Medical Topics – Page 6 – education and deconstruction.com

In a Rocket Made of Ice

The Book of the Week is “In a Rocket Made of Ice, Among the Children of Wat Opot” by Gail Gutradt, published in 2013. This ebook is a personal account of a woman who volunteered to assist with caring for children at a precariously funded orphanage in Cambodia, Wat Opot, that specialized in HIV-positive residents.

The author stayed for about five months at a time in the first halves of 2003, 2004 and 2008. She wrote about Cambodian culture, in which there was discrimination not only against people with AIDS, but also against people with dark skin. Skin lighteners sold well because people did not want to be perceived as poor rice farmers. On the occasion when the children were given Barbie dolls and one dark-colored doll, they played with only the former.

Conditions were less than ideal: “…heat, bad water, the risk of contracting malaria or rabies, of catching tuberculosis…” a more common illness than AIDS. Plus, limited technology and education, and groups of boys going on “wildings” in the streets. It was theorized that the AIDS epidemic came to Cambodia in the early 1990’s, when men of various stripes (husbands and truck drivers who visited prostitutes, UN soldiers who went on holiday in Thailand, and Vietnamese military families) spread the disease.

The orphanage’s truly dedicated American director, who had been a medic in the Vietnam War, heroically fed, housed, clothed and medicated all of the residents at Wat Opot. They included some sick adults, and tens of children, some of whom were HIV-positive, who had lost their parents to AIDS. There were many other non-profit groups that claimed to take care of orphaned children, but some had greedy owners who committed fraud or inadequately provided for their charges due to inexperience.

Read the book to learn of the author’s interactions with the children and their caretakers, an unpleasant episode with the World Food Programme, religious observances at Wat Opot, its neighbors, and how some of the children fared as they grew older, or after they left the community.

Keeping Hope Alive

The Book of the Week is “Keeping Hope Alive” by Dr. Hawa Abdi, with Sarah J. Robbins, published in 2013. This ebook is the personal account of a driven, fiercely independent Somalian doctor.

Around 1970, Abdi did seven years of medical training in the former Soviet Union. She then returned to her homeland of Somalia to practice obstetrics and gynecology. Through the years, she married, had two daughters and a son, and in August 1983, built a clinic.

By mid-1992, Abdi had made available a farm and campus on which poor people and war refugees could reside, and receive medical treatment. In addition, she was a law school graduate. She also took in her sister’s large family when they were destitute. She risked her life many times during hostilities between and among Ethiopians and Somalian clans ruled by warlords and sheikhs.

Abdi gathered quite a following because she was so generous to her community. Her dream was that the Somalian people would unite as one country, instead of killing each other in tribal infighting. “People who are fighting will never be able to build.” By the early 2000’s, “… after fifteen years of civil war, the women and youth ran everything, while most of the grown men had either been killed or were away– out fighting or somewhere abroad, trying to make business deals.”

Read the book to learn the details of: Abdi’s trials and tribulations in protecting her property and family, how she was betrayed by her husband; how in some ways, she refused to comply with Somalian/Islamic culture; the cities to which she evacuated her children, and of her interactions with relief organizations, soldiers and journalists.

Confessions of a Surgeon

The Book of the Week is “Confessions of a Surgeon” by Paul A. Ruggieri, M.D., published in 2012.

These days in the United States, with the landscape changing for the worse in some ways in the medical community, all sorts of factors threaten the progression of the livelihood of a surgeon; namely– bad luck, lawsuits, increasing stress and diminishing financial returns. The author details those factors in the context of patient cases he has seen.

The conventional saying about a surgeon’s career is that the first decade is spent learning how to operate; the next, learning when to operate, and the next, learning when not to operate.

With the rapid advancement in imaging technology of late, more and more patients are accidentally learning that they have certain medical conditions. Such incidental findings generate extra worries and expenses, especially if the conditions are life-threatening. The word “cancer” on a medical report automatically stokes a surgeon’s fear of being accused of medical malpractice. The surgeon feels compelled to order more tests for legal protection and containment of medical malpractice insurance costs (which rise even in cases where the surgeon is exonerated) even when there is only a tiny likelihood of malignancy. Yes, the author writes, there are plenty of greedy surgeons who order more tests (or perform unnecessary surgery) just to make more money.

The author is in private practice at a hospital, so he gets all his business through referrals from other medical professionals or patients. Therefore, he is under pressure to “play well with others” in his community, lest he lose business.

“Surgeons frequently have conversations with body parts or organs they are trying to remove. They also have conversations with themselves. It’s a way to blow off steam while your mind scrambled to deal with the unexpected.”

Read the book to learn more about the trials, tribulations and triumphs of people who perform medical operations for a living.

Island Practice

The Book of the Week is “Island Practice” by Pam Belluck, published in 2012. This ebook discusses in detail, the life of a doctor who has been practicing general medicine and surgery on Nantucket for decades. He is a colorful character: having no qualms about cursing when providing psychotherapy (without a license); making house calls and treating patients at his own house; allowing patients to pay their bills through bartering; not charging indigent patients at all; treating animals as well; maintaining an extensive collection of operative firearms; occasionally allowing a needy person to live with him, his wife and three kids; and engaging in other offbeat pursuits.

Nantucket, a less-than-fifty-square-mile island in Massachusetts, is a socially isolated summer vacation destination for many wealthy celebrities. However, its year-round residents also need medical care, frequently for three serious tick-borne diseases, on which Dr. Lepore is an expert. When a patient has a life-threatening condition that requires immediate treatment, the doctor has them airlifted by helicopter to a hospital in the Boston area. In times of severe weather when aircraft are not flying, he must try to save the patient himself, by doing a Caesarian section or sewing up a hole in a duodenum in a case of pancreatitis.

The author portrays Dr. Lepore as similar to the fictional TV character Dr. Gregory House in that he is often diagnosing “zebras” (rare medical conditions) rather than “horses” (common ailments) through his intuition and then heroically curing the patient while bucking hospital rules.

Read the book to learn of the doctor’s highly irregular approach to practicing medicine, the difficulties and controversies he and his family have faced through the years, and the precarious future that medical professionals like him face, with the introduction of Obamacare.

As an aside, it appeared that this book’s thesis, stated toward the end, is that Obamacare would force doctors such as Lepore out of business. This blogger thinks that that will not occur. The wealthy will always seek out the best medical care, and pay such doctors under the table if necessary, to obtain it. They will find the loopholes in national healthcare to avoid a bad HMO. They would gladly pay the fine for not signing up for Obamacare because the fine will never be sufficiently high to be a deterrent for making their own private arrangements for medical treatment. A major argument some people– not just the wealthy– have against national healthcare– is that it is unfair to make the healthy people pay the high medical bills of the people who knowingly engage in risky, self-destructive behaviors (smoking; poor eating habits, lack of exercise) that result in preventable medical conditions or that exacerbate certain conditions (cancer, obesity, diabetes, etc.) that require expensive medical care. [By the way, this blogger’s medical bills were $0 last year and have been $0 so far this year (this includes out-of-pocket expenses)– for you curious readers.]

Brooklyn Zoo

The Book of the Week is “Brooklyn Zoo” by Darcy Lockman, published in 2012. This is a personal account of an internship of a PhD candidate in psychotherapy.

Lockman started her internship in summer 2007 at Kings County Hospital in Brooklyn, New York State, the final leg of training before she got licensed to practice. Throughout the book, she reveals the lingo, issues and people encountered by clinical psychologists.

A few aspects of the personalities of humans include developmental level (psychotic, borderline or neurotic), and character applicable to it (“masochistic or obsessive or narcissistic or depressive, etc.”). Patients might be diagnosed with a thought disorder, mood disorder or personality disorder, or a combination thereof. These were documented in a reference guide for psychiatry, the “DSM IV.”

During her training, the author saw what she perceived to be a disturbing trend– of treating all ailments, even ones suspected to be psychological in whole or in part, by prescribing drugs with little or no accompanying psychotherapy. The psychiatric professionals at the hospital perceived part of their jobs to be to instill “medication compliance” in patients. Lockman was taught that treatment should include “the talking cure.”

However, it is controversial how effective psychotherapy is in treating addicts, because drugs and alcohol can permanently change the brain chemistry that controls learning. Lockman describes one alcoholic patient’s case: “angry young man plus bad neighborhood plus psychosis equals short life expectancy.”

Since psychotherapists themselves are human, they sometimes cannot help but become emotionally affected by their patients. One time, Lockman realized she was biased by the socio-economic level of a patient she saw: “…upper-middle-class and white… familiar to me.” Lockman later momentarily broke down in front of her supervisor, who told her, “Never apologize for having an emotion. Just make sure you give it some thought.”

Some patients, such as a narcissistic-borderline (personality disorders) married couple, recounted stories of extreme past behaviors, some of which were laughable. The two consisted of a male narcissistic ex-convict and borderline, pregnant female who had four kids total; the oldest two had a different father. The husband had been a pimp, and had committed adultery with one of his employees. The couple ended up at the hospital because they had become physically violent with one another. They had shamelessly revealed this information to Lockman. The husband said, “I’m a shooter, not a hitter.” The wife said she had committed a bank robbery to save her kids from starvation.

Another issue the author had to deal with was the hierarchical nature of the career field. ‘We all needed somebody to buttress our professional worth.” People in different specialties put other ones down. The medical doctors feel superior to psychiatrists; psychiatrists to psychologists; psychologists to social workers.

Read the book to learn the slew of other issues Lockman had to face in her quest for experience in clinical psychology.

Opium Fiend

The Book of the Week is “Opium Fiend” by Steven Martin, published in 2012. This ebook is the personal account of an opium lover living in Bangkok in the last two decades.

The San Diego-raised author, who supported his opium habit through freelance travel writing, also had a passion for collecting antique opium paraphernalia. He considered opium smoking an art form, and its equipment, works of art.

In the mid-1800’s, there were two wars between China and Britain over the lucrative trading of the drug. When China lost, she “…grew ever more addicted, corrupt, and ungovernable. To this day, China and many Chinese around the world view opium as a dastardly British trick that kept their country poor and backward long after the British opium trade had ceased.”

In the 19th-century, Christian missionaries in China produced public outcry against use of opium when they wrote of the drug’s horrible effects from addiction. Meanwhile, bigoted white Americans, seeing opium usage among blacks and Asians, were appalled that the drug “…encouraged the mingling of different classes and races!” These days, very few people are addicted to opium due to strict drug laws, and because it is expensive and hard to find.

An opium user actually receives a high from the vapors produced from a pipe and an oil lamp with a chimney. So as to preserve the drug’s alkaloid chemical composition, the oil used is camellia, vegetable, peanut or coconut oil, rather than kerosene or alcohol.

Read the book to learn of the way the author fooled himself into thinking he was enjoying his opium-centered life, and how he beat his addiction.

Sum It Up

The Book of the Week is “Sum It Up” by Pat Summitt with Sally Jenkins, published in 2012. This ebook is the autobiography of a long-time coach of the women’s basketball team at the University of Tennessee; Olympian, Olympic coach, daughter, wife, mother, etc., etc.

Summitt’s childhood consisted of doing hard labor on her family’s Tennessee farm, drag racing and playing aggressive basketball with her three older brothers. Her father was a gruff, hard worker who refrained completely from showing affection toward his family. Nevertheless, he had a passion for basketball. Therefore, in the mid 1960’s, he had the family move to a fixer-upper residence so that his daughter could play high school basketball on a very good team.

Unfortunately, the team was part of a pathetic interscholastic program that existed for girls at the time. There were many inequalities between male and female sports programs in Summitt’s generation. For one, she had to pay full college tuition, because “…athletic scholarships for women simply didn’t exist in 1970.”

At 22 years old in 1974, even when she was named head coach of the women’s basketball team at her alma mater, she was given a budget that was a fraction of the men’s team’s budget. Also, unlike a male coach, she had to play many roles in addition to coaching, such as serving as driver, laundress, ankle-taper, gym-floor cleaner, and bench assembler. Her office was at the top of five flights of stairs in a hot attic with no elevator and no air conditioning. At the same time, she was taking four master’s degree classes and was required to teach undergraduate classes.

Finally, in 1975, Title IX– which was supposed to “even the playing field” for male and female athletes– was signed into law by President Gerald Ford (according to the book). Summitt started to benefit from progress, but even in the late 1970’s, the men’s sports teams still had bigger marketing budgets and staffs than the women’s teams; plus the men traveled by airplane while the women had to drive hours and hours.

Summitt also discusses basketball as a metaphor for other aspects of life. She writes, “The point guard position in basketball is one of the great tutorials on leadership… they only follow you if they find you consistently credible… If there is a single ingredient in leadership, it’s emotional maturity.”

Read the book to learn about the coaching-career teams, victories, setbacks, comebacks and defeats; and family, health and retirement issues in the life of this overachiever.

Model Patient

The Book of the Week is “Model Patient” by Karen Duffy, published in 2007. In this ebook, Duffy describes her mid to late 1990’s bout with sarcoidosis, a life-threatening illness that is difficult to diagnose.

A prolonged, severe headache was the first symptom. Numerous tests revealed that she had a growing lesion on her brain and spinal cord. This produced numbness and paralysis in various parts of her body, including her limbs. It took months before she saw a doctor who recommended treatment of steroids and chemotherapy. She writes, “I’d lost the playbook to my life. I had no idea what to do.”

Despite the psychological stress brought on by her inability to continue modeling and working as an on-camera reporter for MTV, she did her darndest to remain positive. Fittingly, she happens to have a facial feature known as “risorius of Santorini”– her cheek muscles form a natural smile, without her consciously trying to do so.

Prior to her entertainment career, Duffy had worked as a recreational therapist at a nursing home. Her job was to improve the psychological states of the residents. She continued to try to volunteer once a week there after she got sick.

Read the book to learn other strategies Duffy used to cope with her illness.

The Intern Blues

The Book of the Week is “The Intern Blues, The Timeless Classic About the Making of a Doctor” by Robert Marion, published in 2012. This ebook documents the internship experiences of three medical school graduates in the mid 1980’s.

At that time, interns were “on call”– had to work eighteen to twenty-four hours in a row, usually overnight, in a hospital every three days. Every month for an entire year, the interns in this ebook were assigned to a different unit such as pediatrics, neonatal intensive care, or the emergency room, at a medical center in the Bronx in New York City.

The hospital staff was kept busy treating patients with conditions whose causes were poverty-related— people in poor health, and those who suffered physical harm from violence and drugs. Many patients and their families had psychological problems. One intern remarked, “…we have two psychotic crackheads roaming around the ER, we also had two psychotic crackheads who were paranoid and had no idea what was going on, which is a wonderful combination.”

Severely sleep-deprived, along with doing a ton of paperwork and presentations, the interns had to admit patients, keep “…track of names, symptoms, physical findings, lab results, and treatments…” They witnessed life-or-death situations for which they felt they were not psychologically prepared. They had to tell patients’ families that their loved ones had died, make serious decisions on whether to report child abuse to the authorities (which was a whole bureaucratic process itself), deal with difficult nurses and lab technicians, not to mention their supervisors; all this, along with the extremely stressful circumstances surrounding the AIDS epidemic.

On top of that, one of the three interns became pregnant during her internship. Read the book to learn how that worked out for her, and to get an insider’s view of what it was like to be a medical intern a few decades ago.

The Cure

The Book of the Week is “The Cure” by Geeta Anand, published in 2008. This ebook tells the emotional, suspenseful story of how a family coped with three disabled children, two of whom were suffering from a genetic disease for which a cure is yet to be found.

In the late 1990’s, John Crowley’s daughter and son were both diagnosed with Pompe disease, a muscle disorder. Patients, with varying severity, “have imperfectly produced acid alpha-glucosidase enzyme” which results in paralysis, obstructed breathing, and, if left untreated, death before the age of five.

Even though Crowley possessed the personality, talents, skills, education and privileged background that one would think would allow him access to a life-saving enzyme to save his children, he had to face numerous obstacles. The father naturally fell into the role of entrepreneur to do so. His wife provided invaluable emotional support and around-the-clock care of the children with the help of nurses; not to mention the running of the household.

Nevertheless, lots of genetic and environmental luck determines whether patients become fully cured and/or whether the quality of their lives improves significantly, or whether they die– even when they are sufficiently fortunate to take part in a trial of a new life-saving medicine. Death would be inevitable without the medicine.

Every patient is different. There are many different criteria the U.S. Food and Drug Administration considers when deciding whether to approve particular medical products for sale. Money plays a major part in whether a new product ever sees the light of day. A young medical research company raises funds through venture capitalists, and because the whole operation carries extremely high risks, if the company achieves success– the rewards, fittingly, are also extremely high.

Scientists must do years of preclinical testing on animals to make sure a new medicine works sufficiently well before even considering administering it to humans. In the United States, possible deadly consequences and possible future litigation motivate the scientists to act with integrity by performing tightly controlled experiments, so as not to have to fudge research results.

Another aspect of drug development, is avoiding a conflict of interest such as that in Crowley’s situation. He played a pivotal role in the race to bring a medicine to market; it appeared he was doing it to get the medicine for his own children.

The estimated annual expense of the enzyme for each child was $200,000, and $1 million for all future annual medical expenses, including the enzyme, plus wheelchairs, nurses, ventilators, catheters, etc.

Read the book to learn of the Crowley family’s experiences with American biotechnology.