Tuesday, December 16, 2014
Colonoscopy is an AmericanCancer Society recommended procedure for men and women over the age of 50 who have an average risk of developing colorectal cancer. The results of one such procedure are documented below: Apparently all is not particularly rosy in South Carolina when it comes to a patient's ability, under state law, to obtain damages for mistakes, or accidents resulting from the Doctor's failure to follow that most basic of all requirements of the Hippocratic Oath, "above all, do no harm." Harm seems to be acceptable in South Carolina so long as it may be defined as a "known complication" of a given medical procedure.
Of course traffic accidents are a "known complication" of driving, are they not? Still, if someone T-bones you at an intersection while you are proceeding to negotiate a green light, you will have the opportunity to seek legal recompense. Of course you are not a protected species as is, say, a colonoscopist whose actions in performing his task may be enabled and made sacrosanct by our state legislature under its legislation covering doctors and their insurers in malpractice situations.
The following "Colonoscopy notes" describe a procedure done 10 September, 2012, at Aiken Surgical Center, in Aiken SC by Dr. Afsar Waraich the physician; Stephen V. Geddes the patient and writer.
I arrived at Aiken Surgical Center at 1:45 PM, a bit more than one hour (per instructions) early to fill out needed paperwork.
At 3 PM I was taken to preop.
A short time later I was taken to the procedure room. Dr. Waraich and his anaesthesiologist were there. They administered a general anaesthetic and I went "under."
About 4:00 to 4:45, I estimate, I was returned to preop, now the recovery area. When asked how I felt, having no pain, I said fine. I may have mentioned bloating--I don't really remember. If I was asked about it, I would have answered to the best of my ability, I'm sure.
About 5 PM, the closing time for the Center, I was wheeled to my car. The nurse asked me how I felt. I told her I felt a bit bloated. She said "That's the gas. It will pass." My wife then drove the two of us home.
After two hours with no passage of gas, feeling, essentially, as I did when I left the Surgery Center, I called Dr. Waraich. He told me to give myself an enema. This I did, sitting on a commode. The only problem was the water ran out of me as fast as I squeezed it in. I have given enemas before, and this never was a problem.
I called Dr. Waraich, about 8PM, and explained the problem. He told me to give myself another enema, but this time to lie on my side as I was giving it. He also said if I felt nauseous or feverish, to go to the ER.
As my wife prepared a bed, laying down plastic and towel material, I tried to push the gas out, sitting on the commode. I "pushed" extremely hard. I was finally successful (I really did not want to give myself an enema on my bed.)
I called Dr. Waraich back and told him of my success. I told him I was now "farting like a racehorse" (somewhat something of a mixed metaphor, but I think he knew what I meant.)
I sat back down on the couch and continued to vent gas while watching television.
About 10 PM I got up to urinate. I found out as long as I sat on the couch fairly quiet, I felt fine. Getting up changed that. My innards definitely felt bad. I told Jennie we needed to go to the ER.
About 10:20 we were at the ER at Aiken Regional Medical Center. Vitals were taken, and I told them I needed to lie down (less pain.) Trish, a friend, was on duty as nurse assistant(?) ER Doc Garrett listened to my symptoms--very full gut (still full of gas?), crampy, right shoulder hurting. He said that might be from gas in the body cavity. He ordered a CT scan, a morphine shot, a quart of gatoraid with iodide. Got the scan, through the donut hole.
Maybe the morphine took over. In any case, I met my surgeon, Dr. Chase. He is not sure where the problem is and needs to take a look. He will go in laparoscopically, and find and fix the problem that way if possible. He may need to make a larger incision.
Midway through the surgery, his findings were passed to wife Jennie. The larger incision was needed. A 2 to 3 inch tear was found in the caecum (cecum.) Repair was effected by removal of the cecum with the attached appendix, and the ileocecal valve, and a bit of large intestine. The small and large intestines were then joined together.
I was taken to room 402 where my stay was uneventful. Dr. Waraich came by a couple of times--we didn't discuss the problem. Dr. Muniz, my GP, came by at my request, as did Dr. Chase.
I was discharged on 15 Sep.
Thoughts on the above:
1) At Aiken Surgical Center, I was the last patient of the day. My leaving coincided with the center's closing time. If degassing was attempted at all, perhaps it was not done with much care since the need to close the facility was one concern and the discharge of the "room gas" was apparently expected to be something that would occur as a matter of course. Why CO2 was not used for the procedure, a state of the art method used as a matter of course in many facilities to minimize post-procedure difficulties for the patient, is not known. It was never discussed with me as an option, and the use of CO2 was something I learned about much later.
2) I never told anyone at the Surgical Center I had any pain because there was none. I did feel the bloating, though, in my gut. I experienced no pain until after I had forced some gas out of my body by pushing--the same thing I would have done had I had a recalcitrant, too dry fecal discharge due to some unavoidable delay in being able to access or use a restroom coupled perhaps with a too-high-in-fiber diet the day before. Never before had I had any difficulty discharging any gas that may have accumulated in my intestine--probably because I had never before had my gut pumped full of air and a sigmoid volvulus generated by the combination of the gas and, perhaps, a rather thoughtless, perhaps hasty withdrawal of the colonoscopy instrument. Why a sigmoid volvulus? Well, some sort of obstruction was keeping the air in, and there was no significant fecal material there--it had all been cleaned out by the pre-colonoscopy diet and purging requirement. What else, but a twist of the sigmoid, the last stage of the large intestine prior to the rectum and anus, would have prevented the enema from going in while preventing the gas from going out?
3) If I had been told not to try to force the gas out, to let it come out on its own accord, that is what I would have done (of course, it wouldn't have worked.) If I had been directed to go to the ER for intubation to get the gas out, that is what I would have done. Lacking instruction, I did what I knew how to do--I pushed. While everyone I have told this to has thought it was improbable, I think I blew a hole in my cecum trying to get Dr. Waraich's gas out. Dr. Chase's notes say the cecum appeared to be beat up and the wound he found was described as a 3 inch longitudinal serosal tear with no definite penetration and a mucosa that appeared beat up. He also states there was pneumatosis of the cecum. Could the colonoscopist have done this and been unaware of the damage he caused? Doubtful. As a matter of fact, there was a picture of the cecum in Dr. Waraich's report on the procedure. Was the problem my fault? Truth of the matter is this: Dr. Waraich put the gas in there, and, in retrospect there appears to be no doubt he should have removed it as part of the procedure. The Doctor's "informed decision (or guess)" that it would be OK to discharge me without deflating the gut (what apparently happened,) perhaps to avoid overtime payments to the Surgical Center (I left at "quitting time"), was an informed mistake. Had he left a glove in there, or a piece of the colonoscopy instrument, there would be no question as to his culpability. The fact that the material he left there was in the gaseous as opposed to a solid state should not relieve him of his responsibility for what happened as a result of his "informed decision." The fact that I worked hard to push the gas out is immaterial, since I received no instructions to the contrary--I was only told, "it will pass."
What damage was really done? None, some would say, unless you count having to take a dump several times a day instead of the usual once. Unless you find yourself walking a trail and have to take a dump but cannot due to the nearness of civilization. Unless you are in the middle of a Walmart when the need happens and you find all the stalls in use. The looseness of my bowel material due to the lack of a cecum, the place where much of the water is removed (it has the least thickness of all of the bowel, about 1mm) is something I have had every day for the last two years and it is something I will have till the day I die. I have "messed my pants" more than a few times. I consider this a major inconvenience, and feel some sort of compensation is due. Put yourself in my place. What would you expect. The Doc was paid for his work, defective though it may have proved to be. His insurance should pay for my inconvenience and disability, just as certainly as his automobile insurance would pay if he had accidentally caused a vehicular incident that left me in this condition. The fact that I am not dead or dismembered should not relieve Dr. Waraich and his insurance company of any responsibility to pay whatever the legal system might consider reasonable--be it a dollar or the maximum allowable amount per our state legislature's highly lobbied law limiting payments for malpractice.
Given the relatively small amount of compensation available per the law, and the costs for filing such a lawsuit, it seems to me that the legislature should be notified that their law is unfair to the person having what should be a small settlement and having little means to pay, up front, the relatively large amounts required to obtain legal and medical counsel in order to be able to simply file and prosecute a claim. Justice should not be something that must be bought. It is, though, or at least it was for me, under the terms of the state law on malpractice suits. The legislature lost sight of this when they wrote their law. I experienced more than just difficulty in finding a lawyer to take my case because it was not a slam-dunk, and they do not find the legal potential for profit to justify their participation. What I experienced was a total inability to find a lawyer willing to take the case.
Because of these considerations, I feel, instead of no consideration at all, I should have been compensated with the maximum amount available by law--$375,000 (and expenses) to: 1) Notify the legislature they should re-examine this law for reasonability understanding the difficulty the average person will experience should he need to try to obtain justice given the current constraints of the law and; 2) notify insurance companies, especially Marsh, Inc. of JUA, that they are in a position to determine liability and should so do and not simply deny potential claimants a settlement--their stated position--knowing the economics of filing would cause many of them to dry up and go away regardless of the justness of their claim; and, 3) while I know the economic costs of buying supplies to use in dealing with my disability is relatively small, the fact that almost anyone would totally dislike the added need to deal with their bodily elimination function, the wiping and the washing, etc., as often as I am forced so to do is not something I would wish on you or on myself, or even on our legislators. My condition makes everything I do more difficult: shopping, traveling, enjoying our parks, going to meetings, e.g., everything I might do is liable to be interrupted in order that I deal with the problem Dr. Waraich has "given" me.
Well, as I said, I was unable to obtain legal representation. Specifically, I contacted at least five legal firms specializing in malpractice cases and none would take my case. I contacted several "expert witnesses" and found they would only speak with a plaintiff's legal representatives. I had two years to file a complaint, under the terms of our state law, and was unable to so do. So, I guess I must bear the burden of my condition with no compensation. Is this fair? Our current state legislature thinks so. I think they all should be fired for their lackluster performance in crafting this law (of course they probably did little to craft anything. They seem to have passed a law that was provided by legal lobbyists for the doctors' insurance firms.) I guess what we had when this was passed was a medical-legislative alliance, something akin to the industrial-military complex President Eisenhower warned us about. Goodness--where do you go to find a good President (or, on the state level, a good Governor) when you need one.
Oh, well--guess I've gotta stop. I need to go take a "waraich" (sorry, Mr. Craps, my condition requires a slight redefinition of the vernacular, for me if for nobody else.) And, Doctor, should the term catch on, you have only yourself and your insurance company to blame. Think it'll catch on? Well, strange things do occasionally happen, but in this case probably not--the four letter term seems to be the norm for material such as this.
Monday, June 30, 2014
June 30, 2014, 3:43 AM. Morningbrain time, without a doubt. I've been lying in bed for an hour, now, and my brain has been running over thinking about a number of things that I've done (or half-done) over the last few years. Forty-five minutes ago, I took an antihistamine. A few minutes ago I took a dose of valerian root. Maybe the combination of the two will convince my brain and body there are better things to be doing at this particular time of day--at least that's my hope.
In any case, here I am trying to get my fingers and keyboard to collaborate a bit over one of the ideas that seem to be running through my head. That thought has to do with the political "conservative."
In the true sense of the word, as I understand it, I would have to call myself a conservative. In any case, I am at a point in life where change is not a friendly concept. Keeping up with what is, or has been the case is about my speed these days, and changes only seem to complicate matters. Still, I'm sure many political "conservatives" these days would want to label me as a "liberal" since my inclinations seem to move in directions that mirror those thusly stigmatized. Global warming seems, to me, to be a fact, at least in the lives of the polar bears who are losing habitat in the north, and in the decline of the Antarctic ice cap that seems to be in danger of floating off towards who knows where. Public education seems to need all the help it can get. If the kids aren't getting what they need to be good citizens at home, they sure need to get the training somewhere. The "middle class" seems to be dwindling and along with it our moral values. And, along with that "middle class," American centrism seems to be becoming a thing of the past.
I guess my kind of conservatism would require a redefinition of those who now consider themselves to be political conservatives. These individuals are the ones who have contributed so much to our current "do nothing Congress." Really, the "do nothing-ers" are not living up to that moniker. They are doing quite a lot.
Just let our President present a proposal to the Congress. What happens? At that moment (or milliseconds after the proposal goes public,) the do nothing-ers proceed to trip over one another trying to point out exactly what is wrong with the proposal and why it should be quashed. And are these responsive thoughts particularly well thought-out? To the extent that the Presidential proposal was well thought-out, the do nothing-ers' proposal is also well thought-out, in a 180-degree out sort of way.
Should the proposal be, for example, to dye the national mall reflecting pond green for St. Patrick's day, the do nothing-ers would say "no way. Dye would not be in our national interest." Of course, some might say, "OK, if dye it we must, dye it, but dye it red. Green is too close to blue, you see, and red would be a nice touch, wouldn't you think?" (This would come from those who do not want to be seen as being "do nothing-ers.") In either case, the President would receive his criticism from those whose raison d'etre is criticism, and all would proceed in the town that recently has made the term "snails pace" look like a fast race.
Maybe if the "do nothing-ers" were called "regressionists" those of us who feel like conservatives but then find ourselves in poor company would begin to fit the classification again. "Conservative" really should not imply turning back the hands of time. But turning back the hands of time seems to be what the current batch of political conservatives seem to want to do.
"Regressionists" seems to fit the bill nicely. Perhaps, if this term may be put into play, we can leave it to the new "regressionists" to determine what, if any, difference there might be between the new "regressionists" and the new "true regressionists." This just may give them something constructive (?) to do and give our President a needed break. Who knows--maybe, just maybe, a useful bill might even eke its way through the Congress, while all this redefinition is taking place, and find itself on the President's desk for signature.
Now, if only he is able to remember where he put that pen.
Wednesday, April 23, 2014
Somewhere in the Geddes archives, I found a small, black book, one quarter inch thick by three and a quarter inches high and two inches wide. In it, on blue scribed, quarter inch rulings, I found my Mother’s handwriting. I have very little material of this nature, so, for the family’s posterity, I’m transcribing the writing she made in this small black journal, it having the identifying marking “National 1369 ½,” with a hand written “.20” (probably it’s cost) at the top, on the back of the front cover. The divisions are by page.
It was written by Elizabeth Ann Newbanks (I recognize her hand.) The following is quoted directly from her journal in its entirety:
July 5, 1936 Left home in new Ford V-8. Ran
into some rain and thus had to discover window wiper. Stopped at Kirkland
and got a chocolate soda. Went straight
through to Michigan City,
arriving there at Ate lunch at Milner Hotel. Went with Bill and Luckman boys to the lake but was too cold to go in. Monday night went to show with Julia Kramer.
Tues. July 7, 1936. Started at on trip to Charlevoix.
Beautiful scenery—along lake most of time. Stopped at
for lunch. Dutch waitresses, etc. Stopped at Charlevoix over night at Holland
Inn. Nothing but
resort town. Pretty harbor right across
street from Inn.
called Mackinac because of mailing convenience—really
. Ate at Mackinaw
Island and then found two very
nice rooms at Toms
Restaurant St. Cloud Place
large 3 story house about 2 blocks from town.
Took a 9 mile sight-seeing tour
around or all over the island and through the state park on the island by horse and buggy. Autos are not allowed on the island. We left our car right on the dock they put it right on the steamer. It was on the island that the
war of 1812 was supposed to have been fought. We saw the Sugar Lump, a huge stone standing up high in the middle of a forest.
, on the top of the island;
the devils kitchen; and several other historical points. Fort
Almost the whole down town is made up of souvenir places. A lot of bicycles are used here also. The buggys are all lined up (about 30 of them) on the main street ready to receive passengers from the numerous large boats that dock
at the island. I met a couple of girls from
were rooming at the same place. We
walked down to the Grand Hotel ($20 a day minimum charges) that night and
looked into the exclusive shops in the lobby.
we stayed there and listened to the music of Billy Baer coming from the Blue Room in the hotel. It also has a large swimming pool but I didn’t get to see it. We went in the drug store and then came home at about
July 9th ’36.
After breakfast Henrietta and I went to see the fort on the top of the
hill. It sure is some climb. There is a museum inside and a large display
of guns and other old relics. We wanted
speed boat riding around the island but the man couldn’t find enough passengers—so we missed out on that trip. The Octmara was an hour late so we didn’t leave until . My the meals on the boat.
You can have anything and everything you want—mostly more than you want! We got our costume (gypsy women) and got ready for the big mascarade held that night. Had a grand march and then voted
on the cleverest & most beautiful & funniest costume. A lot were original. The cleverest was a lady dressed like justice with a white sheet wrapped around her and two balanced weights in her hand.
the most beautiful was a little girl dressed in a chimeee deamona to represent a Chinese girl. The funniest was “Romeo” a fat man dressed in a suit of newspapers with a tri-comf hat made of the same. Really funny!
We danced for awhile then changed our clothes and went up on top deck to watch the ship go through the
. There were so many lights on the St. Mary’s
river that I got all mixed up. I thought
a boat in front of us was the locks for a long time It took us a long time to even get to the lock. We had to stop for a while by the
before we entered. Some small kids were down on the Soo
docks yelling “Flip a Coin.” (At in the morning.) Several people would through down money and they’d all scramble for it. The little boy about 4 years old even sang a song for us. At about we passed through the Soo
locks. Then I scrambled for my berth. I believe if the waves were splashing over the deck I would have slept anyway, I was so sleepy. Oh yes, all during the trip there wasn’t even a wave Just as calm or
calmer than the river. Quite unusual for any lake especially Superior. So—I did not get sea sick. Friday., July 10th. Had breakfast at about . Biggest breakfast I’ve had in my life. Henrietta and I
walked 8 laps around the boat to kind of walk the meal down. 8 laps is one mile on the Octnara. Played ping-pong and hosed around the recreation room for a while. Ate a big fish dinner
The best fish on earth. A lady read Henrietta’s & my palm—telling me that I would always be well taken cared of and waited on ! Have a couple of love affairs and so on! Went to bingo party and won $2 on
last hand. I even surprised myself. Went up on top deck and watched us go through another river which cut up the penninsula. Ate supper and then went to Stunt night and song festival
We all gathered together and sang old songs. Mazo, the Master of Ceremony picked out three men and they had a race of drinking milk through a nipple. A scream Romeo said that if it would have
Been beer he could have won but, unfortunately, it wasn’t! Had a game with representatives from different states in it (I was for
Indiana). Mazo would point to (for example) his nose
this is my eyes—1,2,: etc. By ten you were supposed to reverse it and point to your eye and say “this is my nose” A lot of fun.
won. After all the stunts we
danced. All the boys I danced with were
dancers. Mazo danced a couple of dances with me—and has he got personality! I’m going back next year and be his secretary for the ships’ paper! (Oh yeah!) Went to bed earlier because we had
to be up by seven. Saturday, July 11th Docked at
Duluth at about
Ate breakfast on the boat and then went on a sight-seeing tour of Duluth. It is all built on a hill and every block you
have to walk up away from the town or down into the town which is a couple of blocks from the lake.
Duluth is a big country use
town. Left Duluth
at about and started for
about 5:30. Stopped at Hastings Hotel. Ate nice dinner and went in town to the show,
Minnesota. Some show.
Saw Clark Gable and Janette McDonald in “ San
Grand picture. They also had
Lew Forbes and his orchestra on the stage. They sure were good. Sunday, July 12th Ate breakfast at about . Took a sight seeing bus and went through both
and St. Paul.
makes it even more beautiful. At before going through
St. Paul we
had our dinner at the Lowry Hotel in St. Paul. There was a convention going on there and
were those old farmers, or whoever
they were having a big time! We continued our tour and went through
St. Paul. Of course, the capital and everything is
there. The is also in University
of Minnesota St.
Paul. Got back
hotel at .
(That’s all—the rest of the journal is blank. She was 5 pages shy of reaching the exact middle of the book.) I remember some talk about Mom being in a ship wreck. Perhaps that happened on this cruise, interrupting her journal. I wish I had found this book while Mom was still with us. I would have gotten the rest of the story, I’m sure. She would have been 19 when she wrote this, out of high school for a year, and working as a secretary in
I suspect. Maybe this was her first
vacation (who knows, Unkle Stu, perhaps?)
Something definitely interrupted her. I can just see her referring to this small journal as she elaborated on her story, typing it after-hours at her job back in
Louisville. Just imagine what we might have today if she
had taken her lap-top with her on the cruise!
Hah! Of course, she took several
lap-tops with her. They called them
“skirts” at that time. Thanks anyway, mom. What you left was appreciated.
22 April 2014
Saturday, March 29, 2014
Well, it's happened again. It's 4:30, this time, and here I am at the computer. I could have been here at 3:00, but that was just when Tobi got me up for one of his nightly walk-arounds (that's right--I'm talking AM, friend.) My usual response in these cases is to get up, let him out the front door, and set up a folding chair in front of the door to await, in semi-consciousness, his return in a few minutes. I then let him in, secure the door, and stumble back to bed. If all goes well, I'm back in la-la land in short order. If it doesn't, I often lapse into an inescapable period of semi-wakeful musings that end up with me sitting up, like tonight (now,) awaiting the kick-in of a few valerian root capsules. This usually takes about 30 minutes.
What happened? Late yesterday wife Jennie asked me if I had seen son Ed's latest UTube event . I hadn't, and since my trusty laptop is so loaded down with startup stuff that it works verrry slooowly except when I use it in "Safe Mode," and since "Safe Mode" does not provide audio, I sat down to watch Ed's "Happy Birthday Amy" with wife Jennie on her computer. We then moved on to "Making cups" from niece-in-law Nell (For a really unique coffee cup for your work desk, check this one out.) Another good watch. with all this UTube (make that YouTube) activity, it was only natural that at 3:?? in the morning, my thoughts again turned to UTube. It seems a couple of things I would like to preserve there have been put off and put off until they became fodder for a morningbrain episode.
Usually when the muse attacks at this time of day, I make a notation of the offending thought and do a roll-over. This didn't work today, and after an hour and a half of semiconscious ramblings, seeing both paperpersons (one of the AikenStandard and one of the Augusta Chronicle persuasion) drive by leaving their headlight tracks on my window shades, I ended up here waiting on my chemical solution to the problem to kick in.
I look at my note paper and find "UTube," "Shark Teethers," "Dumdrop song," "Police prep to shoot" and "Scars." All of these remind me of my sleep-depriving ramblings except "Scars." I remember writing it down, but, other than its being the title of a CD from wife's bronco-busting cousin, Jon Luse (try it, you'll like it), it now brings nothing to mind.
Well--here comes Tobi again. Guess I'll go out with him and pick up the paper. When I come back in, I'll try the bed again. Three more hours would help. More on this later, maybe. If you share my early-morning ailment, good luck. If you find a good cure, I'd like to hear from you. Morningbrain does give me an opportunity to express myself in ways I probably would not do in the dead of day, but I guess there always can be too much of a good thing. I know during these times I often feel I'm getting too much of a good thing--especially when I have something important to do the next day.
And, by the way, it is the "next day" now, 5 hours later than when the above was written, and I remember my "Scars" refers to the condition of our Hitchcock Woods following last month's ice storm and the subsequent work done by the Hitchcock Woods staff to restore the trails. I guess I'll have to schedule some time out there to see how things are. I always enjoy taking the time to Take a walk in the woods . There will be time for UTube later.