Archive for April, 2010

Is Your Community Hospital Worth Your Life

Tuesday, April 27th, 2010

Jim lies in a hospital bed clinging to life as I write this blog. Ten months ago he was diagnosed with severe mitral valve disease and advised to have surgery. Jim declined. As his health deteriorated he could no longer put off surgery. He had a choice of going to a community hospital or to a university hospital. He wanted to stay near home so he chose to stay in the community. The morning after surgery as Jim lay in the cardiac intensive care unit he complained of vague chest pain. He complained several times until his nurse said ” Now, Jim, You have just had open heart surgery. You should have chest pain.” Six hours later his right lung collapsed. Several hours later the left. Then kidney function deteriorated. Now he clings to his life.
Kyle needed surgery for cancer of the esophagus. The cancer was limited but Kyle was obese and not in good shape. I told him that if he went to a community hospital he had a 25% chance of dying from the surgery vs. only 1% risk of mortality at a university setting. Kyle wanted to stay in the community to be near his wife. Kyle declined to be operated on at a university hospital in Chicago. Six hours after surgery Kyle’s kidneys began to fail. Three days later he was dead.
The evil secret that no one wants to say is that community hospitals cannot provide the post operative support for major surgery that a university hospital can provide. An excellent surgeon can do his job to the best of anyone’s ability, but life and death hangs in the balance of the post operative care unit. Another evil secret is that affiliations of community hospitals with university hospitals are economic alliances and do not bring the level of care of the community hospital up to the level of the university center.
The trauma of a life threatening disease is difficult at best and emotionally traumatizing. It makes little sense that the welfare of a patient is left to the economic survival of a local hospital or the medical staff of a community center. Decisions like these should not be at the whim of emotions of a confused and traumatized family. The only solution is to have centers of excellence where such difficult surgeries can be most safely performed. In fact, we have the centers and we have the statistics to prove them. What we also have is a politically dominated system that cares more for the economics and welfare of local politicians and health care systems than for the welfare of a patient.
Every patient needs to read the book “How Doctors Think” by Dr. Jerome Groopman. Do this before you need to make a decision. Do it before someone has to write a blog about a person close to you.

The Problems Women Have With Hair

Friday, April 9th, 2010

Hair presents a conundrum of conflicting problems to women.
On the one hand they are troubled by loss of hair, any hair at any time. The presumption is that hair is flattering, youthful, and aggrandizing.
At the opposite end of the spectrum women obsess about what to do with hair when they have it. Used incorrectly, as it is often worn by women, it works to their disadvantage (a bald man can write this with impunity since he has no hair-ax to grind) .
I will ignore the nascent attempts at creativity by young women since this is the time in their lives for experimenting with all sorts of presentations to the world. However, adult women should have completed their experiments and should have learned something about the message that hair styles produce.
I will try to list the most obvious hair styles women use to their disadvantage:
The Samson Neurosis- Long attributed to men the Samson neurosis implies that the longer one’s hair is worn the more strength (and youth?) it gives to the wearer. When I see hair down the back my first thought is the woman is identifying with a horse and the more it is flaunted the more ridiculous it looks. Older women trying to look young: ring a bell with anyone? Add 20 years to your appearance.
Bangs – Bangs cover the forehead. They create a lowered frame for the face and project a tiny face from the wearer. Also an up-tight, taciturn look. Tiny is cute in a child, it has no place projecting maturity and vivacity in an adult. Add 14 years to one’s appearance and a complementary membership the DAR.
The Mata Hari Look - Hair worn forward covering the cheeks. This is the best look for narrowing the face beyond that which nature has already produced with time and is a non-verbal sign for “aging”. It is also a good sign for reduced self-esteem since it shrinks the face to its minimum and advertises “I am hiding”. In this it does have a relation to youth who hide their hands within their sleeves, and their faces within their hoods. Looking young and timid may be appropriate for children; it is not in an adult.
Given these misconceptions and possible delusions, try pushing your hair behind your ears, exposing your forehead, and wearing hair no longer than shoulder length. Unless, of course, you are opposed to looking your youthful best.