Tuesday, November 22, 2011
This is a fascinating interesection of science, art, forensics and neurosurgery. You have got to click on this link and read this fabulous piece!
AANS Neurosurgeon – Neurosurgery Cold Case Post-Mortem Identification
Tuesday, June 21, 2011
No, I have not forgotten the = sign in my EMC2
- is an emerging syndrome that will soon reach epidemic proportions,
- will be the AIDS of the 2010-30 decades,
- may consume massive health care dollars.
EMC2= Elderly (with) Multiple Chronic Conditions
I can give you many examples from just the last few weeks and I suspect my medicine colleagues could rattle off dozens. Recently, I was asked to consult on an 85 year old who slipped on some concrete stairs and suffered a skull fracture and small subdural hematoma (blood clot between the skull and brain). He was lucky and had no real brain injury but he remained in the hospital for over a week because:
- He developed an arrhythmia that led to extensive medical testing
- He experienced extreme difficulty urinating and as a result, suffered a bladder infection
- His degenerative lower back problems greatly inhibited his early mobilization and led to high concerns about the risk of acquiring a blood clot in his leg.
One of my colleagues estimated that within 2 years, one of every three patient would meet the criteria for EMC2. Coordinating their care, balancing their social and medical needs, making decisions about complex multi-pharmacy interactions and conflicting health needs (what is good for the heart may be bad for the brain, what is good for arthritis may be toxic to the aging liver/kidney). Sure, geriatrics has emerged as a specialty but there is remarkably little known about how to best manage these patients, few hospitals have geriatric hospitalists (there are precious few geriatric specialists and even fewer that serve as more than nursing home guardians), and many specialists refuse to defer to a geriatric doctor in managing the many medical concerns of a given patient.
I never like to raise an issue without presenting some constructive suggestions. The first step is clearly acknowledging the problem and bringing together innovative thinkers across the spectrum of medicine and medical education to develop a rapid response to this raging epidemic. I promise a future posting to outline some more specific areas that will need to be addressed and some initial steps I hope the medical community will consider.
I think Einstein would approve.
There are only two ways to live your life. One is as though nothing is a miracle. The other is though everything is a miracle.
Friday, June 10, 2011
This hard working man has spent the last 18 months out of work, made redundant in the heat of the recession. Just two months ago he finally landed a great, competitive job which he loves (and his evaluations have been outstanding to date) and is finally beginning to right his personal economic boat. Taking the necessary time off of work, he feels, would jeopardize his job-there are 30 or more talented individuals who would gladly snap his position up. Bad timing all around.
I find it really difficult at times like these to remain a dispassionate neurosurgeon. This man is suffering great pain and disability. He has taken no time off of work and even refuses most medicines because he wants to perform well every minute at work. Firing him because of having surgery would be wrong and probably illegal but as a large company, I suspect they could find some way to handle that. Being ill is hard enough, having those issues compounded by fear and financial insecurity has to aggravate the problem considerably. Of course, I understand that the company needs him at work-that is why they hired him-and what good alternative do they have?
No one plans to have a medical problem and this many has done all the right "health" things (not overweight, exercises, goes to the doctor regularly, etc.) but nature can get in the way. I am glad that I help many patients in my practice because when faced with this patient, I felt largely helpless. I just hope the time I took to talk with him, reassure him, adjust his medications to try and get some relief will help in some small way.
Monday, June 6, 2011
Sunday morning the call came from the service-the Emergency Room is looking for you. OK, so I was on my way out to walk the dogs along the Hudson River on a glorious late spring morning but...I was hoping it would be quick and painless.
"Emergency Room," she answered.
"Hi. This is Dr. Benzil, I am returning the call to Dr. W." I replied.
"Is HE available?" she volleyed back.
PAUSE-I wasn't sure what she meant so...
"This is Dr. Benzil, Is Dr. W. available?" I tried a different tactic.
Still she seemed confused, "I will get her to the phone when HE picks up."
Finally I understood. "I am Dr. Benzil, a she not a he."
I imagined some light bulb turning on, "Oh, I will get Dr. W."
It is June 2011. I have worked at this hospital and this ER for more than 7 years and do more cases there than any other neurosurgeon and yet, the deep seated notion of doctors (particularly neurosurgeons) as male clearly lives on. Sigh, perhaps in the next decade...
Friday, June 3, 2011
|Gill Scott Heron|
I learned early Saturday morning
And I wept
His music and words
Had touched my soul
Had lifted me up
Many late nights and
When much younger
I had a first date
And he sang to the room
But it seemed like he sang
Just to us
And we stayed on
For a second show
That date soon became
My lifelong mate
And still you would
Croon and remind us
Of what was right
And how to live,
Think, and challenge
I am so thankful
You made such music
That I saw you
Not once or twice
But many times
And that I will always have
Your songs in my life
Your revolution is over
The world's will never be
But I hope you have
Found a little slice of
Peace and happiness
You so deserve
For all you have done for others.
Gil Scott Heron Dies May 27, 2911
(For more information see-Washington Post, NPR, CBS News, Chicago Tribune)
Monday, May 30, 2011
Leslie K. Price
It has been nearly a month since I last blogged and for the month prior to that, had found myself with less time to devote to this pursuit than I would like. In the ebb and flow of life-between the challenges of work, family, and personal needs-somethings rise up and others fall to the back by necessity. Once the pause happened, I felt that I would only return when I felt I could potentially return to regular entries. I am hopeful that I now can. How did I feel when I wasn't immersed in the blogosphere? I missed the outlet for the "connections" I made while seeing patients and carried on my day to day clinical practice. I dearly missed writing and the reward that comes from completing a creative endeavor. I felt I had set aside some good friends, even though these are friends I know only from their writing and their "profiles". On some levels, I felt unburdened of the "deadlines" I had set for myself for writing and I realized (AGAIN) that the blog is for me-an outlet, a connection- and not an obligation!
So I return. Hopefully stronger than before, with renewed vigor and interest. I hope you are still out there reading...