MRIs as screening tools

I have really come to enjoy the world of blogs! I was doing a little catch-up reading today of several that I enjoy, and I found a disturbing bit of news on one of my favorites, http://thecountrydocreport.wordpress.com/2008/11/23/today-show-plugs-mri-screening-for-brain-tumors/. This show was aired on 11/17. I don't watch the Today Show, as I tend to get my news online and on NPR, and somehow I missed this story.

Briefly, it appears that there is a push to use MRIs as a screening tool for brain tumors. As the Country Doc points out in his excellent discussion, there are no data supporting this type of use of MRIs. I'm just appalled at the Today Show for airing such a piece! I realize that the mobile MRI traveling around NYC was only charging $169, but that is not a realistic price, just like no-money down house financing...

Our health care system is in shambles; we outspend every other country in the world, yet we have worse outcomes than most 1st-world nations. It seems that finally we may get universal health care, but if it is going to work, we need to make some difficult choices. Fortunately, we have established a few evidence-based guidelines we can use to help make decisions, but we need to use them. There are also studies from foreign countries we can use to help guide us. Please don't get me wrong, I am grateful to live in one of the most scientifically innovative and creative societies! And I do worry that if/when we cut health care spending, some of it will come out of research funding. However, we need to take responsibility and use our limited funds wisely. Perhaps if we place more emphasis on preventive care, we'll avoid some of the huge costs of preventable diseases. I know I'm not saying anything remotely new, but I feel strongly that our American mindset needs to change; in other words, we may not be able to save every life regardless of cost, we may not be able to give every single citizen access to the newest, most expensive, and not necessarily the best drugs! As a medical provider, I share in this responsibility, and it is a heavy burden. I went into the medical field because I like to fix things, make people better, but I too need to accept that there are limits.

The Desert

I grew up on the East Coast, and I always loved all the trees, all the green, the lush green lawns. I also remember driving from Flagstaff down to Tucson for the first time, thinking how brown and dreary the desert was. Shortly after arriving in Tucson, I visited the botanical gardens and started my education about the desert. Slowly, I began to learn the names of desert plants, such as creosote, mesquite, and ocotillo. The more I learned, the more variety I started to see in the landscape. Where I'm going with this is that I have come to love the desert and see more colors in it than in the green landscapes of the east.

Last year, on Christmas Eve, we camped out on the dunes of White Sands National Monument, under a full moon. We were the only ones camped in the park and were utterly alone in the vast expanse of the stunning gypsum sand dunes. The silence was deafening, the light was breathtaking, and the air was sharp. Although we were quite cold, it was one of the most incredible camping experiences I have ever had!

I decided to look up some poetry about the desert to share with my readers, hopefully conveying some of it's beauty and loneliness and power. Enjoy!

The desert has many teachings

In the desert,
Turn toward emptiness,
Fleeing the self.

Stand alone,
Ask no one's help,
And your being will be quiet,
Free from the bondage of things.

This is an excerpt from a poem is by Mechthild of Magdeburg, a German mystic from the 13th century. Although she did not live in a desert, and the desert in this poem is likely not a physical desert, I feel that these first two stanzas of this poem captures the spirit of being in a desert.

The following is a poem by Lord Byron which appealed to me as well!

Oh that the desert were my dwelling place,

With only one fair spirit for my minster.

That I might forget the human race,

And hating no one, love her only.

This next poem is by Bernard Howe, a poet who lives in Tucson, which is part of the Sonoran desert, quite different from the Chihuahuan desert where I live. It is lighthearted and quite descriptive of the terrain.

Way out west where the prickly pear grows,

lived an old man who only had 9 toes.

Seems a javelina wanted one for lunch,

when it got the chance it took it with a munch.

Life in the desert is different from the city,

for out in the sonoran no one gives you pity.

With the hot sun beating down upon your head

if you run out of water the next thing is your dead.

The snakes are hiding quietly amongst the desert rocks,

if your not to careful one may bite you through your socks.

And if that ain't enough there's scorpions that will sting,

then there's monsoon storms that always come in spring.

Yes that old sonoran desert that runs through the southwest,

is home for me old sam the old man thats possessed.

The desert cactus that flowers are pretty to your view,

but if you step on one, the thorn goes through your shoe.

It seems everything grows wild within this here desert,

along with the critters that make sure you stay alert.

But there is still beauty in all of this here land,

like the setting of the sun which is always grand.

Many colored wild flowers cover everything in spring,

the splendor of a sunset which makes your heart just sing.

Yes mother nature protects all that she has made,

and all that lives out here knows where to find the shade.

Yes the desert sage may dry up and become a tumbleweed,

and with a dust devil they can pick up lots of speed.

The road runner runs along like the quail with her young,

and our Native American brothers speak another tongue.

All these things live in harmony along with mother earth,

I hope nothing destroys this for it is beyond any worth.

God made this desert land with all its natural beauty

and we must protect its balance because it is our duty.

The final poem is one that I wrote. Now I put it at the end, with the hopes that my readers don't actually get to it...Poetry is not a strength of mine, and I've probably broken every rule/convention in writing it. It is about White Sands National Monument.

Vast and undulating
Glistening and rippled
Interrupted by lone yucca

The power is overwhelming
The silence roars

I am alone in the vastness
My footsteps are my only past
Adjacent dunes are my only future

Connections

I've been a bit slack with blogging through the holiday, enjoying a break from work, then coming back to a flood of phlegm!! You know how it is when you take off of work, you end up paying for it in spades.

I live in a fairly small town in a state that is not known for it's good schools. I myself was fortunate enough to grow up in areas with excellent public schools, and this was primarily due to my parents' choices of where to live; they sacrificed a lot for us to be able to go to good schools. I also enjoyed school and did pretty well.

Sadly, it seems that a lot of the high school teenagers here are not particularly ambitious and don't work very hard. For example, the first year we lived here, there was no valedictorian in the graduating class because no one had fulfilled the requirement of taking at least three honors classes in four years of school. This was stunning to hear. However, this week I had the pleasure of interacting with a junior who I could identify with a little better. She loves school, is taking the hardest classes she can possible take, and wants to go to college. She hates to miss school, and she feels stressed when she gets behind. It was just such a pleasure to chat with her about school and AP classes! When I saw her a couple of days ago, I felt like we really connected. Today, she came in to see me for some mental health issues, and she was really able to articulate her feelings, and so I felt like I could help her in a way that I can't the teens who simply grunt!

Seeing her reminded me that I do enjoy working with teenagers, I love the conversations, I like listening to their thought processes, I like hearing about their plans for the future. Sometimes I lose sight of this when I have less meaningful interactions, but I was pleasantly reminded today with my last patient of the day.