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Monday, December 27, 2010

Why I Can't Tell You This Story...


This week, I had many interesting cases in my clinical practice.  One posed an interesting ethical dilemma, and 2 others were interesting medical cases in pediatrics that are relatively rare in primary care.

So, since I have not been posting much lately, I figured these cases would be great blog posts.
...Until I realized that I actually did not feel right about sharing the details of these cases.   Because it is my ethical obligation to adhere to privacy practices. Because I have a duty to protect the anonymity of my patients. Because there is no way to change the story enough for it to be unrecognizable.  Even though the general dialogue would make for an excellent discussion.  Even though you would find it interesting.  Even if it gave me a topic for a needed blog post.

So I was out of luck...or was I?
I then realized it would be (just as?) interesting to talk about privacy practices and the physician-writer dilemma.

You may (or may not) know it, but one of the forms buried in the pile of  paperwork that you get upon registering with your physicians office is their HIPPA policy statement.  HIPAA stands for the "Health Insurance Portability and Accountability Act" and was put into effect in 1996.  It basically states that your medical record is confidential, and details cannot be shared with others without your explicit permission.  You, not your doctor, are the owner of your medical information.  And this is how it should be.

So, then the question arises, who owns a patent's story?

A patient comes in to the office with a complaint, a problem, a story.  I sift through their words, translate them into medical jargon, pick out the important information by asking pointed questions.  I may get all the information I need in a short sentence from the patient (this would make my job easy).  But, more often their story is tangled in a web of (seemingly) unimportant detractors details that I must sort through to get to the gist of the problem.  Once we have clarified the problem (the history), we move on to a physical exam and pair that with laboratory or imaging tests that help us arrive at a diagnosis.  It's a bit more complicated than that, but you get the idea.

So, I can synthesize all of this information into a succinct "case presentation".  I would take the pertinent portions of the history, physical exam and lab tests and present them.  I would formulate a short "differential diagnosis" (a list of diagnostic possibilities for the patient) and ultimately arrive at a conclusion that would hopefully give the patient treatment options and a prognosis.

The patient owns the story.  And their signs and symptoms.  But, after all this medical manipulation, I have crafted it into something quite different than its original form.  So, am I then the owner of that case as the treating physician?

Physicians talk candidly quite often about patients, and, unless they are shared patients, anonymity is typically preserved.  The reason for the sharing of information is to get another physician's opinion about a case and allow for a transfer of ideas.  I believe that most patients would not take issue with the sharing of anonymous medical information between professionals as a point of academic interest.

But, what if I decided to share some patient stories with you, my readers on my blog?  What if I protected my patients by changing the names and details of the story?  What if I decided to write a book that included interesting patient stories?  Are those stories mine to share?

What would you, or the patient, think about that?  Would you be honored that your story was interesting enough to share?  Would you feel that sharing your story in this way may help other patients or doctors?  Or, would you feel betrayed?  That a trust had been broken in this important professional relationship?  Do I have an obligation (ethically, legally) to inform the patient that I plan to share the case?

I do not know the answers to many of these questions, I am just posing them for the sake of conversation.  I suppose the answers are quite personal and different for all physicians.  Right now, as a new physician-writer, I will be erring on the side of caution and keeping these stories to myself.  Or letting enough time pass and wait for other similar cases to come along that can be "combined" to adequately disguise the story.

So, for now, my lips are sealed.
____________________________________________________________
So, what do you think?  Would you take issue with your physician sharing your 'story'?

Friday, December 24, 2010

Happy Holidays...

Happy Holidays from The Doctor Mom....

Still testing my feed with my social media 'mentor' from White Coat Underground.

Saturday, December 11, 2010

Bedtime Woes & Bad Dreams...


We have been undergoing quite a bit of transition in the house.  After a tough couple of weeks and a shake-up with the girls school situation, things seem to be, well...off.  And this is never more obvious than at bedtime.

The hot pocket's (now almost 3) previously easy and seamless bedtime routine is now turning into a nearly 1 hour drama, filled with cajoling, books, back rubs and crying.  Oh, and snuggles; she requires lots of them.  And she has worn down my husband's patience, which is very difficult to do.

The Boober (4), on the other hand, has always been quite a handful at night.  The problem, we have determined....she is resistant to sleep.  She lays in bed for a while, and just when you think she may be sleeping, she pops her head in our room to let us know that she is still awake.  And scared.  This can go on until 11 pm.

At first I thought she was "faking" the whole scared thing.  What could she possibly be afraid of in her safe and cozy room?  Well, last night I became convinced that her fears are real.  She was getting ready to go to sleep and her blinds were open and she said "scary tree" and made me close them.  And, in thinking about it, I realized that the winter trees with no leaves and scary shadows may very well be intimidating.  Then, as she does every night, she screams out in the night in the middle of a bad dream.  A couple of ear piercing cries later, I checked on her.  She said..."too many monsters mommy...".  Poor girl...Disney movies are haunting my baby.  I think she may even be afraid to go to sleep.  What solves this problem...of course, someone laying in bed with her.

So, what is a good parent to do?

This brings me to the frequent conundrum between PARENT and PEDIATRICIAN, the difference between DOCTOR and MOM.

The Pediatrician would say...

  • These are classic nightmares
    • Appropriate age (commonly 3-6 when imaginations run wild but the distinction between fantasy and reality is not clear).
    • They happen late in the sleep cycle (not in the deep stages of sleep like night terrors).
    • The child remembers (vividly) what the dream was about and may be afraid to go back to sleep.
  • Do NOT let this be the start of a NEW bad habit...
    • Do NOT let her sleep in your bed because it may make her scared of her own bed
    • Do NOT begin sleeping in her bed because it will become difficult for her to sleep alone
  • Reassure her and let her know that she is safe.
  • Reassure the parent that this is a common stage for children, and it will improve.
The PARENT would say:
  • Go to her when she needs you.  Reassure her and stay until she is asleep, or no longer afraid.  If you are exhausted, well...you may end up sleeping there. Or you may just find her in your bed in the morning.
  • Let her know that dreams and nightmares are a part of every person's active IMAGINATION.  
  • Try to prevent them by not watching scary movies or reading scary books (umm...every Disney movie has a good villain).
  • Think of ways to keep the "bad guys" away...
  • Let her have a security object to keep her feeling safe...or 20 animals/blankets/pillows to fill the bed.
  • If all else fails...call your DOCTOR (ha!)
So...calling all mommies out there, any other suggestions for me?

Thursday, November 25, 2010

To My Girls...

Dear Girls:

Today is Thanksgiving.  This week, in your (home) school, you have been making art projects with turkeys and talking about pilgrims.  But really, this holiday is about giving THANKS.

You will never know a day without a home.  You will never feel unsafe and be without the comfort of your own bed.  Although you may not eat some nights, you will never go hungry.  You may not get every single toy you "need" when you see a commercial, but you will never know what it truly means want.  You will always have your Mommy and Daddy cheering for you [loudly] in the corner.  You have been, and will continue to be, surrounded by a family that loves and supports you.  And that will never, ever change.

But today, I hope you can understand that what you have is so very rare.  There are people out there that work so hard and still cannot provide for their family.  There are families out there who do not have a comfy home and have to stay out in the cold without "feet" jammies.  There are children who don't have enough food and don't have access to the food that "makes you strong for the monkey bars".  There are people who don't have families and have to eat alone tonight on Thanksgiving.

So, today, I will try to help you understand that you are blessed.  And we are blessed to have you.  And we should be thankful for that.

Happy Thanksgiving to all my readers and The Doctor Mom "fans"!

Wednesday, November 10, 2010

iToddler...


I was recently on vacation with my 2 girls.  And each of their iPhones.  I survived the flight and many nice evenings out in restaurants with my newly (perfectly) behaved children.  Now, you may think that is utterly ridiculous OR... you may understand because your children have their own phones/ipads/computers.  I am aware that, as with everything else in life, these phones are a double edged sword.  They are a fabulous distractor in times of need.  You have games and videos at your fingertips.  But user beware, they are HIGHLY addictive to all toddlers.

Well, apparently I am not alone.  There has been a flurry of recent articles in the mainstream media about children using technology.  The bottom line is even the most expert psychologists don't know whether to tout the iPhone as a fabulous learning tool for children or something more sinister.

Click below for 2 insightful articles on the subject of kids and iPhones:
USA TODAY: "Parents Worry About Toddlers Tiny Fingers Itching for iPhones"
NY TIMES:  "Toddlers Favorite Toy: The iPhone"

But, the real point of this post is to say that I am on board with iPhone "learning", because for me, now, there is NO TURNING BACK.  So, instead, I will impart my "research" into the best Toddler and Preschool Apps, so you can learn from all of my searching and wasted monies.

APP:
DESCRIPTION:
COST:
LUNCHBOX:
Works on counting, colors, numbers, letters and even some  puzzles mixed in. Stickers used as rewards.
$0.99
SHAPE BUILDER (LITE): 
A puzzle game that has plenty of great free puzzles of common objects (ie guitar and truck).

FREE!
BALLOONIMALS:
Clever app.  Starts with a picture of a balloon, you blow into the bottom of the phone and it blows up, then shake the phone to change the balloon into an animal.  Push on the animal it moves; and then you can pump it up until it bursts.  Great app, but beware, my toddler spit into the phone so much that it didn’t charge well for a while.
$1.99
(also a lite version)
CUPCAKES: 
Provides hours of toddler entertainment!  Start by picking the wrapper for your cupcakes, then pick from more than 10 different batters.  Put the cupcakes in the oven to bake and then the fun begins.  Choose from many different frostings, toppings and even candles that you can light and blow out.  You can then eat the cupcake (virtually).   Pros: no calories.  Cons:  you make delicious cupcakes that you may wish
you could really eat.
$0.99
PBS KIDS PHOTO FACTORY
Start by selecting a picture from your phone (or take a new one).  Then you can pick from many different PBS characters and objects to add to the picture and finish it off with a cute frame.  My kids save these to the photo library or you can email them.
FREE!
MY FIRST PUZZLES: 
Another cute puzzle game that reminds me of the Melissa and Doug puzzles we have at home.  My 2 year old loves this one.
$1.99
MAKE A MARTIAN: 
Pretty self explanatory; starts with a blob of color and you can change all the body parts to make a cute and wacky creature!
$0.99
TODDLER TEASERS (SHAPES) and others: 
This one is great because there a bit of learning involved.  A bunch of different shapes (or colors) are presented and the game asks you to identify the correct one.  Rewards with stickers.
FREE!
MEMORY PRO:
A FREE matching game
FREE!
PRESCHOOL ADVENTURE: 
This one has 8 different types of skills ranging from colors to typing and is great.  Makes cute noises too.
 $0.99
ALPHABET TRACING: 
This one is great for the 4-year-old (preschool) crowd.  Starts with a letter and a train moves and shows them how to trace both upper and lower case letters with their finger.
 FREE!

Now go...get to the App Store!
_________________________________________________________
Are your kids iToddlers?
Come on...Join in the conversation...
Tell me about your favorite apps below!

Monday, November 8, 2010

The Scoop on Poop...

With a rush of new babies being born both in my medical practice and in my personal circle, the questions about poop begin.  Along with sleep, it seems to be the most talked about subject by parents of newborn babies.  In fact, even with parents of young kids, poop seems to be a very popular subject. 

There may be too much of it.  It may be loose.  It is always smelly.  It can be green, yellow, black or brown.  It may be like a ball or a gooey mustard seed-like mess.  Sometimes it doesn’t come, for days.
But whatever its consistency, it seems to cause much distress. 

So, don't STRESS...
Let’s start with the beginning….

When babies are born the first type of poop that is passed is called MECONIUM.  Meconium is the black tar like poop; it is made up of all sorts of different debris like dead skin cells, hair and amniotic fluid that was swallowed by the baby in utero.  Some babies can pass meconium in the amniotic fluid prior to being born (usually babies that come late); which can cause some problems in the newborn period.  But most babies do not do this and will pass the 1st meconium stool within the first 24 hours of life.  This is the ONLY type of black stool which is NORMAL, other black stool later can signify digested blood (or can be seen in patients taking iron supplements).

BREAST FED BABIES:
After the initial passage of meconium, breast fed baby's poop changes to a soft, runny mustard seed like consistency that some parents confuse with diarrhea (because it is so loose).  Most breast fed babies poop with each feed for the first couple (2-4) weeks of life.  Stool frequency tends to drop off quite quickly after the first 2 weeks of life in breast fed babies and then can BE AS INFREQUENTLY AS ONCE EVERY 2 WEEKS.   This is the cause of much stress and distress by parents because their baby went from a “frequent stooler” to an "infrequent stooler" and the question of constipation and colic arises (see below).  It is very uncommon for a breast fed infant to be constipated, so do not stress if they are not pooping every day.

FORMULA FED BABIES:
Formula fed babies can have a variety of different stools, but they are usually tan colored and soft, and should be no thicker than a peanut butter type consistency.  Stool in formula fed babies can vary, but in general, most babies after the first month will poop 1-2 times per day.  The key here is: IF YOU CHANGE WHAT IS GOING IN, YOU WILL CHANGE WHAT IS COMING OUT.  So, if you switch from breast to formula or change formulas, the consistency of the poop will change too, and that is NORMAL.  Formula fed infants are more likely than breast fed infants to become constipated, so be on the lookout for hard stools. 

SOLID FOOD POOP:
When your child begins solids, their poop will again change.  By this time, stools should be fairly consistent, but again, will vary between children.  Poop will change fairly frequently depending on what is fed.  Click here for a picture of solid food poop (in case you are faint of heart).  Sometimes you may see pieces of digested food in poop that can even look like blood.  Also, beware of blueberries; kids can eat a ton of these and get a dark purple or black colored poop that looks kind of scary!



Is it Constipation?  Is it Colic?

Once there is a decrease in the frequency of infant stools parents naturally wonder if their child is constipated.  The answer is usually NO.  Constipation is NOT defined by how frequently you poop, but rather what the stool looks like when it comes.  If it is soft and mushy, this is NORMAL.  Even if it is once a week.  Do not sweat it.  You don't need suppositories, prune juice or the rectal thermometer; all you need is patience.  Your child is only considered constipated if the stool coming out looks like dried out balls of poop (which is UNCOMMON in newborns).


Now on colic or fussiness and its relation to poop:
            
Unfortunately, the frequency of a baby’s poop slows down at the same time where babies are “waking up” and becoming more alert.  Parents often make the association between less frequent stools and fussiness, but the relationship is likely NOT causative, it just happens at the same time. 

On drawing the legs up and crying:

I frequently hear from parents that their baby appears uncomfortable, cries, grunts and draws up their legs when they poop.  This is actually NORMAL and PHYSIOLOGIC.  When adults go to the bathroom, they sit on the toilet with their legs bent at 90 degrees and bear down to have a bowel movement.  Well, we all know that babies don't (consciously) know how to do this.  So, what they do is draw up their legs (like sitting on the toilet), which lowers the rectum; and cry or grunt, which increases the intra-abdominal pressure (like bearing down).  This is the only way they know how to pass stool.  So, it is not that they are uncomfortable, it is that the crying actually gets the poop out.  In fact, if you feel like your baby is having a hard time having a bowel movement, you can help them by rubbing their tummy and drawing up their legs for them. 

Now that we know about NORMAL poop...stay tuned for an upcoming posting on ABNORMAL poop....

Tuesday, October 19, 2010

When it comes to sex...Are you NORMAL?


Last week, I was in Chicago for the annual meeting of the North American Menopause Society (NAMS).  It was a fabulous conference.  I wish that I could summarize all that I learned and share it here, but I will not bore you with all the details.  Instead, I will fill you in on some information from the most interesting (and relevant) lecture of the bunch.

I have been meaning to post all week, but have been unbelievably busy due to the implementation of an electronic medical record system in my office.  It will be an improvement in the long run, but right now it is a form of slow torture.

A PhD. psychologist named Sheryl Kingsberg presented information on sexuality and aging, which was relevant for women of all ages.  She was witty, the talk was stimulating (pun intended) and packed with useful information.  I wanted to share the ideas presented there so I will do the best job I can of summarizing the main points.  She made 3 analogies that I thought were VERY helpful in explaining issues relating to female sexuality.

1.  My wife/girlfriend/partner never initiates sex (so she must not like it...).  This is a common complaint from men.  And it is true.  In general, women can get by on less sex than men.  Let's say that a women is satisfied with having sex once a week, and her husband is satisfied with 3 times a week.  Well, the woman, being the intellectual that she is, can add well and knows that if she initiates sex once a week and he does 3 times a week, that is 4 times per week which is just TOO MUCH.  So, instead, she decides that she will sneak her one time a week in under his 3 times a week and everyone will be happy.  Right?

Well, not necessarily.  Women know that if they start to initiate sex more often, their partner will want to do it more.  So they wait.  However, an important change then occurs.  Apparently, we all have an "external" type of view of ourselves.  So, for example, if you are faced with a dessert table and every time you go to the dessert table you pick a chocolate chip cookie, over time you will realize that you must like chocolate chip cookies because you always choose them. Over time, if a woman fails to initiate sex she may stop and think "if I don't ever initiate sex, I must not like sex."  And it does not help that her partner may question her affinity to sex as well.  But this is not necessarily true.  She may enjoy sex, just on her own schedule, and she may wait for her partner to make the first move, which is entirely NORMAL.

2.  Women have a DIFFERENT sexual response cycle from men.  In 1966, a linear model of sexual response was produced by Masters and Johnson as seen below.
This model starts with excitement and moves through a plateau phase onto orgasm and then resolution.  It often holds true for males but is NOT characteristic of most female sexual response.  For women, sexual response tends to be more of a CYCLE as more recently characterized by Basson.

For most women, it is actually NORMAL to have a low sexual desire.  Women do not typically spend their day fantasizing about the hot sex they may have that evening with their husband (on a side note, they MAY fantasize about their husband cleaning the kitchen, but I digress...).  For most women, AROUSAL usually preceeds DESIRE.  So that means that IT IS NORMAL to NOT THINK ABOUT SEX until you start to do it. And then once you get started, the desire starts and the whole thing is not half bad.


Think about it like exercise.  I hate going to the gym.  Every night before I plan to work out I start to think of any excuse to get out of it.  When it comes time to do it, I dread it.  But, if I actually get myself on the treadmill, sometime about mid-workout, my perception of it changes and I actually get into it and it's not that bad.  And, when the workout is over, I feel energized and refreshed and vow to do it all over again the next day.  But then, the next day I may dread it again.  And the cycle continues...just like sex.

3.  If sex feels good, and it's free, why doesn't my partner want to do it all the time?  Well, like most things in life, when we are young and things are new you may want to to do them all the time.  So, for most couples, the passion that comes with having a new partner means that sex happens often in the beginning of a relationship.  However, over time, this type of new sexual passion will die down as life often gets in the way of constant sex.  Apparently, passion has about a two year window and after that, to keep the passion going, most couples HAVE TO WORK AT IT. However, because men have an innately higher sex drive than women, there is often a discord between partners in how much sex they are satisfied with.

Here, the analogy she made had to do with ice cream.  She gave a great example of a couple eating dessert.  The wife says to her husband, "we have not had ice cream in a while, why don't we have ice cream tonight".  He says "sure, that sounds like a great idea" and they enjoy the dessert for the evening.  Fast forward to the next evening when the wife says, "that ice cream we had last night was so good, lets do it again tonight."  He is hesitant but finally agrees but feels full and fat afterward and thinks he may not want to do it again for awhile.  The 3rd night the wife turns again to the husband and says "How about ice cream again tonight, we can have a different flavor and you'll enjoy it....and I can't enjoy it alone...".  He hesitates, may beg not to do, but she convinces him to do it even though he does not want to.  Well, on the 4th night he has learned his lesson.  He decides to go to bed early saying he has a headache.  Sounds like a familiar pattern.

The reason I wanted to post these anecdotes is to point out how NORMAL and universal these issues are.  The first step in any type of counseling of a patient having sexual issues is trying to normalize the problem and change perception of what is typical.  Often women are coaxed into thinking that the are ABNORMAL because their sexual drive is different than that of their partner.  This is actually very normal and understanding this can relieve much of the distress surrounding this issue.  In fact, sexual problems are only classified as DYSFUNCTION if the issue is causing DISTRESS to the patient.  So, there is NO NORMAL when it comes to how much sex you have.  That, like everything else, is personal and something you will need to negotiate with your partner so that BOTH people are happy and satisfied.

Wednesday, October 6, 2010

All Alone...




I am at a conference in a big city relatively close to home.  On my ride to the airport I realized that I had not been on a plane in over 6 months.  And, while that may not sound long to some, for me, it is an eternity.

I love to travel.  Let me rephrase that.  I used to love to travel.  Now, however, it is easier to stay home.  But this trip is different.  I am at a medical conference preparing to learn about something that piques my academic mind.  Planning to add to my fund of knowledge to help my patients.  And refueling for more blog topics, I'm sure.

Today I realized that I am a changed woman from the person I used to be.  Now, my mind, my thoughts and my ramblings represent the beliefs of a fiercely independent thinker.  But, in other aspects of my life, I am no longer the independent person I used to be. 

I don’t travel alone much anymore.  In fact, I'm rarely ever alone at all for more than an hour at a time.  As a result, I (embarrassingly), do not even know how to get to the airport in my own hometown without my Nav.   When I got to the airport it felt strange not having my husband to direct me.  Or to ask me 1,001 times if I had my boarding pass.  And to check to be sure I hadn't lost my license.  


This time, as in times long ago, it was just me.  In charge of me.  And ONLY me.  I proceeded through each point, checking and rechecking myself to make sure I hadn’t forgotten anything.  I walked through the airport looking around in the stores, taking my sweet time, buying a magazine, drinking a well deserved latte, and eating dinner with no one to attend to.  No chaos traveling behind me.  No unnecessary potty breaks.  No strollers or kid paraphernalia.  

I didn't break a sweat even once.  A strange feeling, indeed.

And now, here I lay in a hotel room with just myself, my computer and the television.  A little slice of peaceful heaven.  No stories or book readers tonight.  No return trips for one more kiss goodnight.  No headphones on my ears to watch Kardashians.  No potential wake ups with bad dreams.  Just me, my blog and my thoughts.  And, hopefully, a well deserved GREAT night sleep.

It sounds wonderful for tonight.  But I’ll be ready for my life back in the morning.


Friday, October 1, 2010

What My Latte Means to Me...

Like most moms I have little free time on my hands.  My days are filled with patients, errands, phone calls, exercise and a preoccupation with schedules.  But there is one short window of time in my day where that all goes away.

My morning is rushed.  My husband gets up at the BCOD (butt crack of dawn) to get dressed and make lunches.  I roll out of bed a bit later at the COD (crack of dawn).  Then, the torture begins as I have to wake the two (teenager like) toddlers who remain sleeping.  They are crabby.  They resist getting dressed.  They call for daddy even when they know he is not there.  They don't willingly brush their teeth or hair.  They run around like maniacs when I try to put on their shoes.  They both want to be carried down the stairs.  Sometimes at the same time.  Then they fight over which toy they want to add to the endless collection that already fills the back seat of the car.

Then it is off to school.  The car ride begins with begging for a video, to which I initially resist, then, ultimately give into.  2 minutes into the video, we arrive at school.  We may still be at the credits.  I can get them inside quickly by motivating them with "last one there is a rotten egg".  I wonder how long they will fall for this one.  Then into the classroom to quickly prepare a large carbohydrate load for breakfast.  2 kisses on the head, good-bye and I'm off.

To my 15 minutes of heaven.  The only peace and quiet of the day.  Music fills my ears.  And if I am not running late, I get my coffee.  Tall soy latte. One splenda.  $3.13 of pure bliss.

It is the one thing that is relaxing in the morning.  Like a quick trip to the beach minus the plane, bathing suit and large bill.  The first sip reminds me that all the hectic-ness will eventually end.  That this moment will not be filled with whining.  Or questions.  Or "can I just ask you one more thing...."

That this moment is just for me.  And it just ended.

Back to the grind!

Friday, September 24, 2010

On Gratitude...

I have much to be thankful for on an everyday basis.  A healthy family.  A supportive husband.  A secure job.  Wonderful friends.  But, recently, I have learned, I have much more to be thankful for.

This week has been overwhelming.  The response to the recent incident on Kol Nidre has been more than I have ever imagined.  From people close to the family, from my community and from complete strangers.  It is like getting a great big virtual hug.  Many times a day.  And it is heartwarming.  

Ok...and I LOVE the blog traffic.

And, in my usual fashion, I have questioned my role and the bigger meaning of it all.  Truth be told, the recent "publicity" has been a bit uncomfortable.  Good or bad, as a doctor, my job never ends.  It is a constant responsibility, as it should be.  I consider what I did to be an extension of that job.  My duty.  To put my knowledge and education to use when someone needs it most.  Not a hero.  Just lucky.  Right place, right time.  Able and willing to help.  Along with many others, who put forth great effort to make a difference.

In Yiddish it is called Beshert.  Meant to be.  Beshert.  I was near this man and able to help.  Beshert.  This man happens to be the uncle to one of my former partners.  Beshert.  Many doctor friends at the hospital continued to care for this same patient.  Beshert.  That I have a forum to discuss my thoughts and reflect on what happened.  Beshert.  That these words, told directly from my heart, could reach his family and loved ones so quickly.  And that they touched a nerve with them.  And with you.  And that you may have been kind enough to share my story with others.

I spoke with the son of the patient and he expressed his gratitude to me.  He told me about his father.  That he is his hero.  That this was not his time.  That he is a patent attorney, and still working.  That his mind is sharp and he is a thinker.  And that he is kind and generous man.  

I told him that the AED saved his life.  Because it did.  This little machine, that can be operated by anyone, restarted his heart after its electrical system went awry.  That he would not be here if someone had not bought that machine.  Right place, right time.

And then he told me something that made all of my doubts of heroism go away.  Something that made me think less about the science of sudden cardiac death, and more about the meaning of his spirit.  

That machine saved his heart, but you saved his brain.  

He is more than his body and his beating heart.  He is a devoted father.  A loving husband.  A generous member of the Jewish community.  A thoughtful attorney.  And in those few moments before his heart was "restarted", we preserved all that.  For him.  For his family.

There are times when we are reminded how precious this gift of life is.  This, for me, is one of those times.

Thank you for your taking the time to read my post and for sharing your thoughts. 
___________________________________________________________________________


On a more academic note:

Here is important information about HANDS ONLY CPR.  If you are faced with a situation like the above, you do NOT have to be a doctor to save a life.  You don't even have to do mouth to mouth resuscitation.  PLEASE watch the short video for a demonstration.  

I have also included a link to a handout that I give to all parents to put in their cupboards should their child need help.  Click the above link and then select the 2nd box entitled "Choking Prevention".  PRINT this.  Put it someplace you will remember.  You will need it in an emergency.

If you have never seen an AED, watch this video so you could use this simple device if needed.  It could save a life.

Saturday, September 18, 2010

A Kol Nidre to Remember...


It was the holiest day of the year.  Kol Nidre.  The night before Yom Kippur.

I entered the synagogue after a filling meal preparing for my fast.  Running late as usual.  Looking around to find my family and my seat before the service started.  There they were. In the usual place.  We embraced.  Ready to be inscribed in The Book of Life.

Then it happened.  Something I was totally unprepared for; yet, I had spent years of my adult life preparing for this actual moment.  I turn to the elderly man seated next to me, he is slumped over in his chair; no breath, no pulse, no life.  His heart had stopped.  In this most sacred of places, on this most holy of nights.  Right next to his family.  Just as he was to be inscribed in the Book of Life.

I remained calm and my doctor instincts took over.  I have done this before, so many times, so long ago, it seemed.  Yet this was so different.  The hospital is a safe, controlled environment.  There are masks and medicines and respirators and IV lines.  Here, there is none of that.  Just a bunch of well trained physicians and other caring members of the community wanting to help.  Praying that this breath would not be his last.

He lay across on the chairs where we were seated.  I felt his neck and confirmed that he was without a pulse.  Delegate.  Someone call 911.  Start compressions.  I look down.  It is my duty to give him a breath.

ABC.  Airway.  Breathing.  Circulation.

No bag and mask.  No comforts of the familiar "code blue".  I bent down and began to breathe for him.  And then started chest compressions to circulate the blood that needed to get to his brain quickly.

He was moved to the hallway.  The life saving device was there.  An Automated External Defibrillator.  Another doctor placed the pads, called all clear, and the life sustaining shock was delivered to the patient.  The patient, a husband, a brother, a father called Abba.  It had been about 4 minutes.  It seemed like an eternity.

And then a breath.  And with that, a return of a pulse.  And his eyes opened.

"Abba, don't leave me", his son insisted.  "I am here with you."

Time passed, EMS arrived, the patient was stabilized and transferred to the hospital.  He was awake, combative and breathing on his own.  On his way to a recovery.  From death, back to life.

I returned to the service trying to decipher what had just happened.  But before I could gather my thoughts, before I could process this moment, the following words were spoken:
Great is the eternal power at the heart of life; mighty the love that is stronger than death.  Faithful love gives life to all, the acts of grace restore our strength.
Words I have heard every year at this time since childhood.  Yet tonight, they took on a new meaning.
Life's harsh winds uproot the weak; its hard rain beats down upon our kin.  Let those who stand support the falling, keep faith with those that lie in the dust.
And while I would not classify myself as deeply religious or even necessarily spiritual, it was hard to hear those words and not feel as though they were being spoken directly to us.  To all those who helped bring this man back to life.
To the sick, we must bring healing; and to those that are bound, release.  We give thanks for the power to live and act, for the blessing of love that is stronger than death.
Was there some divine intervention that put me in this place?  Was this night not supposed to be his last?  Could his family's blessings of love save this man from death?

I sat through the rest of the service and continued to reflect on what had happened.  I spoke the words that I have every year, tonight, with more conviction.
Birth is a beginning, and death a destination.
And life is a journey: 
from childhood to maturity, and youth to age;
From innocence to awareness, and ignorance to knowing;
From foolishness to discretion, and then, perhaps, to wisdom;
From weakness to strength, or strength to weakness--
and, often, back again;
From health to sickness, And back, we pray, to health again;
From offense to forgiveness, from loneliness to love,
From joy to gratitude, from pain to compassion
And grief to understanding---from fear to faith;
From defeat to defeat to defeat--
Until, looking backward or ahead, 
We see that victory lies
Not at some high place along the way,
But in having made the journey, stage by stage, 
A sacred pilgrimage.
Birth is a beginning, and death a destination.
And life is a journey, a sacred pilgrimage--
To life everlasting.


May this year be a happy and healthy one.  L'shanah Tovah.

Wednesday, September 15, 2010

Flu Shots...Important Information

So with flu season rapidly approaching...I want to provide some information to my readers about this year's flu shots to answer some important questions.

Flu shots are recommended for all children over the age of 6 months.  The flu can be a serious illness in any child, regardless of their previous health status.  If you have a child under 6 months, the best way to protect them from the flu is to get yourself immunized.  Unfortunately, the most devastating effects of the flu can be seen in infants, so be sure to protect yourself and your baby.

Essentially, the only TRUE contraindication to the flu shot is an egg allergy (or a history of Gullian Barre Syndrome within 6 weeks of a flu shot, though this is RARE).  Both the intramuscular vaccine and the nasal mist are manufactured inside of eggs, so egg allergy means no vaccine and even more frequent hand washing.

Though the H1N1 pandemic officially ended this summer, there is still a risk for this type of flu.  This year's flu shot is a COMBINATION of the H1N1 shot and the seasonal flu vaccine.  Though there were (unwarranted) concerns early last year about the safety of H1N1 vaccine, millions and millions of doses were given last year with no increase in adverse events reported.

For kids:  Who needs what and when...

<6 MTHS

NO SHOT
6 MTHS -  8 YEARS
NO PREVIOUS SEASONAL FLU SHOT
2 SHOTS, SEPARATED BY 4 WEEKS

PREVIOUS SEASONAL FLU SHOT,
BUT NO H1N1 SHOT
2 SHOTS , SEPARATED BY 4 WEEKS

PREVIOUS FLU SHOT & AT LEAST 1 DOSE OF H1NI LAST YEAR
1 SHOT
>9 YEARS
REGARDLESS OF PREVIOUS IMMUNIZATION STATUS
1 SHOT

This year, as in years past, there will be 2 forms of the flu vaccine available.  The Flu Mist is a live form of the flu virus and can be given to healthy children over age 2 without any lung problems or immune compromise.  There is a risk of MILD upper respiratory congestion with the flu mist.  The intramuscular vaccine is available as well and this is a KILLED form of the flu virus.  You cannot get sick from the flu shot.


There is even more recent data proving that there is NO association of autism with vaccine preservatives (thimerosal).  However, there is plenty of preservative free vaccine available.  All vaccines for children under 36 months is preservative free.  The preservative free vaccine is in the individually stored syringes and does not need to be drawn up by the nurse.  Ask your doctor what type of vaccine they are using if you are concerned.


The best time to get the flu shot is EARLY IN THE SEASON.  The immunity will last well beyond this flu season and there is no sense in being unprotected early in the season. So, call your doctor and find out if they have received their shipments of shots.  And don't forget the importance of hand washing!

Click here for more information from our friends at the CDC.


Stay healthy!!