Viraj's Weblog

I'm reading another fascinating book called Genetic Rounds about a medical geneticist's experiences. In one chapter, the author describes a mother who comes in with her baby, Jarett, suddenly not wanting to eat any more and whose body is becoming floppy. The discussion steers towards his sibling, Shadow, and her oatmeal breakfast:

"We let her use honey," she replied. "Never more than one or two teaspoons."

"Refined honey?" I asked, again knowing the answer before I asked the question.

"Of course not," the mother replied, repeating that angry look. "The refining process strips the honey of all its natural goodness. We allow only pure, unrefined honey in our house. Everything we put into our bodies is pure and natural. That's why our family has always been so healthy."

I continued: "Ms. Fox, we have to do some tests, but I think Jarrett's going to be okay. I'm pretty sure he's got botulism."

The doctor then imagines a scenario where the older sibling spoonfeeds her little baby brother some honey-laced oatmeal. A possibility. He then goes on:

Like Ms. Fox, most Americans believe that when applied to foods, terms like pure and natural are synonymous with healthy and nutritious. Although this thinking may be accurate for many foods, in the case of honey, eating it in its natural state can lead to serous disease or even death. Because of the environment in which it's produced, unprocessed honey often contains spores of Clostridium botulinum, the bacterium that causes botulism. In most humans, the presence of these spores presents no significant problem: the environment of the stomach and intestinal tracts of older children and adults readily destroys the toxin. But in children under one year of age, infants whose intestinal tracts are still immature, the presence of the toxin, which can survive its stay in the gut unscathed, spells big trouble: after traveling through the gut's lining and entering the bloodstream, the spores are carried throughout the body, where they bind to peripheral nerves and thus prevent them from being able to carry messages from the central nervous system to the muscles. Within hours of ingesting even tiny amounts of contaminated honey, these previously healthy infants become profoundly floppy, lethargic, and placid, unable to smile or cry or suck. If the dose of spores is large enough, every muscle, including those involved in breathing, becomes paralyzed. If not recognized quickly, affected infants may simply stop breathing, suffering respiratory failure so severe that death occurs within minutes.

Think twice about so-called natural foods.

I'm not a big fan of the various medical TV shows, but I do like books written by doctors. Recently I read Something For the Pain, a really good account of one doctor's experiences in the ER.

Here are some quotes I like. This one is about dealing with drunks:

But other drunks, the ones who've gotten in fights or wrecks trying to outrun the cops, are combative, angry, dangerous people. And we all know that the same guy who spits at you through bloody lips and calls you motherfucker will be sober when he sues you if there's a bad outcome in his care. In court, his face will be freshly shaved, his hair carefully combed. He'll be contrite for having been intoxicated. His lawyer will be baffled by the way doctors let him injure himself while he was incapacitated.

To let hostility show is a failure. A failure of boundaries, a failure of self-control. If you counted on human compassion to keep you from smacking one of these guys, you'd be in trouble by the third day on the job. And if you let them get to you to the point where it shows, you have no business being an ER doc.

And he goes on later about making the decision to send to rehab or not:

If I had my way, we'd just total up the costs: rehab, trauma, and medical care. Then tax alcohol sales accordingly. Let the cost of a six-pack or a bottle of wine reflect the true cost to society. Use the money to pay for rehab. But I don't have my way. I'm just the guy who has to ask an alcoholic or a crack addict if he has insurance.

The type of patients in the ER of course vary quite a bit:

The polar symmetry of the two cases struck me, and I hesitated before picking up the next chart. I went to the bathroom, and splashed my face. They lady with the head bleed was going to the ICU, stuck on a respirator, not quite dead, not quite alive. I thought about the teenaged girl with the tiny fetus being squeezed out by the thick fist of her uterus. Of course, this fetus was doomed, just like the woman with the head bleed. The cells may have still been physiologically active, the mitochondria still as busy as the pistons in the engines of the Titanic, the heart still pumping furiously, but futily. For both the forty-three-year-old with the brainful of blood and the tiny fetus, death was only on hold.