Words of Wisdom from Red Forman

“It’s for your own good.”

After literally and liberally hosing down his son, whose hormones were particularly carbonated.

I do this all the time, ‘for your own good’.

Hehe.

War on Terror My Butt

Air marshals pulled from key flights
In case anyone wants my opinion, President GWBush should be insanely glad he has a couple of wars going on, because virtually every other aspect of The War On Terror is a bust.

Fire Norm Mineta. Today. The same agency that oversees hiring Air Marshalls grounded at least 100 because their background investigations weren’t up to snuff. This, after bureaucratic obstructionism has killed arming pilots, a popular and reasonable action to protect the flying public from terrorists.

Now comes word that the key target flights (overseas and transcontinental) won’t have Air Marshals as a cost-cutting move (overnight stays killing the budget and all). This is, pardon the crude language, crap.

At least one part of the War on Terror has to go right, and the answer is clear: can Mineta. Today.

Leaving Against Medical Advice

Mr. Hassle’s Long Underpants
Doc Shazam had one of those frustrating moments in medicine, and was healthy enough to blog about it instead of ruminating. This gave me pause, and I decided to try to explain how I approach this issue.

First, Leaving AMA is a medico-legal minefield. It is not cured by having the patient sign an AMA form (I recall an attorney explaining that the signature on an AMA form only means they were awake when they left, no more).

So, before they leave, I generally try to talk to the patient, and their family. First, ‘why do you want to leave’? Anger/time/unfulfilled expectations are the vast majority. Some are mad they had to wait 8 hours (for a 3 month outpatient workup), and just leave out of pique. I have never managed to persuade these patients to stay, though I try.

Others have to be home to care for their families, etc. I can occasionally get them to put their health first, but it’s rare, and usually involves some calls to get their home roles filled.

The unfulfilled expectations are usually not grounded in medical reality; you’re going to admit me for pain management/observation? I wanted my (expensive, tricky and/or dangerous surgery) today (invariably night/weekend/holiday). I try to connect the dots about timing, necessity, etc., and get about 1/2 to stay.

I have adopted an idea from one of my colleagues, and I ask the family of the patient, “how do you feel about this? They aren’t going to sue me when they die, you are, so what do you think?” Even if they don’t stay, I got them to think about the future beyond the car keys.

I try very hard to make this whole thing non-adversarial, and offer all the services of the hospital, and tell them I don’t care about the cost, I care only about their care. Then, if they still elect to leave, I assure them that there are no hard feelings on our part, and that we’d be glad to have them come back. I usually always mean it.

Medicine isn’t perfect, and neither are people. I really think we try hard for each individual, and I never like it when the AMA form comes out.

Wow, I sound like Mary Poppins. I’m not, trust me.

Update: And, yes, the Texas Dems left AMA too. They didn’t sign the form.

Dems Depart, Vol II

CNN.com – Texas Democrats flee state — again – Jul. 28, 2003
Funny thing, last time it was the House Dems who fled the Great State of Texas, and now the Democrat Senate has fled the State to avoid an ignominious defeat.

Amusingly, this isn’t news. MSNBC has no mention of it (as of
midnight) and this cannot bode well for their cause.

At the very least, they were smart enough to flee to Albuquerque, NM, instead of Oklahoma. Frontier and Delta both fly there from Austin. Generally, New Mexico is considered to be ‘cooler’ than Oklahoma, so they get style points.

I may all come to naught, with the Lt. Governor presiding over the remainder declaring he’ll go for a simple majority, forcing their return (to vote no).

In case you were wondering, I don’t think much of this tactic from our elected representatives (I wouldn’t call them Leaders).

A new Lemon

The Lemon
A new issue of The Lemon, hysterical satire of current events.
Go. Read. Laugh out loud.

Proposition 12

I encourage all Texas registered voters to vote FOR Proposition 12 this coming September 13th.

This is a proposed Constitutional amendment to the Texas Constitution, designed to deflate the expected logjam of appeals of Malpractice cases to the Texas Court of Appeals. Malpractice attorneys realize that tort reform for doctors is popular in Texas, so they’re running their counter/smear campaign against Insurance Companies.

I have not read every word of the proposed amendment, and I don’t need to. On things like this, I see who lines up for and against, and choose which side has the people I identify with. Doctors and my malpractice carrier are for it, and Trial Lawyers are against it. That’s all I need to know.

I’m going to leave the comments open, with this warning. warning via FFM

Bullet Holes

Leaving the ED after a shift, I find:

-a car wrapped in police tape
-several security guards in attendance
-our City Officer inside the tape
-a car with a bunch of finger-sized holes in the door!

Turns out this car, with a couple of GSW victims, drove up to the door of our ED! I have no idea the injuries of the victims, I was leaving. Emergency Medicine is like that.

The best line? Our Ft Worth Officer (a genuinely funny fellow): (while shining a light on the holes in the door) “This is what we in the Police business call a ‘Clue’.”
Hehe.

Home Run

Lt. Smash. Why don’t I have him in by blogroll?

I’ll fix that, soon.

“…all right?”

hehe. I started a comment, and finished a rant.

And, thanks for the opportunity, Dr. Hassel!

Update: it’s Mr. Hassel, and Doc Shazam. My Apologies to both.

Resurrection! Also, Packing and Stuffing

Halleuljah! Dr. Bradley lives. He’s to be moved back to the living in the sidebar.

In the post, Dr. Bradley referres to a patient who was “Stuffing”, as opposed to a patient who was “Packing”. There is a difference.

Stuffing is when a ‘suspect’ eats all the drug evidence quickly, thinking this might ameliorate their plight. It won’t, as Dr. Bradley vividly describes. Stuffing is quite dangerous, but not generally lethal. The effect of the ingested drugs is usually minimal; they’re usually street-level drugs, their potency has already been cut, and they aren’t designed to be effective when swallowed. (There are exceptions, surprise).

Packing is when a person very deliberately swallows condoms filled with ultrapure drugs. These people (generally) live or die, and there isn’t a lot of in-between. If the condom ruptures in the gut, pure stimulant drug pours into the intestines, resulting in (I’m told) a very impressive overdose. Surgically removing these is described, as a potentially lifesaving procedure.

So, a blog-life saved and a medically-related post. And, an intro to the drug culture. Wow!

Words of Wisdom from Red Forman, #1 of a series

“Taken separately, Women and Alcohol can be a lot of fun. But if you combine them, they can make you a dumbass.”

via Red Forman, my new hero/alter ego.

How to drag the US into Liberia

ScrappleFace: Liberia Tries to Buy Uranium, Bush Commits Troops

U.S. President George Bush today committed 10,000 soldiers and Marines to a U.N. peacekeeping force in Liberia. The decision came immediately after U.N. Secretary General Kofi Annan said that a British intelligence report indicates Liberia may have tried to buy uranium in Niger.

Satire is often the best humor.

Blogroll Addition

Alerted By RangelMD, I have added A Chance to Cut is a Chance to Cure to my blogroll. It’s a blog by a pseudonymous General Surgeon, a specialty sorely under-represented in the Blogosphere.

For the non-medical, Bard-Parker is a manufacturer of scalpels.

LCPLs Sledd and Simpson Update

This is long. I care about it. Get something to drink and read it carefully, or skip it.

I initially wrote about this event, which occurred during the run-up to the War in Iraq, in October, 2002. Briefly, during a training evolution on a Kuwaiti island, LCPL Sledd was killed and LCPL Simpson was wounded by Al Quaeda followers. Their assailants were then killed by MP’s (though they were part of a larger cell, and it isn’t clear what has become of those who escaped immediate justice).

I have had a very nice email exchange with the mother of the wounded Marine, LCPL Simpson, on the eve of the release of the investigation of the shooting. I’m going to cut and paste from both the email (with permission) and the investigation:

…(LCPL Simpson) has two titanium plates in his arm and more than twenty-five screws holding things together. It’s astonishing what a single AK-47 round can do to flesh and bone. He will deal with the limited range of motion, the nerve damage, and the chronic pain for the rest of his life, but the important thing to all of us is that he still has his life and he has many plans for his future: marriage, college and a career. He has a positive attitude and anything else would dishonor the service and sacrifice of Tony Sledd and all the men and women who wear the uniform.
There were many heroes that day in October–the Marines who pulled George and Tony to cover, the navy corpsman who administered first aid in the field under fire, the Marines who using their 9 mm pistols faced down and killed the terrorists armed with AK-47s, the helicopter pilots who flew Tony and George to the hospital, and the medical staff who under less than ideal conditions saved George’s life and limb and tried to save Tony. I wish I could personally thank each and every one of them.
It’s been a little disheartening to read the report released this week regarding the attack on Failaka Island (see the July 21 issue of Marine Corps Times or the stories at
Deficient Security Cited in Inquiry

Marines Blame Security for Kuwait Attack
That’s one reason it meant a lot to me to read what you wrote last October 9.

So, being the curious sort, and very concerned that Medical is being implicated in LCPL Sledds’ death, I followed the links (more excerpts, mixed together):

Lt. Gen. James T. Conway, who ordered the Marine Corps investigation, blamed the death of Cpl. Antonio R. Sledd on incorrect assumptions about security at the training site and mistakes in military trauma care.

“While it is impossible to say if everything had been done right and in a timely manner that this young Marine would have recovered, I do believe that the chances would have been greatly improved and that recovery was more than a remote possibility,” Conway wrote in his May 25 endorsement of the investigation’s findings.

The attack on Oct. 8, 2002, came in the early stages of the U.S. military build-up in preparation for the invasion of Iraq.

The Marines were attacked on Faylaka Island, about 12 miles north of Kuwait City. Sledd, a 20-year-old rifleman from Hillsborough, Fla., died several hours after he was shot. Lance Cpl. George R. Simpson, 21, was shot in the left arm.

Marines in the company’s command tent returned fire, killing both attackers. Authorities later identified the shooters as Kuwaiti citizens with ties to Osama bin Laden’s network.

“They were school-trained terrorists,” Marine Col. William Durrett said Thursday. “We think this was a concerted series of attacks.”

The report said Army Central Command, which was responsible for the security of U.S. forces in Kuwait, should have made force protection a greater priority, including staffing a protection office there full time.

Also, Marine Corps officials said that the military hospital in Kuwait City lacked a full surgical staff when Sledd was taken there. A surgical team was doing an appendectomy when he arrived, and officials also suggest the blood supply was limited.

and…

It said, “While in an open society it is impossible to completely protect our Marines from the approach of the ‘lone gunman’ who is willing to sacrifice his own life, it is clear to me that all services including the Marine Corps could have done a better job.”

Conway said if Sledd had received timely medical treatment, “I do believe that the chances would have been greatly improved and that recovery was more than a remote possibility.”

Sledd and others in his company had finished the day’s urban training drills and were preparing to play softball Oct. 8 when two Kuwaitis pulled up in a truck, according to the report. The appearance of a civilian truck wasn’t considered unusual because Kuwaitis used the road.

Armed with AK-47 rifles on automatic, the two men fired on the Marines. They hit Sledd, who was 10 feet away, and Lance Cpl. George Simpson, 21, from Ohio.

Sledd’s company commander and others in a nearby tent shot and killed the terrorists moments later, drawing their fire from the unarmed Marines on the playing field.

The Kuwaitis were part of a six-man terrorist cell led by one of the shooters, the report said. A Marine official said the group had ties to Al-Qaeda, the terrorists behind the Sept. 11, 2001, attacks.

Sledd was airlifted to Kuwait Armed Forces Hospital, where the U.S. military commands one floor. The Marine had been shot five times and died of blood loss and shock.

He arrived at the hospital at noon, an hour after he was shot. No surgeon was available until 12:30, when a team dispatched by ground transportation from nearby Camp Doha arrived, the investigation said.

Simpson survived wounds to his left arm and now has some disability. Marine officials said he is now stationed in Ohio and will finish his enlistment later this year.

There is now a full-time office in Kuwait dedicated to overseeing security of U.S. forces there, said Col. William Durrett, a Marine staff judge advocate who released the report.

Durrett described Sledd’s medical care as “a deviation from what the norm should have been” for the U.S. military’s main hospital in the region.

The investigation does not recommend punishment for anyone involved.

Hmmm. OK, first things first. Neither of these reports says when the attack occured (though the Evil Murderers waited unti they were prepping for a Softball game to attack), so it’s had to tell from the above when the attack occurred, or the delay to care. Also, the final report says they were killed by Marines in the Command Tent, but the original report said they were killed by MP’s. (I suppose it’s possible MP’s were in the Command tent, but it’s unlikely).

The delay by the surgical team is harder to explain, and there isn’t enough here to criticize or to clear them. One article says they were performing an appy, another says they were late, and one doesn’t contradict the other. Odd, but not unlikely, given that the surgical team was stationed away from the Hospital (the appy could have been done at the Camp they were stationed). This makes good sense given the Force Protection (antiterrorist) issues involved, that we’d have a chunk of a hospital set aside while housing the docs elsewhere. That isn’t wrong, not being able to get the surgical team free and a casualty to them in a tmiely fashion has no-doubt been addressed.

Fittingly, one of the Camps for the war was named Camp Sledd, in honor of LCPL Sledd.

I stand by my closing from the October post: I’m glad they’re out there for me.

New Category: Dead Blogs

Blogs cannot live forever.

I have two criteria for declaring blog-death: purposeful, announced death, or a more sclerotic, abandoned and not cared for death. Announced deaths will be declared automatically, abandoned blogs after about a month of inactivity.

The dead blogs have a new sidebar entry, at least for a while. Resuscitation is declared when they repost (or recant their death).