A Laugh A Day

October 28, 2008

A good laugh will do just as much for your health as a mini-workout in the gym.  Did you realise that 20 seconds of intense laughter can double your heart rate for 3 to 5 minutes, a feat that would normally involve rigorous exercise? There is a symbiotic relationship between health and humour. Humour has an impact on most physiological systems of the body.

The medical world started taking note of the possibilities of therapeutic laughter after Norman Cousin’s book, Anatomy of an Illness, came out in the late 1970’s.  In it, he described how watching comedies and reading funny books and articles helped him recover from a life-threatening tissue disease which left him in chronic pain.

So in keeping with the theory that laughter is the best medicine, here is your laugh for today…


Pearly Gates

October 27, 2008

A doctor dies and goes to heaven. St. Peter meets him at the Pearly Gates and checks him in. St. Peter then says to him, “Look at the time, you must be hungry! Heaven Cafeteria is serving lunch, why don’t you get yourself something to eat?”

The doctor goes to the cafeteria and notices the long line. He immediately cuts in at the front, only to hear loud protests. “I’m a doctor” he says, “I’m a busy man, I don’t have time to wait in line.”

The others say, “You’re in heaven now, we’re all the same here, get to the back of the line and wait your turn!”

A few weeks later, waiting patiently in line for lunch, the doctor notices a man come dashing in wearing scrubs and a lab coat, stethoscope around his neck. He butts in at the head of the line and no one utters a peep.

“Hey,” the doctor says to the guy in front of him, “Who does that guy think he is?”

“Oh, that’s God,” says the guy, “He likes to play doctor.”


A Terrible Blunder

October 23, 2008

Last April a young boy was admitted to Crumlin Children’s Hospital in Dublin, to undergo surgery to have his defective right kidney removed. It later emerged that his healthy left kidney had been removed in error. Today a report has been released following an independent investigation into the tragedy and it’s revealed a shocking catalogue of contributing factors which led to the mistake.  It was described as “an accident waiting to happen”.

When news first broke of this medical blunder, it seemed incredulous that such a terrible mistake could occur at the country’s leading children’s hospital. It has now transpired that the consultant general surgeon who recommended the surgery, mistakenly listed the wrong kidney on the surgical request form.  When the child was admitted to the hospital, a junior doctor filled out a consent form for the parents to sign without referring to the clinical notes on the child and again the wrong kidney was listed for removal. The child’s operation was carried out by a senior surgical registrar who had not examined the child on the ward before he was brought to theatre. This surgeon proceeded to remove a perfectly healthy left kidney leaving the unfortunate child with one poorly functioning right kidney.

The investigation carried out by experts at London’s renowned Great Ormond Street Hospital, outlined ten contributing factors to the botched surgery. These included delays in filing hard copy x-ray reports in the medical records, patients being regularly admitted outside of working hours and the heavy workload of doctors at the hospital. The report found that there was no policy in place at the hospital to mark the site of the procedure and that the surgeon didn’t have access to scans for reference at the time of the surgery. It also found that there was no fail-safe system to ensure a patient having surgery had their case discussed by a range of experts. It said the operation was carried out by a paediatric surgeon who hadn’t met the patient beforehand and when the blunder became obvious, it was too late to do anything about it. The report made eight recommendations to ensure the mistake is not repeated, including:

* The hospital should formally monitor the hours junior doctors work. Overwork was stated as a contributory factor in the error over the consent form. It’s a well-known fact that junior doctors are expected to work horrendously long hours resulting in serious sleep deprivation and it’s inevitable that mistakes will occur if their workload is not properly regulated or supervised.

* Surgeons should introduce team briefings at the outset of each theatre list to discuss patients. The surgeons at Crumlin Hospital have an enormous workload and are working under huge pressure to reduce long waiting lists.

* Radiology and x-ray systems should be reviewed. No up-to-date scan was available on the child for reference during the surgery.

* Consent processes should be revised. A hospital spokesperson admitted that the family had repeatedly raised concerns and questioned if the correct kidney was being removed, up to and including the time of handover to theatre.

This tragic case will undoubtedly raise concerns for the parents of any child who is presently awaiting surgery. The report has clearly outlined the need for extra safety measures to be implemented for children undergoing surgery. It has also raised the issue of doctors working under too much pressure in a hospital system that is stretched to the limits. Thankfully, the hospital appears to have handled the situation correctly as it’s taken full responsibility for the tragic error and has offered an apology. The child’s parents are happy for the child to continue to receive treatment at the hospital and have requested anonymity. One can only hope that the child will be a suitable recipient for a kidney transplant in the future and that lessons will have been learnt to prevent a tragedy like this ever occurring again.


Stayin’ Alive

October 23, 2008

Did you know that the Bee Gees’ 1977 hit ‘Stayin’ Alive’ is an ideal beat to follow to perform chest compressions on a victim of a cardiac arrest? A research study in the US has found that the fast beat of the song motivated people to keep up the rate of chest compressions needed to make cardiopulmonary resuscitation (CPR) effective. CPR can triple cardiac arrest survival when performed properly.

An author of the study said many people were put off performing cardiopulmonary resuscitation (CPR) as they were not sure about keeping the correct rhythm. The song ‘Stayin’ Alive’ contains 103 beats per minute, close to the recommended rate of 100 chest compressions per minute.

The study by the University of Illinois College of Medicine saw 15 doctors and students performing CPR (cardiopulmonary resuscitation) on mannequins while listening to ‘Stayin’ Alive’. They were asked to time their chest compressions with the beat.

Five weeks later, they did the same drill without the music but were told to think of the song while doing compressions.

The average number of compressions the first time was 109 per minute; the second time it was 113 – more than recommended by the American Heart Association, but better than too few, according to Dr Matlock.

“It drove them and motivated them to keep up the rate, which is the most important thing,” he told the Associated Press.

A spokesman for the American Heart Association, Dr Vinay Nadkarni, said it had been using ‘Stayin’ Alive’ as a training tip for CPR instructors for about two years, although it was not aware of any previous studies that tested the song.

With thanks to BBC News (and Grannymar) for bringing this report to my attention.

Those Bee Gees in their tight jeans were enough to get my heart beating fast. I feel a touch of Night Fever coming on now!



The Show Goes On

October 21, 2008

Do you remember the television series called M*A*S*H?  It was a medical drama/black comedy and the show followed a team of doctors and support staff stationed at the 4077th Mobile Army Surgical Hospital (MASH) in South Korea, during the Korean War. The series won countless awards and the final show was one of the most watched television shows ever.

Now Ireland has it’s very own version of the same show which can be viewed in most A&E departments around the country, any day of the week. The only difference between this show and the real M*A*S*H is that no-one’s laughing at the Irish version as it ain’t one bit funny.

British-based freelance journalist and author, Diane Taylor visited a friend at Tallaght Hospital’s A&E in Dublin last week. She was shocked by what she saw. Here is her account of that experience (with thanks to the Irish Times online).

“I was impressed by the modern, spacious, hospital buildings at the Adelaide and Meath hospital in Tallaght. Sensible health promotion posters covered the walls of the reception area and dispensers of disinfectant hand rub were clearly visible in triplicate throughout the public areas.

Only the huddles of visitors and dressing gown-clad patients at the entrances inhaling deeply on their cigarettes sullied the wholesome image of the place.

I had just flown in to Dublin from London to spend a few days working with Kathy O’Beirne on the sequel to her book ‘Don’t Ever Tell ‘, a story of childhood abuse in various institutions in Dublin.

But the work plans had to be abruptly halted when Kathy called me to say she had been rushed to hospital with complications to a chronic medical condition. I headed straight to Tallaght Hospital to see her.

The hospital has the largest emergency department in the Republic, with 80,000 patients streaming through its doors every year. The A&E waiting area was full, but not bulging the way I’d often seen A&E departments look at London hospitals.

Those waiting to be seen appeared remarkably resigned and those administering the triage system seemed to be working in a calm and ordered way.

I explained to the two security guards that I had come to see someone receiving treatment in the department and was nodded through the swing doors.

What I found on the other side of the doors shocked me. Lined up on trolleys stretching as far as the eye could see along the corridor were seriously ill patients waiting for beds.

Some lay on bloodied sheets, many were attached to one or more drips and quite a few were elderly.

It wasn’t clear who was unconscious and who was sleeping, but what was clear was that everyone on the trolleys – 35 people in all – were very unwell and needed to be in a proper bed in the relatively tranquil environment of a ward rather than in the frenetic setting of a corridor in A&E.

Kathy lay groaning with pain on one of the trolleys. There were some splattered drops of dried blood on the floor under her trolley. She had a tube up her nose running down her throat and into her stomach, a tube in her arm and a bag attached to a tube running from her abdomen draining out some foul liquid, which was causing her intense pain.

A cocktail of drugs had been administered to her and she was extremely distressed to be so exposed when she was feeling so ill. Sometimes she cried, at other times she appeared to be slipping in and out of consciousness. The other patients on the trolleys appeared similarly discomfited by their surroundings.

Now and again, ambulance staff hurried past the patients lying on the trolleys, dodging the drip stands and other bits of medical equipment as they delivered the emergency cases they had decanted from their vans to the waiting doctors and nurses.

It was distressing for both the patients being rushed in and the patients who were lying, prone, on the trolleys to catch glimpses of one another.

When doctors or nurses examined or administered treatment to those on trolleys, there was no privacy for the patients. Everything was carried out in full view of whoever happened to be walking past at the time.

The nurses kept on shaking their heads when patients and anxious relatives asked them when a bed was likely to become available.

“We just don’t know, we’ve got 35 people waiting. It’s terrible but there’s nothing we can do,” said one.

“I used to work in a hospital in London and people there complained about the state of the NHS – but they don’t know how lucky they are with conditions there, compared with the kinds of things going on here,” remarked another.

“The average waiting time on a trolley before getting a bed is 24-48 hours, sometimes longer,” explained a third nurse.

While all hospital emergency departments expect spikes in admissions at certain times – such as after a major accident or during a winter flu epidemic – neither scenario was in evidence when I was in the hospital.

On the contrary, it was a beautifully sunny October day – nothing out of the ordinary seemed to be happening. The staff said that this situation was not a blip – but, rather, the norm.

When the noxious substance had finished draining out of Kathy’s abdomen, the nurse said that she could remove the tube snaking its way from her nose into her stomach.

“You’re not going to pull the tube out of my stomach here in the corridor, are you?” asked Kathy, aghast.

“Well, where else am I going to take you?” replied the nurse. The tube was duly pulled out of Kathy’s stomach in full view of whoever happened to be walking past. Kathy was mortified.

I’m no health service expert, but during my various visits to A&E departments in London over the years I have never witnessed the kinds of scenes I saw at Tallaght.

After 24 hours on a trolley, with no prospect of a bed on the horizon and only the offer of another trolley in a day ward as a substitute, Kathy could take no more.

Her resistance to infection was low and, with various tubes stuck into different parts of her body, coupled with her extremely close proximity to other sick patients lying on trolleys and the new emergencies being rushed through the corridor, she feared leaving the hospital sicker than when she arrived.

So she opted to go home. She was warned that she was leaving against medical advice and was asked to sign a form accepting responsibility, should any medical complications arise.

She flicked through the “signing out” book and was amazed by the large number of other patients in recent weeks who had also decided to get out before their treatment was complete.

In the six hours that I spent in the corridor I saw nothing but dedicated professionalism and kindness from the doctors, nurses and auxiliary staff in the A&E unit, all working in intolerable conditions.

But it did not stop me from leaving the hospital with the impression that what I had witnessed in Tallaght Hospital’s emergency department was more reminiscent of a makeshift field hospital hurriedly established in the wake of civil war or some other disaster in a developing country, rather than the biggest A&E department in a thriving European country”.

I don’t suppose our Minister for Health will win any awards for this production but you can be sure that her finale will be one of the most watched shows ever.


Make Your Voice Heard

October 20, 2008

Last week the Government caused uproar by announcing plans to scrap the automatic entitlement to a medical card for all over-70’s. Having lulled the elderly into a false sense of security that they would be entitled to free healthcare until the end of their days, they are now trying to claw back on this commitment. There is no denying that this country is facing a serious economic downturn and that harsh cutbacks are required to sustain public finances but this callous plan to target the elderly, is despicable.

Enough has already been said about the bungled campaign to introduce a ‘means test’ for the over-70’s medical card. I have never felt so angry and frustrated by the gross incompetence shown by our Government in their handling of this issue. They are guilty of causing great fear and anguish to those most vulnerable in our society. The comments made over the weekend by our Minister for Health, Mary Harney and our Taoiseach, Brian Cowen have done nothing to allay the fears of the elderly. Now the Government is floundering around trying to find a way out of the controversy created. Our health service is no longer alone in it’s descent into chaos.

A public rally has been organised outside the Dáil at lunchtime on Wednesday to protest against this Government’s attempt to mug the elderly. If you too have been outraged by this medical card débâcle, I would urge you to show solidarity with the elderly and support this protest.

Assemble @ 1pm on Wednesday 22 October in Kildare Street, outside the Dáil.


Vive la France

October 17, 2008

Okay, so here’s how the Irish health service could/should operate if it was properly resourced and managed. The following article was published in the Irish Times and documents the experience of an Irish person who required emergency care in a hospital in France.  I’ll leave you to draw your own conclusions.

Vive la Différence

“No waiting room, no trolleys, no queues, no admission fee and free parking. It was very strange indeed”, writes Michael Foley

“It is 1.30 in the morning, the first night of the annual Feria, when Beziers, in the south of France, goes en fete for a week of partying. Getting to A&E through streets thronging with revellers is a feat in itself, but arriving at the hospital is an even more unusual experience.

I rushed to hospital, with what later turned out to be a blocked artery.

Where is the waiting room? And where are all the corridor trolleys gone? Well, there is no waiting room and no queue, no line of people drunk or groaning with pain, and facing a 12-hour wait, just a woman at a desk and a sliding door that lets you straight into your own single-occupancy examination room. Parking is free and there is no €60 admission fee either.

Very strange indeed. It is so strange that we waste valuable time assuming we are at the wrong place. Why no waiting area? Goodness me, said a French nurse, urgence, the French name for the A&E, means someone requires urgent treatment; you could hardly expect someone in need of immediate treatment to wait, now could you?

It has to be said that when I last attended a Dublin hospital, eight months previously, I did not have to wait either. As I pointed to my heart and handed over the €60 casualty charge, a wheelchair almost buckled my knees as it wheeled me into triage, but behind me were others who would be waiting and waiting and waiting – unlucky enough not to have chest pain.

Back in Beziers, and two-and-a-half hours later, I had blood taken, a brain scan, a chest X-ray, and all the test results returned, and was tucked up in bed. At no stage did I see anyone on a trolley in a corridor.

Trolleys were used to ferry people. Patients slept in beds. My room, in a public ward, was for two patients, with a toilet and shower en suite. The equipment was new and worked. The bed was high-tech and moved in almost every direction.

What followed were days of tests, done without delay, and all ordered by specialists, who personally delivered results, usually within the hour. I was given scans, X-rays, MRIs and investigations I thought I might have been given eight months previously in Dublin. “Should I have had this test before?”

The doctor was non-committal.

The first specialist was a neurologist. The Centre Hospitalier de Beziers has three (as opposed to a dozen for the whole of Ireland). The doctor was a quiet, respectful woman who was available throughout the day, and who delivered the test results she herself ordered.

There was no entourage, no one to fawn and laugh at her jokes. She even had office hours when family could call in for information or advice – no need for intervention, divine or otherwise here.

We kept checking as to her status with the nurses, because her availability was akin to that of a registrar or a junior doctor in an Irish hospital, but yes, she was everything one could possibly want in one’s neurologist – professional, available and attentive. Extraordinarily, if a test was required, it was done immediately, and she delivered and discussed the results in person.

The second specialist, a vascular surgeon, again was one of three. When surgery was decided, I was moved to another floor and opted for a private room. Cost €40 a night.

Surgery was successful and after a period of recovery, I was out. When discharged, I was given a slip that was officially stamped, this is France after all, and that was it; I paid not one cent.

Under the EU health insurance regulations, I received the same treatment as a French person – 80 per cent of the cost borne by the state – and like a French person, my insurance (in my case, the VHI) paid the rest, including the cost of the private room.

One of the most remarkable features of the hospital was the level of hygiene. And not a nun in sight. The corridors were completely clear. The cleaning trolleys, with their colour coded buckets for every individual surface, plied up and down the corridors.

Masks and sprays were used as appropriate, from one patient to another. Head-to-toe disinfection twice before surgery . . .

In the Dublin hospital I attended recently, there was one shower for some 50 patients. This was in a room with a bath fitted out for disabled use. There were cracked tiles around the shower. The bath/shower room was also used as a store. If you were able to walk, you washed and shaved at a row of washhand basins, like a 1960s boarding school.

The VHI was amazing, constantly phoning me and my wife to see if I was alright. Did I want a second opinion? Was I was satisfied with the doctor? Was everything explained adequately? It also had a French-speaking doctor contact the hospital doctors who came back to explain what was going to happen.

Isn’t it extraordinary that the VHI pays no such attention to the interests or concerns of their members in Irish hospitals?

Would I have returned home for treatment if it had been feasible? Not if the advice I was given was to be taken seriously. Proof of the serious lack of confidence there is in the health service in Ireland was evident in the number of calls I had, from friends, colleagues and family, telling me how lucky I was to be sick in France and not Ireland: “Stay where you are. It’s the best place to be.”

If I returned, they thought, I might not get a bed, and if I did, I would be at risk from MRSA. “MRSA is a given,” said one friend, whose mother recently contracted it.

For the next two weeks, a local nurse visited to clean the scar and eventually remove the staples holding the surgical opening together. Cost for a home visit, €5.50 a day. But it is not just money that is the main difference between the two systems as experienced by patients. I was treated as a critically ill patient, the same as if I were French, by nurses, doctors, specialists and home visits,

I even have a GP in France now, who gave me a free consultation, just to get to know me. I only hope we don’t get to know each other too well.”

With thanks to the Irish Times for their online publication.