E.D., not E.D.





Well, what can I tell you…

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:

https://www.healthcareitnews.com/news/biggest-healthcare-data-breaches-2021

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.

https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776#:~:text=Erectile%20dysfunction%20(impotence)%20is%20the,necessarily%20a%20cause%20for%20concern.

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.

https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/diagnosis-treatment/drc-20355782

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.

TY: KK, UWM – Wedgewood, JP

GOOD-BYE BROWN EYES; YOUR STORY IS NOT OVER

BROWN EYES – 1997

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.

RECOVERY

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:

https://afsp.org/suicide-statistics/

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

Disaster Distress Helpline: 1-800-985-5990

suicidepreventionlifeline.org

https://afsp.org/ (American Foundation for Suicide Prevention)

https://www.nimh.nih.gov/health/topics/suicide-prevention/ (National Institute of Mental Health)

https://www.mentalhealth.va.gov/suicide_prevention/data.asp (for veterans)

https://www.militaryveteranproject.org/22aday-movement.html (for veterans)

https://youth.gov/youth-topics/youth-suicide-prevention (for teens and young adults)

Additionally, there are professional organizations dedicated to the education, destigmatizing, and healing of mental health conditions. One of the best is The Boca Recovery Center, at:

bocarecoverycenter.com

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

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.

My heritage is far too Teutonic for a tattoo; hence, my necklace. I swear I’ve got a little Bigfoot in the family tree, somewhere…

https://projectsemicolon.com/

IGY6

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.

https://www.theigy6.com/

BROWN EYES, 2021

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

HIATUS

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….

A BAD ROLL OF THE DICE: THE MEDICAL DOUBLE-WHAMMY

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.

Shut up.

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.

https://www.sciencedaily.com/releases/2010/12/101215121905.htm

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:

https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-11-281

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.

Thanks Pedro!

THE ENDOCRINE SYSTEM: AND YOU!!!


Here are some more notes that I sent my parents last year, while they were in lockdown. This one’s about the endocrine system.
The endocrine system, generally speaking, uses hormones to give your body certain commands. It’s like another control system, like the brain and the CNS, but the endocrine system does things a little differently. A lot differently. To cluster things up even more, the endocrine system is involved in about every other system.
It should be noted, that when we talk about the various ‘systems’ of the human body, these are all really just arbitrary designations of convenience. It’s really all one system, working together, at the same time. Hopefully.
Well, this one is a little more wordy, and has fewer pictures. But it does have a more aggressive sense of humor. What can I say? The human body is hilarious! Also, these notes that I wrote to my parents should in no way be considered a reliable source of anatomy and physiology. I did get a lot of things right; there’s nothing in here that’s way-off-base wrong, as near as I can tell. But when I studied the endocrine system further, and continue to do so, I realize that it’s even more complicated than the smart-ass jumble of words that follow. So, hopefully you can learn a little something about the endocrine system, and get a few laughs, too.

A NEW MEDICAL STUDENT KINDA GETS IT RIGHT

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!

Thanks for reading! Wash your hands!

Medical Terminology (and the ancient Romans were kind of jerks)

Well, the third quarter is underway, and so far it’s going great! I’m taking 2 courses; one is Pharmacology and Medication Administration (this is what the chemical is, this is how I will inject you with it) and Administrative/Clinical review (this class is a lot of fun –  the instructor basically sets up exam rooms, and we practice on-boarding patients; the instructor, playing the MD, then gives us a procedure to carry out with the patient), which ties together everything I’ve learned so far. We are also studying medical terminology, and where it comes from. Not sure why that wasn’t covered in the first quarter; perhaps they just wanted us to get familiar with the jargon before we closely studied the etymology.

Everything in healthcare seems to have a needlessly fancy name, but there’s a good reason for that. Just about every bit of terminology a practitioner uses is either Greek or Latin in origin. There is also the occasional eponymous term, a word named after the person who discovered/invented it (Pap test, Alzheimer’s, Tommy John surgery). I’m oversimplifying the history a bit, but a long time ago, when Hippocrates and his colleagues figured out that illnesses and diseases were actually environmental and not divine punishment (although that unfortunate concept still exists today), and began to actually study the human body, the ‘English’ of the day was either Greek or Roman. Many people in the known world (which was much smaller then, than our own) spoke one of these two languages; much like a good portion of the known world speaks English today. This way, a physician in Rome could correspond with a physician in Roman occupied England, who perhaps spoke a local dialect, and they would know what they were talking about. The practice continues today.

The word ‘doctor’ comes from the Latin ‘docere,’ which means: to teach. It also shares its roots with the word ‘docile.’ The thinking here is that one cannot properly learn and absorb information if one’s mind is not calm and focused on the matter at hand.

But, as it turns out, the ancient Romans could be a little flippant. The word ‘hyster’ comes from the Latin ‘hystera,’ the word they used for uterus (think: hysterectomy). The Romans believed that women got moody and emotional because of their menstrual cycle; therefore, the word ”hystera’ shares a root with the word ‘hysteria.’ Well, that’s charming. Sure, some women do occasionally get a bit out of sorts on their menstrual cycle, but that is not a character flaw or an indication of a psychological or psychiatric disorder. A woman’s endocrine system is simply in overdrive, if you will, forcing an ovum into the uterus. So there you have it. The etymology of medical terminology is fascinating, but glib, dismissive opinions are nothing new.

Wash your hands!

3rd qtr so far

Cute Animal Stories and Physiology

cat nursing puppies

The link above is a very cutesy video, but it had me reaching for my textbook.

According to this video, the mother cat had recently lost her kindle (I love collective nouns) and was, quite naturally, profoundly depressed. This animal foster family took the cat in, and found the cat to be needy, sad and distressed. It was only after the introduction of a litter of puppies that had lost their mother (what is this, a Disney movie?) that the cat came around.

There is an endocrine gland (that means it makes hormones) in the middle of your brain called the pituitary gland, answering to your CNS by way of the hypothalamus, a bridge between the CNS and the endocrine system. The pituitary gland is often called the master gland, because it does a lot of stuff, probably gets paid more. One of the hormones it secretes is called oxytocin. In mammalian females, oxytocin plays a major role in commanding the body for pregnancy, birth, and nursing. However, in both genders, oxytocin, by the very nature of its primary function, also engenders feelings of attachment, belonging, and intimacy. This cat was flooded with oxytocin, was depressed, and needed attention. When the puppies were introduced, the oxytocin returned to its primary role, and the cat became a surrogate mother. At this time, the cat’s pituitary gland produced another hormone called prolactin, and enabled the animal to nurse the puppies.

I’m not trying to reduce the powerful emotions this cat felt, emotions that would also easily occur in a human being, by explaining it away in technical terms. I’m not trying to take the ‘awww’ out of it. Just two things:

1: It is profoundly interesting that external, emotional events have a direct, physiological impact on how your body functions. Your emotions are very real, can be very strong, and, if you need proof, take a look inside and see the physiological process. If someone tells you to suck it up, if someone shames you for mental illness, if someone tells you to stop feeling a certain way, then they are A) ignorant of how the body works, and B) an asshole. “It’s all in your head!” Well, of course. Everything is. But that’s ontology, for another time.

2: It’s also profoundly interesting that we’re looking at two completely different species here. That’s incredible. That speaks to the strength of the survival instinct, but that’s for another time.

Well, I’m procrastinating again. Gotta hit the books. Wash your hands!

Fight or Flight in America as a Sociological Phenomenon

Crisis Fatigue

The link above is an interesting article. The physiological phenomenon known as ‘fight or flight’ exists in most living creatures, and is deeply ingrained into every human being. It’s a crucial component of the survival instinct, and has been for hundreds of thousands of years, existing as well as in our progenitor ancestors.

As simply as I can put it: Your 5 senses and your intuition will perceive a threat. This gets crunched in your consciousness, a poorly understood concept. This threat then gets sent to your amygdala, a part of your brain, for verification. This triggers a response in another part of your brain, the hypothalamus. The hypothalamus wears many hats (and we really don’t know how), but it kind of serves as a command center for a lot of things. In this sense, it triggers the fight or flight mechanism. Admiral Hypothalamus will activate your sympathetic nervous system, a part of your electrical wiring, which fires up your adrenal glands, which generally have about 8 cups of coffee in them already. Your adrenal glands will freak out and push the panic button, and secrete a number of hormones, mainly adrenaline, cortisol and norepinephrine. The adrenaline will ramp up your blood pressure and your pulse, and accelerate the actions of your lungs and muscles. The cortisol will adjust your glucose (stuff you get from food) to provide a burst of energy. The norepinephrine will flood your brain, increasing alertness and response times. Every other system takes a back seat, including rational thought. At this point, you’re ready to kick some ass. This goes back to the time when our ancestors had to face off grizzly bears. We don’t have to do that anymore (except for those idiots in Yellowstone who want a better picture), but fight or flight is very much with us today, in response to both physical (a mugger, a mean dog, road rage) or emotional (fight with your spouse, boss wants to see you, the principal called) experiences. Eventually, the response will abate, and you are left exhausted and weak.

Problems happen when people are under constant fight or flight, and the response does not get a chance to wear off. This will result in anxiety, depression, PTSD, heart problems, or all of the above.

I know nothing of sociology. However, this article posits the idea that American society has been living under a steady, constant fight or flight response ever since 2020 started. We are now suffering from the effects of 3 social phenomenons that are causing Americans a huge amount of stress. It started with the emergence of a virus we thought we may be able to control, but we were very wrong. Then, racism reared its ugly head once again, when George Floyd (and, let’s face it, he’s not the only one) was murdered by a police officer. This has triggered a massive social disruption of anger and violence. Perhaps worst of all, the federal leadership (dammit, GOP, I hate to say I told you so… I take no glee in his failures) has been fully exposed as incompetent, dysfunctional, and unwilling or unable to rise to these challenges. In fact, our President’s behavior has gotten worse, and it is clear that he is in way over his head. In the meantime, the violence continues, and the pandemic has now killed 111k Americans. At this point, things do not show any signs of significant improvement or healing. As with an individual, problems will arise when the fight or flight response does not get a chance to settle down. We are seeing that now, in the hatred, anger, depression, isolation, anxiety and general “I’m pissed off today” attitude in nearly every American. If things do not settle down, the damage to society, as with an individual, will be massive, and will take longer to heal than we can imagine.

Well, I’m just babbling instead of doing my homework. Sorry for the long post. I better hit the books. Wash your hands!