Monday, 8 August 2011
This evening, the five of us (my mom is staying at our place right now) watched the film Benji. I saw the film years ago and had only a vague recollection of it. Jennifer and I thought it would be a good family film to watch – tame enough for the kids + starring a dog so my mom would like it.
Turns out, it is a good family film. It even bills itself as such, the words “A family film from Joe Camp” appearing on screen both before and after the film. However, There’s this one scene where one of the thugs kicks Benji’s ‘girlfriend’ Tiffany. The poor dog looks like she only weights about 8 pounds, so it doesn’t take too much force from his boot to scoot her across the room. She whimpers, slams into a wall, then just lies there.
This came as kind of an upsetting shock to some members of our viewing party. We tried to say it wasn’t that bad – that this was just a movie and the real dog wasn’t hurt and that Tiffany (the character) would be fine by the end of the film. The problem is, it’s still an upsetting visual. Three seconds of upsetting footage in an hour and a half long movie isn’t so bad. What made it worse, though, is that this scene is immediately followed by a segment of Benji running for help. The segment is largely in slow motion, with dramatic music playing, and while the hero runs, we are shown several quick shots of, apparently, what Benji is thinking. And what is he thinking? He’s recalling that his friend Tiffany was just kicked in the leg. So, we get to see her kicked in the leg about 5 more times. Yikes. Pretty brutal. I imagine that even if I was just watching the film alone, I would probably think, “Alright, enough already with the dog abuse scene.”
All in all, however, it was a fun little film to watch. I opened up my list of films I’ve seen and saw that I had previously given it a rating of 6 years ago. I decided to leave it at that.
Tuesday, 9 August 2011
This morning, my wife took Isla to Children’s Hospital in St. Paul. Isla had a fever, and a few incidents from the last couple of days led us to believe she might have a bladder infection.
While there, the doctor said that Isla would need to be catheterized. My wife, knowing that this can be a traumatic procedure for little children, requested that Isla be sedated. The doctor said that this was not a good idea, as it carried some risks with it.
“What kind of risks?” my wife asked.
“Well…death!” the doctor said slowly and ominously.
Okay…how stupid is that? Is that how doctors operate these days (excuse the pun)? They just state the most extreme, least likely risk for any procedure they don’t feel like doing? What if a doctor tells me they need to draw blood, and I ask what the risk are – would they say, “Well…death.” I mean, it’s true, right? There is a risk that I could die from getting a blood sample drawn. Or maybe Jennifer shouldn’t even have taken Isla into the hospital because, you know, leaving the house and driving into downtown carries the risk of death. Certainly the risk is exponentially increased from just staying home.
Anyway, the doctor (in what surely made the insurance company proud) finally relented and agreed to have nitrous oxide administered. Jennifer and Isla had to wait approximately 40 minutes until a laughing gas specialist arrived on site. The nurses ended up preferring performing the procedure on a sedated baby, as they didn’t have to fight against a kicking, screaming baby, or even just a fidgety baby. They also drew blood, which was easier than usual as the oxide widened Isla’s veins. Isla, meanwhile, looked loopy and kept lifting her feet in the air, evidently under the belief that she was floating.
The doctor, pleased that everything went so well for the staff and the patient, then asked my wife to write a letter to the hospital board of directors telling them how successful sedation was and that, in an effort to minimize trauma, the staff should suggest it as an appealing option.
Wednesday, 10 August 2011
Today I delivered my sixth speech in Toastmasters. My speech was titled “The 100” and in it, I discussed Michael Hart’s awesome book The 100: A Ranking of the Most Influential Persons in History.
I first mentioned how compelling the idea of such a list is, and that creating such a list is more complicated than we might think at first. Next, I explained the difference (as set forth by Hart) between widespread influence and depth of influence (using Jerry Seinfeld and Joseph Smith as examples).
The bulk of my presentation was given to explaining Hart’s “ground rules.” I numbered them one through four:
First: only real people are eligible. In some cases, I noted, this is obvious. Mickey Mouse is influential, but he’s not real. But in other cases, Hart has to make an educated guess. Was Aesop real? How about Homer?
Second, we have to know who the person was. Again, sometimes this is easy. Who invented the telephone? That’s easy. But who invented the wheel? If, indeed, it was invented by a single person, that person is of monumental influence. But, unfortunately, we just don’t know who it was. So, they don’t count.
Third, the people on the list need to be on there for being influential. Not great. To illustrate the difference, I noted Hart’s admission that he is disgusted at having to place Adolf Hitler on his list, but he reminds his readers that whether someone’s influence is positive or negative, it still counts as influence.
Fourth, we have to consider that a major historical event is not usually the work of a single person. Hart received much criticism for not including the developers of the computer, but he replied that no one individual had overriding influence and, thus, none of them attain top 100 status. For that reason, there’s no one listed who helped with the development of firearms, the women’s liberation movement, or the evolution of Hinduism. Lots of people contributed – which is great for us – but bad for them in regards making it onto this list.
I next called up a slide listing the top ten from the list of 100, and I gave my thoughts on this portion of the list. Here are the top ten:
- Muhammad
- Isaac Newton
- Jesus Christ
- Buddha
- Confucius
- St. Paul
- Ts’ai Lun
- Johann Gutenberg
- Christopher Columbus
- Albert Einstein
I told the audience that my first reaction upon seeing this list was that Jesus should be #1. Christianity, after all, is bigger than Islam, and it’s been around longer. But then I read the book. Hart notes that Muhammad was also a supremely successful military leader. More importantly, the origins of Christianity need to be divided between a few people – most notable Jesus and Paul (who falls at #6).
It’s funny, a lot of criticism I read about the book is that Jesus is not #1. Most of these people haven’t read the book, such as this doofus who claims the book is biased for not putting Jesus at #1. His argument is that the calendar is based on Jesus, so that should be influence enough. This is beyond stupid. Just because later humans decided to base the calendar on Jesus’ birth has little to do with Jesus’ actual influence. For that matter, perhaps Julius Caesar should be placed at #12, because 1/12th of the year is named after him.
I also told the audience that another thought I had upon seeing this list was: “Who the heck is Ts’ai Lun?”
I then added: “I had never heard of Ts’ai Lun until I read this book. But I read the chapter about him and I agree with Hart – Lun does belong in the top ten. Do you want to know who he was? You’ll have to read the book.” That got a few laughs.
I then said that I respect Einstein and, indeed, of all the people in the top ten, he’s the one I would most like to meet (for one thing – he would speak my language!). However, even after reading Hart’s argument, I still don’t think he belongs in the top ten. Top 100, yes, but not top 10.
I told everyone that I hope I had whetted their appetite for reading the book and, should they ever read it, to please let me know so we could do lunch together and discuss the merits of Hart’s selections.
Nitrous Oxide isn’t exactly sedation because you don’t loose consciousness. I first asked for sedation, but when she said no I then asked for Nitrous Oxide as an alternative. She said yes to that, she just said there had to be a certified nurse on staff. The benefits of Nitrous Oxide is that it has a very low risk. As soon as you take the mask away it leaves there system. The negative is that they fight the mask. But, it’s supposed to make them forget about what just happened, and I’d rather have her fighting a mask than a catheter, so it’s the lesser of two evils.
In your drawing blood analogy, the doctor is telling you that you need blood taken so it’s not really the same thing. She would have weighed it out and have come to that conclusion. A closer analogy would be if the doctor wanted to take a urine sample, but you asked for blood to be taken instead and then she turned you down because of the risk of dying. And yeah, that would be absurd.
I think the problem here isn’t that the doctor overemphasized the risk of general anesthetic, but rather she didn’t give the trauma risks the same weight that Jennifer did. While the severity of the risk is less, the odds are greater. I don’t think it’s always easy to find where the two meet so it makes sense that a doctor and a patient might disagree.
Sedation seems like a good compromise for overall risk mitigation and I’m glad they were flexible.
Jennifer-
I don’t think a person has to lose consciousness in order to be considered ‘sedated,’ but perhaps the medical community uses the term ‘sedated’ to mean ‘unconscious (due to drugs)’.
David-
I’m not sure I get your meaning. Are you saying that the doctor perhaps felt it was best to mention death as a risk because, for example, the risk of death doubles, whereas other, more likely risks did not increase (or only slightly increased)? I guess if the risk of vomiting rises from 20% to 21%, whereas the risk of death increases from 0.1% to 0.4%, then even though vomiting is still far, far more likely than death, the risk of death has quadrupled! Is that what you’re saying? If so, then I see what you mean & I agree.
However, I still think the doctor should have phrased things with a little more bedside manner. Instead of bluntly saying, “death,” it would have been more prudent had she said something like, “well one issue I have with oxide is that the risk of death increases…” and then gone on from there.
James,
They obviously don’t consider Nitrous Oxide to be “sedation”, because when I asked for sedation and was told the risks were “death”, she was not talking about Nitrous Oxide. I then brought up Nitrous Oxide, and was told that was a possibility. I asked what the risks of Nitrous Oxide were and she said vomiting, so I was instructed to discontinue breastfeeding for the 40 minute wait. I realize that Nitrous Oxide is sedation, but it is more like smoking a joint than dropping acid, so they barely think of “laughing gas” as “sedation”.
David,
I get what you are saying about James’ analogy, but I disagree that the doctor didn’t over inflate the risk of sedation. I just read a study about sedation for children undergoing VCUG, which is a procedure involving inserting a catheter. Isla was scheduled to have this procedure once she turned a year old to see if she still had the condition that causes infections (we now know she does). So I have been researching this procedure lately because now that she is older I was worried about the high risk of trauma (for that procedure 70% of children under 3 show signs of severe distress and panic and there parents are highly distressed as well – the most distressing event being the catheter itself). There was an article talking about the use of certain types of sedation and how effective they are during this procedure. I don’t even think the article mentioned death, and some hospitals now use sedation for every VCUG they perform, so I can’t imagine that death is as large a risk as the doctor indicated. However, I did feel that in a setting that does not usually sedate, and with a child so young, and with a doctor so uncomfortable, perhaps the risks of sedation would be increased so I instead asked for the Nitrous Oxide knowing that the article I read mentioned it as a promising alternative and that it would be very safe in an ER setting with a 1 year old. I think James’ point was that giving a major risk without the percentage of that risk is manipulative. Practically everything we do can carry the risk of death, but that risk is so low that they generally ignore it as we go through life and ride in cars and fly on airplanes and go swimming, etc. Almost any medical procedure can carry that risk, and so if a doctor prefers that you not do something for their own reasons, they can say there is a risk of death. I can’t analyze that risk unless I know the percentage of it happening. So saying it without the percentage seems deliberately manipulative to me, since she the procedures themselves carried a tiny risk of death as well.
Jennifer,
I can’t argue with you wanting to have your kid knocked out for her VCUG. I don’t even want to imagine what it would be like to do that to a one year old. I went through all that stuff when I was a kid. I had like half a dozen of those tests, but I was older (I think I was ten when I had my first).
I’ll give another attempt at explaining what I meant, but my hopes aren’t high.
I should first say that I agree that her response of, “Well… death!” is weird.
I don’t know what the mortality risks are for general anesthetic, but that’s not for want of trying. Everywhere I look I get wide and conflicting ranges. What I can figure is that it’s low, but worth mentioning.
Both you and James mentioned the idea that everything carries a risk of death, but I think you can admit that there’s some threshold you cross in which you just stop mentioning it as a possible risk. For example, if you look up GA on the Mayo Clinic site, it mentions death as a possible risk. If you start going through the lists of tests and procedures on their site you’ll see that most have a section for risks and only some tests and procedures mention death as a possible risk.
So I think comparing it to daily activities or more mundane medical tests and procedures that carry an absurd-to-mention mortality risk is a little unfair. GA has a real mortality risk… okay, let’s put a number on it. WebMD has 1 in 200,000, which is about the most conservative numbers I’ve found.
The weird thing isn’t that she mentioned death (it’s a real risk) — it was that she ONLY mentioned death. Even starting off with it among a list of other risks would be weird. Typically you order by odds (highest to lowest) or by severity (lowest to highest). Either way, death wouldn’t be first.
I also doubt that she is unclear or ignorant of the risks or that her measure of the risks of using GA is so far different from our measure.
Her reason for saying it the way she did was something else. You put up a good guess with manipulation. That probably was it — say “death” and move the conversation on.
I just wonder if maybe she wasn’t appreciating the risk of trauma in not using GA or heavy sedation. I mean, I think the risks for using GA are more in their face. They’d have to be. It would be like, “This patient had an arrhythmia, that one died, but these fifty thousand just went home and had nightmares for the next ten years… We never heard about it so…”
So why say “death”? I think that it’s pretty standard to go to the extreme risk when you don’t see the benefit side. Like if someone walked in to a clinic and just asked to be knocked out for no reason, I don’t think they’d be told they can’t because it carries the risk of nausea. No, they’d say, “We don’t just knock people out — that’s a serious medical procedure requiring extensive monitoring… people die from it.”
It may be bad bedside manner, but outside of that I think it’s pretty common. It’s like if a friend wants you to do something you don’t want to do, you might jump to some extreme and then they’d say, “Oh my god, you’re not going to DIE.” And then you’d say, “Maybe not, but I still don’t want to end up…” in which you then state the more mundane things.
To me, in these cases, it’s not that there is some confusion that you’d die from trying that one thing that one time, it’s that you just don’t see why you should try it at all (as well as it being informal, of course).
Anyway, that’s what I meant. I don’t expect you to agree, but I hope it’s a little more clear.
David,
I see what you are saying now. I looked up the study I mentioned and the specific drug was Midazolam, which the study says has an excellent safety profile (but they don’t say what the actual risks are). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2443423/ After reading over the study again I’m glad she had Nitrous Oxide instead, because the only reason to choose Midazolam over Nitrous Oxide is that it definitely doesn’t interfere with voiding – which is not a concern with just a catheter. But I didn’t get the impression that either of these types of sedation had a large risk of death, but I didn’t remember the name of the drug so the doctor may have had other types in mind when I said sedation.
I do think the doctor understood and accepted the risk of trauma. When I asked her what they do to prevent distress she said that they do nothing, they hold the child down and hold their legs apart and that the child often cries and fights, but they go as fast as possible. I then told her I was traumatized by these procedures and she said, “I can understand that, but it has to be done”. It didn’t seem to me that she didn’t understand that the procedure could be traumatic, but that, like you said, she doesn’t see the effects of the trauma so she doesn’t put a lot of weight on that issue in her risks/benefits analysis. I did make an impression on her though, by the end of the night she was asking me to write a letter to the head of the ER asking that someone be on staff 24 hours a day who can administer Nitrous Oxide and that she wanted to get the approval for older kids to self administer. I think the nurses really appreciated doing the procedure on a child who was not fighting them, because as soon as it was done they all told me how well it went and the doctor came back acting like she was so glad that Isla got to have the Nitrous Oxide.