Physician Assistant Day Quotes

All told, approximately 100,000 people were examined in the days and weeks after the accident, 18,000 of whom required hospitalisation. It took the combined efforts of 1,200 doctors, 900 nurses, 3,000 physicians’ assistants and 700 medical students working in shifts to provide round the clock care.185

The Heiligenstadt Testament" Oh! ye who think or declare me to be hostile, morose, and misanthropical, how unjust you are, and how little you know the secret cause of what appears thus to you! My heart and mind were ever from childhood prone to the most tender feelings of affection, and I was always disposed to accomplish something great. But you must remember that six years ago I was attacked by an incurable malady, aggravated by unskillful physicians, deluded from year to year, too, by the hope of relief, and at length forced to the conviction of a lasting affliction (the cure of which may go on for years, and perhaps after all prove impracticable). Born with a passionate and excitable temperament, keenly susceptible to the pleasures of society, I was yet obliged early in life to isolate myself, and to pass my existence in solitude. If I at any time resolved to surmount all this, oh! how cruelly was I again repelled by the experience, sadder than ever, of my defective hearing! — and yet I found it impossible to say to others: Speak louder; shout! for I am deaf! Alas! how could I proclaim the deficiency of a sense which ought to have been more perfect with me than with other men, — a sense which I once possessed in the highest perfection, to an extent, indeed, that few of my profession ever enjoyed! Alas, I cannot do this! Forgive me therefore when you see me withdraw from you with whom I would so gladly mingle. My misfortune is doubly severe from causing me to be misunderstood. No longer can I enjoy recreation in social intercourse, refined conversation, or mutual outpourings of thought. Completely isolated, I only enter society when compelled to do so. I must live like art exile. In company I am assailed by the most painful apprehensions, from the dread of being exposed to the risk of my condition being observed. It was the same during the last six months I spent in the country. My intelligent physician recommended me to spare my hearing as much as possible, which was quite in accordance with my present disposition, though sometimes, tempted by my natural inclination for society, I allowed myself to be beguiled into it. But what humiliation when any one beside me heard a flute in the far distance, while I heard nothing, or when others heard a shepherd singing, and I still heard nothing! Such things brought me to the verge of desperation, and well-nigh caused me to put an end to my life. Art! art alone deterred me. Ah! how could I possibly quit the world before bringing forth all that I felt it was my vocation to produce? And thus I spared this miserable life — so utterly miserable that any sudden change may reduce me at any moment from my best condition into the worst. It is decreed that I must now choose Patience for my guide! This I have done. I hope the resolve will not fail me, steadfastly to persevere till it may please the inexorable Fates to cut the thread of my life. Perhaps I may get better, perhaps not. I am prepared for either. Constrained to become a philosopher in my twenty-eighth year! This is no slight trial, and more severe on an artist than on any one else. God looks into my heart, He searches it, and knows that love for man and feelings of benevolence have their abode there! Oh! ye who may one day read this, think that you have done me injustice, and let any one similarly afflicted be consoled, by finding one like himself, who, in defiance of all the obstacles of Nature, has done all in his power to be included in the ranks of estimable artists and men. My brothers Carl and [Johann], as soon as I am no more, if Professor Schmidt be still alive, beg him in my name to describe my malady, and to add these pages to the analysis of my disease, that at least, so far as possible, the world may be reconciled to me after my death. I also hereby declare you both heirs of my small fortune (if so it may be called). Share it fairly, agree together and assist each other. You know that any

I became expert at making myself invisible. I could linger two hours over a coffee, four over a meal, and hardly be noticed by the waitress. Though the janitors in Commons rousted me every night at closing time, I doubt they ever realized they spoke to the same boy twice. Sunday afternoons, my cloak of invisibility around my shoulders, I would sit in the infirmary for sometimes six hours at a time, placidly reading copies of Yankee magazine ('Clamming on Cuttyhunk') or Reader's Digest (Ten Ways to Help That Aching Back!'), my presence unremarked by receptionist, physician, and fellow sufferer alike. But, like the Invisible Man in H. G. Wells, I discovered that my gift had its price, which took the form of, in my case as in his, a sort of mental darkness. It seemed that people failed to meet my eye, made as if to walk through me; my superstitions began to transform themselves into something like mania. I became convinced that it was only a matter of time before one of the rickety iron steps that led to my room gave and I would fall and break my neck or, worse, a leg; I'd freeze or starve before Leo would assist me. Because one day, when I'd climbed the stairs successfully and without fear, I'd had an old Brian Eno song running through my head ('In New Delhi, 'And Hong Kong,' They all know that it won't be long...'), I now had to sing it to myself each trip up or down the stairs. And each time I crossed the footbridge over the river, twice a day, I had to stop and scoop around in the coffee-colored snow at the road's edge until I found a decent-sized rock. I would then lean over the icy railing and drop it into the rapid current that bubbled over the speckled dinosaur eggs of granite which made up its bed - a gift to the river-god, maybe, for safe crossing, or perhaps some attempt to prove to it that I, though invisible, did exist. The water ran so shallow and clear in places that sometimes I heard the dropped stone click as it hit the bed. Both hands on the icy rail, staring down at the water as it dashed white against the boulders, boiled thinly over the polished stones, I wondered what it would be like to fall and break my head open on one of those bright rocks: a wicked crack, a sudden limpness, then veins of red marbling the glassy water. If I threw myself off, I thought, who would find me in all that white silence? Might the river beat me downstream over the rocks until it spat me out in the quiet waters, down behind the dye factory, where some lady would catch me in the beam of her headlights when she pulled out of the parking lot at five in the afternoon? Or would I, like the pieces of Leo's mandolin, lodge stubbornly in some quiet place behind a boulder and wait, my clothes washing about me, for spring?

Chapter 15 Grace One morning, after an uneventful sojourn at the bath house. The ward received a rare visit from the Physician Superintendent. He walked into the day room accompanied by the charge nurse just as me and Art were preparing the patients for lunch. “Do you say Grace before meals?” inquired the Superintendent of the charge. “Yes Sir.” The charge was well aware of the hospital rules and snapped almost to attention in reply. His response was true. Our charge, being a stickler for the rule book of the institution, always insisted on saying grace. The order was; “Stand behind your chairs.” Usually bellowed by the deputy although Art and I occasionally got the chance. The seventy odd patients milling round in the dining gallery would stand behind their chairs in absolute silence. Years of institutional living had taught them that meals would only be served after a period of absolute silence, followed by grace. The charge, not leaving his chair, would open his office door and poking his head out would call. “For whayouare aboutorecieve maythelor mayoutruly thankful.” To which the patients would dutifully chorus “Amen” and sit down to eat. On this day the “Big Chief” was present and Art and I could tell things were going to be different. “Stand behind your chairs.” Was said. Nothing happened.—Louder, “Stand behind your chairs.” Nothing.—Art bellowed “Stand behind your chairs.” The effect was electric and the mass moved into its lunchtime position of silence standing behind their chairs in the dining room. The charge had slipped into his long white nursing coat. He was going to assist with lunch. He moved away from the side of the Physician Superintendent and stood in the centre of the dining room. There he adopted a posture which he adjudged spiritually appropriate. Hands clasped in front of him, eyes lowered, he bowed his head. Not wishing to get on the wrong side of our boss. Art and I stood one either side of him and followed suit. Absolute silence reigned. Before the charge could proceed any further with this charade the ward kitchen door opened to reveal Benny and Jimmy. They were two long standing ward worker patients who’s job it was to prepare the plates on the servery ready for the meal. Patients assisting with serving meals was against the “rules” and Benny realising that the Superintendent was present blurted out. “For Christ’s sake shut that bloody door.” Seventy nine patients solemnly responded with “Amen.” and promptly sat down in eager anticipation of their dinner. “I see.” said the Physician Superintendent and walked poker faced from the dining room with the red faced charge trailing in his wake. We never said Grace again after that.

The average time of death after stopping eating and drinking is about seven days, though 8 percent lived for more than two weeks. The last days of life were rated as peaceful, with low levels of pain and suffering, even more so than a physician-assisted death.6680 Most hospice workers said they would consider VSED themselves should they become terminally ill.

I was amazed at how expensive economists thought doctors were. They instituted many economic maneuvers—de-skilling medicine onto nurses and physician assistants; computerizing medical decision-making; substituting algorithms for thinking—because they assumed that doctors were such expensive commodities. And yet doctors were not expensive, at least, not the doctors I knew. We cost no more than the nurses, the middle managers, and the information technicians, alas. Adding up all the time I spent with Mrs. Muller, the cost of her accurate diagnosis was about the same as one MRI scan, wholesale. Economists did the same thing with the other remedies of premodern medicine—good food, quiet surroundings, and the little things—treating them as expensive luxuries and cutting them out of their calculations. At Laguna Honda, for instance, while most patients were on fifteen or even twenty daily medications, many of which they didn’t need, the budget for a patient’s daily meals had been pared down to seven dollars, which could supply only the basics. I began to wonder: Had economists ever applied their standard of evidence-based medicine to their own economic assumptions? Under what conditions, with which patients and which diseases was it cost-effective to trade good food, clean surroundings, and doctor time for medications, tests, and procedures? Especially ones that patients didn’t need? Although Mrs. Muller was an impressive example of Laguna Honda’s Slow Medicine, she wasn’t the only one. Almost every patient I admitted had incorrect or outmoded diagnoses and was taking medications for them, too. Medications that required regular blood tests; caused side effects that necessitated still more medications; and put the patient at risk for adverse reactions. Typically my patients came in taking fifteen to twenty-five medications, of which they ended up needing, usually, only six or seven. And medications, even the cheapest, were expensive. Adding in the cost of side effects, lab tests, adverse reactions, and the time pharmacists, doctors, and nurses needed to prepare, order, and administer them, each medication cost something like six or seven dollars a day. So Laguna Honda’s Slow Medicine, to the extent that it led to discontinuing ten or twelve unnecessary medications, was more efficient than efficient health care by at least seventy dollars per day. I