Rooting for the Black Stars

I was born in Ghana, became a man in Germany and made a home in the US. However, no matter how far I go, I never forget my origins – Ghana, Africa.

Why?

Because there is a bond that pulls all Africans together and to the continent.

It is a bond forged by pain and suffering, disease and hunger, exploitation and colonialism, tribal strife and inept leaders.

This bond is not static. It waxes and wanes. It grows and sometimes looks like it’s on it’s death bed.

The bond reaches far. It reaches into the hearts of immigrants all around the world – living rooms in the US, England and Australia. It reaches Darfur. It reaches the pirates in Somalia and rival factions in the Congo.

This bond has stood the test of time because it is nurtured. It is nurtured by family and friends, love and charity, the warmth of helping one another and encouragement. We cry with each other and share the joys too.

Perhaps though, its strongest sustenance is hope. The hope of something great. The hope of rising above the impediments that liter our way. The hope that it can be better. The hope that this time, it is different.

Like a clarion call, nothing gets this bond going more than hope.

So when the Black Stars made to the round of 16 as the only African team, there was hope. The hope fed the bond and the bond grew.

For the first time in it’s 80-year history, the FIFA World Cup comes to Africa. It is really symbolic that it is being held in South Africa. By the end of the first round of games, 5 of 6 African teams are out, including the Bafana Bafana of the host nation, South Africa. The Black Stars of Ghana are left standing, alone.  That also by itself is deeply symbolic, then Ghana was the first sub-Saharan nation to win independence from colonial rule.

Before the games started, I am sure all the African teams hoped to make their countries as well as the continent proud.  And all Africans, on the continent and abroad, hoped for the same.  But only one team seems to believe it more than all the others.  The Black Stars. And with their performance so far they have engendered a lot of hope in Ghana and on the continent.

…and are feeding the bond!

I rooted for Ghana in the Word Cup match against the US not because I don’t like the country I live in now. Far from that! I love the US! It’s just that Ghana and the continent of Africa needed this win more.

Many years ago Kwame Nkrumah, Ghana’s first president said “The independence of Ghana is meaningless unless it is linked with the total liberation of Africa.” Back then (and even now), that was a bold statement and many a critic berated him for it. Nkrumah however recognized how important and symbolic the Ghanaian independence was. It had spurned hope and the hope was feeding the bond. He realized that on this continent of pain and suffering, no one country was an island. We need each other. That is why the bond is essential.

That is why the success of the Black Stars is so important.

The continent needs it.  A proof that we can measure up, if just for a few weeks. A proof that if we set our minds and spirit to it, we can achieve success. A proof that given the chance, like the prepared, we seized it. A proof that in spite of wars, disease, hunger, famine and bad leadership, we can rise above it all. The continent needs that spirit, if just for a few weeks. Then that can change  and save lives.

The US has this spirit. It permeates every aspect of life here. This nation is a “Can-Do” nation. Africa could use a dose of that.

That is why I rooted for the Black Stars.

Technology is not always a luxury

Technology has always changed our lives here on earth, sometimes totally disrupting it. Look what DVDs did to VHS. Lately, the progress has been so swift that keeping up is sometimes head spinning. There is also the tendency to look at the most recent developments as luxurious. That is where I tend to differ. The following story might explain why.
After going through the security check at the airport today, I got to my gate and couldn’t find my iphone! My initial thought – I left it at the security check point. It’s 30 min to board! I rushed back to the TSA folks. Well, none of them had seen it. One lady was actually quite helpful – she called my number and rescanned my bags. No phone! I retraced my steps to the gate – no phone! It’s 15 min to boarding time!
Plan B – I whipped out my Macbook Pro, bought a day’s pass for the T-Mobile Hot Spot and logged on to my MobileMe account. There are apps there to locate the iphone, lock it, wipe it clean or send a message to the phone and have it alarm at the same time if one looses it. I tried locating it but the GPS position was vague. So I activated the alarm and sent a message: “I lost this phone. If you find it please bring it to gate ..”
Two minutes later, I see a TSA lady walking up with the phone. I had left it in one of the trays and someone had stacked other trays on top of it. The alarm had alerted them.
A thank you and a hug later, I’m praising Steve Jobs, Apple, technology and the power of the internet.
Who said technology is a luxury?

Ipad and Books

I

I fell in love with the idea of an electronic reader several years ago when I got my first PDA and loaded a few books on it. For an avid reader, it was awesome to be able to read anywhere without carrying the load. I yearned for an e-reader with the size of a real book.
Sony released a reader but the reviews were mixed so I held off. Then came the Kindle. My excitement grew. Just as I was about to pull the trigger, the rumor started that Apple was going to possibly release an e-reader this year. Now being a believer in all things apple, I decided to wait.
Today, it finally happened!
The iPad is here and I cannot wait till I have one in my hands.
I think all these developments spell the doom of the book as we know it and that is not so bad. Sure, the publishing industry will loose jobs. However, think of all the trees that will be saved. You can literally carry your entire library with you (those heavy textbooks!) Revisions to textbooks will be downloaded  – no need for publishing another book. You can buy books on the fly. It might actually simplify getting published. There won’t be stacks of newspapers, journals and magazines to go through. I could go on….
Maybe in a few years we will look back and wonder where all those records, VHS-tapes and books are!

II

Did anyone get the ipad yet?
I played with it for about an hour on Saturday.
Did not get one yet ‘cos am waiting for the 3G version.
Man does it rock or what.
The screen’s resolution is awesome and the processor really fast.
It fits really well in your hands but has some heft to it.
It’s potential will be seen with time.
I don’t think it replaces you laptop but it fills a niche.
Whether it displaces the laptop or not will be seen with future versions.

It is not an iphone without the phone or a big Ipod touch. Get one in your hands and you’ll realize what it is  – a new way of personal computing!

Say you travel a  lot…well, keep that laptop packed away if you want to watch a movie.
Watch it on the ipad with it’s 10 -12 hours of battery life!
Have a presentation?
Get the pages app (the apple equivalent of PowerPoint) and the VGA cable, hook your iPad to the projector and voila!
So you do some photography and need to show your work?
Well, there is an Ipad for you.
You are going on a looo-nnnn-g road trip, say from DC to Miami.
Stick that Ipad in your kid’s hands and there is total silence for 10-12 hours.
Imagine rounding on your patients with an Ipad connected to the hospital database.
You can pull up Xrays, labs, echos etc.
Read a lot? What about your whole library on your iPad.
The cool thing is you can use iBooks from Apple as well as the Kindle app from Amazon to get books.
Wake up in the morning and pull up all the news immediately – WSJ, NYT, the Post.

I think Jobs has a product that is going to revolutionize the laptop/netbook sector.

III

My Sentiments prior to Naturalization

In about a week, I will be sworn in as a US citizen in the courthouse in downtown Lexington. This is the culmination of a 13 yearlong journey.

I should be excited because after all I get to be a citizen of a great nation with endless opportunities. Like an orphan, I should be happy that I have wealthy parents who are going to adopt me.

Unlike the orphan though, I have been able to observe my prospective parents for a number of years and what I see troubles me.

It’s not the economy; it’s not even terrorism, race relationships or gender politics. It is the unwillingness of those in power to understand each other, try to see things the other person’s way. It is almost a total aversion to finding the middle ground.

The political landscape is as contentious as it’s ever been.  Liberal can’t stand conservative. Republicans are at the throat of Democrats. Either you are with us or against us. Whatever the other person believes in is bad for the country. And on and on it goes.

The political process in this country has been turned into a zero sum game. And so at one point or the other, the country is swung to extremes – right or left.

Like a couple on the verge of divorce, the other cannot do anything right.

I am reminded of the movie “War of the Roses” starring Michael Douglas and Kathleen Turner. In what was akin to a divorce death match, we watched the tragedy of 2 people who refused to find a middle ground.

At the moment, I look at the US and can help but think, “Oh God, I am being adopted by the Roses!”

Whatever happened to finding a compromise? Respecting the other point of view? Working together for the good of the country. Sometimes neither the conservative nor liberal view is right. Sometimes, it’s just common sense! However because the political process is seen as a zero-sum game, party affiliations, ambition, power lust and ideology is trumping common sense increasingly!

The malignancy is spreading to the news media, radio talk show hosts even the common American. For the last few months, I have been asking friends and co-workers which party I should vote for after my naturalization. Ask a Democrat and Republican this question simultaneously, stand back and watch them transformed into Gladiators!

The sad bit is, I have grown to love my adoptive parents-to-be. In the time I’ve known them, they have given me a lot of opportunities to make a lot of my life. I’ll love to give back to them but at this rate, I wonder if there will be any recipients.

In most biological systems, the normal is in the middle and the control mechanisms (under healthy conditions) always force the system back to the middle. Disease results when the system escapes the control mechanism and swings to one or the other extreme.

Maybe we need to learn from nature. Maybe what is needed is a third middle-of the –road party that can keep things in focus by forcing the Republicans and Democrats to the middle. Maybe Congress shouldn’t vote on major issues but the people in referenda. Maybe Senators shouldn’t stay in Washington that long. Whatever the case I pray reason wins at the end of the day.

Come Friday, I’ll don my suit and tie and drive to the courthouse to get sworn in. I hope I don’t get home to find my adoptive parents swinging from the chandelier!

God save the USA!

Not that easy

The issue of MJ’s death bothers me not because I was a huge fan. No! I loved his earlier work but I recently realized I don’t have any of his albums! ….and believe me, I collect! It bothers me because it shows physicians behaving badly.

MJ was using several aliases to get narcotics and propofol, and no one noticed or tried an intervention! My only explanation is that, the money all the physicians were getting, bought their silence and compliance! How sad!
Another issue that bothers me is the fact that MJ was using propofol like water! But then there are lots of non-anesthesiologists who demand to use the drug and will probably not appreciate it’s effects.
The practice of anesthesia is a not something one dabbles in. There are peoples’ lives at stake. I know there is a perception out there that “we just put the patient to sleep”! Well, someone just put MJ to sleep, this time eternally!
We as a profession may also have contributed to this perception. True, there is a lot of downtime during certain cases but the probability for loss of life is ever present. Less if you are dealing with healthy, young adults having elective surgery but much higher with the old and very sick.
So we as a profession always stay vigilant. We understand the medications we use, know their effects and appreciate the possible complications. We get to know our patients as well as a physician should and tailor the anesthetic to their needs, the surgical procedure and their general health status. Most important of all, we try TO DO NO HARM! We will not provide an anesthetic for a patient if the anesthetic will endanger his life and the surgery is not life-saving. We will not provide anesthesia at places where we feel the we will not be able to support the patient’s if he needs cardiopulmonary resuscitation.
Of course there are exceptions. If one works in developing countries, one makes do with what they have in equipment and supplies. Then also, there are anesthesia providers who may not be conscientious, but that is the minority.

So it bothers me to see how easily our practice was mimicked to someone’s detriment. We don’t know the details yet but a non-anesthesia provider thought administering propofol in someone’s home without the necessary support and know-how was a piece of cake.
Whoever you are I have news for you – IT AIN’T EASY!

Changing Attitudes towards Healthcare

The country is in the grip of a healthcare debate that is split unfortunately along party lines. No matter what changes are made, there are certain attitudinal changes that the population has to make or we’ll be worse off than before.

Before all that, there is one question for which I cannot find a good answer.

Is healthcare a privilege or a right?

There is nothing in the constitution about that. Now in the Declaration of Independence, we read:

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

That is the closest we come to healthcare being a right. Now prisoners have it good – they receive free healthcare because it is seen as an obligation of the state to them!

If the constitution does not guarantee it, then any argument for or against is just that – an argument!

Congress must then decide whether to pass this as a law or not. If healthcare is a right, all efforts must be made by the government and businesses to ensure that all have adequate access to healthcare. If it is a privilege, that totally changes the stakes. Then, anything the government or businesses want to do is subject to good will and policy.

My feeling is whereas a majority of liberals see healthcare as a right, many conservatives and libertarians see it as a privilege!

As I said earlier, regardless of what happens, the population needs a huge attitudinal change to make any form of healthcare policy work.

1. Prevention is better than cure.

This is an old saying and it has stood the test of time. Yearly checkups, mammograms, staying active, eating healthy are little things that go a long way to keep one healthy and prevent that severe illness and fat bill from the surgeon! It seems to be an anathema these days. It’s get sick, then rush to the ER! Even people with good health insurance are guilty of this. Whatever type of policy is decided on, it should mandate yearly visits to a physician and quarterly visits to a dentist! Europeans tend to be healthier for several reasons – one is the fact that they have very good preventive healthcare.

2. Each is responsible for his/her health.

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Just as I am responsible for my car’s upkeep, so am I responsible for my body, mind and soul. If my car’s engine burns out  because I forgot to fill it with oil, I cannot blame my mechanic if he can’t fix it. The repair is usually so expensive, most people don’t consider replacing the engine. On the other hand, if one eats uncontrollably, drinks and smokes and ends up in the hospital with heart failure, the expectation is that the doctors should fix him to be as good as new! Consider a scenario where each citizen controlled his/her own healthcare dollars. You paid for every procedure, visit, test etc or you bought the insurance to pay for these services. It would make people  more cognizant of the cost of not taking good care of themselves. I believe there should be an added cost for being obese, for smoking  and/or drinking and for not getting yearly checkups. If a young man decides to go riding his motorcycle even though his blood alcohol level is in the stratosphere, any care he subsequently receives after he wrecks his bike should come out of his pocket. In short, be responsible for your health.

3. Don’t forget the baseline.

We live in the age of Viagra, where sex is possible for the older generation. Age does not seem to be much of a hindrance anymore. In 2007 a 60-year-old woman delivered twins in New Jersey. Last year, a 59-year-old delivered triplets in France! We keep pushing the limit. It is no surprise that patients expect nothing short of miracles when they show up in the hospital. Expectations are so high that, it is not uncommon that both doctors and patients seem to forget the baseline. A diabetic who has  uncontrolled blood glucose for years is not going escape unscathed. If he/she shows up with a gangrenous foot, that limb has to be amputated and their mobility is going to be compromised. This reduces physical activity and increases the already high chances for morbidity. Don’t forget the baseline!  It is sad to loose patients to cancer but terminal cancer is in most cases, well, terminal. Heroics just lead to even greater disappointment and pain. Don’t forget the baseline!

4. Let there be Dignity in Death.

Maybe it’s cultural, maybe it’s the wish not to loose a loved one but millions of dollars are spent every year in the care of patients who should have been left alone to die in dignity. It may be that the patient is too old and frail to survive a surgical procedure or that a particular test won’t add anything to the attempts to save a loved one. Time and time again, family members insist on having everything done. They are not alone in this. Physicians are apt to give them false hope. There is the need among some doctors,  to look like the knight in shinning armor who swooped in and saved the day. Then is the small matter of litigation attorneys who circle like buzzards. It is much more dignified to let a death occur with family members (after the requisite goodbyes) than alone in some hospital room with the body flayed open and expectations crushed! I agree, death can strike anytime but if one has the chance to prepare for it, isn’t that a bonus for the family and loved ones? Lets accept death when it’s inevitable  – we’ll afford family members and patients dying in dignity and save countless healthcare dollars.

Healthcare resources are not infinite. Lets use what we have wisely!

MJ and Propofol

Since MJ died, anytime I give Monitored Anesthesia Care with propofol, I ask myself, “What the hell was he thinking?”

That drugs were involved in MJ’s death, seem to get more certain by the day.
Here you have a man with a long history of insomnia who allegedly was trying to get his hands on propofol (Diprivan) – one of the most powerful anesthetics available!
It is being reported, propofol was found in the house where he died.

And now his cardiologist is being investigated for manslaughter!

Propofol must be given by a medical practitioner who understands how the drug works (a lot of doctors and nurses don’t),
can support the airway and if need be place the patient on a respirator and can support the heart and maintain the blood pressure.
It needs to be given at a place where equipment are present for such support.
Why?
Because this drug not only puts you to sleep, it can also stop your breathing and drop your blood pressure so low
that there is no blood being pumped around effectively! You see, if you stop breathing, no oxygen gets to the body.
If the brain cells don’t get oxygen in 3-5 minutes,…….

It is usually given as the drug to knock you out for an operation.
If however you are getting, say, a colonoscopy ,
one could run propofol as an infusion for the length of the procedure.
At that low dose, the patient is asleep, breaths by himself and wakes up once  the infusion is turned off.
However, there is a fine line between the patient breathing by himself and not breathing.
That is why the medical provider needs to be by the patient the whole time!

So back to MJ.
Was he being given this drug by the cardiologist friend?
If he was administering this drug to MJ, he should<strong> neve</strong>r have left the bedside.
Did he have equipment, the medications and oxygen to support him if need be?
How did he get his hands on the drug?
A doctor or doctors and pharmacists facilitated this and if that is so, they are in a ton of trouble.
If he was taking other drugs that can suppress your breathing – Demerol, Oxycontin etc and you add propofol to it,
it is like pouring gasoline on fire!

A sad fact about the practice of medicine – for the right amount, you’ll find a doctor to do anything!

Marriage and Kids

Many years ago, to supplement my income, I worked part-time as a home health caregiver.  One of the patients I took care of was a 93-year-old woman who never married and had no kids. She was once a very successful attorney but when I met her, she was a cold, bitter old woman who was dying alone. She had a nephew who visited every blue moon.

In sharp contrast to that was another one of my clients who was also in her 90’s but had children. I provided care on those days that her kids could not. She was loved and cared for and was one pleasant person.

I also had a couple who had been married for over 50 years. The man was  recovering from a stroke and the wife had her hands. However, the love that they shared was so evident and palpable, it was always a pleasure to walk into that home.

During this period, I got to thinking about the differences and pondered the essence of family. I wondered about the importance of marriage and children and came to a realization which has really impacted me since.

Marriage and kids are like a retirement plan. You pay into it so you can reap the benefits later. The importance of marriage and children is seen when one is older. Just as the investments in your retirement plan can go south, so can a marriage. Children can also turn out to be disappointments. However, the fear of failing should not hold one back.

Must one wait till one is 90 to see the importance of family? I cannot recount the number of times I have seen patients show up for major surgery in the hospital with no family – maybe a distant nephew or cousin miles away. There is a certain sadness that hangs about them in these times, especially evident when you see other families with tons of family members. Maybe marriage and kids are important at times of sickness too.

I am married now with 2 little kids and sometimes it feels like an unbearable chore taking care of them. Keeping a marriage going is no walk in the park either. In those times, I think of my clients back then and the lonely patients and keep going with a smile on my face.