Compassion And Decency Overwhelmed By Fear

This piece written by Eileen M.K. Bobek,clinging on a heartfelt issue;the matter of our everyday communication clouded by ignorance ,vanity or idifference .It's an old story of coldness hang in the air between us.

The year after I finished my emergency medicine residency, I had all four of my wisdom teeth pulled.

Afterwards, I looked as if I had taken several punches to my face. My jaw was swollen, my skin a cornucopia of muddied blues, purples, greens, yellows and reds. If people didn’t know better, I told my husband with a laugh, they might think that I’d been beaten.
It took weeks for the swelling and discoloration to resolve. I went about my life, aware of both my face and people’s responses to it. Their pitying, uncomfortable, sometimes disgusted expressions told me what they were thinking: I was being abused. But nobody ever asked me how I was, how it had happened or even if it hurt.
“I can’t believe it!” I’d rail to my husband. “Not one person has asked. Not one!”
It wasn’t long before my disbelief gave way to resentment. I started testing people. When our eyes met, I’d refuse to look away, silently daring them to ignore my face. Sometimes I’d relent and reveal that I’d had some teeth pulled. An expression of relief, tinged with lingering suspicion, would wash over their faces. But their nervous laughter and the tension that evaporated from their shoulders told me that their relief was not for me: It was for them. I’d absolved them of the responsibility of asking.
Most of the time, I said nothing, letting the weight of their silence hang in the air between us. Their guilt made me feel certain that I would never be silent.




***

I still don’t know her name.
I saw her only at my six-year-old son’s weekly T-ball games, five years ago. She and her two young sons had the benign, nondescript look of the families advertised in picture frames–all feathery light-brown hair and creamy skin. Her husband dressed in oxford shirts and business slacks, a beeper clinging to his belt. He was a grim-faced Ken doll–clean-shaven, with immobile sandy brown hair and a mouth locked in a thin line.
Once, she and I chatted on the sidelines as our three-year-old boys played together alongside the baseball field. At some point, her son picked up the Styrofoam cup next to her and took a drink from the straw. I saw her husband’s face darken, his body stiffen. He strode from the first base line where he’d been coaching and snatched the cup from his son’s hands, slamming it into the garbage before returning to first base.
The boy retreated to his mother’s lap, leaning his body into hers. As she dipped her head over his, she said, “You know you shouldn’t take Daddy’s drink.”
I thought I saw her glance at me through the curtain of her hair. We never spoke again.
I don’t remember seeing her again until the end of the season. She was sitting on the ground, handing out drinks and snacks to the players. As they swarmed around her like bees, I walked over with my sons. She looked up.
The wind whipped back her hair to reveal a black eye.
She’d made no attempt to hide it; she wasn’t wearing makeup or sunglasses. Her defiant expression mirrored my own of so many years before; she was testing me.
I imagined us in the ER–she sheltered within the walls of a patient room, me sheltered within my white doctor’s coat, freed from my fear and embarrassment and empowered to ask her the question on my lips. If she denied being beaten and got indignant or angry, I could retreat into my role: It’s my responsibility to ask. If she admitted it, I could offer her help–social work, counseling, a safe house, something. But without my coat, there on our sons’ playing field, I felt stripped of my power and authority–a not-so-super hero, crippled without her costume.
I said nothing. There are too many children around, I told myself. This is not the time.
We held each other’s gaze for a few seconds; then she turned away.
Instantly, I knew that I’d made a mistake–but the moment was lost. I reassured myself that I would have another chance; I’d see her after the game, at the nearby ice cream store where they handed out the trophies.
When I didn’t see her there, I approached another mother.
“Do you know the woman at the game who was handing out snacks? She had a black eye. I was wondering if she’s all right.”
She started, darting her eyes away as she stammered, “I…uh…no…I don’t know…I see my son.” She hurried past me, trailing a string of unintelligible words.
It was then that I turned and saw her husband and two sons sitting in a booth ten feet away, eating their ice cream cones in silence. As my son received his trophy, I scanned the entrance for her, willing her to show up and come through the glass doors; she never appeared.
I still think of her sometimes. I don’t know whether her black eye happened by accident or intention. Remembering her husband’s angry response to his young son, I think I know–but still I want to deny.
I recall my own bruised and swollen face and my disbelief that so many people so easily let me go without a word of concern or curiosity. I imagine how alone I would have felt if the unspoken suspicion on their faces had been justified. And I remember her face–defiant, bare of makeup, as if she were testing us, hoping someone might ask. If I had asked, maybe she would have said it was nothing. Maybe she would have lied but also taken comfort in knowing that someone had dared enough, cared enough to ask.
That moment–the wind blowing back her hair, her eyes meeting mine–replays in my mind like an endless loop. I think of all the things I could have said. Are you okay? How did it happen? Does it hurt?
I want to believe that I would never make the same mistake again–that my fear would never again overwhelm my compassion and decency.
I can’t help but think that’s why she didn’t show up later. She had taken a chance on us, and we’d all failed her. I had failed her. I’d had my one chance–and let it slip away.

Eileen M.K. Bobek is a former emergency room physician.

Observed Surge in Emergency Use of CT

The use of CT in hospital emergency departments has increased at a higher rate than in other settings, which is bad news for associated radiation exposure, according to a study from Cincinnati Children's Hospital presented at the RSNA meeting.

The study was also published online today in Radiology (November 30, 2010).
David Larson, MD, and colleagues examined nationwide trends and factors associated with CT use in the emergency department using data from 1995 to 2007 National Hospital Ambulatory Medical Care Surveys. A mean of 30,044 visits were sampled for each year, and data were subcategorized according to multiple patient and hospital characteristics.
The team found that during the study time frame, the number of emergency room visits in which patients were imaged with CT increased 84% -- from 2.7 million to 16.2 million -- an average 16% increase per year. Of this growth, 3.3% was due to increased patient volume, while the remaining 12.7% was due to increased CT use, Larson said.
This overall growth represents a 5.9-fold increase and a doubling time of approximately every 4.7 years," Larson told session attendees.

The percentage of CT procedures in the emergency department grew from 2.8% in 1995 to 13.9% in 2007 -- a 4.9-fold increase, a compound annual growth rate of 14.2%, and a doubling time of 5.2 years, Larson said. CT use in the emergency department increased the most among patients 65 years of age and older, going from 6.6% in 1995 to 25.2% in 2007.
And by 2007, the end point of the study's time frame, overall use of CT had not reached an inflection point -- that is, when growth acceleration of a technology becomes negative, according to Larson.
"We did not find evidence that the increased use of CT in the emergency department was tapering," he said. "It's impossible to predict when or at what level the overall use of CT in the ED will begin to level off."
The growth partially reflects new uses for CT that were rarely used in 1995, such as side/flank imaging, abdominal imaging, and imaging for chest pain, Larson told attendees: By 2007, these indications were the most common for CT. Use of CT for side or flank pain went from 0.4% in 1995 to 43.3% in 2007; abdominal imaging went from 2% to 33%; and use of CT for chest pain increased from 1.2% to 13.7%.

This upswing in CT use means higher radiation dose in the patient population, Larson warned.
"Our study didn't directly address radiation dose, but the evidence suggests that CT-associated radiation exposure in the emergency department likely has increased even more rapidly than the number of CT examinations performed," he said.
Larson's team suggested that inappropriate CT use will decrease as more sophisticated and evidence-based decision models that address patient benefit from the exam are used at the time the decisions are made.



by : Kate Madden Yee

6 Fixtures

The schedule til February 19th:

1-Sunday 31 Jan : Gasteroenerology Ward

2-Thuesday 2 Feb : Emergency Ward

3-Thursday 11 Feb : General Medical Ward IV

4-Friday 12 Feb : Rheumatology-Endocrinology Ward

5-Sunday 14 Feb : Emergency Ward

6-Wednesday 17 Feb : General Medical Ward II