Not exactly the hub of health and wellness makes Las Vegas a great place to practice Emergency Medicine. For those who actually still point and click this site sorry for the 1 yr delay, but I have been... uh, busy with match, then other rotations, then moving, then the actual set up post move and finally residency. As you can imagine, it has been busy. My first month was orientation followed by a couple of weeks in the ED. The second month was CCU which gave me a total of 4 days off and several 30 hr shifts. This month I am back in the ED and doing shift work, which is much nicer than living at the hospital for the month. Anyway, I will try again to drop some more info on this site to keep folks up to date. best regards, Troy

I worked the Basha High School Football game last night, as the team doctor. This went off without incident until late in the second quarter when Mr. S got hit high and hard. The trainer helped him to the sidelines and promptly sat him down. Mr. S was exhibiting classic signs of a Grade 1 concussion (dizziness, ringing in ears, confused facial expression, headache, and some slowed thought processing) After about 5 minutes of monitoring by the trainer I asked Mr. S if his left arm always shook. He said "No, I don't know why its shaking." Next question, "Do you have any pain anywhere? Reply "Yes, in my neck, I can't move my head it hurts too much."

At this point I needed to check my own blood pressure but moved around behind him and began palpating his C-spine. What started as a mild concussion was rapidly turning into a major trauma as Mr. S reported exquisite midline neck pain from the base of the skull to the top of his thoracic spine. Quickly I moved to assess sensory and motor function of the extremities, which were good, but complicated by the new finding of tingling in his left arm.

Of course the pucker factor is now at maximum strength as I am trying to figure out what to do next. Obviously Mr. S needs an xray, but how alarmed should I be, I mean the kid walked off the field? I jog over to the firemen standing at the end of the field and ask if any are paramedics, which I think they confused with EMT, but no matter, I got one of them to come over and look at the kid and concur that he needs to be moved to a more secure setting like, oh Maricopa county's level 1 trauma center.

Within the next 15 minutes he is on a back board and being moved to an adjacent parking lot, placed on a helicopter and flown to Maricopa Co. I barely have time to talk to the now worried sick parents and tried my best to reassure them that this was predominantly a precautionary measure. The unfortunate reality was that their son was leaving on a helicopter, not in their car, and would not be celebrating the win with his friends tonight. Instead he would be spending the night having men and women hover over him assessing whether or not he is safe to send home or needs more attention.

I cannot begin to imagine how most parents must feel when all this happens so so quickly. It just leaves me feeling kinda sick knowing that they are so worried and there is just nothing that we can do until the "test" results get back. I guess this is part of the profession that requires the most compassion and empathy in relating to our fellow humans.

I checked in by phone today. The family was still at the hospital awaiting results from the MRI. Their son was doing fine and was ready to go home by midnight last night, but the hospital was not yet convinced. While I as happy that he was safe I couldn't help but feel guilty that I didn't actually go to the hospital to check up on them in person. I guess I am beginning to understand what it really means to be a doctor.

I have heard it said that being a doctor is not who we are but what we do, I would disagree. Anytime a person invests the kind of time into learning something to the level that a physician does, that thing becomes part of the person. Being a compassionate, empathetic health care provider does not end when the game is over or the shift is done. It is something that you go to sleep with and wake up with each day. I like to believe that it is the skin that surrounds us and the light that guides us.

So this one isn't quite a notable clinic inspired story, but it does have potential. I was reading a post on another blog and there was reference to eating food items that are past expiration dates or perhaps a little moldy (cheese for instance). This brought to mind an issue that is ongoing between my girlfriend and me regarding the fate of leftovers and expiration dates. She happens to be an orthodox follower of the expiration date. It doesn't matter if the milk doesn't smell bad... the expiration date says its bad. If the left overs have been in there for more than three days forget it.

I, on the other hand, happen to be more pragmatic about such things. If it passes the sniff test taste it, if it doesn't taste bad it isn't, middle finger to the expiration date. Its a calculated risk. I took microbiology so I understand that preformed toxins don't necessarily smell, yada-yada, and there are lots of bugs out there ready to do me in. I am not, however, going to let that risk come between me and chicken cordon bleu that has been in the fridge for five days (okay unlikely that it would not be eaten the next day).

This brings me to another point, reheating. If the said food stuff can be reheated in the microwave, so much the better. To my way of thinking, the microwave is going to kill off a good portion of those pesky bacteria anyway. (note that the views stated here are soley that of the author, and as such the author takes no responsibility whatsoever for your food illness. Further more it is his express recommendation that the reader follow the guidelines established by the FDA on food storage and consumption.) I would also note that if you happen to be in the Geology Dept. at WWU, please leave leftovers in the fridge and let Hiram decide if they are good or not.

Alright, so as a health care provider I am obligated to inform patients about the risks associated with smoking and tobacco. I am a non-smoker so one would think that the idea and sales pitch would be easy. However, I find myself torn between upholding an individuals rights and freedoms and attempting to influence behaviors that are not considered healthy. Everything in moderation is a nice idealistic mantra, but unfortunately once we get started down a certain path it is not always easy to maintain that moderation. To this end I encourage cutting back more often than quiting. I try to add good behaviors rather than simply attempt to subtract bad ones. Curious to know if the world-at-large has any thoughts on this subject? Should I be more forceful in my approach or stick with moderation?

And so never thinking much past medical school I am confronted with the big question: What kind of doctor do I want to be? My smart-assed answer up to this point has been "A good one," but that is just not enough of a focus. That being said, I am open to ideas, but need some good pros & cons to sort it all out. Let me know what you think of the various specialties and generalist perspectives and how they fit into the community at large.