Monday, February 28, 2011


The best care in the ED is often tough love. Tough, as in severe and confrontational, with no chance of marshmallows by firelight and the sonorous hum of kum-by-ya. This knowledge no doubt will cause grave issues for medical sociologists. Medical sociologists are those people who tell us how, in the ideal world, physicians should provide clinical care. And a minority of them are genuinely helpful, like when they give us insights like always sit down when providing care. (It puts the patient at ease, allows you to communicate with them at eye level, and they perceive that you’re spending a lot more time with them then you are. It’s also fun to wheel around the room on a roller stool, and if you have enough roller stools you can play a mean game of floor hockey in the wee hours of the night just after housekeeping has waxed the floors.)

The rest of the medical sociologists are totally useless. They remind us to ask open-ended questions and to give the patient plenty of time to express their hopes and concerns. This, if course, is the absolute antithesis of the ED focus on determining if there is an actual emergency or not within a minimal amount of time. They also note that we should think of patients as individuals with life stories and cultural variances, and not as “The Chest Pain in Room 5.” This is probably the right thing to do, but given that I can get hit with up to 40 people I’ve never seen before in a single day (and if it’s someone I know, it’s usually a repeat customer for all the wrong reasons), my choice is to either get to know them or individuals or do what I’m paid to do, which is to get them through the system in the safest and most efficient way I can. It’s a lot easier to do that if I can categorize them by illness or injury and implement a standard protocol for care; and all the patient goodwill in the world can’t excuse excessive throughput times.

But their lack of relevance is most pronounced when they talk about healthy behaviors and “theories of change.” Let’s say that Bob the Hittite (because there are no more Hittites, I run no risk of offending anyone) decides he wants to quit smoking gazelle. Most of us would think that, having come to this conclusion, Bob would flick the ashes from his last antelope limb and, with a heavy sigh and one last long inhale, set aside his vice for good. It would be a rough few weeks and he might gain a few pounds, and need to chew a few crocodile sinews in the process, but eventually he would feel better and learn to substitute a more healthy habit like idol worship.

A medical sociologist, however, would tell you that this isn’t what happens. According to Prochaska’s Transtheoretical Model of Behavior Change, here’s what really went on:

Stage 1: Precontemplation – “not intending to take action in the foreseeable future.”

This stage represents those happy years Bob smoked those gazelles before he coughed up a hoof and thought there might be a better way to enjoy his leisure time between hunting and gathering.

Stage 2: Contemplation – “intending to change with the next 6 months.”

Bob plans this out carefully, making sure that he quits when gazelle is out of season. Besides, dried gazelle is nowhere near as tasty as fresh.

Stage 3: Preparation – “intending to take action in the immediate future.”

Time to smoke up that stash of illegal Cuban antelope you’ve hidden under the rock out back…assuming the jackals haven’t gotten to them first.

Stage 4: Action – “making specific overt modifications in lifestyle.”

The gazelle is gone. It’s a tough day in the cave.

Stage 5: Maintenance – “working to prevent relapse.”

Because chewing on hamster just doesn’t do the trick.

Another particularly useless contribution of medical sociology in the ED includes the belief that all medical problems (and for the true believer, it really means ALL) are really a reflection of social ills. The latter principle led to one of my favorite memories from my Master of Public Health course. I will be first to admit that for one with free-thinking tendencies such as myself (I’m much better now), an MPH course is as close as you can get to living in a house inhabited by members of the Students for a Democratic Society. Everyone is very strident, and it’s made clear that non-believers are verboten.

We were doing a group project where we had to identify the social factors that led to eye disease in patients with diabetes. The usual candidates were trotted out…access to care chief among them…and then the breakdown of contributing factors kept moving along. Maybe access to care was a function of lack of transportation to offices and clinics. It could be the maldistribution of eye physicians in poor inner city and rural areas. Perhaps it was the lack of money to purchase private insurance in a world where physicians are reluctant to see patients on Medicaid. It could be a lack of health literacy, the inability of patients to understand how to properly use their medications. All of which are absolutely valid, but not entirely reflective of the ED world in which I live.

So I asked, “How about if the patient doesn’t want to take their medicine, or chooses to spend their money on something else?”

“You mean they have to spend their money on things like food and housing because they’re disadvantaged?” came to predictable reply.

“I was thinking more like beer and cigarettes.”

“They only do that because they haven’t been appropriately educated about the risks of alcohol and nicotine, and they lack the resources to find more healthy substitutes.”

I like to think I’m an educated guy, and the powers that be have given me enough initials after my name to prove it. But even I know that while I’m supposed to take antibiotics for a full ten days, I stop them after Day Five when I’m feeling back to normal. And I haven’t yet met a smoker who contends that cigarette use leads to better health. People know stuff, but choose not to act upon it. If I had been clever, I might have even said these individuals are permanently stuck in Pre-Contemplation.

Unfortunately, I am not that clever, and my internal filter fails me on more occasions than I care to admit. So as memory serves, my response came out as:

“So you’re telling me that those guys who drop into my ED every week, whose usual weekend routine is to go out, get drunk, and get their face bashed in with a pool cue, do so because society gives them no other choice? That it’s a lack of education that makes them decide that staying home and watching reruns of The Golden Girls is not a better, and less painful, option?”

(Yes, I really did use The Golden Girls as an analogy for alternative behaviors. I’ve been meaning to apologize to Betty White for years.)

What I learned from this experience is that medical sociology is done only in controlled settings, because real life might upset their expectations. This is why the only people who ever really listen to medical sociologists are other medical sociologists; advocates who can find unlimited support for their views that the problem d’jour is a function of the medical profession, the health care system, society as a whole, or anything except personal responsibility; and certain nurse practitioners whose academic training is focused on holistic care to the exclusion of actually getting anything done. (This is not to say that nurse practitioners cannot be a valuable adjust in the ED. It is to say, however, that it takes about three years for them to unlearn how to be a nurse and figure out how to be a practitioner.)

So the medical sociologist would be opposed to the “tough love” approach in the ED, because it does not value the patient as a unique individual with autonomy, who needs to both accept the physician’s advice while rejecting his or her paternalism, and who must be given time to go through the process of change. Tough love places blame solely on the individual and not on society, and the individual is the one who pays the price for their behaviors. And medical sociologists would vehemently disagree with the concept of “punitive therapy.” Punitive therapy is that medical care, while clearly directed towards helping the patient, is also designed to teach a lesson and inform future behaviors. For example, if you come to the ER with certain kinds of sexually transmitted disease, I can either give you oral medications or an injection. If you were the passive recipient of an STD or you seem genuinely repentant for your role in transmission, you’ll get the pills. If you are a repeat offender or appear to be without remorse, it’s the shot for you. Both clinically valid methods of treatment, and you can even make the case that with the shot, you insure patient compliance with care in someone who might not be motivated to complete their antibiotic course. But it’s also quite clear which approach carries a message.

The interesting part about punitive therapy is that most of the time, the patients leave you no choice. If you arrive with an overdose, you will need a dose of liquid charcoal (it is what it sounds like) to get whatever you’ve taken out of your system. I will ask you to drink it form a cup with a straw. If you refuse, I will have to ask a nurse to put a tube down your nose into your stomach to get the medicine into your gut. I will also need to get a urine sample to get a better idea of what’s in your system. (While I trust you, faithful reader, sometimes patients lie about what they’ve taken. Go figure.) You can pee in a cup, or I can have a nurse put a rubber tube up into your bladder, restraining you if needed in order to accomplish the task. And if you are drunk or otherwise unable to control your agitation without a valid medical reason to be so, and you take a swing or spit at any member of our ED family, I will have you restrained until you have either sobered up and have to face your family who has come to pick you up, or until law enforcement takes you away. And in all these circumstances you’ve done it to yourself, probably with a minimum of Contemplation.

Punitive therapy is not always physical. Sometimes it’s informational, as when you remind the intoxicated college student of the legal drinking age; or when you tell the alcoholic, on his fifth ED visit in two weeks and in early liver failure that there’s nothing you can do for him unless he’s willing to go to rehab. (His response to this information was to look at me and use a phrase similar to “Duck Foo,” indicating that he was still in Pre-Contemplation.)

And sometimes it’s therapy by omission. If use the ED for the purpose of acquiring narcotics, I am under no clinical obligation to accede to your wishes. I am under a legal duty to assess you for an emergency medical condition, and to treat you in an appropriate fashion. This treatment may include an explanation of my concerns about your use of pain medications and suggestions for follow-up with your own physician; I may offer you a non-narcotic medication to help you until you can follow-up or even a referral to a detox facility or short-term medication to ease your withdrawal. (You’d be surprised how many patients ask for ”just a few days” of pain medication to manage their withdrawal until they can get to detox….and the appointment is always the following week.) Your “punishment,” if you will, is that you don’t get what you want.

(This scenario illustrates that good medical care does not necessarily equal customer satisfaction, and the customer is not always right. It’s also why health care, when provided by independently licensed professionals at high risk of liability, cannot work in a pure customer-driven, free-market model. My job is not to meet the expectations of the customer. My job is to render high-quality, clinically appropriate medical care. While the vast majority of the time doing so means customer satisfaction, no matter what you do there will be a small percentage of times that what is medically appropriate is not what the patient wants. This fact is lost on the majority of high-level health care pundits, who assume that all patients are reasonable persons with reasonable thoughts, and that health care providers are simple line workers at a task. Come spend a Friday night with me.)

No physician I know wants to harm a patient, and most of us strive for complete patient satisfaction if we possibly can. And while the medical sociologists would disagree about the “paternalistic” attitude I’ve exhibited in making decisions for patients, and deride me for not achieving a “partnership” with the patient to achieve “mutually beneficial goals,” sometimes the role of the doctor is to act like Mom and Dad and insure that actions induce consequences.

Clearly, I’ve been Contemplating this for a while.

Friday, February 11, 2011

The Yu-Gi-Oh Blues

I am fortunate that The Teen, while beginning to assert his independence in increasingly annoying and odiferous ways, still likes to hang out with dear ol’ Dad. We go to movies together, have Boy’s Night Out, and deal the cards for poker. We play miniature games like Heroscape and blast away at Lego Batman on the Wii. And, God bless him, he still wants me to play Yu-Gi-Oh.

For those of you who are blissfully unaware, Yu-Gi-Oh is a trading card game from Japan. If Hello Kitty is penance for the Doolittle Raids, then Yu-Gi-Oh is retaliation for Hiroshima and Nagasaki. But like in-laws and cockroaches after nuclear fallout, it never goes away. Bakugan came and went, the Mighty Morphin Power Rangers have fought their last battle, but Yu-Gi-OH is the Energizer Bunny of nerd-based commerce.

After three years of patient tutoring by The Teen, here’s what I know about Yu-Gi-Oh:

The cards in a Yu-Gi-Oh game are used to duel with an opponent.

There are Monster, Spell, and Trap cards.

These cards are combined to make a deck. Decks have themes. Some of the themes are Arcana Force, Ancient Gear, and Gladiator Beast.

Decks are played on an expensive piece of flexible plastic called The Field.

Someone someplace gets paid way too much money to think of names for cards such as “Blue-
Eyes Toon Dragon” and “Obelisk the Tormentor.”

The wording on the cards is too small for an adult to read.

I lose every time.

While I don’t understand Yu-Gi-Oh, I try to be understanding. I think it’s probably his version of my comic book collection or my fascination with Star Trek (TOS…because there was no Next Generation) at about the same age. And I’m glad it’s something that gets him off the computer and out of the house from time to time to play with others at local card shops. The only thing that bothers me is that most of the cards are “dark” in nature. Characters with names like Ghost Knight of Jackal, VWXYZ Dragon Catapult Cannon, and Judgment of Anubis course freely throughout decks of Chaos and Zombies. The iconography probably doesn’t mean much, a function of the battling nature of the duel coupled with the game’s cultural origins, interesting translations from the Japanese, and marketing to the seething hormones of adolescent boys. But it still disturbs me a bit.

Here’s an example of what I mean. The Teen made me a practice deck for me. Knowing that I’m not too hot on the “darker” side of the world, he built a Dinosaur theme card set. Here are some of the cards in my “tame” deck:

Black Tyranno
Goblin Out of the Frying Pan
Super Conductor Tyranno
Mad Sword Beast
Ultimate Tyranno
Super-Ancient Dinobeast
Dark Diceratops
Hyper Hammerhead
Tyranno Infinity

I understand that in dueling, you have to fight fire with fire. I would never tell my son to go up against someone playing a deck full of Gladiator Beasts armed only with Penguin Soldier. That being said, I would like to see a see a market out there for nice Yu-Gi-Oh cards:

Genial Whale
Happy-Go-Lucky Earthworm
Polite Bunny
Playful Dolphin
Friendly Wombat
Smiling Soft-Coated Wheaton Terrier
Squealing-With-Delight Dacshund

But why stop at cuddly critters? Maybe we can use Yu-Gi-Oh for instructional purposes:

Well-Mannered Child
Homework-Doing Pre-Teen
Regularly Showering Adolescent
Boy Who Limits His Television Time
Admired Father
Glorious Father
Father Automatically Wins

(On several occasions in years past I really would play this card. It was when The Teen was still The Child and I would play Pokemon, essentially a younger child’s version of Yu-Gi-Oh without the rage. As opposed to Yu-Gi-Oh, I could play a fair game of Pokeman and generally pull my weight. This frustrated The Child, so he came up with these things called “Invisible Cards” that would defeat anything I could ever play. So I came up with an invisible card called “Daddy Automatically Wins.” Which is undoubtedly why he switched to Yu-Gi-Oh shortly thereafter.)

Anyway, last weekend I took him to a Yu-Gi-Oh tournament at a local card store. To be honest, I was a little on edge about this…he usually plays the game against kids who are less experienced and have less cards than him, and consequently he almost never loses. Besides, he comes from a line of bad losers. (That would be me.) So I wasn’t certain how he’d react if the cards turned against him. Sure enough, I was watching from a distance when I heard him exclaim that he wasn’t going to play anymore, and saw him cup his head in his hands with a gesture of despair.

Me (adopting deep paternal voice): “What’s going on?”

The Teen: “I always lose. Why should I play anymore when I just lose?”

Please note that I am a father ever-alert for the teaching moment.

Me: “It happens. Deal with it.”

This was apparently not the right answer, because I heard the unmistakable grumble of early adolescence rise up from his chair. But he sat and played, which is what socialization is all about, while I sat in an adjoining room watching a game of Warhammer and listening for the next yell of exasperation that blessedly never came. I’m sure the fact that he won the next three matches helped. I’m a much more gracious winner, too.

(Interestingly, I was actually the only parent there. All then other parents dumped and ran. For which, having suffered through five hours of Gladiator Beasts and Arcana Forces and Magic Cylinders and the like, and not a single Friendly Wombat, I don’t blame them one bit. And in fact, when it came time to run out and get the child lunch, I was able to get down a beer while waiting for our hot dogs at the local Parrot Cay. I’m not proud of it, but as a parent you sometimes do what you must.)

I am really hoping that Yu-Gi-Oh is a phase, not a lifestyle, and that at some point it will go away. Sort of like when I gave The Teen advice about one Justin Bieber:

Teen: “Dad, can I ask you a question?”

Dad: “Sure. What’s up?

Teen: “Why do all the girls talk about Justin Bieber?

Dad: “Who’s Justin Bieber?’

(A brief pause. The conversation resumes after a quick visit to the Internet and 3 minutes 45 seconds of “Baby” that makes even Richard Harris’ rendition of MacArthur Park sound like Placido Domongo. Which, incidentally, would be a very cool version of MacArthur Park, especially the part where he would sing “Oh NOOOOOOOOOOOOO!”)

Dad: “Justin Bieber is like when I was a kid the girls talked about with David Cassidy and Bobby Sherman.”

Teen: “Who?”

(Cut to video of “Easy Come, Easy Go.” Teen rapidly loses interest as I exclaim about the quality of the song. He sits, glaring and bored, as I then watch the video for “Seattle” and the Opening Credits for “Here Come the Brides.” Conversation resumes.)

Dad: “You know, maybe it would make sense if I said it was like the girls used to talk about Michael Jackson?”

Teen: “He did Thriller. Now he’s dead.”

(Pause to regroup.)

Dad: “Okay, here’s the bottom line. They’re going to talk about Justin Bieber for about three years. Then he'll go away and they’ll talk about something else. It’s what they do. Get used to it.”

Another teaching moment found...and lost.

Wednesday, February 9, 2011

Strip Search

On the airplane this morning from Kansas City (Slogan for Today: “We’re Colder Than Your Ex”), I learned from a fellow passenger that Dallas’ main problems during Super Bowl week were not ice, snow, and ticket fiascos. They were actually critical shortages of limousines…and strippers.

The problem with the limos did not strike me as funny. The shortage of strippers did, given that stripping is essentially a spectator sport (at least in the public arena) and any one stripper can theoretically entertain any number of viewers. However, it is true that as opposed to football or baseball, where a view of the entire field is critical to understanding the ebb and flow of the game, the area of focus is really an on-stage cylinder extending six and a half feet from the floor and within arm’s reach of a centrally located pole. (To be frank, I suspect that most spectators are concerned with an even more narrow area of focus, but I may be wrong. It might really be all about personality and intellect. See “The Whore of Mensa” by Woody Allen.) So given the narrow range of interest, distance becomes an issue, and either an excess of strippers or telescopes are needed to maintain the required proximity. Besides, it’s awfully hard to toss dollars down from the cheap seats.

Anyway, the Super Bowl Stripper Shortage got me thinking about a conversation held a few weeks ago in a western Kansas ED. One of our nurses was complaining that her husband had gone to a strip club in Salina rather than joining a group of ER folks for a night on the town. This was news to me, because I really never saw Salina…while the home of the first girl I ever saw non-clinically unclothed…as an epicenter of adult entertainment. True, it is just twenty miles down the road from Exit 272 on Interstate 70, known popularly as the “Exit of Sin” because off the north ramp is the Lion’s Den Adult Supermarket and just to the south is the Russell Stover Factory and Outlet Store. It’s an efficient way to knock out nearly a third of your deadly sins in one stop. And just in case the gravity of your offense is lost on you, as you get back on the westbound road there is a large billboard reminding you that “…the EYES of the LORD are upon YOU.” (Interestingly, there is no such sign as you get back on the highway eastbound, which probably reflects the thought that if you’re headed towards the land of the heathen liberals, like Topeka, you’re a lost cause anyway.)

I was thinking about the odds of having a strip club in Salina, and then recalled that this would not be so unusual given that I had seen a “Gentleman’s Club” in Great Bend. Great Bend is a town of about 10,000 people located on the Great Bend (gentle turn) of the Ar-KANSAS River (mostly dry). The main landmark is a ten story tower public housing project in the middle of the Town Square. The strip club is located in a steel building on Kansas 183, and was noticeable only because it was across the street from Braum’s Officially Delicious Ice Cream.

This got the mental wheels working, and I think I’ve figured out how to resolve any future stripper shortages at major sporting events. Strip clubs need to be organized into farm systems. Places like Great Bend are the rookie leagues; Salina is A ball, and Topeka (where the parking lot outside of the strip club always seems much busier during the legislative session) is AA. Larger places, like Kansas City and Denver, represent the AAA level, just before the majors such as New York, Miami, LA, and Dallas.

You can see how this would work. As strippers in the majors get injured, go on the disabled list, age out, droop, or sag, their places are taken by those brought up from AAA. This progression moves through the ranks, opening up new opportunities at the entry level. Organizations can even offer coaching along the way to improve individual performance and bottom line revenues. (Yep, I really said that). Plastic surgeons can serve as Team Physicians. I see nothing but a growth industry here. (I really said that, too.) And when there’s a shortage, like during Super Bowl week, just call folks up from the farm system.

I can barely wait to buy my team jersey.

One other quick airplane note: On Southwest, they give out crackers shaped like little airplanes. Instantly regressing to the guy who dissembles animal crackers by having the run around the table, then biting off the limbs followed by nipping at the head (I’m sure a psychologist can have a field day with that one), I took the crackers and had them soar around my seat, accompanied by the obligatory “swooshing” sound.

After a minute of play, I bit off the engine. The cracker went quiet, then plunged to the floor.

There were no survivors.

Saturday, February 5, 2011

Cat Nips

There’s an unfortunate man who comes to the ED a lot. He has terrible heart failure, and isn’t a clinical candidate for a heart transplant. Most of the time he stays alone in his room, keeping to himself, simply waiting for his time to end. When he feels especially lonely, he calls EMS and comes to see us. It’s what passes in his life for a social call.

So we’re trying to figure out what we can do to help this man, to help him build a relationship with someone or something other than the health care system of this fine community.

“He needs a kitten,” says the Unit Clerk.

The Tech shakes her head. (Brace yourself, and remember we are in the ED, not a place for normal humans.)

“No, that’s a bad idea. When he dies, the cat’ll eat him.”

This was new knowledge to me. I had no idea that cats ate dead people. That being said, the story of Oscar, the cat that sits by dying residents in a Massachusetts nursing home, makes a lot more sense. Oscar’s not there to provide comfort to those heading towards the Great Beyond. Apparently, he’s out looking for a snack.

Because this is the ED, however, the conversation doesn’t stop just because it’s breached the limits of decency. The Nurse pipes up next.

“You know, if he got several cats, he can save on funeral expenses.”

“So he would be consumed by pussy,” says the Tech.

Metaphorically, I hope.

Friday, February 4, 2011

Counting Down

Some years ago I learned that if I count backwards, visualizing the numbers while I count and matching each number with a deep full breath, I can often get myself to sleep. It doesn’t always work, and if I hit 70 before feeling that disjunction that happens just before nodding off I usually give up. Patience has never been my strong suit.

(Numbers are easier to count than sheep. I used to try to count sheep, but when I did my tangential thinking…helped along by The Bride…meant that suddenly the sheep were being given names, and personalities, and life histories. There was Alice the Sheep, Betty the Sheep, Charlie the Sheep, and so on. The brown sheep was named Pedro. The black sheep was Shaft.)

You would think that counting backwards would be a pretty easy thing to do, and it used to be quite routine. But since I got back into full-time clinical medicine, I notice that no longer do I count down routinely from 100. Some nights it’s everything I can do to not count backwards as follows: 300, 150, 100, 75, 60, 50.

Forty self-esteem points for the reader who can tell me why.

Wednesday, February 2, 2011

Goin' a-Courtin'

You may have heard that earlier this week, a federal judge in Pensacola has ruled the new Health Care for All Act (or The Job Killing Socialist Manifesto, depending on your political stripe) as unconstitutional. The basis for the ruling, as I understand it, was that there is no constitutional allowance for the federal government to mandate that private individuals purchase a specific product (like health insurance).

I can’t say I’m really upset by this interpretation, especially as the government-subsidized purchase of private health insurance it made very little sense to me. It seems an inherent contradiction that the same insurance companies that have been labeled as significant contributors to the crisis in health care...and reaping massive profits as a result...should be rewarded by an infusion of public dollars. Of course, both Republicans and Democrats were perfectly happy to give public money to the large Wall Street firms that drove the current recession, so I guess I shouldn’t be surprised. And I recognize that both the subsidy and the individual mandate are political compromises made to garner support for passage of the law, and that compromise is the essence of policy. But I’m still not thrilled with it. If health care coverage for all Americans is as critical as we are told (and I personally believe that it is), then the logical solution is to establish a baseline, no-frills, economy-class, bring-your-own-snacks level of care for all. If the private sector can add services on top of this baseline, and individuals choose to make those purchases, so be it.

Commentators on television and radio have made it clear that no matter who won this round in Federal Court…and so far the score is tied at two decisions apiece…the battle won’t be over until the issue hits the Supreme Court. While I understand that the Supremes have an unpredictable streak (and have ever since Diana Ross left to pursue her solo career), unless there is a sudden retirement on the bench the chances are a conservative court will at least hold the individual and employer mandates within the act as unconstitutional. And while technically the rest of the Act could still be legit, in reality the financing for the entire scheme falls through if the individual and employer mandates are not in place.

What I know for sure is that these court decisions are pure theater, much like the show put on by the Transportation Security Administration. They obscure the real issue, which is an irretrievably broken system of care. Nobody has ever denied that fact. I can’t think of any voter who is unaffected by a lack of access to care or runaway costs, nor a policymaker of any stripe who will say the status quo is just fine, thanks for asking. Nor can I, despite all the posturing about keeping government out of health care (and right now between 45- 55% of all health care costs in this country are borne by governmental agents), can I find anyone willing to forgo their own Medicare or Medicaid benefit, nor any policy maker willing to take them away.

(And for the record, and because with my fetish for linguistic accuracy it drives me nuts when people say it, government funded healthcare programs are not evidence of socialism. Socialist health programs involve government ownership and control of all elements of care. Nobody has ever threatened to nationalize the hospitals or make all health care workers government employees. Even the subsidies for health care coverage within the new law go to support vibrant private sector insurance companies. So get over it.)

Last November, Republicans were able to whip up the public against health care reform with a large helping of clever rhetoric and a side of fearmongering. But if the health care reform law is declared unconstitutional, people have a right to expect something else to be offered in it’s place. The GOP may have owned the last election and are drawing even in the legal war. But without a real plan of their own, one that enhances access to care while controlling costs, they are sure to lose the war. Either that, or we as people in need of care most assuredly will.

Tuesday, February 1, 2011

Mystery Meat

It’s lunchtime, so between patients I skip down to the Doctor’s Lounge for a bite. At this particular hospital, the cafeteria brings up some trays of hot food to supplement the usual assortment of sandwiches and chips.

I walk up to the food bar to find one of our surgeons, a fairly bright guy, looking uneasily at something chunky, pink, and breaded. Hearing my footfalls, he turns and gives me a quizzical look.

“What do you think this is? Chicken or fish, or something else?”

Now let’s get this straight. This is a guy who cuts into flesh for a living, while in general I only look at it from the outside. And he can’t figure out what kind of meat they’re serving for lunch?

I had a piece of cheese and a Coke.