Service gives meaning to life. Virtually all the emergency As ACEP president, I've traveled the country visiting with physicians I've met committed their lives to our specialty because thousands of emergency physicians. I've been struck by the they wanted to make a difference. We are a special breed that diversity of our members and the common threads that bind us takes on the toughest job in medicine because it is the right thing together. More often than not, I'm asked to "pay" for my trip by to do. We start off as compassionate, caring physicians, but our giving a talk, and the most frequently requested presentation is, job has a way of beating us into submission. It's easy to allow our "Longevity in Emergency Medicine How to Survive Your daily diet of tragedy and the "move the meat" mentality to Career and Love Your Life." squeeze the empathy out of us. The successful emergency I guess that means I'm either really old, or that I've made physician finds ways to recognize when this is happening and enough mistakes to qualify as "experienced." In any case, I thank develops tools to counteract it. For me, seeing each patient as a EM Resident for the opportunity to share my "words of wisdom" member of my family helps overcome the "why are you taking up in their inaugural column. a bed in my ED?" signal that tells me I'm getting overwhelmed. It's been twenty-five years since I completed my EM Over the years, I've become convinced that there are few patients residency, and despite years of formal education, countless hours who come to the ED without a of CME, and a quarter century of good reason -- we're just not clinical experience, most of my "Character provides the basic smart enough or willing enough really important life lessons were to figure out what that reason is. taught to me by father. These framework on which we hang Over any sustained period of lessons have nothing to do with time, you can't be good to medicine and everything to do with the traits that define us as patients if you are not good to how you live your life. One of the individuals. To be really good yourselves. You are a person first, most important things I've learned, a spouse and parent second, and however, is that how you live your physicians and really happy an emergency physician third, or life has everything to do with surpeople, we must work every fourth, or fifth. One thing you will viving, thriving, and loving your never hear a physician say on career as an emergency physician. day to define and defend their deathbed is, "I wish I had Evan Esar once said, our character." spent more time at the hospital." "Character is what you have left Time beats money every time, and when you've lost everything you can lose." Character provides the time with family and friends is basic framework on which we hang the traits that define us as priceless. Friends require cultivation, and friends and interests individuals. To be really good physicians and really happy people, outside medicine provide your life with a balance that is critical to your wellbeing. Just like our patients, our health is ultimately we must work every day to define and defend our character. It's our most valuable possession. We must focus adequate attention a constant battle. Though my father has been dead for more than on maintaining our health, including regular exercise, reasonable a decade, when I face challenging situations, I still hear him diet, avoiding smoking and excessive alcohol intake, and telling me, "Do what is right, not what is easy. Don't do anything developing strategies to assure adequate sleep. in private that you would be ashamed to read about in the papers. I hope these "words of wisdom" help you enjoy your life, Tell the truth -- you're not smart enough to remember all your and your career, as much as I have. Remember, happiness is not lies. Don't ask anyone to do something you aren't willing to do a goal. It is a choice. It is a blessing to awake in the morning as yourself. Leave this world a little better than you found it." He an emergency physician and realize that, "This is the best job really was irritating, but he was right. Many words are used to in the world. I can't believe they actually pay me to come describe character -- honesty, reliability, trustworthiness, caring, to work." I selflessness. As a physician, character is being the doctor that you want to take care of you when your life is on the line.
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If an induction is necessary, your doctor or midwife will schedule it with you through the office. Keep in mind that if the Birthing Center is full, or another patient has a greater medical need, you may be delayed or rescheduled. Please call before you come in and the nursing staff will indicate if admission is possible, due to room availability and staffing. 1 ; Call 847-3830 at 3: 15 p.m. for cervical ripening later that day. The charge nurse will discuss with you when to arrive at the Birthing Center. 2 ; Call 847-3830 at 6: 00 a.m. for induction in the morning. You should be prepared to leave home immediately after making this call. The charge nurse will discuss with you when to arrive at the Birthing Center. Please be prompt in arriving at the hospital to ensure a quick start to your induction. Occasionally, your admission may be delayed due to the number of patients on the unit at the time. We will make every effort to get you in later that day. When you arrive at the hospital, be sure to check in at the admitting patient registration desk before coming up to the Birthing Center. Remember to bring all of the things that you packed for delivery, as well as things to help make you and your partner more comfortable for several days e.g., music, CD or tape player, pillows from home, snacks for partner, etc. ; . Also pack a bathing suit for your partner if he she intends to get into the tub with you. Please be sure to leave your valuables at home. Sometimes you will be sent home undelivered. Your provider will plan your readmission with you.
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Depression in cystinurics who have to have them for an extended amount of time. Stent tubes are safe to leave in for up to six months. They are often removed in a day unit without anesthetic with a Cystoscopy. Some cystinurics find that crystals form around the Stent tube which can make removal uncomfortable. Other cystinurics do not have any problem with stents tubes and prefer them to the nephrostomies. Non Invasive Procedures Extra Corporeal Shock Wave Lithotripsy ESWL ; This is a procedure where the sound shock waves are used to break up stones without the need for surgery. A lithotriptor comes in two forms. The patient either lies in a bath of warm water, under general anesthetic, and the shock waves a fired through this water onto the kidney. This is an older form of lithotriptor which is not always effective. The newer forms of lithotriptor use a table with a hole in it. A patient lies on the table and the dome which includes the shock wave mechanism is raised to meet the cystinurics back. There is often a rubber or silicone sheet filled with jelly or warm water between the patient and the mechanism. The dome is pressed into the patients back and the shock wave is fired. The shock waves are timed to the cystinurics heartbeat. It can take anything from 500 to 2000 shock waves to fracture the stone depending on the size and density of the stone. Monitoring of the progress is done by either ultrasound or image intensifiers. Careful placing or the sound shock waves is necessary to ensure accuracy. The patient must lie completely still duing the process. The process is not always painful although some cystinurics find the pain is either intense kidney pain, or irritating on the lines of water torture. Various drugs are used to control this pain. Usually lithotripsy is performed as a day case and a hospital stay is not necessary. Stone fragments are usually passed within 1-2 days but further treatment may be required. Please note not all makes of lithotriptors are effective in breaking up cystine stones and premphase.
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Mann, O.E. Book Chapter, Chronic Fatigue Syndrome. Therapeutic Choices 4th Edition. The Can Pharm Assoc 2003: 569-576. Peltekian KM. Viral Hepatitis . Therapeutic Choices, ed. Gray JD. Canadian Pharmacists Association 2003; 470 - 484 deGroot, M., Phillips, S.J., Eskes, G. Fatigue associated with stroke and other neurologic conditions: Implications for stroke rehabilitation. Arch Phys Med Rehabil November 2003; 84. Phillips, S.J., Gubitz, G. Acute ischemic stroke. In: Gray J., ed. Therapeutic Choices. Ottawa, ON: Canadian Pharmacists Association 2003: 261-271. Phillips, S.J. The growing burden of heart disease and stroke in Canada 2003. Heart and Stroke Foundation of Canada Editorial Board. Purdy, R.A., Kirby, S. Headache and brain tumors. Neurol Clin N 2004; 22: 39-53. Rayson, D., Metabolic and nutritional complications neurological therapeutics: Principles and Practice: J. Martin-Dunitz, Noseworthy ed ; 2003: 843-848. Rocker, G.M. Controversial issues in critical care for the elderly: A perspective from Canada. Crit Care Clin, 2003; 19: 811-825. Rockwood, K., Darvesh, S. Cholinergic drugs for Alzheimer's disease. In: Gray J. ed ; Drug Advances. Remedica Publishing. London UK. 2003; 1: 159-177. Sadler, M. Seizures and Epilepsy. In: Therapeutic Choices. Jean Gray editor ; . Canadian Pharmacists Association. 2003: 170-181. Sapp, J.L., Epstein, Laurence M. Supraventricular tachycardia. in: Irwin R and Rippe J, eds., Intensive Care Medicine, 5th Edition, Philadelphia, PA: Lipincott Williams & Wilkins, 2003; 437-452. Veldhuyzen van Zanten SJO. Now in Functional Dyspepsia. Editors - Burrough A, Feagan B, McDonald J. Publishers - British Medical Journal: 2004; Chapter 5. Weaver, D.F. Antiepileptic Drugs; fifth edition, edited by Levy, Mattson, Meldrum, Perucca, Lippincott: Philadelphia 2002 for Canadian Journal Neurological Sciences 2003; 30: 179-179. Wood, L.A., Renal cell carcinoma: Cambridge Handbook of advanced cancer care. M.J. Firsh and E. Bruera ed ; , Cambridge University Press 2003.
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