Posts by Brett Hendel-Paterson

Pulling the Welcome Mat Out from Under Our Colleagues

We sat in the living room at a colleague’s home, drinking beer, wine or sparkling water, eating desserts, and talking. Talk started with residents comparing notes about clinical sites or rotations, worries about being prepared for boards, congratulations on fellowship matches, and discussions about trying to decide what to do post-residency. “How are you doing?” my colleague and assistant residency program director asked the group. Silence followed. One person spoke up. “I’m worried about what will happen with my fellowship. I’m still talking with my lawyer.” This was not a question of where he would match, how his clinical skills would be stretched, or adapting to a new location. This was about his immigration status. We met two weeks after the president’s executive order on immigration, and he was worried if he would be able to continue to work under his current visa, being from one of the seven countries…

Finding Hope When There Is None

Young and in pain, she came to us from another country for a repair of a fracture. It wasn’t repaired at home because of the complexity of the fracture. There was some question that it may be a pathologic fracture due to a cancer, but nothing definitive. There were two biopsies in-country. One that was equivocal, one that said it was “consistent with” cancer. Our charge was to fix her fracture and diagnose her cancer. I was to medically optimize her for surgery. She did not believe the doctors in her home country who told her she had cancer. From our first meeting it was apparent she probably wasn’t a surgical candidate. Her thin frame had already shed nearly half of her weight, causing her skin to be stretched thin over her bones. The albumin level in the blood (a marker of nutrition) was half of what it should be,…

Maintaining Balance

I’m not much for New Year’s resolutions. They seem to be too easy to break and lead to disappointment. But my birthday and New Year’s are close together, and they do provide convenient markers to reflect on life, health, and balance. Every day I round in the hospital I find myself discussing healthy lifestyle habits with my patients. Take time to exercise. Eat healthier and eat fewer processed foods. Drink more water. Cut back on the caffeine, alcohol, and soda. Try to control portion size on your plate.   Slow down. Reduce stress. Do as I say, not as I do. When working on the wards, nearly every one of these recommendations go out the window.   Busy days go like this: I get to the hospital too early to do a morning work-out (at least, I don’t pull myself out of bed early enough). Once I’m off and running, I have…

The Pendulum

People ask me periodically how I am doing with my Chronic Lymphocytic Leukemia (CLL). Sometimes the question is easy and quick (last hemoglobin was 14.6, WBC 5.8, Platelets 124). Sometimes I am asked how I am balancing work, family, health/illness, etc. This one is harder. People seem to be looking for words of wisdom. I will tell anyone from the outset that I do not feel particularly wise. I would like to say I have a steady and consistent approach leading to some perfect harmony and balance. That would be untrue. I think the best way to describe our (my family’s and my) approach to CLL is a pendulum. There are times when the CLL is all-consuming due to some sort of flare. Other times it fades into the background and we largely ignore it. Even my monthly infusions, which are a consistent reminder of the CLL, lend themselves to…

What do we do when we can do better?

As hospitalists, we talk a lot about improving quality and patient experience. These are two things that are considered points of emphasis for us. Maybe even points of pride when we point out successes. Unfortunately, sometimes we are just not at our best. Sometimes we are not as connected with our patients as we should be, or we make mistakes. I had one of those weeks my last week on service. “Jay” (not his real name) was my last admission of a very long day. It was late enough that I could have turfed him to my night colleague, but I thought I would just quickly knock this one out. I had taken the triage call from clinic – a previously healthy 36 year-old with progressive shortness of breath. A CT scan done by his primary physician showed multiple bilateral pulmonary emboli. No past medical history, no prior medications and…