Shortie: What about the Pigs?

Above: The American Pig's POV (Part 1, Airdate 4/27/2009)

I COME TO YOU TONIGHT FROM THE
ASSOCIATED ASSOCIATION OF AMERICAN PIGS.

A few weeks ago, I posted a clip featuring Craig Ferguson's serious side on his late night talk show (The Late Late Show) on CBS. Here, I've put a few clips of how this late show host can make a serious issue quite funny by shining a different light upon the subject. Ferguson brings up an interesting point of view of the H1N1 Influenza A Virus (aka the Swine Flu)... Have we really thought about the pigs? How do they feel? What is their point of view?

Well, Craig will make their case best, so enough from me, and watch the following 3 clips (above / below) from The Late Late Show with Craig Ferguson (which airs at 12:35 PM EST on your local CBS affiliate).

BTW - To those new to the show, "The Scottish Conan Guy" refers to Mr. Ferguson himself.

Above: The American Pig's POV (Part 2, Airdate 4/28/2009)

Above: Manfred, The ProfessNor of Dangerous Flus (Airdate 5/4/2009)

All clips above are (c)2009 CBS and Worldwide Pants Productions.

Retrospective: The Flight of Hell

Above: A McDonald's. In America? Nope.

Being at a Caribbean Medical School seems awesome in many aspects: you get good weather, get to taste a different side of culture, and it is an experience of a lifetime. However, last week marked the one year anniversary of an event that was best put as a Hall & Oates song title:

SO CLOSE (YET SO FAR AWAY).

See, the one huge disadvantage about going to school in the Caribbean was moving my life away from the States and taking it someplace else for such a short time. I had to take my life, and restart it over in the Atlantic. But I amazed myself on how much I actually accumulated in terms of experiences and physical things. Talk about baggage... and I only had 70 lbs (sometimes 50 lbs) of it to carry it back home.

Last year, when I was heading home after my fourth semester at Ross, I had my biggest flight nightmare ever. My itinerary had me leaving Ross on the 19th of December in the morning, and arriving late at night on the same day. I was definitely grateful to have a schedule without a layover... unfortunately, one unexpectedly came my way.

PRELUDE:
When flying to Dominica, there are two major options: LIAT and American Airlines. The advantages of flying American Airlines is one layover (24hr) in San Juan and a direct flight from Dominica to San Juan, but the disadvantage is that it was a hefty ($1100 two-way) trip at the time. Utilizing LIAT, you could save $200-$300 depending on the flight connection combinations, but those combinations could result in disastrous transfer times of less than 60 minutes at unfamiliar Caribbean airports. Utilizing my budget mind, I had booked my flight to Dominica that semester on LIAT. I had survived 7 flights, over the past 4 semesters, utilizing my budget itineraries and a handful of crammed transfers.

I guess eight is a charm.

DECEMBER 19, 2008:
Posting my 11 AM flight out of Dominica from the small, but nicely refurbished Melville Hall airport in Dominica, we noticed that our LIAT Airplane was an hour late. Fortunately, during that time I had caught up with my friends Jo and Jemini in the waiting room. They also had similar flight connections with me, as they both were heading back to Chicago. The caveat was that Jo had an international flight to Asia the morning after she arrived. As soon as the plane arrived, we were engulfed with constant promises (and apologies) from LIAT, but I really started to feel unsure about the rest of my itinerary, with a short transfer time in Antigua, I thought everything had screwed up.

Fortunately, we made it. Home free? Not exactly. When I was going through the transfer desk in Antigua, I noticed that my baggage tag copy did not have my name on it. It was someone elses. Because of this tag mishap, the LIAT staff sent me through customs (which was a much longer process). Being the talker that I was, I started talking to people in line about my issue, and I started to talk to someone else who had the same problem happen to him. The name on his tag: mine... and my tag: his. With a jump for joy, I got out of the customs line and went back to transfer after we both gave each other our respective tags. It was then that I had a quick hot dog with one my fellow Rossies, John (which I do truly recommend from the Big Banana Food Bar in the waiting area), and soon Jo, Jemini and I we were ready to board the flight to our next stop, St. Maarten.

When we reached St. Maarten, I ended up staying behind at the luggage carousel to pick up my baggage for my next flight (due to my switching of airlines, I had to re check-in). After a long wait where my patience was tested, my bag did not appear on the belt. I had to spend time to report it. Just great, more hassle, I thought.

At that point, time was of the essence, so I ran through customs and right to the check-in desk... My next flight was a U.S. Airways scheduled flight for Charlotte, N.C. If you imagine the scene in the original Home Alone where the McCallister family is running to catch a flight, you're imagining the way we were running to catch our next flight, with 45 minutes on the clock. As soon as I got to the desk, they said that they had their policy for international flights is that 60 minutes before boarding check-in stops. We pleaded to get on the plane, as the plane was still at the dock, but unfortunately that was a no-go.

Jo, Jemini, and I decided to wave the flag that night, and U.S. airways was happy to reschedule our remaining flights to the next day (making me on target for arriving the next day). We ended up gathering another follower to our "screwed over" group, George (who was heading for Detroit). We ended up staying at a hotel and splitting the bill in St. Maarten. It was good though that it was a touristy area, and everything was close to the airport (including this grand Steakhouse called Ranchero, which we dined at for dinner). After splurging on McDonald's (because haven't had any in a while), we decided to rest before heading home the next day.

DECEMBER 20, 2008:
After grabbing a quick breakfast at the Mickey D's, we scheduled our Taxi for the airport. Jo had left our group earlier that morning, as during the previous night she spent time contacting her husband in America to schedule a flight for her on another airline. Our midday flights out of St. Maarten would make her tardy for her international schedule.

Jemini, George, and I made it to the check in desk to find out that our new schedule combination was not reserved, so we ended up going to the reservation desk to hassle our way to get our way back home today. We were soon rescheduled on another flight just an hour later, also to Charlotte, so we were relieved. Once again... Check-in... customs... wait. When Jemini and I caught ourselves at the gate, we congratulated each other for making it through finally.

We jinxed ourselves. The PA soon announced: "U.S. Airways flight XXXX has just been canceled due to mechanical issues with the airplane. Please come to the desk at the gate to reschedule your flight."

Jemini and I were in disbelief. We rushed up to the desk, and soon were about 40 people back in line. I reached for my cell phone... At this point, I thought that not even roaming charges could keep me from arriving home. I kept dialing the U.S. Airways number, but my phone was not only out of batteries, but kept disconnecting from the signal. It was fortunate that my cell phone could plug into a laptop and charge off of it. And that's exactly what I did (see below). I kept calling, but due to the holding time for an "available operator", my laptop battery had been burned just about to zero. I just had enough time to put in my schedule change (which was for a flight about 3 hours later to Charlotte), but my phone died when I was about to schedule in Jemini's and George's.

I ended up to be the only member of our group that day to land in America, as Jemini and George ended up taking a voucher from U.S. Airways to stay in St. Marteen. Getting out of Charlotte-Douglas International Airport into 50 degree temps and getting a little soggy from the pouring rain was actually an amazing feeling (especially since U.S. Airways picked up the tab), so I boarded my shuttle bus to head back to the Four Seasons hotel they had me post up in for the night. Not bad for a free night, I'd say.

My final flight was at 9 AM tomorrow. I prayed that this escapade would finally run smoothly that night.

Above: The cell phone laptop battery concoction I put together.

DECEMBER 21, 2008:
Awakening from my amazing sleep at a Four Seasons hotel in Charlotte, I took the earliest airport shuttle to the airport. Drowsy and tired, I was welcomed by long lines a the U.S. airways check in booth, and with 2 hours remaining until my flight, this sight was not one for sore eyes. However, things moved along smoothly, and after checking in, security and finding my gate were easy as pie.

I arrived in Chicago, IL at 9-10 AM that day, on time for the flight I was scheduled on, but almost a whopping 36 hours and 2 layovers later than my itinerary had originally proposed.

I visited the U.S. Airways desk at Chicago O'hare hoping my bags had made it... but they didn't. The U.S. Airways representative said that they would bring my bag to my home soon. About a day later, I got the call that it was here. However, by the time the delivery guy appeared at my door, I looked down and a small, blue bag was looking at me. It was unlikely some magical shrinking machine came to life (like the one from that Rick Moranis movie) and shrunk my big rectangular roller suitcase, so I had to come up with the other logical conclusion: this the bag of the man who got his baggage tag switched in Dominica with mine. I ended up sending the bag back to the delivery man (he seemed rather confused, as he seemlingly had rarely heard of this type of issue before).

Although I made it home, my flight nightmares had not ended. Now, I knew that my baggage tag was also switched onto the wrong baggage (talk about wreckless baggage tag placement by the LIAT staff in Dominica), and I needed to find it to study for my big post-break exam (the Comp). To put a long story short, after several calls to U.S. Airways about my baggage, I got in contact with Patrick, the man who I had my bag switched with (fortunately he too was also a Ross student). He told me that my bag was nowhere near Chicago... it had made it to L.A., and on a different airline. After a few more days of intense phone calls, my bag finally... and I mean finally, made it home.

I was glad to be in the right place for the holidays, at home. I was also fortunate enough to have American Airlines tickets to school up my sleeve for next semester.

THE AHA MOMENT:
To those of you to fall upon this long blog entry, and are just about to enter Ross or another medical school in the Caribbean, here's my tip for securing flights:

1. It's okay to have a lay over.
Make sure you select an area that you feel secure in laying over, and reserve a hotel ahead of time, if you are flying during a peak period (i.e. when everybody else is traveling to/from school).

2. Get your tickets early.
For some instances, its best to start knowing what you're going to be doing next semester and getting your tickets once you arrive at school. For Ross students, this could mean securing the limited amount of flights on American Airlines.

3. Make sure your baggage is tagged appropriately.
Always ask to see your bag tagged before you leave the counter.

4. Check all baggage restrictions for all your airlines.
At the point of time I wrote this entry, baggage policies are accepted on the first airline you board until you exit an airport. If you switch airlines after a layover, your baggage restrictions reset to the airline you board the next day (meaning this is the limiting factor). The last thing you want is a hassle of ridding your bag of meaningful things just so you can make it to your next flight... and I know of people who have ended up doing that.

5. Do your research.
Know the check-in and customs policies at each of your connecting airports. it would have made me think twice about my itinerary sending me through St. Maarten with such a short connection time.

Yes, some things do turn out to be the airlines' fault, but as a good doctor would say, prevention can help from a horror trip like mine from ever happening to you. Stress should end when a semester is over, not begin.

Holes in the Net

Above: The hustle and bustle of Interstate 75/85 in Atlanta, aka the "Downtown Connector." Courtesy Wikipedia.

"ATLANTA CAN'T LIVE
WITHOUT GRADY."
From the Grady Health System main page.

Although health care is a quintessential part of society today, the 2008-09 recession has shown that money could still be more powerful. One example: Grady Memorial Hospital of Atlanta was about to be closed in 2008 after gathering $53 million deficit, produced due to the hospital's dedication to taking care of those disadvantaged for health care in the region. However, with the following statistics showing how crucial the hospital is to the area, it would seem that closing should have not been an option:

1. It takes in 850,000 outpatients and 30,000 inpatients each year.
2. It has Georgia's only Poison Control Center.
3. It is the area's only Level 1 Trauma Center
4. It is Atlanta's main safety-net hospital.
5. Its network includes Grady Memorial Hospital and 9 more area community clinics.

In the New England Journal of Medicine, Grady Memorial Hospital was featured in an article about the holes appearing America's current safety-net.

Okay, pause for a second.

For those of you unfamiliar with the concept, a safety-net hospital is a hospital that serves a significant amount of low-income, uninsured, and disadvantaged populations. One thing that really surprised me about the definition of a Safety Net, is that ownership (public or private), isn't really the factor, but other determinants, from philosophy (e.g. having an "open-door" policy for care) to usage (i.e. proportion of incoming patients with low-income or proportion of people who utilize medicare). Most of these hospitals are eligible for what they call Disproportionate Share Hospital (DSH) payments from the government, which aid the hospitals for the costs of providing uncompensated care to those uninsured or under insured.

Whew.

Fortunately, with private donations and grants, the hospital was able to stay for the most part, open. The dialysis clinic at Grady was forced to close. Grady has done much for its patients to assign them to temporarily set them up with other clinics and to help ease transitions for those patients struggling. Although the damage to the hospital itself was minimized, there were patients that were still critically affected by the situation.

Closer to my neck of the woods, the main Safety Net Hospital of Chicago, John H. Stroger, Jr. Hospital of Cook County, is a refuge for those without health insurance benefits. According to a September MSNBC story, these disadvantaged patients are very happy to have some place to go. However, recent health care reform may reduce DSH payments to hospitals such as Grady and Stroger, potentially weakening important links in our health care system, leading to reduced coverage and maybe closure for some institutions. We've seen already how financially tight things are at Grady, for all I know there could be another handful of hospitals that are teeter-tottering in the same financial situation.

To me, the idea of losing funding for these hospitals could be disastrous. Personally, I think that its dangerous to cut funding from these hospitals, as health care for more than the low income could be affected. One hypothetical situation that I thought of is if these high capacity hospitals are closed, where else will these people go? Potentially to other hospitals that are not prepared for the added patients, stressing the rest of our health network in America. A unseen domino effect might be on the horizon.

I personally think that there are other options that are not being looked over, such as tort reform (e.g. protecting doctors from suits, so we can work more efficiently without having to worry about our backs) and many inconsistencies and inefficient ways that medicare and medicaid are being provided. Sometimes I think that the government is attempting to do so much to health care right now that if something goes wrong, we won't be able to figure out what made it go wrong, due to the extreme complexity of our health care system.

Like I said a couple of months ago: I'm all for reforming the system, but we need to be careful and think about all the potential consequences of our decisions in the long term. It concerns me that things that may appear to be good for us now might not be good for the next generation.

Sources:
1. Forum on Displaced Grady Dialysis Patients Held. Atlanta Progressive news. December 7, 2009.
2. The Grady Health System main page.
3. Redlener, I. and Grant R. America's Safety Net and Health Care Reform - What Lies Ahead? The New England Journal of Medicine. December 3, 2009: 2201-2204.
4. Will safety net hospitals survive health reform? MSNBC / AP. September 8, 2009.
5. What is a safety net hospital? National Association of Public Hospitals and Health Systems.

Now, Really?

Above: JD (Zach Braff) and Lucy (Kerry Bishe) are the leads for their respective versions of Scrubs.

“MEDICINE IS A DEAD CAREER.”
Dr. Cox during an orientation to his new Medical School class.

After having two years of medical school under my belt, it is interesting to see ways that Hollywood portrays the medical profession (with some series much more interest than others). Hence, I was willing to plop myself down in front of the television with the recent release of Season 9 of Scrubs (aka Scrubs 2.0) taking place at medical school. With all the crazy stories that we’ve had after two years in Dominica, I’m not amazed they haven’t targeted one of us Caribbean medical schools yet for a screenplay (perhaps an idea to the creator of Scrubs, Bill Lawrence).

As I was watching J.D. pass on his 8 years of experience in the medical profession, now as a professor, onto Lucy – who inherits the next chapter in the Scrubs series – I saw a great example of one of the realities of a medical education: Although one may know every single aspect of the plethora of scientific findings made over centuries, without real life knowledge passed down through the medical hierarchy – from senior surgeon down to medical student – one cannot really survive in the medical world.

That same night, I took a few moments to gleam over a couple episodes of the first season of Scrubs – before the humor got so into a niche that the next time I flipped on the show, I thought J.D. (Zach Braff) and Turk (Donald Faison) had "hooked up "– and watching an “innocent” J.D. walk into Sacred Heart Hospital (along with an innocent Lucy in Season 9) for the first time really reminded me of… well, me.

And its for one big reason: We all go in thinking we’re there to help people, but only to initially discover there's so many obstacles to get to a good outcome sometimes: including red tape, insurance and malpractice claims, and not to mention patients who won't follow every piece of advice we give. Scrubs isn't a 100% realistic show, but that doesn't mean that non-compliant drug addicts, bitchy doctors, and crazy colleagues aren't a part of a typical medical student's / resident's life. As for this season's Scrubs, I think they're covering some very important lessons, and definitely with laughs along the way, I want to see how our new narrator Lucy develops, and what she learns as J.D. passes on the torch.

Oh wait... I just thought of another reason Lucy, J.D. and I are similar: we all think blue sky. I can bet my bucks that we all disagree with Dr. Cox: medicine is not exactly dead... We'd prefer to think that parts of it need a little tweaking.