Thursday, October 27, 2005

Fragrance

Wednesday, September 14, 2005

CNN.com - Evacuations resume at flooded hospital - Sep 2, 2005

They're still evacuating hospitals in New Orleans, and many hope to get the staff out today.  I don't know how they'll be able to go back without a massive cleanup operation.   CNN.com - Evacuations resume at flooded hospital - Sep 2, 2005. more...

physician-desk-reference

TMA: No docs being sent into Louisiana

Just got this from the Texas Medical Association This color is my emphasis:Deployment Status:   TMA has not received an
official notice to deploy volunteers to Louisiana. We appreciate your
willingness to help and ask for your patience at this time. If you have
contacted TMA to volunteer, you are in our volunteer database. You will be
contacted as soon as we are notified. (See Next Steps.)

Overwhelming Response:   Wednesday, Aug. 31,
Gov. Rick Perry asked the Texas Medical Association to solicit 200 physician
volunteers to assist Louisiana with their medical needs. As a result of that
request, TMA has received more than 1,500 responses from physicians, residents,
and medical student volunteers. And more calls are coming in by the minute.


Our initial announcement requesting volunteers was stated
exactly as provided to us by the Governor's Division of Emergency Management.
That notice listed only six specific specialties. However, TMA sent a notice to
all specialties in our e-mail database. We anticipated additional skills and
expertise would be needed. The response from our physician members has been
overwhelming and heartwarming. The rescue shelters established in Texas’ major
cities are in desperate need of primary care physicians.

Next Steps:   The State Operations Center has
been told that additional physicians (except for mental health professionals)
are not needed in Louisiana. Hospitals in New Orleans have been evacuated.
Physicians displaced from New Orleans are being dispersed throughout the state
and are helping with immediate relief efforts. State and federal officials will
not deploy any volunteers into Louisiana until your safety can be guaranteed...From what I've seen on TV this makes the most sense: with no infrastructure there's no need to add to the disaster.  Let's evacuate everyone out of the area and fix the problems out of the disaster zone.

more...

physician-desk-reference

New Orleans Patients arrive in Fort Worth

I worked an afternoon shift in my ED today, and the buzz was all about the New Orleans transfers we'd received, and continued to receive.

Our joint got about 12 that I'm aware of, with a very high percentage being dialysis patients and in need of that service.  It was entirely appropriate that they were sent to us, as we're one of a few hospitals in the area with inpatient dialysis services available.  Our nephrologists didn't bat an eye, and worked hard to get them taken care of.

The patients were flown into the JRC Fort Worth (used to be Carswell AFB), and then a team from the county hospital and the county EMS director started divvying them up.

The patients I cared for showed what you'd expect in a debilitated, chronically ill person with no adequate sanitation for 3 days.  All but one showed up with their inpatient hospital chart (in the binder), and one had not just that but prior charts dating back several years!

The staff, who would gripe even if struck with a new stick, were quite remarkably compassionate and there were no harsh statements made about the sending facilities' care.

Another flight was due in this evening, but I left before that batch of patients arrived. 

A moment of levity in all this: one patient, evacuated with just a gown and a chart arrived with a bottle in hand: a bottle of Tabasco sauce.  When asked, yes, it was the patients' just to make sure it was available for meals.

That should prove interesting for the hospital dietitians.

And now: where in the world are all these cities and hospitals going to put these new patients with chronic illnesses?  My place routinely holds admitted patients in the ED hallways.  There are no empty hospitals waiting for new patients. more...

physician-desk-reference

TCU - Learning to Change the World

If you're from the DFW area and were set to attend college in NoLA: TCU - Learning to Change the World.FORT WORTH, TXWednesday, August 31, 2005




Message to TCU from Chancellor Victor J. Boschini Jr.  


Dear TCU Community,


Devastation caused by Hurricane Katrina in Louisiana, Mississippi and
Alabama has left thousands homeless, businesses destroyed and
livelihoods uncertain. Universities in the area, including Tulane,
Xavier, Loyola, and Dillard, all located in New Orleans, have sustained
major damage and there is great uncertainty as to when they might
re-open. To that end, TCU is offering admission until Tuesday,
September 6 to Metroplex undergraduate students previously admitted to
a university severely damaged by Hurricane Katrina. I am asking that
each member of the TCU community be flexible in accommodating these
late arriving students and help them feel welcome. Although we are at
our maximum for this year's freshman class, we feel a great sense of
duty to offer this gesture of goodwill to these college students.


In addition to these efforts, TCU's Student Affairs division (Community
Outreach/Service Learning and University Ministries) is coordinating an
additional response to the disaster. A full accounting of their efforts
follows below.


Sincerely,


Victor J. Boschini, Jr. more...

physician-desk-reference

Marooned doctors plead 'Please help us'

This is completely unacceptable, and those responsible need to be dealt with harshly.  And I'm not advocating handcuffs, or jail time.

Dr. McSwain, quoted in the article, is one of the dieties of early trauma research.Unruly crowds disrupt, prevent hospital evacuations

(AP) -- Doctors at two desperately
crippled hospitals in New Orleans called The Associated Press Thursday
morning pleading for rescue, saying they were nearly out of food and
power and had been forced to move patients to higher floors to escape
looters.

"We have been trying to call the mayor's office, we
have been trying to call the governor's office ... we have tried to use
any inside pressure we can. We are turning to you. Please help us,"
said Dr. Norman McSwain, chief of trauma surgery at Charity Hospital,
the largest of two public hospitals.

Charity is across the street
from Tulane University Medical Center, a private facility that has
almost completed evacuating more than 1,000 patients and family
members, he said.

No such public resources are available for
Charity, which has about 250 patients, or University Hospital several
blocks away, which has about 110 patients.

"We need coordinated help from the government," McSwain said.

He described horrific conditions. (Watch a report on the scenes of death and despair on the streets of New Orleans -- 4:36)

"There
is no food in Charity Hospital. They're eating fruit bowl punch and
that's all they've got to eat. There's minimal water," McSwain said.

"Most
of their power is out. Much of the hospital is dark. The ICU (intensive
care unit) is on the 12th floor, so the physicians and nurses are
having to walk up floors to see the patients."


Dr. Lee Hamm,
chairman of medicine at Tulane University, said he took a canoe from
there to the two public hospitals, where he also works, to check
conditions.

"The physicians and nurses are doing an incredible
job, but there are patients laying on stretchers on the floor, the
halls were dark, the stairwells are dark. Of course, there's no
elevators. There's no communication with the outside world," he said.

"We're
afraid that somehow these two hospitals have been left off ... that
somehow somebody has either forgotten it or ignored it or something,
because there is no evidence anything is being done."

Hamm said
there was relief Wednesday as word traveled throughout University
Hospital that the National Guard was coming to evacuate them, but the
rescue never materialized.

"You can imagine how demoralizing that was," he said.

Throughout the entire city, the death, destruction and depravity deepened even as the hurricane waters leveled off.

"Hospitals
are trying to evacuate," said Coast Guard Lt. Cmdr. Cheri Ben-Iesan,
spokesman at the city emergency operations center. "At every one of
them, there are reports that as the helicopters come in people are
shooting at them. There are people just taking pot shots at police and
at helicopters, telling them, 'You better come get my family."'

Richard Zuschlag, president of Acadian Ambulance Service Inc., described the chaos at a suburban hospital.

"We
tried to airlift supplies into Kenner Memorial Hospital late last
evening and were confronted by an unruly crowd with guns, and the
pilots refused to land," he said.

"My medics were crying,
screaming for help. When we tried to land at Kenner, my pilots got
scared because 100 people were on the helipad and some of them had
guns. He was frightened and would not land."

Zuschlag said 65
patients brought to the roof of another city hospital, Touro Infirmary,
for evacuation Wednesday night spent the night there. The hospital's
generator and backup generator had failed, and doctors decided it was
safer to keep everyone on the roof than carry fragile patients back
downstairs.

"The hospital was so hot that with no rain or anything, they were better off in the fresh air on the roof," he said.

When patients have been evacuated, where to take them becomes the next big decision.

"They're
having to make strategic decisions about where to send people literally
in midair," said John Matessino, president of the Louisiana Hospital
Association. "It's a very difficult thing to prioritize when they're
all a priority."

Knox Andress, an emergency nurse who is regional
coordinator for a federal emergency preparedness grant covering the
state, said it's impossible to underestimate the critical role
hospitals are playing for anyone left in the city.

"They're
running out of their medications, they're running out of money. They're
having social issues and where do they go? They go to the hospital. The
hospital is the backbone of the community because the lights are always
on," he said.

When hospitals can't take care of people and the rescuers need rescued, there's no social fabric left, Andress said.

Hospitals weren't the only facilities with troubles.

Louisiana
Lt. Gov. Mitch Landrieu, who has been working with search and rescue,
confirmed that 30 people died at a nursing home in St. Bernard Parish
and 30 others were being evacuated. He did not give any further details.

Copyright 2005 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.





































via FFM, who's been all over the medical aspects (by email). more...

physician-desk-reference

Dr. Charles announces his book

And now, presenting Legends of the Examining Room, a collection of the best writing this little weblog has had to offer over the past year.

Read about
the hidden poetry, the hilarity, and the heroic resilience of ordinary
people as they filter through this otherwise unremarkable examining
room.

I’m writing under the pseudonym Aidan Charles. Both names
have a special significance for me, and were chosen mostly on
sentimental grounds. Now you can call me whatever you like, but I
feared that if I didn’t get myself a first name that I was on the fast
track to a Dr. Phil-style reputation.

... 

I will be donating a percentage of any sales to charities such as Doctors Without Borders. For now, I’m going to give 25% to The Red Cross for their efforts in Hurricane Katrina relief (this is assuming that proceeds total more than a 37 cent stamp).He's selling these through an independent publisher, here:

Legends of the Examining Room

Now, who's doing the book review? more...

physician-desk-reference

New Orleans Satellite Photos

Remember those before and after satellite photos from the tsunami?  Now they're out for New Orleans.

Amazing. more...

physician-desk-reference

Ankle Sprain

My son sprained his ankle a few days ago, and I've been making QOD photos, mostly for my own amusement.  No fracture, and he's doing fine, by the way.

Looking these over it occurs to me that I have several ED visits for concerns about the bruising following sprains.So, without further ado:




Day One.  Lateral ankle swelling (no bruising, trust me).Day Three:






Day Five:






So, bruising happens after ankle sprains.
more...

physician-desk-reference

MedPundit reviews the new Quicken Medical Expense Manager

MedPundit has reviewed a new Quicken program that promises to track your families' medical expenses (including pets).  I got an email about this, but lacked the time and motivation to look into it.

Go read about it and see if you could use it. more...

physician-desk-reference

Minor Tweaking

This evening I tinkered a bit with the font sizes for the blog.  It was displaying oddly in IE (go figure), and this is my try to get the same output in Opera, Firefox and IE.

Please let me know if you find odd behaviors. more...

physician-desk-reference

American Red Cross and You

At the top left is now a link to the American Red Cross homepage, which links to a pretty well done donation page, and what they need is moolah.  The days of donating the blankets and beets from the cellar are long gone, and the Red Cross needs cold hard cash to make things happen.  From watching the news, looks like they're going to need a lot.

This also bears keeping in mind, for those who are a little reluctant to give (via LGF):...there is no connection between the
International Committee of the Red Cross (a Europe-based organization
with an anti-American, anti-Israel agenda) and the American Red Cross,
who support the United States whole-heartedly, and have even withheld
dues from the ICRC, out of disgust at their agenda. Don’t target the
wrong group, just because they have a similar name.Give now, if you at all can.
more...

physician-desk-reference

MedBlogs Grand Rounds 1:49

Here at HealthyConcerns I often feel like a lone voice in the
wilderness, speaking from the non-health care professional's point of
view. But if we are heading more and more in the direction of patients
partnering with their doctors to chart their own care, then partners
need to listen to one another and learn from one another.

With that in mind, I've organized this week's Grand Rounds by how
each set of posts helps people like me understand the health care
system and the people that work in it:It's a good one.

more...

physician-desk-reference

Galen's Log: S.K.A.M. unveiled

Galen's Log: S.K.A.M. unveiled.

It was a busy weekend.  I just arrived at the secret underground base for the quarterly S.K.A.M. meeting (Society for Keeping Americans Medicated), and made it through security clearance, when I caught wind of our latest problem.  Overhearing bits of quiet conversation as I moved towards the Inner Sanctum, I appraised that Kevin Trudeau's new book had made the NYT top seller list, and he had been getting some TV time as well.  Definitely a threat to our organization.



You may not know this, but we in the health profession have had total cures for things like diabetes and hypertension for decades now.  Only by turning them into "Chronic Diseases" have we been able to develop returning "customers", and with them, the financial power base that will lead us to world domination.  After decades, our work was finally bearing fruit.  And yet...Heh.  Galen has a talent for satirical fiction.

more...

physician-desk-reference

Active euthanasia in New Orleans: An urban legend in the making?

Orac has put more thought into the out-of-left-field tale of active euthanasia allegedly occurring in New Orleans hospitals during the flood : Respectful Insolence (a.k.a. "Orac Knows"): Active euthanasia in New Orleans: An urban legend in the making?.

I am in agreement with him, that a lot of this just doesn't pass the smell test, and that's not a New Orleans clean-up joke.  more...

physician-desk-reference

Sneezing Po has Grand Rounds 1:51

Sneezing Po has this weeks' roundup, organized as a "virtual gallery".  Another excellent assortment. more...

physician-desk-reference

After the Storm: ACEP and AAEM

ACEP's recovery website: After the Storm.

ACEP continues to be concerned about its members and their families who have been affected by Hurricane Katrina. Now that the storm is over and the recovery phase is beginning, we will provide you with information to help you regain your footing, find employment, relocate, and other resources as you recover from this disaster.It's pretty good, and there's lots of good information and links in there for the EM docs and residents affected, or who want to help.

Contrast that with my preferred organization, AAEM, and this terrificly informative bit on their site:Hurricane Katrina

 The
AAEM Board of Directors is meeting in Nice, France as part of the Third
Mediterranean Emergency Medicine Congress. A statement to the
membership about the AAEM planned relief efforts for hurricane Katrina
will be posted next week. Please stay tuned to our website for more
information.So, ACEP's site is filled with useful links, and AAEM wants everyone to know they're thinking about it from France.  Not a good way to recruit.



more...

physician-desk-reference

The Big Off

Well, it comes to all cyclists, and today I had it.  The Big Off.

There's a long story here, but basically I had a touch of brain fade and bad luck at the same instant.  The next thing I know I'm slapping the left side of my entire body, including my over-rated head, on the concrete.  I'm fine, and except for a couple of abrasions and a forehead bruise the shape of a helmet pad, I'm none the worse for wear.

Basically, I drove off the narrow concrete path.  There was plenty of grass, but I inexplicably cut back toward the pavement and hit a nice deep groove.  It was then I rediscovered one of my brother's sayings, 'gravity never sleeps', and hit the deck.  Hard.  The sound of my helmeted head hitting the ground couldn't have been louder outside my skull than inside, and though I had a millisecond light flash surprisingly I have had no ill effects.  Not even a headache.  Finished the ride, which included adding some mileage before the turn around, and proved something to myself.

My bike, alas, looks like I dragged it over concrete.  Both Ultegra shifter covers are deeply scarred, and both rims have scratches on the left side, making interesting sounds under braking.  I figure nothing expensive was bent, which is good.  Oh, and I get to throw away the jersey I didn't like due to the holes, so there's always a silver lining. 



The helmet, a one-time-use item did its duty.  Its exterior shell looks like it met concrete, but the inner liner has the telltale cracks in the styrofoam, so that's that.  I'd like to thank the nice folks at Giro, who made my helmet and will be the manufacturer of my next one.  Spend money on your helmet like your brain depends on it.  Mine did, and does.  As one of my residency colleagues used to say, "get a helmet, and wear it".

If only this immunized me from future spills.   Heh. more...

physician-desk-reference

Doctors emerging as heroes of Katrina

Good article (requires annoying but free registration): AP Wire | 09/09/2005 | Doctors emerging as heroes of Katrina.

...Disasters always spawn heroes.

On Sept. 11, 2001, many of them wore dark blue uniforms that said FDNY.

On Sept. 1, 2005, many wore hospital scrubs that said MD, RN and EMT. Thousands of health care workers stayed with patients in devastated hospitals after the storm struck. Thousands more rushed in to help.

They are people like Dr. Norman McSwain, a legendary, 68-year-old Tulane University trauma surgeon who on Sept. 1 waded through fetid floodwaters to get out word that thousands of people were trapped in hospitals running out of food and water.

And Dr. Rich Tabor, a 38-year-old Bethlehem, Pa., emergency medicine physician who got partners to cover his shifts and paid $520 out of his own pocket for a plane ticket to Louisiana, where he climbed into an airboat and went door-to-door with rescue workers.

And Barry Albertson Jr., 42, a paramedic from Easton, Pa., who missed his 7-year-old son's first peewee football game to join a caravan of ambulances making the 30-hour trip to New Orleans.

And Dr. Lee Garvey, 48, an emergency room doctor at Carolinas Medical Center who dropped everything to staff a state-of-the-art mobile hospital that provided the only trauma care for seven devastated counties in rural Mississippi.

"We're here because this is what we live to do," Garvey said, "trying to offer something to these people."... more...

physician-desk-reference

U.S. Lawmakers Vow Expanded Health Coverage for Hurricane Victims

via MedScape News: U.S. Lawmakers Vow Expanded Health Coverage for Hurricane Victims.

WASHINGTON, (Reuters Health) Sept 08 - Democrats in the U.S. House and Senate are pushing legislation that would dramatically expand federal funding for the Medicaid health program for the poor, both to states that suffered damage from Hurricane Katrina last week, as well as states that are now hosting tens of thousands of evacuees.

Currently, states share in the cost of Medicaid with the federal government. "But the states directly affected by Katrina, and those hosting the survivors, will not be able to put up their match payments due to the fiscal crisis that Katrina has created," said Sen. Blanche Lincoln, D-Ark. "This is a critical issue that's got to be addressed immediately," she said.

Lincoln offered an amendment to an unrelated bill in the Senate to do just that. Her proposal, originally offered by Senate Minority Leader Harry Reid, D-Nev., as part of a broader hurricane relief proposal, would make it easier for states to enroll eligible people in Medicaid, and would expand Medicaid eligibility to all people below the poverty line. In many states, individuals must have incomes well below poverty to qualify for Medicaid coverage.

The measure would also have the federal government pay the full costs of Medicaid in Louisiana, Mississippi, and Alabama -- the states hardest hit by Katrina -- as well as the full costs of individuals from those states who enroll in Medicaid in other states where they are living temporarily.... more...

physician-desk-reference

Polite Dissent - Triage

First-hand reporting: Polite Dissent - Triage.

Last night, I was one of two physicians on hand as a plane full of New Orleans evacuees landed at our small airport. Our clinic provided 5 people (2 physicians, a physician’s assistant, a nurse, and a medical assistant) and our senior physician was in charge of the medical operations on site. Our job was primarily one of triage — deciding which patients need medical care and how quickly — rather than hands on medical care.

People straggled off the plane one or two at a time, clutching plastic bags filled with toiletries and other belongings. Several people held on to their cats and dogs tightly as well. As they stepped into the terminal, we’d give them a quick medical look-over and make sure they were doing OK. Volunteer greeters came up and directed each passenger and family to food and water and helped them fill out the necessary forms. After that was accomplished, they were taken to the first floor for more food and then loaded on buses to take them to their lodgings.Read, as they say, the rest.

more...

physician-desk-reference

CPR-bot: And The Beat Goes On - MedGadget - www.medgadget.com

MedGadget found one of my favorite gadgets, an automatic CPR-giver: CPR-bot: And The Beat Goes On - MedGadget - www.medgadget.com.

I was an EMT in an ED before I went to med school, and I've done my share of CPR.  Doing it right is hard work, and isn't nearly as easy as it looks on TV.  Mechanical widgets like this are not just better from a mechanical performance standpoint, but they're force-multipliers: your techs or nurses can now be doing something other than hard manual labor.

And now that I've said that, your rescue squad isn't going to show up with one of these.  Please take a basic CPR course. more...

physician-desk-reference

Blogborygmi has Katrina First-person posts

Go over to Nick's at Blogborygmi, and read the two first-person accounts from the Katrina effort. more...

physician-desk-reference

Emergency Department Dirty Words

In any Emergency Department there are a couple of words whose utterance will immediately earn the speaker social disapprobation at minimum, and quite frequently half-joking threats of physical violence.

These are not your average, run of the mill profanities, though one is a four-letter word.  No, we're quite immune to 'Sailor speech', and most of us don't even bat an eye when those pedestrian words are spoken.  No, not those words.

The power of the words is inextricably linked to most ED workers' innate superstition, else these words wouldn't have the impact, and engender the cold sweat and dread way out of proportion to their intended meanings.

Brace yourselves.  The words are "Quiet" and "Slow".  Don't look very fearsome, do they?  Right now you're saying 'this is just silly', and you'd be right, unless you uttered them in a slow or quiet ED, then you'd be a pariah, for the next happening will be the blare of the ambulance radios and a bus-station line at the triage desk.

So, you've been warned.  Ban them from your vocabulary.  Then start on the sailor talk, too. more...

physician-desk-reference

State Bar of Texas Health Law Section

Katrina Questions and Answers for Texas Healthcare Providers, Patients and Attorneys: State Bar of Texas Health Law Section.

This has some excellent information. more...

physician-desk-reference

Tulane Hospital CEO's account of Katrina

This is a letter from the CEO of Tulane Hospital, Jim Montgomery.  I think they're to be commended.  It's long, so keep going into the extended entry.  And his post-script should be a wakeup call for all of us.I thought it might be easier to compose an email to all of you at once
that
tells some of the story of the past few days.  First and foremost I
felt your
prayers and heard your concerns that were registered with
Donna and others
and they comforted me and kept me calm which was
essential in this time.



This storm as of noon Friday the 25th didn't seem like it would be
much
of an event, but by 5pm things began to look different.  We met as
a
group on Saturday to begin our routine preparations for a hurricane.

Donna left for her brother's home and I went home to put things
together
there.  I started to think what do I absolutely not want to lose in
case
the house would be swept away and the answer only revealed the photos of

the family thru the years so that and few clothes was all I took.


The
Storm:  God's Natural World has an awesome power.  From the small
observation
windows from our tallest floors, we observed awnings being
blown off, a
blinding rain and a general sense if God's ever angry we're
going to lose
big.  Our first inspections revealed little damage.  A few
broken windows and
some roof damage but the building held up well.  In
fact, if you were in the
inner core of the facility you only vaguely
heard it.  We even walked around
late in the afternoon since there was
only limited flooding no worse than a
heavy thunderstorm.
Overconfident, we even stated we had absorbed the best
punch that nature
could throw and we seemed intact.


At 1:30 am on
Tuesday morning began the biggest crisis and challenge of
my life and in the
life of Tulane and no doubt New Orleans.  I was
awakened by my COO who told
me the water in the boiler room was rising a
foot an hour since midnight and
if it continued at that rate at best we
had only another two to three hours
before we would lose all power since
we already were on emergency power since
early Monday morning.  We had
only 7 ventilator patients whose lives would
be in jeopardy, and we had
to move fast to get them out.  We had no boat and
no helicopter pad.
Houston we have a problem.


I called Acadian
Ambulance (who I know well) but had no business connection to our hospital
and asked their immediate help.  We have aparking deck connected to the
hospital that we had evaluated as sturdyenough to support helicopter flight,
but it had four light poles in the middle.  I want to tell you what happened
in the next four hours wasnothing short of a miracle.  Our maintenance group
got the light polesdown; Acadian agreed to pick our patients up, we made
arrangements with our other HCA hospitals to take them. Our staff and
physicians got theirpatients ready, and most importantly, the water rise
began to slow to aninch/hr and a little after the sun came up copters were
on the roof and patients began to be transported.

Early on Tuesday
morning we met with our key managers who were at thehospital.  We prayed for
support and comfort and guidance for what weknew was going to be a difficult
period.  We talked about what we knew, and what we didn't know which was
considerable because we had no contactfrom FEMA or the Mayor's office.  We
had no idea why the water wasrising and from what limited facts we had, no
one did.  We had to assume that it would keep rising and we would lose power
and then we would haveno power at all.  Thus, no light, no ac, suction,
oxygen, elevators,phones ie. Everything that is precious to good care.  We
had to get out so we hatched a plan and I tried to stay out of the way and
let ourphysicians and nurses triage patients; others determined what
vitalsupplies we needed replenishing; HCA was working frantically
tocoordinate a transportation effort to pick up patients and eventually,
our staff.  How many people?  Good question. At least 1200 whichincluded
a total of 160 patients, employees and physicians and theirfamilies and 76
dogs and cats that I didn't know about at the time.

Tuesday:  The looting
began.  We witnessed people, dozens of them, wading in front of the hospital
with bag after bag of stuff fromdifferent stores in the vicinity.  Bandits
took over two hotels adjacentto us and forced out many of our employees
families who had been housedthere forcing them back to the hospital creating
further complications.That night our people on the roof evacuating patients
heard gunshots inthe air but they continued their work. The lawlessness and
insurrection certainly was a distraction but our Tulane Police were great,
and theyare very capable. Late in the day we ran out of fuel so our
generatorsshut down and the building began to get hot.  The last of the
ventilator patients had to go up six stories by way of pickup trucks since
theelevators shut down and our ambulance was too tall to squeeze to
thetop.  During the day, I had a conversation with a patient's father
whotold me that the parking deck pad would hold big helicopters.  How
didhe know?  Because he was a Blackhawk pilot.  Ok.  Then there
appearedout of nowhere this guy, John Holland, who was sent in by HCA to be
ourFlight Coordinator - whatever that is.  "The man" had arrived who
wouldcommunicate with the birds in the air and boy is that important
becauseour patients had begun to fly away.

Wednesday:  If you would
like to know if we slept.  Here's a little experiment.  Try heating the
bedroom up to about 90-95 degrees.  First,you're hot and then you sweat and
get cold and then the cycle repeats.Daybreak and I tell you patients are
being moved into a queue to move. I saw our staff, residents, and faculty
move sick patients with a graceand dignity that was most impressive.  This
was our third day and thestress on our people began to show.  Everyone was
asking when, where, & how were we going to get out.  The city sewer
system was obviouslybacking up and spilling out and creating an acrid smell
that over thenext few days made it almost impossible to breath. With no
waterpressure you can't bathe. But here's a general observation:  if
everyone smells the same youreally don't notice it, you just feel
unclean.  On this day, the La.Wildlife and Fisheries Department showed up to
help us move somepatients that we had inherited from the Superdome on Sunday
night.  Yes, over 60 extra medically needy people with chronic
conditions.  So byboat we sent them and their love ones away.  I met a woman
whose mostvaluable possession was her pillow and her radio that I
personallypromised her to protect.  It's in my office now.

The Big
Birds began to fly.  Blackhawk's down.  Instead of one or twopatients they
could move up to four with some additional staff.Beautiful sight but there
was more to come.  By the end of the day wehad moved all but about twenty
patients including two who weighed morethan 400 lbs and one artificial heart
assist-device patient, which wasthe challenge of the week since the device
itself weighted more than 500lbs.  So imagine hauling this weight three to
four floors down a darkstairwell at 90 plus degrees.  It was a young man's
job and it was done.Let me tell you that the coordination from the patient's
room to thestaging area to the helipad into the helicopter was a work of
artcomposed by many painters.  It truly was a thing of beauty and
ittouched everyone who was there.

By the end of day, HCA had
constructed an extraction plan for the remaining staff.  Helicopter to the
airport, buses to pick up and taketo Lafayette.  Sounds good but there were
lots of needs and who knowswhat the government may decide to
do.

Thursday:  Line up and get ready.  Have a little breakfast.  We
basically were living on Strawberry poptarts, honey oat bars and
fordinner a little protein, tuna fish.  Fortunately, I like all of them
butI'm sure I lost ten lbs. or so.  Anyway, the line was formed and
Ipersonally counted.  700 hundred people. Our staff, physicians,
theirchildren and spouses, and just to top it off 76 dogs and
cats.  HolyGod.  How are we going to deal with that? So we relegated
themimmediately to second-class citizenship to another line and pray we
don't have to put the pets to sleep if no one will haul them.

At
first there were just a few small copters and we had some patients tomove
and it was slow.  Moving through the line people were calm with afew
exceptions but overall they managed their plight well.  Then asituation
developed.  A frantic Medical Director of Critical Care showedup by boat
from Charity.  Major problem.  Charity was in a meltdown.  Hehad 21 critical
care patients many being hand ventilated for two daysand he couldn't get any
help from the state.  You may have heard thisstory reported by CNN.  Their
version and ours differs but raise yourhand if you think the media gets it
right all the time.  Can you help me he asked?  This was a tough question
but it had only one answer.  Wewould give them access to the small aircraft,
which wasn't going to helpus move our staff anyway.  So that process began
much to the chagrin of our non-professional staff and family.  They just
didn't understand it.Our nurses and doctors did but it increased the crowd's
intensity.Midday and it was moving slow.  It didn't look good.  Then from 3
to 5things happened.

A Chinook helicopter is big.  Two rotors and it
carries about 50-60people.  It moves with a slow deliberate confidence that
is hard todescribe.  But one showed up.  We had questioned about could it
land so we asked "the man, John" and he said yes but nothing else could be
onthe pad when it did due to the turbulence.  I want to tell you as
itapproached cheers broke out from below and people thought they had a
chance.  So for a few hours we made progress and then it
stopped.  Nomore big birds, big problem.  What happened?  Don't know.  I
called mydaughter Megan where Donna was stayingand she seemed
elated.  "You're back".  "What?" I asked.  She tells me Gov. Blanco had just
announced that Tulane had totally been evacuated.According to my account she
was about 400 people short in her analysis.But we now had a new
problem.  They think we're not here.  Better let someone know.

I
called the La. Nat'l Guard.  Guess who answered, Brad Smith, thepatient's
father I spoke of earlier.  He had gotten a ride back withsome of the
Wildlife boys and was now flying sorties into New Orleans. He quickly got a
hold of the Office Of Emergency Preparedness and letthem know we still
needed help.  So maybe Friday we'd get out.  Peoplewere remarkably calm when
we told them they'd be there another day.  The just sat down and began to
prepare to go to bed.

We left the hospital and remained in the parking
deck.  One it wascooler, two there would be less confusion in the morning
and three itwas safer since there was less territory for our Tulane Police
to patrol.  I know the media has played up the anarchy, and no doubt
therewas some concern, but I always thought we were safe.

So imagine
trying to fall asleep on your concrete driveway without a pador
pillow.  It's kind of tough.  Then throw in an unexpected helicopter landing
at 1 am.  The wind is a little dicey.  The bird dropped off 50%of the
Marines in New Orleans.  One guy who need to go to Charity so wehad to take
him over.  Next event for the evening: at 4 am we weretreated to a massive
explosion at a warehouse on the river several milesaway.  I happened to be
looking directly at it at the time.  It musthave reached a 1000 ft in the
air.  Then by the end of the evening webegan actually to get cold.  But it
finally ended.

Friday:  The end is pretty anti-climatic.  At 8 o'clock
unexpectedChinooks began showing up taking 60 people at a time.  I wonder if
ourpilot friend in the Guard had anything to do we it but I haven't asked
him yet.  So in a matter of 2 1/2 hrs. everyone was gone but our
Policeand the last remnants of management.  So after attempts to arrange
acoordination with Charity to use the helipad, we left for home
sweethome.

Obviously, this is only phase one of a complicated
recovery for NewOrleans.  Each of you no doubt is praying for this
recovery.  So manypeople have lost so much and it reaches far beyond New
Orleans.

I talked to the Chairman of the Board of HCA yesterday upon
returningand told him it was the worse and most difficult challenge I have
everbeen personally involved with but at the same time I don't think
I'veever felt as great a sense of accomplishment from anything I've
beeninvolved with.  Our staff performed like clockwork and it was
abeautiful thing to observe.  Our success in this week is simply
measuredby the fact that we didn't lose a patient during this trying time.


Jim

P.S. This event is just below a nuclear catastrophe in its
degree ofmagnitude, and it's clear we're not ready and if we don't do better
thenext time a really hard rain's a-gonna fall. more...

physician-desk-reference

Jessica's Well Lives!

They're baaack: Jessica's Well.  It's about time. more...

physician-desk-reference

Eject! Eject! Eject!: TRIBES

If only I could write like this: Eject! Eject! Eject!: TRIBES.

And, yes, I like to think I'm a sheepdog.  Woof. more...

physician-desk-reference

Medical Insight from the Astrodome

via Code: the Web Socket.  Alwin has 5 days of communications from the medical director at the Astrodome, and it's worth reading.  I have no idea why they're out of order.  Maybe that's how he got them.

I predict he'll write a book when this is over, and it will be required reading by everyone in my specialty of Emergency Medicine. more...

physician-desk-reference

The Corpus Callosum: It's GRL Time!

GRL means, in this case. Grand Rounds 50: The Corpus Callosum: It's GRL Time!. more...

physician-desk-reference

USATODAY.com - Reporter's notebook: Treating those left behind

A story I highly recommend: USATODAY.com - Reporter's notebook: Treating those left behind.

He's a reporter now, but his Paramedic backgroud both got the better of him, and provided him with a richer story, and he was able to help. more...

physician-desk-reference

Hurricane Katrina Medical Relief Effort Status Report

FYI:this color is my emphasis.Hurricane Katrina Medical Relief Effort Status ReportSunday, Sept. 4, 2005, 4 pm



Dear Dr. :Katrina Rescue Shelters Increase: Rescue shelters are growing across Texas. Most available space
in Houston and the Dallas-Fort Worth metroplex has been filled. Katrina evacuees
are being sent to rescue shelters in Amarillo, Austin, Corpus Christi, El Paso,
Lubbock, and San Antonio on Sunday. Please check with your local county medical
society (CMS) to volunteer.TMA Working with Louisiana State
Medical Society: TMA has been in contact with the
Louisiana Medical Society (LSMS). TMA sent LSMS our roster of the names and
e-mail addresses of all the physicians who have volunteered to help. Over the
next few weeks LSMS or your local county society may call you. Please stay in
touch with your local CMS as the need for medical services is growing in many
Texas urban areas.Bring Your Medical License: Louisiana Governor Kathleen Blanco has issued an executive order
waiving licensure requirements as long as a physician holds a current valid
license from another state. Read the complete executive order on the TMA Web
site Katrina Relief Resource
Page  If you go to
Louisiana, please bring your medical license, valid photo ID, DEA license, and
prescription pads.  (ed: I would have forgotten the Rx pads).Toll-Free Number for Medicaid
Beneficiaries: The toll-free number (800) 473-2783 has
been set up for health care providers to verify Medicaid and Children's Health
Insurance Program (CHIP) enrollment information and procedures to process
claims.For Current Information Visit the TMA Web Site: The TMA Web site Katrina Relief Resource Center at http://www.texmed.org/Template.aspx?id=4292
is updated daily. Please refer to the
site for up-to-date information on the Hurricane Katrina crisis.


Sincerely,

Robert Gunby,
MDPresidentTexas Medical Association





  more...

physician-desk-reference

Use of Former (“Shuttered”) Hospitals to Expand Surge Capacity

via MedPundit, the Government (Motto: "We're Here to Help") has released some guidance for re-opening shuttered hospitals in the even of a disaster, here.

I spent some time looking these guidelines over, and they look pretty good.  This document also points out an incorrect statement I made recently: actually there are empty hospitals waiting for patients.  Nearly every major city has one or two closed hospitals sitting empty, but they're empty of everything: beds, medicines, but mostly the skilled people who make them run.

The guidance gives several hints for who should staff these places, like DMAT's, which make sense, especially if it's a local DMAT and the credentialling is already in place.  The planners state the best way to handle this would be for the 'surge capacity' hospital to be considered a satellite of an existing hospital, which makes sense from an organizational standpoint. more...

physician-desk-reference

Overlawyered: New Orleans Letter and EMTALA

From Overlawyered:Longtime reader C.G. Moore, a 3L at Tulane Law who lives in St. Tammany
Parish outside New Orleans, writes in to say:
My wife, 4 mo. old son, and I survived [Hurricane Katrina] (we live
in St. Tammany parish, about 10 miles from lake Pontchartrain). I noticed you
had a link to WWL
television's plea for medical personnel to assist the victims. I was in a
unique position during the storm and afterward: my wife is an ER doctor, and we
sheltered at the hospital where she works.

The doctors and nurses were
incredible. They worked non-stop, under incredibly stressful conditions. Many
didn't know where their loved ones were, or whether they had survived, and there
was no way to contact the outside world. Many lost everything to the flood
waters, tornadoes, and fallen trees. And still, they worked 12-hour shifts
(sometimes longer).

But one of the first hurdles they had to contend
with was the effects of EMTALA in a disaster situation. [EMTALA is a federal law under
which hospitals can be sued if they turn away patients needing emergency medical
treatment. -- ed.] Under EMTALA, ER physicians are cautious to the point of
absurdity. But as the hospital quickly filled to capacity with seriously ill and
injured patients, the ER was able to attend to life-or-death situations only.
Strict triage procedures were needed to separate the "worried well" from the
dying. Medical care really was a limited commodity. Although the magnitude of
the catastrophe was clear to all, some patients and their families couldn't
understand that minor boo-boos didn't merit immediate care (much less admission
to the hospital, where it was air-conditioned and they could get a hot meal).


So, my concern is this: once the rubble is cleared and the power
restored, the plaintiffs' lawyers will ooze back into the scene -- that this was
a disaster situation won't matter one iota -- and they'll use EMTALA to file
lawsuit after lawsuit.

I really hope I'm wrong. But only time will tell.I wouldn't bet against it. more...

physician-desk-reference

Tarrant County Medical Society Swings into Action for Katrina

This just in:Message from TCMS President Gary W. Floyd,
MD--------------------------------------------------------------------------------------------------------

Donate Sample Medications for Hurricane Katrina
refugees

Fort Worth, Arlington, Tarrant County and other local
emergency organizations are partnering to provide sheltering assistance to
refugees. Both the City of Fort Worth and Tarrant County have declared a local
state of emergency to allow local authorities to provide any and all assistance
needed.

At this point, several shelters have been established in Tarrant
County and there will be a great need for medications of all kind.

The
Tarrant Count Public Health Department is collecting sample medications to
distribute to refugees.

Physicians' office can drop off sample
medications to:

Tarrant County Public Health Department1101 S. Main
StFort Worth, TX 76104(at the corner of Rosedale & Main)That's a good idea, but will be a drop in the bucket of what's needed.  However, this is probably a very good short-term solution.  Since I work in an ED, I don't have any samples. more...

physician-desk-reference

Tuesday, September 13, 2005

CNN.com - Evacuations resume at flooded hospital - Sep 2, 2005

They're still evacuating hospitals in New Orleans, and many hope to get the staff out today.  I don't know how they'll be able to go back without a massive cleanup operation.   CNN.com - Evacuations resume at flooded hospital - Sep 2, 2005. more...

physician-desk-reference

TMA: No docs being sent into Louisiana

Just got this from the Texas Medical Association This color is my emphasis:Deployment Status:   TMA has not received an
official notice to deploy volunteers to Louisiana. We appreciate your
willingness to help and ask for your patience at this time. If you have
contacted TMA to volunteer, you are in our volunteer database. You will be
contacted as soon as we are notified. (See Next Steps.)

Overwhelming Response:   Wednesday, Aug. 31,
Gov. Rick Perry asked the Texas Medical Association to solicit 200 physician
volunteers to assist Louisiana with their medical needs. As a result of that
request, TMA has received more than 1,500 responses from physicians, residents,
and medical student volunteers. And more calls are coming in by the minute.


Our initial announcement requesting volunteers was stated
exactly as provided to us by the Governor's Division of Emergency Management.
That notice listed only six specific specialties. However, TMA sent a notice to
all specialties in our e-mail database. We anticipated additional skills and
expertise would be needed. The response from our physician members has been
overwhelming and heartwarming. The rescue shelters established in Texas’ major
cities are in desperate need of primary care physicians.

Next Steps:   The State Operations Center has
been told that additional physicians (except for mental health professionals)
are not needed in Louisiana. Hospitals in New Orleans have been evacuated.
Physicians displaced from New Orleans are being dispersed throughout the state
and are helping with immediate relief efforts. State and federal officials will
not deploy any volunteers into Louisiana until your safety can be guaranteed...From what I've seen on TV this makes the most sense: with no infrastructure there's no need to add to the disaster.  Let's evacuate everyone out of the area and fix the problems out of the disaster zone.

more...

physician-desk-reference

New Orleans Patients arrive in Fort Worth

I worked an afternoon shift in my ED today, and the buzz was all about the New Orleans transfers we'd received, and continued to receive.

Our joint got about 12 that I'm aware of, with a very high percentage being dialysis patients and in need of that service.  It was entirely appropriate that they were sent to us, as we're one of a few hospitals in the area with inpatient dialysis services available.  Our nephrologists didn't bat an eye, and worked hard to get them taken care of.

The patients were flown into the JRC Fort Worth (used to be Carswell AFB), and then a team from the county hospital and the county EMS director started divvying them up.

The patients I cared for showed what you'd expect in a debilitated, chronically ill person with no adequate sanitation for 3 days.  All but one showed up with their inpatient hospital chart (in the binder), and one had not just that but prior charts dating back several years!

The staff, who would gripe even if struck with a new stick, were quite remarkably compassionate and there were no harsh statements made about the sending facilities' care.

Another flight was due in this evening, but I left before that batch of patients arrived. 

A moment of levity in all this: one patient, evacuated with just a gown and a chart arrived with a bottle in hand: a bottle of Tabasco sauce.  When asked, yes, it was the patients' just to make sure it was available for meals.

That should prove interesting for the hospital dietitians.

And now: where in the world are all these cities and hospitals going to put these new patients with chronic illnesses?  My place routinely holds admitted patients in the ED hallways.  There are no empty hospitals waiting for new patients. more...

physician-desk-reference

Marooned doctors plead 'Please help us'

This is completely unacceptable, and those responsible need to be dealt with harshly.  And I'm not advocating handcuffs, or jail time.

Dr. McSwain, quoted in the article, is one of the dieties of early trauma research.Unruly crowds disrupt, prevent hospital evacuations

(AP) -- Doctors at two desperately
crippled hospitals in New Orleans called The Associated Press Thursday
morning pleading for rescue, saying they were nearly out of food and
power and had been forced to move patients to higher floors to escape
looters.

"We have been trying to call the mayor's office, we
have been trying to call the governor's office ... we have tried to use
any inside pressure we can. We are turning to you. Please help us,"
said Dr. Norman McSwain, chief of trauma surgery at Charity Hospital,
the largest of two public hospitals.

Charity is across the street
from Tulane University Medical Center, a private facility that has
almost completed evacuating more than 1,000 patients and family
members, he said.

No such public resources are available for
Charity, which has about 250 patients, or University Hospital several
blocks away, which has about 110 patients.

"We need coordinated help from the government," McSwain said.

He described horrific conditions. (Watch a report on the scenes of death and despair on the streets of New Orleans -- 4:36)

"There
is no food in Charity Hospital. They're eating fruit bowl punch and
that's all they've got to eat. There's minimal water," McSwain said.

"Most
of their power is out. Much of the hospital is dark. The ICU (intensive
care unit) is on the 12th floor, so the physicians and nurses are
having to walk up floors to see the patients."


Dr. Lee Hamm,
chairman of medicine at Tulane University, said he took a canoe from
there to the two public hospitals, where he also works, to check
conditions.

"The physicians and nurses are doing an incredible
job, but there are patients laying on stretchers on the floor, the
halls were dark, the stairwells are dark. Of course, there's no
elevators. There's no communication with the outside world," he said.

"We're
afraid that somehow these two hospitals have been left off ... that
somehow somebody has either forgotten it or ignored it or something,
because there is no evidence anything is being done."

Hamm said
there was relief Wednesday as word traveled throughout University
Hospital that the National Guard was coming to evacuate them, but the
rescue never materialized.

"You can imagine how demoralizing that was," he said.

Throughout the entire city, the death, destruction and depravity deepened even as the hurricane waters leveled off.

"Hospitals
are trying to evacuate," said Coast Guard Lt. Cmdr. Cheri Ben-Iesan,
spokesman at the city emergency operations center. "At every one of
them, there are reports that as the helicopters come in people are
shooting at them. There are people just taking pot shots at police and
at helicopters, telling them, 'You better come get my family."'

Richard Zuschlag, president of Acadian Ambulance Service Inc., described the chaos at a suburban hospital.

"We
tried to airlift supplies into Kenner Memorial Hospital late last
evening and were confronted by an unruly crowd with guns, and the
pilots refused to land," he said.

"My medics were crying,
screaming for help. When we tried to land at Kenner, my pilots got
scared because 100 people were on the helipad and some of them had
guns. He was frightened and would not land."

Zuschlag said 65
patients brought to the roof of another city hospital, Touro Infirmary,
for evacuation Wednesday night spent the night there. The hospital's
generator and backup generator had failed, and doctors decided it was
safer to keep everyone on the roof than carry fragile patients back
downstairs.

"The hospital was so hot that with no rain or anything, they were better off in the fresh air on the roof," he said.

When patients have been evacuated, where to take them becomes the next big decision.

"They're
having to make strategic decisions about where to send people literally
in midair," said John Matessino, president of the Louisiana Hospital
Association. "It's a very difficult thing to prioritize when they're
all a priority."

Knox Andress, an emergency nurse who is regional
coordinator for a federal emergency preparedness grant covering the
state, said it's impossible to underestimate the critical role
hospitals are playing for anyone left in the city.

"They're
running out of their medications, they're running out of money. They're
having social issues and where do they go? They go to the hospital. The
hospital is the backbone of the community because the lights are always
on," he said.

When hospitals can't take care of people and the rescuers need rescued, there's no social fabric left, Andress said.

Hospitals weren't the only facilities with troubles.

Louisiana
Lt. Gov. Mitch Landrieu, who has been working with search and rescue,
confirmed that 30 people died at a nursing home in St. Bernard Parish
and 30 others were being evacuated. He did not give any further details.

Copyright 2005 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.





































via FFM, who's been all over the medical aspects (by email). more...

physician-desk-reference

Dr. Charles announces his book

And now, presenting Legends of the Examining Room, a collection of the best writing this little weblog has had to offer over the past year.

Read about
the hidden poetry, the hilarity, and the heroic resilience of ordinary
people as they filter through this otherwise unremarkable examining
room.

I’m writing under the pseudonym Aidan Charles. Both names
have a special significance for me, and were chosen mostly on
sentimental grounds. Now you can call me whatever you like, but I
feared that if I didn’t get myself a first name that I was on the fast
track to a Dr. Phil-style reputation.

... 

I will be donating a percentage of any sales to charities such as Doctors Without Borders. For now, I’m going to give 25% to The Red Cross for their efforts in Hurricane Katrina relief (this is assuming that proceeds total more than a 37 cent stamp).He's selling these through an independent publisher, here:

Legends of the Examining Room

Now, who's doing the book review? more...

physician-desk-reference

New Orleans Satellite Photos

Remember those before and after satellite photos from the tsunami?  Now they're out for New Orleans.

Amazing. more...

physician-desk-reference

Ankle Sprain

My son sprained his ankle a few days ago, and I've been making QOD photos, mostly for my own amusement.  No fracture, and he's doing fine, by the way.

Looking these over it occurs to me that I have several ED visits for concerns about the bruising following sprains.So, without further ado:




Day One.  Lateral ankle swelling (no bruising, trust me).Day Three:






Day Five:






So, bruising happens after ankle sprains.
more...

physician-desk-reference

MedPundit reviews the new Quicken Medical Expense Manager

MedPundit has reviewed a new Quicken program that promises to track your families' medical expenses (including pets).  I got an email about this, but lacked the time and motivation to look into it.

Go read about it and see if you could use it. more...

physician-desk-reference

Minor Tweaking

This evening I tinkered a bit with the font sizes for the blog.  It was displaying oddly in IE (go figure), and this is my try to get the same output in Opera, Firefox and IE.

Please let me know if you find odd behaviors. more...

physician-desk-reference

American Red Cross and You

At the top left is now a link to the American Red Cross homepage, which links to a pretty well done donation page, and what they need is moolah.  The days of donating the blankets and beets from the cellar are long gone, and the Red Cross needs cold hard cash to make things happen.  From watching the news, looks like they're going to need a lot.

This also bears keeping in mind, for those who are a little reluctant to give (via LGF):...there is no connection between the
International Committee of the Red Cross (a Europe-based organization
with an anti-American, anti-Israel agenda) and the American Red Cross,
who support the United States whole-heartedly, and have even withheld
dues from the ICRC, out of disgust at their agenda. Don’t target the
wrong group, just because they have a similar name.Give now, if you at all can.
more...

physician-desk-reference

MedBlogs Grand Rounds 1:49

Here at HealthyConcerns I often feel like a lone voice in the
wilderness, speaking from the non-health care professional's point of
view. But if we are heading more and more in the direction of patients
partnering with their doctors to chart their own care, then partners
need to listen to one another and learn from one another.

With that in mind, I've organized this week's Grand Rounds by how
each set of posts helps people like me understand the health care
system and the people that work in it:It's a good one.

more...

physician-desk-reference

Galen's Log: S.K.A.M. unveiled

Galen's Log: S.K.A.M. unveiled.

It was a busy weekend.  I just arrived at the secret underground base for the quarterly S.K.A.M. meeting (Society for Keeping Americans Medicated), and made it through security clearance, when I caught wind of our latest problem.  Overhearing bits of quiet conversation as I moved towards the Inner Sanctum, I appraised that Kevin Trudeau's new book had made the NYT top seller list, and he had been getting some TV time as well.  Definitely a threat to our organization.



You may not know this, but we in the health profession have had total cures for things like diabetes and hypertension for decades now.  Only by turning them into "Chronic Diseases" have we been able to develop returning "customers", and with them, the financial power base that will lead us to world domination.  After decades, our work was finally bearing fruit.  And yet...Heh.  Galen has a talent for satirical fiction.

more...

physician-desk-reference

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