Ended my shift last evening by observing a spectacular hotel fire from the parking lot of the hospital. I couldn't help but think of Notre Dame and the needless tragedy that that was and is. Starting my shift today with a manual disimpaction whilst my colleague informs a patient from last night that her CT scan has revealed a pancreatic tumor with lung metastases. We do what we have to do.

Emergency Medicine in the Tropics

2019-05-30

My second (annual?) Caribbean Regional Hospital Emergency Department contract began with four consecutive 12-hour day shifts followed by two days off including today. I had hopes of going to a neighboring island yesterday or today and taking a snorkeling outing but the weather has not cooperated, with a dense cloud cover and rain squalls all day long, so here I am picking my long-disused blog. Things are better compared to my trip here last year, a short few months after two hurricanes battered the island. The inpatient service in the hospital that was destroyed has been rebuilt and reopened. The cancer center is still condemned due to massive mold, and the cath lab is repaired but still closed because there is no technician to run it. More cruise ships are calling. Last year there were only about four a week, now there are 2-4 per day. The island economy is slowly recovering.

The ER is busier than last year. I am seeing about 25-30 patients in a 12-hour shift. The list of chief complaints runs the gamut. Lots of peds fever/diarrhea/vomiting including a young girl who came in absolutely looking like appendicitis and ending up being admitted with pyelonephritis. A bunch of patients flown over from another island because their CT scanner is down. A drug dealer who was shot in the shoulder, the second bullet of his life. Again, he literally dodged the bullet without any internal chest damage. Several sickle cell patients (the local heme-onc doc did her fellowship at Yale), a woman who broke her foot (pseudo-Jones fracture) but waited four days to get authorization from the VA clinic to be seen in a civilian hospital. An early middle age man with a STEMI who was flown to Miami for angiography (the next day by the time all the arrangements were made). An additional four-hour wait while the plane that was to fly him was being repaired. UTI’s, two miscarriages including a young muslim woman who became dehydrated by observing Ramadan in the tropics without air-conditioning. And so on.

The most memorable case so far has been a young adult who was a back seat passenger in a car that had a head-on crash. Not wearing a seatbelt, he smashed into the rear of the front seat breaking and dislocating his cervical spine with immediate quadriplegia. There is no neurosurgery here and no Gardner-Wells tongs to place him in cervical traction, so I jury-rigged a cervical sling using two soft wrist restraints and ten pounds of traction. He remained on a stretcher in the ED for the next three days before being transferred to the mainland. The issue was that, as an undocumented alien, he would be refused entry by ICE at the Miami airport and probably flown back to his native country without receiving any treatment to stabilize his neck. This would be a further disaster because he had some proximal upper arm strength and losing that remaining function would make him totally paralyzed below the neck. Thanks to a persistent family, pastor, and immigration lawyer, an asylum petition was hastily filed and ICE gave the go-ahead to allow him into the US mainland. Of course, by the time he was transferred he developed a stress ulcer and major bleed which fortunately stopped long enough so that he was relatively stable for the transfer. I can only imagine the snide remarks of the receiving hospital staff at the sight of this patient being held in cervical traction with wrist restraints around his chin and occiput. Well, we did our best with what we had at hand.

Except for the first day I have been good on my food regimen. The hospital cafeteria was closed over the weekend so on my first shift I had an egg mcmuffin for breakfast, a Wendy’s hamburger for lunch, and after work went to a chinese seafood restaurant for grilled snapper and chinese vegetables with brown rice. I then went grocery shopping and have done my own cooking since. Breakfast is 1/3 cup oats, 2 cups water, 1 tbsp chunky organic peanut butter, and a sliced banana. I also cooked batches of chopped red cabbage and onion, boiled eggs, and macaroni with mixed vegetables and cheese sauce. I bought disposable/reusable containers and have lived on that ever since except for the evening of my fourth shift when I met Andy, Marilyn’s old BF who happens to be here working in the hospital lab on a three-month contract, and had greek salad and fish (with fries) for dinner.

I sure would love to have Karen and the kids come and spend a few days here, although I doubt that they would like to be in this apartment for more than a long weekend. It’s okay with good air-conditioning, kitchen, etc., but no pool and nowhere to go without getting in a car. I also haven’t had a really good night’s sleep, which is not unusual of course but I think I would sleep better at home in our bed. At least until about 4 in the morning, ha ha (I am a terrible sleeper.). I also miss our walks which I think we will pick up immediately and twice a day when I get back.

Big hugs.

Yesterday was Black Friday and I decided to take the kids to New York City for a whirlwind tour of Manhattan starting at the occupy Wall Street site. I hadn't been there since the police forcibly evicted everyone at 1 AM a couple of weeks ago, but I wanted to see what had changed. Both Ben and Rebecca wanted to bring a friend along so the five of us drove to Bridgeport, got on the train to Grand Central Station, and then the number four subway to Wall Street.
I was disappointed by what I saw when we got there. Whereas before there were several thousand people moving about freely and sharing their ideas, the park was now completely surrounded by police barricades with just one entry point and no more than 200 people or so within the park. Many have said, "that's okay, it's time to move on to the next phase. It's time to occupy everywhere." I disagree. In the battle, and this is a huge, unending, protracted battle, symbols are extremely important, and a Freedom Plaza with thousands of people needing, beating drums, exchanging ideas, making buttons, holding up signs, etc. was a very important symbol that inspired people all over the country and all over the world to occupy public spaces and make the constant statement that corporations, whose already excessive power and wealth continue to grow, have corrupted our political system and taken democratic control of our government away from us. I see a Freedom Plaza packed with demonstrators stay in night as the fire on the beach in "Lord of the Flies", something to be maintained both as a symbol of the desire for rescue, and a tool of rescue itself. I fear that if we let the fire go out the movement will dissipate.
Visual media, a.k.a. television news, is the dominant source of information for the masses. Not that there was a lot of coverage to begin with, but with a mostly empty Freedom Plaza there will be no further coverage by the news outlets that the great majority of Americans watch. The occupy movement no longer occupies Freedom Plaza. It now merely visits a space that is under the complete control of the police and a private security firm who now control access to the park and prohibit entry to anyone carrying any item that they have deemed unauthorized. It is time to relight the fire as a symbol and a tool for getting the message of the occupy movement, or I should say messages, out to the public who is woefully misinformed. It is time to respond to the systematic, coordinated tactics of the establishment who in city after city have evicted the occupy movement from the public space only to readmit it as an ineffective shell of its previous self.

Having It Both Ways

 

Several months ago Cheshire (Connecticut) police raided a massage parlor that was operating in the back rooms of a manicure establishment. The manicure shop has reopened "under new management" and sans massage, but apparently business isn't exactly booming. We don't tolerate that sort of thing in our town.

More recently Eliot Spitzer, Governor of New York, was forced to resign after it was revealed that he regularly used the services of a call girl, which these days is defined as a prostitute who takes credit cards and has a web site, during trips to New York City and Washington DC. He quickly disappeared from view but is currently attempting to raise his public profile as an occasional political commentator. Which brings us to Dick Morris.

For those of you who don't remember Dick Morris, he was Bill Clinton's pollster and chief political advisor until he was caught in bed with…, you guessed it…, a call girl for whom it turns out he was a regular customer. The two most memorable things about his trysts was his proclivity for sucking her toes as well as his habit of letting her listen in on telephone conversations he had with the President of the United States. After his departure he turned against the Clintons and has made a full-time job of Hillary bashing, going to the extreme of writing an entire book refuting a book which she wrote. Unlike Gov. Spitzer and out local manicure parlor, he did not alter his habit of seeking professional companionship. As recently as 2007, he was on the list of the "DC Madame" as one of that outfit's high rollers. That has not prevented him from being a regular commentator on Fox News, the network which so regularly gets it wrong that it has by far the highest percentage of viewers of any network who falsely believe that Iraq was responsible for 9/11 (For you Fox viewers, Iraq was in no way involved in the 9/11 plot.).

So I found it very curious that, of all people, Mr. Morris would be invited to a local church in town to dish out his view of the world in general and the Obama administration in particular. Mr. Morris is one of the frenzied right wing mob that is screaming from the rooftops, or rather the studios of Fox News, that President Obama is a socialist whose goal is to dismantle capitalism and turn us all into economic slaves. It is ironic that a Christian church would have such a rabidly antisocialist guest speaker. After all, didn't the first Christians share their possessions and live more or less in self-imposed…socialism?

I guess there must be a new brand of Christianity since the church which invited him carries a prominent ad on its home page for a book about becoming wealthy by following Christian principles. On further investigation, however, it seems that those principles are actually Jewish ideas, or at least that's what John Muratori, the pastor who invited Mr. Morris to town says in his article in The Voice which you can read online at:

http://www.johnmuratori.com/articles/13_thevoicemag_winteredition.pdf.

The Voice proclaims its mission to be "Advancing Christian Life and Culture" and it devotes its Winter issue to the evil Democrats (see the menacing cropped photos of Obama, Pelosi, et al on the cover) who are hard at work "dismantling capitalism." Pastor Muratori's article entitled "Thriving in a crisis economy," he advises us Western-thinking Christians to think like Jews. On page 34 he states:

"Today, Christians are facing panic and fear, wondering if they will survive this unstable

time, while at the same time Jews are praising God for the opportunity to thrive during this

economic crisis, as they have done in previous periods."

 

He goes on to say that this explains why for centuries Jews have always achieved fiscal superiority in any country they have settled in. This is very dangerous thinking. If such statements were coming from the mouth of an anti-Semitic agitator, they would show just how fine the line is between purported admiration and Kristallnacht. Indeed, the Nazi movement persecuted Jews on exactly the same grounds that the good pastor says he admires them. I would be very wary of this man as I am of all men who mix religion and politics. After all, all it took for Dick Morris to switch from working for Bill Clinton to despising him was getting caught with someone else's foot in his mouth.

 

Winter is officially over. How do I know? It's not because the calendar says so. In fact the mornings this week have been pretty cold. No, there is a better sign of spring han a yard full of robins jousting for mating rights (which I saw this morning). When I look out the window of my office on campus at all the students walking between dorm row and center campus, I notice that female footwear has gone from all Uggs all the time to mostly flip flops and a few assorted sandals and sports shoes. The upper body clothing hasn't changed (yet), but the footwear is definitely in tune with the warm season. Now if we could actually have a warm day or two........





On the home front, swim season is over giving Rebecca and Ben a couple of weeks or so to laze around the house instead of swimming their tails off with the Sea Dogs. They have each been invited to join the next level of swim team. Rebecca is excited, Ben less so. He is not as enthralled about swimming but he is good at it and we are encouraging him to stick with it. He probably will just to please us but I doubt that his willingness will continue on into the upper levels. Seeing how Ben and Rebecca have developed physically this year, thanks to hours of practice, I don't think it's wrong to keep him on the team, especially since his free time would otherwise be wasted hanging out at home sneaking in TV time......









Speaking of warm weather, it was nearly a year ago that Frederic, Thomas, and I attended the Celtics victory rally in Boston where we happened to be for a visit to Mass General. So much has happened since then!! We had no idea whatsoever. All has turned out well and we are planning a big family trip in July. I will do a three week contract as the ship's doctor in Alaska and the kids (minus Frederic), Karen, Mom, Bern, Dave, and Leila will join me for the third week.



Frederic of course will not be in attendance because he will have shipped out to somewhere in China to begin his stint with the Peace Corps teaching English to Chinese English teachers and to continue his budding career as a Chinese pop star. We are anxious for him to come home for a two-week visit in June. A short camping trip and a concert ("Rain") are in store.

Well, enough newsiness. Until the next posting,

Your humble servant,

Dr B

2009 Update from the Brauhaus

The year MMVIII was a momentous one, full of drama, celebration, hope and fear, at home and elsewhere. It began with Thomas, whose illness ultimately did not respond to medical care, requiring major surgery in January. His post-operative course was very Rocky and precluded his being able to continue his university studies for the Spring semester. This was a big blow for him but he gradually adjusted, got back his strength, started working part-time with Cheshire Youth Services, and looked forward to his final intervention in June and resumption of classes in the fall.
Frederic put in the work necessary to complete his graduation requirements and became part of the vast crowd of dark blue gowned and mortar-boarded UCONN graduates who filled the chairs to overflowing on the floor of Gamble Arena, surrounded by and even vaster crowd of families and well wishers. The yellow dandelion I stuck on the middle of his mortar board prior to the ceremony helped us to pick him out of the crowd. Rebecca Lobo, the UCONN and WNBA basketball star gave a wonderful graduation speech and our spirits were further lifted afterwards when we met up with Frederic’s old New Haven friends Gent and Luis, also proud graduates. How they have all changed from fifth grade days when Karen and I coached their soccer team!
Rebecca put on an amazing growth spurt and ended the year at 5’1”. She excelled in school, continued to develop her violin skills, had significant roles in the school musical (Twinderella) and a summer community production (“Once Upon a Mattress). Her swimming times are solid and constantly improving as she masters all four strokes. In keeping with the times and culture, her week is packed with activities and the recent Christmas vacation was a welcome break. Her newest skill to be developed is learning to use the sewing machine she received for Christmas.
Benjamin, not to be outdone, is also excelling in school, moving up the swim ladder on the Y team, and becoming quite proficient on piano. He finally got his heart’s desire for Christmas, a Sony PSP with four games, and so far has managed not to bump into anything will walking and gaming. As school has resumed, strict limits on total screen time are now in effect with only mild signs of withdrawal. Ben is also shooting up like a weed. He is still fascinated by paper airplanes and all things technical and electronic. He has finally started to follow his sister’s lead and has taken an interest in reading long books. We hope that this new development will blossom.
Karen has remained as busy as ever, not only with her very successful practice where she has become the physician of countless….physicians and their families, but also keeping on top of her role as president of the board of trustees at the United Methodist Church and doing battle with roofing and heating companies, all the while organizing the children’s schedules, keeping up her yoga, and keeping all of us in line with some modicum of success.
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Phil has ended his sabbatical from Emergency Medicine having taken a per diem position at the trauma center in Hartford. This has proven to be a stimulating and rewarding supplement to his main job taking care of the student body at Quinnipiac University, although the evening shifts which frequently keep him up until two or three in the morning have obliterated his newly found “normal” sleep cycle, much to Karen’s chagrin. All in all his new professional life based on an academic schedule with extensive time off and additional work as desired is a welcome change from decades of nights, weekends, and holidays and he definitely does not miss night shifts.
The summer was a study in hopes and fears. Phil had a 21 day cruise doctor contract with Holland America on the brand new “Eurodam,” sailing the Baltic and North Sea out of Copenhagen. Frederic and Thomas were to spend the first ten days on board followed by Karen, Rebecca, and Ben, and much of the Brown family for the second leg of the voyage. Unfortunately the best laid plans……Thomas’s second surgery, scheduled for early June, went off as planned but again his recovery was very difficult. As sailing day loomed on the horizon he improved and came home but then relapsed and became critically ill requiring a prolonged ICU stay. The trip was cancelled, our only interest at that point being Thomas’ recovery. During this very trying time, we discovered the strength of our family and the support of our friends. We also benefited from the extraordinary efforts of our much missed Marilyn. From the depths of despair we gradually surfaced to relief and joy at his recovery.
Thomas is well now, having gone back to school and completed the fall semester. He is spending much of the Christmas break in China and France with Frederic and his mother. Phil, Karen, and the little kids spent their first Christmas at home, enjoying a simple yet elegant Christmas Eve dinner, sitting between the Christmas tree and the Yule log glowing in the fireplace, and opening presents by the tree on Christmas morning, then setting out to Philadelphia for a late Christmas afternoon dinner with the rest of the Browns. A few days after we returned, Jim and his children came up and for three days the cousins played, we rang in the New Year at a large indoor waterpark, and planned for another rendition of “Camp Cousin” this summer, this time a camping trip in the Adirondacs.
Last but not least, we rejoiced that the nation finally came to its senses, or was perhaps slapped to its senses by the economic meltdown, and elected an intelligent (for sure) , wise (we hope), hard working (no doubt), and honest (we trust) pair of men to run the government. There is so much damage to undo. But if we all pull together as a nation we can do it. We at least have the right team in place. And Sarah Palin went back to Alaska, never to be heard from again (we wish).
Best wishes for 2009.
Phil, Karen, Frederic, Thomas, Rebecca, and Ben