September 18th, 2007 by Dr. Val Jones in True Stories
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Dr. Rob wrote a touching blog post today about death and dying. He contrasts two deaths – one in which the family members were excluded from the room as physicians deliberated about the patient’s heart rhythm (while she was dying), and another one in which a patient was surrounded by family members who sang a hymn and held him in their arms as he passed.
Although the ultimate mortality rate of individuals has been 100% throughout history, physicians are trained to fight death at all costs. When you think about it – we must be the most optimistic profession on the face of the planet. Who else would leap headlong into a battle where others have had a 100% failure rate since the beginning of time?
Instead of thinking of medicine as a means to defeat death, I think we should consider it a tool to celebrate life. Adding life to years is so much more important than adding years to life – and yet we often don’t behave as if we believe that. Unfortunately in my experience, death has not been handled well in hospitals. For every hymn singing departure, there must be 100 cold, lonely, clinical deaths surrounded by a crash cart, CPR and shouting.
I remember my first death as a code team leader in the ER. An obese, elderly man was brought in on a stretcher by EMS to the trauma bay. They were administering CPR and using a bag valve mask to ventilate his lungs. He skin was blueish and there was absolutely no movement in his lifeless body. His eyes were glassy, there was no rhythm on the heart monitor… I knew he was long gone. The attending asked if I’d like to practice placing a central line on him, or if I’d like to intubate him to get further experience with the procedure. She saw that I was hesitant and she responded, “This is a teaching hospital. It is expected that residents learn how to do procedures on patients. You should take this opportunity to practice, since it won’t hurt him and it’s part of the code protocol.”
As I looked down at the man I overheard that his family had arrived and was awaiting news in the waiting area. I sighed and closed his eyes with my gloved hand, gently moving his hair off his forehead. I looked up and told the attending that I was sorry but I couldn’t justify “practicing” on the man while his family waited for news. I took off my gloves, quietly asked the nurses to please prepare the body for viewing, and walked with my head hung to the private waiting room.
The family scanned my face intensely – they could see immediately that their fears were confirmed by my expression. I sat down very close to them and told them that their loved one had died prior to arrival in the Emergency Department, and that he did not appear to have suffered. I told them that we did all we could to revive him, but that there wasn’t any hint of recovery at any point. I explained that his death was quick and likely painless – probably due to a massive heart attack. I told them that they could see him when they were ready, and that I believed that he had passed away with dignity. They burst into tears and thanked me for being with him at the end. I hugged his wife and walked the family to his bedside and closed the curtains around them so they could say goodbye in their own way. I hoped that they felt some warmth on that very dark night. “Doing nothing” was the best I could do.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 17th, 2007 by Dr. Val Jones in News
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Physicians have known for at least 40 years that infectious bacteria (like staphylococcus aureus) can be transmitted on clothing. And now, as part of a comprehensive plan to reduce hospital infection rates, Britain’s National Health Service has recommended against physicians wearing white coats.
An interesting research study showed (back in 1991) that the dirtiest part of physicians’ coats are the sleeve tips and pockets. But surprisingly, coats that were washed at 1 week intervals and coats that were washed at 1 month intervals were equally capable of transmitting bacteria. Now that multi-drug resistant bacteria have become so common, they too can hitch a ride on coat sleeves and make their way from patient to patient.
During my residency, I clearly remember being horrified by the grunge I saw on my colleagues’ coats, all hanging up together on hooks outside the O.R.s. and in various parts of the hospital. I used to wonder if they were spreading diseases – but comforted myself that many bacteria need a moist environment to survive – so while the coats were certainly filthy, by and large they were not moist. Unfortunately my self-comfort was somewhat ill conceived – gram negative bacteria (like E. coli) do indeed need moisture for survival, but many viruses and gram positive bacteria (they usually live on the skin) do just fine in a dry environment. Other studies have confirmed that stethoscopes also carry a high bacterial load if not cleaned between patients. In fact, in reviewing some research studies for this blog post, I found that researchers have analyzed everything from hospital computer keyboards, to waiting room toys and patient charts. Infectious bacteria have been cultured from each of these sites.
Which leaves me to wonder: can we ever create a sterile hospital environment? Not so much. Although I agree that infections can be spread by white coats, and that a short sleeved clothing approach might help to reduce disease spread, I’d like to see some clear evidence of infection rates being reduced by not wearing coats before I’d prescribe this practice uniformly (pun intended). Bacteria can be spread on any type of clothing, by blood pressure cuffs, by stethoscopes, by dirty hands, by hospital charts… and we certainly can’t dispose of all of these. What would be left?
White Coat Rants (a wonderful new ER blog) describes the “ER of the future” – adhering to all the possible safety concerns of oversight bodies. Take a look at this whimsical perspective on what it would take to make the Emergency Department truly “safe” and imagine what it would take to make the hospital totally sterile.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 16th, 2007 by Dr. Val Jones in Health Policy, News
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I was glad to to hear from Wendy from wendysbattle.com … like my friend, she is battling stage IV colon cancer. Unlike my friend, she lives in Ontario and has no assistance to pay for her chemotherapy. In a jaw dropping video from a cancer press conference in Ontario, Wendy and 2 other colon cancer patients testify about being denied coverage for standard of care colon cancer therapy. Wendy says that Ontario has valued her life at less than $18 thousand dollars.
In a recent interview with Senator Mike Kirby, I learned that one of the major problems facing the Canadian healthcare system is the cost of expensive new drugs. The universal system was designed to have patients pay out of pocket for their medicines and have the government cover almost everything else. When this health insurance strategy was created, drugs were very inexpensive. However, with all of the technological advances in medicine – diseases like HIV/AIDS and cancer have become chronic, manageable illnesses with expensive treatment price tags. And now, the lack of drug coverage is shifting unmanageable costs directly to the patient. Sadly, Wendy is one of many victims of lack of drug coverage in Canada.
All this to say that the grass is not really greener in Canada – especially for cancer patients.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 15th, 2007 by Dr. Val Jones in True Stories
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Physicians see horrible things, tragic injustices caused by unexpected disease and circumstance. We do what we can to remain compassionate – to be emotionally “present” and yet to keep the professional distance required for our survival and success. It takes courage to set a bone, crack a chest, to do painful procedures to save lives – there must be no hesitation when minutes count.
And I suppose that our saving grace is that the majority of the patients we meet in tragic circumstances are not personally known to us. We appreciate their humanity in a general sense, but are not pierced and incapacitated by a family tie or bond of friendship. We are pained by their suffering – but we can cope.
That is, until we’re confronted with a loved one who is thrust into tragedy. Two days ago, a dear friend and former coworker called me to say that she had been diagnosed with colon cancer that had metastasized to her liver. She had just given birth to her first child at age 41. Her only symptom? Post-partum fatigue.
My friend is a health nut and athlete – she has lived the “gold standard” life from a preventive health perspective. I always wanted to be more like her – eating lots of veggies and running regularly. She has been at her target weight all her life, has the occasional glass of wine, and spends much of her free time in community service projects and charity work. She has no history of cancer in her family – they are all hardworking, clean-living types who enjoy long, productive lives.
So when she told me about her advanced disease I almost fell off my chair. How could this happen to her? She is too young! She doesn’t fit the right description… Why didn’t I catch this sooner? Did she ever give me any hint of a warning symptom?
She told me that after having her baby she just felt really tired and was unable to bounce back as quickly as expected. I was worried about post-partum depression, and she eventually decided to see a family physician about her fatigue. He was unclear as to its root cause, and ordered a broad range of general blood tests – including liver function tests. They turned out to be abnormal, and he inquired as to whether my friend might be a drinker. She denied any such tendencies, so he scheduled an ultrasound. The ultrasonographer noted the appearance of metastatic cancer – she had a CT scan and a colonoscopy to confirm the diagnosis of colon cancer. We were both in shock.
And now as my dear friend faces likely surgeries and chemotherapy, I am witness to her journey – the same one that I’ve observed in strangers – but this time I have no professional defenses. I will watch as her body is wracked by the disease’s treatments, I will understand the individual circumstances behind her bravery, I’ll know and feel everything in a personal way that I can’t control.
I am about to join the millions of cancer patients and their families on the other side of the examining room. This time I’m not the doctor, I’m the close friend who rages against a disease that is not fair. And I am ready to fight.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 13th, 2007 by Dr. Val Jones in News
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My friend and fellow blogger, Kelly Close, tipped me off to a very powerful new diabetes awareness ad campaign that begins today. These will run as TV commercials and Internet ads. I thought they were really thought provoking and original. They feature every day scenarios (like a boating trip, ordering food at a restaurant, and greeting a new dog) and then reveal the hidden danger in each “innocent” situation. Then they go on to say that you don’t have to be taken by surprise by diabetes, as there is a test (hemoglobin A1C) that can give you a glimpse into the future.
As many as a third of people who have diabetes are unaware that they have it. As many as 80% of diabetics do not know what their hemoglobin A1C level is. These are shocking statistics for a disease that is treatable, and complications that are preventable. If you haven’t been checked for diabetes and you have reason to suspect that you might be at risk for it (you are substantially overweight, you have diabetes in your family, or you have symptoms of diabetes such as abnormal thirst and frequent urination) please go to your primary care physician for a check up. Diabetes is one disease that we can control well and sometimes cure – but ignoring it could result in kidney failure, blindness, amputations, and heart disease. Let’s take these TV ads to heart and get blood sugar under control in America.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
