Thursday, April 23, 2009

Visiting a Korean Emergency Room -- Gangwon National University Teaching Hospital: a nurse gave Julianne a needle full of "red stuff" tonight . . .

Earlier today, around lunch, Julianne developed a severe headache. She suffered through the rest of her day at the middle school and then came home.

When I got home from work she was sleeping, and I thought that other than a headache she was okay. Around 6pm she woke up--and I realized she was NOT okay.

I started asking her to describe the pain, but she wasn't verbalizing herself very well--so I simplified it to asking her to give me a number from 0-10 so I could assess whether or not she needed to go the emergency room at nearby Gangwon National University Hospital.

She told me her pain was an 8, maybe a 9.

0 – 10 Numeric Rating Scale

Indications: Adults and children (> 9 years old) in all patient care settings who are able to use
numbers to rate the intensity of their pain.

0 = No Pain
1-3 = Mild Pain (nagging, annoying, interfering little with ADLs)
4–6 = Moderate Pain (interferes significantly with ADLs)
7-10 = Severe Pain (disabling; unable to perform ADLs)


So I got her up off the bed, dressed, and then asked her if she could manage walking outside to get a taxi.

While getting Julianne ready to go outside I called her co-teacher from the first semester of her contract. This woman is an awesome human being. Her English is great, she understands Western culture, and she's very helpful. I didn't waste time calling Julianne's current co-teacher whose English is terrible, who lacks Western cultural awareness, and who just seems to amplify Julianne's stress on a daily basis.

We found a taxi and headed to the hospital. Julianne's old co-teacher told me she'd keep her phone near her in case I needed her to translate and communicate with the doctor if he/she didn't speak English well enough to assess Julianne, and let us know what they wanted to do.

During the taxi ride the car went over several speed bumps, and the driver accelerated in the usual floor it style . . . needless to say this didn't help Julianne's pain level, and a few tears were shed during the short trip.

Arriving at the hospital we went into the main entrance to find a dark almost too dark main foyer with an empty waiting area, and everything closed down for the night. Walking in even further we saw in a back corner a set of doors with Emergency written on them in English. We headed in that direction.

Walking into the Emergency Room I began having flashbacks to the last time we had to go to the hospital for Julianne . . . I told myself to wait and see what kind of doctor we got, and what level of English he/she had.

I sat Julianne down at the entrance of the ER and walked forward to find someone to help us. A doctor and ? (another doctor) walked over to me and I explained that Julianne's head had "shooper pain"--I dropped the Konglish (Korean English style pronunciation) talk the second I realized the doctor was able to speak English.

The doctor gestured for Julianne and I to follow him and took us to an area with 14 hospital gurneys, seven on each side of the room. (Later on I pulled out my Flip Mino and took a few pics).

Something I still dislike about medical care in Korea is the completely communal organization and structuring of space. Fortunately for us there only 3 other patients in the area, and the doctor took us to a gurney that was 3 beds away from the nearest patient.

Then he began asking Julianne questions. Some of the questions were about her pain . . . and a few were about other basic things like allergies, etc. The doctor asked twice if Julianne had diabetes and I began to see where that inquiry was heading and firmly said no she doesn't.

Julianne could barely keep her head up and eyes open due to how much her head hurt. I tried to help with the communication without getting in the way too much of the doctor or Julianne giving an answer (though she was having trouble thinking clearly, and a few of the doctor's words had some pronunciation issues).

At this point I called Julianne's GOOD co-teacher and asked her to confirm what the doctor was telling us. He wanted to do a blood test, a urine test, and X-rays of Julianne's chest and head to make sure nothing serious was going on . . . we thought this was a little excessive, but when in Korea . . . you have to go with the flow--to a degree.

After confirming that was what the doctor wanted, he left, and I helped Julianne to lie down. I then headed about 15 feet away to a registration booth with Julianne's Alien Registration Card and Korean National Health Insurance card/booklet. I handed them to the guy behind the desk and with no questions asked he signed her in and did the computer thing--whatever it is that they do when they sign you into a hospital here.

Getting the cards back I went back to Julianne. She told me they had done a stick test (where they puncture the tip of your finger to get blood), and I groaned. I assumed, rightly so I think, that because Julianne is "fat" (according to Korean norms) that they must think that Julianne has diabetes and that that must be the source of her problem.

The stabbing throbbing pain in her head was still severe and Julianne was not doing very well. I was not happy that the diagnosis wasn't going faster.

And then the nurse walked up with an IV stand on wheels and began setting up a tray full of syringes and IV kit. She began to set up an IV--and Julianne and I both look at each other with a WTF is going on instant communication.

We stop her (Julianne a little more vehemently than me, lol) and ask her why she's setting up a saline bag when no diagnosis had been made, and the problem wasn't clear.

The nurse unfortunately didn't have a lot of English, but actually she did quite well after a moment's hesitation (probably due to us refusing the treatment--I suspect that most Koreans just let her do whatever she's doing without questioning it).

At this point the doctor also walked up. Julianne was about 3 nanoseconds from going ballistic--which actually might have had very high entertainment value if the situation wasn't medical, lol--and I tried to calm her down so that the doctor could explain what was going on and why.

We told him that it seemed very odd, when compared with Canadian and American medical practices, for an IV saline drip to be started when Julianne did not have any medical symptoms of dehydration . . .

The doctor backed off on the IV bag, and we agreed to the IV catheter being put in to take blood. The nurse explained fairly well that she wanted to put in an IV catheter because Julianne needed to have blood taken (possibly more than once) and her veins are small and hard to get to. She never really explained why she ALSO had been planning on putting Julianne on a saline drip . . .

The nurse put the rubber hose tie-thingy around Julianne's elbow and after 90 seconds Julianne and I both looked at each other as the nurse got a quizzical look on her face, and began lightly smacking Julianne's arm trying to get a vein to pop up--nothing.

Julianne told her to use a vein in the top of her hand, and gestured to back up the communication. The nurse moved the rubber band tie down to just above her wrist, and then spent the next 2 minutes waiting and tapping and smacking Julianne's hand trying to find a vein. She finally began probing with her fingers searching for the vein, and after a moment of hesitation decided that she'd found it.

Stick--ouch!

Blood was drawn with the ole fashion style needle with a plunger--as opposed to the vacuum needle blood drawing that most of us are used to back in North America.

We were then told that it would take 90 minutes for the blood test to be completed.

AFTER taking blood the nurse then proceeds to take Julianne's blood pressure, and her temperature using an ear thermometer.

I notice two things. The first is that the blood pressure cuff doesn't fit Julianne's arm--seriously, she's not that big! So I put my hand on the velcro to help keep it secure while the nurse finishes up.

The second thing that I also see is that she doesn't swab the head of the thermometer to sanitize it before sticking it in Julianne's ear. Later, on another patient, I watch even more closely and see that nothing is done to sanitize the ear piece before and after . . . . sigh, why do I torture myself with these things . . . ?

I mention this to Julianne and her reply is, "They don't use gloves so why bother with little things like sanitizing a thermometer?"

Julianne was still experiencing stabbing throbbing pain behind her eyes and forehead, and things were not good.

After about 15 minutes of watching her in pain we talk about it, and I got to find the doctor and tell him that something needs to be done about the pain. He says we should wait until after the blood test . . .

He shows me a computer screen and sas that only part of the blood test results were available and that we needed to wait longer.

Five minutes later Julianne's pain jumped up another notch, and she started crying. I returned to the doctor and while I was telling him that something needed to be done now to manage Julianne's pain levels a nurse was behind me at the bed administering a needle full of "red stuff" through the IV catheter . . . needless to say I was shocked.

I get back to the bed and find out from Julianne that a nurse had just given her a needle full of "red stuff" and I was furious with myself for not keeping her in sight at all times. I had thought that the doctor would tell me he had told the nurse to give her an injection, but he didn't. The nurse also didn't try to tell Julianne what she was doing, and Julianne had had her hand covering her eyes due to the pain in her head so she didn't realize a needle was being put into the IV catheter until it was too late . . . yeah.

I decide that I'm going to remain calm and not freak out that someone just put "red stuff" into my girlfriend and hope that it lowers Julianne's pain level.

About 10 minutes later I decide that I should ask what they are testing Julianne's blood for. If they were just testing to see if she was diabetic I was going to nip that in the bud and suggest that other avenues of diagnosis be explored. The doctor tells me that they are looking for "infections in the blood" . . . odd, but okay . . .

The drug kicks in after about 10 minutes and Julianne's pain levels drop to about 6, though I still feel her pulse beating regularly for about 5 beats, and then racing for 5, as the pain ebbs and flows in her head.

About 25 minutes later Julianne's feeling better, and she says the pain is down to around a 4. She's a little more talkative, and her mood has improved slightly--and so had mine. It's hard to watch your girlfriend in pain . . . never a good thing.

Looking around the room I notice the little guy with an IV--it seems like EVERYBODY who goes to an ER in Korea gets an IV--and an evil thought enters my head.

I tell Julianne, "Wouldn't it be funny if I walk over there and tell him that we're going to have an English lesson" because I'm bored. Can you imagine the poor little guy thinking, "Oh my god! I can't escape being forced to learn even when I'm sick and in a hospital bed!" Lol . . . I didn't do it, but for a moment I thought the entertainment value might have been worth it.

After about an hour the doctor returns and goes over the blood test results with Julianne. He tells her a few things are slightly elevated. He then says that he thinks that stress must be the trigger of the headache, and that she needs to rest and take some 'oral medication.'

We wait for about 20 minutes and he comes back with the meds. Julianne and I look at them and ask him to explain what each pill is--there were THREE. One was the uber-tylenol that apparently only ER's have, the second was a mild sedative (this got Julianne and I raising our eyebrows), and the third was for Julianne's stomach/nausea to help it calm down.

The doctor walks away, and I quickly grab her cell phone to take a pic of the pills. Julianne examines each pill to see if she recognizes any letters, the shape of the pill, and the size or color . . . her mother was an ICU nurse back in America, and her step-mother is also a Radiology nurse . . . so Julianne has a bit of a background in drugs to say the least.

After trying to find out what kind of drug the "red stuff" had been in the injection the nurse gave her while my back was turned for all of 90 seconds . . . and the pronunciation the doctor had while trying to say the name, and then after we didn't understand he tried to describe it which came out as this, "something-flammatory something-steroid something something" . . . he was trying, and if we'd really been concerned we'd have asked him to write it down--but seeing as the drug had already been administered it was a little late to say hey, no, stop . . . sigh.

Julianne pops the 3 pills and then we wait a little more. At this point I'm really ready to get out of there--I hate ERs.

I ask the nurse if we can go, and she goes to Julianne and takes out her IV catheter, and then goes to print out the bill.

The bill was 70,000won. By American standards the pricing it's a fabulous price. By Canadian, a little expensive as the system there is different. I didn't mind paying the fee, and would have paid more without complaining because the doctor was friendly, kind, caring, and spoke pretty good English all things considered.

While I paid the bill the doctor returned to say goodbye to Julianne, and make sure she understood the instructions for the 3 days of meds he'd given her of the same stuff she'd just taken.

I give him my name card and invite him to visit the university. He enthusiastically pulls out his wallet to give me his own card but doesn't have any, lol.

I tell him his English is very good, and thank him profusely for helping us. He gives the typical response, "No, no, my English is poor." Julianne and I thank him again, and then leave.

Overall, a positive experience in spite of the delays in getting Julianne some pain meds, and a few odd attempts to put her on an IV saline drip when there wasn't really a reason to do so.

I seriously hope that this trip to a Korean Emergency Room is the last one I ever have to do.

Julianne is sleeping now, and the pain is almost entirely gone. I hope she wakes up with a painless head tomorrow, and doesn't have to take the drugs the doctor gave her. But at least we have them if we need them.

What a day . . .

J


13 comments:

Robin Hudson said...

Welcome to the wonderful world of migraines!

Glad everything went OK. Sounds like the "red stuff" was a Non-Steroidal Anti-Inflammatory Drug. Basically ibuprofen by injection.

driftingfocus said...

Welcome to Korean hospitals! Aren't they a blast? Honestly, the treatment you got was pretty standard. IVs are also given for everything from nausea to a headache - so that is unsurprising. The packets of pills are also pretty standard as well. They're pre-prepared for different types of problems - antibiotics, pain, etc. I've gone to the ER twice here with bad colds with entirely different symptoms but got given the same 5 prescriptions.

My favourite was that when I got bitten by that dog, I had to go back into the hospital EVERY DAY to have them change my bandages for me. I told them that I was perfectly capable of changing them myself if they'd just give me some gauze and tape, but no, they insisted that only they would be able to fold up some gauze and tape it to my leg properly. >.<

Yeah, Korean healthcare, while cheap, isn't exactly the best, or even all that modern.

Jason said...

Hi Robin,

Yeah, I THOUGHT he said what you wrote, but wasn't completely sure.

Migraines suck!

J

Jason said...

Hi Kelsea,

I'm not new to the hospital experience, and Julianne has a bit of experience too . . . we had to go for her once before and it was a 'blast.'

A guy I work with had to get some stitches on his head, and they told him he'd have to come back every day to get it cleaned. He asked them to give him the stuff to clean it saying he could do it himself--a foreign concept for sure.

I wonder how prevalent the abuse of anti-biotics use is in Korea. I imagine if an epidemic struck that the overuse of antibiotics would create a lot of problems.

I just asked a Korean colleague about the IV bags--and she said, "Yeah, they always do that."

Interesting . . .

J

driftingfocus said...

They prescribe antibiotics for almost everything here. Not only that, but they often give you injections of them ON TOP of the ones they're giving you in pill form. Korea is definitely worsening our global immunity.

Anonymous said...

Your friend had a headache that requiered a trip to the ER. The doctor's action were enitrely appropriate and correct. The checking of the blood suger was simply to ensure that that wasn't the cause. That's pretty routine. The tests on her blood were for the reasons stated by the doctor- to find if an infection was going on. You can tell that by looking at the levels of various white blood cells.

The x-rays were also correct in that the MD wanted to ensure that her headache wasn't caused by some internal bleeding of the head or by having some type of pneumonia which can lead to hypoxia which can produce a severe headache. Remember, your friend had to go to the ER for a headache.

As for the IV, I don't see anything wrong with it. You place an IV to deliver medication rapidly. You don't HAVE to have one but it's the fastest way to deliver relief.

Sounds to me like you got quality care and the actions of the staff was routine even by American standards.

Perhaps if you didn't think Koreans have no idea what they're doing because in the case you described above, they knew exactly what they were doing. You just didn't know it.

Jason said...

Hi Anonymous,

Until you've personally experienced receiving medical care in a country with a language you are not fluent in, and in which the culture is extremely different than your home culture--I'd suggest that you take a less severe judgment on how I question things.

Giving a person a medical treatment, like an IV, when it's not needed is nonsense. It doesn't matter if it's harmless. If it's not needed then it makes no sense to give one.

Julianne's mother, and step-mother, are both nurses. There's quite a bit of practical medical knowledge that she has from having lived with them for years, and the large amounts of time she spent visiting their workplaces.

I also have some knowledge of what looks right, and what doesn't, from my own life experiences.

Add to the mix that I've heard too many scary stories about wrong diagnoses and incorrect treatment for friends in Korea--and yeah, I don't have a high degree of trust.

It's easy to post critical comments when you don't put your name on them, or your blog.

Again, I'd suggest that until you've experienced medical care in a culture and language situation that you don't speak fluently like I have, and Julianne has, that you might not get where we're coming from . . .

Jason said...

Anonymous,

A few more things you might have commented on--but didn't.

1. No latex gloves, and no washing of hands before treating each patient in the ER--this is NOT the same as North American standards of medical care.

2. Not sanitizing the ear piece of the thermometer after each use.

3. Not telling Julianne the name of the medication she is being given . . . again, not good.

In spite of these things I still think it was, "Overall, a positive experience in spite of the delays in getting Julianne some pain meds, and a few odd attempts to put her on an IV saline drip when there wasn't really a reason to do so."

I really liked the doctor, and was grateful he was so helpful in spite of the cultural differences.

I also really liked the nurse, she was very friendly and kind and careful.

Every person in the world, when in a different hospital culture, makes observations and judgements, both positive and negative, about their experiences.

I stand by my observations.

Amanda said...

I only had one doctor in Korea ever ask me if I was allergic to drugs (and I do have an allergy).

I had multiple doctors tell me to get rid of a cold by eating kimchi, not showering and brushing my tongue.

At the same time, I had some OK dental care, good care when I needed some physical therapy, and I ended up finding a good Chinese medical doctor and a good GP.

And compared to the COST of medical care in America...

Glad everyone is better now, Jason.

BTW, there are some real pricks going around the blogosphere right now, leaving prickish comments.

Joe in Korea said...

I believe what the pink stuff was Non-steroidal Anti-Inflammatory Medication.

As soon as I typed that, I looked over at the first comment, and Robin just told you.

Like she says, it is something like Tylenol or ibuprofen but in a liquid form, and probably stronger than what you'd get over the counter.
There's no doubt about it, hospitals are scary places--especially when there is the language barrier you're dealing with. As far as the IV bags go, I'm sure that for most people they act much like antibiotics do. If not a placebo, at least they make the person feel better. I compare them to antibiotics because doctors don't like to send people home empty-handed, so they give them antibiotics for everything. This is not just a Korean phenomenon, as I'm sure you know US doctors are quite notorious for this as well.

Personally, I have never in my life had an IV and hope not to start anytime soon. They certainly would not make me feel better!

Stafford said...

Having experienced medicine at the sharp end (hahahaha!) in Korea, in the "first world", and in both Syria and Egypt I feel reasonably confident in passing a few comments.

The first of those is about gloves, which only arrived in ERs in about the last 20 odd years.

As long as clinicians are sanitising their hands regularly and between patients with rubbing alcohol (think Purel) there is no difference.

Indeed studies (which I would cite correctly if I weren't so lazy) have found clinicians become lazy wearing gloves and they become a greater vector for infection than bare hands.

In addition gloves aren't much protection in a needle stick incident unless the nurses are wearing those hardcore ajumma vulcanised rubber jobbies!

I wonder if the ear thermometer didn't have a disposable end?

A blood sugar test is pretty common for anyone coming into an ER complaining of headaches and up, more to rule something out rather than to sate Koreans' desire to label all people who are overweight as diabetic. (I know this one only too well.)

Likewise IV saline is a pretty common way to defuse medications (I think someone said that in the comments already) and is of no harm whatsoever. Indeed I wouldn't mind one most afternoons.

I think you alluded to the fact that Koreans just blindly follow their doctors without question, and I would have to say that is pretty much the case (and is not confined to the field of medicine) everywhere except in North America where there have been so many cases of misdiagnosis and wrong medications being administered that patients (rightly) question their physicians, and I would like to see more of that in Korea.

I would stake a lot of money on the contention though, that there is much less malpractice and fewer stuff ups in general going on in Korean hospitals than in the US.

I'm not sure it was your intention in the post, and a couple of commenters have picked up on it, but you sound like you are labelling Korean medicine as being a bit back water "third worldy", which of course it's not.

One might infer from your post that your approach to Korean medicine is similar to a Korean mother's approach to English Education. Not withstanding your previous experiences and otherwise, Well intentioned but a little ill-informed.

You have a multitude of education and experience in your classroom, I'm pretty sure the doctors and nurses have the same in their ER.

As for the Middle East, I have a penchant for cutting myself on sharp rusty edges (twice on one trip!) and despite my contention that I was getting my tetanus shot from a used needle the second time I lived to tell the tale.

Jason said...

Hi Stafford,

Because I'm tired, and a little stressed out and bitchy tonight, I'm not going to post my reply to your comments.

Some of them I disagree with, some I agree with, and some I disagree with strongly.

Anyways, I sent you my comments in an email because I tend to deconstruct writing in a very surgical (without anesthetic) way that can be too harsh and intense when it doesn't need to be when I'm tired and stressed.

Out of respect for you I won't do that tonight.

Have a good night, and thanks for reading.

J

Jason said...

Hi Stafford,

I want to reply to your comments. I sent them in an email to you but received no reply.

Since I posted your comments here I think it's only fair that I reply to them too.

"The first of those is about gloves, which only arrived in ERs in about the last 20 odd years."

Expressing a preference for seeing gloves is what it is--a preference for them, and a dislike for when they're absent. It's my personal preference . . . and Julianne's.

"As long as clinicians are sanitising their hands regularly and between patients with rubbing alcohol (think Purel) there is no difference."

Julianne wasn't doing or saying much for most of the time we were in the ER. I had too much time with nothing to do other than watch the doctors and nurses--I didn't see any of them sanitizing their hands . . . so while you SUGGEST "there is no difference" IF such things are happening--there weren't. Does this change your view?

"Indeed studies (which I would cite correctly if I weren't so lazy) have found clinicians become lazy wearing gloves and they become a greater vector for infection than bare hands."

Fair enough--but given a choice between a NEW pair of sterile gloves and someone's bare hands I'll choose the gloves every time. FRESH gloves out of the box when I'm first being looked at will have ZERO vector for problems!

"In addition gloves aren't much protection in a needle stick incident unless the nurses are wearing those hardcore ajumma vulcanised rubber jobbies!"

The focus of this post was about the patient: Julianne. I'm not so worried about the doctors and nurses here as I was about my girlfriend--isn't this comment a little out of sync with the focus of my comments?

"I wonder if the ear thermometer didn't have a disposable end?"

I watched other patients get their temperatures taken with a keen interest in determining if a disposable head was being used--nothing was being taken on and off the thermometer. And there was no cleaning or disinfecting the head after each use.

"A blood sugar test is pretty common for anyone coming into an ER complaining of headaches and up, more to rule something out rather than to sate Koreans' desire to label all people who are overweight as diabetic. (I know this one only too well.)"

I'll concede this point. I still think, though, that in the context of Korea that being asked more than once in a diagnosis if you're diabetic is based on the assumption that if you're fat you must be diabetic.

That being said, I'll play devil's advocate with myself and say that in fairness to the doctor that checking for comprehension (for Julianne and I) about what one has said when you're an English as a foreign language speaking doctor is good practice--and I DID say that I felt the doctor was awesome!

"Likewise IV saline is a pretty common way to defuse medications (I think someone said that in the comments already) and is of no harm whatsoever. Indeed I wouldn't mind one most afternoons."

"defuse" or DIFFUSE--sorry, had to do it--lol.

The right to say yes or no to medical treatment is something North Americans, as you point out, take seriously. Julianne was in no frame of mind to be thinking cross-culturally, or to be sensitive to Korean medical cultural norms when she was in severe pain. Putting in the IV catheter is one thing--a saline bag is another from her perspective . . . and respecting her rights as a patient is something that the Korean doctor and nurse respected--and which I really admire about how they dealt with the whole situation.

"I think you alluded to the fact that Koreans just blindly follow their doctors without question, and I would have to say that is pretty much the case (and is not confined to the field of medicine) everywhere except in North America where there have been so many cases of misdiagnosis and wrong medications being administered that patients (rightly) question their physicians, and I would like to see more of that in Korea."

I couldn't agree more!

"I would stake a lot of money on the contention though, that there is much less malpractice and fewer stuff ups in general going on in Korean hospitals than in the US."

I couldn't disagree more! Having heard stories from friends who have had surgeries in Korea, been misdiagnosed and quarantined in Korea, and who have been given the wrong meds via mis-prescribing . . . . . I think that once the legal system here shifts to one more like the USA's that the lawsuits are going to go off like a nuclear bomb and revolutionize medical practice here.

"I'm not sure it was your intention in the post, and a couple of commenters have picked up on it, but you sound like you are labelling Korean medicine as being a bit back water "third worldy", which of course it's not."

Hmmmmm . . . not sure how to respond to this. I think SOME practices are underdeveloped and need modernization. I think that doctors that were not trained overseas, or at medical universities that have western academic standards of testing and performance that supersede the 'relationships are more important than laws, policies, and contracts' that is the current paradigm in this country . . . simply put, I have a hard time trusting anyone trained within the university system here because of the cultural modes of power and knowledge that place relationships and politics as being more important than objective standards of professionalism and performance criteria . .

I do not claim to have research or statistical studies to back up my opinion. I do claim the right, however, to have an opinion, and to exercise said opinion when it is in a health and safety context while receiving medical treatment--to do otherwise is to invite possible consequences that I want to avoid at all costs.

"One might infer from your post that your approach to Korean medicine is similar to a Korean mother's approach to English Education. Not withstanding your previous experiences and otherwise, Well intentioned but a little ill-informed."

I think there's some faulty parallelism going on here with your comparison. English education can't kill a student, or damage their health. Use a comparison of similar weight relevant to a human being's health and I might consider it as pertinent to my views.

Comparing my views on Korean medical practice to a Korean mother's views on what is good English education and teaching is essentially stating that I have no training, education, or performance training and experience in medicine--none of which are true. You don't know my academic background, nor my job history. The staggering number of assumptions you're making here about me are . . . wow.

"You have a multitude of education and experience in your classroom, I'm pretty sure the doctors and nurses have the same in their ER."

I never claimed to have the same degree of education, training, experience, and mastery of my environment as the ER doctors and nurses do. I did express a dislike for some very SPECIFIC processes that I personally dislike--some of which there are legitimate medical reasons for disliking too. This reeks of more faulty parallelism and poor contextualization that supports a poorly supported view based on no research or knowledge about my personal education qualifications and job history.

The reason I keep mentioning job history is that I spent time in the Canadian Army Reserves where I had two different trades. One was as an armored crewman, and the other was a field medic. I didn't do high levels of training as a medic, but I did learn a lot during training exercises, and from the very experienced Petty Warrant Officer that was in charge of me during one summer's war exercises.

"As for the Middle East, I have a penchant for cutting myself on sharp rusty edges (twice on one trip!) and despite my contention that I was getting my tetanus shot from a used needle the second time I lived to tell the tale."

Arguing that because you got terrible medical treatment shouldn't be compared to what was going on with Julianne--again, drawing parallels with two events that do not contrast and compare in a relevant way in terms of severity and degree of danger . . . hmmm.

The degree and severity of what was done to you has no comparison with what was being done to Julianne . . I am fully cognizant of the fact that the doctor and nurse were not putting Julianne's health in jeopardy (at least not in an immediate and lethal way--but in terms of bacteria and viruses, who knows) by trying to start an IV, not using gloves, etc. It does NOT mean, however, that I should necessarily embrace and like what they were doing.

I think I've said everything I want to.

J