The Olds, the Youngs, and the Others

At the end of the 2nd week, I attended a talk about suicidal incidence in the elderly in NYC. Some of the conclusions include: NYC needs to build more barricade because jumping from a building is the most popular way here; only 20% of the elderly who commit suicide receive anti-depressant, so we need to look out for depressive disorders in patients; and the difference between teenagers who slit their wrists and an elderly person harming him/herself is that the old one actually means it. It was a somewhat depressing presentation, but the sandwich from au bon pain definitely made everyone much happier.

Since Dr. Silver is on vacation, I've been floating around this week. On Monday, Dr. Schafer hooked me up with Dr. Raik in geriatrics out-patient clinics. Interestingly, patients I normally see in hematology/oncology are older than geriatrics patients, on average. I suppose it makes sense in a way because the really, really old patients tend to have more complications and are referred to specialists. Most patients were very nice but clinically not-so-interesting. Almost everyone receives antidepressant here, which is not too surprising since Dr. Bob (not sure what his lastname was) who gave the talk above works here. One lady who came in was very peculiar. She said she had (or have had) hypogammaglobular anemia, thymoma, fibromyalgia, and cellulitis, etc. She was also clearly depressed: she was crying about being on disability due to her medical conditions, crying about, "No body (meaning doctors) wants to take care of me," and having trouble finding jobs because she is sick and noone wants to hire a sick person. Personally, I thought she had some psychiatric problem. How can someone been through at least 6 doctors and have nothing good to say about any of them? And almost all of her conditions seem to be unrelated. She also changed the dosage of her ~15 drugs, which she showed Dr. Raik during history. The patient complained that one drug makes her throat really dry or her ankles swollen or whatever. I wonder how she could figure out which one exactly did that since she takes like 10 at a time. Dr. Raik told me later on that I was right--all her blood/lab tests were negative for everything. Apart from her attitude, she's fine.

Just some funny things I observed: two elderly male patients had different conditions (adrenal gland tumor for one and the other one had something else). Both of them asked the doctors if viagra pills would cure it :)

I've never noticed how white hematology/oncology clinics are until this week when I saw the first black and hispanic patients (haven't seen an Asian person, yet. May be they're made of steel). Apparently only caucasians get myeloproliferative disorder and/or able to afford to come to this clinics.

For the rest of the week, I spent my days in Neonatal ICU. Wow, half the babies are shorter than a wine bottle. Cardiac and respiratory complications seem to be common in premature babies. It amazes me that the survival rate for this NICU is like 80%+ because some babies just don't look like they would make it: they have some weird murmur in the heart, need CPAP, have to be fed directly to the heart, etc. One baby has a mother who did cocane (although for some reasons she claimed she did heroine) right before birth. So he's on morphine until the doctor can weed him off of drug. What an interesting way to start a life and what a great story to tell your friends in the future! ("Yo, man, I did drug when I was 1 hour old!") There is no rigid guideline on how fast to decrease the morphine, though. It's kind of like adjusting an engine's idle speed: you keep turning the speed down until the engine starts stuttering and doesn't run, then you turn it back up. Here, you turn down the morphine until the baby starts to jitter, then turn the morphine back up.

Another thing I found interesting since I'm normally in hematology is that babies normally have Hct of ~50-60% That's crazy! The risk of thrombotic events increases exponentially as soon as Hct exceeds 42 and 45% in female and male adults! How come those babies are not having strokes left and right? Another funny thing is, one baby who has a trisomy 18 had a transient polycythemia, so he had increased Hct among other things. But what is considered an increase when there's a huge variable range of "normal" Hct in premature babies? I'll ask Dr. Silver when I see him