Close call

11:40 PM. I'm on a deserted major road dotted with strip malls in an unfamiliar part of town. I am just about done making a U-turn when a man runs from the side of the road into the right lane, directly in front of my car. I slam on the brakes. The man now is running straight at me. There's something metallic in his hand and he's clasping it to his chest. Is it a pistol? His expression is cold and he says nothing. He is perhaps 30 feet away and closing fast.

What to do? I quickly floor the accelerator and peel out, tires screeching, jerking my steering wheel sharply to the left. I curse loudly. He seems surprised and runs to my right. Everything seems to be in slow motion. I brace myself for the gunfire that I fear is imminent.

I look in the rear-view mirror and see the man returning to the hedges at the side of the road. My car doors are unlocked.

Some experiences make you feel lucky to be alive.

Errors

My heart sank and I swallowed nervously. I had just finished administering a vaccine for the second time, and the syringe's plunger felt strange as I finished pushing it in. It hit me. I had forgotten to check the vaccine for air bubbles, and had almost certainly injected a bit of air into my patient's left deltoid. I pictured him dying overnight of an air embolism, a cruel fate brought on by a vaccine that was supposed to protect from harm.

I tried to look calm and found an attending physician, who assured me that everything was fine. The amount of air in vaccines is miniscule, and in fact, having a bit of air in the syringe often helps an injection. No harm done. But I was still shaken. I had skipped a step that I had believed at the time to be critical.

The experience convinced me of just how easy it is to commit a medical error.

Even a simple procedure like administering a vaccine involves a number of important sequential steps. The sharps disposal container needs to be placed with arm's reach before the needle's cap is removed. The medical chart needs to be double-checked to ensure that the correct vaccination is being given. The injection site needs to be disinfected properly. Inevitably, even the best practitioners mess up a step. And it's a tremendous problem, responsible for 48,000 to 98,000 deaths per year.

There is a growing movement to use checklists when carrying out medical procedures, just as pilots do when they fly. One of my favorite medical writers, Prof. Atul Gawande, wrote a fascinating article in the New Yorker on the subject, which I encourage you to read for free. Yes, individuals commit errors, yet the systems they work in can reduce the likelihood of those errors. For example, anesthesiology equipment wasn't standardized in the past, and turning a knob to the right would release more anesthetic on some machines and release less anesthetic on others. Now the equipment is consistent at every hospital in the country, avoiding needless deaths.

The fruits of prevention efforts are masked. When a hospital implements a labeling system to avoid wrong-side surgeries, a patient whose procedure goes well won't know that it could have ended in catastrophe. It's not very obvious when the system succeeds, only when it fails. But even if prevention isn't sexy, we need to still try. Avoiding medical errors is inexpensive, it saves lives, and it is the right thing to do. For my part, I'm writing up a checklist for myself on how to administer vaccines properly.

Photo reproduced with permission via Creative Commons license. Author: @alviseni

An afternoon at elementary school

How familiar are inner-city kids with vegetables and healthy eating? I was pleasantly surprised to find out.

A classmate arranged for interested students to design and deliver an hour-long presentation about health at an inner-city elementary school. I signed up and received my assignment: first graders. How can anyone spend an hour discussing medicine with kids who can't tie their own shoes?

Lost, I turned to my brother for help. He challenged me to do something about obesity, sending along this must-see video from Jamie Oliver's wonderful Food Revolution. The first-graders shown live in one of the most obese counties in the nation:


A challenge took shape: could my first-graders outdo their Huntington, West Virginia counterparts in identifying vegetables? With little more than a white coat, stethoscope, and zealous enthusiasm, could I inspire young children to improve their diets? My brother proposed a curriculum:

1. Explain how vegetables are a delicious and awesome part of a balanced diet.
2. Show various vegetables and see if students can identify them.
3. Have students draw a picture that has a vegetable in it.
4. Have students vote for their favorite vegetable.
5. Explain that anyone can be a doctor if they work hard in all subjects in school.
6. Feast on baby carrots.


I woke up early to snag exactly one of every vegetable from the local food co-op. My trip to the check-out portended badly for the vegetable quiz later that day, when the clerk and I disagreed over whether a root vegetable in my basket was a leek or a garlic stalk.


A thoughtful classmate who is passionate about nutrition and excellent with kids thankfully offered to join me and split teaching duties. We drove to a rough part of town and found our school.

First graders say adorable things. Our presentation began something like this:

Med Student A: "We're medical students and we're here today to talk about vegetables! Vegetables are...yes, I see a hand."
Ashley: "One time, I got sick and I throwed up."
Med Student A: "Yes, that happens sometimes. Another question?"
Josiah: "My throat hurted...and...my dad made me eat ice."
Med Student B: "Yes! Ice can be good for you. So, about vegetables--"
Deidre: "I ate a banana yesterday for dinner."
Med Student B: "Awesome! I love bananas too! They're so delicious and good for you! So vegetables are..."

We eventually moved on to the quiz. Students successfully identified broccoli, carrots, cucumbers, and even eggplant. They displayed a surprisingly good grasp of what sorts of food were nutritious and which were not. They understood where vegetables grow, where they can be purchased, and even that you can grow your own vegetables in your garden and your yard. Our election crowned carrots as the crowd favorite, although ballot-stuffing plagued the polls. Unfortunately, "one man, one vote" is so foreign a concept that we tallied 50 votes among only 20 students. Fortunately, their math skills were so elementary (15 minus 11 was beyond their powers) that no one realized the election was a sham.

The election candidates

The students unleashed their creative juices and were keen to show us their handiwork. We saw plenty of fruits and vegetables as well as a few head-scratchers.

Annalise (holding up drawing): "What is this?"
Med Student: "That looks like a bunch of grapes!"
Annalise: "And this?"
Med Student: "That's a beautiful banana!"
Annalise: "What is this?"
Med Student: "Umm...I'm not really sure what that is. Is that an airplane?"
Annalise: "Aero-plane!"

It felt like I was acting improv again, where you heartily embrace all of your fellow actors' ideas (even when it meant portraying a manic, toothless, and crazed Louisiana sailor) and encourage and support them. These young minds were delightfully bursting with creativity and non sequiturs.

At the end, it was time to feast on baby carrots. I have never seen kids so excited to eat carrots before. Even the kids on the playground, who we didn't teach at all, devoured our carrots after my fellow med student and I gushed over how delicious they are. Saturday morning cartoons are filled with advertisements successfully pushing sugary cereals and candy onto these malleable young minds. But this one wonderful afternoon, vegetables reigned king.

In the fight against obesity, there is hope after all.