Massachusetts General Hospital

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Mass. General: ‘No Heroes!’ And Other Workplace Flu Protocol

Massachusetts General Hospital (Wikimedia Commons)

Massachusetts General Hospital (Wikimedia Commons)

No, we are not panicking, but yes, there’s a lot of flu about. Boston has just declared a flu-related health emergency, citing 700 confirmed cases thus far compared to 70 all last year.

In an alert to its staff, Massachusetts General Hospital reports that it’s seeing a flu season of “impressive intensity,” with an additional 40 to 80 patients with flu-like illness per day at the hospital’s health centers, outpatient clinics and emergency department.

“This has strained capacity to its limits. Likewise, many inpatient beds have been closed to isolate influenza patients, and hospital and practice staffing has been stressed by illness within their own ranks,” says the alert from Jeanette Ives Erickson, Mass. General’s senior vice president for patient care and chief nurse.

The memo lays out “best practices” for infection control that many a workplace may want to post and disseminate. To wit: (Slightly modified to remove some specifics, and still somewhat hospital-oriented)

• No Heroes! Staff with flu-like [illness] should leave the office and STAY HOME per the protocols of Occupational Health:
Do not come to work if you have a fever of 100.5°F or more and one or more of the following symptoms:
§ Runny nose or nasal congestion
§ Sore throat
§ Cough
§ Body aches
Continue reading

Steroid Debacle Prompts Hospital Pharmacies To Ramp Up In-House Compounding

The “clean room” at Massachusetts General Hospital’s central pharmacy. (Fred Bever/WBUR)

It would be going a little far to call this a silver lining of the national outbreak of meningitis from tainted steroids that has now killed 36 people and sickened over 500. But it is perhaps heartening that the drug shortage that has arisen because the steroids’ makers closed down may lead to some long-term improvements in how hospital pharmacies operate.

In case you missed it, WBUR ran an extremely excellent story by reporter Fred Bever this morning that featured the scene at Massachusetts General Hospital’s central pharmacy:

Patients at Massachusetts General Hospital take some 400,000 doses of medication every month — 4.8 million a year. And until two months ago, close to a million of them were compounded by third-party vendors, such as NECC and, even more, Ameridose. Now, most of that work has been brought in house to MGH’s central pharmacy.

That means a far heavier in-house workload:

“We’ve increased our hours. We have three hoods that are full on all three shifts, that we didn’t have before,” [lead technician Meghan] Federico said. “We were Monday through Friday 7:30 to 4:00 operation, and now we’re 24/7.”

Check out the full story on WBUR.org here. It concludes that Partners Healthcare, the state’s biggest health care provider, “is mulling the idea of creating its own compounding pharmacy that would serve all the hospitals in its system.”

You want something done right, do it yourself…

 

‘Ethically, Is This Right For Doctors To Do?’ Help A Terminal Patient Die?

(Photo illustration by Alex Kingsbury/WBUR)

Ravi Parikh, a fourth-year student at Harvard Medical School, faced conflicting messages.

The American Medical Association, which he belongs to, and the Massachusetts Medical Society oppose Question 2, the measure on next month’s state ballot that would allow terminally ill patients to ask a doctor to prescribe them life-ending drugs.

Harvard Medical School student Ravi Parikh

In contrast, The American Medical Student Association, which he also belongs to, supports it.

Ravi faced conflict within as well. He’d applied to medical school for the usual reason — to heal patients, as spelled out in the Hippocratic oath — not to help them die.

But his medical education introduced him to the complexities of modern American dying.

It stressed patient autonomy as a “central guidepost.” Yet he saw patients losing control as they neared death. “No patient that I have spoken to wishes to die in pain, alone, or hooked to a ventilator,” Ravi said, “and yet that is the way in which many patients pass away in the ICU.”

Seeing similar confusion about the ballot measure among his peers, Ravi and fellow fourth-year Grant Smith helped organize a panel discussion for all local medical students earlier this month at Harvard.

It let the audience pepper panelists on each side of the issue with questions, and also use the teaching tool of a case study: A hypothetical elderly man with metastatic cancer who comes to his doctor asking for a lethal prescription.

That case discussion, Ravi said, brought out a valuable consensus among the opposing panelists: All agreed on the need for more and better end-of-life discussions with patients.

But on the “toughest question” — “Ethically, is this right for doctors to do?” — there was no clear answer, he said. Rather, each side argued that its position represented the true embodiment of “Do no harm.”

‘This conversation involves an irresolvable dilemma.’

If Ravi and his fellow students remain conflicted, they can at least be comforted that they are in plenty of good company.

By all indications, the ballot measure presents an extraordinarily difficult problem of medical ethics — a problem wrestled with nationally as states consider physician-assisted suicide laws. Thus far, only Oregon and Washington have passed them; polls suggest that Massachusetts may be next.

The ethical issues involved are hard and deep enough to divide not just medical associations but medical staffs — a Massachusetts General Hospital panel presented arguments for and against Question 2 earlier this month — and seasoned ethicists.

Consider the Boston-based Community Ethics Committee, a group of 18 diverse volunteers who gather to craft opinions on some of the thorniest of bio-medical issues. Continue reading

Isn’t Parkinson’s Degenerative? How Can Michael J. Fox Be Better?

Actor Michael J. Fox in a 1988 photo (Wikimedia Commons)

“Great news,” I thought when I read that Michael J. Fox was returning to a comic television role, 12 years after he left to focus on treating his own Parkinson’s disease and funding research to help all patients.

“But how can this be? If there’s a big breakthrough in Parkinson’s disease treatment, wouldn’t we have heard about it? And if there isn’t one, isn’t the definition of a degenerative disease that it goes downhill? How can he have climbed back up again?”

Dr. Michael Schwarzschild, a Parkinson’s expert and director of the Molecular Neurobiology Laboratory at the MassGeneral Institute for Neurodegenerative Disease, kindly fielded my questions. First the disclaimers: He is not involved in Fox’s treatment, and has received grant support from the Michael J. Fox Foundation for Parkinson’s Research. Now the answer to my first query: What could it mean that Fox told ABC he “kind of stumbled onto a new cocktail of meds” that made him better enough to work again? Dr. Schwarzschild:

I heard his quote, too, and of course it’s wonderful that he’s making a comeback. In terms of what to make of this somewhat cryptic comment, I don’t think it relates to some new treatment that others don’t know about, or something newly approved and dramatic, because there isn’t anything like that.

‘Someone can improve without breaking the laws of physics about Parkinson’s disease being an inexorably progressive disorder.’

As a clinician who treats patients with Parkinson’s, your impression is right: It’s a progressive neurodegenerative disease. On average, in typical or even not-typical Parkinson’s disease, it’s inexorable.

That being said, it’s not a constant decline even though it goes in that direction, and medication can have a huge effect. Levodopa, when it came around in the sixties and seventies, took people out of nursing homes. Usually, with someone who’s getting reasonable care, you don’t expect, late in the disease, to discover some combination of currently available medications that make a huge difference. But sometimes you do.

I’ll give you a couple of examples even with approved medications in the United States. Continue reading

Hospital Video: What It’s Like To Be Attacked By A Great White

In case you missed the Globe story, Massachusetts General Hospital has posted this two-minute, hospital-bed video of Chris Myers, the swimmer who was bitten by a Great White Shark off Truro on July 30. This is apparently the first such attack in the state’s waters in more than 70 years, so it’s a rare chance to ask the inevitable question: What does it feel like?

Chris Myers on the video: “The first thing i felt was a huge bite on my left foot. It felt like i had my foot stuck in a refrigerator or a vise, and I knew instantly that it was a shark. And we started swimming as hard as we could toward shore.”

Chris says he had eight deep puncture wounds and it took 47 stitches to sew up his wounds. A couple of tendons in his ankle had been severed, and had to be surgically repaired. He can now walk on crutches and take a few steps on his own, he said, and is expected to make a full recovery.

“I feel very lucky to have made it back to that beach in one piece,” he says. “Very very lucky that my son did not get bitten, and very thrilled that the two of us are going to get to home today together.”

Old surfer saying: You don’t have to swim faster than the shark, just faster than your buddy. My thought: But if the buddy is your son, then do you maybe swim slower?

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Biggest Health Challenges: Flu, Polio, Wars — And Now Costs

Massachusetts General Hospital president Peter L. Slavin

Massachusetts General Hospital president Peter L. Slavin (MGH)

The Massachusetts Hospital Association just sent over word about its June 7 annual meeting, including the news that Massachusetts General Hospital president Peter L. Slavin is the association’s new chair of the board of trustees.

It included this:

In his inaugural speech that called for the hospital community to unite during the healthcare reform efforts now under way in the state, Slavin said “For more than 200 years, the hospital community in this state has tackled our society’s most significant health care challenges — influenza epidemics, polio epidemics, and world wars to name a few. I would argue that perhaps the most significant threat to the future health of the people of Massachusetts is the rising cost of healthcare itself. We must tackle this challenge head on just like the others. To do so is our greatest challenge, our solemn responsibility, and a remarkable opportunity for us to lead.”

My first reaction: Flu, polio, war — and health costs? Doesn’t that list end a little anti-climactically? (I’m reminded of the chorus “For God, For Country and For Yale,” cited as “the outstanding single anti-climax in the English language.”) On the other hand, if health costs are crowding schools and safety and more out of public budgets, then perhaps — ? If costs are keeping people from care, as today’s poll suggests? Readers, thoughts?

For Massachusetts medical insiders, here are the new MHA officers: Continue reading

Test Suggests Nine Ingredients Of Depression

hands held over face

A step toward useful biomarkers for depression? Wouldn’t that be great?

That was my reaction when I got word of a paper just out in the journal Molecular Psychiatry. It found that in a small pilot study, a test of nine biological measures — or “biomarkers” — in a patient’s blood, including levels of stress hormones and inflammation, could determine whether they were depressed with nearly 92% accuracy. (See a full list of biomarkers and details of the results below.)

You may scoff at my excitement. Who needs biomarkers? After all, you might say, how hard is it to tell if someone is depressed? They’re miserable. They can’t get out of bed or can’t sleep or can’t eat. Not rocket science.

My response: No, that’s not rocket science. But if there’s one thing psychiatry desperately needs and has been seeking for decades, it’s the biological markers of mental illness — the kind of reliable, lab-testable signatures that so many physical diseases have, and that could be used for better diagnoses and perhaps even to help decide which treatments to prescribe. The new study calls biomarker tests “the ‘holy grail’ of Psychiatry.”

The paper’s findings are just a first step and need to be replicated and confirmed among more subjects before there’s even any question of using them in the clinic. But I asked to speak with the study’s lead author, Dr. George Papakostas of Massachusetts General Hospital, because the findings made me wonder this: What does it mean that you can pretty much nail major depression using nine biomarkers? And that those markers measure oddly disparate processes like inflammation and the birth of new neurons and stress hormones and metabolism? Do we have, in effect, a sort of a recipe for depression, and if so, what does it tell us about what the darkness of depression is? Continue reading

Cardiac Reassurance For Marathon Runners

A new study brings reassuring news about marathoners and heart attacks. In the public mind, they may be linked like…like…rock stars and drug abuse, say, or boxers and brain damage. But research just out in the New England Journal of Medicine reports that marathoners face heart risks no higher than participants in other vigorous sports.

The lead researcher is Dr. Aaron Baggish, who’s in the video above and in the past has kindly shared with CommonHealth his wisdom on cool-downs  and on “hands-only” CPR.

From the NPR report:

Running long-distance races isn’t going to hurt your heart any more than other vigorous sports, researchers say. Just make sure you’re fit enough to attempt the feat in the first place.

The average age of runners whose hearts stopped beating was 42. Most were men.

In the past decade, nearly 11 million runners participated in long-distance races, but only 59 suffered cardiac arrests, according to findings just published in the New England Journal of Medicine. Most of the cases happened to be in runners with undiagnosed, pre-existing heart problems.

“Certainly doing the run didn’t cause the heart conditions,” study author Dr. Aaron Baggish tells Shots, “but it was probably the stimulus that caused the near-fatal or fatal event.” Continue reading

Opening Soon In Boston: Mass. General’s Museum Of Medical Innovation

The new museum of medical history and innovation on Cambridge St. in Boston


I was inching up Cambridge Street this morning, cursing the traffic as I got later and later for my dentist’s appointment, when suddenly my head whipped around and I muttered, “What the heck is that?”

In a spot in front of Massachusetts General Hospital that used to be completely unmemorable — judging by the fact that I can’t remember what was there — stood the gleaming little gem of a building you see above, all shining copper and glass. On the front, I made out “Museum of Medical History and Innovation.”

Who knew? Clearly I’ve been out of it, probably because I’ve been too assiduously ignoring all the big institutional birthdays around town, including Mass. General’s 200th. But the latest word, according to the hospital, is that the museum — named for transplant pioneer and history buff Paul S. Russell, MD — is expected to open to the public in March:

The museum’s ground floor will be home to permanent exhibits which highlight the evolution of medicine and clinical practice over MGH’s 200-year history, while the second story gallery will showcase changing exhibits, while also providing space for programs, lectures and special events.

My vote: Of course it’s a Mass. General institution, but it would be wonderful if it could also feature medical innovations beyond the hospital’s walls. Readers, any suggestions for exhibits?

For more background on the museum, a Beacon Hill-oriented section of the Boston Globe published a full account of the plans for it in February.

Risks Of ‘Driving Under The Influence Of Adele’

Okay, the connection to health care is minimal, aside from the fact that the pop singer Adele did have a vocal cord operation at Massachusetts General Hospital last week. But this morning I belly-laughed half the way to work, so maybe this is a gift worth sharing.

The proximate cause of my laughter: On a quiet side-street, I happened to pass a thirtyish man, sitting in his parked car and belting out, along with the blaring radio, the chorus of the perniciously irresistible Adele hit “Someone Like You.” It would have struck me as comical anyway, but it hit me square on the funny-bone because over the weekend, I had watched the hilarious video above by author (and now Xtranormal virtuoso) Laura Zigman, who has some very personal connections to the song. In the video, a woman is pulled over by a police officer, and he explains why:

“You were singing ‘Someone Like You’ by Adele while driving. Which means I’m going to have to give you a DUIA, that’s Driving Under the Influence of Adele.”

“Were you pointing one of those radar speeding guns at me?”

“No. I could hear you. Even with the siren on. You were really belting it out. It was ridiculous. I was embarrassed for you.”

So what was she being cited for, exactly? Continue reading