Acetaminophen, better known by its brand name Tylenol®, is widely used in the inpatient and outpatient settings for pain management and fever relief. It is favorable in many populations because of its opioid sparing properties and relatively favorable side effect profile. Acetaminophen is most commonly used in oral formulations including tablets, capsules and oral solutions, and also is available as a suppository. In 2010, intravenous acetaminophen, also known as Ofirmev®, was approved by the FDA. However, the place in therapy of intravenous acetaminophen has not yet been well established.

The FDA-approved uses of intravenous acetaminophen include management of mild to moderate pain, management of moderate to severe pain with adjunctive opioid analgesics, and reduction of fever, which are identical to that of oral acetaminophen.

Many of the men and women of science and medicine have been honored by having their names associated with the fruits of their labors. We have Paget disease of bone and breast (Sir James Paget 1814 – 1899), Pasteurization (Louis Pasteur 1822 – 1895), Koch’s postulates (Robert Koch 1843 – 1910), and the Curie, a unit of radiation (Marie Curie 1867 – 1934). And then we have Phillipp Lenard, Hans Reiter, Eduard Pernkopf and Hans Asperger, all of whom made significant contributions to science and/or medicine, but whose names are all but forgotten. Lenard was awarded the Nobel Prize; Reiter and Asperger had syndromes named for them; and Pernkopf produced the most realistic anatomy atlas.

As I write this, COVID-19 cases in our area are soaring; as you read this, they will undoubtedly have reached record-setting peaks. Vaccines loom on the horizon, but approval, rollout and distribution are still challenges which remain to be overcome.

In this cocktail called December 2020, we have equal parts terror and hope, dread and resolve, resignation and revelation. Add a sugar cube of faith and the bitters of loss, and muddle together.

Allow me to suggest a garnish which might make this cocktail slightly more palatable: gratitude.

Let us be grateful for our lives and the lives of our loved ones and friends.

When I was on a toxicology elective as a resident, the fellow and I disagreed over the topic of the presentation I had to give. I wanted to cover a drug commonly prescribed to complex care patients, she wanted something “more interesting,” like an exotic compound that she would only see once in her career if she were lucky (and the patient very unlucky). We compromised on a historical topic of local relevance, the Donora Smog of 1948.

Donora, Pa., named for William Donner and Nora Mellon – lies in a bend of the Monongahela River on the eastern edge of Washington County, 25 miles south of Pittsburgh.