A 55-year-old woman with diabetes, hypertension, obesity (BMI 45 kg/m2), and obesity hypoventilation/obstructive sleep apnea (OHS/OSA) presented to an Emergency Department with dyspnea and somnolence of 2 days duration. Arterial blood, sampled while she breathed 50% oxygen via face mask at a rate of 22 breaths per minute, revealed a pH 7.26; PCO2 80 mmHg; PO2 150 mmHg ; [HCO3] 35mEq/l; BEecf 8.3 mEq/l. She was intubated for hypercapnic respiratory failure and admitted to the intensive care unit.
Questions regarding the pathophysiology and hospital-based management of obesity hypoventilation syndrome addressed by Drs. Roberta Goldring, Kenneth Berger and Beno Oppenheimer at New York University School of Medicine.
A few weeks ago, I contacted several PCCM fellowship directors to ask that they encourage fellows to share teaching conferences and points-of-view on the ATS blog. I received no response from two directors but a third was eager to engage.
For the record, this PD is a great talent. He is a nation-leading educator, scientist and – by all accounts -an excellent clinician. I’ll distill and paraphrase his response: fellows only have 3 years to get a huge amount accomplished. It would be a disservice to encourage them to produce content for the blog, deflecting their limited time/attention away from their once-in-a-lifetime opportunity to build the foundation of an academic career. Incisive on first glance.
Some complex concepts are better caught than taught. Professionalism in Medicine is an acquired demeanor perceived by patients, their families, health care workers, and trainees to indicate that the physician has commitment to the needs of the patient, clinical competence, compassion, integrity, and self awareness (1-3). Each of these attributes have their roots in qualities of the exemplary physician: excellence and compassion.
Our lives outside Medicine can fortify and enrich us. We invite readers to submit their “extracurricular” creativity to decorate our scientific offerings.
Phil Cozzi is an award-winning physician-poet and this is his second submission to the AnnalsATS blog. You can read his first piece, Respecting Fredo, here.
The intuitive mind is a sacred gift
The rational mind is a faithful servant
We honor the servant
And have forgotten the gift.
– A. Einstein
SCIENCE: During a 50 year career in Academic Medicine, I used the scientific method of inquiry to investigate the pathophysiology and treatment of disease. Science is the evidence based generation of knowledge. Using reproducible accurate measurements, scientists formulate hypothetical explanations of phenomena, and then we conduct experiments to falsify each hypothesis. Those explanations that could not be falsified are the truth. We go to this trouble to avoid the errors arising from people’s tendencies to observe what they expect. But the scientific method is slow and tedious, has little to say about subjective phenomena of great interest, and the requisite controls for each intervention can obscure the question under study 1,2.
If a higher power wants to tell us how the Cosmos works, scientists would be wise to learn how to listen to god’s voice. In my memoir Science, Belief, Intuition1, I describe how a person can pursue a productive career as a clinician scientist while cultivating a spiritual relationship. Yet many scientists act as if science and spirituality are antagonistic, so they must choose between them². Some of those choosing science feel the need to discredit spirituality as if it’s existence threatens science or reason, when what it threatens is materialism as a doctrinal world view3.
We on the two coasts of the U.S. were thumped last week by what is sure to be the ugliest national election of our life-time. Politicians will perform “autopsies” to examine how/why a great country has chosen a President whose behavior throughout the election was decidedly (probably purposely) un-presidential. Aside from the extraordinary intuitions and showmanship of this modern PT Barnum, there may be interesting and relevant parallels in Medicine.