Friday, September 29, 2006

Reality of emotion

I was working on an essay recently about “what is reality”. I didn’t quite get done with that when comments from 2 meetings collided with those thoughts. Yesterday I was at an “Assessing and Managing Suicide Risk Conference” that I and my Suicide Prevention Task Force catalyzed. This morning myself and another speaker talked with our County State’s Attorney folks about sexual abuse (I have been doing child sexual abuse evidentiary exams as a volunteer physician for 6 years) and rape.

A similar point came up at each of the meetings: As a survivor of someone who has died by suicide “you will never be the same again, but you can survive and even go beyond just surviving” and as a survivor of rape (or sexual assault) “you will never be the same” again. You will feel overwhelmed by the intensity of your feelings. You will feel anger, guilt, confusion, forgetfulness. These things are true in both instances. That is reality. Emotions are reality, but you can survive “and even go beyond just surviving”.

I had been writing that people were reality. That people are “messy”. They have strings attached and connections and connotations. They are “funny”. They incite thoughts and words. They have baggage. They are what they are, reality. But as I thought through the things that came up at these meetings, I have decided that these statements pertain to emotions just as much as to people. I think I lack the “words” to write about emotions, particularly the emotions that are dredged up by the “experiences” I discussed at my 2 meetings.

“Reality, what a concept.” (Robin Williams)

Tuesday, September 26, 2006

Foods you shouldn't eat

Ripped from Eric Zorn.

Foods you shouldn't eat.

Failure of "Reefer Madness"

Our government tries to be “creative”. The White House Office of National Drug Control Policy (I think their name needs a bit of work) has put anti-drug use videos on the internet where kids may come a cross them in the hope that it will decrease drug use. As a Trib editorial put it, that is like “leaving those sex ed pamphlets on Junior’s dresser instead of bringing up the subject at the dinner table”. Passive persuasion, nice thought but not likely to be effective.

The GAO (Government Accountability Office) pointed out recently that “we” have spent $1.2 billion on anti-drug use advertising over the last 8 years without decreasing drug use among teens. They also found that while teens that saw the ads remembered the message, they were not dissuaded from using drugs. Well, that ain’t working.

We ought to spend that money to find out what works, without a preconceived agenda. What we’re doing now isn’t working. Something different needs to be done to lower drug use (licit and illicit) among teens, it remains a huge killer of teens and young adults in my jurisdiction. Whatever “it” is, I know it will have to be active and honest, relevant to the teens and young adults, it will need to get their attention over the societal din, and give them real reasons to quit and, most importantly, not to start.

I wish I knew what “it” was, but I do know that “Reefer Madness” and its ilk doesn’t work.

Monday, September 25, 2006

Underused cure for drug OD

There was a couple of interesting editorials in the Chicago Tribune yesterday (not that they weren’t all interesting, but I’ll comment on these 2, on different days).

I was discussing some “work things” with a colleague and she said the “real role” of the Coroner is to try and put themselves out of business by eliminating the business (not that that will ever happen). I certainly agree that my primary goal is to forestall death. To that point Steve Chapman had an editorial in the Trib making a point with which I heartily agree.

Naloxone should be available on the street to prevent/treat heroin overdose.
One way to prevent people from overdosing is to stop them from using drugs. But as smokers have demonstrated, knowing you should quit and actually quitting are two different things…
Abstinence is best, but when it's not universal, other remedies are needed…
But it's entirely feasible for governments to proselytize against drug use while trying to keep drug users alive, just as we preach against tobacco while providing medical care to smokers stricken by emphysema…

Naloxone will not only save lives, but by being able to rapidly treat overdoses it will also decrease short-term (ER) medical costs and long-term medical costs (treatment of anoxic encephalopathy and the like from not-so-quick “saves”).

I applaud the efforts of Dan Bigg and the Chicago Recovery Alliance bringing care to the streets. Also, the efforts of Senator Dick Durbin to get federal legislation in place for overdose treatment effort support.

I’ll take all the help I can get in forestalling death.

Make good choices and don’t take chances first of all; prevention is always better than treatment, but treatment needs to be available as well.

Wednesday, September 20, 2006

Another Medical Misadventure/Quality Issue

I came across an interesting blog post. While this was posted in response to the babies who died in Indiana because of an error in heparin dosing (11 doses were given among the babies, so not a singular event), the last section of the post pertains to our case that I wrote about a couple of days ago.

So what happens now?
The quality assurance department in the hospital will perform a root cause analysis to investigate all components of the extant procedure for medication delivery of heparin to infants in the neonatal intensive care unit. AIt will interview the pharmacists, physicians, pharmacy technicians, nurses and any other staff memebers invovled in the process at any point.
It will attempt to find weaknesses in the process, weaknesses in the education of the staff, reasons for noncompliance with the policy and procedure to administer medications, and then it will make receommendations to hospital committees charged with determining the policy and procedure for medication administration of this type.
Outside agencies will also become involved. The two infants that died will be under the jurisdiction of the coroner to determine the cause of death and contributing factors, and to refer the cases to law enforcement if there is suspician of criminal intent or action.
The state department of public health may become involved to investigate safe drug handling and administration practices.
The cases may go to litigation.
The nurses are most likely devastated and should be supported and be receiving counseling.
Their nursing licenses may be investigated, and if found negligent, the licenses may be suspended, revoked or be placed under restrictions or sanctions.
The national hospital accrediting body, the Joint Commission for Accreditation of Healthcare Organizations, JCAHO, will include the incident, investigation and subsequent actions to address the weaknesses in the policy and procedure in its routine survey to dtermine accreditation status.
But in the end, it boils down to nurses not taking shortcuts, nurses safeguarding patients, and nurses standing up for patients' rights in the face of poor work practices, poor working conditions and inadequate resources.

Tuesday, September 19, 2006

Underage Drinking Prevention

At an Underage Drinking Prevention Committee meeting this morning we looked at some local statistics. These were obtained by anonymous survey of local school kids. Are they factual (did the kids tell the truth)? It would be impossible to know, but they look “coherent” enough to be legitimate. I would assume that they are truthful.

Asked about consuming alcohol within the last 30 days 6% of 6th graders said yes, as did 18% of 8th graders, 36% of 10th graders, and 56% of 12th graders.

These results are concerning and saddening. We discussed reasons that we ought to work to decrease the numbers of kids drinking and work to delay the start of drinking in these kids. That discussion was held because while it is “good” to do those things, we need something a bit more ‘concrete’ to “sell” efforts and programs. It pretty much boils down to the facts that if we can do those things we will save a few lives and we will decrease the risky behaviors associated with alcohol consumption (e.g. remembering that alcohol is the # 1 date rape drug). Alcohol does make you stupid.

How can we bring these numbers down? What programs work? That is the target of future work (and no “just say no” doesn’t work).

Monday, September 18, 2006

Hospital Homicide II

The homicide verdict is not an attempt to destroy a hospital or all ERs (as one emailer suggested), but the honest verdict of a jury of 6 that there was a “gross deviation from the standard of care” and that the inaction in this case was “reckless”. By our definitions of manner of death that is “homicide” (again recall that does not mean criminal homicide).

This case and its publicity should prompt system change, locally and nationally. The system failed at Vista East. This 49 y/o did not get the care and treatment she deserved, because the system failed. This is a quality of care issue. The quality of care Ms Vance received was sub-standard (to say the least). I’m not attempting to point fingers or get anyone charged or convicted of homicide (although by our definition this death is a homicide). I want the system (Vista’s and everywhere that it is wanting) and the quality improved. I think there should be outside oversight to ensure their system is changed and, once changed, that it is maintained (this oversight should occur everywhere there are these system, quality problems).

This is a social justice, a greater good issue. No one should have to die like Ms Vance did, feet from life-saving treatment. The quality of medical care must be improved. No more excuses about an overburdened system. Develop systems (quality) to ensure this never happens again.
When I ran for office, I pledged to also investigate “medical misadventures”. Just as our office obviously is there to serve decedents who can no longer serve themselves, just as much we are here to protect the living residents of Lake County and to forestall death when we can1

Friday, September 15, 2006

Hospital Homicide?

Waukegan waiting room death a homicide, jury rules

”Reckless behavior is one of those things that stands out in the coroner’s definition of homicide,” Keller said. “The underlying feeling of the jury is that a reckless act resulted in this woman’s death.”

In an unprecedented move, a Lake County coroner's jury Thursday ruled the death of a Waukegan woman in the emergency room of Vista East Medical Center in Waukegan a homicide.

The definition that I give to the Coroner’s Jury during their instructions regarding what constitutes a homicide:

A death that occurs because of an intentional or reckless act by another person. A person is reckless or is acting recklessly when he or she consciously disregards a substantial and unjustifiable risk of another’s death from their action or when their action (or inaction) demonstrates a gross deviation from the “standard of care”, which a reasonable person would exercise in a similar situation (the latter does not only refer to “medical care”, but to the usual “care” an individual would take in a similar situation).

Coroner’s Juries decide on the manner of death, keeping in mind that “this is neither a civil nor a criminal trial procedure, merely an inquest regarding the death of this individual” (further Jury instructions). Their decisions do not signify criminal findings or intent on anyone’s part, that is left up to the State’s Attorney and/or the Courts.

Yesterday's Coroner Jury felt that the hosptial was reckless in their behavior pertaining to this 49 year old woman's death and found the manner of death to be "homicide". Two hours in the ER waiting room with the complaint of 10 out of 10 crushing substernal chest pain, with diaphoresis and nausea, triaged but not treated, "a gross deviation from the standard of care" (caring?).

We, today, have filed reports referring this individual's death to the Lake County State’s Attorney’s Office, the Joint Commission on Accreditation of Healthcare Organizations, and the Illinois Department of Public Health. Further action is up to them, although I would recommend an advisory panel be established (with local resident involvement) to oversee changes that will no doubt be made at the hospital.

Wednesday, September 13, 2006

Overlaying death

Another death by “overlaying” in our county; I’d say tragic; but so are all infant deaths. Overlaying, as a cause of death, likely far outnumbers the number of SIDS deaths, but it is another one of the causes of death not often heard of or talked about.

Overlaying is caused by an adult (or larger child) rolling over onto an infant while they are sleeping together. The exact mechanism of death may be obstruction of breathing, circulatory impairment, or both. Closely related to overlaying is “wedging”, in which the infant becomes wedged between objects resulting in inability for the chest to move for breathing or in airway obstruction. We’ve seen too many of these as well. Considering the paucity of physical findings, the diagnosis of these causes of death depends heavily on a thorough death investigation, including death scene investigation.

In these cases the adult’s (or child’s) grief is compounded by the guilt of having contributed to the death of the infant.

Infants should not share the “family bed” (or other shared sleeping arrangements). They should sleep alone on a “firm” surface without fluffy bedding or pillows. And remember “back to sleep”.

Monday, September 11, 2006

Family and "pono"

Just a little bit of a twist on the positive effects of family dinner on the behavior of teens and children.

I have been doing some reading (I do make time) about aboriginal (in its broad sense) healing and wellness. In most “native” cultures healing is a communal event. The more people you bring together at the healing ceremony (particularly if they are family) the more effective it tends to be.

I think there is a real community/family effect to healing (also think of this word in its broadest sense). Maybe this is one of the things that also affects folks when they come together for family meals. There has to be something, because the positive effects of the meals occur even if there isn’t “lecturing” about doing the right things and behaving the “right” way.

Just the “being” with family (supportive people, if you don’t have “real family”) has a positive effect. Maybe that can be enough to teach kids and teens to be “right with themselves” (pono in Hawaiian, told you I’ve been reading) and to “value themselves” so that they don’t take chances and don’t make “bad” choices (or be at least one positive influence). [Disclaimer: there are no absolutes in this world, you can only do what you can do]

Friday, September 08, 2006

Death Thoughts

Ah, the end of another week. Except they don’t really end, they just flow on. Weekend, weekday, the Coroner’s business flows on. The only difference is I’m not in the office very much on the week ends. Like the old joke so many folks like to tell me: “They’re just dying to meet you”.

This week the young died when they ought not to have. The old died when they also ought not to have. Some died and their release was a relief. Others died with a flood of grief. But some died when it was time.

I didn’t set out to make this maudlin or poetic; sometimes the words just flow too. People die for so many reasons, in so many ways, and each death has their own story. The stories can be interesting and enthralling. The stories can be obvious or require work to get at and to sort out.

Death is natural and unnatural, but we will all end up there eventually. It is my wish for you and yours (and everybody else) that that occurs no sooner than it must. That you all may grow old enough and get enough done, that you may shuffle off this mortal coil without regrets and prepared for the journey.

Enjoy the ride.

Thursday, September 07, 2006

Asthma Kills

Asthma kills, as I was again reminded recently. Nearly 5000 people die each year in this country from asthma; in another group equally as big, asthma is a contributor to their death. Although most people who die from asthma are over 50 years old, over the last 20 years there has been an 80% increase in the death rate among children and teens with asthma.

Asthma is a common disease. It is one of the leading causes of school absenteeism (and work absenteeism in adults). It is also a frequent cause of ER visits. The disease can be exacerbated by certain activities (e.g. sports participation), certain conditions (e.g. cold air), but it can strike anytime and can strike without apparent trigger.

Asthma is characterized by bronchiolar constriction/spasm and mucous thickening and plugging (with blocking of bronchioles). The latter condition is the most lethal and the most difficult to treat.

How do we prevent these deaths? This is a bit tougher than some of the other causes, but individuals need to have access to medical care and be assured (ensured) that they are receiving optimal care based on the most up-to-date treatment guidelines. People need to also be aware just how deadly this disease can be. We won’t prevent them all, but some deaths will then be prevented. All people must have access to quality medical care, or we must accept the consequences (people will die).

Wednesday, September 06, 2006

I'm your parent, not your friend

A conversation started just before the underage drinking prevention group meeting I attended about a week ago that reinforced an opinion I hold strongly. Two of the folks were talking about talks that they had had with their kids: that they were the parent and not a “friend”. I had a similar talk with my 16 year old not too long ago.

I think we do our kids a disservice when we, as parents, try so hard to be friends with our kids. That is what they have friends for. I am there to lay down the law, teach moral and proper social behavior and to punish when they stray from the rules. I believe this is how to model, mold and develop an individual who will grow up to be a “good” part of the community and will have the best chance possible to grow up and grow old.

That’s not to say we can have fun together and laugh and enjoy being together. That’s part of being a parent (and a family), too. But, at the same time, I am not their equal. I am the parent and they are the kid.

How can you tell your child not to make bad choices and not to take chances if you don’t teach them “right from wrong” in regards to chances and choices? If your goal is to be a friend how can you lay down the law, enforce the law, and teach them “right from wrong” choices and chances. I feel I have done my job as a parent if my child is mad at me from time to time because of corrective measures I enforce. A good parent uses reward and punishment to mold behavior. Someone always focused on being a friend loses the authority to parent and punish. My kids are the better for my working as a parent instead of my being another one of their buddies.

Tuesday, September 05, 2006

More Nicotine in Cigarettes

I will have another “parenting” post regarding something else that came up at the underage drinking prevention meeting that prompted the last 2 posts, but I wanted to mention this news report before it got too “stale”.

It seems that, just perhaps, cigarette makers are adding or otherwise jazzing the nicotine content in their cigarettes. Nicotine is the reason folks get hooked and/or can’t quit smoking, just behind the psychological addiction. It appears that, according to a Massachusetts Department of Health study, the nicotine level in cigarettes has been rising steadily over the last 6 years. And don’t think the ultra-lights are “safer”; the nicotine levels went up in all cigarette “strengths”.

This made only a small news splash when it should have prompted screaming headlines: “Cigarette Makers Jazzing Coffin Nails” or something equally shrill. They get away with admitting the health risks of their product while at the same time making them more addictive. That seems to me to go beyond their statements of innocence; that they warn folks not to smoke, so they are not liable for their resultant health problems and deaths.

Hook them in faster and stronger. Make them customers for life (no matter that that life is shortened after hooking them in). Smoke and die young (though not a pleasant death most of the time).

Friday, September 01, 2006

Keeping them at family dinners

In my last post I sang the praises (with back-up study “proof”) of the great benefits of have frequent and regular dinners with your kids. Regular dinners with your kids may save their lives. But sometimes it’s a bit tough keeping them at the table and/or figuring out what to talk about to occupy the time (nothing worse than repeated “I’m bored” throughout dinner)

To the rescue comes our government and SAMHSA (Substance Abuse and Mental Health Services Administration) with their “conversation starters” listed on their website. They certainly may help and some my plumb some insight into the psyche of your child (e.g. “Do you think of yourself as a risk-taker?”) But do keep in mind that just regular conversation works too (e.g. “What do you think of the weather? or What’s your sign?, well maybe that last one won’t work so well). Also worth remembering is that humor works and the conversation doesn’t need to be deep and penetrating.

TVland also has some tips about family dining and, amazingly, not watching TV (watching TV during your together family dinners ruins the positive effects). (This one also has stuff to do with younger kids.)

Parenting and making a positive difference as a parent takes work and this is one of those works with a benefit (and you get eat dinner in the bargain as well). Cliché as it may be parenting is the “un-drug”, as well as the “un-death” and the “un-bad choice risk taking thingy”.