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.

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