Happy Day of the Physician

Dear readers, listeners, fellow bloggers and podcasters;

Today, December 3rd, we celebrate the Day of the Physician the Americas in honor of all the dedicated and hard-working professionals tending to the health care needs of people from Alaska in the extreme North to Ushuaia in the extreme South.

The Panamerican Health Organization, or Organización Panamericana de la Salud in Spanish, designated this day in honor of Carlos Juan Finlay Barres, a Cuban physician and researcher who had discovered in 1881 that the Yellow Fever was transmitted through an insect vector like Aedes aegypti; he was born on December 3, 1833 in Puerto Principe, Cuba, and studied Medicine at Jefferson Medical College in Philadelphia.

Note. This image of Dr. Carlos Finlay was taken form Wikimedia Commons.

Dr. Finlay, dubbed as “the mosquito doctor” by his detractors, had a hard time to prove his hypothesis but he finally collected enough clinical data to submit to the “Yellow Fever panel” headed by Dr. Walter Reed that finally accepted his findings in 1901. That medical breakthrough prodded the Panama Canal authorities to set up the proper sanitary conditions in the workers’ camps in order to finish the humongous project. In 1902 Dr. Finlay headed the precursor office of the present day PHO.  Dr. Remo Bergoglio, an Argentine physician acting on behalf of the “Sociedad Médica de Cordoba”, submitted a proposal to celebrate this day on the floor of the PHO congress in Dallas in 1953.

To my dear colleagues of the Americas, thank you for your devoted daily work.

A mes collègues de l’Amérique, felicitations pour votre travail dévouée de tous les jours. Salut!

A mis queridos colegas de las Américas, gracias por su trabajo abnegado de todos los días. Salud!

Stay distant. Stay safe. Stay beautiful.

What do you think? Please tell us.

Do not leave me alone.

Fox Sisters: pioneers of American Feminism

Spiritualism was a religious reaction to the “crisis in faith” that the Civil War produced across the United States of America, with millions of citizens seeking to reconnect with loved ones who died in that extremely bloody confrontation. It did not have a formal structure nor supervising hierarchy, for which women welcomed it as a spontaneous way to express their feeling, fears and hopes, without the castrating influence of the Patriarchate that dominated civic and religious entities.

In an era where women were excluded to the back of religious congregations and were prohibited from speaking loud and clear, let alone address the worshippers, it offered an uncensored and unsupervised channel for them to address critical social issues like abolition, labor reform, education of children, health reform, temperance. Spiritualism gave oppressed women a venue to express their opinions without the censoring gaze of the State or the Official churches; it gave them a human presence.

Spirituals affirmed that God gave the gift of talking to every human being, which enabled women to express their personal opinions and fight for a progressive agenda. Acting as inspired “mediums” and “trance speakers” they slowly but steadily gained confidence in talking before the public at large and they forever left the anonymity of their kitchens where they had been perfidiously relegated for many generations. They immediately clashed with the male-dominated healthcare institutions as they were branded of “quacks” and “illegitimate healers” by the envious professionals.

The religious movement, which was born before the Civil War and thrived during the conflict and its very traumatic aftermath, was paradoxically born in the Fingers Lake region of Upstate New York, where Mormonism and Millerism also started. Two young girls named Margareta “Maggie” Fox, 14 years old, and Kate, her 11 years old sister, were living in a farm in Hydesville, New York. In March 1848, they confided to a lady that lived next door, that they had been hearing a series of raps on the walls and the furniture lately. They invited her to witness the experience and under the guidance of Margaret, their mother, they huddled in the girls’ bedroom.

– “Count five,” said Margaret. Then the room shook five times.

– “Count fifteen,” ordered Margaret. The mysterious presence obeyed her command.

– “What’s our neighbor’s age?” she asked. There were thirty-three clear raps.

– “If you are an injured spirit,” she finally asked, “manifest it with three raps. It did.

Note. This image of the Fox Sisters was taken from Wikimedia Commons.

An excellent review article in the Smithsonian Magazine explained what happened afterwards with the Foxx sisters. “The Fox family deserted the house and sent Maggie and Kate to live with their older sister, Leah Fox Fish, in Rochester. The story might have died there were it not for the fact that Rochester was a hotbed for reform and religious activity; the same vicinity, the Finger Lakes region of New York State, gave birth to both Mormonism and Millerism, the precursor to Seventh Day Adventism. Community leaders Isaac and Amy Post were intrigued by the Fox sisters’ story, and by the subsequent rumor that the spirit likely belonged to a peddler who had been murdered in the farmhouse five years beforehand. A group of Rochester residents examined the cellar of the Fox’s home, uncovering strands of hair and what appeared to be bone fragments.

The Posts invited the girls to a gathering at their home, anxious to see if they could communicate with spirits in another locale. “I suppose I went with as much unbelief as Thomas felt when he was introduced to Jesus after he had ascended,” Isaac Post wrote, but he was swayed by “very distinct thumps under the floor… and several apparent answers.” He was further convinced when Leah Fox also proved to be a medium, communicating with the Posts’ recently deceased daughter. The Posts rented the largest hall in Rochester, and four hundred people came to hear the mysterious noises. Afterward Amy Post accompanied the sisters to a private chamber, where they disrobed and were examined by a committee of skeptics, who found no evidence of a hoax.”

There are many references in The Bible about human beings talking with spirits, angels, demons, etc., for which Modern Spiritualism found a fertile ground in the fervently religious, mostly rural communities of the New World. By the mid-1800s the preaching of Franz Anton Mesmer, an Australian healer, had spread all over the young nation. He claimed that everything in the Universe, including the bodies of all living beings, is ruled by a “magnetic fluid” that produces sickness when it is out of balance. He waved his hands over the body of the sick patient and supposedly induce a hypnotic state to restore the homeostasis and get rid of the pathogens. Thus, the verb “to mesmerize” came into being as it referred to a person that can hypnotize another person with a rather uncommon, even supernatural, mode.

The American population of the mid-nineteenth century was also influenced by the teachings of Emanuel Swedenborg, a Swedish philosopher and mystic, that described. After Life as a collection of three heavens, three hells and an intermediate staging ground where everybody went right after their death. Selfish beliefs and deeds pushed you closer to one of the hells while generous ones push you closer to one of the heavens. He claimed to have interacted with spirits in all levels. Seventy-five years later, Andrew Jackson Davis, an American seer nicknamed the “John Baptist of Modern Spiritualism”, claimed that Swedenborg had spoken to him in a trance and urged him to combine the philosophical tenets of Mesmer and his own to create a novel current that would better serve the needs of the American people.

The Fox Sisters had peripatetic lives, full of public demonstrations and excitement. Being national celebrities, Maggie, Kate, and Leah Fox embarked on a tour across the country, even presenting their act before the most rancid New York society. They carried their act in the parlor of the Barnum Hotel with 10 AM, 5 PM and 8 PM sessions that could accommodate up to 30 attendees who had to pay one dollar each. Leah set up a cabinet in the Big Apple where she set up regular office hours for her clientele, while the two sisters went on a national tour in major Eastern cities.

The Smithsonian article added: “On October 21, 1888, the New York World published an interview with Maggie Fox in anticipation of her appearance that evening at the New York Academy of Music, where she would publicly denounce Spiritualism. She was paid $1,500 for the exclusive. Her main motivation, however, was rage at her sister Leah and other leading Spiritualists, who had publicly chastised Kate for her drinking and accused her of being unable to care for her two young children. Kate planned to be in the audience when Maggie gave her speech, lending her tacit support.” Maggie confessed that together with her sister Kate they tied an apple with a string and manipulated it to resemble the clapping that supposedly spirits might make.

Notwithstanding this confession, which she would later recant, Spiritualism became an extremely popular religion, with as many as 10,00,000 adherents in its heyday. And it opened the doors of public discourse and civic engagement to many smart and committed ladies that wanted to voice their opinions about social issues dear to them.

Stay distant. Stay safe. Stay beautiful.

What do you think? Please tell us.

Don’t leave me alone.

 

Uruguay’s Number One football fan in Miami, Florida, USA

Dear readers, listeners, fellow bloggers and podcasters:

Good morning. Today the Uruguayan football team is playing Ghana in the qualifying rounds of the Quatar World Cup. We are winning 2 to 0 in the beginning of the second half.

As the character played by Guillermmo Francella, in the 2009 Oscar award-winning film “The Secret in their Eyes“, explained with the most famous movie phrase about football:

¿Te das cuenta, Benjamín? El tipo puede cambiar de todo: de cara, de casa, de familia, de novia, de religión, de Dios. Pero hay una cosa que no puede cambiar, Benjamín, no puede cambiar de pasión

(Do you realize, Benjamin? The guy can change everything: his house, his family, his girlfriend, his religion, his God. But there is one thing that he cannot change, Benjamin, he cannot change his passion)

VAMO’ ARRIBA LA CELESTE!!!

What do you think? Please tell us.

Don’t leave me alone.

Hasta la Victoria, siempre!!!

Queridos lectores, blogeros y podcasters:

Buenos dias. La gran batalla cultural de nuestros tiempos no esta desarrollándose en los espacios sociales de USA, Inglaterra, Francia o Alemania. Está transcurriendo ahora mismo en los campos de guerra y muerte en el Este y Sur de Ucrania, donde el aguerrido ejército y la población civil de esa gran nación estan enfrentando la invasiôn rusa.

Enfrentados en una guerra reminiscente de la Segunda Guerra Mundial (donde el ejercito alemán luchó y perdió cruentas batallas en esas mismas llanuras) están dos diametralmente opuestas visiones para nuestro plnaeta, con importantísimas implicancias, sociales, económicas y culturales para nosotros y nuestros hijos. Y hasta nietos.

Por un lado está el AUTORITARISMPO DÉSPOTA que niega las libertades individuales y las garantias jurídicas de las naciones democráticas. Eso es la FEDERACIÓN RUSA.

Por el otro lado está UNA NACIÓN MODERNA que esta empezando a implementar reformas sociales y juridicas para ser una sociedad democrática. Esa es la UCRANIA.

Note. This Army poster from the Spanish Republican Army was taken from Wikimedia Commons. The legend says “Grab the rifles. For the Homeland, Bread and Justice.”

https://commons.wikimedia.org/wiki/File:2_posters_of_the_Spanish_Civil_war.jpg

Ahora no es momento de tener posiciones tibias y confuasas en este conflicto . O se está con la DEMOCRACIA REPUBLICANA o se está con la EDAD MEDIA.

Todos los intelectuales tenemos que apoyar, en la medida de nustra capacidad, el gran esfuerzo de las naciones libres para contener el expansionismo ruso.

Como decíamos en nuestras gloriosas épocas de militante político que luchaba contra la dictadura fascista de los militares uruguayos  en las calles de nuestro querido Montevideo.

HASTA LA VICTORIA, SIEMPRE.

Que les parece? Dénnos su opinión.

No me dejen solo.

 

 

Should we get our vaccines against Pneumonia?

Pneumonia is a parenchymal infection of the lungs that presents with acute or subacute onset of fever, productive cough, pleuritic chest pain, localized râles, and radiological signs of consolidation. There are three categories of this disease:

  1. Community-acquired pneumonia (CAP)
  2. Healthcare- associated pneumonia (HCAP)
  3. Nosocomial pneumonia.

It is a worldwide leading cause of emergency visits, hospitalizations, and death; according to the World Health Organization (WHO) it is the fourth leading cause of death, killing more than 2.6 million lives I 2019. There are two major peaks of incidence:

  1. Children less than 5 years of age.
  2. Adults older than 75 years of age.

The combined mortality for influenza and pneumonia has radically decreased in the USA—from 23.7 per 100,000 inhabitants in 2000 to 15.2 per 100,000 inhabitants in 2019—due to the falling of smoking rates across all socio-economic segments of the American population and the increase of use of the corresponding vaccines. According to the American Public Health authorities, the best strategy to decrease the morbidity and mortality rates of CAP is to vaccinate the target groups:

  1. Age: individuals less than 5 years of age and older than 65 years old.
  2. Smoking history.
  3. Chronic Lung diseases: Chronic Obstructive Pulmonary Disease (COPD) Childhood Pneumonia, Occupational dust exposure.

The best strategy to decrease the morbidity and mortality of HCAP is to:

  1. Maintain critical pulmonary defense mechanisms.
  2. Reduce the incidence of intra-hospital infections and similar care events.

The most common pathogen producing Pneumonia is Staphylococcus Pneumoniae, which has been identified in almost a third of patients that had proper testing and approximately 40-50% of all blood cultures-confirmed cases. Patients with COPD often have tracheobronchial colonization with a mix of S. Pneumoniae, Hemophilus Influenzae and Mycoplasma catarrhalis. Heavy use of alcohol carries the risk of dangerous pathogens like anaerobic bacteria, which predispose to lung abscess and empyema, and the opportunistic emergence of gram-negative bacilli tougher to treat.

The American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) noted in their 2005 guidelines that the three variants of pneumonia associated with healthcare facilities –HAP, VAP and HCAP— “are similar in that they often result from colonization, then infection by resistant gram-negative bacilli and methicillin-resistant Staphylococcus aureus (MRSA) necessitating broader empiric antibiotic therapy than that commonly used for CAP.”  These same ATS/IDSA guidelines do not recommend the routine use of blood cultures in the ambulatory setting, except in the following circumstances:

  1. Symptoms or signs of severe CAP.
  2. Suspicion of drug resistant or rare pathogens.
  3. No response to empiric antibiotic treatment after 72 hours.

The same ATS/IDSA guidelines recommend the pre-treatment use of blood cultures before initiating treatment in hospitalized patients who are classified as severe CAP, are being empirically treated for MRSA or gram-negative bacilli or have one of the following: a) cavitary infiltrates, b) leukopenia, c) chronic alcoholism, d) chronic liver disease, e) COPD, f) pleural effusion, g) no spleen, and h) admission to ICU.

Patients who do not have any life-threatening conditions can be managed at home. Pending the results of any blood cultures that were obtained, the 2019 ATS/IDSA guidelines recommend the following initial treatment for Pneumonia:

  1. Amoxicillin 1 gram three times per day.
  2. Doxycycline 100 mg twice per day.
  3. Or a macrolide monotherapy—azithromycin 500 mg on first day and then 250mg per day or clarithromycin 500 mg twice per day.

The ATS/IDSA guidelines recommend at least five (5) days of antibiotic treatment which should be extended 48 to t72 hours if there were any complications; when gram negative or Staphylococcus bacteria are present, treatment should be longer as these pathogens tend to destroy pulmonary tissue and provoke residual scarring.

Note. This 1802 caricature of the Anti-Vaccination movement by Edward Gillray was taken from Wikimedia Commons.

As it has happened ever since Edward Jenner introduced the life saving vaccines against smallpox, there are detractors of the Pneumococcal vaccination. What does the science say?

Pneumococcal vaccination has significantly improved over the past few years, as more variants are accounted for. A single agent, PPSV23, had been traditionally used for immunocompromised individuals and those older than 65 years; it is effective against 85 to 90% of the pneumococcal serotypes in our communities. Considering that the polysaccharide vaccines are not effective in children less than 2 or 3 years of age, we must use conjugate vaccines. In 2010 a 13-valent conjugate vaccine dubbed as PCV13was introduced in the market and its use has steadily decrease the incidence of the disease in children. In 2013 that vaccine was recommended for immunocompromised individuals and two years later for adults older than 65 years. However, considering the sharp decline of Pneumococcal infections in adults after he introduction of PCV 13 in children, they amended that recommendation already.

The influenza vaccine is a trivalent live vaccine that contains the three virus variants that are expected to be prevalent the year following its manufacture. Combined with the pneumococcal vaccine, it has been effective in reducing flu and pneumonia in the USA. However, their use is still limited due to poorly designed Public Health initiatives and lack of provider effective participation in vaccination campaigns.

A September 2022 communique of the CDC to physicians says: “The 13-valent pneumococcal conjugate (PCV15 from Wyeth Pharmaceuticals) and the 23-valent pneumococcal  polysaccharide vaccine (PPSV23 from Merck, Sharp and Dohme) has been recommended for American children; those recommnendations vary by age group and risk groups.”

We, physicians, are notorious for missing that needed vaccination again and again. We paradoxically scold our patients for not getting their yearly flu shots, but….We never got one ourselves. We solemnly promise to get our flu and pneumococcal shots after we get the bivalent Pfizer Covid booster and the Holidays passed. Why? Because we want to minimize any risk, no matter how small it might be,  of interference with the plentiful food and drinks we are planning to load our bodies with. Hey. give us a break…We’re only human!!!

Stay distant. Stay safe. Stay beautiful.

What do you think? Please tell us.

Don’t leave me alone.

Origin of Spiritism – Allain Kardec

Spiritism is a religious and philosophical doctrine that first appeared in 19th century France with the works of Hippolyte Leon Denizard Rivail, who wrote his books with the pen name of Allain Kardec. He discussed the nature, origin, and destiny of spirits plus their connections with the physical world. Initially he studied the acts of the mediums and their claims that they could talk to spirits; he considered then a fraud, but slowly he began to change his opinion and eventually became a believer.

Note. This image of Allain Kerdac was taken from Wikimedia Commons.

This file comes from Gallica Digital Library and is available under the digital ID btv1b8529781h, Public Domain, https://commons.wikimedia.org/w/index.php?curid=77972078

During his lifetime he assembled al the answers that the spirits provided him in what he called the codification, a unifying body of premises. There are three foundations:

  1. Science: study the world around us to discover hard data
  2. Philosophy: give meaning to the findings for humans.
  3. Religion: this critical knowledge must be used in or everyday lives.

Rather than an esoteric practice that has been derided in all the modern forms of entertainment like the cinema, Spiritism constitutes a moral doctrine that appears in almost all religions based on the belief that we all carry an immortal spirit inside our bodies, which can be considered as “a temporary receptacle” to be discarded. The disembodies spirits that wander around our physical world can have good or evil intentions. The believers in Spiritisms also adhere to the Theistic Evolution, which established that God works in accordance with the laws of Mother Nature. Thus, there would not be any mismatch between the theories of Creation and Evolution.

On April 18, 1857, Hippolyte Leon Denizard Rivail published Le Livre des Esprits, which is a collection of the answers provided by the spirits as relayed by the mediums in various seances along the 1850s. These players gave signs of a modern corporate unity as they defined themselves as the defenders of the “Spirit of Truth.” He did not proclaim to be “the author” but rather “the organizer” as he explained that he was just compiling and organizing the thoughts of spirits without prejudice.

The basic concepts enumerated in that book were the following:

  1. Monotheism: there is only One Supreme Being, the source of good and evil.
  2. Creationism: God created the Principle of Everything.
  3. Teachings of Jesus Christ: very valid as moral and ethics lessons.
  4. Survival of the Spirit: our bodies are just temporary receptacles.
  5. Reincarnation: these spirits jump from one receptacle to another.
  6. Plurality of Worlds: there are more than one physical world.
  7. Perfectioning of the souls; through the different reincarnations, the spirits become wiser and savvier.
  8. Power of Migration: the spirits can travel between different worlds.

The worldwide influence of Spiritism should not be underestimated as there is an International Spiritism Council that agglutinates associations from 35 countries. The most powerful one is based in Brazil where millions practice Afro-American religions and are influential in health centers, charity institutions and hospitals.

In a second article, we will discuss the American Spiritism of the 18th Century.

Stay distant. Stay safe. Stay beautiful.

What do you think? Please tell us.

Don’t leave me alone.

 

 

Salmone con pomodoro, pepperoni ed cipolla

Dear readers, listeners and fellow bloggers:

Good morning. Last night we felt a little tired after studying and working the whole day and needed some comfort food quickly. Instead of getting some junk food, we took a different pathway. We found some fresh salmon in our fridge and we decided to prepare a delicious dish with nutritious vegetables  that took us only 15 minutes to complete. We hereby present the fresh, juicy salmon steak ( do not overcook it as it will lose all its nutrients) with some sautée onions, and red peppers in a tomato sauce. Here is the final dish.

We paired it with a bottle of Mahou, the great Spanish beer, which is one of our all-time favorites, and we sat down to eat it in peace on a small table in front of the TV news.

The dish was so good that we even received a Papal Benediction. As if Pope Francis were talking to us at the end of  his Sunday Homily, we heard his words: “Buon pranzo.”

Buon appetito!

Stay distant. Stay safe. Stay beautiful.

What do you think? Pllease tell us.

Don’t leave me alone.

 

The Covid 19 pandemic is not over yet

We are all extremely fed up with any discussion of the tragically deadly Covid-19 pandemic, especially those of us who suffered the irreparable loss of loved ones. We do not want to wear any masking anymore, except in crowded indoor spaces. We want to greet, touch, and hug family and friends. We want to be human again.

However, we should be careful not to toss our masks into the dustbin and engage in dangerous activities like having dinner in a crowded restaurant or board a plane to enjoy a leisurely dinner in the company of a few dozen people. Hold on just yet.

In an excellent article in The New York Times, Sharon Otterman said that the Omicron variant that accounted for most infections through the summer, BA.5, is now giving way to a variant soup—a mixture of different Omicron subvariants including BQ. 1 and BQ. 1.1, which are even more transmissible and better at dodging immunity.

The Center for Diseases Control, CDC, uses genomic surveillance to track the SARS-CoV-2 variants for sequencing; the Nowcast is a weekly updated model used to calculate the circulating variants in the USA. To provide more representative national, regional and jurisdiction—level estimates of recent proportions, calculations are made to track the spread of variants through the states and within the confines of the same state. The estimates are based on measuring the following

  1. Total number of reverse transcriptase polymerase chain reaction, rc-pcr tests.
  2. Total number of SARS-CoV—2 positive RT-PCT test results.

One of the present challenges of the American Public Health authorities is that the testing is now done mostly at home and not in public facilities, which is masking the real extent of the viral diffusion. However, there are indirect signs that these variants might be spreading already as the New York City officials have noticed an increase in the nationwide surge of hospital admissions due to respiratory Syncitial virus, coinciding with the seasonal surge of flu. The three viruses act as a minuet—named in honor of the 18th century ballroom dance where two persons dance in triple time.

There are clinical indications that the approved vaccines are still working against these variants, especially to avoid the hospitalizations and their grave consequences. As the immunity wanes over time, there will be strong need for at least two doses of the vaccines plus one or two booster doses. Vaccines still work, but for how long?

The real challenge is to encourage more American citizens to get the booster shots to protect them form the more nefarious effects of the Covid-19 pandemic.

What do you think. Please tell us.

Don’t leave me alone.

Physician and Nurse Burn – Out – Part XX. Mistakes in Children’s Medications

– “For a nurse, nothing compares to a screw-up in a kid’s medication —period.”

Louise X. is a veteran and proficient nurse that works in the Oncology ward of a large South Florida public hospital, who almost harmed an admitted child when she wrongly calculated the dilution parameters of a medication that comes in adult dosage from the manufacturer and must be adapted to lower children’s dosages. It was early dawn, and she was about to finish her nightly shift with a last round of medications for the admitted patients. The fatal error could have hurt the patient but providentially there is a protocol of double check up of these dosages in her hospital. An on-duty pharmacist picked up the mistake and quickly called her to correct it.

Note. This reproduction of a World War II US Army’s recruiting poster was taken from Wikimedia Commons.

Medication errors are frequent in all medical institutions worldwide. The National Coordinating Council for Medication Error Reporting and Prevention defines them as: “Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer. Such events may be related to professional practice, healthcare products, procedures, and systems, including prescribing; order communication; product labeling; packaging, and nomenclature; compounding; dispensing; distribution; administration; education, monitoring; and use.” Traditionally Nursing Schools have taught their students to follow the Five Rights rule in their practices:

  1. Right patient.
  2. Right Drug.
  3. Right dose.
  4. Right route.
  5. Right Time.

Some reviews claim medical errors in the USA range from less than 0.2% to a whooping 10% of all prescriptions, which is difficult to determine due to under or wrong reporting; a serious study across the whole health care spectrum is needed.

Not only the nursing personnel that administers the medication is to blame but we, physicians, have a fair share of blame as we should avoid these common mistakes:

  1. We should avoid the use of confusing symbols like “U” and write the full name “Units” instead.
  2. We should avoid the abbreviations and acronyms and write the full name.
  3. We should not determine the frequency with complex signs like QD. QOD or QID, but rather spell it clearly with common vocabulary.
  4. We should not use zeros before or after a number.
  5. We should not use any abbreviations for the medications’

There should be sound prescribing policies in al major health care institutions like:

  1. Drug reference material should be available online to care personnel.
  2. Basic clinical information like age, weight, allergies, etc., should be clear.
  3. If a physician’s order is unclear, incomplete, or illegible, it should be clarified.
  4. Dispense single-dose vials and ampules, avoiding multidose vials.
  5. Whenever possible, prefer oral administration rather than parenteral routes.
  6. Avoid distracting activities like texting when you do the medication rounds.
  7. Oblige a second pharmacist to doublecheck all the dangerous medications.
  8. Be aware of look-alike or sound-like medications when you are dispensing.

Pediatric patients are especially vulnerable to any medication errors as a) they cannot clearly communicate any discomfort and b) their physiology is still immature, with the renal and hepatic clearing systems still in their early stages of operation. That is why this nurse felt that she could have harmed the child with that excessive dosage.

There is also a big factor that crosses all the segments and specialties of Health Care. There is widespread tiredness and disillusionment in our files as the persistent micromanagement of payors, the still excessive paperwork despite the widespread use of electronic medical records, the offensive demeaning of professional roles by the encroaching of management and bureaucrats, the need for constant updates, etc., has been sapping our enthusiasm, notwithstanding our strong medical vocations.

One veteran professor in our Medical School warned us, the rookies, as follows:

“Hay que dejar la medicina antes que la medicina te deje.”

(You must leave medicine before it leaves you)

Stay distant. Stay safe. Stay beautiful.

What do you think? Please tell us.

Don’t leave me alone.