Rick Kempa lives in Rock Springs, Wyoming, where he directs the Honors Program at Western Wyoming College. "The Rudeness," first published in the Bellevue Literary Review, dates from a time a few years ago when his mother, who is afflicted with Alzheimer's, lived with his family. His work has appeared in the journals ARS MEDICA and The Healing Muse, in the anthology Beyond Forgetting: Poetry and Prose About Alzheimer's Disease (Kent State University, 2009), and in his poetry collection Keeping the Quiet (Bellowing Ark Press, 2008).
**
THE RUDENESS
Late in the evening, I hear her shout, "Now, that's a little rude, you know."
I look into her room. She is lying on her back, one hand raised above her head, fingers plucking and pruning the air. Her eyes are tightly closed, mouth working.
"Mom, can I settle you in?" I whisper.
She twists her body towards me, eyes still shut, flings out her hand, grasps a handful of my hair, lets go.
"Mom, what are you doing?"
"Oh, I'm reaching for a word."
"What word, Mom? Can you tell me?"
She grimaces. "Oh, you know ... those words ... I don't know."
Deftly, she probes the air, arm bobbing and weaving like a swan's neck. Sometimes her fingers curl into a loose fist around a space. She holds whatever she has found there, then rotates her wrist outward, unfurls the fist, pushes the platform of her palm skyward, coaxing it to fly, be gone - and resumes her searching.
And I am thinking that I do know, Mom. I too have had the best of them torn from my grasp by a whirlwind. I have chased their flitting shadows across the lawn, walked all afternoon, head hung, without them. I have carried their meanings in my pockets, flashed them at strangers - hey, buddy, have you seen ...? I have sat timidly at tables, seven blanks in the Scrabble rack of my brain, and stared into the faces of nameless friends. At night, I open my mouth - leap of faith! - trusting they will dart home, prodigal hummingbirds. Others arrive instead, grackles and starlings, a sorry tribe of stand-ins and has-beens.
"It doesn't matter," I console her. "These other words will serve us well, or if we arrive at a place where there are none, the silence will not be so bad." But I know now, watching the fist of her mind clenching, unclenching around the space that once held words - the very best, the most perfect words - how wrong I am. This is the rudeness, this is what's unacceptable: that at first they were so gracious, so generous with themselves, and are now so spare.
- Rick Kempa
Thursday, 10 December 2009
Thursday, 3 December 2009
Healthy skepticism and improving health communication
In yesterday morning's hearing before the House of Representatives Energy and Commerce subcommittee on health, Dr. Ned Calonge and Dr. Diana Petitti, Chair and Vice Chair of the U.S. Preventive Services Task Force, admitted to a "failure in communication" of the Task Force's recently updated recommendations on breast cancer screening when it came to women ages 40 to 49 years. There was, and remains, absolutely nothing wrong with the science of the recommendations, which included advising against clinicians teaching self-breast examinations due to a lack of benefits (a conclusion also reached by the highly respected Cochrane Collaboration more than two years ago) and having mammograms performed every two years rather than every year, as is common practice in the U.S.
In an attempt to correct the widespread perception that the USPSTF had recommended against ALL women under the age of 50 having mammograms for screening purposes, the breast cancer screening page on the USPSTF website now includes a direct quotation from Dr. Petitti: "So, what does this mean if you are a woman in your 40s? You should talk to your doctor and make an informed decision about whether a mammography is right for you based on your family history, general health, and personal values." Although adding this quotation was too late to quell the political firestorm that erupted in the wake of the new recommendation (which was only pushed out of the headlines by the debate over appropriate troop levels in the war in Afghanistan), it is an attempt to translate what had been a statement directed at clinicians for patients and their caregivers.
In an earlier post on this blog, I mentioned how researchers at the Dartmouth Institute of Health Policy and Clinical Practice had developed a book meant to assist patients with understanding health statistics and using data to estimate their personal risk of contracting a disease or experiencing a disease-related event. In an editorial in this week's Journal of the National Cancer Institute, Dr. Woloshin and Dr. Schwartz (writing prior to the release of the USPSTF breast cancer screening recommendations) argue that while headline-seeking journalists are to blame for some of the exaggeration of health risks and benefits, researchers, medical journals, and academic press offices are also responsible for this common phenomenon:
Important elements that journalists (and, really, all readers) need are sometimes missing or hard to find in the published articles. For example, in six high-profile journals, two-thirds of articles reporting ratio measures failed to provide the underlying absolute risks in the abstract. ... Nor are study limitations routinely highlighted in journal abstracts ... and sometimes are missing from articles altogether. ... Only half of the press releases reporting on differences between study groups provided absolute risks; less than one-quarter noted any study limitation. ... Can we really expect journalists to do a better job than the medical journals, researchers, or their university public relations offices?
Studies have shown that women consistently overestimate their personal risk of breast cancer diagnosis, breast cancer death, and the benefits obtained from screening mammography. For the record, a typical 40 year-old woman has 1.4% chance of being diagnosed with breast cancer over the next 10 years, and a 0.33% chance of dying from it (or 1 in 300). Regular screening mammograms reduce the probability of dying of breast cancer in a 40 year-old woman by 0.05%, to 0.28% (or 1 in 357), at the cost of a 1 in 3 chance of experiencing a false alarm due to screening. Whether or not the cost is worth the benefit lies in the eye of the beholder - which is why, despite all of the unnecessary hysteria, the USPSTF got it right.
In an attempt to correct the widespread perception that the USPSTF had recommended against ALL women under the age of 50 having mammograms for screening purposes, the breast cancer screening page on the USPSTF website now includes a direct quotation from Dr. Petitti: "So, what does this mean if you are a woman in your 40s? You should talk to your doctor and make an informed decision about whether a mammography is right for you based on your family history, general health, and personal values." Although adding this quotation was too late to quell the political firestorm that erupted in the wake of the new recommendation (which was only pushed out of the headlines by the debate over appropriate troop levels in the war in Afghanistan), it is an attempt to translate what had been a statement directed at clinicians for patients and their caregivers.
In an earlier post on this blog, I mentioned how researchers at the Dartmouth Institute of Health Policy and Clinical Practice had developed a book meant to assist patients with understanding health statistics and using data to estimate their personal risk of contracting a disease or experiencing a disease-related event. In an editorial in this week's Journal of the National Cancer Institute, Dr. Woloshin and Dr. Schwartz (writing prior to the release of the USPSTF breast cancer screening recommendations) argue that while headline-seeking journalists are to blame for some of the exaggeration of health risks and benefits, researchers, medical journals, and academic press offices are also responsible for this common phenomenon:
Important elements that journalists (and, really, all readers) need are sometimes missing or hard to find in the published articles. For example, in six high-profile journals, two-thirds of articles reporting ratio measures failed to provide the underlying absolute risks in the abstract. ... Nor are study limitations routinely highlighted in journal abstracts ... and sometimes are missing from articles altogether. ... Only half of the press releases reporting on differences between study groups provided absolute risks; less than one-quarter noted any study limitation. ... Can we really expect journalists to do a better job than the medical journals, researchers, or their university public relations offices?
Studies have shown that women consistently overestimate their personal risk of breast cancer diagnosis, breast cancer death, and the benefits obtained from screening mammography. For the record, a typical 40 year-old woman has 1.4% chance of being diagnosed with breast cancer over the next 10 years, and a 0.33% chance of dying from it (or 1 in 300). Regular screening mammograms reduce the probability of dying of breast cancer in a 40 year-old woman by 0.05%, to 0.28% (or 1 in 357), at the cost of a 1 in 3 chance of experiencing a false alarm due to screening. Whether or not the cost is worth the benefit lies in the eye of the beholder - which is why, despite all of the unnecessary hysteria, the USPSTF got it right.
Wednesday, 2 December 2009
Residency Procedures
The mantra "see one, do one, teach one" has long been thought to be essential to the training of physicians. But how would you like to be the patient on the receiving end of that training - a medical student or resident doing his or her first (or second, or third) procedure of a particular type? My anxiety about one such situation as a second-year Family Medicine resident at Lancaster General Hospital (PA) in 2002 led to the following tongue-in-cheek poem about the disparity between intellectual knowledge and hands-on ability.
**
PROCEDURES
Have you ever been caught
Too close to a lamp
Unable to immediately turn
To evade the scalding heat?
That's where it starts
Your name in block letters
An article tacked up on a door
The thrill of recognition.
They can't see what you can
But the cost is prose burned
Into areas that ought to contain
Other things - for example,
Being on time for noon conference
The dinner you forgot to pack for that long night on call
The chapters of skin diseases you didn't read
So you have no idea what to do with the ugly mole on this man's back.
But ... perhaps he'll recognize you!
Perhaps he'll say, didn't you write that column in Central Penn Parent Magazine?
Your ignorance scrubbed away in a sterile field
Awaiting decisive excisions with number 10 blades
Then sent off to Pathology, where
Under the piercing gaze of microscopes
They'll dissect your pieces,
Label them separately,
Fix them in formaldehyde
So your slides may be admired for generations.
- Kenny Lin
**
PROCEDURES
Have you ever been caught
Too close to a lamp
Unable to immediately turn
To evade the scalding heat?
That's where it starts
Your name in block letters
An article tacked up on a door
The thrill of recognition.
They can't see what you can
But the cost is prose burned
Into areas that ought to contain
Other things - for example,
Being on time for noon conference
The dinner you forgot to pack for that long night on call
The chapters of skin diseases you didn't read
So you have no idea what to do with the ugly mole on this man's back.
But ... perhaps he'll recognize you!
Perhaps he'll say, didn't you write that column in Central Penn Parent Magazine?
Your ignorance scrubbed away in a sterile field
Awaiting decisive excisions with number 10 blades
Then sent off to Pathology, where
Under the piercing gaze of microscopes
They'll dissect your pieces,
Label them separately,
Fix them in formaldehyde
So your slides may be admired for generations.
- Kenny Lin
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