A few nights ago we watched Firewall, a Harrison Ford movie where Indiana Jones reincarnates and kicks butt. Okay, not quite Indiana Jones, but Ford, who looks older and more wizened that his 65 years, still was able to beat the crap out of athletic bad guys half his age—-even though he was supposed to be a three piece suit type who sits in a bank and doesn’t get out much.

I did like the movie, despite the need to suspend the imagination, but I don’t know why Hollywood has given up on its own imagination. Like so many movies which have come out recently, this film had to include a silly and somewhat unbelievable medical crisis that is of course instantaneously resolved.

Firewall, in brief, is about a family held hostage with the threat of death, if the father (Ford) doesn’t do what the bad guys want. Of course, there is a child who has a life threatening allergy to peanuts, and this theme is really getting tiresome. I don’t know how many movies have come out recently that have the “child in peril.” You know right from the start, as soon as they mention the asthma, diabetes, allergy, etc, that the kid is going to have an attack and that is going to alter plans, get the parents to give in to demands, or have the bad-guy-with-the-conscience intervene. It is like, so boring already.

Anyway, in this film, the 12 year old boy has a severe allergy to peanuts. So of course, you know that sooner or later, he’s going to have a reaction. One of the bad guys gives the kid a snack and swears there are no peanuts. So the kid eats it. This scene alone challenges the intelligence—if you were a kid with a severe peanut allergy that you knew could kill you, and the chief bad guy with a big gun who has invaded your home and is threatening your family offers you a snack, would you eat it? This kid must have the IQ of a donut hole, and his lack of fear was also a little annoying.

But anyway, he goes into the movie version of anaphylactic shock. He becomes unconscious, looking nice and pink and healthy. While you can lose consciousness, generally, a severe reaction will cause trouble breathing as the throat swells–ie, lots of wheezing and gasping for air, and yes, the person will turn pale and blue. You can get a rash, vomit, moan and groan in pain—it is pretty rare that someone will eat the offending item and plop down into a sweet and peaceful coma.

Okay, so mom and pop are in a frenzy, screaming and crying and trying to revive their kid. Not sure how shaking him is going to revive him, and then it turns out that the bad guy has stolen the kid’s epinephrine. Ford pleads for it, so finally bad guy relents. They give him the shot, and the kid pops back to life like a jack in the box. He’s wide awake in an instant, no residual effects, nothing.

This scene really has to be added to the annals of idiotic celluloid medical escapades. In fact, beyond idiotic, and there really wasn’t any reason to make this scene so far removed from reality. Wouldn’t having the kid wheeze and gasp be more dramatic?

But the bottom line is that the kid in peril was totally unnecessary for the movie. It added nothing, and in fact, took away from the realism. These tired cliches really dumb down movies and TV shows, and just waste our time.

The nursing shortage is widespread and worldwide, primarily because it is poorly paid, considered a lowly job, and many nurses are abused and mistreated. By abuse, I mean that they are subject to sexual harassment, physical violence, and verbal insults. And in many nations, the workloads are generally horrific, kind that make working conditions in the U.S. seem like a trip to Disneyland.

The level of pay, prestige, abuse, etc, do vary by country or even by regions within nations, but they all have one thing in common–whatever they’re doing is not attracting people to the nursing profession, or keeping them at the bedside.

Here’s an interesting story about the situation in India, from the Times of India.:

India, which has 1,597 nursing schools, 833 BSc (nursing) colleges and 97 MSc (nursing) colleges, has a capacity to train 79,850 diploma nurses, 41,650 graduate nurses and 1,940 post-graduate nurses a year.

However, over 20% of this number every year head to foreign shores in search of better pay. Britain’s National Health Service alone recruits over 1,000 Indian nurses annually. Nearly 12,500 of the 33,250 nurses who registered to work in Britain in 2005 had qualified abroad, mostly from India.

India’s nursing advisor T Dileep Kumar says: “States like UP, Bihar, Orissa, MP and Rajasthan are the worst affected by shortage of nurses. Also, for every doctor, there should be three nurses. But at present, the doctor nurse ratio in India is 1:1.5.”

To add to the ministry’s woes, a recent survey published in the Nursing Journal of India found a tremendously low interest among students wanting to take up nursing as a profession. A study of 200 children in Pune who opted for biology in class 12 found only 3.9% interested in nursing as a first priority.

I can’t blame nurses from India going abroad to seek better opportunities, but it is really sad. I would guess that most of them don’t want to leave India, and be separated from their friends and family, but foreign recruiters make them offers that they have trouble turning down. If India would boost salaries and improve working conditions, I’m sure the exodus would shrink. But then, that always circles back to how women are treated within a culture, and how they are valued.

The second part of the equation is for developed nations to solve their own problems without resorting to poaching resources from those who can’t compete with them. While there are not that many Indian nurses being poached to the U.S., recruiters have their eye on India as the “next Philippines.” With an enormous population, India can mass produce nurses for import, and that’s the answer to the prayers of American hospitals who see nurses as commodities to be gotten at the lowest price possible. Things that can be worked to death, and when they’re too worn out to be of use, tossed out the door and replaced.

On Friday a friend of mine–a journalist that I used to work with at a now-defunct Internet company (yes, casualty of the dot.com droop) underwent surgery to have a kidney removed this past Friday. Her doctors were certain that she had a malignant tumor growing on it, and sure enough, it was malignant. However, the tumor appears to be self-contained, and her prognosis may be quite good.

Okay, so it’s sad that anyone should have cancer, but that’s not the reason why I’m writing about my pal. With all the hoopla about a few high profile cases, and politicians whining and whimpering about health insurance reform, the core of the problem remains unsolved. And my friend with the cancerous kidney, who I will call KT, is a casualty of our present system.

KT is an independent contractor, and as far as health insurance goes, she is considered high risk because she has asthma. So one demerit already, even before her kidney decided to act up. She’s had health insurance in the past, from employers and on her own, but for reasons I can’t quite recall (had nothing with not being able or willing to pay for it) she lost her coverage. In order to provide herself with some coverage, she purchased one of those temporary plans that will cover you for a year or two, but no more. When it runs out, it’s out.

And so, KT was racing the clock because her insurance runs out at the end of this month. And then she will officially join the ranks of the unwilling uninsured. At the moment, she is still in the hospital having some minor complications due to her asthma. Will she get out in time, before her insurance runs out?

I don’t know if the insurance will pay beyond Jan 31, although they might since it’s the same hospitalization. On the other hand, KT may just be cut off. All expenses incurred as of Feb 1 are hers to deal with.

What is really unforgivable in this case, is that KT will not be able to get anyone else to cover her. That is a reality for many people in this country, who are willing to pay for insurance and want it, but had the audacity to have a pre-existing condition. They become untouchables, and are left out in the cold. Nice system, huh.

In KT’s state, she may be able to qualify for what they call “high risk” which is an insurance plan for the untouchables. The upside is that she will be able to get some coverage. The downside is that the deductible is very high, in the vicinity of $5000, and it also will not cover any pre-existing conditions for a year after signing on. So if KT will have to pay for her asthma meds out of pocket. If any complications occur from her recent surgery, it’s out of pocket.

We really do need health reform, in one form or another. The current system that permits this kind of discrimination is shameful. And yes, I realize that many people are responsible for their own illness because they can’t be bothered to take care of themselves. My father was a prime example. He found out that he had “problems with sugar” many years before the diabetes really took hold, but he refused to pay any attention. Even after he got pretty sick, he still didn’t exercise, ate a really disgusting diet, and continued to puff away on his beloved Kent cigarettes. Even after he had a heart attack, he still continued to smoke. Eventually, a second heart attack finally killed him, right in the middle of a cigarette.

But that’s not KT. She’s hard working, looks after herself, and is trying to stay as healthy as possible. She needs health insurance, she wants health insurance, she is willing to pay for a decent plan. So why can’t she get one?

This was part of an ad that I saw somewhere, to work at a children’s hospital:

Kids have heroes…so do we, they’re called nurses. Our nurses face complex medical challenges head on and provide exceptional care with sensitivity and compassion. They do it all, knowing that there is nothing more rewarding than helping a kid believe anything is possible.

While it’s not a really hokey ad for nursing jobs, it makes it sound like taking a job at this hospital is akin to some heroic episode. It mentions that the nurses are sensitive and compassionate (like sweet angels should be), but what about skilled? And helping a child believe that “anything is possible?” What do the nurses do, take courses in the Secret and from Tony Robbins, and then drill the kids?

And of course, these ad never say much about the reality of working in their facility. They just hope that nurses will get all teary and dreamy eyed about tiny tots, that they won’t ask such obnoxious questions like:

What is your nurse to patient ratio?
Do I get sent home if you are overstaffed and lose a day’s pay?
Do I get forcibly floated to units where I am untrained, and don’t have any desire to work on?
Do I get treated like day old bread that’s starting to grow mold?
What is your turnover rate?
How does your pay compare to other facilities in the area?
Is your hospital unionized?
Do you have mandatory overtime?
Are your units staffed with aides, housekeepers and clerks, or are nurses supposed to be the jack of all trades while doling out sensitivity and compassion?

Yes, the questions that no hospital wants to hear….

Hey, just be an angel and shut up!

As much as I dislike McDonald’s, and even though this story sounds right up their alley, it’s just not something that even the PR wizards at MickieD’s could pull off due to the basic biology of the situation. Plus, this post is completely riddled with errors. Nice try…

I’m not sure of the origin of this story, but it appeared on this blog:

When McDonald’s introduced ice cream to its franchises operating in Indonesia, it faced a problem: many people had lactose problems and would not buy the product because it made them sick.

So what did they do? They gave ice cream cones away for free.

You’d be surprised at what people will consume when its free, regardless of the associated nausea. After repeated exposure to dairy products, the allergic reaction diminishes such that people can enjoy the dairy product without any significant consequences. So sure enough, after a while the target market in Indonesia had lost its intolerance. This made McDonald’s (and I suppose the Indonesians?) happy.

Whoever created this story failed to figure out the difference between “lactose problems” and an allergy to milk. They are two entirely different things. An actual allergy to cow’s milk is the same as an allergy to anything else–if you ingest it, you get a reaction. Allergic reactions range from mild sneezing attacks to rashes to life threatening anaphylaxis. Cntinued exposure to milk isn’t going to “cure” the allergy, unless you’re talking something like allergy shots, where minute amounts of the allergen are injected with the hopes of building up a resistance.

But in this case, the issue is lactose intolerance, which is NOT an allergy. Lactose intolerance is caused by the lack of the enzyme lactase, which is required to digest milk. Since milk is baby food, the majority of the world’s population is lactose intolerant—probably 75% of adults. Lactase begins to disappear from the body about the age of 8 years old. Not to get off the subject, but if you suffer from GI problems and consume dairy products, there’s a good chance you’ve got some degree of lactose intolerance, especially if you are Asian, American Indian, or African.

I would guess that probably 90% of Indonesians are lactose intolerant and ice cream isn’t going to be a big hit. And sorry, but lactose intolerance isn’t “cured” by consuming dairy products. If anything, symptoms become worse. The more you eat, the worse you feel. The enzyme doesn’t reappear if you decide to eat ice cream every day. If McDonald’s wanted to get Indonesians to eat ice cream made from cow’s milk, then they’d have to hand out lactase pills with every ice cream cone.

This is really a silly story, but I’m sure that a lot of people are going gaa gaa over it.

There are so many great health stories swirling around the press, but I just have not been up to blogging. I’m lucky that I can walk up and down the stairs without getting too out of breath. Being sick really sucks, which is why I probably just kept ignoring the fact that I was getting sick, hoping that it would just vanish.

I’m managing to get my medical writing work done, albeit slower than normal. But it is still an effort to do anything else. I guess all those weeks of lost sleep are catching up with me, as well as my body screaming that I need to rest so it can continue healing.

But here’s something for weekend reading. This sounds like a really weird case, and as usual in a mainstream media story, there is a lot that remains unsaid.

From AP:

RIVERHEAD, N.Y. (AP) — For months, the nurses complained that they were subject to demeaning and unfair working conditions — not what they were promised when they came to America from the Philippines in search of a better life. So they abruptly quit.

But in doing so, they put more than their careers at risk: Prosecutors hit them with criminal charges for allegedly jeopardizing the lives of terminally ill children they were in charge of watching.

The 10 nurses and the attorney who advised them were charged with conspiracy and child endangerment in what defense lawyers say is an unprecedented use of criminal law in a labor dispute. If convicted of the misdemeanor offenses, they face up to a year in jail on each of 13 counts, and could lose their nursing licenses and be deported.

Well my head is still attached to the neck, which is still attached to my shoulders….

I am feeling a lot better, but as usual, I kept thinking that better means cured and that now I’m ready for action. Well, eating too much because I was feeling a little hungry for the first time in over a week played out into a massive GI upset. One step forward, two steps back.

Coughing less does not mean time to toss the syrup. It means that I’m well, coughing less and getting better, but that the hacking fits are not over. The cough that accompanies bronchitis often lasts for weeks after the initial infection, so I just can’t ignore it. Ignoring symptoms is how I ended up so sick in the first place.

That’s how I feel right now. And the reason for the dearth of posts. It wasn’t enough that I had to attend two conferences and then move right before Christmas, and then try to get a ton of work done and unpack–to say nothing of having two totally freaked out cats. Freaked out to the point of being close to dehydration.

But now, a new angle. An annoying cough. A cough which doesn’t let me sleep, which gives me a headache, and that has taken away my appetite. I can’t deal with too much more of this. My house is barely unpacked, the place is in chaos, and I have been totally unable to enjoy it.

Well I suppose to can always be worse. At least my head is still attached to my neck….for now…

The nurse patient ratio mandate in California went into its final phase as of Jan 1, 2008. So far, it is the only mandate of its kind in the nation, even though similar laws have been proposed in several states.

From the AHA:

California implemented lower nurse-to-patient staffing ratios in three hospital units effective Jan. 1, completing its phase-in of a 1999 state law requiring specific nurse-to-patient staffing ratios by unit. Nurse-to-patient ratios were lowered to 1:3 from 1:4 in step-down units, and to 1:4 from 1:5 in telemetry and other specialty care units. “California hospitals are doing the best they can to comply with the ratio requirement, “said California Hospital Association spokesman Jan Emerson. “This includes the use of traveler nurses, which are necessary because of the continuing shortage of nurses in California.”

This Is The Year

“Wonderful, wonderful, fortunate you,
This is the year that your dreams come true!
This is the year that your ships come in;
This is the year you find joy within.

This is the year you are glad to live;
This is the year you have much to give.
This is the year when you know the Truth;
This is the year when you find new youth.

This is the year that brings happiness;
This is the year you will live to bless.
Wonderful, wonderful, fortunate you,
This is the year that your dreams come true!

–Russell Kemp