The Chaos of Medicine: February 2012

Tuesday, February 28, 2012

Guest Post: Janet Hailstone / Nutribuff

The following guest post is written by Janet Hailstone. She teaches nutrition and cooking classes for Community Education at Dixie State College in Southern Utah. Please head over to her health blog and say hello!
I've been a mother for the past 25 years. I'm also a health nut, so I haven't had to take my children to the doctor for illness for the past 20 years. But, that doesn't mean that I don't have to take them to the doctor. There are physicals for school, and then there are accidents.

an accident waiting to happen; child and stairs
When I had my first child, I brought him in for anything and everything. One time, he fell down some stairs and cut his lip. I was told there was nothing that could be done and that he would be fine. I soon got used to hearing that everything would be fine every time I brought him in.

I started to relax as a parent and knew that I didn't need to bring my child in for every little thing. I also waited to see if my children would get better on their own, before panicking over every little accident, flu, or cold.
Now, the ear infections were usually something my children didn't get better from. They just cried 24/7, and it was so nice to get the antibiotics that helped them get back to normal. And, while I did learn later that there were some simple home remedies for ear infections that were equally effective, it wasn't until my last child that I learned about the connection between dairy products and ear infections.

She was the only one who never got ear infections compared to the other three. The only difference was that while I was pregnant with and nursing her, I was trying the vegan diet. I learned how to get my calcium needs from greens, beans, grains, and vegetables. It seems that eliminating dairy was the cure for her to never get a single ear infection. Well, no matter how healthy your family may be, accidents can still happen. In my family of six; myself, my husband and our four children, only one of them was accident prone. When she was little, I noticed that she was slightly clumsy. She'd be dancing around and trip occasionally. She still loves to dance and is very good at it now though.

She just has a little problem with being the only one to have accidents while growing up. They've happened to her about five or six times through her lifetime. One time when she was around five years old, she was riding her bicycle in the cul-de-sac where we live. Somehow, she lost her balance and fell. She used her arm to steady herself. It looked broken. There was an abnormal bump sticking out of her arm.

She was crying, and we knew that we had to take her to the emergency room instead of a daytime doctor, since it was after hours. She was quiet and seemed calm while the nurse was taking her blood pressure. I remember being so shocked when they read how high her blood pressure was. I don't remember the exact numbers only that they were sky high.

teddy bear with a sling for a broken arm accident

I looked at her and realized that she was under a lot of stress, even though she just sat there pathetically. They did an x-ray of her arm and gave her a sling. It turned out that she only had a green stick fracture, where it's not actually broken, just bent. We were told at the first doctor visit to just take her home, and the arm would heal on its own.

We tried to do that, but every little bump was too tender and painful for her arm and she had troubles moving during the day and when sleeping. We made an appointment with another doctor the next day, who was kind enough to put a cast on it for her. This made her feel more secure and happier. I think she also liked the attention and ability to pick the color of the cast. It was a little scary when it was time to take the cast off. It seems like the saw was going to hurt her arm, but everything came off without a scratch. It's really nice to have doctors around when accidents happen or when there is a sickness or condition that can't be remedied at home.

Accidents and injuries can happen to anyone, even adults. If you like to exercise or run in races, anything can happen; kidney failure, knee or ankle sprains, and torn muscles. My previously accident-prone daughter works for a hospital as a house cleaner. She said whenever they have a big race or marathon here in Southern Utah, the ambulances are busy bringing people in and she has many more rooms to clean.

I'm sure you have your own stories about accidents that have happened to you or someone you know. Maybe you have spent some interesting time in the hospital, or getting treatment for a sickness or disease. You should share your story too, we'd all love to hear about it.

Saturday, February 25, 2012

Random Talk

I am currently sitting in between piles of homework, most of it not very useful. I came home on Thursday from a great vacation. It was a much-needed break, because the next three months will probably consist of a lot of stress and a lot of work. That's OK, though. In three and a half months, I will have finished my exams and all that will be left is waiting for the results. I don't consider planning to be one of my strong suits. Three months is just short enough to make me realize that I do need to start working and as a result, this is the most productive I have ever been.

Of course, I am never too busy to spend some (too much) time online. Lately, I've been loving this blog. A physician with a great sense of humor, the type of doctor we need more of. Another source of inspiration is this blog. I love reading about his random acts of kindness and I support his initiative. Also, I spent so much time online I decided to change my layout. I kind of like it!

A few days ago I talked about death and how it's currently affecting me. I got an interesting response:

"To fear death, my friends, is only to think ourselves wise, without being wise: for it is to think that we know what we do not know. For anything that men can tell, death may be the greatest good that can happen to them: but they fear it as if they knew quite well that it was the greatest of evils. And what is this but that shameful ignorance of thinking that we know what we do not know?" - Socrates

Good point. Still, I've not been able to get over this weird feeling - reading a lot about cancer has not helped this. The positive aspect is that it reminds me to enjoy life now.

Tuesday, February 21, 2012

The Meaning of Life

Yesterday I had a three-hour shift. It is one of my regular small shifts which are arranged when the nursing home cannot fill up the schedule. Except that it wasn't a regular shift.

I entered the nursing home, expecting an easy-going shift. Usually, all I have to do is watch my patients and help them get lunch. I like this type of shift as it leaves me time to spend much-needed individual time with patients. For these people, I also need the time, since two of them have been physically fighting any chance they get. This day seemed like no other day. Everyone was very calm, which is very beneficial to especially patients with dementia. I discussed the patients with my colleague from the previous shift.

"Well, everything is calm and peaceful. Patient A is on a walk with her family. Patient C has been experiencing shoulder pain and we're keeping track of heart rate and blood pressure to rule out cardiac involvement. So far it seems OK, but keep an eye on him. Oh, and did you read the recent emails?"

I answered that I've not been working lately so I didn't read the emails.

"Patients D and E have passed away. Patient D died a week ago and is already at the undertakers. Patient E died last night and is still in his room. The room is locked."

Patients D and E. The patients who were fighting ever since E got here. Two patients in four days, no wonder it's calm. We talk about them for a bit. You never get used to deaths. I talked about this before after experiencing my first deaths. My opinion hasn't changed and I've been told that it will never get easier. Still, this is a very confronting way of deatg, with the patient still being present.

At the nursing home, life goes on. We can't stop every time someone dies. So I tak a bit with my patients and help them get lunch. Two plates less than usual. After lunch, many family members come visit the patients. I don't know many of the visitors. Two women enter. They look lost. "Can I help you?" I ask. They appear to be E's family. They ask me to open the patient's door. As I do this, I see the patient. He looks peaceful. His wife is very sad, his daughteris more relieved. I can understand their feelings. The patient has made it very clear that he never wanted to live the way he did for his last months. Still, it doesn't make his death OK.

I leave the room so the family has some privacy. In the living room, it is very calm, almost too calm. But not for long. Patient C needs to go to the bathroom. I help him get to his room. He tells me his left leg hurts. I find out that his pain, previously in his left shoulder, is now in his left side, radiating to his leg. His pulse is 115. I get a colleague who checks his blood pressure (normal). She decided to call the nurse, though, as his pulse and pain are a cause for concern.

My three hours are up and my colleague takes over. I leave the nursing home. I don't know how patient C is doing. Patient D and E are still dead. It left me thinking a lot about death and the meaning of life. What do I want out of my life? Why does it even matter? Will I ever be able to answer these questions?

Friday, February 17, 2012

The Chaos of Medicine

I know medicine is just like the real world. I personally experience the staff shortages. I know that money is important in achieving anything. But when I read this, I was shocked. In some way, my unexperienced, optimistic self never considered it to be a possibility, not in a developed country. Not in any country that is generally considered 'fair'.

Now I know I can't reasonably expect anyone to work for free. I am also aware of the fact that it probably takes a lot of educated people to produce any type of medicine, and that it costs a lot of money. Still I can't wrap my mind around the fact that medicine doesn't have some sort of special status that makes all these problems go away. Is it even possible to put a price tag on life? How can this be regarded as fair, and if not, why isn't this problem solved yet? I don't have all the answers. I am not pretending like I know how this problem should be solved. It just doesn't feel right.

And there you are, as a doctor. You've studied for 10+ years and know what could possibly cure your patient. Something as trivial as production prevents you from having access to the drug. What do you do next? With limited access, who do you treat? In theory, it might be ethical not to choose. But in practice, would anyone not use a supply of life-saving drugs?

I think it is a horrible situation to have to choose who you provide care to. I will probably never be a doctor in a less developed country for that reason. I am currently considering becoming a pediatric oncologist and many people find this to be strange. They ask me: "Why would you want that? It's depressing. I could never do that." But for me, there is a difference between the two situations. It is terrible if a child dies of cancer. It should not happen, period. That said, if a child dies, we know there is usually nothing more anyone could have done. But if someone dies because of a lack of access to meds that could cure him, it feels different to me. Medicine, in all it's chaos, should be fair. If diseases aren't fair, at the very least, health care should be.

Saturday, February 11, 2012

Waiting for Med School

Right now I am very impatient. I've been told that my chances of getting into med school are quite good, but I I don't want to wait any longer. I don't want to patiently wait for six months until I probably start med school. I live in a country where medical school includes both undergraduate and graduate courses, therefore it starts right after high school. Which means I'm currently in high school. Lately, me and my classmates have been yearning to go to college. I like high school, but I've just outgrown it. Lately, I've been taking a couple of college courses, which kind of make me want to go even more. So I've been an internet addict all week, reading posts like these.

I can't imagine what I would do if I didn't get accepted into med school. Will I go on and study mathematics because I probably would end up happy? Will I get a job at a local hospital and try again next year? I don't know and I hope I never have to decide. Ugh. I guess everyone who wants to get into college feels this way but I just want to move on to the next stage. It does motivate me. A lot. Actually, I'm going to continue studying right now. And read some more med student blogs. Oh, procrastination.

Wednesday, February 8, 2012


It started way back, when I was quite small
I would simply ask “why?", one question, that’s all.
I would wait for an answer, sometimes it would come
“Because,” “I Don’t Know,” “Ask your father or mum.”

But it never stopped there The questions kept coming.
And answers were lacking, adults kept “ho-humming.”
It would start out quite simply and then get all muddled
I’d ask just one question and end up befuddled.

Why is the sky blue? or Why are plants green?
Why are they poor? and Why is he mean?
Why should I be good? Who put you in charge?

My mind would start racing as questions loomed large.
Why are we here? What ought I do?
Is there a rhyme, or a reason, or two?
Can it be learned, can I learn it, from who?
Will the answers be certain, or guesses, who knew?

My mind was unsettled, my brain never rested
But everyone moaned when their answers were tested.
I meant them no harm, I truly did not,
But I wanted some reasons for “why,” “which,” and “what?”

This exerpt from Dr. Seuss and Philosophy sounds so familiar. I've been into philosophy a lot lately, as you could guess with blog posts like these. By nature, I am very curious and I love thinking and analyzing.

While liking to be around patients is very important, being curious about medicine is just as important when considering to become a doctor. The difference between medical professions and most other professions is the likelihood of frequently and seriously impact a person's health, either in a positive or in a negative way. Every single fact you learn counts. every disease you memorize, every diagnostic test you master, it can all count when you need it. I love it. I've always liked to learn, but this way it's even more motivating.

Frankly, as much as I hate school at times, I don't mind adding a lot of education to my list.
I hope med school will provide me the opportunity to challenge myself. To broaden my knowledge and to spark my curiosity.

I can't wait to get into med school.

Sunday, February 5, 2012


This week I noticed a lot of judgment. A few days ago, this article was published in an online university newspaper. I came across the article by coincidence, as neither I nor anyone I know has tattoos. It is an opinion column harshly judging any woman who would choose to tattoo her body. The argumentation behind the writer's opinion is rather weak. Basically, there is no argumentation. According to Khoury, a woman is supposed to have class, by going to the mall and getting her nails done and wearing high heels, and according to her, tattooed woman are classless by definition. That's a lot of judgment.

Not surprisingly, a lot of people were offended by this opinion column. What did surprise me was the large amount of hate mail sent to Khoury, calling her "Stupid Cow" or "Fat and ugly". A day after the original article, Khoury wrote a response called The Day I Met the Internet. After reading the response, I understood her. I still do not agree with what she said, but that could have been me, enthousiasticly writing an opinion piece without thinking it through. Which is why I'm happy to stay anonymous while blogging. Still, it's a reminder. Medicine is a sensitive topic and I need to be very careful in not sharing any sensitive information.

The second article about judgment is a little more medicine-related. It is a blog post from the perspective of a sick girl's mother. She has written before about doctor experiences, which were often negative in terms of attention and respect - those are supposed to be bullet points at any doctor's priority list. After reading some doctor blogs, she comes to a few conclusions. Most of them have to do with judgment. It sounds all too familiar. I judge people too. I sometimes catch myself judging classmates and now that I think of it, I judge patients, too. I judge the patient who complains of bloating but always asks for a third portion during dinner. I judge the patient who pities herself and does nothing to make her life better. I guess it's human, and I try to hide any preconceptions. But still.

Do you recognize being judgmental? Do you think it harms anyone and if not, why not?

Wednesday, February 1, 2012

Medical Ethics

Ethics is a word commonly associated with medicine, especially the negative adjective form - unethical. A lot of things are unethical. Providing opportunity for abortion and not proving this opportunity. Not informing your patient about upcoming procedures. Most aspects related to medical ethics are regulated by law. Where I live (don't bother asking, trying to keep up the illusion of privacy;)), there is a specific law protecting the staff and patients of psychiatric hospitals. The dementia-care part of the nursing home I work at is also considered a psychiatric hospital, so we have to abide by those laws. I did not receive any information about the law yet (which is crazy, but that's another story), but I did learn a bit about it. When we install a motion sensor to increase the patient's safety (because of an increased risk of falling, for example), we have to fill out a form, signed by a physician. This is because it limits the patient's freedom. No problem so far.

Another rule is: never ever lock a door unless on doctor's orders. Again, because the limitation of freedom. Here's where it gets interesting, from an ethical perspective. One evening I was independently running my 'home', as we call it. About ten 'homes' have access to the same hallway, which is password-protected to prevent the patients from going outdoors (by the way, it's also where this happened). Conclusion: the hallway is safe. Still, it is inconvenient, because your patients are not together and can wander through that part of the nursing home. That's why some staff members elect to close the door so everyone is contained, which is easier as they know where everyone is. An illegal action, which is also unethical.

Up to that time, I learned to think about rules in a practical sense, because it was clear that I couldn't work there if I followed all rules. Not that it's a bad nursing home, but coworkers don't like when you say that you can't watch the patient drink their med solution because technically, it's not allowed. But overstepping both legal and ethical boundaries, no way. That day, a particular co-worker asked me to lock the door because "I couldn't work like that, right?". That's what is so scary about overstepping boundaries: when are you sacrificing your patient's well-being for your own comfort?

I think there should be stricter enforcement of rules and laws. I practically have no choice but break some rules, but it is much clearer if no one ever has to. Because sometimes unethical decisions are made based on work load or social pressure. But there is still responsibility. So, politely but without hesitation, I said no. No, I will not compomise my patient's freedom for my own good. Will I make the same decision in five years, or will I get tired of searching everywhere and just lock that door? I don't know. I hope not.