcoholic withdrawal demanded to leave, citing noise. I convinced him to stay by transferring him to a private room and giving him earplugs. Two hours later, he became combative and required sedation.

We have every reason to be confused in the hospital. After a handful of encounters with crazy patients and staff, I became disoriented as well. With GOMERS screeching on 6A (elderly care unit), fluorescent lighting, and wall clocks that permanently read “9:25″, we have every reason to be confused. Every time I walked by the frozen clocks, I had to glance at my pager to reassure myself that time had not stopped. I made every effort to glance out an unshaded window every few hours, even only to gaze at the starlight to reorient myself.

When I step back into the shoes of a layperson, I am always amazed at the tolerance of physicians. After a decade of training and torture in a caste system, perhaps doctors do deserve a fancy house or a fast car. The irony? When I walk out into the parking lot, it’s the nursing staff who have the Beamers, Infiniti’s, and big SUV’s. The physician’s lot is populated with an occasional splurge, but the majority of them are station wagons with car seats, Hondas, Camry’s, and family cars.

medicine inpt medicine, medicine

Unless you’ve been hiding in a bubble over the last few years, you’ve probably heard of Electronic Medical Records (EMR), or Electronic Health Records (EHR). Some of you may even have experience working with these systems. Dozens of companies have invested millions into computerizing health records with the notion that digital information will remedy the healthcare system’s multitude of problems. These software frontends have evolved into impressively complex applications, ranging from Visual EMRs to BrainLab’s Digital Lightbox touchscreen interfaces.

One of the concerns with electronic data of any form is security. When the security of health information is involved, we cringe–there is an intangible queasiness to having your health records disseminated to the world. The feeling is worse than having your credit card information stolen. No matter the number of bits we throw into our encryption schemes, health policy pundits will always claim that our data can be hacked.

Well, how secure are paper records? If a file room goes up in flame, that’s the end of it. No backup. No recovery. What about theft? That simply involves old-fashioned robbery. No fancy hacking required. The irony is that paper records ARE secure, because of their inherent flaw that EMRs are designed to eliminate–penmanship.

Physicians have horrible penmanship. There are always exceptions, but the stereotype holds true in most cases. I recently spent 2 weeks at a primary care physician’s office. Making any sense of the chart records was simply impossible to an outsider. Lab results? If they’re not correctly placed under the “LABWORK” tab, good luck finding it. Progress notes? I barely advanced past the date. I was able to interpret a few of the cryptic scribble, like “RRR” (heart exam reveals regular rate and rhythm), but only because I am familiar with the jargon.

Take the image above. To a layperson, the scribble writes, “AFTER…”? To a medical professional, that looks like a medication dosing. Ceftriaxone? Ceftin? Ceftibuten? Who knows. To the skilled medical professional, we can work backwards to guess which medication we usually dose at “1 gram IV”.

Poor penmanship is the security system for paper records. Good luck reading any of the record. In fact, we might not even have a record for our VIPs. The data is all in our heads. Your health information is safe with your doctor. That is, until your doctor becomes senile.

computing, medicine humor, medicine, tech

I recently made a first attempt to rent an apartment in NYC. Even though I had lived in the city for four years before, I previously dealt exclusively with the university for housing (In retrospect, this was a luxury). The manner I approached the process truly showed my naivete to the housing market–I believed that there was a housing market slump. Several months ago, the NYTimes published an article regarding the amazing deals to be had. I was wrong.

I had been on the hospital housing waiting list for over a year now, and initially hoped to take the first available opening. After calling the housing office daily for two weeks, I was finally told that I had two days to accept an offer before the unit was offered to someone else. I frantically requested a personal day at the hospital, and made a trip up. To maximize my trip, I also found two real estate agents to show me additional apartments.

The hospital housing was atrocious. The building itself was nicely maintained, with an ornate, marble lobby. The apartment was a first floor unit directly next to (3 feet away) the loading bay of Gristedes, a local supermarket. It was still under “moderate” renovation when I viewed it, and the electrician was trying to patch up some nonworking electrical outlets. The bedroom also had an elevated 4′x4′x4′ cube in the corner, which apparently formed the ceiling of the outside walkway down to the garbage alley.

Some of the realtor listed apartments in the neighborhood were situated in a more ideal location, but still had major issues. I encountered one listed with a “renovated” bathroom. The bathroom wall tiles resembled those at my high school, a distasteful pale yellow. The tub, toilet bowl, and wall-mounted soap dish were an algae-green. The toilet seat was an off-white color. The shower wall had four knobs–I did not inquire their functions. Indeed, the bathroom was “renovated”. No missing tiles though!

Have I been watching too much HGTV? Is it too much to ask for matching bathroom fixtures? Hell, if I’m going to shell out $1200+ a month for a 280 sq. ft. studio, shouldn’t I get one without brown fungi oozing out of the water faucet? Fortunately, subsequent apartments I viewed were slightly improved, although they wielded a price difference of several hundred dollars.

Weary after several hours of hunting, I finally settled on a modest 1BR apartment on the 1st floor (geh!). The laundry room is located in another building across the street, but at least there is no visible hyphae growing in the bathroom walls. With the recent housing market slump in mind, I attempted to negotiate a better price. This neighborhood was not in a favorable part of Manhattan, and the building was close to hundred years old (with minimal updates). My realtor smiled politely at me, and told me that she would speak to the landlord.

Several hours later, my realtor informed me that another potential tenant for the apartment was interested in paying more than the asking price. So much for bargaining.

For now, my apartment hunting adventure continues…

misc euphemisms, life

I hate the post office. Unfortunately, it is my only means to send mail economically. There is nothing wrong with the post office itself, only the experience of being there. Back in NYC, the post offices rarely make any of their supplies available–no delivery confirmation stickers, priority mail envelopes…anything. You usually have to wait in a line the length of the Great Wall just to get any assistance. The postal employees are unlikely the ones at fault; it’s a fact that most governmental offices are understaffed.

I religiously use the automated stamp dispenser to avoid the dreaded line. Today I scurried off early to the post office to brave the early crowds. At 8:30am (the post office opened at 8am), the line was already to the doorway, with only two employees. Fortunately I was mailing a flat-rate envelope and did not require human assistance. As I smugly deposited my letter in the bin, I caught eye of a customer at the counter epitomizing the cause of long post office lines.

She was attempting to mail a poorly sealed cardboard box while claiming that the automated stamp dispenser ate failed to print out her postage. As evidence, she displayed a crumpled receipt of dubious origin. The postal employee was kind enough to dispense new postage AND correct the erroneous zip code marked on the box. Ironically, the customer scratched out the corrected zip code and rewrote the original one, seconds after being told that the zip code did not correlate with the destination city. I could sense the frustration exuding from the rest of the crowd. I ducked out before I became visibly irritated from the scene. Good grief.

How difficult would it be to package your missive properly before leaving home? Is it too much to ask to KNOW where you plan to send your letter? Postal workers are overworked without having to deal with incompetent customers.

I dream of the day I have postal pickup in my office. That would be paradise. In the meantime, I guess that the automated stamp machine will have to do.

misc life, rant

Ophthalmologists love gadgets, and fortunately for us, there is no shortage of neat toys to collect. Topping my list of equipment to collect was a new digital camera–I had been carrying around a Canon A60, which was arguably Canon’s seventh-ever point-and-shoot digital camera. At six years old my Canon was simply the victim of Moore’s law, which states that computing power doubled approximately 18 months. Given that digital cameras are relatively inexpensive nowadays, I decided to replace my Canon.

What camera is suitable for the medical professional?

If I wanted a quality enthusiast camera, I’d have gone with a DSLR. For about $1000, you can have a hobbyist set, with maybe even two lenses. I don’t need that for everyday use. For the average medical professional (or resident), a point-and-shoot camera needs to meet these three criteria: 1) portability 2) functionality 3) price.

I wanted a point-and-shoot camera that I could easily carry around the hospital. One with manual controls would be nice, but is not necessary. This would be a camera that I could use to photograph clinical pathology in the hospital and to use for recreation. If you’re in the market for a new camera, read on. Read more…

computing hobbies, photos, tech