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.