by Nick Jacobs

There you have it. The end of our worries. We don't need to have a nuclear holocaust to thin out the world's population, nature is planning to do it herself. With six billion or so of us on the planet, 81 million isn't such a large number, but, then, if it's personal, you might just consider paying some attention to this, the latest and direst prediction. Actually this study showed a range of death from 50 to 81 M and decided that the average would be around 62 M, a number that is considerably higher than the 15 to 20 million that they had expected to predict.

This article will be printed in the Lancet and, if the worst prediction, the headline prediction, is true, it will be about 40 M more people than the number lost in the 1918 flu outbreak. In 1957 and 1968 we only lost two million and one million respectively, small numbers compared to this avian flu prediction. Now, if you're from the United States, you can take some comfort in reading that 96% of the deaths will occur in developing nations. If, on the other hand, you are a human being, the location of the tsunami is not really relevant because these are lost human being statistics, not widgets.

So, as we watch our children or grandchildren cry over opening the last of their 34 gifts because they wanted more, and as we see our pharmaceutical companies back away from the desire to produce vaccine for the masses due to our litigious society, we are forced to sit back and say, "Do we have our priorities in line?"

In that same vein, we need to honestly ask, "Could we ever be ready?" At a physician's meeting a few weeks ago, one of the docs was lamenting the fact that the Democrats want universal health coverage for all of the citizens of the United States. He was worried because it would cost an estimated $6 B, only a few billion more than the Iraq war cost this year.

Maybe, we need to verify our humanness and realign our priorities to ensure that 81 M of our friends, relatives, and fellow human beings are not lost to this pending epidemic. Maybe we should begin to take serious steps to ensure that our pharmaceutical friends have the same priorities that we do, and, just maybe, we need to double and triple check the planning mechanisms put in place by the CDC, our State, local and regional agencies to be certain that our assigned staff is "doing all that we can do" to be prepared.

By Nick Jacobs

For the first time in twenty years, something has happened that has never happened at our hospital before. Our Emergency Room Physicians have refused to provide full coverage for the department for Christmas Day. Now, don't get me wrong, they have contracts, and this shouldn't BE a negotiation, but, due to the extreme shortage of physicians nationwide and the inability to curb liability insurance costs in Pennsylvania, many of these physicians are working the system to their advantage.

In a normal situation, it would be simple. Hire more docs, and give notice to the offenders. The problem is that Emergency Room physicians aren't really easy to recruit right now. This creates an interesting situation. It is also clear that these phenomena may be a sign of the times for those of us running hospitals. As we see more and more shortages in the medical field, those available may become more selective about their availability.

We have seen leveraging that borders on financial blackmail, their version of supply and demand. When neighboring hospitals will hire them at per diem rates, sans benefits, those of us who pay contracted salaries and benefits find our hospital's schedules conflicted as the employees embrace both worlds as often as possible. Two days here, three days there, three days somewhere else . . . with a salary range that can vary by 60 or more dollars per hour.

Fortunately, a friendly, partner doc from our sister facility has agreed to cover the Christmas shift that is OPEN, but the fact that we were in this situation is NOT something that feels good to those of us who have hundreds of other employees who are always willing to work for all of the Holidays.

So, brace yourself America for challenges like this, or open the borders and let our neighboring physicians come to work in the U.S. because, as we Boomers ride off into the sunset, this is NOT going to be an easy or comfortable transition.

by Nick Jacobs

This is a personal medical journey meant to demonstrate the fact that "medicine is not a science. It is truly an art." It also demonstrates accurately why we use the term "practice" when we refer to physicians.

The date is 1996. After having suffered with tightness in my chest after meals which had been diagnosed as GERD for about six years, I went in for a physical. Now, don't get me wrong, I'd gone in for a physicial every year for the past ten. It was a great physicial. I ran on the treadmill for about 14 minutes, no discomfort. Everything was great. Two days before Christmas, my doc was at the front door of my house. He'd never been to my house before.

His visit? "Nick, you need to get a heart cath. I think your scan was one of the 30% false positives because I exercised you too hard, but you won't know until you get a cath."

The cath was positive and it resulted in the opening of three blockages 60, 80, and 90%. All in the right main coronary artery. They were opened by two uncoated stents and a balloon angioplasty. It was then that I started on the Dean Ornish Program. Two years later, chest discomfort and two more stents.

This time they were on the corner of the right descending coronary artery, and, according to some of my cardiologist friends, it was from the damage caused by the first cath. Because it's a blind procedure, the docs sometimes push too hard on that corner. The after affects of that cath was an ancient torture device applied to my inner thigh that required me to take morphine while it was being used.

Six years later, 16 Slice Pet CT shows a blockage in the area of my first non-medically coated stents. Sure enough, it was the body's protective mechanism growing to cover the stents with tissue. Kind of like when they can't get the bullet out. Thank God, they have medically coated stents that should protect me for three years. Since I lasted six years the last time, it seemed like a no brainer.

A little complication this time. After the 30 minute cath where two more medically coated stents were inserted inside the old stents, life was on its way to being good again. Except for one small issue. Because I had complained about the ancient torture device, the doc came to my bedside and held the incision for about 20 minutes. As he left the room he told the male nurse to continue to work out the gel that he could still feel. The nurse put a wedge bandage in place and left. The second male nurse came into my room every hour for the next seven hours and checked the pulse in my foot. He NEVER checked the site of the incision. At 7:30, the night shift nurse came in, lifted the sheet and called the cath lab with these words, "Houston, we have a problem."

Four nurses came crashing into my room and began to push the massive hematoma (blood clot) into a sacred part of my body that I've tried to protect since I was a little boy. I went into shock. My blood pressure dropped to 60/30, and I started trying to remember exit prayers. It was the worst pain of my life, and it went on for 45 minutes. Then the aftermath lasted for nearly a month.

Obviously, I was thrilled to read a few weeks ago that coated stents now are resulting in deaths from throwing off blood clots. My recommendation to all of you? Avoid trans fats, exercise. meditate, and don't trust the for profit companies who are anxioius to make up their R & D funds before there's been enough time for discovery.

Oh, yeah, and say a little prayer for your doctor.