Behind the White Coat

Onc to CCU

The month has come to an end, and so is my time on the oncology floor.  It was much better than I expected, our attending (well one of them at least) was very good I thought, and so were our superstar fellows, and of course, our house staff team.  So it made the month go by smoothly with some fun.  As interesting as it is, despite the therapeutic advances that we have made,there are just too many cases of medical futility and sad stories for me.  But it is a field with a lot of research and new developments, and I think in the near future it will be more popular, and pay a lot of big bucks.  In the end howerver, I'd say I had a positive experience.

But alas, finally I say goodbye to the largely depressing environment of sick, dying, cancer patients, and move to where the good stuff is, well for me at least.  That's right, it's the CCU (cardiac care unit).  If you haven't guessed, I want to do cardiology, so I am looking forward to seeing some good stuff, whipping out my guns of knowledge to impress, and try to kick some ass, and kiss it, at the same time.  Today we were just getting comfortable in the environement of the CCU, and "North 6" which is the telemetry and stepdown floor, where we send any patients that are stable enough to be transferred out of the CCU, and they are followed by the interns.  My ass was done at 3pm, so no complaints yet. (Until I have my 27 hour overnight call on Thursday.  Bring the pain).

The attending will change in two days, but we overlapped with the February attending, who is quite a character.  She is this 75+ year old German cardiologist, who was quite famous back in the day, being involved in some of the big trials of her time.  She is quite smart, but at her age, some of your sharpness is lost, as is your memory for names and information that you have just presented to her.  Rounds as you can guess were painful for the poor Feb team..  She rolls in with leopard versace pants and some low cut shirt, with gaudy rings and necklaces--I shit you not.  Rumor has it she also wears a G-string (I'd rather not know how, and we quickly decided to move on from that subject when it was brought up).  You'll be lucky if you can understand her English through the harsh accent and the "und this, und that" terminology. Nonetheless, it is entertaning... Lets see how our real attending will be.

My back is still killing me!  I am on Soma and Percocet now.  But it gets worse everyday, and I can't exactly take those at work.  I need me an MRI!!!

Today's Muslim World

So much seems to be occuring in the Muslim world today in the post shock-and-awe era.  Unless you live under a rock, we all are aware of the world-wide muslim riots against the Danish newspaper's publishing of the anti-Islamic cartoons.  Almost in a timely fashion now there is this massive domestic uproar against the Dubai based company controlling several U.S. seaports (which I dare to admit I am actually siding with Bush on an issue).  To add some more icing to the cake, there is now a frank civil war in Iraq between the Shiite and Sunnis after several mosque bombings and deaths.  Too many bad things going in the world right now, which is simply worsening the face of Islam and Muslims throughout the world.  Bad timing, bad apples in the bunch, and twisted interpretations and stereotypes.   I figure I should at least throw in my two cents (and no more) about some of em.

Regarding the cartoons, everyone knows whats going on, and too many people have said their piece on the issue through articles, blogs, emails, etc.  I've gotten so many forwarded emails about it, I figure there is no need for me to go on my own dissected rant on the issue.  In a nuthsell:  Forget about my anger and protest.  Forget about the insane human beings who decided to reek havoc and violence in their own home cities, doing retard things like burning KFC's in Lahore so some poor Pakistani business man can go broke.  Forget about the abused and misused "freedom of speech" defense taken by the Danes.  In the end, I ask how stupid can you be to publish something like that in a public newspaper at this point in the world's history?  All I gotta say to this person is, are you happy now?  I don't really have the energy to go on about the issue, especially since others have already said enough, so I'll just divert you to some views by my cousin who will lay out some words if you want to read more. 

I've screwd up my back again and the painkillers are making me drowsy, so I'll rant some more at a later date....

Identity Theft

A young blonde woman in her late 20s entered a bank in Pennsylvania last week with a request to withdraw $4,000 from her checking account.  The woman had her social security card, and a driver's license for identification.  As the request was being processed, the teller, a particularly scrutinizing old lady, found something off with the whole ordeal.  She took a close look at the signatures and realized that they did not match.  She began further questioning regarding the account--how often she banks, what for, where is she based, etc.  The account had a New Jersey address listed, but her license was PA.  The woman claimed they had just moved houses.  Then the teller noticed the date of birth on the account--the person in front of her was about 30 years younger than she was supposed to be!  The jig was up.  The police were called and she was taken in for questioning, revealling the truth--that she did indeed try to impersonate someone to withdraw money from their account, and she did it because her drug dealers made her do it!  Then the owner of the account was notified of this ordeal, it just happened to be my Mother!

Identity Theft.  You think it will never happen to you, but guess again!  How this random young chick got my mom's personal information I do not know.  She is even the overly cautious one in the family.  My mom had to cancel all her credit cards, contact the social security office, her banks, get lawyers involved, etc.  What a bitch!

But can you imagine if the teller did not pick up on the scam?  She could have easily gotten away with it, and I am sure she and her companions have so ni the past. Lucky for us no money was taken.  But it's a wonder how she got a hold of this seemingly private information.  It is also disturbing how easy it appears to impersonate someone and steal their money right from the safeguards of their own bank.  So be careful people.  Monitor your funds, credit cards, and keep your personal info safeguarded!! Anyone is vulnerable.

New Floor, Same Treatments

This week we moved to our new floor.  Construction was just completed giving us a brand new look, fresh coloring, and pristine IKEA-esque styled furniture.  It actually looks like the floors of a real University hospital now!  But alas a new space doesn't mean better quality.  In fact the nurses have become terretorial about their new working areas and computers, but the last thing I need in my final week and a half is turf wars with nurses.  One would think staff and nurses would be motivated by the move to do better, but we shall see if that thought holds to order.  But regardless of the new surroundings, the patients and treatments are the same, and medical futility continues to haunt our patients.

I now have four patients on my service, two of which have been here since I started in the begining of the month!  Treating these high grade leukemias and lymphomas is a tortourous affair for these patients.  For most of the time they are isolated in a room to prevent them from acquiring infections since the chemo knocks out their immune systems.  It is like prison.  Talk about depressing!  One of my guys has HTLV-1 Adult T-Cell Leukemia.  Definitely not the leukemia you want to have.  He has been here for the past week with an infection which arose during his treatment.  We just found out that after one failed course of chemo, he has now failed to respond to his second line therapy, and his leukemia is recurring (which we caught by his blood calcium levels shooting up to 15.6, which believe me is extremely high!).  We have basically run out of established regimens for him, so what do we do next?  Well the oncology fellow and I did a search for new research and experimental treatments for relapsed disease.  Basically going by case reports and small trials of unproven therapy.  A few novel therapies we came across in trials of 20 or so pateints showed maybe 5 of them responding, keeping those people in remission for 12-14 months.  Those results were referred to my fellow as "Great outcomes."  Hundreds of thousands of dollars for a 20% chance to prolong your life for a year.  Fantastic.  We are actually trying to enroll him into one of the study protocols, which is probably ideal for someone like this, since nobody really knows what to do.  Hopefully we can do something good for the guy.

In many of these cancers, the best you can hope for is to prolong survival for weeks or months at a time. That is considered a good response.  Sure there are cancers that can be cured if caught early enough with aggressive screeening etc, but many are caught too late.  Seeing what I have seen so far for many aggressive malignancies, the fact that prolonging survival for months at a time for thousands of dollars a month is considered a good outcome, I can see there is still a long ways to go for cancer research.

The Blizzard!

So I awoke to a mild snowfall, with about 24 inches on the ground!  We really got dumped on.  Managed to get out of the house to go get some brunch, and some streets weren't even plowed yet, and those that were had mounds of snow along the sides and corners.  Thankfully I left my car in the garage at work, because it would be buried along with all the other cars out there!  Quite a site to see.  Didn't make it over to central park as yet, but hopefully in the next few days!

My downstairs neighbor's porch

Sights of 77th Street

Who needs a stroller?

Noreaster

The storm has come.. I am sitting here 4am now, having stayed in saturday night.  The snow is certainly comin down.. Here are views from my window...

Pretty peaceful too... Until I hear the neighbors i think downstairs or the next building over, opening the windows, and hear these drunk girls screaming as they take in the cold, "Ahhhhhooo!! Freezing Titties!!"

Security, Cancers, and Blizzards

So I have been M.I.A. for a little bit, and if you attempted to visit last week, you would have noticed my blog was down for a few days.  This is because I had a security leak, and the blog was compromised.  It's amazing who can find your blog through google, when searching for completely irrelevant information!  But alas, I have temporarily controlled the threat, and will attempt to resume normal posting.  Lets see if I can avoid an emergency shutdown.

Almost 2 weeks through oncology now, and I must say it is not as bad as I expected.  Sure there are sick, dying, neutropenic patients with all kinds of infections, but there are actually some people who do O.K.  We have lots of leukemics, lymphomas, multiple myelomas, with many stem cell transplant patients (formally known as bone marrow transplant).  You see some pretty interesting things.  All types of cancers that pretty much go anywhere, and do anything.. It's kind of disturbing, that it can really happen to anyone at anytime.  It is also amazing how far some people want to go, regardless of how painful and poor the prognosis may be.  We have one patient who has anaplastic cancer of the thyroid--one of the most aggressive and malignant cancers out there.  She has metastases to her colon, bone, lung, and who knows where else.  She has some bleeding into her lung, where nobody knows where it is coming from.  We have given her about 15 units of blood in the past few days, and the surgeons, interventional radiologists, oncologists, nobody knows what to do.  She is totally with it, but she is going to die.  It is only a matter of time.  All I know is when if I ever get to that point, send me home with tons of morphine, and I'll go my own happy way.  In oncology, you sometimes have to get used to medical futility.

Now I sit here, Friday night call.  It's still freezing outside.  And there is a blizzard coming.  12 inches of snow with 50mph gusts!!  Are you kidding? The first real snowfall of the year.  At one time I'd look forward to it, but now I dread getting my ass to work from the city in my civic, which is street parked!  I may just have to leave my car at work and take the subway!! (Yeah, I have become spoiled)