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Grand Rounds 2.05

October 25th, 2005

Welcome to today's grand rounds. This week, instead of departmental presentations, I would simply like to read a letter from a janitor in our hospital.

To:
Hoss Pitle, CEO
Neighborhood Hospital
Sum Whear, SW

Dear Hoss Pitle CEO,
My name is Jan Itore, I am a janitor on the 2nd floor in the hospital. I am writing you today to express how proud I am to be a part of this hospital family - what interesting people we are associated with! I would like to share with you a glimpse into this fact as I was finishing my shift one evening.

As I was walking out, I bumped into Nurse Kim of Emergiblog. I love her stories, especially her EmeriAwards - I couldn't stop laughing at the funny and crazy things patients do in our hospital. As we were chatting, we saw doulicia, who had some thoughts about crazy patients - in particular, OB patients trying to manipulate labor's natural clock.

As we were walking out, we walked by radiology - and they were laughing, too. According to Sumerdoc, someone actually did a study on radiologists' brain activity as they looked at radiologic images. An analysis on the analyzers - I love it! Speaking of brains, we bumped into ShrinkWrapped, who wondered if an "ego transplant" into the brain could one day become a reality.

Like I do every Monday night, I headed over to Bar Louie for a few drinks. I love this bar - always interesting people debating interesting topics. Of course, Hank of InsureBlog and Jill of OUPBlog were there, debating national health insurance. Corpus Callosum chimed in on the worsening health insurance situation, too. Elisa of HealthConcerns had a group of doctors and moms together discussing a case of a mom disagreeing with her doctor's diagnosis of her son's development (does he have autism or not?). Dr. Andy brought up an ethical question about organ donation: does the donor have the right to specify the race of the recipient? Galen's Log also piped in on organ donation: what if a proclaimed organ donor who requests DNR can only donate if she is put on life support? CodeBlog recounted a touching story about a 12-year-old organ donor.

BarbadosButterfly recounted her first patient near-death experience. GruntDoc explained how the challenges of their newly-remodeled ER: as a nurse said, "I just act like it's a new job: I know how to do things but don't know where anything is."

Around a friendly game of pool, the folks at Health Business Blog wondered if the military would start drafting docs and dentists, given the growing shortage. Red State Moron pondered aloud about whether airlines will one day be liable for medical conditions that develop on their flights, like this case of DVT. The folks at Clinical Cases and Images Blog wondered if this new diabetes medicine is the next "Vioxx."

Multiple Mentality came in with a group that ordered calorie-free beer, and he explained the real risks of gastric bypass. Like 5% death within a year.

Rita of MSSPNexus blog came in with a group of wide-eyed 3rd-year residents. She explained the rigorous, somewhat-ridiculous process of credentialing and privileging.

The science booth in the corner was lively as usual today. Dr. Lei, of the Genetics & Public Health blog, was sharing with a group about genetic testing for cancer in African-American women. Mic of Antifaust shared about the concept of the "universal antidote." Tara of Aetiology reviewed the fact that the measles vaccine does not cause SSPE. The whole booth burst into shouts of disbelief as Dr. Emer told them that our beds may be dirtier than our bathrooms - the dust mites on our blankets produce a couple of pounds of excrement per year. Orac knows railed against the stem cell injection treatment going on in a Moscow spa.

In the next booth were the techies. The Krafty Librarian had a few doctors at the table, and she asked them whether UpToDate is really better than FirstConsult and eMedicine. Tim of Medical Connectivity talked more about Cisco's new connectivity product for hospitals.

Difficultpt came in with a group of pediatricians, sharing with them her difficult, painful childhood experience and asked them to be extra vigilant during the holidays.

Dr. Charles and KidneyNotes came into the bar at this point and bought me another drink. Dr. Charles, in a halloween mood, started telling the story of a visit to a "haunted" patient home and how office visits, for better or worse, can grossly oversimplify the patient's problems. Staying with the slightly-creepy-but-informative theme, KidneyNotes chimed in with a remembrance of Gretchen Worden, the late curator of the famous medical oddities museum in Philly.

Then, I saw Kent Bottles of SoundPractice going around table to table, offering a free drink for anyone who could explain why he is so confused about consumer-driven healthcare. The Cheerful Oncologist was offering free drinks for a month for anyone who could get through his 4-question "who wants to be an oncologist?" game show. Enoch of MedMusings then came in, and I bought him a nice glass of wine as he told some stories from his missions trip to help Katrina victims.

So, at this point, it was getting late and I already had my 2 beers, so I thanked everyone for another wonderful evening and decided to head home.

I walked home marveling at everything I had just heard about: soccer ball-sized ovaries, an ego transplant brain surgery, $3,000 genetic tests, 500,000 vaccine-preventable deaths, dust mites on my pillow feeding off my sweat and dead skin, and a drunk patient on a bed peeing 12 feet across a room.

I finally arrived home and picked up my mail. Yup, there it was - the dreaded hospital bill from a few months ago. Thankfully, the bill was not too bad, and I could actually understand it - thanks for making my bill patient friendly (and thanks Andrew from HealthcareTomorrow). My neighbors are always complaining how they wished their bill and healthcare in general came with instructions.

So, Mr. Pitle, thank you for letting me be a small part of this hospital community full of interesting and passionate people. I may "just" be a janitor, but I, too, am committed and passionate to make patients happier and to make healthcare in this country just a little bit better.

Sincerely,
Jan Itore

[I once spoke with one of the most famous hospital CEOs in America. Out of all the things he could have shared with me that day, he talked to me about a cleaning lady in his hospital. This is the story he told... A patient was in a coma and her grieving family sat around her. The patient had been completely unresponsive for weeks. Then, a particular cleaning lady unknowingly and deeply moved this family - simply by doing her job with a smile and by singing/humming a sweet tune under her breathe. The family noticed that the patient actually responded to this far-off cleaning lady's humming ever so slightly - a twitch of the eye, a tear. The family asked the cleaning lady to come in and sing to their loved one in the coma. Without hesitating, the cleaning lady put down her mop, came into the room, and sang an angelic tune. It was a tender, moving moment for the whole family - another tear flowed down the patient's face. A few days later, the patient died, but the family was so moved by the event, that they wrote the hospital, wanting to thank that anonymous cleaning lady. This week's grand rounds is dedicated to that unnamed hospital cleaning lady, and to all those in healthcare who do their job with a smile on their face and a sweet tune on their hearts.]

This concludes this week's grand rounds. Next week's host: Kidneynotes. Archives of previous Grand Rounds can be found here on Blogborygmi. For a list of submission guidelines, click here. For a flashback of grand rounds exactly a year ago, visit my post from yesterday.

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