Rural Scholars Program Grooms Primary Care Docs in AL

Rural Scholars Program Grooms Primary Care Docs in AL

Great article on the University of Alabama Rural Medical Scholars Program. Written by John Commons of Health Leaders Media and also happening to feature yours truly Mark Christensen

Letters of Note

From the incredible find: Letters of Note

New York 

March 5, 1964 

Dear Denny: 

I have been filling out my mortal record called a medical passport. There it is—all down there—the past and the future just as plain as the varicosities on my mother's legs and my father's vascular difficulties. There is one thing pleasantly unconfusing about medicine. The direction and the end are fixed and the patient never works backward. 

It does occur to me that clear as this picture is, there may be other matters, some taken for granted and others ignored intentionally or otherwise. What is the reason for having a doctor at all? It is a very recent conception. I suppose the present day reason from the patient's point of view is to get through his life with as little pain and confusion as possible and out of it neatly and decently. But for the duration the doctor is supposed to listen to frustrations and to cater to various whims of the central nervous system. I am interested in the line in this thesis of disintegration which indicates that on request, you will keep me in sweet ignorance of what is happening to me. I know it is desired in many cases but I can't understand it from my viewpoint.

What do I want in a doctor? Perhaps more than anything else—a friend with special knowledge. If you had never dived and I were with you, it would be my purpose to instruct you in the depths and dangers, of the pleasant and the malign. I guess I mean the same thing somewhat. We are so made that rascally, unsubtle flares may cause a meaningless panic whereas a secret treason may be nibbling away, unannounced or even pleasant as in the rapture of the deep. Two kinds of pain there are—or rather a number of kinds. I think especially of the teaching pain which counsels us not to hurt ourselves as opposed to the blast that signals slow or fast disintegration. Unskilled, we do not know the difference and, I am told, even the skilled lose their knowledge when the thing is in themselves. It seems to me that one would prepare oneself differently to meet these two approaches, if one knew. 

Then there is the signal for the curtain. I think, since the end is the same, that the chief protagonist should have the right to judge his exit, if he can, taking into consideration his survivors who are after all, the only ones who matter. 

Then there is the daily regimen and I have always considered this a fake in most people—the diet, the exercise, the pills, the rest, the elimination. It is probably true that careful following of learned instructions will prolong a usually worthless life, but it has been my observation that by the time the subject needs such advice, he is too firmly fixed in his habits to take it. Oh! he'll do it for a while, but he soon slips back and that is probably a good thing. Pills he will take but little else unless terror should get to him, in which case, many men and women become voluntary invalids and soon find that they love it. 

Of course I love to fool myself as well as the next person, but not to the point where I find it ridiculous. I am trying to give you a graph, Denny, so that you will know what you are dealing with. 

I do not think of pain as a punishment and I will avoid it as much as I can. On the other hand, to use a common experience, I would rather have the quick and disappearing pain of the dentist's chair than the drawn out misery of wearing-off novocaine. In most cases, I have been able to separate what hurts from fear of what might hurt. 

In reporting effects I am reasonably honest. It is difficult to remember after any trouble has passed. Lastly, I do not find illness an eminence, and I do not understand how people can use it to draw attention to themselves since the attention they draw is nearly always reluctantly given and unpleasantly carried out. 

I dislike helplessness in other people and in myself, and this is by far my greatest fear of illness. 

Believe me, I would not go on in this vein, and never do, were it not for the nature of this communication. 

I shall probably not change my habits very much unless incapacity forces it. I don't think I am unique in this. 

Now finally, I am not religious so that I have no apprehension of a hereafter, either a hope of reward or a fear of punishment. It is not a matter of belief. It is what I feel to be true from my experience, observation and simple tissue feeling. 

Secondly—I have had a good span of life so that from now on in I should not feel short-changed. 

Thirdly—I have lived very fully and vividly and there is no possibility of cosmic pique. 

Fourthly—I have had far more than my share of the things men strive for—material things and honors and love. 

Fifthly, my life has been singularly free of illness or accident. At any rate the wellness has far overbalanced the sicknesses. 

Sixthly—I do not come to you as a sick man. 

Oh! I know the heart syncopates and I have fainted twice in my life and a stretch of overindulgence blocked my gall bladder a couple of times, but all in all I am remarkably healthy. And I know that because my curiosity has in no way abated. And as I said before, I would rather live more fully and for a shorter time. 

And now the last thing you should know. I love Elaine more than myself. Her well being and comfort and happiness are more important than my own. And I would go to any length to withhold from her any pain or sorrow that is not needful for her own enrichment. 

I hope this is of some value to you. Now, we go on from there. 

Yours 

John

Small Bowel Obstruction

Excess Costs and Medical Services for Non-Breastfed Infants

Table 22-3   -- Excess Medical Cost Among 1,000 Never Breast-Fed Vs 1,000 Exclusive (>3 Months) Breast-Fed Infants

	EXCESS SERVICES PER YEAR/1,000 NEVER BREAST-FED	TOTAL EXCESS COST
Office visits	1,693	$111,315
Follow-up visits	340	$22,355
Medications[*]	609	$7,669
Chest radiography	51	$1,836
Days of hospitalization[†]	212	$187,866
Total excess cost per year		$331,031

Adapted from Ball TM, Wright AL: Health care costs of formula-feeding in the first year of life. Pediatrics 103:870, 1999.

*	Lower respiratory infection, otitis media.

†	Lower respiratory infection, gastroenteritis.

Gunshot wound to the shoulder

18 year old male with a gunshot wound to the Right shoulder.
He was casted and released without any severe sequela.

The Sky is Falling

Art at 3am

I was finishing rounds this morning when I came across this patient I had admitted earlier in the night for seizures. He drew this with a simple Bic pen that the hospital gives out for free.

A simple, cheap pen.
He gave me permission to take his picture with his artwork.
It was an honor to have him share it with me.

Drug deaths now outnumber traffic fatalities in U.S., data show

Fueling the surge are prescription pain and anxiety drugs that are potent, highly addictive and especially dangerous when combined with one another or with other drugs or alcohol.


http://www.latimes.com/news/local/la-me-drugs-epidemic-20110918,0,5517691.story

Pneumonia

Severe pneumonia in an 88 year old ICU patient.

Note the diffuse haziness in all lung fields. This is easily one of the worst cases of pneumonia I've seen on x-ray.
Unfortunately, the pt died 12 hours later. He had chosen a few years ago not to be placed on a ventillator if he was seriously ill, so we followed his wishes and provided comfort-care with all of his family at the bedside.


Have you ever thought about making an advanced directive to let others know about how you wish to be treated if something catastrophic were to happen?


http://www.caringinfo.org/stateaddownload/

Pilots vs Physicians

"I really dont believe in doctors. I dont get flu shots. I believe in Jesus, and that He will keep everything of harm away."
-My new patient who came to see me for management of his blood pressure medicine. She has a blood pressure of 187/98. (healthy goal blood pressure for an adult=130/80). I guess Jesus doesn't protect against hypertension? I didn't bother to ask.

Collapsed lung

I was called by the ICU nurse and told that this patient's oxygen had dropped suddenly. I ordered a STAT Chest X-Ray and it came back with a collapsed Left lung (actual X-ray below. Notice the arrows that are pointing to the outline of the lung. It's shriveled up and much smaller than it should be.)

Infant walkers

From the American Academy of Pediatrics:
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/790

" In 1999, an estimated 8800 children younger than 15 months were treated in hospital emergency departments in the United States for injuries associated with infant walkers. Thirty-four infant walker-related deaths were reported from 1973 through 1998. 

The vast majority of injuries occur from falls down stairs, and head injuries are common. Walkers do not help a child learn to walk; indeed, they can delay normal motor and mental development."

HIV

HIV infecting a cell. The small blue dots are the HIV viruses attaching to the receptors on the cell (the cell is not really orange, but is colored that way for the picture).

Looking for things to do this summer?

The state of Alabama is promoting its small towns this year.
This website has clickable towns and their festivities (almost all of which are free) for people to discover.
(Another pretty cool aspect of the website is that it has copies of every historical marker in Alabama).
Try looking up your hometown! - The Great Alabama Homecoming

This could help you live longer... quick, try it out below

Healthfinder.gov is a great website. Bookmark it so you can always have a trust-worthy source of medical information. I recommend this site to my patients. It's non-profit and isn't bogged down with tacky looking ads or popups.
It also has free interactive tools to check your health, get personalized advice, and keep track of your progress.

Guinea Pig

Death is a hard thing to cope with. Realizing that someone you love has only a limited time left to live is equally as hard.
People try to deal with it in many different ways, and Julie Staub chose to express her feelings through poetry.
I heard Garrison Keillor read this on the radio today. I've pasted the words below, but I suggest you listen to him read it. Come on-- do it. It won't take long.

Just click play below and scroll to the 3minute 57second mark.

On second thought, that might be a lot of work so I guess I'll let you get away with reading it on your own if you want...

Guinea Pig
by Julie Cadwallader-Staub

As if your cancer weren't enough,
the guinea pig is dying.
The kids brought him to me
wrapped in a bath towel
‘Do something, Mom.
Save his life. '

I'm a good mom.
I took time from work,
drove him to the vet,
paid $77.00 for his antibiotics.

Now, after the kids rush off to school,
you and I sit on the bed.
I hold the guinea pig, since he bites.
You fill the syringe.
We administer the foul smelling medicine,
hoping the little fellow will live.

admitting to each other:
if he doesn't,
it'll be good practice.


"Guinea Pig" by Julie Cadwallader-Staub. Reprinted with permission of the poet.

Crashing Jets and Birthing Babies

I started OB today, and since the day was mostly spent filling out and receiving paperwork about the rotation, I haven't done much in the way of actual medicine. However, I did come across this really interesting nugget of wisdom from the OB textbook, page 1:

Maternal mortality has been an under-recognized issue worldwide despite an estimated 600,000 maternal deaths per year from pregnancy-related causes. Put in numeric perspective, this is equivalent to six jumbo jet crashes per day with the deaths of all 250 passengers on board, all of them women in the reproductive years of life.

The Forecast

By Clay Bennett

Choose Your Own Adventure!

Click Below to see the image full size.
Which path best describes your situation.......?!