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DrOrrange 
10:02pm, October 14, 2009
Today I started back as the hospitalist at LA County-USC Medical Center..which I do 2-3 months of hje year. It is in sharp contrast to seeing private patients everyday and USC faculty and athletes. I have told the story before (a true story) that the reason I love my job is that I will see maggots in the foot of a homeless diabetic woman the same day I will see the tailback from the USC football team...and you know how we love the USC football team.
Doug our founder at DS will come with me one day to see and I wish he had been there today because County is a place that will change the way you look at your city. My intern who has been up all night presents a 37 y/o hispanic female with two kids who comes in with numbness of her right foot and face...witnessed by our ER to have a right facial droop which resolves. She is presented to me today in rounds after being seen by cardiology, neurology, etc...and apparently has had a witnessed stroke this AM by the nurses...and she reports that neurology thinks its a pseudoseizure (faked seizure essentially) based on their lack of objective finding. OK...we see a lot of people who want a hot meal and a warm bed and trust me I can spot them..but when I see her I start fresh and perform a neuro exam and immediately see things she cannot fake. Seeing people at face value is something ive gotten better at during my years of medicine. In the middle of my exam...she seizes.... a partial seizure(right arm and face movements) that then becomes generalized (whole body shaking,etc). For me...I do not sweat this...for my medical students and interns on rounds...I noticed they stand back and let me deal...unable to cope with it because seizures still look scarey to people who havent been doing this a long time...this was no faking. She is now in the middle of a workup with EEG, MRI, etc to see what the heck is going on...and Ill keep you posted. Two of my medical students were so upset by witnessing it...not just by the seizure but by the fact that she had not been taken seriously. I can already see them writing this in their personal statements when applying to residency..."when i learned to not trust chart lore or previous evaulations and start fresh"
Part of my job is as the internist/family physician to my many patients...and the other part is as a teacher. I sometimes forget this. Today I didnt. Everyone deserves to be taken at face value...everyone deserves a complete workup...everyone deserves our years of expertise that have enabled us (though sometimes I think of how many basic science things I have forgotten since med school or residency) to discern who is sick and who is not....and I think there were 3-4 careers that were changed today. I love taking care of patients and their families and sharing their most intense moments with them...today I remembered I love teaching...and not just lecturing...but teaching....being there for a powerful moment when we all realized you need to form your own story...based on your own examination...and that can NEVER change.
Dr O.
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great post, O!
DJH
You are a great doctor!!! Your so caring. I wish there were more like you. I love hearing your stories cause I too work in the medical field.
It is so interesting to me.
looloo
My 93 y/o Mother would say, "You've found your calling." You are blessed to have two 'callings', doctor and teacher --- and your patients and students (and DS friends) are so very blessed to have you.
Hugs, Jessie
Jessie
It is so "refreshing" to find someone who allows their knowledge and heart guide them when doing their "job" ... thank you for sharing this.... you are wonderful
colored_cheerios
As a previous Health Unit Cooridnator at Hennepin County Medical Center, a teaching hospital, I use to observe alot of what you're discussing above. I would always remind the Resident/Intern if you want to become a good doctor in the future just listen and observe with your eyes wide open leave those judgements outside the door. Thanks for caring with compassion.
capricorn7
Isn't God wonderful? He gave you this wonderful talent and filled you with knowledge that saves lives. I truly hope some careers were changed and it was the one that thought this woman was faking.
lynn73
Our own little private ER segment, this is great. I find your posts so interesting. You are such a great Doc, I wish all cared so much on the people level. Thanks...
M~
Mandy68
that's interesting, my wife is going into the medical field next year
cowboy357
Thanks for the post Dr. O. Your patients and students are lucky to have you on their side. Caring with compassion is truly a gift. Most of us whom have had extensive contact with the medical community are treated with a cold, scientific eye and a deaf ear. No wonder many of us feel like lab rats rather than human beings after such scrutiny. Sadly, it seems you are the exception and not the rule, at least from my experience.
fredk
Thanks for sharing Dr. O. It's great to hear your compassion and seeing each patient as a PERSON. Great job! You made a HUGE difference. :)
nursesteph
Wow Dr. O. Your patients are so lucky to have you , as well as your students, you seem like a great teacher, I see how one could wish you were their own personal Doctor, I too wish many had the same concept and ideas as you and saw people like us for Face Value. I could go to ER one hundred times and I guarantee the 3rd to 5th time, they will start to make me believe its all in my head. They get tired of seeing the same person over and over and over and over and over, but had they got it right in the beginning, they wouldnt have this problem, Patience is key and so is being a People person with Heart, Many have made the choice to help heal our wounds, and sew us back up as well as get us back in working order, we didnt ask for them, they were given to us based on their aptitude and knoweledge. I love all Doctors, nurses, Radiologists, Neurologist, Endocrinologists, Etc.... Their are good and bad in everything, we can only hope that we get the GOOD! Like DR. O
Sincerely,
A~
~God Speed~
anisamkinsey
You have to care enough to be able to see through it...Some doctors just dont have your gift and the outcomes is that patient are misdiagnosed, left untreated and become disillusioned with the medical profession. It is difficult to teach what you have. It is a gift. You have it or you don't. You care enough or you don't. That why...we love you a lot..you inspire us with you humanity, you give us hope with your devotion ...we hope to meet one half as caring as you and we will be OK. Last month my father got a heart attack after seeing his doctor...so just imagine how bad bad can be...just to care is a lot..
desifinance1
Dr. O,
I am sure you have seen many things in medicine. And although I am not a doctor I too have experienced seeing a young girl have a seizure. I used too work for a school with teens that had special needs. She had lost her parents in an auto accident, but she survived with head injuries and was being raised by her aunt. Many of these students would have seizures. That particular day I watched her as she went into the seizure, I grabbed her and laid her on the floor and had one of the other students go and get the nurse. She was fine but it all happens so fast that it can be scary. You have to keep a level head.
I also remember when my youngest daughter had a fever convulsion at the age of 5. Now that was scary when its your own child, I called the pediatrician and followed his advice. That was her first and last after that when she had a fever she had to take phenobarbital to keep her from having convulsion.
It takes a doctor with compassion, knowledge and a keen gut feelings to do what you do. You are amazing!
joy2go
yikes just thought about it hopefully the students dont get anxiety problem or some shock after this...
desifinance1
Excuse me but hot meal and warm bed ? IT gets that bad that people pretend to be sick ? We dont get it that bad in Canada...at least havent came across it...usually our social net takes care of it but it not as good as it used to be but still OK...
desifinance1
Wow, what a thought provoking entry. Thank you!
Ash
You seem like a very caring person.
tigger48
Dr O Do you really think that way or for one moment u so the light hay algunos momnetos en nuetras vidas que no nos gusta lo que hacemos y lo tenemos que hacer mejor para poder compenar lo malo del pasado y recuerda mi Doctora hay un Dios en el cielo que nos mira constantemente y el es el unico que le tienes que agradecer por tu talento
feliz
Great reminder for me to document clearly what I see in details for the MD.
Thanks,
Amy
amy7902
You sound like a good doctor. I wish there were more like you out there. Truly I do.
Killingsworth
WOW! I need to send a few doctors your way...but, they have been in practice for many many years...they sure could use a refresher course!
You are such a genuinely caring doctor. Thank you Lord for having Dr. O in the right place today!
ladywinger
I wish you were my doc...
FariyGirl24
Back in '04, my boyfriend overdosed on his meds in a nearly successful suicide attempt. After being transported to the ER at our local (small) hospital, we were transported to a larger hospital about an hour or so away. He was admitted to the MICU ward where he stayed for three days. (he doesn't remember the first two days there) Well, since I had no transportation back home, because we had no car, (I slept in the chair next to his bed) I asked if there was any way I could get a couple of doses of my medication that I had forgotten in the emergency. The head nurse blew up at us...accused us of being drug addicts and totally put the both of us down. I just didn't want to have a set back...I was on a very low dose of Zoloft. I wish that nurse had been more like you. Just because we are poor and dressed in old clothes, doesn't mean we are druggies or dealers. It was a very terrible thing for that nurse to do especially since he already wanted to die. I wish there were more docs and nurses out there who thought like you do...you are awesome and a great help here at DS.
2wicked
LOVE the MAGGOTS! I have seen them before too....so disgusting! People live at home with these too!
I had a patient bring her CPAP machine in from home, and ROACHES crawled out of it. Good thing another Nurse was in the room, she stompled on them. I freaked! YUCK! So, when I see her name on the unit, I warn to NOT let her bring the CPAP in from home, use OURS!
TLCDaisy
I must say, it's so good to start fresh...b/c I see how so many times Doc's just go by what's in the chart, and use that to sway judgment. It's really irritating, when you see something, and someone else doesn't, and just b/c they are going by what the other Doc says, they dismiss it.
Never believe what someone else writes/charts/says....start fresh...you might find something that they didn't discover...and WOW...how good that makes you FEEL!
TLCDaisy
Thank You great info. What do you know about Celiac disease besides becoming gluten free.
jazz5
seizures can be scary. my oldest had her first one at 10 yrs. old. i think it was one of the most frightening things i had even seen. was totally traumatized for 4 months. i finally met a lady that said her son had had one just b4 they had to put some kind of drain tube from his brain to lower body. she was matter of fact about it & not traumatized at all. the behavior she modeled affected me in a positive way. & also the fact that i learned that seizures in themselves are not a medical emergency (unless other things happen along with it). so i was finally okay with it. my younger children were babies when she had her 1st seizure so they grew up around it. one time we were all in chucky cheese (Jackie was 13, Patrick was 5 & Hannah was 3) when she had a seizure & people were freaking out. but my two youngest children were going through her pockets looking for extra tokens & tickets. they were not traumatized at all. LOL!
regarding the way you relate to & care for patients i didn't know there were still people like you in the world. warms my heart. i had a doc years ago that saved my life simply by caring enough to listen & let me cry. my life was in shambles - divorce/terrible job/financial difficulties/raising a child alone/no family support. It felt like I was dying from stress & a broken heart. i had an episode of tachycardia very scary. the drs from ER had put me on a lot of heart medicine which i didn't really need. the side effects were terrible so one day while at work i flushed them down the toilet. i became very sick after that from withdrawal. i ended up at this new doctor's office in arlington texas. he sat me down, looked me in the eyes & asked what was going on in my life. i sobbed & gave him a summary. he helped me get off the meds a little at a time & my life was getting back on track again. i was so greatful. then one day not long after that i read in the paper that he had died after a heart transplant. i was devastated. Up until that point in my life he was the only person that had ever cared enough to look me in the eye & ask what was wrong. Although I never had much in the way of family relationships, it felt like I had lost a family member. I’m sure the doctor never knew how he affected my life & I guess it would not have ever been appropriate to have told him so. Anyway, it was a terrible loss but I consider myself bery blessed to have crossed his path if only for a brief time. i'm sure there are patients out there who feel the same way about you. so hang in there & know that you are loved. Hugs to you! :0)
mckeeckm
Thank you for posting this Dr. Orange. This story made me cry. I am an RN diagnosed with MS since '04. I had steroid induced psychosis from my first round of Medrol. I developed horrible spasms (dystonia) from the stress and central brain lesions. After being taken to the ED, I was completely delusional. But I remember the pain, the fear and the nurses saying, "She's trying to fake seizures." Later, when I was taken to a room, I had spasms of the neck and throat. As I was gasping for breath, I remember thinking, "I am going to die, and no one is going to help me." Thank goodness I had enough wits to place myself in a recovery position.
This went on for 3 days until I finally found an understanding psych nurse who helped me.
Your work is so important, as is the work of all medical professionals. We must never forget that the patient has a right to be treated objectively, with no assumptions--ever.
Thank you so much for your dedication.
((((HUGS))))
Wanda
wandaK