Psyched Out

This is just such a horrible accidental death. She probably just hit her head on her ski. Natasha Richardson was a brilliant actress and fine human being, and her death at such a young age leaving two sons to grow up without her is tragic.

I'm going to riff on some themes from not-good articles, so if anyone doesn't want to read that or might be triggered regarding brain death or emergency medicine please be warned. I'm distressed over coverage because of personal experience with my brother Mike's brain death in the 1980's, and I understand how these public articles and discussions can feel to read. :(

I had an absolutely identical accident in junior high, and the back of the ski gave me a concussion and dislocated 2 of my neck's vertabrae. I had an identical lack of symptoms, and my girl scout leaders were identically advised to take me to the ER and identically refused. For good reason - millions of falls like this happen every year, and only one person dies. It's tragic, but it was an ACCIDENT and nobody did anything wrong. This seems lost on many journalists and commenters - I feel like we've culturally completely lost the acceptance that some things are not in anybody's control, and sometimes there's just no cause to blame anybody. Nobody, least of all Natasha Richardson herself, could have prevented her death.

I hate the health moralism in many of the articles I've seen, "This goes to show she should have been wearing a helmet." or "This shows she should have gone to the hospital with no symptoms." or "it must be malpractice - see what socialized healthcare does." Also, the laughable American neurosurgeon saying "this is why we keep people with possible head injuries 24 hours for observation."

First, I can GUARANTEE that if she had shown up immediately in any US ER, she would've been told to take ibuprofen and discharged immediately with advice to come back if she started to stumble around or slur speech, NOT "kept 24 hours for observation." Her only prayer would have been a typical long wait, but once symptoms appear there's just so little time before brain surgery is futile that she still might not have lived. Most of the surgeons quoted even said so.

Starting when I was 21, my family had to watch my brain dead brother Mike linger for years with no hope of recovery because, "you can't sue us for 'saving his life' but you can for stopping treatment so we won't." (Direct quote from a hospital administrator to my grieving parents, may he burn in hell. But only for a bit, I'm a universalist agnostic, after all.)

Mike and I both had severe asthma, and after watching a movie on a "vegetable" swore a pact to kill each other if it ever happened to us, which frankly was not unlikely given our medical histories. We were maybe 13 and 12. And I didn't follow through on my promise to him, from a blend of cowardice and the knowledge that if I killed him as requested, my parents would just be agonized all over again.

And I can never forgive myself for breaking that promise.

I know intellectually today that I promised when I was too young to understand fully the promise made, and that we didn't regard anyone else's feelings when we made the pact, and even that because Mike was brain dead (presumably unaware) and my parents were not I probably made the "best" choice for everyone else involved.

And none of it changes the magnitude of my betrayal of the person I loved most in the whole world.

Because watching what happens to your brother when bean counters keep the dead artificially alive is disgusting and enraging to a degree that I'm not sure I can express. My funny, loving, cynical, brilliant and occasionally cruel little brother Mike's corpse was mutilated for years by people who swear to preserve health and life (albeit reluctantly by most of them). He was overdosed on antifebrile medications to force his brain stem to regulate body temperature, and steroids to keep him breathing so he couldn't die of an asthma attack. They bloated his body unrecognizably. Because he was brain dead he wasn't "eligible" for physical therapy and his muscles withered and contracted, contorting his limbs. He was often racked with coughing because of opportunistic viruses. I was really outraged when they gave my already dead brother TB treatment that some inner city kid it would actually save desperately needed and would never get because his parents were poor. A recurrence of TB and pneumonia at once finally allowed Mike the peace denied him for six years after his original death. He'd died again and been resuscitated at least 10 times in the interval, all against my parents' wishes.

At least we have laws now that allow families like Natasha Richardson's to stop medical interventions that keep a brain dead beloved family member from dying peacefully. The immediate grief and pain are no less, but I wouldn't wish the prolonged version on any mother's 12 and 13 year old sons. Truly there are things worse than death, but kids shouldn't have to know it.

If you don't have an advanced directive, I urge you to write one and give it to everyone in your family.

I'm fat. I've always been fat, Venus of Willendorf Fat. It's seldom stopped me or upset me, but if I could take an otherwise safe pill to be thin, I'd do it. It'd pay for itself in clothing savings. Still, when my (then) kindergarten son wrote a list of his 5 favorite things about me for Mother's Day, and number three was "SOFT" in scraggly capitals, I melted.

Off the cuff, from the prof who inspired me to pursue neuroscience after I was shakily returning to school after 8 years feeling dulled by years of menial jobs: "Oh, I assumed you were heavily influenced by Stephen Jay Gould, you think exactly like him." That was nice to hear, until I took his advice and READ SJG's brilliant science essays from the journal _Nature_, when it became clear how unbelievably awesome that casual comment really was.

From an ex - "Please don't take this wrong, but you could make a LOT of money giving blow jobs like that." I didn't take it wrong. :)

"You sing like an angel, will you sing me to sleep?" A friend I'd just met on a car trip. Sadly, I had been punished and shamed for singing, and pretended I didn't hear her by acting asleep. :( Update: "Wow, you can really sing!" My very first ever BAND mate a few weeks ago when we rehearsed together for the first time. And she's a brilliant and experienced fiddler!!!

And of course, "Will you marry me?" :)

New Orleans, Louisiana Rep. John LaBruzzo (R-Metairie) proposed paying women on welfare $1000 to undergo tubal ligation, a not especially effective, unsafe, surgical (with attendant risks)irreversible method of sterilization. He later added that he would offer the same to men (on welfare?! we don't GIVE adult men welfare in the US, hence massive male homelessness) for vasectomies, which ARE effective, safe and reversible but also carry surgical risks. Just to make this amount clear, $1000 is less than the cost of:

a running used car without mechanical problems within 50 miles of NOLA

ONE month's rent for a 2 BR section 8 apartment in NOLA (remember, women must have at least one child already to qualify for any welfare payment, and zoning typically outlaws sharing a 1 bedroom or studio with a male child) Sorry, no deposit!

one BEDROOM's deposit and first month's rent in a 4 bedroom house in LaBruzzo'a own district of Metairie (with a girl child and wealthy owners willing to rent to the poor)

10 monthly bus passes for a mom and child in NOLA

one part time semester of community college in New Orleans

and very likely one MONTH of groceries for LaBuzzo's three person upper class family


OR - if you doubt that LaBruzzo's ALL ABOUT EUGENICS:

10 years of instantly reversible, non-sterilizing, non-hormonal and non-surgical copper IUD use - with followup gyn exams every other year (should be yearly) - oh, but wait, that wouldn't PUNISH women for being poor!


MEANWHILE:

Paternal abandonment is the top cause of child poverty in the United States.

Rearing children is the top risk factor for poverty in elderly women in the United States, REGARDLESS of marital status or household income before age 65.

The United States is the only G20 nation that does not count the unpaid labor of women caring for the old, the sick or disabled and the young in its GDP. This nation was economically founded on slavery. It is perpetuated by the unpaid labor of women of all ethnicities and races.

Anyone want to petition the American Psychological Association with me to remove the weight requirement from the anorexia nervosa diagnosis in the DSM 5 (psychiatric Diagnostic and Statistical Manual)?

That's right. No matter how malnourished and close to death you are from self-starvation, no matter if you meet every single symptom (what you report) and sign (what the diagnoser observes) of anorexia nervosa, if your BMI is 81% or more of the lowest "healthy" BMI, you can't be diagnosed with Anorexia Nervosa. My local inpatient hospitals take patients off behavioral plans and starvation precautions the second they hit 81% of "Ideal weight" - 82 lbs for someone my height (5'2') and 116 for a person a foot taller than me. Needless to say, this is less than helpful to my patients.

Did you notice that even at starvation level, we're only allowed a THIRTY FOUR POUND difference over a foot of height? That's less than four pounds per inch of (usually) torso.

GROSS OUT WARNING! SKIP the next paragraph if you are squeamish!

Anyone who has ever seen the "human steak" cross sections at the Chicago Museum of Science and Industry (or anywhere else) can appreciate that this is kind of ridiculous. If I had 32" circumference steak that weighed four pounds for my St. Patrick's Day party, people would think I'm a skinflint because I can guarantee it wouldn't be an inch thick.

Not to mention, putting a *weight* requirement in a psychiatric diagnosis would seem bizarre to anyone not bred in our fucked up culture. I mean, there's no requirement that we withhold the bipolar diagnoses from everyone not in the TOP 20% of BMI measures because everybody knows only REALLY fat people are "jolly." (Yes, I'm aware that mania isn't a bit jolly to live through - but it makes as much sense as labeling only REALLY thin people "starving.")

People can be dangerously malnourished at ANY weight - indeed, about half of the "10 fattest people" in a Dimensions article had died of malnutrition/starvation trying to lose weight. Even when the DSM was originally assembled, there were actual medical tests to diagnose malnutrition that were far more accurate than body weight, for crying out loud. Electrolyte levels. Anemia. Micro and macro nutrient deficiencies. Chronic dehydration. You know, all the problems bariatric surgery survivors (I say survivors both because this surgery is often fatal, and because it is deliberate amputation and mutilation of healthy organs.) encounter down the line.

Malnutrition, not weight, needs to be the basis of determining whether dieting has turned into self-starvation.

Of course, that would force psychiatrists and psychologists to acknowledge that the medical framing of self-starvation as pathological behavior for the thin and a "healthy lifestyle" for the fat is unscientific, superstitious and based on hatred rather than reason.

The only problem with the govt. purchasing health care from private medical providers is that the privatization of medical care is the main problem. Until the 1980s, medical providers were almost exclusively nonprofit. Insurance had been around for years, but when push came to shove the nuns did not ignore patients bleeding at the threshold as profit hospitals literally do. Much of what is blamed on managed care was in place well before the idea was even developed, let alone impossible to avoid. I saw the for profit take over close up - my mom was a nurse.

The first thing that happened was that doctors had to pay for attendance privileges.

The second thing was that the management required the hospital to RUN OUT of medical supplies before re-ordering. Oh, you needed a stent in your heart NOW? Too bad, we used the last one yesterday and we only order stents on Mondays. As long as your insurance or sister is willing to pay for you to stay another week, you *probably* won't die before next Thursday. Either way, we make more money.

The third thing was drastically cutting nursing care. Patient:nurse ratios skyrocketed. In the newborn nursery, the ratio went from 3 newborns to one nurse (can I get a shout out from triplets' parents on this one?) to 10 to one. Better pray your baby doesn't get sick suddenly - there's nobody with time to notice before that breathing problem causes brain damage.

Laws HAD to be passed mandating for profit hospitals to provide lifesaving (only) treatment to anyone who came in. My mom's hospital literally caused the deaths of refused patients. As long as elderly black people were dying, that was okay with the Quad Cities leadership and press. However, when a white woman pregnant with twins experiencing life threatening complications was told to go to the (nonprofit) university hospital 50 miles away if she wanted treatment, and she died on the way (meaning so did the twins) the press took notice. Again, before managed care. Greed ruined health care all by itself.

Not that managed care has been a good idea - I'm a psychiatric social worker who has watched patient care deteriorate horribly. People transferred from the medical hospital after nearly successful suicide attempts get 3 or 4 days inpatient at most. Antidepressant drugs don't kick in for 4-6 weeks (despite the claims of pharma that it's 2 weeks with newer meds). I'll defend big pharma for a minute though - I don't think Prozac causes suicide. I think releasing suicidally depressed patients after 3 days with a prescription that can't possibly help for another month, and no follow up care, causes suicide completion. Our local community mental health - which privatized under the Bush administration and renamed itself something so vague that nobody could possibly know what they do - doesn't even have a listing under that heading in the phone book.

The vaguely christened a big utilization review committee that challenges every day in the hospital even for INVOLUNTARILY COMMITTED VIOLENT/HOMICIDAL PATIENTS. Homicidal people can't be involuntarily committed unless they have a coherent and workable plan to kill (a) specific person(s) and the realistic ability and tool(s) to do so. Community mental health won't buy meds even for potentially lethal patients. These people are typically way too ill to work, so they seldom have insurance. Antipsychotic medication costs $800-1200 in typical doses to prevent suicide or homicide. Mentally ill people taking medication are less violent than the general population, but untreated psychosis can and does lead to violence and even homicide.

I guess if you're a Republican in a gated community with a gun under your pillow, this doesn't affect you. At least until your son goes to college at Virginia Tech. Or your niece has cancer surgery that removes most of the skin on her back and torso and sent on a trip across the state three hours after general anesthesia because she doesn't have $5000 up front in cash. From a university hospital taken over by for profit investors. Or your 28 year old receptionist dies alone in her apartment of pneumonia after being sent home by the ER, and is found by her 10 year old kid coming home from his weekend with dad.

For profit medicine is a bad idea. For profit insurance/managed care is too. These companies ration care as surely as the Soviet government did. They kill people every day. For money.

It's immoral. It needs to end.

Health care isn't just a human right, it's good for our society. That "illegal" little girl might be the next Jonas Salk and invent the HIV vaccine - if she lives through the leukemia that will only be caught in time if she has access to medical care today, regardless of her parents' immigration status and poverty.