Only a Few Understand (The Way It Should Be)

This is an eloquent post by an ED physician about what sorts of things go on behind those automatic doors at your local ED. This real and too few understand and it is good that only a few do. Still, think about your local emergency personnel, whether police, EMT's or the docs in the ED. Most ugly things in our country are quickly cleaned up and moved to their appropriate places. As a result, people here are more separated from death and sadness than ever before, waiting until it strikes personally before ever having to deal with it. I am not sure this is good although I am not advocating for leaving more trauma on the roadside. Still, worth a moment to read about it...

My Friend George, the Crazy Farmer on Vashon!

George Page and I met in the early 1990's while we were both pursuing degrees at the University of Washington. Physics seemed to fit us both for various reasons and we thought the high-tech mathematics was where our futures lay. We were both wrong. Lately, he has had a couple articles (one here, and another here) written in the Seattle Times about him and his farm on Vashon Island. These are in addition to multiple blog entries and personal columns about the farm. (you will find links to several buried in this article) What is fun, is how I remember him getting to this place...

George took a more direct path to his ultimate destination, mine was a little more varied, although we both made some similiar detours. George started a high-tech job after school with a company in Redmond, InControl, that patented a number of cardiac defibrillator technology. This startup was getting into the new field of implantable medical devices that convert atrial fibrillation (heart attacks) back into a normal heart rhythm. The company was eventually purchased by Guidant and for all I know they are owned by someone else now. George and I lived together at the time and I remember his struggles working in that cubicle.

The day George bought a used toaster oven for his cubicle, I laughed but was not too surprised. He was spending larger and larger portions of his daily break and lunch schedule baking French cookies for his co-workers! His evenings were consumed with recipes, shopping and the concept of raising food in a traditional manner, from "dirt to the table" as he used to say. I still remember the day he brought home his first chicken! We struggled with a library book and a sharp knife months later trying to understand exactly how you killed and dressed a chicken. It was not a pretty site. George still makes fun of me for exemplifying the state of American's and their understanding of their food supply that night. After much struggle and effort, we finally had a chicken, without a head, plucked and laying on a cutting board. I made the absurd comment, "There, now that is starting to look like a chicken!" I was immediately aware of what I just said and we laughed for a long time after.

Soon, George was taking weekend flight to France to go shopping and learn more about traditional cuisine. He soon became aware of the fact that the ingredients produced by the commercial food industry in the US were pretty substandard and he imagined a return to raising food in a more traditional manner. It was my impression, it was first his interest in cuisine and desire for quality ingredients that led him to the path he is on now, sustainable farming using nothing but the soil, sun, water and the plants and animals that are fed by it.

George was always a voracious reader and as he absorbed every resource he could find on the subject of food, cuisine and farming he soon saw the close connection between food and health. The health of those eating the food, the health of the animals being raised and the health of the environment we all live in. His farming ideas continued to grow and during this time he met his future wife, Kristin. Her family lived on Vashon and after they were married they found a cute little house with some land and they decided to start a home. Well, George had a LOT of strong ideas of what he wanted to do and Kristin was patient. The place looked like a hurricane had hit it at first. One of the more memorable memories was when George used his used BMW to transport goats! (He argued that the leather seats made them easy to clean!) George started so many projects, experimented with different farming techniques and the entire idea of home, farm and family were nearly consumed in his unbelievable enthusiasm for it all. Eventually, he found systems that worked, convinced Kristin he was not insane (although I am not sure we believe it yet) and the farm steadily grew, as did the family.

Now George & Kristin have a beautiful daughter, Adela, and a farm with full time employees and interns, commercial kitchen, a winery and they sell at most of the major farmer's markets in Seattle as well as supplying some of the most prestigious restaurants in the city. He focuses mainly on meat, dairy (cheese!) and wine these days and leaves the vegetables to many of the other fabulous farms in the area.

Although George and I rarely see one another these days, even though we are only miles apart, I still consider him a close friend and we still have occasional hour long phone conversations about the challenges we each face. Him with family and farm, me with my choice of medicine as a career. We are both too busy to include much more than the few things that we are passionate about, but I think we are both happy. Maybe not all the time, frustration and fatigue takes its toll, but I would believe we both feel we are living a satisfying and important life, and no one said it would be easy. Check out George, Kristin & Adela's farm, Seabreeze Farm and if you happen to see a stand at the local Farmer's Market, be sure to get some eggs. Yeah, they are expensive, but it just feels good eating, not to mention the taste of those golden orange yolks!

A Student's Glimpse of PTSD and My Father

I was talking to my dad (a Vietnam vet) about a patient I saw recently at a local VA Hospital with PTSD. I was hoping to learn more about this patient and my father through our discussions (anonymously, of course). This young man was in the marines assigned to a special ops unit and had just returned from his third tour in Iraq. His PTSD was so severe that his wife had taken their children and left because she was frightened, angry and confused by him. He had checked himself into the inpatient ward at the VA because he was concerned about his actions and state of mind. I was doing a psych interview as a medical student and this was my first encounter with an acute, severe PTSD patient.

I am a 6'1" tall, 210lb and I have to admit that I have never really had too many moments when I have been truly concerned for MY safety with patients. What struck me was that during my interview with this patient I caught myself looking at his arms and sizing him up. I wondered where his weak spots might be. I was ruminating on the fact that this guy was trained in hand to hand combat (and had used it in real life) and I seriously wondered about whether or not I could take him down if he became suddenly violent. I was very surprised when I caught myself thinking this.

I was an EMT before medical school and have spent several nights working in a county ED. I have seen drunk, belligerent, drugged out patients from time to time and I have occasionally needed to restrain them, but I was never honestly ever worried about my safety. This time, it really entered my mind. I knew I was safe and although this guy was tweaking out, I did not think he would hurt me, but the thought entered my mind. It was sad and frightening at the same time when I learned about how many firearms he owns and how short a fuse he seemed to have. His flashbacks lasted for up to two hours at a time and he does not remember much at all during them.

I talked to my dad about this in hopes of understanding both of them a little better. My dad also suffers from PTSD and he has never really talked about Vietnam except on brief occasions. I don’t know how many vets his views may represent, but I liked his response to my email. I mentioned the patient with PTSD and how I saw his life turning out given the resources available to him and what some of my concerns were for his health and those around him. It was heartbreaking and frightening at the same time. This was the response my dad emailed me about what he thought was going on in this vet's head.

"The public, whether they support the current government or not, always count the casualties of war as the dead..... 58,000 in Vietnam, and the dead are to be honored. They were Americans, and whether they loved the current President and policy or not, he is the commander in chief. This is an important part of the separation of powers in government. When push comes to shove, the constitution allows a short cut. The president is the commander in chief of all military forces and can send them to war as he sees fit. And I think this is a prudent part of our constitution, even given that our current president has lost all touch with reality....... I used to say that the U.S. would be lucky to survive GWB, but now I am convinced that the world will be lucky to survive him.....

Anyway, that is politics, and not what I intended to write about.The real cost of war is those that survive. Those trained, exposed and then discharged with no help what so ever. The dead are to be honored; they did as they were ordered. The survivors, nearly to the last man, wish that they had not. It would have been so much easier and would have caused much less trouble to those that cared for them.

What your Marine probably feels is guilt. Guilt that he is alive, that he did not die with his comrades or just for the coffee he has in the morning. He sees the horrific harm that he has caused and all of his buddies that did not make it and at the end of the day realizes that it was all in vain. It was different in WWII. There were clear objectives, although there were thousands that came home with "battle fatigue" and got no treatment. One Pvt, Eddie Slovak, was even executed for trying to get out. (read more about Eddie Slovak here)

There is nothing that you can do for him except render him as harmless as non-invasive methods can. Medicate him to relieve the over whelming guilt and pain he feels, make him as comfortable and productive as he can be. Help him find employment at the local VA facility or elsewhere. Do not feel guilty if he just decides to die.

I slept with a loaded side arm for almost three years. It never gets better but the very, very lucky ones finally find a life that they can live with.......

Do not fear the Marine. He would never hurt you. He understands that you are the only small link he has between insanity and sanity. He may harm himself but rarely would he harm others."

What If There Was No 911!?

This is a pretty dramatic, but an important story that appeared recently in Newsweek. This is not a magazine I read, but the story has popped up on a number of EM blog sites. I read through it and it really tries to give you a realistic idea of what happens every day in our nation's level 1 trauma centers. We are overcrowded, underfunded and many are about to collapse. This is simply the case in the normal day to day. Now, add a single large national disaster to the story and it is immediately obvious this is not going to continue as a functional model. This article highlights national problems but also brings my thoughts closer to home regarding some more specific challenges we face here in the Pacific Northwest with regards to EM.

Washington state is famous for having only a single level 1 trauma center to serve the ENTIRE STATE! (It is also interesting to note that we do NOT meet national criteria to be a level 1 trauma center and that our state has developed it's OWN criteria to assign this important designation.) Here you can see a list from the American College of Surgeons that is responsible for the national trauma center accreditations and note there are NO Washington state hospitals on this list! Here you can find a PDF document that describes the national criteria for trauma center designations)

Emergency Medicine has a long history in the Pacific Northwest. Much of it is something to be proud of and lately it seems mostly tainted with the stench of politics. What happened to the strong, insightful visionary leadership that led the nation in emergency care in the 1970's? It may still be here, but it refuses to evolve in many ways. This article in Newsweek should make us look at the national issues facing Emergency Medicine in general and more closely think about the specific local issues here in the Pacific Northwest regarding our access, as a population, to emergency care when we will need it most. If you would like details, here is a copy of our Regional Trauma Plan.

Get "The Club" for only $20

I have told a number friends that you can get "The Club" for only $20 through a Seattle Neighborhood group. Here is the link to a PDF order form! The limit is two per household and you need to be in a Seattle zip code for this offer! A WAY better deal than my $62 retail version that says "The Club" on it! They also offer a SUV version for $25!

http://www.sngi.org/theclub.html

They Found My Subaru!

My car was found only 12 blocks from my house, but according to trip meter it had been driven over 200 miles!

Evidently, the person stealing the Subarus in the Ballard area is really good, but the cops think they know who it is. Th officer that found my car knew that this person is dumping Subarus in the area, so he runs the plates on every Subaru he sees, and sure enough, he ran plates on blue wagon the other day. They came up as being from a different car reported stolen, so he ran my VIN number and they contacted me.

When I arrived I was not sure it was my car. None of my stickers were on it, and they had put new stickers on it. The bike rack was gone and it looked like any other generic Subaru in the city. It was FULL of weird stuff, mostly stolen and from other cars that had been stolen. Things like 2 small spools of stainless steel cable, art supplies and a large art portfolio, stuffed animals, a rock collection, food containers and even a US Army Survival Manual. There were plates from other stolen cars and tools as well. They had not damaged a thing on my car, for the most part.

From what we could tell, this person can start these cars without damaging the locks. I think I figured it out though. I noticed some wires under the dash looked odd, and I noticed the wireless receiver box for the keyless entry system was not in its normal place. Upon inspection, I noted that there were several wire ports on this box for what look like different options you can get from the dealer. One is the door lock motor, but one is the starter! I checked, and some Subaru models have a "remote starter" option for cold winters. It appears they found a way to bypass this and start the car. Then they crank on the steering wheel hard enough to bust the steering lock and away they go!

I am now the proud owner of a new club, and after 2 hours of detailing the car looks good and is back at my house. I had to buy new plates, but that was only $40 and the Club was about $60. Along with incidental expenses and the things in the car the stole, like snowshoes, my bike rack and a rain shell, I lost about $700 on the deal, but that is not as bad as it could have been!

THE NIGHT I GOT MY CAR BACK I woke at 3:18am. Some noise had woken me, but I was not sure what it was. Something felt weird about it and then I heard a car start up. Perhaps from having my car stolen I was just edgy. I ran to the window and saw someone race off around in a corner in a car from across the street. They were driving erratically and the hazards lights were flashing. I have worked night shifts before, and no one is in that kind of hurry at 3:18am, even if they have a night job. I called 911 and told them I had just seen what I thought was another auto theft. They asked me how long ago and I said, "Oh, about 20 seconds."

I think it is time we start calling my neighborhood "Bad Ballard".