Variety of the Human Sort

On a couple of gifts received this holiday season...

The first is a newish memoir-stroke-expose which pretty much violates every IRB and HIPAA regulation known to medicine -- not to mention some sort of personal honor code one should have to adopt in order to become a physician. Anyway... written by a attending psychiatrist at the (in)famous Bellevue Hospital, the oldest public hospital in the US, Weekends at Bellevue is perhaps the worst book ever written on severe mental illness and the role of the provider. Not to hyperbolize, but any doc who refers to her patients as "crazy" (she's a psychiatrist for chrissake), who writes about her propensity for literally sniffing out male pheromones, intern sex (ew), how her ass looks in scrubs and, let's be honest, has a lot of unexamined contempt for the mentally ill, gets her book tossed swiftly in the trash. Sorry, Santa.

But, never fear. There is also the now-quite-ancient and excellent book entitled Mutants: On the Form, Varieties and Errors of the Human Body (2004) written by the intriguing and somewhat controversial Armand Marie Leroi, an evolutionary developmental biologist and lecturer at Imperial College London. This history and popular-science sampler is humane and insightful, taking on difficult questions of genetic variation and social interpretation. "Injustice creeps in through the cracks of our ignorance... It is to finally close off those cracks" that we should be looking at human variety. He is speaking about genetics, of course, but mayn't this well be applied to other work, needing not to be resurrected here? I think so.

On the Fence

Here is a well articulated and fair article about palliative/terminal sedation. This was a genuine and frightening surprise to me during my first clinical rotation and it continues to be one of those ethical dilemmas with which, inside, I can make no headway. It is probably the number one reason why I have shied away from hospice nursing which I originally suspected to be my calling. My hands and heart don't want to carry the weight. Conscience or cowardice? You decide.

Just a Body

The Kid is ten. Driving home from school last night we had this conversation: "See that dot on their license plate?" he asks, pointing to the car in front of us, "it means that guy's a donor."
"A what? Organ donor? No, they don't put it on your license plate. Someone needing a kidney might run you off the road... they put the dot on your driver's license."


"Oh... Are you a donor?"
"Yes, of course."
"What part of your body?"
"The whole thing."
"Well, that's good. They might as well take it all and help someone else. You won't be needing any of it anymore."
"Does it bother you?"
With some disdain, "No, mom... It's just a body."

Substituted Judgment

An interesting article, provided me by The Partner, describes the application of suspended judgment among first-year medical students, wherein patient self-determination is preserved in the face of loss of ability in autonomous decision making via appropriate, designated surrogate. The results are very interesting and an important consideration for all health care providers. It's the conundrum of best interest of the patient, medical judgment or family wishes placed against patient self-determination. As a nurse and 'patient advocate', you think you know what you would do, don't you? It's worth rethinking because it's a very tricky ethical dilemma.

Cello Scrotum, Revealed

And just in time for The Kid to start his cello lessons.
Hearing the Baroness Murphy's telling is definitely worthwhile.

The photo is of the amazing Ernst Reijseger. If you get the chance, have a listen.

First Do No Harm

The Kid is reading, among other things, The Fortean Times Book of Strange Deaths. He said to me last night after my first med-surg exam, over which I was having mild to massive anxiety, "Mom, you'd better read this; I don't want you to make the same mistake."

"A newborn baby in a Chicago hospital came to an abrupt end when someone accidentally connected the child's heart monitor cables attached to electrodes on the chest and abdomen directly to the mains. Twelve day old Stratton Vasilakos died instantly. Apparently this was caused by a design fault which had resulted in several previous accidents but was supposed to have been corrected."

Somehow that wasn't really the anxiety relief, nor the vote of confidence, I was looking for.

By the way, did you know that "Primum no nocere" is not even in the Hippocratic Oath? I'm no doctor so it doesn't really matter. Interesting, nonetheless. It's actually attributed to the Roman physician, Galen.