Tales From The Trauma Bay

My husband has a saying: Alcohol is the fuel of the trauma bay. You have no idea how true that statement is. On any given day 75% or more of his patients are involved in some sort of self-inflicted medical emergency while under the influence of drugs or alcohol or both.

I know that not all hospitals are created equally, and that the consumer at each hospital is a little different. Long gone are the days when he sees people suffering from regular neurosurgical conditions like degenerative disc disease. These people like to break themselves quickly. This is the first hospital he has worked at that pretty much exists to take care of this group. My husband works at a level 1 trauma center in a large city. Imagine the ED room from the now retired TV series ER. He sees some crazy things that would make a great ER series.

Many of the cases that come through are worthy of coverage and yet I wonder why more people don't hear about them. I know there are all the HIPPA regulations, but their stories deserve to be heard. If nothing more than to serve as a public service announcement along the lines of

DON"T DO DRUGS! 

DON'T DRINK AND DRIVE, BIKE, WALK, SKIP, CLIMB STAIRS, RUN, SKATEBOARD, ROLLERBLADE, SWIM, DANCE, or anything else that requires movement of any kind. You are better off staying completely still. Don't move.

I think true stories like the one I am going to tell could go a long way in the education sector to prevent or discourage the abuse of drugs and alcohol. A compilation of sad, heart breaking, and photographed stories could serve a greater good. If you see something on a book shelf soon (if there isn't one already) then maybe my name will be on it. It wouldn't be hard to compile, there is plenty of material. Problem is, nobody wants to be in it.

Are you ready for a story?

Once upon a time there was a beautiful girl who went to a birthday party with her friends. They had  too much cake and too much punch. Mostly "punch". On their way home by automobile, this beautiful girl decided that she needed to use the bathroom but forgot or didn't care that the car she was riding in was moving. She opened the car door and stepped out.  Now she is paralyzed and will never pee on her own again.  The end.

No happily ever after. There rarely are happy endings in these scenarios. What usually happens is parents crying by the bedside wondering how in the world this ever happened. Maybe their daughter should have been exposed to more true stories like this one. It happens all the time.

Our children are getting to the age where it's time to talk about drugs and alcohol. Maybe we will just take them down to the emergency room and show them. It is not pretty.

So Now You Tell Me!

It was an ordinary day in my ordinary life. I was making a trip to my local Walgreens to pick up a print order and my monthly visit to the pharmacy counter. I finally ran out of those samples, but my previous insurance covered them 100% - so awesome of them. My new insurance doesn't and at $95/month I am rethinking some of my options. So I found a coupon online and only pay $45/month. What exactly is it I am paying for? Oh, yeah.

This isn't a post about the price of birth control. It's a post about all the other stuff no one has ever mentioned to me until today. Technically two days ago.

The elderly man behind the pharmacy counter at 9:30 pm innocently asked if I was taking a multi-vitamin daily. I thought that was a strange question. I would have expected something related to taking the actual pills he was handing me. I told the honest truth - no, I am not taking a multi-vitamin. He then tells me that oral contraceptives can deplete the essential vitamins (B6, C and Folic acid) in your body causing you to be tired, fatigued - and I stopped listening right there. Oh my goodness, I don't have to be tired forever!

I am not a blind drug user. I read the information packets that come with them. Never once did I read about tiredness or needing to supplement with vitamins. If the vitamins are being depleted with the pill itself, why not add the vitamins to the pills! C'mon people.

"Side effects may include: breast tenderness, headache; nausea; stomach cramps or bloating. This medicine may cause dark skin patches on your face. If you wear contact lenses and you develop problems with them, contact your doctor. Contact your doctor immediately if you experience breast pain, lumps, or discharge; calf or leg pain, swelling, or tenderness; change in amount of urine produced; chest pain or heaviness; confusion; coughing of blood; fainting; irregular heartbeat; left-side jaw, neck, shoulder, or arm pain; mental or mood changes (eg, depression); migraines; missed menstrual period; numbness or weakness of an arm or leg; one-sided weakness; persistent, severe, or recurring headache or dizziness; persistent vaginal spotting; severe or persistent trouble sleeping; severe vomiting; swelling of the fingers, hands, legs, or ankles" - and the list keeps going.

Of all those things, that are rather serious, I have dismissed all of them as being crazy - but when my pharmacist mentions tiredness I get all concerned about that! Why, because energy is what rules my life. Without it, nothing gets done. With it, I can do anything. I have been complaining about being tired for years. I feel like I haven't been on top of my game for a long time. Did you notice?

So I have been tired for the last two years and no one thought to tell me that maybe I should be taking a multi-vitamin. Not even the doctor who I am married too! I can't blame my OB/GYN because I haven't seen her in two years. But every month that I picked up those pills and for the decades before that, no one mentioned the need to take a vitamin.

I went through a vitamin phase. Before getting pregnant, and while pregnant, I took those prenatal pills, and afterwards until the bottle of pills ran out. Then I relied on my "healthy" eating to do the rest. I am still a big proponent of using food to get your vitamins - it seems to be the right way. But obviously something is wrong in my diet, my lifestyle, my whatever.

I left the pharmacy with a bottle of multivitamins. When I got home my husband said we already had some in the cabinet. Go figure.

What annoys me is that the correlation between me and fatigue has always been written off as "you have four kids", "you have a lot on your plate", "what do you expect with your lifestyle". All excuses. What if the real problem is the birth control pills themselves?

And that started a whole different train of thought. I am tired of messing with my body! Yes, the pills are working and doing their job - but maybe I am TIRED of the side-effects. I am tired of being tired, the migraines at that special time, maybe that's why those last 10 lbs aren't going any where, what else am I doing to my body that is causing harm that could be taken care of another way. There must be another way.

And that is how you find yourself up all night reading articles online about birth control, hormones, natural family planning, and alternatives forms of contraceptives.

What would it feel like to not be filling my body with chemicals to change the chemicals that are already there to prevent my body from doing what it was meant to do? What would it feel like to be drug free?

A Bag of Cookies is Often Required

Some days the only thing that feels good is eating an entire bag of cookies alone in your room. I feel like I binged responsibly by buying a small bag instead of a regular size bag. I knew exactly what I was going to do with that bag when I bought it, even though I told my daughter that they were going to be for dessert that night. When she asked about them later I replied that I tried them and they were gross. I lied. I ate the entire bag. Not because they were especially delicious, but because I wanted to! With every cookie I put into my mouth I knew what I was doing. I wasn't eating unconsciously, I ate each cookie with intention.

It's a good thing I didn't buy a variety that I knew I loved, like Oreos. They don't stand a chance in my presence. Even still, I ate the bag and threw the evidence away. I wanted to eat them as an act of rebellion. Against who? I guess myself!

I have been watching my weight, exercising, eating better, and in general just looking out for myself. But why bother? In the last eight months nothing has changed. Sure I lost a pound or two, but then gained a pound or two. I weigh exactly the same, my clothes fit the same as they did then, and nothing seems to be working. I was sure when I put my summer clothes away at the end of the season last year that they would be loose by now. How could they not with all the "good" I had been doing? But they fit exactly they way they did when they were packed away. How disappointing!

Either I am not extreme enough, or consistent enough, or disciplined enough - but those all feel like lies. I know that isn't true. I was consistent and disciplined, and changed my exercise and eating behaviors for the better - only my "better" must be manifested on the inside only because the outside hasn't changed. Sure I want my insides to be healthy, but I would really like the outside to look as good as the inside.

What is the point of working diligently only to have minimal results that are fleeting? One bag of chips and you have to start all over. A week off from exercise and you are right back where you were months ago. That is crazy! Eight months ago before I started this new program of eating/exercising I wasn't doing anything. I was eating what I wanted, when I wanted, and not exercising. I baked yummy treats for my kids and enjoyed them with them - things were fine. Only I wasn't as trim as I wanted to be. But after doing months of work I am no trimmer today than I was then, but I have missed out on plenty of cookies and ice cream.

I have no idea what is going on. Is that what late 30's is like? Is this what I have to look forward to for the next decade, and the rest of my life? I am not overly harsh on myself. I don't expect myself to look like I did before kids. If only I knew how awesome I looked then. I am not looking for magic, and I want to do things naturally.  I  want to tone up. I don't even really care if my weight or clothing size changes much I just want what I have to be tighter.... and it's not happening. I feel loose and old.

So for the last two weeks I have given up on exercise, I haven't done anything. I have still be eating healthy, natural foods with the exception of the bag of cookies I ate yesterday.

My husband thinks I am crazy and have some body image issues. He may be a tad right, but he is also wrong. If there is work to be done, I believe in doing the work. Everyone should try to be their best self inside and out. Why shouldn't I try to make things better? Yes, I look good with clothes on, but sometimes you have to take off your clothes, or wear short sleeves! It is summer after all, and the pool opened this last weekend. Nothing like that even to remind you that another season has come and the beach body you were working towards didn't show up.

I recently read about fat triggers. That for people who are unable to lose weight there is often an underlying "trigger" that prevents them from burning fat the way the body wants to. It literally blocks them from responding to the things that we know should work: exercise and diet. For some people these triggers are past emotional abuses, traumatic life events,  medications, over dieting, nutritional famine (eating calories, but not nutrients), stress, limiting beliefs, and there were at least half a dozen others.

I recognize that there have been things in my past that I haven't dealt with entirely and blame myself for. I replay things that cannot be changed over and over again looking for ways I could have altered the outcome - that's not a healthy exercise and it certainly doesn't burn any calories.

Or it could be stress, I seem to have plenty of that. But isn't that just a way of life? Aren't most people stressed? Stress seems like a cop out. I know I am a bit of a control freak and like to be in charge of the things that I am impacted by. I recognize that the feeling of being out of control is uncomfortable for me. I know I need to chill out, but chilling out doesn't seem to get things done. I don't know how to do both.

And then limiting beliefs. This might be the biggest block for me, not just in my weight story but my life story. A misconception that I am not good enough, that I don't deserve the good that has come to me. The wonderful things I have been dreaming of will never be a reality. Logically, I realize how ridiculous that is. Emotionally, it's harder to let go of.

I think in some ways I am afraid to be thin, or fit. Like somehow my success in that area will make others around me feel less successful.  I am holding on to an extra 5-10 lbs as some kind of sick security blanket. What am I afraid of? Maybe the answer to that question is the key to my break through. When I can figure that out and do something about it maybe the extra pounds and inches will give up their stubborn hold on me.

Is there a magic pill to help that process along? If I change the way I think, can I change the way my body responds?

Medicine and Money

I have had this show on my DVR (thanks to my husband who recognized this is my kind of programming) for the last few weeks, and finally started to watch it last night. It is fascinating. You should check out Medicine and Money on PBS. I can highly recommend it. Makes perfect sense to me.

Let me add that just because my husband recorded it for me doesn't mean that he is interested in watching it. He saw a couple of minutes and said, I don't need to watch this. And he is right. This is what he lives every day.

One of the patients they highlighted is very sick. Tubes, wires, monitors everywhere. She has been there for 10 months. I turned to him and told him that in no way would I want to be hospitalized without being able to communicate or feed myself for 10 months. This may sound harsh, but it was obvious even to me, without any medical training, that she wasn't going to recover no matter how much faith her son had. And I am a believing person. I believe in miracles, but come on ... this woman isn't going to make it. She was sick before she even was taken to the hospital after suffering a stroke. Now she has a feeding tube, breathing machine, is non-verbal, and on dialysis.

The hospital ethics committee had to issue a DNR (do not resuscitate) order because the family wasn't budging. The family believed that this is what she would want - to be kept alive as long as possible using whatever means necessary. Really? Did she write that down? The hospital told them that if she gets another infection/symptom they will not treat it as it is an indication that what they have been doing will not work. They will make her comfortable, but no additional symptoms will be treated. I wish I knew what the final outcome was! As one participate rightly pointed out "we all will die eventually".

And this is where I get all opinionated with my views on prevention. Remember my post about health-care, it's like that - sure to ruffle some feathers. If you are of the mind-set that you want to be kept alive at all costs for as long as possible what are you doing before you land in the hospital to make sure you are extending your own life by whatever means are necessary? Think about your life while you still have it to enjoy. Don't spend a little bit every day slowly killing yourself with things you know could cause you harm and then expect medicine to be the super-hero that invokes whatever means are necessary to keep the pronouncement of death from falling upon you. Eventually you will die, too!

Lest I sound like a hypocrite I do take my own advice. Another program I would suggest watching is Forks Over Knives. I have nearly transitioned over to a plant-based diet. Why? Not because I care about the cows and chickens - I watched those shows too. And I felt bad for a few days, but not enough to make me to do anything. But this program actually persuaded me to change because I could connect the dots and it made sense to me. I eat well, exercise and am only 6 lbs away from my goal weight now. I feel amazing. I was bragging to my husband that not only are my pants falling off, but my skin looks better and I have more energy than I did before. That must mean good things are happening on the inside too. I digress.

Medicine is amazing, but extending life when it has been exhausted isn't what it was intended for! No wonder medicine is so expensive. We are keeping people alive (possibly against their true wishes because they failed to tell someone or write them down) who by all accounts have already died. The woman I previously mentioned, just her care alone, has cost 5 million dollars over 10 months and will only continue to accrue costs directly to Medicare. In other words we will pay that bill with our taxes.

If something happens to me. I don't want my family grieving and holding out hope beyond a reasonable time. I don't want to be kept alive for weeks and months just because it is technologically possible when all medical indications suggest my "life" will not recover. I don't want to rob my family of their life because they are spending their time at my hospital bed hoping for a dramatic recovery. I don't want to drag out the inevitable. I don't want to cause a financial burden to either my family or my fellow citizens who could possibly be on the hook for it. Personally, I don't think that is right.

I am OK with dying. I don't want to die right now, but I want to have a life to live not merely a semblance of life.

When did it become a bad thing to die after you have lived a long life? I don't know of anyone who thinks they would like to die in a hospital hooked up to machines. Ideally, I would like to die an old woman in my sleep after a full day holding hands with my husband. I know that is unrealistic, but  I want to have the freedom to die on my own terms when the time comes, and with dignity. Until then I want to enjoy it.

I need a living will and medical directive. I don't want anyone guessing what I might want, or feeling guilty if they don't go to extreme measure just because they don't want the guilt associated with making a decision; a decision that I realize would be hard to make. I will make it for myself and leave them without guilt for following what I expressly have decided. It is the least I could do for those that I love. Now to get it done.

The program also touched on rising c-section rates, mammography, and PSA screening as well as highlighting specific states that are making good health care decisions with their patients and bringing down total health care costs at the same time. That is a win-win.

I think of my dad who is turning 60 this year and hasn't had an annual physical in at least the last 5 years, maybe longer. He looks like a healthy guy, his family risk factors lean towards Alzheimer's and Parkinson's disease (the slow death) and not heart disease, diabetes, or cancer.  Our family (both sides) have all died from natural causes, and my grandfather (80 years old) would still be here if he hadn't had knee surgery. It was a blood clot (PE) a few days post-operative that killed him. But he had bad knees from being obese. One could make the argument that if he hadn't spent 30+ years overweight, he might not have needed knee replacement and thus no blood clot. Or maybe the doctor shouldn't have agreed to replace the knee until he lost weight.

I completely understand why my dad doesn't want to go see a doctor. If you look for something hard enough you will eventually find something. His view is he would rather not know what is going to kill him. Especially when you consider that just because you screen for something doesn't mean you actually have it, or that it will be life threatening. Yeah, I would rather not know in that case, too.

Have you seen the PBS program Medicine and Money? What did you think? Are you going to watch it now:-)

Do you have a living will or medical directive?

Health Care Response

While I was sitting in the sun I guess some pretty monumental stuff was happening in the high courts.

Isn't that just like the proverbial doctors wife? Sitting in the lap of luxury, sipping water from plastic bottles she will throw away carelessly, watching her offspring dance in the surf in designer swim wear, ignoring Rome as it burns (I am not saying Rome is burning) or issuing the order to "let them eat cake". Who cares about the little people when I am having fun?! 

I do have a heart, but this issue is completely overwhelming. Not overwhelming because I am not smart enough to handle the arguments. Overwhelming because it pulls me in so many directions. I don't want people to suffer. I don't want people to go broke from illness. I don't want sick people dying needlessly. I don't want people not seeking medical treatment because they can't afford it. I don't want people to lose their jobs. I don't want doctors to have to consult anyone other than their patients for decision making. I don't want doctors refusing treatment based on ability to pay. And I do care about clean air and clean water for my children and yours.

I love politics, but hate all the political dancing. So much of what happens in our government seems like a complicated waltz, meant to dazzle and convince us that we could never move like they do or that we aren't brilliant enough to understand why they changed directions and paused just so with that little head tilt. In reality a two step could get the job done and everyone could figure it out in one lesson.

The problem I have had with healthcare (since I became a part of the system in a small way by marrying it) is that patients and doctors don't have a vested interest in working toward true health.

When it comes down to it I am not convinced that we (collectively) care about health that much. What we care about is having someone treat symptoms with as little inconvenience to the ill as possible. Wait times, co-pays, unacceptable  - we want on demand medical care. If the cable company can do it why can't health care follow that model?

You could give every American free membership to a local gym, including free babysitting and fancy aluminum water bottles engraved with their name and still the number of people who actually go to the gym wouldn't change much. No one is just that interested in prevention.

We know what we should do to optimize our health but how many people really do it? Stop smoking, eat more fruits and vegetables, lay off the potato chips at 2 am, eat less, exercise more, drink more water  and less soda, whole grains, lean meats. It would be difficult to find one American who couldn't name at least 3 things that would immediately improve their health.

We know it, we don't do it. Why? Because it doesn't really matter. Why doesn't it matter? Because no matter what we do to our bodies the miracle that is modern medicine can take care of it. There is a pill/procedure for that!

You can give free screenings, free contraceptives, free prescriptions all day long and still not everyone who needs them will get them. You can give away fruits and vegetables, but they won't get eaten. It is just the way we are.

How can a group of people with different beliefs, and motivations be moved to change the way they think about their own health? That is the key. Not everyone will respond in the same way to whatever carrot is dangled in front of them. Penalties? Taxes? Liens? Public humiliation? Cash rewards? TV's? Gas cards? Movie tickets?

My husband operates on obese patients all day long with back problems. Guess what is causing the back problems? All that excess weight!!!! If they would lose the weight they would solve the back problems (in most cases). Guess what is easier than losing weight for back pain? That's right, it is easier to operate (i.e. faster, less inconvenient, no lifestyle change, and very cheap if insured) and if it does not work you can always blame your doctor!

The part that really gets me is that there always has to be a bad guy. Why does it always have to be the doctor? Probably because he is an easy target. Overworked, tired, having been slowly "managed" out of reimbursements, regulations driving up overhead costs, and always promised that it will get fixed this time. It's not getting fixed.

When did we go from honoring and respecting the people who care for our health to demonizing them? This would never happen to a firefighter! It shouldn't happen to anyone. Every contribution to our economy/community should be respected. 

Some where the doctor has become the poster child for all that is wrong with healthcare. As if it is their own greed and self-preservation that is causing the problems. Right now we have people deciding what our healthcare system should be, how it should be delivered, who should pay for it, how much providers should get paid, etc who have absolutely no medical experience.

It doesn't give me warm fuzzies thinking that politicians, law makers, and judges are making decisions about healthcare, an area where they have very limited experience and are so very easily swayed by interests that often compete against what is truly best for all the people they claim to serve.

Would you let a mechanic represent you in a court of law. NO! 

The ideal panel of participants in a true reform bill: doctors, patients (insured/uninsured), insurance providers, hospital administrators. Put them in a room for a week, I am sure something useable would come out of it. Let's add a doctors wife to the mix just to make sure it all gets done and no one gets hurt.

THE TAX MAN

Because the Supreme Court decision basically held that this was a taxation issue I thought I would include my two cents here. Who really pays taxes? I have given my complete tax history here in previous posts. Bottom line, I haven't paid federal income taxes in the last 7 years (state taxes is another story). In fact, they keep giving me my money and some back. Maybe some of it was your money... sorry.

So who is going to foot the bill? If it isn't me (and probably isn't you), who?

Well, it will be us (as in me for sure) in 2013. Have you looked at the tax brackets that we are going to be in? Above $218,450 taxable income 36% to 39.6%. That is some serious cash and that is only the federal income tax. Talk about eye opening.

Salaries sound really good, but after taxes..... oh my. The people providing the care will also be the ones paying for it.  There are a whole host of other taxes that we will pay, not to mention the expenses that come with practicing medicine. I am thinking of malpractice insurance to the tune of $50-100K per year (or let's just say another 10%), and then employees/facilities..... how will a doctor be able to afford to provide care when everything they have is taxed or spent in the pursuit of practicing medicine? 

And here is where I have to pause and go hmmmmm. Is it fair that some people will pay 39.6% and others will pay absolutely nothing? And this isn't a question I ask just because I am going from the zero tax payer to the crazy tax payer in the near future. I have always wanted to pay something, but that's just me. 

I belong to the school of "everyone should have skin in the game". Those who have more should pay more, those with less should pay less, but everyone should pay something (unless you really have nothing). For me it is a matter of principle. There never was a free lunch and there never will be, someone always pays.