MySpace demon

I attended a meeting of the 19th Circuit Court Family Coordinating Council yesterday (minor peeve: organization names that sound like they support that which they exist to prevent/eradicate). In addition to updating us about what the various committees are doing, we had a discussion on possible symposium topics.

Part of the discussion centered around the “tools” parents need to raise their children “safe”, but in thinking about it I think that there is a greater need for “tools” kids need to grow up “safe”. Granted there would be considerable overlap, but unless we target the information at kids it may not get to them and they might not listen to it if it does. Targeting this toward kids certainly makes sense in the context of family violence in its many forms (along with ineffectual parenting and other parenting problems, which exist for a variety of reasons). Society has changed (in case you missed it or are too young to have seen the before) and I don’t mean from the artificial “Leave It To Beaver” world people mistakenly think existed in the past. But I do agree with one of the other folks at the meeting who said kids lack people to talk to, confide in, and get decent information and advice from (particularly in the setting of family violence, e.g. spouse/partner violence or child abuse in its many forms).

People tend to demonize the Internet and social networking sites in particular, but the reality is that we are becoming more Internet centered. Is the Internet an asset (my position) or a “trap” where predators lurk at every turn? I think it can help remedy a fair share of the social isolation we experience today (although real human contact is essential and can not be replaced), particularly kids from “problem” homes or those with other “reasons” for their isolation. Kids need others to talk to, even if they have the most ideal parents. They need peers and mentors to learn not to take risks, not to make bad choices, and to learn alternatives to those actions (or inactions). We need to teach kids how to use the social networking sites, and other Internet resources, while at the same time patrolling them just as we do our streets and malls to make certain that they are safe places. Used properly these sites can be sources of support, good information, socialization, and “life skills” learning.

Don’t ban these sites, make sure that they live up to their potential and make sure kids know how to use them “properly”. Making good choices and not take chances extends to the cyber-world as well.

What other “tools” do kids and/or parents need? Let me think…

Resource "work"

The queries I get are at times “unusual”.

Recently, someone wanted to do an art project that “works from its own power” and wanted information about whether a “closed system” of decomposition would fill that bill. He wanted to tap “(non-human) after-life processes” as “energy” to drive something that would satisfy the project goals/requirements. Interesting concept (although likely quite odiferous).

Another: Someone with a Hollywood telephone exchange (are they still called that?) looking for answers to questions about autopsy findings in a mummified corpse. Without giving too much away, there are modern ways to mummify that the Ancient Egyptians likely never even thought of. (And, yes, I told her I had a niggling fear that I was going to read about this in the papers someday, although she assures me she is a writer)

It is fun thinking through these things. I often critique TV shows and movies (burdening my wife with having to listen to my ranting/rambling while trying to watch the show), so I might as well think up some of this stuff without a show on in front of me. I see it as focused imagination with some talent for “writing”, although a different phrase actually came to mind as I was typing this, i.e. Mental [activity not for general audiences].

Remember those that are dying and being wounded in Iraq

At least part of the reason that my father took his own life in 1971 was 2 stints in Vietnam (he was an Army "lifer"). I see too many echos of his likely thoughts in some of those that have served in Iraq. This diary post really got me today.

Each day when I go to my computer the first thing I do is go to the Iraq war casualties website and check on the numbers of soldiers killed and wounded in action and the numbers of Iraqi's killed. Today those numbers were 2,732 soldiers killed in action, 19,910 soldiers wounded in action and 43,546 - 48,343 Iraqi's killed. Day in and day out the numbers go up and up and as they do I ask myself that eternal question, why?
· SGT MAJOR MYERS's diary :: ::
·
It seems to me that in almost all of my posts I write these numbers and even though I have no definitive answer as to why they are dying I do have an answer as to why I write the numbers. I do this in hopes that someone will - really - understand what these numbers mean. That, that someone will "get it", and repeat it and then another someone will understand and then another and still another and finally the 300 million people that are estimated to be breathing in this country this month will all understand. That they will understand that with each of these deaths a piece of us dies and with each of these wounds we are wounded and it is only they who can stop the killing and maiming.
To that someone who might be listening let me share this with you. Regardless of the circumstances; "justly" or "unjustly" the taking of a human life is an act that never leaves you. Knowing that you were personally responsible for taking a human life leaves an eternal, deep, and painful scar on your soul; at least I believe that if you are human it does. Let me share one other thing. The eyes are indeed windows into the soul and I know that when I look at the faces and into the eyes of those who are orchestrating the war in Iraq I do not see scarred souls but instead I see the soulless ice of those who do not care.
Each day as I look at my newspaper it is not the reality of stories of dying soldiers and civilians I see spread across the page but the sad soap opera that is our administration in Washington D.C. It is stories of corruption, graft, and moral bankruptcy that I see and then, even further back after the ads for cars and furniture and every other consumable good, I see the lone article with the number of lives given and taken, buried in the pages of tomorrows fish wrap, without ceremony or homage and before their bodies have hardly grown cold.

End Child Abuse, part 2

Just a few more things about child abuse from the article and talk I mentioned yesterday.

Even though the “most common age at which (child) sexual abuse begins is three”, the average age of victims who get to court is 10, with a median of 13. This occurs because we don’t “find” the cases as early as we ought and because of the general inability and/or unwillingness to work with children at the young age at which we should “work” with them. The current system is failing these kids. It must be fixed.

Despite the fact that child abuse and neglect is a “public health epidemic” we, as a society, do not invest the resources we should to address it. The toll on individuals and on society is huge, but our efforts are limited. Despite the fact that the rate of child abuse is 10 times greater than the rate of cancer, “federal research dollars invested is 5 cents for every $100 of societal cost associated with child abuse whereas we invest $2 for every $100 of societal cost associated with cancer”.

We need a systemic, coordinated national effort to end (or nearly eradicate) child abuse and neglect in our country. We need to support efforts to do that.

End Child Abuse in 20 years

I was reading an article written by an individual (Victor Vieth of the National Center for Prosecution of Child Abuse) that lectured at the Child Death Review Team symposium that I attended recently. As someone said that I shared a copy with: “an interesting read”. I thought I’d throw a couple of things from the article into my blog.

His is a plan to end child abuse in the United States within 120 years. Seems like a long time, but it is a huge problem. The timeline is laid out so that during the first 40 years everyone responsible for every step of finding, reporting, treating, prosecuting every child abuse incident is fully trained and working in a system that functions as it should. Also the next generations of these individuals are trained, ready to be trained and committed to the fight. Over the next 80 years child abuse is ended. He admits that it won’t all go away, but by and large it will be gone from our society. It is a multigenerational problem and will require a multigenerational attack and solution.

I wish him and his plan well and all success. It has got to happen, the toll is too great.

In case you are uncertain about the problem, beyond the shear scope of the problem, the numbers of the abused, two facts stand out. First: “only 40% of abuse cases and 35% of the most serious cases known to professionals mandated to report were in fact reported”. “65% of social workers, 53% of physicians and 58% of physician assistants were not reporting cases of suspected abuse”. “There were several reasons why mandated reporters do not report”. (None seem all that “good” to me) Second: “the large volume of children whose allegations are either not investigated or that result in CPS (Child Protective services) finding of “unsubstantiated” are just as likely to be victims of abuse (later on) as are those children whose allegations are substantiated”.

The system isn’t working. It isn’t working for the kids. It isn’t working for our society. This plan from the National Child Protection Training Center sounds like the way to go. We can end child abuse within 120 years. I am sorry that I won’t see that eventuality, but I will do what I can to get us moving in that direction.

Teen driven program on teen driving

I am certain that crash reenactments don’t work to keep kids from dying in car crashes. (We do them because the adults involved feel like they are “doing something”.) I am pretty certain that trying to scare kids into behaving “right” (driving right, not doing drugs, etc.) doesn’t work. I keep looking for something that works. I don’t want to do nothing and I don’t want to “just do something”. I want to do something that works, that is proven to be effective. That is where we should spend our time and energy. That is how we are going to save lives.

Sunday’s Trib had an article about an approach that likely will work. It is a program designed and driven by teens that encourages “smart driving”. It “encourages them to preserve their lives…and to speak up when they feel uncomfortable with their friends driving habits”. “What we learned in our research is teens don't aspire to be safe drivers because being a safe driver isn't cool”.

You have to get teens’ attention at their “level”, where they will “identify” with what is being done/”pushed” and “take it” as their own. The programs for change must be “teen-led”. Then and only then will you change behavior. We must do this so that they take fewer chances and make the “right” choices. Then we will save lives and forestall death.

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)

Foods you shouldn't eat

Ripped from Eric Zorn.

Cute?
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.

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.

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.

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).

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

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.

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”.

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]

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.

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).

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.

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).