All posts by James Pate, MD, FACOG

I am a board certified OB/GYN physician in Saranac Lake, NY. My practice includes traditional obstetrics and gynecology as well as medical and surgical services specific to the needs of minorities of gender, sex and sexual orientation. I strive to provide personalized, comprehensive and compassionate care to all of my patients.

Tylenol® Terror!

Most people think of Tylenol (generic name: acetaminophen) as a safe medication for pain. After all, you can buy it without a prescription. While it is relatively safe when taken as directed, acetaminophen is also toxic to the liver when taken in excess. If the liver dies so will the body unless a replacement liver is transplanted.

The liver is an essential organ that helps keep the body’s chemistry in balance. It also makes important proteins so that blood will clot when we bleed. When the liver dies, toxins build up in the body causing altered mental function, eventual coma, and death. This is complicated by worsening unstoppable bleeding. All in all it’s a horrible way to die and is certainly not quick and painless.

The maximum dose of acetaminophen anyone should take is 1000mg (1 gram) at a time and a total of 4000mg (4 grams) in one day. If you drink alcohol, have bad kidneys, or have a bad liver, you will have to take less and should be under doctor supervision.

Please check your medications carefully! Acetaminophen has been added to many other medications and you may not even realize that you are taking it unless you pay attention. Some over-the-counter medications that have acetaminophen are Excedrin, NyQuil, Pamprin, Sudafed, and Theraflu. Some prescription medications that have acetaminophen are Lortab, Percocet, and Vicodin. When in doubt, ask a doctor or pharmacist for help.


What an amazing day. Barack Obama is president of the USA! He has united a deeply divided country and filled our hearts with hope when before there was only despair. He is the leader that our country has been waiting for so many years. While I was not alive during the presidency of John F Kennedy, I imagine that Obama will be remembered in much the same light. For the first time in almost a decade I feel proud to be an American once again. And Obama is not a man of empty promises, like so many other politicians. Already the White House website has changed to reveal the transparency of his agenda and the reflection of his vision. He recognizes that equal rights for LGBT persons are not special rights, as so many religious naysayers have claimed. They are civil rights and he will fight for them as president of the USA. You should really check out to see for yourself!

1000s of words

Well not 1000s written, but worth 1000s so the saying goes. I just finished posting tons of family pictures on my facebook profile and it is so nice to be able to see all those memories together and to share them with others.

I am now about halfway done with my medical intensive care unit rotation. It has been very educational learning how to take care of the critically ill with their complex medical issues. I am also seeing a lot of patients die in spite of all the best medical intervention the 21st century has to offer. Even though the majority of the patients on my floor have experienced gradual health decline, it is still painful for families to watch their loved ones drift away and pass on.

One of the patients I keep thinking about was being taken care of by another team, but I am aware of his story because all patients are discussed collectively during morning rounds. This patient was in his mid-twenties and really wanted to live. He was also afraid of dying. Unfortunately he was born with cystic fibrosis, a genetic error with devastating consequences. In spite of years of aggressive medical management his lungs were giving out and he was struggling to breathe even with a high-flow oxygen face mask. What he really needed was a lung transplant, but he was just too weak to hang on. Apparently he knew the end was near and upwards of 70 friends and family members visited him last night. He passed on peacefully this morning.

At one time I was considering becoming an intensivist — an intensive care physician — taking care of very sick people is intellectually challenging and rewarding when they recover. On the other hand, it shares some of the same features as emergency medicine — a revolving door practice without continuity of care. In the ER, patients come in, are stabilized, and are either sent on to another physician or sent home. Likewise in the ICU, patients are either passed off after stabilization or pass on. I know that I have made the right decision with OB/GYN.

Well, seeing as I need to get up in about 3-1/2hours I’m heading to bed. Happy Belated New Year!

So over Step 2

Today I took my 8 hour board exam (USMLE Step 2 CK). It’s over! Tomorrow is my last day off before I hit the ground running on my ICU rotation. I really can’t complain though. Fourth year truly has been a blast. I especially enjoyed the opportunity I had to travel around the country to interview and check out so many great OB/GYN residency programs.

So this is how the residency admission process works… I interviewed at around 14 programs and am now in the process of organizing them into my “rank list.” Basically I put them in descending order from where I want to go the most to the least. Each residency programs in turn creates their own rank list of the applicants they interviewed. Eventually all of these lists get fed into some great and mysterious computer program which determines where all of us are going to go. Apparently the software logic is designed to favor applicant lists over residency program lists. Anyhow, the computer does its thing and everyone finds out on the same day (3/19) where we all match. And we only match at one program, so where the letter says we’re going is where we’re going to go! Exciting times.

My rank list is not due till the end of February so I still have plenty of time to mull things over. Fortunately I will be very busy on my next 2 rotations (I have plastic and reconstructive surgery following ICU) so the time should fly. I also have my “OB/GYN sensitivity to LGBT patient needs” manuscript and some patent research to finish as well as continue my review of primary literature regarding disorders of sex development (intersex conditions). Additionally, my sister is graduating from police academy on 2/11! With so many things to look forward to, I am very excited for the New Year ahead.

Blah day

I’m holed up in my bedroom today, as I have been for the past several days, doing my best to focus and study hard for my USMLE Step 2 Clinical Knowledge exam this Saturday. Basically it is just another standardized 8 hour multiple choice test that I must take to get my MD license. For a while I was wondering if I was even going to be able to drive to the exam due to the “arctic blast” we’ve been experiencing here in Portland. There’s still about a foot of snow outside my window, but I did see some rainfall today and it’s supposed to be getting warmer. It will probably be mostly melted by Saturday.

I’m feeling rather blah today, probably in part because of the weather, in part because I’m doing marathon cramming, and in part because I’m nervous about my exams (the one I’m about to take and the Clinical Skills exam I took before Thanksgiving). While I will most likely do just fine, the fear of failure eats away at peace of mind. Why am I afraid? Because I have a vision for the future and really want to make it happen. I am “attached” to this vision and so I “suffer” when thoughts or circumstances threaten it. I really need to meditate more and keep striving to let go. The more I can let go, the more at peace I will be.

Winter Solstice Wonderland

There is no Christmas tree in my house.
My trim is not adorned with lights
Nor do oversized stockings dangle from my mantle.
Holiday hymns do not fill my ears.
No bobbles and trinkets clutter my surroundings.
Colors, sounds, and smells do not bombard my senses.
Not anymore.

That swaddled Jewish baby is no longer innocent.
And the fat bearded elder has lost his charm.
I will pay homage to these gods no longer.

In their absence I feel still,
The stillness that lingers while so much of nature sleeps.
The crispness of cool air.
The crunch of snow.
The snapping of twigs.
The caw of a crow.

Today I watched in awe
As powder drifted down.
It danced circles with the wind and shimmered in the sun
Before coming to graceful rest upon branches, roofs, and fields below.

The dogs bounded down our vacant road.
Diving into the drifts, and swimming through the snow.
I smiled and laughed.
Moist heat erupting
And condensing like smoke.

This year I decided
To celebrate the season anew.
I discovered that experiencing it
Was celebration enough.

James Pate

Light in the Attic

I toil at glass study in the attic,
White gabled ceiling overhead.
Black night beyond the window,
Disease and death possess my thoughts.

Beagle sprawls and whimpers softly,
Dreaming fitfully on lime futon.
Body embraces velveteen pillow,
Soul wanders within fragrant wood.

Light and music my companions,
On Winter Solstice Eve.
Brown leather chair sustains my weight,
While imminent inquiry proctors my distraction.

James Pate