Faculty Bibliography

The premise: ER resident Dr. Abby Lockhart (Maura Tierney) accompanies the crew of a medical evacuation helicopter to a local community hospital, where an 88-year-old woman is having a heart attack. Abby's hospital is a Level One Trauma Center with a cardiac catheterization lab, which the other hospital lacks. But when Abby and the emergency response team arrive, they find that the woman is already in cardiogenic shock (extreme heart failure) and intubated (has had a breathing tube inserted in her trachea). The woman has a blood pressure of 74/38, a heart rate of 144, and she is receiving the vasopressor drug dopamine to keep her blood pressure from dropping further. A clot-dissolving drug has been given without any effect. Abby also discovers severe EKG changes -- known as 'tombstoning' (giant abnormal waves) -- indicating much heart damage. Seeing the patient's condition, Abby states, 'She's not coming back from this.' She favors leaving her in the community hospital, but the paramedics disagree. They tell the patient's family: 'It's your mom's only chance.' The paramedics prevail, and the patient is transported. But the woman develops a lethal arrhythmia en route (ventricular fibrillation) and dies

Eli Lilly was the winner for the best unbranded television ad award. Their television commercial on depression -- done in black and white -- clearly showed the conditions of a patient who is clinically depressed and badly in need of treatment. There was no mention of a product, but anyone watching this ad became instantly more aware of the symptoms and signs of an underdiagnosed, treatable disease. Lilly continues to have a stake in the proper recognition and treatment of depression

House [Television Program] -- [Allison Cameron] keeps [George Hagel] from being discharged from the hospital by slipping him the antiseizure drug phenytoin, which causes him to stagger and crash through a glass wall. When cerebrospinal fluid is needed, Dr. Eric Foreman decides that the patient is too obese for a routine lumbar puncture, so he takes Hagel to the operating room and inserts a needle into the back of his brain. When he does this, Hagel goes blind. Finally, House notices that Hagel's fingers are deformed (known as 'clubbing'), and orders X-rays, which confirm a paraneoplastic syndrome that House believes is associated with small cell cancer of the lung -- which would explain the coma and blindness. The diagnosis is confirmed by bronchoscopy. Hagel will be treated with radiation but is only expected to live a few months. The reality: A morbidly obese patient presents a series of unique diagnostic problems. Scanners have weight limits -- 450 pounds in many cases -- limiting imaging options. Because of Hagel's mass of fatty tissue, it would also be extremely difficult to place a spinal needle into his lumbar canal, the optimal place to draw fluid in a spinal tap. Ultimately, a neurosurgeon might be needed to place the needle in the back or the neck. But the needle would not generally be placed in the brain, and blindness as a direct result of this rare procedure is unlikely

The premise: Geralyn Lucas is just beginning a job when she's diagnosed with breast cancer at the age of 27. The non-invasive cancer has an extensive intraductal component involving three separate areas of her breast. After debating whether to have a lumpectomy or a mastectomy, she chooses the latter, with adjuvant chemotherapy. Despite frequent episodes of nausea and vomiting, Lucas (played by Sarah Chalke) continues to work, buoyed by her friends. She also bolsters her mood and self-image by dressing well, getting a tattoo -- and wearing lipstick. Although at first worried that her husband will leave her, especially when she spies him speaking privately with a nurse, he ultimately proves to be very supportive. Lucas goes on to become pregnant and deliver a healthy child

The discovery of protease inhibitors was a revolutionary accomplishment in the world of virology that has changed the course of clinical disease for HIV patients. Here is how these drugs work: When the protease enzymes is blocked, HIV makes copies of itself that can no longer infect new cells. Studies have shown that these drugs reduce the amount of circulating virus in the blood and improve the body's immunological response to viruses. At a time when drug companies are routinely criticized for drug safety violations, it is good to recall the life-saving effects of the HIV drugs

CSI: Miami [Television Program] -- Victims suffocate from respiratory depression or sustain lethal heart arrhythmias as the cyanide interferes with hemoglobin metabolism (depriving the body's tissues of oxygen). The initial treatment is to administer pure oxygen. Common cyanide antidotes are nitrites and sodium thiosulfate, which work together to restore the hemoglobin. These aren't often completely effective, however, in part because the cyanide may have already done a lot of damage by the time the antidotes are administered

The 80-year-old was in the hospital after a failed balloon attempt to open the main artery that supplied blood and oxygen to his right kidney. His kidney function was deteriorating, and dialysis seemed likely, but he was now refusing all treatment and had fired his kidney doctor. My friend had contacted a new kidney expert, but he too was suggesting dialysis, and the father-in-law was on the verge of firing him as well. The father-in-law was a thin, tall man with a quick handshake, and his wife -- who immediately smiled when she saw me -- was sitting faithfully by his side. 'We've heard so much about you,' she said. 'We're so glad you're here.' The father-in-law smiled too. I knew better than to discuss dialysis, but in looking over the medical record, I saw that he had a fever and that his white blood count was elevated. My friend had warned me not to offer new treatments, but I feared a kidney infection and -- gambling on our seeming instant rapport -- suggested an antibiotic. The couple nodded and told me they would consider it. Just this month he has finally agreed -- in a state of near delirium from his kidney poisons -- to dialysis. When I had tried to break through his well-established macho structure to help him before he reached such a desperate point, it only created more anxiety and distance. He was afraid of becoming frail and dependent because this would negate his established role as his family's protector. In the end, there was little I could do beyond remaining cordial. This kind of pride and so-called male strength, when a man sets himself up as a quiet unemotional rock who doesn't need anyone's help and can't admit weakness, can be very destructive when it comes to his health

Grey's Anatomy [Television Program] -- As [Benjamin O'Leary] is being readied for brain surgery, 14-year-old Harly Hernandez is brought to the emergency room impaled on a large tree branch. Harly has sustained major damage to his kidney and intestines, and his father is told that his son has only a 60% chance of survival. After Harly's organs are repaired, the large tree branch is removed in sections, and he lives. Benjamin, however, dies when his brain hemorrhages and swells during surgery. Impalement injuries, especially with sharp objects, carry a high risk of major-organ damage, as the abdominal cavity is tightly packed with organs. Although beginning a surgical procedure with the object protruding from the body may seem counterintuitive, it can make sense -- if the object is in a stable position. This allows doctors to immediately stop the bleeding and begin to suture the damaged organs before removing the object. Removing the object prematurely or all at once can risk further bleeding and organ damage

All too often, however, the authors' statements seem more like polemic pronouncements than demonstrable, inarguable facts. They rely heavily on their interpretation of the 9/11 Commission report as well as circumstantial evidence. As an example, they state: 'The Bushes would not be eager for the press to learn that on Monday, September 10, the Dulles hijackers had been guests in the same hotel as Saleh Ibn Abdul Rahman al-Hussayen, the top liaison to the worldwide Islamic charities that funded Osama bin Laden.' The authors never provide us with the specifics about the funding of the terrorists, and they go on to speculate further: 'Because of pressure from Prince Bandar [of Saudi Arabia] on the Bush administration ... on September 19, al-Hussayen was allowed to fly to Saudi Arabia.' Walking through John F. Kennedy International Airport and observing these proud new TSA agents, better paid and with better benefits, it is difficult for me to believe they could be less effective than a group put together by private companies. Yet the Trentos state that 'the TSA screeners have a substantially higher failure rate than the private screeners did.' I speak with one of the new TSA supervisors, who has a background in law enforcement, and he acknowledges that many of his screeners are former teachers, clerks and students. He calls TSA 'a work in progress' but says he would never stay with the job if he didn't think there was real progress and adds that the current system is better than the former one. The contention that we are no safer in the skies today than before 9/11 may seem difficult to believe until the authors detail the poor shape of the current 'no-fly' lists, where dead terrorists and non-terrorists still abound. (For its part, the government claims that it cannot definitively confirm the identities of many of the 9/11 hijackers, which is why some names remain on the list.) The Trentos were also able to interview a sought-after hijacker from the 1980s not in some secret bunker but at an outdoor Beirut cafe. They write that the skies can be safe only 'if the U.S. government, airlines, and local airport authorities demand that our intelligence agencies finally provide a usable national database of people who should not be allowed near passenger planes.'

For 40 years, there has been a burgeoning in life-saving and life-extending medications, the likes of which have never been seen before. Even with the most advanced technologies, some of the greatest discoveries have occurred by accident. From the treatment of HIV disease to the treatment of diabetes to the treatment of acid reflux disease, new drugs have reduced suffering and improved the quality and length of life all over the world. Perhaps, in the interests of full disclosure, it should be mandatory for critics of the drug industry to include a listing of the medications they take whenever they make negative comments