This is just another moment where i can use the internet to hopefully increase awareness regarding a proposed HHS regulation that will have far reaching effects if passed. The regulation will broaden the already present 'conscience clause' to include institutions and those not directly involved with the procedure deemed morally objectionable. This would mean in simple terms that the person who would clean the intruments after an abortion or sterilization technique could not be fired based on his objection to the procedure and can legally not do his job, because he/ she feels morally against the procedure. The new proposal also includes language that is quite vague and open to interpretation. We only have until sept 25 to post comments on the new regulation, so if you have a moment i highly suggest that you go online, take a look at the propsed amendment and post a comment. Since administrative agencies are appointed by the executive branch of government (non elected positions) we have the ability to let them know how we (the people) feel about the changes. These do not go before the legislation, and do not require the same type of voting process to be enacted. This is very important for the future of women's health. Please take a few minutes if you can.
here are some links to help you out.
http://www.regulations.gov/fdmspublic/component/main?main=DocumentDetail&d=HHS-OS-2008-0011-0001
you can view the proposal and follow the instructions to make comments
Sunday, September 21, 2008
Sunday, September 14, 2008
a moment of reflection....PALIN
Ever since i heard about the pick for VP, the name evokes an emotional response - and its not one of those warm and happy feelings. This simple decision, the pick for VP on the republican ticket simply put, gives me nightmares and panic attacks. At first glance, it seems that the McCain is trying to do the smart thing by placing a women to take the 'would be Hillary' votes - but that concept sickens me. Palin is the antithesis to everything Hillary stands for, thinking that women will vote for someone based on the fact she has a vagina is a personal insult to my intelligence and the intelligence of women everywhere. If you believe in what Palin stands for than there is no way you would have voted for Hillary, unless you vote based on gender alone. Joe Biden is more aligned with Hillary politics, and has a record of fighting for woman's rights, unlike Palin - who wants to see us without personal rights.
Having this woman, Palin - take a position that is literally a heart beat away from the presidency frightens me more than 4 more years of Bush. Did you watch her ABC interview?? After watching the interview i am not sure she is qualified to be in national politics - she should stick to alaska (pop 900,000).
feel free to watch the interview and judge for yourself.
Palin interview 1/4
palin interview 2/4
Palin interview 3/4
Palin interview 4/4
here are some of the reasons she frightens me:
- doesnt believe in evolution (she believes in creationism, and thinks this is what needs to be taught in schools) - i guess this means we have no responsibility in furthering the species, god will take of it, sounds a lot like someone who has been president for the past 8 years..
- doesnt believe in abortion even in cases of rape and incest - this is more radical than most republicans who at least want women who have been victimized the right to not have the child born out of hate.
- clearly doesnt believe in teaching the youth about comprehensive sex education, and strongly believes abstinence education works - has she seen her daughter lately??? great work!
- HAS NO, i repeat NO foreign policy experience or knowledge - did you watch the video??
- would be an embarrasement representing our country to foriegn heads of state...yikes! i hope the rest of the world doesnt think all women in the US are like her..
- is a proud member of the NRA, enjoys hunting (has been trying for years to have polar bears taken off the endangered list so she could hunt them)
- thinks oil is the best form of energy and wants to drill in the alaskan wilderness
- IS CURRENTLY being investigating for abuse of power (sounds familar too!)
- remember the 'bridge to nowhere' - seems like someone is a 'flip flopper' on that issue. Evidence she says what she needs to, to get elected. (also sounds familiar)
clearly i think everyone has the right to vote for the candidate they think will do the BEST job. So if you think you Palin is a qualified VP and possibly president (McCain is not getting any younger) then go ahead and vote for the ticket. But if past performance is a sign of future performance, than take a look at her track record. The issues she stands for, and think about what type of person makes those decisions and thinks that way.....do you want that to represent us as a country??? do you really think that it will be any different than the current administration??
I actually think it will be worse than the current administration. Just remember the roles that government plays....taxes are decided by legislation, appointments are made by the executive branch (including appointments to the judicial branch, and other administraive agencies)
well i guess that includes my two cents for the day. If you do nothing else today. Please watch the ABC interview...also if you disagree with me and are in favor of the candidate, please let me know why, i am curious.
Having this woman, Palin - take a position that is literally a heart beat away from the presidency frightens me more than 4 more years of Bush. Did you watch her ABC interview?? After watching the interview i am not sure she is qualified to be in national politics - she should stick to alaska (pop 900,000).
feel free to watch the interview and judge for yourself.
Palin interview 1/4
palin interview 2/4
Palin interview 3/4
Palin interview 4/4
here are some of the reasons she frightens me:
- doesnt believe in evolution (she believes in creationism, and thinks this is what needs to be taught in schools) - i guess this means we have no responsibility in furthering the species, god will take of it, sounds a lot like someone who has been president for the past 8 years..
- doesnt believe in abortion even in cases of rape and incest - this is more radical than most republicans who at least want women who have been victimized the right to not have the child born out of hate.
- clearly doesnt believe in teaching the youth about comprehensive sex education, and strongly believes abstinence education works - has she seen her daughter lately??? great work!
- HAS NO, i repeat NO foreign policy experience or knowledge - did you watch the video??
- would be an embarrasement representing our country to foriegn heads of state...yikes! i hope the rest of the world doesnt think all women in the US are like her..
- is a proud member of the NRA, enjoys hunting (has been trying for years to have polar bears taken off the endangered list so she could hunt them)
- thinks oil is the best form of energy and wants to drill in the alaskan wilderness
- IS CURRENTLY being investigating for abuse of power (sounds familar too!)
- remember the 'bridge to nowhere' - seems like someone is a 'flip flopper' on that issue. Evidence she says what she needs to, to get elected. (also sounds familiar)
clearly i think everyone has the right to vote for the candidate they think will do the BEST job. So if you think you Palin is a qualified VP and possibly president (McCain is not getting any younger) then go ahead and vote for the ticket. But if past performance is a sign of future performance, than take a look at her track record. The issues she stands for, and think about what type of person makes those decisions and thinks that way.....do you want that to represent us as a country??? do you really think that it will be any different than the current administration??
I actually think it will be worse than the current administration. Just remember the roles that government plays....taxes are decided by legislation, appointments are made by the executive branch (including appointments to the judicial branch, and other administraive agencies)
well i guess that includes my two cents for the day. If you do nothing else today. Please watch the ABC interview...also if you disagree with me and are in favor of the candidate, please let me know why, i am curious.
Thursday, September 11, 2008
prison break
Well, i am about to complete my second week working in a prison. I really never thought i would be able to type those words. And unlike my two roommates, i have acclimated well, and even - shudder- started to enjoy myself. The work is interesting, challenging and starting to be rewarding. The two men, or boys, i live with seem to approach ever task with a negative attitude and horrible outlook. Besides being irritating to me, they have started to rub the nurses and staff at the hospital wrong too, so people are not willing to help them out, causing them to get more frustrated, and thus the cycle continues. Today in particular i thought about two proverbs that seem to fit the situation quite nice,
1. you catch more flies with honeythan with vinegar
2. when life hands you a bag of lemons make lemonade
i have started to ignore the horrible comments my roomates make, the constand disregard for those that work and live in the area on a more permanent basis - instead, i decided to just make the most of the two months i have here to learn something. Holy crap! it works :) I walk in smile, say good morning, made an effort to learn the security guards names, the nurses and the other key players (scheduling secretary, radiology techs, transcriptionist and the outpatient clinic nurses) - all this takes very little effort, but the payoff is amazing and already showing results.
For instance, i work in a government institution - the department of corrections, which is currently running with a 13 million dollar deficit (sound familar, like a microcosm of CMS???) basically all this means, is paperwork and lots of it. you want something done, you need to fill out a specific form, have it approved, signed by the correct people and placed in the hands of the correct people to have done, whatever it is you want done. On top of that, certain tests or doctors are only in the prison on certain days. If you want an MRI better have it mon or fri. If you want it read by the radiologist check the schedule to see who is working that can read that MRI. You want your inmate (patient) to see a cardiologist, fill out a form, include all justifying documents, have it approved, signed and give it to the floor secretary who will send it to the scheduling secretary who then faxes it to the medical center to hopefully get scheduled....yep it sounds complicated, and there is a LOT of paperwork.
The same thing happens for medications that are not formulary, or if you want a patient on certain antibiotics or pain medications. Forms, approvals and multiple people before it happens. If you are reading this i think you can figure out where understanding where and how to grease the wheels can benefit your patient.....and being a jerk to everyone is NOT the way to get anything done quickly, esp because most things that are quick, are still not quick by the standards we are used to in the private hospital settings....but here is how i managed to get around this....
for instance today, i have an inmate with a large list of problems, some urgent and others more chronic. But overall he is not doing well, and there have been moments where i wish Dr House would show up and help me diagnosis this patient. But i am trying to do the next best thing, i am advocating for him and his health. He needed to see a neurologist, it is taking too long to get an appointment....so i walked down to scheduling and asked who is the person to talk to re scheduling. I then asked what i need to fill out to have my patient moved to the appointments for tomorrow....she told me, i did it. He was seen. The MRI i had shot last week still had not been read. I waited in radiology for the radiologist to show up, had the film in my hand, and asked him to go over it with me. Had him dictate, asked the transcritionist to transcribe it - then walked it over the appointment with the neurologist. He then recommended that he see an ENT ASAP. I started to fill out the paperwork, went back to scheduling to find out when the next day the ENT is here...its tomorrow, ok. What do i need to do to get him on the list. I got her copies of the consult, the MRI report and my phsyical exam from that day. DONE. he is seeing the ENT tomorrow.
Later in the day i was dealing with another patient, and it turns out one of my forms had not been signed by the correct physician to have the approval. The scheduling secretary came up to the floor (almost unheard of) found me, and told me she is going to track down the medical director for me to have him sign it. Amazing. She really could have simply said the request was denied and than i would have to start all over again and the next week, my patient would have gotten worse....as she has done for the other people who are not nice to her.
the boys constantly want to know how my patients labs, consults and radiology is scheduled, completed and read - while they are still sitting around with their thumbs in their butts. I try to tell them to just be nice to people. Instead, one of my roomates, tries to tell me, "the way things get done is by talking to people like they are stupid, and pointing out their mistakes." Sometimes i wonder if people can hear themselves speak....
i have found that my days go back quickly, there is always something to be done, something to follow up with - or someone to chat with for a few minutes today who will be able to help me out tomorrow. Truly amazing and simple lessons to be learned. I have learned and seen a lot of amazing medicine, but the life lessons of dealing with people is by far the greatest acheivement so far.
i will upload pics when i have some faster internet...if you have facebook you can check them out - they are already posted!
Saturday, September 6, 2008
how do i seem to attract the psych cases.....
well, so far this rotation has definitely been able to live up to the reports from previous students...the pathology is AMAZING and i have been told i will learn a lot during the two months and be more than prepared to deal with most situations i will encounter during my intern year....
it seems i am already getting that experience even on my 3rd day. Each day we get a new patient, so if we can transfer, or discharge the patient we will have less patients to see the next day. My counterparts ended Friday afternoon with 1 each, i on the other hand have 3. I spent four hours on the phone trying to 'turf' one of my patients unsuccessfully. Let me give you a quick recap about the patient (inmate)..
it all started on thursday when my attending looked with a smirk in my direction, and mentioned he has a great case for me - a chronic swallower!
yep thats right, you read that correctly - he gave me an inmate that swallows foreign bodies, and will sometimes require surgery to remove the items. He has been doing this for the past 40 years and knows a lot about the medical system and the correctional system (he is serving what is effectively a life sentence - 165 years without parole). I refused to give him pain medications, so he can have tylenol and motrin. He swallowed 6-7 metal objects 5 days ago, has not passed any gas or had a bowel movement since that time. I can visualize them on XRAY. In the past he has had 78 abdominal surgeries for similar episodes and the surgeon that normally operates on him is in italy for the next two weeks. The partner refuses to take him, and told me to manage him until he gets worse, there are no other surgeons willing to take the case. The inmate gets frustrated because i am not providing him with medical care so he swallows a spring loaded object and shoves a spring into his abdomen so its protruding about 2inches from the skin (and is about 5 inches into the abdominal cavity). Of course he does this at 4pm on a friday. Seriously.... why does this happen when i am trying to leave for the weekend?!?!
i removed the object, gave him some pain medication that in reality is more of a placebo than a narcotic, started to feed him with the idea of pushing some of the objects along and adding some bowel prep for fun....if he wants to be difficult, two can play that game. I also had all the furniture removed from his room and left him wit a blanket, mattress on the floor and a shroud to wear. I am hoping he doesnt find any more objects to swallow over the weekend and i have arranged to have him transferred to another facility monday for a scope to try and remove some of the objects.....
my other cases just make me feel like House. They are a constellation of symptoms without a clear cut diagnosis because of the multiple underlying diseases....
this is def going to be an interesting two months....
not to mention i live in a trailer and florida is gearing up for a major hurricane to strike next week...i hope i will be ok and not have to evacuate....stay tuned to hurricane Ike, it is going to get interesting.
it seems i am already getting that experience even on my 3rd day. Each day we get a new patient, so if we can transfer, or discharge the patient we will have less patients to see the next day. My counterparts ended Friday afternoon with 1 each, i on the other hand have 3. I spent four hours on the phone trying to 'turf' one of my patients unsuccessfully. Let me give you a quick recap about the patient (inmate)..
it all started on thursday when my attending looked with a smirk in my direction, and mentioned he has a great case for me - a chronic swallower!
yep thats right, you read that correctly - he gave me an inmate that swallows foreign bodies, and will sometimes require surgery to remove the items. He has been doing this for the past 40 years and knows a lot about the medical system and the correctional system (he is serving what is effectively a life sentence - 165 years without parole). I refused to give him pain medications, so he can have tylenol and motrin. He swallowed 6-7 metal objects 5 days ago, has not passed any gas or had a bowel movement since that time. I can visualize them on XRAY. In the past he has had 78 abdominal surgeries for similar episodes and the surgeon that normally operates on him is in italy for the next two weeks. The partner refuses to take him, and told me to manage him until he gets worse, there are no other surgeons willing to take the case. The inmate gets frustrated because i am not providing him with medical care so he swallows a spring loaded object and shoves a spring into his abdomen so its protruding about 2inches from the skin (and is about 5 inches into the abdominal cavity). Of course he does this at 4pm on a friday. Seriously.... why does this happen when i am trying to leave for the weekend?!?!
i removed the object, gave him some pain medication that in reality is more of a placebo than a narcotic, started to feed him with the idea of pushing some of the objects along and adding some bowel prep for fun....if he wants to be difficult, two can play that game. I also had all the furniture removed from his room and left him wit a blanket, mattress on the floor and a shroud to wear. I am hoping he doesnt find any more objects to swallow over the weekend and i have arranged to have him transferred to another facility monday for a scope to try and remove some of the objects.....
my other cases just make me feel like House. They are a constellation of symptoms without a clear cut diagnosis because of the multiple underlying diseases....
this is def going to be an interesting two months....
not to mention i live in a trailer and florida is gearing up for a major hurricane to strike next week...i hope i will be ok and not have to evacuate....stay tuned to hurricane Ike, it is going to get interesting.
Tuesday, September 2, 2008
Day 1
Today we had the orientation....all day....government organizations have one thing in common, paperwork, and lots of it.
We learned about the facility and how we function on a daily basis...
some of the fun facts we learned today -
-- always have your personal body alarm on you, even though it doesnt really work
-- if you feel threatened, knock a phone of the hook and help will come
-- do not bring any electronic items into the prison (it is now a 3rd degree felony)
this includes: cell phones, PDA's, flashdrives, cameras etc
-- do not wear blue scrubs - the inmates where blue
-- come in tomorrow at 7:30am for patient assignments.
more updates and pictures to follow
We learned about the facility and how we function on a daily basis...
some of the fun facts we learned today -
-- always have your personal body alarm on you, even though it doesnt really work
-- if you feel threatened, knock a phone of the hook and help will come
-- do not bring any electronic items into the prison (it is now a 3rd degree felony)
this includes: cell phones, PDA's, flashdrives, cameras etc
-- do not wear blue scrubs - the inmates where blue
-- come in tomorrow at 7:30am for patient assignments.
more updates and pictures to follow
Monday, September 1, 2008
Operation Trailer Trash.....
Its been a long time since i have posted anything, mostly because i didnt have much to say. Or i was busy...either way - here is the recap of the past few months...
i finished 3rd year in june started 4th year in july after a 10 day vacation (spent moving home to detroit from florida and studying for boards....not much of a vaca really). The next two months were spent trying to impress potential residency programs, so i will not be posting about those - just know, i DEFINATELY want to do surgery, that has been made cyrstal clear the past two months. Now onto the next phase....
I have just moved into a double-wide trailer, i will be rooming with two married men (also 4th year med students and classmates of mine) where we will live and work together as the medical team at North Florida Reception Center. If it seems like a reality show, its not - its my reality.... i will be posting pictures of the facility later this week (we have very slow internet)
Here is how my introduction to life as TT (trailer trash) started... I pulled into the main entrance of the prison in an attempt to find the 'main control room' so i can pick up my key. After pulling into the wrong gate and being redirected by a guy with a machine gun, i found the control room. I placed my ID against the glass and behind the steel bars while i introduced myself, the guards seemed confused - probably because of my appearance (wearing yoga pants, an old navy shirt and my hair is a disaster after driving for the past 8 hours without a break) They find my key and slide it through the bars, i take the sealed envelope and leave the building. I then start the process of finding my trailer - known as the 3rd trailer on the left.
there are no street signs or roads, just what appears to be a solid field of concrete. I see a row of trailers in the distance and have to assume that is my new residence. I count to three, park take a second to allow my surroundings to set in, and get out to walk to my door. I try the key secretly hoping that it wont work, but it turns and i walk into, *sigh* my trailer home for the next two months. Its actaully quite nice on the inside, we have satelite dish tv, a 40" in the living room, brand new appliances and mosdest size bedrooms. The only DVD on the shelf is "escape from alcatraz" - feel free to laugh, i did.
I unpacked and inflated my airbed - then decided to try and find food for dinner. According to my GPS - everything is about 15 miles away, but i managed to find a CVS with some lean cuisines. Agenda for tomorrow is finding grocery store.
Right now i am waiting for my roomates to arrive - yes, the two married men. (also be on the look for pictures), in the meantime i am relaxing on the couch watching the premiere of 'gossip girl' - just realized we dont get BRAVO (ugh no project runway...this totally sucks, but at least i will be able to watch the 2hour premiere of 90210!!)
cell service is shaddy - but texting seems to work.
GPS - unable to locate the trailer address
8343 SW 155th rd Box #3
Lake Butler, FL 32054
**in case you want to send something***
looking forward to not working weekends and making some trips to tampa, gainesville, orlando and miami...at least there is something to look forward to
i start working tomorrow at 8am - have no idea what to expect but will definately be posting and letting you all know what happens as operation trailer/jailhouse continues:)
i finished 3rd year in june started 4th year in july after a 10 day vacation (spent moving home to detroit from florida and studying for boards....not much of a vaca really). The next two months were spent trying to impress potential residency programs, so i will not be posting about those - just know, i DEFINATELY want to do surgery, that has been made cyrstal clear the past two months. Now onto the next phase....
I have just moved into a double-wide trailer, i will be rooming with two married men (also 4th year med students and classmates of mine) where we will live and work together as the medical team at North Florida Reception Center. If it seems like a reality show, its not - its my reality.... i will be posting pictures of the facility later this week (we have very slow internet)
Here is how my introduction to life as TT (trailer trash) started... I pulled into the main entrance of the prison in an attempt to find the 'main control room' so i can pick up my key. After pulling into the wrong gate and being redirected by a guy with a machine gun, i found the control room. I placed my ID against the glass and behind the steel bars while i introduced myself, the guards seemed confused - probably because of my appearance (wearing yoga pants, an old navy shirt and my hair is a disaster after driving for the past 8 hours without a break) They find my key and slide it through the bars, i take the sealed envelope and leave the building. I then start the process of finding my trailer - known as the 3rd trailer on the left.
there are no street signs or roads, just what appears to be a solid field of concrete. I see a row of trailers in the distance and have to assume that is my new residence. I count to three, park take a second to allow my surroundings to set in, and get out to walk to my door. I try the key secretly hoping that it wont work, but it turns and i walk into, *sigh* my trailer home for the next two months. Its actaully quite nice on the inside, we have satelite dish tv, a 40" in the living room, brand new appliances and mosdest size bedrooms. The only DVD on the shelf is "escape from alcatraz" - feel free to laugh, i did.
I unpacked and inflated my airbed - then decided to try and find food for dinner. According to my GPS - everything is about 15 miles away, but i managed to find a CVS with some lean cuisines. Agenda for tomorrow is finding grocery store.
Right now i am waiting for my roomates to arrive - yes, the two married men. (also be on the look for pictures), in the meantime i am relaxing on the couch watching the premiere of 'gossip girl' - just realized we dont get BRAVO (ugh no project runway...this totally sucks, but at least i will be able to watch the 2hour premiere of 90210!!)
cell service is shaddy - but texting seems to work.
GPS - unable to locate the trailer address
8343 SW 155th rd Box #3
Lake Butler, FL 32054
**in case you want to send something***
looking forward to not working weekends and making some trips to tampa, gainesville, orlando and miami...at least there is something to look forward to
i start working tomorrow at 8am - have no idea what to expect but will definately be posting and letting you all know what happens as operation trailer/jailhouse continues:)
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