End Of Life

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She was an active patient, who I am still trying to see once a week until I direct her in how to survive and flourish in the universe. She was in her forties, depressed and anxious.  She had “a little panic attack,” some chest pain and the feeling her breath was cut off. I wasted no time sending her to an Emergency Room, (or, if she really did not feel it was that bad, to an Urgent Care — what we used to call it a “doc in a box”) because it is cheaper, sounds less foreboding, and any doctor who is sentient and has a pulse and is on duty would send her to an Emergency Room if anything was really wrong.

Chest pain or tightness or shortness of breath or a “tight feeling, like a vice” could always be a heart problem, and could always be life threatening until proven otherwise.  I tend to send  even the most mild discomforts of this nature, that people had for years to primary physicians for a “cardiocentric examination.”  For “auscultation,” the old fashioned Latin-origin word for a good listening to the well as generally an electrocardiogram and sometimes even an echocardiogram.

Read more on Don’t Ignore Chest Pain…

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I think I was in my teens when I heard the playwright Edward Albee interviewed.  It was one of those interviews that sears your soul and that you remember over 40 years later. He said something about people who get older, like when their children who are adults and start having families of their own.  They all ask themselves the same question, which is “Did I do it right?” — meaning “Life” definitely with a capital “L.”

Read more on Don’t Live A Life Of Regrets…

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Fifteen years after.  That means there are sentient, living teenagers who are (I hope) somewhere in school learning about this devastating event in some kind of secondary school curriculum, or perhaps witnessing public patriotic events. — But they don’t remember it, because they weren’t born yet.

Read more on 9-11 15th Anniversary…

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People are not wired the same.

Individual differences are the spice of life and medicine.  I love people, their verbal discourses, because they are so delightfully individual.

To me, the biggest problem with medicine is something I actually never heard anybody else discuss.  I call it “norming.”

Maybe there is no other way to get started on developing a new treatment that could help many people who have similar afflictions.

But people are so different that what is life-saving for one may be poison for another. Read more on Dangers of Energy Drinks…

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I don’t think we plan what our real specialties are going to be.

I frequently tell patients I am an expert on getting through menopause now that I have been able to come through my own relatively unscathed.

I became somewhat of an expert on Asperger’s because I diagnosed many elements of it in my father and just about all criteria in my brother.

They both carried additional diagnoses of bipolar (a.k.a. ‘manic-depressive’) illness.  Neither one was in any way typical.

Both surely had their problems in life.  My father was assisted considerably by his domineering mother who gave him lots — I mean lots — of direction.  She even helped him choose a wife — my mother — who took care of the things in life that were difficult or even impossible for him. Read more on From Sandy Hook to Santa Barbara — Asperger’s Syndrome And Violence…

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Okay, let me get this straight —

Medical care costs are over $7,000 a year for seniors who keep on living, and over $37,000 a year for seniors in their last year of life.

That study was done nearly 20 years ago – so adjusted for inflation, that comes to: Read more on To Die Or Not To Die…

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Some of my friends like to watch cop shows — the ones called “Police Procedurals.”  They think it is exciting to see how crimes are solved and how police interact with puzzling situations. I’ve had my encounters with the police, too.  Sometimes they are very supportive when dealing with mental patients.  Sometimes they make things worse.  I’m pleased to say that many communities now have special personnel trained in handling mental health calls, and they coordinate with caregivers well — and treat the patients with understanding and a sincere desire to help. I was called in by a therapist when a patient was chronically suicidal. The therapist had to commit the patient to a mental institution and called the police to assist. I am thankful that she also called me to try to get the patient to go along involuntarily.  When confronted by a uniformed police officer, and looking at an ambulance or police car, a patient sometimes panics. Here is what I said: Read more on The Speech That Made a Cop Cry, And A Therapist Stand by Speechless…

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I have spent as little time as possible on the staff of hospitals.  The interface between doctors and administrators has always seemed to be dominated by petty politics.  People are interested in money, and secondary to that, some vague sort of reputation or power.

A large and prestigious Midwestern hospital used to have a certain kind of meeting every few months.  This hospital had only the vaguest of University associations — just enough to make it look academic and research oriented.  I knew perfectly well it was neither.

It was a luncheon meeting of the medical staff and a few administrative types — uncommonly well-catered. There were about 25 folks, but only two other women who looked as uncomfortable as I was.

The meeting was to discuss certain hospital statistics, including some case details.  As the meeting agenda was passed around, the head of the hospital reminded us of the meeting “rules.”  We were gently reminded that no recordings were permitted and neither were extraneous notes.  We each received an agenda, which were carefully counted out as they were distributed.  We were told that at the end of the meeting they would be collected — and counted — before any of us could leave. Read more on Hospital Accountability Is An Ideal (Not Always Reality)…

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Recently, a patient’s widow called to cancel a routine assessment because the patient suddenly died. There had been no freak heart attack and it had not been one of those undiagnosed cancers.  He just “died, suddenly, in his sleep, I guess,” she said. That got me thinking.

The first class of drugs I think about, when I think of sudden death, are the stimulants.  I remember when someone decided that everyone who was going to get stimulants needed to have a “cardiocentric” examination first.  Doctors asked a lot of questions about chest pain, and administered an electrocardiogram.  These precautions were especially interesting because they were – of course – used before prescribing Ritalin. Many child psychiatrists had laughed at me when I cautioned usage of this job, claiming it was the safest medication ever invented. Once – at the peak of my massive weight — an endocrinologist offered me a prescription of Meridia, to get rid of my excess weight.  He did not think the fact that there had been a “few” reports of sudden death should get in the way of my using it. Read more on Sudden Death in Psych Patients — From Medicine…

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“Old Marley was as dead as a doornail.”

— A Christmas Carol (1843)

Thank you, Charles Dickens, for creating such a wonderful, enduring story, and such an apt simile.  If you hadn’t heard it before, that’s probably because it is usually omitted from the children’s versions of the oft-told (and filmed and broadcast) tale.  With everyone from Michael Caine to (my favorite) Mr. Magoo starring as the wickedest man who ever snorted “Bah Humbug!” and was converted to the most ardent celebrant of Christmas by the end of the story.

A wonderful, happy story — and it deserves to live forever.  But death is not terribly suitable material with which to start a children’s story.

Young women (and men) — some no older than children and many who could be termed “recent children” — were ardent fans of singer Amy Winehouse — who is now “dead as a doornail.” Read more on Amy Winehouse Proved Drugs Aren’t Glamorous…