Mayhem, Murder, and Medicine

as we near the 5 year anniversary of the devastation of hurricane katrina, news stories and remembrances are popping up. above is a very tragic tale of desperate measures taken during the throws of hurricane katrina and the subsequent legal battle over suspicious deaths of patients. at one of the new orleans hospitals, apparently some 9 patients were not going to be able to be moved/evacuated, presumably because of their degree of dependence (i'm guessing ventilator patients? it never says), and so were given toxic doses of narcotics to facilitate death by the remaining staff physician and pharmacist.

i am dismayed, but not shocked for several reasons. i'm also not entirely sure it was the wrong choice by the caregivers...

during katrina in 2005, i lived in a small town in mississippi, about 3 hrs north of the coast. the hospital where i worked at the time took in patients who were evacuated from our sister hospital in louisiana. from these patients and their families, as well as in local news reports, we heard all sorts of awful stories about hospital wide power failure, then generator failure, and then death for those patients dependent on machines. i heard a lot about MD's having to make tough choices about who could use the remaining resources and who was most likely going to die anyway. there were wings of hospitals quarantined to house the dead and dying with no electricity, no air conditioning, 90 degrees and wet....it was a war zone. and only a scant few of the staff stayed behind to help and didn't evacuate with their families like they were told to do by the state.

things couldn't have been any more bleak and the situation couldn't have been farther from the norm under which these practitioners usually and comfortably practiced (presumably) ethical medicine.

i know i always tend to side with doctors, and i don't know the exact details of these cases. AND the families heart break is compelling. but STILL, if it was as i imagine, put yourself in their shoes... your hospital is drowning, your few staff members have been awake and working for days on end, many of your patients are dying, and you have a choice to either let these few patients who can't get out in time die slow, suffocating, miserable deaths, or you administer meds that will take them quickly.

if that was the situation, wasn't it humane and in fact 'doing less harm' to facilitate death?

you tell me. what would you do?

and then, here's a more happy story about a midwife delivering bebes during the storm.

Post Op Day 2, From the BHE

the OR is really bright and really cold. it took me two days to remember this, because anesthesia is retroactive.

i woke up from surgery on tuesday afternoon, and i'm glad to say the results are considerably better than the surgeon expected. he was able to remove 8 pounds of skin and fat that i wouldn't be able to exercise away or otherwise remove by my own effort. and my amazing wife tells me i look entirely different from every angle. so that starts to make the discomfort i've been in since then generally worth it.

i was told by the doc that i'd be "pretty sore" for about a week. and that's generally true, except that pain meds work. i have a pain pump delivering lidocaine directly into my abdominal muscles and i also have been taking a regular dose of vicodin. so my whole core feels very tight and my range of motion is severely restricted, but my actual pain level is really less than that of a sprained ankle. and that's a pretty crazy thought.

but i have to take a moment to commend the doc, the nurses, the techs, and even the transport personnel at MBH for taking amazing care of me. every single person i encountered at MBH had a big smile and a deep well of concern for my well-being. i felt like a VIP (i kinda was), but i also think my level of care wasn't that much greater than what anyone else receives at MBH. and that is pretty impressive.

most of all, though, i owe a tremendous amount of love and gratitude to the regular author of this blog. she has been incredibly supportive of me from the time i started to losing weight, through keeping it off, through running a marathon, and now through the decision for surgery and my aftercare. she is a model of love and sacrifice, and i'm incredibly blessed to have her.

Post Op Day 1

surgery is done and he's home and feeling pretty good and looking AMAZING.

more details from the BHE to follow.

Guest Blogger: Transmissions from the BHE

hello from the BHE! my former-PA-student-and-current-practically-a-doctor wife has asked me to share about my experiences leading up to what is a very exciting day tomorrow.

i am having abdominoplasty surgery to remove excess skin from my midsection (which she mentioned in her previous blog, "to cut or not to cut"). in fact, i just received a call that i was rescheduled from 9:30am to 7:30am. i have to be to MBH at 6am.

for as much as i've been really excited about results, i'm also a little nervous. i have no relevant experience upon which to base my expectations.

i grew up fat. i was a fat little kid, i was a fat high-schooler, i was fat in college, and i was fat as a young man living his own life. for brief moments, a couple times, i had lost enough weight that people noticed. but i could never sustain the weight loss, and i've always been fat. at my peak i weighed 285 pounds. and then i got married fat. with her help and encouragement i was able to work all that weight off and reach a minimum of 199 pounds. and since then i've put on 20 pounds of muscle. i'm at the peak of my health. i've run a marathon, two half marathons, two 25k races, three sprint triathlons, and an olympic triathlon. i've kept the weight off for four years. i'm ready for the operation. but i've always been fat, so i don't know what it will look like not to be.

the process of elective surgery has been very interesting. there are a lot of procedures and precautions that have to be taken beforehand, and there are a lot of preconditions that need to be met in order to undergo what is very major surgery. surprisingly, because i'm spending a night in the hospital, i'm eligible for FMLA leave, and short term disability insurance, which means i'll be getting paid for about half the time i'm out. it seems a little wrong, but after paying for the surgery in cash, we really could use the money.

i think it will be most fruitful to compare the information i've received and the process i've gone through to this point after the procedure. but i can't help but be impressed with the amount of information that both my doctor and the hospital have been able to convey to me in a very approachable way. but we shall see if the two align tomorrow.

How Would You Design Your Brain?

i would be able to ballroom dance really well and i would speak several languages fluently. i would have a WAY better memory for details and, specifically, things like geography and how to spell werds correctly. i would take out some laziness or complacency and replace it with gettin'-after-it-ness and the tendency to act now instead of sit around for a while instead. i would have already read and retained all the great literary works. i would take out the think/say mean things about other people part and put in more, be-kind-to-them-this-may-be-their-first-time-driving-on-the-street-with-other-cars part. i would greatly enhance the "likes to exercise"part. i might take out the "enjoys peanut butter directly off the spoon and has been known to dip it in chocolate chips and just go nuts for a while" part. i would lose some insecurity and gain some peace of mind.

The World Is a Dirty Place

when you go into medicine, you know you're probably going to get some human waste on you at one time or another. i remember warning my little sister about this when she was considering going into nursing. i promised her that any number of colorful bodily fluids would end up finding their way to her clothes, skin, possibly and awfully, into her eyes/mouth. not at all pleasant to consider, but definitely does happen.

and that's not even counting that funky spunk that could be in said fluids.

yesterday, i was doing a PICC line (peripherally inserted central catheter), which is a fairly invasive, bloody procedure, on a patient with hepatitis. no accidental needle sticks or scary oopses occurred, but this happens not infrequently that we are at risk of exposure. we health care professionals do procedures like this and surgery on patients with hepatitis, HIV/AIDS, chicken pox/shingles, MRSA/VRE, tuburculosis, etc, etc quite often.

we use this safety protocol now called "universal precautions" which means we pretty much never should be touching a patient without wearing gloves. and if they have any known current infection (in lungs, on skin, in stool, etc), we might also wear a gown and mask. but it can get pretty lax. in the OR, we all wear sterile masks, gowns and usually 2 pairs of gloves and we're uber careful when passing/using knives and needles. but i must admit that if we know a patient has a blood borne infection, we proceed with extra EXTRA caution.

lately, everyone in my department has been trying to get pregnant. and though we get fairly cavalier about the whole exposure thing when we're only putting ourselves at risk, it's a whole other ball of wax when you're talking about a vulnerable fetus inside you. in addition to all these nasty pathogens, we work in a fairly hostile environment for growing bebes. cement and xray are both known teratogens and we do our best to stay out of cases that use them (total joint replacements, fracture repairs, etc), but it's a challenge.

some days it feels like to be totally risk-free i would have to leave medicine all together. which i'm not going to do. so i guess you do your best to protect yourself and don't take undue risks while also not living in total paranoia.

no problem, right?

Gross. And Sad. And Gross.

it seems like lately at work, i've been surrounded by more death and dismemberment than i am comfortable with. every time i go down to the cafeteria for lunch, just minding my own business, trying to get a sandwich, there are undertakers in black suits in the morgue hallway, transferring a bagged body onto a gurney.

why you ask is the morgue near the cafeteria? i think it has something to do with refrigeration.

heh....bleh.

it puts me off my feed, but it also is a painful reminder of the gravity of the work that we do. even though all lives will ultimately end in death, and we know this...i can't help but feel a little bit like we failed that one who's being wheeled away, since one of our core tasks as health care providers is, you know, making people stay alive.

most of my days involve elective surgery for hernias or gall bladders...or even for more harrowing things like breast or colon cancer...still, typically, our patients are fairly well when we get to them, and most of them go home at the end of their hospital stay without major problems.

but this week, i had to help amputate a foot for gas gangrene. the patient will hopefully survive, since we got to him soon enough (barely), but part of him will be sent to the morgue.

if you have a clearly infected limb (discolored, bad smell, redness/blackness, hot/cold to touch, non-healing sore, fever) GO TO THE ER. DO NOT WAIT.

i don't want any part of you to be sent down to that cold hallway near where i make my salads.

right then. so we've agreed on that.