Tuesday, December 31, 2013

Misguided Judicial Sympathy

The ghoulish circus surrounding the tragic death of Jahi McMath continues. Alameda County Judge Evelio Grillo has ordered Children's Hospital Oakland to keep her on a ventilator for another week while the family attempts to find a facility that will receive the brain dead girl following complications from a tonsillectomy last week.

I don't know what Judge Grillo is trying to accomplish by prolonging this agony. Multiple physicians, including a court appointed neurologist from Stanford University, have declared Jahi brain dead. Very specific and universally accepted guidelines have been developed over the years to help doctors decide without a doubt when patients are dead. These rules were made to prevent this very type of madness that can occur when grieving families refuse to let loved ones go and doctors are afraid to step up and make the decision for the good of the deceased.

Judge Grillo has taken it upon himself to overturn decades of medical ethics teaching and ruled to keep a human body hooked up to machines despite the unanimous consensus of doctors that Jahi is never going to recover her neurologic functions. Does he think he is doing her family a favor by keeping their daughter on a machine? How can this family ever have closure and grieve properly when they see their child involuntarily twitch to the touch and continue to have a pulse that the machines are providing for her?

What do the actions of Judge Grillo say to doctors all over the country about how their medical decisions can be overturned at the whim of the family and a single non medically trained person wearing a black robe? This is the reason doctors are so leery of stopping treatments for the terminally ill, or in this case deceased, even though all hope of recovery is lost. We are the ones who are at the patients' bedsides every day and are in the best position to decide the best course of action. But because of legal actions like the ones being made by Judge Grillo, any disgruntled family member can make a simple call to a lawyer and effectively make a law judge the patient's caregiver despite having little to no knowledge of medicine. I also find it extremely ironic that the courts will allow a family to keep a dead patient alive on a machine yet at the same time have no difficulty declaring the killing of living fetuses as a constitutional right.

In the meantime the McMath family is trying to find a nursing home that will accept Jahi once she has a gastrostomy tube and a tracheostomy. I don't blame the hospital or its doctors for refusing to perform either of those procedures. It is ethically unacceptible to perform these surgical procedures on a deceased patient. The best thing the family can do is accept the tragedy that has beset them and donate her organs to others who will truly survive with their daughter's gifts. Only then can they come to peace with her fate. After that they can call their medical malpractice lawyer for issues that the courts really are supposed to adjudicate.

Monday, December 30, 2013

Five Hundred Thousand And Counting

It's hard to believe, but my humble little anesthesia blog has just surpassed 500,000 page views. Though that is pretty puny by Amazon, Google, or Facebook standards, it still blows me away that that many people are seeking some sort of information about anesthesia and anesthesiology. As you can see on the map above, virtually every country in the past four and a half years has visited this blog at least once. The only exceptions are the dictatorship of North Korea, who keeps virtually all of its citizens in a technology blackout, and the impoverished nations of sub-Sahara Africa and central Asia.

When I first started this blog on a lark back in July, 2009, it was in response to all of the negative news about anesthesia that was circulating in the media after the death of Michael Jackson at the hands of his pseudo doctor Conrad Murray. I felt that somebody with actual knowledge of anesthesia should have a say about how our drugs are actually supposed to work in the hands of competent and well trained physicians. Since then, I have ventured far and wide in the subjects that I have cared for and written about, everything from food, to humor, to money. Sounds a little like Maxim without the hot models on the homepage.

Ironically, the most popular post I have ever written isn't even about anesthesiology. It was a simple observation that I have frequently made in the operating room. Titled "The Dirtiest Part Of The Body," it has consistently garnered the most views month after month since shortly after it was published in June, 2012. I had no idea there were thousands of people who sat around and wondered which part of their anatomy was the most disgusting.

The second most frequently visited post is a little autobiographical essay that I wrote called, "Why I Chose Anesthesiology." I started that piece to help students and residents decide what they want to do with their lives. As anybody who has ever trained students know, one of the most common questions that is asked is why somebody decided to go into a certain medical field. Everybody has a different explanation but I thought writing this on a blog would disseminate the information more widely. And I was right. I get lots of correspondence from students asking for more information after they have read that article. From there, it turned into a series of posts that chronicled my struggles through residency and its eventual happy ending. I have received many emails complimenting me for my candid story of how difficult choosing the correct residency can be.

So I hope all you readers have enjoyed following me through the years as I've written about medicine, politics, money, and whatever I felt was worth an hour of my time to sit down and write. Thanks to all of you for keeping this blog going for all these years. There is nothing that motivates us blog writers more than the occasional reader comments, whether critical or appreciative. Nothing will drive a blog quicker to its death than apathy. I look forward to hearing from you readers as this blog rolls on into the new year.

Top Ten Blog Posts Of All Time

1. The Dirtiest Part Of The Body

2. Why I Chose Anesthesiology

3. How To Get Into An Anesthesiology Residency

4. Orthopedics vs. Anesthesia

5. The Difficult IV

6. Surgery, A Siren That Will Break Your Heart And Crush Your Soul

7. The Easy Way To Decide What Kind Of Doctor To Be

8. ASA President Defends Anesthesiologists, Feebly

9. Why Is The Operating Room So Damn Cold?

10. Stress Of Being An Anesthesiologist

Wednesday, December 25, 2013

Why We Love Southern California

This is the reason we love living in SoCal. On this Christmas Day, it was nearly eighty degrees outside, perfect weather for going to the park after the kids had opened up all their presents. Hope everybody else had a great Christmas too.

Saturday, December 21, 2013

Orthopedic Surgeons Are Dumb. Fact Or Fiction?

We often chide our orthopedic surgeons for their supposedly inferior intellects. After all, it doesn't appear that it would take too many brain cells to wield a hammer or direct a power drill. There are plenty of jokes about the half-witted orthopods: How does an internist keep elevator doors from closing shut--she uses her arm to stop the doors. How does a general surgeon stop the doors--he uses his foot. How does an orthopedic surgeon stop the doors--he uses his head. Then there is the viral video from a couple of years ago, Orthopedics vs. Anesthesia, that pretty much encapsulated our experiences with our orthopedic colleagues.

But how much of this belittling of the orthopods is justified? Surprisingly there is a study that looked into this very topic. An anesthesia colleague of mine passed along this paper that was published in BMJ.com (formerly British Medical Journal) from two years ago. Written by orthopedic surgeons, it attempts to put to rest the notion that orthopods are nothing more than big lumbering steroidal idiots.

Thirty-six orthopedic surgeons at three British hospitals voluntarily subjected themselves to a Mensa intelligence exam along with a hand grip test to measure their physical strengths. Forty male anesthetists (their terminology) volunteered to do the same. Female anesthetists were excluded because the researchers couldn't find enough female orthopedic surgeons for comparison. A formal IQ test was not performed due to its complexity. Therefore the results are not directly comparable to a real IQ test and the numbers do not reflect the test takers' IQ.

The results showed that the surgeons scored slightly higher than the anesthetists on the intelligence test, with a mean of 105.19 vs. 98.38. The orthopod researchers condescendingly expressed astonishment with the test scores by noting that anesthetists were frequently seen working on crossword and Sudoku puzzles. As for physical strength, it's no surprise that the surgeons won easily. It doesn't take a lot of hand strength to hold a pencil to complete my crossword puzzles.

Surprised by the study's conclusions? Perhaps we shouldn't be. Orthopedics is one of the most competitive residencies to attain. No longer is it the last bastion of college jocks who weren't quite good enough to make it onto the varsity football team. It takes a lot of smarts for an orthopedic residency program to even consider a candidate. Having said that, in the paper's scatter gram of test scores, there is one anesthetist who scored only 60 on the exam. I wonder how much this one individual skewed the results since there were so few participants to begin with.

So next time you think about using monosyllabic words to communicate with your orthopedic surgeons, remember that he maybe hiding his brilliant acumen behind a humble facade. Or maybe not.

Monday, December 16, 2013

A New Way To Give Anesthesia For Colonoscopies

Now here is a new way to give anesthesia for a colonoscopy. I didn't know that the brachial plexus reached all the way down to the large intestine. I must have missed that class in residency.

Sunday, December 15, 2013

The HP iPAQ. That Is Not A Typo

Recently I was cleaning out my old electronics drawer (every guy has an old electronics drawer full of stuff that he can't bear to discard) and I came across an old device that I hadn't given a second thought to in years, my old HP iPAQ powered by Microsoft's Pocket PC. This was HP's answer to the successful Palm Pilot and a precursor of the iPhone and iPad. I'm surprised HP never sued Apple for trademark infringement.

Out of curiosity I juiced up its removable battery overnight then powered it on. After a couple of minutes when nothing happened and I thought the machine was truly dead, the screan turned on. Oh the memories started flooding back. When I had this thing in the early 2000's, it was the cooliest device around. While others were merely carrying around iPods that could only play music, my iPAQ could play MP3's, surf the internet, send emails, and do pretty much anything a Windows desktop can do. Microsoft even included Pocket PC versions of Excel and Word, a marketing strategy that it continued when it introduced Windows RT tablets last year.

And just like Windows RT, the Pocket PC operating system is a memory hog. The iPAQ comes with less than 64 MB of memory. That's right, MEGABYTES. Only power users using desktop workstations had access to gigabytes of memory at that time. MS was able to squeeze in a minimized version of its desktop OS but only by consuming nearly half of the machine's memory. Luckily, unlike an iPad, the iPAQ has an SD card slot at the top. I tried inserting a 32 GB card but it wasn't recognized. But when I put in a 512 MB card, it read it right away. It seems ludicrous nowadays that a 512 MB memory card can be useful for anything. But that will hold about 100 MP3 songs which was far better than toting around a bunch of CD's and a CD player that some anesthesiologists had to use at that time.

After playing around with it awhile, I remembered why I stopped using the iPAQ. First of all, this version did not include cellular functions so it was basically just a PDA. Other versions of the iPAQ did have cell phone functions though. Then its ability to subsitute for an iPod was severely compromised by a loose headphone port. I have to fiddle with the headphone jack for it to seat properly in the port and then it will only play out of one speaker instead of stereo. Finally the data port on the bottom broke loose, making it impossible to charge and sync information directly. I can exchange information by swapping out the SD card and I can charge the battery with the separate battery charger but it is a pain. Removing the battery to recharge it erases all the previous settings and I have to start all over again when I turn it back on.

So there you go, a report on everything you've always wanted to know about a ten year old HP iPAQ. It was far more functional than the old Palms and Apple Newtons. With its touch enabled color screen and included stylus, internet connection, Bluetooth capability, media player, and functional versions of Word and Excel, it seemed like it was an inspiration for the iPhone which would be introduced in just a few years. The iPAQ was truly ahead of its time.