I am calling in a prescription for a pair of Ruby Red Slippers

Ever had to ask yourself: What am I doing here? or What was I thinking? or Where was my brain when I decided to do this?

These are my thoughts as I round up with the dead and with the live PhD.'s and the veterinarian, who are charged with the task of extracting medical information from death records. Except maybe for the veterinarian, the PhD.'s have never seen a medical record and what I spent fours years doing, these PhD.'s are expected to acquire in the span of two days, in the name of epidemiological research. They argue that the methodology is the same so it really doesn't matter if you are studying the epidemiology of frogs laying eggs or the incidence of cancer in textile workers working in the dye industry, it is all the same. There will always be limitations to the data as a result of data gathering but the data always speaks the truth. Except when you have PhD.s extracting information from medical records. You see, you don't really have to be accurate in data gathering, so I am told. You just have to be consistent and make sure that there is very little inter-operator variability. In other words, we could all be making mistakes just as long as we are making the same mistakes. It sure makes me view these CDC reports with a little more skepticism.

I am trying to keep an open mind, but having been scarred by previous encounters with this elite force the government is training to be the health leaders of tomorrow, I am wary.
We settle in for yet another day of meeting the dead when a question is brought up about depression and major depression, which I am only half listening to as the stories I am reading are quite enthralling (it is too bad I had no time to thumb through the pictures). Geez, I sucked at psych, even though I enjoyed the rotation. I remember a lot of psychiatric diagnoses had to do with time; six months of this; two years of that, all quite seemingly arbitrary, as is most of psychiatry. But someone has to make the rules up so the rest of us cattle can follow. So I say:

"I think it has something to do with time, something like two years?"
"No, you're wrong, that's dysthymia," PhD. number 1, young blond chick with a nose like Barbara Streisand's, huffs.
"We can look it up," I ventured, which is the absolute wrong thing to say to the PhD.
"I'm a clinical psychologist and we don't have to look it up!" She squeals.

Well, pardon me for expressing an opinion, but we are all not god, such as yourself, and know everything to know about everything in the world. I will leave you to make your own conclusions about PhD.'s level of self confidence. I humbly quelled the situation by saying:

"I sucked at psych and my total of six weeks of psych exposure in no way measures up to your six years of PhDeityism," which was the truth. Too much ego in a little room and too much ego in an organization for me to feel all warm and fuzzy about.

I am reminded of my flight into West Virginia. I was supposed to meet Ms PhD. at the airport because we were going to share a ride into town. This was a cost savings for the government for why pay for two car rentals when you can pay for only one? I've never met Ms PhD. and so I text her a message on my secret agent cell phone but she never replies. I figured I would find my own way. The flight into WV, outbound from Dulles, Washington, DC, was in a two-engine propeller plane. There were about 10 people on the plane. I wasn't too concerned about finding Ms PhD. After traveling alone for the most part of my life, I think I am capable of handling a ride to the hotel. Besides, I was sure we would bump into each other sometime. I settle in for a short 1 1/2 hour trip and started reading my Micheal Crichton novel about sneaky scientists driven by political agendas and skewing data, when I hear this conversation (it's a very, very small plane):

".....so why are you visiting West Virginia?"
".....I'm a government scientist working for the CDC!"
Despite the props outside going at a loud whir, I hear the conversation distinctly. So did the rest of the other nine passengers. This piece of information, I'm sure, was meant to be heard.
Well, I guess I found Ms PhD.

This should have been my cue that I was going to want something stronger than moral support for the next 12 days.

The second day came and we were to meet the Lead Investigator in his home territory at the Health Department. We are, of course, stopped by security, having no clearance to enter the building. Ms PhD. was again, huffy, wanting to know why we were waiting in the lobby; if lead investigator knew we were there and she asks me if I had his cell phone number, which I did. Prior to the trip, I had programmed phone numbers into my secret agent cell phone. I decided to try him at work first, just in case he had arrived early. So I pull it up and hit send.

"Division of homeland security, Nancy speaking, how can I help you?"
Homeland security? Opps, lead investigator must have given me the wrong number. After an unnecessarily lengthy conversation with Nancy from Homeland Security, I get the correct number for the health department. Meanwhile, Ms PhD. was listening in and did not spare me her comments:

"What is she doing? Who is she calling?"
Look, Ms Brainsinyour ass, I have lived long enough and have had real work experience in the land other the Oz, and know how to conduct a telephone conversation. In fact, I knew how when I was like six and really didn't need to go to PhD. school to learn how to politely ask for someone over the phone or to apologize if I dialed the wrong number.

What am I doing here?

I decided this wasn't worth the fight. I have been wise now, after all these years, to realize that some fights are just better left alone because it would create too much aggravation. I happen to prize my sanity.

So we muddle along. Day three comes and I have been wanting those Ruby Red Slippers secretly now since the first day. Instead, I treated myself to beer, wine, greasy hamburgers and fettucine alfredo. Back at the M.E.'s office, we plod along. There is now talk about liabilities and blaming. How can dumb people get a hold of prescription narcortics and benzodiazepines? Well, a doctor had to prescribe it. Doctors must not know what they are doing! Ms PhD. exclaims.

"I've never seen so many made up diagnoses in my life!" PhD. Barbara Streisand says. "Explosive personality disorder, no such thing!" Strangely enough, I come to find an ICD-9 (International Code of Diagnosis) code, 301.3, for it. These are codes physicians use so they can get billed for services. In Oz land, the world according to PhD. Barbara, however, Explosive Personality Disorder is made up, much like the entire Oz land is made up.

And then, there are comments about a doctor did this? and a doctor did that? Geez, why don't we just fry doctors at the stake? Better yet, why don't we make the world safer by having PhD.'s prescribing medications? Then, when I could not bear it any longer, I say this:

"We have no way of determining what the circumstances facing these various doctors were, or how they rationalized to write prescriptions for these people who had died as a result of not following their doctors' orders and taking too many pills at one time, or acquiring prescription medications illegally. No physician can deny pain medications to someone complaining of pain. That's unethical. At the same time, you cannot question that someone who tells you he is suffering from pain is truly suffering from pain. These judgment calls are easy to make in the comfort of an air-conditioned office when there is no real world experience of what a physician actually goes through."

The veterinarian concludes that I am being defensive.

How can I not while they are vilifying the profession I am about to enter? If I had said something equally offensive about veterinary medicine, about clinical psychology, about whatever it is the other PhD.'s special line of research is, I have no doubt that all of them would have reacted the same way. I continue to say:

"I am no scientist but you people are. You are here to investigate the circumstances in which these unfortunate 360 people met their deaths, all by choice, I may add, while taking prescription medications and then some and out of this investigation, a witch hunt may ensue and other studies will be done to see how we can 'better the system' and out of these studies, recommendations will be made that will affect me as a physician ten years down the road! And there are so many holes, what you call limitations, in your data gathering that I am supposed to believe that all these recommendations will be based on some semblance of truth?"

Oh, the data will affect all of us, they say. Which all of us are they talking about, the people stuck in the Ivory Tower of Research, who have no real world experience of the medical world or the real world, or the physicians in the trenches who, day in and day out, fight the battle of being a good physician despite the surmounting mountains that daily affronts him? Who does it really affect?

Where was my brain when I decided to do this?

After the gun smoke clears and the dead are counted, I was reassured that there are many checks and balances to ensure that research is conducted to accurately reflect the truth. There are committees that come together and I was told that the opinions of the people who will be affected by these recommendations are sought. I give an analogy and, in a nutshell, summarize all these ideas floating around in my head:

There is a proposed hospital to be built. The architects and the engineers come together and they construct this very beautiful hospital that wins awards for its beauty. However, the structure is completely non functional. There are doors that open into work spaces, entrances that lead you round in circles, stations that are built, making the staff totally inaccessible to the patients. No one bothered to ask the people who will actually be working in the hospital if things made sense, or just looked pretty.

On my last day at the M.E.'s office, I meet PhD. number 2's boss. The meat and potatoes of this whole venture is the data. Like a piece of bloody, red meat, it will be at the center of a feeding frenzy as people get a piece of it and claim their stakes at, the coveted, "authorship" of papers that will be generated as a result. He makes a special trip from Atlanta to see how the extraction process is coming along. He is a very nice gentleman. I come to find out that he had gone to medical school with no idea what it meant when someone said "preventative care", enrolled in the same elective I am currently enrolled in, goes on to residency in primary care, and then on to another residency in preventative medicine, joins the EIS program and when he completed it two years later, he finds a job at the CDC. This man has never practiced medicine a single day in his life. Remember Skinny man? Same story. And then I come to learn that Ms PhD. went to high school, entered college, went on the grad school, is now in the same EIS program, having had only one year of internship where she was required to see patients and no breaks in between her academic life. This trend bothers me.

What was I thinking?

Are there real world people around or is it all filled up with people who have never lived beyond the pearly gates of Institution, think themselves to be deities of some kind or other, assume all people are stupid and need to be advised and given recommendations on how to live their lives? What happened to the "art of medicine" or the "trust your clinical judgment" slogans they chant and teach all through one's medical career? Apparently, if these M.Deities and PhDeities have their way, the art of medicine and one's clinical judgment would be squished into a recommendation they have the Tin Man (no heart) and the Scarecrow (no brains) come up with.

I want to go home, I want to go home, I want to go home.

These Ruby Reds seem to be defective. Probably made in China. I will have to take it up with headquarters.