“These parents come to see us every day,” he says. “What can we do, through the parents, to promote the health and well-being of their high-risk newborns?”
Title: Assistant professor of medicine; medical director of inpatient palliative-care consultation
Institution: University of Texas Health Sciences Center, San Antonio
Year: 2009
RIV: “When to Depend on the Kinins of Strangers: An Unusual Case of Abdominal Pain” (clinical vignettes)
Publication: An article on the ethics of determining code status for patients with advanced cancer and a book chapter on the “last hours of life” for a forthcoming book on palliative care and hospital medicine.
As a medical resident, Dr. Morrow met a 27-year-old woman who had chronic abdominal pain and had made multiple visits to the ED for this complaint. The patient had a history of substance abuse and requested dilaudid for her pain—making it easy for staff to consign her to the stereotype of the difficult patient.
“I met her after an interesting finding,” he says. “It turns out that on the previous emergency room visit, she received a CAT scan, which showed duodenal and small-bowel thickening consistent with hereditary angioedema, although with an unusual presentation. As it happened, we had onsite a world expert in angioedema.”
The expert was able to confirm the diagnosis, Dr. Morrow says.
“By giving her this ‘legitimate,’ organic diagnosis, it just changed the whole dynamic of her relationship with her doctors,” he says. “She knew that they knew something was really wrong. The residents were empowered to have something to hang their hats on. And we were able to get better control of her pain.”
Dr. Morrow says he came on the scene late in the discovery process, but he helped to solve the puzzle, and then put together the abstract and poster that told the story of making the diagnosis.
“In my previous job, I was hired as a hospitalist but helped to build the palliative-care program within the hospital-medicine service,” he says. “In my current job, I was brought in to build the inpatient palliative-care-consultation service, although I still moonlight as a hospitalist to stay sharp.”
Dr. Morrow says he enjoys sharing stories of difficult cases and submitting case studies about them to medical conferences, often with clever titles incorporating puns (e.g. the 2009 SHM poster citing kinins, polypeptides in the blood that cause inflammation). Another example is “The Angina Monologues,” a story of an 82-year-old patient with chronic angina pectoris and complex pain syndromes that were difficult to bring under control. Palliative care also emphasizes patients’ stories, he says, in order to understand the person behind the diagnosis.
Larry Beresford is a freelance writer in San Francisco. References available at www.the-hospitalist.org.
References
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