Monthly Archives: April 2010

Underground lair

I just found out about a network of underground tunnels that connects the various buildings on the Medical Center campus to one another.

The pager had been quite all night. In order to break the monotony and do something good for my body, I decided to walk over to the Dark Tower section of the hospital. While most of our hospital is a sprawling mass of mismatched construction projects, each one successively glued to the previous one over the decades, the Dark Tower is the oldest and tallest part of the hospital standing at 17 stories. The seventeenth story of the Tower consists of offices and the two floors below that are filled with ICU and CCU beds. But, the family medicine service does occasionally have a patient on the fourteenth floor - DT 14, we call it. Whenever Dr. Hertz is on service, he insists on making the entire team climb the stairs up to the fourteenth floor. Then we listen to the sweaty intern try and present her patient.

"Mrs. Jameson is 49 year-(gasps for air)-old female who came in with 2 days of (gasps, puts hand on counter to steady herself) fevers, cough and (takes off her white coat panting heavily)..."

So, in the absence of pages, admissions or phone triage calls, I thought I'd get some exercise by taking the stairs up to the seventeenth floor and back down a few times. Our call room is on the 3rd floor of the Enchanted Wing. I walked over to the Dark tower, made the climb from DT 3 to DT 17 and then back down past DT 3 to DT 1 and down 2 more flights to DT Ground. At DT Ground, what I thought was the lowest level of the hospital, I noticed that the stairs continued downward. In order to make my climbing as continuous and uninterrupted as possible, I'd have to start my next run from the lowest level. So, past and unlocked wrought iron gate, I continued my descent. The stairwell had become noticeably cooler and the steps led me to a stone archway flanked by gargoyles holding torches. I couldn't see anything past the 2 gargoyles at the gate, only blackness. But, deep within the blackness I could hear what sounded like the heavy breathing and snorting of an animal. Then, a louder snort and the distinct clanking of chains being dragged along the ground. I listened at the blackness for 60 seconds as the clanking and snorting slowly but perceptibly increased in volume.

I took the stairs back up to DT 3, forgoing the remainder of my workout, and then made the walk back to the call room in the Enchanted Wing. I'm not exactly sure what I discovered down there. If tomorrow night is equally quiet, I may investigate further.

Vaccines

I'm so disappointed in Frontline. I think this episode represents a deviation from their usually excellent reporting. The episode is entitled The Vaccine War. While they do come out on the side of vaccines being safe, it irritates me that they present the issue as if there are 2 sides to it. This is the the danger of reporting on issues where nut jobs like Jenny McCarthy have a substantial voice. Just because a particular group speaks loudly about an issue doesn't mean that their position has any merit. I think Frontline would've done better to have left this one alone.

For christ's sake, people, just vaccinate your kids. There are way more important things to burn calories worrying about than the theoretical risks of vaccines. On the flip side, these parents do have a point. We haven't seen a new case of polio in this country since the 1970's. So, chill out, medical profession. If some parents don't want to vaccinate their kids, we have more important things to worry about as well.

Empiric therapy

In medicine, we have so few tools at our disposal which, just simply, work. More often, any new medical therapy or intervention requires a panel of experts to debate each other and to write long, boring papers about whether the slight improvement in mortality offered by the particular treatment outweighs the risks. This is less true of surgical and procedure-oriented medicine. Suturing, for example, just works. Suturing a wound stops the bleeding and brings the skin together. Done. Draining an abscess gets rid fo the infection. Done.

What about medical treatments? One category of medicines that fall clearly into this category are the inhaled beta-agonists (albuterol). Albuterol works. If someone is having brohchospasm and can't breathe, albuterol makes them better.

So, let's open it up for discussion. For anyone who reads this lonely blog, name one medical (not surgical) therapy which just works. Comments are open!