August 10th, 2008 by Dr. Val Jones in True Stories, Uncategorized
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A psychiatrist friend of mine (we’ll call him “Dr. X”) treats urban patients who have substance abuse problems and often live in homeless shelters. Here are some recent conversations that had me scratching my head:
Mr. P: [recovering from crack cocaine, alchohol, and heroin abuse] Doc, I’ve been feeling really depressed lately and the therapy sessions aren’t helping.
Dr. X: I know that we’ve done all we can to manage your depression conservatively. You may want to consider trying a small dose of an anti-depressant medication. It could really help.
Mr. P: [Eyes bulging, jaw dropped] But, Dr. X, those anti-depressant medications might affect my MIND!
***
Dr. X: Ms. P, why aren’t you taking your prenatal vitamins?
Ms. P: [actively smoking crack while pregnant] I don’t trust that stuff. I think it could harm my baby.
***
Dr. X: Ms Y, I know you’ve been struggling with pain related to your broken leg. Why not let me prescribe some pain medications for you?
Ms. Y: Oh, no – I don’t want any prescription medicines. I don’t trust those.
Dr. X: Well how are you going to manage your pain, then?
Ms. Y: My sister has some pills that I take.
Dr. X: What pills?
Ms. Y: Darvocet and Vicodin.
***This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 18th, 2008 by Dr. Val Jones in True Stories
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This alarming story (h/t KevinMD) of a physician attacked by a drug-seeker reminded me of my intern year. I worked in an inner city hospital in New York, and was scheduled to work in the “detox unit” for a full month. We interns had mixed feelings about our “detox month” – on the one hand, the patients were generally healthy and were unlikely to need blood draws, procedures, spinal taps, intubations, and such. This meant less work to do during our shifts. On the other hand, the patients were hardened drug users, often with a history of violence — and let’s just say that depleting the system of all the heroin, crack, alcohol, and various other substances didn’t tend to put them in the best mood.
I personally did not enjoy my detox month. I’d prefer a “crashing” ICU patient any day over a beligerant, hep C positive man trying to threaten me into giving him an additional dose of colace. And frankly, as a woman it was kind of scary to be around these guys. I never knew if they were going to snap, and no matter how many security guards are around, a lot of damage can happen in the 60 seconds or so it takes them to get to you.
One night the “detox resident” appeared for duty. His shift started at 11pm and the day shift nurses were eager to get home. The security guards were changing shift as well, and had not entered the lock-down area inside the unit. The resident went in alone. Suddenly, one of the patients snapped, and grabbed the unsuspecting doctor by the throat. The patient threw him up against the wall and punched him in the face, breaking his nose and fracturing his eye socket. Blood flew everywhere and the resident tried to fight back to defend himself. Unfortunately he was no match for the 250 pound patient, and sustained a few kicks to the ribs before the security guards were able to subdue the man. The resident was transferred off the detox unit rotation and given an extra week of vacation. I was the intern who was asked to fill in for him.
I felt somewhat paranoid that month, and refused to be inside the lock down area without a security guard within 15 feet of me. Fortunately, I was not physically attacked – I only experienced verbal abuse and the occasional very awkward conversation about genital deformities.
But it was a real wake up call for me – medicine can be a risky business, and white coats do not protect against psychotic aggression. I guess it’s just one of the risks we take in caring for all-comers.
***
Addendum: here’s another example of doctors being abused by narcotic-seekers.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 6th, 2008 by Dr. Val Jones in Book Reviews
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I met the author of Glori: A Different Story
(Nicole Lynn Hannans) here at Revolution Health a couple of months ago. She is a vibrant, beautiful young woman who had a child in her late teens. Nicole explained to me that the vast majority of America’s teen pregnancy resources are dedicated to prevention. Once a teen becomes pregnant, there is very little support for next steps. For this reason, young mothers have difficulty completing a college education and are often trapped in a lifelong cycle of poverty.
As a young African American woman, Nicole was determined not to become a statistic. Despite all the odds, being homeless and surrounded by her boyfriend’s drug dealing business, she managed to escape that life and attended The College of William and Mary as a single mom. She wrote Glori: A Different Story, to inspire other pregnant teens to go and do likewise – knowing that no matter what the odds, an unexpected pregnancy does not prevent women from achieving their potential in life.
The story begins with Nicole as a carefree teen, enjoying outings with friends and flirtations with guys. In preparation for her prom, she ponders her date options. She decides, against her better judgment, to go with a charismatic “bad boy” football player whom she suspects may be dealing drugs. But she finds his charm irresistible and he persuades her that her fears are unfounded.
Soon Nicole is dating this young man (RaKeim) and is deeply attached to him. Sadly, her life begins to spiral out of control as she realizes that all of her suspicions were correct – he is a crack dealer trying to live the life of a big time “gangster.” RaKeim is narcissistic, unfaithful, abusive, and obsessed with money. Nicole gets pregnant, moves out of her home to be with RaKeim and cannot seem to come to grips with who he is rather than whom she hopes he will be.
While reading the book, every fiber in your being wants to scream, “Get out, Nicole, he’s no good for you! Run!” But RaKeim knows just how to play with her emotions, and she is reeled back in time and again. A prophetic statement from a doting aunt punctuates the madness of homelessness and crack fiends: “It takes time to get a relationship out of your system.”
And it did take several years for the RaKeim poison to work its way out of Nicole’s life. The turning point came one night when he tried to steal their baby, and then broke down the apartment door and beat Nicole. After menacing calls, being threatened with a gun, and in-person harassment, Nicole came to realize that she would never be safe. The police were unwilling to issue her a restraining order without further proof of RaKeim’s potential for violence. She had to handle this one alone.
As luck would have it, RaKeim was in and out of jail, which gave Nicole some relief from his behavior. During that time she graduated with high honors from the College of William and Mary, enrolled in a Master’s Program, got a job working with sick children at NIH, and found love again.
Nicole’s straight forward account of her struggles makes a few things quite clear: 1) women are not adequately protected by current domestic violence protocols 2) psychopathic men have an uncanny ability to manipulate their victims 3) overcoming the odds is a matter of will, determination, and very hard work and 4) a mother’s love for her child can inspire her to achieve greatness.
If you’re interested in learning more about Nicole’s life, please check out her website at www.nicoleink.com Her book is aptly named: Glori: A Different Story, and I hope that it inspires many other young moms to reach for glory – and to triumph over adversity.
*** Join Nicole’s Group – Click here***
Further resources for teenage moms:
The Healthy Teen Network
Planned Parenthood
Girl Mom
National Family Planning & Reproductive Health AssociationThis post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 12th, 2008 by Dr. Val Jones in News
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TRUE: New York City adults have more genital herpes than the national average (26% versus 19%). One commenter replied, “Well, that’s what you get from ‘Sex in the City.'”
FALSE: A practical joke sparks Internet health myth: cell phones can cook an egg or pop popcorn. People really will believe anything.
FALSE: Some folks in India swallow live fish to stimulate coughing and to “clean the esophagus” and cure asthma. Must be an interesting feeling to have a live fish swimming around one’s stomach! Of course this doesn’t work. h/t to Happy Hospitalist
TRUE: More and more Muslim women are having their hymens restored so that they will appear to be virgins on their wedding night. I wonder about those women who are born with small or nearly absent hymens? Will they be punished? And what about the men who made the women non-virgins? This NYT story is quite upsetting.
TRUE: The media misrepresents health information 2/3 of the time. Fewer and fewer people are willing to take the time to get a story straight. When perception is nine-tenths of reality, science and truth are in jeopardy.
TRUE: Marijuana smokers enjoy lax laws in Mendocino County, California. It’s legal to keep up to 2 pounds of marijuana and 25 live plants in one’s home. How much marijuana does one really need for medical purposes?
FALSE: Gummy bears do not have internal organs. However, this artist has a wonderful imagination.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 23rd, 2008 by Dr. Val Jones in News
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I was shocked and saddened to hear of the sudden and unexpected death of actor Heath Ledger. As fate would have it, I had watched his movie, “Candy” on the weekend prior to his death. Candy is the sad story of a young Australian couple who get involved in the drug culture, begin shooting heroin, and end up as junkies, prostituting themselves to afford their habits.
While the cause of Heath’s death is not yet known, a drug overdose is suspected and autopsy results will not be available for up to two weeks. A coworker asked me why the results would take so long, and what’s involved in an autopsy. I found a good article on the subject and will excerpt it here:
- Before the actual autopsy, as much information as possible is gathered about the person who died and the events that led to the death. Other information may be gathered by investigating the area where the person died, and studying the circumstances surrounding the death.
- Procedures done during the autopsy may vary depending on the circumstances surrounding the death, whether the medical examiner or coroner is involved, and what specific issues are being evaluated during the autopsy.
- The autopsy begins with a careful examination of the external part of the body. Photographs may be taken of the entire body and of specific body parts. X-rays may be taken to evaluate skeletal or other abnormalities, confirm injuries, locate bullets or other objects, or to help establish identity. The body is weighed and measured. Clothing and valuables are identified and recorded. The location and description of identifying marks, such as scars, tattoos, birthmarks, and other significant findings (injuries, wounds, bruises, cuts), are recorded on a body diagram.
- A complete internal examination includes removal of and dissection of the chest, abdominal, and pelvic organs and the brain. The examination of the trunk requires an incision from the chest to the abdomen. The removal of the brain requires an incision over the top of the head. The body organs are examined before removal, then removed and examined in detail.
- In some cases, organs may be placed in a preservative called formalin for days to weeks prior to dissection. This is particularly important in the examination of the brain for certain types of diseases or injuries. Tissue samples are taken from some or all of the organs for examination under a microscope.
- Completion of the autopsy may require examination of tissues under a microscope, further investigation of the circumstances of death, or specialized tests (such as genetic or toxicology tests). The tests performed may vary based on the findings at the autopsy dissection, the circumstances of death, the questions asked about the death, and the condition of the tissues and body fluids obtained at autopsy. A written report describes the autopsy findings. This report may address the cause of death and may help answer any questions from the deceased person’s doctor and family.
So it makes sense that autopsy results take as long as they do. A thorough investigation requires everything from documenting items from the scene of the death, to a careful analysis of blood toxins, to preserving tissues in formalin before viewing them under a microscope. All of the clues must be carefully weighed (Is there any evidence of a heart attack? Was there a blot clot in the lungs? Was there a brain hemorrhage?) to get the full picture and to be sure of the exact cause of death. All things considered, it’s amazing that the pathologists can render an opinion so quickly.
My heart goes out to Heath’s family as they await closure on the cause of his death.
****
See also:
Mira Kirshenbaum discusses depression, suicide, and a healthy way to handle stressful life circumstances
.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
