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“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Tuesday, March 22, 2005
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    Thanks to Ilyka for the link to this CT picture. This study is nine years old and is apparently the only brain image obtained on Ms. Schiavo. I reiterate: get me more studies. I'd like to see the PET and MRI. The cortex looks godawful to my reading, but then I'm not a radiologist or neurologist. And yes, there is cortex present - I expected there to be, actually; I don't think one gets complete cortex liquefaction except in full-on brain death, and it's clinically obvious that this is not a case of brain death. How well is the cortex functioning, is my question. (And, for the record, it is completely medically incorrect to speak of "liquefied brain" or a "bag of water" or "brainstem only" based on this CT, and I chastise the MD's who did so in court. I still think it's highly likely that she is in PVS, and I don't expect her ever to improve, but for God's sake, people, let us be accurate.)

    University of Miami Ethics Dept. has more info on the case here.

    I suddenly remembered a book on bioethics and euthanasia that I once read that I can highly recommend - Dancing with Mr. D, by Bert Keizer. The writer is a physician in the Netherlands, works in a long-term care facility, and has been involved in several cases of euthanasia (with full patient consent, I hasten to add). For the record, I loathe Jack Kevorkian and I would not be in favor of legalizing euthanasia, but this book is excellent. His patients are not just targets to be knocked off. He has well-established relationships with them and in some cases becomes close to their families as well. I think it's out of print, so try the library. It's difficult reading but it's very good.

    Now. Change of subject. Email from V. regarding a patient she saw today:

    There ain't nuttin' like examining a happy boy for a hernia.

    OK, sir, you can pull up your drawers - NOW!!

    And it didn't help that he came in for a nasal cellulitis. I felt like I was groping Rudolph!!



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