Either it’s Broken or it’s Not Broken

To be filed under sports injuries:

After a 5 turnover, 41-7 loss against the New ENgland Patriots, Mike Shanahan, head coach of the Denver Bronco’s responds to a reporters question about whether Jay Cutler’s injured finger would need an MRI this week:

I don’t think fingers need MRIs, either it’s broken or it’s not broken.   I’m not a doctor, but I think that’s the case.

Four Things…

I got tagged by Kim from RN for Life in my comments the other day, and have been ruminating on my answers. Here goes…don’t be shocked.

[ed note: OK, this post was drafted 2 years ago, I just decided to publish it after finally thinking of four movies & places]

4 Jobs I Have Had In My Life:
Outward Bound Instructor
Retail clerk/manager for an outdoor outfitter (backpacking, rockclimbing, kayaking)
Summer job at a pet kennel (geese & puppies & kittens, oh my!)
Grasscutter/Fence Painter for borough parks

4 Movies I Could Watch Over and Over:

The Wall
Monday Night Football (does that count?)
Men in Black

4 Websites I Visit Regularly:

Beginner triathlete
My Yahoo stock page
Wealthy Affiliate

4 of my Favorite Foods
Freshly Brewed Ice Tea
Dark Chocolate, especially Baker’s squares
Yuengling Lager

4 Places I Would Rather Be Right Now
Laguna Beach
Bay Islands
Rocky Mountains
Danville, PA (where did THAT come from???)

4 Most Wonderful Places I Have Been
Puerto Rico
Estes Park, CO

4 Books I Could Read Over and Over

The Life if Pi
The Kite Runner
The Bible

4 Songs I Could Listen To Everyday
The Other Side of Summer (Elvis Costello, Mighty Like a Rose)
Island in the Sun (Weezer, Green Album)
Barrel of a Gun (Guster)
You Shook Me All Night Long (ACDC)

4 Reasons I Blog
I’m too lazy to call my family & friends
Creative Writing Outlet
Documentation of the amazing things that happen to me in my career

4 People To Tag
Universal Call
Bontrager Diaries
Wescott Studios
Retriever Training Forum

These people know who they are…I’ll be checking in on them…or post in the comments…

John Ritter’s Widow Inspired

Somehow John Ritter’s Widow’s remarks following the not-guilty verdict of two physcians angers me to no end.

 “I disagree with the jury’s decision but I believe in the system and I respect it,” said the widow, Amy Yasbeck. “It inspires me even more to find, with these brilliant medical minds, a path to diagnose aortic diseases.”

So what is she saying?  It seems to imply that she realizes that brilliant medical minds cannot always definitively diagnose and treat aortic dissection.  And yet she disagrees with the jury?  And why did it take a jury of non-medical laypeople to convince her that the medical minds involved were brilliant?  Could neither she, nor her lawyer, nor the media, nor the hospital’s lawyers convince her of this?  So all someone has to do is choose not to believe something that is evident, and then sue numerous physicians and the treating hospital as well?  In a case that took nearly five years to settle?

Are you with me on this or am I crazy?

Shared Health Decisions

The results of this article are no surprise, and this is a real pet peeve of mine. The article says that many patients who were supposedly participating in “shared health decisions” with their physician either had no input and/or reported it as being a negative experience.

That’s no surprise to me. As an ER doc, if a patient comes in with no family members or paperwork, we are forced to do everything possible to keep them alive when we don’t know what their wishes are. Sometimes the family is with them and says, “just keep them comfortable.” Those cases are rare and refreshing. Sometimes there is a stack of paperwork with a list of check-boxes saying No CPR, No Intubation, Yes Antibiotics, etc. But when the family says, “Do everything”, you are forced to comply. Keep in mind, these decisions happen in minutes in the emergency department. There is no time to sit down with the family and discuss the finer points of what their loved one would want…by then it may be too late. Often these critical, but dying patients, get admitted to the ICU where the intensivest is forced to have a sit down meeting with the family to discuss these issues.

While the paperwork with check-boxes is sometimes helpful, I feel that it is really unfair for a doctor or lawyer to sit down with a patient and say, “Do you want CPR? Do you want a breathing tube? Do you want to be electrically shocked? Do you want antibiotics, a feeding tube, IV fluids?” Most people do not really have a good understanding of what these treatment options really mean, or what their implications are. There are an outstanding number of variables that go into what may or may not be appropriate such as prior health, religious beliefs, quality of life, etc. A youngish (say 60 year old) healthy patient who has filled out a living will stating that they do not want to be on life support SHOULD have everything possible done if they find themselves in a car accident for example, with bilateral pneumothoraces and fractured ribs. These things will heal, and the patient will go on to have a good quality of life afterwards. That’s just one example.

I had another patient with “DNR” orders who came in with severe heart failure & fluid overload. I did all the appropriate medical interventions with no relief. I finally told the patient and the family that the best hope for treatment was to be intubated, allow the fluid to be removed from the lungs with positive pressure ventilation along with the other medical treatment and then see how his breathing was. All agreed. This DNR invariable says that they do not want to be kept in a TERMINAL state of life support. This patient’s condition, albeit chronic, was treatable, and his quality of life was not so poor that he wanted it to be ended that particular day. He did fine after a few days of treatment. Yes, he’ll be back, but with better diet and medication control, he can have an even better quality of life.

So you see, many of these “shared health decisions” require a HUGE amount of input and responsibility of the treating physician to help decipher what is and isn’t appropriate for the patient. But it is all based on what the patient himself wants out of life. Without that input, whether it is discussed with the physician or with his family, all assumptions NEED to be for “full steam ahead.”

It’s no wonder patients are dissatisfied with this process when they have a sheet of paper shoved in front of them that says, “Check these boxes” when there is little context for when and how those treatments might be used.