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Guilty of Avoiding Murder

Sometimes I’m not a great sister-in-law.

My husband’s brother, a theater professor, published a book last year – Murder Most Queer: The Homicidal Homosexual in the American Theater. The book is academic, yet it’s written so that a general audience can understand and follow.

We got the book as soon as it came out, and I began reading it immediately. And a little less than halfway in, I stopped.

A lot played into my stopping. The book is fascinating – it wasn’t boredom that stopped me. It is extremely well-written – the writing kept a hold of me. So why did I put the book down?

I put it down partway into the chapter that warned about spoilers. Many of the plays he discusses have twists and surprises that the author explores. I read through the section that included the play I had already seen (Deathtrap), and then paused my reading with a potential intent to read the other plays about which he would be speaking. Then I would return and finish the book.

But I knew I wouldn’t read those plays. Reading a play, at least to me, is nowhere near as good as watching it performed. And these are not plays that I will find produced locally.

Reading through the book would be an admission that I was not going to watch the plays. It would be a symbolic closing of a door onto the possibility of seeing those productions without knowing how they ended. It would cut off possibilities. And I don’t like cutting off possibilities.

But again, I knew I was unlikely to see the plays. And even if I did see any of them at some point, there is a very strong likelihood that I would not remember the plot twist or surprise ending I read about, since I generally can’t remember where I put my keys and I call my sons by the wrong name about 40% of the time. Truth is, the “spoiler alert break” allowed me to stop reading something painful to me.

Murder Most Queer is not a literary critique. It is an analysis within the context of sociology, exploring homophobic paradigms within our society. As I read the analyses, as I learned the histories, as I learned about the writers, performers, and audience members, I felt saddened and sickened by the forces behind the murders in the stories. I felt saddened and sickened by the outcasting of those that don’t fit into an accepted norm. It didn’t allow me my everyday denial of ickiness and my naïve and insulated little world of tolerance and acceptance. It made me uncomfortable. FYI, the book is not a downer – I just read into things. I don’t want to think about people I deeply love feeling like they are villainized or ostracized because of their sexual orientation. I want to think that era is close to over. I don’t want to think about societal disdain translating into self-hatred.

So I jumped on the excuse of not wanting to ruin the endings of plays I knew I would likely never see.

By doing this, I denied my brother-in-law the decency of a “hey, I finished your book – it’s amazing!” phone call. Which is really a big thing. Writing a book is no easy task, let alone the process of publishing. Even when academic, it is an emotional process. And reflecting on a society that can be so filled with hate is difficult, even when the plays themselves many times are simply fun and cathartic. He knew I had started the book (since I had happily told him about how much I was loving it when it first arrived), so what was he to think of never getting that “closure” call? Hopefully he chalked it up to my being a theatrically uncultured boob and not to my not liking his work.

My colleagues and I frequently marvel at the denial of some of our patients and their families. People ignore symptoms. They ignore risks. They ignore prognoses and likely outcomes. They avoid what is not easy or what makes them uncomfortable, and by doing so put themselves in positions not to be healthy or not to get the most out of their lives. Rather than confronting the discomfort or the fear, they hide and end up missing out – on health, on time, on quality of life.

This week, I picked up the book again. I finished it this evening – just in time to be able to say, when my brother-in-law walks in the door tomorrow to spend Thanksgiving with us, “Hey, I finished your book – it’s amazing!” There are storylines I’ve learned, shows I want to see, writers and actors I want to Google and YouTube, and ideas I want to discuss.

To my husband’s brother – thank you for, as always, educating me and opening my eyes. I apologize for being a lousy sister-in-law, and I hope that dinner on Thursday will help make up for it a bit.

What Football and Infectious Disease Control Have in Common

Communication. Such a simple concept. And yet so many ways in which it can fail.

Two examples of communication failures hit the news this past week, both of which have potentially severe medical repercussions, albeit on very different scales.

The first occurred this past Saturday at a Big Ten football game. The quarterback took a hard hit, and his head slammed backwards onto the ground. When he got up, he was so shaken and off-balance that he stumbled and collapsed into his teammate. So obviously, he would be pulled from the game and given medical attention, right? Nope. The coach put him back in for another play, as the crowd booed its displeasure and indignation. No one could believe the coach would show such blatant disregard for his player’s well-being, and there are strict regulations in place regarding head injuries in sports and protecting the athletes when there is any suspicion they have suffered a concussion.

But the coach didn’t pull the player out for a neurological check because he (the coach) hadn’t seen the player’s hit, his head-slam, or his resultant signs of head injury. The coach knew the quarterback was playing on an injured ankle (which had been medically cleared for play), and when he saw him limp back to the sideline, he assumed it was an ankle issue, stuck him in for another play, then had medical personnel check his ankle, and put him in again. Thousands of people in the stadium saw what happened. Millions of people saw on TV. Everyone assumed the coaches saw. But they didn’t – they were monitoring so many different things, planning, talking to people, and assuming important information would get to them. But the information didn’t get to the right people.

The university where this occurred is taking steps to ensure such an event doesn’t happen again. For example, they’re placing medical personnel in the press box for future games and giving them direct communication lines to the coaches. Systems approaches are good. They help. I’m glad they’re putting in extra safety layers to protect their student athletes, and I hope other schools and teams follow this lead. But systems measures can only go so far. We also need individual safety layers, and I cannot overstate the importance of personal advocacy (both self-advocacy and advocacy of others).

If the quarterback had said, “Hey, Coach, I hit my head and don’t feel right,” or, if he was too dazed to speak for himself, if his teammates had told the coach about the injury and their concern, or if anyone who had seen the incident had spoken up and relayed the information to the coach, then the athlete would have been given prompt medical attention and not sent back out on the field to be head slammed again. People need to speak up. And they need to speak up to the people in authority – the decision makers – and not just grumble quietly or complain amongst themselves.

Earlier this week, the news hit that the first person in the U.S. had been diagnosed with the Ebola virus. Ebola requires close contact with someone who is symptomatic with the disease in order to spread. We have good infection control measures in U.S. hospitals. We have quick dissemination of news. We have the CDC (Centers for Disease Control and Prevention). We have state and local health departments. We have a lot of good systems in place. The patient had recently come from Liberia, where there is a current outbreak of Ebola. He developed symptoms, he went to the hospital, and he told some of the medical personnel that he had just recently returned from Liberia. And he was sent home with a prescription for antibiotics. And he continued to be symptomatic, exposing other people for days, until he returned to the hospital and received the correct diagnosis, appropriate medical care, and concomitant infection control measures.

In this case, the patient actually had communicated the important information, but it didn’t get to the correct people. A systems issue, to be sure. But more individual advocacy and strong communication would go a long way here, too.

I was not on the sidelines with the football team, and I was not in the emergency room where the patient first presented, but I have some pretty good ideas as to some of what may have been going on.

Both the sidelines of a football game and an emergency department can be bustling with action. Things are going on in different areas. Different teams (offence, defense, trauma, radiology….) and their respective coordinators (offensive and defensive coaches, head coaches, triage nurses, nurse practitioners, attending doctors, etc.) are functioning within a larger whole, trying to attain their overarching goal (winning a game, getting all the patients taken care of) while trying to maintain the well-being of each individual (the athletes, the patients). With so much going on, communication frequently suffers. And when people are nervous about speaking up, communication suffers.

Players may have been afraid to “argue” with a coach. They may have assumed the coach knew all the facts. The patient or his family or the nurse he originally spoke to may have assumed the ER doctor or Physician’s Assistant or Nurse Practitioner who discharged the patient had read the travel history and considered the possibility of an Ebola infection. Both situations just needed someone, anyone, to say to the decision maker, “Hey, wait a minute. Do you know that (I hit my head and can’t walk straight/the quarterback looks like he has a concussion/this patient was just in a country with an Ebola outbreak/I just flew in on a plane from Liberia)?”

Systems approaches. Individual back-ups. Individual care. Systems back-ups. All necessary to minimize the holes in the information sieve. Don’t skimp on the systems. But also never be afraid to plug the holes in the systems yourself.

 

On the Air Today at Noon!

For those of you who may be interested, I am being interviewed by Health Reporter Sean Lee from WWJ, the CBS affiliate radio station in Detroit. today, sometime between noon and 1 p.m.. So listen in on 950 AM radio, or through their website (click the watch/listen tab and then click on the WWJ 950 button) at http://detroit.cbslocal.com/station/wwj-newsradio-950/

I’ll be talking about how to protect yourself and make sure you’re receiving appropriate medical treatments. I’ll update with more detail after today’s show.

Enjoy!

Web Radio Conversation

Practical Medical Insights will be featured on the Conversations in Care web radio broadcast this Wednesday, March 20, 2013, at 2:00 p.m. EST (1:00 p.m. CST).  I will be interviewed by the host, Tami Neumann, and we’ll be talking about the background of Practical Medical Insights, personal medical advocacy, what I do to help my clients, and tips for staying in control of your own medical situations.  Click http://www.blogtalkradio.com/conversationsincare/2013/03/20/physician-guidance-through-the-medical-maze to hear the broadcast.  You can either listen during the live program or after the show (the same link will be available for on-demand listening after the broadcast).

As always, if you have any questions you can visit www.practicalmedicalinsights.com or contact me directly.

 

Correction

I can’t believe no one caught me yet on my mistake!  I misspoke – I said there wasn’t saturated fat in the cornbread, but it is made with two eggs, so there IS saturated fat from those, and there is a tiny amount in the canola oil and low-fat buttermilk (the Trader Joe’s brand I mentioned only has 1% fat).  But it’s way less than if it were made with the butter or shortening that standard recipes call for, and if you use egg substitute it knocks the saturated fat level close to nothing.

Sorry about that!  I have fixed the post.  And once again, enjoy the Superbowl!