Old Market Street

In more ways than one, a moving time capsule.
I found the detective work that went into it exciting,
so much so that I think film historians are cool.

The Business of Caring

St. Vincent’s Is the Lehman Brothers of Hospitals
Its demise was only the beginning. An alarming number of New York’s major medical institutions are teetering on the financial edge.
By Mark Levine from "New York" Magazine

An astute blow-by-blow description of St. Vincent’s demise. I don’t think of HHC hospitals as safety nets, because all hospitals are safety nets. Once you walk into an E.R., whether you can pay or not, you will receive care.

“They often come into the hospital through emergency rooms, which are required by law to treat anyone regardless of ability to pay and where the cost of care is much higher than it is in other settings. New York hospital patients tend to stay in the hospital longer than others; the city’s average of 6.6 days per hospital stay is more than a day longer than the national average (older people can’t be sent home to walk-ups until they’re capable, non-English speakers require translators to provide discharge instructions, and so on.”

Spurred on by Joint Commission, there’s a new focus on length of stay. An anecdotal example: Families who reside in the U.S. bring their family member from their native countries to the hospital straight from the airport because he or she is sick. The patient stays in the hospital for the work-up and cannot be discharged because diagnostic tests cannot be done outpatient due to lack of insurance. What happens to length of stay?

There’s a comment about salaries in the article, but no one seems to say outright that the taxes from the salaries pay for the uninsured. To put it differently, I’m paying for you to be cared by me – I’m paying myself to work. And I get your attitude on top of that? Sorry, but I did not get myself to a nunnery.

New York City expects all of its hospitals to be charity wards and not in the business of flipping beds. I’m all for benevolence and indiscriminate caring. However, the business of caring as we know now does not make room for charity. As the article puts it, “In New York hospitals, it helps to be smart, but it helps, above all, not to cater to the poor.”

"It Gets Better"

Good sentiment, Broadway babies. But, it wouldn't convince me to step off the ledge. However, Tim Gunn's appeal works. So do the other "talks" by cast members of Broadway shows. For more, check out other stars' PSAs at www.thetrevorproject.org.

"Big Bambu" at the Met

At Doug + Mike Starn's "Big Bambu" installation on the roof of the Met.

I should have worn my native outfit and I'd fit right in. Tinikling, anyone?

BMTs

Personally, I find allogeneic BMTs frightening for its upsetting side effects. GVHD has horrendous clinical manifestations. But I have to let that go because it is what the patients want. T. Brown, RN on the NY Times' Well blog felt the same distress, but who are we to take that hope away? Below is a feel-good piece that re-affirms why I do what I do. I applaud those who are on the registry. I know of one who's on the registry who worries they might call him one day. Take heart, "walking funny for a week" and some pain seem to be the only unpleasant complaints for a donor post-collection.

The Gift of a Lifetime
How a Woman Who Died in April 1999 and an Infant Diagnosed With Leukemia Became Connected by an Act of Kindness
from "CBS Sunday Morning"

"The Bread of Angels"

"Ethan Frome" was never this hot. (It was steamy in its own way.) Lapham's Quaterly published a blue piece authored by Edith Wharton, circa 1919:

One by one they gained her bosom, and she felt her two breasts pointing up to them, the nipples hard as coral, but sensitive as lips to his approaching touch. And now his warm palms were holding each breast as if in a cup, clasping it, modeling it, softly kneading it, as he whispered to her, “Like the bread of the angels.”

I knew she could write. I guess it should not surprise me that she could write like this. I'll just say I would've had more fun with my literary criticism paper in high school if I were reading this in addition to "The House of Mirth," "The Age of Innocence," and "Ethan Frome."

PE, cont'd

Wouldn't you know it? My teacher brought up the Stanford 25 (previous post) in class because Dr. Verghese was profiled in in the NY Times. I was ahead of the curve.

Physician Revives a Dying Art: The Physical
By DENISE GRADY
Published: October 11, 2010
At Stanford, Dr. Abraham Verghese is on a mission to bring back something he considers a lost art: the physical exam.

I volunteered that I had read this two weeks ago and brought up the limitations chimed in by other MDs in BMJ. She seemed put off by that. I agreed with her though that RNs beat PA's and MD's when it comes to "touch"-ing a patient. Because we're a touchy profession.

PE

On "The Fading Art of the Physical Exam," by Richard Knox from NPR.org

I'm not for going back to the days of Dr. Quinn, Medicine Woman or even Dr. Kildare.

Since I will be a “mini-doc,” as my Advanced Health Assessment prof put it, the Stanford 25 seems like a standard to look up to as a program objective. (There are limitations/criticisms.) Nurses are trained to do a physical exam (PE). Yes, we learned these PE skills in nursing school, but do not keep it up. Depends on where we practice. In a hospital setting, MDs and diagnotic machines are within easy reach, so nurses' PE skills rust. Upon review, not many of my nursing preceptors emphasized PE skills in practice when I was a student. Many of my colleagues do not carry a stethoscope around, so I can bet they don’t listen to breath sounds or bowel sounds and are only forced to use it when they have to take a BP manually.