TagArmy Nurse Corps

Grand Rounds Vol 6. No. 7

Hello and welcome to this edition of Grand Rounds!

As I contemplated the possibilities for a cheeky theme and racked my brains for something pithy or unique, my thoughts consistently fell on the fact that tomorrow is Veterans Day in the United States. Veterans Day is simply a day off for some. For others it is a day in which we take the opportunity to show those, who sacrificed greatly for the freedoms we enjoy, appreciation.

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Tomb of the Unknowns
Arlington National Cemetery
Photo Credit: Emily McGee

What does this have to do with an international edition of a medical carnival?

Without Freedom of Thought, there can be no such Thing as Wisdom; and no such Thing as publick Liberty, without Freedom of Speech.

—Benjamin Franklin

Freedom of thought, and freedom of speech is what blogging is all about. I am not only proud of my Army service, but am grateful to those who wore the uniform before me, making sacrifices so I can spend my evening writing my own words without fear of reprisal or censorship.

I am honored to present to you every entry I received. Please enjoy this edition, and take the time, either publicly or privately, to reflect on the freedoms you have, and what it took for you to possess them.

Bongi—you couldn’t have given me a better transition if we planned it! On his blog “other things amanzi” he shares a time in which the freedom of his speech helped solidify his legendary status. Yes, even more legendary then he is to us!

Freedom of speech doesn’t end with sentences and paragraphs. Apparently, a few of my favorite bloggers embarked on a Haiku quest this past week. My two favorites? So glad you asked!

The first is from Ramona over at “Suture for a Living.”

Haiku #2

Too big , too small, sad

Cut, sew, reduce, augment, lift

Happy, happy girls

The second is from Laika at “Laika’s MedLibLog.”

Haiku #8

Wishing he was dead,

Paralyzed from neck down,

Nothing he can do.

Apparently Dr. Rob was in the middle of the Haiku insanity, but who does that surprise?

Having the nerve to discuss mistakes, many times, is difficult to come by. Dr. Joseph Kim tackles not one, but two tough topics his post, Doctors and mistakes: big and small on the blog “Medicine and Technology.”

Healthcare lawyer David Harlow, on “Healthblawg,” digs a bit more into free speech, taking on the subject of Twitter spam, and the use of social networking by drug companies to promote off-label uses of medications to the lay person.

The US healthcare system and insurance debate were tackled as well.

One of the best submissions for this edition came from “Insureblog.” Sandi’s plight highlights how our current medical insurance system was successful, but how it could also fail. Follow that entry up with Dr. Rich’s post, New Jersey, What Were You Thinking? and you will have both a system and an individual view of the debate.

To round out the submissions covering the US healthcare/insurance debate, we have two posts. The first, a podcast and transcript in which David Williams interviewed Peter Lee who is co-chair of the Consumer-Purchaser Disclosure Project. Why does the system perpetually seem doomed to failure? IMHO, lawsuits have a huge chunk of the blame. In the second post “ACP Internist” has a great entry covering the basics related to lawsuits in the post, “Which patients sue for malpractice?

How else does the system lose money? Errors. Error Prevention Strategies: It’s not “Sophie’s Choice” folks is up over at Florence dot com. The situation isn’t helped, however, when things like counterfeit versions of the flu vaccine are being sold, further degrading trust in the system. Go read the post “Drug Wholesaler Found Peddling Mystery Medicine as Flue Vaccine (Pharmacy Liability),” and you will be even more concerned.

Some of my favorite posts were related to the clinical side of medicine. Medication For Pain Series 2009: Antidepressants is part of a series over at the blog “How to Cope with Pain.” The post Baby it hurts: birth practices and postpartum pain on the blog, “Science and Sensibility” keeps the same theme, but proves what a wide topic pain can be.

Have you ever been grossed out by something you see another practitioner do? Next time you cringe when you see a man’s tie dangle over a patient, consider the possibility that it could be germ resistant! “ACP Hospitalist,” in the post Ties that bind, and make you gag talks about this new option for neckties, and also covers an even more scary side of ties—-the perpetuation of tacky prints!

The post which I would give my “Favorite Clinically Based Post” award (if there was such a thing!) to is from Paul Auerbach, M.D. who highlighted a published case study about Recombinant Factor VIIa for Rattlesnake Envenomation. As far fetched as this happening twice seems, about the time that crosses my mind, I will be flying the anti-venom, the Factor VIIa AND the patient to the big hospital in my area!

Rounding out the submissions are posts covering a wide range of subjects. Resources for Sexual Minority Youth made me realize I wouldn’t have even known where to begin looking for information about the topic had a patient asked. I also didn’t realize that those old school fitness tests may have been all for naught! Find out more in the post Fitness Tests – Do They Do What They Claim? And, from our friends to my immediate north, the blog “Canadian Medicine,” in the post Canada is looking out for your health, brings a collection of short topics covering topics such as Solubilize, nebulize, die, and Consumable entertainment.

When I host Change of Shift, I usually save my favorite post for last. Most times it is the post which had the most emotional impact. This edition did not disappoint.

“Notes of an Anesthesioboist”
Glimpse Into a Marriage

Thanks for heading my way for this edition and thanks to Colin for giving me the opportunity to tackle this last minute edition!

Grand Rounds Vol. 6 No. 8 will be @ Health Insurance Colorado on 17 November 2009.

My Weekend in Cartoon

My day was spent painting, assembling lamps (more complicated then it sounds!) and ordering counter top for the Conex—aka, my office. Needless to say I am whipped.

How the heck did my office get such a name? This morning, John was roped into painting with mom and I. He declared that my office looks like the inside of a Conex. Think the name is going to stick, unlike “The Dungeon,” which will disappoint some of you. *pointed looks*

So, with little brain power to finish the lengthy post on HEMS safety that I started at 0430 today, I leave you with some Army humor as I will be wearing that hat (or beret as it were) this weekend.

[Thanks Greybeard!]

Captain McGee
as in ARRRRR Matey!

This is a very VERY long story, and Vijay needs all the props for this one. I really do need to frame this and put it on my desk at the Army. Think it may ruin a bit of my command presence though.

With that, I am racking out (going to sleep for all of you civilian types!).


Advances in Medicine via War: Navy Captain fights to help Traumatic Brain Injury patients

One of the things that excites me about being part of the military is how war of any kind advances medicine and nursing practice in a way that would be impossible otherwise.

The nursing profession was born from war as was the Red Cross.

Wide spread use of antibiotics, damage control surgery . . . the list is amazingly endless.

As much as this topic deserves an entire series of posts, I bring it up as a way to highlight the incredible work being done by Navy Captain Michael H. Hoffer highlighted as “Someone You Should Know” at BackFive.

Now, back in Iraq, Navy Capt. Michael H. Hoffer feels he has won a significant victory against arguably the military’s most serious and common casualty, traumatic brain injury. Traumatic brain injuries, or TBIs, occur when an individual experiences shock waves from a blast, acceleration-deceleration (collision), or an impact or penetration directly to the skull. Doctors divide TBI into severe, moderate or mild.

This also hits close to home as my cousin, a Marine and two tour vet of OIF is benefiting from his research and tenacity.

My thanks to Capt. Hoffer and his colleagues.

h/t BlackFive


Funeral Services Set for MAJ John Pryor, M.D.

I was humbled a few nights ago to have received an email from Dr. Richard Pryor, brother of MAJ John Pryor, M.D., who died while serving in Iraq on Christmas Day.

Thank you to everyone who left comments, and sent emails. As per Dr. Pryor’s request, here is the link to a web site created to honor his memory and spread the word as to his public wake, visitation and funeral mass.

Although I will not be able to attend in body, I will be in uniform this weekend, thinking of him, his colleagues and family often.

I challenge each of you to honor him by thanking a soldier for their sacrifice. And if the opportunity presents thank their family as well.



I’m becoming more aware of a larger role I play in the grand scheme of simply living and breathing. SFC Rodriguez would tell me that no matter how few days you have left of something, never allow yourself to become an oxygen thief. Sometimes I don’t realize why things happen. To me, it just is. Later is when the understanding dawns. My former belief in coincidences diminishes further.

Threes: An airport in Atlanta. A chance meeting at my unit. A tech at my house to fix my DSL.

A physician in uniform returning from Iraq was my chance meeting in a bar/restaurant in the Atlanta airport. We spent an hour or so discussing his time in Afghanistan. His frustrations at being unable to save a pilot injured by enemy fire. The fact that he gave up his private practice to serve and the lack of regret which permeated his countenance.

The flight medic who happened to have a class on a day which I happened into my Army unit on my day off. We few, we flight medic few. Unless you have spent part of your soul on others—so they may live—understanding is virtually futile.

My lack of Internet almost drove me crazy. By relenting and scheduling a repair appointment, I met a communications NCO from the National Guard. Not long home, while on deployment he lost as many have. A roommate and a friend who would never again set foot on the soil they gave their lives for.

All three I was destined to meet. All three shared their stories, parts of themselves they will relive until the day they too fade into an unknown.

Maybe not the unknown. Most hopefully not the forgotten.

Definitely not the forgotten.

I recounted the acts of fate and what these encounters meant to me while visiting an old Infantry Soldier, who served in a time before me. It was comforting to realize that a soldier is always a soldier, no matter the time, or the war. Explaining the details and what these experiences did to my soul could be expressed in a few simple sentences.

He just knew.

Knew that I was meant to simply be.

So now, I sit in an unexpected bar at an unexpected moment, leaving myself to the encounters of fate. I sit reflecting on the past year as only a girl, drinking alone in a bar on New Year’s Eve can do. Okay with being alone, in a crowd, knowing without a second of doubt, that the next 365 days are about to be mine. But, also comfortable knowing that my life has never truly been mine alone, but one of service and sacrifice in both small snippets and intense circumstance.

So Others May Live.

Major John P. Pryor, M.D., U.S. Army, Killed in Iraq

I was wide awake this morning at 0230. As is normal, I rolled over and blindly reached for my iPhone, figuring that if I couldn’t sleep, I would at least make good use of my sleeplessness and catch up on my RSS feed reading.

The moment I read the post title, which simply said something about a New Jersey trauma surgeon dying in Iraq, I knew I would be in mourning when I was fully awake. I hadn’t even read his name and my intuition was going off.

From HUP’s website:

Dr. Pryor is a trauma-critical care surgeon at the University of Pennsylvania in Philadelphia. He completed medical school and general surgery training at the University of Buffalo, in Buffalo New York, and completed fellowship training in trauma surgery and critical care at the University of Pennsylvania. He is currently the Trauma Program Director for the Trauma Center at Penn, and the Director of the Office of Life Support education for the Division of Trauma. Dr. Pryor is also a Major in the United States Army Reserve Medical Corps. He served two active duty tours as the trauma surgeon for the 344th Combat Support Hospital in Abu Ghraib Iraq during 2006, and then with the 1st Forward Surgical Team (FST), in 2008.

John P. Pryor, M.D.
Trauma and Surgical Critical Care

Major John P. Pryor, M.D. was a prominent trauma surgeon at the Hospital of the University of Pennsylvania. MAJ Pryor, while serving in Iraq, died on Christmas Day during a mortar attack.

Dr. Pryor, I would realize later, was a guest lecturer for my Acute Care NP program, and spent time with us in the lab teaching central lines and chest tubes. It was unnerving to find photos of Dr. Pryor among those I took during my time at Penn, finally understanding why the post title, read in the middle of the night, struck a chord.

Lab 2003 001
Invasive Procedure Lab with Dr. Pryor
UPenn, Adult Acute Care NP class of 2004

Lab 2003 020-1
Dr. Pryor (left)
Me (center) with hands raised
after successful chest tube placement

Although I did not know Dr. Pryor personally, his confidence in the classroom and his approachability made the sections he taught some of my favorites. His death is a loss for the students he taught, the patients he treated, the staff he worked with, and the soldiers he served with.

My thoughts go out to his family, Army unit and professional colleagues.
Story at MSNBC.com here.
Story at MyFox Philadelphia with video here.

Original Java: Buy good Coffee and Support the Troops through Project DUSTOFF

“I don’t believe in coincidences . . . I believe in the curly ‘q’ whimsy of fate. After all, everything’s connected”
Sam Tyler (character) Life on Mars

A few weeks ago while at the unit, I held the door for SFC Rick Simmons. My eyes were immediately drawn to his combination Army Aviation Badge, and Combat Medical Badge. Of course, I had to ask, and in the process made the acquaintance of a fellow former Army Flight Medic who flew in support of OIF not once, but twice.

Although his story of quiet heroism isn’t necessarily rare, what he did in his downtime on deployment is. When he wasn’t flying in to provide medical care, SFC Simmons and CPT Pete Huggins created Original Java, a coffee shop in the middle of Iraq.


Rick and Pete flew lifesaving MEDEVAC missions throughout the Iraqi desert. They also shared a common goal; to boost morale and provide respite from the daily grinds of war. Their vision, “Original Java”, became an oasis in the desert, an espresso cigar bar serving coffee, frozen smoothies, and a much-needed dose of sanity. Now back stateside, “OJ” has evolved into an e-commerce coffee shop adorned with “Project Dustoff”. “OJ” is a small family-owned & operated e-commerce business offering superior gourmet, organic, fair trade coffees and teas.

Their story is an incredible example of soldier ingenuity and creativity. The impressive part is that they have brought the spirit of Original Java home with that same ingenuity creating Project DUSTOFF, which is dedicated to helping wounded service members and their families. Part of the proceeds from every bag of Project DUSTOFF coffee goes to the cause.

It isn’t a stretch to see why the spirit of their company is close to my heart. Anyone who has sacrifice for my freedom, supports soldiers, the DUSTOFF community, and sells coffee from my home state deserves a post, a link on my sidebar, and my gratitude.

I consider myself fortunate to have run into SFC Simmons, and excited to be witness to the broad reach that his time in Iraq will have on the Army community, lasting much beyond his tours overseas.

Oh, and I no longer believe in coincidences.


A brief history of DUSTOFF.

War and the Advances in Medicine, as a Text

“War Surgery in Afghanistan and Iraq”

So, Matt you are indeed the coolest—-I promised to mention that up front in exchange for the link.
Textbook Details Progress In Wartime Surgery from NPR

Hetz, who was deployed to Iraq twice, says the battlefield helps surgeons hone existing medical practices with a finer edge. One procedure that he says improved is called “damage control” — a procedure during which the major focus “is to stop the bleeding and further contamination” — whatever doctors can do to get the patient out of the operating room and to a place where he or she can be resuscitated. The process is faster and more effective, enabling higher survival rates.

The coffee-table sized book is not designed for public use. It features more than 400 pages of detailed case studies presented alongside graphic and often disturbing images. These photographs, informal and gruesome, were often taken on consumer digital cameras belonging to doctors and soldiers serving in Iraq and Afghanistan.

This is going on my Amazon Wish List.

Thanks again Matt!