The Land of Ozz

Last night I witnessed first hand the importance of the proper use of handicap spaces and the surrounding area. My wife and I attended the her 10th reunion for the Summerville High School class of 1996. The event was held at clubhouse of a local gated community in Summerville, SC. We were joined by some good friends from out of town at the event and had a pretty good time. The event itself was not worth the $40 per person in my opinion, but the girls wanted to go. I spent a good portion of the night talking with Paul. Paul is the husband of Noel one of my wife’s friends since high school. Paul and Noel were in town from Virginia where they now live. Paul has been bound to a wheel chair for many years as a result of a motorcycle accident that left him paralyzed from the chest down. We have grown closer to Paul and Noel in recent years for many reasons because they also have a young son who has had to battle some very complex medical issues. Our families have endured a lot of common scenarios in dealing with our sons’ health care. They are very knowledgeable about their son’s very unique diagnoses.

They have visited our home several times in the past and we try to have them over or go out with them when they are in the area. Paul can drive. My wife did not even know that cars and vans could be equipped like this until just a few years ago. Paul has a specially equipped van that he can travel with unassisted. He can open the right side sliding door and lower the ramp with a remote control. He then navigates his motorized chair into the van where he rolls right up to the driver’s controls. His chair locks into place and he is ready to go. The use of these features of his van is where the problem came in last night.

Last night Paul parked his van in a handicap spot with the right side facing one of those blue striped areas. You know the ones I am talking about. The are found right next to the handicap space with the diagonal lines that are painted the same color blue as the handicap symbol found painted on the pavement in the handicap space. The purpose of these diagonal lines are alert people not to park there to allow for specially equipped vans to lower their ramps and lifting systems. Paul parked and exited his van using this nice space as it was intended to be used.

After the reunion gathering, Paul, Noel, Sherry, and I were the last of our group of friends to depart. The four of us talked for the better part of an hour just outside the door of the clubhouse. We then proceeded towards our vehicles to find a cute little Honda Element parked about two feet away from the right side of Paul’s van. There was absolutely no way to get the ramp down. There was no way to get him positioned in front of the ramp even if it had come down. His vehicle was rendered useless by the position of the other vehicle. Now we considered for one short minute the possibility that one of use could stand in there and use the controls to move the van back far enough to clear the other vehicle. Noel tried that once in the past when facing a very similar situation. She ended up bending the Paul’s van and another car in the process. We also thought about putting the van in neutral and attempting to push it back far enough for Paul to get in but I was really the only one immediately available to push. The most logical option was to go back inside and ask the DJ to announce a description of the vehicle that needed to be moved from blocking access to a handicap equipped van. I gladly took on this duty and proceeding back into the building. I found that there was no one in there except the DJ who was packing up, some club staff, and a few stragglers from the reunion. I asked each of them if they drove a Honda Element. No one claimed the vehicle. The club staff offered to call a tow company and I gladly accepted. The remaining few of the reunion attendees were gathered outside the front door. I stopped by every single group of people standing around talking and asked if any of them owned a Honda Element. I did not find the owner of the Element, but I did get some very proud responses from some who wanted to make sure I and others knew they drove Hummers, Mercedes, or BMWs. Once I explained why I was asking, they quickly piped down. I am guessing that these overly proud folks were a little embarrassed about using this unfortunate circumstance to play the “mine is bigger than yours” game.

I went back out by Paul’s van where Sherry was waiting with Paul and Noel. I told them that I could not locate the owner of the vehicle and the staff was calling for a tow truck. A few minutes later the lights flashed on the car like someone was hitting the lock button on a remote. I immediately yelled out that who ever owned this vehicle should move it immediately because a tow truck was being called to haul to off. No one responded and the few groups of remaining folks just stood a looked at us like were crazy.

A few minutes later a couple of the clubhouse staff members came out. One of them said that none of the towing companies would respond to this situation because they had no one to pay for the tow. The staff then called the North Charleston Police to see if they could help. The police arrived a few minutes later. They proceeded to inform us that there was nothing that they could do. The officer said that since this was private property they could only leave a situation on the car for $25 for illegal parking, and they had no authority to order a tow truck to move it. The officer said that he could write the owner a $200 ticket if they could be located. We were stunned. I asked the officer what Paul was supposed to do if the owner could not be located. He just shrugged and walked back to his car to run the tag number. He was going to see if they could locate the owner and that was about all he could do.

Here we were a good ten miles from Paul and Noel’s hotel with no way to transport him and his chair (about 600 lbs) and nothing that could be done to help us if the owner could not be located. We could have paid for a tow truck to move Paul’s van or the other vehicle, but how is fair for one of use to pay to get Paul out of this situation?

It was about this time that a second police car arrived. Then the lights flashed on the Element again. Then we saw a woman walking in our direction from the front of the clubhouse. We asked if she owned this vehicle and she confirmed that she did. We told her that the nice officer would like to speak with her. He asked here to first move her vehicle and she did so. The officer then came over and asked if we wanted him to cite her with the $200 ticket. I told Paul that I would appear in court as a witness, but it was up to him as to whether to pursue the charges. The woman told the officer that it was raining very hard when she arrived at the clubhouse and that she did not realize it was a “no parking” area. It had been raining hard earlier, and there was not a sign in front of the space. There were only the pavement markings. Paul and Noel decided to let it go without pressing the charges. They displayed an amazing spirit of forgiveness even though the woman didn’t even ask them to forgive her.

Sherry and I talked in detail about this experience on the way home. We learned just how difficult life can be when a person in a wheel chair is faced with circumstances like we witnessed. While no one was hurt, this was certainly a violation of Paul’s rights in my opinion. He could not make use of his vehicle due to this woman’s choice in parking spaces. Ignorance of the situation is not really an excuse. I have been told that a few times in my life by officers writing tickets for my speeding.

The moral of this story is to be aware of your surroundings and how your seemingly innocent actions may affect others. Use common sense when arriving late to a function. If most all of the spaces in the parking lot are full then you should look very carefully before parking in that one little space right near the building. It is probably vacant for a reason. And by all means, DO NOT park in a handicap space if you are not transporting a handicap person regardless of how far you might have to walk.

My little boy Caden is in surgery this afternoon at the Medical University of South Carolina (MUSC). Please pray for God’s protection over him.

Caden’s Page

A case of an eleven year old girl named Haleigh and her fight to survive has taken a turn after making it to the Massachusetts Supreme Court. The high court of the state ruled that she should be allowed to die. “Haleigh wants to live,” is how Michelle Malkin put it and I think God agrees with Haleigh.

I believe that people view the life of those on a feeding tube with sort of an “oh you poor thing” type of mentality. It is amazing to watch people’s reactions when you pull out a bag half the size of your one year old child and hook him up to eat while in a public place. They are even more amazed to see how normal he is no matter how he gets his nutrition. Caden will eat without a feeding pump soon as will Haleigh. Caden spends about forty minutes four times a day hooked to his feeding pump. This is his only source of nutrition at this time. It is a method of eating, not a death sentence. Actually, Caden can eat while he does just about anything else including playing.

I would love to see the faces of the judges on the Massachusetts Supreme Court after watching Caden play for over three straight hours and then watch as we lift his shirt to attach the feeding pump to his tube. You can not tell that Caden even uses a feeding tube until it is time to eat. People’s view of this method of eating is way distorted until they have to deal with it first hand. Every judge who thinks that a feeding tube is a death sentence should spend a day with Caden to learn that they are VERY wrong.

Virtual reality helps diagnose heart defects by ZDNet’s Roland Piquepaille — Dutch doctors are using a virtual reality system to visualize the heart in three dimensions and detect if it is healthy or not. In a pilot study, ten doctors were able to move around virtual three-dimensional animated images or ‘holograms’ of the heart and to make correct diagnosis after a ten-minute training.

It sounds like a pretty good deal, but how does it compare to current methods of diagnosing heart defects? A standard ultrasound being performed by a technician (not a doctor) found the defect in my son Caden’s heart while my wife was less than five months pregnant. The diagnosis of his Interrupted Aortic Arch (IAA) type B with a ventricular septal defect (VSD) was confirmed with a standard fetal echo cardiogram on July 29, 2004 more than four months prior to Caden’s due date.

Here is a comment from a reader over at the The MUSC Tiger in response exchange started with my last posting.

However, I hope the folks at MUSCTiger are wise enough to not post ‘diary’ entries any further. It is a shame you cannot vent to your peers in this medium, but it seems obvious someone could use your post to get you expelled. Posted by Lawtonfunk at The MUSC Tiger

I really don’t have a problem with medical students venting to their peers. The problem is that I am a customer of the establishment in which these students are venting over. These students are walking with teams that make life changing decisions that could affect me or my family. I have witnessed from a distance upwards of fifty or more of these doctor/resident/student/nurse practitioner care teams making their way from room to room in the early morning hours at the MUSC Children’s Hospital. I do not know what all is said during these hall talks, and that is really what this whole exchange was about at least from my perspective. I thought that Katie was advising any medical professional reading her blog to resist telling patients the whole truth.

There’s no rule that says a reader is required to read X number of postings on a blog to gather a feel for the author’s personality and likelihood to use sarcasm. Some of the readers and Jenks would obviously disagree with me on this point. I feel that it is the author’s responsibility to consider the audience. My initial reaction to Katie’s post was actually much worse that what I wrote in my last posting. I actually came very close to writing a letter to the MUSC Hospital administration in lieu of posting to my blog. It is funny that Lawtonfunk made that point, but I would not have been doing it get anyone expelled. I would have been doing it to hopefully raise awareness to a potential problem in the attitude and training at MUSC.

I would suggest that if medical students want to vent online to their peers in the way Katie did then they should consider a private forum requiring registration and proof of truly being a peer. You MUST consider who your audience when posting to a blog or any other public web site. That is precisely why many companies are creating blogging policies. The name of the “The MUSC Tiger” blog and the public announcement of the student status at MUSC by the contributors of the blog leave no room for anonymity. MUSC and more importantly the hospitals are represented by The MUSC Tiger blog. I as layman and infrequent visitor to their blog had no way of knowing that what Katie was writing was anything more than a true “Lesson of the Day” gained from an attending physician at the Medical University of South Carolina during one of those hush-hush hall meetings in front of a patient’s room.

I am as bad if not worse about writing before I consider my audience sometimes. I hope that this posting is taken as a “Lesson of the Day” from a patient’s perspective. It should be pretty clear that patients don’t know what they are not told. I know there legal requiremnts for doctors to disclose everything, but who’s policing this requirement? Well today I guess I am.

I feel that I have generally become more tolerant of medical professionals because I have lived sixteen hours per day among them with my son in the hospital for more than two months since his birth last November. That is why I wrote on my blog instead of to the MUSC hospital administration. Bash me for expressing myself if you want. I can take it. My intent was only to try to influence what I perceived to be bad practices and a bad attitude towards patients.

I wish all doctors made it this easy to determine whether to use their services or not. This MUSC medical student named Katie has taken all of the guessing out of the equation for me. She has basically made it known that she believes that telling patients as little as possible is in her best interest. The things that make her life easier is all she seems to care about in here recent posting on a blog run by three MUSC medical students. That is the root of my concern when it comes to dealing with medical professionals these days. Here is a bit of her posting:

Don’t tell patients anything. Fight the urge. You want to seem like good member of their care team by explaining the plan and their options. But don’t. Trust me, it will only placate them in the interim.

Katie is not yet an MD, but I do still have a chance of running into her during one of my son’s hospital stays. I try my best to keep things positive and upbeat on this blog these days, but I can not let this one slide. It is a huge pet peeve of mine. My wife and I have a few good friends who have kids with complex medical issues who detest this attitude as well. They are well educated with plenty of life experience not to mention the extensive trial by fire medical training related to the complex issues related to their own children’s conditions.

I spoke last week with a family in San Antonio on this very subject. I mentioned in my last posting that I had dinner with a great family in San Antonio. The friends of the hostess had a child with a rare chromosome deformity. My son Caden has a micro deletion of the 22nd chromosome and we were comparing notes on the care of our children. One of my only negative comments of the evening was on this very subject. I felt convicted about spreading such negativity without knowing for sure that doctors actually do this information hording on purpose. My wife has been told of one doctor at MUSC who admitted to our friend Stephanie that he felt that she did not really need to know everything he was considering about her son’s case. What gives the doctor the right to make this decision? I don’t remember ever signing anything that waived my right to information about my son’s health or my own. As a matter of fact, my wife and I just met with my son’s cardiologist today to gather more details on Caden’s heart condition. There is a chance he will need to have more open-heart surgery in the future and we have not been given the same story at every visit with this department in the past. They do great work, but they don’t always tell you what is going in the patient record. We have begun to make contact with other clinics outside of MUSC to treat some of Caden’s other conditions. We want to make sure we are fully informed before moving to fast with care at other facilities.

I basically want to say that I was disturbed to read Katie’s posting titled Lesson of the Day. I don’t know if Katie is even her real name, but you can bet your bottom dollar that I will respectfully request that this medical student along with anyone sharing her attitude be removed from my son’s care team in a heartbeat. I only want medical professionals working on my son who are putting his care first and foremost. I want to be fully informed when making a care choice related to my son’s health. I know that doctors, nurses, and even medical students have lives and feelings of their own. They have a right to guard themselves from pain and uncomfortable situations, but not at the expense of a patient’s health. When they are making decisions related to my health or one of my family members then I want them to be primarily concerned about the patient and not about how tough their job might be if they share too much information. I am sure there are cases where sharing too much information might complicate some situations and there are definitely exceptions regarding emergency circumstances. Outside of that, a patient who wants the whole story should be given every bit of information requested.

I sincerely hope that this is an isolated attitude tied to this one medical student. I also hope that this thinking is not being taught in our medical schools. There is a good chance that she came up with this philosophy on her own, but I would not count on it.

Think tanks blast S.C. Medicaid plan was the headline of the front page of The State on Wednesday of this week.

I have had my share of battles with the Medicaid system in the state of SC and I can say from first hand experience that it needs something. I even contacted the Governor Sanford’s office a few months ago to get a little help lighting a fire to the red tape I encountered when trying to get specific coverage approved for my son Caden.

Watch this Medicaid process closely. It could help set the standards for other states who are looking at major Medicaid changes.

CBS ran a story last night that briefly mentioned that the FAA has recently revoked some medical certificates due to certain medical conditions. This little piece about medical certificates is the part I want to expand on. The story primarily focused on a young pilot in Florida who was able to learn to fly even though he suffers from a spinal cord injury that does not allow for him to walk. It was a great story and I applaud CBS for pointing out that an injury like this does not shatter all dreams.

I just recently went in to my Aviation Medical Examiner (AME) for a FAA Second Class medical certificate. I got the certificate, but it was not the easiest trip to the medical examiner this time. I have been diagnosed with hypertension since the last time I was awarded a FAA medical certificate. Here is what the FAA has to say about hypertension.

“The Examiner may issue first-, second-, or third-class medical certificates to otherwise qualified airmen whose hypertension is adequately controlled with acceptable medications without significant adverse effects. In such cases, the Examiner shall:
1. Conduct an evaluation or, at the applicant’s option, review the report of a current (within preceding 6 months) cardiovascular evaluation by the applicant’s attending physician. This evaluation must include pertinent personal and family medical history, including an assessment of the risk factors for coronary heart disease, a clinical examination including at least three blood pressure readings separated by at least 24-hours each, a resting ECG, and a report of fasting plasma glucose, cholesterol (LDL/HDL), triglycerides, potassium, and creatinine levels. A maximal electrocardiographic exercise stress test will be accomplished if it is indicated by history or clinical findings. Specific mention must be made of the medications used, their dosage, and the presence, absence, or history of adverse effects.
2. Summarize the results of this evaluation in Item 60 of the transmitted application and forward the appropriate documents to the AMCD.

3. Report the results of any additional tests or evaluations that have been accomplished.

4. If appropriate, state in Item 60 on the FAA Form 8500-8 that the applicant’s blood pressure is adequately controlled with acceptable medication, there are no known significant adverse effects, and no other cardiovascular, cerebrovascular, or arteriosclerotic disease is evident.

5. Defer certification if the person declines any of the recommended evaluations.”

I reported on my application for my new medical certificate that I had been diagnosed with hypertension since my last FAA examination and that I was taking blood pressure medication regularly to regulate my condition. I was referred back to my attending physician just like the rules above require. I did all of the tests required including blood tests, ECG, and daily blood pressures for a few days. During this process my attending physician told me that several of his other patients were pilots who had been diagnosed with hypertension. He said that many of them used the same medical examiner for their FAA medical examinations and that this was the first time he had ever been asked to provide the items listed above. That inforamtion was very disturbing to me.

I can only come to a short list of possible reasons why a pilot would not need to go back to their attending physician with this issue especially using the same AME that I use.

• The pilot has not tried to renew their medical since the diagnosis
• The pilot went to a new attending physician to meet the above requirements
• The AMA missed the diagnosis on the application
• The pilot forgot to report their new diagnosis (yeah right)
• The pilot lied on their application for the medical certificate

The last reson in this list is the most disturbing to me and the one that I fear is the more common reason for my doctor not seeing his pilot patients coming back for the same reason that I did. I can only speculate on that.

I encourage any pilot who has been diagnosed with anything new since their last medical to report it on the application. Any false or information intentionally omitted from the application leads to an invalid certificate. I find it difficult to believe that a pilot who is able to remember to take medication every day could forget to list blood pressure medicine on an application for a medical certificate that clearly asks for the information. A pilot who lands in court due to some aviation related incident might easily be found at fault regardless of other circumstances simply due to operating an aircraft with an invalid medical certificate.

I realize that I have not provided any specific instances of people getting in trouble with invalid medical certificates. I hope my first story on such a thing is not related to someone I know. I hope that this story helps my fellow pilots understand the importance of filling out official applications correctly and completely. My Second Class Medical was granted. It was not the most fun process I have ever endured, but I see it as necessary.

Sources:
AOPA Online Members Only -– Medical Subject Report -– Hypertension
FAA Guide for Aviation Medical Examiners - PROTOCOL FOR EVALUATION OF HYPERTENSION