April 30th, 2007 by Dr. Val Jones in News
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I had an eye-opening conversation with Dr. Jim Hill
today. He told me that Denver’s
Metro Mayors (Denver’s
metropolitan area is actually composed of 37 cities and towns!) are competing
with one another to see who can get their inhabitants the most fit and thin.
Why would they be so aggressive about fitness and good
health? Because they say that large
corporations considering investing in Denver
(where they’d build factories or large office buildings) know that setting up
shop in areas where the population has a lower BMI means that health insurance
costs will be lower.
That’s right my friends.
Being thin can lure investors! It
makes sense that a corporation seeking to avoid the skyrocketing costs of health
care would want to create facilities where new employees are likely to have
fewer medical issues. And BMI is a good
surrogate marker for health… so there you have it.
Do you see this approach to wooing investors as a form of discrimination
or just good business sense?
Either way, I’m going to get on the treadmill later.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 29th, 2007 by Dr. Val Jones in Humor
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I got a good laugh from a few sarcastic posts lately. This first one (via Graham) is about the
medicalization of modern life (where every symptom must have a diagnosis):
Consumer: I get
very moody if I don’t eat in the morning. If I don’t eat until 3-4pm I get
headaches, drowsiness and feel nauseous… I think I’ve always had this. Since
I usually eat enough it doesn’t really bother me. I’m 21, male, and a
vegetarian. What do I have?
Physician: You have a condition
known as hunger.
The good news: it is easily treatable
The bad news: there is no permanent cure
This condition can be treated at a specialized clinic, the one you want is
known as a restaurant. This condition can also be treated at home, but you will
need specialized supplies from a grocery store. Most sufferers find that
several treatments per day are necessary.
———
And this conversation was pretty funny (though I can’t for
the life of me find where I read it – sorry I would certainly love to give
attribution here):
Physician: we’re
going to need to get an MRI of your teenager’s head since he had a seizure.
Mom: why are you
going to get an MRI of his head, it was his body that had the seizure!
Have you heard any good jokes lately?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 21st, 2007 by Dr. Val Jones in True Stories
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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.
April 20th, 2007 by Dr. Val Jones in True Stories
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An elderly woman had had a
cardiac arrest and was resuscitated long after a lack of oxygen had permanently damaged her brain. Her daughter remained at her side day in and
day out in the Medical ICU, keeping watch on a hopeless situation.
Many staff had encouraged her to go out and get some fresh air, to take
care of herself… but she was compelled to stay with her mom 24-7 for reasons I will
never know.
I spent some time gazing at the patient’s face – it was delicate
and quite beautiful, with flowing white hair framing fair, soft skin. I wondered what she was like when she was
herself, if she had a gentle disposition, or a fiery wit. I wondered if she had loved her husband, and
if she had had a happy life… I wondered why her daughter was clinging to her,
barely able to leave her for bathroom breaks.
The situation continued for a few weeks – I was a medical
student, and wrote some very bland and unenlightening notes about the patient
each day, describing her unchanging condition.
I felt sad as I watched the daughter slowly come to realize that her mom
was already gone.
One day the daughter looked at me and said, “I think I’ll go
out for a bite.” I smiled, knowing that
this was a turning point for her, and gave her a hug. “I’ll watch her for you,” I said.
As it happened, the patient was on the “house service” –
assigned to the teaching attending of the month. She didn’t have her own doctor, so she was
followed by a team of rotating residents and attendings. The new team started this day, and were
somewhat unfamiliar with her case. I
dutifully updated them on the history and events over the past few weeks.
As I stood there with the team, rounding on the patient –
they noted that her lungs were becoming harder and harder to ventilate. “ARDS,” they said. “She’s going to code any time now.”
And then the unthinkable happened. The new attending, who was a bit of a cowboy,
said “let’s just end this madness. Turn
off the ventilator, it’s done.” The
residents looked at one another – one protested, “I don’t think we should do
that.”
“She’s already gone – look at her! Her oxygen is dropping, she has no pupillary reflexes,
she’s on maximum pressors…”
“But wait,” I said, “Her daughter would want to be here.”
“It’s better for her not to have to go through this,” he
said. And he turned off the machine.
I gasped. “What will
we tell her daughter when she comes back from lunch?”
Annoyed by my persistence he snapped, “Tell her she coded
when she was out.”
Thirty minutes later the daughter came back to the ICU. As she walked towards her mom’s bed, the
residents scattered. Frightened, I
approached her. She could see from the
look on my face that something bad had happened.
“She’s gone,” I stumbled… “it just happened after you left.”
She looked at me as if I had convicted her of the crime of
abandonment. At that moment, her
greatest fear of leaving her mom’s side had come true – she wasn’t with her
when she died. She ran into the room,
saw that the machines were off and all was quiet. She fell to the floor and screamed.
That scream still haunts me to this day.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 20th, 2007 by Dr. Val Jones in Medblogger Shout Outs
4 Comments »
“Be quick to listen, slow to speak.” That’s the old wisdom I was taught growing
up, though it sure is difficult to apply regularly and consistently, isn’t it? Nonetheless I can’t think of a better
principle for practicing good medicine.
I was reading Dr. Smith’s blog and was touched by his
observations:
Patients don’t know
how to put words on their pain, and there is no disease named for the pain that
the patient wants to tell you about. It’s about the inner anguish of this
particular person’s quest for life, their disappointment, the abuse they have
experienced, their feelings of failure and lack of significance, their rage at
the injustices they endure and they don’t have anyone else but you to talk
to. And, by having a relationship with a safe professional, some of their
pain is relieved and, in many cases, they get well or better! In some
cases, they don’t, but that begins to matter less than the fact that you begin
to understand that “getting better” is not the goal here. And,
if you keep trying to make the patient better with a prescription pad, they
will just keep bringing you new problems to chew on until you figure out what
they really need.
The truth is that at the root of many medical
misunderstandings is a listening problem. Sure we hear
lots of things, but in our rush to package complaints into a convenient
diagnosis we often miss the elephant in the room. An excellent example of a doctor practicing
good listening skills was described in Signout’s blog this week.
Some parents appeared a bit overly concerned
about their young child’s cold symptoms. The resident taking care of them
wisely recalled that the mom had mentioned that her aunt died of leukemia
as a child. The doctor made the
connection between that bit of history and their angst – and reassured the
parents that the child’s blood tests were normal, and did not suggest
leukemia (without them directly asking the question). The emotional relief that
ensued was the most therapeutic effect of the physician encounter that day.
The moral of the story is that listening really can be
a healing art. And it’s not just
reserved for psychologists and psychiatrists.
*another case of good listening here*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
