Global Cooling

It's July 22 in the sun belt and today the high was 85 degrees. I'm scared. The average temperature for my region on July 22 is 94 degrees. I think I'm seeing a trend. I'm afraid we may be entering a time of global cooling and that glacier's may envelope my home within the next ten thousand years. I believe the blame for this must be laid squarely at the feet of both Presidents Bush. Don't ask me why except that they just don't seem to care.

Forced Chemotherapy?

Click on the title above to be directed to a story about a young man with Hodgkin's disease who has been ordered to undergo chemotherapy. The gist, as I understand it, is that his parents wanted him to try 'alternative therapies' as his first experience with chemotherapy was not curative and was highly unpleasant.

Chemotherapy is simple in concept. Most cancer cells reproduce much more rapidly than normal cells. Chemotherapy agents kill all cells, but since cancer cells metabolic rate is very high they are killed much more rapidly than normal cells. Therefore chemotherapeutic agents tend to work well. They all cause all manner of unpleasant side effects however. Most patients experience hair loss, nausea, and vomiting. There are many other side effects, but to continue the explanation, the GI tract and hair follicles are normal cells which divide rapidly and are therefore killed preferentially along with fast dividing cancer cells.

We were told in medical school that the first chemo agent was a form of nitrogen mustard, and it was discovered when army physicians noted that soldiers with certain forms of cancer who were exposed to mustard gas in WWI had partial or complete remissions of their cancers. This is a neat story and it makes sense but I am not vouching for its veracity... That should be easy enough to do with google.

So back to the case at hand. I gotta tell you, this is a tough one for me only because of the age of the patient. Obviously with a name like Starchild Abraham Cherrix one can make some assumptions about the parents. Then when one notes that they want to pursue "alternative treatment of a sugar-free, organic diet and herbal supplements supervised by a clinic in Mexico" then it is hard keep the image of an LSD munching, Jerry Garcia loving, laissez-faire 'child raising unit' out of one's head. But so what?

So Starchild's parents are patchouli-wearing, tree-hugging, 'free thinkers' who have chosen to put their faith in some charlatan in Mexico. Is this the United States? Well, yeah, but it's a bit tougher than that. Starchild himself can not, by law, make his own health care decisions. Therefore, the court can assess his parent's capability to make reasonable decisions for him. These days I'm surprised that the parent's aren't being awarded a medal. Reminds me of the cases in which Jehovah's Witness parents denied their children life saving transfusions only to have the transfusions enforced by emergency court edict.

From a medical perspective, Hodgkin's disease, especially in the young, is very curable with chemotherapy. I personally witnessed the demise of a 23 year old from the disease who had made the exact same decision as Starchild's parents... He refused referral to an oncologist when he was first diagnosed. A year later he was back in the ED with a huge tumor burden and without options. He died three weeks later. He could have been cured. In his case it was simply a severe lesson. In this case I kinda don't know how to feel.

I will say, however, that it is ironic that if Starchild were a female, and were pregnant, that she could abort her living human fetus in most states without a second look from a court and without her parents knowing about it. Or, if she were merely infected with syphilis or gonorhea that she could receive secret treatment.

Finally, I must ask, what is it that makes the court sure that the alternative treatment will not work? As a physician and a father there is no way in hell I would go to some 'holistic' doctor in Mexico with my child who had Hodgkin's, but I'm not a gorp-eating, hankie-head, tree-hugging freak either. That being said, I like the fact that in America we leave freaks alone.

I know I can be sued for wrongful death. Can someone be sued for "wrongful life"? What I mean is what if the chemo works as it should... What then? Do this kid's parents continue to be his parents? What if he dies? Can the government be sued? No. It can't. Everyone has faith in something, eh?

GSW

GSW (gun-shot wound). It used to scare the hell out of me when I was a resident taking care of the trauma side of the ED. Really, taking care of GSW patients is not too hard for the emergency physician. You merely have to determine whether the patient has to have surgery or not... Now, admittedly, this is sometimes difficult, but when the decision is difficult the surgeon decides or you simply transfer the patient to a facility with a trauma service.

In our medium sized town there aren't too many surgeons who want to take these patients to the operating room because they fear they will be held to the standard of a fully trained trauma surgeon. Not an unreasonable fear.

When the patient has a GSW to the head and is essentially dead when the paramedics arrive however, the decision is not too difficult. But what happens when they succeed in starting the heart again? The answer is that in an otherwise healthy young patient that you send him to the trauma center with one main purpose... That he or she may "live" long enough to be an organ donor.

I had one of these patients the other night... In fact I had three GSW patients in one night! Only the head-shot patient died, but he did, in fact, become an organ donor before he did. All I did for him was shoot a one view skull film and a one view chest film. The idea here was to be able to tell the accepting facility the likely track of the missile through the skull, and to make sure the slug did not divert down into the neck or thoracic cavity.

My patient was shot just above the left ear. The patients brain matter was protruding from the entry wound. The slug, probably a 9mm, was in the opposite hemi-cranium with bits of metal left in its path. This made the wound transcortical and told me that the patient would likely never regain any meaningful existence. We flew him and he "lived" another 36 hours. The police arrested a handful of gang members the next day and charged them with murder.

How Do You Know She's a Witch?

Took care of a suicidal/homicidal witch the other day. This multiply pierced and tattooed woman had decided that she didn't want to live anymore. She had a plan to walk onto the nearby military base with a gun and start blazing away (I didn't ask why she didn't use her wand). In the room to comfort her were her 'clergy'... One, evidently, her "high priestess", and the other merely an acolyte of some sort. Both of these "clergy" (really, I'm not making this up) were multiply tattooed with images of broomsticks, black-cats, and pentagrams. I guess it says something about what I do that between the nursing staff and my other colleagues the patient generated only a few minutes of bemused discussion. Whatever. A homicidal witch. Boring.

Oh, by the way, you know she's a witch, according to the great scientist Sir Bedevere, if she weighs the same as a duck.