Wednesday, February 26, 2014

You can't escape death but you can sure as hell fight it to the bitter end.

Many years ago my friend, former professor and mentor Diana discussed Dylan Thomas's "Do Not Go Gentle Into That Good Night" in class.

Thomas wrote the poem about his dying father and I will never forget the words or their meaning. When you read this, you can feel the angst, the desperation Thomas felt wanting his father to hold on to his very last breath. This poem encourages one to fight like hell against death, with whatever means necessary. Because we only get one life, we have to make it count, every second. Every single second.

We know we can't escape death ultimately, it comes for all of us, but that doesn't mean we have to sit back and let it take us without giving it a run for its money.
Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.

Though wise men at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.

Good men, the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.

Wild men who caught and sang the sun in flight,
And learn, too late, they grieved it on its way,
Do not go gentle into that good night.

Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.

And you, my father, there on that sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.


Tuesday, February 25, 2014

Much like House, I had my epiphany at 55 minutes into the episode...

...well, sort of, it was kinda in the last 10 minutes of my shower this morning, but that doesn't make it any less extraordinary, right? As I was doing a final rinse before getting out of the shower, a thought suddenly hit me, out of the blue .When we're young and every other day, we change our minds out everything...friends, jobs, our futures, well that's just considered normal because we're just trying to find ourselves. Twenty years later, we're still doing it--friends come and go, jobs change and we second-guess our chosen careers, only this time around it's not so embraced by society. 

Say for example, for years, you've been working towards a specific goal and you've sacrificed and endured much to achieve that goal. Suppose though you come to the realization that while you plan to complete the major task that will lead you to that goal, you don't want that goal anymore, you want something else. Now the tasks you've completed are not lost, they're not irrelevant, quite the contrary. The tasks have helped make you a stronger, smarter, better person.

When you're twenty years old, changing your mind about what you want out of life is acceptable but when you're forty, not so much, at least not to you, because you've been under the impression most of your life that older = wiser, at last in most cases, and changing your mind midstream throws a big goddamn wrench in the works and causes a hellacious amount of upheaval in your life. Your family and friends (unless they're just like you and get you) wonder what the hell you're doing.

I won't say you that your long-term life goal changes overnight. You don't just wake up thinking, "Oh My God. I don't wanna really be a pole dancer, I wanna help underprivileged kids in the Sultanate of Oman". No, it's more like the frog in hot water (I've hated the oft-used analogy since I was two days old, mostly because it pisses me off that it's actually spot-on and we've all been that frog at one time or another), where we're working towards a goal and doing what we think we should be doing to get there, and throughout the years we think about it a lot, which means it's simmering in our brains, and finally when the water boils, that's the point where we say "Oh hell no!". Hmm...looking back on this, it makes no sense at all because a frog in water has no idea what's going on until he's well...well beyond cooked, of course by that time it's dead so...

On second thought, the frog in water analogy sucks. The frog has no idea what's going on, but you do. So let's forget everything I just said. What's really happening here? In a nutshell, our experiences shape who we are. The older we get the more we learn, at least it's supposed to work that way. For the majority of us it does. With our experiences, we learn more about ourselves and the people and world around us. We become better equipped to make rational, grounded decisions, even if those decisions seem ludicrous to others and yes even if they throw the goddamn wrench in the works. So, really, maybe society has it all wrong. Maybe the twenty-year olds who change their minds every five minutes are the real idiots because they aren't basing their major life decisions on anything solid. Maybe we are the cool ones.

There was a time it was hip to be young and not cool to be old. Folks, I think the tables may have finally turned. :)


Monday, February 24, 2014

Implementing 24-hour Urgent Care Centers is a win for everyone.

Everyone hates Emergency Rooms and it's no wonder--wait times are just too damn long and often times  people get sicker as they wait. In my city, there's generally an eight to ten hour wait for a non-life threatening condition. I have already told people I know, "I better be near death before you take me there."


Why would people go to the ER for a non-life threatening condition? I give you three reasons:
  1. No after-hours urgent care available.
  2. Urgent care available but cannot pay.
  3. No knowledge of the difference between the functions of urgent care and ER.

While Urgent Care Centers can treat non-emergency illnesses, most are not open twenty-four hours. In my city, if you're sick after 8 pm, you either deal with it till your doctor's office opens at 8 am the next morning or, if you're in enough pain, you trudge down to the ER in your pajamas at midnight and wait at least another eight hours to be treated. 
 
The inability to pay for regular doctor's office visits and urgent care sends millions to the ER every year for minor illnesses. ER waiting rooms are full of people who do not need emergency are but who cannot be seen anywhere else because they cannot afford it. These people can't go to Urgent Care because those facilities are not bound by law to treat them without the ability to pay. The good news is that for all its flaws, the Affordable Care Act may have solved this problem. Now that every American is required to have health insurance, the people who have normally gone to the ER can now go to the Urgent Care Center instead. Because this would increase the flow of traffic to the Urgent Care Centers, it makes more sense to have more of them open all-night.  

Finally, how do you decide which one to see? It's actually simpler than you think. (List compiled from several sources)

Emergency rooms: Catastrophic care (Life or limb threatening)
Head injury
Amputations
Severe burns
Eye injuries
Chest pain, abdominal pain, or other sudden or severe pain
Deep wounds by gunshot, knife or other object
Strokes, symptoms that could be signs of a stroke like slurred speech, numbness
Coughing up or vomiting blood
Suicidal or homicidal thoughts
Heart attack
Shortness of breath, difficulty breathing
Severe bleeding

Urgent Care Centers: Minor Medical Conditions (Non-life or non-limb threatening)
Colds, flu, coughs, sore throat
Urinary tract infection
Sprains
Mild lacerations, cuts, bruises, burns and scrapes
Ear infections
Mild stomach aches
Allergic reactions
Broken bones
Animal bites

Of course, if you are not sure, always err on the side of caution and go to the ER but in most cases, we can tell by looking at this list. If you are able to distinguish, you could save yourself a lot of time and money.

I for one would be very interested to see the stats on cities of different sizes which have all-night urgent care and how they reduce ER waiting time and improve care.  I think studies should be done and results shared so that cities who do not yet have these twenty-four hour facilities could benefit. It's a win for everyone. Emergency rooms can concentrate on the more serious life threatening cases while patients who are ill but not seriously ill, who cannot wait to get an appointment with a doctor, can get efficient and inexpensive treatment at alternative facilities. I can't imagine anyone whose illness fits into the categories of urgent care would choose to go to the ER and wait twelve hours for treatment and pay ten times what they'd pay in the Urgent Care Center.

Also, my friend Deletta, who I shared this with earlier had an excellent suggestion. If there's an issue of not being able to properly afford and staff a stand-alone all-night facility, what if hospitals had both an ER and Urgent Care Center? The patient could be triaged immediately and sent to the appropriate facility for treatment. Teaching hospitals could staff the Urgent Care Center with student interns. The patients are treated, the med students learn. Everybody wins.

Of course it seems simple but it's probably much more complicated. The point though is that we can and should do this. If we're going to revamp the healthcare industry this is an important part of it. Call it a simple case of supply and demand. The demand for the all-night Urgent Care Centers is out there, now we just need to supply them.

Friday, February 21, 2014

Some interesting stats on gun violence

For informational purposes only. I'm not advocating one way or the other. Just thought the numbers were interesting.

Gun related Crimes: 1980-2008    (number in percentages)

By Gender

Victims:  82.6 male, 17.48 female
Perpetrators:  92.1 male, 7.9 female

Homicides by age group
Victims 
Under 18 = 8.1
18-34 = 59.7
35-49 = 22
50+ = 10.3

Homicides by age group
Perpetrators
Under 18 = 12.2
18-34 = 65.9
35-49 = 15.1
50+ = 6.9

Homicides by city size
Large city 59.6
Small city 12.4
Suburb 20.3
Rural 7.7

Gang-related Homicides
Large city 69.6
Small city 13.3
Suburb 16.6
Rural 0.5

Other pertinent info
Homicides most often committed by handguns

Handguns involved incidents increased sharply in late 80s and early 90s before falling to low in 2008

Homicides with guns other than handguns hit lowest point in 1999 then increased after that

Gang related gun involvemenmt with guns increased from 73% in 1980 to 92% in 2008

source: Cooper, Alexia, and Erica L. Smith. "Homicide Trends in the United States, 1980-2008." Washington, DC: Bureau of Justice Statistics (2011).



Most people believe that criminals should not be able to possess firearms lawfully. Yet, our current laws permit many people who have been convicted of crimes—most misdemeanor crimes adjudicated in adult court and felony crimes handled in juvenile court—to possess firearms. Data from two studies of individuals who have committed the most serious crimes indicate that prior to committing these crimes, the perpetrators were not prohibited from possessing a firearm under federal law. A recent study, based on surveys of inmates in state prisons, examined the criminal history and ages of persons imprisoned for committing crimes
with a gun in the 13 states with standards for legal gun ownership that do not go beyond those set in federal law. At the time when they committed the gun crime leading to their incarceration, only 27 percent of these gun offenders were prohibited from possessing firearms because they had previously been convicted of a felony. Of these offenders, 60 percent could legally possess guns prior to committing the gun crime that led to their incarceration, including four percent who had prior misdemeanor convictions involving violence and/or firearms, six percent convicted of other misdemeanors, five percent convicted of a felony in a juvenile court, and 13 percent with prior arrests but no convictions.

Some may assume that persons convicted of misdemeanor crimes do not pose a significant threat for committing serious violent crimes. But many suspects charged with felony crimes are convicted of lesser charges as a result of a plea agreement. Research has shown that misdemeanants who were legally able to purchase handguns committed crimes involving violence following those purchases at a rate two to ten times higher than that of handgun purchasers with no prior convictions.29 Handgun purchasers with a history of arrest but no convictions have an equally high or higher risk of committing violent crimes following handgun
purchases as do misdemeanants who legally purchased a handgun.

We believe the evidence above justifies an extension of firearm prohibitions for persons with a history of criminal behavior to include persons convicted of all misdemeanor crimes of violence, as well as individuals who have committed felony crimes as a juvenile. Such prohibitions do not necessarily need to be life-long. Many states have laws prohibiting firearm possession for individuals convicted of serious crimes as juveniles. These restrictions are time limited, based on either the age of the individual or the number of years since the prohibiting conviction.

Central to effective gun policy is being able to identify higher-risk, prohibited persons attempting to buy guns, and to prevent those purchases. The Brady Law is the foundation for the federal government’s attempt to achieve this objective. Before the Brady Law, ―gun control within many states worked on the honor system. Firearm purchasers simply completed a form indicating whether they met any of the exclusion criteria for legal firearm possession, without independent verification of the information provided. With the passage of the Brady bill, gun purchasers buying from a federally licensed firearm dealer are subject to a background check. Since the Brady Law was enacted in 1994, more than 2 million applications to purchase or
transfer firearms were denied because the applicant was prohibited from purchasing firearms.35

Some unknown, but likely larger number of prohibited individuals did not attempt to purchase a firearm because they were legally prohibited.But the Brady Law only requires prospective purchasers to pass a background check if they are purchasing the firearm from a licensed firearm dealer. Data from a nationally
representative sample of gun owners indicate that 40 percent of firearm acquisitions are from individuals who are not licensed gun dealers. Not surprisingly, criminals exploit the private sales loophole. Data from a national survey of inmates indicated that nearly 80 percent of those who had used a handgun in a crime had acquired it through a transaction with an individual who was not a licensed gun dealer. An advocate for closing the private sale loophole† once likened current federal gun policy to an airline security system which offers passengers a choice between submitting oneself to our current screening system, or side-stepping it, and boarding with whatever you would like to bring on board. Should we expect gun laws with the private-sale purchaser screening loophole to be any more effective than voluntary airline passenger
screening?

Available research shows the harms of policies which inadequately hold gun sellers accountable for dangerous and illegal practices. In a national survey of armed criminals, illegal purchases from licensed gun dealers (e.g., no background check conducted) were as common as were legal purchases from licensed gun dealers.38 Data from federal gun trafficking investigations indicate that scofflaw gun dealers are the most important channels for diverting guns to traffickers and criminals.

Phone surveys of gun dealers reveal that many are willing to bend or break the law to make a sale. Findings from a study of Chicago’s underground illegal gun markets found that certain retailers, set up just across the city’s border, colluded with traffickers to funnel large numbers of guns to gang members.

Diversion of guns to criminals shortly following retail sales is much less common in states that license retail gun sellers, require careful record keeping that can be reviewed by local or state law enforcement, and where law enforcement agencies conduct regular compliance inspections. Undercover stings to catch retailers facilitating illegal sales, followed by lawsuits against scofflaw gun dealers, also deter the diversion of guns to criminals.


Weaknesses in U.S. gun laws may cause skepticism about whether gun control can work. Yet, a growing body of research shows that common-sense policies adopted at the state and local level succeed in reducing the diversion of guns to criminals. A study using crime gun trace data from 54 U.S. cities examined the association between gun sales regulations and the diversion of guns to criminals. Strong regulation and oversight of licensed gun dealers, regulation of gun sales by private sellers, and permit-to-purchase licensing systems (which require potential gun purchasers to apply for a license directly with a law enforcement agency, where they are typically photographed and fingerprinted) were each associated with significantly fewer guns that were diverted to criminals.

A systematic observational study of gun sales at gun shows found anonymous undocumented firearms sales to be ubiquitous, and illegal straw sales more than six times as common in states that do not regulate private sales, compared with California,which does regulate such sales.

Separate research shows that states which do not regulate private gun sales, adopt permit-to-purchase licensing systems, or have gun owner accountability measures, like mandatory reporting of gun thefts, export significantly more guns used by criminals to other states that have constrained the supply of guns for criminals by adopting strict gun sales regulations.

Broad adoption of these policies could greatly enhance our ability to keep guns from those most likely to use them in crime.

http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-for-gun-policy-and-research/publications/WhitePaper102512_CGPR.pdf