Thursday, September 11, 2014
Doctor's Perspective
Remember, interns are training to be doctors

By Dr. Anthony Policastro
When medical students graduate, they become interns. Most people take for granted the fact that interns are in training. What they do not realize is that it can sometimes be difficult to face the obstacles that interns are subject to. I once had a very good intern. I diagnosed him with a short term memory disorder when I was his attending physician in July. He had very good coping skills and kept all the information on each of his patients on an index card. He would be able to quickly consult the card if he needed to look up something. He also carried around a great deal of reference material. Despite his weakness, his performance was outstanding. He continued to play to rave reviews for the next six months of his internship, however, he came to me in February to tell me that he was going to quit his internship. This made no sense and I asked him why. He told me that the internal medicine physician attending on his unit required all the morning presentations to be done from memory. He was not allowed to use index cards. Every morning was a disaster. I knew I just needed to get him through the month. I asked him what the hardest part of the presentations was. He told me that the multiple lab results created the most difficulty. I asked him if he could handle memorizing the five to six abnormal lab results that most patients had. He told me he could. I advised him to learn those for each patient because then he would know that all the other results were normal. When he got to the normal results, he should make up any normal number. The attending physician only cared if the result was normal. He didn't care about the exact number. The plan worked like a charm and he presented that way the rest of February. He went on to be one of the best residents to graduate from the Family Practice program. Another example occurred during the July 4th weekend in 1974 when I was a senior pediatric resident. The new interns had just started the week before. July 4th was on a Thursday and my intern had admitted a four week old patient with meningitis on Wednesday. The decision needed to be made whether to treat it as a bacterial infection or just observe since we were in the summer season of viral meningitis. Cultures were sent and the patient was treated as bacterial meningitis. On July 4th, we admitted an eight week old with pneumonia. We treated the pneumonia but the patient got sicker. It became apparent that we were dealing with a very serious viral pneumonia that would not respond to antibiotics. Over the next 48 hours the patient failed to respond. We increased the oxygen on the respirator to 100%, as high as it would go. We increased the pressure that we were using to hold the lungs open to as high as it could go. If we went any higher, we would blow the lungs out. The patient failed to get better. Saturday morning came and we made rounds with the attending physician. He asked about the patient with the meningitis. The cultures were still negative. They usually grew out bacteria in 24 to 48 hours in bacterial meningitis. He read us the riot act. We had over-treated a patient with viral meningitis. My intern was in tears. She had been up all night with a patient dying of pneumonia. Now she was being berated for over-treating another infant. She was ready to quit her internship after less than two weeks. I sent her home to get some rest after her 48 hour shift. I was cleaning up preparing to leave when I received two phone calls. One was from the ICU. The patient with the pneumonia had turned the corner and was starting to improve. She would recover and do well. The other call was from the laboratory. The spinal fluid culture on the four week old was growing out a very rare bacteria that grew slowly. The patient indeed had bacterial meningitis. By the time the intern returned on Monday, both patients were doing well and it was all because of her efforts. She performed admirably. She too went on to become a superb pediatric resident. We sometimes forget that interns are still students. They are in a relatively fragile position as they have to make life and death decisions for the first time. Sometimes those decisions can have profound effect on their ability to complete their training. If you have comments about this column or suggestions for other topics, send an email to Dr. Anthony Policastro at

DBCC offers peer mentor training The Delaware Breast Cancer Coalition (DBCC) announces a Peer Mentor Support Training for breast cancer survivors in the Allen Room at the Seaford Library and Cultural Center on Tuesday, Sept. 23. DBCC peer mentors are trained survivors who provide free one-on-one support and education to those newly diagnosed with breast cancer. The session will take place on Tuesday, Sept. 23 from 3:30 to 7 p.m. and a light dinner will be provided. Training is free and experience is not necessary. Registration is required and space is limited. Topics include listening skills, the mentorship role, confidentiality, problem solving, handling difficult situations, and reporting requirements. Trainees learn through lecture, interactive activities and role plays. To register, contact Connie Holdridge at 302-644-6844 or

Current topics in Medicare Are you one of the more than 157,000 Delawareans who have Medicare? Will you soon be eligible to receive Medicare? Do you know someone with a disability who doesn't have Medicare? If so, learn what is happening with Medicare in Delaware, and how to access valuable, free resources to assist you with managing your benefits. Join the Sussex County Advisory Committee on Aging and Adults with Physical Disabilities for its next meeting on Monday, Sept. 15. Ms. Janae Aglio, assistant director of the Delaware Medicare Assistance Bureau, will present, "Current Topics with Medicare in Delaware." The meeting begins at 10 a.m. at the Sussex County Administrative Offices West Complex, 22215 N. DuPont Blvd., Georgetown.

The public is invited to attend. For more information, visit the committee's page at

Stroke Support Group Nanticoke Memorial Hospital's next Stroke Support Group meeting is at 1:30 p.m. on Tuesday, Sept. 16, at the Seaford Library. The support group is designed for individuals who have survived a stroke as well as their families and caregivers. The two-hour support group meetings will consist of guest speakers and breakaway sessions, in which caregivers and stroke survivors will meet in two groups to discuss concerns, provide support, and allow for networking. Refreshments will be provided. Pre-registration is not required for this free support group. For more information, contact Nanticoke Memorial Hospital at 629-6611, ext. 8626.

Sleep apnea support group offered Nanticoke Memorial Hospital in Seaford is hosting the A.W.A.K.E. - Alert, Well, and Keeping Energetic, sleep apnea support group. A.W.A.K.E. is a free support group for people with sleep problems including sleep apnea, insomnia, excessive daytime sleepiness, restless legs and narcolepsy. The support group also focuses on the impact medications may be having on your sleep. Family and friends are welcome to attend. Meetings will be held from 2:30 to 4 p.m. on: Wednesday, Sept. 17 at the Sleep Disorder Center; Wednesday, Oct. 22 at the ground floor Nurse's Conference Room; Wednesday, Nov. 19 at the ground floor Nurse's Conference Room. There is no meeting in December. For more information about the group, call the Sleep Disorders Center at 629-6611, ext. 3815.

West Nile Virus found in chickens West Nile virus (WNV) has been detected in Delaware in blood samples taken from DNREC's sentinel chickens that are monitored for mosquito-borne diseases. The samples are collected as part of a statewide surveillance program conducted by DNREC's Mosquito Control Section. No cases of West Nile virus have been found in horses or humans so far in Delaware this year, with two cases found in wild birds in August. The virus-positive chicken results were reported to DNREC by the Delaware Division of Public Health Laboratory. The chicken was sampled at a monitoring station along the Delaware River in southeast Wilmington on Aug. 25. Based upon these positive virus findings, Mosquito Control will increase its mosquito population monitoring activities in this area and take appropriate mosquito control actions. Mosquito Control operates 20 monitoring stations with caged chickens statewide. The sentinel chickens are humanely kept and tended in the field. "So far in 2014, mosquito populations and occurrence of mosquito-borne illnesses have been a bit below normal, probably due to a relatively cool and dry summer," Dr. Meredith said, noting Delaware's numbers are similar to what's happening across the country. Dr. Heather Hirst, state veterinarian with the Delaware Department of Agriculture, said effective equine vaccines exist to protect horses from WNV and EEE. There are no approved WNV or EEE vaccines for humans. "Most people bitten by an infected mosquito won't get sick," said Dr. Karyl Rattay, Division of Public Health Director. "Others are not as lucky. The risk of severe disease, such as meningitis and encephalitis, increases with age resulting in the elderly being at higher risk for complications." Take common-sense precautions against mosquito bites. These include wearing long-sleeved shirts and long pants when outdoors in mosquito-prone areas, applying insect repellent containing 10-30 percent DEET in accordance with all label instructions, and avoiding mosquito-infested areas or times of peak mosquito activity around dusk, dawn or throughout the night. To reduce mosquito-breeding, people should drain or remove items that collect water. To help determine when and where control services are needed, Mosquito Control encourages residents in Sussex County to report intolerable numbers of biting mosquitoes by calling the Milford office at 302-422-1512.

Beebe to offer 3D mammography Beebe Healthcare will offer 3D mammography for patients beginning in October. 3D Mammography, or breast tomosynthesis, is the latest advance in digital mammography technology. 3D Mammography means earlier detection and fewer unnecessary biopsies for women. The 3D mammography machine takes multiple images of breast tissue using a low-dose scan. The technology improves the ability to see abnormalities in dense breast tissue, reducing the number of return visits. 3D mammography provides the greatest benefit to women with very dense breasts, who may be more likely to develop breast cancer, and those with a higher risk due to family history. Women who fall into these categories will be selected to have 3D imaging. The first machine will go into use in October and a second machine will be added in early 2015. It is fitting that Beebe Healthcare will start scheduling patients for this new breast care technology in October, Breast Cancer Awareness Month. "Beebe Healthcare will now be able to offer one of the most comprehensive breast cancer programs in the state," said Judith Ramirez, manager of Oncology Population Health. "We are the first in Sussex County to have this technology which will allow our patients to have increased confidence that even early-stage breast cancers will be detected." Starting in October, 3D mammography will be an additional screening option for women with significantly dense breasts and those with a higher risk of breast cancer. This option will be available to women at Beebe Healthcare's Health Campus in Rehoboth Beach. Schedule your mammography today by calling 302-645-3278. For more information on Beebe's 3D mammography program, visit