Grand Rounds - Volume 3 number 9

Welcome to the most anticipated Grand Rounds in a long time! These are the 27 best posts that the medical blogosphere has to offer this week. In my editors picks, I wanted to highlight well-written stories. There's also a short excerpt to check out from the best of the week. I've tried to make this a potpourri of posts for your enjoyment. Let's go!

Best of the Best: Editors Picks of the Week!

The end of life is always difficult for healers to discuss. But, the death of a newborn is even more tragic. Carrie, a NICU nurse, writes this moving first hand account of Love's Labor Lost.
Everyone slowly filtered out of the room - except for one nurse. The nurse who had cared for the baby that morning was standing at his bedside in tears. I walked in and asked her if I could do anything to help and she turned to me and said, "What do we do now?" It was a good question... She was newer than I am even, and neither of us had ever done "post-mortem care." (I'm sorry - I cringe when writing that, too...)

Grunt Doc, a Texas ER physician, writes a powerful and moving post called My Grandfathers' Guns.
My paternal grandfather (step-grandfather, really, but functionally my grandfather, and role model, long story) I knew during my life: a slightly built but sturdy man, one who worked every day because that's what Men Do. He was not an elaborative fellow, and never one to brag or conflate so far as I know; his role seemed to me to be provider and pair for my grandmother. He had a good sense of humor and I will always remember his and hers bowling trophies they won in League Competition in Wink, TX, because that's where the bowling alley was. They lived modestly, which is more their upbringing than financial status. That's just who they were, as a couple. He loved my grandmother, completely, and she him. A good match.

Watching patients slowly get worse with their chronic debilitating medical conditions is very tough to watch. In her first contribution to GR (Yay!), Artemis, a physician, shares her thoughts on a patient when optimism and realism collide.
I don't want to imply that I am devoid of hope when talking with patients regarding various conditions. I'm the first to realize that in too many neurological conditions hope is the ONLY thing we have to offer our patients...but I'm all for a healthy dose of realism and planning for the future as well. When patients agree that physical therapy is a good option, and go to all of their therapy sessions and follow through with the home exercise program and actually see a benefit, we all can rejoice in the improvements made. But what is the next step when patients have exhausted therapy options because no improvements are identified and medications are no longer providing any discernable advantage?

Susan Palwick, a patient with depression, writes a heart-felt analysis of society's attitudes toward cancer patients compared to society's attitude to patients with depression.
Depression's not sexy. It's common as dirt and every bit as dull. Depression's boring, both for the patient and for everyone else in the vicinity. For one thing, there aren't visible battle lines. Depression isn't an invasion by foreign or mutated cells. If anybody's come up with a sexy metaphor for neurotransmitter imbalances, I haven't heard it yet.

Ever wonder what it is like to be a volunteer at your hospital? Difficult patient (Thanks for coming back to Grand Rounds) describes an evening in the newborn nursery.
One Friday night when I arrived, I was summoned by a tiny and apparently inconsolable little guy. Because the baby hadn’t been named, I decided to give him a “pet” name as they do in India--children in India sometimes go for years before being named officially. I held the baby close, using this “pet” name, whispering prayers of hope, health, blessings, and protection. His tiny body jerked periodically, and I snuggled him closer. I thought, what this little guy needs is love, crazy love. That is something that I am qualified to give.

Bad Doctor, a second year medical student, faces a death in his family and his first request for medical advice in An Unwilling Consultant.
You can imagine the turmoil that her imminent passing threw my wife's family into. Of course they all knew that sooner or later her body would fail at her age (or, as she liked to say, her body would go "kaput") but I'm not sure they could imagine a life without her, or their immense family without her as the matriarch. The family that I had joined only a year previous was on the cusp of great change, and I soon found myself thrust into the situation, honored and more than a little terrified, as I found those I love looking to me for medical knowledge for the first time.

Always Learning, a resident physician, elaborates that there is more than meets the eye when breaking down the true meaning of the patient-physician office visit.
We're taught to hone our skills continuously so that we can best detect and treat disease. We're taught and tested and mentored so that our physical exam is done well. There are classes that teach you how to ask your questions so that you get the answers you need to make a diagnosis. There are classes (can you imagine!) that teach the budding medical student that there are two agendas during each patient encounter. The first is the agenda that the patient has - why they are here. The second, most importantly, is the physician's agenda - to treat the high cholesterol, to talk about weight loss, to freeze a precancerous skin lesion. You do this because there may be medical issues that do not bother the patient, but treating these today may prevent health problems in the future.

On the lighter side, Mother Jones RN writes this amusing tale of classic books from her family collection. Ah, the golden days of medicine....
Nurse! Don’t you know it's unprofessional to parade around a doctor’s office dressed like a trollop? You certainly have the doctor’s attention. I also see you’re thinking about what happened last night after office hours instead of tending to your patients.

Kerri Morrone, a patient with diabetes, writes an "Open Letter to My Pancreas." (Great stuff!)
Dear Pancreas I’m not sure what the hell happened to you, but you’ve taken it upon yourself to stop working. You did have that job for about six years, where you got up early every day and produced my insulin, but apparently that was too much for you. You were laid off or fired or something. Don’t blame it on that virus again. I think you just slept through the alarm and were let go and you just don’t want to admit it.

Here are the best of the rest...

TSCD, a doctor, shares personal feelings and family frustrations in dealing with a patient's choice to refuse life-prolonging treatment.

Type1EMT presents a poem called Three Pairs of Shoes. Not only is it very creative, but also it relates to her diagnosis of diabetes which she's had since 1998.

Holiday time is quickly coming. Kim from Emergiblog remembers one of her first patients in this post called Merry Christmas, Katrina.

Dr. Trofatter shares a poignant story about young child, who is dying of leukemia, helping his mother who has just found out she has a baby with a birth defect.

Topher tells the story of the people and students of St. Vincent as they are drawn together in the death and autopsy of The Old Man.

There are times life moves fast. Inevitably, there is always something that occurs which makes you stop and think. The #1 Dinosaur share this story of being Blessed.

Ripped from the headlines, Dr. Deb links pathological narcissism and sociopathy in discussing OJ's new book. (OJ wrote a book? Me? I'd rather see that new Borat movie. HA!)

The Tundra PA describes the difficulties of large distances and lack of transportation in assessing sick patients in Distance Triage.

All of you know how I love talking about flu shots. The Fat Doctor rants on five stupid reasons people give for skipping the flu shot. You go girl! Also check out the 20+ comments which follow - sheesh!

Pain, especially a headache, is very difficult to deal with when it comes on. Drytears describes an experience and frustration with an occipital nerve block.

Dr. Wes describes the challenges of a new policy initiative to perform primary angioplasty within 90 minutes of arriving to the ER.

Rita Schwab expresses concerns about the validity of anonymous physician rating sites. I would have to agree that I'm also concerned about potential abuse of this system.

Why doesn't anyone allow you to have food or drink beginning at midnight prior to your surgery? Judy answers these questions in NPO after midnight.

Dr. Rob talks about the challenges of balancing patient autonomy with patient responsibility in improving the health of medicaid receipients.

I had no idea where Borneo was in the world until reading this blog. Borneo Breezes describes a training course for volunteers of the Healthy Child Uganda project (Great pictures here!)

Seeking medical care outside a patient's home country is becoming more common these days. In separate blogs, Doctor Emer and Louise discuss this topic.

I'm a tech geek like anyone else. In this piece, Dr. Palter from Docinthemachine predicts the future of surgical procedures as it is influenced by technology.

That's it! Sheesh! Thanks to Nick Genes for giving me this opportunity to host Grand Rounds. Glad to step in at the last minute to help out. I'll share my host experience in the near future. Look out! Next week, Grand Rounds goes to Notes from Dr. RW.

Addendum: My "Pre-Rounds" interview with Nick is right here.

For those of you in the USA (and around the world), Happy Thanksgiving!



I had many requests to at least mention the rest of the links submitted, as a kind of compromise to leaving all these out this week. So, if you're interested here is the list of the rest of the links:
Moreena reflects on what it means to live life to the fullest when it comes to her post-transplant daughter.
Volkmann's Ischemic Contracture from Unbounded Medicine.
Dr. Lisa Marucci interviews surgeon Dr. Carol Scott-Conner.
Henry Stern reports on an insurance company venture to try to address the uninsured.
Tara Smith reports a scarlet fever outbreak in North Korea.
Dr. Aleksandr Kavokin discusses hip fracture cost and complications.
UK Community Pharmacist discusses medicine use reviews.
Mona Johnson talks about an association between diabetes and dementia.
Nancy Brown talks about HPV and meningitis vaccination in teens.
Dr. Auerbach gives tips on how to avoid shark attacks.
Dr. Bob reflects on a patient and shares how ER physicians deal with death.
Cyndy King gives tips cancer patients & families can to to survive the holidays.
Dr. Choi gives tips to survive the in-flight medical emergency.
The Granola discusses silicon implants.
Mike Pechar reports on a study involving semen allergy.
Amy Tenderich interviews a health care executive about diabetes topics.
Marcus Newberry objects to being left out of last week's GR.
Gerald Pugliese writes a commercial post for a book.