Personal Account of Medical Worker or Student or Patient – Page 2

Doctored

The Book of the Week is “Doctored” by Sandeep Jauhar, published in 2014. This is an eloquently written autobiographical slice of life from a cardiologist in Long Island, NY, within the last decade.

Dr. Jauhar suggests that America’s broken health care system is the fault of all parties involved– the government, the doctors, the insurance companies and the patients. He writes that his specialty, heart failure, actually generates losses for the hospital at which he is employed. The money is in the installation and monitoring of stents and pacemakers, not prolonged hospital stays of patients. He resists going into private practice because he would be a “…grunt, overtesting, kissing ass for referrals, fighting insurers to get paid” not to mention being forced to pay the out-of-pocket, astronomical cost of medical malpractice insurance. Medical school doesn’t show students the real-world worries of practicing medicine in the United States. One of countless worries of doctors is of lawsuits brought by litigious patients, notwithstanding the malpractice insurance.

Doctors have to deal with a slew of issues peripheral to treating patients; among them, that doctors these days have trouble making a living due to the facts that reimbursement of Medicare and insurance companies to doctors are at an all-time low, and doctors have the burden of student loans while possibly trying to move into their own home and raise a family. This puts pressure on them to engage in the behaviors of private practice mentioned above.

The pay of even an “attending physician” (employee) such as Dr. Jauhar, fluctuates with the amount of revenue he generates for his employer. He writes, “Insurers can make doctors jump through hoops to get paid… tell patients which doctors they can see… restrict medications. But they still cannot…” control the referrals doctors make to other doctors.

Read the book to learn about the (sleazy) strategies used by the medical community to protect itself against (stingy and at times, unreasonable) insurance companies, the author’s moral dilemmas on his own situation told through real-patient anecdotes, and the author’s family life.

Side Note: Despite the flaws in the way health care is provided in the United States– as John and Hank Green (YouTube Nerdfighters) directly or indirectly remind viewers in every video they make lately– people born in the United States have won the world birth lottery, and thus have access to the best life-saving and life-prolonging technology, procedures and treatments, due ironically to the profit motive.

Behind the Gates of Gomorrah

The Book of the Week is “Behind the Gates of Gomorrah” by Stephen Seager, published in 2014. This book describes the personal experience of a psychiatrist working with violent criminals in a state mental hospital in California. He was the only medical doctor on his unit. The rest of the workers who treated the patients were psychologists and nurses. Some of the patients were faking mental illness because they would rather have been there than in prison. All the patients had taken human lives; some in gruesome ways.

Almost every week, there were emergencies with sirens blaring, usually due to patients’ poor impulse control. The patients would engage in physical fighting with eyeglass stems or other sharp weapons they fashioned themselves, just like in prison. But they hurt hospital employees too, even killed a few through the years. The employees were unarmed (unlike prison guards). The patients fought for their legal rights (like obtaining eyeglasses, which they would accidentally-on-purpose damage so as to get a new source of weapons). According to the book, on the author’s first day at work, he had to have ten stitches in his scalp when he was caught in the middle of a patients’ fight.

There was a tendency on the part of the employees to rationalize their bonding with the patients. It seemed to this blogger that the employees were showing signs of “Stockholm syndrome.” In some ways, the employees were actually captives.

Read the book to learn the answer to the question: “If lots of people are mentally ill, and the great majority are not violent, who then should we be worried about?” [the ones who go on shooting sprees] Here’s a hint: It’s not those who have autism, OCD, depression or the “foil-hat-wearing, babbling street schizophrenic.”

Struck By Genius – Bonus Post

This blogger skimmed the repetitive ebook, “Struck by Genius” by Jason Padgett and Maureen Seaberg, published in 2014.

This ebook tells the story of how Padgett, the victim of a mugging, suffered a traumatic brain injury, and not only lived to tell about it, but also experienced improved cerebral processes (along with some negative side effects) due to it.

Padgett developed the conditions of savantism and synesthesia. The former causes his vision to form geometric patterns in everything he sees; he also acquired a natural, conscious talent for mathematics and physics which he had not previously had. Synesthesia means he sees a specific color when he sees a specific number or letter.

Read the book to learn of the psychological problems that have plagued the author since he was violently struck on the head, and the two with which he still grapples; how he finally became sufficiently functional to learn more about his conditions, and to find and contact other people with the same symptoms.

God, If You’re Not Up There, I’m F*cked

The Book of the Week is “God, If You’re Not Up There, I’m F*cked” by Darrell Hammond, published in 2011. This ebook is the autobiography of a professional entertainer who recounts how he has dealt with his serious psychological problems.

As a versatile impressionist of celebrities, Hammond made appearances on the TV show “Saturday Night Live” for about a decade and a half, starting in 1995. He describes the show’s people thusly: “…an incredible staff of Emmy winners– hair, make-up, costumes, writers, producers.”

Hammond grew up in Melbourne, Florida, and moved to the Hell’s Kitchen section of New York City as an adult. He erroneously writes that the Javits Center is at Forty-Second Street– an easy error to make for even clear-headed New Yorkers, as the city has so many famous points of interest; keeping their locations straight is a tough job.

However, from his twenties to his fifties, the author was often drunk, high, cutting himself, and/or trying to escape uncomfortable feelings in other ways that resulted in his taking various medications (some self-prescribed), numerous emergency room visits and psychiatric hospital stays. This was because, in his childhood, Hammond experienced extreme psychological and physical abuse at the hands of his mother, and was witness to the violent behavior of his father, a veteran of two wars. Hammond concisely states that he was plagued by alcoholism and trauma– a progressively fatal combination.

Hammond naively went from one psychiatrist to the next, each one misdiagnosing the cause of his behavior by labeling it as schizophrenia, bipolar disorder, etc. This way, they could write prescriptions for anti-psychotic drugs for him. They were afraid he would commit suicide on their watch, so it was safer for them to minimize his ability to harm himself.

Read the book to learn of: how Hammond beat the odds despite his problems; what happened when he finally found a competent doctor; the three kinds of bipolar disorder; and intimate details of the culture of Saturday Night Live.

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.

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.