Category Archives: Non-Fiction

Unshattered: Overcoming Tragedy and Choosing a Beautiful Life

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Unshattered: Overcoming Tragedy and Choosing a Beautiful Life by Carol Decker (with Stacey Nash) is a great story of encouragement. If you’re struggling with challenges, depression, or adversity you’ll find help for your soul in this book!

Carol was nearly 8 months pregnant when she became ill and went into preterm labor. Her daughter, Safiya, was delivered prematurely and spent time in the NICU, but ultimately was a healthy baby. Carol didn’t fare as well. Ill with pneumonia, she was also septic (where infection triggers chemicals to be released into the body, causing widespread and life-threatening inflammation which cascades into organ failure or even death), and additionally developed DIC (Disseminated Intravascular Coagulation) a clotting disorder which ultimately cost her her legs below the knee, her left forearm, and her right ring finger….and left her blind.

After surviving the initial battle with sepsis she was transferred to a burn unit for her skin grafting. Carol endured multiple surgeries, not just for her amputations, but approximately 30% of her body needed skin grafts because of the death of tissues. She was treated as they treat a burn patient, with debriding (removing dead tissue) and dressing changes that were excruciating. Simply laying down caused her extreme pain because one site they took donor skin from was her back. Her physical — and mental — suffering was immense.

Upon arrival at the burn unit, she was told that her trach (breathing tube in an incision in her neck) would have to be capped making it so she couldn’t speak (again depriving her of her one connection to the world around her…remember, she couldn’t see).

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Filed under Autobiography, Christian, disability, Non-Fiction, women

Emergency Doctor

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This book was on my Amazon wishlist and I got it for Christmas. I just got around to reading it this summer, and I fully expected to zip through it, devouring story after story that reminded me of my career in Emergency Medicine. I. Was. Wrong. I had to force myself to keep reading. There was so much back story that I really got bogged down in the biographical, geographical, historical, and medical details (that I already knew). This book would be good if you are a non-insider (for want of a better term) to emergency medicine/medical services.

There were lots of cases mentioned, but few were followed through their entire course of treatment in the Emergency Department (ED – the preferred term for what was previously called the ER or Emergency ROOM). Most of the cases mentioned were just a stepping off point for the history of that disorder, or it’s treatment, or the social implications thereof. Don’t get me wrong, all of those things are interesting and important, but they weren’t what I got this book hoping I would find. Honestly, I wanted to work (vicariously) again.

Many of the issues that plagued Bellevue in the 80s (the setting of this book) are still issues faced in EDs today: homelessness, overuse by “frequent flyers”, poor continuity of care, lack of primary care (using the ED as primary care), IV drug use, alcoholism. One issue that was paramount in the 80s was AIDS. HIV is still ever present, but it is no longer the death sentence that it was in the days when emaciated patients presented with Kaposi’s Sarcoma and Pneumocystis pneumonia. Now, thanks to antiretroviral therapy, HIV doesn’t necessarily turn into AIDS, and HIV has become more of a chronic illness that is managed by a lifetime of medication and less of a sentence to certain, premature death. “With appropriate treatment, a 20-year-old with HIV infection can expect to live to reach 71 years of age.”

The book reminded me how much has changed in 35+ years…what Emergency Medicine was like way back when…cassettes in Dictaphones, paper charts, lack of EMTALA (Emergency Medical Treatment and Active Labor Act, passed in 1986) laws to keep patients from being ‘dumped’. MAST (Military Anti Shock Trousers) pants, KEDs (Kendricks Extracation Device), and air splints have all gone the way of the dinosaur.

Goldfrank quotes Hippocrates: “Discussing money before caring for the sick lacks propriety.” Yet he fears that “financial triage” is already eroding medical ethics and leading some to forget that “the health providers’ responsibility is above all the health of the patient.” (p.184)

Emergency Doctor also reminded me how far EMS has come in the 35+ years since this book was written. One scene describes a man who attempted suicide by jumping from a wall on the Brooklyn Bridge, landing on a taxi driving below. His condition is described: “He was still breathing even though his back appeared to be shattered. To try to insert a tube into his throat would risk doing further injury because that would mean moving the neck. Doubtless that would reduce whatever slight chance for survival he had. But it was clear from the gross injuries to his cervical spine that it would be impossible to make an adequate assessment of his airway in the field. About all that could be done was to place an oxygen mask over his mouth and nose and rush him to Bellevue.” (p.188) As a medic, that made me cringe. Although the outcome would likely be the same in this case (death), ignoring a compromised airway because one can’t intubate without c-spine injury is anathema. First, there’s the ABCD’s:Airway, Breathing, Circulation, Disability…in that order of priority. Second, we can intubate without further injury to the c-spine by using certain techniques. Third, medics can now do what was ultimately done at Bellevue for this patient: perform a cricothyrotomy (a “cric” in EMS slang) where the persons’ throat is incised and a tube is inserted through the incision into the trachea. “Scoop and run” might have merit in the urban setting where the trauma center is a mere blocks away (by Google Maps estimation it is 15 minutes from the Brooklyn Bridge to Bellevue) but in most situations, 15 minutes of a compromised airway=probable brain death.

Some things in the book are only foreshadowings of problems we deal with now. Back then, it was DRGs (Diagnostic Related Groups) and HMOs (Health Maintenance Organizations) that threatened to reduce patients to numbers, rather than people who are sick. Now there are many more gatekeepers practicing medicine without a license. Chief among them are insurers (#Anthem, I’m looking at you), who feel they can deem (after the fact) what was or was not an emergency, thereby denying payment. So the person with chest pain waits to go to the ED because “it might not be a heart attack and insurance might not pay” and then dies because it WAS indeed a heart attack.

Overall, I think Emergency Doctor is aimed at the layperson in the 1908s, not a medical professional in 2018. Time to retire, doctor.

 

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Filed under EMS, Non-Fiction

Unified

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Tim Scott is a US senator from South Carolina. Trey Gowdy is a US congressman from South Carolina. Tim Scott is black. Trey Gowdy is white. They were both elected to Congress in 2010 (Tim Scott subsequently became the first African American elected to both the US House and US Senate since reconstruction). Their grandmothers would not have been able to be friends, in the racially divided south where they lived. When Tim Scott got news of the fatal shooting of nine blacks at a prayer meeting at Emmanuel African Methodist Episcopal Church in Charleston, the first person he called was his white friend, Trey Gowdy.

It is sad that a friendship between a white man and a black man is rare enough that it seems unlikely, but there is still a marked racial divide in the United States. I believe it has widened, rather than narrowed, since the election of our first African American President, Barak Obama.

Sen. Scott and Rep. Gowdy assert that when meeting someone who has obvious racial, ethnic, socioeconomic, political, or religious differences, looking for something we have in common is the first step. There are certain commonalities that cross many barriers: love for family, hope for a better tomorrow, desire for our communities to be safe, etc. In the aftermath of a disaster (9-11, hurricanes, wildfires, and the like) people tend to forget their differences and go into a mode that allows our better selves to come out. We pray together, we mourn together, we rally. On 9-12-2001 there were no “us and them” — we were all Americans. Our fear, outrage, pain, and grief united us. Trey Gowdy asks, “Why must we face a calamity before we will join hands, pray, and seek healing?”

I’ve not lived life as a person of color. I haven’t experienced the prejudices that come from having brown or black skin. I’ve never been viewed suspiciously for “driving while black” (getting pulled over because you’re a black person in a predominately white area). I don’t experience fear when I’m glanced at by a person in law enforcement. Still, prejudices are widespread and they aren’t exclusively against people of color.  Prejudice can be about whites from people of color. It can be about religion, sexual orientation, perceived education (or lack thereof), or socioeconomic status. Tim Scott says, “Our perception of people is too often colored by preconceived notions and expectations, whether those are based on past experience or shaped by cultural norms and attitudes.” Trey is quoted as saying, “…the only two divisions there ought to be in the nation are “people of good conscience and people who are not of good conscience — not racial, not gender, not ideological.””

Tim and Trey have forged a solid, valuable friendship by capitalizing on their similarities, rather than their differences. Trey says, “We can build real trust with others by stepping into their story, by committing our time and attention to what matters to them…As you seek to build rapport and trust with someone, you must be willing to see the world from a perspective that is not your own…The 24/7 news cycle we have today so often seems to focus on differences and divisions within our nation…But as I talk to people one-on-one, I find a universal hope and desire for unity.” (emphasis mine).

Trey states, “People look to Washington for solutions to our nation’s problems, but Congress is often where anger and frustration come home to roost. Although Tim and I are both currently in politics — or perhaps because we’re in politics — we see the limitations and shortcomings of legislative remedies. We believe the firmest foundation for positive change is found with individuals in relationship with one another. Laws are external. Relationships are internal. Policies make you have to. Relationships make you want to. Relationships contain the power necessary to change the course of history, and the delicate, personal touch needed to change the trajectory of a single life.” Isn’t that beautiful, and oh, so true?!

One of the most powerful stories in Unified is a story of a blog post that slammed Senator Tim Scott. Trey read it first and rushed to Tim’s office to see if he had seen it. Indignant, Trey says, “I’m sick of this…something must be done.” Tim’s answer was a simple “You’re right. Please close the door and have a seat.” Trey thinks they’re finally getting somewhere…he’s finally gotten his friend fired up enough to respond (Tim was evidently notoriously calm). Instead, Senator Scott says, “We’re going to pray for [the author].” Tim Scott proceeds to pray for someone who was intentionally hurtful to him. Trey says, “Tim simply modeled what Jesus teaches: ‘Love your enemies and pray for those who hurt you.’…I was not the victim, but I was angry. Tim was the victim, but he forgave and prayed for the person who wronged him.”

I was simply amazed by the wisdom and truth in this book! If you want a different world, one where people love and respect one another in spite of their differences, this book is a great source of advice on how to start down that road. Christians, especially, need the words written here. Some of the most judgemental and hateful people I’ve ever encountered were Christians who, mistakenly, thought that by pointing out the speck in their brother’s eye they were doing him/her a big favor, all the while ignoring the beam in their own (Matthew 7:1-5).

Read this book, then go find someone “different” than you and try to make a friend. We can change the world, one heart at a time.

*I received a complimentary copy of this book from the publisher in exchange for my honest review*

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Filed under Christian, Non-Fiction, politics, Self-help