I’ve been trying to avoid talking about health-care reform (or deform, if you want to be accurate) on here, because it makes me so angry that I’m virtually speechless. I’ve also stopped talking about politics with my liberal friends at work. I used to enjoy a friendly debate, but there’s nothing fun about the looming disaster.

I can’t not talk about this any more. I just opened a mass email to all the physicians at my hospital, informing us that, in addition to compazine (a very basic anti-nausea medicine; cheaper and more effective than zofran, and less sedating than phenergan; my go-to drug for post-op nausea) and some iv narcotics, and antibiotics, there is now a national shortage of propofol (the fast-acting sedative used to induce anesthesia for a general case, used as almost the sole agent for a conscious-sedation outpatient procedure, and relied on heavily to sedate ICU patients, because its very short duration of action means you can turn it off quickly to check for neuro status, and trials of vent weaning, and get it back on quickly if needed), and we are going to be using the European variant, whose key features are that people who are allergic to peanuts can’t have it, and it doesn’t have the same anti-microbial agents built in, meaning it’s more liable to acting as a culture tube for bacteria.

I can’t see any explanation for this sudden, simultaneous shortage of all kinds of basic drugs (which I have never seen before in my career; one at a time, maybe, and usually more rarely used drugs) than that pharmaceutical manufacturers are scared stiff of the antics in Congress, and are trying to cut their losses by not manufacturing surpluses when they can’t tell if they’ll get paid properly in the near future.

In other words, it’s starting to feel like a third-world country (or maybe just Europe) and they haven’t even settled on which gigantic, mysterious, debt-riddled, unworkable socialist plan they’re actually going to force down our throats. (Anyone else seeing this phenomenon too? Any less depressing explanations?)

60% disapproval rating across all polls, and it’s still full-steam ahead? Who still thinks Obama gives a rat’s — what the people really want?

Although I have to say, since a majority of the American people were idiots enough to vote for this traitor, after having heard him advertise his socialist agenda loud and clear for a year’s worth of campaigning, it’s their own fault that he’s now giving them exactly what he promised. (And I say traitor because I mean it, in the sense of someone who’s committed to the destruction of Constitutional government and the traditional American way of life, and perhaps even national security. Think KSM trial in New York.)

If any non-medical people are reading this, and if you’ve been wondering what the medical profession thinks of Obamacare, I have two remarks for you: the AMA does not represent us, and we haven’t been screaming simply because we’re too busy taking care of patients, and too despairing of being able to stop this railroad crash, to try to express our fear and disapproval. (And a minority of us are socialists, don’t ask me why.)

Guys, this is how freedom is lost: we’re celebrating Christmas, we’re not watching, and Obama and his socialist cronies in Congress are about to transfer 15% of the national economy to government control, after having already taken banking and finance. . . this is going down fast. I’m glad I got to at least see America as a free nation, although I guess I won’t get to spend much of my grown-up life in that country. . . If I wanted socialism and multiculturalism gone crazy, I would move to Europe. . .

Merry Christmas.


As if reading about the Baucus healthcare “reform” bill making it out of committee in the Senate wasn’t depressing enough for one day, I was paying my bills this evening, and made the mistake of reading the “newsletter” that the electricity company sends with the bill. Apparently, the state legislature passed a law requiring electricity companies to decrease consumption in their areas by 1% in the next year, and 3% in the next three years.

I ask you: how is the electricity company supposed to decrease consumption? Aren’t I the one doing the consuming? How can the government mandate a third party to change what I’m doing? Personally, I already try to keep my electricity consumption down, simply because I hate spending money unnecessarily. Now that I’m the one writing the checks, I’m a worse fanatic than my mother ever was for turning off every light except the one I’m using, and keeping the heat or air conditioning as low as possible (to tell you how crazy I am: I wear a jacket nearly all the time at home because it saves $50/month in the winter).

The newsletter went on to explain various programs that the company is enacting to reach this goal. Blah blah, very nice, not applicable to me, and wouldn’t make much difference to me if I were a bigger consumer. Then the punchline: these programs are going to be paid for by an extra charge on the bill. So despite the fact that I already use a minimal amount of electricity, and will not be using any of these programs to encourage decreased consumption, the state legislature just increased my electricity bill. Basically, in the name of saving the environment (which doesn’t need saving, and I’m not the one hurting it), they just took some more of my money; in addition to the property tax and income tax bills that arrived in the same mail, and the school taxes, and the gas taxes. . .

I can’t win. The harder I work, the more of my money the government wants. Even if I live frugally and try to conserve resources on my own, I still end up paying for the people who don’t. Seriously, folks, if Obamacare passes, I’m not going to waste money on getting my license once I finish residency. The amount of impending paperwork for decreasing monetary returns is soul-crushing. . . One of the residents is reading Atlas Shrugged, and was raving about it to me today. . . I think I would only get more depressed if I read it: the vision of an unattainable, unrealistic ideal of personal responsibility and freedom would be so far from the European-style socialist morass that our country is devolving into.

This is unbelievable: a woman has an abortion induced at 23 weeks gestation, but the abortion is not completed. The baby is born alive, then bled to death and thrown in the trash by one of the clinic owners.

The story itself is horrific, but I’m more amazed by the tone of the newspaper article, and of the people quoted in it. Why is everyone so shocked that this could happen? Why is the mother acting as though she’s been wronged? After all, killing a 23-week old fetus is legal in Florida. The woman visited the clinic three times in the space of one week in order to plan and carry out the death of her unborn child. The child ended up dead. Why is she surprised?

It’s obvious, of course. We all recognize that a child outside the womb is human, and deserves care. But this story highlights the logical and ethical impossibilities of the pro-death position: What essential fact about the child changed when it was born prematurely? Outside her mother’s womb, the baby had the exact same physical makeup as she’d had had a few minutes earlier, inside. She was the same person, whether in the womb or out of it. The clinic owner only carried out the mother’s expressed wish: the death of a child she didn’t want to be burdened with.

Wake up, America. Millions of similar innocent children are murdered every year, and we stand by idly. If this story shocks you, think a little bit about the thousands of helpless babies just like this one killed every day. Simply because their bodies are mangled and mutilated before anyone ever sees them and recognizes their humanity doesn’t change the essential fact.

May God have mercy on this nation, and lead us to stop killing our babies.

Thanks to Scalpel or Sword for pointing out this story from Dr. Wes about rationing of medical care in Canada. Think about it, folks. This is what you’re asking for when you ask President Obama to create health insurance for everyone. Government-run healthcare doesn’t work in Canada or Britain, so why should we be in such a rush to follow our neighbor’s bad example?

This election madness is getting to the point that it’s infringing on the hospital. People keep blurting out comments on the election, or even diving into a complicated analysis of each state’s possible outcome and impact on the electoral college instead of the football calculations which usually occupy the guys.

The attending tried to hold a discussion session on current therapies for some surgical disease or other, but was completely unable to restrain himself from explaining, instead, the great danger that a radical socialist president in complete control of both houses of Congress would pose to the nation. I, of course, joined in, and we exchanged rumors and speculations. The chief shook his head and insisted that he prefers not to think about such things. To be sure, I much preferred to keep the attending on the subject of politics, on which we were on an equal footing, to returning to surgery, in which I was making a rather poor showing (along the lines of, there’s only two answers to each question, and I persisted in remembering the wrong answer to every one. . . bother).

Possibly I was a little distracted. I’ve been plotting for a week now how likely it is that I will be able to get out of the hospital in time to vote on November 4. I decline to vote absentee, on the grounds that everything I’ve read suggests that these ballots get lost, mislaid, and miscounted in droves. I don’t actually have any particular expectation that the electronic voting machines won’t simply eat my vote as well, or reverse it, but somehow there seems to be strength in numbers – do it all at once, I say. (And doesn’t the whole concept of “early voting” rather dramatically undermine the purpose of Election Day? What if some horrible truth about either McCain or Obama were revealed next Wednesday, for instance? What about the people who already voted? Or what if, God forbid, this country were to suffer another terrorist attack? The point of a set day for elections is to do things in an orderly fashion. . .)

With the advent of ACORN and the gross insistence of Secretaries of State across the country (Ohio’s being the most egregious – refusing to enforce federal law? how does she get away with that?) upon not enforcing any kind of rational limits on fake voters, I give this country one more election cycle at the most before all trust in the ballotting system disintegrates completely, and we are reduced to the level of any African/Asian/post-communist country. The end is closer than we think. Frankly, no matter who wins in November, I personally will have only a very faint hope that it was an honest result. (And why does CNN, deciding finally to cover voter fraud, after the online new media has been all over it for weeks, choose to highlight a Republican who jammed Democrat headquarter phone lines a few years ago, rather than ACORN, which has literally registered millions of Disney characters, dead fish, and defunct seniors in the past few months?)

Ahem. Will stop ranting now. You may conclude that I had very little of surgical interest to occupy me today. Although the specter of the absite is starting to loom closer.

Sorry, nothing much to report here. I’m functioning as the social worker again: sort out nursing homes, home care, jump through the different insurance companies’ hoops about how one qualifies to be allowed to take this or that medication. The nurses and case managers and I just shrug our shoulders and give up; it really doesn’t matter any more what the doctor says. We’re forced to prescribe and practice with our hands tied by bureaucrats with no medical training, but we’re the ones who will get sued if anything goes wrong.

It won’t even necessarily take Obama getting elected and passing his socialized healthcare plan through a completely Democrat Congress to get me out of medicine; it’s not like I need a lot more excuses; but that would sure make a good one. These high school kids ask my advice about how to get into medical school; whereas what I ought to be giving them is advice how to stay out of this debacle.

Hold on for a couple days, I’ll write you something more cheerful after I get another case. The OR is still magic – the best anti-depressant.

Two conclusions for the night:

1) Obama is a smooth talker, but what he’s selling is nothing more than pure old-fashioned socialism, just barely warmed over. It’s unfair for CEOs to make more than schoolteachers? It’s unfair for Fortune 500 companies to make billions of dollars a year? That sounds good to middle and lower class Americans – if only we could get our hands on some of that money – but it’s economically wrong. Those CEOs and companies create jobs. Their wealth is not harming the rest of us. Economics is not a zero-sum game: one person making more money doesn’t necessarily take anything away from me.

Two places to look for more facts about McCain: an NRO piece about Obama’s ties to communists and terrorists, and another piece documenting Obama’s radical support for abortion through the end of the third trimester, and his opposition even to protecting babies who survive an abortion (for a survivor’s story, and her take on Obama, check out this WSJ article).

2) McCain’s catering to the global warming crowd is ridiculous; but at least he manages to act as though increasing drilling and nuclear energy is green. I like his solution, even though I think he’s got the problem a bit mislabeled.

Oh, and Obama just said something along the lines of, electronic medical records would decrease medical errors. For one, I bet this is going to be an unfunded mandate. For another, all electronic records do is perpetuate errors: if it once gets into that computer that a patient is allergic to penicillin, or carries MRSA, even when it’s completely false, it would take an act of Parliament to get that unfounded statement out. . .

But there, McCain wants medical records online – open to hackers and identity thieves. Thanks guys, try thinking before talking! . . .

That’s better: McCain opted away from calling healthcare a right. One thing he’s got right. . .

Good job, McCain, pushing Obama on his mistaken opposition to the surge in Iraq, which turned out so successfully. . . “No time for on-the-job training.” Good line.

That’s all the talking heads I can stand for one night.

Still nothing medical to write about. I spend my days doing social work and case management. I’ve gotten really good at sitting in patients’ rooms, taking the time to actually sit in a chair (which certainly does lend a more relaxed air to the conversation), and listening to all kinds of details about their lives which are not medically related. This makes me feel like a good person, and hopefully is giving me practice at establishing rapport with people. I haven’t done some of this stuff since medical school.

It makes me feel like a bad surgeon. Why do I not have anything else to do with my time? A surgery resident is doing something wrong if they are not busy. I keep going through my list looking for something to do, and except for the occasional consult (who now gets the complete history and physical, including review of systems, social, and spiritual history – some of which I have been in the habit of omitting when rushed), I have very little to do.

On the other hand, since it seems like every other surgery resident in the hospital loves Obama, there is no shortage of conversations opening with, “You actually like Palin? She’s an idiot. She’s never been outside this country. She likes to ban books. She likes guns. She believes in abstinence-only sex education. She is opposed to abortion at all times. Isn’t that horrible?” And I grin at them and say, “No, that sounds just perfect to me – except for the idiot part and the banning books part, which the media made up.” And we’re off. I think my political and religious convictions have a perverse fascination for my more liberal colleagues, and they can’t stop coming back to check if I still believe this stuff.

(And yes, I give up, all the rabid Obama supporters hating on Palin have convinced me: I’m voting Republican this year. Once I find the absentee ballot registry form. When does another chance like this show up: A Vietnam vet (from the Hanoi Hotel, no less; those guys are some of my biggest heroes), and a gun-toting pro-life soccer mom with five kids. Compared to an America-hating socialist with no clue about policy – and the only policy ideas he does have consist of taking more of my money to give to the unemployed, and nationalizing my job; after he surrenders to the terrorists, and invites Ahmadinejad to the White House.)

I thought WhiteCoat’s story about medical professionals not having heard about Medicare’s new strategy to avoid paying healthcare professionals for services rendered (otherwise known as the “never” events) had to be an exaggeration.

Then I mentioned their upcoming enforcement (next Wednesday, Oct. 1) to a senior resident, and he gave me a blank stare. He seemed to think this was another piece of raving insanity, along with my defense of Palin (what can I say? when all the men in the room start attacking her, I morph into a Republican) and my objections to abortion. It took me quite a lengthy explanation to get him to think I might be right – this despite signs all over the medical records department warning physicians of the events that are now not permitted to occur, as well as notices popping up all over the charts, and random walls in the hospital. I had no idea that my time in the medical blogosphere was so well spent.

(For further information on the concept developed by some genius in Medicare (who really deserves a million dollar bonus – this scheme is going to save the government so much money – except didn’t they take it all from us in the first place? – until all the hospitals go bankrupt; do you think the government will bail out hospitals who fail because they tried to take care of patients, the way they’re bailing out the financial institutions that made foolish choices?) – excuse me. Back on track: for further information, see Buckeye Surgeon’s analysis, and this piece by Dr. WhiteCoat (as well as a good deal more on his site). Basically, the idea is that Medicare (and the private insurance companies will inevitably follow suit) picks several events which everyone would prefer not to happen, and unilaterally mandates that they will now not pay for these occurences; the goal being to promote “quality” healthcare. Which is fine for the “never” events like wrong-site surgeries and mismatched blood transfusions; those are rare and truly preventable. But then you come to things like urinary tract infections, central-line associated bacteremia, C difficile infection, wound infections, and on and on – things which we all deplore, but which there is no scientific evidence to suggest the possibility of completely eliminating. All the studies show ways to decrease their incidence, but not to prevent them from ever happening at all. I can quote you the statistics; that’s stuff I get pimped on. Anyway, basically, Medicare is going to penalize hospitals for existing in the real world. They’ll all go bankrupt. Somebody please help me figure out some alternative career options? I need to get out of this circus before the whole thing falls apart.)

(And in case you were wondering, I know that the goal of all this is to decrease costs to Medicare, not to improve patient care. Because if patient care were the point, hospitals could be held to evidence-based standards for acceptable rates of infections and other complications. But this whole rigmarole is being arranged by some accountants and their secretaries, who know nothing about taking care of sick people. . . . I’m looking for the exit, and that’s only partially rhetorical. I do not want to spend my life explaining myself to bureaucrats, and begging for permission to take care of the patients that I am morally and legally responsible for.)

In the absence of any medical subjects of interest to write about, I’ll throw in my two cents worth about Sarah Palin: As someone who determined from the minute his name was mentioned that I would never vote for McCain – I’m impressed by his VP choice.

I don’t think it’s enough to make me vote for McCain (if you read this blog, you’ll know that I’m too far off the ultra-right wing/libertarian side to like his straight-down-the-middle politics), but Palin is certainly enough to make me think two and three times. She knows an easy solution to the rising gas prices (drill in ANWR; why do we have to give all our oil money to the Arabs?); she supports gun rights; she’s lived out the pro-life commitment to the value of all human lives (keeping a Down’s baby, as busy as she is, takes some commitment, no matter how much help she may have) (which balances out my biggest gripe with McCain, which is that he sprouted pro-life ideas overnight during this election season); she has some executive experience. We could stand to know more about her ideas on several other key issues (terrorism, immigration, taxes), but based on her record so far, I’m optimistic that once she has the chance to talk, small-government conservatives will at least be mollified by what she says.

McCain made a pretty smart choice: someone who has everything that he lacks to get the conservative Republican base excited about his candidacy – and a woman. I’m also not a feminist, but from plain schadenfreude, I’m tickled to see the Republicans as the ones running a serious female candidate on a national ticket. (I’m not sure Ferraro counted as serious. And Hillary didn’t make it onto a ticket.) It’s going to be fun watching the feminists go through their contortions for the next few months, trying to explain why they don’t want a woman as vice president (and a vice president who incidentally stands a good chance to inherit the presidency; a fact which could make me even happier about voting for them).

Caveat: There’s a catch, of course. In addition to distrusting McCain himself, who is still the lead name, I probably won’t vote Republican this year because it’s inappropriate/wrong for a married mother of five to hold a position of such authority, and one that will take her so much away from her family. It’s a little pointless to have five children, and then not raise them wholeheartedly. And as vice president, one step away from the presidency, her authority will far supercede her husband’s, which is not right. Fun as it maybe to have the Republicans running the female candidate, I still don’t want a woman in the White House.

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