Saturday, May 21, 2011

How I Spent "Judgment Day" 2011

If you knew, or thought you knew, when the world was going to end, would you change the way you live your life?

Would you spend your life savings and forego career plans? Would you take one last trip to see some places you'd always wanted to see?

I never believed in preacher Harold Camping's prediction that the Rapture would occur today. Even if Jesus himself hadn't said plainly that no one can know the day or the hour, Camping's calculations would still have held no merit, based as they were on a) a literal interpretation of the Bible and b) a calendar that failed to take Dionysus Exiguus into account. But I did follow some of the media coverage around this phenomenon with interest. It generated questions like, "What makes people willing to take such risky actions for the sake of one fallible man's ideas?" and "What would you change about your life if you knew it was ending - SOON?"

I was pleased to realize that the answer to the latter was "not much." I'd still go to work and do my job - but keep it part-time, or make it even MORE part-time. I'd still spend as much time enjoying my family's company as I could. And if today had really been our last day, I would have been truly happy to have spent it as we did today.

My husband and I had a long, relaxing lunch outdoors. The weather was perfect - sunny, breezy, dry, in the 70's. The food was delicious. Later in the day we went to a fair two towns over. I love small town fairs; they evoke simpler times, happy families, and friendly communities with something to celebrate. The best thing about this particular fair was the presence of a book tent, where my husband and I spent contented hours browsing through tables laden with used books while the kids enjoyed the games and rides outside. Back home I concocted some Thai-spiced burgers for a late dinner, and they were yummy. It was a day full of all the things I enjoy and the people I love most. If the world had actually ended, I would have counted myself blessed to have known such lovely moments.

Monday, May 16, 2011

Blog Anniversary - It Kinda Snuck Up On Me!

I can't believe this blog has been around for four years!

I know it's been much quieter lately, but that's been working for me. Not that there's anything too extraordinary going on in the rest of my life right now - other than the usual extraordinariness of my ordinary life. One day I am running to the emergency room to help with a potential difficult airway, anesthetizing a patient for abdominal surgery, or putting epidurals in expectant moms; the next day I have a cake decorating class, or a post office errand, or a movie night with spouse and kids. Life's got stresses, life's got joys, and I'm finding that this kind of balanced, un-remarkable existence is just what the doctor ordered (so to speak!).

It seems fitting, then, that I should celebrate with...

Berry-Basil Guacamole. An ordinary treat with an extraordinary twist.

This is my latest obsession. I had some at my in-laws' and fell head-over-heels for it. I really enjoy this kind of food adventure: take something rather ordinary (mashed avocado), and make it a little special with the unexpected ingredient, a not-your-usual combination of flavors. The strawberry-basil combo is, I must admit, kinda old news; it's been done a lot, as a salad, an ice cream, and even a cupcake. But I still consider it somewhat special.

Let me know if you develop (or have) a good version. Mine is just what you see above: avocados, strawberries, fresh basil, a little diced cherry tomato and onion, and whatever sprinkling of seasoning and citrus juice happens to be on hand and palatable at the moment. Best with my other latest obsession: Tostitos brand Artisan Recipe roasted-garlic-and-black-bean whole grain tortilla chips.

Happy Berry-Basil Blogiversary!

Tuesday, May 10, 2011

On Advocating For Patients

The following is based on an actual conversation from an evening on call. Some details have been changed.

Situation: Emergency surgery for a patient whose vital signs were unstable and whose mental status was deteriorating.

Doctor: "I have some quick questions before we enter the operating room, and I'll also need signed consent for the anesthesia."

Family Member #1: "Oh, I'm his health care proxy. I can sign that."

Doctor: "All right. Can you tell me about his medical history?"

Family Member #2: "You mean why we're here?"

Doctor: "No, I know that part, but I was hoping you could tell me about his major medical problems. Does..."

Family Member #1: "Oh, I don't know any of that. I'm just the health care proxy."

What does the average person understand to be the role of a health care proxy?
What should that role consist of?
Can people really advocate for others whose situation they either are in denial about or don't understand fully?

Family Member #1: "My brother knows some of that stuff, though."

Doctor: "I was reading through some old records. He has high blood pressure?"

Family Member #2: "Oh, no, he doesn't have that."

Family Member #1: "No. Not that."

Doctor: glances at listed hypertension medication in the record

Family Member #1: "He's actually really healthy."

Doctor (puzzled, glancing once again at list of medical issues from previous hospitalizations): "Oh? I thought I saw..."

Family Member #2: "Yeah, he's healthy."


Family Member #2: "He just has a little congestive heart failure and some emphysema."


The physician ran down a list of specific questions, asking about recent hospitalizations, heart symptoms, frequency of inhaler use, mental status changes, and other medical information felt to be germane to the patient's care. In this situation, however, time was short - surgery needed to be performed as soon as possible. Not only was the information not readily available, but also the sources of information were largely unreliable. Such circumstances can have a significant impact on patient care. The doctor here is responsible for efficient and thorough information gathering and the performance of a proper focused physical exam, but time and available sources can be very limited in situations like these.

Plea: Please know your own medical history, and if advocating for another, know that person's issues as well as his or her medical management preferences. The best care is provided when clinicians have the best information available, especially during emergencies, and sometimes loved ones / proxies / advocates are our only source.