Tuesday, January 13, 2009

Grand Rounds: Vol. 5 No. 17

The (optional) theme I suggested for this Grand Rounds was connections -- connections among people, groups, ideas, opinions, facts, devices, places, events, just about anything. I am interested in how the connection between things led to an outcome that was in some way beyond what could have happened had those things remained apart. It has been intriguing to read what our fellow bloggers chose to connect.

One area of connection that has fascinated me for deca
des is the realm of science fiction films. Sci-fi films connect the past, the present, and the future; our darkest fears and loftiest hopes; the devastation humans cause and the healing we bring; the divine and the utterly outrageous.

Here's a confession. For the past twenty seven years I have attended the annual 24 hour science fiction film festival. I bring my pillow and my ra
y gun and sit in the dark with my crew watching the sublime( Blade Runner), the drek (Plan 9 from Outer Space), the naughty (Invasion of the Bee Girls) the forgotten ( A Boy and His Dog), the political (Aelita - Queen of Mars), and the Sean Connery (Zardoz)

So the organizing theme for this Grand Rounds is sci-fi films.

Dr Strangelove or How I Learned to Stop Worrying and Love the Bomb -- A Kubrick masterpiece. A subversive anti-war film that is wonderfully satirical with Peter Sellers in three bizarro roles. It shows us how the collision of perspectives can result in Armageddon, but in a really funny way.

Bongi from Other Things Amanzi writes in his post, Quagmire, about the confusion and tragedy that can result when you move across hospital units to treat a patient and crash up against different practices and attitudes.

Dr Deb introduces us to a new Showtime show, The United States of Tara, about a woman with dissociative identity disorder (formerly known as multiple personality disorder) - although Dr. Deb's withholding her judgment about their depiction of mental illness until more shows air.

No Nurses in the Unemployment Lines on Colorado Heath Insurance Insider points out the sadly ironic gap between the shortage of nurses and the dollars spent, not on better salaries and education grants, but on prizes, spas, and art work.

The Adventures of Buckaroo Banzai Across the 8th Dimension -- deserves its status as a cult classic. Buckaroo is a rock star, a surgeon, a car racer, a planet saver, a real sensitive guy, and a bona fide hero. He's also a servant leader and a humble warrior who knows the value of a good relationship and always speaks the truth (and may perhaps be the originator of the aphorism, "Wherever you go there you are.").

Anesthesioboist, in See One, Do One, Teach One, writes about how meaningful teaching of medical trainees requires more than providing rote instructions and observation. It requires a relationship, a real connection between teacher and studen
t, which can be tough to find in medical education.

Kim from Emergiblog in an alliteratively titled post, Pain, Potty, and Position Protocol for the Professional Peon, brings to our attention a group of unsung heroes who get little recognition from the powers that be, the ER technicians.

Dr. Val in What To Do When Mistakes Happen reminds us that medical errors do occur, and some have tragic consequences. What we do about the error and how we communicate, with truth, to the victims make a world of difference.

2001: A Space Odyssey -- Kubrick's genre busting epic of metaphysical and intergalactic exploration. Stretching the bounds of the familiar to the mind altering vastness of time, space, imagination, and technology. Will we ever forget supercomputer HAL's attempted coup and his ultimate demise?

How to Cope With Pain helps us stretch our thinking to consider that chronic pain, a condition no one asks for, may actually have some positive benefits in her post, Are There Some Benefits To Your Chronic Pain?

Duncan Cross boldly tries new technology to help manage his own upcoming surgery - with some frustrating, useless, and enlightening results. Have a look at The Adventure Begins.

Sharp Brains offers us a way to stretch our thinking capacity with the The Ten Most Popular Brain Fitness and Cognitive Health Books.

The Day the Earth Stood Still (only the original version, please) -- Klatu, a dreamy alien, comes in peace to warn humankind of the path it is on to self destruction. He brings his indestructible robot buddy Gort along as added persuasion. Klatu speaks the truth, we humans ignore it, and as an extra bonus, we try to kill the messenger.

Dr. Siadat from Receiving writes in No Love in the Time of Cholera about the devastating cholera outbreak in Zimbabwe. The solutions are known. The obstacle is implementing them. So what can we do before it's too late?

Scalpel's Edge illuminates some of the harder truths about heath maintenance and understanding your doctor in Expecting Illness Helps Improve Your Health. He writes, "One of the most common obstacles to receiving good health care is the expectation that medicine is magic and that it is normal to be healthy."

Mudphudder shares with us, with a retrospective sense of humor, My Worst Day in the O.R. as a medical student.

Soylent Green -- Overpopulation, environmental degradation, urban paranoia at its juiciest and gun toting Charlton Heston trying to find a murderer and fight a corrupt corporation. Our Chuck uncovers the pernicious secret (stop reading here if you don't want to know) - that the food the corporation produces and the government distributes to the masses, soylent green, is ground up people. We are what we eat, literally.

Dr. Mintz asks us to think about The Problem With Insulin. The new guidelines for managing type 2 diabetes push more patients towards insulin, which might not be such a good idea. These guidelines, he conjectures, are connected to the biases of the authors who write them.

ACP Internist in the post Let Them Eat Drugs informs us that chain groceries, in an attempt to be more competitive, are offering free antibiotics to customers. Won't this just drive overprescribing and antibiotic resistance?

Dr. Rich from The Covert Rationing Blog, in the post Maintaining Plausible Deniability, tells us the story of nurse Dewitt who was allegedly fired because of her husband's high medical bills. Dr. Rich conjectures that the firing managers were placed in an intentional untenable position -- where their only recourse was to take an action that is officially forbidden, but also unofficially invited. He likens this to what health insurance companies do to patients every day.

Invasion of the Body Snatchers (again, only the original, please) -- this red menace tale is about small town residents who begin to lose their personalities about the same time alien pods start hatching everywhere. The pods are evil wombs that absorb humans when they sleep and spit out alien reproductions. Paranoia prevails, no one believes the truth speaking hero, and America is ultimately taken over. The chilling questions that linger are: Who controls your body and can you really tell who the pod people are (just think about the recent presidential and vice presidential campaigns)?

In a thought provoking piece, Pregnancy, Children, and Chronic Illness: Can versus Should?, Laurie of A Chronic Dose asks -- Just because you can get pregnant, should you? and - How can we be the parents we want to be with bodies that don't cooperate?

The Humours blog in its post La Greffe, reviews the French film Un Conte de Noel which connects medical themes to the holiday season. The film is about a family that discovers its shared genetic history of physical and mental illness. The genetic fates of family members cross forbidden relationship lines and create unusual connections

Insureblog, in a post about Hair Transplant Insurance,
makes a provocative connection between hair plugs and in-vitro fertilization and discusses how insurance coverage for either (or both) can drive up costs, affecting the entire health care financing system.

The Back Pain Blog gives us a wealth of excellent tips (accompanied by LOL pictures) on How to Prevent Back Pain with an Ergonomic Workstation.

Forbidden Planet -- a knock-off of Shakespeare's The Tempest, a spaceship crew is on its way to Altair-4 to find out what happened to an earlier crew that hasn't been heard from in 20 years. A strange voice warns the crew to land only at their own peril. They soon discover (along with Robby the Robot, the whacked Dr. Morbius, and his nubile daughter) the destructive force that murdered the previous crew and threatens them -- a force powered by human fear and hate. The only salvation is love.

Keith from Digital Doorway, in Reaching Out to the Margi
ns, with his usual eloquence and compassion reminds us that reaching out and connecting with the vulnerable and disconnected members of our community is a public health concern.

Doc Gurley in Week Two - How Are You Doing? helps us approach the changes we resolve to make not burdened with shame and despair but with a sense of wholeness and practicality. We need to see the connection between who we are now and who we will be in a year, including the bumps and digressions that we'll encounter. She offers science-based behavior change tips.

The Semmelweiss Mystery described on Providentia is a (web) page turner. It's a story about the mysterious death of Dr. Semmelweiss (who is now considered a heroic medical pioneer for advocating hand washing) who died in a lunatic asylum because of the jealousy, prejudice, and fear of his medical colleagues.

Strange Days -- as the millennium approaches and the world hovers between resurrection and annihilation, people peddle "clips," full-sensory pieces of memory from other people's lives. Once inserted into your brain, the lines between present and past and between me and other blur. Our memories become collective and we're all to be tested in the big final countdown.

A story about the FDA spending on morale boosting brought back some high school memories for David of Health Business Blog in his post, FDA Staff: Damned If They Do and If They Don't.

Nancy offers us a collection of memories of the top ten, most read posts on Teen Health 411, including topics such as - can my partner spend the night and a global perspective on teen sex habits. Have a look at Most Read Posts In 2008 From Teen Health 411.

The Fitness Fixer offers us a rich compilation of her readers' stories about how they used her approaches to achieve a stronger, healthier, pain free, active life in the post, New Years Resolutions for Fitness Success -- Readers Hall of Fame.

Thanks to all who submitted posts. And thank you for your encouragement to a first time host. Next week Dr. Val will be hosting Grand Rounds at Get Better Health.

And finally:

May we all have wonderful adventures, never panic, and always know where our towels are.


rlbates said...

Wonderful edition!

Dr. Val said...

Loved the theme! Thank you for your terrific, well written edition!

Laurie said...

Love the original theme here, and how compiled the posts. Great job, and thanks for including my post!

Henry Stern, LUTCF, CBC said...

Great job, Barbara!

Thanks for hosting, and for including our post.

You missed one, though:



Indian Medic said...

Awesomely put together.
nice collection of sci-fi flicks.

Doc Gurley said...

What a futuristic, fabulous Grand Rounds! Amazing!

Barbara K. said...

The following was emailed to me by a wonderful woman who reads this blog and has been dealing with cancer. She wanted it to be included in Grand Rounds, but doesn't have a blog of her own. Her story is about making a real human connection with the team that's about to operate on you. Here it is:

In June of 2006 I was diagnosed with uterine cancer. I arrived at Mass General Hospital on the morning of the surgery, and sat with my family for an hour or so in a large waiting room filled with other people in my situation, listening to every mangled name to hear mine. There were perhaps forty people, a few in hospital johnnies waiting to be called, the rest having come along for support. It was difficult to get any information from the desk staff other than “Someone will call you shortly.” I felt anxious and invisible, but I was trying to hold myself together.

After an hour I was called in for the pre-op interview, which was with a lovely nurse who had been at MGH for 30 years. When she touched my knee kindly, I started to cry, just from the feeling of being seen. I was told to put on my hospital gown and rejoin my family in the waiting room, again to be called “shortly.” “Shortly” wound up being three hours later, when the anesthesiologist was ready to meet with me, and I was put on a gurney in an anteroom to the operating room. (We learned later that the delay was due to the fact that there were no beds free in the hospital, including in the recovery room, so that there was a backup, much as when planes stack up over Logan.)

I was there for another hour and a half, but that was fine, as I was kept company throughout by the anesthesiologist, and by the surgical fellow, both lovely men. It gave me a chance to talk with them about my beliefs and wishes regarding the surgery, which I have developed over the last thirty years of various surgeries that my husband and I have had. I told them my belief that, even when people are anesthetized, they hear everything that is said around them; they just aren’t able to process it fully. I asked if they would be comfortable talking to me throughout the procedure, especially during the time going into and coming out of unconsciousness. I told them that it would help me very much if they reassured me periodically that everything was going very well, that the surgeon felt good about things, and, if there were any comments that an unconscious, non-medical person might misinterpret, (e.g. “Boy, this is a mess!”), could they just reassure me that everything was going fine, this was just shop talk. I couldn’t tell if either of them was familiar with all the research that has been done on this subject, but they were very respectful, and agreeable to my requests. (Though, when I told them they could even ask me to bleed less profusely, or to raise or lower my heart rate, I did think I saw the flicker of a smile.)

When they left me alone for a few minutes, I began to think about my situation. What occurred to me was that, really, I was a “dead man walking.” If I lived in a different time, or place, or was from a less privileged social class, or had not had symptoms, or my symptoms had not been taken seriously, I would, in not too long a time, be dead. But I felt quite confident that, in a few minutes, I would be wheeled into the operating room, and that, when I left it, I would be okay. I thought to myself that I did not want the magnitude of that reality to go unacknowledged. So when they returned and asked me if I would like to be given something to put me to sleep, I told them that I felt calm, and asked if it would be possible for me to be awake when we went into the OR, as I wanted to meet everyone who would be involved in the surgery. They were fine with that.

I liked being wheeled in, and seeing the room and all its equipment. My surgeon was there, and he re-introduced me to his two fellows, and to the anesthesiologist. I asked to also be introduced to the scrub nurses, who were busy getting things ready. Then I told them what was in my heart. I said, “ I know that this is your work; you do this job every day, with great skill, and I know it is routine for you all. And I understand that this is not an unusual or complicated surgery for you. But I want you to know that, for me, it is not routine: I know that what is about to happen is that you are going to save my life. I want to thank you profoundly for that.” Both of the nurses turned around and looked at me, and one said, “Thank you so much for that.” One of the fellows said something too. I felt so grateful, not only for the surgery, but that a moment which could have felt so anonymous, in which they might not ever know who I was, and I might not ever know who they were, was now a brief moment of visibility, of connection. I felt calm and peaceful.

Then they gave me the anesthesia. The anesthesiologist sat so that his arm cradled my left side, and my surgeon stood so that he was cradling my right side, and I felt held as if I were a baby. I could hear the anesthesiologist speaking to me, telling me that everything would go well.
And as I awoke from the operation, I could still hear his voice, and the surgeon’s, gently reassuring me that things had gone well, and that I would feel comfortable and calm when I awoke. And that is exactly what happened.

Brian said...

Thanks, Barbara K., for passing along this wonderful story of connection at a critical juncture. It is very moving.

Nancy L. Brown, PhD said...

Great stuff - I posted a thank you on Teen Health 411!

Anonymous said...

Simple and sweet. I’m thinking of starting another blog or five pretty soon, and I’ll definitely consider this theme. Keep ‘em coming!.