Some things don’t make much sense, and they’re disturbing to the degree they jar with reality. Such as: my mother, who since her tussle with breast cancer in the mid 1960s has held a deep suspicion of the medical profession stepping way over the line of the rational, remains in the hospital due to her mental status changes, and she’s okay with that.
She seems to be aware of her surroundings. According to my sister, she thinks the high school my dad taught at in East LA has been turned into a hospital, and that’s where she is. She also tends to think my brother and I are in the hospital somewhere, or in town, and she frequently asks where we are.
My dad said he got angry yesterday because she wasn’t eating. She would chew her food, but when she thought he wasn’t looking, she would spit it out into her hand and hide the food in her lap. Or she would hide the bolus in her cheek. “Angry” seemed a surprising word to me; “distressing” seems a more appropriate emotion. It’s distressing when someone’s behavior changes so radically. She’s always been out there, my mother, or at least “always” for my lifetime, but now she’s out somewhere else.
Things went downhill quickly, but the signs have been present for a while: worrisome memory lapses, withdrawal, increasing neglect of her appearance. She’s been falling more and more, too, but it’s hard to know how much that has to do with mental status.
My sister and I find this all very distressing, and for selfish reasons. Our grandfather died with dementia, and now his daughter’s manifesting the same symptoms. Little comfort in being a long-lived clan if we’re looking forward to such an undignified exit. And while I’d like to say medical science will surely come up with preventive measures or treatments by then, I know enough to have very little faith in the system.
Karen was diagnosed with MS about 25 years ago. Know how much progress has been made in treating MS in all those years? Squat. There are more drugs on the market now, but they really do very little to change the disease.
It’s remarkable, in fact, how much progress has been made in molecular genetics and related disciplines in the last 30 years, and how little that has translated into material progress for most diseases. HIV treatment has come a long way (a testimony to what can be done with money and manpower), and we have better treatments for a handful of cancers. A few better drugs for diabetes, heart disease, chronic lung disease. But I suspect people aren’t living any longer.
Nope, can’t count on medical science to save our asses. Or our brains.
So it all boils down to the usual truisms: treasure the day, love and be good to one another, because you never know when everything is going to turn to shit. It’s not a new lesson for me, “thanks” to Karen’s illness, but it’s a stern reminder nonetheless.
Angry patients today. I wrote a post about them and then I got paranoid that someone from work might read it. So I thought I’d post it over at The Other Place, but I can’t remember the password there. Sheez.
People are angry for so many reasons. They should be happy they have decent health insurance, but of course if they thought it was decent they wouldn’t be angry.
As for why they vent on me . . . What can I say, I’m there. I listen. I’m convenient.
Not that you can placate these people. Tried my best not to inflame them further — how’s that?
And after work, I stopped off at an Indian market to buy some sweets for Karen, only to have an 8-year-old boy holler at me, “YOU CAN’T GO IN THERE, YOU’RE NOT INDIAN!â€
And I’m thinking, even the children are bitching me out.
D.
PS: Internet’s been down the last couple of days, but we have it fixed. And I’m back.
Did you catch Bama’s presser tonight? I found out something interesting. Absolutely laugh-out-fricking-loud fascinating.
Turns out we’ve been making tons of money on tonsillectomies. I must be a millionaire many times over by now, and the money is, oh, I don’t know . . . Hey, Karen, what did you do with all the millions I made on tonsillectomies?
“Squirreled away in overseas accounts,” she says.
No, no, it's way too easy.
I was hanging out in B-field Memorial’s doctor’s lounge waiting for their Medical Executive Committee to call for me. I’m applying for privileges, along with three other new docs, and the MEC here likes to meet and greet each new doc individually. We hung out together watching Bama’s presser, making cat-calls at the TV. Now, folks, you know I voted for Obama, but when it comes to health care this guy is laughable. His example of cutting out waste from the system? All those instances where docs order the same test on a patient because each doesn’t know what the other has ordered.
Oh, that’s going to save us a ton of money.
But it was his crack about doctors choosing to perform tonsillectomies because they reimbursed so well that made me laugh out loud.
Yes, there was a time when “general practitioners” took out tonsils and made lots of money doing so. Perhaps $100, perhaps less, but that was in the day when someone like my dad could fill the cart with a weeks’ worth of groceries for less than $20. But that was then, and while we may make a bit more on a tonsillectomy than we did in the 1960s, that money doesn’t stretch nearly as far. Given the time spent on doing pre-ops and post-ops (which are not reimbursed, but rather, are considered part of the ‘global package’) and time on the phone counseling the parents or patients, tonsillectomy simply doesn’t pay. From a purely greed-centric point of view, we would make better use of our time seeing patients than removing tonsils.
We do it, nowadays, because it’s medically indicated, i.e., the right thing to do. The idea that some docs might do it with dollar signs in their eyes is, well, LOLZ.
***
An interesting bit I discovered while feeding my rage over Obama’s tonsillectomy crack:
The Health Insurance Institute estimates that “getting sick and getting well†will cost the average American $105 in 1960. This sum will be distributed about as follows: $34 for the hospital, $26 for the doctor, $28 for medicines, $11.50 for the dentist, and $5.50 for other costs. The average United States family in 1957-1958 spent a little over $300 for medical care.
If yesterday was as easy as making pancakes, today was as easy as making toast. I had a handful of orientations in the morning — orientation to the pharmacy, to medical records, etc. — each of which took maybe 1/3 of the time allotted. Thanks to yesterday, I knew what to expect, so I brought my book along. Good thing, too, since I had plenty of time to read it. (And that’s a good thing, too, since this is one long book.) And I still had time to take a leisurely lunch, pick up some deli stuff for the family, bring it home to them, and make it back for the afternoon orientation.
The afternoon was all bollocksed up because SOMEONE SOMEWHERE neglected to transfer my National User ID number from Northern Cal to Southern Cal. As a result, they can’t set up my local computer account, which seriously undermined plans for this afternoon. Instead, I got a tour of my soon-to-be office, and I shot the bull with the So. Cal. doc who is up this week to man the fort. They rotate from one of the San Fernando Valley programs, one doc a week. Those are the guys I’ll be replacing.
I was able to shoot the bull with him because his schedule fell apart, I guess, and he had nothing to do either. So I’m wondering (and probably jinxing myself by wondering) exactly how hard is this going to be, anyway? He tells me he has put in 13 weeks total, and on only one occasion was he called into an ER on the weekend. “They just don’t call,” he told me.
I suppose I should put in a year or two before chortling about my good fortune. Still, every indication thus far suggests I’ve made an excellent career shift relative to the Bay Area (and also relative to the North Coast).
I am guardedly optimistic.
As for the book, Sacred Games: if you read the various blurbs, you won’t find out that this is primarily a mystery interleaved with a Bombay gangsta Bildungsroman. That, IMHO, is a far more tantalizing description than the crap on the back cover.
Can I possibly express the delight I find in waking up at a reasonable hour (7 AM), driving a mere 15 minutes to get into the office, and finishing work with enough time to spare that I was able to shop for groceries, put in 60 minutes on the elliptical trainer, make dinner, and eat it — all by 7 PM?
It’s as if I had tunneled into an alternate universe where people work like 19th Century factory drones, 18 hours a day or whatever, with only enough time to catch a little sleep before it starts all over again . . . and now I’ve tunneled back into the civilized 21st Century. That long commute was evil.
And if all that weren’t awesome enough, I found a decent barbecue joint at lunch today. Melt-in-your-mouth pulled pork: why haven’t I ever managed to make pulled pork that tender?
We’re in Starbucks, the three of us, taking turns doing our essential internet. Karen’s trying to figure out what went wrong with our Garmin GPS (I think the company is trying very hard to commit corporate suicide . . . we suspect they yet again screwed up everyone’s GPS with downloaded code most foul); Jake had to catch up with his Mafia Scum bbs, and I’m letting y’all know I’m still alive.
Internet access was supposed to start today, but something got screwed up. I blame AT&T. Somehow, they ended up with four separate purchase orders for internet access, only one of which was workable (the others would have required rewiring of our apartment’s phone lines, which I doubt would have gone over well with out landlords). That’s set for the 10th, so we’re only two days away. Frustration quotient very high since I had to call AT&T ten times to find this out, which means I had to navigate their phone tree ten times. Tenth time is the charm, and I finally got a woman who clearly knew her shit. Thank heavens. And it could have been worse; two of those purchase orders were set to trigger service on the 14th.
Meanwhile, I’m waiting for next week to come. I have a whole week of orientation. Real drag since it feels like I just did a week of orientation (last December) and I really don’t feel the need for remedial orienting. Do you suppose I could bring a book and read it during these interminable talks about safety and risk management and electronic medical records?
I’m feeling dread for the job proper. No matter how many different venues I practice my trade, whenever a new venue comes along I find myself wondering if I’m up to it. I never said this was a rational fear.
I didn’t get to sleep until after 4 AM. Kept thinking about space-filling with irregular units, each shaped like file boxes, luggage, backpacks, computer components, and assorted Sta-in-Pet tarantula cages. Oh! And don’t forget carriers for the cats and ferrets. Honestly, I couldn’t imagine how it could all fit into our Camry, not unless I stuffed things to the ceiling, and that can’t be good for visibility.
And I had to wait most of today to get down to business. Couldn’t load up the car in the hot sun, so it had to wait until past sundown. We had dinner at a French bistro in downtown Santa Rosa called Rendezvous, had a decent if pricey meal, then came home and I got down to business.
Surprisingly roomy, these Camrys. I might even be able to fit Jake’s gaming computer, though that might be pushing our luck. I’ll see how things look once the rest of our bags are in the car, come morning.
The plan is to be on the road by 9, which means B-field by 2:30, 3 at the latest. Then we need to hope that our landlords for temporary housing don’t spot me loading up the apartment with about 20 Sta-in-Pet carriers containing arachnids of various temperaments. Karen likes the nasty ones, what can I say.
So begins the next phase of our lives. I miss the cool weather of the North Coast, and I’m even going to miss the relative cool of Santa Rosa (we’d have to move to Vegas or the Mojave to find something more hellishly hot than Bakersfield). But I like the idea of being able to retire by 65 which, sad to say, probably wasn’t going to happen back in Crescent City*.
Now, if only I can get this idiotic tune out of my head . . .
D.
*There’s a reason why solo practitioners are a dying breed, and it’s called $$$. Or should I say, .00000$$$.
One week ago, the FDA issued a warning regarding three Zicam products: Zicam Cold Remedy Nasal Gel; Zicam Cold Remedy Nasal Swabs; and Zicam Cold Remedy Swabs, kids size. The long overdue warning stems from the FDA receiving 130 reports of anosmia (loss of the sense of smell) since 1999. (You can count on that 130 number being the tip of the iceberg; our legal friends are interested in finding others who have been similarly affected.)
Because homeopathic products are regulated in a similar fashion to dietary supplements and not as drugs, prior FDA approval was not required for the Zicam “remedies.” But Zicam is more than a homeopathic treatment — it contains hefty amounts of zinc gluconate, which might be the culprit in these cases of anosmia.
While I’m not a huge fan of the FDA, I do think the loophole for dietary supplements and homeopathic products is ridiculous. These things get marketed as remedies, so they should be subjected to the same standard of proof as any other medication. Homeopathic agents have escaped this level of scrutiny because we docs tend to view them as placebos — sugar pills — which they often are. You see, the idea behind homeopathy is this: poisons which cause particular symptoms can, in diluted form, be used to treat diseases that have those same symptoms. The dilutions are usually so extreme that none of the poison’s molecules remain. No matter — that compound’s vibrations (or whatever) are still present. Spray this on lactose beads and you have yourself a cure.
Yup. Lactose. Milk sugar.
So, yes, we’ve winked at homeopathy all these years because we figured that snake oil salesmen will always be among us; better that our patients take a sugar pill than some tonic that might do them some harm. But this Zicam story makes me question that belief.
The AP story is worth reading, as is the excellent Quackwatch article, which includes the math demonstrating that not a single molecule of the original substance remains after a typical number of homeopathic dilutions.
What I learned on The Colbert Report tonight: Zicam is one of Rush Limbaugh’s big sponsors. Watch it here.
I learned a lot of things in training. Learned to develop a thick skin, for one thing. (Interesting how it protects me from the outside barbs, but not the inside barbs.) Learned how to function on two hours of sleep or no hours of sleep. The worst, by the way, is one hour of sleep. I would rather have no sleep than one hour of sleep. One hour of sleep is an absolute misery.
Someone told me on my first or second day of internship that I would learn to get blood from a stone, and it was true. “Stones,” in this case, are IV drug abusers who have shot all their peripheral veins. I could always find the femoral vein, of course — that was my preferred last resort, since I never was too comfie with subclavian sticks. Not to mention jugular lines — Yeesh! But I always tried to find a good peripheral vein, because the big ones are riskier and they bleed like stink if the patient yanks it out.
Veins do seem to roll away from you, and they also seem to go into spasm and disappear altogether. I say “seem” because who knows what they really do. One minute they’re there, the next they’re not.
Those first few days on Urology were brutal. To the patients, I mean. (Never get sick in a teaching hospital in July. That’s when all the noobs come on board.) Couldn’t do much but practice on patients until I got it right. I remember the learning curve being pretty quick, though; my first day, I turned an old Hispanic guy into a pincushion, but I don’t remember too many traumatic sticks after that.
Infants and children are a different world. The stress on the doc, me anyway, is indescribable. The tissues are pristine, but the vessels are tiny. I guess the worst case scenario would be an 18-month-old IV drug abuser, but fortunately I didn’t meet too many of those.
In med school, I learned how to do arterial punctures and set arterial lines. Most people would consider these to be more difficult procedures than drawing blood or setting IVs, but for me that pulse had become a beacon. Back again to my first day on Urology: I remember thinking, “How do I find it without a pulse?”
I wonder if I would have made it through internship if I’d had any idea what I’d gotten myself into.
***
You learn, too, that your patients are forgiving. People forgive a lot when they know you’re trying your best.
It’s that magic time again, Weekend Call, and have I pulled a doozy. Between the two hospitals we cover, there are nine patients on our inpatient and/or consult service. Three of them could easily get worse and become OR cases.
I told the Chief of Service: “Well, if I’m busy, the weekend will go faster, right?”
“Your weekend is going to go VERY fast,” he said.
Another doc (the former Chief of Service, another guy who has been around a while) called me to commiserate. “I think this must be some kind of record,” he said.
I don’t mind working hard. Really, I don’t! The main thing that stresses me out is when things are more than I can handle. I can’t do everything, after all, and I can’t be in two places at once. In residency, there were always three of us in house (plus med students, plus a chief you could call in, if necessary) so there was little risk of having to be in two places at once.
My Chief of Service tells me that in the ten years he’s been here, only once has he had to be in two places at once. He called in one of the other guys and they dealt with it. So, yeah, there’s backup if I need it — but everyone here figures this should be RARE.
Let’s hope it is. Stay tuned.
D.
P.S. It’s been a grueling week, by the way, which is why I haven’t been around much. The upside? Once I’m through with this weekend’s call, it’s mostly downhill from here. Not too many bumps in the road between here and Bakersfield.
One week ago, the FDA issued a warning regarding three Zicam products: Zicam Cold Remedy Nasal Gel; Zicam Cold Remedy Nasal Swabs; and Zicam Cold Remedy Swabs, kids size. The long overdue warning stems from the FDA receiving 130 reports of anosmia (loss of the sense of smell) since 1999. (You can count on that 130 number being the tip of the iceberg; our legal friends are interested in finding others who have been similarly affected.)