Wayne
@Toaster_Pastry
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Cardiologist. Cardiac electrophysiologist. Fountain pen enthusiast. Former body man at Buddy's Texaco.
La Jolla
Joined June 2009
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I attended a Zoom meeting of doctors who, as a subculture, is not used to technology (we are the "Reply All" crowd), nor understands the "MUTE" function. Some guy in the middle of the meeting says, "This guy's a fucking idiot." And that ended the meeting.
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These little red spots on the fingers are Janeway lesions, which are septic emboli associated with endocarditis. All my life I have waited to see these, and now here they are.
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I'm not saying Cardiac Electrophysiology is the superior medical field. But as a bunch of techno-geeks we can identify the MUTE button during on-line conferencing.
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Best part. There are like 160 doctors in this meeting. After the meeting ended, the guy who ran the meeting immediately calls me, and asks me if I was the one that made the comment.
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Patient woke up in the middle of the night checked her Apple Watch her heart rate was under 40 bpm for 10 minutes. She called her primary physician who told her to come to the emergency department. These are the case studies that never make it to NEJM.
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Well, this tweet went viral. Instead of taking the cash prize in a lump sum, I would prefer my winnings to be issued in monthly installments. Thank you.
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I made a very strong martini, and toasted my dad. He died today after 97 wonderful years.
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Wearing one of these is like driving a Mercedes. You’ll never go back.
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Let me add that Dr. Jeff Barke is a family practice concierge physician who is wearing scrubs like he just came off duty, but has never seen the inside of a hospital in the last 10 years.
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I got a call for ventricular tachycardia. She needs dialysis, not a defibrillator.
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There is concern about a malfunctioning pacemaker, but evaluation of chest X-ray reveals that the patient does not have a pacemaker.
— hospital chart note
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97-year-old doctor:
I remember when we first used penicillin. It was September 1944. I remember treating an Austrailian boy with septic peritonitis following a ruptured appendix. He had a fever of 107º We gave him 20,000 U Pen 4 x per day. His fever broke, and he was cured.
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My dictation translated, “Give him metoprolol please,” to “give him Taco Bell please.” This is how critical medication errors happen.
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My dad designed a lot of buildings. But this was his masterpiece. Never once did he argue with the client. Costs were never cut. He built this house in South Dakota for his family. It’s going up for sale soon.
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Now that the coronavirus is over, I'm starting to see a lot of it in the hospital.
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Yes, I'm a doctor, and I've been hoarding masks. I have two. I reuse them and then leave them on the dashboard of my car to bake in the sun.
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I see physicians working well into their 80s and even 90s, and I wonder what the hell is the point. What are they trying to prove? My goal is to comfortably retire, read every book ever written, and travel every place on the planet.
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You know whom I see still wearing masks in the hospital? Infectious Disease doctors.
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Patient: I see you are using a fountain pen.
Me: Yes. This one is from 1938. I collect them.
Patient: I'm so glad I met you. My husband's father had a Waterman's silver pen from 1920. My children don't want it. I would like you to have it.
Me: 💥
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This is not Zillow Gone Wild. This is my parents’ home. This is the home I grew up in. It saddens me to the core to let it go to sale.
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I've been asked to clear a patient for cervical spine injection, holding Xarelto for 7 days. I responded, "3 days should be fine." They responded, "our protocol is 7 days, please clear." I responded, "the half life of the drug is 13 hours."
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Woman is upset because she has been waiting in the ER for an hour. She is obviously new to the ER experience.
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A woman thanked me for putting in her defibrillator (I did a damn good job). But thank the unnamed bystanders who did CPR, the person who found the AED, the medics, ER MDs, and the nurses who came before me. She’s going back to work on Monday.
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Everyone seems to a new expert on ventilators. While they're "simple" machines (they're not), the human body is complicated. I haven't touched a ventilator control in 10 years for fear a respiratory therapist will cut off my hand.
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Google knows me. Amazon knows me. So does the CIA, FBI and NSA. But my doctor can't get medical records from the other hospital to treat me.
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102 year old patient was pleased to learn that the battery life on her new pacemaker is 15.3 years.
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I'm a cardiologist who deals with cardiac arrhythmias. I'll weigh on
#DamarHamlin
and the cause of his cardiac arrest. The truth is no one knows. Into the vacuum of unknown "experts" like to plant their agenda. 1/5
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Patient: I have POTS
Doctor: You don't have POTS
Patient: I have POTS and I want to do a tilt table test.
Post tilt table test
Doctor: You don't have POTS
Patient: I have a mild case of POTS
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Several months ago I told the story of an old man who didn't want to go to the hospital because he was worried about his cat. Everything turned out okay. But his condition grew worse, and he elected hospice. Today he passed. His hospice nurse adopted his cat.
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I call this a COW (computer on wheels). But they want me to call it a WOW (workstation on wheels) because, you know, Liberals.
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Patient: My chiropractor wants me to take these supplements. Are these okay with you?
Me: Does the chiropractor by chance sell these supplements out of his office?
Patient: Yes. Why do you ask?
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I am seeing more and more patients with COVID. I don’t feel like a hero. I don’t feel like I’m on the front lines. I feel bitter and sad.
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I almost put a pacemaker in a 32-year-old woman, until I realized she’s a regular marijuana user. I don’t want to cast moral judgment. But people need to be aware there are consequences on using an untested substance.
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Much like the Bible, those who quote HIPAA regulations have failed to read it.
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In medical school I met a 12-year-old girl that was impregnated by her step father. Don't ask me where I stand on Alabama's abortion law.
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I almost broke my own rule today. An old guy came in without an appointment, hadn't seen him in a year. Almost told him to go home and come back. Turns out, he had a massive pleural effusion (O2 sats 80%) that I picked up by pectoriloquy and egophony.
@DGlaucomflecken
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A well-meaning hospice physician discontinued all of my patient's heart failure medications (my patient is dying of cancer), and now she struggles with breathing at rest. Dyspnea is worse than pain.
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There's a physician, now a patient, in the ICU. He just retired. It made me wonder whether it is better to work long hours, and then retire; or enjoy life day by day because you don't know what the future holds.
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50 years ago, cardiologists were like magicians, diagnosing any cardiac condition by stethoscope and ECG. The old arts are now passe, thanks to malpractice attorneys and better diagnostic equipment.
Proctor Harvey diagnosing hypertrophic cardiomyopathy by "squatting maneuver."
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I'm holding the first the first external, battery-operated, transistorized, wearable artificial pacemaker, made by Earl Bakken's newly formed company, called Medtronic.
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Telephone message from a patient. It's a Holter monitor, not a drug deal.
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“If a person burns their hand on the stove, we tell that person to be more careful. But if everyone burns their hand on the stove, then they’d redesign the stove.”
My statement telling lT they need to re-design Epic rather than telling doctors to conform to bad software.
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As the man was being intubated, he begged doctors to not give him the vaccine while he was on the ventilator. He died with his wishes honored.
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I had to do my first peer to peer authorization from the insurance company prior to an atrial fibrillation ablation. I’m sorry, but a retired orthopedic surgeon going down a checklist of indications is not my peer.
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What happened to all the hospital administrators who in the early days of the COVID19 pandemic harassed doctors and nurses for choosing to wear masks?
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While I was in the ER, a young child had been pronounced dead, a drowning victim. Her mother cried hysterically. The person in the next stall told her to quiet down.
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"It's a little pink pill."
*Doctor quietly pulls out Field Guide To Pills, turns to the pink section*
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Overheard: A 104-year-old man on his deathbed was asked how many children he had.
"I have three, so far."
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I've been selected as a Top Doctor in San Diego County. Do I think it's a big scam? Of course. Am I going to hang my framed award in the office? Damn right.
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I told an old man who's having chest pain he needed to go to the hospital. He lives alone, and he's worried about his cat. I'm tempted to drive up there and take care of the cat myself.
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I got a man off dialysis by placing a biventricular pacemaker, and I’ve been chasing that high ever since.
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Well, my patient officially fired me. I’ve known her for 10 years. Gave her perfect advice. But her Apple Watch (53 bpm on Amio + Coreg) said she needed a pacemaker. I wanted to wait to let the medicines wear off and continue to watch telemetry. Bad advice, apparently.
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I was called to consult on a patient with ventricular tachycardia, persisting for several minutes; patient without symptoms. Cardiac rhythm has a natural order and organization. This is not "ventricular tachycardia." Put the Amiodarone drip away.
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We've known each other for 34 years, married 29 years ago today. Can't think of anyone with whom I'd rather spend a pandemic.
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"Costochondritis" is a big word meaning "we don't think your chest pain is a heart attack but we want to use a big doctor word to impress you."
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One of my patients is an 84 year old woman. While I was doing the telemedicine appointment, I let her talk and talk. She had a lot of things to say, and she sounded like she needed someone to talk with.
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Here is what I have learned during this pandemic: Many people are not aware that air goes in and out of their nose.
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I met a 93-year-old woman here in the hospital. She was born in Paris. She was a ballet dancer. She moved to California and lived in San Francisco (Nob Hill). She married a Danish architect, and had the most perfect 20th century life. We’ve fallen in love, and plan to marry.
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As you’re driving through California on Highway 101, pull off at Nipomo and visit (the unmarked) site of the greatest American photograph ever recorded (“Migrant Mother,” March 1936).
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Blood supply of the cardiac conduction system. Image source Clinical Cardiovascular Physiology April, 1976
by Herbert J. Levine
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Someone said that physicians were in collusion with Big Pharma because we supported the vaccine. Actually, I got tired of going to work thinking I might die.
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I wish diltiazem fixed atrial fibrillation as well as everyone thinks it does.
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A colleague developed atrial fibrillation with rapid ventricular response, ran over to the ER, got shocked, came back to the office and saw patients pretending like nothing ever happened. But that stuff gets into your head.
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People have asked me what kind of doctor they should be. If you enjoy methodically solving problems one at a time, don’t go into Emergency Medicine.
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Ways to make a hospital better for patients:
1) Get rid of the 5 a.m. lab draws. It's part of the academic "rounding" culture from the Osler days. We don't need it.
2) Frequent checks during waking hours. Sleep hygiene during hours of sleep.
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Any food dropped onto the floor of a hospital ER violates the 5-second rule even before it lands.
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Participants on America’s Next Top Model get more regular COVID-19 testing than doctors and nurses who work directly with COVID-19 patients.
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My 96-year-old father is in the hospital. I've been preparing for this moment for 10 years, but now I'm paralyzed by indecision.
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They cleared out the hospital gift shop to make it a possible unit.
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Hospitals will need to expand their capacity for the new influx of patients. May I suggest administrative offices and conference rooms? I understand it's a sacrifice. But I think we'll be okay without them.
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The man with lung cancer thanked me for talking to him because no one—not the oncologist, the palliative care physician, or the hospitalist—told him what it was like to die, and he was scared.
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When a 95-year-old man talks to you about The War, you put the computer down and listen.
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Once I finally unpacked this ECG, it’s probably one of the coolest arrhythmias I have ever witnessed. But it took 4-1/2 hours to figure it out.
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Tonight’s call. A guy with history of syncope passes out at the kitchen table while wearing a monitor. Can you guess why?
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Epic help desk just called me moments ago because I had trouble ordering a platelet transfusion.
That issue was months ago. Either I figured it out, or the patient is dead.
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I've come to appreciate the spouse showing up for clinic visits to set the record straight.
"I was a little short of breath walking up the hill."
"Short of breath? You were collapsed on the sidewalk."
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A 20 year old male in good health has a cardiac arrest in the field. Ventricular fibrillation, CPR and defib to sinus rhythm. Full recovery. CT coronary angiogram, cardiac MRI, EP study, and genetic screening ALL NORMAL. Why did he have a cardiac arrest? I seriously don't know.
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I came across a doctor, whom I saw less than a year ago. Instead of walking in, he was in a power wheelchair, diagnosed with ALS. Even though I knew, I was stunned. Human life is so transient, make the most of it.
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It's my father's 96th birthday. He and my mother are going out for fish tacos at Red Lobster because that's what you do when you're 96.
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While we’re defunding the police, let’s also “defund” healthcare. Let’s redirect money from insurance carriers to the people who actually deliver healthcare.
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Seeing a 95 year old woman in the office, who sat silently in her wheelchair, didn't smile, didn't engage, didn't speak. Just then I fell off the back of the stool and landed on the floor with a crash. I looked over at her and there was tiny smile on her face.
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It's almost come to the point where I'm more comfortable with COVID-19 going into the hospital, than I am going to the supermarket.
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I’m outside a man’s hospital room. He had chest pain. He’s been unable to afford his diabetic meds. His wife, also hospitalized, has advanced Huntington’s chorea. His daughter has cognitive issues. They all live in a car. I’m not making this up. Merry Christmas.
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Consultation for atrial fibrillation. Patient states that he acquired this condition after two people who had been vaccinated coughed spike proteins onto him. I wish I was making this up.
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Don't let this happen to you.
If you are performing an external defibrillator shock (for atrial fibrillation), always remember that the defibrillator returns to a non-synchronized setting after a failed shock.
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Also, does the benefit and long efficacy of steroidal injection into the cervical spine warrant the overall risk of stopping anticoagulation for 7 days? Sorry, I can't let this go.
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Man shows up to the ER in an Uber with right sided weakness, and an inability to express words, so he can't tell triage his problem. Someone says, "I think he may be having a stroke." The woman at triage immediately asks, "Do you have your insurance card?"
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If a lawyer calls me because he has a question about his heart, and he wants me to call him back immediately, am I allowed to charge him $438 per hour for the call?
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Patient had a cardiac arrest, resuscitated in the field, intubated, then extubated. He then expressed interest in going home as soon as possible. I said, “Sir, you nearly died. Do you have somewhere important to be?” I’m an old doctor now, and I don’t care.
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