Since I can’t seem to get enough writing about health, I’m excited to start a new gig as the Boston Health Examiner at Examiner.com. Check out my first post on eating well, one in a series on healthy New Year’s resolutions. Enjoy!
Awhile ago, I wrote about the challenges of primary care when you are a patient with multiple (and rare) diseases…Or, as my friend Lyrehca says, when you are “clinically interesting.” I have specialists for several different body systems and they each provide fantastic care, but I don’t want to bother the lung guy with the GI problems, or the rheumatologist with the allergic reaction.
So, I embarked on a quest to find a primary care physician. I wanted my new doctor to be in the same hospital as all my other doctors, and finding a group that still accepted new patients proved daunting. Life, the book, and work got busier, and I let the search slide a bit. Then this summer I came down with mesenteric adenitis and was shuffled between specialists and eventually sent to the hospital. I came home re-committed to finding a primary care doc, someone who could have fielded that problem, and put my name down for an appointment five months down the road.
Well, that initial appointment recently happened, and it feels good to have someone coordinating all the moving parts of my care. My new doctor and I clicked; I felt comfortable talking with him, and I appreciated that he’d already become familiar with my case and had been in touch with my other doctors. Since they all work in the same system, they all have access to my latest test results and notes, and I’ve never had such efficient, streamlined care. The new doctor noticed some unusual lab results no one else had looked at—because they didn’t fall under their realm—and followed up on them. We made some important decisions about diagnostic tests for other problems, and I feel good about moving forward.
It’s been almost 20 years since I’ve had an official primary care doctor, and I told him I was worried about contacting the appropriate person for certain infections. Those of you with more experience negotiating this balance between primary care and specialists, do you have any feedback?
“With all you’ve been through you know your body best. Just trust your instincts,” he said. Sounds like a plan, indeed.
On a less personal level, I’d also like to circle back to the issue of universal health care in Massachusetts. As I mentioned before, part of the primary care shortage and the several months’ wait many patients find when they try to make an appointment is an unintended consequence of providing insurance to more people…and of course people without prior access to health insurance and preventive care are often most in need of primary care physicians. Anyway, according to this recent post on WBUR’s Commonhealth blog, Massachusetts now has the lowest rate of uninsured citizens in the country. This is wonderful news—now, let’s try and make sure each of those citizens can get an appointment!
Well, I’ve been a delinquent blogger. I have several posts in stages of completion, but I’m having some aspiration issues here at A Chronic Dose (the physical kind, not the ideological) that demand full attention. Expect a real post in a few days but until then, Merry Christmas, Happy Hanukkah, and Season’s Greetings to everyone!
Grand Rounds Vol. 5 No. 13: The Best of 2008
It’s the time of year when the “Best of ” lists start popping up everywhere. As a writer, I pay the most attention to the holiday book lists and that is where I got the inspiration for this edition’s theme. Quality writing is a gift to everyone who reads it, so I challenged the medical blogosphere to send me the best writing of the year–the funniest, most poignant, most controversial, etc. What follows are the Best Posts of 2008, as selected by each of the 49 bloggers who submitted to this week’s Rounds.
(*= Editor’s Choice. Think of these posts as the best of the “Best Of…”)
Best of Health Practice
The way doctors, nurses, and other health care professionals interact with patients and with each other, the way our bodies interact with the environment around us, the way the health care system interacts with emerging technology—these are just some of the topics covered in the Health Practice category. There was a lot of wisdom passed around in 2008.
*Kim at Emergiblog offers a post on empathy she is particularly proud of—and once I read it, I could see why. A must-read, indeed.
*Doc Gurley chose “How To Break Bad News,” thinking its message would appeal to new readers. I have to agree, and I’ll add that its content is important for everyone.
*The Happy Hospitalist describes what a real life Code Blue resuscitation is like in “Don’t You Dare Touch Me.” When you read it, you’ll understand why.
Canadian Medicine is most proud of this post about the dangers of anonymous blogging. It’s an extremely relevant topic for everyone involved in medical blogging, and a great treatment of it.
Notes of Anesthesioboist discusses Code Indigo. Not sure what that means? Be sure to read this powerful post.
Medicine for the Outdoors considers this post on the environment to be the most important subject matter covered on his blog all year. His explanation of why is thoughtful and detailed.
Other Things Amanzi describes a textbook case that is anything but usual.
Clinical Cases and Images Blog asks, “How Should Hospitals Use Twitter?” It’s a good question, so make sure you catch up on the conversation.
Allergy Notes continues with the theme of Twitter as quite the hot topic in 2008 in the post Allergy and Immunology Journal Club on Twitter.
Dr. Shock ponders if psychiatrists should wear white coats. According to one study, 96% percent of patients preferred their psychiatrist sans white coats. Do you agree?
Sharp Brains sends along “Art Kramer on Why We Need Walking Book Clubs,” where they discuss how emerging brain research areas are going to have a major impact on our lives in the next 5-10 years.
Teen Health 411 suggests a recent post about developmental assets and teens, calling it “the closest thing to a guidebook for conscious parenting I have ever seen.”
Receiving shares an interview with Dr. Lewis Goldfrank, a world-renowned emergency physician and toxicologist who is dedicated to social justice and human rights.
The Angry Medic learns from a patient that really, some wounds never heal.
Neuroanthropology writes about
Our Blessed Lady of the Cerebellum, a compelling story of personal, medical, and political drama.
Dethmama Chronicles offers the story of a daughter’s last act of love and respect for her mother in “Joie de Vivre et Madame M.”
Leslie at Getting Closer to Myself explores the emotional impact of chronic illness and questions the concept of “First Do No Harm.”
Lyrehca at Managing the Sweetness Within deals with the best way to treat insulin reactions. She’s a diabetes veteran, so she would know.
Aequanimitas discusses the unique qualities of elite alpinists in “Achieving Impossible Heights.” Check out what it takes for yourself.
ACP Internist tells us that alternative medicine use holds steady at more than 1 in 3 Americans. This post follows up a topic that is occurring more and more frequently in the communication from patient to doctor.
Laika’s MedLibLog describes the difficult concept of randomized controlled trials in an easy to understand manner.
The Fitness Fixer offers innovation in abdominal muscles, saying this post was one that directly quickly stopped the source of chronic back pain for many people who wrongly thought they had to tighten or strengthen abs to stop back pain.
Best of Health Policy
As you know, 2008 was a busy year in the world of health care policy—the recent presidential campaign certainly added more urgency to important conversations about health care reform, health insurance, and other issues surrounding health care delivery.
*Mind, Soul, and Body writes an impassioned response to where the path of blaming patients for their illness will always lead in “Those People.”
*Mike Feehan at InsureBlog thinks many people mix up health care and health insurance—and he’s here to set the record straight. (I love a good semantics discussion…)
David Harlow of HealthBlawg tells us that
ambulance diversions will soon be banned in MA and explains how overcrowding factors into this decision. Be sure to read miss his interesting interview with Alasdair Conn, MD, Chief of Emergency Services at Massachusetts General Hospital.
David E. Williams of Health Business Blog asks an important question to think about as we move forward: Generic Biologics –or Me Too Drugs 2.0?
Duncan Cross has a decisive answer for why health insurance is tied to jobs.
Survive the Journey shares some good ideas on how to address the primary care physician shortage in “Dear Doctor, I Can Help.”
Louise at Colorado Health Insurance Insider stirs up some dialogue when writing about the affordability of health insurance.
Best of Health Humor
Even weighty topics warrant a good dose of humor, and I’m pleased to see a little snark, some (not so) subtle sarcasm, and the occasional silly story come through in 2008.
*Barbara K at In Sickness and In Health likes the idea of starting the year with a laugh and offers “A Conversation Overheard in a Waiting Room.” Since I live in the Boston area, I could really relate.
How To Cope With Pain takes a break from more serious topics in chronic management and gives us a
humorous look at invisible illness courtesy of “I Can Haz Cheezburger” photos.
*The Week is used to medical school rejections, but one in particular came from Drexel many weeks into the academic school year: “As if I was on the edge of my seat thinking they would accept me after classes began!”
At Sutures for a Living we hear what it’s like to have “one of those days” in the post “Mama said there’d be days like this.”
Dr. Val offers some Christmas humor in “The Christmas Miracle.”
Shrink Rap keeps up with the holiday theme, offering an edgy piece about gifts.
Dean Moyer of The Back Pain Blog offers some tips for avoiding injury in
Back Pain and Anger. And for what it’s worth, kicking a fire hydrant isn’t one of them.
Covert Rationing Blog sends along
“How To Think About the Obesity Dividend,” saying that “my usual ironic voice was misinterpreted here by more than a few. While it is probably a sign of my own pathology, I always enjoy it when that happens.”
Best of Health Inspiration
Attitude is an important part of living with medical conditions, and the following posts offer insights and experiences that uplift, entertain, or motivate.
*Rosalind Joffe at Working With Chronic Illness thinks fighting illness is the wrong approach. Check out her reasons why.
*Kerri at Six Until Me writes about her wedding day, the best thing that happened to her in 2008. It’s written “with love in mind and with diabetes in mind.”
Jenni at ChronicBabe says she wants to be a turtle, which she calls “the concept of carrying your positive self everywhere with you; the times when things are hardest and you just want to pull your head inside your shell; and the benefit of going slow and steady – pacing yourself.”
Adventures of a Funky Heart! says you can’t help but getting “fired up” about all the things that are coming in the Congenital Heart Health field when you sit down and talk with Amy Verstappen, President of the Adult Congenital Heart Association.
Rachel at Rachel’s Diabetes Tales is getting back into the exercise groove a few weeks early. Who needs to wait for New Year’s resolutions?
Chocolate, Music and Hope offers “Hair Today, Gone Tomorrow: Learning to Accept Disability,” saying it is “the most meaningful post I have written to me because it really marks how far I have come in learning to accept my disability…”
In “All Souls,” Writing and Healing responds to a patient’s death and learns firsthand how reflective writing can bring clarity, release and a profound gratitude for simply knowing the patient.
Day of the Doc remembers all the veterans in our country and poses a heartfelt and educational discussion of PTSD.
Lastly, Emerald Arts gives us inspiration of the visual persuasion. Check out her post in photos chronicling a day at the beach.
Best of Health Debut
Since 2008 was my debut year as well, I can relate to what it feels like to put yourself out there for the first time. The bloggers who sent the following posts have never submitted to Grand Rounds before, but took the plunge and shared their estimation of 2008’s best posts. Welcome!
Genevieve at Spit Happens has a rare form of cystic fibrosis coupled with bronchiectasis (a girl after my own heart with those diagnoses). In this post on chronic illness and relationships, she discusses the downside of being a passionate fighter—and no, she’s not crazy.
Living in the Midwest knows the low point chronic illnesses can bring a patient to—and wants to confront it directly and honestly.
My Journey from Nurse to Doctorshares what happens when a mentor is anything but in “How Things Change.”
Thank you to everyone who submitted posts and made the Best of 2008 possible. Highlight Health will host next week’s edition.
I know I just gave you a ton of books to think about, but here’s some Friday reading I had to pass along. As reported in the Boston Globe, New research from JAMA suggests a genetic link exists between celiac diseases and type 1 diabetes
So I’ve talked here about why books make great holiday gifts. To help give you some ideas, Moon Rat has a fantastic, detailed list of “best-ever” titles over at Editorial Ass. You can also consult Salon’s Best of 2008 book list, or the NYT’s 100 notable books of 2008, among many others.
So what’s my contribution to the book-buying suggestions? I thought I’d try out a different approach. My very random, totally un-scientific, un-researched and completely off-the-cuff list of suggested titles is just that—books that immediately come to mind, with no consulting my bedroom bookcases or bestseller lists. It’s neither exhaustive nor exclusive, but maybe that’s a good thing. After all, if these titles are at the front of my mind right now, with 700 pages of student writing to comment on, freelance deadlines, and a respiratory infection, they must be memorable, right?
Nonfiction (memoir and narrative):
The Obvious: Eat, Pray, Love by Elizabeth Gilbert
A Three Dog Life by Abigail Thomas
The Sky Isn’t Visible from Here by Felicia Sullivan
Mountains Beyond Mountains by Tracy Kidder
Friday Night Lights by H.G. Bissinger
In Cold Blood by Truman Capote
Into Thin Air by Jon Krakauer
The Spirit Catches You and You Fall Down by Anne Fadiman
I Remember Running by Darcy Wakefield
All in My Head by Paula Kamen
Marley and Me by John Grogan
(Note: Though a couple of titles cross over, please see my previous post on narrative medicine if you are interested in a more complete list of books about medicine, illness, etc.)
Food:
The Obvious: In Defense of Food by Michael Pollan
Animal, Vegetable, Miracle by Barbara Kingsolver
Garlic and Sapphires by Ruth Reichl
The Man Who Ate Everything by Jeffrey Steingarten
Fast Food Nation by Eric Schlosser
Beef: The Untold Story of How Milk, Meat, and Muscle Shaped the World by Andrew Rimas and Evan Fraser (Note: I have only just started this, but the author is local and a friend of mine so it’s on my mind)
Miscellaneous:
Eats, Shoots & Leaves by Lynne Truss
Freakonomics by Steven Levitt
Fiction:
The Obvious: The Interpreter of Maladies by Jhumpa Lahiri
The Emperor’s Childrenby Claire Messud
Runaway by Alice Munro
Case Histories by Kate Atkinson
Water for Elephants by Sara Gruen
The Poisonwood Bible by Barbara Kingsolver
Kissing in Manhattan by David Shickler
The World According to Garp by John Irving
Prep by Curtis Sittenfeld
Namesake by Jhumpa Lahiri
Little Earthquakes by Jennifer Weiner
Lost City Radio by Daniel Alarcón
Someday, I’ll be good and post a more complete list with commentary and all that, but right now a different stack of writing awaits me. Please feel free to throw in your favorite or current reads in the comments section, and remember—books make wonderful gifts!
It seems fitting that I started out the semester hosting Grand Rounds and am finishing out the semester with another edition at A Chronic Dose on Tuesday, December 16th.
It’s hard not to get thematic during the holiday season, and at first I thought about using “Gifts” as the common thread for submissions. But I’m knee-deep in “Best of 2008” book lists, and it occurred to me that for writers and readers, quality writing truly is a gift. So, please send along what you think is your “best” post of the year…and why. Whether it’s your funniest post, the one that was the hardest to write or stirred up the most dialogue, or touched on a topic that really matters to you, etc, I want to see it.
Please send them to laurieDOTedwardsATgmail.com by 11 pm on Sunday, Dec. 14th and put “Grand Rounds” in the subject line.
Thanks, and I look forward to reading your entries!
I hate to shop. When compared to all the other things I could be doing, the thought of spending time wandering around crowded stores seems incredibly inefficient to me, and I don’t usually want the item in question enough to warrant a trip. (Of course I also bring student papers to hair appointments and squeeze my laptop open on the subway, so clearly I have some issues with downtime.)
While my dislike of shopping is year-round, it kicks into high gear near Christmas; my proudest shopping moment of last year’s holiday season was when I realized I got every single gift I needed online, minus one.
I do have one huge exception, though. I love buying books and being in bookstores, and if left un-chaperoned, I could easily spend far too many hours and too much money. My husband fully supports (encourages, even) my book-buying binges, but I like it when we go together because I’m more conscious of that wily little word “moderation.”
I know the economy’s in terrible shape and holiday budgets are much tighter for most people, and I have a solution: Buy books. Seriously. They are affordable, durable, and can be used over and over.
Now, I know I am biased because I recently published my (affordable paperback)book Life Disrupted. But I’m making this plea not as a book author but as a lifelong book lover, someone whose favorite childhood Christmas present was the Little House on the Prairie boxed set of books, and who got a floor-to-ceiling bookcase for a 10th birthday present. I cannot go to sleep at night without reading, if even for 10 minutes, and I cannot leave the house without at least one book tucked into my briefcase.
The only gift I always buy in person for my nieces are books, and my gift to my oldest niece each Christmas is a hardcover book with an inscribed note. My brother told me she makes him read them to her throughout the year.
So buy books this year, and maybe even start a new tradition. What’s more, whenever possible support your local independent bookstores. They are more than simply places that hold shelves of books; between readings, lectures, and other literary events and book clubs, they foster a sense of community in neighborhoods. Like many independent retailers, they need our support and patronage more than ever right now.
For local readers, I just scored several great books on the sale table at Brookline Booksmith, and my two local favorites, Porter Square Books and Newtonville Books (both of which were awesome in supporting this local author with events) have tons of interesting readings and events this December and offer good discounts.
Obviously I believe books are a perfect gift for people of all ages and inclinations, but since this is a blog about illness, I do have to say that for people with chronic illness, books can take on even more significance. They bring the outside world into our homes when we can’t always leave, and they offer escape and entertainment when we need it most. I think part of the reason I was such a big reader at such an early age is because it was the one thing I could always do, no matter how sick I was or how many IVs I had in my arm.
I’m working on my own recommendations, but for now, check out this book editorial from the Boston Globe–it’s full of quirky selections for the readers in your life. Happy shopping!
About this time last year, I lost a loved one. Because we knew her preferences for end of life care, she was able to die at home, surrounded by family. It was a beautiful thing. However, many of us don’t know how or when to have these important but difficult conversations, which is where the One Slide project from Engage with Grace comes into play. Today, bloggers around the country are participating in a blog rally to spread the message of Engage with Grace and get people talking. Please see the details:
Engage with Grace: The One Slide project
We make choices throughout our lives – where we want to live, what types of activities will fill our days, with whom we spend our time. These choices are often a balance between our desires and our means, but at the end of the day, they are decisions made with intent. But when it comes to how we want to be treated at the end our lives, often we don’t express our intent or tell our loved ones about it.
This has real consequences. 73% of Americans would prefer to die at home, but up to 50% die in hospital. More than 80% of Californians say their loved ones know exactly or have a good idea of what their wishes would be if they were in a persistent coma, but only 50% say they’ve talked to them about their preferences.
But our end of life experiences are about a lot more than statistics. They’re about all of us. So the first thing we need to do is start talking.
Engage With Grace: The One Slide Project was designed with one simple goal: to help get the conversation about end of life experience started. The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it. Five questions designed to help get us talking with each other, with our loved ones, about our preferences. And we’re asking people to share this One Slide wherever and whenever they can … at a presentation, at dinner, at their book club. Just One Slide, just five questions.
Let’s start a global discussion that, until now, most of us haven’t had.
Here is what we are asking you: Download The One Slide and share it at any opportunity with colleagues, family, friends. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about end of life experience for yourself, and for your loved ones. Then commit to helping others do the same. Get this conversation started.
Let’s start a viral movement driven by the change we as individuals can effect…and the incredibly positive impact we could have collectively. Help ensure that all of us – and the people we care for – can end our lives in the same purposeful way we live them.
Just One Slide, just one goal. Think of the enormous difference we can make together.
(To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team)
I was sandwiched between two people on a crowded subway trolley a couple of weeks ago when I smelled it. Instantly, my stomach tightened with rolls of nausea. I grabbed the silver pole next to me with whitened knuckles. Do not throw up. And in a matter of seconds, I wasn’t an adult on my way to work, I was a little kid on a cold November morning about to have the warm blanket placed over my legs in the operating room.
The woman who sat down next to me smelled just like anesthesia. I don’t know how to describe the smell accurately, but it is somewhat sweet and plastic-y at the same time. It is a very particular smell, and it gags me (obviously). Usually I am more prone to hear songs and associate them with a time or place than I am to associate smells, and I’ve never had a more visceral reaction to a smell than I did that day on the train.
It was fitting that this occurred on a cold, sunny November day. You see, when I was little and needed surgeries to drain infections from my head, ears, sinuses, etc, they tended to cluster around the holidays, the peak infection season for me. Also, we tried to plan surgeries for when I had a day or two off from school anyway so as to build in some extra recovery time. Accordingly, Veteran’s Day and Thanksgiving week were prime candidates, and in some particularly acute circumstances, Christmas Eve day also became a go-to surgery day. The sharpest details from these accumulated late fall surgeries are being asked to count backwards from 10 to one as the anesthesia mask was placed over my face, and the wrenching nausea that gripped me in the recovery room (I’ve since learned to ask for Zofran)—and that particular smell brings me right back to those moments.
So where am I going with the charming tale of anesthesia memories? Well, it’s two days before Thanksgiving and our house is starting to fill with much better smells: cornbread baking, sausage sautéing, cider mulling. These are the smells that should accompany November, and I’m happy to replace the surgery smells of my childhood and the inpatient smells of many lung-related holiday hospitalizations as an adult with them.
And so the traditional Thanksgiving post is tinged with special appreciation for where I am in this moment, and the people and circumstances who are part of that:
My family, who was there for me during all those surgeries and is there for me in so many ways today.
My husband, who is seriously amazing (and fairly obsessed with making Thanksgiving perfect).
My friends, who are funny, smart, caring and patient.
My readers, those who buy the book, show up at readings, or get in touch with me to share their feedback, and those who take the time to read this blog—without you, all this would exist in a vacuum.
My favorite reads and the wonderful writers, scholars, and bloggers who always give me something to think about.
My fabulous physical therapist, who gets up at 5am every day and fights gridlock traffic to show up at my house with a smile and deliver superb chest physical therapy.
My doctors, who actually communicate with each other and aren’t deterred by the lack of easy or obvious answers when it comes to this body.
My job and my husband’s job, because at the end of the day if we both still have them and have health insurance, we are fortunate.
And lastly, the fact that despite their many health problems, everyone I love is healthy enough to sit at the table this year.