At Their Best by Pat Conrad MD

University Medical Center of Southern Nevada, mass casualties:  the shootings in Las Vegas have locked the national attention and horrified everyone watching.  I’ve no interest in the politics of the scene, and am not here to discuss the motivations, terrors, opposing views, or potential societal consequences of this nightmare.

This site celebrates “authentic” medicine, and advocates for physicians at their best, doing what they and we all want them to do.  At this writing, 59 are dead and many others wounded, some grievously.  There are a plethora of decent internet stories that can give you the numbers of surgeons, ER docs, nurses, trauma bays, shuffling, and adaptations that have gone on to handle what must have felt like a tidal wave to the folks at the back of the ambulances.  I’ve only worked in small ER’s in rural areas, which can get dicey sometimes, but “mass casualties” is something we give occasional lip service too, a virtual drill every couple of years, and never, ever expect to see.  To be at the epicenter of true mass casualties in a major city must have been an experience almost as wrenching for the medical teams as for many of the victims.

Those of you who read my stuff know there is a lot that I really dislike about modern health care, and what it has done to this profession.  But there is at least one thing that I truly love about it.  At every stage of my medical career, from medical school through residency, in offices, urgent care clinics, hospitals, mission trips, and ER’s, there has been one consistent, wonderful fact:  whenever someone is truly sick, or really injured, from the most junior housekeeping staff to the most senior surgeon, and everyone in between, dives in to help the patient.  I have never once seen an exception to this, and I really admire it as all of us at our best.

Sunday night the very best in bystanders, first responders, police, fire, and EMS personnel was immediately evident.  And though the cameras won’t show it, you and I know that the teams in the hospitals from top to bottom were on their game and practicing truly authentic medicine.

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  11 comments for “At Their Best by Pat Conrad MD

  1. Sung Kim
    October 3, 2017 at 11:44 pm

    The reason why we are practicing the art of medicine ….. Equanimity under Duress

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    • JAMES
      October 4, 2017 at 9:02 am

      HOSPITALS DO NOT CHARGE EQUALLY. NOT EVEN WITHIN THE SAMRE HOSPIITAL
      YOU HAVE 3 PATIENTS ALL COME IN FOR THE SAME THING.
      ONE HAS INSUANCE A
      ONE HAS INSURANCE B’
      ONE HAS NO INSURANCE
      ALL 3 ARE BEING CHARGED DIFFERENT AMOUNTS FOR THE SAME THING.
      WHAT I AM CALLING FOR IS A SET PRICE LIST .
      EVERYONE CHARGED THE SAME FOR THE SAME THING.
      AND PRICES UP FRONT.
      SO YOU KNOW IF YOU CAN AFFORD IT OR NOT.

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  2. JAMES
    October 3, 2017 at 3:48 pm

    WHY WAS HTIS COMMENT OF MINE DELETED TOO?
    I KNOW THIS IS NOT REALLY THE STORY BUT SINCE THIS JUST HAPPENED TO ME AND I’M ON HERE I WILL WRITE IT.
    WENT TO THE DOCTOR YESTERDAY. HE GAVE ME A PRESCRIPTION FOR FLONASE NASAL SPRAY. AND CALL IT INTO WALLGREENS.

    MY MOM CALLED WALLGREENS AND THEY SAID IT COSTS 77 DOLLARS.

    I WENT TO PICK IT UP JUST NOW THIS MORNING. THE LADY AT THE COUNTER ASKED FOR MY INSURANCE AND I SAID I DO NOT HAVE INSURANCE.

    SHE SAID I SHOULD BUY IT OVER THE COUNTER THEN CAUSE OF THE PRICE.
    THE PRICE WAS 19.99 ON THE OVER THE COUNTER SHELF.

    WALLGREENS WAS GOING TO CHARGE AN INSURANCE COMPANY 77 DOLLARS FOR THE SAME EXACT BOX.

    I APOLOGIZED TO THE LADY FOR THE MIX UP. BUT NOW I AM THINKING ABOUT IT.

    NO WONDER THE COST OF INSURANCE PREMIUMS IS SO HIGH.

    IF WALLGREENS CAN LEGALLY CHARGE THE INSURANCE COMPANY 77 DOLLARS FOR THE SAME EXACT BOX PRODUCT THEY ARE SELLING OVER THE COUNTER FOR $19.99.

    SOMETHING WRONG.

    NOT TO MENTION I AM RELEGATED TO HAVE TO SEE A STUDENT DOCTOR FROM RUTGERS AT CENTRASTATE, WHO HAS TO RUN EVERYTHING BY HIS ATTENDING DOCTOR .

    I HAVE NOT BEEN ABLE TO BREATH OUT MY RIGHT NOSTRIL FOR 25 MONTHS STRAIGHT NOW.

    YET THEY THINK I HAVE DIVICTULITAS/ DIVICULOSES. WHICH IS THE POOP MECHANISM INSIDE YOUR BODY DOWN THERE. CAUSING THE HIGH WHITE BLOOD COUNT,….

    MEANWHILE ME HEAD FEELS LIKE IT IS GOING TO EXPLODE EVERYDAY, AND IT IS GETTING UNBEARABLE TO NOT BE ABLE TO BREATH OUT MY RIGHT NOSTRIL.

    UGGG.

    OF COURSE THE HIGH WHITE BLOODCELLS COULD ALWAYS BE THE ONSET OF MULTIPLE MYELOMA TOO.

    I’M GOING TO DIE. I KNOW IT.

    DAMNIT.

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  3. JAMES
    October 3, 2017 at 3:47 pm

    WHY WERE MY COMMENTS DELETED??
    IT IS LEGITIMATE TO WONDER HOW MUCH MONEY THE HOSPITALS AND DOCTORS ARE MAKING OFF THIS
    ===============================================================
    GOT THE HOSPITAL BILLS TODAY. SEPT 30, 2017

    WENT TO THE ER 830AM SEPT 8, WOUND UP BEING ADMITTED OVERNIGHT TO TO THE HOSPITAL FOR A HIGH WHITE BLOODCELL COUNT. IV ANTIBIOTICS

    I WENT THERE SAYING I FELT LIKE I HAD TO PEE AND I THINK IF I POOP I CAN PEE

    WHAT I THOUGHT MIGHT BE 2-3 HOURS IN THE ER, AND 1000 DOLLARS AT THE MOST

    WOUND UP COSTING  $19,781.90

    THATS INSANE

    I CANT PAY THAT.
    I HAVE NO MONEY. I DIDNT THINK IT WOULD COST ANYTHING LIKE THIS.

    FROM MY RESEARCH AN ICU ROOM AVERAGES 600 A NIGHT
    THEY CHARGING ME $5,824 FOR ONE NIGHT IN A REGULAR HOSPITAL ROOM.

    THE PROBLEM ISNT THE HEALTH INSURANCE

    THE PROBLEM IS THE INSANE COST TO WALK INTO THE ER FOR WHAT ONE BELIEVES TO BE A MINOR MEDICAL PROBLEM

    =========================-===================
    HERE ARE TRHE CHARGES
    TOTAL  $19,781.90

    ALCOHOLS -220

    BLOOD COUNT 126

    COLLECTION OF BLOOD 44

    METABOLIC PANEL 166

    COMPUTED TOMOGRAPHY – 4669

    CULTURE – 436

    DRUGS  34.95

    ELECTROCARDIOGRAM – 239

    ELECTROCARDIOGRAM 26

    EMERGENCY DEPT VISIT – 3000

    IV – 709

    IV – 486

    IV SOLUTIONS 56

    LACRTIC ACID – 376

    LIPASE – 124

    HOSPITAL ROOM – 5824

    MED SUPPLIES – 19

    PROTHROMBIN – 78

    RADIOLOGICAL – 577

    PROPHYLACTIC – 209

    THROMBOPLASTIN – 87

    URINALYSIS DI[P STICK 83

    BLOOD COUNT 126

    REACTIVE PROTEIN 142

    COMPREHENIVE METOBOLIC PANEL 166

    DRUFS 7.95

    LAB 365

    LACTATE 188

    MAGNESIUM 127

    PHOSPHORUS – 70

    EMERGENCY ROOM SERVICES – 1001

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    • Doug Farrago
      October 3, 2017 at 9:34 pm

      This was not the right place for this comment. “THE PROBLEM IS THE INSANE COST TO WALK INTO THE ER FOR WHAT ONE BELIEVES TO BE A MINOR MEDICAL PROBLEM”. Don’t go to the hospital for minor problems! Go to a family doc. This is my last response to you. If you continue to give unrelated responses they will be deleted.

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      • JAMES
        October 4, 2017 at 8:52 am

        WHAT DO YOU MEAN YOU R LAST RESPONSE TO ME?
        YOU THINK A WHITE B;LOOD CEL CPOUNT OF 28 IS A MINOR PROBLEM?
        WHAT KIND OF DOCTOR ARE YOU ANYWAYS?

        THIF A PERSON CAN BE CHARGED 20,000 FOR THE VISITI I DEXCROBED,.. THEN A GUN SHIT MUST BE WHAT OVER 100,000 DOLLARS AT LEAST RIGHT?
        THESE DOCTORS AND HOSPITALS ARE MAKING A KILLING ON THEIS TRADGEDY

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    • Sonny
      October 3, 2017 at 11:50 pm

      So how much did you pay??? And that’s one of the reasons why the healthcare is so expensive. Goto an urgent care center….. get a health insurance ….. get a primary care giver….. don’t blame the doctors and healthcare providers. I will send you my bill just like a lawyer. Nothing is free.

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  4. George Voigtlander
    October 3, 2017 at 8:29 am

    A character in Curt Vonnegut’s Timequake said that the secret to happiness is to notice when things go right. The docs, nurses and first responders will probably be ignored. As pointed out above, they made things go right.

    The politicians will try to pass laws to further limit access to firearms. There is only one level one trauma center in the entire state of Nevada, the consequence of irrational regulation and tort system. Why not address a real problem of counterproductive rules? What if this happened in Reno which does not have a level one trauma center, the state ‘s tort system has driven out neurosurgeons willing to take trauma call.

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  5. Steve O'
    October 3, 2017 at 7:36 am

    Trauma Centers were all rockin’ and rollin’ with the awareness – now is the time to do your best, to do what you need to do to help the patient. I’ll bet the lifesavers made the worst notes of their life “Gave ringers, clamped bleeder, BP stable, slight tachycardia.” I’ll bet the night saw the worst quality measures in a decade. No questions about seat belt use – how incomplete! A1C’s were unchecked! And not counseled on! I’ll bet there were scads of improperly-handed consents, hundreds of forms not filled out – critical forms! Lives were saved without proper documentation!
    It was a disaster for bureaucracy – to see what doctors and nurses really do when they are allowed to. You rock, LV docs!
    Quis inserviat quo et quare? means – Who serves whom, and why? Last night, it was the hospitals and community serves the first responders and trauma staff, for the purpose of saving the citizen. That’s the way it always should be.

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    • Pat
      October 3, 2017 at 3:34 pm

      Steve, I insufficiently addressed an aspect which you emphasized: when it’s real, the BS goes out the window. Thanks for your comment. Pat

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