Speeding To An Early Demise

       Western societies place such a high premium on speed, multitasking, goal oriented living and accomplishments that we, as Americans, are incurring/suffering from an epidemic of anxiety, panic disorder and depression. Coupled with the national tendency to also suffer from denial we, as a culture, are experiencing increasing rates of occupational and professional burn-out. Ultimately, this will not only make us a more sickly populace but an ever dependent one. It will also harm and make inaccessible the works of great artists, musicians and geniuses who are born each generation but develop incapacitating mental illnesses or addictions causing same; they die before their artistic skills effloresce (or come in to their own). We are our own worst enemy.

       Mark Twain, writing in The Keokuk Daily Post, November 29, 1856 astutely observed while riding on a train that the scenery, and hence by reference life, was moving way too fast (the actual speed was in the 40 mph range!). "I jest took a peep out of the winder, and drat my buttons, if I wasn't astonished at the way that rail road was a gittin over the ground. I tell you, Mr. Editors, it made a rail fence look like a fine tooth comb, and the air actually turned blue in the vicinity. Thinks I if that devil at the other end of the train's going home tonight, it won't take him long to get there." (Snodgrass; http://www.twainquotes.com) He couldn't appreciate any of the visual rewards of travel; he could not see the terrain, the flora. It, to him, was a blur. He implied this did not bode well for our culture.

       Practicing medicine, I witness Hurry Up or Mac Donald's Syndrome borne out daily. While it is unfortunately an imbued characteristic of the majority of working and nonworking persons, I am most familiar with its manifestations in a medical setting.

       Patients (and their families) incorrectly and incredulously think the delivery of medical care is analagous to procuring a hamburger. You simply arrive at the hospital, very ambiguously state your intent or wants, and the entire ER staff will jump right on that. I am not talking about true life-threatening emergencies which comprise a small proportion of the patients seen in an ER on any given day.

       To worsen matters to a tremendous degree is the very common patient lack of any detailed knowledge concerning their medical/surgical history, the names and dosages of current medications and any recent medical treatments or hospitalizations. The majority of folks who have a primary care physician generally can't tell you his/her name or practice name! Yet this information, along with allergies, can literally not only make a major impact on treatment decisions but may, by the patient's own hand, cause themselves harm. It is the patient's responsibility to provide an accurate and current medical history. Rare is the knowledgeable patient or one who at least maintains a database (such as writing on paper!) on their person with details of their medical history. Nearly all folks of middle age and beyond presenting for evaluation are on prescription medications and have one or more chronic illnesses. But when asked about this information they again become impatient demanding "a pill or shot so I can get out of here." [sic]

       Oftentimes, the patient and/or their family has an ulterior motive in their need for speed in the ER. Granny-dumping is an example. Bring Grandma to the ER under the premise she is acutely ill when in fact she is not; the family is either incapable or more often unwilling to devote the time and resources to care for their parent. It is a despicable scenario. The associated scenario is that of the elderly patient who was recently hospitalize; the physician strongly suggested skilled nursing care facility placement but the family refused, out of some ill-conceived and misinformed emotional notions of "never letting Momma go to a nursing home." Well, sometimes things simply are as they are. The care required may be totally beyond what the family can provide and guess who suffers? Momma. So, she is brought to the ER, usually during the night or early morning hours, again under the guise of an acute illness but it ultimately comes out, "We just are at our ropes end. We can't take it anymore. We want her admitted for three days and then moved to a nursing home." This is such a common scenario. Even more heartbreaking are the times family members, having brought Momma to the ER, leave and never respond to phone calls and never return. Apparently they are too busy and in too much of a hurry to care for their parent.

       Common presentations of the Mac Dondald's Syndrome involve a patient or entire family demanding rapid service because:

1. "I haven't eaten all day and want food with a drink" (Whose fault is that?)

2. "I was sick yesterday and need a work excuse." (From the ER?)

3. "I ran out of my medicines a couple of weeks ago." (Hello!)

4. "I have an appointment with my doctor in 2 hours - I came here because I thought it would be faster." (You obviously haven't been here lately or read newspapers!)

5. "I need help with drugs." (And how many years have you had this addiction? What is today's emergency?)

6. "I need help with alcohol." (How long have you been addicted and how many times have you enrolled in detox programs?)

7. "I want a pregnancy test." (So the patient presents, without insurance or funds, with the complaint of a missed period and early morning nausea and vomiting. The patient can purchase an OTC pregnancy test just as accurate as the urine test used in the ED. However, they would be expected to PAY at the time of purchase in the store for the test. Now, without a thought for hospital, societal and resource cost they will incur charges exceeding $500.00 for something costing less than $10.00; their own fault)

8. "I ran out of my Lortab." (Did you call your doctor? "No.")

9. "I was in a car accident and now my neck, back etc. hurt and that guy is gonna pay." (The patient then expects the hospital and physicians to wait for this presumed financial settlement believing [falsely] that they can put the charges on hold because something wasn't their fault. They are asking for the service therefore they are responsible for the charges.)

10. "I've had [chest pain, a headache, abdominal pain, etc.] for a month or two." (And what made today so special after waiting all this time?)

11. "I've got better things to do with my time than stand around in here and wait for you to treat my wife (or husband)." (Isn't the health of your loved one paramount in importance; it must be, you brought them to the ER)

       If the physician makes the mistake of trying to accommodate or feed into their demands of hurried evaluation and inappropriateness, some of these same people will, at some time in the future, file a malpractice suit against the physician and completely deny they demanded speedy service with its attendant risks. They and their lawyer will make a litany of false allegations and the hope for winning The Malpractice Lottery will go on for the 1-3 years it will take to process the claim. The plaintiffs lawyer may argue that the physician should have imposed his/her control of the patient evaluation. The Hospital Administration will not support the physician, although their unwritten policy, reiterated over and over, is to "move the meat" and "do whatever you can to make our Patient Satisfaction scores high - Just give the patient what they want.") Although from a strictly business model patients are customers, the nature of diagnosing and treating diseases on individual human beings negates much of this analogy and does not make patient satisfaction scores comprehensively relevant.

       Mac Donald's Syndrome is a serious manifestation of the psychological and behavioral ills which have befallen the denizens of industrialized society. As a matter of fact, those societies, industrialized or not, who adopt our perspectives soon fall victim to this same phenomenon. As individuals and as a society it is imperative we look closely at our behaviors and what modifications are needed to maximize our mental health. Hurry Up Syndrome is merely a sign of the underlying severe anxiety and associated disorders which now afflict so many people. The human brain has not had time, in an evolutionary sense, to adapt and develop appropriate coping mechanisms for the immense profundity of attention required of it. The sheer number of persons requiring psychotherapy and/or anxiolytic medications is immense and growing. We set goals we cannot reasonably accomplish. We set time tables we cannot meet. We demand "multitasking" as a means of accomplishing more in shorter periods of time.

       Yet we don't take time out for ourselves nor our loved ones. By the time we retire our minds and bodies are literally exhausted. We may physically live longer but we do so sustaining more and more maladies, spending our retirements sitting in physician's offices or lying in hospital beds!

Mark Twain Never Saw This!

      5:30 AM. Really early for me. I awoke to get ready for work. Since my cardiac bypass surgery I have to be careful not to stand or move quickly after sleeping, primarily due to the medication I take. So, I slowly walked into the dimly lit bathroom sitting on the toilet to urinate. In sitting, I won't run the risk of passing out.

      You know it's damn dark at 5:30 AM, especially when you're tired and half asleep. So I'm just getting used to the cold of the seat when  Wham! I get hit in the ass! Wham! It happens again! What the hell is going on?! By the third strike I gather my senses enough to literally leap off the toilet! On go the lights. What the hell hit me? I look in the clear toilet water. There in the shiney bowl is a black frog with white spots! Am I seeing things?

      I start to go after it but by now my wife has heard my scream of terror and is standing next to me. "What's the matter with you?" "I just got slapped three times in the ass by a damn frog!" "No way!" I'm still trying to grab the thing when she pulls on my arm; "Leave it alone-he didn't hurt you!" Didn't hurt me?! My heart is racing, sweat is beading on my forehead and I thought something in the toilet was after my gonads!

      Before I could catch it she was back in the bathroom with an aquarium net fishing the frog from the toilet. "He's cute!" Out the door she goes into the woods behind our house. When she returns I've calmed down sufficiently to regain my senses. "You are always so over reactive!" she tells me. I reply, "Yea, well you just wait. I'll put something in the commode when you least expect it that will jump up and bite you on the ass!"

      We have a septic tank system. I had heard stories about frogs, snakes and other reptilian or amphibious creatures meandering their way, in true Shawshank Redemption fashion, through the septic tank lines making an appearance in your toilet. But I always thought they were just tales. Not so my friend. I am here to tell you I got smacked three times on my buttocks at 5:30 AM while trying to pee on a cold commode! Look before you sit!

      As I enjoy sharing stories with folks, when I arrived at the ER this day I told not a few nurses and other people. And as I am fairly good-natured, I can take what I dish out. So, I was the butt of many a joke that day, even to the point of an artist amongst the RN's drawing me, the toilet and frog on a whiteboard! I thought my surprise amphibious encounters were over. Not a chance!

      Several weeks later while standing during the day in the kitchen my wife tells me, "Don't turn around." Why do people say that? Of course you're going to turn around. Well I did and there next to the sink was that damn frog! He is black with white spots, not a frog I have ever seen in this part of South Carolina. So, I am convinced it is him. I lunge toward him hoping at last to terminate his existence after nearly doing the same to me. Again, my tree-hugging wife moves defensively to guard him. Again she takes him out in the woods. Some 3-4 weeks go by and Carl, our new cat (who looks and acts like Garfield) is noted chasing something on the porch knocking over all the plants. We discover Mr. Ebony & Ivory Ribbit is hopping about with Carl trying to nab him. Carl succeeds and I am cheering him on (something I don't usually do with cats). My lovely wife goes after Carl, removing the frog from his mouth and again, for the third time, takes him into the woods.

      The good news is I have not seen Mr. Ebony & Ivory since that time. My family, though, is doing its level best to maintain this as a running joke about me. My youngest brother, unbeknownst to me, mailed my wife a large package about a week prior to this past Christmas. She wouldn't say what was in it. Working nights the week of Christmas, I awoke late Christmas Eve night to ready myself for work. I sleepily walk into my bathroom, turn on the lights and the whole damn place is filled with frogs! Thankfully, these are the artificial variety. But there on my toilet seat is a big green frog smiling and staring at me. Frogs are everywhere, in the shower, on the counter and even near the various potted plants. Sitting amongst all this is a porcelain framed Christmas photograph of my brother and his wife; the frame has a frog theme, the frog seemingly holding an umbrella over them!

      Just to remind myself of the vicissitudes and unpredictability of life, most of which turns out to be either interesting, funny or both I take the Green Frog with me when I go to the ER. He sits near my computer monitoring, staring and smiling just like Mr. Ebony and Ivory!

Dr. Dennis

Daughter Has Brain Fart, Mother Injured

       Momma was riding in the front passenger seat with her daughter driving. Momma is in her 50's. Her daughter is married with children. As they proceed down the street the daughter swerves to avoid an oncoming car and runs her vehicle into a nearby conifer (pine tree). Subsequently, Momma is transported to the ER with a multitude of complaints and injuries.

       Momma is lying on the stretcher trapped in the "boarded" condition well known to all of us in the ER. Her neck is in a brace; she is lying on a hard, plastic backboard and she has a at least 6 "seat belt" type belts confining her to the backboard. She is alert and oriented. She weighs over 250 lbs. She is miserable and lets all of us know that.

       She is quickly assessed and all lab/x-ray orders are placed. She has an IV and is given analgesics. A second history is taken from her, this time more detailed (after assuring she is stable). She has multiple linear abrasions on her forehead, chest and knees. She assures me she was wearing a lap-shoulder belt. The vehicle in which she rode has no air bags. She also, somewhat perplexing me, states her head struck the windshield, shattering it and her chest hit the dashboard "straight on." Fortunately she did not loose consciousness nor is she significantly bleeding from any site.

       Now why would a passenger wearing a lap-shoulder belt not only strike her chest wall but be thrown forward enough to nearly go through the windshield? This does not physically make sense. While it is true that obese persons sitting too close to a dashboard can sustain chest injuries her seatbelt should protect her from any head injury, particularly striking the dashboard.

       Reviewing the sequence of events leading to the collision revealed her daughter had sustained a brain fart. An electical disturbance occurred resulting in a wholly inappropriate behavior. In turns out as her car swerved to avoid stiking another vehicle she noted a pine tree dead ahead. Attempting to break, she apparently decided striking the tree dead center was not avoidable. At that crucial moment, she reached over to her mother unlatching the seatbelt! Wham, the auto struck the tree and her mother was thrown forward at a high rate of speed, striking her chest on the dashboard. Adding insult to injury, Momma's head struck the windshield with sufficient force to cause a "starburst" breakage.

       Taking this in simply defied any and all logic. The mother had secured herself with appropriate safety precautions but her daughter decided, at a crucial moment, that Momma did not need protective restraint and would rather allow her to thrust her body and head into the dashboard-windshield respectively! Pausing for a moment, I had to collect my senses. Surely the mother was mistaken. Surely no daughter would deliberately, literally, place their mother in harms way. Sadly, this story is true.

       I spoke with the daughter about 30 minutes later when she came to see her mother. Incredulously I approached her and inquired why she would behave in such as way as to actually increase the harm her mother sustained, in actuality placing her in the potential path of death from a head and/or chest injury. The answer was as ludicrous as the action itself.

       The daughter proceded to inform me that, "Those damn seatbelts are dangerous. I saw on the TV a person who done got kilt wearin' one of them damn harnesses. So, when I saw the tree and knew I couldn't stop my car I reached over and unbuckled Momma." [sic]

       I was sorely tempted to again attempt to teach someone about the benefits of seatbelts; however, I realized that on this daughter I would be wasting my saliva. Therefore, knowing the mother understood the importance of safety devices I left to attend other patients. I later found out there was a child in the car; yes, the child of this daughter. So the phrase goes, God works in mysterious ways. Momma had lovingly buckled the child into the back seat unbeknownst to the mother. The child was safe, sustaining no harm.

       Momma was not so lucky. While she did not incur any life threatening injuries she fractured two vertebrae in her thoracic and lumbar spine resulting from the forces generated by slamming her head into the windshield. She also had not quite a few abrasions and multiple muscle/joint pains. Her chest, by the by, hurt as well due to a thoracic wall contusion. Thankfully she had no internal chest injury.

       No mechanized device is 100% safe. Nothing we do or encounter in this life is 100% safe. There are, however, many ways to protect yourself. Statistically, wearing seat belts has prevented disproportionately more injuries and death than not wearing them has caused. It is a simple fact. You can't refute it. Also, if an adult decides to protect themselves no one, not even a daughter with Brain Farts, has the right to place Momma in harms way.

Dr. Dennis