A few months ago, I described the hospital where I used to practice and what was happening there recently.
Now, we have some new developments.
A couple more years went by and I learned that the hospital had laid off the low wage “environmental services” workers who cleaned the operating rooms between cases. Nurses, who made three or four times the hourly wage of the cleaning staff were now expected to clean rooms between cases in addition to their other duties.
That practice continued and now has caused severe problems. Last week, I learned that the Joint Commission on Accreditation of Hospitals had visited the hospital and had withdrawn the accreditation from Surgery, Labor and Delivery and Cardiology services. These are the heart of the acute care hospital. The reason ? Let’s read the paper.
From todays Orange County Register.
All elective surgeries at Mission Hospital, the third-largest hospital in Orange County, are on hold after four patients who underwent orthopedic operations developed infections.
The hospital opted to close its 14 operating rooms in Mission Viejo and Laguna Beach last week after a major accrediting agency, The Joint Commission, intervened and found, among other problems, high temperatures and humidity in some of the rooms, according to Chief Medical Officer Dr. Linda Sieglen.
If those infections were in patients undergoing total joint replacements, they are disasters for those patients. The cost of laying off those room cleaners has finally come home.
The scandal, and that is what it should be, is deeper than that story suggests. Surgeries are being shifted to other hospitals and doctors are going to have to make changes in their practices. Relationships may change permanently.
It is frustrating and infuriating to see the great hospital we built up in the 1970s, reduced to a news story about poor care as the result of ignorant and corrupt administrators.
A caller to a radio show has described officer Darren Wilson’s version of the attack by Michael Brown. It pretty much follows what we know now.
CNN said it verified with its police department sources that the story Josie told on the radio was the same as Wilson’s version of events. CNN called the stories an exact match.
First, we know that Brown had robbed a convenience store and manhandled the clerk shortly before the shooting.
Second, we know that the Holder DoJ tried to suppress the video.
The crowd was “peaceful and jovial” the Post-Dispatch informs us, and dotted with people who had traveled long distances. “Antonio Cuffee, 30, drove 13 hours from Baltimore with six others to join in the protests,” we are told. “‘We felt we had to come out here to be part of change,’ Cuffee, a policy worker, said. ‘It’s a shame so many black people are getting killed by police,’ he said. ‘Just by the nature of being black we are targeted, we are suspect.’”
This, of course, is nonsense as most murders of black men are by other black men.
The story told by the officer’s friend is as follows.
Wilson said 18-year-old Michael Brown and his friend Dorian Johnson were walking in the middle of the street, so Wilson pulled up in his patrol car and told them, “Come on guys, get out of the street,” but they refused, saying they were almost at their destination.
He kept rolling beside them and they cursed at him. He finally pulled over, at which point Josie said she believes he called for backup.
“He pulled up ahead of them. And he was watching them, and then he got a call-in that there was a strong-arm robbery,” she said. That was the convenience-store robbery shown on surveillance tapes of Brown grabbing a handful of cigars and pushing a clerk away when Brown and Johnson left without paying.
The pair matched the description of the robbers, and also appeared to be holding cigars.
This was the moment when the event began to spin out of control.
“So he goes in reverse back to them. Tries to get out of his car. They slam his door shut violently. I think he said Michael did,” Josie said. “And then he opened his car again. He tries to get out. And as he stands up, Michael just bum-rushes him, just shoves him back into his car, punches him in the face. And then Darren grabs for his gun. Michael grabs the gun, at one point he’s got the gun turned totally against his hip. And Darren shoves it away, and the gun goes off.”
Brown and Johnson then ran, Josie said, and got about 35 feet away.
“Darren’s first protocol is to pursue. So, he stands up and yells, ‘Freeze!’ Michael and his friend turn around. And Michael starts taunting him, ‘Oh, what are you going to do about it? You’re not going to shoot me.’ And then he said all the sudden he just started to bum-rush him. He just started coming at him full speed. And so he just started shooting. And he just kept coming. So, he really thinks he was on something because he just kept coming.”
This sounds reasonable to me. The rest of the story is at the link.
Why the virulent racism and riots by blacks ?
Unlike the preceding Emperors Trajan, Hadrian, Antoninus Pius and Marcus Aurelius, he seems to have had little interest in the business of administration and tended throughout his reign to leave the practical running of the state to a succession of favourites, beginning with Saoterus, a freedman from Nicomedia who had become his chamberlain.
Sound familiar ? Also:
the evidence suggests that he remained popular with the army and the common people for much of his reign, not least because of his lavish shows of largesse (recorded on his coinage) and because he staged and took part in spectacular gladiatorial combats.
One of the ways he paid for his donatives and mass entertainments was to tax the senatorial order
But enough of his biography. Why does he resemble Obama?
Obama’s rapid withdrawal from Iraq and disengagement from the Middle East in general is therefore understandable, even though it’s a justified target for criticism in the recent memoirs by former officials of his administration. The allure of proclaiming peace and the appeal of focusing on domestic undertakings trumps the unrewarding slog of negotiating with allies and chasing barbaric groups in distant valleys. But the risks are big and, now, they are on the front pages.
Obama is not the first one to have withdrawn from a fight. Commodus did it before him. As recounted by Herodian in his Roman history , Commodus, Roman Emperor in the second half of the 2nd century AD, inherited a war with the barbarians along the Danube River from his father, the prudent Marcus Aurelius.
Marcus Aurelius was noted as an educated and benign emperor but he was also concerned with defending the empire.
He ruled with Lucius Verus as co-emperor from 161 until Verus’ death in 169. He was the last of the Five Good Emperors, and is also considered one of the most important Stoic philosophers.
During his reign, the Empire defeated a revitalized Parthian Empire in the East; Aurelius’ general Avidius Cassius sacked the capital Ctesiphon in 164. In central Europe, Aurelius fought the Marcomanni, Quadi, and Sarmatians with success during the Marcomannic Wars, with the threat of the Germanic tribes beginning to represent a troubling reality for the Empire. A revolt in the East led by Avidius Cassius failed to gain momentum and was suppressed immediately.
He is also revered as a scholar and philosopher.
Marcus Aurelius’ Stoic tome Meditations, written in Greek while on campaign between 170 and 180, is still revered as a literary monument to a philosophy of service and duty, describing how to find and preserve equanimity in the midst of conflict by following nature as a source of guidance and inspiration.
How did Commodus do ?
two groups of advisers competed for Commodus’s ear. On the one hand, sycophantic courtesans, “who gauge their pleasure by their bellies and something a little lower,” kept dangling in front of Commodus the attractions of a return to Rome. Life was easier, more pleasant there; the new Emperor would be celebrated and praised by the populace, and he could enjoy there the excitement of intellectual conversations at well appointed tables of influential men (perhaps the Roman equivalent of a “2006 Brunello, grilled rib-eye and three pasta dishes—cacio e pepe, all’arrabbiata and Bolognese” and a conversation about “the importance of understanding science, the future of the universe, how sports brings people together, and many other things,” as recounted in a New York Times article describing Obama’s attraction to such meetings). How preferable this vision must have been to the grinding details of frontier warfare! Moreover, were he to return to Rome and to a direct control over domestic affairs, the Emperor could perhaps also keep an eye on his political opponents, quickly criticizing them or bringing them to his court to coopt them.
Commodus was eventually assassinated by his sister’s lovers. Before that, he was a disappointment.
Michael Grant, in The Climax of Rome (1968), writes of Commodus:
The youth turned out to be very erratic or at least so anti-traditional that disaster was inevitable. But whether or not Marcus ought to have known this to be so, the rejections of his son’s claims in favour of someone else would almost certainly involved one of the civil wars which were to proliferate so disastrous around future successions.
We shall see how Obama turns out.
On the frontier, the Emperor decided to let others fight the war. He left the war “in the hands of leaders he deemed capable and trustworthy.” And they chose to avoid a fight. It was easier to buy the barbarians off, even though they sold “peace at a huge price.” But this approach was preferable to Commodus too: he “bargained for release from care and gave the barbarians everything they demanded.”
We shall see what happens after Obama.
Roger L Simon has an interesting column on the consequences of a GOP win this fall.
Barack Obama is a man unaccustomed to losing. Life has been exceptionally kind to him, sailing, as he did, through balmy Oahu sunsets, college, law school and career on into the presidency with scarcely a bump. He has been a protected man beyond any in recent memory, feted and praised virtually everywhere he went until the last couple of years. Even now, despite catastrophe after catastrophe, there are acolytes who continue to celebrate him, paying tens of thousands merely to have their photographs taken with him.
When such cosseted people are forced to confront failure, they typically do not do so with grace.
Obama’s style of governing seems to be quite unusual for modern presidents. He does not have a circle of “Wise Men” as most presidents have done, including Bill Clinton, who had Robert Rubin advising him on economics and the bond market.
Obama, instead, relys on a small circle of advisors with little or no experience in national affairs.
Insider books by Robert Gates, Hillary Clinton and Leon Panetta have appeared in rapid succession, implying or directly alleging that the president lives in a bubble, unwilling to listen to advice. He frequently threatens to — and sometimes does — go around the Congress to get his way via, often unconstitutional, executive fiat. We all know that he lies, constantly.
His closest advisor appears to be Valerie Jarrett who has no policy experience and who seems to be a Chicago insider.
The early information of the Ebola patients in Dallas seems to suggest that competence has not been high on the list of priorities. First, the patent seems to have known about his illness before he got on the plane to the US. He lied to the authorities in Liberia but that is not that unusual. All it takes is ibuprofen to evade the screening at the airport.
Second the treatment of the relatives Has finally become humane after days of cruel treatment including quarantine in a contaminated apartment.
The initial treatment was not a model of infectious disease protocol. Why he was sent home with a GI illness and a history of travel to Liberia is still not explained. My medical students are all told to take a history of travel with any GI illness symptom. It’s not clear who he saw but many ERs use Nurse practitioners or PAs to see ER patients.
He is not doing well and he seems to be declining. We will see how he does but his relatives are still in serious trouble. We are still in trouble.
The promised treatment program is still inadequate. Tomorrow will bring more bad news.
A CDC official said the agency realized that many hospitals remain confused and unsure about how they are supposed to react when a suspected patient shows up. The agency sent additional guidance to health-care facilities around the country this week, just as it has numerous times in recent months, on everything from training personnel to spot the symptoms of Ebola to using protective gear.
This is only the first case.
UPDATE: More news from Bookworm.
Ebola can transmit through people’s skin. It’s not enough to keep your hands away from your nose and mouth. If someone’s infected blood, vomit, fecal matter, semen, spit, or sweat just touches you, you can become infected. Even picking up a stained sheet can pass the infection. Additionally, scientists do not know how long the virus will survive on a surface once it’s become dehydrated. The current guess is that Ebola, unlike other viruses, can survive for quite a while away from its original host.
Oh oh. This explains the infection of hospital workers in Nigeria from urine.
The good news, if any, is this:
If patients get Western medicine that treats the symptoms — drugs to reduce fever and to control vomiting and diarrhea, proper treatment if the body goes into shock, and blood transfusions — the mortality rate is “only” 25% — which is still high, but is significantly lower than the 70%-90% morality in Africa, where patients get little to no treatment.
I will update this as news becomes available.
Now we have a possible case #2
A patient with Ebola-like symptoms is being treated at Howard University Hospital in Washington, D.C., a hospital spokesperson confirmed late Friday morning.
The patient had traveled to Nigeria recently.
That person has been admitted to the hospital in stable condition, and is being isolated. The medical team is working with the CDC and other authorities to monitor the patient’s condition.
“In an abundance of caution, we have activated the appropriate infection control protocols, including isolating the patient,” said hospital spokesperson Kerry-Ann Hamilton in a statement. “Our medical team continues to evaluate and monitor progress in close collaboration with the CDC and the Department of Health.”
No final word yet. Then, of course, we have the NBC case.
Thursday, news broke that a freelance NBC cameraman covering the outbreak in Monrovia, Liberia had tested positive for Ebola after experiencing symptoms of the disease.
The cameraman, Ashoka Mukpo, had been working with chief medical correspondent Dr. Nancy Snyderman. NBC News is flying Mukpo and the entire team back to the U.S. so Mukpo can be treated and the team can be quarantined for 21 days.
The growth of terrorist state ISIS has taken all the attention lately. This is just a resurgence of al Qeada in the vacuum left by Obama’s withdrawal of all US troops. Maybe, if we had kept a significant force in Iraq, something could be saved of all we bought at such terrible cost. Now, it is too late.
We do have allies worth helping but they are not in the Iraqi government. It is Shia dominated and dependent on Iran for support. They have alienated the Sunnis and the growth of ISIS is the result. We still have the Kurds as allies and they know we were their only hope in 1993. Jay Garner did a great job working with them once we decided to protect them after the First Gulf War. I have never understood why he was dismissed by George W Bush.
The Kurds have been an embarrassment for us for decades in the middle east because they occupy parts of three nations two of which were at one time our allies.
Kurdistan includes parts of Iraq, Turkey and Iran. They have never had a modern nation and the neighbors are enemies. Only the mountains have protected them. Now, it is time we did something. Iran is certainly no friend. Iraq has dissolved and it is time to allow it to be broken up into the Sunni, Shia and Kurdish provinces it should be. Turkey is increasingly Islamist and has not been an ally at least since 2003 when they blocked our 4th Infantry Division from invading Iraq from the north.
The 4th was initially ordered to deploy in January 2003 before the war began, but did not arrive in Kuwait until late March. The delay was caused by the inability of the United States and Turkey to reach an agreement over using Turkish military bases to gain access to northern Iraq, where the division was originally planned to be located. Units from the division began crossing into Iraq on April 12, 2003.
The Kurds know this is their opportunity and Dexter Filkins piece in the New Yorker makes this clear.
The incursion of ISIS presents the Kurds with both opportunity and risk. In June, the ISIS army swept out of the Syrian desert and into Mosul, Iraq’s second-largest city. As the Islamist forces took control, Iraqi Army soldiers fled, setting off a military collapse through the region. The Kurds, taking advantage of the chaos, seized huge tracts of territory that had been claimed by both Kurdistan and the government in Baghdad. With the newly acquired land, the political climate for independence seemed promising. The region was also finding new economic strength; vast reserves of oil have been discovered there in the past decade. In July, President Barzani asked the Kurdish parliament to begin preparations for a vote on self-rule. “The time has come to decide our fate, and we should not wait for other people to decide it for us,” Barzani said.
The Kurds were surprised and routed by ISIS mostly due to limited weapons and ammunition. We could supply the deficit but Obama seems to be oblivious to the true situation. The Iraqi Army will not fight, a characteristic of all Arab armies. To the degree that the Iraqi army is Shia led, the Sunni Arabs will not cooperate or will join the enemy.
The present situation in Kurdistan is desperate.
Erbil has changed a lot since I was there last. In early 2013, on my way into Syrian Kurdistan, I had stopped off in the city for a few days to make preparations. Then, the city had the feel of a boom town – shopping malls springing up across the skyline, brand new SUVs on the road, Exxon Mobil and Total were coming to town. It was the safest part of Iraq, an official of the Kurdish Regional Government had told me proudly over dinner in a garden restaurant.
A new kind of Middle East city.
What a difference a year makes. Now, Erbil is a city under siege. The closest lines of the Islamic State (IS) forces are 45 kilometers away. At the distant frontlines, IS (formerly ISIS) is dug in, its vehicles visible, waiting and glowering in the desert heat. The Kurdish Peshmerga forces are a few hundred meters away in positions hastily cut out of the sand to face the advancing jihadi fighters.
The problem and a solution are both clear. Obama is not serious about doing anything in Iraq or Syria and the Kurds may have to fend for themselves. Interesting enough, there are Jewish Kurds. Israel may have more at stake here than we do. We are an unreliable ally with an anti-Israel president and party in contra, right now.
The phrase “Kurds have no friends but the mountains” was coined by Mullah Mustafa Barzani, the great and undisputed leader of the Kurdish people who fought all his life for Kurdish independence, and who was the first leader of the Kurdish autonomous region. His son, Massoud Barzani, is the current president of Iraqi Kurdistan. Other family members hold key positions in the government.
Perhaps the Israelis and Kurds can work out an alliance. The US, under Obama, is untrustworthy. We will see what happens.
The Yazidi minority we hear about in the news is not the only Kurdish minority. The Jews of Kurdistan, for example, maintained the traditions of ancient Judaism from the days of the Babylonian exile and the First Temple: they carried on the tradition of teaching the Oral Torah, and Aramaic remained the principal tongue of some in the Jewish Kurdish community since the Talmudic period. They preserved the legacy of the last prophets — whose grave markers constituted a significant part of community life — including the tomb of the prophet Jonah in Mosul, the prophet Nahum in Elkosh and the prophet Daniel in Kirkuk. When the vast majority of Kurdish Jews immigrated to Israel and adopted Hebrew as their first language, Aramaic ceased to exist as a living, spoken language. Although our grandparents’ generation still speaks it, along with a few Christian communities in Kurdistan, Aramaic has been declared a dead language by the academic world.
Israel might be an answer to the Kurds’ dilemma.
Ebola has become an uncontrolled epidemic in Africa. I have previously posted on Ebola elsewhere.
UPDATE: There is now a conclusion that Liberia and Sierra Leone are lost.
But Jonas Schmidt-Chanasit of the Bernhard Nocht Institute for Tropical Medicine in Hamburg told DW that he is losing hope, that Sierra Leone and Liberia will receive the neccessary aid in time. Those are two of the countries worst hit by the recent Ebola epidemic.
“The right time to get this epidemic under control in these countries has been missed,” he said. That time was May and June. “Now it will be much more difficult.”
Schmidt-Chanasit expects the virus will “become endemic” in this part of the world, if no massive assistence arrives.
This is from a German source. Our own CDC will not yet say this.
In the balance therefore, the probability is that the virus is not airborne — yet — but it is more dangerous than its predecessors. This would account for its ability to slip through the protocols designed for less deadly strains of the disease. It’s not World War E time, but it’s time to worry.
The results of full genetic sequencing suggest that the outbreak in Guinea isn’t related to others that have occurred elsewhere in Africa, according to an international team that published its findings online in the New England Journal of Medicine (NEJM). That report was from April 2014.
Now, we have more news. From 2012, we know transmission in animals may be airborne.
While primates develop systemic infection associated with immune dysregulation resulting in severe hemorrhagic fever, the EBOV infection in swine affects mainly respiratory tract, implicating a potential for airborne transmission of ZEBOV2, 6. Contact exposure is considered to be the most important route of infection with EBOV in primates7, although there are reports suggesting or suspecting aerosol transmission of EBOV from NHP to NHP8, 9, 10, or in humans based on epidemiological observations11. The present study was design to evaluate EBOV transmission from experimentally infected piglets to NHPs without direct contact.
The study of this potential explosive development showed:
The present study provides evidence that infected pigs can efficiently transmit ZEBOV to NHPs in conditions resembling farm setting. Our findings support the hypothesis that airborne transmission may contribute to ZEBOV spread, specifically from pigs to primates, and may need to be considered in assessing transmission from animals to humans in general.
Now we have more articles appearing about this.
The second possibility is one that virologists are loath to discuss openly but are definitely considering in private: that an Ebola virus could mutate to become transmissible through the air. You can now get Ebola only through direct contact with bodily fluids. But viruses like Ebola are notoriously sloppy in replicating, meaning the virus entering one person may be genetically different from the virus entering the next. The current Ebola virus’s hyper-evolution is unprecedented; there has been more human-to-human transmission in the past four months than most likely occurred in the last 500 to 1,000 years. Each new infection represents trillions of throws of the genetic dice.
If the New York Times is publishing this, somebody is worried.
The rise of ISIS seems to have caught the attention of hitherto oblivious segments of the US public. Cutting off the heads of western journalists seems to do that. What we are seeing is the total collapse of civilization in that part of the world.
That is what civilizational decline looks like in real time. The roots of the crisis were visible four years ago before the so-called Arab Spring beguiled the foreign policy wonks. Hundreds of thousands of displaced Syrian farmers already were living in tent camps around Syrian cities before the Syrian civil war began in April 2011. Israeli analysts knew this. In March 2011 Paul Rivlin of Tel Aviv University released a study of the collapse of Syrian agriculture, widely cited in Arab media but unmentioned in the English language press (except my essay on the topic).
In response to the Tunisian and Egyptian uprisings, President Assad reduced taxes on oil and sugar, and cut import tariffs on basic foodstuffs. This action had unintended consequences. A blogger on the Syrian website sy-weather.com reports, “I spent fifteen days on formalities to reduce customs duties on some basic food items, but I have not seen a glimmer of hope on the horizon. This was supposed to reduce the prices of the targeted goods. On the contrary, a liter of oil that sold for 65 Syrian pounds [US$1.38] now sells for 85 pounds.” That’s an increase of 30% over the month. Other bloggers report that the prices of basic foodstuffs have risen by 25% to 30%.
This has resulted in the presence of 14 million refugees with no hope of relief.
When I wrote in 2011 that Islam was dying, this was precisely what I forecast. You can’t unscramble this egg. The international organizations, Bill Clinton, George Soros and other people of that ilk will draw up plans, propose funding, hold conferences and publish studies, to no avail. The raw despair of millions of people ripped out of the cocoon of traditional society, bereft of ties of kinship and custom, will feed the meatgrinder. Terrorist organizations that were hitherto less flamboyant (“moderate” is a misdesignation), e.g. the Muslim Brotherhood (and its Palestine branch Hamas), will compete with the caliphate for the loyalties of enraged young people. The delusion about Muslim democracy that afflicted utopians of both parties is now inoperative. War will end when the pool of prospective fighters has been exhausted.
I was just thinking tonight about an amazing character I knew years ago. In 1972, I moved to Mission Viejo and began a surgical practice at Mission Hospital, now known as Mission Medical Center. When I arrived in December of 1972, I met an internist who had an amazing career and personal history. He was born in Holland and during World War II was supposedly a fighter pilot in the Dutch Air Force in what is now Indonesia. At the time it was the Dutch East Indies. He was also a physician at the time and was chief of staff at the hospital in Indonesia where another physician friend, Sergei Lockareff was born.
Maynard practiced as a physician in Santa Monica and was the personal physician for a number of movie stars, including Humphrey Bogart, Greer Garson and Carole Landis.
Life seemed very good indeed. But Bogie came home one day and told me that he’d run into an old co-star, Greer Garson.
Over lunch, she’d announced that she didn’t like the sound of his cough, and dragged him to see her doctor, Maynard Brandsma, at the Beverly Hills Clinic.
I was so used to Bogie’s cough that I never paid too much attention. He’d been off his food a little, but that wasn’t unusual. I should have realised at once that the mere fact that he’d consented to go with Greer to a doctor was indicative of something serious. Any time I’d ever mentioned a doctor to him, Bogie bristled.
Maynard discovered Bogart’s esophageal cancer and cared for him during that illness. Another physician friend, Burt Meyer, was the surgeon who operated on Bogart and who later said that the cancer was so small that he would never operate on another. If he couldn’t cure that one, there was none he could cure. Burt operated on John Wayne for his lung cancer with better luck.
Maynard was the physician who examined and treated the wife of David Niven for her fatal head injury, suffered when she fell down a flight of stairs in the dark at a Hollywood party.
When I came to Mission, Maynard had been there for several years. He had moved to Mission Viejo after marrying his second wife Mickie. He was active in practice and was kind of intimidating to a new surgeon. By that time, he was 65 years old but still very active. I remember that he tried to get me to join the Coto de Caza gun club, which was abruptly closed by the developer in 1991. At the time that Maynard was a member there was good quail shooting there but I couldn’t afford it.
He was quite the character. One night his telephone did not answer and the hospital asked the sheriffs to go to his house and let him know it was pout of order and they were trying to reach him. They knocked on his door at 3 AM and he came to the door with a .45 automatic held behind his back. Things were far less tense with the police in those days and they thought nothing of it.
The hospital was quite small at the time and Maynard was seeking a second career and life with his new wife. His career at St John’s Hospital in Santa Monica was spectacular in that he had been chief of staff and had a Hollywood practice, as well. One of his patients was John Ford and he made the diagnosis of Ford’s colon cancer that ultimately killed him.
Maynard was a good physician and continued to practice for a number of years after my arrival. Eventually, he and Mickie moved away and they are buried in Montana. He was a very colorful character and I remember him fondly.