Letter 2 From the Front

GruntDocs heard from again! For his prior missive, follow the link.

Things are going well here. We don’t know when we will be coming home yet as things start to wind down. Even though we got word directly form the CO’s mouth yesterday the possibilities range from not having a mission here within 2 weeks to staying here for at least 3 more months as the last medical asset in the area while all of the other assets egress. Who knows?
I will wait until someone tells me to start packing my bags.Motivated Blue DevilDoc(Friend) has been busy with lots of work. The orthopedists (writer not an orthopod – ed.) have been working the hardest. We are hoping for the Humanitarian Organizations to set up shop in country because that will lighten our load significantly. Right now, we have nowhere to send Iraqis that will need long term re-hab etc.Fleet Hospital OROtherwise, camp life is good. Mail sucks but thank God we have the internet to communicate with. The STPs, Surgical Companies and the FRSSs don’t have any way of communicating except for the broken mail system. The medical system is completely different now. There are no casualty clearing companies. Everything is based on these shock trauma platoons and forward resuscitative surgical suites which are staffed with ER Docs and surgeons that are located right near the front lines.

That is about all for now.

And the wind is for real.
breezy

The Coolest Honda Commercial

Honda spent 6 months and disassembled a car for the most interesting bit of kinetic art (think Mousetrap game) ever, and made an entrancing 2 minute commercial.

As the linked news articles make plain, this wasn’t CGI or trick photography, the final commercial was on take 606!

from my brother, who read it on Dave Barry’s Blog.

May I Have Your Attention Please

The US now has the undivided attention of the world, (agree or not with how it happened). Most importantly, the Axis of Evil must be sweating, or whatever it is evil does (pinky-finger-to-corner-of-mouth).

A terrific graphic depiction by the cartoonists Cox & Forkum:
Iraq didn't Listen

via LGF

Medication side effects

MSNBC has a nice article about the prescriptions given to 1,202 adults in four outpatient clinics in Boston. From that they found that 1 in 4 have had a problem, either a drug reaction (including GI bleeding and low blood pressure); ‘serious’ side effects were found in 13%.

Other problems found:

-given the wrong drug 45 percent of the time,
-the wrong dose was prescribed in 10 percent of the cases
-told to take it too frequently 10 percent of the time.

The drugs that posed the greatest risk of side effects were the serotonin-reuptake inhibitor class of antidepressants, the non-steroidal anti-inflammatory drugs often given for joint pain, and calcium-channel blockers used to treat high blood pressure.

The article has a bit of editorializing about brief office interactions contributing to the problem. I have no idea whether this is a real cause or not, but I suppose it could contribute. I do see a terrific number of people on more than 10 different prescription meds, and wonder how they have room for food, let alone function on that many meds. The article does not make clear where the problem occurred, whether in the doc’s prescription, the filling or labelling of the med, etc.

Pharmacists have a tough job, and not just reading doctors’ handwriting. We get calls from pharmacists questioning prescriptions once in a while, and about 1/2 of the time it seems they’ve caught a substantive issue before it causes a problem, which is how it’s supposed to happen. (On the other hand, the patients sent back to the ED because ‘the Doctor wrote the prescription wrong’ because that one pharmacist cannot do math drives me crazy; it calls our competence into question to the patient because the pharmacist cannot figure out that Prednisone 60 mg PO QD, with a Dispense# of QS (quantity sufficient), meaning they have to multiply their 20mg tablets time three to get to the D# makes me wish we could dispense from the ED).

Anyway, I have yet to find a problem with a pill bottle brought into the ED. And, ‘side effects’ isn’t defined in this article. Headache? Indigestion? Don’t feel right? Underwear too tight? All ‘side effects’ of medications. If you want to see side effects, see the Physicians’ Desk Reference (PDR) wherein they have to list every reported side effect during clinical trials. Useless for actual side effects, it’s in there because it’s required.

As Rick says, medications are controlled poisons, and they have effects, good and bad. If you have side effects, talk to your doctor (and when he says ‘go to the ER’, just laugh and say OK).

Tax Reform

Taxes are a necessary evil, but their evil is hidden for most, in that taxes are deducted from paychecks, so when you get your paycheck it’s fait accompli, and although there’s some grumbling, it happens without the individual really being involved in the process.

This was brought home to me in the last couple of years, when I became an Independent Contractor: I get a check with nothing taken out of it, which is eye-opening. Then I get to take care of everything, and that’s when taxes became something I paid attention to, because now I have to write checks to pay them. It has sensitized me to our tax system, and not in a good way.

I was wondering how best to advocate reform, and it occurred to me that we’d have tax reform in about 90 days if everyone had to take care of their own taxes quarterly instead of being deducted automatically. Think of it as being like medpundit’s cure for the health insurance crisis (delink it from paychecks, make people responsible for their own healthcare spending at it will be much better controlled).

Where’s that Flat Tax?

I’m in the US

I have gotten a couple of very touching emails from readers who are interested in knowing if I’m ‘in the field’ and if I know their loved one, and can get them a message.

No. I’m right here in the Continental US. Sorry.

Joe Gallardo, USN HM

Watching MSNBC, still following the Iraqi developments, I was enjoying a report about the USMC finding a orphahnge, staffed by nuns, intact and doing their job well in a difficult situation. The embedded reporter then spoke about the Marines bringing in their corpsmen, there was a blast from my past:

Petty Officer Joe Gallardo!

Gallardo was a corpsman in my BAS way back when, and he was a motivated and dedicated sailor. He spoke on camera, sounding the same as I recall, and made the Devil Docs look good. He held a child, and the reporter stated they did brief medical checks on the kids.

He’s the first person I’ve see that I knew, and it was great to see him. I’m glad for him he stayed in, and I’m glad for my country guys like Joe Gallardo are there.

‘Suicide’ vests found in Schools

Recently, the USMC found suicide (homicide) bomber vests in an Iraqi school. The article makes it clear that those vests were put there by “fedayeen” (imported murders), and that made me wonder: Who makes these vests?

I read about the vests, and learned that they’re leather, made to look like a ‘regular’ vest (never trust anybody wearing a vest in Mid East heat), with composition C4 plastic explosive and ball bearings, the better to spread the misery. Although the MSNBC link to the story doesn’t show it, they were on hangers, and individually wrapped in plastic, just like commercial clothing.

Now, just what kind of opportunistic piece of crap decided to go into the commercial manufacture of clothing designed to kill innocents? Googling yielded no results, nobody claims to manufacture these. I want the tag on the back, what does it say? Product of what country? How do you wash them? (Dry clean only – absolutely no heat, do not apply 18 volts across the wires in the left pocket)? I’ve seen news coverage of the Stupidfata, and it sickened me, but I never even guessed that there were ‘standard suicide vests’ for these mudrerous stooges to wear. Someday, I hope the opportunistic piece of filth who made these dies of his own handiwork, and those who commision instruments to murder others are beneath contempt; hell awaits them.

May you manufacturers of the death of civilians rot in hell, castigated by those who wore your garments of hate.

I wanted to close this with a clever little thing to make readers laugh. I failed.

National Amber Alert Bill Passes

A bill creating a national Amber Alert system could be signed today by President George W. Bush.

Congress approved the bill Thursday as House members passed the bill 400-25 hours before the Senate approved it on a 98-0 vote.

The bill is named after Amber Hagerman, 9, of Arlington who was kidnapped from her home and later found murdered.

The legislation creates a national system to find kidnapped children.

It includes tougher penalties for child kidnappers, molesters and pornographers. It also gives money to states and local communities for equipment and training on the network.

This is good news, I’m pretty sure. I haven’t read the details, and the devil is in the details. Here in the DFW area, when a kid is reported abducted, the TV’s have a scroll across the bottom and the highway info signs all display the lookout information. Now, I don’t want to see abducted kid from Washington state within 10 minutes of their disappearance (until we finally get those Star Trek transporter gadgets), but I like the emphasis on proactively looking for these kids.

Sign it, Mr. President.

via nbci5.com

Lubbock Professor Indicted On Missing Plague Charges

Per “nbci5.com“:

FORT WORTH, Texas — A Texas Tech professor is facing a long list of federal charges after erroneously reporting vials of bubonic plague missing from a university lab.

Last January, Dr. Thomas Butler, 61, reported the plague missing when it was not, triggering a nationwide terrorism alert and sending FBI agents rushing into Lubbock, Texas.

Butler first said the plague was missing but later admitted he had accidentally destroyed the vials, according to court documents filed by the FBI.

Butler is a noted researcher who had previously worked at Johns Hopkins and Case Western Reserve universities. He’s is on paid leave from Texas Tech’s medical school, where he is chief of the infectious diseases division.

Butler was freed on $100,000 bond shortly after his arrest in January.

His attorney, Floyd Holder, said Butler will plead not guilty to the 15-count indictment.

Butler faces up to 74 years in prison and almostd $4 million in fines if convicted.

Good news? No plague in terrorist hands. Bad news? Poor judgement by someone for whom judgement is the lives of others. His career is irreparable, and he’s going to stand trial (and be convicted of something).

Honesty. The unpleasantly best policy.

Baggage Handler Shot; Baggage Packer in BIG Trouble

Per one of our local TV stations, as quoted on MSNBC.com:

GRAPEVINE, Texas, 5:15 p.m. CDT April 11, 2003 – An airline employee was accidentally shot Friday morning while handling baggage at Dallas-Fort Worth International Airport.

Officials said an American Airlines baggage screener dropped a piece of luggage that contained a gun. The gun then reportedly discharged at a ramp area in Terminal C at about 11:30 and shot the employee in the foot. The worker was treated at a Grapevine hospital and later released.

The airport has referred the case to the FBI and Transportation Security Administration.

To me, this is inexcusable. (There’s a joke in here about getting even with baggage handlers for treating bags badly, but that’s not funny right now). The rules for traveling with firearms aren’t secrets, and are openly available. And putting a loaded gun in your luggage is more than stupid, it’s dangerous (ask the fellow with the newly creased foot). This could just as well have gone off inflight, causing all kinds of problems, up to and including loss of the aircraft (and you, you fool, who packed a loaded gun in your suitcase).

AA.com says:

Firearms and Ammunition may not be carried by a passenger on an aircraft. However, unloaded firearms may be transported in checked baggage if declared to the agent at check in and packed in a crush-proof container manufactured specifically for the firearm or a hard-sided suitcase. Handguns must be in a locked container. Properly packaged small arms ammunition for personal use may be transported in checked luggage. Amounts may vary depending on the airline.

I’m willing to bet the hassel avoided by not declaring the gun wasn’t worth it.

Who makes the ED run? The Secretaries

Having been threatened reminded of their contribution I have decided to expound upon the unsung heroes of the ED: The ward clerks/secretaries.

Most people don’t realize the power the ward clerk has over everyone in the ED: patients, nurses and most especially doctors. ED clerks/secretaries (I will use the term interchangeably, and always with the greatest respect) make the place function. A bad one can completley ruin your day, and a good one can make you look better than you deserve.

Let’s go over the duties I know of for clerks: order supplies, answer the phone, order lab tests and tell jokes. Sounds simple, doesn’t it? Well, here’s how it works: while entering 12 lab tests and the same number of xrays for a critically injured patient they’re overhearing the doctor yell for the neurosurgeon to be called, while taking the call from the on call specialist for another doctor, not forgetting the other two calls to doctors (which aren’t really calls to doctors, they’re to answering services, who seem to delight in thwarting our efforts to contact their doctors). This doesn’t prevent them from calling to get the light repaired in the view box, paper towels in the bathroom and vomit mopped in the halls. Oh, and remember where the joke telling stopped so we can pick it up when things slow down.

It has never occurred to most doctors that the clerks don’t know every medical abbreviation, have never heard of the Kleihauer-Betke and don’t know what it does, and will look on, flabbergasted, when the “spiral chest CT for PE” gets entered as a regular chest CT (they look for different things, and aren’t necessarily interchangeable). This isn’t their fault, and the experienced/smart ones shine when they make the doc/nurse look good (I knew you wanted a pregnancy test on that patient, so I added it on), to our eternal gratitude. (Eternal measured in ED minutes, which last about 10 seconds, or until the next time they’re needed).

I cannot imagine running an ED with inexperienced ward clerks, and I offer the following as an illustration: I worked in an ED that moved from the clerk-runs-the-world system to one in which the ED docs entered all the orders on a computer. It worked fairly well, but there wasn’t a second set of eyes seeing the entries, leading to the inevitable delays wherein needed tests are belatedly entered. The real fun began when the computer went down, and the clerk wasn’t one of the heavily experienced ones. Suddenly the entire load of the ED went onto their untrained shoulders, and it wasn’t pretty.

I’m glad we have the system we have, and I appreciate our clerks, and fully understand the hell we’d be in without them. Thanks, folks!

Information Minister

The Iraqi information minister has been terrific entertainment. So much so, that one site has looked for his other moments in history: WeLovethe IraqiInformationMinister.com.

via Sgt. Stryker

Update: and it’s a popular site, too.

You Know it’s Over…

you know the war is over when the PC vs. Mac sniping returns.

via USS Clueless

MSNBC and Rosie

I’m watching MSNBC (coverage that fits my style – discuss) and they’re, well, celebrating a bit. At the end of one of the segments of the Joe Scarborough show he shows about 10 seconds of noted foreign affairs expert Rosie O’Donnell, saying ‘…there are alternate means, and this is just an atricity, there’s no doubt’. The exact wording may be a trace different (it went by quickly) but that was the gist. Wow.

What a slap.

That’s gotta hurt.