05.31.09
Judge Sonia Sotomayor: A Great American Story
- Image by Jay Tamboli via Flickr
2009 could possibly be called the year of miracles. First, the election of President Barack Hussein Obama, the Orlando Magic are in the NBA playoffs and now the nomination of Justice Sonia Sotomayor. Somebody quick, hand me another tissue.
The tears of joy that I cry are for all of the pregnant women who step out in faith, not knowing what the future holds for their unborn children. Out of humble wombs emerge some of our greatest gifts and it never ceases to amaze me. As a physician who once lived in a New York City housing project (the same former home of entertainment mogul, Jay-Z) I can attest to the inordinate amount of courage, tenacity and stamina it takes to excel in an Ivy League institution. Thank you Columbia University and BU School of Medicine for believing in me. Sotomayor’s ascent from the South Bronx to Princeton and Yale makes her nomination to the highest court in the land that much sweeter. She will not render justice with an inflated sense of entitlement.
As a public health servant, I have dedicated my professional career caring for the least among us who deserve the most. My patients are from every corner of the globe and while some may be “undocumented,” all are carrying jewels. We thank the mothers of President Obama and Justice Sotomayor for giving us such sacred gifts.
The Latino presence was clearly felt during the 2008 election and as the landscape and demographics of America continues to change, we celebrate its diversity. We are a blended family bound by a desire for the common good of all.
Thank you Justice Souter for holding down the fort. Please enjoy your well deserved retirement. The spirit of Thurgood Marshall can finally rest in peace. Who is Sonia Sotomayor, CNN asks? She’s a Latina from the Bronx who will definitely watch our backs.
![Reblog this post [with Zemanta]](http://img.zemanta.com/reblog_e.png?x-id=dd64543c-f154-4040-870c-46f8860a20e1)
05.24.09
A Gratifying Day
- Image by kevindooley via Flickr
I really didn’t want to go work that day. I was battling the healthcare blues. Nor did I want to see my first patient.
She was big, angry and intimidated the hell out of my staff; and she wasn’t used to being up so early. She eyed me as I walked past the exam room and I had eyed her as well. My staff was considering calling security.
I entered the exam room then calmly sat down; feeling her stares piercing the back of my head. I reviewed her chart. It was complicated. And she was waiting for me to pass judgment so that she could rip me to shreds. But there would be no judgment from me that day. I had seen her anger reflected in the eyes of my own mirror. I knew what it was like to feel her pain.
Her health problems were a mile long; each one compounding the other. And her lifestyle certainly didn’t help. The first order of business was to lower her alarming blood pressure before she ended up having a stroke. She had been given five different medications in the ER; all inappropriate for a pregnant woman. Thankfully she hadn’t taken any. We called the social worker, who came right away and then we began to chisel away at her problems. She had fallen short of life’s expectations and had alienated her family, but this pregnancy had given her the courage to try again. She was not young and neither was her partner. The baby represented their second chance for redemption.
By the end of her visit, I gave her a hug. She clutched her new prescriptions with pride. She entered our clinic as an angry woman but departed with a smile. And I remembered — why I became a physician.
![Reblog this post [with Zemanta]](http://img.zemanta.com/reblog_e.png?x-id=85d3b70b-8c37-4f32-a484-924aef08390d)
A Bumpy Ride
- Image via Wikipedia
Five single-payer protestors arrested. And so it begins. MSNBC’s Ken Strickland reported the arrest of five protesters at a Senate hearing on healthcare reform. Why am I not surprised? It seems the Senate Finance Committee had a roundtable discussion with “experts” but declined to invite physicians or nurses. So, they invited themselves.
25 nurses stood up wearing red shirts with signs taped on their backs that read “Nurses say patients first. Pass single payer.” They stood for five minutes, turned their backs and walked out silently. Message received. However, shortly thereafter, the physicians had another agenda. Someone shouted, “We want guaranteed healthcare. We’re tired of private insurance” leading to their arrests. The chaos reminded me of the refrain from the 1976 movie, Network: “I’m mad as hell; and I’m not going to take it anymore.” Something has to give.
I implore all Americans to beg the following questions: Why does an IUD in Egypt cost $20.00 but the American version $400.00? Retin A cost $10.00 in a Mexican drugstore but $95.00 in a U.S. pharmacy. God bless Wal-Mart for the $4.00 generic drugs. And thank you Publix for your free drugs as well but it’s still not enough although every little bit DOES help.
I’m presently in the midst of a pitched battle with a local hospital who “sold” my bill to a New York City commercial bank with an interest rate of ten percent. I’m determined to pay it in full. They will NOT profit from my pain and suffering.
I encourage all of my colleagues to be relentless and ride this train to the end of the line. If not us, then who? If not now, then when? It’s time for us to take back our profession.
05.11.09
A Healthcare Nightmare
OMG, here we go again. Sam Stein’s article, Obama and Industry Groups to Propose $2 Trillion in Healthcare Savings (The Huffington Post) reflects mendacity at its best. We’ve been sucker-punched before.
Back in 1992, they called it managed care but the only thing managed was corporate profits, to the peril of patient safety. Family practitioners were told that they could keep whatever money they didn’t spend and our healthcare system flat-lined. They stopped ordering tests; stopped referring patients to specialists; and laughed all the way to the bank. But they’re not laughing now. None of us are.
The decision-making authority of physicians is practically gone, never to be seen again. There is no antivirus software available to remedy this dilemma and physicians have no one to blame but ourselves. No other professional can dissect the human body and not commit bodily harm. We’ve invested more than 10,000 hours of professional training in our careers but are afraid to speak with one unified voice.
We’ve been devalued by accepting the term “provider” and an almost 40 percent reduction in reimbursement for services. We are afraid to speak truth to power. The threat of losing hospital privileges, breaking “antitrust” laws and facing insurance disenrollment is just too much for some of us to bear. However, maintaining professional integrity and fighting for our patients takes COURAGE, even in the eye of a storm.
When President Obama made the clarion call for health care reform, I waited for the shoe to drop. And it did, in the form of a bribe. The insurance companies will reduce their costs over the next ten years and save two trillion dollars? Yeah, right.
In the meantime, I’m diving in my bed and pulling the covers over my head. Don’t wake me until this nightmare is over.
05.09.09
Swine Flu and High-Risk Pregnancy: A Precautionary Tale
It seems we’re not completely out of the wood yet. Unfortunately, the second US victim of the H1N1 swine flu virus was a pregnant woman.
Judy Dominguez Trunnell was a 33-yeard old special education teacher from Cameron County, Texas that lies on the US/Mexico border. CDC reports that she was admitted to the hospital at approximately thirty-three weeks because of respiratory problems. Her pregnancy was complicated by asthma, rheumatoid arthritis and psoriasis. She remained in the hospital for two weeks then succumbed to a coma. Although an emergency cesarean section delivered a baby girl, mom died on May 7th leaving behind two daughters and a husband.
Tunnell had a weak immune system making it difficult to fight off infections. Rheumatoid arthritis and psoriasis are autoimmune diseases that attack its own body. Living near the Mexico border and teaching special needs children probably increased her risk of exposure to the H1N1 virus as well. Some necessary precautions are in order:
• Most symptoms of seasonal flu involve fever (90 percent); cough (84 percent) and a sore throat (61 percent). However only one in four people complain of vomiting or diarrhea. Symptoms of vomiting or diarrhea along with fever, sore throat or a cough, requires a trip to a healthcare provider for further investigation that includes obtaining a special swab from your nose.
• CDC reports that the virus spreads not only through the air but also through feces-contaminated hands. Wash your hands; wash your hands; wash your hands; PLEASE – and preferably with an alcohol based gel.
To be forewarned is to be forearmed. I will continue to report updates as they emerge.
A Pop Quiz for Pregnant Moms
In celebration of Mother’s Day, I’d like to share a few pearls from my book, The Smart Mother’s Guide® to a Better Pregnancy. Those who orbit my universe know how impassioned I am about babies. Crazy would probably be a better term. I cringe when a newborn is admitted to the NICU because someone wasn’t paying attention.
The path to a successful delivery becomes much straighter when everyone marches in the same direction. Knowing how to sidestep some of the imperfections of our hospital systems will greatly improve your chances of having a successful delivery.
Please take my Smart Mother’s Guide Quiz© and see how you do:
You are thirty-five weeks pregnant and were admitted to the hospital by your physician for suspected pre-eclampsia or high blood pressure. You were also evaluated by the maternal-fetal medicine specialist, who recommends inducing your labor in the morning after he has obtained your lab results. The next morning your physician’s partner is on call. He examines you and states that he is going to discharge you home because your blood pressure has improved. Is the physician correct?
Answer: No.
The maternal-fetal medicine specialist had ordered lab tests and had recommended an induction of labor. You should request that the on-call physician discuss your case with the maternal-fetal medicine specialist before discharging you since there is a difference of opinion regarding your care. The specialist wanted to induce you for a reason. Sending you home would place both you and your baby in harm’s way.
For more helpful tips regarding pregnancy and delivery, please pick up a copy of the Smart Mother’s Guide® to a Better Pregnancy available at all book stores and Amazon.com.
A healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
Miraculous Babies
As my high school photography teacher, Mr. Bieber would say: A picture is worth a thousand words. Kristy Alley might grace the cover of the May 18th issue of People Magazine but the most poignant photo was on page 79.
Joanne Fowler’s article, When Miracle Babies Grow Up, demonstrates what every obstetrician and neonatologist prays for: a successful life for a premature baby, despite it stormy beginning. The smiling faces and incredible stories of April Palo, Charlie Debeck, Alicia Shuman, Jonathan Engholm, Katie Kenefick, and Chris Cremons rekindled my diminishing love for medicine.
All six of these amazing men and women are now college students with academic achievements. They were all born before 27 weeks, weighed no more than two pounds and as Fowler aptly describes, were “no longer than a dollar bill.” April was the most premature baby born at 23 weeks and weighed 1b. 8 ounces. The statistics regarding preterm outcomes are usually dismal, but not so at Children’s Hospital of Minnesota-Minneapolis. A dedicated medical servant and neonatologist, Dr. Ronald Hoekstra proved fate wrong. According to Fowler, nearly 90 percent of Dr. Hoekstra’s patients born with extreme prematurity finished high school and approximately 60 percent have gone to college. What a sigh of relief.
In my book, The Smart Mother’s Guide to a Better Pregnancy, there is a section entitled Preserving Your Miracle which encourages readers to view their pregnancies as miraculous as opposed to the mundane. Everyone is born with a gift according to the world of Dr. Galloway. The parents of these talented six never gave up nor wavered in their faith and emphasized an attitude of gratitude.
“I survived against terrific odds,” says Charlie Debeck, a college senior, rock climber and possible future senator.
You certainly did, young man. You certainly did.
05.07.09
Kudos for Senator John Kerry
The comments regarding Jacob Goldstein’s Health Blog in the Wall Street Journal made me want to run for cover. His article, Health Insurance May Stop Charging Women More Money evoked the haters on the Right to come out in full force. Goldstein discussed Senator John Kerry’s proposed new legislature, The Women’s Insurance Fairness Act. This legislation would effectively end higher insurance premiums for women, deny gender discrimination and require maternity coverage. Imagine that. I’ll refrain from my usual diatribes about the evils of insurance companies. I’d like to give my hypertension a rest.
Gender discrimination is a life-long battle and affects every aspect of our society. I had to ultimately “fire” my dry cleaner, (although he performed excellent work) because of his inequitable pricing practices. My husband’s shirts cost $1.29 to be cleaned, my blouses were $3.50. His suits were $8.50; mine $12.50. Every time I questioned the discrepancy, he’d give me a litany of incoherent excuses that made absolutely no sense.
According to actuarial tables, women outlive men by a factor of seven years, but does that justify charging us higher premiums? Oh, excuse me. We get pregnant — as if that’s a crime. Does the testosterone-dominated crowd over at WSJ realize that every living species on this planet enters life through the uterus of a woman? In the world of my youth, when a man or a corporate entity exploited a woman financially they were commonly called in the language of street vernacular . . . a pimp.
The insurers’ acknowledgment of a disparity against women gives me a glimmer a hope despite their attempt to arm-wrestle the government from providing Universal Health Insurance. Kudos to Senator Kerry for writing this outstanding bill. Healthcare reform may not arrive in the morning but at least we’re taking small steps in the right direction.
05.04.09
A Mother’s Decision
Just when I think I’ve heard and seen it all, something pops up that proves me wrong. Both Amy Gates” article, Home birth advocate’s baby dies during free birth: Do you blame or show compassion? And Cate Nelson’s Unassisted childbirth one woman’s story, gave me reason to pause. Both journalists discuss the March 27th death of Janet Fraser’s infant daughter and the controversy regarding unassisted childbirth.
Fraser is an Australian advocate of the unassisted childbirth movement that encourages pregnant women to deliver babies alone without the benefit of a midwife, a doctor, or a hospital. She used phrases such as “birth rape” to describe a delivery assisted by a healthcare provider. Please. As a descendent of a slave midwife and an obstetrician I am highly offended. Birthing is in my genes. There is nothing more satisfying than assisting in the delivery of a healthy and crying baby be it by midwife or physician. Heck, even a cow gets a c/section when necessary.
Cate’s article described a woman who had an “orgasmic” unassisted delivery during the birth of her daughter and then made frozen smoothies out of the placenta that she ate for the next thirty days. A placenta smoothie?
A reality check is in order. Forty percent of women died in childbirth during the 19th century but less than one percent, or 520 women today; and even those deaths are preventable. Do we really want to proceed in reverse? Perhaps members of the “unassisted” crowd would like to trade places with women in Sierra Leone and Afghanistan, who have the world’s highest number of childbirth deaths.
We need our babies born healthy and alive. All of them, without exception. The adverse outcome of the Fraser’s “unassisted” delivery speaks for itself. Here’s hoping she’ll never experience it again.
05.01.09
The Ultimate Betrayal
On rare occasion an anomaly emerges from within my profession that makes me cringe with shame. Such is the case of Philip Markoff, a former medical student who attended my alma mater.
Craigslist is not part of my vocabulary nor on my immediate agenda. However, when I discovered that Markoff was a BU med student, I almost passed out in shock. My first concern was that his association would not tarnish the school’s reputation. My fellow alumni have a unique reputation of becoming “the first” with their achievements.
Dr. Louis Sullivan was BU’s first Secretary of Health; Dr. Charles Eastman was the first Native American physician from the Lakota tribe at Wounded Knee; and BU was the first to train female physicians at a time when it was not politically correct. The fact that Markoff allegedly meandered all over Boston and Rhode Island preying on unsuspecting women is an outrage of the highest order.
Julissa Brisman is a martyr and may she rest in eternal peace. Had her horrendous murder not come to light, Markoff might have slipped under the radar screen with a medical degree empowering him to create greater havoc. An alleged healer by day. A predator by night. The ultimate betrayal to unsuspecting patients.
No one can predict the final outcome of Markoff’s fate. He will certainly “lawyer up” with the best possible defense team that money can buy. Convicting a member of the upper echelon can be extremely tricky business. However, here’s one comforting thought that gives me profound relief: they will never call him “doctor” nor will he grace the sacred halls of Boston University again.
