A neurosurgeon on medicine, euthanasia, and God

I’m off to my GP as I injured my shoulder, most likely acquiring bursitis, and will probably get a cortisone shot, which a friend just informed me “really hurts!” Now what was the point of telling me that? It adds no value to my day except a soupçon of fear (I’m not afraid of needles, but I don’t like pain).

As we age, our bodies gradually accumulate infirmities and scars: now I have two crooked fingers and a ruined toenail. (The day I moved into my office, the building manager and I had to move my huge and heavy oak desk out of the elevator, since the movers would only take it to the building entrance. It dropped onto my foot, completely severing the bone of the left big toe, causing me to faint, and then to visit the hospital where they pulled off the toenail with pliers, causing me to faint again. The doctor said the nailbed was screwed, and the toenail would always be deformed. True!)

But enough of these infirmities: this is by way of saying that this is the last post for today unless Grania is kind enough to start an open discussion thread.  I simply call your attention, via reader Paul, to an interview in the Guardian with neurosurgeon and author Henry Marsh, who wrote a highly acclaimed memoir called Do No Harm: Stories of Life, Death and Brain Surgery . Has anyone read it?

It’s a nice interview and I’ll just excerpt two bits:

There has been a slew of books about that old-fashioned idea of what makes “a good death” recently. Do you welcome them?
I think Atul Gawande is a very good writer, but I didn’t get on with his book Being Mortal that much. He only very grudgingly says that maybe doctor-assisted suicide is a good idea. I am a great proponent, to the extent I feel I would take it up myself – though you never know, when push comes to shove, what you will decide. But it does seem to me increasingly that the two markers of a civilised society are bicycles and doctor-assisted suicide. It is not about licensing doctors to kill people. It is about allowing everyone with mental capacity to make a choice about how they would like to end.

I guess religion still partly gets in the way of that idea
It seems to me that the only rational case for theism is that God is a complete bastard. I have seen a lot of children die with inoperable brain tumours, particularly one horrible one called a diffuse intrinsic pontine glioma, for which there is no treatment. When I go out to Ukraine their parents are lining up to see me in the hope of a miracle. It just seems the proof for God is so very thin. “There’s a friend for little children above the bright blue sky.” I mean, really?

. . . You clearly left the NHS [National Health Service] dispirited. Can you see grounds for optimism?
I am afraid I don’t. Politicians seem unable to stand up to the public and say: if you want better health care you are going to have to pay for it. Instead they still say it is all about management and reorganisation. The evidence is clearly out there in the other wealthy European countries, though: we spend far less on healthcare in both absolute and per capita terms than they do, and almost across the board you see that in the relative outcomes.

Marsh has a newish book, Admissions: A Life in Brain Surgery. 

97 Comments

  1. Stephen Barnard
    Posted July 20, 2017 at 11:24 am | Permalink

    “The evidence is clearly out there in the other wealthy European countries, though: we spend far less on healthcare in both absolute and per capita terms than they do, and almost across the board you see that in the relative outcomes.”

    According to the OECD, he couldn’t be more wrong. The US is an outlier in how much is spent on healthcare per capita.

    https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita#/media/File:OECD_health_expenditure_per_capita_by_country.svg

    • Posted July 20, 2017 at 11:45 am | Permalink

      That struck me too – he must have meant something else. The fact that the US spends so much on healthcare and yet the quality of the system is so poor is, to my mind, its biggest indictment.

      • TJR
        Posted July 20, 2017 at 11:53 am | Permalink

        I assumed he was referring to UK, not US – see the same graph above.

        The US is indeed a bizarre outlier, though.

        • Richard
          Posted July 20, 2017 at 11:59 am | Permalink

          Given that he is answering the question “You clearly left the NHS dispirited. Can you see grounds for optimism?” he is obviously referring to the UK.

        • Gregory Kusnick
          Posted July 20, 2017 at 12:02 pm | Permalink

          Yes; since they’re talking about the NHS, it’s clear that “we” refers to the UK.

        • Posted July 20, 2017 at 12:13 pm | Permalink

          Ack! My mistake. I mentally converted NHS to NIH. Thanks for the clarification!

      • Randy schenck
        Posted July 20, 2017 at 11:55 am | Permalink

        I am not sure he was comparing US to others in Europe. If so, he was wrong about that. The really big difference about this health care in the states is that some get it and some don’t. At the high end, we get really good health care but in most of the rest of the civilized world everyone gets the care. Control of health care cost is mostly left to the market or to the public Insurance Companies. And so, where is the incentive for the insurance company to lower cost or even control cost? Either you pay the premiums to get this service or get lost.

    • Geoff Toscano
      Posted July 20, 2017 at 12:02 pm | Permalink

      As he refers to having worked in the NHS I assumed he was referring to UK health spending and not US which, I agree, is something of a puzzler.

    • Derek Freyberg
      Posted July 20, 2017 at 12:03 pm | Permalink

      Marsh is talking about healthcare spending in the UK compared to healthcare spending in “the other wealthy European countries”, and indeed many other western European countries do spend more than the UK according to the OECD numbers. He’s not talking about the US.

      • Heather Hastie
        Posted July 20, 2017 at 12:58 pm | Permalink

        Exactly. NHS = Britain.

    • nicky
      Posted July 20, 2017 at 2:47 pm | Permalink

      I notice that per capita public spending is highest in Norway, but that in the US nearly half of the expense is private. Which makes it the highest spender per capita by far.
      Marsh is wrong indeed, the UK is clearly somewhere in the middle, just above the OECD average, lower than say, Denmark, but higher than e.g. NZ.

  2. Posted July 20, 2017 at 11:33 am | Permalink

    I am told that the shot is not pleasant when it is happening, but that very quickly you will feel much, much better.

    • Posted July 20, 2017 at 11:40 am | Permalink

      Oh Jebus, another one!!!!!!!!

      • Darrin Carter
        Posted July 20, 2017 at 1:01 pm | Permalink

        Jerry, My wife has R.A. And is deathly afraid of needles, to the point that I have to hold her and cover her eyes. She received cotazone injections in both knees and her shoulders every six months. She says to say it’s tolerable and the few minutes of discomfort is well worth the months of pain relief.

        • Darrin Carter
          Posted July 20, 2017 at 1:14 pm | Permalink

          Aww … auto correct … one of life’s little miseries. Should be recives and cortisone.

      • Heather Hastie
        Posted July 20, 2017 at 1:02 pm | Permalink

        Jerry, I’ve had at least 4 cortisone shots in my left shoulder that I can remember (recurring rotator cuff injury). I don’t remember any bad pain, and I drove myself home afterwards.

        • Diana MacPherson
          Posted July 20, 2017 at 4:02 pm | Permalink

          I’m jealous because I never get offered the shots and in fact was told I can only have 3 in my life because they damage the joints. I’d love to have them in my feet. I just found a new podiatrist that I’m hopeful about so maybe he can hook me up!

          I’d like to have them in my neck for the pain the bone sour gives me but maybe they don’t like giving them there up by the head. I’d like them in my head to be honest. Oh just shoot me up all over!

    • Posted July 20, 2017 at 12:16 pm | Permalink

      A properly done shoulder injection (with a 25 gauge needle!) should not hurt much at all; just a little pinch.

    • David Duncan
      Posted July 21, 2017 at 3:56 am | Permalink

      I had a cortisone shot 10-15 years ago, in the shoulder region I think. Not much if any pain but didn’t really help.

  3. BobTerrace
    Posted July 20, 2017 at 11:42 am | Permalink

    Getting old is not for the young. Sitting here for the third day in a hospital bed for cellulitis.

    • darrelle
      Posted July 20, 2017 at 11:57 am | Permalink

      Sorry to hear that Bob. I hope you improve quickly.

    • Heather Hastie
      Posted July 20, 2017 at 1:04 pm | Permalink

      All the best for a speedy recovery!

      • BobTerrace
        Posted July 20, 2017 at 1:23 pm | Permalink

        Thanks.

    • Diana MacPherson
      Posted July 20, 2017 at 4:03 pm | Permalink

      Ouch! Hope you have doctors that are understanding about pain and you get better fast!

  4. busterggi
    Posted July 20, 2017 at 11:43 am | Permalink

    I’ve had cortisone shots in a couple of places – they weren’t all that bad.

    Then again, I also stayed awake when all four wisdom teeth were extracted (three broke) and didn’t think getting a spinal tap a year ago was much either.

    • Colin McLachlan
      Posted July 20, 2017 at 1:13 pm | Permalink

      Did the pain not go up to eleven?

  5. Eli Siegel
    Posted July 20, 2017 at 11:49 am | Permalink

    See the film ‘The English Surgeon’ about Dr. Marsh’s work in Ukraine.

  6. Posted July 20, 2017 at 12:01 pm | Permalink

    A good counterpoint to Ben Carson and so on.

    • BobTerrace
      Posted July 20, 2017 at 12:12 pm | Permalink

      A brick from a building is a good counterpoint to Ben Carson.

      • Ken Kukec
        Posted July 20, 2017 at 12:42 pm | Permalink

        Would make a better HUD secretary, too.

  7. Randy schenck
    Posted July 20, 2017 at 12:03 pm | Permalink

    Just a timely note, considering this doctor’s specialty. We just discover that John McCain has a brain tumor and has already had an operation and will need more care. They had wanted him back in DC to vote on killing Obama care (ACA) but he could not make it. Now, we also know that being a member of congress also means that his health care is going to be very good and that he can go into almost any hospital and be covered very well. We cannot say that for millions of Americans and if the republicans get their way, millions more.

    • Heather Hastie
      Posted July 20, 2017 at 1:13 pm | Permalink

      The irony of delaying a vote to take away the coverage of 23 million people while a senator receives exemplary care should not be lost on USians.

      I don’t begrudge McCain his care. However, the US is the richest country in the world. It can afford to provide decent healthcare for all. That might require a tax increase for some. However, no one will have to pay medical insurance anymore.

      Medical insurance is more expensive than the cost of a single-payer healthcare system so single-payer is cheaper overall.

      • Randy schenck
        Posted July 20, 2017 at 1:35 pm | Permalink

        And the hell of it is, we have single payer experience and have had for years (MEDICARE). Everyone 65 and older (that includes me and Professor Coyne) are on Medicare and it is pretty good coverage. You should also have a supplement to it because it does not cover prescriptions and it covers on average about 80 percent. I would guess, don’t know for sure, that Prof. Coyne’s visit and shot will be covered. I recently had a pretty expensive procedure at a hospital, maybe $50,000 to $75,000 if you had to pay for it? I will probably get by with paying only a few thousand or less. But you put this on someone who is poor and under 65 and getting the care you need here is just not good.

        • Heather Hastie
          Posted July 20, 2017 at 1:44 pm | Permalink

          I would add the Veterans Hospitals etc. They have a bad reputation because the administration of them has never been properly sorted out, but the care they provide is excellent.

          • Randy schenck
            Posted July 20, 2017 at 2:18 pm | Permalink

            That is a great point. When we talk about poor care and no care in America we forget about a place that does care for thousands and thousands of Vets. Mostly here, we are talking about people who did one or two terms of service in the military and got out. We are not talking so much about retired military because most of them have insurance. It is called Tri-Care and it is very good. But the many who do not stay in long enough to retire – they get no insurance and those are the people that fill up the Vet’s hospitals.

        • Paul S
          Posted July 20, 2017 at 3:31 pm | Permalink

          My father who used to rant against socialized medicine was in the hospital for 4 months until it was pointed out to him that Medicare is socialized medicine.

          He had a minor stroke, two collapsed vertebrae replaced, a few odds and ends and a lot of therapy. The pre-adjusted total for his stay was 1.4M.
          Adjusted down to 400k by Medicare and United Health, his out of pocket is about $2,500.

          That’s what single payer can do for you.

          • Paul S
            Posted July 20, 2017 at 3:33 pm | Permalink

            Rewrite:
            My father who used to rant against socialized medicine until it was pointed out to him that Medicare is socialized medicine, was recently in the hospital for 4 months.

            I need to proofread.

          • Diana MacPherson
            Posted July 20, 2017 at 4:06 pm | Permalink

            And it can be better. The US could make that bill $0 fo everybody because you have a big tax base. You could have the best care in the world with the most healthy population.

            • Randall Schenck
              Posted July 20, 2017 at 7:43 pm | Permalink

              Exactly, just have everyone pay their fair share. Right now, in Medicare, everyone pays the same in. That is stupid. The more you make, the more you should pay. That is the way Social Security works, up to a point and it is the way insurance works in the private world. Medicare could do it all if handled properly.

      • rickflick
        Posted July 20, 2017 at 2:37 pm | Permalink

        “should not be lost on USians.”

        “should” is the operative word. But you know us as well as we do. 😎

  8. Kevin
    Posted July 20, 2017 at 12:08 pm | Permalink

    “two markers of a civilised society are bicycles and doctor-assisted suicide”

    Kind of a low bar, but necessary conditions. How about: no religion. [Full disclosure: I commute everyday on a bike and endorse euthanasia.]

    As for the bursitis of PCC(E). Have them flip a coin: heads, cortisone, tails, saline. Take the shot and see what happens. Soft tissue damage is not fully reparable anyhow…PT and strengthening can help.

    • Posted July 20, 2017 at 12:31 pm | Permalink

      Indeed: PT and strengthening. Only long-term solution. However, I have had help getting to where the exercise works from steroids (short term).

    • rickflick
      Posted July 20, 2017 at 2:41 pm | Permalink

      Caution, PT can cause lameness lasting 6 months. It happened to me. Walk, don’t run…er…limp…?

  9. Geoff Toscano
    Posted July 20, 2017 at 12:10 pm | Permalink

    I agree with his point about the public and the NHS. If we want to maintain it in any meaningful way for the future then we need to encourage people to realise that contributions toward care will be needed. In a similar way to the way in which dental charges were introduced some years ago. One simple step would be to levy a charge for a GP appointment. People would be much more considered in making such appointments, and those who couldn’t afford it would be exempted in the same way as the prescription charge is managed.

    • boggy
      Posted July 20, 2017 at 12:29 pm | Permalink

      NHS dental charges were introduced in 1951, thus the concept of ‘free at the point of delivery’ only lasted less than 3 years.

    • Steve Pollard
      Posted July 20, 2017 at 4:12 pm | Permalink

      Many NHS trusts are already limiting some forms of treatment for some patients. The easy options are to restrict procedures such as cosmetic surgery or IVF treatment. But we are now seeing delays in, for instance, hip or knee replacement operations. What we have not had is a serious national debate about what needs to be part of universal free treatment and what doesn’t. In the current political climate there is little chance of that happening any time soon.

      Nevertheless, and despite all its current problems, the UK’s NHS still comes out at or near the top of most international comparisons of health systems. Imagine how we’d be placed if we actually funded it properly!

      • Richard
        Posted July 21, 2017 at 4:51 am | Permalink

        “there is little chance of that happening”

        The NHS has become a sacred cow whom no-one in the UK dare criticise, and the idea that people should have to contribute towards the cost of their own health-care – no longer “free” at the point of delivery – is so unacceptable that it is almost political suicide to suggest it.

        It is now a standard for virtue-signalling: I’m a better person than you because I lurve the NHS more than you do. Frankly, I found Danny Boyle’s “ode to the NHS” in the 2012 Olympics opening ceremony to be embarrassing – surely no-one still seriously believes that “the NHS is the envy of the world”?

  10. Posted July 20, 2017 at 12:16 pm | Permalink

    “It is not about licensing doctors to kill people.It is about allowing everyone with mental capacity to make a choice about how they would like to end.”

    This isn’t true. Here in Oregon the law requires that a viable candidate for lethal drugs must be “diagnosed with a terminal illness that will lead to death within six months.” So in effect the law is “licensing doctors to kill people.”

    I don’t accept the notion that a doctor can accurately predict that an illness will lead to death within six months, nor do I like the idea of the state having the power to decide who should be allowed to end their lives and who shouldn’t. I totally agree that everyone should be free “to make a choice about how they would like to end,” but if they can do this only if the state “allows” it, then they’re not free. This is a personal decision—I can hardly think of anything more personal—and the state should stay out of it.

    • Randy schenck
      Posted July 20, 2017 at 12:36 pm | Permalink

      In a perfect world your preferred way is correct. People should be able to freely make the choice but we don’t have that world. In the US each state controls their own rules and licenses the doctors and the lawyers. It will likely never be a federal control so the individual state will make the rules. The only thing to do is fight at the state level to get the laws on this the way you want. De-regulation has been very popular now for a long time but not on this issue. Right now, just getting the state, any state, to allow doctors to assist in this is very hard. Getting the state to butt out all together is just not going to happen.

    • Pliny the in Between
      Posted July 20, 2017 at 12:56 pm | Permalink

      The state (Oregon) became involved in this because it was the only agency that could reasonably provide the wide range of protections needed by all participants (freedom from prosecution for MDs who provide the assistance, freedom from financial ruin for families involved through claims denials, freedom of autonomy, etc.)

      • loren russell
        Posted July 20, 2017 at 2:12 pm | Permalink

        Another plug for Oregon:
        We also have “bicycle assisted suicide” — it’s known as Zoo-bombing in Portand

    • Gregory Kusnick
      Posted July 20, 2017 at 1:01 pm | Permalink

      Perhaps I’m misunderstanding your first objection, but surely there are some cases in which doctors can confidently say you’re going to die within a couple of months. Predicting exactly how many months isn’t really the point, and six months seems like enough leeway to cover any uncertainty on that score.

      On your second point, suppose someone in a state of temporary depression commits suicide unassisted. They might be within their rights in doing so, but we would normally consider that a tragedy, knowing that the person could very likely have recovered and lived a happy life had they not killed themself.

      Now suppose that such a depressed person is physically incapacitated and requests medical assistance in killing themself. Should doctors be legally obligated to provide such assistance in cases where they can be reasonably certain that the patient will recover from their depression?

      • Posted July 20, 2017 at 1:54 pm | Permalink

        “On your second point, suppose someone in a state of temporary depression commits suicide unassisted. They might be within their rights in doing so, but we would normally consider that a tragedy.”

        Of course it would be a tragedy, but no more so than if that person had committed suicide in some other way. If over-the-counter lethal drugs were readily available to that person, it would simply be one more way for him to kill himself without having to ask a doctor for assistance or get permission from the state—this along with knives, guns, poisons, plastic bags, buildings to jump off of, car exhausts—the list is endless. Why lethal drugs should be singled out as being off-limits as a means of suicide without state and physician approval escapes me.

        Randy is no doubt right that “Getting the state to butt out all together is just not going to happen.” But in the meantime let’s not pretend, as Dr. Marsh does in his interview, that physician-assisted suicide is all about respecting the individual’s freedom of choice, because it does no such thing.

        • Gregory Kusnick
          Posted July 20, 2017 at 2:16 pm | Permalink

          But physician-assisted suicide isn’t just about access to lethal drugs. Somebody has to administer the drugs in cases where patients are unable to do so themselves. You seem to be arguing that such patients have (or should have) an inalienable right to recruit medical personnel as accomplices in their act of self-destruction, without any requirement to show that the condition motivating that act is unrecoverable. That sets physician-assisted suicide apart from other forms of suicide, in which there is no such right to recruit accomplices.

          As for freedom of choice, it seems pretty clear that Oregonians have more freedom of choice in this matter than residents of states where physician-assisted suicide is strictly illegal.

          • Posted July 20, 2017 at 3:31 pm | Permalink

            “You seem to be arguing that such patients have (or should have) an inalienable right to recruit medical personnel as accomplices in their act of self-destruction. . . .”

            No, I’m arguing that such persons should be free to commit suicide via lethal drugs without recruiting medical personnel at all. If they need to recruit someone to go purchase the lethal drugs, fine. It still leaves the person free to take or not take the drugs. In cases where the person is physically unable to take the drug, you may have a case, since giving another person a lethal dose of drugs opens a whole different can of worms. But I’m guessing that this accounts for a relatively small percentage of people who take such drugs—certainly not any of the several people I know of personally who have committed “physician assisted suicide.”

            In essence I’m arguing for over-the-counter access to lethal drugs and letting people who are physically capable of taking the drugs make that decision for themselves.

            • Posted July 20, 2017 at 4:59 pm | Permalink

              “This isn’t true. Here in Oregon the law requires that a viable candidate for lethal drugs must be “diagnosed with a terminal illness that will lead to death within six months.” So in effect the law is “licensing doctors to kill people.””

              The laws about Death with Dignity in Oregon are meticulously crafted and have served as a model for similar laws passed in other states. Two doctors are involved in the process of evaluating the health condition of the patient as to how terminal it is, or isn’t. This is fully documented. The doctors are in no way personally involved in physically assisting the person to die. Our family physician’s beliefs did not permit him to participate in supporting my husband’s wishes, but he was able to connect us with a doctor who could. He did not compromise his beliefs or force them on us. (He even drove over 100 miles to visit with my husband in our home shortly before he died.) This is an exceptionally caring doctor. I have the greatest respect for him.

              There are organizations set up specifically to help people who want, or need help, in dying. They know the law, they come talk to you, they
              know where and how to get what’s needed in the way of medication, which ones seem more efficacious, and they will physically and emotionally support you at the time of death. I can’t commend too highly the generous, caring people we met in such an organization. But, as I mentioned in my previous memo, the individual who has chosen to terminate his/her life must take the medication unassisted by anyone.

              In my husband’s case, it was a foregone conclusion that he would die. There were no miracle (or otherwise) cures in the pipeline
              for the type of cancer he had. We investigated
              studies at OHSU, the hospital in Seattle and Mayo Clinic in Rochester, MN. We went to the Mayo Clinic where the oncologist we saw stated that my husband’s oncologist in Portland was doing everything possible for him. So, all that current medical science could do for him was done to help him remain with us as long as he could stand the pain.

              I haven’t gone back through the medical bills from this time to assess what the overall cost would have been if we hadn’t had medical insurance (Medicare and a supplemental insurance.) But, the chemotherapy would have cost $30,000 to $50,000 per session (plus use of the oncology unit, doctor and staff) if we’d had to pay full boat, which would have depleted our life savings and more. As mentioned, he also had radiology and a surgery. He also had blood transfusions. He also was hospitalized for a short duration.

              This may not be an option for everyone, but no one should attempt to prevent another adult person who wants to end his/her suffering from taking advantage of this option. It is a cruelty beyond understanding.

  11. Gregory Kusnick
    Posted July 20, 2017 at 12:16 pm | Permalink

    I injured my shoulder, most likely acquiring bursitis

    This is why you should always lift from the knees when acquiring bursitis.

  12. Posted July 20, 2017 at 12:27 pm | Permalink

    I’ve had cortisone shots to the knee — and they (despite my fears) did not hurt at all (surprise!).

    I hope yours isn’t (too) painful!

  13. Mark R.
    Posted July 20, 2017 at 12:51 pm | Permalink

    The shot will be nothing compared to your toe-smashing incident. I remember you writing about that accident a couple years ago, creating a thread asking readers to describe their most painful accidents. That was a memorable post. OUCH!

  14. DarthJoeBob
    Posted July 20, 2017 at 1:25 pm | Permalink

    If Professor Ceiling Cat sees this before his doctor’s visit I just want to assure him that my cortisone shot, also in the shoulder, was no more painful than any normal vaccination. I did have some unpleasant side effects with alternating constipation/diahrea, but the pain is not the thing to worry about. I hope your visit goes smoothly.

  15. Diana MacPherson
    Posted July 20, 2017 at 1:39 pm | Permalink

    Ugh, I finally made a doctor’s appointment because I find it difficult to make a full week of work with the migraines and now worse neck pain. I don’t want to go because I feel I’ll just get the run around again. My doctor has no sympathy for pain and I’ve had terrible shoulder and neck pain for years. He basically told me to deal with it.

    • Monika
      Posted July 20, 2017 at 2:40 pm | Permalink

      Your doctor is an arsehole! Can’t you fire him/her? With years of pain you might need a pain-specialist.

      • Diana MacPherson
        Posted July 20, 2017 at 4:10 pm | Permalink

        I really should but I decided to take specialist care into my own hands and went on rate my md to find one that seemed good and is local to work. I’m going to ask my doctor to sign me up with that person and if that neurologist sucks I’ll find someone else.

        Funny enough I work at a university with a hospital. I had a meeting in the hospital a couple weeks ago and walked past a fancy pain clinic I had no idea about. I’m going to pop in there and ask about it next time I’m there.

  16. ed hessler
    Posted July 20, 2017 at 1:41 pm | Permalink

    I thought by now someone would have recommended Marsh’s memoir.

    In short: READ IT!

    I didn’t know about the second book. Marsh’s route to medicine was remarkable to me–a different kind of medical education than I knew existed and don’t know whether it is still possible in the U. K. Certainly not in the U. S.

    Marsh organizes his book around various brain surgeries which I found fascinating. He also had surgical students from the U. S.–an arrangement with a medical school here. He is a fierce and relentless questioner of his residents but what an M. D., to study and learn with.

    • Wayne Robinson
      Posted July 20, 2017 at 3:15 pm | Permalink

      I’ve read both books. i strongly recommend both. They’re are a very good antidote to Ben Carson and Michael Egnor.

      The second book is a little more autobiographical than the first.

  17. nicky
    Posted July 20, 2017 at 2:41 pm | Permalink

    Not so long ago due to an accident ‘in the line of duty’ I contracted syphilis. That means 3 (in fact 6 six, half in each buttock) weekly injections of ‘depot’ benzyl penicillin 2.4 million units. I was told it would be excruciatingly painful. However, it was not so bad, a bit like muscle stiffnes after a hike.
    So, I hope this will alleviate your fears a bit. Some people just like to scare, or maybe have low pain thresholds.

    • Diana MacPherson
      Posted July 20, 2017 at 4:12 pm | Permalink

      Yeah I think some people just have bad experiences. I told everyone foot canals were easy after a good experience then I had a bad root canal that took 5 hours and I felt bad. I also told a friend that tooth implants were easy and she had a bad one. I think it was because hers was in the front and mine was a molar. So I’m probably bad the other way – saying it won’t hurt them the poor people have horrible pain. Oops.

      • Diana MacPherson
        Posted July 20, 2017 at 4:13 pm | Permalink

        Root not foot. Haha my feet are sore today. Must be a Freudian slip.

        • rickflick
          Posted July 20, 2017 at 7:07 pm | Permalink

          You spoiled it for me I was imagining what a foot canal would be. I was about to google as I imagined removing a big toe and…
          Well, anyway, I can sympathize with the 5 hr root canal. My wisdom teeth took over an hour each. The roots were curled under the adjacent molar.

          • Mark R.
            Posted July 20, 2017 at 7:41 pm | Permalink

            I’m 48 and have only one erupted wisdom tooth. I’ve had two oral surgeons say they wouldn’t extract them unless they caused me pain or got infected, or some other hazard. My recent dentist said he was afraid that extracting my lower wisdom teeth could destroy important nerves that he pointed out in an x-ray. Maybe I’ll be lucky and never have to go through wisdom tooth extraction. I don’t know why my wisdom teeth never moved, but I’m OK with it; I don’t know anyone who thought extracting their wisdom teeth “was a breeze”. Wisdom teeth are the evolutionary equivalent of the appendix. Though the appendix has recently been revealed as a healthy bacterial breeding factory. Is that an example of a vestigial trait becoming useful?

            • Randall Schenck
              Posted July 20, 2017 at 7:49 pm | Permalink

              I suspect maybe you are a special case on this issue. I had my wisdom teeth all pulled long time ago, maybe 1975 and went back to work the next day. I cannot say it was fun and I recall waking up or coming out of it was not pleasant but otherwise not a big problem.

            • Diana MacPherson
              Posted July 21, 2017 at 12:06 pm | Permalink

              I got my wisdom teeth out at a non-profit clinic after I graduated. I had to go through my first undergrad degree taking loads of Tylenol because I had two impacted & infected wisdom teeth and no dental insurance. I’m lucky my liver survived.

              But, the extraction wasn’t a big deal. I had freezing only and had minimal bruising after (though I followed instructions on treating the sore area to a T).

          • Diana MacPherson
            Posted July 21, 2017 at 12:09 pm | Permalink

            Ewww re both foot canal & root canal! I’m lucky my roots weren’t curled so much but I thought my whole jaw was going to come out when they were tugging.

            I remember when I saw the teeth, I was shocked at how small they were. They felt like entire mountains were in there!

          • Posted July 22, 2017 at 3:02 am | Permalink

            My husband had to have a wisdom tooth extracted
            that was growing sideways and grinding off the root of a molar. It caused a great deal of pain. He was anesthetized and surgery performed. The wisdom tooth had to come out in pieces and the molar had to be extracted as well. The situation was unusual enough that the dental surgeon called in all of his fellow surgeons to take a look. I can’t remember how long the surgery took, but recovery took time.

      • David Duncan
        Posted July 21, 2017 at 4:13 am | Permalink

        I had a root canal 15 years ago. Never. Again.

        A few weeks ago my dentist offered me the choice of a RC or extraction. I instantly said “extraction.”

        • Diana MacPherson
          Posted July 21, 2017 at 12:03 pm | Permalink

          It depends on where you get them and how the tooth is doing. I’ve had 3 now. I have one that is sore all the time but we’ve discovered it is referred pain from recession in my teeth above this tooth.

          When I had that 5-hour root canal, the tooth was close to abscessing so it was almost impossible for them to freeze me enough not to feel pain. It was so terrible that they actually gave me a gift bag after. But, at least, unlike my doctor, they take your pain seriously.

        • nicky
          Posted July 21, 2017 at 2:56 pm | Permalink

          Had a second root canal three days ago. No big deal. I think the agony is the abdcedation (abcess) that precedes it. One should never do (or rather let be done) a root canal before the abscess is drained and infection gone. That may take a week or two-three.
          Infection renders the tissues slightly acidic and that impedes the effectiveness of lignocaine.

          • Diana MacPherson
            Posted July 21, 2017 at 3:00 pm | Permalink

            Yeah – I learned that one the hard way! Of course, I didn’t really know how bad it was until they started working on it. 😦

  18. claudia baker
    Posted July 20, 2017 at 4:20 pm | Permalink

    Your left big toe accident and subsequent nail-pulling at the hospital. No wonder you f’n fainted twice! I nearly fainted just reading about it!

    • Diana MacPherson
      Posted July 20, 2017 at 7:15 pm | Permalink

      Toenail injuries are being gross. I had an infected ingrown toenail. It wasn’t too far gone and I was able to fix it myself because I watched the operations on YouTube under just freezing & thought nope! It didn’t seem to hurt but it looked awful.

      • rickflick
        Posted July 20, 2017 at 8:11 pm | Permalink

        The surgeon who operated on my ankle years ago stopped by my hospital room to chat while I was recuperating. He bragged to me that he lanced a boil on his own butt and stitched it up. He had to curl up and use a mirror.

        • boggy
          Posted July 21, 2017 at 5:32 am | Permalink

          (Very old joke) No,no, nurse, I said prick his boil, not boil his pr*ck.

    • Torbjörn Larsson
      Posted July 20, 2017 at 7:17 pm | Permalink

      I am faintly envious of those who can faint, if the reason is pain. (It is better to avoid accidents, of course.)

      The only time I have lost consciousness apart from sleep and narcosis was when I had a bike accident. Turns out that getting flung a few meters up and away, and then whamming your head on asphalt – with enough force to break two ribs when the body came after – is no good method to stay conscious. But at least I cannot remember any pain.

  19. Posted July 20, 2017 at 5:27 pm | Permalink

    MONEY in Health.
    Does money in healthcare equate to quality healthcare?
    always, sometimes, never?
    The proliferation of false and bad reporting about health, Gwyneth Kate Paltrow magic healing, TV DR nincompoops clouding the issue… ignorance, obfuscation and lies for what? money.
    Health is simple and genetics (very important though it is) and accidents aside, eating and drinking your way through the planet with no control and exercise is just plain dumb.
    Climb the stairs, bend at the knees, pick up that bit of rubbish.
    I/you don’t need a degree to tell i/you that.
    How much MONEY do you need to tell, provide facilities and encourage people to better health…
    Now i’m gonna eat my own words, ok some for education, it seems you need money to ward off those who want to make money off our ever longer living bodies, our obsession with consumption and sensory excitement, the novel. Those providing bad food, promoting excessive alcohol, drugs, sit on your arse lifestyles with no consequence. If it’s in the fridge eat, drink now.. fuck it, eat the fridge.

    For what it’s worth, moderation and exercise to me is the key, play to our evolutionary past, walking, climbing (not the lift) crouch, activity outdoors in the sun, in the rain even… it is to feel alive.
    Slouching is that relaxing?
    This makes me think of my deceased friends from my young adult life. Im sure the would like to feel the rain. I’m 63.
    The money question and health does my head in. All that said, todays science of the human body is astounding and yep it needs money, for research, etc.. fact of life.
    And where’s the money?
    I guess to me in large part, it’s in the ambulance at the bottom of the cliff.

  20. Lisa
    Posted July 20, 2017 at 5:59 pm | Permalink

    I have read his book “Do No Harm…”, I highly recommend it and looking forward to the new one.

    • andrewnwest
      Posted July 21, 2017 at 8:07 am | Permalink

      I agree, it was very good. Except for the bits where he says ‘young people these days just have no work ethic’ and ‘it were better when I were a lad’.

  21. Randall Schenck
    Posted July 20, 2017 at 8:00 pm | Permalink

    I cannot complain about my experience with the insurance or the medicine because I have always had good coverage. Had an aortic aneurysm about 8 years ago so that was big time open heart surgery. Probably somewhat caused by a defect in the aortic valve, bicuspid instead of tri. So come on to 8 years later and I needed a new valve. Had that done via TAVR and was out of the hospital the next day. None of this was cheap and insurance is a must.

  22. Karen Bartelt
    Posted July 20, 2017 at 10:41 pm | Permalink

    I came to the party very late, so just two comments. This spring I fell while hiking (twice) and landed on the same shoulder. Lots of pain, so I figured I tore the rotator cuff. I finally went and got X-rays, gave them a history of crashing down hillsides and tripping over tree roots, and the doctor said, “Well, you know that your shoulder is basically shot anyway and you’ll need to have it replaced”. Massive arthritis and a big bone spur. So I’ve had one cortisone shot and am getting ready for #2 soon. I got a shot of something that numbed the area first, then the cortisone. No biggie. I’m hoping to put off the replacement for awhile.

    My second comment is about John McCain. I think that the most (last, best) patriotic thing McCain could do is stay in Arizona and live out the time he has left with his family, NOT resign his Senate seat, and never bother to visit Washington DC again.

  23. David Duncan
    Posted July 21, 2017 at 4:14 am | Permalink

    The grass is greener elsewhere…

    http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/

  24. Fernando Peregrin
    Posted July 21, 2017 at 4:30 am | Permalink

    Some reliable statistics seem to contradict Jerry about health spending by countries. The United States has a per capita expenditure and in the whole of the GDP much higher than the EU countries. And its health care system is not considered the best in the world

    Health expenditure, total (% of GDP)
    https://data.worldbank.org/indicator/SH.XPD.TOTL.ZS

    World Health Organization ranking of health systems in 2000
    (I doubt that it has changed significaly in tha last 17 years)

    https://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems_in_2000

    N. B. : Note that Spain is in 5th place (USA is 24th). Good news for me, as our surgeons and oncologists are trying to cure me — and I hope that they will do it! — of a cancer in the colon-rectal with metastases in the liver in the Public Health System, for free. It will cost to the Spanish tax-payers 8 to 9 times less than in the USA for the same patology and treatment!

    But… But it is true that Americans contribute almost 80% of the cost of scientific and clinical research against cancer. Many thanks for that, American friends

    • nicky
      Posted July 21, 2017 at 3:14 pm | Permalink

      Grrrrr, the horrible alphabetic list in those rankings: ‘Afganistan first’. They should have chosen one parameter, e.g. costs or general health outcomes and then rank it accordingly. Would become a much more user-friendly list.
      Although it is difficult to see and make sure in such an alphabetical list, Cuba appears to get the biggest bang for their buck.

  25. Posted July 21, 2017 at 5:43 am | Permalink

    Reblogged this on The Logical Place.

  26. boggy
    Posted July 22, 2017 at 5:43 am | Permalink

    About 60 years ago I had my second molars extracted (by my father) which allowed my wisdom teeth to erupt with impunity. Dentists today seem reluctant to do this which means that people have to undergo traumatic surgery to extract their third molars.

    • rickflick
      Posted July 22, 2017 at 7:23 am | Permalink

      That sounds fine as long as the wisdom teeth are coming in straight. Often, however, they are not properly aligned – as in my case.

      • boggy
        Posted July 22, 2017 at 11:15 am | Permalink

        Radiographs are taken before extractions so the surgeon can assess whether the 3rd molars are likely to become impacted. The removal of the second molars will tend to allow the eruption of the 3rds in good alignment.


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