(I can’t concentrate. I admit it. Sorry. -PB)
So I was absent for about a week from my blog and my daily readership actually went up. Clearly there is some optimal number of posts per month that will maximize daily hits and I am usually exceeding it….or maybe if I stopped posting altogether my sitecounter would explode. The end is coming, actually. I can feel it. I don’t know what more I can say about most things without doing some research and producing the kind of footnoted and referenced articles that would delight about six of you and bore to tears the rest. Either that or I could get overtly political which would probably increase readership but I am trying to avoid that kind of thing. I’m not even following the election that closely. I like John McCain of course (without feeling the need to take my ball and go home if he doesn’t exactly mirror my opinions), feel a little sorry for Mrs. Clinton, and think that Mr. Obama is the quintessential empty suit, full of rhetoric that signifies nothing except to draw attention away from his doctrinaire leftists opinions.
I marvel at how quickly the leftigentsia have turned against the Clintons and are only just now discovering that they are both totally corrupt and infinitely corruptable. It’s as if all over the United States old grizzled reporters are slapping themselves on the forehead and saying, with sheepish grins spreading across their once credulous faces, “Man, they sure had us fooled!.”
And I confess some distress. Is being a war hero important this time around? It’s hard to keep track. It was the last time, I’m sure about that, and the Lord Marshal certainly made a big deal about the medals that he threw away…or didn’t. To make matters more confusing, at one time being a draft dodger was de rigueur and then a few years later flying a jet fighter in the Air National Guard wasn’t. All I know is that of the three candidates left in the race, all of them were surrounded by communists when they were young but only one of them fought back.
But I digress. I mightily appreciate all of you who take the time to read my excessively verbose ramblings. I’m not whining, just informing, but producing a blog is hard work. It can be a chore, actually. If I haven’t posted for a while I get the nagging sensation that I am neglecting something important and, although I enjoy writing, I don’t always have the time and feel somewhat pressured to produce. Ridiculous, isn’t it? Except for some minor advertising revenue from Google and the good people at Epocrates, nobody is really paying me that much to write and although it might cause a small stir in a tiny corner of the vast internet, when I disappear no one will be worse for the wear.
I Kept My Mouth Shut
I had a trauma patient the other day who quickly informed me that he was a chiropractor and then rattled off the cervical vertebrae he believed to be injured just to show us that we were dealing with a medical professional and not some yokel. He had fallen off of a ladder and bumped his head. After the usual “pan scan” that the trauma surgeons order on everyone regardless of mechanism or history he was given a clean bill of health and discharged from the department. We usually send these minor trauma patients home with a small prescription for vicodin or percocet even though all most people really need for this kind of thing is some motrin. I have been sticking to the motrin lately because we don’t have to give narcotics to everybody. He flagged me down before he was discharged and demanded something stronger for his pain. I smiled politely and wrote him a prescription for Vicodin. Chiropractor, heal thyself. Doesn’t he have any colleagues that could, I don’t know, adjust him or something?
Speaking of chiropractors, I have had a run of patients lately who are under their treatment. I keep my face blank and my tongue still but most of them feel the need to apologize which shows you that even most of the chiromancer’s customers suspect that the they are being hornswoggled by this century’s equivalent of the Patent Medicine Man. Look, its not rocket science. You can’t cure an inflamed gallbladder or a pulmonary embolism by adjusting the spine. You can’t actually adjust the spine either because, while I am second to none in admiration for the typical chiromancer’s knowledge of spinal anatomy, all of those ligaments and muscles that they rattle off prevent the kind of movements that they claim to induce. Hell, in my line of work we call chiropractic “spinal adjustment” by its correct term, “trauma,” and it is only the inability of most chiromancers to generate motor vehicle collision-type forces that keep them from hurting more patients than they actually do.
Despite what Dinosaur thinks, I can tell the difference between an elderly patient who can benefit from medical care and one upon whom dollars fall as ineffectually as autumn leaves on a rusty old car propped on blocks waiting for the time when the junkyard shall give up her wrecks. And I believe I have repeatedly come out in support of providing expensive, high-tech medical care to the elderly. My in-laws for example, two of the finest people you could ever meet, are still in total command of their mental faculties and have benefited mightily from a couple or three artificial knees and the attentions of a cardiologist or two.
But just the other day I had three critical/trauma bays occupied by three patients with a combined age of 288. To keep clear of HIPAA I will just say that between them they had three legs, one working kidney, and the combined ejection fraction (a measure of cardiac output) of a healthy two-year-old. None of them had moved purposefully for the better part of a year and they probably had enough viable brain tissue between them to fit out two border collies or one pharmaceutical salesman of average intelligence. And they were all “full code” and headed to the ICU for an all-expenses-payed sojourn into the belly of our completely out-of-control health care system where I have no doubt that at least one of them will be “saved” and sent back to the warehouse until the next time.
Look, I understand what Dinosaur is saying. But I also think that he doesn’t spend a lot of time with patients at the futile end of the spectrum. I don’t believe anybody is advocating severely rationing care for the elderly like they do in the vast Freeloader Dependocracies Across the Water (although this kind of rationing is inevitable) and I don’t think withdrawing futile care will solve all of our money problems but, my Lord, it would be a start.
My eight-year-old daughter. God bless her. One of her little friends was over and kept calling me “Mister” Panda. My daughter finally had enough and said, “Um, my daddy didn’t go to four years of Evil Medical School to be called ‘Mister.'” We are all huge Austin Powers fans.
(This is the same little girls who, when she was five, was told by her mother that I had been a Marine and, having heard it imperfectly, spent the next year telling her little friends that her daddy had been a “ballerina.” )