A sample of typical telephone calls I get at work:
The phone rings, I pick up the receiver: "Women's Clinic, hello."
(Breathless voice on the other end, usually calling from a mobile phone with bad reception or she is in the noisiest intersection in town, and it is obvious she is holding an infant, since the baby's screaming is considerably louder than the woman's voice): "Hello, is this the Women's Clinic?"
I affirm that it is, thinking that it has hardly changed from my greeting not five seconds before, but too wise to say that, as it would lead to impossible complications in explaining why it was the same clinic it was five seconds ago.
Patient: Well, what I wanted to know…my doctor is overseas/on vacation/not available/only has office hours once a week and it isn't for a few days yet…what I wanted to know…you are a nurse, aren't you? You see, I did a pregnancy test today and I want the result, what I mean is that I've got the result from the internet but I don't understand it…" (This is said usually without pausing for breath, which is one problem, since it is usually very hard to understand what she is saying, as if the bad connection and the screaming kid isn't enough)
For reasons known only to the kupah lawyers, who work out of Tel Aviv and have never had any contact with patients, we are not supposed to give lab results over the phone. Kupah members can download results from the internet, but no one ever understands them, which is predictable, since they are patients, not medical professionals. Most of the names of the tests are either abbreviations or in Latin or English, and all are written in the Latin alphabet, which also poses a problem for certain sectors of the Israeli population. Hence, the need to call us, even if they do have the results in their hot little hands. I tell the woman I cannot give her the results over the phone (this often provokes a discussion in which I have to defend the kupah's ostensible regard for patient privacy. That can waste 10 minutes right there, and, btw, shows just how misguided the policy is, as some doctors give their patients instructions to go to hospital, etc. depending on certain lab values) But this lady to whom I am talking has her results in front of her, although I suspect she's probably finding it difficult to juggle her cell phone, her baby, and the page with the results.
Me: All right. Look for the line that begins H.C.G., followed by the word Q.U.A.N.T., 'quant' …
Patient: What? Where? Oh, I see it says " if less than three, negative, if more than 25"…
Me: No, above that.
Patient: What's the "less than three"?
Me: Those are the normal parameters. A result of less than three units means a negative result, more than 25 units means a positive result. Look for the line immediately above that".
Patient: Where it is written 'HCG'?"
Me: Yes. (I'm beginning to get pressure behind my eyeballs) After 'HCG QUANT' and 'S' in parentheses, what is written?
Patient: Negative.
Me: Negative means you are not pregnant.
Patient: Are you sure?
Me: Yes. (the headache is definite by now)
Patient: Why not?
Well, madam (or miss), I'm sure I don't know (no, I don't really say that)
Repeat this conversation, or a variant thereof, at least 5 times a shift. Another interesting fact is that I now know exactly how badly math is taught in Israeli schools. Unless there is no human chorionic gonadotropin to measure at all, the result is given in numbers. A perfectly incredible number of women do not understand the meaning of a decimal point, and vehemently insist that they ARE pregnant, because the result is 0.69 and "69 is more than 25". I've actually been told that I don't know what I'm talking about when I insist that 0.69 is less than 1. I would attribute this to a natural desire to have a positive result, except that I've gotten the same response from women who are anxious not to be pregnant.
Here's another:
The caller has an elderly sort of voice, combined with a strong Middle Eastern or North African accent. She wants to know if her daughter is pregnant. After going through a whole "we can't give results over the phone" spiel, the woman triumphantly says that she has the results in front of her, and her daughter is standing by, but is "unwilling" to come to the phone. The woman also says that she can't read the results, but after mangling several abbreviations, it is apparent that she does indeed have some lab results in front of her. I pull up the exam on my computer, since I don't know precisely to what she is referring. I note that the young lady who had the tests done is 18 years old. I also notice that no pregnancy test was done, only a blood count, which is normal. I tell her mother that. Officially I shouldn't, since I'm talking to a third party, but there's no harm in telling her that her daughter is healthy.
Mother: Why can't you tell if she is pregnant? She had blood drawn.
Me: But not for a pregnancy test.
Mother: What's the big deal? You can't tell from the lab results? Blood is blood, after all.
Me: There are several hundred different kinds of tests that need blood. The doctor did not order a pregnancy test. He ordered a blood count, which tells him several things, such as if your daughter needs to take iron, which she does not.
Mother: You can't tell if she is pregnant from a blood count?
Me: No, I can't. And Madam, I wouldn't tell anyone but your daughter if I did have that result. So why don't you either put her on the line, or ring off? Obviously, I don't say that out loud, either.
Mother: Make a guess. Surely you can tell something from the results. Why else would the doctor order a blood test?
Oh Lord, give me strength. Or give them some intelligence. For a long time, my idea of purgatory was being locked in a room with Elizabeth Schwarzkopf singing lieder endlessly. I'm beginning to reconsider that, in favor of an unending stream of such telephone calls. I think that might be a lot worse than La Schwarzkopf.
ANTIGONOS' BRAIN
| Your Brain is Green |
 |
Friday, February 19, 2010
Oh, Goody!
It seems that quite a few of my favorite "light" novelists will be publishing new books soon.
Lindsey Davis has a novel about the English Civil War, as well as the 20th Falco novel on the way.
Deanna Raybourn is offering "The Dead Travel Fast", but it is unclear (to me, anyway) whether it will feature Lady Julia Grey and Nicholas Brisbane. I rather hope so; I quite like him, even if he occasionally becomes just a little too much like Sherlock Holmes. But maybe marriage has mellowed him (I prefer him unmellowed, however)
Speaking of Holmes, Laurie R. King's Mary Russell will be present in "The God of the Hive". Ms. King's last book, "The Language of Bees", was not one of her best, partly because it seemed truncated at an odd point, and "The God of the Hive" is largely considered by her fans to be its completion -- or so we hope. Ms. King seems to want to make Mary more independent of Holmes, but it is the interaction between the two that is the main attraction, in my opinion.
Amelia Peabody returns! Sensibly, the new novel will take place before the "Tomb of the Golden Bird", which saw Peabody and Emerson, in their late 60s [possibly, in Amelia's case, at 70, although her "editor" has claimed that Amelia fudged her age at some point] present at what was the end of an era in Egyptology, the opening of Tutankhamun's tomb. This novel is supposed to take place during the period in 1910 when Ramses was excavating in Palestine. Living, as I do, in one of the places that features in the novel, I eagerly await it. I'm currently listening to all the series in audiobook form again (why are three of the novels only available in abridged form??) and am finding them delightful all over again. It's not just the way Elizabeth Peters writes, but the way Barbara Rosenblat "performs" them.
Diana Gabaldon has an Outlander-connected short story, called "A Leaf in the Wind of All Hallows", appearing soon in an anthology, a Lord John Grey short story in another anthology, and in the autumn will publish the Outlander graphic novel. None of these projects fills me with unalloyed enthusiasm; I really want to read the short stories but mildly resent having to buy fairly expensive books full of lots of other stories that do not (probably) interest me, and I have no interest in adult comic books, especially when the art work looks to me like typical "manga" type of illustration (albeit beautifully colored). But since the story line will expand on the text of the first book in the Outlander series, I'm probably going to have to buy it, just to see what twists DG has come up with.
By the way, I've recently listened to "The Whiskey Rebels" by David Liss, which was very well done -- he's an author I've come to enjoy quite a bit. I heartily recommend the audio version of Dennis Lehane's "The Given Day" as well. Generally speaking, I choose audiobooks which have quite a lot of dialogue and can benefit from a dramatic reading; books with long narrative sections seem to fare badly in audiobook form (despite repeated attempts, I could not get into A.S. Byatt's "The Possession", which has lots of "extracts" from works of the fictional author at the center of the novel, for just that reason) When buying books for Kindle, I tend to go for non-fiction (history, mostly), since I like books with lots of "meat" (the fatter, the better, IMO -- or, to be crass about it, more bangs for my bucks). For the time being, I've got both audiobooks I haven't yet listened to, and a few books to read on my Kindle...together with my iPod, I'm all right, Jack, for the nonce.
Lindsey Davis has a novel about the English Civil War, as well as the 20th Falco novel on the way.
Deanna Raybourn is offering "The Dead Travel Fast", but it is unclear (to me, anyway) whether it will feature Lady Julia Grey and Nicholas Brisbane. I rather hope so; I quite like him, even if he occasionally becomes just a little too much like Sherlock Holmes. But maybe marriage has mellowed him (I prefer him unmellowed, however)
Speaking of Holmes, Laurie R. King's Mary Russell will be present in "The God of the Hive". Ms. King's last book, "The Language of Bees", was not one of her best, partly because it seemed truncated at an odd point, and "The God of the Hive" is largely considered by her fans to be its completion -- or so we hope. Ms. King seems to want to make Mary more independent of Holmes, but it is the interaction between the two that is the main attraction, in my opinion.
Amelia Peabody returns! Sensibly, the new novel will take place before the "Tomb of the Golden Bird", which saw Peabody and Emerson, in their late 60s [possibly, in Amelia's case, at 70, although her "editor" has claimed that Amelia fudged her age at some point] present at what was the end of an era in Egyptology, the opening of Tutankhamun's tomb. This novel is supposed to take place during the period in 1910 when Ramses was excavating in Palestine. Living, as I do, in one of the places that features in the novel, I eagerly await it. I'm currently listening to all the series in audiobook form again (why are three of the novels only available in abridged form??) and am finding them delightful all over again. It's not just the way Elizabeth Peters writes, but the way Barbara Rosenblat "performs" them.
Diana Gabaldon has an Outlander-connected short story, called "A Leaf in the Wind of All Hallows", appearing soon in an anthology, a Lord John Grey short story in another anthology, and in the autumn will publish the Outlander graphic novel. None of these projects fills me with unalloyed enthusiasm; I really want to read the short stories but mildly resent having to buy fairly expensive books full of lots of other stories that do not (probably) interest me, and I have no interest in adult comic books, especially when the art work looks to me like typical "manga" type of illustration (albeit beautifully colored). But since the story line will expand on the text of the first book in the Outlander series, I'm probably going to have to buy it, just to see what twists DG has come up with.
By the way, I've recently listened to "The Whiskey Rebels" by David Liss, which was very well done -- he's an author I've come to enjoy quite a bit. I heartily recommend the audio version of Dennis Lehane's "The Given Day" as well. Generally speaking, I choose audiobooks which have quite a lot of dialogue and can benefit from a dramatic reading; books with long narrative sections seem to fare badly in audiobook form (despite repeated attempts, I could not get into A.S. Byatt's "The Possession", which has lots of "extracts" from works of the fictional author at the center of the novel, for just that reason) When buying books for Kindle, I tend to go for non-fiction (history, mostly), since I like books with lots of "meat" (the fatter, the better, IMO -- or, to be crass about it, more bangs for my bucks). For the time being, I've got both audiobooks I haven't yet listened to, and a few books to read on my Kindle...together with my iPod, I'm all right, Jack, for the nonce.
Wednesday, February 03, 2010
Pass the Nausea Antagonist, Please
Mike Lester Rome News Tribune Feb 3, 2010 |
Amazing. A few weeks ago I didn't know who Tim Tebow is. Now I wish I didn't. I really hope he doesn't get drafted into the NFL, or he's likely to be the victim of some of his teammates. Of course, with an IQ as low as his obviously is, another concussion might actually jog the brain cells and improve his intelligence.
Fortunately, since the Superbowl airs here in Israel in the middle of the night, and I tape it and watch it the morning after, I will be able to skip hearing about his miraculous life, along with all the other commercials.
Sunday, January 31, 2010
I Suppose the Next Step is an iWallet Full of iMoney...
Nate Beeler Washington Examiner Jan 31, 2010 |
To be honest, I didn't think of "feminine hygiene products" since a different term entirely is used in British English, and anyway, I'm so far past the time when I needed such stuff, it has pretty much slipped my mind.
But I do wonder about the possible confusion between iPOD and iPAD. In certain accents, the words sound almost the same.
For the time being, the iPad is eminently resistable [just as I don't have an iPhone, either]. But my 160 GB iPod Classic is nearly full, and if the iPod Touch gets a bigger memory, I might think about getting one...
Friday, January 22, 2010
If This Young Man Had Been a Moslem
A few days ago a flight was diverted because of strange behavoir deemed possibly the prelude to an act of terror.
It turned out that the young man who was behaving oddly was davvening with tefillin.
The incident was quickly brought to a close since the boy cooperated with the authorities, explaining what he had been doing, and showing them his tefillin. Neither his parents nor his grandparents have made an issue of what must have been a major embarrassment and not a little frightening for the 17 year old in question.
They, nor their rabbi, nor American Jews in general, have issued threats, of violence or death, against the airline, the US Government, or indeed anyone at all for "insulting Judaism" or "racism" or abusing the right of freedom of religion. No fatwas, no physical attacks, no paranoia, no attempts to sue for damages, as we have seen ever since Salman Rushdie put his life in danger by writing a book, or a Scandinavian cartoonist attempted to poke fun at Islamic extremism, or a Dutch filmmaker who tried to show what lies behind Islamic misogyny. This shows very clearly the difference between the Moslem mentality, and the Jewish mentality. Moslems seem to need to be provocative, "in your face", to demand not just equality under the law but to be superior to the local civil code [witness calls for Shari'a law in the UK for Moslems], and to behave like thwarted, but heavily armed, children when their demands aren't met for complete capitulation.
The Jewish response: “I would suggest, pray on the plane and put the tefillin on later on,” the boy's rabbi said. “Pray, and fulfill the ritual later.” That is called being civilized, something Islam has yet to understand.
It turned out that the young man who was behaving oddly was davvening with tefillin.
The incident was quickly brought to a close since the boy cooperated with the authorities, explaining what he had been doing, and showing them his tefillin. Neither his parents nor his grandparents have made an issue of what must have been a major embarrassment and not a little frightening for the 17 year old in question.
They, nor their rabbi, nor American Jews in general, have issued threats, of violence or death, against the airline, the US Government, or indeed anyone at all for "insulting Judaism" or "racism" or abusing the right of freedom of religion. No fatwas, no physical attacks, no paranoia, no attempts to sue for damages, as we have seen ever since Salman Rushdie put his life in danger by writing a book, or a Scandinavian cartoonist attempted to poke fun at Islamic extremism, or a Dutch filmmaker who tried to show what lies behind Islamic misogyny. This shows very clearly the difference between the Moslem mentality, and the Jewish mentality. Moslems seem to need to be provocative, "in your face", to demand not just equality under the law but to be superior to the local civil code [witness calls for Shari'a law in the UK for Moslems], and to behave like thwarted, but heavily armed, children when their demands aren't met for complete capitulation.
The Jewish response: “I would suggest, pray on the plane and put the tefillin on later on,” the boy's rabbi said. “Pray, and fulfill the ritual later.” That is called being civilized, something Islam has yet to understand.
A Difficult Week
It's been a somewhat difficult week. Sunday I felt a cold coming on. Colds, with me, run a predictable course. First I get a bad sore throat, then my nose starts running but the throat feels less tight, and lastly it all goes to my chest, and sits there for up to 10 days.
I doubled my dose of antidepressants for the nonce. I've found the main effect of my particular little blue pill isn't to make me happier, just to make me care less about all the s**t going down, and a cold is one of those things you've just got to last out: "treat it, and it will go away in a week; don't treat it, and it goes away in 7 days". So I faced the next few days, sneezing, sniffling, and coughing, with equanimity.
Of course, I couldn't take any time off work. Right now I work with two other nurses, who work from 8 a.m. to 2-3 p.m. One has 4 children under six years of age at home, which is a commute of over an hour. The other, who can do the occasional evening, has 5 children and is currently attending university in order to upgrade her nursing diploma to a nursing degree. I've created the closest thing to an indispensable position for myself, and while it will be very difficult for the organization to retire me against my will, it means it is also a real problem if I need some time off because either of those nurses will have to put in 11 hour days.
So, with notices plastered everywhere about how vulnerable pregnant women are to both ordinary and H1N1 flu, and how they ought to be inoculated, there I was, pockets filled with tissues, and trying hard not to breathe on anyone. Every medical institution I've ever worked for has made it difficult for nurses to take sick leave; obviously the profession doesn't take its own advice.
For some weeks our completely inadequate facilities ["don't fuss; this clinic is only temporary; no point in doing renovations since in 6 months/a year/2 years/5 years/when the Messiah comes there will be a super-duper new clinic"] have had an additional problem: suddenly both our fetal monitors began to produce static so loud that sometimes the microphones were recording the static rather than the fetal heart rate. When we first complained, we were told it wasn't so bad, and to carry on. When it became obvious that it WAS bad, we were told to "cope somehow". The maintenance folks came around, fiddled with the electrical sockets, said it must be the machines. The technicians from the company that makes the fetal monitors came around, and demonstrated that, when taken to another part of the building and plugged in, there was no noise at all, and told the building maintenance crew it was THEIR problem. Meanwhile we are wrestling with up to 8 women an hour--nearly all with multiple or high risk pregnancies, or who claim not to have felt fetal movements for some time--whose fetal hearts only occasionally can be heard above the static. And at least one of the "emergency walk-in" doctors (we have one doctor specifically for non-scheduled patients all day until midnight) orders an NST on anyone and everyone more than 26 weeks pregnant, no matter what the reason they came ["ran out of prenatal vitamins and need a new prescription"]. He's from the FSU and was so appalled, and terrified, by the stories he heard about doctors in the West being sued for malpractice, he wants to absolutely sure he's missed NOTHING. If a woman wants a prescription for birth control pills he's perfectly capable of sending her to the dentist if he thinks her teeth need cleaning.
[Yesterday one of the medical secretaries plugged in her electric kettle and caused a short circuit. It not only knocked out all the computers in the clinic, it also knocked out all the electronics in the adjoining, very large, pharmacy. I find it immensely fascinating that so much stuff -- nearly one half of an entire floor in the building is on one electrical line. But hey, this is Israel. I wonder if this could be part of our problem...]
But I soldiered on. Old Florence would be proud. I probably only infected a dozen women with my cold, and sent another dozen to the hospital for no good medical reason because I couldn't get a decent FHR tracing. After 42 years I really ought to let this kind of stupidity wash over me; after more than 30 years in Israel I ought to shrug and say "Yiheyeh b'seder" [it'll be all right in the end], or "Hashem yishmor" [God will take care of it]. But my inability to do so is one of the reasons I take little blue pills.
There is a high-risk couple we see on a weekly basis. They are both ex-Americans and extremely ultra-Orthodox, I suspect they are converts, although perhaps the wife is merely a born-again Jew; both are considerably past child-bearing age, and since the husband has a number of fairly severe chronic conditions he may just look like he's in his sixties but might be much younger. I know this is the second marriage for the husband, who speaks freely of his grown children in the US, but it is the first marriage for his wife. She's 40-ish, has gestational diabetes, and only got pregnant after extensive fertility treatment. They came on Thursday for their weekly appointment, and all was well. She's now in her 34th week. An hour later she phoned me to say she was bleeding. I, of course, told her to come back immediately, and our on-call doctor sent her straight into hospital. I hope she can hold the pregnancy for another couple of weeks. While a 34 week premature isn't such a bad situation, it's all relative, and they can still have a rocky course. This is not only a high risk pregnancy, it is a very precious one. She will not be able to try again.
I also give progesterone injections to a woman in her middle thirties who is pregnant, after IVF, with twins. Until the 12th week, progesterone, which maintains the pregnancy, is made by the open wound on the ovary where the egg cell erupted [the corpus luteum]. From the 12th week onwards the placenta produces it. Since several previous pregnancies, also IVF, ended in miscarriage, her doctor has ordered the daily injections this time, and all has seemed to go well. She being now in her 12th week, the dosage is being reduced gradually, and everything was fine until today, when she began bleeding and cramping. The doctor immediately ordered the higher dosage resumed, and we've all got our fingers crossed, but I don't have a good feeling about the outcome. I sat and talked with her and her husband for a while; there really wasn't a lot more I could do. She is highly intelligent -- a psychologist -- who simply left off starting a family early, and then it became apparent that both she and her husband have fertility problems [which is why they had more than one embryo implanted; it seems unlikely that another round of IVF will succeed].
I hate ending the work week like this, with two "cliffhangers". I don't blog often about work, because while it might seem exciting and glamorous to an outsider, most of what I do is really very repetitive and mundane. For every intelligent and knowledgeable patient -- and many of the women in fertility treatment are extremely so -- there is at least one dumb bunny who has, as we nursing professionals are wont to say, an IQ lower than her BUN [blood urea nitrogen, which normally is almost zero]. They ask questions it takes 5 minutes to understand, and since the answer needs to be repeated at least three time for it to sink in, takes 15 minutes of my precious time [the gynecologic equivalent of "Who is buried in Grant's Tomb?" is "My doctor prescribed vaginal suppositories for me. Where do I put them?" This ranks close to "My boyfriend swears he didn't come inside me. How did I get pregnant?"
I doubled my dose of antidepressants for the nonce. I've found the main effect of my particular little blue pill isn't to make me happier, just to make me care less about all the s**t going down, and a cold is one of those things you've just got to last out: "treat it, and it will go away in a week; don't treat it, and it goes away in 7 days". So I faced the next few days, sneezing, sniffling, and coughing, with equanimity.
Of course, I couldn't take any time off work. Right now I work with two other nurses, who work from 8 a.m. to 2-3 p.m. One has 4 children under six years of age at home, which is a commute of over an hour. The other, who can do the occasional evening, has 5 children and is currently attending university in order to upgrade her nursing diploma to a nursing degree. I've created the closest thing to an indispensable position for myself, and while it will be very difficult for the organization to retire me against my will, it means it is also a real problem if I need some time off because either of those nurses will have to put in 11 hour days.
So, with notices plastered everywhere about how vulnerable pregnant women are to both ordinary and H1N1 flu, and how they ought to be inoculated, there I was, pockets filled with tissues, and trying hard not to breathe on anyone. Every medical institution I've ever worked for has made it difficult for nurses to take sick leave; obviously the profession doesn't take its own advice.
For some weeks our completely inadequate facilities ["don't fuss; this clinic is only temporary; no point in doing renovations since in 6 months/a year/2 years/5 years/when the Messiah comes there will be a super-duper new clinic"] have had an additional problem: suddenly both our fetal monitors began to produce static so loud that sometimes the microphones were recording the static rather than the fetal heart rate. When we first complained, we were told it wasn't so bad, and to carry on. When it became obvious that it WAS bad, we were told to "cope somehow". The maintenance folks came around, fiddled with the electrical sockets, said it must be the machines. The technicians from the company that makes the fetal monitors came around, and demonstrated that, when taken to another part of the building and plugged in, there was no noise at all, and told the building maintenance crew it was THEIR problem. Meanwhile we are wrestling with up to 8 women an hour--nearly all with multiple or high risk pregnancies, or who claim not to have felt fetal movements for some time--whose fetal hearts only occasionally can be heard above the static. And at least one of the "emergency walk-in" doctors (we have one doctor specifically for non-scheduled patients all day until midnight) orders an NST on anyone and everyone more than 26 weeks pregnant, no matter what the reason they came ["ran out of prenatal vitamins and need a new prescription"]. He's from the FSU and was so appalled, and terrified, by the stories he heard about doctors in the West being sued for malpractice, he wants to absolutely sure he's missed NOTHING. If a woman wants a prescription for birth control pills he's perfectly capable of sending her to the dentist if he thinks her teeth need cleaning.
[Yesterday one of the medical secretaries plugged in her electric kettle and caused a short circuit. It not only knocked out all the computers in the clinic, it also knocked out all the electronics in the adjoining, very large, pharmacy. I find it immensely fascinating that so much stuff -- nearly one half of an entire floor in the building is on one electrical line. But hey, this is Israel. I wonder if this could be part of our problem...]
But I soldiered on. Old Florence would be proud. I probably only infected a dozen women with my cold, and sent another dozen to the hospital for no good medical reason because I couldn't get a decent FHR tracing. After 42 years I really ought to let this kind of stupidity wash over me; after more than 30 years in Israel I ought to shrug and say "Yiheyeh b'seder" [it'll be all right in the end], or "Hashem yishmor" [God will take care of it]. But my inability to do so is one of the reasons I take little blue pills.
There is a high-risk couple we see on a weekly basis. They are both ex-Americans and extremely ultra-Orthodox, I suspect they are converts, although perhaps the wife is merely a born-again Jew; both are considerably past child-bearing age, and since the husband has a number of fairly severe chronic conditions he may just look like he's in his sixties but might be much younger. I know this is the second marriage for the husband, who speaks freely of his grown children in the US, but it is the first marriage for his wife. She's 40-ish, has gestational diabetes, and only got pregnant after extensive fertility treatment. They came on Thursday for their weekly appointment, and all was well. She's now in her 34th week. An hour later she phoned me to say she was bleeding. I, of course, told her to come back immediately, and our on-call doctor sent her straight into hospital. I hope she can hold the pregnancy for another couple of weeks. While a 34 week premature isn't such a bad situation, it's all relative, and they can still have a rocky course. This is not only a high risk pregnancy, it is a very precious one. She will not be able to try again.
I also give progesterone injections to a woman in her middle thirties who is pregnant, after IVF, with twins. Until the 12th week, progesterone, which maintains the pregnancy, is made by the open wound on the ovary where the egg cell erupted [the corpus luteum]. From the 12th week onwards the placenta produces it. Since several previous pregnancies, also IVF, ended in miscarriage, her doctor has ordered the daily injections this time, and all has seemed to go well. She being now in her 12th week, the dosage is being reduced gradually, and everything was fine until today, when she began bleeding and cramping. The doctor immediately ordered the higher dosage resumed, and we've all got our fingers crossed, but I don't have a good feeling about the outcome. I sat and talked with her and her husband for a while; there really wasn't a lot more I could do. She is highly intelligent -- a psychologist -- who simply left off starting a family early, and then it became apparent that both she and her husband have fertility problems [which is why they had more than one embryo implanted; it seems unlikely that another round of IVF will succeed].
I hate ending the work week like this, with two "cliffhangers". I don't blog often about work, because while it might seem exciting and glamorous to an outsider, most of what I do is really very repetitive and mundane. For every intelligent and knowledgeable patient -- and many of the women in fertility treatment are extremely so -- there is at least one dumb bunny who has, as we nursing professionals are wont to say, an IQ lower than her BUN [blood urea nitrogen, which normally is almost zero]. They ask questions it takes 5 minutes to understand, and since the answer needs to be repeated at least three time for it to sink in, takes 15 minutes of my precious time [the gynecologic equivalent of "Who is buried in Grant's Tomb?" is "My doctor prescribed vaginal suppositories for me. Where do I put them?" This ranks close to "My boyfriend swears he didn't come inside me. How did I get pregnant?"
Thursday, January 07, 2010
Tuesday, December 22, 2009
Wednesday, December 16, 2009
Health "Reform"
Clay Bennett Chattanooga Times Free Press Dec 16, 2009 |
Like Mom, the flag, and apple pie, "health reform" has such a nice ring to it. And soon, I am sure, Obama will market this deformed and aborted baby to America as a victory. But nothing's going to get better...
Wednesday, December 02, 2009
Endless War
Bruce Beattie Daytona Beach News-Journal Dec 2, 2009 |
I don't understand exactly what the American goal is in Afghanistan. Eliminate Al Qaeda and bin Laden? Prop up the Karzai government? Rebuild the country? Guarantee women's rights? Stop the opium trade?
For one thing, bin Laden may not even be in Afghanistan right now. The geography creates a porous border, wherever there actually IS a border anyone recognizes. Anyone other than an Afghani stands out like a sore thumb, and terrorists can always find support, and hide, among the natives. The Karzai government is part of the problem, not the solution. Rebuild the country as What? The 52nd state of America, complete with McDonalds'? The Afghanis don't want to be democratized, or Americanized. They've got a lot of customs that we think are barbarous, but they have always lived that way, and want to continue to do so. Tribal systems and modern democracy are really quite antithetical.
Afghani men want to continue to have absolute control over their women and families. Their religion backs this. America is fooling itself if it thinks it can change this in any appreciable degree. The opium trade pays better than any other cash crop; until it becomes more lucrative NOT to grow it, it will continue, and the cost to the US taxpayer if that were to happen would be immense [and would have to continue indefinitely, or the farmers would just go back to growing opium.
Pakistan is very ambivalent, and cannot be regarded as a partner of the Americans. If fighting can be suppressed in Afghanistan, the Taliban and other terrorists will just go over the border [indeed, they're doing it now] and return to Afghanistan when the heat is off.
The Russians and the British can testify to the fact that there cannot be any real victory in Afghanistan. The most the US can hope for is to quarantine it like a malignant disease, until the entire face of radical Islam changes, and, for that, I'm not holding my breath.
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