Ever since Katrina passed through, tourists have been coming here by the carload and busload to see the devastation. On the whole, I've been a supporter of this idea of "disaster tours" or "disaster pilgrimages." As much as you might read or see of Katrina, I assert that words and pictures simply cannot convey the total experience. In order to fully understand Katrina, you must experience its aftermath first-hand: the 360-degree immersion, the assault on all your senses, the mind-numbing sight of block after block of debris and destruction. Even at this late date, 18 months after the storm, most outsiders would be shocked at the extent of what has not been done, and the further publicity of such can only help.
Besides, this event has become part of history, and it's only natural that people will want to come and bear witness, to tell their friends and family, just as crowds flocked to Ground Zero in New York City in the months after 9/11.
All the same, this is not a sterile museum exhibit, or an isolated preserve. People live here. People work here.
About once a week I'll be driving home, and a car ahead of me will stop. In the middle of the street. And people will step out and gape and start taking pictures.
Other times cars will creep along Beach Boulevard at less than 10 miles per hour.
Please, people! I wouldn't drive like that if I came to visit your town!
Yes, by all means, come and see the devastation for yourself. Contribute your dollars to the local economy while you're at it. But is it too much to ask that you obey basic driving rules? We've been through enough already. If you're going to come and visit, at least show some respect for the people trying to live semi-normal lives here. Not stopping in the middle of the street would be a great start.
Monday, February 26, 2007
Thursday, February 22, 2007
Katrina Story, Chapter 7: Damage Assessment
We drove through the National Guard checkpoint and turned left on Highway 90, towards my office and the hospital. On the corner we caught a glimpse of the K-mart parking lot, now known as "Camp Katrina." Survivors and volunteers alike had congregated here and proceeded to take over the lot, which was now populated with RVs, campers, and tents.
The tire store in front of the K-mart looked like it had collapsed in on itself; the glass was smashed and the metal garage doors were caved in. Along the road, store signs were either down or the plastic blown out, leaving gaping rectangles. Some stores had their roofs torn off or fallen inwards.
We continued down Highway 90 and arrived at my office. The building looked largely intact from the outside, even though its neighbor had lost its metal roof. I peered in the waiting room and saw chairs and tables intact, on the ground, if not in the exact position where they had been 1 1/2 weeks ago.
I unlocked the front door and was hit by an overwhelming smell of mold. Wallpaper in the hallway was warped and buckling, and part of the hallway wall had actually given out, exposing the flooring store next door.
Picture my office as basically one long hallway. From the waiting room, the hallway went down the left side of the office. First room on the right was the reception and business office, followed by three exam rooms, and then my office, which was also the break room, which had a back door to the outside. The lab was across the hall from my office.
The reception/business office was trashed. Ceiling tiles had collapsed to the floor, covering a desk and bookcase with grey foam on the way down. The flood line was three feet off the floor, just above the desktop computers, laser printer, flatbed scanner, telephones, and all other electronic equipment. A horizontal file, which had been completely submerged, wouldn't even open anymore.
The exam rooms originally had white vinyl floors, but now they were just a thick brown-grey, covered with muck. The exam tables had also been submerged, and water still remained in the drawers. I couldn't even enter the third exam room; presumably a chair had floated between the exam table and the door, blocking the way.
In the lab, the refrigerator had tipped over on its side. Vaccine vials were strewn across the floor. But as I entered the back office, I realized the office had saved the worst for last.
The back bookcase, which previously held my medical textbooks, was now half-full, as its contents were strewn around the room and up the hall. My desk was tipped up at an angle, with a book somehow wedged under one corner. Whatever had originally been on, and on top of, my desk, was now also on the damp floor. The break room refrigerator had floated out of its corner into the middle of the room. The office server, placed up on the nurse's desk, was neatly covered with water, muck, and even dried leaves and grass.
I tried to open the back door to let in fresh air, but it wouldn't budge. On further inspection, I saw the back door had been wedged out of its frame. I wondered if a looter had tried to break in to the office. I then took a closer look at the door between the back office and the hallway. The door, including frame, had been torn out of the wall and was lying at the end of the hall. No looter did this. I realized the storm surge must have built up outside the back door, until it was breached; then the flood waters came in with such force, like a burst dam, that it swept books off the shelf and pushed the inner door completely aside, before tossing about the refrigerators and furniture.
I set to gathering a few basics, knowing that we had limited space in the car and had yet to visit the house. Salvaged from this first trip: office spirometer (purchased two weeks before Katrina, never used on a patient), cash box contents, damp office files (receipts, contracts, personnel papers), hard drives from desktop computers, and the office computer server. The latter weighed eighty pounds and drained water when we lifted it, but I hoped against better judgement that something might be salvageable--perhaps, if nothing else, the hard drives? Besides, if the drives were even remotely intact, they might have recoverable patient medical data, and I couldn't risk that information falling into the wrong hands.
We got back in the car to drive next door, to the hospital.
What used to be a hospital now looked like a military base. Army green tents covered the front lawn, and a black metal fence surrounded the entire military-hospital complex. On the road, a wooden sign painted green had a red cross letting people know that this was where they could get medical care. National Guardsmen milled about or walked to and fro. We drove up near the ER entrance, where we faced another guard post and more soldiers with M-16s. After producing my hospital badge, we were waved through and pulled up to the ER itself.
The waiting room had become a warehouse, where both donated and pre-existing supplies were being organized into neat stacks and piles. Here was the sterile gauze, there were boxes of gloves, that's the place for diapers and baby food. Extension cords snaked through the ER and the hallways, running from generators to construction floodlights. I found the hospital administrator in his new "office," a dark nook of the ER that used to be the staff lounge and library. He was talking to the head of maintenance on a two-way radio, hopeful that Mississippi Power might be able to restore electricity to the hospital this afternoon.
As it turns out, the hospital had not closed, but instead remained open during the storm. By the time they tried to evacuate some of the sicker adults, the storm was upon them and ambulance transports were no longer running. The wind ripped open a ventilation duct during Sunday night, but otherwise the building did fairly well until Monday morning, when the storm surge arrived. The first floor hallway became a stream. Then the generators flooded. As the water level continued to rise, the staff started evacuating patients up to the second floor, in the dark, in the heat and humidity.
After the storm, the worst was yet to come. Within a few hours, a steady stream of survivors began making their way to the ER. A nurse described it as a scene straight from "Dawn of the Dead," with an advancing horde of staggering, dazed people. Many had physical injuries: cuts, bruises, scrapes; others were trying to find food and water, though the hospital barely had enough for its own personnel. Some just wanted to be checked out after their ordeal. The makeshift ER ended up seeing 800 people in the first 4 days, before the federal Disaster Medical Assistance Teams finally arrived. Only then did the hospital close its doors and the brave, battered staff go off shift.
Needless to say, the hospital was in no shape to reopen anytime soon; the CEO thought it would take at least a month before even the basics could be provided. I asked about office space, since mine was completely unusable, as was just about every other building in town, and it might be two months or more before electricity and running water was restored. He said that FEMA might be providing the hospital some portable trailers in the next few weeks, perhaps by the start of October, and that the hospital would allow interested doctors to use the temporary space. I also learned that FEMA does not provide trailers directly to doctors; apparently, we are considered the same as any other small business, and our services are not essential to the community, no more than the local burger shop or clothing boutique.
Now we had some timeframe and direction: a hospital-provided trailer, in early October. This would be my new office.
Before I left the hospital, passing stacks of donated medicines arrayed in the ER, I realized I probably had some intact samples back in my office. The administrator said, "yeah, I don't think we went in your building." What did that mean? In the first few days after Katrina, the police and National Guard broke into some offices to commandeer medicines and create a small stockpile at the hospital. It was decided that the meds could better be kept safe, and distributed as needed, under appropriate supervision, at one central facility--which now happened to be also under armed guard. I should note that some offices stored not only antibiotics or cholesterol meds, but also controlled substances: painkillers, Valium, and similar.
We offered to add my meager pediatric samples to the pharmacy, since I wouldn't be distributing them anytime soon. We ended up collecting five boxes worth of medicines, all above the flood line, untouched and usable.
Outside the ER a truck from the Florida Department of Health was unloading bags of ice.
We walked back towards my office, about three blocks away. Just outside of the hospital grounds I saw a multicolored foot-long shard of hard plastic that looked vaguely familiar. It was a fragment of my office sign that had originally been by the road, perhaps 1/4 mile away. It was the only piece of the 4 x 6 foot sign I would ever find.
The tire store in front of the K-mart looked like it had collapsed in on itself; the glass was smashed and the metal garage doors were caved in. Along the road, store signs were either down or the plastic blown out, leaving gaping rectangles. Some stores had their roofs torn off or fallen inwards.
We continued down Highway 90 and arrived at my office. The building looked largely intact from the outside, even though its neighbor had lost its metal roof. I peered in the waiting room and saw chairs and tables intact, on the ground, if not in the exact position where they had been 1 1/2 weeks ago.
I unlocked the front door and was hit by an overwhelming smell of mold. Wallpaper in the hallway was warped and buckling, and part of the hallway wall had actually given out, exposing the flooring store next door.
Picture my office as basically one long hallway. From the waiting room, the hallway went down the left side of the office. First room on the right was the reception and business office, followed by three exam rooms, and then my office, which was also the break room, which had a back door to the outside. The lab was across the hall from my office.
The reception/business office was trashed. Ceiling tiles had collapsed to the floor, covering a desk and bookcase with grey foam on the way down. The flood line was three feet off the floor, just above the desktop computers, laser printer, flatbed scanner, telephones, and all other electronic equipment. A horizontal file, which had been completely submerged, wouldn't even open anymore.
The exam rooms originally had white vinyl floors, but now they were just a thick brown-grey, covered with muck. The exam tables had also been submerged, and water still remained in the drawers. I couldn't even enter the third exam room; presumably a chair had floated between the exam table and the door, blocking the way.In the lab, the refrigerator had tipped over on its side. Vaccine vials were strewn across the floor. But as I entered the back office, I realized the office had saved the worst for last.
The back bookcase, which previously held my medical textbooks, was now half-full, as its contents were strewn around the room and up the hall. My desk was tipped up at an angle, with a book somehow wedged under one corner. Whatever had originally been on, and on top of, my desk, was now also on the damp floor. The break room refrigerator had floated out of its corner into the middle of the room. The office server, placed up on the nurse's desk, was neatly covered with water, muck, and even dried leaves and grass.I tried to open the back door to let in fresh air, but it wouldn't budge. On further inspection, I saw the back door had been wedged out of its frame. I wondered if a looter had tried to break in to the office. I then took a closer look at the door between the back office and the hallway. The door, including frame, had been torn out of the wall and was lying at the end of the hall. No looter did this. I realized the storm surge must have built up outside the back door, until it was breached; then the flood waters came in with such force, like a burst dam, that it swept books off the shelf and pushed the inner door completely aside, before tossing about the refrigerators and furniture.
I set to gathering a few basics, knowing that we had limited space in the car and had yet to visit the house. Salvaged from this first trip: office spirometer (purchased two weeks before Katrina, never used on a patient), cash box contents, damp office files (receipts, contracts, personnel papers), hard drives from desktop computers, and the office computer server. The latter weighed eighty pounds and drained water when we lifted it, but I hoped against better judgement that something might be salvageable--perhaps, if nothing else, the hard drives? Besides, if the drives were even remotely intact, they might have recoverable patient medical data, and I couldn't risk that information falling into the wrong hands.
We got back in the car to drive next door, to the hospital.
What used to be a hospital now looked like a military base. Army green tents covered the front lawn, and a black metal fence surrounded the entire military-hospital complex. On the road, a wooden sign painted green had a red cross letting people know that this was where they could get medical care. National Guardsmen milled about or walked to and fro. We drove up near the ER entrance, where we faced another guard post and more soldiers with M-16s. After producing my hospital badge, we were waved through and pulled up to the ER itself.
The waiting room had become a warehouse, where both donated and pre-existing supplies were being organized into neat stacks and piles. Here was the sterile gauze, there were boxes of gloves, that's the place for diapers and baby food. Extension cords snaked through the ER and the hallways, running from generators to construction floodlights. I found the hospital administrator in his new "office," a dark nook of the ER that used to be the staff lounge and library. He was talking to the head of maintenance on a two-way radio, hopeful that Mississippi Power might be able to restore electricity to the hospital this afternoon.
As it turns out, the hospital had not closed, but instead remained open during the storm. By the time they tried to evacuate some of the sicker adults, the storm was upon them and ambulance transports were no longer running. The wind ripped open a ventilation duct during Sunday night, but otherwise the building did fairly well until Monday morning, when the storm surge arrived. The first floor hallway became a stream. Then the generators flooded. As the water level continued to rise, the staff started evacuating patients up to the second floor, in the dark, in the heat and humidity.
After the storm, the worst was yet to come. Within a few hours, a steady stream of survivors began making their way to the ER. A nurse described it as a scene straight from "Dawn of the Dead," with an advancing horde of staggering, dazed people. Many had physical injuries: cuts, bruises, scrapes; others were trying to find food and water, though the hospital barely had enough for its own personnel. Some just wanted to be checked out after their ordeal. The makeshift ER ended up seeing 800 people in the first 4 days, before the federal Disaster Medical Assistance Teams finally arrived. Only then did the hospital close its doors and the brave, battered staff go off shift.
Needless to say, the hospital was in no shape to reopen anytime soon; the CEO thought it would take at least a month before even the basics could be provided. I asked about office space, since mine was completely unusable, as was just about every other building in town, and it might be two months or more before electricity and running water was restored. He said that FEMA might be providing the hospital some portable trailers in the next few weeks, perhaps by the start of October, and that the hospital would allow interested doctors to use the temporary space. I also learned that FEMA does not provide trailers directly to doctors; apparently, we are considered the same as any other small business, and our services are not essential to the community, no more than the local burger shop or clothing boutique.
Now we had some timeframe and direction: a hospital-provided trailer, in early October. This would be my new office.
Before I left the hospital, passing stacks of donated medicines arrayed in the ER, I realized I probably had some intact samples back in my office. The administrator said, "yeah, I don't think we went in your building." What did that mean? In the first few days after Katrina, the police and National Guard broke into some offices to commandeer medicines and create a small stockpile at the hospital. It was decided that the meds could better be kept safe, and distributed as needed, under appropriate supervision, at one central facility--which now happened to be also under armed guard. I should note that some offices stored not only antibiotics or cholesterol meds, but also controlled substances: painkillers, Valium, and similar.
We offered to add my meager pediatric samples to the pharmacy, since I wouldn't be distributing them anytime soon. We ended up collecting five boxes worth of medicines, all above the flood line, untouched and usable.
Outside the ER a truck from the Florida Department of Health was unloading bags of ice.
We walked back towards my office, about three blocks away. Just outside of the hospital grounds I saw a multicolored foot-long shard of hard plastic that looked vaguely familiar. It was a fragment of my office sign that had originally been by the road, perhaps 1/4 mile away. It was the only piece of the 4 x 6 foot sign I would ever find.
Monday, February 19, 2007
Jurisdynamics
The other day I received a blogosphere welcome from Jim Chen, Dean of Law at University of Louisville. Lest you think I routinely have friends in high places, I first made an "Internet connection" with Professor Chen through his blog, Jurisdynamics.
I don't remember exactly how I stumbled across his site, but I've found it to be incredibly insightful and thought-provoking on, among other things, the law as it relates to disasters. The site is actually about "the interplay between legal responses to exogenous change and the law's own endogenous capacity for adaptation."
Huh?
That sounds pretty heavy, but my interpretation (and I hope Dean Chen or his colleagues will correct me if I'm wrong) is that Jurisdynamics deals with the law's application towards, and evolution around, a rapidly changing and complicated society. Since we can't expect any single judge, lawyer, or lawmaker to be an expert on the many developments in technology, computers, communications, complex nonlinear systems, medicine and healthcare, even sociology and mathematics, we need to make sure that the legal system can be flexible enough to accomodate new situations. After all, at the risk of getting classically philosophical, what is the purpose of law, if not to serve the good of common society?
So Jurisdynamics is nothing if not interdisciplinary. But it's also fairly down-to-earth. You won't see (many) obscure Latin phrases, high-falutin' references to so-and-so court cases, and such. It's about ideas; it's about practical concerns. It's not concerned with impressing anyone; it is concerned with exploring issues.
And though I've never personally met the man, I get the impression that Jim Chen is much the same. Go to the site and peruse his CV: Fulbright Scholar; Harvard Law School; clerk for Justice Clarence Thomas; visiting professor in France, Germany, and Slovakia; 91 published papers or chapters; and now, dean of a law school. I stand in awe of this man's accomplishments in his field. But look at the papers he's written: the titles are full of witty cultural references: "A Vision Softly Creeping," "Come Back to the Nickel and Five," "Midnight in the Courtroom of Good and Evil," and my favorite, "The Sound of Legal Thunder: The Chaotic Consequences of Crushing Constitutional Butterflies." (Five points to the first reader who correctly identifies that last reference!) And I get the impression he has great respect for the English language, not as a crude tool for hammering out papers, but as an art form, as an elegant vehicle for complex thoughts.
I see Dean Chen and his CV and his intellectual curiosity and breaking boundaries, and I can't but help to admire him. That is what I aspire to, professionally speaking. That is one reason I want you to check out his blog. (Note: I say "his" blog, but in giving credit where it is due, I want to point out that Jursidynamics is not a solo effort, but rather the collaborative work of an exceptional cohort of scholars.)
The other reason? If you have any interest in Katrina, the failed response, and the stumbling recovery, you need to keep up with his site. It won't go into every breaking news item--just the important ones, and how the law can either help or hinder current and future efforts.
I don't remember exactly how I stumbled across his site, but I've found it to be incredibly insightful and thought-provoking on, among other things, the law as it relates to disasters. The site is actually about "the interplay between legal responses to exogenous change and the law's own endogenous capacity for adaptation."
Huh?
That sounds pretty heavy, but my interpretation (and I hope Dean Chen or his colleagues will correct me if I'm wrong) is that Jurisdynamics deals with the law's application towards, and evolution around, a rapidly changing and complicated society. Since we can't expect any single judge, lawyer, or lawmaker to be an expert on the many developments in technology, computers, communications, complex nonlinear systems, medicine and healthcare, even sociology and mathematics, we need to make sure that the legal system can be flexible enough to accomodate new situations. After all, at the risk of getting classically philosophical, what is the purpose of law, if not to serve the good of common society?
So Jurisdynamics is nothing if not interdisciplinary. But it's also fairly down-to-earth. You won't see (many) obscure Latin phrases, high-falutin' references to so-and-so court cases, and such. It's about ideas; it's about practical concerns. It's not concerned with impressing anyone; it is concerned with exploring issues.
And though I've never personally met the man, I get the impression that Jim Chen is much the same. Go to the site and peruse his CV: Fulbright Scholar; Harvard Law School; clerk for Justice Clarence Thomas; visiting professor in France, Germany, and Slovakia; 91 published papers or chapters; and now, dean of a law school. I stand in awe of this man's accomplishments in his field. But look at the papers he's written: the titles are full of witty cultural references: "A Vision Softly Creeping," "Come Back to the Nickel and Five," "Midnight in the Courtroom of Good and Evil," and my favorite, "The Sound of Legal Thunder: The Chaotic Consequences of Crushing Constitutional Butterflies." (Five points to the first reader who correctly identifies that last reference!) And I get the impression he has great respect for the English language, not as a crude tool for hammering out papers, but as an art form, as an elegant vehicle for complex thoughts.
I see Dean Chen and his CV and his intellectual curiosity and breaking boundaries, and I can't but help to admire him. That is what I aspire to, professionally speaking. That is one reason I want you to check out his blog. (Note: I say "his" blog, but in giving credit where it is due, I want to point out that Jursidynamics is not a solo effort, but rather the collaborative work of an exceptional cohort of scholars.)
The other reason? If you have any interest in Katrina, the failed response, and the stumbling recovery, you need to keep up with his site. It won't go into every breaking news item--just the important ones, and how the law can either help or hinder current and future efforts.
Friday, February 16, 2007
It's All In Your Head
I realize that making fun of Scientology's take on mental illness is an easy and cheap shot (much like Tom Cruise himself nowadays). Still, a patient yesterday reminded me of just how laughable/misguided/disgraceful such a denial is. For the few of you who don't already know, Scientologists believe all mental illness is curable through sheer willpower and exorcism of personal demons (the latter on multiple levels), and therefore they proclaim psychiatrists to be frauds who like doping up kids for money.
Of course, Scientologists believe the gospel according to L. Ron Hubbard, a hack sci-fi writer who invented a religion based on the evil space warlord Xenu and the "thetan" spirits that inhabit our bodies. Or something like that. No, really, look online if you don't believe me. Doesn't sound like they're in any position to judge the mental fitness of anyone else.
Anyway, without divulging too much detail, yesterday I saw a six-year old who was depressed. WAY depressed. Not like "I feel sad." More as in, "I hate everybody. Everybody is mean." Sitting on the exam table quietly, looking down, not cracking a smile, for the entire 30-minute visit. Mom says he's been like this every day for 2-3 weeks now, doesn't even want to play his video games.
So, Tom Cruise, want to try to clear his thetans? John Travolta, do you believe you can make this kid happy again?
It's fair to say, without being judgmental, that this is not normal for a six-year old boy. It also doesn't take a clinical psychologist to realize that there is something acutely screwed up in his brain chemistry. Adults with major depression will remind you that their condition is not simply a "bad mood:" it's more like being taken over, becoming physically and mentally incapable of rising above. Yes, there are many factors converging here: his home and family environment, his intellect and inherent ability, his experiences around Katrina. But none of this accounts for why a six year old boy would act like this for 2 weeks straight.
He needs to see a psychiatrist. Pronto. Unfortunately, there are none around here. I'm not averse to prescribing meds myself, when appropriate--but antidepressants are tricky. Last year the FDA became concerned about a few case reports of teenagers becoming agitated and even suicidal while on antidepressant medications (specifically, "SSRIs" such as Zoloft, Paxil, and Prozac). The FDA mandated a "black box warning" and urged extreme caution. So us pediatricians (already being told by many insurance companies that psychiatry was "not our area of specialty" and therefore not a reimbursable office visit) didn't want the extra liability, and we stopped prescribing SSRIs ourself, and referred all depression to the child psychiatrists.
Of course, the vital statistics released last month revealed a double-digit percentage increase in childhood suicides last year. Gee, who would have thought: if you don't give people antidepressants, they become--wait for it--depressed, and depressed people are at risk for being--wait for it, again--suicidal?
The perfect storm: politics, legal liability, and ivory-tower academics. But until the FDA decides to rescind that black-box warning, I'll be in BIG BIG trouble for any adverse effects from SSRIs that occur on my watch. I picture the malpractice lawyers licking their chops like ravenous wolves.
The mom assures me that she will watch and notify immediately if the child becomes a danger to himself or to others. In the meantime, we've spent 2 days trying to find a child psychiatrist (thank goodness he's not on Medicaid, or we'd be really screwed). We may have one an hour away, if we're lucky, who might be able to get him in one month from now (and mom will have to pay cash because she hasn't yet met her insurance deductible). And I guess he'll just have to suffer through it until then.
Of course, Scientologists believe the gospel according to L. Ron Hubbard, a hack sci-fi writer who invented a religion based on the evil space warlord Xenu and the "thetan" spirits that inhabit our bodies. Or something like that. No, really, look online if you don't believe me. Doesn't sound like they're in any position to judge the mental fitness of anyone else.
Anyway, without divulging too much detail, yesterday I saw a six-year old who was depressed. WAY depressed. Not like "I feel sad." More as in, "I hate everybody. Everybody is mean." Sitting on the exam table quietly, looking down, not cracking a smile, for the entire 30-minute visit. Mom says he's been like this every day for 2-3 weeks now, doesn't even want to play his video games.
So, Tom Cruise, want to try to clear his thetans? John Travolta, do you believe you can make this kid happy again?
It's fair to say, without being judgmental, that this is not normal for a six-year old boy. It also doesn't take a clinical psychologist to realize that there is something acutely screwed up in his brain chemistry. Adults with major depression will remind you that their condition is not simply a "bad mood:" it's more like being taken over, becoming physically and mentally incapable of rising above. Yes, there are many factors converging here: his home and family environment, his intellect and inherent ability, his experiences around Katrina. But none of this accounts for why a six year old boy would act like this for 2 weeks straight.
He needs to see a psychiatrist. Pronto. Unfortunately, there are none around here. I'm not averse to prescribing meds myself, when appropriate--but antidepressants are tricky. Last year the FDA became concerned about a few case reports of teenagers becoming agitated and even suicidal while on antidepressant medications (specifically, "SSRIs" such as Zoloft, Paxil, and Prozac). The FDA mandated a "black box warning" and urged extreme caution. So us pediatricians (already being told by many insurance companies that psychiatry was "not our area of specialty" and therefore not a reimbursable office visit) didn't want the extra liability, and we stopped prescribing SSRIs ourself, and referred all depression to the child psychiatrists.
Of course, the vital statistics released last month revealed a double-digit percentage increase in childhood suicides last year. Gee, who would have thought: if you don't give people antidepressants, they become--wait for it--depressed, and depressed people are at risk for being--wait for it, again--suicidal?
The perfect storm: politics, legal liability, and ivory-tower academics. But until the FDA decides to rescind that black-box warning, I'll be in BIG BIG trouble for any adverse effects from SSRIs that occur on my watch. I picture the malpractice lawyers licking their chops like ravenous wolves.
The mom assures me that she will watch and notify immediately if the child becomes a danger to himself or to others. In the meantime, we've spent 2 days trying to find a child psychiatrist (thank goodness he's not on Medicaid, or we'd be really screwed). We may have one an hour away, if we're lucky, who might be able to get him in one month from now (and mom will have to pay cash because she hasn't yet met her insurance deductible). And I guess he'll just have to suffer through it until then.
Monday, February 12, 2007
It's Mardi Gras Time!
The Waveland Krewe of Nereids held its annual Mardi Gras parade yesterday. For those of you not from the Gulf Coast, Mardi Gras is a BIG DEAL here. The Waveland parade may not be anything like you find in New Orleans, but it did have 80 floats, and it is one of the more family-friendly parades on the coast.
Afterwards, the streets looked like a giant pinata explosion, with colored beads and trash and smashed cups strewn everywhere. They're still cleaning it up as we speak, and by tomorrow it will be just another memory--but one of the happier ones as of late.
Friday, February 9, 2007
Pandemic Panic
Amidst the hoopla over the Gardasil (HPV/cervical cancer) vaccine this week, one news item largely overlooked concerned OSHA and the CDC issuing more pandemic flu guidelines. In the event of a severe pandemic, children would be largely quarantined; no school, no daycare, no spreading the nasty little hobbitses...er, I mean, flu viruses...until the pandemic started to abate.
By itself, that sounds prudent. Past studies have shown children to be the principal "vectors" for spreading the flu. Interrupt transmission by keeping them away from each other.
I'm curious if anyone on the federal level has considered the economic consequences of this. As a med school professor used to say, "if this is true, what does this imply?"
No school or day care means teachers and day care workers out of work, possibly for as long as 2 months. Parents will need to take off work themselves to care for their children. And parents' employers will no longer be able to function. Even if we prevent the flu from causing widespread death (which is very optimistic), the US economy would basically crash.
Has our government considered how they would bail out millions of small businesses? Pay for massive unemployment benefits? Would public employees still be paid?
On a personal level, what will happen to healthcare? Will I basically shut down my pediatric office for 2 months? Will I temporarily confine my practice to check-ups and children without fever or respiratory symptoms? Will I only allow one child in the office at a time? Will I leave my office to staff the ER? Note that none of these options leave me with a financially viable practice. After Katrina, I don't have any more financial reserves. A two-month shut-down--or even a slow-down--would most likely cause me to go under without state and federal assistance.
The devastation from Katrina will be repeated, but this time on a national scale. I'm not talking about the physical destruction; I'm referring to the economic fallout. The fact that we have still failed to address the Katrina recovery makes me very, very scared that pandemic flu would be far, far worse.
Have a nice day. >:)
By itself, that sounds prudent. Past studies have shown children to be the principal "vectors" for spreading the flu. Interrupt transmission by keeping them away from each other.
I'm curious if anyone on the federal level has considered the economic consequences of this. As a med school professor used to say, "if this is true, what does this imply?"
No school or day care means teachers and day care workers out of work, possibly for as long as 2 months. Parents will need to take off work themselves to care for their children. And parents' employers will no longer be able to function. Even if we prevent the flu from causing widespread death (which is very optimistic), the US economy would basically crash.
Has our government considered how they would bail out millions of small businesses? Pay for massive unemployment benefits? Would public employees still be paid?
On a personal level, what will happen to healthcare? Will I basically shut down my pediatric office for 2 months? Will I temporarily confine my practice to check-ups and children without fever or respiratory symptoms? Will I only allow one child in the office at a time? Will I leave my office to staff the ER? Note that none of these options leave me with a financially viable practice. After Katrina, I don't have any more financial reserves. A two-month shut-down--or even a slow-down--would most likely cause me to go under without state and federal assistance.
The devastation from Katrina will be repeated, but this time on a national scale. I'm not talking about the physical destruction; I'm referring to the economic fallout. The fact that we have still failed to address the Katrina recovery makes me very, very scared that pandemic flu would be far, far worse.
Have a nice day. >:)
Thursday, February 8, 2007
Katrina Story, Chapter 6: Birmingham and Beyond
One week after Katrina, we were back in the car, this time to our soon-to-be host family in Birmingham. By the time we would arrive at our new temporary home two days later, J. (all of 2 years old) clearly had become unsettled by the experience of, well, being unsettled. Over the past week we had driven hundreds of miles and spent the night in six different places. Little J. may have had some idea as to what had happened in Waveland, but that didn't affect him as much as the immediate lack of stability and his world turning upside-down. He began to associate the car with this turmoil and responded by kicking and screaming whenever he needed to be buckled into his car seat. The portable DVD player lost its calming effect (even with some new discs we picked up on the way), and we simply had to endure the noise until he tired himself out.
This would last for the next three months.
On reaching Birmingham (and exiting the car) we felt some semblance of calm for the first time since Katrina. Our host family (father, mother, 23-year old daughter, 21-yr old son, 14-yr old son, and 7-yr old son) were warm, gracious, accommodating, and almost eerily understanding. They let us know in no uncertain terms that, despite our protestations, we were not to consider ourselves a burden to them, and that we were welcome to stay as long as we needed. They asked for nothing in return, other than allowing them to help ease our way. Obviously, we would have none of that, and we tried to repay what we could, helping with groceries and meals and whatever else we could, but in the end, it would never be anywhere close to what we felt we owed this family.
In anticipation of our arrival, they had printed a local news item about previously unknown Waveland. A local pilot had flown his plane down with donated relief supplies, and he described massive devastation, but the specifics were otherwise scant. I was eager to drive in and assess the situation first-hand, and the father shared my sentiment, but how to arrange it?
The next day he came to me and asked if I wanted to drive down tomorrow. He, his oldest son, and I would set off before dawn, spend the day on the coast, and return that night.
The plan was set; I packed a backpack with some essentials, went to bed early, woke a few hours later, and we were off. I brought a notebook to remind me of my mission objectives: survey the office, talk to the hospital CEO about possibilities for returning to practice, visit our house, salvage a few valuables, and bring back Oscar the dog.
Approaching within 100 miles from the coast we saw trees snapped like toothpicks and stripped of leaves. We stopped in a Wal-Mart in Mobile, Alabama for last-minute food and water. Mobile had its fair share of damaged roofs but it had returned to being a functional city. As we continued west on I-10, the extent of destruction seemed to grow with every mile. More and more trees were down, as well as metal billboards twisted and folded in half. From the highway we saw only one or two gas stations open, identifiable by the cars lined up for up to a mile distant. (Thank goodness we took the family's fuel-efficient diesel.) Finally, we reached Exit 13: Highway 603, Bay St. Louis/Waveland. The hotel and gas station at the interstate exit were mangled wrecks of concrete and metal. We were about 5 miles from the main road through town, Highway 90, and another 2-3 miles from the water.
One mile from Highway 90, the National Guard was manning a checkpoint, complete with radio antenna and soldiers with M-16 rifles. Only locals or those on official business were allowed through, presumably to minimize looting; my hospital ID and driver's license were sufficient to let us pass.
We had entered the disaster zone.
This would last for the next three months.
On reaching Birmingham (and exiting the car) we felt some semblance of calm for the first time since Katrina. Our host family (father, mother, 23-year old daughter, 21-yr old son, 14-yr old son, and 7-yr old son) were warm, gracious, accommodating, and almost eerily understanding. They let us know in no uncertain terms that, despite our protestations, we were not to consider ourselves a burden to them, and that we were welcome to stay as long as we needed. They asked for nothing in return, other than allowing them to help ease our way. Obviously, we would have none of that, and we tried to repay what we could, helping with groceries and meals and whatever else we could, but in the end, it would never be anywhere close to what we felt we owed this family.
In anticipation of our arrival, they had printed a local news item about previously unknown Waveland. A local pilot had flown his plane down with donated relief supplies, and he described massive devastation, but the specifics were otherwise scant. I was eager to drive in and assess the situation first-hand, and the father shared my sentiment, but how to arrange it?
The next day he came to me and asked if I wanted to drive down tomorrow. He, his oldest son, and I would set off before dawn, spend the day on the coast, and return that night.
The plan was set; I packed a backpack with some essentials, went to bed early, woke a few hours later, and we were off. I brought a notebook to remind me of my mission objectives: survey the office, talk to the hospital CEO about possibilities for returning to practice, visit our house, salvage a few valuables, and bring back Oscar the dog.
Approaching within 100 miles from the coast we saw trees snapped like toothpicks and stripped of leaves. We stopped in a Wal-Mart in Mobile, Alabama for last-minute food and water. Mobile had its fair share of damaged roofs but it had returned to being a functional city. As we continued west on I-10, the extent of destruction seemed to grow with every mile. More and more trees were down, as well as metal billboards twisted and folded in half. From the highway we saw only one or two gas stations open, identifiable by the cars lined up for up to a mile distant. (Thank goodness we took the family's fuel-efficient diesel.) Finally, we reached Exit 13: Highway 603, Bay St. Louis/Waveland. The hotel and gas station at the interstate exit were mangled wrecks of concrete and metal. We were about 5 miles from the main road through town, Highway 90, and another 2-3 miles from the water.
One mile from Highway 90, the National Guard was manning a checkpoint, complete with radio antenna and soldiers with M-16 rifles. Only locals or those on official business were allowed through, presumably to minimize looting; my hospital ID and driver's license were sufficient to let us pass.We had entered the disaster zone.
Monday, February 5, 2007
Your Insurance Sucks
A mother was in the office the other day, and her child was covered by a certain for-profit, commercial insurance...not to name names, but the company rhymes with "You lie, Ted."
Last year her co-pay on office visits was $20. As of Jan. 1 it rose to $40. She was not happy about this.
I wouldn't be pleased either. And I will go out on a limb and guess that her premium did not decrease. So this health insurance company gets the family to pay $20 more per office visit, and they get to pay $20 less.
That is an awesome way to make a profit: shift the cost to someone else!
Too bad I can't figure out a way to do that (legally, that is).
This same insurance company (whose letters can also be rearranged to form the phrase, "DIE, NUT") announced last year that it would finally start paying for both a sick visit and a check-up on the same day. Previously, it would only pay one or the other. Now most check-ups are pretty straightforward, and minor issues are expected: the baby has some cradle cap, my teenager has a little sniffle today. But every once in a while they present with something more complicated: a wheezing infant, a preschooler with bad behavior problems. If the insurance company won't cover both on the same day, I tell the parent: we can address the problem or do the check-up, but not both. (Expecting a doctor to do otherwise is like taking in your car for a tune-up, finding that your brakes are shot, and expecting the mechanic to fix the brakes for free, since "it's all part of the tune-up.")
Well, this nameless insurance company now says that due to computer issues, it won't start paying for both a check-up and sick visit on the same day until, oh, December 2007.
(Warning: sarcasm ahead.)
Dang, that must be a wicked bad computer problem. They must be getting some serious l33t hacker dudez to crack that code. Maybe they're asking both Steve Jobs and Bill Gates to work together on this one. I mean, how in the world would you program a change in a reimbursement rule? They must be outsourcing that one to, heck, every computer programmer in Bangalore and Boston combined. I hope they're at least consulting with MIT.
"Computer issues?" Really, couldn't they at least think of a better excuse? Though I admit it does sound better than saying, "we delayed the implementation to continue diverting money from the premiums to our shareholders."
I don't want to paint all health insurance companies with the same putrid brush, but as a doctor (or, as they say, a "health care provider,") I think the average person doesn't realize that these companies are first and foremost in the business of making money for their shareholders. If they can provide health coverage along the way, great, but they aren't in this for their health. Nor for yours.
Last year her co-pay on office visits was $20. As of Jan. 1 it rose to $40. She was not happy about this.
I wouldn't be pleased either. And I will go out on a limb and guess that her premium did not decrease. So this health insurance company gets the family to pay $20 more per office visit, and they get to pay $20 less.
That is an awesome way to make a profit: shift the cost to someone else!
Too bad I can't figure out a way to do that (legally, that is).
This same insurance company (whose letters can also be rearranged to form the phrase, "DIE, NUT") announced last year that it would finally start paying for both a sick visit and a check-up on the same day. Previously, it would only pay one or the other. Now most check-ups are pretty straightforward, and minor issues are expected: the baby has some cradle cap, my teenager has a little sniffle today. But every once in a while they present with something more complicated: a wheezing infant, a preschooler with bad behavior problems. If the insurance company won't cover both on the same day, I tell the parent: we can address the problem or do the check-up, but not both. (Expecting a doctor to do otherwise is like taking in your car for a tune-up, finding that your brakes are shot, and expecting the mechanic to fix the brakes for free, since "it's all part of the tune-up.")
Well, this nameless insurance company now says that due to computer issues, it won't start paying for both a check-up and sick visit on the same day until, oh, December 2007.
(Warning: sarcasm ahead.)
Dang, that must be a wicked bad computer problem. They must be getting some serious l33t hacker dudez to crack that code. Maybe they're asking both Steve Jobs and Bill Gates to work together on this one. I mean, how in the world would you program a change in a reimbursement rule? They must be outsourcing that one to, heck, every computer programmer in Bangalore and Boston combined. I hope they're at least consulting with MIT.
"Computer issues?" Really, couldn't they at least think of a better excuse? Though I admit it does sound better than saying, "we delayed the implementation to continue diverting money from the premiums to our shareholders."
I don't want to paint all health insurance companies with the same putrid brush, but as a doctor (or, as they say, a "health care provider,") I think the average person doesn't realize that these companies are first and foremost in the business of making money for their shareholders. If they can provide health coverage along the way, great, but they aren't in this for their health. Nor for yours.
Thursday, February 1, 2007
The Secret Lives of Pediatricians
When I first thought about creating my blog, I had to make a very important decision: use my real name, or hide my identity?Some medical bloggers, such as Flea or Dr. Dork, prefer to stay secretive. Their nom de plumes write passionate about controversial issues, or reveal much about the men behind the facade. Others, such as Dr. Bryan Vartabedian at Parenting Solved, proudly post as their professional personae (yes, much like Dork, I like alliteration), preferring to speak with a calm, informative voice to the layperson. And some, such as Dr. Mary Johnson at Dr. J's HouseCalls, disregard these rules entirely, with blogs so personal and pointed they simply wouldn't work anonymously.
I knew my blog potentially would fall across all of these categories. My Katrina Story, for instance, can't be told without very personal and revealing details. Besides, a well-written blog can be an marketable asset for a practice, a source of information for patients. On the other hand, those same patients might be turned off by a particularly provocative tirade, or details of my personal life. I thought for a long time about what path to take.
I finally decided to go to the middle. So even though you all know me as "Dr. Scott," I've left enough clues on "Just Practicing" and in my posts that it would not be very hard to find out my Secret Identity. A couple of well-targeted Google searches should do it rather easily.
Now you might ask, why not just come out with it? Why make the general public work for it?
First, I do make reference in my posts to my wife and children, and the Internet can sometimes be an abusive place; I don't want to bring them any unwanted advances.
Second, and more importantly, is that I am a pediatrician.
It's part of my job to foster the wholesome development of children. And what better way to encourage healthy behaviors than model them? So, at least in the public sphere, I have to be careful of my image, whether online, or in the local Walmart.
When Pee-Wee Herman was caught, shall we say, partaking of some adult entertainment, the uproar was not because he was famous. He was the famous host of a children's television show. In theory, what the actor known as Paul Reubens did on his own time shouldn't have mattered. He didn't go to an X-rated movie dressed in his character's red bow tie and too-short pants. Pee-Wee Herman never hinted at such subject matter on his Saturday morning show (not even in a subtle, above-the-kids-heads kind of joke). Nevertheless, adults were now uncomfortable having him entertain their children, and so he disappeared for years.
In an even more dramatic example, the fledgling PBS Sprout network fired its eveningtime host last year. Sprout is a cable/satellite network with programming exclusively for the toddler and preschool crowd: Bob the Builder, Teletubbies, Barney, Dragon Tales, the whiny brat Caillou, and the like. Word leaked out that Melanie Martinez, of their "Good Night Show" segments, had acted in two commercial parodies six years before. The films, called "Technical Virgin," poked fun at abstinence-only messages for teens. No pornography, nothing illegal or even risque, just raunchy humor. Not only were the "Technical Virgin" clips far outside of wide release, but it's safe to say that the young viewers of PBS Sprout were unlikely to encounter this aspect of Miss Melanie, even accidentally in the wider world--unless the major media started making it a big deal, or these toddlers knew how to use YouTube. All the same, this unsavory past was enough to kick her off the show. (As a side note, PBS doesn't seem to mind that George Carlin narrates some of the Thomas the Tank Engine episodes. Perhaps they have a different standard for voice actors? Or just famous ones?)
I don't think I lead a particularly immoral life, but I do want the freedom to post about some of my interests, and receive comments back.
I like the occasional premium ethanol-based spirit. For the holidays my wife gave me a bottle of Bombay Sapphire gin. The word intoxicating was invented for this drink, in every aspect. I've also been working this past year on a bottle of Evan Williams Single Barrel bourbon, a truly sublime Kentucky whiskey. All the same, I don't advocate alcoholic beverages for children.
My wife will be glad to tell you that one of my other vices is video games. Another holiday gift, which I recently finished, was F.E.A.R. This is a first-person shooter that features telepathically controlled paramilitary clone soldiers. I couldn't make that up if I tried. It's bloody, excessively violent, and great fun. It's also rated "M" for a reason. I only play it when my children are fast asleep.
We're not talking about child pornography or something equally reprehensible. Nevertheless, I don't think the parents of my patients need to know these things about me. I don't think they really want to know. Why spoil the illusion of wholesomeness?
And so, if you meet me at a party, just don't tell my patients. And if you do, I'll just deny it all. It's all for the kids.
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