June 9th, 2007 by Dr. Val Jones in True Stories
2 Comments »
My grandmother was a kindly woman. She grew up in a frontier town in Alaska, the daughter of
a photographer. She lived simply, and
spent the majority of her waking hours figuring out how to stay warm. Much to her delight, her mother eventually
moved to San Francisco,
where she was able to thaw out and bloom.
She went on to marry a charismatic business man (one of the
early founders of Technicolor Films) and had 6 children, the first of whom was
autistic. It was a great challenge
taking care of all those kids, with her husband away on business much of the
time. And there were no special services
for children with autism then. So it
came as no surprise when my grandmother seemed a little forgetful and frazzled. But that forgetfulness was not so innocent as
it turns out.
Memory lapses grew into more advanced confusion, as her
children noticed that she was becoming unreliable. She would forget to pick them up from school,
couldn’t remember where they were going next, and didn’t recall what they had
told her only moments prior. My
grandmother had early onset Alzheimer’s disease – and it would take her on a
path of no return.
By the time I was old enough to know my grandmother she was
being cared for by home health aids. She
was still extremely sweet and gentle, and could have short conversations that
were interesting and engaging, but she had no idea who I was, or why we were
speaking. Still, her Victorian
upbringing caused her to be extremely well mannered – never letting on that she
secretly wondered why this “nice young girl” (a perfect stranger) was spending
time with her in her house.
But the strangest part of grandma’s journey with Alzheimer’s
was that it took her on a reverse tour of her former life. She seemed to be reliving each day that had
had the most emotional impact on her – in descending chronological order. So that some weeks she believed that each day
was her 60th birthday… and then she’d move on to each day being her
58th birthday, and so on… But the most heart-wrenching span of weeks
were when she thought it was the day of her husband’s death. She wept all day long, reliving the
experience. We would ask her why she was
crying, and she’d look at us incredulously, “Well, don’t you know that Kay died
today?” Our lack of appreciating that
obvious fact added to her extreme loneliness… as if she had lost her husband
and no one else cared or noticed. We
would try to dissuade her of that notion, reminding her of the actual date and
who each of us was. But alas, the
neurons that housed her emotions seemed to outnumber those that ordered her
memories, and so only time could change her of her perception of reality.
We all watched grandma deteriorate over the years, being
dragged backwards through time by some invisible force, verbalizing her
experiences as she relived them. It was
a kind of bizarre way to learn about her life – through the eyes of a woman who
told old stories as if they were currently occurring.
But eventually the stories ceased, and she regressed to a
non-verbal state. Her mind had finished
its story telling long before her body was ready to let go.
Grandma lived until the age of 96, and passed away
peacefully in her sleep. I can only hope
that she was dreaming of pleasant events in her early childhood when she
slipped into the ether – a baby in a shadow of memory.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 8th, 2007 by Dr. Val Jones in Announcements
No Comments »
This has been a really interesting week for me. My “Top 10 Tips for a Healthy Wedding” really struck a nerve – and in an unparalleled flurry of interest, I have been speaking to groups of people on the radio and in podcasts about weddings, marriage, and the medical angle on this wonderful celebration of human connectedness.
I was speaking with Gordon Deal from the Wall Street Journal Radio Show (Gordon is a truly affable interviewer) and I got a question that I had not anticipated but in retrospect makes a lot of sense. I was telling him about my decision to buy a wedding dress on the fly, picking one off the shelf in the first store I went to. He transitioned nicely to: would you say that your financial decisions follow your style for purchasing dresses? How have you and your husband worked through financial planning together?
Wow. I had to think on my feet on that one – leave it to a Wall Street journalist to get a financial angle on a story. My answer was truthful and brief – yes, my husband is more conservative than I am, but we have worked hard to get on the same page, thanks to a great financial advisor. (Squirm)
Kristi King at WTOP (partnered with the Washington Post) was up next – and we had a nice chat about the do’s and don’ts of wedding diets.
Then I got to speak to a Randy & Ken in Oklahoma City on KOKC. The weather report preceded my interview, and I couldn’t help but worry about the severe wind conditions down there. When asked about some good tips for a healthy wedding I mentioned that having a plan B is critical – especially if you’ve planned an outdoor wedding with a tent in Oklahoma!
On the eve of my second wedding anniversary I participated in a blogger call with Dr. Charles Foster (who is an amazingly insightful psychologist and relationship counselor – you should definitely listen to this podcast because it is very well worth it if you have any problems whatsoever with in-laws or your own family). We spoke with Rhonda from “Our Wedding Plus” blog and fielded questions from others remotely.
On I moved to a live show in Chicago with Theo & Gerrard at WVON (host to the Al Sharpton show) where we had a warm conversation about the meaning of marriage and the importance of a strong family nucleus for the fabric of American society.
There is at least one more interview awaiting (a contemporary music radio station in Hawaii) and I have to say that this has been one wild ride. As a physician I feel totally privileged to have been given the chance to speak with such a wide variety of Americans about a joyful, complicated subject that unites us all – the wedding.
Now if my taxi hijacking post sparks this sort of interest, I suppose I might need to hang up the stethoscope and focus on social commentary and relationships.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 6th, 2007 by Dr. Val Jones in Health Policy
No Comments »
I’ve blogged previously about how unhelpful most Pay for Performance measures are for improving healthcare outcomes and “rewarding” physicians who provide evidence-based care. But this sentence (spotted by Kevin, MD) summarizes my pages of opinions perfectly:
“Judging medical quality from claims data is like judging a restaurant by looking at its grocery bill.”
And if that didn’t sum it up perfectly, consider this:
The amount of “pay” for performance is so small that it is not incentive enough for physicians (or hospitals) to change their clinical practice behavior. In effect, as JAMA says, “the carrot is not big enough.”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 4th, 2007 by Dr. Val Jones in Opinion
No Comments »
In a bleary eyed state I misread a blog post by PandaBearMD. He was on one of his well- written, sarcastic tears, and (jokingly) blamed nursing salaries for the rise in healthcare costs. I didn’t get the humor of that, and proceeded to defend my nursing colleagues. Of course, I took some hits for being unable to recognize sarcasm, but this event got me thinking about nurses…
I have always been grateful for the wonderful work that nurses do – and as I think back at all the amazing feats they’ve accomplished in front of my very own eyes, I thought I’d start a list:
NICU: can place an I.V. in a 1 lb preterm baby with veins the diameter of hair (but docs: don’t TOUCH the baby!)
ER: can put an I.V. in a 400 pound, anasarcic patient with no palpable pulses.
Psychiatric ED: can convince a fulminantly psychotic, violent patient to sit quietly and play with a teddy bear while waiting for the doctor to see him
Medical Floors: can clean up a fecal mess so foul that even the anosmic wouldn’t have the courage to enter the room – and do it in such a way that the patient feels no personal embarrassment
OR Nurse: will anticipate the instruments needed for an unforseen surgical complication and have them ready for use before the doctor gets a chance to ask for them
Pediatric ED: can distract a small child with stuffed animals, toys, and picture books so successfully that they don’t notice sutures being placed in their hand.
Obstetrical Nurse: can withstand the force of a 200 pound leg pressing against her for hours on end as mom bears down to push the baby out of the birth canal
Rehab Nurse: can get any patient out of bed, single handedly, and with little obvious effort (while the rest of us call for the Hoyer Lift, and 3 resident physicians)
This is just the beginning of a long list of magical things that nurses can do… please share some of your favorites!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
