Weekend musings

It’s another cold, windy, winter day here in the Great Lakes state.  From my kitchen table I can see the snow drifts pile up against an old oak tree.  There’s a baby swing still hanging from the lowest branch.  PalKid hasn’t been able to sit in it for years, but for some reason, I’ve never bothered to take it down.

Yesterday around five a.m., a small voice woke me up.

“Daddy, I can’t sleep.”

“Come on in bed next to me and you can stay here, just be quiet, honey.”

A few minutes later: “Daddy, I don’t feel good.  I have a headache. Can I have a cold cloth?”

Mrs. Pal called me at work later to tell me PalKid had a fever of about 102 and was feeling miserable.  I ran into a colleague today at the hospital and he told me, “You’re only as happy as your least happy kid,” and that seems about right.  Last night was rough, and that cute little voice got me up at four this morning.  She was feeling miserable, and after getting some tylenol in her, she asked for a cool bath.  A few hours later, I was on my way to the hospital, not for her thankfully, but to see patients.

My new practice uses a hospitalist service, so I’m not the one taking care of my patients in the  hospital anymore, but I still like to check on them once in a while when time permits.  The new practice is very, very busy, which is great, but there really isn’t time to round regularly.  I did manage to visit a couple of folks today (and missed a few also…sorry).  I got a big hug from one patient, and nearly cried.  I was happy to see he was recovering nicely after a big scare.

Someone asked me this week how I deal with giving bad news, with maintaining a clinical distance.  I have no idea.  Much has been written about this, but there is no right way to deal with these boundaries.  Being a physician is a privilege, and a strange one.  It’s a bit like being a writer, inhabiting lives that aren’t yours, being privy to the private dialog of others, to their happiness and tragedy.  Sometimes it hurts.  Sometimes it is ecstasy.  Rarely is it simple.

But for today, at least, I’m mostly a daddy taking care of a sick kid, bringing her ginger ale in bed, enjoying a smile meant just for me.

8 Comments

  1. Interesting that the medical profession embraces the practice of hospitalists taking the handoff from internists when a patient enters the hospital, but screams bloody murder about the horrors of handing off patients when it’s in the context of attempting to limit the insane shifts of hospital residents (which are dangerous to both the residents and their patients alike).

    • There are financial interests both ways, and one group (attendings) has more power to decide than the other (residents).

      To be fair, though, these two types of handoffs are quite different. Neither is without problems, and these problems are hardly insoluble.

      • MarcoTolo

         /  January 15, 2011

        “To be fair, though, these two types of handoffs are quite different. ”

        Would you mind commenting on the differences? (I believe you, just looking for a little insight.)

        • Shift-change handoffs can occur 2-3 times a day. Having a separate doctor for the office and the hospital isn’t so much a handoff as a split responsibility, with the weak point being communication between the two, which is arguably less essential than communication between inpatient teams, where the situation is more acute and more fluid.
          But handoffs can by systemized and done safely, and will be as the ACGME duty hour rules go into effect.

  2. khan

     /  January 17, 2011

    What is the purpose of giving ginger ale to a sick person?
    My ex-MIL always wanted to give me ginger ale or coke when I was sick.
    Is this some sort of mid-west 0ld wive’s tale?

    • Jim

       /  January 18, 2011

      My mom as well – At the time she said that ginger “calmed the blood” but later admitted that she figured it was less boring than water and was something I could keep down.

      And, well said Pal – from a father who’s been in that situation before, it’s a comfort to see someone else expressing the same concerns and the same feelings.

    • I suspect (but haven’t really done any serious investigation on it) that ginger causes the production of superoxide via being metabolized by P450 enzymes and this lowers the NO level and the lowering of the NO level reduces nausea.

      Sickness is often a time of very high NO levels and lowering the NO level will make one feel less sick.

      Early pregnancy is also a time of very high NO levels. There is a correlation between severity of nausea and pregnancy outcome; pregnancies with more nausea tend to have better outcomes. I think this is due to higher NO levels being causal in both nausea and pregnancy success. I think anti-nausea meds will only be effective if they lower the NO level which (I think) would be a bad thing to do.

  3. Beautiful, Pal. Just beautiful.

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