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Patient Safety
Silence vs
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Silenced
White wall
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Silencing
Conflict Of
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Psychology of
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Subjectivity
Blacklisting  
Nurse survey
Loyalty
Mobbing and
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Trust Us
Defensive
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Report Rate
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SOAP
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Crime in
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Thomas Jefferson said that given the choice between government without newspapers and newspapers without government, he would choose to have newspapers.

In medicine we have government without newspapers. Patients cannot find out what they need to know to make informed choices. No one in medicine records or reports the information patients need to know the most. So patients will have to.

Colorado Fluoride

Before there was a state or even a territory named Colorado, there was a town called Colorado in Ohio. It got that name from a Lt. Reillison who was part of a regiment sent to quell Indians in the early 1800s. Everyone in the regiment had heard him repeat stories he had heard at a dinner in Rhode Island given in honor of an explorer who told them, among other things, an account of boating down the Colorado River - the amazingly high cliffs, the rushing whitewater and the surprises around every bend. Everyone in the regiment had heard Reillison repeat the stories. So when they were making notes on a map and, to refer to a stream they had crossed earlier that day, he said, "back there at the Colorado River," everyone laughed. The joke became the way to refer to the location on the map. That location became a suburb outside of Cincinnati where Aaron was born and Dr. Masser was the health commissioner.

Dr. Masser had thought that there should be a healthcare facility in the community. He thought that a community that could afford two country clubs and two golf courses should be able to support a medical facility. There was no industrial area and only one retail area of about six shops, but there was the old commuter rail stop. No train had stopped there in years, not after everyone started commuting in cars. Dr. Masser thought the spot should be turned into a healthcare facility. He was so loved and respected that people wanted him to have whatever he wanted. To help him get support for the project, the town council created an official title for him - Health Commissioner. It was not an empty title. It conferred upon him authority over healthcare matters in the town of Colorado. His name appeared on the town's letterhead. A seat was added to the town council chambers. He attended the meetings and voted with the rest of the council. His project gained momentum. Plans were drawn. A period of public review was scheduled.

Then came fluoride.

Colorado, Ohio had been founded by soldiers and businessmen. The first houses built were stately. It's location attracted people affluent enough to commute by rail or buggy so that they could live in pretty, serene surroundings. It became an expensive community where new arrivals tended to be successful, educated people wanting their children to be in one of the best schools in the country and wanting the prestige of living in Colorado. That resulted in the town's being almost entirely Republican. In the 1950s it had voted solidly for Eisenhower and worried about the communists. It managed to postpone dealing with fluoride for about twenty years after it became an issue.

Early on the town of Colorado had been a focal point for the fluoride debate partly because it was in the state of Colorado that the beneficent effects of fluoride had been discovered. Around the turn of the century it was found that children living below Pike's Peak had fewer cavities than children anywhere else. About thirty years later it was determined that the cause was the fluoride that occurred naturally in the drinking water flowing from Pike's Peak. A movement spread to get fluoride into water systems all across America. The pros and cons were front page news and created some hysteria, including some saying it was a communist plot.

In the town of Colorado when the possibility of its being a communist plot was mentioned, the community's self-awareness of its own conservatism was great enough to keep that suggestion from being brushed off as ridiculous. But it was close enough to ridiculous that there was almost no one suggesting that they themselves believed it to be true. There was, however, an awareness that some of these people probably did but just were hesitant to say so and so one needed to be polite about the proposition.

There also were religious objections. And there were political objections against forcing an entire community to imbibe something regardless of whether or not they wanted it. This was the land of freedom of choice. Most people would not be helped by fluoride. How sure were they that no one would be hurt? Debates raged across the nation. Journalists in southern Ohio liked to drop in on Colorado when writing about it because of the parallel between name of the place and the place where fluoride was discovered - that and the kind of people who lived there. They were laying the ground work for a continuing story expected to end in fiery debate in a town council meeting and a referendum. Journalists even had gotten citizens to speculate on who might represent the opposing sides in the debate. Dr. Masser's name was mentioned frequently.

The debate in other states had divided communities and stalemated in people screaming each other. One community cut the matter short during a debate in which one of the debaters turned to the other and said, "This jar holds a cup of salt. That jar holds a cup of fluoride. Right here right now I will eat this cup of salt if you will eat that cup of fluoride." Of course that much fluoride would be lethal. The point was made. The community voted down fluoride. Citizens in Colorado said that was manipulative and not a good way to set policy. They were against fluoride, but they wanted it to be refused intelligently, not through sensational ploys like that.

In a town that was ahead of the curve in so many other things, they managed to delay making a decision on fluoride for almost twenty years. Then they got a new mayor. One night after a town council meeting the mayor and a couple other council members said to Dr. Masser that they wanted to schedule a special meeting for the fluoride debate and make plans to hold a referendum once and for all. Dr. Masser asked, "Why would we do that? They don't know what's good for them. Put it in the water." And that was that.

As much against fluoride as Aaron's parents were, they were not going to question Dr. Masser. The rest of the community responded the same way. He got his healthcare facility and he got fluoride and he got whatever he asked for whenever he asked for it. He deserved the love and respect and gratitude he got. He deserved every bit of it. Aaron knew that and felt that. Still, it put a place marker in his mind that would stay there like a place marked in a book to turn back to and reread in light of new information someday.

Like twenty years later when he was dating Karen who literally lived on the wrong side of the tracks in Shrumpville. Often we fall in love with people before we find out who they are. Once he fell in love with her, the only thing that mattered was that he get to spend the rest of his life with her. He met her parents (her father, irony of ironies, owned a shoe store) and siblings, but now he was at a gathering of her extended family where he would meet the rest. There seemed to be hundreds of them. She had more siblings than he did cousins. She had almost a hundred cousins. She had nine cousins her same age. While trying to get a fix on who everyone was, he kept noticing an older gentleman sitting quietly without interacting with anyone. Aaron asked who it was. It was Karen's grandfather. Aaron said he wanted to meet him.

Karen explained that when her grandfather had been in his fifties he had developed symptoms of Parkinsons, a disease that ran in their family. Their family doctor said he could treat. It was the family doctor to whom they had gone their entire lives. They were used to doing whatever he said. The doctor had them make an appointment for him to perform a short procedure in a few days.

During the appointment the doctor, there in his office, performed a procedure that was in vogue at the time. Although he was not a licensed surgeon, and was not in an operation room, he had her grandfather lean his head back while he inserted an instrument very similar to an ice pick over the eyeball and under the roof of the orbital cavity. He slid it in until it hit the roof of the orbit and then with a wooden mallet knocked it through into the frontal lobe of the brain. He swished it from side to side like a windshield wiper for several minutes. This was the Bilateral Transorbital Lobotomy that was so popular at the time. It was done at Johns Hopkins and at the Mayo Clinic and was popularized by Dr. Walter Freeman who was traveling the country showing other doctors how to do it. A doctor in Texas had done 75 in one day.

One of Mr. Apkern's children had come with him and his wife because their doctor had said that he should not drive himself back home after the procedure. No one thought to ask whether he would be able to work the next day. Or whether he ever would be able to. When the procedure was finished, her grandmother took Karen's grandfather by the hand and led him to the car. When they got home she took him by the hand to lead him into the house. At dinnertime she took him by the hand to lead him to the table. At the table she had to feed him. And that was the way it was for the next thirty-five years.

The doctor operated with the best information available to him at the time, but little was available to the family. And not enough was available to the doctor. It still is the case that doctors do not track the long term results of their treatments in a meaningful way. Surgeons do not keep tables to see what percentage of their own patients are better or worse off ten years as a result of their procedures. They do not compare their success rates to the rates of other surgeons who may be doing things differently. There is no outside scrutiny making objective evaluations of any of this. For all the changes in medicine, it is no different in ways that are crucial to patients.

The extended family continued to rely on that doctor for all of their healthcare. Her grandmother continued to take her grandfather back to that doctor when necessary. But her grandfather never again knew who the doctor was or who his wife was or who his children were or who he himself was. He never participated in another conversation or made another comment about anything. He never spoke again. Twenty-five years later he was led by the hand to this family gathering where he sat in a chair staring blankly at nothing. Aaron wondered if the doctor had had any training in doing the procedure, or if he had read an article that said this would work and so he tried it out on her grandfather. He wondered if he did this to many patients.

Aaron knelt down by the chair, got her grandfather to look at him, took his hand and shook it saying, "Mr. Apkern. I'm Aaron Roark. I'm in love with your granddaughter. Thank you for your part in bringing her into this world and helping her to grow up to be the woman I am going to get to spend the rest of my life with." As glazed eyes stared at him with no apparent comprehension, Aaron thought about how the town of Colorado got fluoride, and about how his mother got the scar on her forehead, and became more sympathetic of his mother's position on doctors and medicine and healthcare.

Next Chapter

Medical Novel Table of Contents

Persons, places, events, and situations in this story are purely fictional.
Any resemblance to actual persons, living or dead, is coincidental.

Rough Draft / Under Construction

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Silence versus Patient Safety
Loyalty versus Patient Safety
The White Wall of Silence versus Patient Safety
Blacklisting Patients
Freedom of Speech for Patients
Medical Complaints - How to

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It's a path

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