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When Lightning Strikes Your iPod

The New England Journal of Medicine published a letter to the editor about a  man who was struck by lightning while wearing his iPod.  He was jogging home in a thunderstorm, listening to some energy-boosting music when -whammo- the poor Canadian man got more than he bargained for on the energy front.  A nearby tree was struck by a lightning bolt, and the side flash reached him, and followed the wiring to his ear buds.  The electrical shock passed from one ear bud to the other, blowing out his ear drums and causing such a violent contraction of all his facial muscles that his jaw snapped under the tension.

So this begs the question: could this happen to you?  Does carrying a cell phone or iPod put people at higher risk for being struck by lightning?

Well, because lightning strikes are exceedingly rare there are very few case reports in the literature about folks who have been struck while talking on their cell phone or carrying an electronic device.  And best I can tell, this is the bottom line:  carrying a cell phone or iPod does not increase your chance of being struck by lightning (there is not enough metal in those items to act as a lightning rod).  The lightning is more likely to strike a nearby tree or tall object than it will a human.  However – if you are struck (such as the man described above) any metal objects (even ions found in your sweat) that you are in contact with can influence the direction of the current.  Normally, lightning passes over the skin externally, but if you are wet or have metal in your ears, it can direct the electricity internally, where it can do more damage.

So if you’re caught in a lightning storm, I’d consider keeping metal out of direct contact with your skin.  But the chance of you being struck by lightning in your lifetime is almost one in a million, so I think there is little cause for general alarm.  Or to use a bad pun: we can all lighten up about lightning risks.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Kitty Rescued From Fire

Thanks to GruntDoc for posting a link to a heart warming story of a cat rescued by an EMS team in Britain.  Firefighters and ambulance crews were called to the scene of a house fire, and fortunately found no people inside.  They did, however, find the family pet – suffocating, wet and terrified – and brought the poor cat out to the street where they administered some oxygen.  Unsure of next steps, the crew asked for permission to transport the animal to the nearest 24 hour veterinarian hospital.  Being that there were no humans in need of the ambulance at that time, they were given permission to call ahead to the animal hospital and hand off the kitty to the vet team, who proceeded to save her life.

Let’s hear it for the compassionate EMS team who took the time to be kind to all creatures great and small…This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

The cardinal sin of medicine?

An Emergency Medicine physician blogger calls laziness the “cardinal sin of
medicine.”

How did this quality achieve such status?
TrenchDoc explains:

Simple. It is the ONE thing that we as
physicians can control. We cannot prevent patients from smoking and driving
their minivans into light poles. We cannot help that patients have myocardial
infarctions without any symptoms whatsoever. We certainly can not force them to
take medicine or have routine checkups. We CAN however be careful,
double-checking and unassuming diagnosticians. I don’t mean by this that we
should order a whole boatload of tests on each patient… quite the contrary… I
mean we should SPEND THE TIME with the patient to find that one unlikely detail
that is the key to solving the problem.

Honestly though, being lazy, quick and
cheap are the easiest of sins to commit in our vaunted system. We pay
physicians in this country basically upon the number of procedures or the
amount of patients they care for per hour. Eventually, poorly directed
efficiency gives way to poor quality of care and to be honest, I am as guilty
as anyone when it comes to missing important clues from a patient.

In his blog post, TrenchDoc goes on to describe a terrible
case of a mentally disabled woman who fell out of an electric shopping cart at
a Value Mart.  She complained of severe back
pain and got every imaging study under the sun (which showed a normal
spine).  She was discharged from the
Emergency Department, only to be readmitted to another ED weeks later when her
pain was still too great to bear.  This
time she said it was her leg that hurt… take a look at the horrible fracture
she had that was missed at the first ED.

I have argued that one of the major causes of decreased
quality of care is reduced patient-physician interaction time.  We are so pressured to rush through our
history and physical that we often miss the diagnosis, furiously documenting
everything without mentally processing what we’re doing.

I agree with TrenchDoc’s call to spend more time with
patients, though time doesn’t come easily.
How do you think we can help physicians find more time to be with their
patients?

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Baking cookies, part 1

When the president of a country dies suddenly, they say that
the citizens forever remember where they were, and what they were doing, when
they first heard the news. I’ve heard people
discuss their personal circumstances when they received word that President
Kennedy was shot. For some reason, that sort
of news is a memory fixative, preserving individual experience along with
national tragedy.

For me, 9/11 was one of those events. I was getting off a night shift rotation at a
hospital in lower Manhattan, sitting in morning report, dozing off as usual –
my eye lids sticking to dry corneas, my head feeling vaguely gummy, thoughts
cluttered with worries about whether or not the incoming shift of residents
would remember to perform all the tasks I’d listed for them at sign out.

And as I dozed off, suddenly our chief resident marched up
to the front of the room, brushing aside the trembling intern who was
presenting a case at the podium at the front of the dingy room. “How rude of him” I thought hazily, as I
shifted in my seat to hear what he had to say.

“Guys, there’s been a big accident. An airplane just crashed into the World Trade Center.”

Of all the things he could have said, that was the last
thing I was expecting. I shook my head,
wondering if I was awake or asleep.

“We don’t know how many casualties to expect, but it could
be hundreds. You need to get ready, and
ALL of you report back to the ER in 30 minutes.”

I thought to myself, “surely some Cessna-flying fool fell
asleep at the controls, and this is just an exaggeration.” But worried and exhausted, I went back to my
hospital-subsidized studio apartment and turned on the TV as I searched for a
fresh pair of scrubs. All the channels
were showing the north tower on fire, and as I was listening to the news
commentary and watching the flames, whammo, the second plane hit the south
tower. I stared in disbelief as the “accident”
turned into something intentional. I
remembered having dinner at Windows on the World the week before. I knew what it must have looked like inside
the buildings.

I was in shock as I hurried back to the hospital, trying to
think of where we kept all our supplies, what sort of injuries I’d be seeing,
if there was anything I could stuff in my pockets that could help…

I joined a gathering crowd of white coats at the hospital
entrance. There was a nervous energy,
without a particular plan. We thought
maybe that ambulances filled with casualties were going to show up any second.

The chief told me, “Get everybody you can out of the
hospital – anyone who’s well enough for discharge home needs to leave. Go
prepare beds for the incoming.”

So I went back to my floor, recalling the patients who were
lingering mostly because of social dispo issues, and I quickly explained the
situation – that we needed their beds and that I was sorry but they had to
leave. They were actually very
understanding, made calls to friends and family, and packed their bags to
go.

And hours passed without a single ambulance turning up with
injuries. I could smell burning plastic
in the air, and a cloud of soot was hanging over the buildings to the south of
us. We eventually left the ER and sat
down in the chairs surrounding a TV in the room where we had gathered for
morning report. We watched the plane hit
the Pentagon, the crash in Pennsylvania…
I thought it was the beginning of World War 3.

The silence on the streets of New York was deafening. Huddling inside buildings, people were
calling one another via cell phone to see if they were ok. My friend Cindy called me to say that she had
received a call from her close friend who was working as a manager at Windows on
the World. There was a big executive
brunch scheduled that morning. Cindy
used to be a manager there too… the woman’s last words were, “the ceiling has
just collapsed, what’s the emergency evacuation route? I can’t see in here…
please help…”

That night as I reported for my shift in the cardiac ICU, I
was informed by the nursing staff that there were no patients to care for, the
few that were there yesterday were either discharged or moved to the MICU. They were shutting down the CICU for the
night. I wasn’t sure what to do… so I
went back to my apartment and baked chocolate chip cookies and brought in a warm,
gooey plate of them for the nurses. We
ate them together quietly considering the craziness of our circumstance.

“Dr. Jones, you look like crap” one of them said to me
affectionately. “Why don’t you go home
and get some rest. We’ll page you if
there’s an admission.”

So I went home, crawled into my bed with scrubs on, and
slept through the entire night without a page.
The
disaster had only 2 outcomes – people were either dead, or alive and unharmed –
with almost nothing in between. All we
docs could do was mourn… or bake cookies.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

A tale of two car accidents

A few years ago I was walking home from the hospital after a long shift, when I witnessed a bicycle messenger struck by a taxi cab. The cyclist was riding at high speed across a crowded intersection and the cabbie was accelerating through a stale yellow light. THUD. The man flew across the pavement, the cabbie screeched to a halt, horns honked, a crowd gathered… I ran up to the man to check him out. His right shin was bleeding (he was wearing shorts), but I didn’t see any obvious deformities or broken bones.

The man was panting, his adrenaline pumping. I asked him to stay down for a moment while I checked him out. “F-off,” he snarled, “I don’t need your help.” Since I saw him fall, I knew that he hadn’t sustained a head injury that could explain his potential disorientation and poor decision making. I called 911 on my cell phone and gave them the scene coordinates while I tried to get the man to agree to get checked out. “I don’t need a f-ing ambulance, don’t call them!” he screamed, blood dripping down his leg. I did my best to reassure him, but he was adamant. He got up and started limping towards his bike (which, quite miraculously, was not bent out of shape from the blow). I continued to plead with him to just wait a moment to let the paramedics take a look at him, but he would not be detained. Short of using brute force to keep him down, there was nothing I could do. Distant sirens sounded, he hopped on his bike, muttered “I don’t have insurance” under his breath, and rode off. The taxi driver appeared extremely relieved. The crowd dispersed, the taxi left the scene.

When the fire truck arrived, I explained the situation. They asked which direction he’d driven off in, and they pursued. I don’t know if they ever found him, but catching a cyclist with a fire truck on the crowded streets of Manhattan is unlikely.

——–

A few weeks ago I was walking down a narrow street in DC. An ambulance was parked in the middle of the street, a small SUV was in front of it, and a middle aged woman in a dark suit was sitting on the asphalt appearing angry but unharmed. I heard from an onlooker that she had darted out behind the SUV while it was moving slowly in reverse. She had been struck lightly, but was speaking loudly about suing the driver, and was demanding that she be taken to the ER for a full check up. The EMS team interviewing her was hesitant to put her on a stretcher since it was so obvious that she could walk. The woman was refusing to get up, and they were trying to figure out how best to carry her.

I gritted my teeth and walked away, wondering what kind of legal torture the SUV driver was in for.

These two car accidents left an impression on me – the uninsured will go to extremes to avoid costly medical care, while the personal injury lawyers rack up serious cash on trumped up claims. What’s the point of this post? I guess it’s a reminder to look both ways before you cross the street, drive carefully to avoid pedestrians, and make health insurance a priority!

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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