Most of my posts recently have been rather heavy, and personal. I thought I would trot out another attempt at medical humor that (actually!) happened to me on the job.
Everyday, before a Medical Assistant begins seeing patients, there’s a litany of things to take care of. Some mornings are busy, some run smooth; but, the ducks need to be in a medical row before showtime can begin and the first patient is seen. You’ve got to meet with your provider and pow-wow the day, make sure every room is stocked, make sure you’ve got equipment set aside for any special procedures that day, and gulp down about a gallon and a half of coffee.
Nearly every hospital or facility uses what’s called an EHR, or: electronic health record. This is essentially the operating system of the clinic. You can see all sorts of nifty PHI (patient health information) here, as well as the schedule for the day. Many facilities use an EHR known as Epic, although there are others. The days of paper system providers are practically an anachronism.
In February of 2009, President Barack Obama signed the HITECH act, or the: Health Information Technology for Economic and Clinical Health Act. The goal of this act was to compel ‘meaningful use’ of electronic health records; that is, to facilitate national healthcare information between different healthcare facilities, and to promote the safety of patients by digitally checking drug interactions, duplicate orders, unrecorded allergies, a current medication list, and a host of other measures.
There are, of course, drawbacks to this measure. Any electronic system of information can be hacked. If you’d rather not be discouraged, please do not read this:
To be fair, nearly all modern healthcare facilities use state-of-the-art electronic security systems for their internal network, with an army of techies constantly guarding it. The chances of someone cracking into a hospital’s system are extremely low. So please, do not follow this link:
But, by and large, your information is quite safe. Another criticism of the electronic health record system is the difficulty transmitting information from one facility to another. Within the same company, it’s not a problem. But if Epic goes to link a patient’s PHI from another healthcare company, the results can be quite variable. Sometimes, the information is linked immediately. Other times, the targeted EHR does not respond; or, in some cases, it does, but painfully slow. However, when it works, it’s a fantastic tool for healthcare practitioners.
Still another criticism is purely opinion, one I have heard from many in the industry, and not necessarily my own. The Department of Health contributed nearly $37 billion dollars to promote the adoption of EHRs. This was a worthwhile incentive for a worthy endeavor, but essentially, this all but rendered small, private practices extinct. It is extremely expensive for a small provider or a facility to convert from a paper records system to an electronic system, generally running over 6 figures per provider. Thus, the Amazon analogy applies.
Personally, I find the Epic EHR a great system, easy to use, very customizable, and a wealth of PHI. I could not imagine doing my work without it. In my opinion, the developers have done a fine job.
But, back to the matter at hand: the beginning of a Medical Assistant’s day. Within Epic, there is a schedule for the day feature, listing the patient, their pertinent information, the time and length of visit, and, at the click of a button, whatever else you need to know. Perhaps the most useful category on this list is: ‘reason for visit.’
It was early on in my healthcare career, while I was an extern at a primary care clinic, using Epic. My mentor, who had the grace and social skills of a rabid possum trying to do math, asked me what reasons patients were coming in for today. I glanced at the computer monitor showing Epic, looking under the reason for visit column. There is was.
At least 8 of the 14 or so patients coming in that day, for our provider, were listed as ‘ED follow up.’
My God, I thought. These poor patients. So many. One of them was only in his early 20’s…
Erectile dysfunction is no laughing matter. So go ahead, get it out of your system. Go ahead with your vienna sausage problem jokes. Yuck it up. But the truth is, erectile dysfunction can be a very debilitating, and alarmingly frequent condition. It affects over 30 million men in the United States. The causes can be quite varied: diets, medications, neurological disorders, psychological disorders, kidney disease, age, lifestyle habits, and many others.
Sadly, one of its main side effects, other than the ability for a male to perform during sex, is psychological. There are a myriad of of psychological reasons why this is important to men, a topic for another time. But erectile dysfunction can cause seriously debilitating psychological damage to a male. Self-esteem can take a massive hit, and depression can result. A male may feel woefully inadequate, a self-defeating thought which pervades other areas of the man’s life. It is an embarrassing condition, one which men don’t like to talk about, it sucks, it’s no fun, women laugh at you, you think you’re worthless, I hate myself, no one will ever love me again, I am only half a man, why does God hate me, I…. wait, who am I talking about, here? I wasn’t talking about me! WHAT?!? Anyway, I digress.
There are, of course, many treatments available for ED. Depending on the cause and severity, it may range from a simple medication or lifestyle change, all the way up to an unfortunate but life changing surgery. It can be fixed.
So, my mentor asked me the reasons for patient visiting that day. I really didn’t know what to say. I paused, turned to her, recalling that this is healthcare, and said to her: “It looks like we have a lot of patients coming in today for ED.”
She looked even more annoyed than usual, looked at her screen (with the same schedule pulled up), and scowled. Turning back to me, and said, with the tone and temperment of a ferret with a flamethrower: “Some of these patients are female!” Huh? I looked back at Epic. I hovered the mouse cursor over the reason for visit column. (Epic has this neat feature… hover to discover… you pull up more detailed info when hovering the cursor over the subject…) Further information was displayed in an expansion of the display.
“Emergency Department follow up for dog bite.” “Emergency Department follow up for sore lower back.” “Emergency Department follow up for transient tachycardia.”
Ah. Emergency Department follow up. E.D., not E.D. Well, egg on my silly face! I learned that day something very important: in healthcare, what is colloquially known as the ’emergency room’ or ‘ER’ is actually called the ’emergency department.’ Well, that’s good to know. Would have been nice if that had been in the classroom curriculum. Back to you, Jaimers!
So, there you have it. If you need to go to the ER, it’s just fine to call it that. Let’s say you go in for a bad bee sting or something. Then, the staff there will advise you to follow up with your regular provider. When you schedule that follow up appointment, behind the scenes, Epic will list the reason for your visit as an ED follow up. But don’t worry. You don’t have ED. Especially those of you coming in for gynecological exams.
As an aside, my mentor turned out to be a very cool person. She and I keep in touch, years later, as she was very instrumental to my success. Although, I remember more than a few times, while I was turning an exam room (cleaning it and restocking it after a patient’s visit), I overheard her say: “Having an extern rules. He has to do whatever I tell him. I love that!” Heh. She was a great mentor, and a great Medical Assistant, and very much part of my education. Thank you again, KK at Wedgewood.
Well, there you have it! Take care of yourselves! Wash your hands! Get vaccinated! Be good to each other! Bye for now.
In healthcare, there are, of course, procedures that are gender specific. That is, a woman will get a breast exam, while a male will get a prostate exam. For the most part, as patient comfort is paramount, a practitioner of the same gender as the patient will be assigned to the procedure. This is not always the case, and, in my experience, I have found that most patients, of either gender, as long as the procedure is not terribly invasive regarding sensitive areas, are perfectly okay with a practitioner of either gender carrying out the procedure or examination.
No one particularity likes going to the doctor, anyway, so many patients have ‘do what you have to do and get it over with’ kind of attitude. Fair enough. If practitioners are performing professionally, there is an air of confidence about them, of speed, that conveys to the patient that they have done this process countless times, and this is just another day at work to them.
Indeed, we’ve seen it all. Nothing shocks us. Nothing embarrasses us. It is extremely difficult to gross-out or disgust a healthcare practitioner. I helped an MD remove a cyst slightly larger than a golf ball from a patient’s leg once. She had the cyst out of the patient’s leg, grasping it tightly but delicately in a large pair of surgical grips, so that it would not burst. It was still connected to the patient by a thin strand of tissue, and she asked me to cut the connection just inside the abscess pocket in the patient’s leg. No problem. Kinda cool. Please don’t burst that cyst, doctor. These are new scrubs.
However, all of us in the industry are well aware (or damn well should be) that this is not just another day at the office for the patient. From day one, in whatever training you take, the abstract and highly important skills of empathy and compassion are drilled into your head. We may move confidently and business-like, but patient comfort, to the best the procedure allows, is always on our mind. We cannot sympathize, but we do, often heavily, empathize. There is a difference. We hate pain and suffering. We don’t show it, but it kills us when we see it in a child. That’s why I and thousands of others joined this industry. You may not be able to nauseate or embarrass a practitioner, but even the most seasoned MD can be emotionally moved by the site of suffering. But we carry on. The tears are for later, often alone.
But, back to the matter at hand. As I said, whatever procedure a patient is going through, it is often new to them, or, at best, they are somewhat familiar with it. However, an invasive, gender specific procedure can put a patient on edge if the person performing it is of the opposite gender. We are always aware of that potential.
Take, for instance, the common work a Medical Assistant will do. Give injections. Perform a lavage. Dress a wound. Take vitals. Draw blood. And: the EKG.
Allow to me to switch tracks for a moment. The human body is an amazing machine. Simply put, your body has two command systems that boss your other organs around: the endocrine system, which uses hormones to carry out instructions; and the central nervous system, which uses electricity. Both of these systems, frequently in concert with each other, tell the rest of your organs what to go do with themselves.
The tireless, all-important, paramount, primary organ known as the human heart receives it’s commands via electricity, from the CNS. This tireless, muscular organ is the centerpiece of human existence. It’s role is simple; it keeps your blood flowing through your vascular system. Sounds like an easy workload, but the movement of your blood, which, among many other things, carries needed oxygen throughout the body and removes things it does not need, gives us substance that we cannot do without. Your all-important brain can suffer severe trauma, one can become nearly brain-dead, really, and you might still live, most likely with the aid of machines. If your heart takes enough damage, and it is not tended to in time… well, head for the big light. We’ll see you in the whatever comes next.
As an embryo, the heart is the first functional organ to develop , and starts to pump blood in the developing human in about 3 weeks. However, the brain begins to slowly develop afterwards, around 7 weeks of pregnancy, so pain is not an issue, before anyone turns this fact into an abortion diatribe. That’s between a woman and her doctor.
As a human being, the heart is well protected, encased in the mediastinum, a chamber inside the thoracic cavity (upper torso), protected by the rib cage. Makes sense; it’s important, put it someplace well protected. Which is the opposite of the human brain, which is protected by a thin skull and sits, like an easy target, in the head, which sticks out prominently from the top of your body. Not the best spot for it. Just my opinion; I didn’t design the mess called the human body.
Anyhoo, the heart itself, receiving its constant instructions to contract and relax from the CNS, is about the size of an adult fist. It consists of 4 chambers, the upper atria and the lower ventricles. It will beat about 115,000 times a day, pumping roughly 2,000 gallons of blood everyday. This tireless, dedicated organ is truly the running back of the human body.
As I mentioned, the heart is controlled by electricity, from the CNS. It’s a fascinating combination: a grouping of muscular tissues, a collection of cells, really, that responds to a jolt of internal juice. Neato.
Let me run through this quickly: the vagus nerve, from the brain, carries electricity to the top of the right atrium, to a ‘node’ called the sinoatrial node (good Jeopardy fact, there), which then carries the spark through the rest of the heart, stopping briefly at other nodes to ensure that the chambers contract and relax. Contraction is known as systole. Relaxation is called diastole. So, when you get your blood pressure measured, the top number is the systolic, how hard the heart is contracting, and the bottom number is the diastolic, how well the chambers are relaxing. Now you know that.
Okie-dokie, let’s come back around to the EKG, one of the many procedures a Medical Assistant will perform. The electrocardiogram is a fascinating machine. It’s concept is simple; as the heart runs on electricity, the EKG measures this electrical process, allowing practitioners to ‘see’ how the old ticker is doing. Many of us have undergone this procedure.
That the body is manipulated by electricity was first proven in 1790 by Luigi Galvani, who made a dead frog’s legs dance by electrical stimulation. Physicians at the time were… shocked. It was an interesting trick, but Galvani was also obviously kind of warped, to conduct this experiment. Why is the poor frog always taking the brunt of medical research? Frogs are cool. Anyway.
In the mid 1880’s, two researchers named Ludwig and Waller developed their ‘capillary electrometer’ that showed the heart’s rhythmic electrical stimuli could be monitored from a patient’s skin. They were on to something, and they didn’t even have to slaughter a poor frog.
In 1901, Dr. Willem Einthoven, using magnetic poles and silver wire, and a whole lot of ‘let’s try this,’ finally invented what became known as the EKG. The device continued to develop, into the EKG that you will see in a clinic or hospital today.
Healthcare is very pompous and traditional. The device is called the electrocardiogram. However, as healthcare honors tradition more than major league baseball, Einthoven used the Greek ‘kardio’ as his invention was very, very important, and maybe now Dad might like him. Thus, the acronym ‘EKG’ is used.
Here’s a mind-bender for another time, that took me a while to figure out: the EKG uses 10 electrodes, placed across a patient’s upper body. These are the little sticky pads, connected to wires. The electricity is only measured; no current is carried to the patient. Many of us who have had the procedure often find electrodes later on in the shower that the practitioner forgot to remove. Be that as it may, these 10 little sticky electrodes give 12 ‘leads,’ or views, of the heart’s electrical activity. That’s 12 views from 10 electrodes. That explanation is for another time, but as a student, it took me a bit of time to wrap to my head around that one.
These 12 leads, interpreted by a computer, which render a wave-like display, can tell a great deal about how a patient’s heart is performing. Many, many problems with the heart can first be detected with the EKG. It is an invaluable diagnostic tool in healthcare.
There’s a little more to it, and some instruction in its use is needed. I was trained how to use the EKG when I spent a year in Medical Assistant school.
So, let’s bring it back around, to finish, with my opening: gender specific procedures. The EKG itself is not gender specific, but the procedure of using one can be.
The role of Medical Assistant is heavily female dominated. Only about 15% of Medical Assistants are male. Of our class of 9, I was the only male, other than our wise instructor, a patient, erudite veteran. To protect his anonymity, let’s use the name ‘Jaimers.’
We were trained in the EKG early on in our program. We were not quite yet a team, and the group-trust, while growing, was not there yet. As I mentioned, the EKG is not gender-specific. However, with a female patient, it does involve her removing much of her upper clothing, while lying on her back, putting her in a vulnerable and perhaps uncomfortable feeling state. Not every women getting an EKG feels this way, but I can see how one might.
Jaimers asked my fellow 8 female students if any of them would have an issue if I, the only male, practiced the EKG on them. Several of my classmates said they would. I took no offense. However, one particular classmate had absolutely no problem with this.
This classmate and I clicked early on in the program. She was intelligent, driven, and, like myself, determined to bury the program into the ground and come away with a cumulative 4.0 gpa. She has had quite an accomplished life, and I could see her determination. In school, always get a smart friend. Anyway, to protect her anonymity and dignity, let’s call her ‘Heidie.’ As an anecdote, had I been born a female, my name would have been the same, only my parents would have spelled it correctly. And even weirder, had I been born a male, my name would have been Tom. Inside joke!!!
Anyway, Heidie did not give a rat’s ass who worked on her; like me, she just wanted a 4.0. So, I had the honor. Even though she is older than I am, Heidie is quite beautiful, but that did not enter my mind at all when she was lying down on the exam table, her scrubs up, just exposing the bottom of her bra. Like I’ve mentioned, it’s just another day at the office for a practitioner.
But, I ran into trouble. The first two electrodes of the EKG go to just the right and left of the patient’s upper sternum. Heidie had decided to be Pamela Anderson that day. I hope you can see the logistical problem I was having. I needed my 4.0, but Heidie’s damn hooters were in my way. Heidie and I have gone on to be great friends, to this day, but at that moment, Dolly Parton there was annoying me. I needed to place the first two electrodes, but I did not want to molest my classmate. I was frustrated, trying to delicately place the first two electrodes at the sides of Heidie’s sternum, without touching her silicone work. Impossible.
Jaimers, our seasoned, knowledgeable instructor, noticed I was having trouble. He came over to assist me, and briefly instructed me on how to delicately and professionally, explaining what you are doing to the female patient, move her bazingas out of the way so that you can place the electrodes. His advice was spot-on, of course, but at that point, I was ready to just heave the annoying hooters out of the my way and use duct tape to hold them until I was finished. Jaimers and I got the electrodes hooked up, but, of course, Her Majesty happened to be wearing a bra with an underwire that day. This can cause AC interference in the EKG’s reading. I eventually had to move on to another willing female patient. This was the only time in our friendship that Heidie has annoyed me. Of course, she got the last laugh, when she performed an EKG on me. My family is mostly Swiss, with a fair amount of Sasquatch thrown in. That is to say, I am a hirsute man. I shed. It sucks. Whenever I have a girlfriend, the lights have to be off. So the process then, the humility reversed, is that the Medical Assistant has to shave, with a razor, the locations where the electrodes go. Actually, I probably disgusted Heidie. I hate being part Bigfoot.
After class, when everyone was leaving, Jaimers said his daily: “Andrick, may I talk to you for a moment?” I really got tired of hearing that. But that day we spent a good 20 minutes talking, staring out the window down onto Seattle’s downtown, a typical misty day. All we needed was some armchairs, soft jazz, and lower lights. He was quite informative that day. He imparted the (extremely useful) wisdom on how a male patient performs an EKG on a female. You explain what you are doing, politely and professionally, asking for permission, and use the back of your hand to briefly raise the female patient’s breast to place the electrode. It was an informative, bonding chat. So, please don’t miss the next episode of Hooter Talk, with Jaimers and Andrick, Sunday nights at 9:00 PM on your local PBS station. Won’t you donate now, to keep this quality program going? Hooter Talk with Jaimers and Andrick is brought to you by viewers like you, the Corporation for Public Silliness, and the National Endowment of Andrick Smarting Off Again.
All kidding aside, let me finish up this essay with my original opening: gender-specific procedures. I have indicated that the EKG is not gender-specific, but it can be to the patient. On my externship, my mentor tasked me with performing and EKG on a female patient. I asked her if we had checked with the patient to make sure that a male performing this procedure was comfortable with her. My mentor blew it off, saying that it shouldn’t matter. Oh well, I thought. She’s the boss. I grabbed the EKG kit, and entered the exam room.
I could tell there was a problem as soon as I entered the room. The woman looked scared and nervous. I used a soft voice, and politely introduced myself, telling her I was there to perform her EKG. She began to cry. I told her that it’s okay; what’s troubling you? She tearfully asked if a female could perform the procedure. I have no idea if I caused her concern, or something prior. Perhaps abuse, anxiety, or a troubling potential diagnosis. It did not matter. Empathy and compassion. I told her that that would be just fine, no trouble at all, and that I would find a female Medical Assistant. I excused myself.
I went back to my mentor and told her what happened. She seemed surprised. Whatever…
It can also work the opposite way. People are all unique individuals. I was working at a community clinic, and was asked to perform an EKG on a female patient. I entered the exam room and introduced myself. Bam! Off went her gown, off went her bra, she laid down flat, and said: “Okay!” Well! My kind of patient! Who gives a crap? Just do your thing, MA!
None of that EKG encounter with that patient bothered me. Her unabashed style made things quite easier. There is a little dead space in the EKG process, when the MA connects the electrodes, straightens the lines, and ensures that the computer is correctly connected. So she and I talked about Star Trek. It was quite the memorable EKG experience.
So, my final points. You never stop learning, even after school is over. When you practice on real patients, it’s a brand new world. The procedures we do in healthcare may all be similar, but each patient is unique. You never know the full story of what brought them to this place. Empathy and compassion. Most people are fighting a battle you know nothing about. The other thing I learned was: if you are a female patient, and going to the clinic or hospital, please don’t wear a bra with an underwire. We’d appreciate it.
Thanks for reading, everybody! Happy Thanksgiving!
Hey everybody! It’s been a while. I thought it would be good to post again.
I’ve got a little time; I’m on a medical leave right now to take care of a sudden and troublesome condition. I’m hoping to return to work in January. So, I’m using the time for research and writing. Good time for a new post.
My time as a Medical Assistant has not been terribly long, but I have learned a few things. The world of healthcare is full of drama, intrigue, gossip, strong emotions, and downright assault. They didn’t exactly prepare me for that in school. But, many veterans of the industry are a bit burned out these days, so I joined the ranks just in time for the rampant profanity and frayed nerves. Good times!
But, all that’s for another time. Today, I’d like to write about broken male genitalia, hearing aids, and a federal government that just continues to annoy the crap out of me.
Okay, bear with me, because this is sort of round-about.
Older males can develop a condition called Peyronie’s Disease. Simply put, this a pronounced curvature of the ding-dong when it becomes ready for the old hoo-hoo cha cha with a nice lady. Many illnesses and conditions in medicine are eponymous; that is, they are named after the scientist or physician that first identified them. I have done no research, nor do I wish to, of who Peyronie was, and why he chose this area of study. Well, I suppose someone had to do it?
Anyway, this curvature of the little fella can be quite debilitating, preventing regular sexual intercourse. Please, please, please do not follow this link:
I warned you. Anyhoo, Peyronie’s Disease is generally caused by a buildup of scar tissue and plaque in Mr. Johnson. This is typically due to a number of various medical conditions, but most often due to penile trauma. What happens is, the old timer really, really wants to do the bang-bang dance with the pretty lady friend. However, along with age can often come another unfortunate condition, erectile dysfunction. ED, as it’s known, can be varied in its severity. If it is not too bad, the gentleman will do his darnedest to guide the not-so-stiffy into the nice lady’s fun zone. This invariably does not work, and is probably not all that fun for the female partner. I’m guessing. But, this continued practice will cause physical trauma, damage, to Mr. Johnson. This often results in Peyronie’s Disease. Oh, the tragedies of man…
But wait! Hope abounds! Modern modern medicine triumphs! There is a medication known as Xiaflex (triumphant music sounds) that can cure this condition!
Xiaflex is a medication that breaks down the plaque buildup in a shlong with Peyronie’s Disease.
It is injected directly into the affected area of the penis. You are reading that correctly. A needle, made of metal, is inserted right into a crooked penis. In my practice as a Medical Assistant, I have seen Peyronie’s Disease, and I have seen it corrected by an injection of Xiaflex into the affected area of the male member. It cannot be unseen. I am different now.
Xiaflex is not inexpensive. Depending on the severity of the Peyronie’s Disease, it can take up to 12 injections of the medication. Each administration of Xiaflex costs roughly $3000.
Okay, so my 87 year old mother, who I love dearly, is nearly deaf. I know that there was no segue there, but bear with me. This all comes around. Nevertheless, I hope my Mom is not reading this.
Charlsia Schall is still very sharp mentally, and I inherited her wicked sense of humor. Physically, she’s doing okay for someone who is 87, but she needs to use a walker and she desperately needs hearing aids.
You can still speak with her, but it is usually best to speak directly in front of her, in a louder, clearer voice. Being that her cognitive acumen is still strong, it is easy to carry on a conversation with her. At her age of 87, I am truly lucky. Not many people have such a luxury. Again, I hope you’re not reading this, but I love you, Mom.
My mother and late father, through living frugally and saving as much as they could, did okay for themselves. You know, living within your means and saving as much money as you can. Like you’re supposed to do. Sheesh. Old people, wise with their money… I tell you… Anyway, though she could definitely afford it, Mom is not keen on making large purchases. On some level, I don’t blame her at all. Hearing aids are profoundly expensive, with decent ones starting at at least 4-5 thousand dollars. As my Mother is not entirely deaf, this is an economic button she is just not comfortable pushing.
Social Security was signed into law by President Franklin D. Roosevelt in 1935. Again, I got no segue here, but trust me, this is all going to come together. Hopefully. If this is a good day. Anyway, Social Security was part of the rescue package intended to mitigate the Great Depression. Apparently, economies occasionally need medication and therapy as well. The Great Depression had ravaged the United States. A recap of history is not needed here.
The government, at all levels, has always taken a strong interest in the American healthcare system. This can be a good thing, as government oversight can ensure the safety of patients and the efficacy of treatments, strengthening out healthcare system. (How we go about paying for this masterpiece is another story entirely). Federal agencies exist to oversee healthcare at all levels, ostensibly to protect the American patient: the FDA, the CDC, the DEA, the Joint Commission, etc. Occasionally, these departments can become weaponized for political reasons, as we are human, all of us flawed, and humans run the government.
My education and professional experience is in medicine. I dislike talking politics, as people can easily get all yelly-shouty-pissy. I know only the basics of our political system, and I hold opinions based on what I see. There is a branch of philosophy (I have dabbled, but am not educated) known as epistemology. This school of thought seeks to differentiate between what is fact and what is opinion. In today’s era of social media, it is quite easy for anyone, from any ideological camp, to loudly shout an opinion, with scarce facts backing it up, until, in this era of blatantly partisan media, their opinions are reinforced enough to become, in their world, facts. A nice twist of logic. It is difficult to speak of politics these days, as we live in a largely binary political belief system, with inflexible, unyielding opinions (not facts), and people quickly get emotional and confrontational. You cannot have a rational discussion with someone in that state. Hence, I avoid politics.
Anyway: back to politics nonetheless, the federal government, and Social Security. Over the years, the government has changed, tweaked, and adjusted Social Security, but the basics of the original intention still stand. All taxpaying Americans pay into it, and our senior citizens can enjoy an easier way of life, as medical bills mount with age. Be that as it may, there are certain things Social Security still will not pay for.
My beloved mother could really use those hearing aids. Hearing aids are not covered by Social Security.
Xiaflex, the medication that treats Peyronie’s disease, is covered by Social Security.
Let that sink in for a moment.
Hearing aids? Up to $7,000 or $8,000 dollars.
Xiaflex? Up to $36,000 dollars.
Yup. No hearing aids, no new glasses, no covered dental work for my Mom.
Bent weener? No problem. Got you covered.
I was a little stunned when I heard about this. Surely, I thought, the powers that be in Congress would have rectified this by now. An RN I was working with at the time gave me his opinion:
RN: Andrick, who do you think makes the laws in the Senate?
Me: Uhh… Well, for the most part, mostly older white males.
RN: And who do you think they have staffing their offices?
Me: Usually insanely hot 35 year-old women.
RN: Okay then, do the math.
Me: Aw, crap!
Joe Biden and the slim majority of Democrats in Congress have recently tried to stabilize the country and give long-needed help to the working class. Again, I hate speaking politics, but two of his Republican predecessors did the same thing. But, because half the country believes Joe Biden lost (dude… people… really?), the opposition is suddenly concerned about all this money we’ve been throwing around.
Initially, Biden’s rather largish spending plan included adding hearing aids, vision, and dental to Social Security recipients. Sounds like the right thing to do. But people balked at it. Biden has scaled his ambitions back. Recently, Congress at least passed an infrastructure spending bill. There is more work to be done. Biden and the Democrats are still trying to pass legislation that would help the needy. After much yelling, the plan was scaled back, as far as Social Security benefits go. Vision and dental are out, but hearing aids would be included. At least my Mom could finally hear again.
However, the opposition is again balking at this one. Along with them are two Democratic obstructionist Senators. One is a cranky old man, with an 85 year old body and 500 year old face,a Republican dressed as a Democrat, who doesn’t like spending money at all. He wears sensible shoes. He represents the state of Virginia. I had to Google Virginia; evidently it’s a suburb of West Virginia or something. East Virginia was infamously destroyed by the Cloverfield monster. The other Democratic obstructionist Senator is a woman from Arizona, who’s really pulling off the naughty-behind-closed-doors school librarian look. I’ve been to Arizona. Head south to the deserts of SoCal, go east, and stop where all the retired people are. Anyway, this Senator is rather hard to read. She doesn’t seem to stand for anything, and dislikes speaking to reporters, her constituents, or the clerk who asks paper or plastic. Maybe she’s just there collecting a paycheck. She certainly does not need the Viaflex. So, there is a good chance that the aid package that includes hearing aids in Social Security will not pass.
So, there you have it. Penny-pinching senior citizens can’t rely on Social Security for hearing aids, but senior citizen males, no matter what their station, can afford Xiaflex to fix their bent ding-dongs. Makes perfect sense to me!
I first met in her in mid-May, both of us in a strange place in a strange state of mind. Neither of us could adequately explain what brought us to that place, but her company there in that isolated pocket of sadness was an unexpected source of happiness, of companionship, and, eventually, guilt. But for those two weeks, she was my rock, my angel, and above all, someone who understood.
She had the most beautiful brown eyes. In fact, that’s what I called her: ‘Brown Eyes.’ Peering into them was as if I were at the edge of deep pool of still, dark waters, both calming and dangerous at the same time. There were several of us there, about twenty, but Brown Eyes was the only one close to my age; myself, 23, Brown Eyes, 22. We hung close to each other those two weeks. Practically every hour of the day.
Soon, however, we understood that it was pain, a deep hurting, that brought us to that place. Sometimes, a mind will work against its own, the cause of which could be a host of things, and will damage that soul, driving them down, causing pain, causing despair, madness, and, all too often, death.
Brown Eyes was an incredibly gorgeous young woman, both to the eyes and to the mind. She was caring, compassionate, prone to giggling, and a devoted listener. She radiated a warmth that I was instantly drawn to, a solace in a world gone mad.
Yes, we stuck together. We loved each other’s company, yet we were both afraid, both hurting. No wonder, then, that we were drawn to each other. But though our time together was brief, the days we spent together were full of closeness, friendship, and a kinship that I will never forget. Brown eyes and I used to have wonderful times together. We played poker, told hilarious stories about ourselves while we smoked cigarettes on the patio, we watched (and mocked) the nightly film, we ate together, and sometimes we were just together. We were as close as two young people could be in a place such as there. We shared a bond. We shared everything.
I remember once, one of the older residents, at one of our sessions, noticed the spark between Brown Eyes and myself. She remarked: “You two are going to get together when you get out of here, aren’t you?”
We both blushed. Brown Eyes managed a: “Well….” I smiled broadly, in the hopeful affirmative.
But Brown Eyes was hurting. Deeply. I so wanted her to get better, to see that she had value, to myself and to the world. Once, when we were journaling together, she had written ‘I am hopeless’ repeatedly across her worksheet. That crushed me. No one is hopeless. All life is precious.
I never discovered what brought her to that place, but her pain, so evident when it manifested, was so profound, so powerful, I could not help but be wounded further myself. I would find herself alone, trying to sleep, but crying. The suffering Brown Eyes would be curled up into a ball, clutching a Roald Dahl book, no doubt a book from her childhood, from a happier time. I went to her then, and felt her pain, stronger than my own. I did not understand it wholly, but I knew what it was like. I would hold her. Our little world, however, was constantly monitored. Such is the nature, the precautions the physicians must take, when two young people find themselves in the psychiatric unit of an old hospital on Seattle’s First Hill.
I remember what brought me there. I had been diagnosed with clinical depression only a year before. The treatment was still new to me, and I was battling old demons at the same time. Note to self: certain medications and alcohol are a terrible mix. My physician saw the signs as I collapsed, the ideations. Thus, this was how I met Brown Eyes.
Her eyes. Those deep worlds of both pain and compassion; never will I forget them. I remember the day Brown Eyes was discharged. She had given me her phone number. I will always remember this moment, the last time Brown Eyes spoke to me: “Please,” she said, “Do call.” I promised I would.
I don’t know why, but I waited a day. Perhaps I wanted to give her time to reacclimate with her family. Perhaps I thought it too early, for whatever reason. This is a regret that haunted me, ate at me, damaged me for several years.
I eventually did call her, the next morning after breakfast. The phone just continued to ring. I called several times that day, but no answer, no machine. The phone would just continue its incessant ringing. Finally, that evening, someone picked up. “May I talk to Brown Eyes, please,” I asked. The voice replied: “Who’s calling?” There was a sense of disbelief, and also inconvenience in his voice. “This is Andrick,” I replied, “A friend of hers from the hospital.” There was a long pause, followed by deep sigh. Finally, the voice, an uncle, spoke: “Brown Eyes is dead.”
My world collapsed. My time in the hospital was extended. I recall very little of the first few days afterwards. And yet, even in those dark days, I strongly disagreed with Brown Eyes: There is always hope. With the skill of the mental health providers at the hospital, and the daily visits from my psychiatrist, I improved. I wanted to improve. My father, whom I recently lost, would visit me everyday. Friends would call me, offering support. This is crucial to a recovery from a mental illness: a strong social support system and a team of dedicated professionals. And recover I did, more determined than ever to live. This was the first gift that Brown Eyes left me with: the will to push on, to live, to change the lens and see the world, and myself, as a wonderful place to be. This was her second gift to me: suicide will destroy those left behind.
I was not in the hospital much longer. Though I had learned painful lessons, this is often how one learns and grows, especially in the assessment of those lessons. Pain is there to teach.
My psychiatrist was very skilled. He was both a physician of the brain, and a psychologist of human behavior. My Doctor was a rare breed then, and now, practically, an anachronism.
I have written on this before:
Now, these days, an unfortunate schism has happened: the divorce of psychiatry and psychology. But in 1997, I was very fortunate to have my physician and my confidant in the same office. Our visits were for an hour, several days a week after my discharge, as I began the healing process. We would discuss medication, but we would also discuss the illness, and the guilt.
Though I had only known Brown Eyes for two weeks, the bond we shared, in that environment, with someone my age who suffered a similar illness, was strong. My Doctor and I spoke of her extensively, and the choice she had made.
For that is what her suicide was: her choice. But the nagging guilt still gnawed at me; why didn’t I call sooner? What if I had said something different in our time together? What could I have done?
My recovery was strong. I returned to acting. The local theater community in Seattle was a strong source of support. I loved to perform for an audience, an emotional release you might not be able to tap offstage. I worked in hospitality, and rose to the position of Operations Manager. I switched to banking, where I eventually filled the same roll, with Chase Bank for fifteen years. I tried my hand at writing, and had a couple of books published (they were not very good, nor well received…. it turns out I am better at writing essays than I am at writing novels). At the tender age of 47, I made another choice, one of the best I have ever made. And so now I find myself in healthcare. Ironic, perhaps, but a profession I love nonetheless.
But those early years after the hospital were a steep climb. And yet, recover I did. Those who have recovered from a mental illness are aware that this is an affliction that may forever be a part of them. But, along the way, you learn skills, and ways to cope, so that each time the affliction attempts to return, you know what to do. Oftentimes, this involves one the hardest things there is to do: ask for help.
But there was always that little demon in the back of my mind, worming its way into my consciousness: that feeling of guilt. Eventually, as part of the healing process, you must accept that certain things are not your fault. There was nothing I could have done. Brown Eyes had made her decision. I understood her pain; I understand why she did it. Sometimes, the dark night of the soul is so powerful, one sees the only relief as oblivion. It was a decision I myself could never make. This was her choice. It was not my fault.
SUICIDE IN AMERICA
Suicide is the most destructive act one can do to those that love them. Survivors of those who have lost loved ones are often adrift emotionally and mentally, sometimes for years, or for the rest of their lives.
It is a difficult subject to broach, as it always stirs feelings of confusion, sadness, resentment, depression. Those who have lost loved ones to suicide oftentimes find themselves alone and misunderstood. Conversations can be awkward. The guilt can be overpowering.
Survivor’s guilt can lead to complicated grief, a kind of post-traumatic stress disorder than can degenerate into depression. Most of us have faced death, and we feel the hole it leaves within us. But to lose a loved one to suicide is a wound that is very difficult to heal.
Yet talk about suicide we must. Here in America, though we have faced profound problems for the last year and a half (to put it rather lightly), we have the resources and intelligence to address this problem. And a problem it is:
In 2020, over 48,000 Americans died by suicide, making it the 10th leading cause of death in the country. On average, 132 Americans died by suicide every day.
Suicide is to succumb to the darkness, but it is also a desperate cry for help: a staggering 1.4 million Americans attempted suicide.
Suicide is the 4th leading cause of death of those aged 35-54.
A statistic that is absolutely heartbreaking: suicide is the 2nd leading cause of death of those between the ages of 10 and 34.
Every day, 22 American military veterans take their own lives. That is 1 suicide every 65 minutes. This number is appalling and unacceptable. No matter what your stripes, these men and women put their lives on the line every day, for very little money and insufficient appreciation.
THE LACK OF MENTAL HEALTH RESOURCES
Though suicide is obviously a profound problem in the United States, there is an unfortunate lack of resources for the mentally ill. At every clinic I’ve worked at, nearly every provider has decried the lack of options and availability for those who are on the edge. But, these physicians do their best. If one is depressed, and contemplating suicide, it is better to seek help from any Doctor than none at all. Every Doctor you will meet, every Nurse, every Medical Assistant; all of them will do their absolute best they can for you. I have worked among some of the best. They are dedicated to their craft, and to helping you heal as best as they possibly can.
Though we have come a very long way in understanding and accepting the existence of mental illness, we still have quite a ways to go. The social stigma still exists. The lack of awareness, though decreasing, is still present. There are often limited options and long waits to see a mental health professional. And, though I realize this is a subject of debate, healthcare in America can be egregiously expensive, and oftentimes, recovering from a mental illness takes in-depth and lengthy care.
WHAT YOU CAN DO
First and foremost, if you are having thoughts of suicide, and have made plans: CALL 911.
If you are depressed, or feel that life is not worth living: reach out for help. See a Doctor. See your religious counselor. Talk to a friend or family member you can trust.
If you are a survivor of losing someone to suicide, take care of yourself. It will take time to heal. As so above: reach out for help, wherever you can find it. Someone out there knows what you are going through. You are not alone.
In fact: Anyone suffering from depression or thinking of hurting themselves; please realize, you have value, you have a future, and you are not alone.
National Suicide Prevention Lifeline: 800-273-8255
Veterans Help Line, for those currently serving: 800-342-9647
Their information on depression and addiction is outstanding:
As the saying goes: I would rather listen to your story than attend your funeral.
Project Semicolon, stylized as ‘Project;’ is an American nonprofit organization known for its advocacy of mental health wellness and its focus as an anti-suicide initiative. It was founded in 2013 by Amy Bleuel of Wisconsin, who lost her father to suicide in 2003. Tragically, Bleuel herself committed suicide in 2017.
Project Semicolon defines itself as “dedicated to presenting hope and love for those who are struggling with mental illness, suicide, addiction and self-injury”, and “exists to encourage, love, and inspire.” A semicolon ( ; ) is used as a metaphor: the author could have ended the sentence, but chose not to. “The author is you and the sentence is your life.”
Today, one might see or notice people with the semicolon tattoo. Many celebrities have been seen with such a tattoo. I dislike it when entertainers use their positions of prominence to talk about politics, but if they are bringing awareness to mental illness, more power to them.
IGY6, or: I’ve got your six (I’ve got your back) was inspired by project semicolon, created by military combat veterans to advocate for suicide prevention and awareness. One may occasionally see a veteran or first responder emblazoned with “IGY6;22.” The number 22 represents the number of combat veterans who commit suicide every day.
It was not until earlier this year that I accomplished something that I had neglected to do, perhaps unconsciously. I have lead an exciting and successful life; setbacks, here and there, to be sure, but with my new education and my new love of healthcare, I have a great future to look forward to, full of potential. But it occurred to me, 24 years later, that I never officially said goodbye.
It took a little digging on the internet, but I found it. I drove across town, and visited Brown Eyes’ grave.
There was an outpouring of emotion, to be sure, as memories came back. But there was also a sense of relief, of closure that I was not aware I needed. Her grave is on a beautiful, gentle hill, overlooking Seattle. It sits underneath a Japanese Holly tree, surrounded by trinkets and memories of those who had come by.
I said goodbye to Brown Eyes. I said I loved her, that I was not angry with her, and that it was her choice, but I wish she had made a different one. I imagined the conversation we might have had then, had she survived her illness, so long ago, as if we were two old friends, catching up on old times. I have absolutely no idea what happens in the world to come, but if we persist, in whatever form, after death, she will be the first person I hug.
Good bye, Brown Eyes! I remember your spirit, and our memories, both of which I will carry; your story is not over.
Dedicated to Hannah Elaine Harvey, 1974 – 1997
This will be my last blog post for the foreseeable future. Though I have loved writing my observations and thoughts on healthcare, it is time-consuming, and there are things I must move on to. All of you who enjoyed reading my posts, I can’t thank you enough. My website will still be there, and, somewhere down the road, I may post again. Thank you all, and do feel free to contact me.
Thank you all! Wash your hands! Get vaccinated! Take care of yourselves! Take care of each other! Bye for now….
Okay! I have a guest post today. It’s my brother Pedro (his name is Peter, I call him Pedro), and I asked him to share his experiences with a seriously bad roll of the medical dice. When he was about 11, in the 6th grade, he came down with a disease known as mononucleosis. He recovered, but six months later, he came down with another nasty disease known as meningitis. Dang! That’s some bad luck, big brother! So, he was kind enough to share his experiences of the ordeal(s). He was young, so many of his memories are hazy, but he clearly recalls the more painful moments during this time span of infections. Myself, I would have been about 6, so all I remember is that my big brother was home from school, not feeling well, and we had to have separate eating and drinking utensils for him. Then I probably played with my legos.
Both mononucleosis and meningitis are serious and potentially deadly diseases. During his narrative, I will jump in and do my best to explain what he may have been experiencing. Take it away, Pedro!
I left school one day, feeling kind of weak. By the time I got off the school bus, the weakness and fatigue had increased. I went to school the next day, but the teacher sent me to the nurses office, as it was obvious to her that I was feeling tired. I had also complained of a headache. By the time I got to the nurse’s office, I ended up barfing on her desk. Mom had to come pick me up.
It is widely known that younger adults, and specifically children, are more susceptible to disease. This is simply because their immune system has not been around long enough to develop antibodies to the various pathogens that love to call human beings home. Their defense mechanism is simply not yet developed, like the rest of their bodies. Most young children have 6 to 8 colds per year, according to John Hopkins Medicine.
Mom and Dad thought it might just be a cold or a flu, but I began to gradually feel weaker, I had a fever, no energy, and I had trouble keeping food down. I had a pretty bad sore throat. The weakness is what I remember the most. After a few days, Mom and Dad took me to the Doctor. My lymph nodes had begun to swell and actually felt like little rocks. I barfed in the Doctor’s office. Mom says I cried when they drew blood from me, but you ought to see my brother try and practice blood draws.
Later that day, the Doctor called to say that I had mononucleosis. I had no idea what that meant. Mom and Dad tried their best to explain it to me, but to me, it just felt like a really awful flu.
Unlike most diseases that infect children, mononucleosis typically effects young children in the early and mid puberty stages of life. Adults can definitely be infected with mononucleosis, but in those instances, the symptoms are usually mild to moderate. There is no vaccine against mononucleosis.
Yeah, like a bad flu. But it just wouldn’t go away. I started to feel better, but only gradually. I was out of school for almost two weeks. At the beginning of the second week, I started to feel a little better. My lymph nodes had returned to their normal state, I was no longer nauseaus, and my fever lowered back to an almost normal temperature. But I was seriously fatigued.
There is no specific treatment for mononucleosis. Like a flu, bedrest, OTC painkillers and a simple diet will do the trick. The disease itself is usually caused by the Epstein-Barr virus, one of the eleven or so types of herpes that can infect human beings (hey… it doesn’t have to be sex… my brother was 11…) In fact, about 90% of the world’s population is infected with the Epstein-Barr virus at some point in their lives, usually with no ill effects.
The little virus is generally spread by contact with an infected person’s saliva, hence, it is often called the ‘kissing disease.’ My mother recalls the kids our age that lived in the house being sick just before my brother came down with mono, and if they were playing around, and shared a swig of soda pop, that might have done it. However, we all have to eat and drink, and we typically use utensils to do so, so Pedro could have caught it just about anywhere.
The virus usually attacks the epithelial (goop, mucous) that lines your alimentary canal (the passageway from your mouth to your pooper) in the pharynx, often causing a sore throat. Later, the virus goes to war and tried to replicate your B-cells (a lymphocyte, one of your system’s bodyguards). In most cases, your B-cells win this round, and develop antibodies, a sort of ‘memory’ of how to defeat this antigen (a substance, a pathogen, anything nasty that invades your body).
Viruses like human hosts. Viruses exist. Viruses can be easily transmitted. Some viruses are particularly nasty, aggressive, unpredictable, and opportunistic. Some of these viruses can kill over 600,000 Americans, even though there are precautions you can take to avoid them. If there is a vaccine against this virus, it would probably be a very good idea to get it. I don’t know what made me think of that. But I digress…
In the few days before I was supposed to go to school, my teachers started sending me stuff I had missed. I don’t know how people found out, but when I first got back to school, my friends were avoiding me like the plague. It didn’t last long, though, they could tell I wasn’t sick anymore, and I had a bunch of missed class stuff to catch up on.
Mononucleosis is not a reportable disease in Washington State, despite it’s prevalence to easily spread. It rarely causes serious problems, and it goes away with time. That’s not to say it’s an easy ordeal; like my brother said, it’s like a bad flu, only it last about two weeks.
I felt fine for a long time after that, with no lasting effects. But then, about 6 months later, I woke up Sunday, after going skiing on Saturday, with a sudden fever of 102 degrees. I felt cruddy and tired, worse than the mono.
Again, children and young adults have weaker immune systems. It was postulated, later on by his physician, that my brother’s mononucleosis, though he had recovered from it, was still doing lingering damage to his immune system as it rebuilt itself. The pathology is not well understood, but it has been estimated, by one study, that 1-18% of children who are infected with mononucleosis are susceptible to meningitis:
I was no better, in fact I was worse, Monday morning. My parents took me to Children’s Hospital. By that time, my fever had increased, my neck was terribly stiff, and I had trouble looking at bright lights. I had no idea what was going on.
Well, I’ve said it before. Seattle is a good place to get sick. Some of the best healthcare providers in the world are here. The sudden, rapid symptoms my brother was describing immediately cued the physician that this might be a case of meningitis. The definitive diagnostic to test for the presence of the disease is the performance of a lumbar puncture, better known as a spinal tap.
I remember laying on my right side. The doctor put anesthesia on my back, but it really didn’t do any good. Dad had to hold my legs down so that I wouldn’t buck and break the needle off in my spine. I really can’t describe the pain. Incredible pain. It was more like an electric shock. Thankfully, the needle was in my spine for only a few seconds.
A lumbar puncture is a medical procedure in which a needle is inserted into the spinal canal, most commonly to collect cerebrospinal fluid (CSF) for diagnostic testing. The main reason for a lumbar puncture is to help diagnose diseases of the central nervous system, including the brain and spine. In my brother’s case, meningitis. I love the movie Spinal Tap, but after hearing my brother’s story, the medical procedure is not something I’d look forward to.
There are protective layers covering the brain and spinal cord known as meninges. There are actually three layers of meninges: dura mater, the arachnoid mater, and the pia mater. I’ll take anatomy for $600, LeVar. The word meninges comes from the Greek ‘membrane.’ Then: ‘itis’ is the medical term for inflammation. Hence: meningitis. This puts enormous pressure on the brain and spinal cord, causing severe pain for the victim. The entire human body’s entire nervous system stems from this area, and the entire body will be in pain.
There are a few different types of meningitis. The most common are bacterial and viral. Either one, particularly bacterial, left untreated, can cause septicemia: the poisoning of the blood, frequently fatal.
I remember when the doctor pulled the needle out. There was an odd little kind of wet ‘pop’ sound. As the doctor took the specimen to the lab, a nurse brought me an orange popscicle. They offered one to Mom and Dad, but they passed. I was still in incredible, intense pain. Evidently, the testing procedure did not take long, as the doctor returned before I had finished my popscicle.
The ‘good’ news was that my brother had viral meningitis, as opposed to bacterial. There are vaccines against this virus, and my parents were good about keeping us up to date, but sometimes the little creature will find a way. Viral meningitis will generally go away on it’s own. Some virus do not.
It’s most likely that my brother, with his immune system still rebuilding itself after mononucleosis, caught the virus while he was on his ski trip. On the bus, in the lodge, who knows. Viruses are opportunistic pathogens, and can spread very easily. It’s too bad that my brother was not wearing his ski MASK. And staying safe while speeding down the slopes, practicing proper SOCIAL DISTANCING. Because viruses are REAL and can easily spread if you don’t take PRECAUTIONS.
Hey! Is this my story, or your rant about Covid again?
Sorry. Go on.
When we got home, and I tried to sleep, I couldn’t. The pain was incredible. It felt like a third-degree burn all over my body. Cold beverages didn’t help. Aspirin didn’t help. I was in misery. The folks called the hospital, and the doctor told them that I’d pretty much have to ride it out. It sucked.
Had my brother had bacterial meningitis, there is a good chance he would not be here today, or, at the very least, be severely crippled. Children that are fortunate enough to survive bacterial meningitis face a lifetime of medical problems: memory loss, cognitive difficulties, difficulty retaining information, motor-skill and coordination problems, headaches, hearing impairment, epilepsy and seizures, paralysis and spasms, speech problems, potential blindness; all or none to varying degrees. I understand now why my mother could never watch the Jerry Lewis Telethons. To see a child suffer is the worst image possible.
Unlike the mono I had, this one didn’t last as long. I gradually felt better in about a week. But those first few days were fucking awful. It’s impossible to describe the pain. You cannot comprehend it until you have been through it.
So, back to school I went, and once again, I was way behind on schoolwork, and my classmates steered clear of me. But, eventually, life returned to normal.
Meningitis is a reportable disease, as it is contagious. How myself and my parents, and anyone else at my brother’s school, managed to not catch it as well is… just a roll of the medical dice.
Back in early 2020, when the world began to unravel, when I had just finished my first quarter of school, the lock-downs across the country had begun. My parents, I had both at the time, were considered vulnerable (right… remember when it only infected elderly people or people with compromised immune systems? It’ll go away in April! Like a miracle! Drink bleach!) and they were living in an assisted living facility. In fact, it’s only recently that restrictions have been relaxed, and I’ve been able to regularly visit my mother.
Anyway, I was having such a great time in school; I was particularity blown away by anatomy and physiology. The human body is an amazing machine. When our instructor first started lecturing about the roles that the cardiovascular and pulmonary systems play together, I devoured his words, scribbling furiously in my notebook. I read through the relevant chapters in our massive textbook. I was fascinated.
I wanted to tell my parents what I had learned, but that’s hard to do over the phone. So, I scribbled together these following pages and mailed my attempt to understand the human body off to them. They got a real kick out of it!
Needless to say, I was a green student, and I got plenty of things wrong in my notes. I think I got the actions of the diaphragm mixed up. I left out the other semilunar valve, the aortic valve. I did my best with the white blood cells, but I’m no biochemist. I got the test tube of blood wrong; white blood cells and platelets are actually in the middle, in a thin layer called the Buffy coat (seriously). There are also plenty of spelling and grammatical errors, and a few pages have this evening’s PB&J on them. Sorry about that.
If you manage to make it through my mangled scribbles of a new student barely understanding, and get to the part where I talk about platelets, you might notice something interesting. Platelets, the cells in your blood that form a mesh to stop bleeding, use serotonin in this process. This is the same serotonin that rattles around in your brain, affecting your mood, and are the primary target of most antidepressant medications. Huh. The human body’s kinda weird like that… Anyway, enjoy!
It is a well known fact that the healthcare industry does not speak English. Sure, when you’re talking to your doctor, or any practitioner, you’ll use layman’s terms, the ones we all know. Relatable, common sense terms. However, behind the scenes, healthcare has a needlessly complicated language. It’s like a strong tradition, a superstition almost. As if only the initiated can use this sacred tongue.
Typically, after any visit to a clinic or facility, you are given a sheet of paper, sometimes emailed, summarizing what your experience there was. It’s usually called an After Visit Summary, or a Visit Information Sheet. Depending on your facility, if you read the summary in-depth, you might see some of this obscure language pop up.
Much of the language of healthcare is derived from ancient Greek and Latin, when the smart people of the time began to (very slowly, often incorrectly) figure out how the human body works. The Latin work for uterus is ‘hyster,’ derived from hysteria, as the Greeks thought women could be overly emotional, as they did not understand that a woman ovulating can have her hormones thrown off. How charming of them. ‘Tomy’ means to cut, or remove. Thus: hysterectomy.
Today, much of the modern healthcare lexicon is an alphanumeric code, a relatively recent development. This eases communication between different languages, and it is also a common way for clinics to communicate with insurance companies.
Perhaps the most intriguing healthcare term of all is the eponym; that is, a procedure or discovery named after the person who pioneered it. The PAP smear was invented by Georgios Papanikolaou. The cruel disease of Alzheimer’s, an illness as old as humanity, was first pathologically described by Alois Alzheimer. Crohn’s disease was first identified by Burrill Crohn.
Now, considering anatomy, that is, the parts of the human body, there are many eponymous terms that, when first read, are downright silly. Here now, is a list of the most ridiculous sounding names for parts of your body:
Purkinje fibers: These are located near the bottom of the heart, and aid in the pumping action of the heart muscle and blood. They are named after Jan Evangelista Purkyně.
Bundle of His: (Actually pronounced bundle of HISS) These are fibers in your heart that help conduct the electrical impulse that keeps the heart beating. They were discovered by Wilhem His Jr.
Islets of Langerhans: These are parts of the pancreas that aid in the metabolism of glucose. They are named after researcher Paul Langerhans.
Cowper’s glands: These aid in the transmission of male semen from point A to point B. They are named after William Cowper. Mama Cowper must have been proud.
Pouch of Douglas: This is the pouch between the rectum and the uterus of the female body. Anatomist James Douglas took his work very seriously.
Golgi apparatus: This cellular substance aids in protein packaging. They are named for the Italian Scientist Camillo Golgi.
Loop of Henle: This handy little structure aids in the production of urine. It is named after German anatomist Freidrich Gustav Jakob Henle. Dr. Henle liked to study how we pee.
Little’s plexus: This is part of your nasal septum. It was first discovered by American surgeon James Little. I don’t know much about him, but judging by his name, he was probably 6’4″ and 280 lbs.
Crypts of Lushka: These are the mucous membranes on the inside of the gallbladder. They are named after German anatomist Dr. Hubert Von Luschka.
Zonule of Zinn: This is a suspensory ligament in the eye. They are named after Johann Gottfried Zinn.
Spiral valves of Heister These are valves in the cystic duct, connecting the gallbladder to the bile duct. They are named after German anatomist Lorenz Heister.
Wormian Bones: These are structural bones in the skull. They are named after Ole Worm, professor of anatomy at Copenhagen. Cool name.
Artemis Schlong: After centuries of debate, a name was finally settled on the name of the male reproductive organ in 1692, by Costa Rican anesthesiologist Artemis Schlong.
All human beings, gender dependent, have within them these anatomical parts with unusual and odd sounding names. There are of course, many more. And still… more to be discovered.
Healthcare is more than just needles and vitals. A long time ago, I remember my first day at the clinic. I was speaking with the front desk manager, and she asked me: “Do you have thick skin?”
I had just finished a 15 year stint at Chase Bank. I assumed she meant unruly and angry customers, only in this case, patients. I had indeed gotten used to angry customers at good old Chase. You can usually tell you might have a ticking time-bomb on your hands as soon as one of these types of customers hit the front door. I became very skilled at calming them down; it’s a trait I have carried over into healthcare. Patients can be nervous or angry. I’m good, most of the time, at alleviating some of these feelings.
I have come to realize she was talking about something else. Yes, you do have to be thick-skinned, as patients are not always in the best of moods when they come to a medical clinic. That’s why they’re at a medical clinic. I’m talking about a suit of armor you must wear, maintain, and strengthen.
It’s a suit of healthcare armor that every practitioner must wear. In fact, there are two layers to it. The first layer is the blood armor. The second layer, the harder one to develop, is the emotional armor.
It’s something that they can’t really teach you in school. In our first quarter, the instructor pulled no punches when he showed us images of what we might see. And the endless education about the tragic things that can go wrong with the human body; that gives you just a slight idea of what you might see. Healthcare is not for the squeamish.
To be honest, this has never been a problem for me, blood and guts. I don’t like seeing people suffering, but gore does not bother me. It’s disgusting and unfortunate that this has become a genre in the entertainment industry, torture porn. Eli Roth can go screw himself. But in reality, in my clinic, blood and gore occurs frequently. It’s never bothered me. I remember walking into an exam room after the provider I usually work with, Susan, texted me that she needed help with a punch biopsy. I walked into the room. Apparently, the area she was working with was more infected than expected. There was a large pool of blood on the floor. Huh, I said. Dr., you’ve got the patient’s DNA all over the floor. What can I help with?
My station is right next to the lab. More that once, I have had to run over and help our lab technician, a big, good-natured fellow who works in tight quarters, help a patient to the floor after they have passed out during a blood draw. He’s very skilled at helping people lie down in a cramped area, while I grab a pillow and a blood pressure cuff. And some apple juice. Afterwards, when the patient comes to, they are usually embarrassed. I’ve written about this before. We don’t judge you for that. Metal is going into your body, and you see your blood coming out. Perfectly natural, the fight or flight reflex.
We call this vasovagal syncope; fainting at the sight of blood. It’s actually somewhat common. People hate needles. I’ve written about this as well. Perfectly natural. You will never be shamed or judged by a healthcare worker. If you feel you are, advocate for yourself, and let the clinic know.
The stronger, more important armor to develop, the thick-skin the front desk manager was referring to on day one, is the emotional armor. It is imperative in healthcare that this armor be strong. But all of us realize that we are human beings. We have emotions, and you have to feel them. Like I said, I’m still a bit of a rookie, and my emotional armor is still developing. It gets stronger every day. Last week it became even stronger.
They cannot really teach you about this in school, either, even more so. But the fact is, if you are going to work in healthcare, your emotions will be tested.
The other day, Susan had a patient who was a recent stroke survivor. As in, very recently. His friend and neighbor, Gary, had found him unconscious on his apartment floor. This patient had spent a month in the hospital, and a month in rehabilitation. In fact, he had not been home yet. Gary, at the advice of the facility, which he had left just hours beforehand, had brought him straight to a doctor. This patient had no primary physician. This patient had no one really, just his friend Gary.
Of course, it reminded me of father. My father passed away last February, just two weeks shy of birthday number 93. He had had two strokes in the last two weeks. In a way, my father was lucky, though I still miss him greatly, every day. My father was surrounded by good medical care, his wife of over 60 years, and his family. He did not suffer long. He died peacefully, in his sleep, and stepped into whatever comes next.
But this patient had no one, except for his friend Gary. He had no next of kin; indeed, he had no close family. No other close friends. He was old, but getting along fine. Gary wheeled him into the exam room. During my rooming process, I asked Gary, as the patient was having difficulty speaking, how long he had used the wheelchair. Gary told me he was walking the day before the stroke. It was clear, as I took his vitals, that this patient had suffered badly.
After Susan had spent some time with him, we were wrapping up the visit, going over the next steps for him. Susan remarked how sad it was that this man was nearly alone, except for Gary. It had been a stressful day (not all of them are in healthcare, honestly), and I began to well up. Susan knew I had lost my father a few months ago. She apologized as I excused myself.
It was heartbreaking. To have this man go down so quickly, and so nearly alone. He had been walking two months ago. He did not have the care or the support my father had. It seemed cruel. Whatever your beliefs, God may be merciful, but Mother Nature is not.
I was cleaning up the exam room after the visit. Susan came in to talk to me, to see how I was doing. I tried to explain how sad that was, through a broken voice. Susan said that we are all human. She told me that I am still new, and that this is part of my education process. And she mentioned the cliché that happens to be very true: it never gets any easier. Your armor just gets stronger.
We’ve all seen interviews with the burned out nurses and MD’s, after working 4 or 5 days straight in the Covid ward. They are broken. Our armor is strong, but the hardships of life we encounter can be stronger. We are only human.
To a degree, you have to laugh about it, as a means of coping. We never mock a patient, but we do have to make each other laugh. I told Susan that if this were TV, we’d be sitting out on the loading dock, chain smoking, tears running down my face as Susan, with the thousand-yard stare, said: “I remember when I lost my first patient. It never gets any easier. Hang in there, rookie.” Of course, using her best Sam Elliot voice.
That’s my biggest challenge, going forward. Not a technical skill, not a memorization of what type of needle you use for what, but my emotional armor. I knew things like this would happen. You’re just never ready for it when you start.
The next day, Gary called us to let us know that the patient had died overnight, in his sleep.
There is a massive problem with the practice of psychiatry in today’s modern healthcare industry. There are several reasons for this, which I will address in a moment, but first, let’s get a few things out of the way.
Many people have a very reactionary, negative opinion of the field of psychiatry. They feel that it does more harm than good. In today’s healthcare environment, they may have a point, but I am speaking in general terms. Psychiatry, to many, is a dangerous science that can damage your brain. Of course; many medical procedures can damage you if administered improperly. That’s why I went to school. Many people feel that psychiatrists have very little clue as to what they are doing. While it is true that the study of the brain, which has remained a difficult and emerging science for a very long time, and will continue to be so, there are millions of Americans who have benefited from what psychiatry does know, and what treatments it can provide. And still others feel as though psychiatry, and indeed, any treatment of the mind or emotions, should be out of the realm of medicine, and kept in either the family or church. While it is very true, and studies have confirmed this, that those of faith, or at least some level of healthy optimism about life, tend to heal much quicker from whatever affliction they may have, that does not mean that medical intervention is sometimes required. Nor does it mean that atheists do not heal.
Plenty of people have a negative opinion of healthcare in general. That is unfortunate. Many millions of people have benefited from the proper treatment of an affliction, and go on to live healthy and productive lives, despite an illness that would have been a death sentence one hundred years ago. The human body is a machine, an amazing construction, the triumph of life on Earth (although the debate about that is for another time). Whether by evolution or design, you and I, and everyone else on Earth, are amazing creatures, composed of practically countless processes, organs, chemical and electrical reactions, and things still yet to be discovered. However, just like any other form of life, like any artificial machine, like any magnificent creation of geology, things can, quite simply put, break down. Sooner or later, it happens to all of us. Have you ever thrown your back out? Well, so have 65 million other Americans. We are wondrous creations, but not entirely perfect. Healthcare plays a role in our repair, and improving our quality of life.
But back to psychiatry. The negative connotations I mentioned above are not entirely unfounded. The history of psychiatry is replete with practices that today seem barbaric, and would never be considered as an option for treatment. What is worse, in modern history, authoritarian regimes have tortured and killed untold numbers under the guise of psychiatry: Nazi Germany, The Soviet Union; even the CIA is guilty of using psychiatry for nefarious purposes.
However, like all healthcare, psychiatry is an evolving field. Healthcare, in essence, is an applied science. That is, it is a scientific endeavor, used for practical means. Many constructive gains have been made. However, the application of these discoveries, when applied to the practice of modern American healthcare, has been severely misappropriated.
I can’t get into the tired debate of whether or not mental illness exists. Believe what you will. Many people, intelligent people, will claim that there is no definitive diagnostic test to prove whether or not a mental illness exists. It is true that nearly all mental illnesses, particularly the behavioral ones, are diagnosed by interview and observation, or that form you occasionally fill out at your annual exam where you check the corresponding box as to whether you are happy or sad. However, you can get out the fancy medical equipment and see it for yourself. In people with anxiety, a part of the brain called the amygdala is overactive. In cases of depression, insufficient monoamines are developed in the neurons of the brain. One could utilize these ludicrously expensive machines if you want to see the proof, but good luck getting insurance to pay for this.
Mental illness exists. I was once speaking to a friend of mine, who had a negative opinion of psychiatry, and said to just get that person with depression some dancing lessons, a cat, and an exercise program. Okay, Tom Cruise. You tell the guy with the gashes in his wrists who’s hanging from a noose to get some dancing lessons, B-vitamins, and some duct tape, and I’m sure he’ll be fine. Sheesh. But I needn’t be snide. Annually, roughly 49,000 Americans take their lives each year. Suicide is the 10th leading cause of death in the United States; however, it is the second leading cause of death for those between the ages of 15 to 34. There are, on average, 132 suicides per day. Perhaps worst of all, according to the Department of Veterans Affairs, 20 veterans die from suicide every day.
To be fair, engaging in activities that one enjoys that are healthy, socializing with others, becoming involved in a community art or political program; these are great ways to alleviate the symptoms of depression. So too with the natural remedies; regular exercise, a healthy lifestyle, artistic expression, prayer and faith, whatever you might like. But many people are too depressed to even get out of bed.
Besides depression, anxiety disorders are the most common psychiatric disorder in the United States. They affect 40 million people. Untreated, this illness will damage those around the afflicted, cost industry labor, and overburden the healthcare industry. People having panic attacks often end up in the emergency room. The number of those with anxiety disorders is no doubt growing, considering the trauma of the last year and a half.
And we’re not even talking about schizophrenia, ADHD, PTSD, bipolar disorder, panic disorder, and a host of others. Intelligent people with fancy degrees will argue that the DSM, the Diagnostic and Statistic Manual of Mental Disorders, is cluttered with debatable mental disorders. It contains nearly 300 diagnostic entries. It should be noted that the ICD, the International Classification of Diseases, contains about 80,000 entries.
But I am severely digressing. The main point I am getting at with this article is the unfortunate practice of psychiatry that one will often encounter when they visit their regular clinic or provider.
Somewhere along the way, a great disservice was done to the field of mental health. Psychiatry and psychology were divorced. This is profoundly wrong, and does not do nearly enough to heal the mentally and emotionally afflicted.
These two sciences, psychiatry and behavioral psychology, go hand in hand. They are deeply intertwined. You cannot simply address psychiatric needs while at the same time giving little consideration, or even downright ignoring, the psychology that goes along with psychiatric suffering. It is analogous to a physician simply giving a person with diabetes insulin, and telling them to monitor their blood sugar at home, while not counseling them on their dietary habits. So with psychiatry. You cannot simply throw pills at them, without addressing the psychology, usually damaged, that accompanies it. This makes no sense.
Unfortunately, that is the solution of much of modern healthcare: throw a pill at it. Also, due to the profit motive, patients are generally allotted 15 to 20 minutes for a visit with a healthcare provider. That is not enough time. The psychiatrist, or MD with a specialty in psychiatry, may ask them how they’re feeling, how’s the job, etc, but that is insufficient time to dig deep enough to treat the illness.
Psychotherapists exist, of course. However, they are harder to find, as insurance will still balk at their treatment, or they are booked far in advance due to the dire need, owing to the stressful times we live in.
Some clinics will not even have a dedicated psychiatrist. Your primary care physician will treat you. I’m sure that person cares about their patients, and has studied, at whatever length, both psychiatry and psychology, but they are much more likely to just throw pills at you, tell you to keep a journal or do some art or something, and come back and see them in a month.
I was diagnosed with a mental illness in my early 20’s. It should be noted that there is no ‘cure’ per se, but there are treatments to alleviate the symptoms, mental exercises to retrain your thinking, so to go on and live a healthy and happy life. I was able to do so. Despite a crippling depression, in a way, I was very fortunate. I was first treated by a seasoned psychiatrist, whom I called Dr. Dispensapill, who knew that psychiatry and psychology cannot be separated. He would see me for an hour. We would talk briefly about medications. Then we spend the bulk of the visit speaking about psychological challenges I might be facing. Then we would wrap it up with any medication or lifestyle changes to consider.
His is a disappearing style. You can still find psychiatrists like him, but they are rarely covered by insurance, and they are frequently booked far out.
Dr. Dispensapill, north of 80 years old, recently ceased being able to practice. It was difficult to find help for my mental health afterwards, but I have found a combination that works. I see, for 15 minutes at a time every few weeks, Dr. Deer In The Headlights, who knows little of psychotherapy, it seems, but knows all about the different medications and how they work. She got a 4.0 in advanced chemistry, I guess. I have also been able to find a very skilled psychotherapist, Dr. How Many PhD’s Does One Actually Need. She has been fantastic.
More than one of the providers that I work with have complained to their superiors that there is a woefully insufficient staff of human resources to refer psychiatric and deeply troubled psychological patients to. They will help the best they can, but they are there to treat skin rashes and broken bones.
This is a great problem in American healthcare. We have made a damaging mistake. The mentally ill are not getting the proper treatment that they so often need. The separation of psychiatry and psychology is, in my low-level practitioner opinion, the biggest systemic mistake modern American healthcare has made. You can’t treat one without treating the other, and vice versa.
Until we fix this problem, and there are other, massive problems with American healthcare, the treatment of the mentally ill will remain insufficient. Many more will take their lives. Millions will continue to be crippled with anxiety, living tortuous lives. And the dangerously mentally ill, with no options for treatment, will continue to commit violence.
I’m not sure why this happened. It shouldn’t have. Just my opinion.