How Old is Too Old?

Yesterday I saw a 90 year old woman in consultation.  She presented to the emergency room in September with abdominal pain, and in the process of working her up, a chest X-ray was taken which showed an infiltrate in her lingula, part of the left lower lobe of her lung.  As it turned out, there… Continue reading How Old is Too Old?

How Do I Know This is Working?

This is the question I get asked the most:  “So Doc, how do I know that this is working?”  Sometimes my patients come to me with visible or palpable disease—something on the skin that they can see fading away, an enlarged lymph node in the neck that shrinks visibly during treatment, a lump or a… Continue reading How Do I Know This is Working?

TANSTAAFL, or There Ain’t No Such Thing as a Free Lunch!

Robert Heinlein got it right.  In “The Moon is A Harsh Mistress”, sometime in the future, we colonize the moon.   But we don’t send our best and brightest, we send our criminals, our misfits, our dregs of society.  They eke out a hard living in this future penal colony:  their language becomes muted, shortened;  their… Continue reading TANSTAAFL, or There Ain’t No Such Thing as a Free Lunch!