A major cause for E.R. crowding is the hospital practice of boarding inpatients in emergency departments. This happens when patients who come to the E.R. need to be admitted overnight. If there are no inpatient beds in the hospital (or no extra inpatient nurses on duty that day) then the patient stays in the E.R. long past the completion of the initial emergency work. This is what happened to Green, and it has become widespread and common. The problem is that boarding shifts E.R. resources away from the new patients in the waiting room. While E.R. patients wait for inpatient beds, new patients wait longer to see a doctor. As more new patients come, the waits grow.

So why would hospitals do such a thing?

There are two competing sources for inpatient beds. The first source is patients who come in through direct and transfer admissions. They are more likely to come with private insurance and need procedural care, both of which maximize profits. The second source is E.R. patients, who are more likely to be uninsured or have pittance-paying Medicaid and less likely to need high-margin procedures. Do the math: If you fill your hospital with the direct and transfer admissions and maroon the E.R. patients for long periods, you make more money.

In effect, then, E.R. boarding allows hospitals to insulate themselves from the burgeoning needs of the poor. E.R.s are safety nets: By law, we who work in them see any and all patients, regardless of their ability to pay. But as more E.R. beds are devoted to boarders, the E.R. has less space for new patients, which keeps a lid on the number of un- and underinsured. So unless you are having a heart attack and can jump the line, your emergency—though it may still be serious—may wait for so long that you give up and go home. Bad for you, good for the hospital's bottom line.

Sick yet? Wonder how a country with universal health care might handle such a problem?

In England, the National Health System now has a rule that 98 percent of patients have to spend less than four hours in the E.R.. Apparently, the son of a member of parliament spent too long in an E.R., we've heard.

I experienced this first-hand last year when I went to the ER with appendicitis. I was in the hospital for around 24 hours, spent more than half of that time in the emergency room, and the hospital charged $16,000.00. That did not include the surgeon's fees or the cost of testing to determine what was wrong. Thank God I had insurance.

Read the entire article here.

In my patient’s case, he received a medication that was contraindicated given the multiple diseases he had. The situation was very complex—as it almost always is in the hospital these days—and no one anticipated the problems that might occur. The end result was a patient with organ failure who became one of the many people for whom modern medical care is fraught with error and complication.

In 1999, the Institute of Medicine issued a report on medical error titled “To Err is Human,” which called attention to this problem. The report concluded that on the one hand, high-tech medicine had become a victim of its own success: More procedures, more interventions, and more medications meant more opportunity for ill-fated combinations. And people who at one time would not have survived an initial illness were living long enough to require long hospital stays, leaving them vulnerable to hospital-acquired illnesses. On the other hand, health professionals were ignoring the most basic opportunities to prevent unnecessary illness, such as washing hands before seeing patients.

Since that report there has been a great effort to improve safety in hospitals. Some of it seems pedantic, designed to improve our documentation of what we do rather than our actual care. For instance, we now have a “time-out” at the patient's bedside before doing a procedure, to confirm the identity of the patient. Then we document the check in a sticker placed in the chart. This is designed to make sure that we don’t do procedures on the wrong patient—an excellent goal. But when it comes down to it, I can’t imagine that people harried enough or distracted enough to contemplate a procedure on the wrong patient would be stopped by this sticker system (or prevented from making another error in the process).

Some interventions seem more useful to me, like the proliferation of sinks and alcohol soap stations throughout the hospital. It’s hard now to forget to wash your hands, and that is a great improvement.

Other changes that can make a huge difference include the implementation of computer systems to catch drug interactions and allergies, pharmacy stocking systems that don't allow concentrated and potentially fatal doses of medications to be stored in one vial (necessitating nurses to properly dilute them before use), and rules that prevent the dispensing of medications that require intensive-care monitoring on wards that do not have those monitoring systems in place. Yes, you can teach 500 nurses that a medication is deadly in the concentration it comes in, but it would be more effective and safer to never allow that concentration on  the hospital floor in the first place.

The patient I saw recovered, but others do not do so well. The frailer, older, and sicker patients are at the greatest risk. We have to recognize what the Institute of Medicine’s report highlighted: Safety cannot be achieved by well-meaning individual doctors or nurses who are, at bottom, human. It requires hospital systems that help us avoid making terrible mistakes.

(PHOTO: GETTY IMAGES)

Recent posts by Dena Rifkin, MD:

On April 11 I had an appointment with the Patient Advocate at the hospital where Raul was interned at during those last 18 days of his life. I made the appointment to discuss and rectify the matter of the errors in my husband's Death Certificate as well as matters in regard to the billing of that hospitalization.

The errors in regard to RR's Death Certificate were careless -- as if it did not matter what caused his death as long as the hospital could not, in any way, appear to have had fault in his death. In my mind the MD pulled at straws ... I could not believe what I read on the first certificate. It made me so angry.

It was a month after Raul's death that I could move a little in my numbness to make that call, that appointment. The other matter was that of billing. Bills had already been sent to both my husband's health insurance as well as the Workers Compensation Insurance.  Workers Compensation. aaaack -- and with errors in the death certificate........ what a terrible place for one to be in. When the bills were sent to WC they were sent with the incorrect diagnostic codes so they were returned to the biller as 'denied'.. so the hospital billing office just turned around and sent them to Raul's health insurance.. bad move.

Bad move because it made me even more angry. ,,, BUT.. I went to that appointment. Not with anger on my mind.. but with the pain of having to discuss Raul's hospitalization and the resulting death, death certificate and aspects of billing which, were he alive, I wouldn't even be there.

I have to take a break from this. I am becoming agitated. antsy.

"The pointless, stubborn treatment on David"
By Francesca Savino, translation by Daniele Nicolucci

The doctors wanted to cure him as much as they could to make him live as long as he could. The parents wanted him to be cured, without getting to heroic treatment [stubbornly administering therapies when it's clear that there is no hope for any improvement]. The court first suspended the parents' parental authority, then returned it provided that they followed the doctors' orders. Davide, struck down by Potter's's syndrome, slowly and relentleslly worsened to the point that not even doctors could do anything more. He died on July 18th, at the Bari general hospital. Today, his mother explains the reasons for their fight against heroic treatment.

Maria Rita Vigilante isn't left just with the sorrow for the loss of a son. The mother of Davide, born without kidneys and ureter because of a very rare illness called Potter's's syndrome, a week from the child's death still wants to fight: «so that this doesn't happen again». "This" is the eighty days of life spent by Davide, fed alternately by a tube and by a bottle, between seven-hour dialysis almost every day, and crises that forced him to resort to artificial ventilation. In the meantime, a court took and returned parental authority to his parents, admist controversy and public petitions.

Did you know anything about the illness before April 28th, the day Davide was born?
«No, the diagnosis only came four days later from the United Hospitals in Foggia. We have long been encouraged to set our minds at rest, but at one point dr. Magaldi asked for our authoritazion to have Davide undergo dialysis. We asked to be allowed to think for a day, and he dragged the judiciary in: he has been dishonorable.»

Davide was then moved to the Giovanni XXIII hospital in Bari, following a court's decision. How did you feel about having your parental authority taken away?
«We felt violated. Our son was taken away from us while we were trying to understand what was better for him. Then it took weeks before we could be heard by a judge. Heard, not understood.»

The authority has been returned to you after twenty days.
«It was a decision that forced us to follow the directions ordered by the doctors, under the threat of a new suspension [of the authority]. A humiliation: the top clinician, dr. De Palo, ordered me to stay at the hospital 24 hours a day, but our two other sons were with my husband and I in Bari. For several days the oldest of them, who is 6 years old, ate in the ward on a small table covered with medicines.»

Davide was the first child affected by Potter's's syndrome to live more than 39 days. For him, people not only spoke about heroic treatment, but also about a "miracle".
«I don't believe in miracles. If God existed and wanted to work a miracle, he wouldn't have been born like that. There is no medical evidence, among the 400 children with Potter's syndrome, of any successful case. Forcing a newborn child to undergo invasive treatment, knowing that it never worked, is simply fierceness.»

Didn't you feel the need to endeavor the impossible?
«We restlessly researched the topic, we listened to many opinions. My son was born with a conviction upon him: the prognosis for his illness is "constantly inauspicious". He underwent tremendous surgeries. They applied a cathether to his navel, then another one to his jugular which Davide removed on his own, then to his groin. The cures were supposed to have him feel better, not increase his pain.»

Looking back, would you have ever agreed to dialysis?
«Dialysis wasn't even supposed to begin: it doesn't make sense to have children with Potter's syndrome undergo dialysis. All researches agree with that, and the WHO itself gives precise indications about not reviving children with this syndrome. Medicine is fobased upon experience, but in the case of Davide nobody took documented experience into consideration. Once dialysis had begun, however, it was impossible to suspend it.»

For some time, there has been debate about heroic treatment also for the case of Eluana Englaro [a woman who has been in a vegetative state for 16 years, and had clearly asked her parents not to prolong her life, should she ever find herself in such a state]. What do you think about the fight run by her father to stop feeding her?
«I hope he wins it, and I am close to him. My sensitivity and the experience I lived reinforce my being against heroic treatment and against the [catholic] Church's intervention about these topics. I am thinking about what Luca Volontè [a member of parliament known of the Union of Christian Democrats party] wrote against us on "Liberal": he wrote that we are cynical, that we wanted to kill our son, sacrificing him as in the ancient times, just because he was not perfect. He hurt us, and I'm still angry about it. Nobody can step onto others in order to state his own alleged truth.»

Did anyone help you through that time?
«Many, most of whom were strangers: the over two thousand people who signed the petition to have our son returned to us, Mina Welby [widow of Piergiorgio Welby, who was forced to depend on machines to live and fought a battle for euthanasia], lawyer dr. Vaira, dr. Zingariello, senators Poretti, Marino and Cappato, the Luca Coscioni association, the mayor of Bari, enterpreneur dr. Maizzi who paid for the transportation of the body from Bari to Foggia. I also have to thank the moving humanity of dr. Giordano and dr. Messina from the Giovanni XXIII hospital, and professors Laforgia and Rizzo and their teams at the general hospital, including the nurses who treated Davide with the love and cures that they would have had for their own son. And I thank Michele Farina and his wife Chiara of Agebeo, who hosted us in Bari: their association gives a concrete help to those in need.»

During these months, did you get in touch with other parents who had similar experiences?
«Yes, and lately we have been contacted by a worker who lost two sons to Potter's syndrome. He asked us whether we are vegetarians, and when we said no he felt relieved: his wife and he had been accused of causing the illness through that. These superstitions probably serve to hide other things. My husband is a worker too, and works at the Fiat plant in Melfi. We know about several cases of severe malformations among the sons of the plant's workers.»

Do you think that there is a link?
«I am unable to claim that there is a cause and effect relationship, but it's a coincidence that makes me wonder.»

...the evolutionary worldview is not only unnecessary for the practice of medicine, but actually contrary to the humanitarian nature of the medical profession. A biblical worldview explains the origin of disease and death as part of the curse that marred God’s perfect creation after man sinned. God loves us and mercifully enables us to relieve much suffering through medical science. Physicians are not working against the driving force of nature, but against the effects of a sin-cursed world.

So, I would challenge Dr. Dini to ask his students who are evolutionists, “Why do you even want to be a doctor?” Aren’t doctors ultimately working at odds with the process evolutionists hold dear?

Why Would an Evolutionist Become a Doctor? - Answers in Genesis

The wealth of Australia's raw materials are boundless, coal,gold, iron ore, uranium (not all mined) natural gas, wheat,sheep,cattle,wool and probably more can be added to those Ive mentioned. Overall thats a lot of exports and a lot of money coming in, a lot of dough. Millionaires and billionaires are created overnight lavish houses and lifestyles are the norm for those fortunate enough to be in the high income bracket alongside the politicians who make the rules and laws that allow the few to reap the financial benefits of this much publicised boom. So where does all this money go and is its distribution fair, I think not. Big companies either pay taxes or royalties, I think the raw materials belong to all Australians and the people who make the money out of them should pay taxes also.

Here are some figures........ About now our population stands at 21.372.029 people in OZ........of these there are approximately 4.000.000 children 14 and under. Unemployed approximately 470.000. These are figures I just got off the net so Im guided by that.

My opinion is, this with all the money that is being accrued by the employed and these rich companies from taxes and royalties and the waste that there undoubtably is I can see no reason why any employed person that earns $40.000 or less a year should pay tax at all. Based on the fact that everything we eat, drink, wear, and generally use in our everyday life is taxed to the hilt anyway why cant the struggleing,  be free of these personal taxes.  The wealth from our raw materials and and industrial gains should be spent on our basic infrastructure, hospitals education, transport, care for pensioners and the disadvantaged etc, its about time the governments started to put ordinary Australian people first and themselves further down the money grabbing pecking order....I Just wonder why its impossible to keep 22 million people living in a reasonable lifestyle instead of grinding them into debt and misery.

I think I'm getting better at this; started off with 'doing my best'.

Yesterday was my second chemo session (it was supposed to be on Monday but it was rescheduled for Tuesday) and it went much better than the first one. Well, it helped that I knew more about what to expect so I could do some chemo planning beforehand, though I didn't get everything right . . .

I had my bag packed with Pipocas's mini dvd player, a book (more Pratchett), my iPod, and I also took all the hugs and best wishes you guys have sent me. La J and I got on the rental bikes and arrived at the hospital in plenty of time for my 1.30 appointment. I put my form in the tray, we took a seat in the waiting room for awhile and then (because the first time I'd had to wait two and a half hours to get in) I suggested that we go to the cafeteria for a sandwich. Because - and this was the bit I didn't get right - I'd forgotten to have anything to eat before leaving home. Well, other than two cups of coffee and a couple of digestive biscuits for brekky. And then they called my name!

The plan was that La J would come with me to the hospital and wait until I was all set up in the comfy chair, and then Bosco was going to come at the end of the chemo and accompany me home. And I would keep myself occupied with a dvd, book, etc. in the meantime. Instead, I found out that the oncologist had made a mistake on my chemo pill prescription and so La J went to get that fixed and then went to the Farmacia across the street to fill the prescription for me. And then went to another farmacia, and then another, until she found one that had the pills in stock.

After she got back she told me all about her farmacia adventure and we ended up talking about ... oh gosh, I don't know. Life, the universe and everything. All the props were left unused and before I knew it I was calling Bosco to tell him that he needn't come to pick me up because Judy was still there. I couldn't believe how fast the time went. Must've been all the laughs. But possibly due to lack of food (and I couldn't bring myself to eat one of the mystery white bread sandwiches on the food cart) I was feeling very lightheaded once it was all over. So on the way home La J and I stopped for a snack and since then I've just been vegging (and snacking) at home on the sofa.

My arm hurts like hell again. The oncologist told me on Monday that this is in fact a side effect from this particular chemo - something to do with the platinum. So although it's very painful and I am 'one-handed' once again, at least I'm not worried about it because I know it's a normal reaction that should be gone in 7-10 days. I also had a couple of new weird side effects. After my first drink of (room temperature) water my tongue swelled up so much I could barely speak. This went away after awhile. Then later on at home I was talking to my friend Paco on the phone and suddenly started to cry (just a little) and the tears nearly made my eyeballs pop out. Yikes. Happily this painful 'add water and swell' thing seems to have stopped now.

And so, a lot less fear this time round. This really made a difference. As did all the help (and extra offers of help) these past couple of weeks, including emails and donations. You all know who you are. :)

I can't imagine getting through this without you. *hugs*

]]> http://gulfsouthfreepress.wordpress.com/?p=181 Tue, 22 Jul 2008 12:46:45 +0000 lobotero http://gulfsouthfreepress.wordpress.com/?p=181 Now, nearly three years after Hurricanes Katrina and Rita, local leaders are again trying to show why Washington should send more help to Louisiana. Pelosi and other congressional leaders promised to turn their focus to health care and education needs.

But they continue to deal with other state requests. Gov. Bobby Jindal said Monday that his top priority is to persuade his former congressional colleagues to give the state 30 years to pay its $1.8 billion share of levee construction costs, rather than the three years signed into law last month. The congressional group also met over the weekend with New Orleans criminal justice officials, some of whom were disappointed when the House removed from the Senate version of the emergency war spending bill $300 million in hurricane recovery money, including, $17.7 million to double the size of city drug courts, add drug rehabilitation beds, build detention centers for nonviolent juveniles, expand the district attorney's staff and improve the Police Department's technological capabilities.

Under Jindal's proposal, Washington would keep Louisiana's revenue from Outer Continental Shelf oil and gas revenues until the $1.8 billion was paid off. Such an arrangement would help Louisiana avoid the need to borrow money, although it would result in the state forfeiting about $20 million a year until 2017, and about $600 million or more each year after 2017 -- until the bill is paid -- as production from new offshore finds increases the state's share of the revenue.

New Orleans Mayor Ray Nagin hoped for a more generous arrangement, arguing that the state and local governments shouldn't have to pay anything for the levee work.

The delegation also braved the midday heat at a Louisiana State University community health clinic in eastern New Orleans. The modular facility was built with federal aid, and clinic officials thanked Congress. But that section of the city is still 10 miles from the nearest hospital.
While New Orleans has far to go in restoring its downtown hospital corridor, local leaders said community clinics represent a post-Katrina success, helping bring better care to traditionally underserved groups.

Clayton Williams, director of health systems development for the Louisiana Public Health Institute, said a $100 million grant helped launch the initiative. It features 70 sites run by 25 organizations in an effort to bring primary care to low-income populations.
Williams said Bush's Office of Management and Budget stepped in and prohibited the $100 million grant from being used for improving health technology. Clyburn said a new provision is being considered in Washington specifically to finance health technology improvements.

Kari and I are speaking a little and aparntly she was thinking about me at the wedding, again see the post of I want to believe.  Anything to make this pain stop. I can feel it in me when she will do or say something.  Her facebook pics do indeed include sam as well, so that means son is about there as well and well..  Actually now I think on it there is no son in her recent days out pics so wonder what the deal is there

Its odd I can actually sense when she will text or getin touch and iswear this morning that i was there, nothing thinking about nething till she popped into my head and blam there was a text message.  Yes its all sounding a bit crackpot but I kid you not, its not normal to say the least

My pain is about halfway up my torso on th right hand side and it feels like its popping somewhat.  If I dont move much then I am ok but this is only going to be a bad thing, surprise surprise.

Fuck it why wont anything just work out for me, things arent fair now, I want to shout and scream and just let it all out but I know I cant because its all deserved, cause and effect and such.

In the darkest moment walking home and hearing a car drive up behind me there have been moments of temptation just to stop the pain dead, end it all and walk on to another world so to speak.

everything tells me taht I am being used to make her feel better but there is a big part of me that wants to cling on , to see and to hold just one last time, however I know better and thats what really hurts.  There is no love from her to me its all the other way about.  A while ago whenaout and about walking my thoughts were focused on not wanting to live life like this anymore to not live like i was anymore.

Becareful for what you wish for because you might be alive in body but I know that deep down my soul is completly and utterly dead.

We're not talking about physicians here. The Diva claims that "thousands of physicians are active in social media." I'm not sure if she means these docs have a Facebook or MySpace page to keep up with their friends or if they engage in online conversations with their patients.

The Diva is referring to healthcare organizations–hospitals, drug companies and corporations–which she writes treat social media as "more of a revolutionary strategy than an evolutionary way to reach customers." I think she's on to something. Shouldn't healthcare practitioners go where their customers are?

Wouldn't it be great if you could log on to the website of your local hospital and have a conversation with a nurse, department head, physician or some other representative to answer your specific questions about an upcoming procedure and your hospital stay rather than scrolling through the FAQ and not finding the information you are seeking. Reading the blogs of a hospital's administrator or one of its doctors might give you a better sense of that organization's philosophy or bedside manner.

Several of the hospitals that serve the Washington, D.C. metropolitan area where I live mail monthly or quarterly newsletters to local residents. These printed marketing tools provide updates on technology, treatments, personnel changes and public programs. Perhaps these institutions should save postage and help the environment by shelving the paper and going digital.

The Diva notes that those hospitals and drug companies that do have blogs have reaped the benefits. One Web 2.0 convert, Nick Jacobs, president and CEO of Windber Medical Center, credits his blog posts for speaking engagement invites around the country.

Because of these presentations, Jacobs says he "was exposed to the magnitude of not only blog power, but also You Tube, Facebook, Twitter..." Jacobs tells the Diva that his blogging led him to write two books and four newspaper columns "that have increased our business by double-digit figures."

Johnson and Johnson and GlaxoSmithKline are two corporations that use blogs to communicate with the public. The J&J site notes that "everyone else is talking about our company, so why can't we?" Recent posts have focused on nutrition, first aid and the company's health channel on YouTube. The GSK site is built around its alli weight-loss product.

How many people have logged onto WebMD at one time or another? Quantcast, the media measurement service, ranks the medical information site in the top 50, with more than 15 million people in the U.S. visiting each month. With so many consumers in the marketplace for health and medical information, doesn't it just make sense for these organizations to join the Antibloggergirldc and step into the 21st century?

_________________________________________________________

It was almost ten years ago that I moved into my home, and it was only a few days later that I saw my new neighbor outside working in her yard. Turns out she had been my neighbor many years before when I lived in the house on the other side of her's. I was only a child then, so I couldn't exactly remember what she looked like or if she would even remember me.

"Are you who I think you are?", she asked. Once I nodded yes and smiled, she immediately wanted a hug and told me how thrilled she was that I had moved in next door to her. She would go on to tell me over the next several years that God sent me back to her.

Over the past decade, I've spent countless nights with her watching movies, eating her delicious fried chicken, and taking her to see fireworks. Several months ago, we took her to see a film, and she said it was the first time she had been to a theater in 45 years. Coming from a family that usually doesn't understand or feel comfortable with my sexuality, she became my surrogate grandmother and I'm actually closer to her than many of my blood relatives.

When I met Alan, she immediately took him under her wing and he often takes her to doctor's appointments or to the grocery, helping her in and out of the car and making sure she uses her walker like she's supposed to. She often tells strangers that we are her grandsons, which causes both of us to break out in giggles at the mere idea of our "incestuous" relationship.

When she fell last summer and broke her hip, we nursed her through three months in the nursing home, visiting her almost every evening, bringing her dinner (she hated the food they prepared), and laughing as we watched "America's Got Talent" on the small television that she had to share with her roommate.

Just before bringing her home from the facility, a physical therapist toured Mrs. J's home with Alan and pointed out all of the pieces of furniture that needed to be removed or rearranged to prevent her from falling. Unnecessary pieces like the coffee table were moved to the garage, while furniture items in hallways or close to doors were moved to more appropriate locations.

For the first few weeks after her return home, we took turns spending the night at her house, making sure that her transition was as painless and uncomplicated as possible. We bought groceries, cooked meals, kept up with her medication, and did any other household chores that a disabled person would need help with.

She often told people (and us) that she didn't know what she would do if we weren't there. We would simply smile, give her a hug, and tell her the same thing. We weren't performing these tasks out of a sense of responsibility or obligation, we simply did them because we loved her, they needed to be done, and there was no one else willing to do them.

We often complained about her "real" family, although only amongst ourselves so that she would never hear. We were flabbergasted when her son arrived after her hip surgery and didn't even offer to spend the night. We were amazed that he only came to visit her a couple of times during the three months she was in the nursing home. Although she always made excuses for his apparent lack of care, we knew that she probably realized his behavior was selfish.

Her nieces and nephews seem to be far more concerned with her well-being than her only offspring and grandchildren. They call and visit her very often, and one niece is always the person that I call when a medical emergency arises.

A few months ago, her son (who lived a couple of hours away) decided to sell his house and move in with his mother. FINALLY, we thought. This would have to be a big relief for us because we wouldn't have to constantly worry about her falling and lying helpless on the floor, or leaving the stove on, or getting her medication mixed up. It was about time that he helped take up the slack and start contributing to his mother's quality of life.

He and his mother started selling off furniture from their respective homes, knowing that they would have to combine everything that was left into her smaller house. His home wasn't on the market long, so it was only a couple of weeks ago that he started bringing down his belongings.

Mrs. J bought her house when I was a child, so she's been sleeping in the master bedroom for around 30 years. The adjoining bathroom with walk-in shower was very convenient for someone who has problems walking and getting in a bathtub. However, when her son decided to keep his king-size bedroom suit, Mrs. J asked us to come over and move her furniture into a much smaller spare bedroom so that he could have the larger room.

She sold antiques that she had purchased and cherished for years to make room for his more modern pieces. She boxed up glassware and dishes, advertised beds and sofas in the newspaper, and basically cleared out half of her belongings. I could tell that all the change was weighing heavily on her mind, especially due to the fact that these were items that she had meticulously dusted and looked at for decades. Change is hard for anyone, but certainly more so for a women months away from her ninetieth birthday.

When the son moved in for good last Monday, we really didn't know what to expect. A couple of days ago, he asked us to swap out her television set with his and that gave us our first opportunity to see the house with new contents. It actually looked pretty nice, but was still very much in the process of being permanently arranged. What really caught our attention was all of the pieces of furniture that had been placed back in walkways and doorways. When I pointed out one of them to her, he interrupted a telephone conversation to tell me that she had plenty of room.

Yesterday morning, just before 7am, our phone rang. The son was calling to tell us that Mrs. J had fallen outside and couldn't get up. Alan immediately ran over and found her sitting in the driveway in her bra, soaking up the blood from a head wound with her shirt. She had tipped over head-first while pulling weeds and gashed her head open on the concrete water diverter under her gutter downspout. After pulling her off the ground, he ran back over to tell me that she had to go the emergency room. I offered to go, but he said it wasn't necessary.

A few minutes later, I look over to see her son unloading furniture from his truck and carrying it into the house. I just couldn't believe that he didn't ride with his mother to the emergency room! Alan soon called to let me know that her wound had required several stitches and that they were keeping her in the hospital for monitoring. He, of course, also called and informed her son of the same thing.

Alan came home a few hours later and the son was still at home, acting as if nothing was wrong. We went back to the hospital yesterday evening and I asked if he had been there to visit. No, she said. He had apparently started to the hospital and had a drop in blood sugar, so he had went back home.

Knowing that there was not even the slightest possibility that he would spend the night in the hospital with his mother, and realizing how she hallucinates when taking pain medication, we decided to stay. Finally, late in the evening, her son showed up in her hospital room and stayed a few minutes. As he got up to leave, there was no mention of whether anyone was going to stay with her, no explanation of why he couldn't... nothing.

This morning, he arrived just before she was checked out of the hospital. We followed them home in our car and then walked next door to help get her settled in. The house was a complete disaster.

The blood and grass from where Alan had prepared to take her to the hospital was still all over the bathroom. The kitchen counters were completely covered in dishes and knick-knacks that he had brought in. As we led her into the den to sit in her recliner, I was appalled to see an antique goat wagon sitting right in the middle of the floor.

Once I was alone in the room with her, I asked about it. She explained that it has belonged to his deceased wife. I asked if it was staying and she said it was. I reminded her that she wasn't even supposed to have a coffee table in front of the couch, and that this was much, much worse considering it had jagged edges and large wheels. She didn't even respond. I found out later from Alan that this "cherished" wagon had been stored in Mrs. J's garage for years and her son had moved it into the house while she was hospitalized.

So, we've come to the point where we have to step back and throw our hands up. We can't protect this woman properly without alienating her son. It's even strange for me to think badly of him when I consider that he's almost 70 years old, but selfishness doesn't only apply to the young. Even though we realize what a lazy, careless, and spoiled brat he is, we can't do anything about it.

The only thing we can do is be there to pick up the pieces, because God knows he isn't going to.

I recently spoke with Ted Townsend, the CEO of St. Luke's Hospital in Cedar Rapids, Iowa, about what their hospital could expect to face after this catastrophe. It was a sobering experience for me to advise a colleague that his institution may face a long term financial crisis similar to the one that the Federal government has not dealt with in the almost three years since Hurricane Katrina decimated the healthcare delivery system in our region. ...

I have not been to see her because I have an irrational phobia of hospitals. Maybe not so much a phobia of hospitals themselves, but I don't like seeing people I know and care about so... disarmed. So she is going to call me when she knows something and then we'll proceed from there. I guess.

If you're the praying type, I'd appreciate a few words for her.

Resolving Doubts - A day At The Super Speciality Hospital Puttaparthi

Sathya Sai Baba has repeatedly asked us not to indulge in or listen to rumours, and yet it is sometimes difficult to avoid doing so. The secret obviously is to take no notice of the content however ‘believable’ the rumour may seem, until proved correct. Normally I adhere to this principle as much as is humanly possible, but I actually weakened momentarily when someone happened to mention that they had heard from a ‘most reliable source’ that the medical treatment in the Super Speciality Hospital was, in fact, not up to scratch.

I later discovered that this information came from a magazine noted for its negative stance. However at the time I was susceptible enough to accept that this was a possibility, due to my own incredulous state. I had visited Prasanthi Nilayam many times since 1986, and had been over to the Super Speciality Hospital in 1991. Overawed at its beautiful atmosphere then; I wondered whether the medical treatment would after nine long years, still match the pristine grandeur of the Hospital.

In July this year, my wife and I were in Prasanthi Nilayam for one month and the thoughts of the Hospital were nagging at me from time to time. A few days before we were due to leave I felt a sudden desire to find out the facts for myself and contacted Dr. Safaya, the director of the S.S. Hospital and made an appointment to see him: this turned out to be the day before we were leaving.

Dr. Safaya asked me what it was I wanted exactly. I explained that there was talk in the western media that the conditions in the S.S. Hospital were substandard; and I should like to see for myself if it was true.

Dr. Safaya called in his Head of Security, a Dr. Barkuni, who has a practice in Delhi and like many in the Sai Organisation gives his time freely for several weeks every year, and directed him to take me wherever I wished to go in the Hospital and to answer any questions I may ask. And so commenced what I can only describe as a V.I.P. tour which could only have been bettered by a visit from Swami Himself. I spent the whole day at the hospital going into general wards, intensive care wards, the kitchen and maintenance areas.

I was capped and gowned and permitted by the operating surgeons to enter operating theatres where I witnessed two open-heart operations (without heart-lung machines) at close range. I was even able to converse with the surgeons who explained the symptoms and the techniques. I also watched a mitral valve replacement operation done with breathtaking precision. I saw a cataract operation whilst almost breathing down the shoulder of the operating surgeon, who, even to my untrained eye, was obviously highly skilled despite his apparent youth. Incidentally, there are an average of 12 cataract operations a day carried out in this theatre plus an average of eight laser treatments in the Department of Ophthalmology itself.

In the Department of Cardiology an average of over a thousand heart surgeries are carried out each year. This includes bypass, valve replacement and as well as pacemaker implantations. Over 1900 patients are admitted into this department each year.

Like all major hospitals through out the world, the S.S. Hospital caters for every medical need. It incredibly has the lowest mortality and infection rate of any hospital in the world; in fact, an area such as Puttaparthi where dust and germs seem to find such an easy footing, infection in the Hospital is almost unheard of. The Hospital gleams with cleanliness and there is a wonderful air of calmness and efficiency, which is quite inspiring. The intensive care wards (like the operating theatres) are all air-conditioned, and have the latest electronic equipment installed from bedsides to central control. The wards are well staffed by competent nurses and there is a doctor on call at all times.

I was introduced to the Heads of all Departments, including : Dr. Sunil in charge of the Anesthesia Section; Dr. Sara Pawan, an anesthetist, who spends his time between the General Hospital and the S. S. Hospital; Dr. K. Prasad of the Catheter Laboratory section and Dr. K. Bhat who although officially retired, still gives all of his time giving lectures and advice whenever needed, and his wife, the senior microbiologist at S. S. H.

They were all happy and enthusiastic about their work and their dedication was obvious when speaking to them.

It was all the more refreshing to me as I had gone to the Hospital with mixed emotions, and, to be honest, was somewhat apprehensive that there might be some truth in what I had heard. Not so. I was, if anything, even more impressed than I had been nine years before.

I moved on to the Department of Engineering and Maintenance and was introduced to its Head Mr. K. Viswanathan, who is an electronics engineer and is responsible for maintaining all the electronic equipment thoughout the Hospital. He explained some of the ancillary equipment needed for the smooth running of the Hospital including enormous generators-such as the latest Swiss 180KVA model, so efficient that should the mains power suddenly drop out at any moment, it will immediately ensure an uninterrupted continuation of power, especially vital when operations are in progress. In addition there are 2 ´ 260KV and 1 ´ 100KV and 1 ´ 500KV generators for different areas in the Hospital in case of power failures.

Although the General Hospital at Puttaparthi screens all patients before they are sent on to the S.S.H., a typical day sees an average of 150 of the more serious cases being treated at the S.S.H. Some of them come from as far as Nepal, such has the fame of this hospital spread.

In addition there is a demineralisation plant, which supplies absolutely pure water to the operating theatres. An incinerator which takes solid waste to convert it into gaseous products and pass into another chamber where the temperature is over 10000 C rendering it safe to be passed into the atmosphere. There is a needle separator and disposal unit: in fact every piece of equipment needed to ensure that this ‘quite isolated’ Hospital has every thing needed to be totally self-sufficient. There appeared to be no shortage of any medical equipment in the theatres or wards.

The prevailing ambience whenever I went in the hospital was one of tranquility and love. It is no wonder that patients heal so quickly in this vibration. Swami has often said that more love at the bedside results in faster recovery. It is certainly true in this Hospital where love is shown through efficient care and encouraging words, everywhere.

In conclusion, I can only say how grateful I am to have been given this wonderful opportunity to experience this most remarkable Hospital and at the same time to dispel any doubt I might have had.

Raymond Lindsay

Reference

Pat Gillespie • pgillespie@news-press.com • July 5, 2008

Fort Myers, Florida

A Fort Myers man's lawsuit against Lee Memorial — alleging the hospital falsifies Medicare and Medicaid claims — has been dismissed because he doesn't have an attorney.

U.S. District Judge John Steele dismissed Roy Meidinger's lawsuit Wednesday because of a recent 11th Circuit Court of Appeals ruling that doesn't allow plaintiffs representing the United States to proceed without an attorney.

Meidinger filed the lawsuit in Dec. 2006, but it wasn't unsealed until July 2007 because it was filed as a qui tam proceeding, a way for individuals to sue on behalf of the government, under the False Claims Act. Meidinger believes Lee Memorial's “customary charges” for services rendered are overpriced and therefore the hospital has been overcharging the government.
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Meidinger also claims the hospital paid “kickbacks” to insurance companies and coerce them to use the hospital's services by not collecting the full amount billed and forgiving the uncollected debt.

Could these be the headlines ten or twenty years from now?

Due to the dreaded MRSA super bug, we in the UK are obliged to wash our hands with a special ‘Bacteria-killing’ hand cleanser every time we go through various points within the hospitals. A good idea probably, though I personally think it’s all just ‘politics’.

But what about doctors and nurses? They are obliged to do it all of the time as they move around the hospital, meaning they probably ‘cleanse’ their hands in excess of one hundred times a day with this ‘solution’.

Now I use the painkiller gel ‘Ibuleve’ fairly regularly. I use it because I can’t take ‘Ibupofren’ internally due to an allergic reaction. It’s very similar in consistency to the hand cleanser gel we’re all obliged to use throughout our hospitals.

the reason ‘Ibuleve’ works so well and so fast is because our skin absorbs it very fast and it gets directly to the pain in record time. The worry with doctors and nurses is that if they are constantly cleansing their hands through the day, just how much of the solution is being ‘absorbed’ by their skin and entering the blood stream, travelling through all of the major organs on a regular basis?

If the cleanser is meant to ‘kill’ bacteria, what might it be ‘killing’ as it passes through these people’s body in such a concentrated amount? Has anyone even given it a thought? Or do we have to learn from our mistakes like the millions of people who have had their exposure to asbestos come back to haunt them years down the line?

I only mention Doctors and Nurses because on my regular visits to hospital I see them constantly ‘cleansing’. The cleaners and orderly’s appear to be exempt from this practice.

One old chap pulled a couple of cleaners up as they just walked straight through one of the ‘cleansing’ points. They just turned and laughed at him. Hmmmmmm?

Pete Moring.

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For anyone that has pedaled around the neighborhood or down the street you know that some people think it is great entertainment to see how close they can get their car to your bicycle in hopes you will topple over. I never understood these people because surely they wouldn't throw you from a car moving 20-30 mph but bumping their car into a moving bicycle is much worst . . . isn't it?

A friend of mine carries a steel rod in a tube attached to the frame of his bicycle. It seems that cars getting to close quickly learn the body damage is a two way street when it comes to thrusting a moving automobile into a steel rod. I can't say I condone his actions but I have seen "crazys" become sane when the rod hits their car.

For me I think John Lennon said it best with, "All that I'm saying is let their be peace".

This post is going to be about Jaundice and what you should know about it regarding your newborn.  As always, I want to thank all of you for taking the time to read this post and as always appreciate your input and experiences. 

Jaundice and your newborn:

Jaundice is a yellowish or light orange appearance of the skin and whites of the eyes.  It is a common condition in newborns and is usually not dangerous.

Jaundice usually appears on the 2nd or 3rd day of life in full term healthy infants, often disappearing in 1 week.  About 50% of full term infants get jaundice, but it is more likely in premature babies, more like 80%, and can last longer also.

Infants with bruising from birth, a sibling with jaundice or those who were delivered with help of a vacuum are at higher risk.

In most cases, jaundice is mild and is not problematic, but if it is more severe, present at birth or appears prior to 24 hours of life, treatment may be necessary. 

The causes of juandice :  Babys liver and other organs aren't fully mature.  One function of the liver is to rid the blood of excess Bilirubin, which is formed from the normal breakdown of old red blood cells.  This occurs all through life, but is more pronounced in the newborn period.  Until the babys liver begins to function fully, bilirubin tends to build up in the babys bloodstream, causing the skin and the whites of the eyes to become yellow in appearance.

The color change progresses from head to toe, so an infant with mild jaundice may only be yellow in the face, while one with severe jaundice will be yellow over more of his or her body, possibly all of it.

After being changed by the liver, most bilirubin is removed from the body through the babys bowel movements.  Increasing the feedings will increase bowel movements and help get rid of more bilirubin.

Occasionally jaundice can be caused by other problems.  If a baby and mother have different blood types, the mother may produce antibodies that destroy the newborns red blood cells.  This is called ABO incompatibility ( from the blood groups ), and can cause a sudden serious increase in bilirubin.

Another type of jaundice is called breast feeding jaundice, often because in the first few days baby doesn't get enough breastmilk, his bowels are not moving frequently and the bilirubin cannot be removed as easily.  The best way to treat this is by nursing more frequently.  Giving water feedings WILL NOT help.

The level at which jaundice may be dangerous depends on a few factors:

The babys age, whether the baby was full term or premature, or if the baby has any other medical conditions.  If your pediatrician is concerned they will do a skin or blood test as I discussed in my previous post.  When treatment is needed phototherapy is used.  Ultraviolet lights to help the body remove the bilirubin.  This is done in the nursery, baby is undressed except for his or her diaper and eye covers are used to protect his or her eyes.  The pediatrician will order checks to be sure the level is decreasing as it should.  The nurses will also check babys temps frequently, as the baby will be undressed and we don't want cold-stress to occur.

Report any yellow-orange discoloration to your pediatrician promptly, because if the level becomes extremely high, nervous system damage may occur, though this is very rare.

In my next post I will discuss Circumcisions.  Guys might not want to read that ! :  )

As always, thanks for reading and contributing your experiences. 

God bless you and yours,

Meredith - RNC