We’re revisiting the subject of restricted duty hours. As Aggravated DocSurg comments in his humor-laced sarcasm, any sane person would be happy to be working less; so I must not be sane, to be a resident arguing for longer hours. But I think the “old fogies” have a point; and we ought to listen to them before it’s too late to turn this around.

This essay by a neurosurgeon (beyond being an extraordinary demonstration of how to claim to be superhuman, without being arrogant) has applications for all surgeons. Dr. Vates argues that neurosurgeons are unique because they deal with the only non-replaceable, non-repairable part of the human body, which is true; and that they are a breed apart, and that’s true as well. But he also suggests that if you think a surgeon’s ability to perform complex or delicate operations is impaired by fatigue, the solution ought to be to get really good at the procedure, so as to have room to work with when you’re tired. He repeats the line, which ought to be a self-evident truism, but apparently doesn’t compute for the folks at ACGME, that there are no hour restrictions in private practice, and that if we’re concerned about fatigue impairing judgment, that too should be practiced first under supervision.

Apparently some idiots are seriously proposing limiting the work week even farther, to 56 or 48 hours. I object. 80hrs is barely enough now; frequent readers of my blog will have recognized that I regard this as a rule made to be broken. If they cut it down to 56, they will have to extend the length of the residencies; right now, most people are 30 by the time they finish residency, let alone non-traditional students. Lifestyle may not be an issue under that regime, but paying back debts in time to have some money saved for retirement will be.

So I highly approve of Dr. Vates’ solution: The ACS needs to take its toys and leave, ie opt out of the ACGME, and set up its own standards for residency accreditation. Of course, since ACGME recognition is a prerequisite for Medicare to pay for anything, and for board eligibility, this is the kind of thing that would have to be orchestrated with 100% participation, essentially a boycott of the ACGME by the surgical specialties. I’m looking to see where I can sign a petition to that effect. . .

Pursuing the issue of work hours: suppose a patient dies right before change of shift. The family has been notified briefly on the phone (via a message, because no one is answering, or perhaps a conversation cut short by grief and shock), but won’t arrive for at least a couple of hours. If the day team goes home as planned, the only person there to talk to the family will be the night float junior resident, who, with all the good will in the world, is overworked. Even if he gets time to talk to the family, they’ve met him maybe once or twice before, and have discussed little of their loved one’s situation with him. The attending and chief who did most of the interaction with them will be gone. As residents, we’re not about to ask our attending his plans, but we doubt that he’ll come in from home, on a night he’s not on call, to discuss how one of his cases went bad.

Your initial response, and our instinct, would be for at least the chief to stay in the hospital (trying to use the time to study or do something else productive) or perhaps arrange to come in from home when the family arrives.

But the chief has been operating late into the night for the last several days, and was in the hospital almost the entire last weekend. Staying a few extra hours to wait for the family, or even coming back for an hour later on, will push him over the 80hr limit, and hinder him from fulfilling his responsibilities later in the week. He can either stick with the rules, and satisfy himself with having spoken on the phone, or ignore the rules, misreport his hours, and stay around to fulfill this last ultimate duty to a patient and family, to talk with them personally about the death.

This is an extreme but very plausible scenario which illustrates the basic problem with the 80hr rule: an outside agency (government, and the ACGME, which is not surgery-specific) imposes an iron-bound rule which sets our regard for the law and for honesty in our reporting at odds with all professional instincts and obligations, and leaves us feeling guilty no matter which we end up following.

A GOP insider reveals a conspiracy to prevent Ron Paul supporters from being heard at state and national conventions. It’s nice to have our suspicions confirmed (how come Paul was winning 10-15% in most primaries, a strong 3-4th place, and yet was almost never mentioned as a frontrunner, whereas Giuliani, who polled way behind him, was much more prominent? and how come someone who was winning 15-20% in the later polling states, with people deliberately coming out to register their objections to the McCain victory parade, is not getting any recognition from the national party?)

Anyway. It’s always special when a member of the conspiracy group (not that Doug Wead seems to approve of the general plan to silence Ron Paul and his supporters) admits that it exists.

My brother and I have been re-discovering one of Robert Heinlein’s less well-known masterpieces, The Moon Is A Harsh Mistress, about a Lunar colony which fights for independence from Earth. The revolution’s architects are a bunch of libertarian/anarchists, who speak a magnificent Russian-influenced English slang, participate in group marriages, and are assisted by a (secret) sentient computer. This is one of my favorite Heinlein books, right up with Starship Troopers. The way he manages to weave hard science and even harder political science into a novel set in a complete and believable future society with an action plot is amazing.

Clearly I can’t leave well enough alone. This is just a quick link to an MSNBC article about FLDS parents driving hundreds of miles to see their children, as the sibling groups have been scattered to all corners of the Lone Star state. The FLDS spokesman claims to see something fishy in this, and although I’m more disposed to suspect any spokesman than I am the individual parents, I have to agree. Forget about the parents. Does anyone honestly think it’s good for children from tightly-knit families to be separated from their siblings? We’re talking about elementary-age children here. And again, why the big emphasis on keeping the mothers, not accused of any crime, away from the children, unless the real point of all of this is to reprogram them into proper modern children?

Just basic constitutional principles here. No one should be deprived of life or liberty without due process of law. Both children and parents here are being deprived of liberty, and with only a farce of a legal hearing so far. What kind of a precedent is this setting? What if the Arkansas authorities decide that being forced to grow up in a family of 18 children constitutes abuse, or brainwashing? Can they just go and confiscate the Duggars’ children? What about Amish children, brought up in isolation from the world, without simple amenities like electricity and TV? Should we forcibly assimilate them, distribute them through foster homes? What about homeschooled children? Back in the ’70s and early ’80s, they were indeed kidnapped away from their families, and parents spent weeks, even months in jail, for the crime of not conforming to the government-run school system. Maybe we should reopen this. They get spanked, after all, and taught all kinds of weird things: creationism, obedience to their parents (rather than teenage rebellion), the biblical perspective on all subjects, and forbidden to date. Maybe we need to move towards imitating the German government’s approach, where they recently put a teenaged girl in a mental asylum because her parents were brainwashing her by teaching her at home. (in case you thought the Germans had gotten over the fascist approach to the state’s privileges)

Whatever happened to the old-fashioned idea of burden of proof? Doesn’t the Texas government need to prove its allegations in order to keep these children locked up away from their mothers, brothers, and sisters?

For someone who spends as much time communicating as I do, I’m obviously still not very good at it.

Since between work and Pascha services this week I don’t have much time, let me, as the fastest way of saying what I really think about Mormonism, refer you to a post I made this spring, back when Romney was a viable contender. You can find it right here. Basically, I conclude that Mormonism is a false religion, just as much originated by Satan as Islam is, in that he probably inspired two men (Mohammed and Joseph Smith) to write blasphemous lies against Jesus. Mormonism, unlike true Christianity, does not regard Jesus as divine, the only-begotten, unique Son of God. Mormonism teaches that God was once a human, and that all humans (or at least all males) can become gods in their own private universes, peopled by the offspring of their subservient wives (so yes, Mormonism, like other false religions, tramples on women, and, unlike Christianity, regards them as lower in kind than men).

Regarding polygamy, I agree that it’s illegal in America, and that even the biblical patriarchs limited themselves to two wives, and those of an age to consent.

What I was trying to say about the FLDS branch of Mormonism is that 1) I think most Americans’ visceral reaction to them is based on lifestyle choices that have nothing to do with polygamy, but which do present a glaring challenge to the culture of hedonism and free sex that prevails in America today; and 2) I respect groups which hold to the original tradition when it’s not politically correct to do so. The mainstream LDS church threw out Joseph Smith’s original teaching on polygamy because it made their life easier to do so. The FLDS hold onto it; even though that may involve brainwashing women, it’s at least the original form of Mormonism. Similarly, I respect “radical” Muslims more than “moderate” Muslims, because I think the radical Muslims understand and obey the original commands of Mohammed (kill the unbelievers until they submit to you, make no friends with Jews or Christians) better than the watered-down, secularized, moderate Muslims. That doesn’t mean that I approve of suicide bombers; I simply think they’re acting on the logical conclusions of their beliefs.

Does that help at all? Maybe I should also mention that in my personal beliefs, I try to stick to the Bible exactly as God gave it, without making alterations for modern sensibilities. God created the world out of nothing, in the space of six days, and all very good, until it was marred by man’s sin and the entry of death. God condemns sinners to hell in the next life because of their infinite crimes against him, and he is righteous and loving to do so (we can take this up in a later post). God offers free forgiveness and eternal life to all who confess that they have broken his laws, and accept his merciful gift in Christ, who died for us and rose from the dead on the third day, and sits in heaven until his kingdom is established through the whole world, and all nations kneel down and worship him. And along the way, women should submit to their husbands, men should have one wife and be faithful to her, and Christians ought to love their neighbors as much as they love themselves. This is absolutely true, and I make no apology for any of it, except to say that I wrote it as forcefully and bluntly as possible in order to parallel my wild statements about Islam and Mormonism.

They and I are at least in agreement about the existence of absolute truth and the extreme importance of finding it out; just as I had more in common, regarding modest clothes, and avoidance of wild parties, and chastity, and taking time out from studying for religious observances, with the Muslim girls in medical school, than with the nominal Christians.

I look forward to reading your comments.  :)  And I guess I had better also put out an apology in case any of the above is needlessly offensive, as I may not have time to answer comments till late in the day. I don’t mean to be insulting, but to state the truth as I know it, forcefully. The lateness of the hour may make some phrases ill-judged.

You know the reason everyone is really so rabid about the polygamists? It’s not just the matter of teenage mothers (who, after all, are a common enough phenomenon in this society; here, at least, they’re respected as legitimate, and the fathers are involved with their children).

No, it’s the women’s clothes. Modern Americans take one look at their appearance – which I would describe as graceful, elegant, sweeping, modest dresses and beautiful swept-up hair – and react viscerally, I believe because they’re convicted by this total contravention of modern society’s flagrant embrace of everything vulgar and obscene. It’s almost as though men think they have a right to see barely-clothed women, and are affronted by these women denying them that privilege; as though women think that they earn respect by flaunting their beauty in the eyes of all, and are defied by these women’s refusal to do that.

That, and the large families. In a society where a single child is pondered before years before being accepted, and where two children are an imposition, three unheard of (in the professional circles I seem to be in these days), the idea of having many children is shocking – the 400 kidnapped children (since I don’t see where the government gets the right to take all of them without specific evidence against everyone’s fathers) are described as a crowd of toddlers and 4-5 year olds running around under foot.

Plus, their rejection of the modern world. My friends talk as though it’s evil not to have TV and internet and cell phones. Who am I to talk, of course; but I think I can at least recognize the beauty and possible desirability of such a lifestyle (the Amish, for instance), while still choosing to use some of modern technology myself. So far, I’ve refrained from pointing out to my colleagues that I was raised without TV (although they may have figured that out from my profound pop culture illiteracy), and regard my cell phone as a necessary evil.

(I have previously described Mormonism as a heresy. But I respect the FLDS people for being consistent and true to the original spirit of Mormonism in spite of intense persecution.)

I betook myself to the Coptic Pascha evening service tonight after work. I missed Palm Sunday service through falling asleep post-call, and not being able to muster the energy to get myself out of bed after a 15min nap. So I felt bad about that, and I considered giving up on the enterprise of keeping Pascha and working 13-15hrs a day at the same time. But then there wouldn’t be an Easter that meant anything to me, and that would ruin the whole year, and that would be pretty bad.

So I dragged myself to church after work, not entirely thrilled about a 1hr round trip, and two hours of service (allowing for missing the first hour, and skipping the last 45min due to the sermon being entirely in Arabic).

Somebody please kick me the next time I consider missing Coptic church. I was so glad to be there. I didn’t know many of the people, and I didn’t have a service book. But we were praising God and commemorating Christ’s passion, and there is nothing better in the world.

Thine is the power, the glory, the blessing, and the majesty, forever, Amen.
       Emmanuel, our God and our King.
Thine is the power, the glory, the blessing, and the majesty, forever, Amen.
       My Lord Jesus Christ, my Good Savior.
           The Lord is my strength and my song, and has become my salvation.
Thine is the power, the glory, the blessing, and the majesty, forever, Amen.

The Copts are my identity, one of the only things about me that’s still the same at the end of this year. At that church, everything is right and in order.

(Man cannot live by bread alone; and neither can one get by entirely with Presbyterian church services, especially the strict ones. They’re missing something, like icons and incense and color and music. I should point that out to the elders of the church I’ve been going to. The reaction at least would be interesting.)

Ok, this is scary. We actually had a workplace shooting incident turn up at our trauma center lately. I comforted myself with the idea that people come to the hospital after such incidents. Remind me to check and see if our security guys have guns. I think they do.

Last night I came across a couple of news articles about a prominent Italian Muslim (who, to be fair, hadn’t actually practiced Islam for many years) who converted to Christianity and was baptized by the pope as part of a televised Easter vigil service. I say congratulations to him, and admire his bravery. Magdi Allam, who took the name Christiano in the baptismal ceremony, already had one death warrant against him for his activism against Islam, and I am sure this very public conversion will earn him another.

Some media commentators, ever ready to deliberate on matters they don’t understand, questioned why the Pope would create such a public show. It seems consistent with his bold statements about the true nature of Islam, and I think he as well as Allam is to be praised for boldly confronting an issue which Muslim leaders would rather keep secret, that is, that conversion out of Islam deserves the death penalty under sharia law – law which is often effectively carried out by vigilantes or family members of converts in Muslim countries.

In American politics, I finally decided to read Obama’s famous race speech. I have to say, much as I disagree with his philosophy and his grasp of history, conservatives who denigrate his speaking abilities seem to be doing so unfairly. It is a rhetorically effective speech, well constructed, cleverly addressing all the key issues and defusing them. Not that I think he actually solved the question of his connection Jeremiah Wright, but he did the best possible job of explaining him and at the same time making the attacks on him part of a bigger picture.

Since I actually had a whole day off today (sleeping in is so rare, I fantasize about it now the way desert travellers fantasize about water – I dream about sleeping past 4am) – there wasn’t much to talk about here. (The other day I took a ten-minute nap in the call room, woke to find it light outside, and ran halfway down the hall before I realized that I was already at work, and had not just overslept to an unbelievable degree.)

Until my sister called. I trust she’ll excuse my turning our conversation into a blog. She’s involved in some discussions about medical ethics, specifically involving the concept of positive and negative rights. Positive whats? I said.

Positive rights, it appears, are a big concept largely developed by those who want us to believe that we can/should/do depend on the government for everything. Even in the basic discussion found in Wikipedia, you can see the difference between these new “positive rights” and the classic natural right theory on which our Constitution was based. Positive rights essentially mean that you have a right to have something provided for you – healthcare, education, food, income after retirement, income while unemployed. Natural rights, on the other hand (which have now been redefined with truly Orwellian freehandedness as “negative rights”), simply mean that you have a right to not be something – killed, kidnapped, robbed (since the three natural rights are life, liberty, and property).

Positive rights are a key concept for those who argue that a healthcare is a right which ought to be provided by our kind, beneficent, ever-growing government to all Americans. Somewhere, somehow, the socialists introduced into popular American thought the concept that being alive isn’t enough, if you’re not also happy, healthy, and fairly well clothed and housed. So if we are to truly enjoy the right to life, we also have to have the following rights enforced – in other words, funded – by the government: secure retirement (social security); healthcare for the poor and elderly (medicare and medicaid); funds with which to not be employed (unemployment benefits); education (free public education); and very soon now, healthcare funded by the taxpayers in the classic redistributionist scheme of socialism.

These kind of rights were not even in the imagination of our Founding Fathers. As I told my sister, Ron Paul is mild compared compared to what James Madison, Thomas Jefferson, Benjamin Rush, John Hancock, and the rest of them would have to say if they were around to see the current state of affairs.

Let me quote the Declaration of Independence – at length, because I love these thundering phrases:

When in the course of human events it becomes necessary for one people to dissolve the political bands which have connected them with another, and to assume among the powers of the earth the separate and equal station to which the Laws of Nature and of Nature’s God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.
— That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed,
— That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. . . .
(emphasis added)

The Founding Fathers based their claim to independence, and later the Constitution, on the political philosophy of men like John Locke, who taught that human rights are granted by God and the laws of nature, not by the gift of any government. If a “right” is given to you, it can also be taken away, and so is not unalienable. Universal health care, if, God forbid, it materializes in this country, will not be an unalienable inborn right of all humans. It will be a gift from the government (at taxpayer expense, of course). As such, should the government ever decide that dissidents don’t deserve free healthcare, or that it can no longer afford healthcare for anyone, this “right” will disappear as easily as it was created.

The natural rights, however, depend on no human for their existence. We are all alive by the gift of God. Our right to freedom – freedom of action, of thought, of speech – comes with the rationality that God gave us. The government can try to limit these rights, but humans everywhere continue to break through repressive rules. Property is also a right which even the youngest children understand. The Communists’ efforts to eradicate this concept failed. The peasants always worked hardest on the little plots of land which belonged to them, not on the acres which belonged to the “soviet.”

The government’s function is only to protect these rights, not to create them. The government’s job is to prevent people from being murdered, being kidnapped, or having their property stolen. Again, the government’s role is preventive, not creative or donative.

There is no such thing as a positive right. It’s socialist-speak for “things that we want the government to give you so you will lose your independence and become dependent on the government for all aspects of life, and thus obliged to follow all the government’s [politically correct, atheistic, humanist, socialist] whims, whatever those may turn out to be.”

To equate healthcare with the true human rights is to denigrate the suffering of those whose human rights are truly being violated. For an American, a citizen of the wealthiest country in history, for whom the poverty level is ten times above the standard of living of most modern countries, to have to spend their own money for healthcare, is not, by the wildest stretch of the imagination, on the same level as Jews, Rwandans, Sudanese, and others being the objects of genocide; or as Chinese and Cuban dissidents who spend decades in labor camps for daring to question the ruling party; or as Christians in Saudi Arabia, Pakistan, and Indonesia, or Muslims in China being tortured and killed for their beliefs; or as blacks in South Africa being oppressed for decades as an inferior race; or as the white farmers in Zimbabwe being driven off their farms and deprived of their livelihood; and the list goes on. These are true human rights violations. These are indeed appalling crimes against humanity. To even mention the absence of national healthcare in the US in the same breath is a slap in the face to all these people, and only undermines the validity of the very concept of human rights.

We’ll see if my sister tells her friends all that. I’ll be proud of her for being a disruptive firebrand in the hypnotic echo chamber of liberal academia if she does.

(And please don’t quote the UN Declaration on Human Rights to me. The UN put Libya and Sudan on the Human Rights Commission. To quote Shakespeare, I snap my fingers at the UN.)

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