Wednesday, September 29, 2010

Mur pourrit, trou s'y fit, rat s'y mit; chat l'y vit, rat s'enfuit; chat suivit, rat fut pris.

i'm doing a little (a very little) retail therapy online. 

this is an actual item description. try repeating it 3 times:

"sheer crinkle gauze hoodie over a adjustable lingerie strap opaque cami."

Monday, September 27, 2010

The Checklist: Pause and Reflection... FAIL!

As part of the eternal quest to identify the nasty pathogen causing infection and inflammation in my left shoulder (and hip), I underwent an aspiration of that shoulder joint last Monday.  The hospital radiologist used dye and a fluoroscope to guide the insertion of the needle.  A nurse and a radiology tech were there to assist him, as there were beaucoup bottles and slides that needed to be prepared once he managed to get a sample.

So there we were, the four of us.

Before getting started, we participated in a strange and wonderful ritual -- a Procedure Pause and Verification of Site Ceremony.  For short:  The Checklist, an adventure in Pause and Reflection.

Essentially, the head medico calls out for everyone's attention, then tediously goes over who the patient is and what procedure is to be performed and on what body part.  The site is marked and signed by the doc, and everyone is in accord about whether it is the north leg or the south toenail of the eastern ankle that is to be poked, cut, or otherwise handled and abused.

In my case, despite a desperate attempt on my part to shave a decade off of my date of birth, we all concurred that we were there to stick a large-bore needle into my left shoulder in an attempt to draw off some nasty fluid from which we hoped to farm some identifiable nasty bugs.  The radiologist signed my shoulder with a flourish, and we were off!

Having experienced the impact of medical errors, I did not find the Pause or the List or the Purposeful Redundancy to be any kind of imposition.  Quite the contrary -- I was impressed.  I even told a few people about it... Folks who know the extent to which I have suffered due to medical errors, and the attempt to cover up those errors.

Of course, I spoke with  Brother-Unit Grader Boob -- at some point in the 1990s, he supplemented his teaching salary by working at a hospital near his university -- a hospital most known for its surgical errors, by which I mean the amputation of THE WRONG LEG.  In the lingo:  wrong-side surgery.

What a horrible thing to happen!  And how upsetting when it happened again!  Yes, that was the reigning attitude -- the mistakes just somehow "happened." In my sad experience, I learned much about verbs in the passive, about hospital-acquired booboos.  [In one of the more sinister conversations Fred and I enjoyed during a riotous stay at Saint Joseph's Hospital of Atlanta back in 2002, the retort to our query regarding what, if anything, the orthopods planned to do about my "hospital-acquired" tibia fracture was:  "Oh.  So you know about that?" {with a beautifully arched eyebrow} It just made us mildly curious as to what we might NOT know, you know?  Beyond the initial medication owie, concussion, internal bleeding, and fractured ankle -- with CRPS onset within hours -- had we missed anything besides this tibial oopsie?]

As a Gimp, the attitude in play in these instances horrifies and pisses me off no end:  Well, this person already knows pain and disability, so it is no big deal that a little more pain and disability might be added to their lot.  They probably won't even notice!  Of that 1995 BooBoo, a NYTimes article noted:

"Some doctors who appeared as witnesses said that the leg Dr. Sanchez removed was in such poor shape that it would probably have been amputated in the future." 

What a pompous, convoluted, ass-saving and totally deflective (better than Teflon!) attitude! 

Okay, so I may have given some considerable prior thought to the impact such attitudes can have.

Back to our story!

Yes, it was an impressive display, last Monday, inside a tiny radiology suite.  So simple a thing as a pause and basic review of identities and of left or of right -- what a marvelous idea! 

So there I was this afternoon, getting an incredible amount of Face Time with a noted Infectious Disease Specialist, and we were reviewing the goings-on of the last few years.  Given the back-and-forth rhythm of the orthopedic surgeries I underwent, it was difficult to stay on top of which shoulder did what, when -- even in a fairly ordered conversation.  The ID Dood and I chuckled over the note sent by my Go-To-Guy, which clearly stated that the present culprit, in terms of pain and diminishing range o' motion... was my RIGHT arm. 

Chuckle, chuckle.

Good-natured guffaw!

He said, "Well, with so many shoulder surgeries, it is easy to get confused."  Spurfle!

Then ID Dood called the lab to check on culture growth from last week's aspiration.  So he's on the phone, all Chatty-Kathy, with some minion when his eyes go into Serious Squint.  He had asked for the results of my "left shoulder aspirate," identifying me by name and date of birth.  Lab Minion, however, informed him that there was no left shoulder aspirate being cultured.  There was, however, a sample from...


...a RIGHT shoulder aspiration!

So congratulations on the Careful Checklist, the Procedure Pause,the Reflection and the Verification of Site and all -- but if you are going to then mislabel your biopsy or culture samples, you are still chopping yourself off at the knees.

So to speak.

I was  making light of it as Fred and I climbed into Ruby, the Honda CRV, and loaded the power chair on Bruno's Lift, when he said:  "Yeah, but imagine...  you are brought into the ED unconscious and all they get is your name.  They plug that in and see that you have had a shitload of tests done on your RIGHT shoulder.  They can tell you have a raging infection somewhere... and that must be it -- your RIGHT freaking shoulder.  So they amputate..." Okay, so his scenario kind of fell apart at that point, but you get his drift.

The possibilities running through my mind were less extreme but equally catastrophic.  What if such an error had occurred before, but without such an obliging lab technician on the other end of the telephone?  What if, say, following one of the five surgeries on my right shoulder, SuperShoulderMan rang up to inquire about intraoperative cultures from said shoulder, only to be told something slippery like "no report of growth," when in actuality there was growth, but in a specimen mislabeled as left?  Hmm?  Before you get all pissy and dismissive, ask yourself if it could happen...

I still feel they are to be congratulated for these steps to stop medical error.  They just need to tweak a few straggling details -- like somehow including a review of labels on lab forms on the checklist.  Or something.

Marmy and the Elven Wood Smurf

For the Cat Lovers among you Fearless Readers, this is the first decent photograph -- ever -- of Ms. Marmy Fluffy Butt.

She has undergone a Personality Transplant since Sam-I-Am left us in early July.  Part of that process includes Severe Persistent Lovability and Charming Chirps -- and now, her first Posed Photo Shoot, with suitable Classic Prissy Paws.

World, allow me to present Your Queen, The Marmy. 

These were my Wee Hours -- I was in Desperate Pain and Worried about the ID consult.  In response, this Girly-Girl Cat posed The Stations of The Marmy and promised me Measured,Passionless Devotion.

Yes, I had the dreaded Infectious Disease Consult today, and wish to retract my statement describing the good doctor as an ancient Pillsbury Dough Boy with Liver Spots.  He was more of an Elven Wood Smurf.

More importantly, he has Ideas.  Based on those Ideas, we drew Blood, although not enough to get all the desired tests done.  When I left, they were still going round and round about whether 5 ml. of blood were sufficient for Immuno Goblins, or some such thang.  He's pretty convinced my Immune System is shot all to hell.

I was touched by how he understood my state -- how he said I probably cannot remember what it feels like to feel good -- by how he said "Oh my, oh my" when examining my legs.  I needed Sympathy, Empathy, Compassion and all in Ridiculous Measure... I was quite the Needy Bitch, baking along merrily at 101 degrees. 

He completely won me over when he said he would, at least, like to make me more comfortable, bring the fevers down, and convince my heart to beat at a rate below 128.

I think I am in love.

Sunday, September 26, 2010

The Charles Prize for Poetry, 2010

The worst part of failing at blogging is the inevitable failure to keep one's promises.  I got you all hot and bothered about Dr. Charles' Contest and then went adrift before the deadline.

Here, belatedly, is the link to The Examining Room of Dr. Charles, and to his announcement of the winners in his wonderful poetry contest -- winning and notable poems included. Go give them a read, as there are some very talented folk telling truths in remarkable ways!  Then spend some time wandering around the archives -- An enjoyable prospect for a Sunday afternoon.

The Charles Prize for Poetry, 2010
September 12, 2010

It is with great pleasure that I announce the winner of the poetry contest. Over 125 poems were received with a general theme of medicine or science. 7 judges were consulted, representing a diversity of training in medicine, science, and the humanities. A few of the judges were moved to tears at times, and all expressed their wonder at the quality of writing.

What makes art, poetry, or literature special? Perhaps it is a combination of graceful observation and hopeful creation which lends light, perspective, and meaning to our existence. We know it’s good when a certain hum of neuro-electricity splashes brilliant colors across our satisfied brains, soothing ills, making us want more.  [Read the rest HERE.]

"I felt like he made me undress for fun."

You know those websites that "rate" or "evaluate" physicians? 

I landed on one while trying to find the address of the new Infectious Disease Dood I see tomorrow.  There were seven reviews, but only one person felt moved to leave a comment:

Pompous with a god complex! Hates women! I found him to be completely boorish while talking to me---talked to me like I was a little girl!! I felt like he made me undress for fun. He's a perv.

Not helpful.  Nope. No.  Not at all.

Plus he looks like an Expired Pillsbury Dough Boy with Liver Spots.

Oh, relax!  I employ sufficient discernment to realize that, were this woman's numerical evaluations taken away from the whole, Dough Boy would have near perfect marks.

(But how dare any doctor demand that she get nekkid!)