I met patient who was presenting for a pneumonectomy. He had had several back procedures for stabilization of his thoracic spine due to fractures after a fall. When I walked up to his bed, my first impression was the look of pain on his face. Even though he was on over 200mg of Oxycodone a day, his pain score was 8 out of 10!

The sad bit is that most medical providers may not believe how much pain he is in. This guy needs adjuncts like clonidine and neurontin in addition to the opioiod. One may even consider methadone. The oxycodone alone does not cut it at this point.

I am not very interested in chronic pain management but his case made me realize how important that field is.

jnkdg

In May of 2006, there was an article in the WSJ about how a Dutch economist was studying the behavior of contestants on shows like “Deal or No Deal” to predict how people make economic decisions (http://wsjclassroomedition.com/archive/06may/cons_edmay.htm). I watch it as study of how people invest and trade.

The show is entertaining (not only because of the hot models), but because it constantly depicts how greedy and stupid the human being can be. It explains why Vegas casinos are still in business and why people loose money investing and trading.

One of the first lessons I learnt in my quest to understand the art of trading and investing in the stock market was, “Know why you bought a particular stock and know when to sell it and above all, stick to your plan.” Why do I bring this up? Well imagine you bought a stock at say, $45 and plan to sell it when it hits $50. Well, lets just say it hits $50 but looks like it might go to $55. Do you hold on or sell like planned? I say, stick to your original plan. Have some discipline!

How does this relate to “Deal or No Deal”? Why can’t contestants set themselves a monetary value they want to win? If one hits that amount, deal! You walk away with money you did not have in the first place.

I guess, in reality it must be tough to do. Gambling it all away looks easier. I guess being a winner takes more discipline than most people can muster.

A 30-year-old woman with a history of cystic fibrosis is on the lung transplant list. One morning in early December, she gets the call to go into the University Center for a double lung transplant. Her answer: “I would prefer my transplant after the holidays.”

A 54-year-old man on the liver tranplant list is asked to come in on Thanksgiving Day for a liver transplantation. His answer: “Today is not a good day.”

A 61 year-old man was in the University Hospital waiting for liver transplantation. Harvesting of the donor liver was being held up because problems placing the heart. The patient had been NPO for about 12 hours. The anesthesiologist would not let him have anything other than clear liquids so he left the hospital and opted to forego his transplant.

What should be the next course of action?