Medical Examiner 11-3-23

MEDICALEXAMINER FREE T AKE-HO ME COP Y!

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NOVEMBER 3, 2023

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THE PROBLEM OF

BURNOUT

There is no doubt that the healthcare workforce is one of the strongest and most resilient groups of people around.

However, they are humans with all the assorted strengths and weaknesses that come with that label.

When weaknesses overpower the strengths, the result can be the umbrella term “burnout.” What exactly does that mean? The CDC offers one definition: “feeling emotionally exhausted and detached, and experiencing a low sense of personal accomplishment at work.”

Although burnout under various names is nothing new, existing long before COVID, it gained new attention because of the pandemic. People were so impressed with the tireless efforts of those “in the trenches” of healthcare delivery and “on the front lines” during the past two or three years that being a nurse or doctor became synonymous with being a hero.

Some organizations and experts dedicated to fostering healthy workplaces feel that definition is not at all beneficial. “You should not have to be a hero, putting others first even at your own peril, to do your job,” says the Dr. Lorna Breen Heroes’ Foundation, organized in the aftermath of Dr. Breen’s death by suicide in the wake of a grueling around-the-clock workload during the early days of the pandemic.

Just last week, the CDC’s National Institute for Occupational Safety and Health (NIOSH) issued an extensive report addressing both the problem of burnout and its solutions. The report noted the very understandable reasons for burnout: long hours of taxing and stressful work; exposure to infectious diseases; challenging interactions with coworkers, patients, and their families.

These are chronic issues that come with the job, and as difficult as they may be, the report stated “The pandemic intensified existing risks and workloads because of [staffing] shortages, high patient loads, supply shortages, fatigue, and grief, exacerbating preexisting crisis levels of burnout.” NIOSH blames management’s role in the crisis, since burnout is worsened and magnified by a lack of supportive supervision and failure to include staff in decision-making.

As demonstrated on a daily basis in the political arena, anyone can spout off about troublesome problems. Even a 5-year-old can do that. The real issue is not the issue; it’s the solution. Is there any solution to burnout? See page 3. +

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AUGUSTAMEDICALEXAMiNER

NOVEMBER 3, 2023

THE FIRST 40 YEARS ARE ALWAYS THE HARDEST

MEDICAL MYTHOLOGY

PARENTHOOD

by David W. Proefrock, PhD

Your 8-year-old daughter has complained to you that an older boy in the neighborhood has been trying to touch her inappropriately. She says she has stopped him and he has not actually touched her yet, but he keeps trying. What do you do?

A. Call the Sheriff’s Office and report him.

B. Talk to the boy’s parents and tell them what has been happening. Tell them that you will notify the authorities if this keeps happening.

C. Tell her that she should learn to protect herself and that she should hit or kick him if he keeps trying to touch her.

D. Tell her that boys just do that kind of thing and that there’s really not much she can do about it.

If you answered: A. This would be the best response if he had actually touched her, and will become the best response if he does not stop trying to touch her.

B. This is the best response, but not the easiest. The boy’s parents should be given the chance to deal with his behavior.

If he does not stop, however, call the authorities.

C. It’s okay to tell her to protect herself, but it sounds like she has already been trying to do so. It’s time for you to take action to protect her.

D. This response is even worse than what has been happening to her. She has done the right thing by telling you what he has been doing. It’s your job to protect her.

Your children should be warned about inappropriate touching. Coming to you and reporting it is what you want them to do. You have to protect them. + Dr. Proefrock is a retired local clinical and forensic child psychologist.

NEXTISSUENOV17

ARE COLON CLEANSES BENEFICIAL? OR NECESSARY? Let’s answer those two issues separately: No. And no.

In the interests of full disclosure, there are plenty of people who would vigorously disagree with those answers. Full disclosure again: proponents of colon cleanses have a financial stake in convincing you to have their procedures.

You have to give them props for creativity. One website has a list of some of the “proven” benefits of colon cleansing. Among the benefits of a squeaky clean colon: • Maintains pH balance in the bloodstream • Improves concentration • Increases fertility Another site provides some handy pointers to alert its readers about whether or not they need a colon cleanse. Here’s one of the clues: • “Bad skin: Another telltale sign of a dirty colon that is not functioning properly is lousy skin. Since the colon isn’t working at its prime, it can lead to toxins overflowing.

These toxins are then spread throughout the body, eventually making their way to the skin. From there, skin issues such as acne and rashes can occur.”

As convincing as those claims might seem, it’s noteworthy to examine what the

medical community has to say.

For example, the American Journal of Gastroenterology published the results of a review of all the available research studies examining the risks and benefits of colonic cleansing. They noted that “The data supporting colonic cleansing and body ‘detoxification’ have not been studied well in a systematic manner.”

In other words, it isn’t possible (or at least honest) to make specific claims about various benefits when those benefits have not been carefully and impartially proven.

The Journal researchers reached this conclusion: “There are no methodologically rigorous controlled trials of colonic cleansing to support the practice for general health promotion. Conversely, there are multiple case reports and case series that describe

the adverse effects of colonic cleansing. The practice of colonic cleansing to improve or promote general health is not supported in the published literature and cannot be recommended at this time.”

What do they mean by adverse effects? Among the dangers of cleanses?

The National Institutes of Health (NIH) reports that some juice cleanses contain ingredients that increase the risk for kidney problems. Further, some “detoxification” programs include laxatives strong enough to cause serious dehydration and electrolyte imbalances. Diabetics, children, the elderly, people with a history of heart, kidney or gastrointestinal diseases are among those who can be at increased risk for serious side effects from colon cleanses.

Weight loss is one of the common motivations for doing cleanses, but NIH cites a 2017 study which found that juicing and detox diets often result in initial weight loss followed by weight gain once a person resumes a normal diet. There is no magic short-cut to weight loss, including colonics.

It’s ironic that many cleanses tout their “natural” approach, since the human body naturally does a great job of keeping the colon clean and all our dietary byproducts moving in the right direction.

The best ways to improve colon health are things that will benefit our overall health, including good habits like eating a plant-based diet: more fruit, vegetables, beans and whole grains, and fewer fried and processed foods. The healthiest diet is one that goes easy on red meat, bacon, deli meats, hot dogs, and other processed meats. That doesn’t mean saying goodbye forever, but as stated above, a plant-centric diet will not only do more for colon health than any cleanse could do, but will also benefit our overall health greatly. +

NOVEMBER 3, 2023

SOLUTIONS TO

BURNOUT It’s amazing how much of the public focus on the burnout crisis — which extends far beyond healthcare into numerous other professions — centers around its individual victims: the struggling nurse or the unhappy teacher and all of their distressed coworkers.

The solutions suggested by those who have carefully studied the problem, however, focus extensively on management’s role in creating, and therefore solving, the crisis.

In reality, both individual and organizational effort is needed to make the changes that are desperately needed.

After all, management can hardly afford to sit by and merely hope their workers are happy at a time when record numbers of workers are quitting. A 2022 study cited by NIOSH in its report said “the very likely intention to find another job” increased by 50%

in the healthcare community compared to earlier data.

What can help stem this exodus? How can workers who stay be assisted?

Real world research has the proof that fostering a supportive work environment is crucial. What does that even mean? Among other things: actively promote worker safety and health, and not just with posters in the nurses’ lounge.

Example: remove penalties or systemic stigma attached to accessing mental health services. Encourage and reward employee feedback on ways to change for the better. Publicize the suggestions made and the actions taken. Build trust in management through honesty and transparency. Train managers in mental health awareness, improved safety culture, and in specific ways to demonstrate support for employees. Strongly support

TURNING 65?

3 +

AUGUSTAMEDICALEXAMiNER workers through policies that protect them from workplace bullying and violence, and when incidents occur, show that those policies have teeth by fully backing workers. Create a culture of appreciation.

Clearly, none of that can happen overnight. What can workers do in the meantime?

Prioritize your health: eat a healthy diet; get sufficient sleep; schedule relaxation (for example, let your family know you are not to be disturbed at certain periods each day; it’s your dedicated quiet time); learn what preventive/ care services your employer offers; ask for help; learn to say no; be reasonable with yourself; know your limits and respect them; set realistic goals; talk to a trusted friend about stressful issues or about things that have nothing to do with work and stress.

Burnout is a complex issue with no single solution, but if it takes a dozen steps to lessen its impact, they will all be worth taking. + A link to the NIOSH report: https://www.cdc.gov/mmwr/ volumes/72/wr/mm7244e1. htm?s_cid=mm7244e1_w

MEDICARE CAN BE CONFUSING. CALL US TO HELP UNDERSTAND YOUR OPTIONS.

WHY DO WE BLUSH? The simple answer is because we are human. As Mark Twain put it, “Man is the only animal that blushes. Or needs to.” Charles Darwin described blushing as “the most peculiar and most human of all expressions.”

It is a curious phenomenon for a number of reasons: it is generally viewed as beyond anyone’s ability to prevent or stop, and it is unique among all bodily reactions in that it can create a vicious cycle: blushing often causes more blushing.

Blushing is often associated with awkward or embarrassing social situations, but that’s not always the cause. There is the ever-popular idiopathic craniofacial erythema which, as its first name suggests, has an unknown cause. As its last name reveals, though, it may look the same as blushing, since erythema describes superficial reddening of the skin. “Idiopathic” differentiates it from other causes of facial flushing such as rosacea. People with rosacea may look like they’re just blushing to others, but it can go far beyond that into scaly skin, pustules, and facial pain such as burning or stinging.

Getting back to simply blushing, it’s harmless, although it never seems like it while it’s happening. And it’s never helpful when, in the throes of the embarrassing situation that triggered it in the first place, someone helpfully announces loudly, “Oh look! You’re blushing!”

Fortunately for those who blush and hate that they do, its incidence tapers off gradually for many people as they leave adolescence behind and progress into adulthood.

On the other hand, there is an undeniable appeal and attractiveness to blushing. It shows our humanity, and even our moral character. To blush at something immodest or scandalous silently says, “I am not brazen and shameless.

I have principles, and they are higher than this.” It suggests that we know when something is out of place or inappropriate. If we’re caught red-handed doing something we shouldn’t, being also red-faced instantly says we are sorry and ashamed. That isn’t a bad thing.

In short, there’s no need to blush due to blushing. +

MEDICALEXAMINER

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#200 IN A SERIES

Who is this?

I

f you’ve been wondering whether we would do anything special for the 200th installment of this feature, we don’t want to disappoint you. We respect this man — Samuel Alderson — and his contribution so much that for years every issue of the Medical Examiner, including this one, has featured a picture of the invention for which he is most famous.

You could say that the arc that led to his chosen career began with a fatal accident on August 1869, 45 years before he was even born. That blessed event took place in 1914 in Cleveland, but Alderson’s parents moved to southern California when he was just a toddler.

His Romanian-born father operated his own custom sheet metal and sign shop, and Samuel worked there off and on through college, even putting his academic career on extended hold a few times to help out his dad at the shop.

Since Samuel was kind of a genius, he graduated from high school at age 15, and went on to attend Caltech, Columbia University, and the University of California, Berkeley. He graduated from UC Berkeley under the tutelage of a couple gentlemen you may have heard of: J. Robert Oppenheimer and Ernest O. Lawrence. Oppenheimer probably needs no introduction these days (if he ever did), but Lawrence is the Nobel Prize-winning inventor of the cyclotron, and the founder of the Lawrence Berkeley National Laboratory and cofounder (along with Edward Teller) of the Lawrence Livermore National Laboratory.

Although both of those men were involved in the Manhattan Project, Alderson took his career in a different direction. One of his earliest professional challenges was an IBM project to create a prosthetic arm powered by a tiny motor.

That task may have been a fortuitous turn of events, because Alderson left IBM in 1952 to launch his own firm, Alderson Research Laboratories. He soon won a contract to create dummies to use in testing aircraft ejection seats. Although they were primitive and rudimentary, they served their purpose in the aviation industry and got the attention of the growing auto industry.

Two significant developments gave particular impetus to a new project for Alderson: the passage of the 1966 National Traffic and Motor Vehicle Safety Act, and the year before that, the publication of Ralph Nader’s best-selling book Unsafe at Any Speed, an exposé of the auto industry’s behind-the-scenes resistance to implementing safety standards.

The combination of those two events created an urgent need for a practical and realistic way to test safety features under development. Can you believe that car makers used to use human cadavers and pigs for crash testing?

Thankfully, Samuel Alderson stepped up and created the crash test dummy we all know and love today (see page 10), an invention extensively used in the automotive, aviation and aerospace industries. Dummies they may be, but Alderson’s invention is credited with saving more than 330,000 lives.

And the 1869 event that eventually gave birth to Alderson’s enterprise? The death of someone who might herself be featured in this very spot in a future issue: Mary Ward, the first known auto accident fatality. She was certainly not the last, but Samuel Alderson played a major role in making roads safer for all of us.. +

NOVEMBER 3, 2023

AUGUSTAMEDICALEXAMiNER

SHORTSTORIES THE PATIENT I’LL REMEMBER UNTIL MY DYING DAY ...and because of him, I realized with blinding clarity what hospice hare is for.

Let’s call him Vladimir.

He was 101 years old and in a diabetic coma. He had gangrene of both feet, so if he regained consciousness he had a double amputation to look forward to.

Per his medical history, he had been a professional dancer in his youth.

Vladimir had outlived his entire family, including his only grandson.

During his entire stay in my unit at the hospital he never had a visitor.

Even though he was in a coma I used to sit at his bedside to work on chart notes, just to keep him company. Sometimes I’d read the newspaper to him, or tell him jokes. This went on for weeks with nary a twitch

from Vladimir, so I didn’t know if he could hear me, or not. I was definitely leaning toward not.

But one Monday morning I was at his bedside as usual, and I suddenly felt I was being watched. I looked up from my charting to find Vlad’s intense blue eyes staring at me imperiously: “DO YOU VANT ME TO LIFF?” he demanded.

I was startled to the point of stuttering: “Uhhhh...

Sure!” I finally replied weakly.

“Then you must get me…

THE CHOCOLATE ICE CREAM!” he thundered back.

“Wait here,” I said idiotically, and I ran to the nurses’ station. I asked the charge nurse where I could get chocolate ice cream, pronto, because the patient in 20A had just regained consciousness and was asking for it

specifically.

Without even turning around, she said, “You can’t give 20A ice cream, chocolate or otherwise, because his primary diagnosis is uncontrolled diabetes”.

“Yes I can,” I replied, “Because his condition is terminal. It may be the last time he gets to taste ice cream before he dies. Do you want to tell him he can’t have it, that he needs to have sugar-free jello instead — for the sake of his health at age 101?

What kind of sense does that make?”

“When you put it that way….You can usually find individual servings of ice cream up on Maternity.”

So Vlad got a half-pint of chocolate ice cream, and he gleefully savored every spoonful.

He gave me a wink and a smile. Then he sighed, closed his eyes…and died. +

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I GUESS I’LL KEEP COMPLAINING UNTIL MY WIFE MAKES ME SHUT UP

I-20

new messages. I didn’t lose hope though. I just figured they had called it in as they had promised, so I loaded my pharmacy’s phone app and checked what prescriptions might be waiting for me. There weren’t any. This was a major disappointment. Trust me, in a situation like this you do not want to disappoint me, because when I am in pain you are going to hear about it.

By Saturday night, the pain was unbearable. Only the use of a heating pad could keep it under control, so early on Sunday morning my wife, who was no doubt tired of hearing about it, drove me to the urgent care closest to us.

It is affiliated with my doctor’s office, so I let my dissatisfaction be known. While we waited to be seen, though, I decided to vent some more through their phone app since my wife forbade me to say anything else to the people there; she rightfully pointed out that it was a different facility and so it wasn’t the fault of these people. I was upset with them because they made me pay a co-pay even though I had already paid at the other office and didn’t get help, and I already met my maximum outof-pocket for the year. But I backed down at my better half’s insistence.

Now that the app had my attention, I expressed my true feelings about how I had fallen through the cracks and wondered how they could forget someone that was in pain.

Once I got taken to the back, the nurse apologized since she had been able to read the messages I had posted just minutes before.

She was very kind and even agreed with me about my complaints. Then the doctor or PA came in, I don’t remember which, and she too was very kind and apologetic. They gave me a steroid shot and a prescription for some antibiotics that we promptly filled. I finished that course of antibiotics, but the infection and pain have continued. I am now on my second course of some different antibiotics, and I am hoping this clears it up.

I have a question. Why is it that if I want to talk to my mechanic about my car, I can call him directly, but if I want to talk to a physician about something so much more important — my life and health — I have to go through an often nearly impenetrable electronic phone system where I have to listen to messages and press buttons until I reach the point where I can wait on infinite hold, or I can leave an electronic message or voicemail and hope and pray it gets answered in time?

If my mechanic knew I was counting on my car for a weekend trip, he’d keep me apprised of the situation, but here I was, with an infection, in pain, and I was in the dark until it was too late for me to do anything about it other than go to a different place and pay all

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Have you ever noticed the difference between the bathroom of a typical young person and that of a middle-aged person? I just thought about it as I went through my morning bathroom regimen and thought I’d share what I saw. Maybe I won’t share all of it because you know how I try to never embarrass myself in my column. Oh, wait. Never mind. That is exactly what I do. I want to talk about that and something else less funny, but much more important.

As to the first item, when did my bathroom go from having a blow dryer, some brushes and combs, a toothbrush, a razor, deodorant and soap to now also having toenail fungus treatment, athlete’s foot spray, nose hair trimmers, industrial sized thick toe-nail clippers, diabetic foot lotion, therapeutic hand lotion, a battery-powered tool for grinding down callouses, an entire kit for fixing skin issues like milias and black heads, a medicine cabinet full of prescriptions, an electric trimmer with the heavy duty blade to tame thick and wild eyebrows that would otherwise crawl across my scalp and wrap around my ear or even merge with my mustache if I did not trim them back on a regular basis and any other number of things I probably forgot? (Whew. That was a sentence, wasn’t it?) As we age, we slowly begin to put a higher percentage of our income into the pockets of the medical professions and the pharmaceuticals industry.

That said, it is better than the alternative, I suppose. I have heard that growing old isn’t for wimps, and I now understand why. The maladies that accompany aging are bad enough, so it is particularly galling that a couple of weeks ago when I got what I thought was just a kid’s problem. I’m talking about earaches. Until last week, I don’t recall having an earache since I was in elementary school. It started with some cold-like symptoms that quickly turned into bronchitis, but I also could not hear out of my right ear and there was constant ringing. I went to the doctor and they tested me for Covid and for strep. To be fair, the ear wasn’t that bad yet, and since my tests came back negative they didn’t give me any prescriptions. They said I should call them if it got worse and they would call something in.

Two days later, early on Friday morning, it got very bad, so I contacted them through their phone app, which they said was the quickest way to assure action. Hours later, in the afternoon, I had heard nothing back, so I messaged again and got a response that the person I had dealt with on my visit (one of the PAs) was off that day, but another staff member, my doctor, would call something in. I was busy and didn’t check again until shortly after 5:00 and there were no

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NOVEMBER 3, 2023

BIG BUGGIES & BIG BOTTOMS I sat in front of a major chain grocery store and non-scientifically surveyed 100 consecutive people coming out. 76 were women.

No surprise there as most grocery shopping is done by women, and rightly so. Women usually cook, they should buy. I ignored race and national origin. They were of various sizes and shapes.

The predominate findings were: • Too much padding around the belly and the buttocks, men and women.

• Gaits seemed to widen as mass increased.

• Overloaded buggies tended to be associated with wider bottoms. There was no way to know how many were in the family associated with the heavily loaded buggies.

• Skinny women have fewer bottled drinks. Heavy women

BASED ON A TRUE STORY (most of the time) A series by Bad Billy Laveau

tended to have at least 4 six packs of soft drinks.

• Heavy women who buy alcohol bought beer. Slim women bought wine.

• Heavy women tend to have heavy kids. Most likely, it is not genetic, but related to how much food Mama dips onto the plate. No self-respecting mother wants to see food left on the plate.

(Remember: There are starving children in India.)

• A few women smoked on the way out. They tended to be heavy. Maybe it has something to with compulsion to

put something in the mouth.

• They scurried toward cars, expertly shoving overloaded buggies. Gotta get home quickly and cook up a pot full of Southern food.

(Makes my mouth water just thinking about it.) Maybe that was the genesis of the ancient country song, Ole Slew Foot: “Big around the middle and broad across the rump. Going 90 miles an hour, taking 30 foot a jump.

Never been caught. Never been treed. Some say he looks a lot like me.”

• One third of their children were clearly obese. Fluffy kids tended to follow behind heavy set women.

State of Obesity 2023: Better Policies for a Healthier America says 23 states (up from 19 states a year ago and none 10 years ago) has 35% who are obese. Obesity (Body Mass Index = 35>) is

Augusta Office: 2283 Wrightsboro Rd Augusta, GA

a disease that kills you. Insurance actuarial tables bear that out.

Maybe it is not the eating habits that leads to the extra globs of adipose tissue.

More likely it is our lifestyles and mechanization. Maybe it is jobs that do not require much physical work. A century ago, 48% of Americans worked on farms. Now it is less than 2%. Farm work back then took much energy.

Daylight to dark. Or as my mother said, “Can to Cain’t.”

Not many fat farmers. Same for brickmasons, field hands and builders.

But those days are far apart and few in between.

What can we do about obesity as a health hazard that shortens life and lowers quality of life?

Eating less is obvious. No one wants to do that and even fewer will actually follow a healthy diet. Education seems in order. But we are living proof that knowing better and actually doing better are two different things.

We want passive help with weight loss/control. 50 years ago, amphetamines were used to suppress appetite and increase physical activity. Biphetamine 20 would drive your engine for 12 hours and suppress your appetite with energy to spare.

Work output increased.

Everybody was happy...until abusers took multiple doses and stayed up for days before literally crashing to the ground. Long-term damage surfaced. Gradually prescription amphetamine fell into disuse.

Now we have multiple TV ads telling us the wonders of their specific diet that you must pay for. Weight Watchers. GOLO. And others.

New diabetic drugs cause you to excrete glucose and induces anorexia. Ozempic, for one., decreases food intake because you feel full.

Passively get rid of glucose (calories). It does the work for you. Weight falls off safely. There are manageable some side effects.

Within a few years TV will be full of lawyer ads regarding a class action law suit against manufactures of Ozempic.

Some skeptics might suggest smaller shopping buggies to reduce obesity.

Others might think an economic recess would reduce money available to buy extra groceries. Somehow, I think neither will achieve a healthier America.

No, dear hearts, Big Bottoms and Big Buggies are here to stay. Unless, we actually stop over-eating, that is. + Fat chance of that.

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TRYTHISDISH NOVEMBER 3, 2023

by Kim Beavers, MS, RDN, CDCES Registered Dietitian Nutritionist, Chef Coach, Author Follow Kim on Facebook: facebook.com/eatingwellwithkimb

CHICKEN PERI-PERI OVER MANDARIN SALAD A little spice, a little sweet, and the perfect combination of protein and vegetables make a great lunch or dinner any day of the week.

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Add marinade to the bag and marinate for 1 hour to overnight. Place marinated chicken on an aluminum foil lined baking sheet and broil 6-inches away from the heat for 4-5 minutes on each side or until chicken is done, which is when the chicken’s internal temperature registers 165°F on a meat thermometer.

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gether in a medium bowl. Or add ingredients to a mason jar, screw on the lid and shake to combine. Alternately, this can be made in a food processor.

ered almonds Combine the lettuce and greens with the celery. Top with oranges and almonds. To serve, place sliced chicken on top and drizzle with dressing.

Salad Base • ½ (5-ounce) bag chopped Romaine lettuce (3 cups chopped Romaine) • 1 (5 ounce) bag of mixed greens (6 cups fresh mixed greens) • 3 stalks of celery • 4 green onions, chopped (green and onion) • 1 (15-ounce) can mandarin oranges, drained • ¼ cup honey glazed sliv-

Yield: 4 Servings Nutrition Breakdown: Calories 380, Fat 18g (2g saturated fat), Cholesterol 75mg, Sodium 450mg, Carbohydrate 23g, Fiber 5g, Protein 27g.

Percent Daily Value: 70% Vitamin A, 8% Calcium, 10% Iron, 60% Vitamin C Diabetes Exchanges: ½ Fruit, ½ Other Carbohydrate, 1½ Vegetable, 3½ Lean Meats, 2 Fats +

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AUGUSTAMEDICALEXAMiNER

ASK DR. KARP

NO NONSENSE

NUTRITION A student at Aquinas High asked me: “Which is worse, salt or sugar?”

This is a great question because it points out how much misinformation is out there about salt and sugar.

First, salt and sugar are not bad. Nobody is sponsoring a contest to see which one is worse. Both salt and sugar are, and should be, part of a healthy way of eating.

The overconsumption of salt and sugar is the issue.

Salt and sugar are being added to so many foods these days. They don’t get into your food just when you use the salt shaker or sugar bowl at the table. A great deal of salt and sugar is already in the foods you buy at supermarkets, restaurants, and fast-food places. I am talking about foods such as luncheon meats, self-basting chickens and turkeys, sodas, cereals, pre-prepared “convenience” foods and meals, fast-food combo meals, and so much more. This is in addition to our over-consumption of soft drinks, chips, and other snacks. All that sugar, all that salt, and all those calories.

Is it better to use a high-fat salad dressing, or a lower-fat

dressing which makes up the lost taste by adding more sugar and salt? Replacing the flavor of high fat foods with high salt or high sugar foods is not the way to go, either.

You see, nutrition is not a “factoid” you can summarize in a cute catch phrase or by looking at a single simple ingredient in the food. Read the Nutrition Facts label.

When you evaluate a food, you need to look at all the nutrition information on the label. And about the salad dressing, have you tried any of those herb-flavored vinegars? Sprinkle on as much Italian seasoning or other

NOVEMBER 3, 2023 each day. That means that if you eat a candy bar, a piece of cake, a cookie, or a soft drink, you’re heading tooward overconsumption of sugar, so consume those foods only occasionally.

Sugar calories should make up no more than 10% of the calories you eat. So if you are consuming an average of 2000 calories per day, only 200 should come from sugar.

There is very little room for those extras, such as soft drinks, candies, cakes, cookies, and pre-prepared foods. I once asked a group of people how many of them drank 2 or more soft drinks a day. Most raised their hands. Then I asked how many of them drank only one soft drink a month. One guy raised his hand, smiling from ear-to-ear. “What are you so happy about?” He said, “Today’s the day!” (P.S. Excuse the nutrition humor.)

herbs and spices as you like.

Make sure the herbs and spices you use do not also contain lots of sodium (salt) or sugar. For example, many Cajun, Indian, and Jamaican spice mixtures are also loaded with sodium (salt).

Looking at sugar more closely, the sugar you consume needs to come from foods such as fruits, veggies, some grains, and low-fat dairy, which contains the What about salt? Instead milk sugar called lactose. If of helping Americans lower you eat the suggested number of servings of fruits, veg- the salt content in their foods (it’s the sodium part of the gies, and dairy, you are ausalt molecule, NaCl, that we tomatically taking in all the required sugar recommended Please see NO NONSENSE page 9

IT’S ON! OPEN ENROLLMENT IS HERE NOW.

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AUGUSTAMEDICALEXAMiNER

MIDDLE AGE… from page 5 over again just to get what I should have gotten earlier. What is wrong with this picture? I don’t even really blame most of the people involved. Sure, somebody dropped the ball, but I don’t know who that person is.

The system itself is broken. I’m old enough to remember when I could call my doctor directly and tell him about an issue I was having, and if he couldn’t get me in to see him that day, he’d call in a prescription that usually took care of the problem. I’m sure the monkeywrench in the machine is multi-faceted and likely made up of equal parts unhelpful and even oppressive government regulations, profit motivated medical corporations, heartless corporate lawyers and faceless actuaries at insurance companies. I don’t personally have the solution, but as a middle-aged person who is highly dependent on healthcare to have any quality of life, I sure hope somebody has one. Until then, I guess I’ll keep complaining about it until my wife makes me shut up. She tells me that you draw more flies with honey, but I don’t want flies. I just want patient-centric care focused on the best outcome, not maximizing profit.

The funny thing is, based on my personal interactions with the medical professionals that are actually providing the healthcare, I am confident that the vast majority of them feel the same way I do and are sincerely doing their best, despite all the obstacles in their path. The people who know the most about how to take good care of people are doing just that, while the ones who don’t are feverishly working to ruin healthcare by making the laws, the rules, the regulations and the financial decisions that actually seem designed by intention, ignorance or incompetence to thwart their efforts in the name of the almighty dollar or to be able to tell their constituents or shareholders that they did “something.” That’s how they get a bonus, or re-elected, and that’s how we got the system we have.

It reminds me of a saying from comic book heroes that I will borrow and paraphrase: We don’t get the medical care we need, but we get the medical care we deserve. + J.B. Collum is a local novelist, humorist and columnist who wants to be Mark Twain when he grows up. He may be reached at johnbcollum@gmail.co

NO NONSENSE… from page 8 want to lower), restaurants and pre-prepared foods seem to be getting saltier and saltier. One gimmick food preparers use is instead of using higher quality ingredients, they add salt and sugar to create taste artificially. It really doesn’t substitute for the taste of good quality food, and it is unhealthy.

How much sodium should you take in each day? Most Americans who are overweight or have diabetes or high blood pressure should eat no more than 1,500 mg of sodium per day. This translates into no more than ¾ teaspoon of salt, combined in both the food you buy and what you add at the table. The only intelligent way of approaching this without walking around with a calculator and a reference book, is to look at the Nutrition Facts label on every product. Also, you can check the nutrition information online or in restaurants and fast-food places. Nancy and I always check the web before we go to a new place with which we are unfamiliar.

We stay away from high sodium foods and dishes. You will be amazed and surprised at how much sodium is being put into your foods, so make sure to check it out.

What is the “No-Nonsense Nutrition” advice for today?

Stop focusing on this nutrient or that nutrient. Sugar and salt are not the enemy. They are not the work of the devil. They are part of a healthy way of eating — or at least they can be.

The problem is the daily over-consumption of sugar and salt.

Stop treating yourself and splurging like every day is Christmas, Hannukah, Devali or Eid al-Fitr.

The good news? The holidays are fast approaching. Happy Holidays! +

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CRASH

COURSE

More Americans have died on US roads since 2006 than in World Wars I & II combined

P

traffic signals are nothing short of screwy? For instance, cars on Alexander Drive will get a green that lasts maybe 5 seconds before turning red and giving the green to Riverwatch traffic.

But then maybe 10 seconds later, the green goes back to Alexander again. It’s completely erratic.

With that preamble, back to the promised bizarre scenario we witnessed firsthand.

Cars were sitting at a red light on the Furys Ferry railroad bridge near Barney’s Pharmacy as traffic crossed ahead on Riverwatch Parkway. Eventually the light went green for straightahead traffic on Furys Ferry Road. Neither car in either lane moved, and it just so happened that this was one of those weird traffic signals that only offered about a 5-second green. By the time it occurred to anyone to impatiently honk, the brief green had already gone red.

Question: how often have you seen a green light that resulted in not a single car making it through the intersection?

There can only be one explanation: the drivers in both lanes were looking down at their cell phones.

Now that’s annoying.

{

erhaps you missed the first three installments of this series. If so, our general premise is that bad driving annoys other drivers, and annoyed drivers become bad drivers. We are not here to excuse the reactionary drivers and lay all of the blame on the triggering drivers. No, they are both to blame, the first for their initial offense and the second for being too immature to just be an adult and drive on.

Even so, the fact remains that doing something that makes other drivers’ blood boil (rightly or wrongly) has to count for something bad. Those actions should be avoided. For instance:

{

TEN THINGS I HATE ABOUT YOU Part 4

7. You do know it’s illegal to use your phone while driving, right?

(See the Sept. 15, Oct. 6, and Oct. 20 Medical Examiners online for numbers 1 through 6) The law is no secret, so presumably anyone talking and driving, or texting and driving simply doesn’t care.

Of course, there is Exemption Syndrome (ES), a term we just made up, which plagues the human race in so many ways. The syndrome explains why people do things that are decidedly ill-advised because they are personally exempt from the consequences. For example: “I happen to be able to drive quite well despite consuming a quart of scotch in the past hour. I’ll be just fine. Watch me.”

It matters not to the person blessed with ES that scientifically compiled statistics prove that his risk of a crash is astronomically higher than someone who is 100% focused on the task of driving down the interstate at more than 100 feet per second (aka 70 mph). The ES-enabled driver reasons, “The road is wide and straight and traffic is fairly light. I definitely wouldn’t recommend doing this for mere mortals, but I have capabilities they don’t.”

Such a driver ignores the fact (or is perhaps unaware) that while they were texting they drifted two feet over into our lane.

And therein begins the argument that cell phone use is a hateable offense. We know people who have been rear-ended or otherwise crashed into by texters. Less serious but no less annoying is being behind someone at a red light who just sits there when the light goes green.

They aren’t waiting for the inevitable procession of red-light runners that cross against the green at every intersection (See #8); they don’t even know their light has turned green.

Here is an absolutely crazy scenario that our roving Crash Course roadway investigators personally eyewitnessed a couple of weeks ago. Have you noticed that a number of area

8. Remember when red meant stop?

In the real-life scenario just described, if the two lead cars had not been sitting there in park, here’s what would have happened: a few cars would have gone through on the brief green, a few more on the yellow, and several more on the red because by all rights that red should have still been green. We have seen that with just about all of these micro-reds. It’s partly as just described: “it should still be green, so the heck with it; I’m going.” And it’s also partly the plain and simple fact that if a light goes green, virtually no one expects it to return to red mere seconds later; so we think some drivers don’t even notice that their fresh green has already died a quick and unexpected death.

None of this is intended to suggest that it takes a short red to spawn red light runners. No, handfuls of them zip through nearly every single red light like cabooses used to follow freight trains. Quite often these ES-entitled drivers are still streaking across on red when cars in the crossing road start making left turns on their green arrows. Sometimes the red-runners make left turns cutting right in front of cars beginning left turns on their green arrow.

Now that’s annoying.

When did red stop meaning stop? + In part 5: More sources of highway hatred.

NOVEMBER 3, 2023

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AUGUSTAMEDICALEXAMiNER

JEWELRY SHORTSTORIES The blog spot SURGEON the

— posted by Katherine Eby on July 25, 2016 at themighty.com

BEFORE YOU JUDGE THE MOM BUYING SODA IN THE GROCERY STORE...

One day my daughter was with me while I was running errands. We made a quick stop at a grocery store and loaded a shopping cart down with packs of soda cans. After grabbing a few more groceries, we struggled to push the heavy cart to the checkout lanes. As we got up our speed and rolled past the deli meats, one lady stared at me disapprovingly. I knew what she was thinking. Assuming she could plainly see why my daughter is overweight, she shook her head and said, “Ugh! I can’t... I just can’t...” as she turned away from us. I wanted desperately to set her straight, but the cart was rolling with a lot of momentum now, and it wasn’t worth my effort to bring it to a stop just to tell this lady how wrong she was.

Tonight my house is quiet and my brain is active, so I thought I’d send out a public service announcement: if you see a child with weight issues in the grocery store with a mom whose cart is full of soda, please reserve judgment. You just might not know as much as you think you know.

The lady in the grocery store did not know my daughter has a rare genetic syndrome called Bardet-Biedl syndrome that causes obesity. She didn’t know my daughter’s hypothalamus does not correctly receive the satiety signal and that she lives every day of her life feeling hungry, even when she’s eaten enough. She didn’t know my daughter’s hypothalamus believes she is starving and constantly tells her to seek and eat food with intensity, or that a starving hypothalamus will tell the body to decrease metabolism to conserve energy so my daughter only burns 75 percent of the calories a healthy child burns. This lady had no idea this genetic syndrome also causes fat cells to more rapidly store fat than in a healthy child.

The lady in the deli aisle didn’t know we’ve worked incredibly hard to control my daughter’s weight, including placing her on special diet, restricting her calories, and encouraging daily exercise and participation in sports. She didn’t realize my daughter’s endocrinologist had praised our efforts at our last appointment and declared my daughter was “the healthiest child with Bardet-Biedl syndrome” she’d ever heard of.

But you may be thinking, “surely drinking soda doesn’t help the problem.” And you would be correct. This is one reason my daughter hasn’t had a sip of soda in more than six years, and why we strictly limit fruit juice to 3 ounces per day — just enough to help her absorb her daily iron supplement.

So why did I have a cart loaded down with packs of soda cans? I’m a mobile home park manager. It’s my job to fill the soda machine.

Please be careful to not judge, even when it seems you know the situation. You just might not know as much as you think you know. +

“I knew what she was thinking.”

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THE PATIENT WHO TAUGHT ME NOT TO JUDGE The first time I met her, she was in jail. She was wearing a bright orange jumpsuit and plastic slides on her feet. The officer undid her handcuffs so I could examine her and he waited outside the exam room.

She was pregnant. I always ask my incarcerated patients why they are in jail (mostly in case it was for killing their former obstetrician). Most often they will say it’s for violating parole or probation, and eventually we will get around to why they are on probation in the first place.

Her reason involved a significant amount of theft.

What bothered me much more than that: I was immediately disturbed and put off by her homemade swastika tattoo.

She was always polite and respectful. She was released from jail prior to giving birth. She gave birth to a beautiful baby and was a conscientious mom and did a nice job breast-feeding.

She saw our lactation educator many times to help with her breast-feeding. After a year her baby self-weaned.

But she kept pumping. And pumping. And pumping. Once a week she would drive 30 miles to the nearest NICU and drop off a freezer-full of breastmilk.

SHE DID THIS FOR TWO YEARS. For two years she helped feed a NICU full of small and sick babies of every ethnicity and multiple nationalities.

She still has the swastika tattoo. Every year when I see her I always look for it, hoping she will have had it covered up.

I’ve never asked her about it.

I do hope that one day she’ll cover it up.

But she is reminder to me that our worth is not simply equal to the worst thought or the stupidest decision we’ve ever made.

We are more than that. +

SHORTSTORIES

A NEW THING IN MEDICINE: INFLUENCER DOCTORS You know, the ones with thousands of followers on social media who provide educational content but also market for other companies (ie scrubs or facial products) while injecting aspects of their personal life into their brand.

Admittedly I found my now dermatologist on social media. She has over 20k followers and a strong social media brand. In person

she was very much just a regular doctor with basic recommendations, but she’s a spitfire on socials.

Same for my cardiologist.

I thought he was very average and went to read his reviews after my appointment and his IG came up: he has 50k followers and works for multiple NBA teams.

He shares his personal life on social media as well.

Nothing crazy from either specialist, but I wonder why they make so much effort to

FUNFACT: This issue contains more than

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EYEGLASSES REPAIRED Welcome COSTCO and EyeGlass World customers, and former Murphy & Robinson customers!

engage.

The derm just opened her own practice but the cardio doc works at our local hospital. They can only see so many patients.

Both are informational on topics in their respective fields, which is great, but do people really want to get to know their doctors like this? I guess obviously the answer is yes given the number of followers they have. +

25 different letters!

+ 12

AUGUSTAMEDICALEXAMiNER

The Examiners

NOVEMBER 3, 2023

THE MYSTERY WORD

+

Is is amazing how medicine has changed over the centuries.

by Dan Pearson

This article about the Ever read the four humors that were jokes page of the What does that have the foundation of What made you Medical Examiner? to do with anything? think of that? medicine back in the day.

Half the time they don’t even have one humor.

The Mystery Word for this issue: LAPTALE

© 2023 Daniel Pearson All rights reserved.

Simply unscramble the letters, then begin exploring our ads. When you find the correctly spelled word HIDDEN in one of our ads — enter at AugustaRx.com

EXAMINER CROSSWORD

PUZZLE

1

2

3

4

5

6

7

8

9

10

14

15

16

17

18

19

11

12

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, NOV. 12, 2023

We’ll announce the winner in our next issue!

13

1 E 7 4 3 S 9 6 8 X 8 U 4 A 6 2 5 D M 3 7 I 3 O 2 9 N 7 5 K E 6 8 2 5 6 3 U R 4

20 21 22 23 24 ACROSS 1. CTs and MRIs 25 26 27 6. Former Russian ruler 28 29 30 31 10. Pineapple seller 32 33 34 14. It sometimes precedes larceny 35 36 37 38 39 15. South American Indian 40 41 42 16. Level 43 44 45 46 47 48 17. Sun-dried brick 18. Heating fuel 49 50 51 19. Curve 52 53 54 20. Battering word 21. Charge per unit 55 56 57 58 59 23. Unusual word for trouble 60 61 62 25. Like Neapolitan ice cream 63 64 65 27. Skating figure 28. Assign

by Daniel R. Pearson © 2023 All rights reserved.

29. Sign on 50% of certain doors 62. Slang 29. Augusta park 30. Come down with 63. Linkletter and Garfunkel 31. Young boy something 64. Bleary tail 33. Andre’s nickname?

32. Dentist’s org.

65. Impede 34. Anticipation singer 33. “From ___ to Beersheba” 35. Prostate test abbrev.

34. Capital of Fiji DOWN 36. Needle-shaped (said of 35. Home of a noted tower 1. Hancock County seat crystals) 38. Lopsided, as a grin 2. [blank] of Sinai 37. Urgent warning of danger 39. Put away papers 3. Super-accurate clock type 38. Tue-Thu bridge 40. Palmetto util.

4. Penpoint 39. More than quadruple 41. Victory sign 5. Body builders’ favorite way 41. Capital beginning 42. A 2¢ word for caliginous to cheat?

42. Challenge 43. Help 6. _____ around: carefully 44. Bind 44. Talk of a certain kind avoid 45. Derailed 45. Privileged 7. Contemptuous smile 46. Blvd in medical district 49. Mamie’s _______ 8. Obamacare acronym 47. Materialize 51. John or Mary, for instance 9. Coarse woolen fabric of old 48. Borrower 52. ______ train 10. Fix program problems 50. Endow with 53. “As gladly” (Archaic) 11. Renovate and renew 51. Distress signal at sea 54. Belle of the ball (in brief) 12. Mild laxative 52. Ali’s last name 55. On sheltered side 13. Conclusions 57. 2004 Foxx film 56. Russian range 22. Honest CEO 59. Contend 58. Blatant 24. Transgression 60. Obstructs 26. Augusta’s Chief Judge 61. Like some steaks Solution p. 14

BY

DIRECTIONS: Every line, vertical and horizontal, and all nine 9-square boxes must each contain the numbers 1 though 9. Solution on page 14.

QUOTATIONPUZZLE 7 5 2 1 9 8 U E Y 8M 6 Y R U 5D 4 C O E 3O 7 1 9 T 6 3 4 2 — Author unknown

O D H O W T T F L Y C U I D E A H T T S R O T O R ’ A O I D S F N U

by Daniel R. Pearson © 2023 All rights reserved

DIRECTIONS: Recreate a timeless nugget of wisdom by using the letters in each vertical column to fill the boxes above them. Once any letter is used, cross it out in the lower half of the puzzle. Letters may be used only once.

Black squares indicate spaces between words, and words may extend onto a second line.

Solution on page 14.

Use the letters provided at bottom to create words to solve the puzzle above. All the listed letters following #1 are the first letters of the various words; the letters following #2 are the second letters of each word, and so on. Try solving words with letter clues or numbers with minimal choices listed. A sample is shown. Solution on page 14.

1

N 1 2 3 4 5 6

1 2 3 4 5 6 7 8 R H 1 2 3 4 5 6 7 1 1 2 3 4

1

2

1 2 3

4

1

2

3

4

5

— Aesop

5

1.CAATFIDEW 2.HOONSER 3.AURRIE 4.STEMBN 5.NEYAT 6.DIF 7.UN 8.L

SAMPLE:

1. ILB 2. SLO 3. VI 4. NE 5. D =

L 1

O 2

V 3

E 4

I 1

S 2

B 1

L 2

I 3

N 4

D 5

by Daniel R. Pearson © 2023 All rights reserved

WORDS NUMBER

by Daniel R. Pearson © 2023 All rights reserved.

4 3 6 2 9 1 8 5 7

2 9 5 4 3 6 7 8 1

3 7 1 9 2 8 6 4 5

8 6 4 1 7 5 3 2 9

NOVEMBER 3, 2023

13 +

AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE ha... ha...

B

ack in the Middle Ages every monastery had a profession or trade, something the monks produced that was sold to support the monastery. One monastery in the far north of England was known far and wide for making the very best fish and chips in the entire British Empire. As it happened, a man living in London who was a connoisseur of fish and chips heard about the monastery and determined to sample their wares if it was the last thing he ever did did.

It being the Middle Ages, the trek was rather arduous, but the man saved up what he could and set forth on foot to fulfill his desire for the very best fish and chips that could be had.

Sparing you the details of his tedious and often dangerous sojourn, suffice it to say that eventually after many weeks of travel, the gates of the monastery appeared before the man one day just as the sun was about to set.

He hurried forward and encountered one of the brothers in the act of closing the gate against the night. The man rushed up to him and asked, “Are you the fish friar?”

“No,” the monk serenely replied, “I am the chip monk.”

The

Advice Doctor

Samuel Johnson, author of the first great dictionary of the English language, was visited by a delegation of genteel ladies of London.

“Dr. Johnson,” they said, “we congratulate you for omitting all the vile, indecent and obscene words from your excellent dictionary.”

“And I in turn congratulate you ladies,” replied Dr. Johnson, “for looking them all up.”

©

Moe: When one door closes, another always opens.

Joe: That’s what they say.

Moe: Other than that, I’m real happy with our new kitchen cabinets.

Moe: How many teenagers does it take to change a light bulb??

Joe: Well, from the ones we’ve hired so far we don’t know. But surely we’ll eventually discover the answer.

Moe: Heard any good time-travel jokes?

Joe: Seems like I heard a pretty good one tomorrow.

George and Georgeanne just got married, and in his privaye jet on the way to their honeymoon, George asked Georgeanne, “Would you have married me if my father had not left me a fortune?”

“Of course, darling,” said Georgeanne. “I would have married you no matter who left you a fortune.”

Moe: Why was the broom late for work?

Joe: Because it over-swept. +

Why subscribe to theMEDICALEXAMINER? Staring at my phone all day has certainly had no Effect on ME!

Because try as they might, no one can stare at their phone all day.

SUBSCRIBE TO THE MEDICALEXAMINER +

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By popular demand we’re making at-cost subscriptions available for the convenience of our readers.

If you live beyond the Aiken-Augusta area, or miss issues between doctor’s appointments — don’t you hate it when that happens? — we’ll command your mail carrier to bring every issue to your house!

Dear Advice Doctor, I work with a woman who is the biggest lazybones on planet earth.

I swear, she will do anything to get out of work. And if she does manage to be responsible for anything — miracle of miracles — she always tries to pass the buck if anything goes wrong. How would you handle a situation like this?

— Needing Occupational Therapy Dear Needing, Thank you for writing to request my advice on this very timely topic. I am of the opinion that you work with someone who deserves a round of applause. I would carefully study her actions and do my best to imitate them, especially this month: November is peak season for Georgia’s 50,000 annual deer collisions. The fact that your coworker is so adept at passing bucks suggests she is a cautious and observant driver.

What makes her sterling record so enviable is that deer are most active (and therefore most likely to be a danger to drivers) early in the morning and late in the evening, which happens to be the very times more cars are on the road.

Being aware of this triple threat — dawns and dusks during November — is the first step in avoiding car/deer collisions, assuming that knowledge translates into safer driving.

And it really is up to drivers. It’s mating season for these beautiful creatures, and as a result in the throes of passion they throw caution to the wind and can act in reckless and unpredictable ways, like running right out in front of an oncoming car.

One of the factors that can make deer encounters extra dangerous is when automatic responses take over. You’re driving down the proverbial two-lane country blacktop when a deer darts out from the trees. Your natural default reaction: swerve to avoid a collision. By doing so, some drivers veer right into a tree or even worse, oncoming traffic. In such a situation, deer experts like DNR officials recommend hitting the brakes and keeping the steering wheel straight, challenging though that may be. Nobody wants to hit a deer, but hitting something immovable or oncoming is even worse. And there is often a second or third deer waiting to follow the first, so don’t think passing the buck is a one and done scenario.

Of course, your friend apparently knows that already.

I hope this answers your question. Thanks for writing! + Do you have a question for The Advice Doctor about health, life, love, personal relationships, career, raising children, or any other important topic? Send it to News@AugustaRx.com. Replies will be provided only in the Examiner.

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THAT ONE TIME I TOTALLY LOST IT WITH A PATIENT He was a longtime smoker, a habit which had destroyed the vascular health of his legs, which were becoming ischemic because the arteries couldn’t get blood through them. He needed a surgical procedure where they either put stents in the arteries to keep them open or where they take veins from other places to create bypasses around the blockages. Exactly the same as heart bypasses and heart stents, just in the legs instead. Without these procedures, the guy’s legs would steadily continue getting worse until the tissue finally died from lack of oxygen and his legs would need to be amputated. From this moment to that eventuality the guy would be in agonizing pain while all of the muscle and bone basically suffocated. The procedures to keep the arteries open

different way) Anyway, as I’m talking to the patient and doing my initial assessment, I ask if he smokes and he says yes. Of course he does. If he didn’t, he wouldn’t be about to lose his legs.

Me: Ok, so you’re going to quit smoking now, right?

Patient: Oh, no. I’m not going to quit Me: Yes, you are.

Patient: No, I’m not.

Me: Fine. You’re at least not going to smoke while you’re here at the hospital.

Patient: Oh, no. I’ll just go outside and smoke. I’m not going to quit This is where I lost it.

Me: Look here. If you had insurance, you’d be discharged to have this surgery as an outpatient. You’d have to pay your deductible and then whatever insurance cost on top of it. The only reason we are admitting you is because you don’t have insurance. The hospital will send you a bill and you will tear it up and the hospital will write it off.

No one helping you while

SHORTSTORIES

and blood moving would save his legs and relieve his pain.

This patient had no insurance. That makes a difference. This procedure does not usually require admission to the hospital. If he had insurance, he would’ve been sent home to see the vascular surgeon in his clinic and schedule the procedure as an outpatient. This patient couldn’t afford to do that. So we were admitting this guy so he could have the procedure as an inpatient. This way, the hospital would end up writing off the cost as part of their charity care. None of us providers would be paid. We were all wording our notes “creatively” to justify admitting this patient. Because, given the choice between protecting my patient and protecting the hospital admins, I’m always going to choose the patient. (Sorry, admins. I know your jobs are hard in a

15 + you’re here is going to be paid. We are all risking our jobs and volunteering our time, educations, and skills just to ensure that you are able to walk out of here in a few days. The absolute least you could do is lift a finger to support your own health so that this doesn’t happen again.

I said all of that pretty loudly, then basically stormed out of the room because I was so angry with that entitled patient.

But when I rounded on him the next morning, he told me that he immediately quit smoking the minute I lost it on him. We both apologized and had a great rapport.

A few months later, he was admitted to the hospital again for an unrelated issue. I walked in his room and he immediately cried, “I haven’t been smoking!

I swear! I haven’t smoked even once since I saw you last!”

I burst out laughing, told him how proud I was, and how happy he made me. +

OUR NEXT ISSUE DATE: 2023

17

NOVEMBER

WE’RE BEGGING YOU

We’re never too proud to beg. What we’re begging for is “Everyone Has a Story” articles. With your help, this could be (should be) in every issue of the Medical Examiner. After all, everybody has a story of something health- or medicine-related, and lots of people have many stories. See the No Rules Rules below, then send your interesting (or even semi-interesting) stories to the Medical Examiner, PO Box 397, Augusta, GA 30903 or e-mail to Dan@AugustaRx.com. Thanks!

“OUCH!”

“The cause was a mystery for a long time.”

“And that’s when I fell.” nearest hospital “He doesn’t remember a thing.” “The was 30 miles away.”

“I was a battlefield medic.” “He was just two when he died.”

“It was a terrible tragedy.”“She saved “I sure learned my lesson.”

“I retired from medicine my life.” “It seemed like a miracle.” seven years ago.” “We had triplets.”

“It was my first year “I thought, ‘Well, this is it’.” NOTHING SEEMED of medical school.”

“They took me to the hospital by helicopter.” TO HELP, UNTIL. . “It took 48 stitches.”

ambulance crashed.”

“Now THAT hurt!” “The “My leg was broken “I’m not supposed to be alive.”

“This was on my third day in Afghanistan.” in three places.”

“I lost 23 pounds.” “Turned out it was just indigestion.”

“At first I thought it was something I ate.” “The smoke detector woke me up.”

Everybody has a story. Tell us yours.

Here’s our “No Rules Rules.” We’ll publish your name and city, or we keep you anonymous. Your choice. Length? Up to you. Subject? It can be a monumental medical event or just a stubbed toe. It can make us laugh or make us cry. One thing we’re not interested in, however: please, no tirades against a certain doctor or hospital. Ain’t nobody got time for that.

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