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Articles by Ton La
What hospice care really means to a grieving family
Before my grandfather entered hospice, I believed it was where physicians sent patients to die. I saw it as the end of treatment, a quiet admission that medicine had given up. It was only through watching my grandfather’s final years that I came to understand hospice differently: not as the abandonment of care, but as one of its most compassionate forms. A decade ago, Alzheimer’s disease slowly began taking that man away from me. At first, the changes were subtle.
Pain and laughter for a veteran patient
Mr. Sampson, a 70-year-old man with a history of diabetes, was referred to us by his primary care physician for nerve conduction studies. He had been experiencing increasing numbness in his right hand for the past year and had recently started having trouble playing his beloved guitar. As a Vietnam War veteran, he had a fascinating story to tell. As I approached him in the waiting room, he greeted me with a hint of playful sarcasm.
Unlock the secrets to aging gracefully: specialized care and support for elderly patients
She sat in the hospital bed, staring out the window as the nurse flitted in and out of the room, adjusting IV lines and checking her vitals. It had been a long time since she’d been in a hospital, but at 75 years old, her health was beginning to fail. She knew that she was considered “elderly” now, but she didn’t feel old. She still had so much life left, and she was determined to keep living it. But as she lay there, she couldn’t help but wonder: what exactly made someone “elderly”?
Unveiling the global pandemic threat: insights into risk factors and urgent measures for prevention
As the current COVID-19 pandemic continues to rage across the globe, many are left wondering when the next pandemic will occur. The reality is that pandemics are not a new phenomenon, and throughout history, we have seen numerous instances of infectious diseases causing widespread devastation. While we cannot predict with certainty when the next pandemic will occur, there are certain circumstances under which they are more likely to occur.
The meaning of death in medicine: the role of compassionate care in end-of-life patient care
Death is an inevitable part of life, and in medicine, it is a topic that is frequently encountered. As medical professionals, we see patients who are faced with terminal illnesses and inevitably nearing the end of their lives. Dealing with death can be a daunting task, and it’s a topic that requires sensitivity, empathy, and compassion. At the forefront of end-of-life care are the principles of compassionate care.
Reflections on 500 patients, unique cases, and making a difference in health care
As I reflect on my first year of residency, it’s hard to believe that I’ve cared for nearly 500 patients spanning across multiple departments; floor medicine, ICU, ER, neurology, cardiology, and surgery. I’ve had the opportunity to perform one central line placement, three intubations, ran a code blue, and performed CPR in both the ICU and the ER.
A glimpse into the fragile balance of life and death in the ICU
It was a calm and quiet night in the ICU during my rotation when suddenly, the piercing sound of a code blue alarm filled the air. An elderly female patient, 66 years old, had come in earlier with lung clots due to ovarian cancer. She was on the other side of the hospital, and as part of the ICU team, I was tasked along with my attending to immediately go see the patient that was suffering from a heart attack.
a doctor's appreciation for therapists
As a doctor who has cared for countless critically ill patients, I cannot stress enough how important therapists are for patient recovery. Whether it’s occupational, physical, or speech therapists, these health care professionals play an integral role in helping patients regain their abilities and quality of life after an illness or injury. In my experience, occupational therapists are especially crucial for patients who have experienced loss of motor function from a stroke, for example.
Against all odds: 17-month-old defies death and improves neurologically after craniospinal irradiation
Three months ago, a case was discussed in the multidisciplinary tumor board. A 17-month-old child was admitted through the ER with a posterior fossa tumor (brain tumor) and multi-level spinal cord compression due to tumor deposits. The tumor was so extensive that only a biopsy could be performed rather than maximum safe resection.
Surviving monkeypox: a story of compassionate care and an emerging disease outbreak
Mr. Sanchez had been feeling unwell for days before he decided to visit the emergency room. When I walked into his room, I immediately noticed that he was scared and anxious. His sore throat had been persistent for five days and was now so severe that he couldn’t eat or drink anything. He had also developed a rash covering his entire body, which was only getting worse. The lymph nodes in his neck were painful, and he was visibly uncomfortable.
A glimmer of hope for a child with suicidal ideations
Eleven-year-old Abby sat nervously in the emergency department, her eyes darting around the room as she clutched Patches, her beloved stuffed sheep. Her guardian sat beside her, anxiety etched on her face as she explained the situation to me. Abby had been diagnosed with depression at the tender age of nine after suffering years of abuse and neglect at the hands of her biological parents.
A veteran's battle against possible lung cancer
During my night shift at the emergency department, I encountered a 72-year-old decorated war veteran named Mr. Sun. Accompanied by his concerned wife, he came to address a year-long struggle with fatigue and a non-productive cough he’d been experiencing in recent weeks. Initially resistant to seeking medical attention, Mr. Sun finally gave in to his wife’s insistence. As I entered the room to assess Mr. Sun, it was immediately apparent how unwell he looked.
A tale of two patients: one journey, two stories of courage
It was a busy night in the emergency department, as usual. I rushed from one patient to the next, trying to keep up with the constant stream of people coming in with various ailments and injuries. One patient, in particular, stood out to me that night. He was an older man, probably in his early 70s, who had come in complaining of severe back pain.
Unlocking the secrets to aging gracefully: How to keep your spine young
An excerpt from The Spine Encyclopedia: Everything You’ve Wanted to Know about Back and Neck Pain but Were Too Afraid to Ask. As we age, our cells become less functional, and bodily tissues lose the ability to replenish and regenerate. The spine is not excluded from this process and undergoes predictable degeneration as we age. For some, spinal degeneration turns into serious pain and disability that can end in the need for surgery.
From uncertainty to certainty: Finding the cause of seizures in a young patient
It was a Tuesday evening when I received a call from the emergency room that a young lady had been brought in after experiencing seizures. I quickly walked over to the ER, preparing myself for what was to come. As I walked through the entrance, I could see the family of the patient huddled together, whispering to each other. The patient was lying on the hospital bed with wires attached to her chest, monitoring her vitals.
The secret to staying alert during night shifts: coffee naps and more
Working night shifts in health care, particularly emergency medicine, requires maintaining alertness and focus during extended hours. I’ve experienced firsthand the challenges and risks associated with sleep deprivation, including a frightening incident when I fell asleep while driving after a long stretch of night shifts. Fortunately, nothing serious occurred, but it highlighted the importance of staying alert.
Fighting for life: inside an emergency room during a medical crisis
The emergency room was bustling with activity as the medical staff worked to stabilize the patient, who was lying unconscious on a hospital bed. His wife sat anxiously by his side, tears streaming down her face. It wasn’t the first time 70-year-old Mr. Smith had been to the emergency room. His past medical history included high blood pressure and cholesterol, but his non-compliant attitude towards medication had put him at risk.
From hope to heartbreak: a story of loss in the ICU
Ms. Laura was a vibrant and feisty lady with a personality that filled the room. She had been my patient two months ago when she was admitted for an irregular heartbeat and COPD exacerbation. She was a smoker, and despite her heart issues, she had a strong will to live. I had advised her to quit smoking, but it was a habit that was hard to break. When I saw her again in the ICU, she had to be intubated and connected to a ventilator.
My patient with an aortic dissection almost died
“I just moved here from Portland two weeks ago,” said Ms. Shelly in a weak voice. When I walked into the room, I immediately noticed her blood pressure was 224/108. The patient was mostly sleeping, but when I started speaking with her, it was apparent to me something was wrong. “Do you have a history of any heart problems?” I asked Ms. Shelly. “I had aorta surgery two times…” she murmured before falling back asleep. Aortic dissection.
The nicest patient I’ve ever met
The nicest patient I’ve ever met was Mr. Harris. I first met him in the ED with his son and daughter by his side, noticing a foley bag filled with bright red blood. He was an elderly gentleman with ALS and was brought by his children for hematuria and blood clots overnight. Never happened before, and we were all unsure of the cause. Urinalysis soon showed likely UTI, so we started antibiotics. I called urology, and his nurse initiated continuous bladder irrigation for the next three days.
Death is what gives life meaning
“He knew it was his time a month ago. We were sitting at the kitchen table, and he told me he couldn’t feel half his face. He kept tapping the left side and saying he couldn’t feel anything. I knew he had a stroke because my daughter had one. He was stubborn, didn’t want to go to the doctor.” One week ago, I saw Mr. Samson for the first time in the ED. He was a 70-year-old gentleman with end-stage renal disease and cirrhosis but came in for blood in stool for the past few days.
A friendly battle with a patient’s potassium
“By God’s grace, Dr. Sal!” “Yes, T.J.! What’s the good news?” “Guess what Mr. Thompson’s potassium is now?” “3.1 …” “Wrong! 4.1!” We high-fived each other immediately and breathed a huge sigh of relief. For six days straight, we’ve been giving Mr. T potassium through an IV and by mouth with little to no change in his potassium level. He came to the hospital after being found passed out in his home. Very low initial blood pressure, and incidentally found to have very low potassium. The culprit?
How writing a letter on Substack might recharge your life in medicine
“The good life is ever-changing, challenging, devoid of regret, intense, creative, and risky.” -Friedrich Nietzsche One year ago, bruised and battered like any physician practicing in this pandemic, I decided to double down on weariness and start writing a medical letter on Substack. I’ve been writing about once a week, with subjects ranging from the newest coronavirus variant of concern, to a reflection on the hidden strengths in frailty, to the pleasure and poison of drinking alcohol.
My patient left against medical advice
“Mr. Stenson left AMA …” “Why?” I said out loud to my attending. “He left with his IVs in …” said his nurse in disbelief. An hour earlier, before rounds, I sat down with Mr. S to talk about his anxiety attack. Ten years ago, he was shot ten times in the chest, which left him with PTSD and depression. Not long after, he started having unprovoked panic attacks. What started as once or twice a day became three to six every day over the next several years.
How every doctor should address a patient's pain
From medical school to residency, I’ve worked with colleagues who don’t prescribe pain medications for their patients who truly need them. Or they are just very hesitant about doing so. Some simply don’t believe in them. Others fear the legal implications like being named to a med mal or wrongful death lawsuit. And several avoid pain meds, specifically opioids, like the plague because of possible addiction risk even when their long-standing home med is an opioid prescribed by their PCP.
What it takes to build a pediatric weight management program
What they want is power, control, and to take all the credit. In short, they want what you have. Vision. Even more so, the ability to manifest a vison. Even more so, they want your energy. Your passion. “Candy Everybody Wants” by 10,000 Maniacs is an epic song. I know every word.
Is burnout the wrong word?
An excerpt from Determined: How Burned Out Doctors Can Thrive in a Broken Medical System. Let’s address the elephant in the room. The word “burnout” has come under fire recently (pun intended). The reason is that burnout, which was first coined by German psychologist Herbert Freudenberger in the 1970s, implies to some that the mental anguish and trauma that physicians experience is “caused by” the burned-out doctor. In other words, some feel that the term burnout blames the victim.
Less resiliency may heal burnout
The word “resiliency” has been lauded, applauded, and buzzed about in talks about physician burnout. When I hear it, I tune out. My stomach churns. I feel sick. Why? Because physicians are resilient. We are, in fact, the walking, talking, breathing personification of the word. We cannot manage to get through medical school, residency, and boards, without being resilient. And remember, we do this by choice. Lots of schooling and academic demands. Inhumane hours. Little sleep.
Doctors need to advocate more for their patients
My first patient of residency was Mr. John. He endured life-threatening injuries that left him without speech or the ability to move his limbs. Every day had obstacles, and I met most of his family over time. Mr. John was a family man who looked after others first before himself. A self-made man. He was a man who was physically strong and dedicated to every project and goal he set his mind to. Each day before I left, I held his hand and told him there was love always around him. And to keep fighting.
For medical students: 20 pearls to honor every clinical rotation
With medical school graduation on the horizon, I wanted to share my pearls for success for any clinical rotation. 1. Integrate yourself into your team and be engaged in all patient care. 2. Ask questions and be motivated to learn. 3. Follow up on patients without being asked. 4. Be the “extra” pair of hands to help the team. 5. Be proactive in picking up new patients. 6. Come up with solid differentials and plans before presenting to your attending. 7. Start every day with energy and enthusiasm. 8.
VIP medicine: Where patients get bad medical care
Let’s take a pediatrics patient as an example. She has a rare genetic disorder, heart problems, is G-tube dependent, and home-bound. The child is also on countless medications and requires 24-hour nursing. The family is rich and pays 100 percent of the child’s medical care. Parents want what’s best for their children, right? I mean, their child’s care is 100 percent private pay, so obviously, yes? Yes, but to the detriment of everyone involved.
Wear your mask to protect your family
Below is a story a patient shared with me about how he went from being against mask-wearing to wearing one every day. *** Last year, my mom died from stage 4 lung cancer. Before she passed, she received her transplant at this hospital, but it was too late for her. Now, I am fighting cancer. Lymphoma. Stage 2 verging on Stage 3. Before my diagnosis last summer, I never wore a mask. I walked around like the virus wasn’t here, and I felt free not wearing a cloth mask, N95, or what have you.
Uncertainty in medicine: the patient’s and doctor’s roles
“When will I go home?” asked the patient. “Hopefully, by the end of the week, if everything goes well,” said the doctor. “What do you mean by ‘if’?” Uncertainty. It’s the one thing that is common among all hospital patients. When is my discharge date? How is my diagnosis affected by the other things I have going on? How in the world will I pay my medical bills? Why am I taking this many medications? What do they help me exactly? When will I go back to work and do things like how I used to do them?
A COVID long-hauler shares her story
According to the WHO, 10 to 20 percent of COVID-19 patients experience lingering symptoms for several months following infection. What we know as long COVID is now termed post-COVID condition as of October 6. Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually three months from the onset of COVID-19, with symptoms that last for at least two months and cannot be explained by an alternative diagnosis.
3 ways your rehabilitation doctor advocates for you
If you’ve ever been in a serious accident or traumatic event leaving you with one or multiple injuries, you’ve probably met the rehab doctors a few times. Physical medicine and rehabilitation (PM&R, also called physiatry) is a branch of medicine geared towards helping people heal and adapt to new circumstances after their diagnosis using medications and rehab. Here, I want to share three ways a physiatrist can be your advocate after an injury. 1.
5 Questions to Ask Your Doctor at Your Next Appointment
Your doctor often only has 5 to 15 minutes to see you, and every minute counts. When your doctor asks at the end, "Do you have any questions for me?" you may feel like you shouldn't take up any additional time. However, the face time you get with your doctor is being paid for, so definitely ask any questions you may have to be clear on what's going on and next steps. Here are five questions you need to ask your doctor at your next appointment. 1.
Medicine is very much like driving. But don't be a passive driver.
Medicine is very much like driving. As an emergency physician, when you see a patient, you ask the same questions, “What brought you in today? What’s bothering you?” and go through the normal flow of the history and physical. You order the same labs and imaging reflexively. When you’re driving to a location that you’ve been to many times before, when you get into your car again and turn the ignition on, it seems like seconds later you are at your destination.
5 Ways Doctors Can Empower Patients
Visiting a doctor can be nerve-wracking for patients – which is why it's particularly important for doctors to take steps to put them at ease. Doctors, here are five ways that you can empower patients and help them become their own health advocates. Tip No. 1: Toward the end of your patient's visit, as you're summarizing what took place, ask your patient to summarize things back to you in their own words.
Tips for Dealing With Insurance Companies During a Medical Emergency and Beyond
Medical emergencies can happen at any second. It's vital to not only have health insurance, but also to have an overall understanding of how to reach out to your insurance company when issues arise. Deaths outside hospitals and emergency calls for cardiac arrests spiked in metropolitan Detroit during a COVID-19 surge last year, a new study finds.Getty Images Here are some tips on how to work with insurance companies during a medical emergency and after.
Health insurance in this country leaves a lot to be desired
I was an ICU nurse for 17 years, and it was during my last two years of my career when I was diagnosed with lung cancer. Going into and out of the hospital for my chemo sessions. Going into and out of the clinic for my follow-up appointments with my oncologist was the most harrowing times of my life. At this moment, I realized that my own health insurance refused to pay for parts of my care.
5 Tips to Advocate for Loved Ones Hospitalized During the Pandemic
With visitation restricted at most hospitals and nursing facilities due to COVID-19, progress on a loved one is often communicated via phone or video chats. This can be frustrating because you might feel like you're left in the dark and that don't know exactly what's going on. Don't worry! Here are five ways you can advocate for your family member from afar as they recover. Schedule a meeting with the administration before your loved one's admitted.
Physician suicide: We need safe spaces to talk about it
Three years ago, I met Dr. Boyce Fish*, the ER physician revived after suicide. I also met Rachel Dawson, wife of Dr. Chris Dawson who killed himself and his two children. We all sat in red ballroom chairs in a room with nothing in it, but it felt full. All the lights were dim, and I was privy to the darkest innermost thoughts a person can ever act on.
Addressing mental health needs for our frontline responders and health care providers
Coronavirus. Doctors. Nurses. PPE. Social distancing. Sound familiar? Our entire conversation about the COVID-19 pandemic surrounds those words and phrases. We see celebrities, companies, coworkers, family members, and friends donating PPE and money to organizations and local hospitals, trying to do some good. No one wants our front-line health care workers to get sick. If that happens, the public will be at even greater risk.
COVID-19? We are not even ready for a hurricane.
The hurricane made landfall during the early morning hours. When I woke up, all I saw was devastation. Highway 288 transformed into a lake. The bayou running underneath was completely flooded with water spilling into the roads. The park, a place where I find solace in every day, was unrecognizable. People had abandoned their vehicles. I could see them all submerged. The garage floor was underwater, and the roads that lead to and from my apartment were not traversable.
Practice social distancing because the lives of your health care workers matter
I was in medical school when the world saw the news of the Zika and Ebola viruses, but never have I seen mass hysteria to this level for COVID-19. No longer is coronavirus what is depicted in a copy of First Aid for the USMLE Step 1, where it says coronavirus is a cause for the common cold. Intense coverage of the virus has been sensationalized to the point where you cannot be in any public or private place without hearing “coronavirus” uttered.
The parallels between basketball and pandemic medicine
Michael Jordan. Kobe Bryant. Yao Ming. These are the biggest names in the basketball world, and all three were my superheroes growing up. Even though I’d never had the chance to meet them, to see how they carried themselves on and off the court-inspired me to push myself, to find out what my limits were physically and mentally, and to constantly create new goals for myself after accomplishing what I already set out for myself. It’s the same mindset NBA players have.
The cacophony of the COVID-19 crisis
ICE is requesting bids for 45,000 N95 masks Why is ICE soliciting for masks when our frontline health care workers need them? There is no social distancing during detention and deportation, and what ICE is doing puts the public at risk.
Why medical students shouldn't always fall in line
As I saw the fellow purposely manipulate her fractured ankle, I knew I was wrong in not stopping him. Three hours earlier, Mr. Sanchez*, a past boxer, and soccer player, came in with a broken pinky. He was moving from Atlanta to Houston, and in the process of moving boxes, a rock smashed his finger against something. Odd story, but he was the nicest patient I ever talked to up to that point. He had surgery for his fracture and was happy the entire time.
Losing a patient in an emergency
“Are you f*cking serious! What are you doing to my son! How can you have him tied to the bed like this!” Michael’s* mother was irate and yelling at my resident as I stood at the back of the room. Michael had HIV/AIDS with a CD4 count of 20 and disseminated histoplasmosis. Hours before, he had bit his mom on the hand, leaving visible bite marks. As his mom continued to scold my resident, my level of concern raised fast as I saw Michael violently pull at his wrist and ankle braces.
A medical student's advice for clinical rotations
As a rising fourth-year med student, these are my words of wisdom for all students who are on their clinical rotations. Your mental health is paramount; do not neglect how you are feeling! There is not one med student that I know of who hasn’t felt anxiety, paranoia, or depression. Some of your peers may even be diagnosed with psychiatric disorders and take medications.
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