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I was called to your room in the middle of an overnight shift. There you were, breathing quickly, neck veins bulging and oxygen levels hovering despite the mask on your face. I placed my stethoscope on your back and listened to the cacophony of air struggling to make its way through your worsening pneumonia. “We’re going to place a tube down your throat to help you breathe,” I told you. Your eyes were pleading, scared. “We’ll put you to sleep. It’ll help you breathe more comfortably. Okay?” You nodded. You had already told the doctors who cared for you during the day that if your breathing worsened, you would agree to intubation to allow more time to treat your pneumonia. So I called for the anesthesiologists. Minutes later, you were sedated and intubated, silenced — maybe forever. I thought about you recently, when I read a poignant Perspective in JAMA Internal Medicine : “Saving a Death When We Cannot Save a Life in the Intensive Care Unit.” In this piece, critical care

For many people receiving care in a hospital or emergency room, one of the most common occurrences (and biggest fears) is getting an IV, the intravenous catheter that allows fluids and medications to flow into a vein in your arm or hand. A trained health professional puts in an IV by sticking a needle that’s inside a thin tube (catheter) through the skin into a vein. Once inside the vein, the needle is removed. The catheter is left in the vein and taped down to keep it from moving or falling out. While IV lines are typically painless, the initial needle stick can be quite painful, especially for those who are a “difficult stick” (when the needle misses the vein, requiring multiple attempts). IVs can be medically needed when the digestive system isn’t working well, to receive more fluids than you’re able to drink, to receive blood transfusions, to get medication that can’t be taken by mouth, and for a host of other treatments. In cases of massive bleeding, overwhelming in

When it comes to protecting brain health, you may think about exercise, diet, or engaging in activities that challenge you. Yet most of us hop into the car to travel to work, do errands, go on vacations, or drive the kids’ carpool as a matter of habit. But driving is a huge responsibility. One miscalculation on your part or the part of another driver and the results could be disastrous. Staying safe in the car not only protects your body, but also your brain. Follow these common-sense tips and recommendations, understand the law, and never take chances. Safe driving means never drive if you are feeling woozy, overtired, or can’t see properly Perhaps your young child has kept you awake for most of the night, and you can tell as you prepare your morning cup of coffee that you are shaky and slow. This is a good day to use public transportation (maybe you can catch a brief nap if you can grab a seat), call a friend for a ride, or use Lyft. Think about backup options for travel, and remembe

During the first year of life, naps are crucial for babies (who simply cannot stay awake for more than a couple of hours at a time), and crucial for parents and caregivers, who need breaks from the hard work of caring for an infant. But as children become toddlers and preschoolers, naps aren’t always straightforward. Children often fight them (following the “you snooze you lose” philosophy), and they can conflict with daily tasks (such as school pick-up when there are older siblings) or lead to late bedtimes. Here are some tips for making naps work for you and your child — and for knowing when they aren’t needed anymore. Making naps work for your baby Most infants will take at least two naps during the day, and early in toddlerhood most children will still take both a morning nap and an afternoon nap. Naps are important not just for physical rest and better moods, but also for learning: sleep allows us to consolidate new information. As children get older, they usually drop one of the

Writing in the October 10, 2018 New England Journal of Medicine, Eve Rittenberg, MD, assistant professor at Harvard Medical School and practicing physician at Brigham and Women’s Fish Center for Women’s Health, reflects on the impact the Kavanaugh hearing and #MeToo movement have had on patients who have experienced sexual violence. Important principles of trauma-informed care—including ways to ask permission, offer control, and find support—described in her article and in Monique Tello’s post below can make a real difference to many women and health care professionals alike. Many years ago, when I was a trainee, I helped take care of patients at a family medicine clinic.* One day, a school-aged brother and sister came in for their annual physicals. They were due for vaccines. Neither wanted any shots, and they were both quite upset. “You’ll do what the doctor tells you, is that clear?” ordered the mother. She and the nurse worked together to hold the sister’s arm down. But just as the

A new guideline from the World Health Organization (WHO) aims to help reduce steadily rising rates of caesarean sections around the globe. While crucial at times for medical reasons, caesarean births are associated with short-term and long-risks health risks for women and babies that may extend for years. In June 2018, Serena Williams told Vanity Fair about her journey to motherhood, including the story of how she nearly died a few days after giving birth. In September, Beyoncé punctuated her Vogue cover with the story of how she developed a life-threatening pregnancy condition called preeclampsia, which can lead to seizures and stroke. Throughout the summer, headlines like “Dying to Deliver” and “Deadly Deliveries” and “Maternal Mortality: An American Crisis” popped up on newsfeeds and streamed on screens across America. As a professor who studies safety in pregnancy, I was quoted in many articles and media features. I explained what the harrowing stories indicate about our health sys

Dividing cells face daunting challenges when replicating the billions of letters of DNA in their genomes. For instance, DNA letters in new cells can get mixed up, and then the affected genes don’t function correctly. To fix that problem, healthy cells can deploy so-called mismatch repair (MMR) genes that put scrambled DNA letters back in the correct order. But when those genes are themselves defective, then this repair system breaks down. And as a result, cells develop a progressive condition called microsatellite instability that leaves them vulnerable to cancer. Those sorts of defects are shared by many different tumor types. The good news is that they are susceptible to the killing effects of an immunotherapy drug called pembrolizumab. The FDA approved that drug last year for all MMR/MSI-positive metastatic cancers, regardless of where they originate in the body. Pembrolizumab works by prompting the immune system’s T cells to recognize and destroy cancer cells bearing this genetic b

Alcohol is embedded in our society, and it is difficult to be in a public space without seeing a reference to alcohol or being offered a drink. Alcohol is broken down in the liver by an enzyme called alcohol dehydrogenase. People with a variant in this enzyme have issues with metabolizing alcohol and can develop total body flushing or reddening of the skin. Alcohol consumption has been associated with pregnancy defects, liver disease, pancreatitis, high blood pressure, coronary artery disease, stroke, cancer, addiction issues, and physical injury (trauma to self/others with acute intoxication). The health benefits of alcohol may be up for debate. However, moderate alcohol consumption may have some beneficial effects, which was appreciated in 1992 based on the observation that populations in France had high dietary intake of saturated fats, but a relatively low incidence of cardiovascular disease. This phenomenon was labeled as the “French paradox,” and has been thought to be due in par

Here’s why parents need to know about e-cigarettes. First, many more teens are using them. In 2017, 3% of middle school students and 12% of high school students reported using them, and while that may not sound like a lot, since 2011 use has gone up about 500% in middle school and 800% among high school students. And, e-cigarettes can be dangerous. How e-cigarettes work E-cigarettes are basically delivery devices for nicotine, the addictive chemical in tobacco. The hope of the Food and Drug Administration (FDA) is that they might possibly decrease smoking — which would be great, as smoking is the leading preventable cause of death in the United States. It’s the smoke itself that causes the vast majority of the health risk, so the idea was that perhaps if you gave people a way to inhale nicotine that didn’t involve burning tobacco, you might get them away from tobacco, especially if you were able to gradually decrease the amount of nicotine they inhale. The problem is that not only did