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I think that one of the best things we do in the ICU is when we allow people to die with some degree of peace and respect. We recently had a Cambodian patient, on life support, with no hope of recovery. Discussions were started with family about withdrawal of care. And while they were in support of the idea, their concern was that he somehow had to die at home, and not on a Tuesday.  I understand the dying at home part, but I was never clear on what it would be bad for him to be allowed to pass on a Tuesday. It had something to do with his Buddhist religion, but I was never informed of the specific reason. I would have asked all the monks that where there in their orange robes, but none of them spoke English. So when Wednesday morning rolled around, the monks and family gathered in the room, the ambulance crew showed up. We loaded him onto the stretcher and literally pulled the breathing tube out as he rolled out the ICU doors. Medics were instructed to NOT check a pulse, NOT check for breathing, not to do anything other than get him home as quickly as possible. And, under no circumstances, where they to come back to the hospital. It was the best thing we did in terms of patient care all month.

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One of the things in medicine that most amazes me, is when a woman chooses to have prophylactic mastectomies. I can only imagine how difficult a decision that must be to make for a woman, or anyone facing a similar choice. I say this as I had a 25 year old patient who had undergone elective bilateral mastectomies a few months ago, and was presenting with breast pain. Now, most of the young people I see in our ED’s, especially the women, for whatever reason, seem to be a good 5-6 years behind on the mental maturity curve. I’m sure the guys are just as far behind, and that’s probably why they don’t bother coming to the ED, haha. But, this woman was different. Maybe she was just innately mature, or perhaps it was having to make such a  heavy decision at such a young age that made her grown up fast. Regardless, she was incredibly impressive in her outlook towards her situation, and her life in general, and was true pleasure to be able to treat.

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I was in seeing an older couple, probably late 60’s, the wife having come in for chest pain. They were recent immigrants from Turkey, if I had to guess, within the past few years. The husband had a basic grasp of English, but hers was still a work in progress.  Culturally, they were still obviously working on acclimating, the husband wearing a bright red, entirely too tight tank top, and leather biker’s cap, on a freezing cold winter day.  They were both very pleasant people, trying their best to understand what was happening, but anxious nonetheless, despite multiple reassurances, both very concerned that I was admitting her to the observation unit for a chest pain rule out. Looking back, their anxiety makes sense, I can imagine that in other countries being admitted into the hospital must be a pretty big deal, and probably only happens if you are pretty sick.  Not necessarily so in this country, but a topic best discussed elsewhere. After multiple trips into the room to answer all the husbands various questions and to reassure the wife that she in fact was not dying, I noticed that they both were wearing matching necklaces. The necklace was a gold chain attached to a black leather triangle, maybe 3cm at it’s widest point, and it actually appeared to be a pouch of some sort. On my final trip into the room, I couldn’t help but ask about the necklace and what it was. The husband turned to me slowly, and put his finger to his lips is a “shhh” gesture. He leaned in close to me, and whispered in heavily accented english “ Wife and I are exiled Turkish royalty, necklace contains key to safe deposit box. BIG stacks of money”, making a wide gesture with his hands.  He must have seen the incredulous look on my face, because he waited a few seconds before him and his wife both broke out laughing. Realizing it was joke, made extra funny given the language barrier, I couldn’t help but cracking up too. He then explained it was a prayer necklace, not in fact a pouch holding a key to untold riches.

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