Archives for September 5, 2006

Medblogs Grand Rounds 2:50

Ves at Cinical Cases (Cleveland Clinic, maybe you’ve heard of them?) brings the latest:

Grand Rounds is a weekly summary of the best posts in the medical blogosphere. Pre-Rounds is an article series about the hosts of Grand Rounds on Nick Genes of Blogborygmi, who writes the Medscape column, is the founder of Grand Rounds and he maintains the archive.
This week’s Grand Rounds is loosely structured in a “medical journal format” using the table of contents of one of my favorites — the British Medical Journal:
Editor’s choice
Clinical review
Analysis and Comment
Career focus

I usually say something pedantic like “It’s up”.  Here’s what this deserves: This is how a Grand Rounds should be.  Refer to it when you host.

Here’s my must-read post from this grand rounds.

Labor Day: A Day when I liked my job

Labor day was spent in my particular labor, the ED, doing my thing to save disease and stamp out lives (joke).  I was at my part-time gig, which is a very nice ‘community ED’, a departure form the inner city referral-center ED that’s my real job.

At the real job I don’t see kids under 12 much, as we’re in a  complex with a huge peds referral center.  At the real job I see inner city problems and patients, and a lot of exacerbations of chronic diseases.  Oh, and a terrific lot of blunt trauma.  It’s good emergency medicine, and I help the team make a difference, but it’s a pretty well defined patient population.  A lot of acuity, a lot of sick patients, a very high admission rate.  Not bad or good, just different.

The part-time gig, on the other hand, is on the edge of the big metroplex, and as such is much more of a ‘real’ ER: kids with colds, ankle sprains, and the occasional really sick patient.  Lots of patients, but as a rule they’re not as sick and not as chronic.  Trauma is steered away by EMS, but they get MI’s, etc.  And nursing home patients, but not nearly the volume of the Big Joint.

Today I got to talk to my patients a little bit more.  I got to get a bead out of the nose of a kid (10 Fr. foley plus a little etomidate worked the charm in a rambunctious and completely uncooperative toddler), I did a diagnostic and therapeutic thoracentesis in a nice little-old-person who felt miserable trying to breathe with one diseased lung rather then the usual two; the change was dramatic.  And appreciated, by both of us: the patient for a life made better, and me for a renewal of energy.  I used judgement, skills and hands to make a patient comfortable, facilitate a diagnosis, and prove to myself I cold help.

Yes, they’re common procedures for an EM physician, but today it felt different.  Good.

I’m like you, I need good days, and love them when I have them.  Today was one.