August 9th, 2009 by Toni Brayer, M.D. in Better Health Network, True Stories
Tags: Prison, San Quintin, Tennis
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I spent this morning on the “yard” at San Quintin Prison, playing tennis with the inmates. The prison has a tennis court, built right in the middle of the yard with hundreds of inmates shuffling about, shooting hoops, playing dominoes, working out or just milling about.
The guys who play tennis are a remarkable bunch. They are serious about their game, play whenever they can during the week and are really happy on Saturday morning when authorized “outsiders” come to play with them.
We play round robin; first team to 4 wins and a new foursome takes the court. They seem to have an understanding among themselves about who plays when. It is competitive but, believe it or not, very gentlemanly. Everyone is encouraging, with lots of high-fives and there is no cheating or bad line calls. The best part is when I am not playing, I am sitting on the bench with the guys, just chatting.
The tennis players in San Quintin are without attitude or posturing. Some do yoga or go to school. Some work in various prison jobs like making furniture, or stocking or cleaning cell blocks. Keep in mind some of these guys are there for life and they look pretty young to me.
In case you are thinking they have a soft life there, playing tennis and hanging out with civilians, think again. One guy showed me his lunch. It was 2 slices of white bread, a piece of bologna and mustard with a handful of corn chips. They can not receive gifts from the outside. If they have the money, they can order things from a catalog (tennis shoes, clothes, food items, personal supplies) every three months up to 30 lbs. There is no internet, no ipods, no electronics, no cable TV.
People ask if I feel “safe” there and I must say I do. Certainly the tennis players are respectful and warm. The other prisoners in the yard watch us but keep a respectful distance and no-one has ever made a comment or shown any aggression. Of course there are 4 guard towers with guns pointed down at all times.
One of the tennis inmates told me this cell block is less troublesome and there is less gang activity or fighting. Most of them are long timers or even lifers. I was told that “Bert”, one of the guys I played with before was finally released after 23 years. I hope he is playing tennis on the outside.
For a look at how it is playing tennis in San Quintin, watch this.
*This blog post was originally published at EverythingHealth*
August 9th, 2009 by Bongi in Better Health Network, True Stories
Tags: Bowel Ischemia, General Surgery, Ischemic Bowel, South Africa
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Recently I spoke a bit about interaction with foreigners. The impression I left would have been strained to say the least. But as with all things there must be balance.
They were tourists (aren’t they all?) when in the Kruger she developed severe abdominal pain. Her son brought her to hospital.
When they called me, besides the usual clinical history the casualties officer made a point of mentioning to me that they were American and that her son, the one who brought her in, was a physician. Let me take a moment here just to mention a language difference between English and Americaneese. In South African English, a physician is a specialist in internal medicine. In American, it seems, a physician is simply a doctor. At that time I did not know this. None of us did. So when the patient told us her son was a physician we all naturally assumed he was a physician and not just a common or garden variety MD.
I mentally prepared myself for a confrontational family. Usually with non medical first worlders they question you at every turn. A physician (South African definition) traditionally is sceptical of the knife-happy surgeon. I couldn’t help thinking of the internist in scrubs trying to protect his patient from the destructive steel of the blood crazed surgeons. All I could hope for was a benign abdominal cramp which would soon pass.
The patient was in pain. She associated her discomfort with some or other something she had eaten the previous day in the Kruger. But it just seemed too severe. Besides, could anything bad actually come out of the Kruger? She had none of the signs which indicated that she needed immediate surgery. But the pain really bothered me. It nibbled away at the back of my mind. Then came the x-rays. They were worrying. I was looking at a partial obstruction, but the bowel was just too distended. One more thing to quietly eat away at my mind.
Then suddenly the son appeared as if out of nowhere. He greeted me in a friendly manner. I introduced myself as the surgeon. Even after hearing who or rather what I was, he remained friendly. I remained guarded. Afterall I was under the impression I had to do with a physician (when in actual fact I later found out he was only a doctor).
I showed him the x-rays. He could see they were not good. I then went on to tell him I was worried and I felt an operation was in order. At this stage let me mention that a partial bowel obstruction does not need to be operated immediately. It can be left for the next day. But in this case there were just a few too many things eating away quietly at my mind. I had a pretty good idea what this meant. He surprised me. He said that I should do whatever I thought was needed. I did.
The operation went as I expected. I expected necrotic bowel. I resected what was needed and did all the other things that us surgeons do in these circumstances. But when you have necrotic bowel, especially in people with a few years behind their names, the patients tend to be much sicker than they initially looked. This was no exception. We were worried about here generally and her hemodynamics and kidney function specifically. We were worried enough to send her to ICU. The gas monkey even felt the need to leave her intubated. I concurred.
After I had tucked her into bed in ICU I wondered where her son was. It was way after midnight so it was reasonable to expect him also to be neatly tucked into his own bed in one of the many guest houses in nelspruit. But I just felt I’d better check in the ward where his mother would have gone to if she hadn’t ended up in ICU. He was a colleague and besides, he might expect the worst if he found his mother in ICU intubated unexpectedly. I took a stroll to the relevant ward.
I found him and his wife sitting in the scantily lit room where his mother should have ended up patiently waiting for her return. I smiled. I was starting to like them.
I greeted them warmly. I didn’t want them to expect the worst. I then went on to explain that there had been necrotic bowel due to a twist of the bowel and therefore we felt it prudent rather to send her to ICU. I reassured them that she was well and we expected no further unforeseen problems. I warned him that she would be intubated and reassured him we would probably wean the ventilator and extubate her the next day. He was pretty ok with everything but I could see in his eyes the normal amount of stress associated with hearing that your mother needed to be admitted to ICU.
He put a strong face on it. He asked me a few questions and I did my best to reassure him on each point. Then he asked a question I was afraid I would not be able to reassure him on.
“And when we go down to ICU, will we be able to speak to the intensivist?”
“Umm…errr….that would be me.” After all, this was a peripheral town in South Africa. In fact there is no real intensivist in our entire province. Suddenly I felt sorry for these Americans. They were far from home, their mother was very sick and the best they had to look after her in ICU was a mere surgeon. There must have been at least some inkling of a misgiving in their minds. But he didn’t show it. He smiled at me and simply said;
“Ok. Well we’ll see you tomorrow morning then?” I was impressed.
The next morning I did not see them. They must have still been asleep after such a late night, I assumed. However the following few days their involvement really did leave an impression on me. It was also about this time that I realised he was not in fact a physician as I understood the word, but a doctor who was busy specialising in tropical diseases (or some such thing).
Anyway the patient did well. She had the setback of a bit of wound sepsis which, considering everything, I could live with (although I have heard that some people in America want to put it onto a never event list?????). That was soon sorted out and after not too much time she was sent on her merry way.
This case also caused me to be contacted from the States. The patient herself sent a thank-you letter as soon as she got home, as did her son. She then sent a further thank you letter a year later and the year after that.
So, if I left the impression that I have my reservations about treating foreigners, please think of this delightful old lady and her equally wonderful family.
*This blog post was originally published at other things amanzi*
August 8th, 2009 by Dr. Val Jones in Humor, True Stories
Tags: Baseball, Hats, Jose Conseco, Logo, Nolan Ryan, Personal, Summer, Texas Rangers, Umpire, Walgreens, Washington Nationals
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Well, it’s a summer Saturday on the blog – which means that the Better Health editorial standards are a little more lax. And this week I’m willing to share some highly embarrassing personal details for your amusement.
Over the course of my lifetime, my exposure to baseball has been somewhat limited. In fact, the only games I ever went to were at the demand of an old grad school roommate who had a crush on José Conseco. We lived in Dallas at the time and she forced me to accompany her to the games so that at the end she could stand by the exit gate and catch a glimpse of him as he left the ballpark.
As a long-suffering and supportive friend I endured countless games in the Texas summer heat – sitting in the nosebleeds at Ranger stadium, with no more than a folding seat, napkins to wipe my brow, and a long line to a dirty bathroom. Apparently Nolan Ryan was an amazing pitcher – but it was hard to tell from such a distance.
So that was pretty much the sum total of my experience with baseball, and the reason why I hadn’t been all that interested in taking friends up on more recent invitations to go to a ball game. But yesterday my world changed.
My dear friends Heather and Doug (aka Mr. Heather) convinced me to join them at Nationals stadium yesterday… and I was astonished by the creature comforts of the place. Open air sports bars, restaurants, game tents, air conditioned box seats… food buffets. My goodness. This was not at all what I remembered about baseball – and we got to sit just above home plate.
Now, the only problem was that I really never learned the more complicated rules of the game – like why can the guy on third run home after the outfielder just caught the batter’s ball and he’s out? I know I’m the only person in the world who doesn’t get it, but that’s ok.
The real problem came when I was en route to the game and experienced some brand confusion. I noticed everyone wearing these red hats (on the right below) and I knew that our team was called “The Nats” so… I just didn’t make the association between the W and our team. And quite frankly, the font looks an awful lot like Walgreens doesn’t it?
Yeah, so I did accidentally let slip my confusion about all the “Walgreens hats.” I thought maybe they were a big team sponsor or something.
My friends were at first confused, then horrified, then laughing uncontrollably. I kept protesting that it was an honest mistake (given the branding similarities), and they said, “Oh yeah, like TOTALLY” and did their best blonde Valley Girl impressions.
The other problem was that although I knew the hand movements made when the umpire wanted to indicate that a player was “safe” on base, I didn’t recall that the opposite resulted in a movement very similar to what I do when I’m really psyched about a victory of some sort and say “Yes!” You know, you make a fist with bent arm and bring it quickly down to mid abdomen from shoulder height.
So, in all truth, there was a moment of confusion in my mind when I saw the umpire making the “Yes!” movement – it seemed kind of partisan to me, and I wondered why he didn’t just make the “safe” sign. And then the runner walked away all dejected. I should have kept my mouth shut and let me brain process, but I let it slip to Heather – why does that umpire guy go “Yes!” all the time?
We had a good laugh… some amazing nachos… and our team won 7-6 so it was a really exciting game all the way through. I told Heather the stadium was so nice I’d be happy going there just to hang out – game or not.
Kudos to the Washington Nationals marketing team – even with our team being in last place, the experience was outstanding – causing even a hardened baseball skeptic to rethink her position on game attendance. Now if you could just do something about the Walgreens logo… 😉
August 7th, 2009 by Emergiblog in Better Health Network, True Stories
Tags: Colonoscopy, Endoscopy, Gastroenterology, Inflammation, Protonix, Ulcer
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I hope you can read the print on this.
It’s a hoot!
Apparently, the Vacuum Tympan cures the most “desperate causes” of hoarseness and sore throat, massages vocal cords and gives immediate flexibility (to what?). Oh, and after it brings relief, “a permanent cure soon follows”.
Maybe it sucks out the phlegm. (Ewww…just writing that made me gag.)
It sort of looks like the old incentive spirometers we’d use for post-op patients.
Or maybe it’s a type of nebulizer.
Frankly, it looks like a bong.
********************
I’m at that age where certain tests involving scopes and colons are recommended, so I did my duty as the good custodian of my health and scheduled the pre-test appointment.
(Don’t worry, this will not be a case of “TMI”.)
I’m sitting there with the GI doc going over my health history, when he notices I’m on Protonix. Based on this fact (and the fact that my upper abdomen is sore on palpation – well, duh, you’re pushing on it!) he says “Well, you are going to be out anyway, I might as well take a look down there, too!”.
Say what? I’m here for a tube up one end and you want to put a tube down the other end, too?
I swear to (insert-your-own-deity-here), my first thought was “dude, you’re just trying to add a procedure to crank up the income.”
I’m not proud that was my first thought, but I’m being honest here. “Sure!” he said. It might be a structural problem, we can make sure you don’t have Barrett’s Esophagus (note to self: look that up) and basically just know what we are dealing with.
Well, okay. But I don’t have indigestion/heartburn when I’m on Protonix; I’m rather asymtomatic, actually.
“What kind of anesthesia would you prefer? We can use Versed/Fentanyl or if you want, we can use proprofol.
Propofol? Dude, you can stick a tube anywhere you want. Go for it!
*****
Easiest thing I’ve ever done. I have no idea why I waited so long. When I fell asleep Shania Twain was feeling like a woman and when I woke up, the Eagles were takin’ it easy and I wondered when the hell they were going to start!
I was done.
The procedure went well, the biopsies were taken (routine) and I would get my results by mail within two weeks.
*****
My colon rocks. No problems except divertiulosis and I can live without nuts and seeds.
It was the endoscopy that I almost refused that showed the problem.
The biopsies showed acid-induced esophageal and gastric inflammation.
What??? How??? I thought the Protonix was taking care of that!
*****
And then came the “treatment” boxes checked off.
“Keep taking your medicine for the next three months, then stop.”
Okay…if I have this inflammation now, why would I stop the medication? Won’t it get worse if I do?
“Please avoid Aspirin, Naprosyn, and Motrin. Tylenol is okay.”
Aw man, Motrin is my best friend, my right hand! It’s gotten me through many a rough shift; 12 hours in the ER can make you ache. Tylenol isn’t worth the powder it is printed on.
I took a swig of my Diet Pepsi.
“Avoid fatty foods…”
Okay, doing that already with ol’ Richard Simmons’ plan.
“…chocolate, peppermint, spearmint and smoking”
Bah – I don’t smoke and I can live without chocolate and who wants spearmint anyway?
Took another swig of Diet Pepsi.
“…alcohol…”
No biggie, I only have two Bud Lights a month, during Nascar races, and that’s only to support Kasey Kahne’s sponsor (and I know you all just doubled that to four per month…).
“Avoid caffeinated beverages…”
Uh oh.
Took a tiny swig of Diet Pepsi.
“Decaffeinated coffee…”
That…means…ohh nooooo…
*****
Oh HELL no.
I will NOT give up Starbucks.
Damn it!
I don’t smoke, I barely drink, I don’t do drugs, my diet has more fiber that corrugated cardboard, I’ve lost close to 30 pounds and I’m working on the other 25.
My only “vice” is a total addiction to Starbucks and the goal of someday mainlining Diet Pepsi.
It will be a cold day in hell before I give those up.
*****
I’m giving them up.
I know the effects of chronic esophageal and gastric inflammation can lead to bigger problems.
And in the scheme of things, given the impact a diagnosis can make on a life, this borders on laughable.
But we all talk about how the patient has to take responsibility for their health. I could keep on downing Starbucks twice a day and Diet Pepsi in my sleep and then whine because my Protonix isn’t working.
Or I can make the changes suggested and see if they will make a difference.
But how ironic that the main problem was found in a test I didn’t even know I needed; and how scary that I was essentially asymptomatic, but the inflammation was still there!
Kudos to the doc for being interested enough to find out why I had needed to be on Protonix to begin with.
I shudder to think what things would have looked like had I been on no medication.
*****
Who knows?
Maybe I can go off Protonix if these changes work.
And I can still go to Starbucks, only my new drink will be a Grande Skinny Vanilla Steamed Milk.
With a little cinammon on top.
Hey, a girl’s gotta have something to look forward to…
*This blog post was originally published at Emergiblog*
July 29th, 2009 by DrRob in Better Health Network, True Stories
Tags: Apologizing, Apology, Law Suit, Physician, Primary Care, Rush
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A recent oft-cited study showed that doctors who who apologized for mistakes were less likely to be sued. My initial reaction to that is to file it under “duh.”
But then I was greeted with a note lying on my desk.
Dr. Rob:
First, I want to tell you that for the majority of the many years my family has been patients of your practice, I believe we received excellent care and you always had our best interests in mind. Further, we appreciate all that you and your staff have done for us.
However, it is with great regret that I find myself in the position of writing to you with a problem I see as pervasive in your practice…
Ugh. This is not the way to start my day.
The letter went on to describe a problem with communication of a concern the patient had about a medical problem that was very worrisome to her. It didn’t point the finger of blame at my nurse, nor any one else in the office. It wasn’t at all angry in its tone to me. It simply expressed the disappointment of a patient who felt let-down by her physician.
The letter ended with:
I look forward to speaking with you about this issue early in the week of July 20.
Thank you in advance for your attention to this matter.
I put off calling her until the end of the day. I knew she would be reasonable overall, but beyond the fact that I hate calling people on the phone at all, I hate calling when I know I have to apologize. The problem in this case was not with my staff or with confusion in the office. The problem was with a physician who simply dropped the ball and did not follow-up as promised.
I finally called:
Hi.
First let me say thank you for the letter you sent. I mean that sincerely. I would much rather hear about problems in our office than to simply having people get angry and leave. This is something I needed to hear.
Second, let me say that the blame is 100% mine. I really wasn’t worried about the problem and so I honestly just let it slip my mind. I did tell you I’d contact you and would send you to a specialist if things weren’t clear after the tests I ordered. I’m sorry about that.
I went on to discuss the situation and that I didn’t think anything was serious at all. She still wanted to go ahead with the consultant because of some stuff she had heard about the condition. I told her that I have no problem with that, as I see my job as one of giving my advice and perspective; but not as making the final decisions. The most important thing is that her worries are addressed and that she feels comfortable that everything is OK. If it takes a consultant to do that, then I have absolutely no problem with that.
I also explained that communication in a medical office is very difficult – and has gotten much harder as we have gotten busier. It is our plan to eventually have communication by e-mail, but that is not ready for prime-time. This is not an excuse, I told her, but an explanation and a promise that I do see the problem and we are doing something about it.
As expected, she was gracious about the situation and was thankful for the apology. I didn’t do it to avoid lawsuit or to protect myself. I like this family and didn’t want to lose them as patients. Beyond that, though, I owed her an apology. I had let her down. I hadn’t done what I promised I would do. She had been kind enough to send me the letter and deserved a quick resolution to the situation.
I still hated picking up the phone, though. It isn’t easy to admit fault, no matter how accepting you know the other person will be.
As obvious as it seems that apologizing will prevent lawsuit, it is a hard thing to do.
But I am glad I did.
*This blog post was originally published at Musings of a Distractible Mind*
