Sybil's death

Being a few days after the showing of Downton Abby season 3 episode 4, I hope I'm not spoiling it for anyone.  However, consider yourself warned that this could be a spoiler for someone living completely under a rock, or maybe in 3rd year or residency or some other all life-consuming activity.

Sybil's death brought with it a flood of emotion for me.  I always find myself crying when a character dies regardless of the medium.  This dates all the way back to my obsession with "doom and gloom" and reading Luriene McDaniel books in middle school.  I still love books that make me cry and I often find myself crying in movie theaters (though airplanes are the only movie theaters I have time for now a days) so it comes as no surprise that tears flowed as Sybil died. 

The flood of emotion though was because of HOW Sybil died- in childbirth, from eclampsia.  While skewed in accuracy, especially with modern monitoring and treatments for pre-eclampsia and eclampsia, is still brings light to the gravity of birth.  Evolutionary pregnancy and birth have to happen for us to continue and so it does, but it does with great risk.  According to the CDC, "at the beginning of the 20th century, for every 1000 live births, six to nine women in the United States died of pregnancy-related complications".  Reported rates in Brittan were closer to 40 in a 1000 births.  Today, the rate is closer to 12.6 per 100,000 births in the United States, putting us at a rank of 21st in maternal mortality.  21st!!!  That's pretty shitty.  The rate is even more horrific in other parts of the world, and often from preventable and/or treatable causes.  We need to do better.

I believe the episode also brought to light the fact that practicing medicine is an art and not a science.  It requires knowing your patients and trusting your instincts.  Doctors are human and make mistakes.  Communication between doctors, patients, and families is key.  So are medical surrogates, medical power of attorney, and living wills.  If you don't already have one, take this as a sign to make one!  Have conversations with your loved ones about what you might want/not want to happen to you if you are ever in a situation where you can't decide for yourself.  Talk about organ donation. 

I know, I know.  It's only a television show.  Maybe I'm reading too much into the plot, or transposing too much of my daily life into it.  Oh well, so be it. 

Also, before anyone starts blaming western medicine on the risks of childbirth (I too have seen Business of Being Born), that is not what I'm implying.  To say this again: birth more often than not is VERY safe and does not require much, if any, medical intervention.  But, when things go wrong, they tend to go wrong fast and can have dire consequences.  Even during my 3rd year clerkship I saw both the beauty of birth and the devastation from horrible unexpected tragedy.  I try to focus on the beautify and fragility of human life in this amazing feat of the body; humbly remembering that I cannot always be in control of, or know what to expect from, every situation.

The revolution will not be televised

I'm beyond frustrated with politics in our country. While we are a very diverse country with very diverse views/morals/ethics, violence is NEVER the answer. Hopefully we can all agree on this. Hopefully we can use the tragedy that happened yesterday as a spring-board for anti-violence campaigns. Rather than simply saying "it's a pity" and then returning to our normally scheduled lives, let us not stand idly by in the face of the unacceptable. Let us teach our children about the power of hate and evil speak, and then through our own actions we can teach them that they too have the power to stand up against this type of behavior.

What I'm currently fixated on though is the House's desire to repeal the health care reform bill. How is this productive? Effective? Are we seriously going to waste time tying up the legislator with silly political games instead of getting shit done? Oh, and waste tax payer's money in the process too. It is not like the repeal will get by the Senate, or even if it does, that Obama will approve it. Fine, I admit, I'm a STRONG believer in health care reform. I DO believe that health care is a right (not a privilege) and that our pre-reform system of health care was on a crash course towards crashing. Not only was it doomed to eventually fail, it was accelerating on it's trajectory in the process. Way too much of our GDP was going towards health care and the money being spent did not reflect the quality of care being offered. Why do we spend far more than any other developed country and yet have some of the worse health care available? So yes, I will not deny that I am biased and I am pro-health care reform.

In short, I'm angry. I want to know what I, as a medical student and as a concerned citizen of The United States of America, can do to take a stand? How can I do my part to make people realize how important health care reform really is? What kind of national movement can I, along with other concerned citizens, start to ensure that our voices are collectively heard? That we want politicians to stop playing childish games and start actually fixing the problem!

Earlier this year Dan Savage had an idea to take a stand. Out of his inspiration the "It Gets Better Project" was born. Why can't we do the same? Why can't we create a national movement to support health care reform? Any ideas on how we can start our own grassroots movement would be greatly appreciated. If someone else out there is bouncing around some idea in your head about how to do this, stop thinking and start doing! If you do, I promise to be standing proudly beside you!

Broken, part 1

"Medicine used to be simple, ineffective and relatively safe; now it is complex, effective and potentially dangerous." -Cyril Chantler

This is the first part of what I am sure will be a many part saga; an epic about how broken the US health care system currently is. I say all of this with the caveat that a) I'm really not sure what would be better; b) if I did, I'm not sure I would know how to transform our current system to this new shiny, effective, and cost efficient system; and c) as imperfect as I know single payer systems to be, I support systems that acknowledge my belief that health care is a right. However, I am never really sure what to say when asked "how much health care is a right?"

Two things happened last week that made me think about how broken our system is. The first was a public health class on health care management. We spent 5 days sitting around a room, shooting for the moon with our ideas about what health care should offer. We then discussed authentic leaders, and how to use leadership to make these things happen. In 20 years it will not surprise me to see these classmates transforming the way health care is delivered; and with the ideas that were shared, I pray that these minds are able to make an impact much sooner than 2030.

Second, I received two e-mails. The first from a friend worrying that her birth control pills were fallible. This friend should have been educated about all the possible signs and symptoms that may present when put on the pill. The lack of premptive education caused needles worry, undue anxiety, and possible misstrust in the system. The fact that she came to me (a know-nothing medical student) instead of her clinician speaks to the inaccessibility of educational services. Second, another friend, with a history of asthma ended up with multiple time-consuming and stress-inducing specialists appointments because of follow-charts. She saw her clinician presenting with shortness of breath and heart palpitations which automatically sent up the red-flag for cardiac trouble. While this red-flag supports the effectivness of the system (along with the fear of malpractice litigation), no one took a time out to actually think about the situation. The fact that she's young, healthy, had a normal EKG in the office, and that her signs and symptoms were consistent with her asthma regiment. If this thought process had been followed, she would have been saved excess time, money, use of precious resources, risk of added interventions, and excess time before the necessary change in asthma medicine.

I may be a naive medical student. Maybe you don't agree that these examples illuminate some of the many issues with our medical system. But, even still, can you really say that our system isn't problematic? And should we settle for something so broken?