INTERESTING TIMES

I read this morning about a doctor who went mad and shot people in a hospital. As a doctor myself, I know that docs have terrible stresses trying to deal with a corrupt medical-industrial system that impairs our ability to help people regain their health. Then I went to look at the NY times article, here: https://www.nytimes.com/2017/06/30/nyregion/bronx-hospital-shooting.html. He's richly melanated, that is to say, he has lived a life of fear because of his skin color. I infer from his violence that he may have been guilty of the accusation--sexual misconduct. He was a man, and he was angry enough to shoot others and hopeless enough to set himself on fire and shoot himself. He did not see any way out. He knew he would not receive compassion.

What people forget when they demonize any group of humans is that they are human. Dark skinned people. Doctors. Men. Gun owners. Murderers. Whatever group. All humans share the same basic needs. When those needs are not met, we have the same basic emotions. Driven hard enough, any of us could become dangerous. Hitler had reasons. The Arabs that flew airplanes into buildings had reasons. No one is pure evil, we are simply human and if tortured we can lash out, or become cunning.

My hope that that everyone who reads this will take a deep breath or three and think about the kind of pain that drives a person to such horrors. My hope is that compassion will rise in spite of the poisonous atmosphere of shame and blame that dominates our political world. We all deserve an opportunity to be free from fear, long enough to find our centers and our hearts and reach out into the world from that place. It will take a lot of us finding compassion to heal these wounds.

Do you have any thoughts, opinions, experience?? Please tell me. What did you have done? What helped? What didn't?

We all know that the hospital is the last place you want to go, unless you really desperately need to be there. That's where the gnarly infections live.

Healthgrades compared mortality data from hospitals across the US and rated them all. I'm pleased to say that Memorial in Chattanooga, TN, made the list, as well as the Mayo clinic hospital in Phoenix, AZ. The Great Lakes region has a top 50 hospital in every state. Ohio and Florida had the most top hospitals (per state). Not a single OR, WV or NY (et. al.) hospital made the list.

According to Atul Gawande there are 90,000 new ICU admissions per day in the US. Here's more of what he says:

This is the reality of intensive care: at any point, we are as apt to harm as we are to heal. Line infections are so common that they are considered a routine complication. ICUs put five million lines into patients each year, and national statistics show that after ten days 4 percent of those lines become infected. Line infections occur in eighty thousand people a year in the United States and are fatal between 5 and 28 percent of the time, depending on how sick one is at the start. Those who survive line infections spend on average a week longer in intensive care. And this is just one of many risks. After ten days with a urinary catheter, 4 percent of American ICU patients develop a bladder infection. After ten days on a ventilator, 6 percent develop bacterial pneumonia, resulting in death 40 to 45 percent of the time. All in all, about half of ICU patients end up experiencing a serious complication, and once that occurs the chances of survival drop sharply.
--Atul Gawande in The Checklist Manifesto p28.

You've heard about antibiotic resistant staph infections. In Flagstaff they had several deaths in the hospital from so-called "flesh eating bacteria", but the media was muted about it. Nobody wants to know. I'm sure it happens a lot more than anyone really knows. Even the doctors don't want to think about it.

ACINETOBACTER BAUMANII
Acinetobacter baumanii is a gram negative rod that is a strict aerobe, non-motile and grows in reddish purple colonies. It is found everywhere in the soil, food, and water, and is normal flora of humans with 25% of people having it on their skin, and 75% of people have it on their pharynx. Because it lives on us all the time, it is subjected to all the antibiotics that people take, and so it has evolved to be highly antibiotic resistant. The only antibiotics that work at all against this bug have side effects like nausea/vomiting, siezures, and other toxicity. Soldiers who spend time in Iraqi hospitals often come home infected with it. It causes suppurative infections in any organ. The cost of war just got higher. Now we have this bug in our hospital systems, and it is gaining prevalence as a nosocomial infection. It most frequently causes pneumonia, but also infects the brains, eyes, hearts, bones and joints, blood, the pancreas, liver and urinary tract. You don't want it. Luckily, if you are healthy, it won't get you. You live in equilibrium with it. But if you are ever stretched to your last stand in a hospital, it may be something like this that finishes you off.

PSEUDOMONAS AERUGINOSA
A better known nosocomial infection is Pseudomonas aeruginosa. It is also a gram negative rod but is limited to where it can colonize because it is an obligate aerobe. So it only grows on surfaces where it has a good air supply, such as the insides of the lungs, or in burns. It also likes the respiratory mucus of cystic fibrosis patients. It grows into a thick "slime" which is actually a colony of bacteria that begins to function like a tissue. The outer layers that protect the inside from antibiotics or immune agents. The cells of the tissue signal each other, and when P. aeruginosa reaches a QUORUM it begins to turn on the genes that make it lethal. It produces a range of enzymes to digest tissues (known as invasins) and a couple of exotoxins that impair the host's ability to make proteins (exotox A) and cause part of the host's immune system to self destruct (the T cells are rapidly activated and apoptosis induced by exoenzyme S). If you grow the slime on an agar plate it looks blue-green and swells sweet, grapey by some reports. Don't let the sweet smell lull you.

Luckily for most of us, the slime never gets started good enough to slam us with its full power. Our immune systems and functioning respiratory cilia get that shit out. But if you're sick, and you go to the hospital, you don't want to know what I'm about to tell you. P. aeruginosa is the #2 cause of nosocomial pneumonia, osteochondritis and surgical site infections. It's the #3 cause of nosocomial UTI's. The #6 cause of nosocomial blood sepsis. It's the #1 cause of pneumonia in ICU patients, and is the most common cause of death among patients with cystic fibrosis. Once it reaches a quorum it is rapidly fatal. I have no idea if there are any antibiotics left that can kill it. And here's the topper. It lives in hot tubs and swimming pools. Don't let your immune system get beat down too far. These bugs are frightening.

So much has been happening lately that I can't even come close to keeping up with my journal. This weekend I'm attending a conference at NCNM on "Transforming the Mind" and the presentations today were fascinating. I think the most interesting one for me was this wild mathematician guy who has decided to represent aspects of dynamic living systems in three dimensional moving lines as drawn by his computer. But I don't want to write about this too much now. There will be more of this conference, and I'll have more insight after I finish the whole thing.
( long and rambling, about movies, studying, Governor Kitzhauber's talk on the future of healthcare and the Archimides Movement, and a couple of vocabulary words (grok and transmogrify) )