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Audio Interview: What You Need To Know About Thyroid Disease

thyroidimageJanuary is thyroid disease awareness month, and since an estimated 25 million people in the U.S. have various thyroid problems, I thought it would be a good idea to get an expert update on this often over-looked gland.

Victor Bernet, FACP, is Director of the National Capitol Consortium Endocrinology Fellowship at Walter Reed Army Medical Center in Washington, D.C., and the author of MKSAP 15′s chapter on disorders of the thyroid gland. I interviewed him about why thyroid disorders go undiagnosed, what alternative treatments are available, and how primary care physicians and specialists can work together to manage thyroid disease. Please listen to the audio of our conversation or check out the written summary below.

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Nurses And The Military: A Historical Perspective From Walter Reed

In honor of National Nurses Week, the National Museum of Health and Medicine hosted a discussion about the history of nursing at Walter Reed. Debbie Cox, former Army Nurse Corps Historian, initiated the conversation by describing what nursing was like at the turn of the 20th century. Steam-driven ambulances transported patients out of “mosquito-infested” Washington, DC to fresh-aired Fort McNair. A leading controversy of the time involved the intention of the hospital administrators to place the nurse baracks near the horse stables rather than the main hospital. In a dramatic twist, Jane Delano (cousin of Franklin D. Roosevelt) saved the nurses from relegation to the stables. However, it wasn’t until 1920 that nurses were given rank by the army.

Entry into nursing was through the Red Cross exclusively until the first nursing school was opened at Walter Reed in 1918. From there, nurses grew in numbers and prestige, until they became a cornerstone of medical research in the 1950s, leading the way in understanding how to reduce the spread of infections in the OR, decubitus ulcers in the hospital wards, and radiation damage related to nuclear war.

Jennifer Easley, a nurse who works in the pediatric intensive care unit at Walter Reed, described her experiences as a nurse leader for a team of soldiers in Iraq. She derived great satisfaction as an officer in her unit, and said that the team spirit and camaraderie was unlike anything she experienced in civilian nursing. She had this to say:

“I only made it 18 months as a civilian nurse. When I was called back to serve in the army, I had my paperwork in so fast you could hardly blink. I found out that in the private sector, no one ‘has your back.’ There’s no protection for those who raise safety concerns and nurses don’t have the authority to request back up in cases where units are dangerously understaffed.

I remember one day when several nurses called in sick and there weren’t enough of us to cover the children and babies in the ICU safely. I reported this to my nurse supervisor and she told me that maybe I wasn’t cut out for a challenging work environment. I was shocked, and really feared for the patients.

Another problem with private sector nursing is that there are glass ceilings. If you apply for a job as a staff nurse, you can’t work your way up to nurse manager. You’d have to leave that hospital and apply for a nurse manager position elsewhere. In the army, I had many more opportunities to contribute, grow, and lead.”

The final speaker was a nurse who returned from Iraq with head and neck cancer. He (LTC Patrick Ahearne) was an inpatient at Walter Reed for many months, losing 35 pounds and experiencing severe nausea, vomiting, and depression. At his lowest point, when he had lost hope of recovery and wanted to die, he was met with kindness by an experienced nurse who knew how to ask the right questions and reframe his perspective:

“This wonderful nurse stayed with me for 2 hours, watching me vomit and talking me through it. I remember her asking me what I’d learned about myself through my illness. I thought it was a strange, and medically irrelevant question – but it was just what I needed at the time. I realized how strong the human body can be, and the inner strength I had to endure my cancer. In those two hours nurse McLaughlin took me from wanting to die to wanting to live. She taught me that it was ok to be angry. It was ok to be sick.”

Many thanks to the unsung heroes out there who touch lives like nurse McLaughlin. We couldn’t do it without you.

A Hospital Closes Because Staff Don’t Want To Walk Too Much?

I volunteer at Walter Reed Army Medical Center (WRAMC) a half-day per week. I’m inspired by the soldiers in the occupational and physical therapy center, and am continually amazed by their abilities. The other day I watched a soldier with an artificial leg climb a rock wall better than I ever could, and marveled at a man who had both legs amputated above the knee – he was ambulating almost without a limp, and with the help of a straight cane alone.

As I watched these wounded warriors learning how to maximize their functional abilities – I overheard a staff member explain the reason why the Walter Reed hospital building is closing in 2011.

Apparently WRAMC is built on land owned by the District of Columbia. In an effort to subsidize the over-budget subway system, the city purposefully disallowed sufficient parking spaces to be built on the WRAMC site. The idea was to force staff to take the subway to WRAMC. The closest subway is a 20 minute walk from the hospital.

In addition to the limited parking, DC imposes a height restriction on all buildings in the district – they cannot be taller than the Washington monument.  Therefore as Walter Reed grew and expanded, they could not add any floors to the hospital, but had to construct additional buildings on campus.

And so, in about three years time, Walter Reed will shut down, moving their remaining staff to the Navy hospital in Bethesda, Maryland where there is plenty of parking and no building height restrictions.

I’m not sure what the total cost of moving the army hospital to the navy center will be, but I’m guessing in the hundreds of millions. How much did the staff complaints about not wanting to walk to work play into all of this? I don’t know, but I’ve seen them drive in as early as 5:30 am to get one of the few parking spots. This attitude is consistent with Americans’ general unwillingness to adopt an active lifestyle, and it’s costing us all so much more than we realize.

It’s possible that laziness dealt the final blow to Walter Reed: a facility created to get people active again after war injuries.

How Ironic.

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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