Winter 2006
ARTICLES In the eye of the storm: Charity Hospital and Hurricane Katrina The epic devastation rendered by Hurricane Katrina, which made landfall along the Gulf Coast of the United States on Monday, August 29, 2005, has been well-documented. Many New Orleanians were unable to escape the storm’s fury and had to ride the hurricane out in the city. These included patients and physicians in New Orleans’ historic downtown Charity Hospital, which has long served the healthcare needs of the city’s indigent patients. Until the hospital’s complete evacuation on Friday, September 2, more than 1,000 people were stranded in unbearable conditions: hot, hungry, and desperate for the rescue that sometimes seemed as if it would never arrive. The author provides a thought-provoking personal account of the challenges encountered at Charity Hospital before, during, and after the storm.
Titles from Horace: Adapted by Gerald Weissmann My translations show that Horace has served a valuable function for modern writers: a model of concision and rational thought for those who share his skeptical temperament, as I do.
Moral distress in health care professionals: What is it and what can we do about it? This edited transcript of a University of Virginia School of Medicine Medical Center Hour examines moral distress, a common phenomenon that has only recently garnered scholarly attention in nursing, bioethics, and medicine. Physicians and nurses alike experience moral distress in clinical situations when they know the ethically appropriate action to take but cannot pursue it because of institutional or other impediments. When unrecognized and unaddressed, moral distress can compromise patient care and ethical practice and contribute to health professionals' job dissatisfaction and burnout, with consequences for health-care teams, health-care organizations, and patients. This presentation by a physician and a nurse uses a clinical case as a touchstone and addresses what moral distress is, how both doctors and nurses experience it, and what they and their institutions can do about it. The collaborative presentation also models the interprofessional approach the presenters recommend for dealing with moral distress in clinical practice.
HIV and liver transplantation: Past, present, and future The two fields of HIV treatment and transplantation have changed dramatically in the past 20 years. Advances in treatment in both fields have led to improved patient survival and better quality of life. Now, physicians are exploring a new possibility: should organs be transplanted into HIV-positive recipients? This would not be the first time organs have been transplanted into individuals with known infections; Hepatitis B was a contraindication for liver transplant up until recently. Its role has changed dramatically, and physicians have learned how to successfully transplant this population. HIV's role in liver transplantation is following a similar course to that of Hepatitis B. Small studies have shown success in liver transplant with the HIV positive population. It is time to consider transplantation in this population in the centers most prepared to do so.
Should patients be compelled to undergo HIV testing after a needlestick injury involving a health care worker? When patients involved in needlestick injuries refuse HIV testing, an ethical dilemma results, pitting a patient's right to privacy, autonomy, and bodily integrity against a healthcare worker's right to avoid harm. This conflict is not easily resolved, as both parties have valid and competing interests. This paper examines the scope and limits of patient privacy, the status of legislation providing for compulsory testing after healthcare exposures, and the ethical obligations of patients to their healthcare providers, if any. Aside from HIV infection, healthcare providers may also suffer serious psychiatric sequelae from needlestick injuries, and serious medical adverse effects from antiretroviral therapy. This paper argues that patient consent should be waived to make relevant patient medical records available, and to perform HIV testing on stored blood samples. As a last resort, compulsory HIV testing is intellectually justifiable, but obnoxious and perhaps incompatible with the notion of medicine as a compassionate profession.
PERSPECTIVES Thoughts on aging There is a time for everything to begin and end. The practice of a much loved profession must end, but retirement should not mean inactivity while waiting for the hearse. Rather it is a time to do what has been delayed, not to become dissociated from society.
TO OUR STUDENTS Finding balance Many physicians sacrifice their own personal interests for the sake of work and family. In this essay, I argue that kindling such interests need not be viewed as a selfish endeavor, but rather benefits one's self, family, and patients.
POETRY Fireflies Snow upon the Blue Jay's Nest Sisyphus Remembering The Malpractice Accusation Lights in the ICU Morning Rounds DNR For Marge Love Song of an Interne Hospitalist Haiku |
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