24 May 2008

Everything I needed to be a surgeon I learned in kindergarden

A friend sent this interesting article from the New York Times. It describes several hospitals that experienced decreased malpractice claims and settlement amounts after adopting a policy of full disclosure of complications and apologizing to the patient. Was there any doubt about this concept? It surprises me that anyone would ever follow a policy of concealment and refusal to apologize. There's another word for that: LYING. Miss Forgetta in kindergarten told us that lying is wrong and we should apologize when we hurt someone. Before that, my mother taught me the duty to the truth.
Besides being bad manners, a policy of concealment just doesn't work. If something goes wrong, the patient always finds out. It is in the medical record, unless for some practitioners concealment extends to covering their tracks in the chart. Even if the surgeon doesn't tell the patient's family, there is always another doctor or nurse who advises them to look a little closer at the details when something has been withheld. Once a doctor has lied to a patient or their family, their statements and judgement will always be suspect. The teamwork between doctor and patients requires trust on both parts. I trust my patient's parents when they say that they have never had their appendix removed. I believe them when they say they are allergic to a drug and I don't give them that drug. When parents doubt my assessment of a child's illness and the plan I propose, I encourage them to double check me with other doctors or information on the Internet. But if they cannot trust what I have said, I tell them that it is time for them to find another doctor they do trust, and I will help them. (That can be tough sometimes, since I'm currently the only pediatric surgeon stationed at an Air Force hospital, worldwide, but there is always a way!) I cannot promise that things will always go well, but I can guarantee them that they will always get the truth from me.
I hate when complications happen after surgery. Every surgeon does. After a complication, it is hard to look the patient and their parents in the eyes. It is hard enough to see a child suffering from the effects of illness, but when I know that my mistake has added to that suffering, it is torture. I performed an appendectomy on one child whose appendix had burst and had endured several days of pain and fever. I used the laparoscope, and it was somewhat difficult to tease apart the swollen and infected tissues, but when it was over, his appendix was out, and he had three tiny cuts on his belly.
As the days went by, he continued to get fevers longer than I expected. A CT scan showed that even though the appendix was gone, a small fecalith, a hardened pellet of stool, was still in his belly and had a small infection around it. I sat down with his mother, and told her exactly what had happened. I told her that a second operation was necessary to fix what I had left unfinished. I apologized to her and her child because my error had prolonged his illness. She had the choice to request to be transferred to another hospital, but for whatever reason, she allowed me to perform the second operation. After the fecalith was out, his recovery moved along nicely.
It never would have occurred to me to hide the truth from this family. Abscesses are common after a perforated appendicitis. It would have been very easy to describe the infection as a result of the disease. But the truth was he would not have remained sick if I had taken that pellet out during his first operation. That is why it amazed me to read in the article that hospitals and lawyers were heralding this policy of disclose and apologize as a practice they were going to teach doctors. If they aren't using that policy already, they aren't the kind of doctor I would want for my family.

15 May 2008

Medevac mission: Iraqi style

Yesterday a historic event occurred at Balad Airbase: the Iraqi Air Force ran their first Medevac mission, transporting an injured farmer from Balad to Baghdad. The crew was shadowed by experienced US troops who have been handling a high volume of missions to and from Balad. There were a few moments of adjustment getting used to the differences between the Iraqi Huey helicopter and the US Black Hawk, but the team quickly adapted and overcame. After all, the Bell Huey flew many medical missions in Vietnam. This is important work because it is incorporation of the Iraqis into necessary lifesaving activities.

13 May 2008

Books for Soldiers in need of help

I know, it seems like whenever I'm writing these days, it seems to be talking about a cause in need of help. But now that I'm on the sidelines and not actually doing anything myself for the troops, I can at least draw attention to those who are.

While I was in Iraq, I was greatly assisted by Laurel from Books for Soldiers who sent us many care packages at the hospital. I polled the staff for movies that we wanted to see, and Laurel delivered on every one. It made a lot of difference, not only to have a great movie to distract us for a couple of hours, but also to know that someone back in America had heart with the troops, rather than with celeb gossip or cell phone ring tones.

A little while ago I heard from Laurel that BFS was having a tough time financially with the upkeep of their website.

Below is a letter from Storm Williams the founder of BFS:

(Begin quote)

Books For Soldiers2008 Fundraising Update Newsletter April 2008

It Is A Bad Economy

Starting at the first of this year, BFS started a robust fundraising campaign here in North Carolina. We contacted small companies and some large companies you probably have heard of. To date, we have received a stack of letters that begin with "we deeply regret not being able to donate this year" and no cash. From our corporate donation campaign we have received a tad under thirty dollars from a philanthropy grants group in Winston Salem, NC. That was it, nothing else.Times are tough for all non-profit groups, food banks from all around North Carolina and across the nation are suffering from a lack of donations and a sharp increase of those in need. The article below arrived in my email today about a women's shelter closing because of a lack of donations.



The Next Step

The BFS Board of Directors have discussed this problem for some time and have decided to have another go at fundraising. We are working on a different campaign aimed at companies in larger states - California for example. Every time we want to do fundraising in a state (cold call, direct mail, advertising) we need to file with that state's Secretary of State - filing in all states if prohibitively expensive so we have to pick and choose.In our last newsletter, we reported on the hacker attacks that coincided with our 5th Anniversary. Those DNS attacks didn't help our balance sheet. Our final IT bill from the datacenter for that week was a tad over $11,000. If you recall, the hackers brought down the whole datacenter just to try to kill us.The Board set a goal of $70,000 to raise by November 1st of this year. If that amount is not raised, the site will close on December 31st, 2008.If we cannot make the fundraising target, the Board will seek to sell the site to another 501(c)(3) and any new owner will need to be qualified - have the IT talent to run the site, the funding to keep it going and the funding for the required upgrades, both software and hardware. We would also stop accepting new OVs on November 1st and stop accepting new books requests from soldiers on December 1st, 2008.


What Does It Take?*

It takes a lot to run BFS on a monthly basis. The monthly funds required to run an operation like BFS are large. Here is a partial summary of where the donations go.All figures are a monthly average for 2007.
Books, DVDs, other carepackage items
IT Services (server farm, hosting, bandwidth)
IT Maintenance Contract
IT Security Software License Fees
$350There are other things like broken computers, the occasional software purchase, insurance, pencils, toilet paper for the bathroom, etc. that we purchase.No one at BFS receives a salary.The BFS presence on MySpace, Flickr, YouTube are all free. Our presence in Second Life has also been donated.We will be disabling the uploading of photos in the next few weeks to save bandwidth. Please post your photos to the Flickr BFS Group (http://www.flickr.com/groups/booksforsoldiers) and include the Flickr link to the photo in your forum post. If you want keep your photos on BFS, place them on Flickr and post the code in your post. Instructions can be found here: http://www.flickr.com/help/photos/#68My hopes is that eventually we can raise more than the $70k survival goal. Last year our goal for 2008 was to move to a website design where the cumbersome OV process was performed online and searching and finding soldiers would be a breeze - subscribing to soldier requests is my favorite new BFS feature. Now we are just struggling to stay open.


How You Can Help

The ONLY reason we are open today is because of the OVs that have donated so far this year, but now I need to ask more of everyone.1) Office party fundraiser - Coordinate a "Save BFS Day" at work and urge, beg, cajole your co-workers into coughing up something for BFS.2) Have your company cough up some cash. We will send your company a formal donation request, just send us the company name, contact name and address and we will get it out right away. Send these requests to me personally (storm@booksforsoldiers.com)3) Have your place of worship pass the plate (hat, kippah, whatever) for BFS. Consult with your church's leader about holding a "Save BFS Offering" one day this month. Checks should be made out to "Books For Soldiers." If they have any questions or concerns, please contact me directly to set up a call.4) Visit our donation page and give what you can.http://booksforsoldiers.com/donate.phpor by checkBooks For Soldiers2008 Fund Drive353 Jonestown Rd #123Winston Salem, NC 27104


In Closing

I started BFS five years ago and fully expected it to be online for only six weeks, that is the length of time I thought it would take for our troops to finish up in Baghdad and come back home. I am also terrible at predicting who is going to win the next NASCAR race.If worse come to worse, it has been a good run - a great run in fact. In the first 6 months of operation, we collectively shipped over 400 tons of packages to the Middle East, that is when I stopped counting. We also built the largest English library in the Middle East - together with US soldiers at the Baghdad International Airport in the months following the fall of Baghdad.We have done a lot of tremendous work, made a lot of great friends and even a wedding or two! We have also lost a lot of friends and we have received way too many memorial flags. Either way, you can all be proud of what we have achieved.I promise that we will do everything in our power to meet our fundraising goals and will appreciate any help from you.Thank-you for your support, patience and hard work over the last 5 years.And most of all thank-you for your support of our troops.Storm WilliamsFounderBooks For Soldiers

(end quote)

In this same discussion, I came across an excellent idea from Andrew Carroll in the Washington Post urging Americans to use their tax rebate checks to support charities that help the troops. I guess it is up to the thousand points of light again.

10 May 2008

Iraqis helping Iraq

Johnny Waltz of Severus Worldwide let me know about the existence of Iraqi Health Now, a project out of Paw Paw, MI. On the site you can read about Haider, an Iraqi living in America. His nephew is one of the doctors working in Basra Teaching Hospital to try and improve the medical care available in Iraq to civilians. Since most of the people we treat at our hospital in Balad when I was there were civilian, that is a pretty important goal.

On the site, Iraqi Health Now asks for assistance, including connections to pharmaceutical or medical supply companies who might be willing to donate materiel for their project. Here is the press release from Severus Worldwide after they met with the group:

MEDIA ADVISORY FOR MAY 7, 2008Contact: JOHN WALTZ (513) 488-0892

Iraqi Youth Union and Severus Worldwide Join in Unity

Dearborn, MI –At this time much of our world is divided and in conflict with each other and it is imperative we come together to stop the division between brothers and sisters. In a show of unity, the Iraqi Youth Union and Severus Worldwide met together in Dearborn, Michigan on May 2, 2008.

The events on September 11, 2001 and the ensuing wars have only made relations worse between Americans and Muslims. Many quickly utilize stereotypes with Muslims and put them all in a tidy box with the label terrorist on it. It is imperative that we set aside any and all religious, political, and ideological stereotypes in order to realize that Iraq is in the middle of a humanitarian crisis.

The Iraqi Youth Union is comprised of Iraqi Americans whose mission is to assist the children in Iraq with critical medical needs. IYU President Duaa Al Karawy knows the importance of her mission first hand after being born shortly before the Iraq war in 1992. Severus Executive Director John Waltz said, “the stories of perseverance of overcoming monumental struggles is the template for what it will take to help provide Iraq with the tools for a better future.”
Duaa Al Karawy says that she “wants to set an example for everyone who is looking at Iraq as if it is just a land of oil or simply as an enemy of America. I want everyone to realize what 35 years of war has done to their future. The reality is that children who are being filled with hate, war, and killing are the future politicians, teachers, mothers, and fathers. I want to stop the cycle of hatred to see that we are here on earth to help each other regardless of race or religion, we are all human, we bleed, we cry, and we hurt the same.”

For more information on how you can make an investment in Iraq’s future please visit www.severusworldwide.org and www.iraqihealthnow.org/