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Posts Tagged ‘emergency medicine’

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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Last night, instead of watching the Republican Convention wrap up, Bob was working a shift for our dear friend and his colleague, Harvey. They have known each other for many years. Bob was an attending in the Berkshires when Harvey trained in Emergency Medicine, back at BMC when residents had to wear jackets and ties. And after we moved back to NJ to be closer to family, so did he and his wife Vicki. Bob ran the department at Riverview Hospital, and Harv worked at Community Medical Center in Toms River. A Philly guy, his family had a summer home in Seaside.

The funny thing is, they moved further south when their children began attending VA colleges. And before you knew it, Harvey was the Assistant Director in Bob’s ER.

In yet another example of this one degree of separation, Harvey’s daughter graduated from medical school and decided to follow in her Dad’s footsteps. Ashley is currently an EM resident at UVA Medical Center…and last night she delivered a grand daughter to our friends! Brighton Grace is 7lbs 6oz and doing well along with the whole family.

Congratulations Harvey and Vicki, your heart will expand every day from now on. Your lungs will exhale love with every breath. Your arms will ache to hold her whenever she comes into view. Get used to it. This job of grandparenting is the easiest one in the books. Discipline isn’t our job, spoiling and loving unconditionally is; be prepared to redesign your home. You will want it to be a grandparent magnet, drawing this little one and those who will follow, closer and closer.

You will create a Frozen bedroom – or whatever the pop icon of 3 year olds will be in 2019

You will stockpile her favorite Mac n Cheese

You will put baby locks on your cabinets and gates on your stairs

You will purchase infant car seats; and look at Craig’s List for cribs

You will tell your daughter that nobody ever dies from lack of sleep

You will tell your son-in-law to try a ride in the car with loud rock music

You will be there when she first puts her toes in Jersey sand

You will be there when she can’t talk to her parents anymore

When a child is born, so is a grandparent. Many many mazels from us to you Vicki and Harvey. Cousin Anita gave me a picture frame that sits above the kitchen sink when the Love Bug was born, it made me actually print a picture off the computer. And if you need a high chair, Anita says you can have the one I borrowed!

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Yes, I’m a child of the 60s. That was my coming of age decade. But instead of going to Woodstock and taking the fast lane, I was living the life of a newlywed in Cambridge. MA. Shopping for groceries in the same corner store with Julia Child, walking the cobblestone streets and learning to love New England.

Up until that point I had seen only one band live and in concert. The Byrds, an LA wannabe Beatles-type folk outfit, played at an MIT mixer in 1967; this Freshman at Emerson College was invited by an engineering student. And that was it. No love-ins, no more rock concerts. You might say that I missed out on most of the rock music revolution of my generation.

“Bob went to Woodstock and I went to Westchester.”

But after my divorce and marrying Bob, moving back to NJ in 1985, I had a second chance at the fast lane with NY just a short train ride away and the Garden State Arts Center in our own backyard. My cousin Jamie took me to see the Stones for my 50th birthday. The Boss was a ubiquitous presence in town. And in the 90s, my friend Betsy, who is married to a musician/promoter turned agent, danced in the aisles with me at my first Eagles concert.

In the wake of the Eagles’ guitarist and cofounder Glenn Frey’s death yesterday, I’ve been reliving my life in lyrics. http://www.rollingstone.com/music/news/glenn-frey-eagles-guitarist-dead-at-67-20160118

Most people don’t know that the Eagles became a band as a direct result of touring with Linda Ronstadt. She was one of my favorites. In fact, Bob and I would sometimes entertain friends at parties singing “Prisoner in Disguise” together, with Bob on guitar and harmony.

You think the love you never had might save you
But true love takes a little time
You can touch it with your fingers
And try to believe your eyes
Is it love or a lie?

Read more: Linda Ronstadt – Prisoner In Disguise Lyrics | MetroLyrics

And the Big Chill would never cease to sing “Suite: Judy Blue Eyes” every Thanksgiving – to our kids’ utter disdain – a song made famous by a guy the Eagles threw out of their band!

Recently we cleared out our music system, giving away 30 years worth of speakers and amps. The only thing Bob wanted to keep was the turntable. When I asked my hair stylist what he would buy now for a sound system, he said, “Are you analog or digital?”

Well I’m not sure. I suspect I’m a little of both. We are not “gamers,” and we don’t need a wall of sound set up around the TV. I remember when the Rocker started playing with the Parlor Mob. He had all sorts of pedals to recreate the kind of distortion our early bands had on their albums. After fronting with his first heavy metal band in our garage during high school, I found this new band’s sound somehow achingly familiar. My friend DeeDee even downloaded some of PM’s greatest hits!

I spent the weekend in Nashville, it was a quick grandbaby visit. A chance to catch up on butterfly kisses and teach the Love Bug how to rock the Twist. Yep, I had Chubby Checker on YouTube, and clapped while the Groom played guitar, Buddha Baby pounded a keyboard, and my Bug was on the harmonica.

When you marry an Emergency Physician, you marry a nomad. Bob always thrived on risk and adventure, he loved breezing into a new town and fixing a hospital ED. I was always the opposite, hating to rip out my roots, starting over with “no place to arrive.”  Trying to bloom again every single time

I guess I’m still in the slow lane. RIP Mr Frey.      IMG_3743

 

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Over the weekend we had a friend come for dinner. While sitting on the deck at twilight, sipping VA wine and gazing out at the mountains, she noted the lack of bugs. Which of course led to my narrative on life at the Jersey Shore, how Monmouth County was the epicenter of tick/thug life, and eventually my experience as a West Nile survivor.

It was the summer we were packing up the Rocker for college. We lived in a tony swamp, on an estuary of a river. I’d have to swat mosquitoes off my hands in the middle of the day while hanging laundry outside on my clothesline. Let it be said, I love hanging towels, sheets and everything else in the sun and wind for that smell. It’s become a meditation of sorts.

For a full week I suffered with a blinding headache and a fever. But I carried on, never seeing a doctor because why bother, I lived with one.

Not until my eyes had turned as bright red as stop lights, and I could no longer read. That’s when I went to the first eye doctor. The one who told me to go home and wash my hands, I had conjunctivitis…

Then Bob took me to the “good” eye doctor, my savior, the one who realized right away what was going on. I remember distinctly his feeling of – what? Pity, sympathy – no doctor has ever looked at me like that before or since – and I was off to Bob’s old ER on the river for tests. Dropping steroid drops in my eyes every hour, swallowing steroid pills while packing up my son for his next great adventure. And eventually, I was an empty-nester who had lost my right-mid and lower-quadrant visual field; the peripheral vision of both eyes. My daughter’s favorite medical term, I think just because she liked the sound of it on her tongue, became my final diagnosis; Homonymous Hemianopsia. Say that five times fast!    

When i think about it, that’s most likely the reason I fell to the right in the bounce house. It’s the reason I jump when someone approaches me from the right. Most likely I abhor crowds because of my brain injury and it’s why I turn my head to the right so much while driving. All because of a little bug.

Which is why this recent headline caught my eye, “Orange horse is first West Nile equine victim of the year.” 

Orange is not the color of the mare, it’s a county one field away as the mosquito flies. “In 2014, there were seven cases of West Nile virus in humans in Virginia and three equine cases, according to the Virginia Department of Health. The human cases occurred in August and September and the equine cases occurred in September and October.” http://m.dailyprogress.com/news/local/orange-horse-is-first-west-nile-equine-victim-of-the/article

So even though we live in the mountains now, in a relative bug-free zone, I guess these are the months to spray bug repellant and light citronella candles. Makes me long for the Berkshires.  IMG_3030

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