Wonderful, Istiaq. I love hearing about cases like this. I obviously don't get to interact much with hospitalists as an EMT, but since we're gathering data as best we can in the field, I'm always grateful when we learn something new or surprising about the ultimate diagnosis after the fact, in the ED or beyond. I hope you write more of these stories.
I still think about the hospitalist whom I only ever spoke with on the phone, when my mom was spiraling and in between memory care and the hospital, where she'd gone several times with intense GI pain, never diagnosed. He very gently, over the course of a couple days and multiple phone calls, led me to the realization that hospice/palliative care was the most humane option for her. I'll never forget how warm and kind he was, how respectful of the magnitude of this shift was for me, as her son and healthcare proxy.
So glad that doctors like him and you are out there, looking out for these fortunate patients and their loved ones. Looking forward to reading and learning more.
the respect is mutual Rob. when i was in training at hennepin county, we interacted more with EMT's - some of them passed through hennepin's ICU as they were training so they could see what happened to patients after they landed in the hospital. i know you probably have tons of stories Rob and I'm excited to read your substack more! I do plan to write more cases in the future, trying to achieve some kind of balance between cases and personal essays.
I'm glad to hear the hospitalist you had took time with you and guided you. those conversations can be difficult - in palliative care, they say conversations are procedures because they ultimately change courses and outcomes.
It's great when they connect folks across the spectrum of patient care. I'm a volunteer EMT, only out on a few calls a week, usually, so any opportunities are welcome. We do get hospitalists teaching CMEs sometimes, which I love.
Conversations are procedures... that's going to stick with me for a long time. Can't wait to read more of your insights and stories.
This is fascinating. I realized halfway through - I was once one of those cases! A hospitalist was on my case, I had sepsis and weird symptoms they couldn’t figure out.
I didn’t realize how sick I was until day four when I woke up and saw five white-coated specialists standing in a semi-circle at the end of my bed.
Ended up the rheumatologist figured it out. And reading your essay I realized it’s probably because she was the one who happened to have some free time; I know she researched my case at home, off duty.
It was aortitis and side effects from an allergic reaction to Neulasta.
I skim the NYT medical cases because they’re too long for my interest. Your essay is the perfect length and also features burritos, which makes it perfect 👍
Tina - you were definitely one of those cases. The visual of five white coats around you sounds like that could be a post in itself ;)
I'm glad you commented - helps re-iterate to myself how important it is to keep reading/thinking about patients after hours. Sometimes it's when the mind is clearest because when I'm at the hospital, I'm being flooded in so many directions. Hope you recovered well (had to read up on aortitis from neulasta) and enjoy a burrito for me soon!
Reads like a clean procedural— where the big reveal are some suspicious labs and two large bowel movements! Jokes aside, I really enjoyed. As someone who has been a patient in dire need of being “cracked”, it’s nice to read a doctor’s pov of someone on the dogged hunt for the problem.
I loved this piece Istiaq! I had the goosebumps excitement reading about you cracking Diane's case that I get when I do that with a patient or read about someone like you doing so! It's the best feeling. I loved my hospitalist colleagues, they always taught me so much (I did inpatient medicine for 22 years including ICU for ten but no longer!) and had a unique perspective on hospital care given their expertise. I'm grateful for you and all of your colleagues for focusing care on the hospital and teaching us so much!
just a recurring thing where you talk about a puzzling medical case and how you arrived at the diagnosis . i know it's been done to death ("house," the nyt column about this) but people love reading about a doctor's process.
Great post Istiaq. You're right. The thrill of cracking a difficult medical case is something else, especially those occult malignancies and vasculitis. Regardless of the outcome, there is closure for the physician and the patient. House MD is an exaggerated version of the same.
Thanks Sanuj. I've never watched House, been told to, but not sure I would prioritize the time. I've yet to diagnose vasculitis but a few occult malignancies come to mind (one presented with pulmonary embolism, the other, new ascites).
Dawn - if this is your takeaway from the essay, then I've done my job. (kidding!)
I've certainly left interactions not feeling incredible. I've been rushed. I've been wrong. Sometimes personalities don't click. But, it's okay. Just have to keep learning.
I hadn't realized the term hospitalist was so new! You all are the life blood of the hospital!
Dianne's story illustrates how important it is to listen. And that you need to have a detective's mindset in some instances. As someone who was once on Depakote for seizure control, I'm not suprised that it was the culprit - intense stuff!
Reading your comment makes me feel like I unfairly smeared depakote! (though I know that's not your intent). But for context, it was a very large dose that made me think about it twice.
Please enjoy a burrito for me Christine and thanks for reading.
Wonderful, Istiaq. I love hearing about cases like this. I obviously don't get to interact much with hospitalists as an EMT, but since we're gathering data as best we can in the field, I'm always grateful when we learn something new or surprising about the ultimate diagnosis after the fact, in the ED or beyond. I hope you write more of these stories.
I still think about the hospitalist whom I only ever spoke with on the phone, when my mom was spiraling and in between memory care and the hospital, where she'd gone several times with intense GI pain, never diagnosed. He very gently, over the course of a couple days and multiple phone calls, led me to the realization that hospice/palliative care was the most humane option for her. I'll never forget how warm and kind he was, how respectful of the magnitude of this shift was for me, as her son and healthcare proxy.
So glad that doctors like him and you are out there, looking out for these fortunate patients and their loved ones. Looking forward to reading and learning more.
the respect is mutual Rob. when i was in training at hennepin county, we interacted more with EMT's - some of them passed through hennepin's ICU as they were training so they could see what happened to patients after they landed in the hospital. i know you probably have tons of stories Rob and I'm excited to read your substack more! I do plan to write more cases in the future, trying to achieve some kind of balance between cases and personal essays.
I'm glad to hear the hospitalist you had took time with you and guided you. those conversations can be difficult - in palliative care, they say conversations are procedures because they ultimately change courses and outcomes.
It's great when they connect folks across the spectrum of patient care. I'm a volunteer EMT, only out on a few calls a week, usually, so any opportunities are welcome. We do get hospitalists teaching CMEs sometimes, which I love.
Conversations are procedures... that's going to stick with me for a long time. Can't wait to read more of your insights and stories.
This is fascinating. I realized halfway through - I was once one of those cases! A hospitalist was on my case, I had sepsis and weird symptoms they couldn’t figure out.
I didn’t realize how sick I was until day four when I woke up and saw five white-coated specialists standing in a semi-circle at the end of my bed.
Ended up the rheumatologist figured it out. And reading your essay I realized it’s probably because she was the one who happened to have some free time; I know she researched my case at home, off duty.
It was aortitis and side effects from an allergic reaction to Neulasta.
I skim the NYT medical cases because they’re too long for my interest. Your essay is the perfect length and also features burritos, which makes it perfect 👍
Tina - you were definitely one of those cases. The visual of five white coats around you sounds like that could be a post in itself ;)
I'm glad you commented - helps re-iterate to myself how important it is to keep reading/thinking about patients after hours. Sometimes it's when the mind is clearest because when I'm at the hospital, I'm being flooded in so many directions. Hope you recovered well (had to read up on aortitis from neulasta) and enjoy a burrito for me soon!
Reads like a clean procedural— where the big reveal are some suspicious labs and two large bowel movements! Jokes aside, I really enjoyed. As someone who has been a patient in dire need of being “cracked”, it’s nice to read a doctor’s pov of someone on the dogged hunt for the problem.
Bowel movements...simple, yet essential to life.
Thanks for reading Elliott. Glad to have your eyes on my work! Hope to have more for you in the future.
I loved this piece Istiaq! I had the goosebumps excitement reading about you cracking Diane's case that I get when I do that with a patient or read about someone like you doing so! It's the best feeling. I loved my hospitalist colleagues, they always taught me so much (I did inpatient medicine for 22 years including ICU for ten but no longer!) and had a unique perspective on hospital care given their expertise. I'm grateful for you and all of your colleagues for focusing care on the hospital and teaching us so much!
Thank you Tanmeet! The feeling is mutual - everyone has a role. Are you mostly clinic based now?
Yes outpatient now. Used to do inpatient and OB but now all outpatient. After 22 years it feels like a good transition!
Wow ! Very well written . I love your work and your observation of every little detail. Thank you for what you do . Love , your biggest fan !!
Crazy - I’m your biggest fan!! :)
Very well-crafted and interesting piece. Could see this becoming a recurring feature.
I especially identified with the patient Dianne, as I also "had two large bowel movements overnight."
Thanks Gary! Tell me more about the recurring feature - what did you have in mind?
Regarding your similarities with Dianne, that did make me laugh out loud. As an internist, happy to hear that.
just a recurring thing where you talk about a puzzling medical case and how you arrived at the diagnosis . i know it's been done to death ("house," the nyt column about this) but people love reading about a doctor's process.
Definitely. I write about what I see in the hospital often but I’ll keep puzzling cases in mind. Thanks for the input Gary.
Great post Istiaq. You're right. The thrill of cracking a difficult medical case is something else, especially those occult malignancies and vasculitis. Regardless of the outcome, there is closure for the physician and the patient. House MD is an exaggerated version of the same.
Thanks Sanuj. I've never watched House, been told to, but not sure I would prioritize the time. I've yet to diagnose vasculitis but a few occult malignancies come to mind (one presented with pulmonary embolism, the other, new ascites).
Do you ever write about medical cases?
I'm in the process of writing one.
Thanks for sharing this, Istiaq. You are an incredible human.
Dawn - if this is your takeaway from the essay, then I've done my job. (kidding!)
I've certainly left interactions not feeling incredible. I've been rushed. I've been wrong. Sometimes personalities don't click. But, it's okay. Just have to keep learning.
I think you're great too!
I hadn't realized the term hospitalist was so new! You all are the life blood of the hospital!
Dianne's story illustrates how important it is to listen. And that you need to have a detective's mindset in some instances. As someone who was once on Depakote for seizure control, I'm not suprised that it was the culprit - intense stuff!
Also, now I want a burrito!
Considering the timeline, yes it's pretty new!
I like the detective analogy.
Reading your comment makes me feel like I unfairly smeared depakote! (though I know that's not your intent). But for context, it was a very large dose that made me think about it twice.
Please enjoy a burrito for me Christine and thanks for reading.