Insanity scale

Now it all makes sense to me. I used to wonder why I met all the crazy people. How come every where I turned there was another lunatic in my way? Now I get it. EVERYONE is crazy, except me. They are all whacko's. I get it now.

First, there is the matter of degree. Some people are EXTREMELY crazy in everyway, and they are the ones who can be seen arguing with a brick wall or hanging out in the emergency room at three in the morning with blood dripping down their faces.

Some people are mildly crazy, and you only realize it when you talk to them a little bit. These are the ones who think there is a big conspiracy behind everything in the news, who believe George Bush, and who believe in religion and a supreme being. In other words, they believe things for no reason except that they want to.

And some people are extremely crazy, but hide it well. These are the people who seem normal enough until they tell you "I don't know why I'm so heavy, I don't eat much. It must be fluid." Or they have surgery and everything goes nicely, but the nagging pain they get when they think about going back to work just won't go away. Maybe more percocet will help. And an extra month off of work.

So I propose a new paradigm for insanity. It will be like an IQ test, except it will be for the Sanity Quotient. It will measure whether people want to blame someone besides themselves for every problem. It will measure how little responsibility people will take for their own lives and their own happiness. It will measure how unreasonable and irrational their expectations are.

Of course, I will be the gold standard and everyone else will be defined by how far they fall short of me. To the extent they believe what they read in the newspaper, their Sanity Quotient will go down. If they believe everything the read on the internet, it goes even lower. If the answer spam, lower still. Drive an SUV and complain about gas prices? Down. Have cable TV and spend $100 on your hair and nails but can't afford health insurance? Down. Ride your motorcycle drunk with no helmet? Down, down, down.

But insanity today takes the responsibility from people. Don't feel like getting out of bed? You must be depressed. Not motivated to go to work? You have a diagnosis. Drinking? Gambling? Can't sit still in class? Cheated on your spouse? Fell asleep behind the wheel? Poor baby. You are a victim. With the SQ scale, there will be no diagnosis except a number.

There is such eagerness to dump the problem on to someone else, or even better, something else. Kids can't read? Blame the schools. Can't get out of Iraq? Blame the Iraqi government. Banks collapsing? Blame market forces.

There are two other possibilites that don't get considered: that there are individuals involved who may not be doing what is needed, or that there is no solution to the stated question. Perhaps it isn't the "schools", perhaps it is teachers with a low SQ score. Or more likely, PARENTS with a low SQ score. And perhaps the Iraqi government can't make things stable because nothing could make things stable. Perhaps the answer to the question "how do we stabilize Iraq?" and the answer maybe that you can't, except when it gets so unstable that it breaks apart.

I see this on a small scale every day. A case was brought up for its teaching value last week. It happened at another hospital, but it went like this:

A woman came into the emergency room bleeding from her rectum. She was supposed to drink a jug of stuff that would clean out her intestines so that she could have a colonoscopy. Instead, the nurse gave her a jug of another persons urine to drink. The discussion was about how do you tell the patient about this mistake, etc. But one midlevel hospital administrator talked about what sort of policy could be instituted so that it wouldn't happen again.

Do we really need hospital wide policies against giving patients urine to drink?

I would like to think their is already a policy about that, even if it isn't written down. But we can't blame the nurse, it has to be a "system failure".

And there is a 90+ year old in the hospital now who has a perforation in her colon. Stool is spilling into her belly. We have a half inch plastic tube poked into the area of the problem which can hopefully drain some of it, and she has a colostomy so the stool will come out in a bag instead of out the perforation. But she has pain and we give her pain medication. Then she gets confused. Then she looks dehydrated so we give her fluid. But the fluid sits her lungs so she can't breath. So we can give her lasix so she pees the fluid out and she can breathe better. But then she is dehydrated. How are you going to fix it? The family wants to know.


What they should be asking is how are you going to make her comfortable, because sometimes there is no answer to the stated question.

The problem with the Easter bunny

I am disappointed in this whole Easter bunny thing. It's nothing compared to Santa Claus. My kids get the idea that Easter is supposed to be a big deal, but after I filter out the religious crap and all the Jesus stuff, there isn't much left for them. Plus, the bunny doesn't have a very coherent story, as near as I can tell. With Santa there is a complete story. Maybe you don't get an "origin" like you would in a comic book, or "backstory" like you would in a movie, but at least you know where he lives, how he gets around, where the toys come from, how he gets in the house, why there arre stockings, and so on.

But with the bunny, where does he live? Is he human sized, or regular bunny sized? Can he talk? Does he keep a list? Where he does he get the candy, and how does he carry so much? How does he get in the house? Then I run into a problem that may arise from my own education. Is the bunny supposed to be responsible for the eggs out there, or am I? And if the bunny is supposed to be responsible for the egg hunt, how am I supposed to hide them in the back yard without the kids knowing I'm doing it? At night, by flashlight?

Easter eve around here (New England) is usually in the 20's at night and the snow is just melting. That would be a good egg hunt, under three inches of newly fallen snow. "Kids, your eggs are hidden out there, somewhere on our five acres, under three inches of snow." Then assuming there is no snow, if I put the eggs out too early, the raccoons and opossums will get them.

And as the kids get older it's getting harder and harder to come up with a reason to celebrate Easter without bringing Jesus into it.

"Daddy, why didn't we have school on Friday?"
"It was Good Friday."
"So?"
"It's the day a guy named Jesus was killed."
"And that's why they call it 'Good'?"
"Hmm, that's a good question. Some people think he came back to life three days later."
My three year old said, "But when your dead you stay dead."
Smart kid.
But my six and seven year old have gleaned it on the playground or something. Someone told them Jesus really did come back to life.
"I don't believe that," I said. "How could that happen?"

You always think there will be time. It's my own fault, really. I kept putting off "the talk". PLEASE! Talk to your kids. Warn them about religion before it's too late. I may start a program called R.A.R.E. The cops have D.A.R.E., the Drug Abuse Resistance Education. We need Religion Abuse Resistance Education.

Who would think that kids as young as six and seven are being exposed to these things? Then my seven year old says he thinks maybe Jesus did come back to life. He thinks it would be good if he did. I didn't want to give him nightmares, but I had to straighten him out. "If he came back to life," I said, "there is a lot more that goes with that story. Like after a person dies, if he was bad, he goes to hell and burns in fire and flames and suffering for ever and ever."

But something inside makes him want to believe it. But then again, he was looking for candy-filled eggs left behind by a magic bunny who has a lot of inconsistencies in his story, too.

Epiphany

I feel so foolish for not realizing it before. It should have been clear, the evidence was in front of me all the time. But I always discounted it. I said, "Of course these people want to live. There is nothing more valuable than a human life, right?"

Maybe the cancer patients with horrible pain, they might not cling to life as tenaciously, but the big fat person with a perforated colon or something, surely they want to live. They want us to do everything we can to pull them through.

I used to get confused by the notion that some things were worth dying for. Surely anything worth dying for is worth living for, isn't it? But some people are willing to die for causes they believe in. Some people die for Truth, Justice, or the American Way. Some people die trying to pull others out of burning buildings. Some people die fighting in Iraq for one side or another. Many people die for their religion. We may not agree with it, but at least it seems to make some kind of sense.

But now I know that some people are willing to die for Freedom, and the Freedom for which they gladly lay down their lives isn't always freedom of speech, or freedom of religion, or even the right to bear arms. It is the right to eat bacon double cheeseburgers. It is the right to inhale the exhaust of burning tobacco leaves. The right to ride your jet ski drunk.

And now I realize that there is another right that Americans feel is more important than living a long healthy life. It is the right to cable TV. A cable bill might be $1000 a year, but who can afford health care?

It finally occurred to me that people are making the choice to live in an unhealthy way and to not carry health care, and it may be a rational choice. If people choose to spend their money on cigarettes, alcohol, motorcycles, or calories instead of healthcare, who am I to tell them they should do anything else?

Live free or die, right?

There are plenty of people who consider the options and make different choices. They get a little exercise now and then, they only eat when they are hungry. They buy health insurance. They are deciding they value somethings more than the right to ride a motorcycle without a helmet. In the rain. At night. While high.

And the others, well, autonomy id one of the doctor's guiding principles, right?

Those psychiatrists are crazy

I will start by saying I am a bystander in all of this, that I have not been diagnosed or accused by any of these guys, but I am beginning more and more to see through the sham that is psychiatry and psychology. I am not a scientologist or anything like that, those guys are just as crazy, but the psychiatric profession is scaring me more and more. I know that mental illness is real, and that it is a huge burden for indiviuals and for society. But it is part of the greater problem of over-treatment in health care today. I know there are raving lunatics who think god or the C.I.A. or whoever is talking to them from the fillings in their teeth, or that the orbiting mind control lasers are responsible or something. When I was in medical school I met a guy who claimed to be Ross Perot's son (this was a black guy) and when the cops came for him he was sitting on the front porch with a shotgun waiting for them.

But the real crazies who have real organic problems, can be treated by internists and neurologists. The rest is just a slowly creeping expansion of unscientific, even magical, thinking into medicine. When up to 26% of people get diagnosed at some point in their lives, then you have to start wondering. First people noticed that antidepressants might lead some people to kill themselves, then they noticed that perhaps they don't do anything at all.

I can't do as thorough a job of writing it as the March 1 Economist, which discusses this in detail, but suffice it to say the evidence supporting anti-depressants is pretty thin. Yet 10 billion doses of anti depressants were taken in 2004. Ka-ching $$$.

Is this any different than televangelists selling hope? For modern man looking for the answer to life, the universe, and everything in science, they turn to this. And medicine obliges, and big pharma obliges.

Selling hope, happiness, and solutions to existential crises in pill form. And the methods of science are applied to happiness, and the illusion of objective truth is created.
"The statistics say the pills make people happy, therefore it must be true." This is the same fallacy that puts a dollar value on human lives. Human lives can't be measured in any meaningful way with dollars, and happiness can't be measured with statistics and surveys of subjective symptoms. It's like trying to catch moonlight in a pail.

The illusion of objectivity is disturbing. We say these problems are a result of too much or too little dopamine, too much or too little serotonin, or norepinephrine, or GABA. Which is exactly what people thought about black bile, green bile, phlegm, and blood. I predict in twenty years, instead of calling people "sanguine" or "melancholic" or "phlegmatic", they will be dopaminish. Perhaps we could sell snake oil labeled "Sero-tonic", and people can be seroterrific when they feel good.

And even the blood/black bile/green bile/phlegm theory was simply the theory of demons and evil spirits updated for the times.

Anyway, I feel GABAish, so I am going to sign off now.

The problem with health care today...

I have the answer for everyone. If anyone really wants to know why health care costs so much today, here is the answer.
A woman started to complain to me today about her health care from last week. She works in the hospital, so you might think she has at least a TINY bit of knowledge about the subject. The problem was this:

She was a driver in an SUV and she rolled it over on the highway. She says she remembers going through the air and hitting the Jersey barricade, and then she blacked out. And they brought her into the ER. They wouldn't take her to the closest hospital, because it wasn't a trauma center, and instead they took her to our hospital, where she works. And when she got there, all they did was xray her elbow. No CAT scans or anything. She wanted to know why she didn't get any CAT scans.

I said, "But you're OK, aren't you?"

Yes, she agreed, but shouldn't she at least have gotten some CAT scans?

"I guess you didn't need them," I pointed out. "You're OK, right?"

"They didn't even xray my neck," she said.

"Does your neck hurt? Did it hurt then?"

"Well, not really, but..."

Here is the biggest problem with American health care: the American patient. I know there are other problems, but over treatment is a big one.
I know another woman who says she was really mad because when the ambulance brought her into the ER no one even looked at her. No one checked her to make sure she wasn't dying. "I saw you in the ER," I said. "And that was after the ER doctor saw you in the ER. Then he called me. And the residents saw you in the ER." In fact I am certain that at least four doctors saw her in the ER, not to mention all the nurses and EMTs, and she is in fact still alive and going home three days later without any big interventions. But what she was driving at was that someone should have been there to meet the ambulance as it rolled in to check on her.
The ER has patients stacked like cord wood waiting for help, but she feels that because she has a belly ache, the medical equivalent of a SWAT team should be ready to save the hell out of her as soon as she rolls in the door.
I can come up with a hundred examples, but these are the two I saw this morning. So if any politicians know a good way to alter the demands and expectations of the AMerican patient, our health care crisis will be fixed.