Gerald O'Malley, DO

We are deep into interview season now. Fresh scrubbed senior medical students come from all over the world to sit in front of my desk, drink bad coffee, eat stale donuts, and regale me with their self-congratulatory exploits of derring-medical-do, sprinkled with an appropriate amount of wanting-to-serve-humanity humility.

Physicians Practice blogger Gerald O'Malley continues his tour in Hanoi, Vietnam, taking us deeper into the emergency department and poison control center of Bach Mai Hospital.

Physicians Practice blogger Gerald O’Malley attended the Asia Pacific Association of Medical Toxicology annual conference in Hanoi, Vietnam and while there, toured a local emergency room and poison control center.

An ER doc checks the status of a memorable patient.

“My doctor sent me in to be admitted. Is he here yet? I packed my bag and rushed right over, so I probably beat him in getting here. I hope he had time to finish his dinner.” I almost burst out laughing. The situation would almost be charming in a quaint 1950s television kind of way. This little old lady with her nonurgent problem had called her primary-care doctor’s office and had been instructed to hurry on over to the ER.

Whatever happens in the election I can only hope that the new Congress will repeal the monstrous power grab disguised as healthcare legislation that was rammed down the gullet of the country earlier this year. How any physician or healthcare professional can possibly support this disaster is simply beyond my understanding.

Running late. Monday afternoon. Busiest shift of the busiest - Ow! Banged my shoulder - busiest day of the week. Duck through the waiting room. Standing room only. Alan looks frazzled. Three people waiting for him to get off the phone. We make eye contact and he rolls his while silently mouthing “Shoot me” - then points animatedly toward the trauma room.

There are a lot of meetings and conferences in the fall, and this year I typically overcommitted to several of them. Jet-setting across the country is great when you are Mick Jagger, but it really stinks stuck in coach or ripping off your clothes for security. How did we get to this point? Flying is such a god-awful pain in the neck that I’ve come to dread meeting season.

Connor Carter loved to practice riding his unicycle. His father called him “Superman.” Connor loved his dogs and sports and music and good food. He was quick-witted and kind and gentle. In short, he was a healthy, well-adjusted, happy, self-confident, and marvelously normal 14-year-old boy. Whether or not the fentanyl patch caused the death of Connor Carter is something that will probably never be known.

Bill Carter had been misled and information about the death of his son had been withheld and misrepresented by the District Attorney's and coroner’s offices of Lancaster County. Jon Rutter, a newspaper reporter from the local Lancaster newspaper, took an interest in the case and published a series of reports that brought public attention to the case.

It was clear that the levels of oxycodone, fentanyl, and promethazine in Connor Carter’s post-mortem samples were not consistent with any previously published reports of death associated with any one of those agents or any combination of them.

Shorty after Connor’s death, Bill was notified that the Lancaster County District Attorney’s office was considering charges of manslaughter and narcotics trafficking against him. Bill’s oldest son is an attorney and had become aware of the DA’s actions through professional contacts, so Bill sought the advice of an attorney and after some legal investigation was told, “Someone wants your medical license.”

Several weeks into 2009, Dr. Carter was notified that the district attorney of Lancaster County was bringing criminal charges of narcotics trafficking (diversion) and manslaughter against him.

As I looked out on my audience of uniformed physicians and nurses, the stories of destroyed lives and war ran through my mind and I thought, “Does anybody besides the military remember that we are fighting two wars?”

The surgical attending said to me, “The more pain he has from his ulcer, the more he will realize how serious this is, and the more likely he will be to consent to the surgery.”

My guilty pleasure this summer was reading “Here’s the Story,” an autobiography of Maureen McCormick, Marcia Brady from the Brady Bunch TV series ($4.99 in the discount bin at Borders). It’s a pretty typical tell-all book and it’s a fun read and it reminded me why I hate taking care of drug addicts so much.

Eminem's new song is disturbing and not easy to listen to, but as art it has merit. But not the video: If Eminem was truly smart or courageous he would not have allowed his music to be corrupted or himself to be used by the makers of this soft-core Hollywood porn.

The shout comes like a rifle shot through the calm. “There’s an unresponsive patient in the back of a car!” Aaron the security guard holds the door open as we bolt into the waiting room and out into the ambulance bay, the nurses following with a stretcher.

These people have been my patients for so long that, like it or not, they feel like family. They depend on me and in a weird way, I think I need them too.

I was required to perform many post-rape exams when I was a resident and in the Navy and when I resigned my commission I swore that I would never do one of those horrible exams again.

Police cars, ambulances, TV reporter - something big was happening.

I ended my shift angry at the unfairness of it all - the young narcissistic addict who doesn't want to get better and the death sentence for the one who wants to reclaim his life. Who is to blame for this young man’s dash toward self-destruction? I blame the do-gooders.

When your job is to wade everyday through the quicksand of tragedy and sorrow and hate and violence that fills an emergency room, the people that stand by you are your lifeline.

Male nurses have to be the toughest guys in the ER but they also have to know when to turn it off. The meanest, saltiest, crustiest ER nurse becomes a quiet, tender bodyguard around a sick or injured kid.

I could not be the doctor or man that I am without having befriended and been taught by the nurses I’ve known. I write about this now because I’ve accepted a new position in a different ER here in Philadelphia and I’ll be saying goodbye to some nurses that I’ve know for almost 18 years. They are my family, as much as my wife and children and leaving them and this ER that I love is one of the hardest things I’ve ever done.

The WHO has been accused of exaggerating the potential health consequences of the H1N1 pandemic, causing “unjustified fear” about the H1N1 virus. One possible explanation for the hysteria and hand wringing? Members of the WHO advisory committee have financial ties to pharmaceutical companies that make flu virus vaccines.

When I was a kid, my mother and teachers reminded me to mind my manners by teaching me to say the magic word, which was “please.” Today I was reminded of the 21st century version of the magic word when one of my patients threatened to sue me. The magic word is no longer “please,” it’s “sue.”

There is a different vibe in the hospital at night. In the wee hours of the morning, things are less rushed, and conversations seem to have an intimacy that they don’t have when the sun is shining.

It seems that now the healthcare bill has passed, the people that passed it are actually reading it and understanding has started to sink in. This horrible legislation will cost billions and not actually result in anyone having any increased access to healthcare.

What would a lawyer say about the five minutes that just passed? “What do you mean you didn’t know what the diagnosis was? What do mean you didn’t wait for her companion to return before paralyzing this patient? Aren’t you trained to stabilize patients? Didn’t you consider that the companion might have important information?..."