Monday, August 24, 2009

Going to the dogs


After seeing her doctor for a chronic cough, a woman had a workup including imaging (an X-ray and a CT). This revealed a concerning 1.5 cm nodule in the right upper lobe of the lung. Unfortunately, this workup was performed as her health insurance ran out, and she had to wait 6 months until she could get enrolled in the California Medicaid program, Medi-cal, and get an appointment with a pulmonologist, get seen, have her old images reviewed, and then get set up for a biopsy.

We, the pulmonologists at the public hospital, diagnosed her with cancer last week. Now we get a PET scan (3 wk turnaround), and then on to oncology or surgery (another 3 wks). But she knew she most probably had cancer 6 months ago.

This is what I deal with every day, and this is one of the good outcomes in our country's health insurance mess. She at least had insurance at one point and was able to get seen by a doctor who was concerned enough to order an X-ray. If she hadn't eked out that appointment on her dwindling insurance, she may have bounced around ERs getting prescriptions for Tessalon, until she had widely metastatic disease. It doesn't even scratch the surface of the absolute disaster our system is.

For wanting to change this, for wanting to make things at least a little better, for wanting to make sure our infant mortality is as good as Cuba's, we get a significant portion of the populace "erupting" at town halls. Our Constitution is under the greatest threat because our President believes that the richest country in the world should at least have a life expectancy as long as Jordan. And now there are people with guns at these events, and being put on national television thereafter. And their representatives just egg them on.

All the while these same folks were silent while the United States adopted an official policy of torture. They were silent when the US government was expanded with the largest non-military discretionary increases, which amounted to little more than corporate welfare for drug companies.

Sure, these nutballs are true believers. But they are true believers of misinformation and lies, planted by assholes on television and radio who will say any damn thing for viewership and market share. They are planted by cynical politicians who know they can get electoral headway as they will never be called on it. They are planted by the same people who have put "recission" and "preexisting condition" in the lingo.

It's enough to make me want to pull my hair out. Worse, it makes me think of what happens when the violent talk actually takes root. Lincoln, Gandhi, MLK, Rabin -- just a few clear-headed thinkers taken out by reactionaries. At this point in time, with the economy still in the shitter, with unsustainable rises in health care, with two wars still going on, I just don't know if we could get through that without this country falling apart. With it over a debate on helping people not go bankrupt when they are diagnosed with cancer, I wonder if we really should...

Tuesday, August 18, 2009

First post in a month

Sorry for being away so long, for the four people or so who read this blog.

A lot has happened:
1) I finished at the VA and now am in the beautiful Potrero Hill district at the world famous San Francisco General Hospital. I believe it is world famous for being the most urinated upon building in the Northern Hemisphere. It is the site of a homeless encampment so large that the UN has a permanent platoon of Cambodian soldiers deployed to it.

2) I did a week of sleep medicine. This was an interesting experience. Realty, and by proxy, hospital beds being in dire shortage in the UCSF system, the geniuses in sleep medicine have rented out a wing of a Best Western in Japantown. This hotel, being in Japantown, true to form has giant vending machines in the lobby that dispense Japanized souvenier toys and t-shirts. Regular rooms have giant anime figures painted on the walls. There is a lounge with giant televisions and game systems, and it hosts gaming tournaments.

The sleep medicine folks have geared out 8 rooms with night vision cameras, EEGs, sleep sensors, snore sensors, CPAP machines, intercoms, etc, and have another 2 for control rooms. Every night, the chronically tired and morbidly obese come to Japantown in order to diagnose sleep apnea, narcolepsy, bruxism, restless legs, and so forth. All the while, 14 year old boys point their Wii mats to the same hotel 5 times a day...

3) I took the national internal medicine boards. 240 questions, most of which were three paragraphs and started with "a 54 year old woman" and ended with me trying to remember the correct treatment for cryoglobulinemia. It sucked. It was shorter than I thought it would be. They just had to work harder to cram the annoyingness into a shorter time.

4) Hosted the parents, went to Sausalito, the Muir Woods, Muir Beach and its overlook, Monterey, and of course all over San Francisco and the East Bay.

5) I've eaten like a huge hog. Working in the Mission doesn't help. We've gone to shabu, sushi (and the dude from Mythbusters was at the next table), original Mission burritos, the most unbelievably good tortas, excellent Chinese food 5 blocks from our house, incredible banh mi in San Jose on the way to Monterey (we knew the way...), not to mention countless neighborhood sandwich and coffee places. I need to stop eating. It's wreaking havoc on my gastrointestinal system.