Fearing For My Children

Fearing For My Children

By

Leonard Zwelling

         I do not see any way that my kids can be protected from the
world I am going to leave them.

No,
I am not worried that ISIS will invade Houston although Ebola is possible. I am
not even worried about the collapse of medicine, although having that fear
would not be unreasonable. I have some faith that just like those who trained
me and were convinced that I could never deliver the quality of medical care
they could, the next generation of physicians will rise to the occasion. It may
well be harder to find a doctor who can think with little sleep because doctors
who were ever sleep-deprived may become harder to find. But every now and
again, I meet a young doc who is just terrific and my faith in my profession is
restored. No, that’s not what worries me.

         This is.

         Today I learned that I had acquired yet another in a long
line of medical diagnoses. My ever-growing problem list now includes psoriasis.
Fortunately, so far, it is just the minor dryness on elbows and knees that is
easily controlled with topical meds. I go to Walgreens to pick-up the
prescription my dermatologist ordered.

         I drive up to the window and am handed a package with a
large brown plastic bottle labeled Kenalog 0.05% in Eucerin and with it a
smaller box that I assumed had contained the Kenalog (a steroid) that was now
mixed in the larger bottle. Both bottles were contained in a plastic bag that I
did not read until I got home. It said in big red letters “MIX” when I did read it which seemed  curious.

         Hmmm. Has the pharmacy now degenerated to the point where I
am to mix my own drugs? Am I now the compounder of last resort? So I call
Walgreen’s.

         After going through a few phone menus I speak to a real
person. He informs me that a mistake was made. I had already ascertained this
as the small vial of Kenalog (goodness knows how much that cost) was obviously
pristine, unopened and sealed. Their pharmacist was supposed to have mixed a
portion of the Kenalog vial (2.5 ml of the 10 ml in the vial) with the vehicle
called Eucerin and retained the Kenalog vial’s residua for the next patient as
this is a commonly prescribed formulation. This meant that I had to go back to
the pharmacy where they correctly (I hope) mixed the two compounds for my
topical use.

         I am physician. I can read labels. The label in the large
bottle was inaccurate as there was no corticosteroid in the large bottle when I
first picked it up. Because I had mixed my share of injectables in my career, I
knew the smaller vial had not been used. The question is, would my children (both non-docs) have known these things? I hope so, but I am not sure.

I
hope that I have taught them that they should take nothing at face value, that
if things don’t make sense ask, and that stupidity is the most powerful force
in the universe. I hope, but when this may become vital for them, I probably won’t
be around.

         In a world in which the President of the United States seems
baffled half the time about what his job is, where the leaders of the major
organs of health in the government say silly things on national TV when the
country needs to feel that at least they are trying to understand both a
possible epidemic and the possible panic it generates, when a world famous medical reporter breaks a quarantine she very publicly vowed to keep (see below), and where leaders of
major academic medical centers are frankly committing acts that are surely
unethical and perhaps criminal, you can understand my concern.

But
when Walgreen’s dispenses a drug and a vehicle for that drug unmixed, there is
real danger for the unaware.

         My children are not doctors. Are yours? If not, you better
teach them my three tenets of doubt, questioning and the assumption of
stupidity. Their lives may depend on it.

And in a follow-up to a
previous blog re the awful Dr. Nancy Snyderman:

http://www.nj.com/mercer/index.ssf/2014/10/nbcs_dr_nancy_snyderman_apologizes_for_violating_voluntary_isolation_agreement_when_in_princeton.html