Let’s not reify visuals:
Visual cliche can so strongly influence us.
We associate some imagery with our professional identity.
And that can mislead us.
In the spirit of this blog’s previous incarnation as Medical False Knowledge I want to talk about two dismaying stories on the Canadian Broadcasting Corporation. The CBC got caught up in ‘pop medicine’ like a pant leg caught in a bicycle chain. The first was an episode of The Nature of Things on heart attacks. It did well on how the cholesterol hypothesis has died. (It has. The question is what comes next. I’ll probably have something about that in the future.) But the rest of the episode which had some jokey cartoon graphics (the heart attack cause “suspects” pictured as criminals in a lineup) proceeded to seek out a ‘single simple chemical’ cause of heart attacks. This startled me because I have an internal medicine textbook, Harrison’s, from 2004 that describes heart attacks is being caused by plaques. Plaques are hardened areas inside of arteries with hunks of stuff sticking to them. Plaques have anatomy. According to Harrison’s the stuff on the plaque breaks off and flows downstream blocking the artery. Or by the accumulated stuff of the plaque causing blood clots to form. Which break off and float downstream, etc. Anywhere your blood flow slows down too much clots start to form. But here’s the really creepy part, Harrison’s said that plaques are formed by cells from one layer of muscle tissue, your blood vessels are made of muscle tissue, migrating into the lining layer. The lining layer is really thin like, I don’t know, wet Kleenex. Whereas the muscle layer is made of you, know, muscle. So when these muscle cells go into the lining layer they make it all stiff. That’s the beginning of the plaque. They also I believe bugger up the surface and cause blood clots to start to form. There’s another process I know of involving cholesterol. Cholesterol is a chemical that does lots of vital things in the body. Including making steroid hormones. It gets inserted into the inside of these wet Kleenex type lining cells. And then a chemical comes along and takes it out again. We have no idea why. If the chemical doesn’t come along and take it out again the cell gets fatter, and starts to fill in the hollow part of the artery. That’s narrowing of an artery like people have bypass surgery for. None of this was in The Nature of Things show about how heart attacks happen. Though the show was being presented as the big new insights into heart attacks. But was pop medicine. Which is, among other things, all those stories on the news with the Headless Giant Tummy People or telling you What Not To Eat. The “medicine” in pop medicine stories is never about what real diseases are like. It’s about how to avoid some disease (usually heart disease) and by fiddling with what you eat. Sometimes “exercise” of some indeterminant sort is thrown in. Now we even have meta pop medicine stories about how the fiddling with what you eat stories disagree with each other! The point is this stuff is crap. No news outlet should do it. Including the CBC and certainly not on The Nature of Things.
The CBC show Marketplace, which is an often excellent consumer affairs show, had a pop medicine story too. They went after sodium again. THE new pop medicine bogeyman and one Marketplace already sullied itself with in May 2013. Both stories claimed that certain diseases and medical conditions are caused by excessive sodium intake. Now to be fair Health Canada actually puts out guidelines on how much sodium intake/eating per day is “too much”. I have no idea how they would get a number like that. Our bodies turf out all the sodium we don’t need. It’s one of the main activities of the kidneys. It totally works. Unless you have a particular kidney disease. If not, we can eat huge amounts of sodium and it will not hurt us. Interesting fact, some of the diseases they claim are caused by sodium aren’t even diseases. High blood pressure. Kidney stones. Obesity. It’s not biologically possible for high sodium intake to cause kidney stones or obesity. (Obesity?) No matter how goddamn high it is. On the show the person presenting this Diseases It Causes information was, wait for it, a nutritionist. Interesting thing: a nutritionist isn’t a doctor. In the 2013 story they had a doctor. But he specialized in quitting smoking. As you’ll recall an intrinsic element of pop medicine is fiddling with what you eat to prevent some disease. 1) that’s not how medicine works. Medicine starts with diseases and tries to find out everything about them that is relevant. Not just everything about them that is food related. 2) having a doctor on your consumer affairs show say a bunch of crazy ass stuff (food, disease, prevent) does not make it medical and scientific and okay. It just means you found a screwball doctor. Or in the case of this story, nutritionist. The message for journalists is: don’t do pop medicine stories. Real medical stories are about diseases or about medical fuck ups or things our medical system needs to do or about new treatments. On the latter the journalists are always being manipulated though.
The context in which they were going after sodium was breakfast sandwiches, like Egg McMuffins. They also felt it was important to pitch a fit about the number of calories in each of the different fast food chains brekkie sandwich. The high one which the presenter affected to be appalled by it was 500 cal. For breakfast. If normal caloric intake is said to be 2000 cal per day, or more, then unless you’re eating four meals a day it seems to me 500 cal for breakfast is actually a little low. Although the show was happy to quote Health Canada’s nutty maximum sodium number they didn’t manage to present any number for daily caloric intake. Apparently we’re just supposed to think every bit of food we eat should be the lowest number of calories it could possibly be. I call that the anorexic mindset. And it’s really not appropriate that a consumer affairs show try to teach us that.
In short pop medicine stories are terrible and bad and medicine is not a toy for journalists. If the news, especially on TV, is going to have anything about medicine they need to vet it way, way better than anything else they tell us about, short of an evacuation order. Pop medicine stories usually feature food. But that doesn’t make ’em food stories. If you talk about diseases it’s medicine. Do it right.
This is phenomenal. The Controversial Field of Brain Imaging If you have ever seen or read a story about fMRI brain research you need to read this. He lays out, with a beautiful clarity, the problems and limitations of the extremely dubious fMRI technology and experimental methodology. And he said it was a great deal more calmness and then I could have.
A blog called Science-Based Medicine recently had a post on ghastly naturopaths chatting on Reddit about injecting people with hydrogen peroxide! Diluted yes, but still. It’s a poison. And no, injecting people with hydrogen peroxide has zero medical benefit. Ever.
But within this rather blandly stated exposé the writer, a surgeon, made a sneering throwaway comment about “chronic Lyme disease”. Now, Lyme disease is a real disease, no one disputes that. (What kind of world are we living in where that sentence needs to be said or even makes sense?) But a small group of Assholes Doctors (and I don’t mean proctologists) have convinced themselves, in defiance of rational thought, that some people who get Lyme disease after treatment still think that they have it when they don’t. Here’s the thing: the people who “think” they still have Lyme disease still have symptoms and are still positive for it on the Lyme disease test.
Seems the Asshole Doctors have decided the wimpy two weeks of antibiotics that are the standard treatment for Lyme (a duration some doctor pulled out of his ass when the disease was discovered 30 years ago) is for sure, enough, for everybody. Even though infection treatment doesn’t work like that. Drug treatment for TB is given until the TB is gone. Drug treatment for AIDS is given for life. The drugs we have are supposed to be used in a way that is effective not that conforms to some timetable in a book.
The people who, quite sensibly, believe they are still ill have positive Lyme tests. What do the Asshole Doctors say about that? ‘The test isn’t very good. It has all these problems… ‘ Now, for all I know these problems are real. Or made up. But the Asshole Doctors don’t dispute the test results when it’s finding new cases of Lyme. Only after the magic two weeks. Then it’s’oh the test is poor!’ So we know what kind of docs we are dealing with here. (Hint: Assholes.)
I think one (only one?) objection to the Lyme test was it can be positive if you have some other microbe. Fair enough. Cross-reaction. That’s a thing. But as is typical in Medical Bad Reasoning the Asshole Doctors don’t realize that went two things are possible: Lyme not cured yet or cross-reaction, that doesn’t mean you (Asshole Doctor) get to choose one. This isn’t shopping! It means either could be true and you need something else to tell you which. That’s logical reasoning 101. But then the MCAT (the med schools’ LSAT) is the only test of that sort, which include the GRE and engineering and management ones, that does not have a test of logical reasoning. And it shows.
If I was a doctor with a patient who after a wimpy two weeks antibiotics wasn’t all better I would be utterly unsurprised. If after three months they were still infected I’d wonder if their immune system was buggered in someway. But I certainly wouldn’t reach for the idiotic “all in your head” explanation. A non-medical, unscientific myth no better than astrology. With MDs like this who needs a naturopaths? (To have hideous superstitious weirdos providing “medical” care.)
Some patients are treated till cured, even when it takes years. And guess what? When the symptoms go, the lab tests are negative. This is completely straightforward. Get the disease, have the symptoms. Get test. Test positive. Given drugs. When they have worked, no symptoms, test negative. It doesn’t get any simpler.
The Asshole Doctors are in the grip of a nonrational myth. Patients “imagining” they are ill. The “imagining” is undefined and cannot be made to make sense. The uncomprehending zeal of the doctors who promote this myth makes them appear disturbed. This sort of superstitious nonsense is not something we can afford in medicine. And especially not in what wishes to be Science Based Medicine.
In early October the Colbert Report had a clip of two CNN employees talking about Kim Jong-Un. Apparently he has gout. So CNN guy says “which is caused by too much booze and rich food”. WTF? Thanks for that breaking news: from the 18th century! Gout, which is very painful, is uric acid crystals forming in the synovial sac of fluid inside your big toe joint. Synovial sacs are part of joints. What makes the crystals is some screwup in a complex chain of biochemical steps. (We are made of biochemical steps.) What you eat has sweet FA to do with it. In fact what you eat, unless you eat poison, has nothing to do with any disease. Booze, which is a poison, can damage your liver. It doesn’t damage your big toe.
So, Colbert? Nothing to report. CNN? Get it together. Don’t have reporters freelancing medical BS on the air!!! Kim Jong-Un? Couldn’t happen to a nicer dictator.
Any scientist can tell that 90% of medical stories on the news are presenting information that is not true.
You heard it here first. If you read my earlier post https://thebrainsciencecritic.wordpress.com/2014/10/03/ebola-in-dallas-sars-in-toronto/ In Ontario we’re now hearing from the head of the Nurses Association and you can read the story http://globalnews.ca/news/1616000/potential-ebola-patient-horror-stories-in-canada-concern-nurse-union/?utm_source=Homegnca-toronto&utm_medium=MostPopular&utm_campaign=2014 about the lack of preparedness in our hospitals for an actual ebola patient. There have been some suspected cases, they’ve been reported on the news, with all kinds of happy talk about the person was put in isolation, blah, blah, blah. Now it turns out that at least one of them sat in the waiting room with seven other patients. For some period of time. That is exactly how isolation is NOT supposed to work. That is how the SARS epidemic happened. It spread in the emergency room waiting area. Nurses all over the country are reporting that they either don’t have the protective equipment, disposable plastic suits, gloves, special masks. Or they have it but it’s too small. But here’s the thing, if they’re finding out now that it’s too small that means they haven’t put it on before. There’s also mention in the above news story about “having seen the video”. That shows how to put on and take off the protective clothing. Now, what’s the protective clothing protecting you from? What it’s doing is making a barrier, think barrier birth control, between the nurse or doctor and the person who has the virus. The virus is coming out of that person. So the medical personnel have to not just not get that virus on their skin, they have to not carry it out of the isolation room (remember isolation is just the new term for quarantine). The virus riding on their clothes then gets on the countertop and somebody leans on it and it’s on their arm and they scratch their arm and they touch their eye and BOOM! they have ebola. That’s how it spreads. So once you are ready to leave the isolation room you have to do something with all this protective gear you’re wearing. The plastic suits are like coveralls. There’s a special way to take them off just like there’s a special way to take off plastic gloves. I don’t quite know what it is but you pull off one halfway, then pull off the second glove with your fingers still in the glove fingers of the first one. Is that clear? Yeah exactly, it’s fiddly and counterintuitive and complicated. Watching the video is not how you train medical personnel to do these procedures. There’s a whole academic specialty, Schools of Public Health, that deal with this stuff. We know what the correct procedures are. And if you actually intend to prevent disease spreading then you drill. Yes drill. Like pilots in flight simulators. But you don’t need fancy equipment you need a room, you need a doorway, you need the protective clothing. And you need the nurse and somebody shows the nurse how to do all this complicated suiting up and especially the unsuiting. Remember when you’re taking it off it’s shmutzy. It is presumed to have the deadly virus on it. So, special way to remove it. And the way you’re taught how to do something complicated like that, think of it on the same level as how to make a cheesecake or how to drive a car, the instructor watches you. So the instructor watches the nurse put on the special clothing, she pretends to do some patient care and then comes back and takes it off and the insrtuctor watches how she does everything and tells her when she’s doing it right and when she’s doing it wrong. Then she does it over and over and over again. Like firefighters. That’s what Mr. Singh in the Global news story (link at start of post) is referring to when he mentions muscle memory. It needs to become second nature to do each little movement in the exact right way. That’s training. Nothing else is. Watching a video is not training. The nurses in our hospitals have a friggin right to this. They may even have a legal right to it in their contracts with hospitals. And in Canada today our government is not doing it. The minister for health in Ontario went on TV and said some vague stuff about we are committed to doing the whatsit thing. This is what you say at the beginning of the planning process. We’re way after the planning process now. The planning process happened and the buying the stuff happened, in some hospitals in Toronto, but not in others in Nova Scotia. The handing out the equipment part has already happened. But it sucked. They buggered up. They didn’t train them the way I describe above. And the protective clothing doesn’t fit. Which is how I know that they didn’t drill. If they had drilled, and they were supposed to before the epidemic in Sierra fucking Leone even began, they would have found that out. It sounds from the reports that they found out the equipment didn’t fit ie didn’t work when they had a suspected ebola patient. Who ultimately tested negative, thank God. And not just for them. Because we are unprepared. It’s getting ready to be SARS all over again. 44 people died, over 100 were in intensive care. If everything had been done properly and again the textbooks tell how to do this, it ain’t rocket science. If everything had been done correctly two people would’ve died of SARS, not 44.
Ebola was discovered in the 1970s, I think 1976. We’ve had since then to prepare for this year’s epidemic. We knew it was coming. And we knew it was coming to North America on airplanes. Jet spread. I learned that term in the 90s. Right now this is idiotic, but it could easily become a disaster. And it will be a disaster born entirely of governmental incompetence, unwillingness to prepare in the proper way, and to a very great extent the fact that medicine is completely unregulated. Yeah the boneheads who screwed this up are not the ones who we would want to have regulating it. But it needs to be regulated. So that someone who has learned how you do infection control out of those wonderful textbooks would, with the authority of the government, go and check in advance that the hospitals were actually doing the stuff to be prepared. I mean for chrissakes the actual term for it is preparedness! But they didn’t get ready.
Hats off to the nurses and Nursing Association for blowing the whistle on this. Well done. Next time, do it sooner.
Let’s go to Dallas. So far two nurses who looked after the ebola patient in Dallas have contracted ebola. So yeah we’re a first world country and we don’t screw things up so bad. You catch ebola looking after an ebola patient by not keeping yourself fully covered 100% of the time that you’re in contact with their body or with stuff their bodily fluids have leaked out onto. Doing that and providing patient care is extremely difficult. And as a prize if you mess up even briefly, even a tiny bit, you get a potentially fatal disease. And you have to stop the epidemic by stopping the spread of the virus by doing everything in your job correctly. With absolutely zero mistakes. And when they do it right it works like magic. This is the only thing to stop the spread of infectious diseases. There’s no drug. There’s never a drug for these kind of diseases. Vaccines yes. But once the epidemic has started we need these excellent people to do this work. Stopping the epidemic with basically plastic sheeting. Sure it’s made into all kinds of stuff gloves and masks and those plastic jumpsuits. This, for all epidemic diseases, before a vaccine is created, is how they will be fought forever. This is the super expertise that our ancestors didn’t have. It doesn’t look like much, plastic sheeting, but it works.
You know what’s not as effective as plastic sheeting (made into clothes)? The CDC. Two nurses so far have contracted ebola at the Dallas hospital. One of them took a trip to Cleveland and when she was due to come home had a fever and called the CDC and asked if it was okay for her to fly and they said yes. The next day she was diagnosed with ebola. So more fuck ups. Now the flight crew has to be in quarantine for 21 days. The airplane is out of commission until they disinfect it. And there’s all the people who were on the airplane too. Now they get to be really really terrified. This is an example of the economic impact of an epidemic. When it’s screwed up. You have to put people in quarantine and then they can’t do their jobs, or be an airplane that flies around. This is costing the airline money. And it didn’t have to if the CDC hadn’t fucked up. They didn’t just guess wrong they didn’t follow the normal protocols. Err on the side of caution. Okay so two nurses caught ebola from Mr. Duncan, the now deceased ebola patient in Dallas. Another nurse there describes a “chaotic” scene when the ebola patient first arrived. I don’t know specifically what happened but I have to wonder if it’s like SARS. Where someone with a fever and clearly severely ill with an infectious disease arrives in the ER. They know that they’re supposed to put this person in isolation but there is no isolation room. Those went out with polio. So everyone freaks out and runs around. And during that whole time the patient is shedding virus. Preparedness means having isolation rooms that just sit there being isolation rooms when they’re not being used for that. The hospital administrators just will not get it through their heads that they need to do that. They need to be required by law to do that. They also need to have a separate entrance to the isolation area. During SARS a hospital in Western Canada where there was no SARS realized that they were not ready for fatal contagious diseases so they created a new doorway directly into their (newly created) isolation area. That’s what you do. There’s no shortcuts. During SARS in Singapore they took one of their hospitals and moved everybody out of it, and made it into their all SARS hospital. And the medical personnel wore moon suits. That’s slang for the kind that have their own air supply and look all puffy like you’re walking around inside a balloon. Those are the best kind. But even those you have to have special training and drill, to take them off safely. So that you don’t get the shmutz on the outside of them on your hands and then go put it on the countertop or the elevator button or in your eye. I dare say we shall hear more detail about how the Dallas hospital screwed up. To be fair the protective clothing that the CDC told them to get did not cover the nurses necks. That’s absolutely insane. As you can easily see based on what I said above. The shmutz is on your glove, you touch your neck, the shmutz is on your neck. The shmutz is the virus. That ain’t a moon suit. So when you see stories on the news with people saying “oh I’m much more afraid of the fear that of ebola itself”, snicker. It’s bullshit. You don’t need to panic about ebola, but you should be really pissed off at your government whether in the US or Canada for sucking so bad at this. Again, not rocket science.
So a woman having a stroke walks into an ER. And you’ll never guess the punchline. Yeah, they said it was stress.
In April 2014 a woman, Stacy Yepes, had one of a series of small strokes called a TIA (more on those below) and she went to the ER, described her classic textbook stroke symptoms. And was told it was stress by what are supposed to be competent doctors. Apparently she was also told that she needed to deal with her stress better (Now “all in your head” isn’t just a dismissal, it’s a guilt trip too!) And given instruction on how to manage her stress. With slow deep breaths. So, real jet age stuff. 40+-year-old woman in our society, yeah, she’s probably never heard that before. Interesting to me is that it’s a relaxation technique. Like for when you’re freaking out. Say at the dentist. So, the Bad Hospital people told her she had stress but clearly were thinking panic attack (stress, ripe piece of false knowledge, is normally portrayed as a pervasive force not a specific super noticeable event. This makes it less than useful when you want to use it to excuse inaction in the middle of a crisis! So now we have the panic attack.) Now, panic attacks may or may not exist. Certainly panic, the feeling, exists. Which begs the question what’s different about a panic attack versus a moment of panic? We’ll take that up another time. (Brief preview: it’s a mess.) Subsequent events will show Stacy’s not a panicky gal. So, if the doctors asked her about panic and she said no, what did they think? That she was a lying? “No, I feel perfectly calm. Get me the fuck away from these imbeciles!” So “stress” is now a panic attack and panic attacks have developed a deceit characteristic? “Oh, these panic attack people, always lying about the panic they feel.” Yeah. Right. Another problem: she’s having a fucking stroke! She knows it! That could make anyone panic, plus her doctor is AN IMBECILE!!!!!! Who doesn’t know the signs of a stroke from a flippin public-service commercial on TV! What kind of shithole hospital is this? she must of been thinking.
A word to medical people: if you bully, act crazy or really, really dumb – all common occurrences in hospitals – you will scare the living shit out of your patients, and yes that could make them appear panicky. So let’s not dismiss patient’s physical symptoms just because they are having an emotion (everyone always is) and especially one that you and your creepy, awfulness have induced. On top of which Ms. Yepes may have been perfectly calm. All we know is the doctor decided to say it was stress.
So the Bad Hospital sent her on her way. I cannot even imagine what that night was like. Ms. Yepes isn’t a stupid woman. (And no, in a situation like this, in a hospital you cannot just throw a tantrum and insist on seeing someone better. They just call security and might even have you arrested. Hospitals are well practiced and getting rid of their mistakes.) So Yepes is at home, goes to bed. Next morning another TIA. (No she doesn’t die in this story.)
This is what she experienced: the left side of her face drooped. And felt numb and tingly. Her talking movements were wonky. She still could but clearly not normal. And her left arm and leg got heavy and hard to move.
This is what happened inside her: a blood clot, which are not the little red spheres I used to picture but rather a long squishy piece of liver like thing, formed. So it’s in a vessel (blood pipe) in her brain. She had several of these TIAs (Transient = intermittent versus one big stroke where you go unconscious and you live or don’t. Ischemic, just means no blood so no oxygen to the tissues. Same thing as in a heart attack where heart muscle tissue is destroyed. Strokes are when that happens in the brain. The brain tissue is dying a.k.a. brain damage at all the thrilling problems that causes. And Attack is just redundant. Transient tells us it’s an event in time and can repeat. Oh wait, attack tells us it’s noticeable including by the person it’s happening too. Versus a transient event you don’t notice like some heart arrhythmias. So yeah Attack tells us it’s important!) Okay so a clot is in Ms Yepes’s brain, it could be short and stubby or really super long. And pieces of it are breaking off and stopping her blood supply, like someone standing on a garden hose, from getting to bits of her brain. This is a massive medical emergency. 1) because even a couple small clots that stop the blood supply briefly then dislodge (foot off garden hose) can cause life-changing and unpleasant brain damage. 2) but if the”mother clot” keeps shedding baby clots or breaks up completely, leaving the hunk of blood vessel lining it’s stuck to, it could kill her. Quick. That Yepes’s whole left side was affected, not just her head or vision or a weird skin sensation in a single big hunk of skin, means the middle cerebral artery was involved. (No, as I write this I haven’t seen Yepes’s medical records. Literally hundreds of thousands of people know those of the signs of a middle cerebral artery a stroke. This is not the hard stuff in medicine. And yet the Bad Hospital…) So Yepes is having little strokes that could build up to a big stroke that kills her. She goes to work. Yes, after a second TIA that morning. Why? Because the doctor at a hospital told her it was stress! This is why we can’t have nincompoops or any moronic blunders in hospitals.
After work Yepes is driving home and it happens again. She clearly has decided “screw the stress hypothesis” because she pulls her car over, gets out her phone and videos her stroke! Holy fuck! 1) she’s a genius, 2) WTF is wrong with our society and with our medical profession that something this evil is necessary? That’s a question I really want answered. How did the Bad Hospital fuck up so badly?
Then Yepes drove to a different hospital. She lives in a bedroom community north of Toronto but she drove to Mount Sinai Hospital in Toronto. The Toronto Star story on this doesn’t say if she needed the video at the competent hospital, or if they just listened to her textbook description. But they transferred her at once to the special stroke unit at Toronto Western Hospital. (Remember this is Canada so everyone has all the insurance they need for any in-hospital thing. And every test. And the Bad Hospital still booted her with a BS excuse.) At Toronto Western they did look at the tape but just to see it happening. And they treated her. Either with a clot dissolving drug. Or manual removal of the clot. With a kind of blood vessel rotorooter thing. And Yepes’s life was saved! And she was doing rehab at time of the Star article in June 2014. Hooray!
Now, here’s the thing, the article tells her story but never even names the Bad Hospital. There are no questions about an investigation at that hospital. Let alone what government agency now swoops in like the Transportation Safety Board does after a transport truck loses a load of watermelons on the freeway, to investigate this phenomenal stroke diagnostic balls up. Nothing. Nor any discussion of the lack of an investigative agency. The whole second half of the article is the stroke doctor (named, unlike whoever Yepes saw at the Bad Hospital) basically repeating all the points of a how to spot a stroke pamphlet.
One or more person at the Bad Hospital fucked up, big time. And Yepes could have died. You can watch: https://m.youtube.com/watch?v=SUzqLeC6XTQ She’s in her car doing the deep breaths the imbeciles “taught” her. And she could’ve died right there. That TIA was a little one. But it could have been a big one. How bad a failure of competence did the Bad Hospital personnel commit? 1) they should have immediately recognized when Yepes said that one side of her face drooped that this was a stroke. Why? Because literally nothing else affects only one side of the body, and is sudden onset. (Versus all the head colds we ever had: gradual onset.) The only other thing I can think of that affects just one side of the body is shingles. Also neurological. That’s how both can. ‘One side’ is a diagnostic gimme. So did she see a doctor? Or was she turfed by the triage nurse. Nurses are highly skilled. A nurse who didn’t know one side meant stroke would be an idiot. But triage in lots of hospitals is bullshit. It’s supposed to be a fast but real medical assessment. Often it’s no better than a) a check if you are bleeding and b) a time for staff to decide they hate you because you supposedly don’t have any ER worthy medical thing. Did Yepes see just triage or a doctor? Did the triage nurse write down that Yepes’s was a bullshit patient? Even give a bogus made up psych “diagnosis”: panic? I met a woman once who had started having convulsive seizures. Went to the ER, told: it’s panic. (Panic = leave the ER.) It was a brain tumor. Her husband had to pitch a fit to get her seen by a neurologist. Another person I knew had a long history of atopy: allergic with anaphylactic shock (which is fatal) to everything. Horrible condition. And asthma! Having an attack, goes to ER and once again: panic. So who decided Yepes’s problem was panic and not medical? Triage nurse? Or a doctor? A doctor hearing the one side thing should’ve just sent her to Toronto Western at once. Remember: at that point doctor or nurse, they knew she’d had a TIA, they knew that’s a small clot, they know clots are are like a long piece of liver and that the TIA could have been it, or just the beginning. Of a lot of small clots, so five or seven TIA in two days? Bing! Crippled. Or the “babies” of a huge fatal clot. They knew that. Because everyone in medical school is taught that. The doctor did the bedside neuro exam. (It is a defective, no-tech Stone Age piece of crap test for brain damage, but I will talk about in detail in another post. It is rubbish.) This includes having the patient move their face in various ways, supposedly to show weakness of the muscles. You can see Yepes doing those movements in her TIA video. (It makes me so sad. To a competent doctor her description of the face droop and numb-tongue way she was talking on the video is enough. It doesn’t matter how weak the weakness is. She should never have needed to do that. She described it fine in the first place. And Americans reading this remember: insurance for all the procedures and in-hospital drugs was 100% not an issue. Her government insurance covered all of that.) And because this was a TIA = transient, the very low sensitivity – meaning weak and crappy – bedside neuro exam would have been negative. Showed nothing. At which point the doctor should have said “are you having any of the symptoms right now?” She says no and looks at him like he has five heads. And that’s it. It’s a TIA. She described a TIA, she knows she is not having the symptoms when she clearly isn’t, ergo her account of the symptoms can be taken at face value. The only reason to do a bedside neuro in that situation is in case her degree of impairment is way worse than she’s saying. Like she’s 80% paralyzed on one side. If she’s seated how do you tell? This doctor clearly (since we know he did the bedside neuro tests, she’s repeating them in the video the next day) took the negative bedside neuro results to mean she did not have a TIA. So sharp he cut himself. The very nature of the TIA is that between the attacks there are no signs or symptoms. So the Bad Hospital is employing someone that incompetent. How that happened, would be one of the questions the Medical Fuckup Investigators would try to answer. If there were any. Does the hospital check their ER doctor’s references? If so, do they have any means by which to find out if they are turning their ER over to a joker like this? Was the doctor that Yepes saw a family practitioner i.e. a GP. Not an ER doc? If so, probably the problem. Undereducated for the job. (For any medical job?) But also may not be up-to-date on what to do with patients needing specialized care. This is probably a community Hospital outside the University of Toronto medical school’s network. But the main conclusion the investigator would draw is that this doctor is incompetent. Or weird. The doctor may have, for his or her own bizarre emotionally disturbed reasons, decided that Yepes had a psychological condition and that the doctor knew that. How? He just did. And thus she got her creepy stress counseling with the breathing crap. We will probably never know how appalling this doctor is. Or if he/she was responding to pressure from the administration to not have ‘too many’ patients. Because there is no Transportation Safety Board-like thing for medicine. There can and should be. And because even when the newspapers (including the crack mayor exposing excellent one!) do a story on a life-threatening medical fuck up they don’t dig. They don’t ask how did this happen?
First we hear there’s an Ebola case in Dallas. The man is in hospital, in isolation and everything is fine. Today, October 2 we hear when he first went to hospital he was turned away. And I thought oh my god it’s like Toronto.
In 2003 SARS hit Toronto. And everything fell apart. The first SARS case in hospital was the fortyish son of the elderly patient zero. She got it in China came back to Toronto, passed it to her son. And died. First screwup, she got a sign out autopsy. That’s where if you’re old and have multiple diseases when you die they don’t do an autopsy they just pick one of them and call that the cause of death. This is considered completely acceptable. So her son is in the emergency room coughing all over everybody the doctor he saw, an intensive care doctor, thought he had tuberculosis. Funny thing, tuberculosis is a reportable disease. To public health and you’re supposed to isolate the person. Like immediately. (Isolate means put the person in a room by themself where the air from that room can’t mingle with the air from the rest of the hospital. It’s very clever and it stops airborne diseases from spreading.) Did they isolate him? No, didn’t have the facilities to isolate people at that hospital. Because hey the age of epidemics is like over right? So he coughed on a guy named Pollock, Pollock then passes it to his wife and they both died.
Before people die from SARS they have trouble breathing so they get intubated, the people who do that are anesthesiologists. Anesthesiologists got sick with SARS and passed it to their family members and at least one anesthesiologist and his teenage daughter were both on respirators in the hospital. But did not die. An entire hospital Westpark IRCC was taken over for just nurses and doctors who were sick with SARS. A lot of people were on respirators all at once. This actually helped lots of places prepare for the and H1N1 outbreak in 09. They were ready with the respirators because they knew they might have to, and would be able to deal with, an epidemic of people needing help breathing. Please be aware, the hospital in your town does not have 30 respirators just sitting around in the basement. They may well have used them many during H1N1. They had to order them. That’s one good thing that came out of this and where people showed that they had their head screwed on right. During SARS, and planning for what came in 09.
Two family doctors died because patients were sick with a cough went to see the family doctor. The city didn’t have adequate protocols or places to put people with suspected SARS. No isolation rooms.
Except for Sunnybrook hospital, the major trauma center in Toronto. The guy in charge there as soon as he heard about the SARS thing rented compressor units that allowed him to turn regular rooms into isolation rooms. They’re called negative pressure rooms. They’re used in treating cancer too when the patients’ immune system is all buggered. In cancer they keep everybody else’s germs away from the cancer patient. They worked. None of the other hospitals did that. Not right away anyway. Two infectious disease doctors at another hospital both got SARS. They lived.
In an epidemic like this the public health department of the city government is one of the most important agencies in keeping it from being an even worse disaster. What a thrill. They are in charge of tracing contacts. Anybody who came into contact with the person who has in this case the respiratory-cough-the-germs-all-over the place disease. We’ve all heard about contact tracing when there’s an outbreak of foodborne illness. At a banquet or from a store. Whatever. This is a little more complicated. It’s some individual person’s trail through the city. Okay so public health departments did this all the time in the era of polio. They do it now for sexually transmitted diseases. The city of Toronto was completely unprepared. Their computer crashed. They were reduced to using tiny slips of paper with peoples names on being stuck into little charts on for floor. Well you might say nobody expected SARS. Everyone knew it was coming for a fact. They didn’t know what the disease would be but they knew that an epidemic like that and like Ebola now, was coming. They’ve had a name for it since at least the 90s and that name is jet spread. Okay you may say but if they didn’t know what disease was going to be spread by the jets then they couldn’t prepare for it. BULLSHIT. The way you fight epidemics of air- or sputum-borne diseases is with barriers. With the negative pressure room. With gowns and masks and gloves. It doesn’t matter what the microbe, the germ, is. What the microbe is matters for the drugs you give the person who is sick. But the keeping it from being spread is a whole other critter. They didn’t preplan they didn’t prepare they were fuck ups.
People were in quarantine, now it’s s called isolation in, their homes. They had suspected SARS and some of them did, some of them didn’t but nobody could tell until a certain period of time had passed. So they had to stay in their homes in a different room from the other people in it and wear masks. And they had to change the masks every so often and they had to take Their temperature. And they were checked on by an organization that was monitoring them, the Salvation Army? I think. Lots of quarantined people to monitor. They had to call in volunteers. Like during a hurricane or something. So that sounds pretty good right? And it would’ve been if they had been able to do it competently. They kept calling to check their temperatures of people who had already died of SARS. Competent planning, competent administrative stuff in a crisis would have completely prevented that. This stuff is doable. But you have to spend the time and money before the crisis to prepare for it. You do drills. They didn’t drill. Is that on the Salvation Army? It’s on the city of Toronto public health department. Let’s hope the Dallas one is more competent.
It gets better. The epidemic was slowing, maybe it had stopped. But with epidemics you have to wait until there have been no new cases for some period of time. Depending on the incubation period for the disease. Okay so one hospital in the north of Toronto said oh it’s over we’re going to stop doing our special procedures with the gowns and masks and gloves. We’re going to stop isolating people in the hospital who have pneumonia when we don’t yet know that it’s SARS. You know, the proper precautions. So they stop them. And there was a secondary outbreak of SARS in that hospital. Old people died who were in there to get joint replacements. Even though the outbreak was in a completely different ward. Why did it affect them. Weaker immune systems. That’s medicine 101. They had all the information they needed to do a good job. And this secondary outbreak was in the media for days before the goddamn hospital administration brought back the gowns and gloves and masks. Everyone knew what was going on and some idiot in charge managed to keep the right thing from being done for days or weeks. So elderly people in for joint replacements died. So did a young woman who was in having a fibroid removed from her uterus. Something you can wait six months or six years before you have done. Absolutely elective surgery. If the hospital had told her the truth about this possible SARS outbreak, that in fact was one, she was simply have had it done later and she would be alive today.
This is why the level of governmental that is in charge of fighting epidemics in our society can’t fuck up on every possible point.
Let’s just hope they don’t do this in Dallas.
Luka Magnotta is on trial right now in Montreal for the dismemberment murder of Jun Lin, a student from China. Yes, Jun came to Canada, to see a whole other world and was brutally murdered. This case is entirely about NCR: not criminally responsible. Magnotta admitted to killing Jun and all the other acts of the crime: dismembering Jun, videoing it, uploading the video to what I guess was a torture video website(!) (the proprietor of which has been charged) and mailing pieces of Jun’s body to government offices and a school(!).
Okay, this case illustrates why the law needs changing. We now have a jury who has to decide if Magnotta is criminally responsible for these acts. Whether he is or not turns on the idiotic, incomprehensible and 19th century legal weirdism: did he know the difference between right and wrong. This concept is from Victorian psychiatry. Which was full of theology including sin. To knowingly do wrong is a sin. But to not know, like a little baby, isn’t. In these trials everyone mentally switches to modern psychology. So the whole thing is already a mess. And defense lawyers only use this strategy when there is a handy psychiatric diagnosis in the client’s past. Which the lawyer uses like it meant the Victorian concept of “lunacy”. A magic baby-like state of no moral culpability. Change the law! Turns out that Magnotta was once diagnosed with schizophrenia. We are told. Not mentioned at the time of the crime. Because, oh yeah people with actual schizophrenia are all almost (or always?) psychiatrically disabled by it. It’s not a take a couple pills, go to your job at the bank type thing. Unlike bipolar or depression or anxiety disorders which can be. Magnotta was auditioning for reality shows.
According to the book Far From The Tree people with schizophrenia spend all of their time fighting the symptoms. The hallucinations don’t tell them what to do they assail them like loud noises. Visual hallucinations can be terrifying. They experience confusion similar to Alzheimer’s. And there’s something called disordered thinking. I don’t understand what that’s like, but it might be like being on really strong LSD. In the no fun way, as you try to do practical things. And the drugs don’t erase all this. They just dampen the symptoms. But you may ask: don’t some people with schizophrenia have delusions where real people play roles Wizard of Oz-like in a little story in the schizophrenic person’s head and they go and do elaborate (murderous) things because of stuff in the story? No. Doesn’t exist. Total literary invention. When people with schizophrenia or Alzheimer’s get really confused they don’t interact with the world at all. They sit in a chair and experience their hallucinations. And disordered thinking. Which aren’t little stories or delusions. Too muddled. Also contrary to tv shows (big eye roll) people with schizophrenia are not the ones who commit gruesome crimes in our society. Serial killers do not have schizophrenia. Rampage killers do not have schizophrenia. Write that down and put it on the fridge. ZERO ambiguity about this in psychiatry and in the murder statistics. Schizophrenia is not the Victorian evil “lunatic” stereotype. It’s a disease. Like Alzheimer’s.
Magnotta engaged in complex planning, (including mailing packages of bloody corpse pieces), videoed and posted the video and fled. To Europe, ie passport use. All serial killer things. Especially a torture killing! And the bragging via videoing and posting. Oh, plus befriending and luring Jun. Who I think he found at the convenience store where Jun worked, like a serial killer: killing a handy stranger. This shows abilities will beyond what a psychiatrically disabled person has.
Now, people with schizophrenia do have lucid periods. Even months long. And statistics I read in the 80s said one third spontaneously recover (which suggests that they maybe were misdiagnosed. Teenage/young adult depression idiotically misdiagnosed as schizophrenia. Schizophrenia has a looooong history of slovenly misdiagnosis.) So 1) even if Magnotta was diagnosed, especially as a teen, he could have “spontaneously recovered”. 2) was he like treated for it? My mother (who was a horrible person) ran a sort of drop-in center for ex-psychiatric patients. Most had schizophrenia. They were long-term disabled. Lucid on medication (or in remission?) And super boring. Nothing will cure you of medieval BS attitudes about mental illness like being in a room full of people with schizophrenia playing euchre. (I hate euchre.) These folks couldn’t hold jobs, survived on crappy Government disability (as do I, with a different disability) and many lived in supportive housing built and run by the Canadian Mental Health Association. Magnotta did none of these things. He didn’t need any of that kind of help. So if Magnotta does somehow “have” schizophrenia but it somehow doesn’t affect him what does that mean for the law? Both in this case. And for the question of what kind of law should we have?
Well are there different kinds of schizophrenia? Yes there’s uncontrolled, the overwhelmed by hallucinations sitting in a chair kind. Alzheimer’s-like, and the person can’t look after themselves. And there’s controlled. We have been “taught” by TV shows that if “on meds” (what are we, all Nurse Jackie now?) People with schizophrenia are “fine”. Meaning no different from a well person. Total BS. The medications just dampen the symptoms, the hallucinations, the fear, the disordered thinking. They help the person work really hard to pay attention to what’s happening outside their head. Versus being overwhelmed by them.
So we’ve got controlled, uncontrolled and sometimes it goes into remission. Or let’s say a person had it in their teens and then all the confusion, hallucinations, disordered thinking stopped. For five years. Then they do a murder. Does former schizophrenia effectively give them immunity on the murder now? It shouldn’t. Same if they have schizophrenia symptoms but controlled by medication. They still have to try to stay focused on the world around them and they use that hard-fought focus to kill somebody. Should they get NCR (and sent to a mental hospital with possible release in mere months) because they have schizophrenia? No. And here’s why. First change the scenario to: because had OCD. Not obvious yet? Change to: because had major depression. (And not a school shooting with the shooter killing themself.) Still not clear? Change to: because had arthritis.
We don’t accept arthritis as a defense in murder because it has nothing to do with how the killer came to kill. Neither would OCD or major depression. Because they don’t make you do something. OCD famously makes people do stuff, but it’s picyune stuff not a cunning criminal plan. It makes you do snippets of every day life stuff like washing (it’s not being a neat freak. More like Tourette’s. Doing normal thing over and over like a skipping record. OCD is neurological NOT psychiatric.) Or a movement thing like flipping a light switch 100 times. In which case that ‘ritual’ is really Tourette’s. So even OCD can’t make you invent a complex plan and make you carry it out! And it and sleepwalking are the only medical conditions known to make you do something against your will. So schizophrenia can’t make someone kill. And that should be the criterion. Not the Victorian/right from wrong crap. That’s from an era when masturbation was thought to be both a form of insanity and a sin. Enough with the Victorians!
Unless a person’s medical condition makes them kill it should not mitigate their responsibility one bit.
(Any) illness should however influence how/where they’re incarcerated. But that’s it.
So should NCR for murder be turfed out? Probably. But if it is used it should only be considered for someone who is clearly psychiatrically disabled. Someone who is so symptomatic that they cannot hold a job, have occasional periods when they can’t understand their bills. Stuff like that. And even then if they kill somebody NCR should only apply if the schizophrenia made them do it. Which I wouldn’t, because it can’t. NCR could still exist and be more appropriately used in a case of someone with Alzheimer’s or Alzheimer’s-like schizophrenia hitting someone because the person with Alzheimer’s or schizophrenia was frightened. The disease did cause them to do the criminal thing. By making them extra frightened and making them respond in an extreme way.
But if we only even consider NCR in murder for schizophrenic people who are psychiatrically disabled, first off they don’t kill people! So won’t come up. Secondly if not considered, meaning not allowed by the courts, except for psychiatrically disabled people we keep sado-serial killer types like Magnotta from using it. You can’t do serial killer stuff, including luring and then fleeing, and also be psychiatrically disabled. You can play euchre, not pull off the crime of the century. And any ex-schizophrenic person or one with controlled schizophrenia who might kill someone in a “regular” murder: for revenge, to inherit money, in domestic abuse and seek to use the schizophrenia to escape punishment would also be barred from the NCR defence. Mind you, controlled schizophrenic criminals, I’ve never heard of. On the other hand if someone is a wife beater or a sociopath who would kill to get the family business that doesn’t mean they couldn’t get schizophrenia. It’s a brain disease. The schizophrenia doesn’t then retroactively become responsible for them being a bad person. Someone who is already a violent person could get it. Just as the crack mayor got cancer.
Last point: the idea mentally ill people should not be punished the same as well people comes from the late 19th century. And applied to, wait for it: the death penalty! It wasn’t let them go (in six months). They still got life in prison! And: the objective was to not hang someone who was raving. That was their criterion for “lunacy”, “out of touch with reality”. (How someone like that 100% of the time could dispose of the body and then sneak away is a good question.) And because back then mental illness was as much theological as medical it was held the “lunatic” did not have intact moral judgment. So “right from wrong” is sort of a super indirect Victorian shorthand for raving. We don’t have raving as an important concept in psychiatry anymore. But a thing we do have that is close to it is: psychiatrically disabled. But the law doesn’t use that. We have all of these fuzzy concepts instead. And 12 citizens have to dig through this crap while everyone in the court system pretends at them that it makes sense.
We need reform.