Two weeks ago, a seven-year-old girl came into clinic to see me for a second opinion about a bump on her head. She wasn’t a patient of mine up until then, but her mother wasn’t satisfied with the answers that their primary pediatrician had been giving them, so she ended up with an appointment to see me in clinic. Unfortunately, I wasn’t scheduled to see patients that morning, so the girl ended up seeing another resident in the clinic. (To make things easier, I’ll call her “Jenny” — rest easy, though, that’s not her real name.)
The basic story was that Jenny had fallen off of her scooter last August, and that night, her mom had noticed a bump on the back of her head. She brought her into her pediatrician the next day, and after examining her, he felt that the bump was probably traumatic; he got skull X-rays, which were negative, and reassured Jenny’s mom that it was probably just swelling that would resolve over time. As standard practice, the doctor told her what she should look for if it was a fracture that had caused injury — dizziness, headaches, confusion, loss of normal sensation or movement, loss of consciousness, or anything that Jenny’s mom thought was out of the ordinary.
Over the next couple of months, the bump didn’t resolve at all, but her mom also didn’t notice any of the things that Jenny’s pediatrician had warned them about, so she didn’t worry all that much. Come last month or so, though, she began to think that it wasn’t normal for swelling from a scooter fall to last that long, so she booked the appointment to see me in clinic.
When I got to clinic that afternoon, the resident who saw Jenny filled me in on the visit. On his exam, he noted that the bump was at the back of her head, was around three or four centimeters in size, and was firm and nontender. She had no other symptoms to speak of — no neurological changes, no other bumps, no developmental changes, nothing. In this age group, the most common thing to suspect would be a dermoid cyst (a benign growth of tissue), so he had paged the dermatology resident on call and set Jenny up to see the dermatologists and get an ultrasound of the bump the next day.
Two days later, the derm resident called me to give me the details of his visit with Jenny. They had done the ultrasound, and saw a mass around six or seven centimeters in size with “cystic changes” at its core. (This just means that some of the tissue had formed walled-off areas filled with fluid; for various reasons, many masses do this when they reach a certain size.) This was consistent with the idea that the bump was caused by a dermoid cyst, but because ultrasound doesn’t do a great job penetrating very deeply (especially when there are cysts of fluid obstructing the beam), he had obtained a head CT scan.
His call to me was to tell me the reading on the head CT scan. It had shown pretty much the same thing as the ultrasound — a six or seven centimeter mass — but it also showed that the mass was inside the skull, compressing her brain. The radiologists had not been able to determine the type of mass, though (they weren’t able to tell what type of tissue it was, or where it originated), so they recommended that we get an MRI.
Now, the problem with getting an MRI is that it’s just not that easy to do at a big academic center. MRIs take a long time to do (much longer than a CT scan), and if the patient moves at all, it means that the study has to be restarted. This means that the scanners are constantly booked, and since priority is (obviously) given to patients who are currently in the hospital, getting an MRI for someone who isn’t in the hospital usually means waiting anywhere from a few weeks to a few months. I’m a persistent and ornery bastard, though, so instead of calling the scheduling desk, I called the attending radiologist directly; I managed to convince him that I needed to get this MRI sooner and he set it up for last Friday. I called Jenny’s mom and explained to her that we needed to further clarify what the bump was, and she said it wouldn’t be a problem to bring Jenny in Friday for the scan.
When I got into clinic at the start of this week, I went onto the hospital info system and checked the report on the MRI, but I wasn’t really prepared for what I read. The high resolution of the MRI allowed the neuroradiologists to clarify more about what was going on, and based on a few pretty specific findings, they predicted that the mass isn’t a dermoid cyst — instead, they read the scan as consistent with a meningioma or meningiosarcoma. Both are brain tumors, and both are very, very rare in the pediatric population; the difference between the two is that meningiomas are generally benign, and meningiosarcomas are universally aggressive and malignant. Either one of them would mean major brain surgery for Jenny, possibly followed by radiation.
I immediately paged the neurosurgeons and asked them what would be next, and they set up an appointment for Jenny to see them in their next clinic. I also called Jenny’s mom to ask her to come in, and we arranged for a visit this past Thursday… and then I realized that this would be the first time that I had told a mom that her child has cancer. That’s about when my stomach clenched up into a tight little ball, and my heart sunk into my legs. Nonetheless, I started to arrange all of the support that I’d need (my clinic attending and a social worker), making sure that at least one of them spoke fluent Spanish — Jenny’s mom is a native Spanish speaker, and I didn’t want there to be any chance of misinterpretation.
Alas, Thursday did roll around, and Jenny came in with her mom. And, since nothing that I dread ever gets easier, mom also brought in Jenny’s sister as a sick visit; I quickly examined and cleared her before asking their mother if we could go talk in private. The social worker and my attending joined us, and that’s when I had to break the news. I started by telling her that she had done the right thing by bringing Jenny in, and that we had the results from all the studies that Jenny had had done. I told her that Jenny had a mass in her head, and that from the MRI, it was likely that it was cancer — and at that point, mom lost it. The rest of the visit was alternating between consolation and answering questions, and it was probably the toughest hour of my life. At one point, the two girls came and opened the door to the room we were in, and I quickly got up to shepherd them away; as we were walking back to my exam room, Jenny asked me why her mom was crying, and I just plain didn’t answer.
The social worker spent another half-hour with Jenny’s mom, making sure that she had someone to take them home, that mom had someone to talk to (it turns out that she has a therapist), and that they had all their paperwork for their visit to the neurosurgeons. During that time, I went into my exam room and just played with the sisters, trying to block out that one of the two was about to begin one of the most trying and difficult things a person can ever go through. And once their mom was ready to go, Jenny reached up and gave me a big hug goodbye; it took absolutely everything that I had in me to not completely disassemble into a sobbing mass right there.
Two weeks ago, I learned all about the exciting side of being a pediatrician, but this week, I had to experience a little more of the depressing side — I had to tell a mom that her daughter has cancer.
I really like Sylvia’s post from April 19th. Go read it.
It’s funny — I didn’t realize how much I rely upon being able to search the Usenet archives until Google Groups took over and temporarily took most of the older posts offline. Lucky for me (and everyone else), the old posts are back; the icing on the cake is that Google’s searches occur much faster than they did under Deja’s old system. (Remember that it’s searching a database of over one terabyte of information.)
Other cool things about Google’s new interface: it redirects from old Deja.com URLs to the right article in Google’s new database, and it supports equivalents of almost all of the old Deja search language terms. Something I don’t like is that it seems that it takes much longer for articles to get into the database, but given how quickly Deja got the old databases online, I’m not too worried that this will remain a limitation for long.
Lest you think that the judges of this country are immune to the temptations of vice, Law.com has compiled a list of last year’s most injudicious wearers of the robe.
Reading the email that Gary Krakow received in response to his review of Apple’s OS X, I’m glad that I don’t write a widely-read computer opinion column. It just doesn’t seem like it would be all that satisfying to deal with that many uninformed, rabid evangelists who feel welcome to call you an asshole for writing about your experiences and beliefs.
A robotic, remotely-controllable plane completed the first unmanned crossing of the Pacific Ocean yesterday, taking off from Edwards Air Force Base in California and touching down in Adelaide, Australia. The plane is a Global Hawk reconaissance and surveillance plane, produced by Northrop Grumman and not anticipated to be in active service until around 2005; it will be participating in military exercises in Australia for the next week. This plane ain’t no tiny whirlygig, either; it’s 44 feet long, and its wingspan, at over 116 feet, is longer than that of a 737.
Once again, Dahlia weighs in from the Supreme Court, and this time, Clarence Thomas speaks!
Great headline of the day: FAA Orders Jam Nuts Inspection. I knew that the airlines were becoming more concerned with passenger comfort and safety, but I guess I didn’t realize how far they had gone…
Wow, this not-so-little bug sucks. The short form of it is that there’s a way to disguise non-text files as text files (actually, any file as another type of file) in Windows; when the user double-clicks it, it will execute as whatever real kind of file it is (e.g., a big whopping virus, or a trojan that just deletes everything on your computer, or whatever). BugNet has a self-extracting archive file that (safely) demonstrates the bug.
My cellphone company is growing and growing. Originally, I was concerned that I had chosen a company which was too small and wouldn’t be able to handle any significant growth; now I’m worried about it getting to be too big to maintain good customer service.
The Supreme Judicial Court of Massachusetts (the highest state-level court) ruled today that a man must continue to make child support payments for a seven-year-old girl despite conclusive DNA testing which shows he’s not the father. The ruling hinged on the fact that dad waited too long to challenge paternity; what a load of crap. (I tried to find a copy of the decision, but it appears that Massachusetts is still stuck in the 1980s — the only way to get decisions is via a dial-up bulletin board system.)
In looking through my archives to find the other two times I’ve talked about forced child support despite proof of non-paternity, I noticed that the majority of news articles I’ve linked to over the life of Q Daily News don’t exist anymore. That just plain sucks.
Screw the X-ray — they should get an MRI of the Liberty Bell. Oh, wait, no….
I admit it, I signed up for Salon’s premium content today. I really like Salon; I like the mix of traditional news and more colorful content, and I can’t say that the occasional dip into sex and the general liberal slant hurt the site at all.
I ain’t gonna lie to y’all — the coolest example of why the Internet rocks is that I’m currently watching a live, full-motion video feed from a camera on the outside of the International Space Station, with the CanadArm 2 hanging off of it and Earth’s surface soaring by below. So freaking cool. (The funny part is that, on the live audio, they’re actively trying to debug a serial and an ethernet connection somewhere on ISS.)
Dahlia Lithwick is back on Slate with her latest Supreme Court dispatch; this one covers the Court’s ruling on whether police can arrest people on relatively minor misdemeanor offenses, and wonders how the Court would look if, instead of voluntarily retiring, the Justices were subjected to Survivor-like rules.
The flooding in the Midwest has finally hit home for me. (In all seriousness, this is a pretty cool picture.)
If you’re running the latest-and-greatest Linux kernel (the 2.4 series) and you’re having repeatable trouble contacting certain websites, you may want to take a look at this. The 2.4-level kernels contain support for a new networking protocol, ECN (explicit congestion notification), and the networking equipment serving certain websites doesn’t appear to support the new packets.
My biggest mistake last night was beginning to read she hates my futon at around midnight. I finished it around 2:00 AM; what a great novella. It’s all on the web, and what’s written so far is divided into 23 easy-to-digest chapters, so you don’t have much excuse for not going there now and starting to read.
Wow — finally, good medical news for people like me!
Damn, sometimes I love my referrers log. Today, I found pleonasm through the log, which has some pretty great photo archives and is based on the no-tables, pure-CSS three-division layout that makes me drool. Nice, nice work, Matt.
I cannot even begin to understand how someone managed to program both a chess game and an automatic computer player into an under-5K web page.
The Institute of Medicine has finally released its long-awaited report, and has concluded that there is no evidence of a link between the MMR vaccine and autism. The IOM committee is an impressive group of people who were all carefully screened to eliminate even the smallest tinge of bias; automatic exclusion criteria were any prior research on vaccine safety, any prior receipt of money from vaccine manufacturers or parent companies, or time served on any vaccine advisory committees. Of course, the cynic in me realizes that this won’t quiet the rather vocal group of people who insist that the link exists; that being said, it may help prevent parents from believing them.
And in semi-medical related news, the Supreme Court today let stand a lower court ruling that will allow Terri Schiavo’s husband to have her feeding tube removed, ending her life and his struggle to stop life-sustaining treatments against her apparent wishes..
Due to the request of a friend, there’s now a super-lightweight version of Q Daily News (perfect for AvantGo usage, for example). If you would like to use it for AvantGo, you can click here to automatically create the custom channel subscribing your handheld to the page.
Yesterday, New York Yankee Paul O’Neill hit a game-tying home run in the tenth inning, something that isn’t terribly unique. What was unique was his reaction to the home run — when the ball left his bat, he reacted with disgust, as if he had hit a ball straight into the hands of an infielder. It was priceless when he looked up and noticed Red Sox outfielder Darren Lewis backing against the wall, and watched as the ball dropped into the crowd. Two batters later in the lineup, David Justice hit the game winner, and the Yanks redeemed themselves against a Red Sox team that has opened the season well.
It’s sad that Dubya’s handlers weren’t able to slip that meeting in with him when they would have explained that the language spoken in the nation south of our own is named “Spanish.” (For those uninterested in picking through the article to find the quote, Bush was asked if he’d answer questions; his response was that he wouldn’t, not “in English, French, or Mexican.”)
Why do otherwise-ordinary people use pseudonyms on the web?
Going into the first round of the NBA playoffs, just what the New York Knicks needed was two players being quoted making pretty overtly anti-Semetic statements in today’s New York Times Magazine. Since the story actually hit the wires yesterday sometime, both Allan Houston and Charlie Ward (the two players quoted in the article) have further “clarified” their statements; this clarification involves saying that they’re “just the messenger” and making some inscrutable claim of context.
Cool — zero-copy networking is going to make it into the mainstream Linux kernel. I wonder how easy it will be to enable or disable it; I can’t imagine that it will be useful for your average low-load server, whereas large web and database servers probably will get enormous benefit from not having to copy data multiple times before putting it onto the wire.
Dammit, I know this will shock you all, but Dubya’s hypocracy continues to piss me off.
Disney is continuing the evisceration of its internet divisions by shutting down Mr. Showbiz. It’s a damn shame; between Mr. Showbiz and the Internet Movie Database, it’s a tough call which is the most valuable movie website. The oddest part of the move is that they are replacing the website with “a beefed up dot-com” related to Us Weekly, a title in which Disney only owns equity.
At my other job today, our server room air conditioners decided that they’d had enough. Let me tell you, 60 computers in a closed, uncooled room does not make for a good scene; two or three machines aren’t with us anymore, and we had to shut down all but five or six of them just to keep the room from crossing the 100 degree mark. The kicker, though, was the monitoring system that hit me with three thousand email messages alerting me to the temperature problem. Would you say that it’s time to find a better way to keep tabs on the room?
Today, I was reading a (damn funny) article on the web, and noticed a link at the bottom, “Want to use this article? Click here for options!” The link takes you to an iCopyright page, showing you the price list for various things that they will “let” you do — like print the article (for a mere $10!). I know that iCopyright’s lunacy has been discussed before, but do they really think that I owe them $10 if I print a copy of the article? With a business model like this, it’s no wonder that the company nearly shut down.
Mostly for my own future reference, but also for those of you who are interested in locking down your Windows server installations: Hardening Windows 2000, by Philip Cox. (That thar is a PDF, by the way…)
Geeks at NASA’s Goddard Space Flight Center have put together some of the coolest videos I’ve seen — they’re virtual camera views, of a camera that starts out way up in orbit above a city and literally falls until it is a couple hundred feet above the ground. Here’s Washington, D.C.; they also did Atlanta, Orlando, San Fran, and Los Angeles. (Each is an MPEG movie; consider yourself warned.) Go check ‘em out, now.
The Brunching Shuttlecocks has a great set of life lessons learned from Black and White. Like the True God is “whichever one dumps the most food and lumber in your home town. It’s a lot like Congress.”
Why is it that (arguably useful) companies like Kozmo, Pets.com, and Deepleap have gone under, yet (completely useless) companies like Digital Convergence are still alive and kicking? There seems to be a major injustice afoot. (A benefit of Digital Convergence’s continued life, though, is that you can still go and read the FAQ page for the CueCat; it is pretty much the most asinine group of questions I’ve ever read, each repeated about twenty times in ever possible iteration and phrasing.)
It seems so tragic when Darwin tries to grab hold of another young American. (In all seriousness, what’s tragic is that there’s another kid who has so little guidance as to what’s right and wrong from his family that he’s both watching Jackass and imitating stunts from the show.)
John Dvorak has weighed in with his opinion on Microsoft’s newest licensing strategy (online authorization of WinXP and Office XP); it’s been a while since I’ve seen an editorial so full of sheer conjecture and suppositions. Of course, any online op-ed piece about Microsoft is worth reading, if only for the rabid comments by users. (P.S.: John, it’s “toe the line,” not “tow the line.”)
I have to confess, I don’t really understand why people are sooo up in arms about the licensing scheme for Windows XP and Office XP. Microsoft is faced with a problem — many, many people pirate the company’s software, on the person-to-person level (intra-office, in homes) and on the mass-production level (Israeli and Chinese pirating organizations). Because of this, Microsoft loses lots of money. Now, one thing we all agree on is that Microsoft is a company which exists to make money; being a publicly-held company means that it exists to make money for its shareholders. It would be irresponsible of the company to not institute a strict control system for licenses on their products; they don’t exist to give things to people who are too greedy, lazy, or otherwise disinclined to part with their money for products which they install and use.
My newest little patient went home from the hospital today, pink, healthy, breathing comfortably, and eating “mucho, mucho mas.” Mom is bringing him in to see me in clinic on Monday.
I’m glad that my TiVo is of the regular variety, since it appears that owners of DirecTiVo boxes have reason to be less than enthralled with last year’s best invention.
Rule number one of protesting: you don’t belong on the front lines if you have a tendency, if apprehended, to lose control of your bladder.
I’ve been listening to Paul Simon’s new album a lot lately, and completely dig the track “Pigs, Sheep, and Wolves.” It’s so far outside of Paul Simon’s normal vocals — kinda trippy, very mellow. It’s also an indictment of the death penalty, but wound into a little fairy tale about farm animals. Buy the album; check out the song.
I have no idea how I missed it when it was written, but the Democratic Response to Barbra Streisand’s Memo (courtesy of Modern Humorist) is a sheer work of genius. Then again, any web page that encompasses the sentence “Nothing captures the spirit that is Barbra like a child dressed as a Victorian whore” is a sheer work of genius.
I’m sorry if this offends any of you, but the red-blooded male in me just needs to point to the News Of The World’s photo spread of Anna Kournikova sunbathing topless. (My brother has been forwarding me URLs for years that are all obvious fakes; this time, he appears to have found the real thing.)
Today was another day at the Child Advocacy Center, but this time, it was a good day. Instead of spending time with children referred in for suspected abuse and parents who both confess to and believe in that abuse, I had two cases where there was clearly no evidence to back up the accusations that brought them to my interview room. In the first, the mom admitted to hitting her son once, but also produced evidence that she has sought out conseling and anger management classes; in her words, “I lost my cool, and I know that it wasn’t right. I want to make sure that it doesn’t happen again.” The second case was even more clear-cut — the parents were some of the most loving ones I’ve met, and all I can guess is that the accusations against them were made out of spite. Their case was the first time I’ve ever reported back to Child Welfare that there was no need for any further intervention.
Cool — it appears that my bitching about the disappearance of All-Star Newspaper became the representative link that Suck chose when discussing the death of the Web. It’s funny, but I never think that people read this site, and then someone links here, and I’m amazed.
Since the Pulitzers were announced last week, I’ve tried to spend some time finding and reading articles written by the winners. So far, my hands-down favorite is the writing of Dorothy Rabinowitz, opinion columnist for The Wall Street Journal. Her article on the false prosecution of Patrick Griffin is stunning; likewise, her recount of Brandeis’ “internal judicial proceedings” against a male student accused of rape is a rare glimpse into how today’s colleges try to hush sexual accusations (and brutalize basic civil liberties in the process).
Interestingly, my alma mater has been at the forefront of the move to eliminate due process from sexual assault accusations. A year ago, Columbia adopted a new sexual misconduct policy that eliminates the ability to cross-examine the accuser, prohibits the accused from having an attorney present during the hearing (or the appeal), and even explicitly states that the accused doesn’t have the right to be present to hear all witnesses. (Seriously, you have to read the policy to believe it.) The Columbia Daily Spectator has published quite a few good articles and opinion pieces on the new policy; likewise, the national press has picked up the story, and there’s even a national petition against the horrific policy.
Kozmo decided to put its website back up yesterday, but with a disturbing note: if you were holding onto a rental, unsure of what to do with it once they closed their doors last week, you had until the end of the day to return it or you’d pay for it. Janelle Brown thinks that maybe, instead of an inconvenient necessity for the failed company, this stunt was a way to try to get more money to pay off creditors.
In one of the more disturbing things I’ve read in a while, a West Virginia man defended himself against the accusation of raping his 13 year-old daughter by saying that he was only trying to teach her about sex and birth control. (The judge didn’t buy it; he was sentenced to 20 to 40 years in prison.)
Today, I received a junk fax from some travel agency, and decided that they deserved to be punished for breaking the Federal law against unsolicited faxes. Along the way, I discovered the FCC’s online consumer complaint form — it provides the ability to complain specifically about unsolicited faxes, and (ostensibly) starts an investigation by the Commission. We’ll see what happens.
The upcoming week of April 23 through 29 is TV Turnoff Week — one week to discover that there is life beyond the boob tube. I can’t tell you how many kids I see in clinic who have the TV as a babysitter; many of them have learned far more from their TV than they have from their entire family. So, if you have a child that spends a little too much time in front of your television, consider planning some alternative activities next week.
From Phil comes a link to Cisco’s security advisory for the bug that I mentioned yesterday (the one which crashes Catalyst 5000 switches when you plug Windows XP machines into them). Update thy flash ROMs, people…
Tonight, I was putzing around with Quicken, finally getting around to setting up all my investment accounts and whatnot. After entering everything, I got back to the global summary page, noticed the various entries (Roth IRA, SEP IRA, 401(k), mutual fund investments, blah blah blah), and it hit me square in the face — I’ve become an adult. When the hell did that happen? Why didn’t someone warn me about it? Damn you all.
Wow — The MetaFilter Scholarship. There are about a billion good things I could say about this, but instead, I’ll let everyone else’s words speak for me, except to add that it should surprise nobody that one of the most impressive guys on the web should step up and do something this noble and deserving of praise. Now go, everyone, and donate more to the cause.
Cool. I was surfing around tonight, trying to find out some information on neonatal screening programs across the country, and ran across NewbornScreening.com. The coolest thing about the site, though, is that it appears to run on the SlashCode bulletin board system (the same system that’s behind Slashdot). Finally, a good use for the software…
Business Week has a great article on how, despite the eventual crash of last year’s internet-crazy market, the money managers and brokerage firms raked in the profits. The best quote of the piece:
So will the financial firms’ newfound restraint hold them back next time? Don’t bet on it. Experienced money managers say the lesson to draw from the Net bust is that investors need to do their own homework and not just rely on the experts. “At the bottom of the cycle, they tell you they’ve tightened their due diligence standards,” says Van Wagoner. “At the top of the cycle, they always find a reason to take companies public. You can’t rely on them to do the due diligence.”
One of my friends and I always laugh at the corporate IT department when they tell us that we can’t plug a machine into the network when it’s running some new version of an operating system; their reason is always that “it could destabilize the network,” something that we just don’t believe could be true. Well, I should amend that to didn’t believe it could be true, since a bug in Cisco’s Catalyst 5000 operating system causes it to crash when faced with traffic from a Windows XP machine, bringing down the network. (Meanwhile, read the talkback threads at the bottom of the article — typical Microsoft bashing, even when the article specifically notes that the bug is Cisco’s, not Microsoft’s. Morons.)
I sorta felt that I should update people on what’s happening with the little boy I brought into the ER on Thursday — he has respiratory syncytial virus, but is doing much better. He’s still in the ICU, but should be coming out to the general ward this weekend.
I also wanted to say thank you to everyone who sent or posted kind words about the narrative. It all means a tremendous amount to me; it just extended the good mood that much more.
I had all of these great links that I was going to share today, but then I had one of the best days in the history of great days, and I felt like sharing it with all of you instead.
I’m currently on an outpatient rotation, which means that I spend most of my time in my clinic, seeing well children and walk-in, nonemergent sorts of things. Another thing that we do during outpatient is spend a day with one of the nurses from the Visiting Nurse Service of New York, and today was that day for me.
Now, I had been warned by some of the other residents that there aren’t pediatrics-only VNS nurses, so part of my day would also include adults (bleah); our first visit (a fortyish diabetic woman who was pregnant) bore this out, and afterwards, the nurse I was with told me that our second visit would also be an adult. This woman had recently delivered her baby via C-section, and VNS was involved only because mom’s abdominal wound was having problems fully healing. Our trip to the family took us into one of the poorest neighborhoods in New York, and likewise, into one of the more dilapidated buildings I have seen in my life. Up four flights in a tiny urine-drenched elevator, and we were there.
When we got into the apartment, mom immediately told us that she was doing very well, but that she was pretty worried about her new (16 day-old) baby. The nurse told mom that today was her “lucky day”; I, a pediatrician, happened to be along for the ride. I asked mom what she was worried about, and she told me that her son wasn’t eating very well, that he was less active than normal, and that he had a pale color — all of which can serve as red flags in a newborn. She then told me that he had been delivered at 36 weeks and that the early C-section was because mom had had preeclampsia (also red flags), and I asked to see the boy.
That’s when she handed me her newborn son, and also when I began to worry.
He was not just “less active,” he was lethargic. (Anyone in the medical field can tell you that we reserve that word — lethargic — for a very select and special class of patients. You have to be pretty sick for that particular adjective to enter the conversation.) He was mottled, yellowish-purple, didn’t seem to have all that great a respiratory effort, and his arms and legs were completely limp. I tried to stimulate him, and it didn’t do much… no crying, no major movement or increase in muscle tone, not even much eye-opening.
I quickly grabbed my stethoscope and put it on his chest, and his heart rate seemed to be pretty good — 150s to 160s (normal range for a newborn). Just as I was taking the stethoscope off, though, I heard it start to dip, and after listening for another ten seconds or so, I heard his rate go as low as 60. During this, he had no respiratory effort, but after the ten seconds, he started to breathe deeply again, and his heart rate came right back up. Over the next two minutes, he did this a few more times, and when we took the temperature, it was 95.2.
This is about when it hit me fully that this had ceased to be a visit for mom, and turned into an emergent visit for her son — he needed to get to an emergency room, quickly.
I pulled out my cellphone and called 911, and explained that I was a pediatrician with a patient who needed an ambulance immediately. I told them short form of the story (16-day old, lethargy with apnea and bradycardia, guarded condition), and they patched me directly through to the precinct dispatcher; he reassured me that someone would be there very shortly.
Again, I remembered — we were supposed to have been visiting mom.
After hanging up, I briefly called my hospital’s pediatric ER, got the attending for the acute side on the phone, and told him what was going on, warning him that we would be coming in in a hurry. Then I asked mom how long her son had been like this, and she said that it had been since yesterday morning. That begged asking her why she had waited to say something about it, she said that she had. She had called her pediatrician when she noticed the change, and after having her take the baby’s temperature (99), he said that the baby didn’t have a fever, but that she should go to the ER if she was concerned. She did go to the ER (not at my hospital), where they examined her son, decided that “he had a cold,” and sent them home. Mom remained concerned, though, and said that she had been waiting for VNS to come so that she could talk to her about it.
This whole conversation with the ER and with mom took about two and a half minutes; I know because that’s how long the police took to arrive at the door. They told me that the ambulance was less than three minutes away, but that if I felt that we couldn’t wait, they would take me in the police car — my fear of needing oxygen or advanced resuscitation equipment prevented me from accepting that offer, though. Once the EMS paramedics got there, we put an oxygen mask on the boy and started helping him breathe with the manual ventilation bag, and he perked up a bit. Next, it was down four flights in the tiny urine-drenched elevator (this time packed with the paramedics, me, the baby, and a policeman) and into the ambulance. I spent the duration of this concentrating on (a) not dropping the baby, (b) continuing to ventilate the baby, and (c) maintaining a good seal between the baby’s face and the oxygen mask, and because of that, the paramedic literally had to sit me down in the jumpseat and harness me in. He took over the manual ventilation while I held onto the baby and the mask, and we roared off, sirens blaring.
We were supposed to have been visiting mom.
About four minutes (and two hit curbs) later, we pulled into the ambulance bay, and the attending met us at the door. There were about six other people gloved, gowned, and ready in one of the trauma bays, and the baby got swallowed into their mass. IVs were put in, EKG leads and oxygen sensors were attached, blood was drawn and urine was obtained. The baby was still markedly hypothermic (95-96 degrees), he wasn’t managing to maintain his own blood oxygenation (88-89% on room air), and he was in moderate respiratory distress. The senior resident pushed antibiotics immediately, and with that, the oxygen, and the constant stimulation, the infant looked to be improving. While waiting for some results to come back, I grabbed the parents and explained to them everything that had gone on. And while speaking with them, I realized that, for the first moment in my residency, I had the real, undeniable, concrete understanding that I had been the difference between life and death for a child.
The first labwork to come back was the arterial blood gas, telling us that the baby was acidotic (he couldn’t breathe fast enough to keep up with and expire the acid that his body was producing). A stat portable chest X-ray told us why — it looked like our little boy had pretty sizable right upper-lobe pneumonia. At the least, he was suffering solely from the respiratory symptoms of the pneumonia, but much more likely, he was septic from whatever was going on in there. I called the respiratory therapist to have him come down to set up CPAP (it’s a relatively non-invasive form of positive-pressure ventilation), and then went back to talk to the parents, updating them on what was going on.
Finally, the senior resident secured the baby a spot in the peds ICU, and I told the parents that they would be going upstairs in a few minutes. I reassured mom that she had done everything right, shook their hands, and said goodbye, but just as I was turning the corner to leave the ER, mom called me back. She seemed to be nervous, looking at her shoes and tentatively rustling a packet of papers in her hands; she finally asked if I would consider becoming their baby’s primary pediatrician.
And I was pretty much the happiest person alive.
A judge in Washington, D.C. is facing an interesting conundrum — holding a capital punishment trial in a city that hasn’t had one in over 30 years, and overwhelmingly voted to reject a death penalty law in 1992. It’s a federal case, with the federal death penalty, and once you factor in that two-thirds of the potential jury is automatically disqualified on belief, that the defendant is not accused of killing anyone by his own hands, and that the jury will remain anonymous, the case is expected to be an epic.
Thanks to Matt, I now know a little about what happened to my favorite former news site, All Star Newspaper. Wow — what an effing disaster Brill’s seems to have been. Seems like we all graduated from fifth grade a long time ago, but some seem to deny it. Meanwhile, Tim Carvell (a college friend of mine, the only friend I have who’s in the know, as it were) has a good essay questioning how well Brill’s and Inside.com will get along.
Awesome — Marlon Brando will have a cameo in the upcoming Scary Movie 2. Charlton Heston apparently turned down the role (for which I am very thankful, being as he makes me ill).
I don’t know about y’all, but there’s a bit of outrage brewing in me about how blatant and out-in-the-open it was, UPS bribing two-thirds of our national elected officials in order to secure a U.S.-to-China shipping route. Of the 368 Congressmen or Senators who wrote letters of support, 279 of them received checks from UPS; even more, both UPS and our elected representatives are quoted denying the link between lobbying and donations. Bastards, all of ‘em, I tell ya’.
Did anyone else know that there’s a registry setting in Windows 2000 that allows you to intentionally crash your machine with a single key combination? Seems kinda dangerous, but I guess there does need to be a way to test these kind of things…
There have been some interesting goings-on in the space where sports and the media meet. Last year, the NBA sued the New York Times over the latter’s sale of images that were taken by photographers at basketball games, arguing that news outlets are only permitted to use images of NBA games for news coverage, not commercial sale. Yesterday, the two settled the lawsuit for what seems to be a pittance — the Times agreed to link to NBA.com from the website selling the images. At the same time, though, Major League Baseball is going after media outlets over the same issue; it remains to be seen how this settlement will effect this effort. (The New Yorker currently has an article on the baseball issue, but I doubt that the link will work next week.)
Found at MetaFilter: UNC techies were having a bear of a time finding a server on their network — it was responding to network traffic, but could not be physically located. After tracing wires a bit, it was found — sealed behind a wall.
The people at iRobot are doing something very cool, both with robots and with programmatic concepts. Instead of building robots that are programmed to perform single tasks independently, they’re building swarms of robots which are programmed to work together. Instead of each of them having discrete information, they all contribute to a pool of information, and feed off of the same pool to make decisions. Very, very cool.
Merrill Goozner has some interesting points to make about the justifications used by big pharma to price their drugs as high as they do, and restrict them from markets in which they are direly needed.
The operation succeeded! 88 hours of surgery, and both little girls survived. It remains to be seen how much neurological damage they sustained (some is, I suspect, inevitable).
The tough job was to reroute all the shared blood vessels so that both brains had full blood supply. This is an awesome achievement.
Hey! What happened to my All-Star Newspaper??? I loved this spin-off of Brill’s Content, having given it the prime spot at the top of my IE Bookmarks “News” category folder; now, it redirects to the main Brill’s Content page. (Strangely, though, it’s still in the header navbar there.)
Why is this the first time I’m reading the thread on the old Userland discussion group where Dave Winer broadly banned people from crawling the group and generating an email list out of it? My interest stems from the fact that the reasons he uses to spell out why he doesn’t want people to do this can all be thrown back at his new product, Radio Userland. Radio crawls weblog syndication files and throws the content onto people’s desktops — even if you aren’t done editing it, which is what Dave’s panties seem all tied up over.
I have to tell y’all, reading Greg Knauss is a pleasure that’s difficult to top. EOD is either a journal-sans-detail or a weblog-sans-links… but either way, it rocks. Go there. Now. (Update: after deeper perusal, I found that it does have links occasionally. I apologize for misleading you all.)
This weekend, I went with my parents to our yearly seder event (we have to act Jewish sometime), and they brought along a present for my four-year-old cousin, a puzzle game named Rush Hour Jr. What a terrific game — it involves sliding pieces around a grid in order to get a car out of a blocked-in space, and it requires pretty good concentration skills and deductive reasoning. It’s rated for a minimum of six-year-olds, but my cousin (who’s damn smart, mind you) had no problem with a lot of the layouts. If you’ve got a young child, buy the game. Trust me. (If you’ve got a PalmPilot, you can also download a version that someone wrote. I’m now an addict.)
Meanwhile, I’m also now addicted to the online puzzle site that’s run by Binary Arts (the maker of Rush Hour). I don’t think I can do a single puzzle that’s under the advanced header…. ouch.
Fascinating: in Singapore, an operation to separate a set of conjoined twins is continuing into its third (now probably fourth) day, with the surgeons swapping in and out so that they can rest. The twins are joined at the head, and share vascular supply to their brains (the article doesn’t mention if they do or don’t share actual brain tissue as well).
And while on the subject of brains, who would have predicted that Wired would have a good article on the controversies surrounding the concept of brain death?
The FCC has released a policy statement intended to help guide broadcasters understand how it determines decency and indecency, but in reading it, I can’t get over how entertaining it is simply standing alone. The excerpts of things that have been sanctioned by the FCC range from hilarious to sick; also interesting is how much DJs try to get around the rules, and how little the FCC lets them. (In addition, I had no idea that the Monty Python “Sit On My Face” lyrics had been found to be indecent by the FCC!)
NASA launched the Mars Odyssey surveyor this morning, starting its 6-month trip to the Red Planet on the hunt for water. The best part of the launch is that there were on-rocket cameras; from the launching pad to takeoff to booster separation to bare-bones, the images are pretty damn cool. The Houston Chronicle also has a seven-minute video from the on-rocket camera… whoa.
Do yourself a favor and check out the two stunning pictures that are part of MSNBC’s Week in Pictures — dog with tigers and spiral galaxy. (The home link is here; after this week, it will most likely move here.)
Speaking of pictures, the Astronomy Picture of the Day site had a great week. First came Aurora Alaskan Style, a great picture of the hazy aurora over Fairbanks caused by the sun’s massive ejection last week. Then, APOD displayed Equinox + 1, an image of the sun rising above an east-west water canal in Tempe. And lastly, they reported on the American victory over the Russians in the first space Quidditch match (which, if you hadn’t guessed, was their contribution to this year’s April Fools library).
Is there something I’m missing in this quote?
The Senate needs to leave enough money in the proposed budget to not only reduce all marginal rates, but to eliminate the death tax, so that people who build up assets are able to transfer them from one generation to the next, regardless of a person’s race.
This week, I decided to build myself a new, blazing desktop, and last night was the night I brought everything home to build the beast. I learned a few things: those infernal rear-panel punchout templates can make or break an ATX computer case, all PC133 SDRAM is not the same, and always upgrade to the latest motherboard BIOS before beginning the installation. All in all, though, everything went as it should have, and I’m very happy with my new machine.
Which leads to a minor note: this server will be down for a few minutes later today, so that I can upgrade a piece of hardware that was pulled out of my old desktop.
You’ll remember that yesterday, my connectivity was restored only by the grace of a Verizon tech who installed a functional T1 in parallel to my broken one. Well, overnight, my ISP got the original one working… which means that, for the next couple of weeks, I’ve got two T1s. Of course, traffic is only routed over one of them, but I can dream, can’t I?
Oh, what incredible genius lies within The Guardian’s world primer for George W. Bush. Take, for example, the entry on Russia: “A confusing one these days. Recent reports suggest that the Russian government is seething with corruption, its labyrinthian offices and corridors staffed by indolent good-for-nothings with a history of heavy drinking. As such, few points of similarity with a Bush administration, and probably therefore not a priority.”
What a hell of a surprise — Bob Knight is a nutbag, and seems to have screwed his new school’s team already by bagging three scholarship recipients without understanding that he can’t replace them until next year.
And another surprise — Network Solutions is untrustworthy and contemptible. They trick people into discount renewals and then claim that they’re ineligible, charging them more; they trick customers of other registrars into renewing with them; worst of all, they do all of it with a database of names and addresses that they shouldn’t be allowed to use. I think that it’s time for me to move my domains to another registrar.
This morning, I worked in the Child Advocacy Center in the hospital. Kids who are the suspected or proven victims of abuse are assigned to followup in the CAC; the attendings there are the people who are called by the ER at all hours of the night when a kid comes in who has suffered through unspeakable trauma. One of the kids I talked to was referred in after his school noticed a bruise on his face and he said that it was from his mother hitting him. The worst part of it was that mom told me that she hits him — and that she’s a New York police officer. She seems to think that it’s part of acceptable discipline to “pop” her son. I swear, sometimes I think people should need licenses to have children.
The past 24 hours of outage here have been courtesy of my ISP and telco, who don’t seem to be all that frazzled when one of their T1 lines goes down. The only reason I’m back up is that one of the techs at my telco decided to come and see if he could get a parallel circuit up and running; the original T1 is still down. Bleah.
I cannot tell you how much I hate that RealNetworks is involved in so many big deals with content providers to be the exclusive distribution method for their music. RealPlayer is such a piece of garbage, from the insidious installer that spams the hell out of your computer’s bookmarks, menus and startup groups to the app itself which stays in resident memory even after you quit it (“to make things faster,” as I was once told by a support rep). If the company truly is able to make their app the exclusive mechanism for me to obtain content online, then I’m quickly going to migrate back to my CDs and stereo.
Remember back when Toysmart.com went bankrupt, and a huge uproar developed over their attempt to sell their customer data? Well, the same thing is apparently happening over at eToys, but for some reason, this time nobody’s complaining. Why?
Stepmother Forces Boy To Stitch Up Mouth. I can’t really say anything that that headline doesn’t already say.
Is it just me, or does it appear that Damien has recently been defamed and/or slandered by someone who has appropriated his identity? (April 3, 2001 entry, damn that lack of permanent links…)
Following a trend from the weekend, Matthew Schwartz has an article about honeypots, this time specifically those honeypots put up on corporate networks to detract hacker’s attention away from systems that really matter. A cool-sounding product mentioned in the article is ManTrap, a real Sun system with multiple security mechanisms to keep hackers interested and well-logged; seems like it would be fun to play with.
The Microsoft DHTML Dude has a great column this week on Internet Explorer 6.0 and standards. (I created a new VMware Windows 2000 installation this week, and installed the IE6 beta into it; I’ll report more after I play with it a bit. Update: It appears that the Manila HTML tag editing tool doesn’t show up in IE6. Bummer.)
One in four major banks are now implementing ATM card rental fees — annual surcharges that customers pay for the ability to use an ATM card to withdraw money. I was always under the impression that banks pushed ATMs because they were a way to phase out live tellers who earned salaries; now, it’s clear that they also see them as limitless buckets of income.