The Medical Cathedral by the Sea

This is a true story of a medical case.

“I have worms crawling out of my skin,” she said to the front desk of the major medical center on the coast. This front desk receptionist had heard it all, and without blinking an eye booked this new patient into the General Medicine Clinic.

The Lady from Nevada

She was a blond from Las Vegas, a lady you could easily picture walking down the Strip on a warm desert night, dressed to the nines, living the good life. She was not a fan of big cities or formal occasions.

She had run a medical gauntlet through Las Vegas, then Reno, then finally screwed up her courage, and on to the big medical center on the coast. After Las Vegas and Reno she knew that she’d been written off as a nut, and she was not having it. She had to have answers.

The Sea of White Coats

The General Medicine triage desk, with barely a glance at the chief complaint, told the nurses to put her in the next exam room and tell the doctors. And there she sat, in a typical small, sparse, chilly room.

In a bit an internist and three white coat shadows came in, a resident, an intern, and a medical student. The chief complaint had attracted them like moths to a flame. “A good teaching case”, the internist had said. And thus she sat before the assembled experts with nothing to show them but her own conviction.

The Medical History Mystery

She told her story to yet another assembly of disbelieving faces. Every week or two, she said, a worm would crawl out through her skin. No, she couldn’t show them where because the little holes would close up after a day or two, disappearing like they had never been there. No, she hadn’t brought any with her. She explained that when one wiggled out it upset her. She hates bugs. Instinctively she’d slap it away, to get it off her. Later she’d try to find the worm but, so far, hadn’t been able to find one.

Mysterious But Vanilla

She was so normal it as boring. Rural Nevada childhood, moved to Las Vegas after high school to find work. Average height, weight, and BMI, normal vision. Did safe sex and no history of infections. She admitted that she smoked more than she should but drank very little. She ate a fairly healthy diet. No psychiatric history.

Heart sounds normal, lungs clear, abdomen soft, neurological and mental status exams normal. Lab orders went in for lipids, glucose, basic chemistries, urinalysis, more out of professional habit than a hope that the levels would explain worms crawling through one’s skin. After two hours of careful history and thorough examination, Internal Medicine had exactly what they started with: a lady with a story. Nothing else.

A Really Healthy Woman, Except That…

When a patient is not well but everything’s “within normal limits”, it’s awful. The team of four in white coats huddled. Dermatology? Maybe, well, no. There’s nothing on her skin. Infectious Disease? More tempting. Hey, there is that guy in Infectious Diseases who knows everything about parasites. And so it was that she was booked to see the Parasitology guy in Infectious Disease.

Chasing Doctors Chasing Parasites

As luck would have it, their “main guy” parasitologist was on vacation. Our lady had to return to Las Vegas and come back the next week. She was grumpy about it but she now had hope that someone would look at her and say, “I know exactly what this is.”

She comes back the next week still empty-handed. No new worm had wriggled out, so no specimen in a bottle. She had to admit this new specialist was impressive, and a nice guy to boot. He listened and probed for details. She said the worms always wiggled out from her forearms, or rarely, from her hands. He carefully examined her arms with his magnifying headlamp. Rough skin, too weathered for her age, the forearms but not the upper arms. But, no tracks, no scars, no visible tunnels. No rash, no nodules, no signs of anything clawing its way from the inside out.

When Even The Brilliant Guy Is Puzzled

Her story felt solid, sincere, convincing. And there really are worms that crawl out of one’s skin. The Guinea worm, for instance, is a cruel little thread that comes in from contaminated water, travels around inside the body for a year, then surfaces by burrowing through the skin. Chigoe fleas invade feet. Then there’s filarial worms, screwworm infestations, creepy moving lice. He thought through his long list of crawling, burrowing, biting creatures.

The problem was, none of them fit. Not in the Nevada desert. Her geography was wrong. Her exposures were wrong. The timing and patterns were wrong. Her skin, examined up close, told a story but not the right story. Nothing added up.

And when nothing adds up in biology, medicine starts whispering a different word: psychiatry.

There Are Things That Are Real That You Can’t See

(See “Your Mind & Your Brain“)

When everything seeable is normal and the medical chart is fat, where is the illness hiding? The internist and the parasitologist started chatting in the hallway as they walked toward the doctors’ lunchroom. Her story was like a 3-D puzzle that they turned one way then another while they ate. A surgeon joined the lunch group, then a radiologist. One of them snagged a passing pathologist for a curbside consult. It had become a multidisciplinary case conference over cafeteria food, five specialties and zero answers.

The surgeon finally said out loud what they were all thinking: “delusional parasitosis.”

Yes, of course, there it is. Delusional parasitosis. When a person is utterly convinced that they’re infested with parasites when every test, every exam, and every bit of logic suggests otherwise.

The Great Worm Delusion

It’s not common, but is more frequently in women. When there’s no discoverable cause it goes into this box. So the big doc posse around the lunch table referred our lady to the Division of Psychiatry where they can diagnose “crazy”.

It’s usually true that by the time someone gets to a psychiatrist in a the general medical/surgical hospital world, they’ve already been labeled in half a dozen unspoken ways.

The View From The “Looney Bin”

It happens in consultation psychiatry that the psychiatrist needs to push back when a surgeon or internist wants to stamp “psychiatric” on someone’s forehead just because the lab work came back boring. It helps to be prepared.

Her thick paper chart appeared in my inbox the afternoon before our lady from Las Vegas was to appear in my office. Yes, this was back in the days of paper medical records with notes written in cursive. There were records sent from Las Vegas, from Reno, from our own clinics. I stayed late.

The Cautious Return and Revisiting the Story

The next day she was pleasant but ill at ease. Why see a psychiatrist? She had worms coming out of her skin, and now she’s been sent to see a shrink.

We started over. History again, same life story, same symptom description, same frustration. More discussion of the weatherbeaten skin on her forearms. How does an attractive, healthy young woman end up with arms that look older than the rest of her. She had never done hard physical labor.

We ran out of time before either of us felt it was a finished conversation. To my surprise, she seemed oddly unbothered by the need to return yet again. For someone who resented psychiatry, she didn’t seem mind the follow-up.​

The Sandboxes of Las Vegas

She sat down with a different energy at her second visit to psychiatry. All the docs focused on her arms. The previous discussions had been spinning in her head like slot machine reels, and she felt she had hit a jackpot.

There had been this job at an antique auto restoration shop as a parts cleaner. There were big clear plastic boxes. You opened the box, put in the rusty car part, and closed it. The front panel had two thick rubber gloves built in, attached to holes so the operator could slide their arms into the gloves and work on the dirty part inside without getting hit by the cleaning “sand”. You step on a pedal and the “sand” shoots out from the side at the rusty part. As you hold the part in the sand blast with your gloved hand, the sand blasts away the rust.

A Small, Old, Poorly Run Las Vegas Business

It was an old shop with old equipment. The oldest cabinets for cleaning parts had gloves with tiny cracks and holes. Sand could get in. When she drew the short straw and ended up having to use one of the older boxes, her forearms and hands were red and felt sore in the evening. The “sand” found its way into everything.

The job paid really well so she stayed working there as long as she needed. Eventually she found an even better paying job in a Las Vegas resort as a spa attendant. She’d forgotten about the auto parts cleaning job until all the questions about her arms and hands.

The Parts Cleaning Shop Was Not a Day at the Beach

She had poked around the old shop in Las Vegas she found out that the blasting “sand” wasn’t sand like beach sand. Everyone called it sand so she thought it was sand. She tried to learn more. Someone vaguely told her that they couldn’t use real sand because that would be dangerous.

She and I needed more information. I asked her to go back and find out more.

Invisible Injuries and Glass Clear “Sand”

Back home, she tried seriously snooping around the shop. Everyone clammed up. They remembered her. They had other ex-employees give them grief about the old blasting boxes, and one of those others came with a lawyer attached.

Using her sneaky and sociable skills, she spotted a new, young guy working there. She was really friendly with him, then offered to buy him a drink. At the corner bar he answered her question over a couple beers. The “sand’ was a cleaning media made of glass beads of varying sizes. An OSHA inspector made the shop get rid of the old boxes because some operators complained of getting hurt. The owners had to replace them with new ones. So, they didn’t want old ex-employees walking back in the door.

The Fly in the Ointment was a Worm in the Skin

And so it was that, before she came back for a next appointment, the light had turned on for her. Glass beads, huh. Glass beads. Other employees injured. Doctors and attorneys. Worms coming out of my skin. It was starting to maybe add up.

And then, as if on cue, another “worm” appeared. Same as always: wiggling out from the skin of her forearm. But this time, instead of panicking and brushing it away as fast as she could, she froze. She leaned in. She examined the twisting little devil.

She picked it up.

One Hellofa Parasite If You Ask Me

It was not soft. Not living. It was a tiny, clear, irregular splinter, a twisted little piece of glass. It was not perfectly round like a marble, but bent and kinked, exactly the kind of shape that could feel like a worm under the fingertip.

She put that glass splinter in a bottle and brought it with her. That’s what all the doctors kept asking her to do, collect a worm and bring it in. And, there it was, the physical evidence in this entire story. Not a parasite. A piece of a past job, literally working its way back out of her body a long time later.

So, the “worms” were not hallucinations. They were not delusions. They were real glass bead “worms”.

The Joy of a Quiet Absolution of Being Believed

This is the best part of this story, how absolutely great it feels for a person to walk out of a major medical clinic having finally been told, “You’re not crazy. You were right all along.”

She had been bounced from city to city, clinic to clinic, edging closer to being written off as delusional. People had discussed her over lunch and assigned her a psychiatric label in absentia. But in her case, her body simply had a long-kept secret.

Finally Our Lady from Las Vegas Understood

Glass beads had been driven under the skin of her forearms and hands through tiny cracks in old blasting gloves, and over time, the body had done what it often does with foreign intruders: walled them off, worked around them, pushed them gradually outward. Every so often, one would finally make it to the surface and escape, a silent confession of an injury long forgotten, reemerging in a form that looked, to the brief glance infused with fear, exactly like a little, wiggly worm.

She was relieved. And embarrassed. Embarrassed that she had to see a psychiatrist. And angry that she was made to feel that she was mentally ill.

The Uneasy Truce with Psychiatry

She even said that it bothered her that she actually looked forward to coming back to see me. She had thought to herself, “Best not make a habit of that.” Because she knew, and all of her friends knew, that no one wants to be the kind of person who’s comfortable seeing a psychiatrist.

That visit was the last time I saw her. There were no subpoenas, no phone calls from attorneys, no requests for expert testimony about occupational hazards in auto restoration shops. Knowing her personality as I’d come to, my guess is that she chose not to sue. She seemed, in the end, more interested in reclaiming her life than in reliving the chapter where she thought she had worms crawling out of her skin and doctors thought she was crazy.

Helpful links:

National Institutes of Health on Parasitic worms and inflammatory diseases

Center for Disease Control and Prevention on Parasites

National Library of Medicine on Delusional Parasitosis: Diagnosis and Treatment

This is a true story of an actual medical case. Some details have been changed to protect medical confidentiality and the identity of some of the individuals involved.

This New Book Is Now Available

Below is the Introduction and Foreword

Safe, Effective, Fraudulent: Choose Two: When money is the drug by Jim E. Durand

Welcome to the Neuroscience Research and Development Consultancy website. Have a question or a comment? Send it to us at: Comment@NeuroSciRandD.com

Foreword to Safe, Effective, Fraudulent: Choose Two: When Money is the Drug by Jim E. Durand

Pharmaceuticals. Saving lives. But full of corruption. This story of sex, power, riches, and intrigue drives a compelling understanding of how the keys fit into the locks to shove an industry forward. Though a fiction novel in that the names, places, and situations have been changed to mask the real events, there were real events. And as the real events unfolded I was there and saw it all. The novel’s author is justifiably humble in his fields of physics and philosophy, yet still fears not to tread where acquired skill in story-telling will serve a noble purpose, illustrating that real people in the pharmaceutical industry truly care about you, the ultimate customer. He brings a moral compass and a gavel in judgment to the story line in his ability to add color and personality far beyond my subdued observing.

You must read this book. You’ll be caught up in the balance between condemning and yet understanding the redemption of those who both cure our cancers but yet fleece us and those we love. And as with the current opioid crisis, it’s supposed to be just collateral damage if a few die along the way.

Decades of caring for patients, prescribing medications, and working inside the pharmaceutical industry have shown me the consistency and replicability of the often-bumbling process of drug discovery and development. Whether the medications are overwhelming successes such as penicillin and insulin or undeniable tragic disasters such as diethylstilbesterol or thalidomide, the process grinds forward in the midst of proponents and critics, hostilities and benefactors, coercion and facilitation.

There are people in the United States who complain about the price of medications, not understanding that we in the Unites States have fueled the progress in medicines for the last century. In the 2006 film, The Devil Wears Prada, the character Miranda Priestly (played by Meryl Streep) makes the famous “cerulean sweater speech”. She explains that while high fashion begins with Oscar de la Renta or Yves Saint Laurent, through the next few decades that high fashion cascades down to the discount clearance bin at the bargain basement store. So the whole expensive top part of designer fashion fuels the entire multi-billion dollar clothing industry, top to bottom, worldwide, for decades.

This same top-to-bottom flow is true for medications. Walk into your local drug store. See the thousands of bottles and boxes of medicines of all sorts for every conceivable condition? Every single one of those started its journey as a new, expensive, branded drug. As the years go by all the good ones become more available and cheaper. Modern medicine can do what it can do today because our grandparents bought these medications, and our parents bought them, and we buy them. They’re only seem expensive if you don’t have vision and don’t have a calendar, you only live for yourself and for today.

And if one understands this comprehensive view, our children must also buy them. Look around you at this huge, rambling medical care system we have. Hospitals, clinics, doctors, nurses, emergency departments, urgent care clinics. Expensive facilities, expensive professional employees. It all costs a lot of money. How to save money? The least expensive way to treat any illness is with a medication, if we have a safe and effective medication to treat it. If you’re dying of pneumonia and an antibiotic will cure it, you’re saved. We can now cure hemophilia and sickle cell disease genetically. Not just treat these disorders, cure them. Why would anyone want to diminish this part of the medical care system. We all know there are specific problem companies and problem people. Shut them down, fine them, jail them, get rid of them. But the bad apples are not the whole bushel. We don’t throw out the baby with the bath water.

Introduction to Safe, Effective, Fraudulent: Choose Two: When Money is the Drug by Jim E. Durand

The background to this story is the universal background to how drugs are developed. The marketing and sales division is a good place to start. They are key, oddly enough. If there’s no market for a drug, if you can’t sell it to anyone, it will never become available. The billions needed to develop a single medication is far too high a price for a charity effort. If there is a market, then call in the clowns. These are the scientists, physicians, statisticians, and many other professionals who actually find and develop our next miracle drug.

Most of us might think that these bright scientists are the important group. But the marketing division truly controls the process and they view the scientists as their worker bees, their pieces on the chessboard. Because until you sell a drug, it’s worthless. A team could discover the world’s best next drug, but unless a sales team guided by the marketing division sells it, no one will buy it. Few will even know about it. It’s not possible to successfully promote a medication by word of mouth.

So the marketers see a place to sell a specific drug and start the ball rolling. First, they need a group to make the drug so that they have something to sell. But wait, you say, what about the physician scientist who discovers a new drug and wants to get it to patients? The doctor’s only doorway to get it to patients is to go talk to the marketing division. If there’s a great market for it, the doctor will get the research money and permission to move the drug’s development forward. No market, no dice. If the new drug does not really have a market but a similar drug would, the marketing division leaders will tell the doctor to go back to the lab and make this other new drug that does have a market. And so it goes.

Often along the way in development the new drug will reach a decision point. Now $10 million have been spent, but the next phase will cost $100 million. Should the candidate drug move forward? If the scientists and marketers agree to either stop development or continue onward, all is well, the die is cast. What if the physician scientists huddle and say, “No, wait, it’s not effective enough. It’s not safe enough.” And the marketing and sales groups come together and say, “You know, this could be a blockbuster. Maybe peak year sales of $15 billion.” The scary part is, it’s not clear who would win this disagreement of opinions. Most often, the marketing division wins.

And so our story begins. As with a Shakespearian play or an Agatha Christie murder mystery, the theme is universal while the story and characters, love them, hate them, or cry for them, are specific. Time to find out who lives and who dies…

Denis F. Darko, M.D.
Fellow, American College of Physicians
Distinguished Life Fellow, American Psychiatric Association
CEO and Managing Member
Neuroscience Research and Development Consultancy, LLC

Used With Permission

This announcement, the Introduction, and the Foreword are used with permission.

Who Are We? What Are We?

Even to those involved it’s not clear whether this identity crisis started as a joke or a real concern. Mostly it remained a joke in that in the discussions leading up to this article there was a lot of laughing. But there was a little edge of seriousness in a few people that we really did need to address the situation. It even became the top article in our recent monthly Newsletter. (You can sign up for our free monthly Newsletters.) Our website continuously gets comments. We pay attention to what our readers have to say, and we’ve gotten several comments about this specific question. Getting these comments seemed to show us that we’re not doing very well at communicating our role, that is, what we see as our job description.

Welcome to the Neuroscience Research and Development Consultancy website. Have a question or a comment? Send it to us at: Comment@NeuroSciRandD.com

First, A Few Humble Words

We at the Neuroscience Research and Development Consultancy, LLC, actually do have a job description. It defines our role to play in the larger scheme of things, that is, it’s the job function that’s been assigned to us. It’s what we do. And, we hope this doesn’t sound boastful, but we do consider ourselves at least capable and competent to do the job. However, we try not to take ourselves too seriously in the process. As we humorously point out on our Home Page, many people call our company and us “nerdsy” from the acronym for the company, NRDC, or NRD-C. What we offer below in addressing the readers’ concerns is not meant to sound grandiose, rather, just factual. We just feel that we have a job to do and it’s important to us that we try to do it well.

On the One Hand, There Are Reporters and Commentators

When you read a blog, a newspaper, or a magazine, or watch TV news or listen to radio news, it’s a reporter that’s informing you. A news reporter gathers information, hopefully interesting stuff, has an editor put it into a reasonable form, and then the reporter gets it out to all of us, the public. Reporters don’t add in their own opinions in their stories because it’s not ethical to do so. One of the duties of a reporter is to keep their own personal opinions out of the public news. It’s an obligation for professional reporters who are committed to keeping news coverage unbiased and impartial. There are other people whose job it is to add their own opinions to the public news: the news commentator. Commentators give their opinions on news stories and current events. They are specifically sought out for their opinions.

On the Other Hand, There Are Consultants

Consultants are professionals with rich experience and an in-depth understanding in their area of expertise. Because of this store of knowledge and their history of skill and good judgment they are paid by the clients who hire them to give opinions, do analyses, and make recommendations on what to do next and how best to do it. Businesses hire consultants because the business wants to succeed in reaching a goal, and the consultants expert advice can help them reach that goal. We at the NeuroSci R&D Consultancy are consultants. That’s how we make our living, that is, it’s our job.

So, What Were the Comments And What Is The Area?

Readers have pointed out that when we report on a research paper, discuss a medication, or critique a clinical procedure, we don’t stick to reporting the facts. We add, we push out, our own opinions. These readers feel that we’re overstepping our role. But we not only offer our opinion, we often push in a specific direction, because we’re not reporters. Our job is not just to relay facts as we find them. Our job, in a sense, forbids us to keep our opinions to ourselves. And, we’re not just commentators, tossing out our opinions and hoping someone is interested. We make our living as consultants, tearing into research papers, researching medication effects and side effects, and dissecting medical and scientific procedures. We do so explain the relative quality of the information and we push the best way for the reader to go or not to go forward.

One of our Swansea, Wales, UK Readers Wrote to Us to Ask:

How can you be my consultant when I haven’t signed anything or paid anything?

Our Swansea reader asks an interesting question and it was part of the humor and laughter as we discussed the various comments. We address this question more below, but in truth, we are only paid consultants for those who are (or were) paid subscribers to our website. If you, as a reader, are not paying us then we can’t be your consultant. Then there’s the contrary question: If you’re not paying us and don’t want us as a consultant why are you reading our website material? It does become circular. As we say in the meta-description for this page, “A sense of humor is good to bring to the party.”

We at NRDC Are Working for You

We are your paid consultants if you are or were one of our paying subscribers. We’re working to help these readers succeed in reaching a goal of better use of medical information toward better health and a longer life. You are paying us for our judgment calls, our analyses, and our recommendations, that is, you are paying us as consultants. We let you know whether a medication or medical procedure is good or is junk. We find research reports of quality and put the information in your hands with an explanation that will help you make your own judgment calls and use it to your benefit.

We Think You Enjoy Having Us As Your Consultant

As with job hunting, with dating, love, and marriage, and with shopping, eventually everyone finds their match and, over time, it all sorts itself out. If you don’t want us as your consultant we have to assume that you’ll stop reading our website and our newsletters. If you enjoy our added expertise you’ll probably stay with us. Of course, as our reader from Swansea said above, you can choose not to pay us! But if you’re not paying us and you’re still reading, hey, such a deal. You’re getting a consultation for free for which others are paying. You’re getting something for nothing in this transaction. So either way, welcome to nerdsy.

Helpful Links:

Indeed.com on Consultant Roles And Responsibilities (A Complete Guide)

Spiegato.com on What Does a Commentator Do?

CBS News on When Journalists Have Opinions (That Is, Always)

An Insider Connection – Sound Baths

There’s a guy who works with us at nersdy. He’s a sound designer by training (Master of Fine Arts in Sound Design) and by experience. Not a sound engineer. A sound designer, you know, the creative side of using sound. The other day he said he was headed to The Gong Shop in San Francisco. What? Wait a minute! What’s a gong shop. Well, he works at one of these posh weekender retreat places as a Naturalist, taking people on nature hikes in the woods and along the beach. The place has all sorts of health building and relaxing therapies going on and the management asked him if his sound design expertise could help them with their Sound Bath program. So, he’s buying new gongs, handmade by craftsmen in China, to create new sounds for the program. When something improves health and promotes relaxation, we can’t ignore it.

Welcome to the Neuroscience Research and Development Consultancy website. Have a question or a comment? Send it to us at: Comment@NeuroSciRandD.com

The Sound Bath Immersion for Your Body and Soul

For many people a water bath in a bathtub can be relaxing. Slide into a tub of nice warm water, not too hot, and the cares of the world can melt away. Immersion in an atmosphere of specifically-designed sound can do the same thing, or even do it better, and you don’t have to get wet. It’s quite a bit like good music, but not dance music or ballads. It’s sounds you both hear and feel. A quality sound bath uses sounds with felt vibration frequencies. At first you’re just relaxing in a room and you start to hear a variety of sounds and noises, but within a few moments you slip into the embrace of sounds so resonant you feel it almost more than you hear it. Boom, you’re gone. It’s sort of like meditation but without any effort. Unlike yoga or exercise, there’s no physical work to be done.

A Reader Asks:

How can you recommend sound baths? I tried one and it made me feel dizzy and a little nauseated.

Sound baths are a specific and personal experience. While most people find them remarkably relaxing, it’s not a good experience for everyone. They are immersive. There are a few individuals who don’t do well with immersive experiences. The environment unsettles them. Sound baths can be energizing, which some people experience as anxiety. As with the various forms of meditation, as a person relaxes, emotions can well up, leaving one joyful or sad and tearful. Whether it’s a roller coaster ride or sleeping in a pup tent on a camping trip, people tend to continue to pursue what feels good and avoid what causes discomfort. And that’s the way it should be.

The Process of a Sound Bath

The first task of the sound bath guide is to set up a comfortable location and help each person assume a comfortable and relaxed position, often lying on a yoga mat with a pillow under their head and, if the person wants, a blanket. A typical configuration is to have people arranged in a semicircle with their heads pointed toward the source of the sounds. The arrangement, of course, needs to vary depending on the size and shape of the room and the number of participants. Then the sounds are started and people are left to enjoy it. The sound is created by various musical instruments noted for making vibrational sounds that one can feel.  Examples are gongs, bell-like instruments called “singing bowls”, bells, Tibetan chimes called “tingshas”, and other vibrational instruments. At the end some people need to be gently reoriented to their surroundings.

Sound Baths and Well-Being

The intent of experiencing a sound bath is to promote emotional and even spiritual well-being. “Spiritual” in the sense of the search for meaning and purpose in life. A perhaps hoped for secondary benefit, to the extent that emotional well-being supports better physical health, is improved bodily well-being, too. Building on this concept, some people consider sound baths as curative in some way, calling them sound healing, or sound therapy, or even vibrational medicine. Typically sound baths last about 45 minutes, but sometimes as long as an hour. There are individuals who prefer to enjoy them on a schedule, like maybe a sound bath every other week.

Sound Baths Are Different Than Meditation

There are many sorts of meditation that people enjoy, like mindfulness, Zen, mantra, or Transcendental meditation. There are actually many others. A complete list would be too long for this discussion. Meditation presents a dilemma, however, in that one needs to learn it, practice it, and finally gradually get better at it. The benefits of relaxation come with time, practice, and patience. Not all of us are patient people, and many of us don’t want to spend a lot of time learning something new. It’s almost as though, if you’re willing to do meditation, you don’t need to meditate. You’ve already got the needed mellow personality that can make it work for you. There’s no learning curve to sound baths. Just sit back and listen to the music. It works the first time, no training needed.

So, Sound Baths Are Just Music Therapy

No, not true. Music therapy is different. Music therapy is just music. We all like listening to the music we like and don’t want to hear music we don’t like. So music therapy requires a matching of the person and the music. Music therapy also depends a lot on the expertise of the musician. While it’s true that sound baths might be more finely tuned when given by a trained and experienced practitioner, years of training are not a necessary component for learning to play the gongs, “singing bowls”, and other sound bath instruments in a way that provides the central effect of immersion and relaxation.

Sound Bath Information on the Internet: Pay Attention to Quality

A final word of caution. Sound baths are a helpful, healthy way to relax. Our intent here at nerdsy (NRDC, the Neuroscience Research and Development Consultancy, LLC) is not to promote mysticism, magic, or religion, but solid pathways to better health. As with every topic, there’s a lot of poor quality information about sound baths floating around on the Internet. For example, today’s sound baths are for us today, and are a recent addition to the art and science of health and relaxation. The typical sound bath, as it’s done today, did not originate 40,000 years ago, or 2500 years ago, or 900 years ago. True, some of the musical instruments have been around for a couple of millennia, but today’s version of sound baths have been around for about twenty years.

Helpful links:

Sound healing information from Dr. Tamara Goldsby, a Clinical Research Psychologist in Integrative Medicine at the University of California, San Diego.

Effects of Singing Bowl Sound Meditation on Mood, Tension, and Well-being: An Observational Study by Tamara Goldsby PhD

Sound Healing: Mood, Emotional, and Spiritual Well-Being Interrelationships by Tamara Goldsby PhD

 

The Peace of an Afternoon Break is Broken

As is often the case when these discussions start, it was about 3:00 in the afternoon, so “break time”.  People wandered in for a cup of coffee or tea, or a soda from the machine.  Nora and her fiancé Marshall, Jennifer, Jack, and Diane were sitting around the table, chatting about what they each planned to do after work. Sheila got up to leave, feeling she’d wasted enough time and wanted to get back to work. Right then Ashley walked in, and said loudly, “Wow, have I got a story for you!” Sheila paused, and sat back down. Ashley went to the soda machine, put in her $2, and hit the button for a coke, without saying anything. Jack yelled across the room, “Well, come on, spit it out. What’s going on.” Ashely still said nothing as she popped open the can and sat down with the group.

As With All Dramatic Happenings, It Started Very Ordinary

Ashley said her mother had gotten a frantic call from her sister (Ashely’s aunt Helen) a couple weeks ago. The sister’s husband, Frank, is a jogger, used to be a marathon runner, and is “healthy as a horse”. Last week he was running and missed a dip in the path and did something to a muscle in his leg. Later that night it started to spasm, really hurt like hell, so Aunt Helen drove him to the Urgent Care near their home. The PA there listened to this medical history, examined his leg, and gave him a prescription for a muscle relaxer. The PA had him take one, a Flexeril, in the UC and wait an hour, then Helen took him home.

It Was a Happy Medical Story, Until…

Through the rest of the evening the muscle spasms calmed a bit with the Flexeril. By morning he felt fine. The PA had given him a prescription for 30 of the Flexeril, to take three a day as needed. By the second day the spasm was gone, and the little bit of remaining pain was gone after he took Motrin. But Frank was afraid the spasm would come back so he decided to keep taking the three-a-day cyclobenzaprine (Flexeril) for a few more days. Five days later Frank woke and didn’t look well. Helen was worried, and her worry went through the roof when he said he couldn’t go to work because people there wanted to kill him. He also refused to eat anything at breakfast because he was afraid the food was poisoned.

It Went from Really Bad to Really Worse

At this point in the story Sheila got up again to get back to work. She’d heard enough gossip and decided she’d catch up on the events of Ashley’s aunt and uncle later. But Nora, Marshall, Jennifer, Jack, and Diane were transfixed at this point and didn’t move. People wanting to kill him, poisoned food? Seeing that everyone else was staying to listen, Sheila again sat back down. Ashley said that about half an hour after Uncle Frank refused to eat breakfast he decided that Helen was poisoning his food, and he locked himself in the bedroom. An hour later he was banging on the bedroom walls. When Helen shouted through the door, asking what’s wrong, he said he was trying to kill all the bugs crawling on the walls.

A True Crisis

Ashley’s Aunt Helen had no idea what was wrong. She told Frank she was taking him to Urgent Care but it refused to come out of the bedroom. She called a friend who worked as a Surgical Nurse in a hospital for advice. The friend didn’t know what to tell Helen to do but did offer that Frank was psychotic. Well, THAT scared the B’Jesus out of Helen. She told Frank through the door that if he didn’t come out and go to Urgent Care she was going to call all their neighbors and have the come over for an “intervention”. She knew that would embarrass Frank so much he’d want to die, so he finally came out, and, carefully staying as far from Helen as he could, got into the car.

Not Yet Out of the Frying Pan But Already in the Fire

The car ride to Urgent Care was awful. Frank kept smacking the windows to kill the “bugs”. Helen was afraid he’d open the door and jump out. Finally they got to the UC and waited to see the NP on duty. Frank told the receptionist he had to stay away from Helen because she was trying to poison him. The poor young woman wondered if she should call the police, but when Frank kept smacking the walls saying he had to kill all the bugs, she decided he was nutz and there was no reason to believe him. The Nurse Practitioner tried to talk to Frank but he became afraid of her, too, saying she must be helping his wife try to kill him. The NP explained to Helen that the UC really could not manage a patient with Frank’s level of “behavioral dyscontrol”, and called an ambulance.

The Ambulance Ride to the Hospital

The ambulance arrive and the paramedics spent time talking to Frank. They, too, decide he was crazy. Eventually they gave him an injection of something, saying it was the antidote for the poison his wife was giving him. He got really sleepy, they put him on a portable ambulance stretcher gurney, and into the ambulance he went. The big medical-surgical hospital one town over had an inpatient psychiatric unit, and after a quick trip through the Emergency Department, that locked psych unit is where Frank was deposited. By then it was late evening. The staff told Helen he would be fine with them overnight, he was still sleeping, and they knew what to do if he woke. They advised her to go home and try to get a good night’s sleep. The psychiatrist-on-duty would see her husband in the morning.

A Reader Wrote In:

Just after we posted this story we did have a reader, an incredulous reader, write in. He clearly had not read the whole story. He said it’s too wacky a story and he didn’t believe a word of it. He didn’t understand how a healthy guy in his 50s could just suddenly go psychotic, out of the blue.

We understand that people can be incredulous and we always enjoy critiques from our readers. But this really can happen. We encouraged him to read the whole story, and then look at the links below under “Helpful Links”. If he still didn’t believe the story, let us know. We tried to assure him, it really can happen.

How Often Does One Thank God for a Psychiatrist?

The young woman psychiatrist arrived the next morning to make her rounds on the inpatients in the psych unit, and evaluated Frank. He was groggy and not making much sense, so she got Helen’s number from the computer and called her. Helen told her the story of the bizarre behavior that previous morning and the chaotic trip to the Urgent Care. The psychiatrist called the UC for more information and found out about the leg injury, the muscle spasm, that first trip to the Urgent Care, the PA, and the Flexeril prescription. She then called Aunt Helen back to talk about the Flexeril. “It worked great,” Helen told her. “The muscle spasm pain was gone by the next day.” “Did he keep taking the Flexeril?” asked psychiatrist. “I don’t know,” was Helen’s honest reply.

Aunt Helen Investigates the Cyclobenzaprine Situation

Aunt Helen found the Flexeril vial in Frank’s bedside table. Of the 30 pills, there were only 7 left. He must have kept taking them since he got them, and maybe threw in a couple extra for good measure. She called the psychiatrist to report what she’d found. As it turns out, Flexeril has a rare side effect. In the clinical studies send to the FDA to get cyclobenzaprine approved fewer than 1% of the people in the studies has this reaction. The description reads something like this: abnormal sensations, agitation, excitement, psychosis, hallucinations, and abnormal thinking and dreaming. He’d not had any Flexeril since being brought to the hospital the day before. The psychiatrist told Helen that if the Flexeril was the problem he should be fine, back to his normal self, in two to three more days.

A Happy Ending for Uncle Frank and Aunt Helen

As so it did happen. Helen visited Frank daily. That first day, when the psychiatrist saw him, he was about the same as the night before. The psychiatrist saw him twice a day, morning and evening. By the second day Helen thought he was a bit more himself, but it was hard to tell. On the third day in the hospital she could tell he was a lot better, and the psychiatrist said that, if all went well, she would discharge Frank into Helen’s care the next morning. On the morning of the fourth day, he was discharged and Helen took him home. He was back to being himself. No bugs. No banging the walls. No fear of Helen or poisoning. He had a good appetite. He said he didn’t remember much of what happened but was sure he did not need to be in a psychiatric hospital.

A Lesson Learned for All Who Hear the Story About the Medication Side Effect You Can’t Tell Your Doctor

The real point of the story that Ashley wanted to tell was her Aunt Helen’s conversation with her friend the Surgical Unit nurse a few days after it was all over. Because that’s when it came up about the medication side effect that you can’t tell your doctor. If a doctor prescribes a new medication for a person and it causes a headache, or nausea, or insomnia, or tiredness, or almost any other side effect, the person calls the doctor and says, “Hey, this new med is making me sick. Let’s try something else.” But if the new drug causes mental status changes, like psychosis, or hallucinations, or other abnormal thinking, the person doesn’t know what’s happening. They’re “on a different planet”, the nurse said. They can’t call the doctor, they don’t know what’s going on.

The Medication Side Effect You Can’t Tell Your Doctor

Psychosis. That’s the side effect a person can’t tell their doctor. They don’t realize the new drug caused it, they don’t remember a doctor or a new prescription. It’s a real bad trap, a real bad place to be. At this point, Sheila did get up and left, without saying anything. Nora looked at Marshall and just said, “Wow, that’s bizarre!” Ashley just sat there looking from person to person, pleased in her discovery about the side effect you can’t tell your doctor. Their breaks are usually 15 minutes and Ashley walked in half an hour earlier. Time to get back to work. Jack, Diane, and Jennifer all shuffled out mumbling to each other how amazing and crazy Ashley’s story was. No one seemed to put much stock in it as an important revelation. Though each, in their own minds, hoped it would never happen to them.

Helpful Links:

Scholarly article on Induction of Psychosis by Cyclobenzaprine

Journal of Clinical Psychiatry on Psychosis following cyclobenzaprine use

The Recipe – Old World Cabbage Rolls

The recipe’s secret step is simmering the cabbage leaves on a bed of sauerkraut.

Ingredients

• 1 1/2 pounds lean ground beef
• 1 medium-sized onion, finely chopped
• 1 cup cooked rice
• 1/2 teaspoon salt
• 1/4 teaspoon each of pepper and paprika
• 1/4 cup tomato ketchup
• 1 clove garlic, minced or pressed
• 1/8 teaspoon liquid hot pepper seasoning
• 1 large cabbage
• A large kettle of boiling, salted water
• 1 quart sauerkraut, well drained
• 1 pound kielbasa, cut In 1-lnch pieces
• 1 can (8 oz.) tomato sauce

In a wide frying pan over medium heat, brown the beef, then add the onion and cook until the onion is limp. Spoon off any fat. Stir in the rice, salt, pepper, paprika, tomato ketchup, garlic, and hot pepper seasoning. Then, remove the fry pan from the heat.

Core the cabbage, separate the leaves, and cut off the thickest portion of the central rib from 16 large leaves. (You can save the remaining cabbage for other uses.) Place and soak the leaves in the large kettle of boiling, salted water just long enough to blanch and soften them, about 1 minute. Drain the leaves.

In a 4-quart casserole, make a layer of half of the sauerkraut. Place about 1/4 cup of the meat mixture at one end of each cabbage leaf, then fold the edges of the leaf over the meat, tuck in the end, and roll up the leaf. As each roll is prepared, place it on the sauerkraut, seam side down, in a single layer.

Spoon any remaining meat mixture over the cabbage rolls, then add the remaining sauerkraut, sausage, and tomato sauce. Cover and bake in a 350° oven for about 1 1/2 hours, or until the mixture is steamy throughout and flavors are well blended. Makes 8 servings.

Mr. Darko published his “Charlie’s Cabbage Rolls” recipe in Sunset magazine in 1977. The reference is below.

Welcome to the Neuroscience Research and Development Consultancy website. Have a question or a comment? Send it to us at: Comment@NeuroSciRandD.com

In Service to Our Readers’ Convenience

Many of our readers commented that, just like all the other recipe sites, we put a lot of our personal story text first and then the reader finally gets to the actual recipe. We know. That’s so that the reader has to spend more time on their page, boosting the page up in the rankings. We are not particularly page-ranking-oriented. So, despite the fact that we do think our story’s interesting, we moved the recipe to the top of the page. People who just want the recipe have the recipe. Those who like stories and want to read on, can do so. And, of course, that makes us happy.

Old World Cabbage Rolls from the Austro-Hungarian Empire

Dr. Darko’s grandparents emigrated to the U.S. from the Austro-Hungarian Empire in 1907. This genuine union between the Austrian Empire and the Kingdom of Hungary was one of Europe’s major powers in the late 1800s and the second largest country in Europe after the Russian Empire. It was dissolved at the end of World War I. Their homeland gone, they were never able to return. This old world cabbage rolls recipe is straight from their Austro-Hungarian kitchen circa 1900.

A Cooking Tradition Lives On – Old World Cabbage Rolls

Their son, Charles Darko, grew up with his mother’s recipes and cooking straight from the historic old Empire. His parents cabbage roll dish was one of his favorites. We bring you a traditional meal from the 1900 heart of Eastern Europe.

One of our readers in Toledo, Ohio commented:

If this is a family recipe there must be more. A woman immigrant from the Austro-Hungarian Empire would not come to the United States and cook just one dish.

A perceptive observation. There are more. Others have not yet been posted on the website, but the plan is to put them here eventually. This one was chosen first as it was a favorite of Charles Darko and was published in Sunset magazine in 1977 (reference below).

Here Are Three Hungarian Chefs You Might Find Interesting

Eszter Palágyi

In 2016 Eszter Palágyi won the Chef of the Year award granted by Hungary’s Dining Guide. She is seen as the leader in a movement to make Hungarian cuisine “lighter” than the traditional meat-based goulashes and rich cream-based soups. It’s a movement toward a new Hungarian cookery. She moved a restaurant forward in Budapest to win a Michelin star in 2010, the first Hungarian restaurant to win one. She goes with seasonal recipes to follow the produce of each season, a tradition that flows from growing up in her grandmother’s kitchen. She began her studies in a culinary school in Budapest, then went on to the Mount Falcon Country House Hotel in Ireland to train further. Here’s a link to an interview with Eszter Palágyi published in luxurious magazine.

Ádám Mészáros

Ádám Mészáros is a true Hungarian, born in Budapest and at a young age became interested in cooking. At age 14 he went to the Gundel Károly Secondary School, and, after graduation, went on to the Vocational School of Hospitality to make his interest in cooking into his career. After graduation he worked in several prominent restaurants in Budapest, learning more as he pursued his career. He’s married and has two children. If you’re interested, here’s a recipe of his that was published in Four Recipe Magazine, the October 20, 2018 issue. It’s Ádám Mészáros’ Saddle of Lamb with Fondant Potato and Summer Truffle recipe. The result is said to be perfectly pink lamb, luscious fondant potato, and scrumptious truffle.

Ákos Sárközi

A common history of these Hungarian chefs is that their interest in cooking started with learning from their mother, and this is again true of Ákos Sárközi. His higher aspirations came after years as working as “just a chef”. Then he got a position at Alabárdos, an extraordinary restaurant in Budapest that food lovers describe with the highest praise. Suddenly he found himself in the rich atmosphere of top-level gastronomy. This whole new world of cuisine was wonderful for him personally and for his career development. In 2022 received the Best Chef Award, putting him permanently on the map.

Publication Reference

Sunset (Desert Edition), Vol. 159, No. 3, September 1977, p. 142.

Bring a Photo to the Hospital

The elderly are too often mishandled and their wishes ignored in Emergency Departments. The story below shows one example of what can happen. And there is a way to try to get the ED staff to pay attention and give your elderly relative the appropriate medical care they need. When on older relative or friend calls you and a trip to the ED is needed, on the way grab a recent photo of them when they were well, one that you can spare and leave with their medical chart. As you’re helping explain their medical history show the staff the picture of how they looked when they were well, active, and feeling great. Tell them, “Here’s how they looked just a few days ago. And look at her now.” Ask them to put the photo in the medical chart with a note saying here’s how the patient looked before admission.

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How the “Bring a Photo to the Hospital” Conversation Got Started

Jennifer’s parents, Mary and Jim, were still living at home. They had reached the stage in life when the two of them together added up to one full functioning person. After sixty years of marriage they filled in for each other’s omissions and errors smoothly. Jim was doing well, just a touch of arthritis. Mary was having problems. Twenty-five years before she’d had adenocarcinoma of the colon, colon cancer. The primary tumor was removed but there were local lymph nodes questionably positive for cancer cells. The oncologist asked whether she would want to have chemotherapy or radiation therapy “just to be sure” to kill all the cancer cells or do nothing more and wait and see if there were any cancer recurrence.

It Had Been the Right Decision for Twenty-Five Years

It was a tense time and a tough decision. Mary’s doctors explained the choices and the benefits and risks of each choice to Mary and Jim. Doing nothing with maybe having cancer cells living in lymph node felt too scary. So, chemotherapy or radiation therapy. With chemotherapy she would feel ill a lot for the next year and would lose all her hair. Not so with radiation therapy. So, radiation therapy was chosen and all went well for the next twenty-five years. There was no cancer recurrence and she had no problems. What wasn’t well understood and so wasn’t explained to Mary was that the radiation therapy damages the bowel. During that twenty-five years the world of radiation oncology realized the existence of this risk of the therapy and learned a lot about it.

Radiation Therapy for Colon Cancer – Your Bowel Can Fall Apart

While it’s true that the radiation zaps the rascal cancer cells still left in the body, it also hits the other tissues of the small bowel and colon. But, it takes a very long time to be a problem, and sometimes it’s never a problem. The cancer might recur anyway and the person could die of colon cancer. Or the person might die of any other cause before the bowel damage is a medical problem. And some people don’t seem to have the colon damage. But Mary did have it and lived long enough for it to be a problem. She was at times bleeding into her bowel.

Deteriorating Bowel Tissues and Radiation-Induced Liver Disease

Mary also had radiation-induced liver disease in addition to the bowel tissue injury. Vitamin K is used by the liver to make proteins needed for blood clotting. When the liver is damaged such that it can’t convert enough vitamin K into the needed proteins, the person bleeds easily and the bleeding won’t stop. So blood would slowly leak into Mary’s bowel and she would become anemic, weak, and pale. The result was that for months she’d be fine, especially with Jim to help. She’d take walks with her friends, go grocery shopping, and do some housework. But then a day would come when she would almost collapse with anemia and look like “death-warmed-over”, looking decrepit and awful. But with a trip to the Emergency Department and a couple of units of packed red blood cells in a day or two she was fine.

Jennifer Got the Call from her Dad, Jim, to Help

Mary had one of those anemic episodes and Jennifer’s dad called her to help take Mary to the hospital. When Jennifer got to her parents’ home her mother was not yet dressed for the day. She and her dad got her mom into casual clothes, got her purse with her IDs and insurance cards, and bundled her into the car. They got her to the Emergency Department. As was typical her mother was in bad shape even though just the day before she seemed fine. She was 81 years old. The Emergency Department staff checked her in, the doctor got her history from Jim and Jennifer, did his physical exam, and ordered lab tests. Her red blood cell count was way, way down. Severe anemia. And, truly, she really did not look well at all. They admitted her to the hospital and ordered two units of packed cells.

To Live or To Die – What an Odd Question

Jennifer and her dad found out which ward she would be in and went there to wait. The nurses were bringing her up from the ED with the usual bags of liquid on poles and a blood pressure cuff around one arm. They wheeled her into a semi-private room. In the ED they had gotten her into a hospital gown. They gave Jennifer a bag with her street clothes and shoes. A nurse came in with an iPad tablet and began reviewing questions about dietary preferences and emergency contact people and numbers. Then the nurse said something that completely blew Jennifer away. She confirmed that her mother told the ED doctor that she wanted to be DNR.

What? Whoa! Wait a Minute! DNR?

That comment grabbed Jennifer’s attention. “Wait. What’s DNR?” The nurse explained that DNR was “Do Not Resuscitate”. It meant that if there was a “medical event” while in the hospital her mother did not want to be resuscitated. “That’s not true!” Jennifer said, clear alarm in her voice. “Of course she wants to be resuscitated.” She looked at her mother. “Mom, if you have a heart attack or something while you’re in here, do you want them to resuscitate you?” “Sure, yes, absolutely. Why?”, her mother replied. Jennifer explained that, from the ED, they have it in her medical record that she did not want to be resuscitated. Jennifer’s mother had no idea where they got that bit of misinformation and told the nurse to take the DNR out of her chart.

Happily, an Uneventful Hospital Stay

All went well in the hospital. As usual, with the transfusion and a day’s rest she felt well again quickly. She was discharged from the hospital and Jim and Jennifer got a wheelchair to take her to the car. As they were getting her into the car Mary saw a couple of the nurses whom she had met in the ED when she was admitted. She said high and they looked blank, said a weak hello back, and looked puzzled. Jennifer’s mom said her name and said, “I met you a two days ago in the ER.” Both nurses looked shocked. They brightened, big smiles, and came and gave her a goodbye hug. One said, “We’re sorry. You look like a completely different person now that you’re feeling better.”

Home Again for Jennifer’s Mother – But A Scary New Revelation

The threesome headed home, and her mother was glad to be back in her own house and her kitchen. A few days later Jennifer came over and helped her mother set up an online account with the hospital so that she could download her medical record. They downloaded it and printed a copy. That’s when the trouble started. As Jennifer and Mary read it they saw something that both angered and terrified her. The DNR order, the “No Not Resuscitate” order, was still in the record as valid. It appeared that it had never been taken off her record. If her mother had had a stroke or something in the hospital they would have let her die! Jennifer, Mary, and Jim were furious.

Trying to Hold the Hospital Accountable

Jennifer had her mother call the hospital to demand the DNR be taken out of her record. From the printed record it appeared that an ED doc had put the DNR order in the chart. No one had ever removed it. No one had removed it despite her mother making it clear to the admitting nurse on the floor that she DID want to be resuscitated in case of some medical event. The phone robo-triage got her to the ward where she had been a patient. They said she had to talk to the ED people since the doc there had put the DNR order in the chart. The ED staff said she had to talk to Medical Records, and transferred her call. Medical records said she could not change a DNR order over the phone. She had to come to the hospital and talk with someone.

Back to the Hospital – Well and Healthy This Time

The whole family, all three of them, Jennifer and her parents, went to the hospital. Her mother was armed with her driver’s license, her Social Security card, her Medicare card, and her Humana Medicare Supplement insurance card. She was ready to show that she was she. They went to Medical Records. The staff sent for a senior-level nurse to come talk with them. From there it was actually really simple. Jennifer’s mom told the nurse that she did not want to be in the hospital records as DNR. The nurse said fine, no problem, they would remove it.

Well, Okay, Maybe, But What Went Wrong?

The nurse helping them did not know what went wrong. The doctor in the ED had put the order in. It would be assumed that he had talked with Jennifer’s mother, confirmed that she wanted to be DNR, and put the order in her record. But it was just a checkbox in the electronic record. One checkbox for yes, one for no. Maybe he just checked the wrong box. The nurse also could not explain why it was not taken out when they asked for it to be removed when they first got to her hospital room that day. In any case, it was out of her record now, with apologies.

The Solution Is Not Obvious – Bring a Photo to the Hospital

When they got home her mother logged in and checked the record to make sure the hospital had changed it. Thank goodness, the DNR order was gone. A few weeks later Jim told the whole messy story to a retired nurse he knew from the local YMCA. They were in an Arthritis Aquatics swimming class together. The nurse said she had heard this story before. A patient will come into the ED looking more dead than alive. The ED doctor, based on appearance or maybe by accident, will check the DNR box. Hey, the ED is busy. There are times when the physician thinks he talked to someone but didn’t. When someone looks almost dead people might think maybe they shouldn’t be resuscitated.

One of our  Rhode Island Readers Asked:

What would have happened if Mary had a heart attack in the hospital and they let her die?

Well, to start, whatever might have happened, Jim would be a widower and Jennifer would have lost her mother. Could there be a lawsuit? The Emergency Department physician could say that Mary did say she wanted to be DNR. It would legally be “he said, she said” when he is a doctor standing there alive and Mary’s deceased. The nurse on the unit could deny that the conversation about DNR ever happened. It would be a hard lawsuit to win. And even if a lawsuit were filed and Jim won, what would the damages be? Mary was not producing an income and, in fact, with her medical problems was costing the couple money. It would be hard to show that losing his wife was anything but an emotional loss. And anyway, Jim was not the type to pay a lawyer and file a lawsuit.

Well, That’s Pathetic Practice for a Doctor – So Bring a Photo to the Hospital

This experienced, retired nurse offered Jim this advice. Whenever you’re taking a gravely-ill older relative to the ED, take along a hardcopy recent photo of them, a copy you can spare to give away. It should be a picture of when they were well and feeling great, just before they fell ill. Tell the staff to put the photo in their medical chart. Then, confirm very clearly and assuredly that, if a medical event occurs, the person wants to be resuscitated. So often an elderly ill person comes to the ED looking “half-dead” pathetic. It’s hard to believe that they were active in life and in robust good health just a few days earlier. The photo gives the staff, even hurried staff, a better idea of the person, not just of the patient.

Well, I’ll Be Damned! – Bring a Photo to the Hospital

It’s all very upsetting. For one, how would a doctor accidently make a patient DNR without permission. And, how could a hospital leave the person on DNR status after she says that she wants to be resuscitated, yes, please do resuscitate me. But best and finally, how simple a solution! Take a hardcopy photo you can spare. Show that the person was robust and engaged in life recently. Show the staff that they’re not about to die. You want the staff to save them. To get them back to where they were. To make them well again.

Helpful links:

Arken Legal on the Rise in Inappropriate DNR Orders

The Medical Wisdom of Keeping Yourself as Healthy as Possible for as Long as You Can

There are medical miracles that are launched every day for one or another medical condition. There are many women who, in the past, died of breast cancer but that today could be cured. Kidney and other organ transplants save hundreds of thousands of people every year. We each know of someone who died twenty or thirty years ago that today could have been treated and saved. And now this COVID-19 pandemic teaches us the lesson again. The healthier people are, the more likely they are to survive a SARS-CoV-2 infection. If people were able to survive until the vaccines come along, the vaccines could protect many more people from hospitalization and death. By staying as healthy as you can for as long as possible it’s more likely that, when some medical condition does befall you, there might be a good treatments that will save your life. It’s a lesson to remember and practice lifelong. It’s a way to achieve a long and healthy life.

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This Page Is Not Really About the Pandemic, It’s For All of Life: Stay Healthy Until There Are Better Treatments

The pandemic examples below are just that, examples. This concept is much bigger that the pandemic. It’s a life lesson. For your whole life, guard your health, exercise, and eat healthy foods. Leave time at night for a good night’s sleep. See your doctor for regular checkups. Go to the dentist for a cleaning every 6 months (periodontitis can cause pancreatic cancer and other GI cancers). Stay socially connected with friends and family. Plan recreation time and go out and have fun doing what you love to do. Stay as healthy as you can for as long as you can. That way, when you do come down with some illness (and everyone does eventually), it will be more likely that medical science will have found a better treatment, maybe even a cure.

Example: COVID-19 in March 2020 vs. February 2022

Here’ an example. Think about the medical care that you would have gotten if you had fallen ill with COVID-19 when it first hit the US full blast in March of 2020. It was a new virus, a new and unknown infection, that your doctors had never seen or treated before. The best treatments were not known and medical care, even in the country’s best hospitals, involved a lot of guesswork. Does the SARS-CoV-2 virus affect everyone the same? No one knew. Can we depend on the NIH and the CDC to be the first to have all the correct answers? Most people thought so. Is obesity a risk factor for poor COVID outcome? No doctor would have guessed so. Doctors and nurses scrambled and did the best they could. Studies were quickly started to discover which treatments actually worked and which ones didn’t help.

It Took a Long Time to Find What Worked to Treat COVID-19

The “learning curve” was steep and progress on more successful medical care was slow. But, gradually, month by month, scientists and medical doctors learned. No one believed you could get an FDA-approved vaccine in six months. Everyone struggled to get ventilators and expand the intensive care units. Old available medications were tested to see if any helped. Would plasma from COVID survivors contain enough antibodies against the virus to help people in the hospitals with the acute illness? For a while it seemed so but then maybe not so much. Courageous doctors and nurses did better than their best and saved lives. Medical scientists started looking for new medicines. Survival rates began to get better.

A Successful Vaccine Against the Virus in Six Months

For whatever you think of President Trump, he fired the starting gun in an all-out race to develop a vaccine. The Trump administration pumped billions of dollars into his Operation Warp Speed, the seed money to create a miracle in an astonishing short time. The little new biotech who had never made and launched a drug, Moderna, and the massive multinational pharmaceutical juggernaut Pfizer, hit the ground running. They had the idea for a new kind of vaccine. They competed on early stage testing, then both launched huge phase 3 clinical trials. They raced “neck and neck” and hit the finish line in a photo finish, producing successful vaccines at record speed. By December 2020 the FDA granted Emergency Use Authorizations for both company’s mRNA vaccines.

Vaccines Shield Everyone Who’s Willing

Those people who were able to wear masks, keep social distances, shelter at home, use hand sanitizer, and wash their hands frequently survived until January 2021. And then, like “shields up” on Captain Kirk’s Starship Enterprise, there was protection. As 2021 rolled forward, the vaccinated were safe from hospitalization and death. By the summer of 2021 the only people admitted to the hospitals and dying, with rare exception, were the unvaccinated.

But Even Unvaccinated, If You Got COVID in January of 2022…

But consider now a vulnerable individual, who for whatever reason is not vaccinated. And he gets ill, tests COVID-positive, gets worse, and is admitted to the hospital. What do you think his medical care would be like in January of 2022 as compared to March of 2020. While they still can’t save everybody, now nurses and doctors know what to do, what works best. It’s known which medicines help and which do nothing. And, brand new medications have been developed, like the antiviral drug remdesivir (Veklury®) for adults They know whom to admit to the hospital and who can be sent home with medication. For admitted patients, they know when to send them to the ICU and when to intubate and put them on a ventilator. This person now would have a much better chance to get out of the hospital sooner, and a far better chance to live and not die.

The Value of Those Masks, Socially Distancing, Washing Your Hands

So, we’re all still here. Or at least those of us that are still here are still here. If you’re one of the people who put on a mask, kept a good social distance, used hand sanitizer, and frequently washed your hands, you did well. You kept yourself out of danger while all the physicians and scientists learned what to do and while the pharmaceutical industry was developing the vaccines. And realize that now, today, even if by some terrible stroke of bad luck you catch the SARS-CoV-2 virus and get sick with COVID, you will have much better medical care and a better chance to survive than you would have had in March of 2020.

A Reader Asks:

But it robs your quality of life to do all this stay healthy stuff and when you get sick there still might not be a cure.

You’re right, sort of. There are some who might feel that staying healthy, eating well, exercising, sleeping soundly, and avoiding harm is adding to your quality of life, not robbing it. But if you want to eat junk food, be a couch potato, and stay up all night, then you’re right, trying to stay healthy would rob you of this lifestyle. It’s like the risk with buying insurance. Many people pay for homeowner’s insurance all their life and never get anything back because nothing ever happened to their home. And, the money that was spent in some way lowered their quality of life. They had less to spend on fun. But for those who had homeowner’s insurance when their house burned down, it made all the difference in the world. Staying healthy is insurance. Each person makes their choices and increases or avoids risk.

There’s a New Medical Treatment Every Month

There are so many new things, almost miracle cures, there’s no way to write a complete list. Medical science has devised targeted cancer treatments where doctors take your cells and the cancer cells, train your cells to kill the cancer cells, and put your trained cells back into you to chase down and kill the cancer cells. Gene editing is being used to fix people who inherited problem genes, like sickle cell anemia. Doctors can now cure sickle cell anemia. Not just treat it, cure it so it’s gone. Stem cells will make it possible to repair and replace vital organs. The human papilloma virus (HPV) vaccine will save the lives of 270,000 women a year who won’t die of cervical cancer from the virus. Since the list is almost endless so we won’t go on and on. You get the idea.

Consider the Case of President Jimmy Carter

President Jimmy Carter is 97 years old.  When he was 91 he had metastatic melanoma cancer that had spread to his brain and liver. That’s always been a death sentence. In addition to the usual surgery and radiation therapy, he was able to have a newly-developed immunotherapy. His immune system was made to keep fighting to find and kill every single cancer cell. The immunotherapy medicine is pembrolizumab (Keytruda®). The FDA had just approved pembrolizumab in 2011, 4 years earlier. His immune system killed all the melanoma cells. Every one. Gone. Before this it was rare for a person to survive metastatic melanoma. What if President Carter had lived a less healthy lifestyle and got the melanoma 10 years earlier, in 2005. He’d be dead. He would not have lived long enough for the medicine to have been invented and to have been there when he got the cancer.

So Keep Yourself Well and Healthy

So keep yourself well and healthy so that all those scientists and physicians will have found the cure for the next maybe-fatal illness you will get. If your health is poor and you get the fatal illness and die too soon, well, no cure for you.

Prescription

The doctors gave my grandmother
six months to live,

We were fond of saying.
As if all hospitals were filled

Not with equipment and medicine
but with time,

gaseous and swirling
in high-ceiling atriums,

ready to be compressed
into tanks and dispensed.

How do they decide
how much to give us?

One of life’s
great mysteries,

like some people prefer cake
and others pie.

Still, it can’t hurt
if the doctors like you,

so in the interest
of time,

best to mind your manners
when they enter the room.

The doctors gave my grandmother
six month to live,

and that was five years ago—
a medical error, a stray zero

on the prescription pad,
a chronological overdose.

She transitioned to hospice,
to myth and magic.

Se politely declined to eat
anything but Hershey bars.

We had a dog
who bit everyone

but would lie for hours
tightly gripped in her lap.

Of solid New England stock,
growing up in Maine

in the exhale
after World War I,

she drove a one-horse sleigh
to a one-room school

like a rosy-cheeked girl
in a painting.

The doctors gave my grandmother
six month to live,

and what followed was too much
and not nearly enough.

On Christmas Day,
dozing in her favorite recliner,

surrounded by nutcrackers and family
she stopped breathing.

My father
in his New-Age way,

said it was a miracle
she had chosen this moment to depart.

A minute passed.
But as we finally inhaled,

so did she,
vigorously and fearfully,

as if waking
from a bad dream.

She looked up at her congregation
of premature eulogists,

smiled,
and said hello.

Poem by Matthew J. Farrell, MD, MFA
Department of Radiation Oncology, University of California
Los Angeles, Los Angeles, California
Published in Annals of Internal Medicine Vol. 178 No. 5, May 2025, pp. 749-750.

Noncompliant

Who wants to be
Complaint?  After all

Her diagnosis isn’t
One that medicine can bend

She’d trade you ten diagnoses
For a single month’s rent

Of course she hasn’t swallowed
Each and every pill you promised-

Of course she craves more
Than a pinch of salt with breakfast

Nobody wants to back down
Everyone aches to get home

Of course the first thing that she did
Was spark a cigarette

Aren’t cigarettes delicious?
Here-

Let me take that good advice
Off your hands

Sit down
Have a drink

You remember?
What it’s like to live

By Gaetan Sgro, MD, VA Healthcare System, Pittsburgh, Pennsylvania, and published in the Annals of Internal Medicine, Vol. 177 No. 8, August 2024, p. 1137.

Half of What You Learn

Half of what you learn is wrong.  We can’t
say which.  The oracles of medicine
are fond of saying this, when blathering on

about progress.  Like learning Latin
in high school, it’s not the principle of use
that counts, but the idol of discipline.

Study today, delete tomorrow.  In a decade,
truth will bifurcate along an unknown line
into wheat to be retained; chaff, discarded.

There is something fishy about the rule
of glib transition from right to wrong
in the annals of progress — the human

is missing.  The pain is missing.  The action
is happening today.  The podium
is nowhere to be seen in a patient’s room.

by Jack Coulehan, MD, Center for Medical Humanities, Compassionate Care, and Bioethics at Stony Brook University, Stony Brook, New York.

from the Annals of Internal Medicine Vol. 177 No. 4, April 2024, p. 540.

My Own Blood

I told her I liked the lines on her face,
the way her crow’s-feet speak of longing.
And she said thank you. You are kind.

I told her I liked her smile, the way it
brings out her eyes, how, in their depth,
they speak of loss. And she said, thank
you. You are a gentleman.

I held her hand and hold her I liked her
pale blue veins and her calluses, how
they speak of work and the lessons of
time. And, smiling, she said, thank you,
you are kind, a gentleman.

I brushed her white hair and told her it
shown like a golden crown. She said,
you are kind, a gentleman. You remind
me of my son. I said, you are my mother,
and I am your son. She smiled and said,
you are kind, a gentleman. A kind gentle-
man. You could be my own blood. My son.

“My Own Blood” was written by Benjamin D. Carson, PhD, at Bridgewater State University in Bridgewater, Massachusetts. It was published in the Annals of Internal Medicine, Vol. 173 No. 12, 15 December 2020, p. 1040.

Villanelle in Honor of American Hospitals

There was a time when hospitals were shy.
It wasn’t right to advertise or claim
to be the most compassionate, or any lie.

Without a marketing plan, without a guy
in charge of building the corporation’s name,
there was a time when hospitals were shy.

The major signs were, Quiet, please. A spy
who dug deeply within, would come out dry.
No most compassionate. No other lie.

Then the vicious tide came in and with it high
production medicine and slogans that exclaim,
My hospital —  although quite shy —

has the biggest new machine. That’s why
we’re best! And for those who like to name
compassion their concern, they easily lie

with slogans like, We’re most humane. We try
hardest, we’re better, the best, our fame
for compassion is honest; because we’re shy

and unassuming. And for patients who fly
on the winds of awards, We won our acclaim
with the Gold Medal for Compassion. A lie.

In the cutthroat scene of caring, the sky’s
the limit. The target suffers for the aim.
There was a time when hospitals were shy,
compassionate, and didn’t lie.

Poem by Jack Coulehan, MD, Center for Medical Humanities, Compassionate Care, and Bioethics at Stony Brook University, Stony Brook, New York.

Published in the Annals of Internal Medicine, Vol. 175 No. 2, February 2022, p. 304.

(A “villanelle” is a carefully structured poem. It’s composed of five tercets followed by a quatrain, with two repeating rhymes and two refrains.)

The Family Doctor by Edgar A. Guest

I’ve tried the high-toned specialists, who doctor folks today;
I’ve heard the throat man whisper low “Come on now let us spray”;
I’ve sat in fancy offices and waited long my turn,
And paid for fifteen minutes what it took a week to earn;
But while these scientific men are kindly, one and all,
I miss the good old doctor that my mother used to call.

The old-time family doctor!  Oh, I am sorry that he’s gone,
He ushered us into the world and knew us every one;
He didn’t have to ask a lot of questions, for he knew
Our histories from birth and all the ailments we’d been through.
And though as children small we feared the medicines he’d send,
The old-time family doctor grew to be our dearest friend.

No hour too late, no night too rough for him to heed our call;
He knew exactly where to hang his coat up in the hall;
He knew exactly where to go, which room upstairs to find
The patient he’d been called to see, and saying: “Never mind,
I’ll run up there myself and see what’s causing all the fuss.”
It seems we grew to look and lean on him as one of us.

He had a big and kindly heart, a fine and tender way,
And more than once I’ve wished that I could call him in today.
The specialists are clever men and busy men, I know,
And haven’t time to doctor as they did long years ago;
But some day he may come again, the friend that we can call,
The good old family doctor who will love us one and all.

When thou arte called at anye time…  

When thou arte callde at anye time,
A patient to see:
And doste perceave the cure too grate,
And ponderous for thee:

See that thou laye disdeyne aside,
And pride of thyne owne skyll:
And thinke no shame counsell to take,
But rather wyth good wyll.

Gette one or two expert men,
To help thee in that nede:
And make them partakers wyth thee,
In that worke to procede.

The poem above is from Goodlye Doctrine and Instruction, John Halle, physician (1529 – 1566)

I’m Fine

There’s nothing whatever the matter with me.
I’m just as healthy as I can be,
I have arthritis in both my knees
And when I talk, I talk with a wheeze.
My pulse is weak and my blood is thin,
But I’m awfully well for the shape I’m in.

I think my liver is out of whack
And a terrible pain is in my back,
My hearing is poor, my sight is dim,
Most everything seems to be out of trim,
But I’m awfully well for the shape I’m in.

I have arch supports for both my feet,
Or I wouldn’t be able to go on the street.
Sleeplessness I have night after night,
And in the morning I’m just a sight,
My memory is failing, my head’s in a spin,
I’m peacefully living on aspirin.
But I’m awfully well for the shape I’m in.

The moral is, as this tale we unfold,
That for you and me who are growing old,
It’s better to say, “I’m fine” with a grin
Than to let them know the shape we’re in.

by James H. Motschall, Detroit

Speak of your Science

Speak of your science, but when all is said,
     Patients like a bald and shiny head.
Age lends the graces that are sure to please.
     Folks want their doctors moldy, like their cheese.