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Posts Tagged ‘emergency medicine’

It’s been a very busy first day of Spring. I took my first Nashville Yoga class after breakfast, and joined a T’ai Chi bunch before lunch! I learned quite a bit, about tuning into my body and tuning out the noise of the city. And this city can be pretty noisy; Great Grandma Ada told me even the NYTimes was writing about the Demolition Blues here in the Music City. Right down the block we’ve had intermittent blasting through limestone that shakes the house, makes me jump, and has Ms Bean running around in terror.

It’s like a war zone, I feel a bad case of PTSD coming on. Between Mr T’s morning rambling via Twitter, and the Federal Trade Commission investigating Facebook (ps here’s how to clean up your account https://www.slashgear.com/facebook-personal-audit-privacy-app-sharing-19523634/) – the random, bomb-like explosions have thrown me over the edge. The whole existential crisis of a possible nuclear showdown pales before the everyday reality of our current climate.

Hence my plan for Zen Tuesdays.

Now for the other six days of the week… While I was saying “Namaste” today, we learned of another school shooting today, this time in Maryland. The 17 year old gunboy is dead, and the girl he targeted is in critical condition. There’s another teen boy who was targeted. Enough is enough. It certainly feels like we’ve reached a tipping point towards gun reform, although I’ve felt that way in the past too. But somehow, this time feels different.

The Tennessean published an opinion piece on Sunday that was co-authored by the Bride and her friend, another Emergency Physician. They are calling on state legislators to repeal the Dickey Amendment which curtails research and funding of gun violence. Oh yes, NRA, we’re coming for you!

It is time to treat gun violence like the public health emergency that it is, and to let the scientific community conduct the necessary work to find solutions.

Unbiased medical research has led to the eradication of smallpox, the dramatic reduction of injuries and death due to motor vehicle collisions, and lifesaving advances in the care of those injured in combat.  

 We can – and should – add the prevention of unnecessary gun-related deaths to this list.     

   

It was signed by 128 TN physicians!! Mostly ER docs who see the results of unfettered access to guns. https://www.tennessean.com/story/opinion/2018/03/15/opinion-gun-violence-national-public-health-emergency/426997002/

Let’s face it y’all, grandpa’s rifle is NOT the same as an AR-15, and even here in the South minds are being changed. The massacre in Las Vegas shook the music industry to its core, and now teenagers are planning a March on Washington to bring their message home. Our children deserve to feel safe in school, freedom from fear is our God-given, Rockwellian right in this country. The police don’t want these guns on the street, and we the people don’t want them either. It’s about time our legislators listened…

I think the explosions have stopped. Our neighborhood has been strangely quiet for a few days now. We managed to plant our lilacs yesterday, and now they are predicting snow. Happy first day of Spring to everyone from our little Irish Star Wars colleen!

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Bob has returned from the sexiest city in the country. The Emergency Department Benchmarking Alliance (EDBA), a group that looks at ED performance, held their summit at Caesar”s Palace in Vegas! One of the young doctors at the conference told Bob that his book on ED management was her bible during her first tour as a director. Last night, Bob said he just doesn’t “get” that city, it’s all fake news. Plus, he doesn’t gamble.

We kissed hello, and I said goodbye. The Bride and I were off to a family forum at the Love Bug’s school on “Raising Sexually Healthy Children.” The Groom was still at his conference so I was invited, and of course I was the only Nana in the group. There were only a few dads; still, we represented a diverse range of opinions and concerns about sex. Ranging from the nitty gritty of “What and When,” to how can we keep them safe in the age of smart phones and social media.

My take-away for raising a sexually healthy adult (ie imagine your child at the age of 35, which of course, I didn’t have to do) is that you stay positive about anything they may ask  you. For instance, instead of immediately saying, “Where did you hear that?” in an accusatory voice, you begin a dialogue with your child. Staying available and open as a parent means they will keep coming to you for advice instead of their peers and/or porn. At least until they turn 16.

Ideally, you should present the facts to them in an age appropriate way.

Our culture has a way of making sex shameful. In fact when the Bride was young, she had exactly one year of sex ed in school, and it was all about STDs and HIV/AIDs. Bill Clinton and Ken Starr were duking it out when the Rocker was in middle school. One fundamentalist Christian mom looked at me and said, “We can thank our President for teaching our children about oral sex.” So I guess we can thank Mr T for teaching our grandkids what…?

Do you know what the average age of first sexual intercourse is in the USA? I didn’t! It’s 16.7; but I guess that depends on what the definition of “Is” is… The speaker recommended a book to start this journey on positive/holistic sexuality with your child titled, “It’s Not the Stork” by Robie H Harris for 4-5 year olds. If your child hasn’t been curious about sex by the age of 7, this is a good way to start the conversation.

The Groom returns home today triumphant! He was just published in the New England Journal of Medicine as the lead author in a study on the use of saline vs balanced crystalloids in the ICU. He’s been interviewed on our Nashville NPR station and the local news programs, and if that’s not sexy. I mean. It’s like winning the Oscar in medicine!

I remember the Bride twirling around at 3 in her twirly skirt, saying, “sexy” over and over again. I asked her what sexy means, and she said “Beautiful!”

My favorite flowering tree, the tulip magnolia, is in bloom and spring is in the air.  IMG_2318

 

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It’s warm and rainy in Nashville today, the first day of winter. Our car smells like wet dog and the house still smells like latkes. This will be my second Christmas with Bob not working the ER; but, the Bride will be and her Groom will be in the MICU, sooo we’ll be doing some grandparenting on Christmas Day!

It’s been a busy week, but the highlight by far was yesterday’s Nutcracker. We all ubered downtown to see the Nashville Ballet. The scenery was stunning, the orchestra was phenomenal, and the ballerinas were perfect. The Love Bug sat entranced; like the daughter of two scientists, she asked if Uncle Drosselmeyer’s magic was real? And she waited patiently for the ballerinas to appear, and laughed as it actually started snowing on the audience during intermission!

Her Mama played a reindeer in the Berkshire Ballet’s Nutcracker when she was the Love Bug’s age.

Some of you may know that I was a dancer in a previous life, and was thrilled to dance the opening waltz myself at the ripe “old” age of 35. If I was asked when I was the happiest in my life, those moments on stage, dancing, were among the best. Maybe it’s the Flapper’s influence, she would slip out of her bedroom window as a teenager to meet her friends and dance to the Tommy Dorsey Orchestra. And once the Bug was born, she tied a stuffed pink ballet toe shoe over her crib.

I asked the Bride if she had any memory of being under La Mère Gigogne’s (Mother Ginger) skirt? She said, “I remember being dizzy!”

It’s a dizzying time of year, but my wish for you today is that you stop and breathe for just ten or twenty minutes. Step away from Amazon on your computer. Pet your dog or cat and put on some Tchaikovsky, with a cup of hot tea on the side. Try to let your mind wander, or meditate. Practicing self-care can easily be forgotten when Hanukkah and Christmas demand so much attention. Remember that “stressed” spelled backwards is “desserts!”

And that the days, and therefore the sun when it reappears, will lengthen. We are beginning that stretch towards Spring, which is how I like to think of the Winter Solstice – not as the shortest day, but the beginning of longer daylight hours. https://news.nationalgeographic.com/2017/12/winter-solstice-2017-first-day-winter-definition-space-science/?_ga=2.23714169.2115897125.1513975428-807897739.1513975428

May you and yours have a peaceful and joyous Christmas. And thanks in advance to all those doctors, nurses and emergency personnel who will be working on Monday. You are truly doing God’s work.

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You’ve all seen them while running through an airport. The giant ads – no, not the picture of the Parlor Mob at JFK – pictures of doctors in white coats, smiling in front of computers. Why wait for hours at your local Emergency Department? Can’t get an appointment with your actual doctor for months? Maybe you’re too sick to drive, and just too busy to take an Uber to an Urgent Care?

Well, the Virtual Doctor is in!

The first time I saw my very own Dr McDreamy at UVA I was slightly disappointed. Like many women, I had never had a primary internal medicine doctor before…ObGyns sure, and specialists to repair meniscus tears etc. Whenever something was seriously wrong, I always had Bob to remind me this was just a virus and it would get better with time. But a real doctor, this was something new to me.

Let’s go over the best parts first: the waiting room was almost empty; he was on time; his nurse was efficient, I was blessed with some very good genes so my medication list is mostly vitamins; his resident asked all the right questions; and finally, when I saw the doctor, he sat and talked with me for a very long time. I was in love!

And now for the not so good parts: I had to drive 40 minutes to park in a gigantic cement parking garage I would later get lost in; the walk to his office was well over a mile; and the worst part of all, he never actually touched me. I never got undressed and jumped onto an exam table clinging to a paper robe. No physical exam…I left his office with appointments for tests like blood work and a mammogram.

Let’s skip ahead to that week between my fall off the steps in Nashville, and our trip to the South of France. I called my Primary Care doctor and he was away and they couldn’t fit me in. I called my Orthopedist and his office said since I didn’t break any bones, he doesn’t do muscles! I didn’t bother trying to see my Dermatologist. I wondered aloud, is this what it’s like for everybody? When you finally really really need to see a doctor, like you can barely walk and you’re about to get on a plane, they are nowhere to be found?

Well folks, I think Bob may have found his retirement second act. Emergency docs have to know a little bit about every disease and a whole lot about the ones that will kill you. And isn’t that what we all want to hear? You don’t have a terminal illness. It’s just a cold, get over it! Well, maybe they will say it with a bit more finesse, into their monitor.

Dr Ali Parsa, founder and chief executive of digital healthcare app Babylon, sees the (remote physical and mental) health trend as an undoubted force for good.
“It’s time to do with healthcare what Google did with information – using the power of technology to democratise access for all, and put a personal (digital) doctor in everyone’s pocket regardless of geography or income,” he says. http://www.bbc.com/news/business-40629742

Bob’s been doing this for years already with our relatives and friends. People send him pictures of rashes, x-rays of broken bones, brain CAT scans. He’s functioned as our collective consultant at seders and dinner parties. “My foot’s just not getting better.” Or, “Will you just take a look at all the drugs I’m taking?”

I’m pretty sure I wouldn’t want an App or a Bot to speak to about my medical condition, but having a real, live physician on FaceTime or Skype? Sure! And the doctor or the patient could be in Katmandu, so long as the WiFi is working – this takes boutique medicine to the next level.

Lots of hospitals do this already. Did you know in most rural parts of the country, smaller community hospitals have critical care ICU docs checking in via monitors from their big city university hospital? At night, radiologists in other countries read X-Rays that are sent  digitally from the US. This has been going on for years.

I’m feeling hopeful today after the Senate saw fit to drop their misguided bill to “fix” the ACA and throw millions off Medicaid. The sheer irony of Sen McCain delaying the vote because he was busy having a surgical procedure his insurance covers illustrated their sinister deliberations. http://www.cnn.com/2017/07/18/politics/how-the-republican-health-care-bill-fell-apart/index.html

I hate that we politicize health care in this country. Until we see fit to have Medicare for all, maybe technology will help restore access and autonomy to the doctor/patient relationship. And at the very least, we would know if we need to go sit in an ER because our neck is tender and we must rule out meningitis. The doctor is on deck!IMG_0846

 

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Now that Bob has retired, we’ve decided it’s time to finally find our dream beach house. Someplace for family reunions, holidays, and maybe even an investment opportunity on AirBnB or VRBO from time to time. The only problem is, what beach?

Of course the island we love is not affordable. So that leaves us with a few options: Outer Banks, too cold; Florida, too predictable (sorry Floridians); Texas Panhandle, nah. Working our way across country, we really loved California, so maybe? But then Hawaii comes to mind.

I was listening to an ER doc from Hawaii on NPR yesterday, he was talking about a new Bill he introduced on the floor of the senate; Josh Green, MD also happens to be a state legislator. After years of practicing Emergency Medicine he said he and his colleagues know by name the homeless people who frequent his ER, and he knows that they suffer from chronic medical conditions that would benefit from simply being off the street. So he proposed a Bill that would give docs the right to prescribe six months of housing, to be supervised by case workers. Treat homelessness as a medical condition. An unusual, intriguing and not a half-bad idea!

A small number of homeless people require a disproportionate amount of medical treatment. According to Green, a recent internal study by a major Hawaiian insurer found that over half of the state’s $2bn Medicaid allotment was consumed by a tiny fraction of users, many of whom are dealing with homelessness, mental illness and substance addiction.

Yet research suggests that healthcare spending for those who have been homeless for long periods and struggle with mental illness and addictions falls by 43% after they have been housed and provided with supportive services. Green said many of the individuals he hopes to house cost the healthcare system an average of $120,000 annually, yet the annual cost to house an individual is $18,000. He thinks that the total savings to the state could be hundreds of millions of dollars a year.  https://www.theguardian.com/us-news/2017/feb/28/hawaii-homeless-housing-bill-healthcare-costs

Surprisingly, just a few days ago, I reconnected with an old friend, a woman who used to be an administrator in Bob’s first ER. After telling me that “Bob and retirement” are two words she never thought she’d hear in the same sentence, she also mentioned that retirement in Hawaii was something she and her husband were thinking about…and for my third coincidental island musing, Hawaii is the first state to file suit against’s Trump’s new “Travel Ban.” Aloha and Mahalo!

For these islanders, the memory of rounding up Japanese citizens after Pearl Harbor is still very real! http://www.bbc.com/news/world-us-canada-39215990

Now I’ve never been to Hawaii, and I hear that each island is different. Maybe it’s time we scheduled a little trip to the Big Island, or one of the medium-sized ones? Of course, our retirement plans may fall apart depending on what the Republicans do to the ACC, and Mr T does to the global economy.

Meanwhile back at home, we’ve been planting some perennials, practicing Hygge, and dreaming of our Purim Princess Warrior!     IMG_0166

 

 

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If Mirriam Webster is on to something, they just let the world know. The Word of the Year for 2016 is “surreal,” or “having the disorienting, hallucinatory quality of a dream; unreal; fantastic;” and after the past few days and months I’d have to agree: a truck plows through a Christmas Market in Berlin, mimicking the Nice attack earlier this year; a Russian ambassador is assassinated in Turkey while being filmed by an AP journalist, just as citizen journalists have been documenting killings by police and streaming them in real time in this country; a Twitter-babbling, boisterous billionaire wins our election with a little help from Russia, just as many populist politicians all over Europe are disrupting the status quo.

The past year does seem like a nightmare, surreal, only we are not dreaming. Yesterday the deal was sealed with the Electoral College, and Melania (or Ivanka) will get to pick out the new White House china, not William Jefferson Clinton. Will it be American (I love my pattern from Lenox, which was once produced in NJ) or Slovenian? Just think, if Hillary had won, Bill could have just recycled the fine china Hillary picked the first time around! This would have saved taxpayers plenty!

I wonder what kind of food Mrs T will serve at state dinners? I heard a fascinating author discussion on NPR about the history of First Ladies and how they have sparked culinary trends in the past. Think of Jackie O introducing French food to the American palate. She and Julia Child shaped my young interest in all things French. I nearly burned down my first home trying to make coq au vin.

Just as Eleanor Roosevelt told her chef not to produce any meal costing more than the average American could afford during the Great Depression, Michelle Obama has been instrumental in getting our country moving and making sure her chef, Sam Kass from Chicago, planned his meals based on Real Food.

Kass changed the Obama’s diet—more fruits, vegetables, and whole grains; less processed foods and desserts. As first lady, Michelle Obama passionately told her family’s culinary story, especially how it benefited the health of her girls. She and Kass turned to broader health initiatives beyond the first family’s table. They grew a vegetable garden on the South Lawn, launched the health and lifestyle initiative “Let’s Move,” tackled school lunch reform and redrew the United States Department of Agriculture’s food pyramid as a simplified icon called “My Plate.”http://www.npr.org/sections/thesalt/2016/12/09/504693961/first-ladies-often-forge-food-trends-but-melanias-menu-is-a-mystery

If I were to apply the term surreal to Mrs T’s gastronomical philosophy, we might imagine a state dinner consisting of her favorite fruits. After all, this is what we know, she eats 7 fruits a day. So perhaps the first course would be a baked fig? Followed by a blueberry and raspberry terrine? Would she serve a third course, a potato or pasta dish? Maybe she would branch out and serve cauliflower rice in a lovely crystal bowl? For dessert, it would have to be apple pie…or maybe strudel? We already know Mr T doesn’t drink alcohol, but I’m sure they would have to serve the appropriate wine pairings to their guests of state. Right?

This week we are off to Nashville for some grandparenting fun. It will be the first year in a very long time when Bob will NOT be working on Christmas, however our daughter WILL be seeing any and all comers in her ER on Christmas Eve. She loves her urban hospital as they see lots of ages and real life and death problems – unlike a suburban hospital’s typical run-of-the-mill, free-floating anxiety problems. The staff really cares for their homeless population who tend to come in as the temperatures drop. I hope she doesn’t mind my little synopsis.

I’m looking forward to my enforced news sabbatical and will try to write between grating potatoes for the Bride and Groom’s Hannuka party and warming up the dreidel. Hope whatever holiday you are celebrating this year is filled with family love, cheer, real food and friends. And I hope your dreams are filled with nutcrackers and sugar plum fairies! Thought you might want to see my tiny, surreal tree!

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“Do we have any plans?”

A simple question yes, but I’ve been hearing it alot lately. At the end of this month my husband Bob will retire. You heard me correctly, he will hang up his stethoscope for maybe the last time. And like most American housewives of the newly retired, I am beginning to wonder what the rest of my life will be like.

Our cousin Anita tells me that men who golf do much better in retirement. Her friends are not complaining so much. They don’t require lunch, they make dates with their friends and get their manly fix swinging sword-like putters on the golf course, returning home from their natural habitat conquering (or quivering) heroes.

Bob doesn’t golf. But he does fly.

Unfortunately, someone is flying up from Florida this weekend (we shall see how Hurricane Matthew affects this plan) to buy his little Arrow four-seater. It’s been on the market since his surgery last year; so hanging in the hangar so to speak will be off the table.

Our friend MJ tells me that when her husband retired, at about the same time her daughter’s family moved out of her second floor and into their new newly built home, she was trepidatious. After all, her husband was a businessman who travelled the world frequently. But men in the business world can remain as consultants, and that is exactly what her husband has done. Plus, he can drop in on his grand daughter anytime he wants.

Bob’s always been the leader of his pack, the director, the owner.

Bob’s grandkids are in Nashville with my grandkids and doctors rarely consult after retirement. When we visited his UVA doctor this past year for a check-up – a man about the same age who is cutting back on patients and teaching more – he swiveled away from his computer and looked Bob right in the eye, saying bluntly.

“What are you going to do? You’re not the kind of guy who goes to Lowe’s every day.”

True. And do doctors ever really retire? I’ve known some to work right up into their 80s, but these are usually Internists, GPs who sit and swivel mostly. Not ER docs who run around the clock moving all sorts of serious and semi-serious emergencies in and out the doors like a Roadrunner…24/7 every day of the year…

It’s hard to imagine my husband doing nothing, literally. And to be honest, there are a few new things he can dabble with in medicine. After all, he’s been doing telemedicine his whole life with our family and friends. Rashes are sent via text, foreign objects in the eye are discussed. But the cord to a hospital will be cut for good.

He doesn’t do laundry, even though he likes folding. He is an excellent sous chef in the kitchen, when asked. And strangely enough, I didn’t think this whole retirement phase would bother me. After all, he never worked a 9 to 5 job and often works weekends and holidays; I am used to him puttering around the house, mowing the lawn on good ole John Deere, editing medical journals in his office and catching up with charts. Once upon a time he would cut down trees for firewood and tend a garden…

Long ago I put my foot down – I don’t do lunch. So when Bob’s home during the day, we often go out to lunch, or just “pick.” That’s one of those generational things, like Ada makes lunch for the world should they stop by. That greatest generation would leave a cooked dinner covered in the fridge for the hubby if they happened to be out one night. Millennials order food online and cook it together.

My generation was stuck in the middle, fledgling feminists feeling the need to hunt and supply a “home-cooked” meal every night. Last night I made bangers and mash. WHY? Because sausages were on sale at Whole Foods, and I was thinking about those beer gardens in Eastern Europe since a friend is posting her travel pix on Facebook! Thank God I didn’t Instagram it.

Last night I politely asked Bob to stop asking me about plans. He said he thinks maybe he should get another job! Will we travel more? Take long walks on the beach? Talk? Make more vegetable soup? To quote Disney’s Chef Gusteau:   793759230-f6b3178ce351ee8f3901fe91febe95fb

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