Tuesday, January 11, 2005

Grand Rounds: Welcome to Scut Hall

The electricity was in the air and the Mad House was buzzing. Even the *Commish and the *Giants were ecstatic, excited at the thought of the greatest minds coming to lecture at this most prestigious of medical places. Being Residents, we knew that our pagers would never allow us a moment of calm and so we devised a plan to avoid interruption during this grandest of all medical events.

And so it was that on Tuesday, the eleventh of January, that all the stretchers were collected and burned, the elevator was suddenly made to “malfunction”, and we bought the Patient Transport Department lunch, a little benefit for conveniently disappearing this fine Tuesday morning. For the few hours we needed, patients would remain where they rested and no new admissions would make it to the floor. Our pagers were to remain peaceful until the day’s end.

As the Bloggers entered Scut hall a hush filled the air and anticipation descended upon the Housestaff. As the *Commish made his way to the podium to anounce the commencement of these Grand Rounds it became clear that this was no ordinary day. And as the gavel pounded our eyes lit with anticipation, the Grand Rounds were officially in session.

First to approach the podium was the Cheerful Oncologist. He discussed a gut wrenching dilemma of foregoing surgery for quality of life at the expense of cancer growth and ultimate death. Our Surgery Attending, Respectful Insolence, empathized with this Oncologist and reminded the audience of how Surgeons often face this same dilemma and how multiple factors must always be taken into account. Ultimately, he stressed, everyone deserves at least one chance. After his speech the Surgeons and Oncologists exchanged glances in what can only be described as gleams of admiration.

Last month’s Atul Gawande article in the New Yorker has been a hot topic of conversation in the Mad House and the surrounding Blogosphere. The Surgeons admire this hero, as he is one of their own. So when Joan from Oasis of Insanity called the article Irresponsible it got quite a negative reaction from the surgical housestaff and they threatened to boycott the Rounds. Jim Hu from Blogs for Industry quickly negotiated calm by softening the accusation and pondering if the article should have been written differently?

On a more serious note, Dr. Jim Baker from Mental Notes, commented on the new perspective of American Psychiatry gleaned from post-Tsunami Sri Lanka, including unbearable living conditions. After his commentary the crowd stood in silence for one minute as we honored the tremendous loss of life incurred in this great tragedy. The Madman would like to thank everyone in the blogosphere who took it upon themselves to help with this catastrophe, by contributing and by linking to other organizations attempting to aid the suffering. Special hat tip goes out to Shrinkette for being at the forefront of directing our readers to the proper destinations.

Dr Tsai, from Morning Retort, reminded the Interns that tragedies also exist at home and discusses the case of life on a plantation with an example of children who leave traits to be desired.

Quickly sensing that the mood was becoming gloomy in the great hall, St. Nate rose to the occasion and delivered a speech about alcohol, our favorite beverage. How interesting that Journalists and Physicians have something in common, a love for the bottle. Our cravings were calling and my *Sub-I began to salivate. We knew there would be mischief in the call room tonight and many drunken housestaff officers.

On the other hand, we immediately envisioned how alcohol and violence often unite and lead to the unfortunate cases we see in our ER. That’s when Diana, from The Write Wing, was heard ranting in the corner about the new ACLS guidelines for rape victims. She was livid about the fact that there’s no mention of emergency contraception?

As the audience was getting restless calming Diana, Dr. Charles began a heated debate with the lawyers in the back row. He Included a compendium of facts released by the AMA about the current malpractice crisis. Then, a war of words broke out in the comment section. Suddenly, Grunt Doc and Bard Barker jumped in with some words of their own about the Bush medical liability plan and before we knew it we were holding the surgeon back. Dr. Henochowicz, from Medviews, quickly calmed the enraged physician by reminding him that liability law suits have never been proven to reduce medical errors and that what is really needed is changes in the system.

The curious character arguing the Attorneys standpoint held his own and wasn't even slightly intimidated. As the room became more hostile he stormed out of the room exclaiming “I will get my own Blog and then we’ll see”. The argument was brilliant, punching and counter-punching on different Urls which collided somewhere along these electric synapses. It was war, dare I say, keyboard to keyboard ‘Blogo e Blogo’ combat. (We still love you JD, even though you’re on the wrong side of the fence).

Next, Cathleen from the Philippines requested permission to speak. She discussed how her government is finally acknowledging the meningococcemia outbreak and also expressed her frustration of being unable to help. Emer, from Parallel Universe, pointed out that it’s no surprise she is confused and afraid as the local health officials are putting out inconsistent statements. We calmed the young student of medical magic and reminded her that she will have her chance to save life when she is finally ready. To pick up her spirits, Geena, one of our own CCU nurses quickly added a story of a nurse who left the profession because of all the red tape and how after all the forms and signatures we are still living the dream.

Interested Participant interjected to explain that medicine in the US is unlike medicine in any other country. He added; just imagine if you lived in England where hospitals are actually asking people to stay away!

On a more scientific note, Journal Club approached the podium and discussed this week’s New England of Medicine articles correlating CRP levels and cardiovascular events. Then, a chant of “Vioxx..Vioxx..Vioxx” filled the auditorium. Risk management, fearing legal repercussions, sprang into action to quiet the crowd.

We asked, how can lower CRP levels be beneficial for heart disease when the best medications for lowering CRP are COX-2 inhibitors? Haven’t they been proven to increase the risk of heart disease?

Robert Centor calmed the outrage by postulating that cardiac inflammation is probably different from inflammation elsewhere but Jonathen Wilde, from Catallarchy, riled the crowd again, reminding us that every person has the right to decide what chemicals he/she wishes to put in their body? And what exactly is an "unsafe" drug anyway?

Grabbing the cue on drug development, Issemelweis from our Pharmacy, pondered who is truly navigating the ship when it comes to the development of medication? Is it the Insurers or the consumers?

Obviously, this was a deep question and easily left the surgical side of the auditorium looking very perplexed. Medications?...Hah? Blogborygmi quickly recaptured their short attention span by describing his experience with Ultrasound use in unexpected places. And no, he doesn't have Tourette's.

Kevin M.D then presented a case report on a very interesting patient with some tingling in his fingers and a fascinating new rash. We wondered if some Vioxx might help?

To close out the day’s events, Respectful insolence regained the podium to deliver his best Jeff Foxworthy you just might be an altie if imitation that left the audience in stitches.

Our great day was over and the audience left the great hall of Scut in high spirits.

The *Interns and *Residents of the Medical Mad House would like to thank Jacob Reider for Medlogs and thanks for sticking us on the students page where no one ever goes, yeah Jacob, thanks. (Just kidding)

Next week’s Grand Rounds will be hosted by Waking Up Costs. Thanks to Nick from Blogborygmi for arranging this whole event. E-mail Nick if you would like to host.

About the Chronicles: This blog is my escape and a way of expressing myself, my reality and ,sometimes, my imagination.

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