If the Medical Intensive Care Unit has a scoreboard, I don't want to see it. Some days it feels like the home team always loses. Patients that look like they are about to recover take a nosedive. The real fighters eventually give up. The most hopeful clinicians must face the grim inevitable. But sometimes you just need one, good ...

I had a student ask me recently if I had a dermatoscope and if I could show her how to use it. The answer was simple enough. No, I don't need one. This of course led to the logical question...Why? This blog post was inspired by this exchange. The simplest answer to this question is that if I see something that looks abnormal, I biopsy it. ...

Her only enemy was time. There was too much of it. As my patient lay in her bed and slowly suffocated, each tick of the clock brought a desperate battle to stave off panic. Ms. M had dealt with her difficult lungs for years. Without explanation, the delicate tissues and air sacs had hardened and scarred; they stiffened and refused to ...

You don't have to break the law to fail a pre-employment drug test. In fact, you could lose your job just by using countless products hanging on the wall of your local gas station. That's because at my hospital, when an employee's urine drops into that little plastic device during a pre-employment drug screen, it is checked for ...

Above, a 75-year-old patient with stage 4 metastatic melanoma. He came to us after a staged excision and graft. The black dots are new satellite nodal mets. Above, metastatic satellite lesions on the scalp of the same patient. He had the original scalp lesion treated numerous times with LN2. The lesion continued to be treated with LN2 ...

So I go from working part-time as a nurse to not really working and just doing clinicals. My preceptors were pretty good about working with us regarding schedules, which was amazing because I have 2 kids and a crazy husband. This was more beneficial than I EVER realized! Now? I realize... Let's see... In my first three weeks, I've gotten ...

''ED personnel to the stabilization room in 5 minutes.''  This is a common overhead page in the ED where we treat patients with serious MVA injuries, gunshot wounds, cardiac arrest, respiratory failure, or altered mental status. As a student, my responsibility is to assist with CPR when needed and be the ''recorder,'' writing down ...

I was going to write a blog about neuro-syphilis because I just recently treated a 29-year-old patient for this condition, however, on reflection it seems more apt to discuss the enormous financial costs associated with her care. That being said, neuro-syphilis is a tricky diagnosis; I advise clinicians to read up on it. Syphilis is commonly ...

It's ironic that I wrote my last post on October 15, 2012, the 1-year anniversary of my one and only job as an NP. What a year! Or, rather, what a year and a half! The worst of times, yes (the end of a 30-year marriage in June 2011), but also the very best of times (Duke MSN/FNP in May 2011, certification in September 2011, dream job in ...

A 38 year old female presented to the clinic for a new enlarging black spot under her toe nail for six weeks. She declined trauma of any kind. Notable history includes strong family history of melanoma. Her mother had two melanomas, including one on her toe. Upon removal of the tumor of the toe, her mother lost the second, third and fourth ...