Chinese Curse

I took care of an elderly lady once. She was brought to the hospital by police after someone reported elder abuse. She was found in her room in diapers only. There were only crackers in the room. Apparently she was locked in the room by her family member; she was kept in diapers, as it would be “easy” to care for this way. She was fed mostly crackers and water. There were no sheets on the bed as it makes it easy, no sheets…. No cleaning.

When I saw her in the room she was eating grapes…… her bed side table was full of food. She was voraciously devouring her food. It was embarrassing to see her eat like that but on the other hand I was also glad that she could eat. She would not talk to me as every time I would ask her a question, she would give me an evil eye and continue to gobble something else…… grapes, lots of them I remember the most from that moment.

The sad part was that even after all that she did not complaint about her family member who did this…. only a mother can protect her child like that.

This event reminded me of a story from my childhood. There was this little kid, he was asked by her mother to go to the bazaar and buy the cheapest plate from a thrift store. He asked why mother? She said “this is for your grandmother as she breaks all the new stuff; I don’t want to waste money on a new plate”. This child went to the bazaar and came back with two old dirty plates. She was surprised and asked him “why two plates my dear?” and he said “one for granny and …. one for you when you are that age”.

In South Korea, a couple is being charged for murder after their baby daughter starved to death while they went out to play an online computer game. Sadly the game was about nurturing a virtual girl as she grows in a virtual world. What an irony.

It has been a famous Chinese curse, may you live in interesting times. I hope not too interesting.

Blog You Later.

About the picture:I spotted this presidential rabbit outside White House, hoarding something.


PS: Correction, obviously that is not a rabbit, I am not sure what I was thinking. LOL.... thank you Ann.

Snooki Or Not To Be....

To be or not to be---that is the question. Whether ‘tis nobler in the mind to suffer. When Shakespeare penned these words in Hamlet I am sure, that he was not thinking of Snooki.

I am not sure how many of you are familiar with the infamous Snooki, the star of “Jersey Shore”. She has made quite a name for herself in so many ways. To top it all she wrote a new book too.

I read this most interesting news the other day; she was invited to be a guest speaker at Rutgers University. Now the amazing thing is that she was paid $32,000. She was voted by students to get an invite.

During her talk she was full of wisdom and insight regarding this perplex thing we call life. She pondered on various subjects from fist pumping to laundry and tanning. I will take the liberty to quote one historic pearl from her speech,

                              “Study hard but party harder”.

When you Google Rutgers University, the first hit you get about this esteemed New Jersey University is

Rutgers, The State University of New Jersey, is dedicated to advanced learning, creating knowledge and contributing to the growing vitality of the state…….

Great……….

All jokes aside it is fine and dandy that you want your students to have all kinds of exposure. In all fairness the next speaker is 1993 Noble Laureate in literature , Toni Morrison. She will be speaking to a jam packed stadium audience.  She is known for her eloquence, role of black women in society and her contemporary style.

The only problem is she is getting paid two thousand dollars less than our party hardy girl. I think our Beloved is getting the short stick…. again!

Blog You Later.

About The Picture: That is JFK at a monument in Tampa, not to be mistaken for a Snooki quote.

Human Factor. Sepsis

 I recently received this email from a follower regarding sepsis,

I read your blog regarding the necessity of urging hospitals to develop a protocol as a preventable measure in the early detection of sepsis in a patient. 

You blog rings very true to my family and as we buried our mother last month.  A victim of sepsis.  She was scheduled to be released from the hospital within the next two days, when the hospital realized at that point that her overall condition had started to rapidly deteriorate.

We are at a loss as to the hospital's late discovery about the severe infection our Mom had detected and the hospital's seemingly either misguided or complete misunderstanding of the early signals for sepsis”.

I think this is occurring more than we anticipate. One way to prevent this from happening is to have a good screening system in place. Patients should be screened for SIRS (Severe Inflammatory response syndrome) not only in the ER but also on the floor with the change of shift. As we know, SIRS is the initial phase of sepsis followed by Sepsis, Severe sepsis, Septic shock and finally multi-organ failure.

SIRS consists of

1.      Heart Rate more than 90/min.

2.      Respiratory rate more than 20/min.

3.      White blood cell count more than 12000 or less than 4000.

4.      Temperature less than 36 degrees or greater than 38 degrees.

A number of hospitals are implementing this screening protocol. I hope we should be able to do that too. I will keep you posted as we move along.

Blog you later.

About the picture:  Big Island while I was lava hopping. Temperature around 1,200 °C. 

Irony!

Few years back I received a call from a lawyer in North Carolina. He was calling to find out if I wrote a letter in favor of an inmate. I knew the patient but I never wrote a letter on his behalf.

I asked him to fax the letter to me. It was a most interesting letter. The letter basically stated that this former patient of mine should be released from jail due to health reasons. I wish if this was as simple to get a "get out of jail" card from a doctor. My letterhead was forged using my business card and interposing the image on a copy paper. The terminologies and language in the letter were flawed and the context was way too simple.

I called the lawyer back and told him that I am not the author of this letter. He laughed and said he thought so. Out of curiosity I asked him what is he convicted of. 

He replied "forgery". 

Blog you Later,


About The Picture: I took this picture of a picture at Hirshhorn Smithsonian art museum by Tomas Struth of Pergamon Museum, Berlin.

I am not a carpenter.

Working as a physician gives you deep perspective of our society. I decided to be a physician because I  care about the human factor in medicine. Now you may wonder what does that mean. Well sometimes we are so immersed in evaluating data, recent studies and X-rays etc. that we forget the emotional and human aspects of a person. I feel in order to heal a person you need more than a computing mind., no wonder we have no robots doing this job. Sometimes sitting down with the patient and inquiring them about their emotional needs does more than just asking them if they have chest pain of SOB (shortness of breath not to be confused by a common street phrase).

Healing is a holistic process. If our job only requires fixing a broken bone with screws and plates or opening a blocked vessel than we are nothing but glorified carpenters or for some plumbers. I sometime feel that this is what we are some times.

Today I had a meeting where I was discussing how we are suppose to meet Medicare requirements. But than I thought we need to go a little more than that. Isn't meeting bare requirements mean that you are admitting for being a mediocre doctor. Our goal should be to achieve excellence. On the other hand in this day and age where we have to worry more about volume of patients in order to keep afloat, there is not enough time to go above and beyond. You feel guilty because you have to meet your RVUs (revenue value units). But if you won't we have to deal with powers to be.

Unfortunately medicare does not have a code for physicians to sit at the bedside and hold a dying patient's hand. Though do pay very well for putting a pace maker (40 grand just for the pacemaker) on a 93 year old woman who I had today with advanced dementia, she is constantly asking for her dolls. Maybe I am naive and ignorant and do not understand why at this stage of her life a pacemaker would probably comfort more than a gentle hand.
But what do I know I also work in the mill though not a true carpenter!

Anyway catch you later.

PS: I took this picture on my visit to Chicago.