Cure This - Recent Comments

Very good point! Thank you!

nightowl724 — Sun, 24 Aug 2008 16:54:02 GMT

I forgot to mention the dollar stores, even though I myself use them, too.

OTC drugs

poppyseed — Sun, 24 Aug 2008 01:20:27 GMT

i've become quite a fan of the 99c store. honestly, there's a lot there if you're looking for it. most of the ones around here stock clotrimazole cream, advil, tylenol, zantac, benedryl, guafenesin, and a host of useful non-medications like vaseline, rubbing alcohol, and ace bandages...

so sorry to hear...

los anjalis — Thu, 21 Aug 2008 06:40:04 GMT

Wow, that's quite intense. I'm so sorry about the haste and inconsideration. I'm sure it was a case of residents harried and trying to do their best to help your husband, but i wish they would have worded that/handled the situation a BIT differently. wow.

Thank you for this, Los Anjalis!

nightowl724 — Tue, 19 Aug 2008 18:03:05 GMT

Having been both a patient and a family caregiver, I can tell you that some of the jargon used by doctors can really frighten, shock, or hurt.

And then there's the delivery of those words!

My husband was in kidney failure. A clot had broken off from an angiogram he had that afternoon. It had lodged in his kidney. His blood pressure was bouncing all over the place - from more-or-less zero/zero to seventy/zero, as I recall. He had been given last rights.

My 80-yr-old cancer-ridden, high BP mother-in-law and I were desperately trying to keep up with what a team of residents was telling us while were were practically running through a long underground corridor that connected two parts of the hospital. They were trying to get my informed consent to inject a clot-busting drug. I asked what would happen if the drug didn't work.

Without even looking at us or slowing down, one of the residents replied, "Why, he'll die, of course!"

I stopped and turned just in time to catch my MIL as she collapsed to the floor! The residents didn't even notice and they kept right on going...

among the things that suck about being poor

poppyseed — Sun, 10 Aug 2008 18:15:58 GMT

it is a struggle in free clinic world to keep the perspective that our patients deserve the same treatment that they'd get if they were insured. it's the difference between coping and settling. you know that if you had a laboratory that would accept your samples, you could offer the slew of blood tests that would allow you to use first line drugs instead of second line drugs for high blood pressure and diabetes. you know that your patients need yearly eye exams and regular dental care but you can't find an eye clinic or a dental clinic that will take them. you know your patients could use better food and a couple days of rest, but they can't afford it and you can't make it happen. so you cope.

the trick is not to settle, to recognize that you're not done yet, that the clinic isn't in its finished form-- the trick is to look directly into the eyes of anyone who tells you that what you need isn't practical "in this setting" and to quietly repeat that it is the standard of care, it is the standard of care.

the real world

poppyseed — Sun, 10 Aug 2008 17:27:51 GMT

so i spend a lot of time in the hospital documenting things-- filling out little forms to appease some administrator or hospital lawyer or an insurance company or Medi/Medi or something. in the free clinic world, the ratio flips: instead of spending all my time writing the same thing over and over on different forms (this lady's sick and she really needs this medicine/scan/equipment) i take care of people and write only what the next doctor needs to know in order to assume care. i ask my patients what's wrong, examine them, go get the medicine they need, and hand it to them. when i run out of medicine, i go back to whoever gave me the first batch and give them the big-sad-eyes routine and they give me more medicine to hand out. see, the difference is that in free clinic land i get to be a real doctor and being a real doctor is a whole lot of fun.

setting aside that fair is fair, setting aside that caring for the sick is a duty and a privilege, setting aside that failing to do so is just wrong-- setting all those concerns aside: medicine is just way more fun in the free clinic.

More discussion on this...

los anjalis — Sun, 03 Aug 2008 22:34:51 GMT

Jessica Hoffman wrote a piece on this video today, over at Bilerico. Check it out.

Ditto the thoughts above and at bilerico.

I'm surprised anyone can look at this video and think that it's well thought-out art, and disregard the major problems with this kind of "feminism". hmm...

survival

poppyseed — Wed, 30 Jul 2008 22:37:41 GMT

so yesterday evening, while we were picking up the OB service, somebody handed me a call list and the day team started signing out-- talking about each of the patients, what they'd need done during the night. about the third name down had a bunch of unusual information in it, all in quotes, often used to indicate that this is what the patient said rather than what the doctors are saying (e.g. "felt like my head was going to explode" or "worst pain i ever felt" as opposed to 10/10 bursting type HA). the stuff in quotes stated that the patient was required to provide unprotected sex in exchange for a place to stay. the stuff outside the quotes talked about how she was homeless, used multiple substances, was 24 years old and that she was awaiting a shelter bed that would open up the next morning so was just boarding with us for the night. i meant to go visit her that night in between things, but never got there. still, this morning, i can still see the little note talking about how she had to provide unprotected sex in order to have a place to sleep and i keep hoping that the resulting child never, ever finds out.

words

poppyseed — Thu, 24 Jul 2008 21:28:19 GMT

the "historian" part of "poor historian" has amused me since medical school, as though we were discussing the franco-prussian war or something. it's also sort of unhelpful-- as soon as someone starts trying to tell me how bad a historian the patient is, i start wondering why.

been trying to use language like "this was a difficult history to obtain/tease out because..." when presenting and tend to write things like "pt unable to provide history due to..." in the chart. i like the "because" or "due to" part, because it gives you a chance to put why it's so hard to figure out what's going on-- "pt intoxicated, uncomfortable, confused and no family available, stridorous, disoriented as to time, monolingual mandarin and no interpreter available at night no matter how hard you tried" or "slow, smouldering, insidious onset of symptoms" or "brought in by concerned family and/or friends who hadn't seen pt in months but considered him much more confused/lethargic than baseline" which gives a window into the situation that "poor historian" does not.

Language

archofatlas — Tue, 22 Jul 2008 16:12:26 GMT

There are some basic things that I won't do - I won't describe patients as "male" or "female", but as "men" or "women" (still haven't figured out how I should have described the patient I had who was biologically a man, but gender-identified as a woman - it was a quick follow-up for a post-surgical procedure so it didn't seem terribly necessary to go into the details for the sake of a history)...

But I've stopped cringing at some of the words that we use, and I forget how they sound to patients. Poor historian is one of those. I remember telling someone that their lymph nodes were "unimpressive", and they were bemused... "Sorry, I'll try harder next time."

Not sure how to get around it, except to be extra-conscious of it, and to remember that the language we use in the medical profession has a specific purpose. No, not for condescension to the patient and their family.

Words are so tricky, aren't they? I love how this post links with your post about telling someone they said/did something rascist.

totally hear you

los anjalis — Tue, 22 Jul 2008 04:52:03 GMT

I went through that for much of residency (obviously intensified in intern year). your biggest challenge this year is going to be figuring out how to "leave" the hospital. you're an awesome doc already and your self-learning, resourcefulness, and humanity and passion for caring for others is inspiring to say the least. but you've gotta stay sane, you've gotta take care of yourself.
-a

asthma inhalers

poppyseed — Fri, 18 Jul 2008 04:33:38 GMT

a couple places to go for free while you're sorting things out:

1) UCLA mobile clinic, wednesday evenings from 6pm-9pm at sycamore and romaine in west hollywood. get there at 6pm and mentally prepare to be there until closing but the people are nice and friendly and the meds are free no matter how much money you do or do not make. the formulary is limited, but you can get your albuterol and whatever controller inhaler we have on hand at the time. (last year we were all about the advair discus). if you need something special, we can order it and have it in stock for next time.

this will give you some breathing room (okay, it's a pun, but not too bad of one) while you decide your next step.

2) i'm not opposed to the lomita clinic idea. there are two clinics at the facility (i'm upstairs) but the county part of the clinic (upstairs) has a bunch of financial options that reach all the way to free care that covers clinics, meds, and hospitalization. there's financial services there on tuesday afternoons-- again, prepare yourself mentally to have a long afternoon of waiting around and filling out forms but at the end of it you get really good coverage. bring a utility bill or something that shows you live in LA county. it's a big, full-service clinic with a full formulary. (wouldn't it be nice if you were my patient?-- i love fixing asthma!)

so never, ever, ever run out of meds-- get yourself a month's supply at ucla mobile clinic and come to lomita for follow-up.

unnatural censorship

poppyseed — Fri, 18 Jul 2008 04:21:01 GMT

our residency aired a little bit of the show for us-- very insightful stuff in this documentary.

last year, there was a very nice doctor visiting us from France. she couldn't seem to quite explain how France was different from the USA-- just couldn't find the words-- until micheal moore's cinema essay opened. after that, she would simply ask us if we'd seen "sicko" and once we said "yes" we would all nod together. having grown up here, i spent my whole life truly believing that i lived in the finest country in the world; it had its problems, sure, but the US was certainly the best there was. as pauline assured us that what we saw about France in "sicko" was true (and as i knew from personal experience that the "dumping" scene on skid row was one of a great, great many and by no means the worst i'd personally seen) my opinion began to change. while uncomfortable, knowing that we had such room for improvement (and so many good examples all around us) gave me the motivation to work toward change, the hope that we can together build a society that really is fair and compassionate and beautiful.

the truth hurts, but it helps, too.
i hope that unnatural causes will air widely and be viewed widely.

the art of pap smears

poppyseed — Wed, 16 Jul 2008 21:59:49 GMT

a couple of things i like to do are:
1) use two sheets-- one for the "lap" area and one to go from the knees to the ankles. that way i can keep the patient covered whenever i'm not actively working in the area. also, i've got something to quickly cover her with if i hear any noise from the door (like someone about to barge in without realizing i'm doing a gyn exam)
2) warm the speculum with warm water before using
3) talk about what i'm doing and why it's done while i'm performing the exam
4) set things up on a mayo stand before asking the patient to disrobe
5) have a chaperone (even though i'm female)
6) and do most of my talking while the patient is clothed

but i do feel weird asking about sex and violence when i'm heading into a pap smear and much better when i ask about general health (like smoking). usually i ask how previous pap smears have gone when i see the knees placed together or an apprehensive look on her face. and i don't think i've ever gone looking for the mirror (we were shown to do so in med school but i always found it sort of odd-- after offering it my first few times and getting strange looks from my patients i sort of assumed that sentiment was shared). but it's nice to know that maybe my patients would like me to ask about violence and sexual practices and to continue to ask about the mirror-- hadn't really thought they'd prefer it.

we were also told to put domestic violence pamphlets in the restroom, as violent partners have a way of hovering over the people they hurt and tend to be close observers of their behavior (but no matter how clingy and watchful you are, no one's going to follow you into a public bathroom.)

Passion and Progress can sometimes go in different directions

veetz — Tue, 15 Jul 2008 23:21:39 GMT

I have one ex-girlfriend who was raped. Twice. Once by a man and a separate time by a woman, who she knew and was dating. I have another ex-girlfriend who is a doula. My GYN forgets I'm gay and at every time asks what I use for protection. Not to mention she's depressed and almost suicidal and talks to me like I'm her therapist when I go there. Once I asked her a question about the effects of a certain sexual practice and she had no idea. Mind you, this was not something specific to gay sex either. I go to her only for pap smears.

My ex who is a doula struggles with doctors all of the time and prefers to work with midwives. In every case comparison she has with mothers who work with doctors versus midwives, the midwife has spent more time with the mother, asking more questions, getting to know everyone involved in the pregnancy. The doctors have continually been about numbers and statistics. Not to say doctors are not good. It seems the midwives have a singular mission and an essential part to that mission is getting to know the person and the environment they are working within.

My ex who was raped, was never asked any of these questions. And with all of her uneasiness was still dealing with the effects of this experiences 10 and 2 years later when we started dating. There was no doctor to help her when the PTSD started to recur years after both incidents. The rape line in Los Angeles only dealt with immediate crisis. There are no support groups for family and friends of the victims. Two of the best books that are written for the surviving victim and the friends/family of the victim are written by two women, who are gay.

I don't mean to be taking an entirely gay stance here. But I think there is a serious problem with health care for women in general. It doesn't start with the GYN. It starts with the whole system. How do you change the whole system? I don't know. How do you have some effect so that there is change, you can only start with what and who you know.

My general MD meets with me in his office after every visit. I go to him for physicals every year aside from any other needs I may have. When I walk into the examination room, after not having seen him in a year or more, he remembers me and things about the past year and asks me how I'm doing. How's the house? How's work? And even when everything is ok, he sits with me in his office and tells me the results of everything and asks me if I have any questions. Now, that wasn't so hard was it. Dr. Drury is his name. Go see him. I do! (Sorry, not sure if there rules about saying specific doctors names, but go see him, if you're a patient or a doctor who wants to know how to be a better person in the doctor's office)

actually figured out how to comment here!!!

brownfemipower — Mon, 14 Jul 2008 21:09:55 GMT

hooray!

I have a real problem with 'harm reduction' because that seems to be all we ever do--and if anybody thinks that pharmaceutical companies, HMO's and the medical establishment in general doesn't KNOW this and do what they can to capitalize on it....

it's disheartening to read that even medical professionals are so quietly just "choosing" the lesser of two evils for so many women, without even considering how to complicate things. I'm so grateful to those in the medical establishment who haven't given up, who haven't acquiesced. I personally am fucking tired as hell from a goddamn blog, I don't know how those who are fighting something as important as medical justice for all can sustain themselves...

nods

sly civilian — Mon, 14 Jul 2008 02:37:29 GMT

where do you begin when so many things are broken?

i really hear you on this, because the kind of triage you end up doing in fucked up situations feels so critical to do something, to stop some of the bleeding, to make things a little bit better.

but you have that pit in your stomach when you worry if that's where it ends...if the effort you make in harm reduction is going to let the powers that be justify leaving things fucked up and not changing the system....

good to see you again...

and heavy industry

poppyseed — Sun, 13 Jul 2008 17:50:00 GMT

so the hospital at which i work is in a large urban center. there are three oil refineries in the community it serves and one more on the border. we're located next to two ports which match the carbon footprint of the network of freeways that serve them and the whole city every day. i guess what i'm saying is that sometimes you $hit in the air.

(and that when you do you generally aim at the poorest part of the city)

sharing humility

los anjalis — Thu, 10 Jul 2008 05:56:55 GMT

wow thanks for sharing your thoughts on starting internship. the best of us are those who admit and are aware of how small we really are. keep this awareness with you throughout residency as you strengthen your skills and treat people, and you'll come out much respected by other docs and by your patients.

Best wishes for a first day of internship!

out of passions...

los anjalis — Tue, 08 Jul 2008 06:19:45 GMT

...grow new passions. or something to that effect.

I completely feel you on your dilemma and your transition. I think you've got a lot of health blogging in you and a lot of local politics/community discussion in you (about michigan). And movies, I know they're your passion too. I don't see why you can't blog about all three. Shows you're well rounded :> Makes us all proud, you know? (all of a sudden i've put on a long-island motherly accent).

I'm very happy that you're recovering health-wise. Caves are much needed.

Again, as I've said incessantly (getting sick of it yet?), your posts on your own blog regarding health and healing have helped folks heal, have helped folks unlearn years and years of indoctrination of what they should or shouldn't do to survive and thrive in this world.

And you can get the bfp out of michigan but you can't get the michigan out of bfp.

And I don't want to see a dearth of Youtube videos from movie dance sequences or less of a discussion about babybfp or grown up bfp movies on your blog and elsewhere.

So -- my vote's for all three!

In regards to how one moves from one movement to another, I don't know that it requires much of a paradigm shift or leaving folks behind. Or even moving from Y tools to M tools. Your posts regarding health and wellness have had a feminist angle, as have your writings about michigan.

Now i'm talking too much, but I love that you're embracing rebirth, talking shiva, and not letting your fear of dying become a permanent state :>