First, some comments on music of the East Coast. The Captain and Tenille as well as the BeeGees are big and it drives me crazy. This is one thing that I don't miss about the East Coast. The same lovely music plagues other cities in this quadrant of the U.S. I thought the Kenny Gland of Overlake Hospital was bad but this music is worse...I think I need music desensitization therapy.
Also, I must say, the best news and stories often come from cabbies. Yesterday I took a cab to classes on bioethics at the UPenn Medical School. I got talking with the cabbie about baseball since all of us are ready for Spring. He told me a story of his son growing up. For years he took his family of four to opening day of the Phillies. They usually play the Pittsburgh Pirates and this was a family ritual. But one year recently his fifteen year old son told him that he didn't want to see the Pirates anymore. His son didn't want to go, instead he went skateboarding with his friends. The rest of the family didn't go either, because of the son's unwillingness, and the cabbie was sad because he sensed his son growing up and not wanting to be with him, his wife and his little sister. He told me that he still has those four tickets saved and sometimes looks at them with lament. I hope his son comes back and I think he will. In baseball and religion children may stray but they always come back, in some way, to the game.
Now about medico-legal stuff. This week I have been going to the medical school to sit in on the classes that University of Pennsylvania gives to their fourth year students on medical ethics. Today prosectuting attorneys spoke in the morning and defense attorneys, and the University of Penn Hospital attorney spoke in the afternoon. Here are some salient points:
As physicians and nurses all know, document. But some recommendations include, try not to document opinion if one expects bad outcome. That is, don't speculate, just write the facts, M'am. Speculation is bad for everybody.
Electronic documentation not helpful to doctors if there is no narrative involved. Templates and drop down point-and-click software can be more detrimental for legal issues even though it may fit reimbursement criteria. Always add summary narrative.
Encouraging information for nurses, there have been no lawsuits against nurses (alone) that the chief counsel for UPenn Hospitals, defense and plaintiff attoroneys of Philadelphia knew of. Of the lawsuits that come against doctors, about 10% included nurses and plaintiff attorneys don't like to bring nurses into lawsuits because juries are very sympathetic to nurses, no matter what the circumstances.
It's snowing again in Philadelphia, ugh.
Thursday, February 25, 2010
Sunday, February 21, 2010
New York and Friends
Another travel section. I hope to present my bioethics "thesis" on this sight soon, with a little lead up from my take on the Declaration of Independence (it took me three stabs to spell independence correctly, just so you know what you might be getting in my analysis), the U.S. Constitution (got that right first stab) and liberty. Please don't be afraid. I also want to propose an anthropologic explanation for why we are the way we are in America. But first...
Last week-end my friend John came out for a visit. I've known John since I was fourteen and I was best man at his wedding. We are best of buds and we had a lot to talk about. For those of you who don't know John, he is someone who autographs the Gideon Bible when he travels..."Hope you like my book, Jesus H. Christ"... and that's his level of humor, which I love. But he also has scruples and knows a joke is a joke. He's a great guy. We went to Atlantic City, Gettysburg, and toddled around Philly.
This week-end I went up to New York and saw my friends Fabio and Yuk Ming, two others who have great senses of humor and good souls. I always like getting together with them. Yuk and I went to the museums together and then we got together with Fabio, his wife Lorna and their friend Dominique. Three hours havin' a great time at an Italian restaurant, Trattoria Del Arte, with plaster art of human parts on the walls. Great laughs and catching up. By the way, the art is done very tastefully, like one might find in Roman ruins, not like one might find in a barn in Wisconsin.
Some other stand out moments of my sortie to New York: I managed to put my foot in my mouth with Yuk once or twice like the time that I was dissing Atul Gawande's latest book, "The Checklist Manifesto" only to find that she was friends with his wife, and the time that I used a Chinese dialect to make an attempt at a joke at dinner. I apologised for both and I still hope she was not deeply offended, as she assured me she was not. As my Mom has said(this is her parental obligation), I have to watch my mouth, and she is very correct on this one. Mea culpa.
This reminds me of a talk that I gave in Bellingham about the discovery of antibiotics. I accused Fleming of being a messy person, allowing his bacteria ager plates to sit open, and it was only this that allowed him to discover penicillin after he discovered mold growing on the open plates. It was a comment made without expectation of rebuttal since Fleming lived in Scotland and died long ago but there was a personal acquaintance of Fleming in the audience, Who would have expected that!, and he took umbrage with my remark. I was agog, apologised for my tone, but did comment that I had references. AND, science is sometimes made from mistakes and serendipity.
On the train into New York City I got a glimpse of the sky line from the New Jersey side. I was struck by the lack of the World Trade Center's signature rising above the downtown district, since this was the first time that I had seen the sky line from this vantage since living in Manhatten in the nineties. All that remains is the Empire State Building and the assorted downtown mess and the midtown mess of buildings. I felt sad and reflected on the "still hard to grasp" aspect of the WT Towers' demise.
The smell of New York is always noticeable. It seems a combination of sweet, bitter and exhaust. Winter is a time when vendors have chestnuts roasting, yes, like in the song, and I think this contributes. There was a lot of street construction making traffic a snarl. I wonder if federal stimulus money has something to do with this?
I was going to go to Dia:Beacon, an art installation in an old Morton Salt factory in Beacon, NY on the Hudson, but I got so caught up in taking pictures that I bagged that idea. I got to Rockefeller Plaza, walked along 5th Ave. and Madison Ave. and spent time in Grand Central Station, a building I love to visit. I took the Grand Central shuttle to Times Square, where I took a picture of a very attractive shoe, and made my way to the original Barnes and Noble bookstore on 18th St. and 5th Ave. I spent some time there and finished my day taking pictures of the Flat Iron Building. Went out for Italian after watching the New York news station, the One, and got up to return to Philadelphia a happier man. I love New York and consider it a great place to visit. I'm glad I don't live there though for reasons too cumbersome to enumerate. Three years seemed enough. Sometimes I think that I have graduated from the Life University of New York City. I enjoy the alumni connections but am glad that I have moved on.
Last week-end my friend John came out for a visit. I've known John since I was fourteen and I was best man at his wedding. We are best of buds and we had a lot to talk about. For those of you who don't know John, he is someone who autographs the Gideon Bible when he travels..."Hope you like my book, Jesus H. Christ"... and that's his level of humor, which I love. But he also has scruples and knows a joke is a joke. He's a great guy. We went to Atlantic City, Gettysburg, and toddled around Philly.
This week-end I went up to New York and saw my friends Fabio and Yuk Ming, two others who have great senses of humor and good souls. I always like getting together with them. Yuk and I went to the museums together and then we got together with Fabio, his wife Lorna and their friend Dominique. Three hours havin' a great time at an Italian restaurant, Trattoria Del Arte, with plaster art of human parts on the walls. Great laughs and catching up. By the way, the art is done very tastefully, like one might find in Roman ruins, not like one might find in a barn in Wisconsin.
Some other stand out moments of my sortie to New York: I managed to put my foot in my mouth with Yuk once or twice like the time that I was dissing Atul Gawande's latest book, "The Checklist Manifesto" only to find that she was friends with his wife, and the time that I used a Chinese dialect to make an attempt at a joke at dinner. I apologised for both and I still hope she was not deeply offended, as she assured me she was not. As my Mom has said(this is her parental obligation), I have to watch my mouth, and she is very correct on this one. Mea culpa.
This reminds me of a talk that I gave in Bellingham about the discovery of antibiotics. I accused Fleming of being a messy person, allowing his bacteria ager plates to sit open, and it was only this that allowed him to discover penicillin after he discovered mold growing on the open plates. It was a comment made without expectation of rebuttal since Fleming lived in Scotland and died long ago but there was a personal acquaintance of Fleming in the audience, Who would have expected that!, and he took umbrage with my remark. I was agog, apologised for my tone, but did comment that I had references. AND, science is sometimes made from mistakes and serendipity.
On the train into New York City I got a glimpse of the sky line from the New Jersey side. I was struck by the lack of the World Trade Center's signature rising above the downtown district, since this was the first time that I had seen the sky line from this vantage since living in Manhatten in the nineties. All that remains is the Empire State Building and the assorted downtown mess and the midtown mess of buildings. I felt sad and reflected on the "still hard to grasp" aspect of the WT Towers' demise.
The smell of New York is always noticeable. It seems a combination of sweet, bitter and exhaust. Winter is a time when vendors have chestnuts roasting, yes, like in the song, and I think this contributes. There was a lot of street construction making traffic a snarl. I wonder if federal stimulus money has something to do with this?
I was going to go to Dia:Beacon, an art installation in an old Morton Salt factory in Beacon, NY on the Hudson, but I got so caught up in taking pictures that I bagged that idea. I got to Rockefeller Plaza, walked along 5th Ave. and Madison Ave. and spent time in Grand Central Station, a building I love to visit. I took the Grand Central shuttle to Times Square, where I took a picture of a very attractive shoe, and made my way to the original Barnes and Noble bookstore on 18th St. and 5th Ave. I spent some time there and finished my day taking pictures of the Flat Iron Building. Went out for Italian after watching the New York news station, the One, and got up to return to Philadelphia a happier man. I love New York and consider it a great place to visit. I'm glad I don't live there though for reasons too cumbersome to enumerate. Three years seemed enough. Sometimes I think that I have graduated from the Life University of New York City. I enjoy the alumni connections but am glad that I have moved on.
Wednesday, February 10, 2010
Am I in Philadelphia, or HELL?!
Churchill apparently said, "When your going through hell, just keep going." so without further hyperbole I will say that the 2010 snows of Philadelphia, and the East Coast, have been trying so far. Today we will get another foot of snow on top of 28 inches we got five days ago. The federal government has been closed for 3 days without relief in sight. Here, I got up at my usual 7:30A and watched Morning Joe while brushing, shaving and showering. A ritual I have settled into. I put my parka on, walked out of the apartment, forgot some things as usual, so I went back, but finally got to the train at 15ht St. with my Starbucks, half-caff venti drip, and stopped at the Dunkin' Donuts for the usual two jelly donuts from the team of Indian women behind the counter. Walked past the cadre of street guys and buskers as well as a flock of sleeping pigeons. Got on the subway to the 34th St. stop and went to the third floor of the Science Center at 34th and Market where the Center for Bioethics has its command center. But today it was dark. The University closed, but there wasn't any snow yet. Should've checked my emails before leaving for the day.
Mona, the security officer at the Center's entrance said, "It's never going to stop". I said that I was locked out of my office and couldn't go home, so I was cast onto the street. Maybe I could recover some of the money I had given away over the last few days.
Slogged over to the Biomedical library at Penn realizing that every intersection was an event as it has been for days now. The walks are reasonably clean but at each intersection there are ponds of slush and snow that require acrobatic skill to navigate. I feel that I am in an eternal Dristan commercial...the kind where the poor sod is standing on a corner sniveling and sneezing only to have a car throw a wake of slush on him from the waste down.
I got into some kind of dance with a Penn snow plow. I moved from one unstragegic postion at the intersection to another while he seemed to move to plow exactly where I had moved. He was having fun with me. I was trapped. He plowed slush all over me. What kind of person...City of Brotherly Love?
Got some papers on the philosophy of humor at the library. My only refuge mentally and physically. But they were closing. Went to the Penn Book store, but they were closing. Got back on the train and went to Barnes and Noble to read, but, yes, they were closed. The blowing snow and slush and general miserableness wouldn't be so bad if things could just stay open, but no way. Grocery stores are closed but a shoe store is still open, what the...?
I am back in my 200 sq. ft. palace which is warm and open. The consolation is that people are talking to each other and still have a sense of humor. Nice! Tomorrow, will be different? Maybe.
More than any other time in history human kind faces a crossroads. One path leads to despair and utter hopelessness, the other to total extinction. Let us pray that we have the wisdom to choose correctly. -Woody Allen
Mona, the security officer at the Center's entrance said, "It's never going to stop". I said that I was locked out of my office and couldn't go home, so I was cast onto the street. Maybe I could recover some of the money I had given away over the last few days.
Slogged over to the Biomedical library at Penn realizing that every intersection was an event as it has been for days now. The walks are reasonably clean but at each intersection there are ponds of slush and snow that require acrobatic skill to navigate. I feel that I am in an eternal Dristan commercial...the kind where the poor sod is standing on a corner sniveling and sneezing only to have a car throw a wake of slush on him from the waste down.
I got into some kind of dance with a Penn snow plow. I moved from one unstragegic postion at the intersection to another while he seemed to move to plow exactly where I had moved. He was having fun with me. I was trapped. He plowed slush all over me. What kind of person...City of Brotherly Love?
Got some papers on the philosophy of humor at the library. My only refuge mentally and physically. But they were closing. Went to the Penn Book store, but they were closing. Got back on the train and went to Barnes and Noble to read, but, yes, they were closed. The blowing snow and slush and general miserableness wouldn't be so bad if things could just stay open, but no way. Grocery stores are closed but a shoe store is still open, what the...?
I am back in my 200 sq. ft. palace which is warm and open. The consolation is that people are talking to each other and still have a sense of humor. Nice! Tomorrow, will be different? Maybe.
More than any other time in history human kind faces a crossroads. One path leads to despair and utter hopelessness, the other to total extinction. Let us pray that we have the wisdom to choose correctly. -Woody Allen
Sunday, February 7, 2010
Snow in Philadelphia and the Super Bowl
Wow, a Super Bowl that was exciting, what a treat. The New Orleans Saints win a thrilling game in Miami. I got to watch from my room in Philadelphia after snow disrupted the Dish TV at my room earlier in the day. Apparently a chunk of ice fell into the dish on top of the building almost disrupting the "big game". And what a game. New Orleans came back from a first quarter deficit of 10 point. By kicking an on-side kick to start the second half and playing great pass football the New Orleans Saints won the game. Drew Brees, who won the MVP, was shown talking to his infant son at the end while his son was wearing ear protection against the noise. I don't know what he could have been saying to his infant son with ear phones on in a Super Bowl full of noise but it seemed endearing.
Peyton Manning, whom I like and respect, may have thrown an interception that will knock him from the discussion of "who is the best quarterback of history" at the hands of the Saints, just as Brett Favre threw an interception two weeks ago that may leave him a broken man at the end of his career. The same Saints player made both interceptions. My only concern about the post- game is that Len Dawson of the Kansas City Chiefs, who beat the Vikings in Super Bowl IV, brought out the Vince Lombardi Trophy. As a Vikings fan I had to muster energy to accept this but I have now come to terms with it. Damn him!! Oh, I have zen, yes I do. As an aside, is there no running in the NFL any more? It seems that the game is now a quarterback and receiver's game.
Best commercial goes to the one where Betty White gets tackled in the mud. The Google one where some schmo- googles his way to marriage in Paris wasn't bad.
The Who played the half-time show and did an OK job with the usual montage of hits. The question is whether this was really the Who since John Entwihistle and Keith Moon are dead and Pete Townshend can't hear. Roger Daltery looked like he had some arthritis in his neck but I'll let that go since his voice was there. Peter Townshend was almost boycotted by descendants of the Abolitionsts (alright, different subject, different cause, but the zealotry was there) since he was officially listed as a sex offender in Britain in 2003 but never charged. He said he was doing "research" when he was caught with kiddy porn on his computer. I tried to do a web search on the issue and didn't get very far except to find out that he had a friend from childhood that was abused and he has said on multiple occasions that he has tried to be an activist in pedophilia, against it that is.
In other news, Philadelphia got 28 inches of snow this week-end, and Washington D.C. got more. It has been a helluva winter in this area. I have been concerned about the number of street people that I have to pass on my way to work each day in Philadelphia. So much so that I took the effort to try to help this week-end. A purely selfish move on my part, mind you, since I want to assuage myself of some of the guilt I feel passing up many of these guys on a daily basis. I have traditionally been against giving to people on the street since I don't know if I would be an enabler or not. But the Philadelphia scene seems particularly bad, i.e. I think many on the street guys(and most are guys) are legitimate and not all drug users or crazies that can't find their way to the Salvation Army or a job, so with my extra time, being snowed in, I wanted to help. I searched the web for some food bank sites but found that my research left me going to places that were abandoned. Eventually I just bought a bunch of food, slogged through the blizzard that Philly was experiencing and ended up passing through the train station, where the police had cleared out the street folks, and got on the subway to West Philadelphia, beyond the University of Pennsylvania. I was told of a Salvation Army at 69th and Market but couldn't find it and no one knew what I was talking about when I asked around. I was a tall white guy with a bunch of food and no where to go. Eventually, I was asked to stop taking pictures of birds and headed back to my apartment on the green line, out of a place where I felt rather uncomfortable. At the 15th St. station, my home base, I tried to give away some food in the terminal. I interrupted some gentleman in a dank corner of the station with sparrows and many wet smells around him, reading an old newspaper, and asked him if he wanted some food. He looked at me like I was interrupting him and asked what I had. I said, "I have some cheese and bread". He said, "No thank you...don't you have any money? I said, "No". He said, "What else do you have?" I said, "Do you want some cashews?" He said, "Nope" and went back to reading his paper. So I moved on. Fickle people these guys. Or maybe he wasn't a reasonable representative of who I was looking for. What I did know is that I was cold and I had wet feet and I was lucky enough to have a warm place to stay so I headed back to my room with a boat load of food. As a last effort I tried to pawn some cashews off on someone else and he sincerely admitted that he couldn't eat them since he had no teeth. He was a real guy and took some cheese. I felt good about that and he seemed happy. I'll try to find a food bank in the light of day and with less snow blowing around, this week.
Peyton Manning, whom I like and respect, may have thrown an interception that will knock him from the discussion of "who is the best quarterback of history" at the hands of the Saints, just as Brett Favre threw an interception two weeks ago that may leave him a broken man at the end of his career. The same Saints player made both interceptions. My only concern about the post- game is that Len Dawson of the Kansas City Chiefs, who beat the Vikings in Super Bowl IV, brought out the Vince Lombardi Trophy. As a Vikings fan I had to muster energy to accept this but I have now come to terms with it. Damn him!! Oh, I have zen, yes I do. As an aside, is there no running in the NFL any more? It seems that the game is now a quarterback and receiver's game.
Best commercial goes to the one where Betty White gets tackled in the mud. The Google one where some schmo- googles his way to marriage in Paris wasn't bad.
The Who played the half-time show and did an OK job with the usual montage of hits. The question is whether this was really the Who since John Entwihistle and Keith Moon are dead and Pete Townshend can't hear. Roger Daltery looked like he had some arthritis in his neck but I'll let that go since his voice was there. Peter Townshend was almost boycotted by descendants of the Abolitionsts (alright, different subject, different cause, but the zealotry was there) since he was officially listed as a sex offender in Britain in 2003 but never charged. He said he was doing "research" when he was caught with kiddy porn on his computer. I tried to do a web search on the issue and didn't get very far except to find out that he had a friend from childhood that was abused and he has said on multiple occasions that he has tried to be an activist in pedophilia, against it that is.
In other news, Philadelphia got 28 inches of snow this week-end, and Washington D.C. got more. It has been a helluva winter in this area. I have been concerned about the number of street people that I have to pass on my way to work each day in Philadelphia. So much so that I took the effort to try to help this week-end. A purely selfish move on my part, mind you, since I want to assuage myself of some of the guilt I feel passing up many of these guys on a daily basis. I have traditionally been against giving to people on the street since I don't know if I would be an enabler or not. But the Philadelphia scene seems particularly bad, i.e. I think many on the street guys(and most are guys) are legitimate and not all drug users or crazies that can't find their way to the Salvation Army or a job, so with my extra time, being snowed in, I wanted to help. I searched the web for some food bank sites but found that my research left me going to places that were abandoned. Eventually I just bought a bunch of food, slogged through the blizzard that Philly was experiencing and ended up passing through the train station, where the police had cleared out the street folks, and got on the subway to West Philadelphia, beyond the University of Pennsylvania. I was told of a Salvation Army at 69th and Market but couldn't find it and no one knew what I was talking about when I asked around. I was a tall white guy with a bunch of food and no where to go. Eventually, I was asked to stop taking pictures of birds and headed back to my apartment on the green line, out of a place where I felt rather uncomfortable. At the 15th St. station, my home base, I tried to give away some food in the terminal. I interrupted some gentleman in a dank corner of the station with sparrows and many wet smells around him, reading an old newspaper, and asked him if he wanted some food. He looked at me like I was interrupting him and asked what I had. I said, "I have some cheese and bread". He said, "No thank you...don't you have any money? I said, "No". He said, "What else do you have?" I said, "Do you want some cashews?" He said, "Nope" and went back to reading his paper. So I moved on. Fickle people these guys. Or maybe he wasn't a reasonable representative of who I was looking for. What I did know is that I was cold and I had wet feet and I was lucky enough to have a warm place to stay so I headed back to my room with a boat load of food. As a last effort I tried to pawn some cashews off on someone else and he sincerely admitted that he couldn't eat them since he had no teeth. He was a real guy and took some cheese. I felt good about that and he seemed happy. I'll try to find a food bank in the light of day and with less snow blowing around, this week.
Saturday, January 23, 2010
Washington D.C., and health care reform
I woke up in Washington D.C today. I'm going to meet my friend Johnson "Spud" Maxey tomorrow to go to the International Spy Museum and to eat some Ethiopian food at his request. Today I wanted to spend the day on the Mall. I ate breakfast near my place at the Club Quarters and it was here that I read that health care reform will be dropped in it's current form by Obama and the Democratic majority in Congress.
I am two blocks away from the White House so I stared at it. After breakfast I started walking and my path took me past a woman in a short black cocktail dress and strappy high heels absolutely yelling into her cell phone. She was pissed at somebody, perhaps her boyfriend, and every other word out of her mouth was f--k this and f--k that and "You better get your f--king ass out here!" etc. She and I were the only ones on the street since it was about 8A and D.C. was sleeping in, or trying to. I took this as a metaphor for...what? I don't know.
Anyway, I was to the White House in a snap. I almost got Lafayette Square to myself. It was only me and the guy with tattoos on his forehead who had been part of a group sitting in front of the White House continuously since 1981 demanding nuclear de-escalation. An issue that has fallen far on the "to do list" of the nation.
Health care is on top and this thing has upset me. While staring at the White House I couldn't help but feel that President Obama and the Congress have not done us a service at this time, that health care for more Americans was within our grasp. In fact, we had it in the boat but it wiggled out. I don't think they should have given up. Since the turn of the previous century there have been two Republicans and a hand-full of Democrats that have tried to get more broad coverage for Americans and all have failed. It appears now that Obama may fail as well and this is especially crushing since he was elected on a health care platform and he came so close. Health care is the holy grail and no President has found it yet.
As a physician I have worked in public hospitals: Hennepin County Medical Center in Minneapolis and Bellevue Hospital in New York City. I have felt, like others, that there is disparity in health care delivery and those without insurance are at a distinct disadvantage. Some could afford it and choose not to buy it, they deserve some knuckle rapping, but I also think that there are enough that are struggling, or are not sophisticated enough, to figure out a system that follows no reasonable rules of economics and they suffer disproportionately.
The preamble to the constitution addresses ensuring domestic tranquility and promoting the general welfare of Americans. Health care is right down its alley. Yet the Constitution does not state a right to health care, as it doesn't mention a right to a public education, yet we have chosen to offer that to the citizens of our country. Arthur Caplan, at the Penn Center for Bioethics, addressed this at a recent keynote speech at a Critical Care meeting. He invoked our desire as a nation to see equal opportunity for all, as one might evoke with creating public education, and he went on to suggest that more accessible health care may also afford more equality of opportunity. By not having reasonable access to health care there are those with asthma, diabetes, seizure disorders, etc. who may not be able to get reasonable health care and thus they experience disproportionate limitations financially and physically that limit their access to a more level playing field of opportunity through little fault of their own.
As cost has always been an issue let me throw this out. The governor of Colorado told me that his office estimated that each uninsured person in his state costs more than $20,000 a year in E.R. costs alone. The average cost per insured person in Colorado seems to be approximately $7,000 based on government statistics from all fifty states. One could estimate 500,000-1,000,000 uninsured in Colorado alone (40 million in U.S.). If one conservatively thinks that there would be $10,000 a year saved on 500,000 people if they were brought into some insurance pool this would add up to $5 billion dollars of savings in Colorado alone.
My personal feeling is that a lack of reasonable health care access for everyone in a country that claims to be the beacon of truth and justice in the world should leave us embarrassed. Lyndon Johnson tried to limit the Congress into drilling down on the cost of medicare because he thought health care coverage, in some form, for the elderly was a necessity in this country. He likened it to having milk and bread in your kitchen. No matter how much milk and bread cost you would just have to spend the money because you had to. Broad health care access is just such an issue. The cost matters, but it doesn't matter, so why not JUST DO IT. We can adjust the budget deficit, we can afford not to buy the next weapons system, or we can let the grass grow at the campsites of our National Parks, or we could all reap the financial benefit of a more healthy medical sector, but health care is bread and milk for the nation. We need it, be it in single party payer form, with a public option in a privately managed system, or some form of mandate without a public option and it seems extremely disappointing that we can't seem to do this.
The White House just sat there, in its beauty and splendor. I walked around and took pictures of the Washington Monument, saw Whistlers Peacock room, and went to the Air and Space Museum after having a hot dog near a childrens group so large that they reminded me of a school of sardines. Then I went to the National Art Museum and saw a Chekov film in Russian with subtitles.
When all is summed up I feel lucky to have economic stability, wonderful friends and family, and I'm lucky to be in D.C.
I am two blocks away from the White House so I stared at it. After breakfast I started walking and my path took me past a woman in a short black cocktail dress and strappy high heels absolutely yelling into her cell phone. She was pissed at somebody, perhaps her boyfriend, and every other word out of her mouth was f--k this and f--k that and "You better get your f--king ass out here!" etc. She and I were the only ones on the street since it was about 8A and D.C. was sleeping in, or trying to. I took this as a metaphor for...what? I don't know.
Anyway, I was to the White House in a snap. I almost got Lafayette Square to myself. It was only me and the guy with tattoos on his forehead who had been part of a group sitting in front of the White House continuously since 1981 demanding nuclear de-escalation. An issue that has fallen far on the "to do list" of the nation.
Health care is on top and this thing has upset me. While staring at the White House I couldn't help but feel that President Obama and the Congress have not done us a service at this time, that health care for more Americans was within our grasp. In fact, we had it in the boat but it wiggled out. I don't think they should have given up. Since the turn of the previous century there have been two Republicans and a hand-full of Democrats that have tried to get more broad coverage for Americans and all have failed. It appears now that Obama may fail as well and this is especially crushing since he was elected on a health care platform and he came so close. Health care is the holy grail and no President has found it yet.
As a physician I have worked in public hospitals: Hennepin County Medical Center in Minneapolis and Bellevue Hospital in New York City. I have felt, like others, that there is disparity in health care delivery and those without insurance are at a distinct disadvantage. Some could afford it and choose not to buy it, they deserve some knuckle rapping, but I also think that there are enough that are struggling, or are not sophisticated enough, to figure out a system that follows no reasonable rules of economics and they suffer disproportionately.
The preamble to the constitution addresses ensuring domestic tranquility and promoting the general welfare of Americans. Health care is right down its alley. Yet the Constitution does not state a right to health care, as it doesn't mention a right to a public education, yet we have chosen to offer that to the citizens of our country. Arthur Caplan, at the Penn Center for Bioethics, addressed this at a recent keynote speech at a Critical Care meeting. He invoked our desire as a nation to see equal opportunity for all, as one might evoke with creating public education, and he went on to suggest that more accessible health care may also afford more equality of opportunity. By not having reasonable access to health care there are those with asthma, diabetes, seizure disorders, etc. who may not be able to get reasonable health care and thus they experience disproportionate limitations financially and physically that limit their access to a more level playing field of opportunity through little fault of their own.
As cost has always been an issue let me throw this out. The governor of Colorado told me that his office estimated that each uninsured person in his state costs more than $20,000 a year in E.R. costs alone. The average cost per insured person in Colorado seems to be approximately $7,000 based on government statistics from all fifty states. One could estimate 500,000-1,000,000 uninsured in Colorado alone (40 million in U.S.). If one conservatively thinks that there would be $10,000 a year saved on 500,000 people if they were brought into some insurance pool this would add up to $5 billion dollars of savings in Colorado alone.
My personal feeling is that a lack of reasonable health care access for everyone in a country that claims to be the beacon of truth and justice in the world should leave us embarrassed. Lyndon Johnson tried to limit the Congress into drilling down on the cost of medicare because he thought health care coverage, in some form, for the elderly was a necessity in this country. He likened it to having milk and bread in your kitchen. No matter how much milk and bread cost you would just have to spend the money because you had to. Broad health care access is just such an issue. The cost matters, but it doesn't matter, so why not JUST DO IT. We can adjust the budget deficit, we can afford not to buy the next weapons system, or we can let the grass grow at the campsites of our National Parks, or we could all reap the financial benefit of a more healthy medical sector, but health care is bread and milk for the nation. We need it, be it in single party payer form, with a public option in a privately managed system, or some form of mandate without a public option and it seems extremely disappointing that we can't seem to do this.
The White House just sat there, in its beauty and splendor. I walked around and took pictures of the Washington Monument, saw Whistlers Peacock room, and went to the Air and Space Museum after having a hot dog near a childrens group so large that they reminded me of a school of sardines. Then I went to the National Art Museum and saw a Chekov film in Russian with subtitles.
When all is summed up I feel lucky to have economic stability, wonderful friends and family, and I'm lucky to be in D.C.
Wednesday, January 20, 2010
TB-like bacteria that cause leprosy, AND read the Bible with some skepticism.
Here's the skinny on nontuberculous mycobacterium. Mycobacterium is a genus of bacteria. Remember, in a family of bacteria there is the genus, Mycobacterium and the species, like tuberculosis, leprosy, and about 130 other species of bacteria that cause lung disease, skin disease and a bunch of other problems. These other species don't get the press that tuberculosis gets.
Nontuberculous mycobacterium share some of the structure of tuberculosis but they have never been known to be transmitted from person to person like TB. I think that is why they fly under the radar.
The classic findings of these bacteria are mycolic acid in their cell wall and a similar structure in something called 16s rRNA. Within this 16s rRNA there are subtle differences which seem to give the different genus' of mycobacterium their unique fingerprint, but this might be getting a little technical.
The most common lung disease from nontuberculous mycobacterium is caused by MAC, or mycobacterium avium intracellulare. It is commonly found in those that work with soil like construction workers and farmers since it is most prevalent in the soil. It is also common, for some unknown reason, in older women who are skinny. We are finding out that cholesterol and and the "fat" hormone leptin may play a role in fighting mycobacterium infection. These are the only diseases that may let you feel good about being obese with a high cholesterol because the immune system may work better against mycobacterium if you have extra weight and higher cholesterol. There are many other reasons to not be fat with a high cholesterol though so I wouldn't go pigging out on McDonalds' just yet.
Recently the New York Times and other papers reported the work of a Colorado State scientist, Norman Pace, who swabs things like subways, clothes and shower heads and found evidence of this bacteria to be ubiquitous. In fact he found that these bacteria form a film that allow them to survive in great numbers in shower heads. There have also been case reports of women having lung infection from isolates found to be from their showers. Hot tubs seem to be a source as well since the chlorine kills other bacteria but not mycobacterium. Infection is rare though so don't go selling your hot tub in a garage sale and if showers are your bag, and you're otherwise healthy, don't stop washing since your social well-being may be at risk more than your health.
Leprosy is caused by a mycobacterium that grows best in the 9 band armadillo, perhaps this accounts for reports of leprosy in Louisiana. But it is most common in India, the continent of Africa, and Brazil. It is a neuropathic bacteria that also causes depigmentation of the skin. Usually patients present with anesthetic patches on their skin and sometimes lumps. The immune system seems to have a difficult time with leprosy so antibiotic therapy is sometimes required for up to ten years. Antibiotic therapy for TB is usually 9 months, for bronchitis, 10 days.
The Bible references leprosy a lot. But recently scientists and Bible scholars have been noting these references with some skepticism since diagnostic skills were not as astute in Christ's time. After the Bible scholars such as Hippocrates, Herodotus and Galen have referenced leprosy. A common theme seems to suggest that these patients were "white as snow" and they comment on plaques of the skin and sometimes growths on the limbs. Many other disease have been suggested by modern science that would account for these reports from the Bible and Greeks such as: vitiligo(immune mediated depigmentation of the skin not caused by infection), psoriasis, elephantiasis(caused by a parasite), ringworm(fungus), elephant man's disease(neurofibromatosis) and other skin infections like those caused by Staph or Strep. It is commonly noted that the clothes and homes of lepers were "moldy" or the equivalent in our modern speak. Often the clothes and homes of these people were burned needlessly as a consequence.
So if you have boil on your skin don't let anyone burn your house down.
That's it for now.
Nontuberculous mycobacterium share some of the structure of tuberculosis but they have never been known to be transmitted from person to person like TB. I think that is why they fly under the radar.
The classic findings of these bacteria are mycolic acid in their cell wall and a similar structure in something called 16s rRNA. Within this 16s rRNA there are subtle differences which seem to give the different genus' of mycobacterium their unique fingerprint, but this might be getting a little technical.
The most common lung disease from nontuberculous mycobacterium is caused by MAC, or mycobacterium avium intracellulare. It is commonly found in those that work with soil like construction workers and farmers since it is most prevalent in the soil. It is also common, for some unknown reason, in older women who are skinny. We are finding out that cholesterol and and the "fat" hormone leptin may play a role in fighting mycobacterium infection. These are the only diseases that may let you feel good about being obese with a high cholesterol because the immune system may work better against mycobacterium if you have extra weight and higher cholesterol. There are many other reasons to not be fat with a high cholesterol though so I wouldn't go pigging out on McDonalds' just yet.
Recently the New York Times and other papers reported the work of a Colorado State scientist, Norman Pace, who swabs things like subways, clothes and shower heads and found evidence of this bacteria to be ubiquitous. In fact he found that these bacteria form a film that allow them to survive in great numbers in shower heads. There have also been case reports of women having lung infection from isolates found to be from their showers. Hot tubs seem to be a source as well since the chlorine kills other bacteria but not mycobacterium. Infection is rare though so don't go selling your hot tub in a garage sale and if showers are your bag, and you're otherwise healthy, don't stop washing since your social well-being may be at risk more than your health.
Leprosy is caused by a mycobacterium that grows best in the 9 band armadillo, perhaps this accounts for reports of leprosy in Louisiana. But it is most common in India, the continent of Africa, and Brazil. It is a neuropathic bacteria that also causes depigmentation of the skin. Usually patients present with anesthetic patches on their skin and sometimes lumps. The immune system seems to have a difficult time with leprosy so antibiotic therapy is sometimes required for up to ten years. Antibiotic therapy for TB is usually 9 months, for bronchitis, 10 days.
The Bible references leprosy a lot. But recently scientists and Bible scholars have been noting these references with some skepticism since diagnostic skills were not as astute in Christ's time. After the Bible scholars such as Hippocrates, Herodotus and Galen have referenced leprosy. A common theme seems to suggest that these patients were "white as snow" and they comment on plaques of the skin and sometimes growths on the limbs. Many other disease have been suggested by modern science that would account for these reports from the Bible and Greeks such as: vitiligo(immune mediated depigmentation of the skin not caused by infection), psoriasis, elephantiasis(caused by a parasite), ringworm(fungus), elephant man's disease(neurofibromatosis) and other skin infections like those caused by Staph or Strep. It is commonly noted that the clothes and homes of lepers were "moldy" or the equivalent in our modern speak. Often the clothes and homes of these people were burned needlessly as a consequence.
So if you have boil on your skin don't let anyone burn your house down.
That's it for now.
Saturday, January 16, 2010
People of Philadelphia
I have been refreshed by the human spirit. The city of Philadelphia is dirty and beaten down, perhaps not as much as other cities in the Northeast, and less than others, but the people have generally been quite open and friendly. First, I have had a wonderful reception at U. Penn since my emails have led to email introductions and more emails and meetings than I imagined. I have been over to the Hospital at the University of Penn. a few times already and interestingly sat in on a session where the institution is trying out "narrative medicine" with staff doctors. This is based on a principle that patients who are able to tell a narrative of their ills feel more comfort in the care they are given, they have better outcomes and are more compliant with therapy. Doctors themselves are found to feel better about their patients as well if they can periodically give narrative amongst professionals about emotional issues they have with patients, nurses and other doctors. Kind of group therapy with the purpose of allowing "us" to keep from strangling our patients or ourselves. For deeper personal issues one has to maintain their therapist visits though. Black humor was endorsed by the moderator of the session, he is an english professor from Scotland.
As for the people of Philadelphia, I'll relate a few encounters I have had. Today on the subway I asked the person next to me how to get to the art museum. He was very helpful as were many others in the car. His recommendations were either confirmed or countermanded by at least 3 or 4 others in our vicinity. I heard recommendations to turn around, take a cab, and to get the 121, 34 and the 440 bus. I decided to get off the subway to take a cab. The bus system is difficult like it is in most cities until one gets the hang of it. But the enthusiasm of the people on the subway was way cool.
Yesterday, I was walking to work behind a woman in a burka. She tossed a gum wrapper on the street.
On the steps of the Philadelphia Art Museum, where Rocky made his triumphant run, there was a muslim kid in bare feet, on a cold day, and white religious outfit preaching about Ala. He was saying how "We should all lie prostate at the feet of God", as I was passing. I suggested he wanted to use the word prostrate. He nodded his head in agreement and without missing a beat repeated his instructions, "We should all lie prostrate at the feet of God..." I apologized for being so bold but he didn't seem to mind.
The security officer at the entrance to the Science Center at U Penn, where the Center for Bioethics has offices, told me about her sinuses when I asked her how she was doing, although I wasn't really expecting a medical report. She didn't know that I was a sinus expert from my practice so I gave her a few pointers, yet I still don't think she knows I'm a doctor. She was grateful and not pissy or resistant. Yet I seem to be maintaining my reputation as being a "know-it-all". But perhaps this is the refreshing part of living in a place that respects accuracy. There is often little difficulty here, and from my memory of New York, if one person helps by correcting or helping another with an accurate correction or a pointer. There is not that visceral uncomfortable feeling that one gets when being corrected or doing the correcting as one gets in other places. There's not so much of the "you're not smarter than me" crap. I like that. I certainly have received enough correction already at U Penn when it comes to ethics and that's OK with me. The U Penn crowd may or may not be smarter than me but what I do know is that they know more about ethics than me. I continue to pursue a path of less vanity and the people of Philadelphia have shown me the way so far.
As for the people of Philadelphia, I'll relate a few encounters I have had. Today on the subway I asked the person next to me how to get to the art museum. He was very helpful as were many others in the car. His recommendations were either confirmed or countermanded by at least 3 or 4 others in our vicinity. I heard recommendations to turn around, take a cab, and to get the 121, 34 and the 440 bus. I decided to get off the subway to take a cab. The bus system is difficult like it is in most cities until one gets the hang of it. But the enthusiasm of the people on the subway was way cool.
Yesterday, I was walking to work behind a woman in a burka. She tossed a gum wrapper on the street.
On the steps of the Philadelphia Art Museum, where Rocky made his triumphant run, there was a muslim kid in bare feet, on a cold day, and white religious outfit preaching about Ala. He was saying how "We should all lie prostate at the feet of God", as I was passing. I suggested he wanted to use the word prostrate. He nodded his head in agreement and without missing a beat repeated his instructions, "We should all lie prostrate at the feet of God..." I apologized for being so bold but he didn't seem to mind.
The security officer at the entrance to the Science Center at U Penn, where the Center for Bioethics has offices, told me about her sinuses when I asked her how she was doing, although I wasn't really expecting a medical report. She didn't know that I was a sinus expert from my practice so I gave her a few pointers, yet I still don't think she knows I'm a doctor. She was grateful and not pissy or resistant. Yet I seem to be maintaining my reputation as being a "know-it-all". But perhaps this is the refreshing part of living in a place that respects accuracy. There is often little difficulty here, and from my memory of New York, if one person helps by correcting or helping another with an accurate correction or a pointer. There is not that visceral uncomfortable feeling that one gets when being corrected or doing the correcting as one gets in other places. There's not so much of the "you're not smarter than me" crap. I like that. I certainly have received enough correction already at U Penn when it comes to ethics and that's OK with me. The U Penn crowd may or may not be smarter than me but what I do know is that they know more about ethics than me. I continue to pursue a path of less vanity and the people of Philadelphia have shown me the way so far.
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