Thursday, July 31, 2008

I've never been so clean in my life

I’ve been working at the hospital since October and I’ve never been so clean in my life. I’ve washed my hands about a thousand times. I have three pairs of pants with NO STAINS -- these are the ones I wear to work. I have spotless tennis shoes, clean shirts, and frequently shampooed hair.

In the past, my relation to the soil of the earth had always been close and highly involved, with a hands-on approach to the compost pile to which we will all return someday. I’m grounded, literally. And to this I attribute my robust immune system -- I know from bugs and microbes.

But we keep things clean at the hospital, and I have gotten on board.

THE NEWS. Senator Barack Obama says he wants to send more troops to Afghanistan. I will have to be convinced about this. The null option, the one that got him the nomination, was to bring the troops home, not shift them from one country to another.

Obama has been criticized for acting like the President. Well, somebody has to. He’s moved into a vacuum. De jure President George Bush is fading, and becoming almost transparent. There’s really nobody running the shop right now at the White House.

GOOD NEWS FROM AFRICA. As bad as it is in Zimbabwe, the beautiful starry skies of Africa still shimmer. David Maritz, of Camano Island, reports a wonderful trip to Zambia, right next to blighted Zimbabwe.

Maritz is a native born African with roots he can never shake off. He flew a small plane from Johannesburg to Botswana, and then over to Zambia. The last leg of his journey was by car over Zambia’s questionable roads. He spent a wonderful interlude at his family's abundant game farm far into the country. I’m glad he went, and I’m glad to report this good news.

HEALTH CARE. Doctors and nurses don’t get along well. Nurses don’t know what doctors do, and doctors have no idea what nurses do. There are two completely separate career tracks in health care. Whose idea was that?

It would be good if some doctors rose up through the ranks, like they do in the military, where at least some of the officer corps has served as enlisted personnel.
It would be good if a young person were to start as a nursing aide, rise to nurse, then to nurse practitioner, and then go on to get an M.D. and be a full-fledged doctor.

As it is, doctors give orders to nurses who don’t understand why, and nurses report observations to doctors which are not understood or appreciated.

It is good that more women are becoming doctors. They have improved the profession. Women doctors are not so high and mighty. In fact, most of the doctors to day are closer to the ground -- not God anymore, but still archangels.

More men have taken up nursing, somewhat over ten percent of the corps at this point. This hormonal balance is welcome, but I expect it will top out at 15 percent male to 85 percent female. Women, overall, make better nurses than men do, although it’s very handy to “have a man around the house.”

THE SIXTEENTH HOUR. Nurses and doctors commonly work double shifts. Do you want to be the patient on someone’s 16th hour? Not me. A good question to ask, should you find yourself in the emergency room is -- “When did you come to work today?”

Oh, and at those big city hospitals like Harborview, where you get residents who do 24-hour shifts -- watch out.

I read in a medical journal where a hospital in Maryland has instituted a nap-time for double-shift and night-shift workers. The journal reported breathlessly that this radical innovation has reduced medical error and improved service. What a great idea.

PODIATRY. How could so many people have foot problems? Nine doctors and foot clinics advertise in the Skagit Valley yellow pages. That means that hundred and hundreds of Skagitonians have serious foot problems -- and need those special skills.

HEMOPHILIA. One in 8,000 males suffers from hemophilia, according to the literature. It is a genetic disorder which prevents the clotting of blood. When hemophiliacs become bruised or injured they might bleed to death because their blood will not clot. The disorder is passed on by the female, but only males are susceptible.

Skagit County has 120,000 people, 60,000 of the male. That means that 6 or 7 men in our area suffer from hemophilia. It can be treated, but not cured.

RUDE GOOD HEALTH. Some people enjoy a rude good health. They ignore all the good rules of healthy living and thrive anyway. Such a one has inspired to me to establish the Rule of 75.

The patient -- but I’ve seen several, so this is a composite -- was 79 years old and built out of pure stubbornness, bullheaded to the max. That’s how he got to be 79 and there wasn’t nobody, no high-class doctor, who was going to tell him otherwise.

Well, we had him in the hospital for a low-grade pneumonia -- it was probably not going to kill him -- but he needed a good dose of antibiotics and bed rest.

He was the worst patient you could imagine, and he fought the whole staff for several days. The problem was that he wanted a smoke. He wanted to go outside, have a smoke and a Martini too.

I had to deal with his great irritation for hours at a time, but in my humble position I was not able to make a somewhat radical suggestion -- let him have a cigarette, for Pete’s sake. It’s his life. And a dry Martini too.

Instead I have privately introduced the Rule of 75 -- if you make it that far, to age 75, than nobody, I mean NOBODY, can tell you what to do.

Monday, July 28, 2008

I know How to Win a War

“I know how to win a war.” I’ve heard John McCaine say that several times, but that is a wrongful boast. Strictly speaking, you don’t know how to win a war unless you have already done just that.

Like General Dwight Eisenhower, who led Allied forces to victory in World War II in Europe. He knew how to win a war -- but he never said that. When Eisenhower ran for President in 1952, his military record spoke for itself, and he had no need to boast.

And, based on his experience of military victory and its cost, Eisenhower negotiated a truce in Korea between the American led forces and the Chinese and North Korean communists. It was not a total victory. The fighting stopped in 1953. The two armies, after three years of fighting and 33,000 American deaths, fought to a standstill on a border, called the Demilitarized Zone, where soldiers from these two sides still glare at each other.

Eisenhower did know how to win a war, but in the case of Korea his decision, as President and as Commander in Chief, was that a complete victory was not possible.

Let that be a lesson for both candidates.

HARBORVIEW MEDICAL CENTER. I went down to Seattle last week. The water was sparkling on Union Bay. The Space Needle, built for the Worlds Fair in 1962, still looks beautiful. I visited a friend with a panoramic view of Lake Washington. We sat in cozy armchairs looking out the window at the sailboats far away on the lake, far down the hill. And we had coffee and talked about good fortune and hard times, and she was happy to have her view, but other things were taking her life away.

The next morning I took a busman’s holiday to tour Harborview Medical Center, right near downtown Seattle, in the midst of roaring traffic, situated on top of First Hill with dramatic views of Puget Sound and skyscrapers, ferries, and seagulls.

Harborview is the big time -- over 400 beds, a Level I Trauma Center, and a teaching hospital. I work at a small regional hospital with a helicopter pad on the roof, and we send our most difficult cases by chopper down to Harborview where they have fully staffed surgical units around the clock and a burn unit that takes cases from all over the Pacific Northwest.

Harborview is owned by King County, but staffed and managed by the University of Washington Medical School.

My goal was limited -- could I navigate through this nine-story building with several outlying buildings? Could I make contact with nursing staff who might have a moment to speak with me?

I succeeded. People were friendly, they gave me directions, I found the Kidney Research Institute and the hand clinic -- they have a clinic for everything from bunions to broken bones. And people were willing to answer my questions. But then I’m good at this -- I’m good at observing somebody who might have a spare minute. I’m also good at not caring if they brush me off.

My sense, which I trust, is that Harborview is not wasteful or chaotic. Good things happen

I had lunch in the cafeteria. They have the same steam table that we have out here in the country, with the same mashed potatoes and gravy -- an inviolate hospital custom. There must be a tanker truck coming every day out of Idaho, with a spigot that connects to the kitchen at every hospital in the country -- squirts out the mashed potatoes, drops off a vat of brown gravy, and goes on to the next hospital.

Otherwise -- and I’m coming from a smaller place and prepared to be impressed -- the Harborview salad bar wasn’t very good -- not as good as ours up here in the Skagit Valley.

My friend, the one I visited the day before, she used to live in the Skagit Valley and her opinion is that the medical facilities in the big city are superior in every way -- their doctors are the cream of the crop, with better focus and training, and with more experience doing unusual procedures.

I’ve heard that from other people as well. You even hear it on the radio, like “our hospital does bypass heart surgery 450 times a year, so we’re really good at it, and you don’t want to try some general access surgeon who has only done it three times and might be a little rusty.”

Maybe, but I’m not convinced. Harborview is an exciting and stimulating place -- it’s got major sex appeal, right out of a TV show. The atmosphere of research and education is enlightening, and that is something our smaller regional hospital could emulate. I’ve studied this possibility. Medical research is not just for the big prestigious institutions anymore. The online medical journals show an emerging pattern of doctors from every corner of the globe forming collaborative research efforts -- and simply bypassing the bigshots.

That sounds good to me, and I hope they might try this where I work.

Friday, July 18, 2008

Real Men Drink Tapwater

The following Frog Hospital fatwas are decreed:

1. Real men drink tap water. Bottled water is for sissies.

2. It is wrong to put croutons in salad. They are crunchy, noisy, and dusty. Croutons are supposed to go in your soup.

3. There is no fruit in salsa. Such abominations as peach or mango salsa are forbidden.

4. The way to a man's heart is through his stomach. This is still true but pending reversal.

5. Don't get even, get odd.

SIGN. Sign at the LaConner Produce Market, "Unattended children will be given an espresso and a free puppy."

OBAMA SEES THE WORLD. "Obama will visit a series of European and Middle Eastern capitals with an enlarged traveling press and has carved out time along the way for separate interviews with each of the three network anchors" --- I hope Obama remembers that nobody over there can vote for him in November.

Otherwise, nothing in politics matters right now. The summer doldrums will continue until mid-August, when the conventions begin. Enjoy the peace and quiet, because the Obama v. McCain contest will go ballistic on Labor Day. It's going to be very intense, very exciting, and a little scary. Get your rest now and be prepared for a titanic struggle.

This fall, Obama will be drawing some of the biggest crowds in American political history. McCain cannot draw that size of audience or speak as well, but he is a steady fighter, and this race is going down to the wire.

The economy is in the tank. It's not just a mental recession, as Phil Gramm said, but there is a psychological component to all the ups and downs of the market. And I agree with Gramm on one thing -- No Whining. This is the time to put your confidence into play -- in yourself and in the people you trust. We are a resourceful country and there is nothing wrong that we can't fix.

AMY WINEHEART. Amy Wineheart is a fabulous talent. The way she delivers a lyric is heart-rending. There are so many celebrities about with all their self-destructive nonsense -- nothing people like Lindsey Lohan. But Amy is a major, major talent. I love her music. She gets a lot of press for her offstage antics -- ignore that. "You know I'm no Good." Listen to it on YouTube.

VICTORY GARDEN. Plant your victory garden. Invest in roses, rhododendrons, and raspberries. Put your money in your own backyard and watch it grow, with interest. Grow your own food. It's easy to do, really. I've done it myself. It's not like farming. Farming is when you grow enough food to make a living at it -- that's very hard. But growing a hundred pounds of potatoes in your own garden -- that's something you can learn how to do.

REBUILDING FISHTOWN. This is a tricky thing to write about, because if we announce the plans and put it on the Internet, that will screw everything up. A lot of people want to know where Fishtown is, and what people do in Fishtown, and how do you get to Fishtown, and what do you do when you get there.

I cannot answer these questions. It's one of those things that you find out when you find out.

Fishtown is not on the map and there is no plan.

Saturday, July 12, 2008

Bitter Winds in Bulawayo

We be barefootin' in the Skagit Valley now. When it finally gets to be summer here it's really wonderful. Rasberries are ripe. Plums and blackberries will be coming soon. The cold, wet spring slowed all the crops down, but they have recovered nicely. The tourist business is way down on account of high gas prices. Visitors are either not coming to LaConner, or if they do come, they just enjoy the view and buy an ice cream cone and go home without spending money in the gift shops.

Still, Nell Thorn's, the best restaurant in town, is doing a good business -- they get a lot of local business, for one thing. You would give up a lot of other luxuries before you pass up a meal and a drink at Nell Thorn's.

LaConner Mayor Ramon Hayes reports that a high number of houses are on the market in the LaConner area. He said he tracks it on the Internet. A few years ago there was an average of 30 homes for sale, now it is 80. Several LaConner retail businesses are also for sale, but who's buying?

So it's time to bring out the old saying of Louie Nelson, one of our famous oldtimers. He said, "If you live in the Skagit Valley, you're rich."

Ain't that the truth. Life is good here in the abundance of nature. Income tends to be optional.

BITTER WINDS IN BULAWAYO. Time and again, when I was in Zimbabwe ten years ago, I wanted the facts, but I couldn't get any. Africa is the world's largest fact-free zone. Visitors might ask "What time does the bus get here?" And the natives smile and say, "Well it will come today at some time, God willing." But isn't there a schedule?
Yes, there is a printed schedule somewhere, but you really have to let go of your need for information while traveling in Africa.

And then, are they telling me the truth, or what they think I want to hear? Or they might get bored giving the same answer, so they make up a new answer. This can be very creative and highly amusing: "I had a dream last night, and there were two leopards with beaming dark eyes staring at me from deep in the bush. They bounded out into the path, and one of them seized my leg. But then the leopards turned into friendly dogs, and I began to pet them. The next day I realized that the leopards represented the Leopard Bus Company, and so it is highly doubtful that the bus will be punctual today."

Okay, I have to work with this. They do have leopards in Zimbabwe. They are rarely seen, but ever present. And the saying is, "You don't see the leopard, but the leopard sees you." And also, one of the major private bus companies paints a leopard logo on their bus to symbolize speed and power.

But the man who told me that story was probably just making it all up. Or I might be making it all up. Maybe it was my dream.

So how can you tell what is really going on in Zimbabwe right now? I got an email from an American friend, a nurse, who has lived in Zimbabwe for many years. Her message was of common daily activities with no hint of danger or troubles or hardship. So, perhaps, the troubles have not touched her community. Or perhaps she is constant danger, but she doesn't want to talk about it. Or maybe she is afraid that someone from the government is intercepting her emails and she had better be very careful about what she writes.

I can't tell. How can I know for sure?

So I can only say one thing with certainty. It is cold in Zimbabwe right now, and bitter winds are blowing in Bulawayo, the southern capital. July is the Southern Winter. Bulawayo sits on a semi-tropical plateau, at an elevation of over 4,000 feet. And every year at this time, they get six weeks of winter with overcast skies and raw winds. It's flu season, down to 50 degrees and lower at night. A frost can be expected. No one has any heat. Most people just bundle up in every available sweater or jacket.

More prosperous people will use a working fireplace indoors, or else an electric space heater. But the average folks just stamp their feet and hope the cold weather won't last long.

Harare is equally chilly. The deciduous trees are bare of leaves. But the people of Zimbabwe have visions of hell fire and Robert Mugabe consigned to the flames. And this dream will keep them warm at night.

MEETING, NOT MEETING. ARMED, NOT ARMED. The MDC denies that they are negotiation with Robert Mugabe's people, but they are talking to each other, trying to find a way out. I discovered the first rumors of MDC militants seeking to arm themselves and take to the bush. This may be just talk -- but I have not heard this talk before.

They are meeting and not meeting. They are armed and not armed. Anything can happen, but the doom is not sealed.

Wednesday, July 09, 2008

Madonna and Michelle

Michelle Pfeiffer at 50 ( you can find 100 photos on Google) is so much better looking than Madonna at 49.

I will explain.

Of course, I never liked Madonna, not since she came out at the same time as Cyndi Lauper in the early 1980s. I liked Cyndi Lauper much better.

But Madonna is back in the news because she has been linked to A-Rod, Alex Rodriguez, who plays for the New York Yankees.

I began to despise Alex Rodriguez when he deserted the Seattle Mariners and went to Texas -- Texas! -- to play for big bucks for the Texas Rangers. And then A-Rod went to the Yankees for even more money.

Only I put this weight on A-Rod -- He will never play in the World Series -- because I don't like him.

Anyway, A-Rod gets linked with Madonna and the tabloids are going nuts. They are meant for each other as far as I'm concerned. Two brass-plated marriage wreckers in the same bed. They'll make a fortune for the divorce lawyers. Geraldo is salivating.

So, this morning at coffee, Stuart was saying that Madonna is pretty hot for 49. Jimmy said yeah, because she works out. But I said phooey, you can buy a figure like that if you have enough money, and she's much too skinny for an Italian woman.

But I've said that before, and they thought I prefer women on the plump side. I said no, fat, thin or in between, it's all good. You start out with who you are and you make it better. It's about posture and attitude and how you carry yourself. That's good looking. Well, they began to see my point.

Madonna at 49 is trying -- trying! -- to look like she's 25. Wrong.

Then I remembered Michelle Pfeiffer. Beautiful, lovely Michelle, beautiful at 50, not trying to look 25, not trying to look like someone she used to be. But looking like who she is, only more so --- and you should be able to afford her hairdresser and jewelry which can be a big help no matter who you are.

Michelle Pfeiffer is better looking than Madonna. It's a matter of aesthetic judgment, which is not entirely subjective.

MBECKI WARNS ABOUT CIVIL WAR IN ZIMBABWE. President Thabo Mbecki of South Africa went to the G-8 summit meeting of world leaders and warned them about the dangers of civil war in Zimbabwe. World leaders have been pressing for tough economic sanctions against the Mugabe regime. Concerned people all over the world have wondered about Mbecki's "go easy" approach to Mugabe. They say it's appeasement, but that is a term with no context in Africa.

We should take heed of Mbecki's warning. Daily reports from Zimbabwe describe dozens of murders and tortures by rampaging thugs. Yet a civil war would have ten times that level of brutality. As bad as it is, Zimbabwe can get far, far worse.

And the African context, not the European context, is the one that counts. It is a memory of horrible civil wars in neighboring Angola and Mozambique -- wars that raged for decades and reduced the human population to savagery and beggary.

Besides that, there is no message from the Zimbabwe opposition, neither stated or implied, that suggests any armed resistance, and we ought to respect that. We might choose to take up arms under such provocation, but the people of Zimbabwe have not made that choice.

What we can do is pay attention and pray.

BARACK OBAMA'S SUMMER. Obama is floundering and flipping right now, unsure of himself. This is to be expected. He's only 46 and he rose up much higher and faster than he expected to. He is faced with an overwhelming responsibility.

Sure, he wanted to be President, but now it seems that he will be President. In private moments, he is shaking in his boots. In public moments he is making false gestures. I say, give him a chance to gather himself up.

Besides that, it's summer. The real fight with John McCaine begins in September. That's the time of Judgment.

Tuesday, July 08, 2008

Things are not what they seem

In Africa, things are not what they seem. There was a widely published photo that I used in the last issue of Frog Hospital -- of an injured Zimbabwean baby. The baby's legs were broken by Mugabe's ZANU thugs -- so it was said, but it might not be true. It might be that the baby was having its club feet repaired -- nothing more than that.

And yet it is so easy to find credible accounts of torture in Zimbabwe, and I have seen many very gruesome photos. I picked the baby's photo because its cry was so poignant. So we know two things from this -- that life is very bad in Zimbabwe right now and that things are not what they seem.

Anything you think you know for certain might not be so.

THE HIGHER POWERS SANCTION ZIMBABWE. The world leaders, at the G-8 Summit, are considering economic sanctions against Zimbabwe. President George Bush is urging this proposal. Bush has wielded an effective policy toward Africa -- and I cite no less an authority than Senator Barack Obama.

I heard, with my own ears, at Obama's speech in Austin, Texas, on the day before the March primary, that George Bush had a good policy toward Africa.

Things are not what they seem. George Bush has been a very bad President, but he has been effective in African affairs.

It is good to remember that the United States was not a colonial power in Africa, and that African leaders have a much higher mistrust of European powers.

Nevertheless, African leaders are rejecting this interference by the G-8 powers --- "Stop interfering in our continent. Only give us the kind of help that we ask for."

It is the legacy of colonial rule and the history of slavery. Always remember, never forgive and never forget, that is the mantra, and I support that.

But shouldn't we reserve our anger for current abuses? Shouldn't we ask who is being harmed now?

BARACK OBAMA'S SUMMER. If Senator Barack Obama is no more than a mainstream Democrat with a bit of charisma, many people will be happy with just that. All signs point to a summer strategy of Obama saying, "I'm just like you."

He is addressing an unstated concern, "Yeah, but you don't look like the rest of us."

Indeed not. In fact, a rarely discussed by easily noticed fact is his hair. Barack Obama, if elected, will be the first President of the United States with hair that is not like mine.

Never mind skin color, I mean his hair. It is not straight and lanky and brown, like mine. It is black and short and tightly-coiled.

My hair blows in the wind. But Obama's hair is stiff and sculptural. Ask any barber. African-Americans shop in the same grocery stores, live in the same neighborhoods, go to the same churches and schools as the rest of us -- but they don't go to a white barber.

I'm not talking about the ladies' hair, which is on a wholly different level. I'm talking that black men go to black barbers because their hair is different. It is a natural difference.

A black man's hair is soft and woolly, or it might be springy and bristly, it all depends. The thing is that you can't touch it just to find out, unless you're about four years old. If you were a four-year old white child, and you had never met any black people, then when you did meet one for this first time, you could say, "Hey mister, how come your hair is like that? Can I touch it?"

But you're all grown up now, and you don't get to ask questions like that. Barack Obama knows that. That's why he's going around the country this summer, making very bland mainstream statements about politics. That's his outward agenda. But his real purpose is to let every one know that he's just like the rest of us, except for the hair.

FROG HOSPITAL READER SURVEY. The results of the reader survey were gratifying. Respondents endorsed the current mixed of topics. They said there was no need to focus on a single topic, but that my writing represented a coherent point of view which they found interesting. Thank you for the reinforcement. I will carry on.

Saturday, July 05, 2008

Broken Babies

Atrocities and hyper inflation continue in Zimbabwe. The legs of this baby were broken because the father is an MDC official. See the photo broken baby

Neighboring Botswana, an intelligent, democratic country, is amassing troops and armor on its border with Zimbabwe -- to deflect an expected flood of refugees.

There is talk of military intervention by neighboring countries. Idi Amin, the terrible killer of Uganda, was finally overthrown by an army invading from Tanzania in 1979. Amin settled prosperously and anonymously in Saudi Arabia after he was deposed.
One hopes that similar arrangements can be made for Robert Mugabe.

And yet, who are we to watch and worry? It is an African problem, so let them solve it. That is what African leaders say -- but that is not what the people on the street say.
The common people do not display the racial fears of their leadership. The common people welcome friendship, investment, and support from any decent party.

But the African leadership is threatened -- by their own incompetence and corruption, which is on display on the world stage. And they excuse themselves by saying that others are just as bad.

But I would say -- No, Africa does not belong to you alone, it belongs to the world, because we hear the cries of your broken babies.

And when you are wrong, it does not matter if someone else is worse.

AMERICA IS FOR SALE ON CRAIGSLIST. gives a global view of property prices. From Copenhagen to Rio de Janeiro to Tokyo -- every major city on earth has a presence on Craigslist -- with jobs wanted, and personals, just like here in our country.

What I have found especially interesting are the property for sale listings. You can cruise the world and find out what a condo costs in Paris or Singapore.

What also struck me is how many American properties are listed on foreign sites. The weaker dollar and the housing bust make American homes and businesses a bargain right now.

Smart investors from Europe, Asia, and Latin America are checking out the deals in the USA.

Our country is in a recession and facing a host of problems, but foreign investment in American property shows that some people have confidence that we can turn this around. So this is good news.

Or it might not be good news. In Zimbabwe, so-called "vulture funds" are buying property right now -- houses, game farms, resorts -- sold by desperate people at fire-sale prices for pennies on the dollar. It's a long shot bet -- that the Zimbabwe economy will ever recover -- but some sharp-witted profit-seekers are willing to take the chance.

THE SUMMER OLYMPICS will be in Peking this year. The Olympics Games, since their re-establishment in 1896, have never been held in Africa. Capetown in South Africa made an unsuccessful bid to host the games of 2008, but this beautiful city was turned down -- because it was "too far away" -- from who?

The Olympic Games have been held just once in Latin America -- in 1968 in Mexico City. Latin America is also "too far away."

What does this say about the so-called international, multi-cultural spirit of the Games? It's all about the money.

HEALTH CARE. People make mistakes, in every manner of human endeavor -- the administration of medicine, for instance. The nurses learn the Five Rights -- you must give the Right Medicine to the Right Patient in the Right Dose at the Right Time, and by the Right Route.

The Route means if its by mouth, or by an injection or by other means.

If you don't get all the Five Rights, the patient might be harmed. Take this hospital where I work, with over a 100 beds, not counting the ER and the birthing center. And many patients are taking five or more different kinds of medication.

That is a very complicated procedure -- subject to intense and constant scrutiny. The order goes from the doctor to the nurse, to the pharmacy, back to the nurse, and then to the patient, and it all gets documented and signed off and counted, and there are all manner of checks and double checks.

It's a good thing I'm not in charge of that.

DATING DOCTORS. I dated a doctor a few years ago. It didn't last long. She was researching a disease that she had herself, and I thought that was a very bad idea. I'm not a scientist, I said to her, but where is your objectivity? And she thought it was none of my business, and I said yeah, I guess we don't have much to talk about. That was it.

I was right, by the way.

OSTEOPOROSIS is the weakening of the bones in old age. It mainly effects women, because of their different hormones, so I am not likely to have this problem. But every hospital in the country has a constant stream of hip fractures -- women of 80 years who fall down -- just an easy fall, but their bones got so brittle that it broke at the hip.

The surgeons can pin the bones back together, but it heals very slowly on an elderly person, and often the patient will never walk again.

Osteoporosis is a growing problem -- in a way it's a good problem -- because so many women survive so many other diseases nowadays -- and then live long enough to get brittle bones.

Vitamin D and calcium tablets are supposed to help prevent this problem. Zoledronic Acid is a new drug being tested now. I've read about it in the medical journals. Then I looked up the price on the Internet pharmacy -- about $800 for a 4 milligram vial. That's enough for one injection, and one injection should get your bones all right for a year. Plus whatever the doctor charges you for telling you to take it, plus the nurse who gives you the injection. If you have the money or the insurance.

FROG HOSPITAL ANALYSIS. I am thinking to write exclusively about health care, in order to give this newsletter an identity and more coherence.

I know I want to trim the wide-ranging subject matter and reach a sharper focus.

The other topics of which I have an ability and an interest are: Africa and national politics.

I have also written knowledgeably about agriculture, gardening, and some cultural matters.

I would appreciate your opinion about this -- tell me what you think.


Thursday, July 03, 2008


I have a variation on Donald Rumsfeld. This is what I've been telling myself at those times when I think I ought to have a better, higher paying job:

"You don't make money with the job you want, you make money with the job you have."

It's the summer doldrums as far as the election goes. I wish both candidates could agree to a simultaneous two weeks vacation. It would do them and us a world of good.

Obama's Father's Day speech was excellent. His speech on patriotism was also well done. His endorsement of faith-based social action groups surprised many.

McCaine is viable. He is behind but he is not losing ground.

BACK TO HEALTH CARE. I met a nurse last week in the medical library at the hospital where I work. She said she was going back to school to become a Nurse Practitioner. I told her I was very glad she was doing that, because --

America needs about a 100,000 more nurse practitioners and a 100,000 primary care physicians.

While Obama and McCaine debate who is going to pay for health care, the underlying problem remains --- a top heavy health care system with million dollar MRI's stacked up like so many SUVs in the parking lot. Sure, you don't have to wait for an MRI scan, you just need a $1,000 in your pocket, or an insurance company that will pay for it.

It's like if movie tickets cost $50, you would never have to wait in line either.

But the real need is at the level of basic care. If Congress passes a bill for universal health care, we will quickly discover that we lack the manpower to deliver on that promise -- because we lack the resources on the ground.

Got to MD Salaries on the Internet for a look at physician salaries around the country and in various specialties. Cardiologists and Anesthesiologists make the most money, often well over $300,000 per annum.

But Primary Care doctors and Pediatricians are at the low end, averaging around $125,000. That's still a pretty good living, but who can blame the docs for going for the high-paying specialties.

So, we need more Family Doctors and somehow we have to encourage and reward those who choose that profession.

Meanwhile, Wal-Mart is not waiting for Congress to act. They have plans to open more than a thousand medical retail clinics in their stores. The clinics will be located right next to the pharmacy. They will be staffed by Nurse Practitioners who can diagnose common ailments and write prescriptions. You don't need a doctor for the common cold, a diaper rash, or an ear infection.

The Nurse Practitioner can quickly judge if the problem is more serious, but most often she can deal with it herself.

A visit to these clinics will cost less than $60. No appointment necessary. It's quick and convenient, and half what it would cost at a doctor's office.

Of course, it doesn't solve the whole problem. Like what if you don't have the $60.

But it's a step in the right direction.

Frog Hospital does not favor government or market-based solutions. We are only interested in what works.

So, on this Fourth of July, let's salute our American heroes -- the Nurse Practitioners.