Heart of a Lion, Hands of a Woman: What Women Neurosurgeons Do
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Monday, August 30, 2010

Great News-Insurance Premiums on the Rise

Great news-California just approved double digit rate hike for insurers  there.
I thought we were in a recession...I thought the cost of doing business might be level...I know most California residents are not seeing double digit increases in their salaries.  The rate increases were granted to a spectrum of  insurance carriers including the Blues.  The current health reform legislation caps administrative costs starting in 2012-seems they are grabbing every dollar they can before things get tight.  What is the likelihood any of this will be passed on to direct health care providers?

Friday, August 27, 2010

Selfishness: Why I Blog

To be honest, I started this blog at the suggestion of a friend as a way to raise interest in (and sales of) a book I had edited (Heart of a Lion, Hands of a Woman: What Women Neurosurgeons Do).  As best I can tell, the site has been pitiful in this regard.  So why did I continue? Part of the answer is that I can't stand GIVING UP (not a neurosurgeon's nature) so I wanted to figure out how to "succeed."  So I did a little studying (of other blogs), I asked questions and I set my own goals.  Perhaps I also saw the blog like the journal I kept for many years-though a blog is obviously more public.  Another motivation may have been that I have been told many times that we, as physicians, have so many poignant stories to share about our patients (all which we swear we will remember until retirement when we have the time to properly record them).
I have come to realize that blogging forces me to filter everything I do through a different, noncomplacent lens.  Now as I pass my day as a physician, citizen, parent, child, wife I find infinite connections to write about.  It forces me to SEE my patients-their lives, their struggles, their grief through an entirely new filter-and I really think it has made me a better physician and person.

Looking at my statistics (yes, I just figured out how to do this) I am humbled and amazed in some months this blog has more than 500 views! The map view shows visitors from four continents and always the surprise at what brings the most viewers to this space.  
Many of life's journeys start on one road and detour to another.  I searched for a way to bring the outstanding and deserving voices of women neurosurgeons  to a wider audience and found a new vehicle for inner discovery.  Thanks for all those who join me (past and future) on this wild ride.

Monday, August 23, 2010

Fool me Once

Fooled me
Last summer, all summer
Out late
Many lies
Wasted work
The graduate! Ha!

Fooled me
Freshman blues
More lies
Wasted time
Opportunity lost

Fooled me
Said you blundered
Wanted help
Change would come
Had ideas

Fooled me
Summer home
Big plans
Getting it right
Taking control

Fooled me
Deceit everywhere
Where to turn?
What to do?
Is it too late?

Fooled me
Once, twice
Again, again
Fooled me
Me Fool

George Bush: Fool Me Gaff (must watch!)

Thursday, August 19, 2010

Is this right?

Had a patient today who I have been working up for back and neck pain.  She has been on high doses of narcotics for many years (something called Opana-always a red flag to a neurosurgeon).  This woman is rail thin, has no neurological deficits and essentially normal MRI scans.  Her heavy doses have been routinely prescribed by her PMD while she has never done a day of PT or real pain management-she also has not worked in more than 4 years...am I missing something here?
Another patient same day-obese, injured lifting at work, maintained with just narcotics and "rest" for 15 months-exam normal, MRIs normal-only seeing a chiropractor who she swears does wonders...but not miracle enough to return to gainful employment and stop drawing workman's compensation.
Sojourner Truth suffered from serious back pain
The estimated annual cost of workplace low back injury in the US is between $50-100 BILLION!!! These account for 1/4 of all claims.  Studies show if out of work just 6 months, there is a 50% chance of return to full time work.  After 1 years that number drops to 25% and after 2 years nearly 0%. (Bureau of Labor Statistics)
I don't mean to pick on these two women, rather to use them to illustrate how our system is broken-

  • Too many physicians find it easier to just give narcotics than deal with the challenge of a more comprehensive approach
  • With increasing time constraints, it is simpler to complete paperwork (even if annoying) than to confront the patient
  • Maintaining the status quo is less trouble than challenging the patient to lose weight, start exercising, and retrain.
I would never want to penalize an employee truly injured at 
work but within the realm of low back injury, the "state of the state" needs significant improvement.
    How far have our treatments come?

    Monday, August 16, 2010

    End of Life: Should we Mandate?

    Recently I floated the idea that one requirement of Medicare enrollment should the completion of some type of "End of Life" document-at a minimum a Living Will and a Health Care proxy (with a regular renewal/update also required).  Everyone knows that too many health care dollars are spent in the last hours, days and months of life because (just a few of many reasons):

    • No discussions have ever been had with the one who becomes critically ill (too depression, too sensitive, too...)
    • Family members dislike the burden of decision making (are we killing Mom/Dad?)
    • Physicians are ill-trained to confront the challenging issues
    • The unexpected too often happens
    The idea was largely either ignored or dismissed because:

    • Promoting this will seem "cold", uncaring
    • We can't impose this sort of thing, it is too individualized
    • How could we enforce??
    Recently, a California Study clearly demonstrated that using end of life documents that are carefully constructed does indeed save tons of money AND improve patient and family comfort with the end of life process. Has the time finally come for such a mandate?  I think the answer is YES.

    Further reading:
    Daily Finance: Costs Too High
    Kaiser Health News
    Cost of Death Video

    Friday, August 13, 2010

    Green Hospitals: Too Much Trash

    Finally some early signs that making hospitals more environmentally friendly is no longer "fringe business."  Recently, the NY Times highlighted the challenges facing American hospitals in reducing the enormous amount of waste.  As any surgeon knows well, the operating room is fraught with disposable items where re-usables were standard a decade ago.  In addition, many items that have not been used at all just get tossed!  As the article points out, much of this has been done in the name of patient safety-with the unmerited fear of reprocessing.  In addition to the shear volume of trash, medical waste is three times as expensive as regular refuse to process.  In an era when we recycle so much (think plastic containers into decking), healthcare lags way behind.
    There are some people who are looking to turn this trend around.  For physicians, nurses, architects, health care workers or interested patients can join the Green Hospital Movement and access many educational materials and learn how you an make a difference in your own community.  Another good resource for healthcare professionals is Teleosis.
    Isn't it time we all got onboard?

    Monday, August 9, 2010

    My Patients: I am So Lucky

    It was 7 am and there she sat, her two grown sons by the bed.  They must have left the house before 5 but she greeted me with the biggest smile.  In her regulation hospital fashion, she looked older and more vulnerable then when she visited me in the office and we made the mutual decision to proceed with her second major spine operation in 5 years. So I take her through my pre-surgical routine-check her medications, orders, consent and mark the surgical site.  I take her hand (I always do at this point) and say, "We will be going in the room shortly, we'll take good care of you."  Then I look at her worried sons and assure them I will be out to speak with them just as soon as the surgery is over.
    I turn to walk out of the room when her voice calls me back.  "How is your garden this year?" and after my answer, "Did you have a good vacation? I can't wait to hear about your time with your mother...but we will have plenty of time after the surgery."
    I leave the room and smile, amazed again at the strength of my patients.  At a moment when she could have been nervous beyond the pale, she was curious enough about me as a person.  I knew that for her,  being a person as well as a doctor was part of why she liked and trusted me.
    Over the years, I have tried to ensure that I know something "personal" about every patient-perhaps something about their jobs, family, favorite books, or where they like to travel.  It serves as a constant reminder that they are people as well as patients.  By sharing little stories about myself, I hope they will feel a stronger bond, too.
    I thought about this special lady all through her surgery and beyond.  Healing is a gift, and it doesn't always come from doctors.

    Friday, August 6, 2010

    This Boy, A Memorial

    This boy came into the world not fully closed
    And his mother gave him to me
    And I closed him

    This boy came into the world with too much fluid
    And his other entrusted him to me
    And I drained him

    Then the years passed and this boy grew
    His mind expanded though his feet hung still
    And together they were happy

    As the years passed, I watched this boy
    I marveled at his spirit and his family
    And he made me smile

    One day, this boy got dizzy and his head ached
    He told his mother to come see me
    And I knew he was sick

    This boy came to my hospital
    His mother gave him to me again
    And I fixed his drain

    The next day, this boy was happy
    I saw his spirit return the ache disappear
    And we all smiled

    At home, this boy played and ate ice cream
    He laughed and read books
    Then he went to sleep and never woke up

    To J, 
    I hope you are running in heaven.  Tell the angels to send your mother, father and all your brothers and sisters strength-we all miss you.

    Thursday, August 5, 2010

    Journey Back-Poland 3 (Auschwitz-Birkenau)

    After a full morning in Krakow, we made the journey to the Auschwitz-Birkenau Concentration Camp.  I was thankful that we had opted to have a guide for the day, releasing us from the burden of driving, organizing and navigating as we experienced the most somber portion of our journey.  Having lost so many of our family, I wasn't at all sure what the experience would be like for me or for my mother but with our experienced and thoughtful guide, we could let it all sink in with no distraction.  The drive took us through verdant fields and lovely, small Polish villages-all with dramatic signs of rebuilding and prosperity, slowly erasing the vestiges of Soviet domination.  It seemed almost unreal that we were closing in on a site of unparalleled human tragedy.  First we were shown the immense factory complex that was the lynch-pin of the "work" side of the camp.  Many acres of factories were built to the most modern standards and the cruelest twisted way, Hitler used Jews (and any others deemed not suitable for the Aryan race) for forced labor-making items that were then used to sustain the Nazi regime.  Today, to my surprise, these factories have been transformed into thriving chemical plants and represent a critical portion of the economic base for the region.
    Then we entered Auschwitz-the first concentration camp built on the site.  Today, all Polish students must visit Auschwitz as part of their studies, the Polish nation is steadfast in their determination to "Never Forget".  In addition, you must see the museum with an official guide (with a mandatory visit to Birkenau included) which translates into a minimal visit of 4 hours.  Out guide said in year's past, tour guides would rush their bus-loads of visitors through in under 30 minutes, making a mockery of the stop.  I was gladdened to hear of this approach.
    The museum has remained largely unchanged for many years, the impact relies primarily on the stark reality of what the place was and how it functioned.  Just seeing the well known gates put a chill in my heart.  I think what struck me most about this portion of the tour was just how detailed the Nazis were about their plans to build a "Master Race" and the depth to which they used psychological manipulation to maintain control.  I was also moved by the survival instincts and tactics developed that allowed for some escapes, a few testimonials, a some small degree of spiritual solace if even for a few days/weeks for the many who did not survive.  I can honestly say that no book, movie, photograph or lecture (even the two I heard Elie Wiesel deliver) do justice to the horror of Auschwitz-Birkenau.  Particularly moving was the barrack that simply displayed mountainous piles of the everyday belongings stripped from the concentration camp victims: shoes, glasses, and of course hair...
    Firing Wall at Auschwitz
    And just when I thought my emotions were near their limit, we entered the yard between the final two "barracks" (hideous prisons-more torture chambers) where the firing wall stood stark against a gray sky.  Tears pricked my eyes thinking of the the lost lives, the lost years, the lost love.
    After that, I was extremely grateful if was past lunch time and we could all sit and catch our breath.  I felt drained and assaulted though I knew even worse coming.  For a moment, I did wonder what it was like for those generous, kind Polish women who served borscht, potato pancakes, cabbage salad and perogies with smiles for the millions who visit this site every year. But I didn't have much time to wonder as soon we were off again for the short trip to Birkenau.
    Skeletons at Birkenau
    For most, Auschwitz is the name associated with the largest, most deadly concentration camp but in reality, the Birkenau portion of the camp was significantly larger and more horrific.  The first thing that struck me as I entered the camp was the enormity.  The prison stretched on and on and on.  Where the buildings at Auschwitz were brick, those at Birkenau were built rapidly to accommodate the massive influx of workers and were of highly degradable wood.  As a result, little remains of most of the camp beyond the brick chimneys which leaves an eerie "skeletal" monument. At this point, the day's perpetual gray skies turned to rain and the infamous Birkenau "mud" appeared almost immediately.  It seemed a fitting backdrop as we walked the final length down the railroad tracks that had been built to allow direct delivery of Jews and other undesirables directly to the crematoria.  Slowly the remains of the crematoria came into focus-the buildings have been left as the pile of rubble created when the Nazis blew them up as the war was ending, attempting to disguise their crimes.   While there is an "official" monument, for me I paid final tribute to the 6 million Jews and 5 million more as I walked slowly around this crumbled pile of bricks.

    Monday, August 2, 2010

    My Job

    Just a routine surgery
    On a routine patient
    All went well
    Should be out in 3 days, BUT
    Home not so good
    Lovely lady
    Not so lovely spouse
    Surreptitious  arrangements made
    Will get an extra 10 days
    At rehab.