I was generously offered an advance copy of

“The Man with the Iron Tattoo and Other True Tales of Uncommon Wisdom: What Our Patients Have Taught Us About Love, Faith and Healing”

by doctors John E. Castaldo and Lawerence P. Levitt.  Additionally, I was given the opportunity to interview one of the authors by telephone (my first phone interview of an author!).

The book (which needs a more abbreviated title) is a series of stories mostly about patient interactions, and what they learned about themselves and their profession and practice from them.  The one that wasn’t about a patient was about the suicide of a physician colleague, and its effect on them (it is a model for how docs should look at themselves and each other to see and acknowledge the warning signs of serious depression in people conditioned to ignore their own problems and feelings).

Although I don’t want to spoil the book, there is one chapter in which the child of an author is brain injured in an auto accident, and there is a subtext of what incredible jerks doctors are, even to each other, which is painful to read but very very real.

I enjoyed it, and recommend it for a general audience, but the medical types will enjoy it as well.

For those who don’t want to read the interview, it’s available at Amazon , Independent Publishers Group, and Ben Bella Books.

Dr. Larry Leavitt (Senior Neurologist Emeritus at Lehigh Valley Hospital) took some time from his busy schedule and agreed to be interviewed by me, and here is a poorly-transcribed partial transcript (and any missing conversation or errors are mine):

Read the rest of this entry »

U.K. Dept of Health: Prescription for Disaster

…
The NPfIT was initially budgeted at close to $12 billion. That figure is now up to about $24 billion, according to the National Audit Office (NAO), the country’s oversight agency. And it is as high as $28.4 billion, according to other estimates. Even the lower of those two amounts is more than the price tag for building the English Channel Tunnel or Boston’s massive Big Dig project, considered to be the most expensive civil project ever. Worse, the funding established to pay for the system has, temporarily at least, dried up….

Nobody said it would be easy or cheap, but I don’t think anyone thought these projects would cost this much, either.

via Slashdot

Grand Rounds 0308 the rumors were true

Hello there! I am A Very Famous Historian and I welcome you to the Grand Rounds. From a field of over 60 submissions, 26 authors have been chosen to seek the Grail. It will be a dangerous journey full of peril and death may await with nasty big pointy teeth. We shall see if anyone makes it out of these woods….alive. Feel free to traipse past all quotes.

This is probably the future of Grand Rounds, actually selected posts rather than all submitted (though were I to do it this way I’d have a link dump of all submitted posts at the end).

Today I was seeing an adult female patient, and as I was exiting the room, she winked at me.  Though I’m a doctor, I couldn’t help notice she was pretty decent looking, as well.

There I was, feeling good about myself.  (‘Still attractive’ said the inner monologue).

The tests came back, and everything was fine.  I went to give the good news.

Patient: “Good News!”

me: Yes.  You will need pain medicine, as this will hurt tomorrow.  Are there any pain meds you don’t tolerate well?

Pt: “Something with a C made me itch”, and pt. has a conversation with family members, during which, !Another wink!

and then, “I’m a drug rep…” comes out in the conversation.

My flattery is found out: fake.

A drug rep.  Trained, by experience if not instruction to wink at docs.

Aah, well.  Fun while it lasted.

Well, done, folks!  The target was $180,000, and as of this check we’ve raised $184,000!

Thanks, from all of us, and all of our wounded vets who will benefit.

Wow, it’s going very well!  (First post here).

As of right now,

We have raised $ 162,045 towards our goal of $180,000 so far!

Teams USMC and USN have beaten their marked goals of 45K each, leaving the Army and AF behind, so far.

It’s for a good cause, and there’s no reason to stop giving to your team (hint) even if they’re over their target; someone has to do it.

Oh, and for personal valor, Congress awarded another posthumous Medal of Honor to a Marine.  I hope it is a true consolation to his family.

One I keep because I want to, the other because I have to. Feel free to skip this post. It’s more for me than anyone else.

I have my late grandfather’s shotgun, and have had it for several years. I’m the only one in the family with any big shooting pretensions, which is why I also have my other grandfathers’ pistol. I am the Family Repositor of Shooting Heirlooms, and I don’t mind. One I keep without thought, the other I think about. I cannot part with either, but for different reasons.

The pistol came to me after the death of my grandmother, and from the reports of its discovery all involved were surprised, as grandma had just kept the thing in a drawer for more than three decades. ?What to do with the pistol? GruntDoc shoots, give it to him. I’m glad to keep it, and have fired it, but being a weird caliber (38, not special, the old 38, lead bullets in a short revolver cylinder), it’s not fired often. Nice to have, though; it ties me to the stories of my maternal grandfather the Continental bus driver; long routes, picking up fares on the side of the road, men on their own in the ships of their day, etc. It’s a pretty gun but not terribly useful; for family reasons I’ll keep it until it’s my heir’s problem. And I never think about it.

My paternal grandfather (step-grandfather, really, but functionally my grandfather, and role model, long story) I knew during my life: a slightly built but sturdy man, one who worked every day because that’s what Men Do. He was not an elaborative fellow, and never one to brag or conflate so far as I know; his role seemed to me to be provider and pair for my grandmother. He had a good sense of humor and I will always remember his and hers bowling trophies they won in League Competition in Wink, TX, because that’s where the bowling alley was. They lived modestly, which is more their upbringing than financial status. That’s just who they were, as a couple. He loved my grandmother, completely, and she him. A good match.

When I was a teen I asked about his WWII service, and his only answer was that he was proud to have been ‘just a cook’ in Patton’s Army. He wasn’t elaborative, which was a little disappointing. Only later would I understand his reticence to remember. I wonder if he was ‘just a cook’ now, as time fills in gaps.

He took me ‘hunting’ once, which was some experience: he, quite the bird hunter (he went on frequent trips across many states to hunt pheasant every year for decades, it seems), me aged about 11 and weighing nearly 100 pounds wet, and my younger brother by a year and a half. I seem to recall waiting for dove to come to our tank, where we’d set up, but they were disinterested in displaying themselves for us.

So, out of boredom and I believe now a sincere desire to teach me something useful, an empty box of 12 gauge shells (roughly a box 4″x4″x3″) was set up, filled with sand and stood up about 30 feet distant. I was instructed on sight alignment with his Winchester 11-48, a 12 gauge shotgun, which I could just barely hold up at arms length while sitting Indian-style, in order to brace against the weight. (I’m told this method of sitting is now taught to kids as ‘cris-cross-apple-sauce’, and I wonder which is a more demeaning term and to whom).

There I am, cross-legged with a very big shotgun, and the sights occasionally wobble across the target box. I jerk the trigger (not a nice squeeze) and the next thing I know two things happen: I’m flat on my back in the dirt, and he’s laughing! For the record, my first kill is a box, and I was very proud of it. Unfortunately, we never went hunting again (I had the ‘teenager disease’, and he was not getting younger).

Many years later, Grandma died; we made a sort of pilgrimage with my newborn daughter to see her just before, but the latest and last stroke had ended her consciousness. Grandpa was appropriately sad, but eventually recovered; every morning found him at the Dairy Queen, having coffee with “The Smart Club”, a group of like-minded retirees. I suppose these were the first to hear about his prostate cancer.

Mortality from prostate cancer is low, as I was educated in med school, and his first round through the system went well. The mestatic recurrence, despite all medical therapy had to offer, was much more painful and less predictable. Pain was the determining factor in his death. Two weeks before he died he told me, in a phone conversation, that he could live with the cancer but feared the return of the pain. As I was a half a continent away I did what supportive relatives do, reassurance.

Reassurance wasn’t enough. He put a shotgun in his mouth and ended his life on his own terms. The shotgun I shot the box with. The shotgun I have now.

I’ll keep it, as a reminder of a good man, and try to stop thinking about it. And I’ll never let it go.

On CNN (warning: popup video) is a story about a burger joint that sells the ‘bypass burger’ or somesuch, and their shtick is that the owner wears a lab coat and calls himself the doc, and the waitresses wear ‘naughty-nurse’ outfits (pretty tame by any account, don’t watch the video looking for skin).

It’s a pretty silly idea, but decent marketing to a certain crowd (think Hooters) .

Of course, they found someone from “The Center for Nursing Advocacy” to denounce the waitress-nurse connection on the grounds that it ‘sexualizes’ nurses, that ‘on some level, it implies that nurses do in fact provide sexual services’, and goes on to say it’s no wonder people don’t want to be nurses these days in such an environment, where nurses are thought of as possible sex objects.

Get a grip, Center for Nursing Advocacy.  I work with nurses every day, and have had discussions with them about the declining numbers of new nurses, etc; not one has said “if we could just get rid of the Naughty Nurse imagery our profession would be doing great”.  I do, however, have an idea why younger people aren’t champing at the bit to be nurses: Advocates who sound a lot like a disapproving, fault-finding, joyless people.  Wow, motivating!  Can I be on their team?

Nursing demographics have problems (I’ve written about it before), but the Naughty Nurse Outfit is not to blame.

In looking for their link, I found an entire, longgg page of angst about this place on their site.  It defies parody it’s so strange:

October 2006 — We hear that a fine new ¨establishment in Tempe, Arizona, one Heart Attack Grill, has been the subject of complaints by those battleaxes at the Arizona State Board of Nursing. And it’s all because the Grill uses scantily dressed “naughty nurse” wait staff to sell burgers and beer! Last month, the real nurses (or “Terrorists & FemiNazis,” as the Grill describes them) even got the Arizona attorney general’s office to ask the Grill to stop suggesting that its employees are real nurses, in alleged violation of the state’s protected title statute. The Center is outraged at this assault on the free speech rights of scrubs-clad Grill owner “Dr. Jon” Basso. But we will explore what those scary Arizona nurses might be getting at, when they aren’t busy killing millions of Jews or crashing jets into buildings.

I added the emphases, but just admire the bizarreness: ?battleaxes?  To describe their colleagues in nursing?  Then the ‘outraged’  BUT and then more bizarreness about killing Jews?  I will assume this is just ham-handed writing meant as some insider’s joke (?), but as a tool to persuade the neutral to your side this is not the way to start.  More:

The nurses might be upset because the Grill is exploiting nursing’s long-standing position as the most sexually-fantasized-about job on the planet. That reinforces stereotypes that discourage practicing and potential nurses (especially men), foster sexual violence in the workplace, and contribute to a general atmosphere of disrespect that weakens nurses’ claims to adequate resources. Those stereotypes exacerbate the global nursing shortage, a public health crisis that is killing thousands of people. It would even be killing those whose poor diets help lead to heart attacks, if the link between food and cardiac conditions were not just another silly lie in a world in which, as the Grill says, “insane political correctness stands as a barrier between the average man and his pursuit of happiness.”

Read more below, or go straight to our letter-writing campaign!

So, I went to the letter writing campaign, and, heh:

…Those stereotypes discourage practicing and potential nurses (especially men), foster sexual violence in the workplace, and contribute to a general atmosphere of disrespect that weakens nurses’ claims to adequate resources.   …

Someone draw the line for me that connects all those dots.  French curves are not allowed.

Geez.

Update: I asked some nurses at work in the ED tonight if the Naughty Nurse outfit was the problem with recruiting nurses.  Their unanimous answer?  “No”.

What did they think was the biggest barrier?  “Shifts, pee and poo” would be the paraphrased answer.

A day late, but here it is: MSSP Nexus Blog

Here’s the link.

My comments are in the comments of the post.

In the ?what were they thinking? category: Columbus Dispatch

…

But the American Red Cross now calls first for back slaps, a method the Heimlich maneuver’s namesake rejects as dangerous and deadly.

Dr. Henry Heimlich, 86, lives in Cincinnati.

Rescuers should start with five back blows and follow with five abdominal thrusts (the Heimlich maneuver), repeating the sequence, advises the Red Cross, which no longer uses the name Heimlich.

Some sense remains:

Despite those findings, the Heart Association continues to teach and recommend the Heimlich exclusively, said Brianne Harman, a spokeswoman for the Columbus office. “It’s easier to teach and easier to remember,” she said. The organization favored staying with the Heimlich “in the absence of data that another procedure is superior,”

So, the Heimlich works, and they decided to add in a step before doing it.

Seems silly to me.

aka, don’t check your mail during a shift:

Bad Night:I was going to blog about this stab wound guy in much more vivid details with xrays of the taser leads still stuck in his chest, pictures of my finger in his heart, the fine mattress sutures I threw down and everything. But after seeing this letter, and especially after saving the life of this scumbag just a few minutes earlier, it all makes me feel so ill I wanna puke. God, now I gotta walk back into the ED and see more patients.”

This is interesting, and more than a little sad:

PATIENTS who abuse staff at a Greater Manchester hospital will become the first in the country to face an £80 fine in a crackdown on anti-social behaviour.

Police will patrol the accident and emergency unit at the Royal Bolton Hospital for three months in a bid to prevent aggressive and threatening behaviour.

They will issue penalty notices for disorder inside the hospital and arrest any patients or relatives who physically attack staff.

The scheme follows shocking new figures which show staff across Greater Manchester are physically attacked on average five times a day – suffering 2,000 assaults last year.

…

Abuse

But Bolton medics say this is the tip of the iceberg and they also face a barrage of verbal abuse and antisocial behaviour.

…

“Nobody should have to put up with that kind of behaviour in their workplace and it also causes distress for other patients and visitors in the department.”

We have the same thing in the US, horribly entitled, horrible people who know that they can’t be removed from the ED until their MSE is completed, and behave in a manner that would get them thrown out of any other place.  (I’m not talking about patients with uncompensated psychiatric problems here, nor those experiencing delirium).

It’s not all patients, a tiny few, but they make the job less enjoyable (and occasionally more dangerous) for us all.

I am replacing some wood deck railing with sturdier (and less warped than wood) steel railing.  The installers called this afternoon, and want to put them in in the morning.  So, time to take down the old wood rails on the deck.

(Your reaction to the above sentences, BTW, discerns your home ownership status: if you’re still reading intently, you’re a homeowner, and if you’re not you aren’t.  I learned this earlier this year in personal conversations when installing siding).

So, of course it’s the last section of the old railing that shows the damage: rot in a supporting structure, right at a corner.  A corner where the new rails have to bolt in securely.  Frantic call to the installers, at the stroke of 5, and they’re okay with holding off a day or so.

Good news?  I found it in time to fix it properly.  Bad news?  Now I get to replace a 12 foot section of structure that is hanging out in an awkward position tomorrow.  Fun.

It’ll be worth it, the new railings are going to be stylish and very very safe.

Update: The rot removal and the board replacement went well.  I now sport only one band-aid and another skinned knuckle; also, I got to use most of the power tools I’ve accumulated, and it was fun!  Tomorrow, the rails.