May 19th, 2007 by Dr. Val Jones in Medblogger Shout Outs, True Stories
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Although these 3 stories are incredibly sad, they serve to
illustrate the realities of this imperfect world – and how heavy some “crosses”
are for people. We should count our
blessings when things go right for us, and reach out to those who are suffering
in unimaginable ways…
From Hallway Four: A
40 year old woman was seen for difficulty breathing and eventually diagnosed
with pneumonia and fluid-overload secondary to need for dialysis. This
lovely lady had been diagnosed recently with kidney cancer of her right kidney
and had undergone nephrectomy (removal of the diseased kidney).
Ordinarily, this would still have left her with one good kidney, which is all
you need. But, as luck would have it, this lady had donated her left
kidney to her ailing sister three years prior.
From Charity Doc: A father of a 7 y/o little boy brings him
into the ED last night reporting that his mother’s boyfriend had beaten him
black and blue with a belt, an assertion that the mother did not deny. The couple had
been divorced for a little over a year. On physical exam, the little boy had
indeed not been spared the rod at all. His buttocks and back were ecchymotic,
black and blue with scattered scabbed marks from numerous whippings and
beatings. It was unbelievable. [Child
protective services ruled that the child should go home with the mother
because] the mother has legal custody of the kid and we can’t send him home
with his father.
From a story relayed at a Rehabilitation Medicine
conference: A set of conjoined twins were born fused at the hip. They were sickly, sharing a circulatory
system that was insufficient to serve both of their needs. The doctors had to make an educated guess as
to how to dissect the two apart from one another – there was only one set of
male genitals, and three legs. They
carefully studied the anatomy and decided to part the twins, giving the
healthier appearing one two legs and the genitalia, leaving the other with only
one leg and no genitals. Several weeks
after the surgery the first twin (with the 2 legs) died. The second twin is still alive, is in his 20’s,
and has been in and out of jail for drug trafficking.
Makes our own problems seem pretty trivial, doesn’t it?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 14th, 2007 by Dr. Val Jones in True Stories
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Several years ago I was taking care of a pleasant elderly woman with a heart condition on an inpatient unit. One morning I went into her room to check on her and I found her sitting up in bed, clutching her purse and crying.
“What’s wrong, Mrs. Johnson?” I asked, perplexed.
She blew her nose in a Kleenex and replied, “Someone stole my insurance cards, my money, and my credit cards! They were in my wallet just yesterday evening – and this morning they’re gone.”
I paused for a moment, considering the order of priority in which she reported the missing items, glanced at her telemetry monitor (her rhythm was regular though her heart rate was elevated from crying), and asked if she knew how this might have happened.
She told me that she suspected that a certain patient had sneaked into her room in the middle of the night and removed the items from her wallet.
“How do you know it was that patient?” I asked, growing suspicious.
“I’ve seen her sneaking around at night in other people’s rooms – a couple of nights ago she was in here digging through my roommate’s dresser drawers.”
The suspect was a 38 year old woman with a known history of heroine abuse, who was admitted to the General Surgery service (conveniently boarded on our Internal Medicine floor) from the Emergency Department to complete an acute abdominal pain work up. This woman had already terrorized the surgical intern assigned to her case (as I had heard on rounds the day before) by chasing her around the hospital room with a hypodermic needle. Security had come to restore order and had found a stash of heroine and some needles in her bathroom that had been brought in by her visitors the night before. The team decided not to discharge her because they had discovered a large abscess on her ovary (from an advanced and untreated sexually transmitted disease) that they felt obligated to drain and treat her with antibiotics. Of course, on the morning of her scheduled surgery she ate breakfast, making it unsafe to put her under general anesthesia. These games continued (sneaking food before surgery, refusing surgery or medications, then changing her mind, then claiming to be homeless with no safe discharge plan, etc.) so that her length of stay grew from days to weeks.
“And now,” I thought to myself, “she’s using our hospital as a flop house, victimizing MY patients on the same floor – stealing their belongings in the middle of the night?!” This was the last straw. I told Mrs. Johnson that I would get to the bottom of the matter.
And so I waited for the victimizer to leave her hospital room for a scheduled test – I sneaked into her room and went through her bedside table drawers. Lo and behold, my patient’s ID and credit cards were stashed in a box with a bunch of other IDs that clearly didn’t belong to the woman.
I called hospital security, and we reviewed all the items that she had stolen. As it turned out, she was admitted to the hospital under a stolen Medicare card (the woman had claimed to be on disability). Her name matched with our records of a 67 year old woman, so we knew that she had been admitted under another’s name – and the admitting clerk had not noticed the age discrepancy. A careful record search turned up the drug user’s previous admissions under this alias. This predator had been gaming the system for years, eluding detection!
I asked the security guards to help me interview other patients on the inpatient unit to see if they had experienced anything out of the ordinary over the past few weeks. What we found was astounding. Several frail elderly patients described similar night terrors (being unable to stop the woman from going through their personal items at night) and one gentleman with advanced AIDS, who was admitted for treatment of severe pneumonia, reported that the woman had attempted to molest him in the middle of the night when she was high and in a hypersexual state.
Thanks to our investigation, many patients had their belongings returned to them (though some of their jewelry was not recovered – the woman probably sold it for heroine to her visiting dealer), and I heard that the predator was caught by the city police after choosing to leave the hospital against medical advice.
I don’t know what happened to this woman after that, and I doubt that the police were able to detain her for very long. I felt horrible for the patients who had been victimized in their ill and vulnerable states, and I wondered what kind of lasting psychological damage that this woman had inflicted upon them, especially poor Mrs. Johnson. I also felt frustrated and vulnerable – unable to really protect my hospital from future assaults. What could I do, stand in the Emergency Department each night to identify her if she chose to return? I can only imagine that this woman is still up to her old tricks at a neighboring inner city hospital near you…
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 17th, 2007 by Dr. Val Jones in Opinion
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– continuation of previous post –
What does a PM&R doc do?
The foundational principle upon which rehabilitation medicine is based, is this: physical modalities (exercise, movement, muscle strengthening) are critical components of achieving the highest level of wellness and functionality. The goal of a PM&R specialist is to maximize a person’s functional ability within the constraints of their physical limitations. So that if a person is an amputee, or has had a spinal cord injury, or stroke – the goal is to make them as independent as possible, using prosthetics, orthotics, adaptive equipment, physical training or family assistance.
The rehab physician works tirelessly to enable the disabled. Whether the patient has temporary (such as after a broken bone) or permanent (such as a spinal cord injury) disability, the rehab doctor wants to seamlessly reintegrate the patient into society, into meaningful work, and into a joyful participation in life to the max.
PM&R physicians are the ultimate integrative medicine specialists – they practice a combination of physical and medical healing techniques, while leading a team of specialists to help their patients achieve their goals (nurses, social workers, physical therapists, occupational therapists, cognitive therapists and psychologists, speech & language pathologists, prosthetics & orthotics specialists, and more).
I guess I could sum it up like this: when the proverbial Humpty Dumpty “has a great fall,” the surgeons knit his bones back together, the internists maintain his vital signs, but the rehab doc finds him some crutches, teaches him how to walk again, gets him cognitive therapy and counseling, helps him reintegrate into society, and stimulates his progress towards physical independence and emotional wellness.
Why did I choose this “odd ball specialty?”
Well, truthfully, I didn’t hear much about PM&R during medical school. I happened to meet a group of exceptionally happy residents in the hallway one day, and I asked them why they were smiling. (My only experience with residents was that they were tired, bedraggled, ill-tempered and hen-pecked – and this group defied the stereotype).
They explained to me that they were “rehab residents” and that’s why they were happy. That seemed like a non-sequitur to me, so I investigated the specialty in more detail, and became convinced that there was no higher call than to care for the disabled. I had been a home health aid in college, taking care of young adults with cerebral palsy, and I spent my summers at a camp for disabled adults, sponsored by the March of Dimes, so this was familiar territory and seemed to be a good fit for my nurturing temperament.
As we look at Americans’ current medical needs, we don’t see hundreds of thousands of war amputees (though there is a steady trickle coming from the war in Iraq), or polio victims – but what we do see is a population disabled by obesity and its collateral damage: diabetes (with its amputations), heart disease, stroke, severe arthritis, and various pain syndromes.
I believe that Rehabilitation Medicine, as a specialty, should adapt to serve the needs created by this new obesity epidemic. We have always been the masters of physical exercise for healing – now we should apply those principles to help Americans lose weight and keep it off. I couldn’t agree more with Dr. Jim Hill, who believes that dieting leads to weight loss, but exercise leads to weight loss maintenance (the real key to long term health benefits).
As I have argued in the past, America needs to be rehabilitated. And I hope that my work at Revolution Health will contribute to improving the general wellness of our citizens.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
