My column in today’s GJWHG.
http://girlsjustwannahaveguns.com/2013/04/moral-authority/
Edwin
The moral authority for law; how do we derive it?
Reply
This morning brings unbelievably good news! Happy Easter!
This morning brings unbelievably good news!
My column in today’s Greenville News.
Easter Sunday is the day we too easily make Jesus the God of good people, the God of nice boys and girls and proper men and women, with freshly pressed clothes and baskets of candy, who go home for nice dinners. The people who know all of the right Sunday-School answers to life’s questions.
However, having spent my medical career seeing a lot of wounded, broken people, I have a message this Easter, whether you’ll be in church or not; whether you’ll have chocolate bunnies or just be happy for food. Whether you have a new dress or an old pair of jeans. Because the miracle of Easter is for all; and especially for those who are longing for hope and love.
Here’s what you need to know. The resurrection was for ancient alcoholics and 21st century Methamphetamine addicts. It was for the prostitutes of antiquity and the sex-workers of the Internet. That magnificent event was meant to heal the bitter slave holders and oppressors of times past and the manipulative money-launderers of modern banking scams. The Man from Galilee died for physical sicknesses of the past that left men and women beggars, and for the schizophrenia that leaves people babbling beneath underpasses today. He died for the grief, depression and anxiety that we now treat only with pills and more pills.
Jesus’ act was for all. For the Roman soldiers who crucified Him and for the terrorist bombers of our time. It was for the poor and rich, for the starving and the obese. He died and rose for environmentalists and litterers, for progressives and fundamentalists. It was for those whose sin is pride and for those whose pride was long ago lost in professional failure. It was for those who rob from the poor, and for the vicious poor who use poverty as an excuse to steal and murder. It was for the married and divorced, the widowed and the engaged, the orphan and the beloved son or daughter. It is for the believer, but it remains available for the ones who can’t believe; at least not yet.
Jesus came for scientists and simpletons; for academics and tradesmen. He made no difference between them, for all were ultimately in need of the same saving work. He came for the religious leaders who condemned him, for wayward pastors, embezzling televangelists, abusive priests, patient missionaries, non-committed universalists and the martyred founders of the Church. Indeed, He came to give the same clarity to all. The clarity that He was the way and that by believing and seeking Him they could find their longings answered and be re-born in Him and in His love. His intent was for His followers to continue in kind, and embrace everyone else with the love they received, offering them not sterile, disinterested ‘tolerance,’ but much more. They were to spread His offer of healing, forgiveness, redemption, transformation and eternal life.
Consider this. In an age of endless demographic groups used for politics and marketing, there is no demographic for whom Jesus did not die and live again. There is no sin or affliction, no shame or personal abuse, no history, no wound, no lie, no faithlessness, no cruelty endured or inflicted that did He did not take to the cross. Nothing, and no person, that He neglected in His universe changing, soul-saving, death-ending, time-shattering, sin-atoning act.
This is harder for us to accept that we might like to admit. It’s one thing for Jesus to die and return for me; but quite another that he did it for someone I dislike, disdain or with whom I share no commonality. And yet, that is the salient point. The bruised, bloodied and resurrected point. He is our commonality, who unites us in redeeming our common sin.
Whomever we are, we bring our wounds and sins to this new day, this resurrection day; sometimes hidden beneath our pinks, greens and blues, suppressed (even in church) by the right words and smiles. Happily, whatever we woke up bearing, whatever personal agony, whatever tomb we seem to dwell in or be destined for, this morning there is unbelievable news.
Jesus took our place, Jesus took our pain and guilt and sorrow and fear. Jesus took our disease and wounds and very mortality and condemnation up to the cross, down to the grave, and left it behind. And whatever we are, or did, or bear upon us, these words remain relevant.
He is risen. So are we if only we desire and accept.
The national uterine registry initiative.
This is a link to my column at Girls Just Wanna Have Guns.
I hope it proves thought-provoking!
http://girlsjustwannahaveguns.com/2013/03/the-national-uterine-registry-initiative/
Edwin
State physician licensing guide
If you do any locums work, or are contemplating it, this is an excellent licensing guide from Barton Associates.
http://www.bartonassociates.com/physicians/state-physician-licensing-guide/
Thanks!
Ed
For want of a knife; my column at Girls just wanna have guns.
http://girlsjustwannahaveguns.com/2013/03/for-want-of-a-knife-what-we-dont-know-can-kill-us/
This is a new opportunity for me, so any comments and links would be appreciated!
Ed
Play nice in the EMR! My blog post at Barton Associates.
Using different EMR can be challenging. Here are some insights for locums workers.
http://www.bartonassociates.com/2013/03/14/play-nice-in-the-emr/
Request from readers
Dear friends, dear readers,
You are very important to me! In modern writer terms, you are my ‘tribe.’ Given that fact, I’m working on a project and I need your input. Can you tell me the top five to ten (more or less) columns of mine that have meant the most to you? Columns that have been entertaining, touching, relevant or educational?
I’m not looking for praise, mind you, but I want to put together a packet of my best works.
I need your input here, so any and all comments are appreciate!
Edwin
PS I’ll keep you posted as it moves along.
Reading to your children will change their lives
This is my column in today’s Greenville News. Read to your kids!
I love bedtime. As a husband and father, it’s just a time of absolute wonder. Life winds down in the evenings. The sun sets, the children slow down and become quiet. Even teens are less active; their texting fingers weary from constant communication.
The cats settle into the window-boxes, flower-free for the winter. Weary dogs stretch out on the lawn, or in their large house under the porch as bold rabbits run across the yard in the twilight. Or maybe, its a kind of truce, ‘live and let live.’ Quiet descends on our hilltop house as the sun slips past the Blue Ridge.
But my favorite part of bedtime has always been the time I read to my children. We’ve read board books and fairy tales, nursery rhymes and other poems. We’ve shared Bible readings, myths and novels. I’ve read the Book of Virtues, tongue twisters by Dr. Seuss, poems by Shel Silverstein and Edgar Guest and everything in between.
I found that bedtime reading was my time with the children. Jan had spent the day with them and sometimes wanted a little well-earned mama time. The books, the stories, were my special domain. I would say ‘time to read!’ And as soon as I sat on the floor, a child was on my lap and the others crowded around, ready to hear another installment, a new book or an encore of a well-loved tale.
It served many functions. First, when we read to someone we love, there is a kind of wonderful intimacy. Words are sacred and the passage of ideas, in the form of beautifully wrought words, is a kind of sacrament.
Reading to the children was also a time of learning. Whatever the age, reading was a chance to comment on stories and characters, to shape their ideas of right and wrong. To hold forth, gently, subtly, on morality and virtue. It was also a way to teach them pronunciation, vocabulary, syntax. A time for me to read, and for them to read to me in due course.
It was a time for them to learn what genre’s of literature they loved, and to hear classic stories and poems from our culture and a few others as authors from exotic lands, with strange stories, visited us. In essence, bedtime reading is a time in which the hearts and minds of children can be shaped and made both beautiful and useful. A time to become civilized in pajamas. And a perfect segue to a night of dreams.
At Christmas I noticed many ads for books that would read to children. Since then, I recently saw a commercial in which the mother of a toddler reveled in her peaceful cup of coffee, as her child watched his favorite video on her phone, over and over. These technological developments are fascinating, but a little sad. Whose schedule is so restrictive that they can’t read to their children, at least a little? Unless afflicted by physical limitations or the inability to actually read (which is still a problem, though relatively uncommon in America ), every parent can make time to read, in the morning or evening or afternoon. We spend enormous amounts of time on worthless websites, toxic television shows and communicating nonsense on social media sites. Surely, everyone can pick up a book, plop a child on his or her lap, and tell a tale
My children now spend far more time reading on their own. I can’t keep up with their reading, in fact, as they turn the tables and bring books to me that I should read, just as I still do to them. Novels and science, short stories and theology, we read and recommend, and point out favorite quotes.
I still read to the kids some evenings. They are beyond laps, but their minds and hearts are still growing. I still have nutrition to give their souls. There are things for me to interpret for them, as their ideas mature. Sometimes what I read leads to discussions, or friendly arguments. But they still benefit. Just as I benefit from their fresh visions. It’s Socratic now; reading is more dialogue and less lecture.
I watch the news. I contemplate the terrors, tragedies, dysfunction and disarray that stalk the world today. But I can’t help thinking that far more than any law or program, the lives of generations could be permanently elevated for the cost of a few books, and a few minutes every night, spent reading.
The New Religion of Narcotics
I just finished reading Neil Gaiman’s fascinating novel, Gods of America. Here’s a link to it on Amazon. http://www.amazon.com/American-Gods-Authors-Preferred-Text/dp/0062080237/ref=sr_1_1?ie=UTF8&qid=1362266866&sr=8-1&keywords=American+Gods I first learned about his work by watching the movie Stardust, then reading the novel.
One of the themes of Gods of America is that the deities of the old world came to America in the hearts of their followers, but over time lose their followers and thus their power. A war is arranged between the ‘old gods,’ and the new ones that Americans have instituted. In the story, media, technology, entertainment and others are the new deities for a new age.
I thought about it as I considered my work. It seems that every day of my life is an endless discussion about narcotics in the emergency department. Or is it a kind of liturgy to another new god?
‘Can’t I get no Lortabs?’
‘I can’t take Percocet, all I can take is Dilau, Dilaud, what is it called? Dilaudid? I don’t know anything about those drugs, you know!’
‘I’m allergic to the 5mg Vicodin, but I can take the 1omg Vicodin just fine!’
‘Somebody stole my Fentanyl patches and my Morphine pills, and all of my Oxycontin and all I have left is my Methodone, and I only have a few but I don’t see the pain doctor for another month. Now what am I supposed to do, doctor, just suffer?’
‘My nerves are torn up. I’m out of Xanaxes and my brother’s friends came over and stole all of my Klonopin and Valium! Sure, I still got some Ativan, but look at how I’m shaking! Oh, and I’m out of Suboxone.’
‘See, doctor, I have the degenerating disc disease. I guess I’ve had chronic back pain since I was, oh, 14. That’s ten years I’ve suffered! Nobody will do anything for me, so I just take pain pills wherever I can get them. Can I get some Percocet?’
I could go on. It’s dialog in a bad novel. It’s a sonnet to somnolence. It’s an endless homage to anesthesia. It’s all but worship.
So it must be a religion. The people I see are worshippers of pain medication and anxiety medication. Or maybe, they worship pain and anxiety, and the offer up the drugs to their deities. Or perhaps they are slipping into amazing dream states, sleeping all the time, and having ephiphanies of wonder and delight. Scratch that. They’re dreaming of television and snack food. Of reality shows and disability payments.
And the object, or objects of their worship are taking a terrible toll in lives lost, as epidemic prescription drug abuse sweeps across the land. (http://oxywatchdog.com/category/surveys-statistics/.) It’s enabled by a culture that in its own way worships disability and victimization, incapacity and the medicalization of all things.
It makes sense, really. We cannot possibly suggest that anyone isn’t telling the truth, because a) truth is relative and defined by each person and b) to suggest that would be poor customer service, or discrimination or to be ‘judgmental.’ Furthermore, we reject anything that might suggest an individual take responsibility, or make good moral decisions because morality is relative and faith is irrelevant.
Thus, the internal discord and evil and even legititimate suffering of the human heart must be medical, must be made somatic and mechanistic so that it can be treated mechanistically, and so that no one need concern themselves with uncovering the layers of difficulty and untruth in the human heart, no one need ask hard questions or suggest that one may have guilt or fear for good reasons. All we want to do is call it a ‘pain’ and offer it a ‘pill.’
Well there you are, America. We worship at the feet of pain and pills. We offer our young and our old and our middle aged and vital to the sleepy gods who accomplish so little and cost so much and offer only restless dreams and ultimately breathless deaths.
I will not worship them. I hate them. But I acknowledge their power.
Edwin
Silly Scripting Games. Yet another scourge on medicine and nursing.
This is my March EM News column
Silly Scripting Games
Our nurses will soon have ‘scripting’ guidelines for their interactions with patients. This is apparently widespread in many industries. The idea being, patients will be more satisfied with their care if certain key phrases are repeated to them; phrases which might, possibly, just maybe find their way onto satisfaction surveys. Wink, wink!
Whether I will have to engage in this tawdry bit of theater remains to be seen. But bless the nurses and clerical staff! Here are the early scripts, printed on yet another laminated card to go with the other assorted cards all the staff wear with their ID badges (predicted to weigh at least 5 pounds in total policy reminders before long):
“Hello, I’m (name, occupation)”
“I’m here to (Meds, Procedures, Clean)”
“Is there anything else I can do for your?”
Key words: Safety, Privacy, Care
Our nurses and secretaries are wonderful people, and might have had careers in Hollywood if things had gone differently. But one of the last things they really want to do is act. Nevertheless,
I know the game.
Someone will read this and think that I’m a Luddite, a curmudgeon, a stick in the mud of progress. Others will say, as they do about every new customer service initiative, federal ruling, Joint Commission rule or state nursing board policy: ‘It’s only a little thing, so stop being a baby and get with the times. Sheesh!’
Indeed. It may be the case. Only today I was reminded, in a meeting about STEMI, that my group is tragically, woefully lax. We are failing to use a key phrase that explains why thrombolytics might be given instead of percutaneous intervention. In order to meet quality indicators (and get paid appropriately), we must write, in the chart, the following magical incantation: ‘The patient received thrombolytics because his time to cath lab would exceed 90 minutes.’
Silly, lazy doctors, trying valiantly to reach the bedside and touch a patient, make a good decision and save a life when we could be populating data fields! Bad, bad doctors! To quote Monty Python and the Holy Grail: ‘You must spank us! Yes, spank us all!’ I digress.
Let me bring it round again. Scripts are about patient satisfaction scores, which remain quite the rage despite some rather damning suggestions that they might not be good for doctors or patients. Scripts come to us from firms hired, using hospital budgets, to teach us how to increase satisfaction scores in order to put more money in the budget…and on and on it goes. How much we lose on consultants in order to make enough increased money to pay for consultants is a bit of a mystery to me.
Still, progress marches forward. So let me suggest how I might find scripts useful:
‘Hello, I’m Dr. Leap. I’m here to take care of you while you’re sick, not do data entry. Is that OK with you?’ Key words: care, sick, data.
‘Hello, I’m Dr. Leap. I’m here to preserve your airway and rescue you from your own alcohol toxicity. Is that OK? Is there anything else I can do for you? Sorry, I can’t understand when you vomit.’ Key words: airway, sick, alcohol, toxicity, data, scores…vomit.
‘Hello, I’m Dr. Leap. I’m here to decide if your pain score is really a ten, since you look uninjured. Is there anyone I can go ahead and call to take you home?’ Key words: ten, uninjured, call, home.
‘Hello, I’m Dr. Leap. The last time you were here you stole an entire drawer of dressings and a dirty needle box. I’m here to report that. Is there a parole officer I can call for you?’ Key words: stole, drawer, needle, parole.
‘Hello, I’m Dr. Leap, I’m here to commit you to a psychiatric hospital to help you obtain disability at 30. Is there anything else I can give you besides my time and my tax dollars to help perpetuate your life of inactivity?’ Key words: commit, psychiatric, disability, 30, tax, inactivity.
‘Hello, I’m Dr. Leap. I’m here to ease your suffering, my dear, stoic little lady. Whatever you need is fine. Is there anyone bothering you because I will shut them down!’ Key words: suffering, dear, stoic.
‘Hello, I’m Dr. Leap, I’m here to find out why you’re smoking in the emergency department, and ask you to leave. Is there any way I can make that happen faster?’ Key words: smoking, leave.
‘Hello, I’m Dr. Leap. I’m here to explain to you that you can’t speak to our nurses that way. Is there a bar of soap I can shove in your gullet, you nasty man?’ Key words: nurses, speak, soap, gullet, nasty.
‘Hello, I’m Dr. Leap. I’m here to explain to you that you will not be receiving Valium, Ativan, Klonopin or Xanax for your panic attack. Just like the last four times. Can I get you a cup of coffee with caffeine? Key words: Valium, Ativan, Klonopin, Xanax…not.
‘Hello, I’m Dr. Leap. I’m here to protect you from your neglectful parents, little one. Would you like a coloring book? Look! Your parents are too busy texting to hear us talk! Funny, funny parents in orange jump-suits!’ Key words: neglect, parents, little one, texting, orange jump-suit.
‘HELLO, I’M DOCTOR LEAP! I DON’T SPEAK YOUR LANGUAGE. I’LL FIND SOMEONE WHO DOES, OR A TELEPHONE! IS THAT OK? IS THERE ANYTHING YOU NEED? Key words: LANGUAGE LINE!
‘Hello, I’m Dr. Leap. I’m here to talk to you, not to text you. Let me know when you put it down. Is there any other means of communication I can get for you? Until then, I’ll ignore you.’ Key words: text, communication, ignore.
“Hello, I’m Dr. Leap. I’m a health-care professional who does great job. I won’t always follow the script, but then, you won’t always follow the text-book. I’ll do my best. If you’re unhappy, tell me and we’ll work it out. But let’s not play word silly games. Let’s make you better, shall we?”
Key words: professional, better, best.
Silly game.
PS Send me some samples of your own scripting! If we have enough, we can write a screen-play!