Greatly Relieved - that a cease fire has finally been established in Gaza. Though...
Endlessly Frustrated - that a true peace seems further away than ever.
Growingly Anxious - about big career decisions that I'll need to make this year as I realize med school is nearing its final few stretches and most of my information comes in second hand form.
Downright Concerned - about the fate of medical practice in America where managed care, government regulations and CYA practice secondary to litigiousness is progressively grinding enthusiasm out of the field.
Abashedly Hopeful - as I see the strength of American democracy in the upcoming inauguration of Obama, through whom I also feel a...
Frank Solidarity - with the Black people of America who are seeing what was unthinkable just a few decades earlier.
Awed Delight - for Sully Sullenberger who with aplomb saved 150+ lives with an amazing landing in the Hudson.
Defeatedly Blase - about studying all this week for the coming exam that caps off my latest hospital rotation. Though I've also got..
High Hopes - for my irregular week off after that exam when maybe I'll go skiing and have a superbowl party or something.
There you go. The latest review of what's on OP's mind lately.
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14 comments:
Good luck on choosing what kind of doctor you want to be. Does anything come to mind?
YA,
Acute care surgery vs ER medicine vs vascular surgery vs ???
My focus is actually relatively narrow compared with some of my classmates (since most fields I have already all but ruled out), but all the same a decision needs to be made and I feel like I don't have all the information yet.
Good luck. What is the downside of choosing incorrectly, btw?
E,
Well, that depends how long it takes someone to figure out what's wrong. At the very least you might have wasted a year doing the wrong residency which means you'd likely need to start all over again if you switched. Plus there are integrated specialist programs designed to be completed in fewer years (like a 5-year vascular surgery residency) which are applied to directly from med school. Missing that competitive opportunity would likely mean one would have to take the longer way around, which would mean a five-year general surgical residency and then a two-year vascular surgery fellowship.
That translates into two more years of grueling apprenticeship-like working conditions (read 80+ hour work weeks) for modest salary. And two more years of letting your multi-(hundred-)thousand dollar student loans accrue against you.
A second large is issue is that teaching hospitals get federal aid through a system that pays out per resident spot and per length of training. Through some goofy federal stratifications, hospitals may not be willing to accept your switch from one residency to another as it could pose a monetary loss for them to do so. You could get stuck in an unwanted career path!
(Interestingly, if you ever watched the show ER - one of the early storylines involved Dr. Carter who did a first year of surgical residency before deciding to switch to ER. The hospital couldn't afford another ER resident spot, so he [being from a wealthy background] agreed to work for free during his first ER year.)
Yeah - i remember that ER now that you bring it up...
You realize, of course, that Sully Sullenberger didn't save those people on his own.
Those people all survived due to the excellent recurrent training of the entire crew (as required by government regulations), due to the excellent mechanical maintenance of the very sound aircraft (as required by government regulations), due to the excellent training in emergency procedures done by the crews of the responding ferry boats (as required by government regulations), due to the presence of appropriate rafts, inflatable evacuation slides, life vests, and other first aid and medical equipment on the aircraft (as required by government regulations), due to the presence of life vests and other emergency equipment on the ferry boats (as required by government regulations), due to the excellent training of all the other first responders (as required by government regulations), and the emergency equipment they brought with them (as required by government regulations), etc.
Do you think that this situation would have played out the same way without government regulations?
Sully's own initial and yearly recurrent training is subject to all kinds of government regulations. He did what he was trained to do. Sully's skills are kept sharp by attending regular recurrent training in emergency procedures. Recurrent training required by the government.
Do you think the cash-strapped airlines would accomplish even a tiny fraction of the training, maintenance, or emergency-equipment-outfitting that they do now, without government regulations?
I guess regulations aren't always bad.
Tigerboy,
You've done well at lighting a straw man afire. Good for you.
All of what you said is true to greater or lesser degrees, and you would find few people objecting to government safety regulations for air travel, but the fact in hand is that our guy Sully here was the man on the spot and he alone brought that airplane down safely. It wasn't 'the government' in the pilot's seat. Ninety-nine times out of a hundred fully regulated pilots in similar positions don't manage to accomplish anything nearing this feat.
So in the end: Do I think that this situation would have played out the same way without government regulations? Could be! Sully is a man apart and it seems to me like the main force behind this grace is him as an individual.
Another long one. Sorry.
I guess it doesn't surprise me that someone training to be a doctor would choose to see only the glory of the individual, whilst totally discounting the value of Sully's government-mandated training, or the contributions of the team of flight attendants, air traffic controllers, ferry boat crews, paramedics, police, etc. that were there backing him up.
Pilots and doctors are the two biggest offenders of the "God-complex." The public worships them, and many, the obnoxious ones, worship themselves.
From the admittedly little knowledge I have of Sully, from the media, I would say that he seems to be a man of humility and dignity, so my guess is that he would be embarrassed and even possibly offended by your statement:
- - - " . . . the main force behind this grace is him as an individual."
I am quite confident that he would strongly disagree with your statement:
- - - "Ninety-nine times out of a hundred fully regulated pilots in similar positions don't manage to accomplish anything nearing this feat."
Every single pilot, who finds him or herself with an aircraft that cannot stay aloft, is trained to look for water. It is drilled into their heads.
When is it drilled into their heads? Every year, when they receive their government-mandated recurrent training.
I'm not saying that Sully didn't do his job very well. He did. But, this isn't some magic bit of genius. He was trained to respond to a specific situation in a very specific way, and that is exactly how he responded.
I'm not saying that we shouldn't all be grateful for Sully's good judgment and individual skill. But, he's not some sort of superhuman. Every single time I step onto an airplane, I (we all) make the assumption that this particular pilot is capable of just such a feat. It's not magic, it's good training. Training required by government regulations.
Just like I assume that the flight attendants are capable of performing CPR, or directing an efficient evacuation, or extinguishing a cabin fire. Regulations.
Just like I assume that the air traffic controllers are capable of plotting a safe course for us and the hundreds of other aircraft. Regulations.
Just like I assume that the TSA workers are capable of preventing dangerous goods from entering into secure areas of the terminal and the aircraft. Regulations.
Just like I assume, should I have a health crisis, that I can count on the very capable professionals who have been trained as 911 dispatchers, EMT's, nurses, therapists, X-ray techs, etc.
It may be the most natural thing in the world to give up all of the glory to the one with the big paycheck, the one with the most education, but these people do not operate in a vacuum.
Sully might have done exactly as he had been trained, he might have successfully brought that plane down into the water, yet, without a team of the unsung, underpaid individuals behind him, they all, including Sully, could have easily sunk to their watery graves.
Who was responsible for opening the doors, inflating the evacuation slides, and, with clear voices and authority born of government-mandated training, directed the people out of a highly-chaotic situation, out of an imminently sinking aircraft?
Flight attendants.
Who arrived on the scene very quickly, and plucked those people out of freezing water that could have killed them in brief moments?
First responders of many descriptions.
And, who made sure all of these professionals, including Sully, had proper training, and that all of the appropriate emergency equipment was on-hand when it became needed?
The Federal Government of the United States of America.
The reason this incident went off so beautifully is that EVERYBODY acted efficiently and according to their training. The fact that there were a number of fully-equipped ferry boats in the vicinity certainly helped tremendously. And, the fact that both the ferry boats, and the aircraft, carried government-mandated emergency equipment was INVALUABLE.
It's not just about Sully. Much like, it's not just about doctors.
A system devoid of regulations, and I'm not just talking about airline regulations, a system devoid of government regulations would have lead to a VERY different outcome.
Guaranteed.
As a matter of fact, chew on this:
Remember all the glory given to firefighters, police, etc. after Sept.11? -and I'm not saying they didn't deserve it- but, who was the very first protector of public safety killed in the line of duty that morning? A flight attendant. Did anyone acknowledge her? Not really.
Who almost single-handedly prevented Richard Reed, the so-called "Shoe Bomber", from blowing up a whole planeload full of people, immediately after Sept. 11? A flight attendant.
Bimbo.
People not only don't give flight attendants any credit for being watchdogs of public safety, for being first responders in medical crises, for being trained to deal with all manner of emergency situations . . . many, many people seem to greatly enjoy ridiculing flight attendants.
What other profession, in our society, what other person who could easily end up being the one person available to provide CPR, or to operate an AED, or to fight a life-threatening fire, or to be Sully's eyes and ears in the cabin during a security threat, or to administer the Heimlich Maneuver on your child, what other first responder is the recipient of such little respect, in fact, is the butt of so many insulting jokes?
(Perhaps nurses, though not nearly as egregiously.)
Refer to any "blond joke" you have ever heard, I guarantee that it has been told referring to flight attendants.
If it's not rich, white, and male, it gets zero credit.
Only acknowledging the actions of Captain Sullenberger is a good example of that. He was part of a highly-trained crew of airline professionals, and part of a larger group of highly-trained rescue responders. He brought the plane safely down to earth. He gets big credit for that.
He does not get ALL the credit for saving everyone's life.
Tigerboy,
"whilst totally discounting the value of Sully's government-mandated training, or the contributions of the team of flight attendants, air traffic controllers, ferry boat crews, paramedics, police, etc. that were there backing him up."
I'm not discounting, I'm properly recognizing their place as, you said it, back up. You might as well credit farmer Joe in Iowa too, because without farmer Joe Sully would have had to make his own food and never would have been a pilot! Of course flight attendants and the like should get some credit, but would the plane have landed without them? Probably!
Sully was the man on the line with the most crucial task and he pulled it off. Trying to turn this into a 'win' for government regulations is silly. Heck, I'm not even saying I have a problem with those safety regulations - but they didn't land that plane. You can't regulate good judgement and consummate skill.
Similarly in medicine, the surgeon is the man doing the work. Support staff are necessary for the smooth functioning of the operation and even follow up care, but it's not them on the spot. The lion's share of credit quite properly goes to the individual surgeon.
"I am quite confident that he would strongly disagree with your statement:"
Little doubt on that count, but a Mosaic humility only adds to his credit. I don't think you get how this is only the second time in human history that a passenger plane has landed in the water and everyone survived.
"Just like I assume that the flight attendants are capable of performing CPR, or directing an efficient evacuation, or extinguishing a cabin fire. Regulations."
How naive. Regulations just submit that the person was able to pass a regulating exam. How they act on the scene very often doesn't match up. I've been an EMT and I assure you there were people in my class when we passed the exam who I had zero confidence in.
You have to be an individual who wants to accomplish the duty, to be willing to put in the effort to know how to do it well and have the confidence to follow through when the time calls for it. Regulations ensure that at least an echo of these gets through the doors, but I guarantee that not everyone who comes through has 'em.
"The fact that there were a number of fully-equipped ferry boats in the vicinity certainly helped tremendously. And, the fact that both the ferry boats, and the aircraft, carried government-mandated emergency equipment was INVALUABLE."
How do you figure? Do you think they were trained to get people off of a sinking plane? The truth is that their simple near vicinity counted for far more than any particular set of skills or equipment. Most of the people on the plane were fine when it landed. If the ships had a few ropes and life preservers that would have been largely sufficient in this case. The biggest threat to life here was not the crash but the cold. Again, not that I think they should not have the emergency equipment - you're just overplaying your hand.
"Who almost single-handedly prevented Richard Reed, the so-called "Shoe Bomber", from blowing up a whole planeload full of people, immediately after Sept. 11? A flight attendant.
Bimbo."
LOL, Freudian slip?
"If it's not rich, white, and male, it gets zero credit."
I love how you turn a non-issue into a total non-sequitur.
My use of the term "bimbo" was not a slip, Freudian, or otherwise. It's called sarcasm. My point was about how these safety professionals are viewed by the public. I was pointing out that a member of this often maligned profession had saved an entire planeload of people.
"What a bimbo!" Sarcasm. Get it?
----"I don't think you get how this is only the second time in human history that a passenger plane has landed in the water and everyone survived."
Oh, really?
On January 16, 2002 Garuda Indonesia Flight 421, a Boeing 737, successfully ditched into the Bengawan Solo River near Yogyakarta, Java Island after experiencing a twin engine flameout during heavy precipitation and hail. The pilots tried to restart the engines several times before making the decision to ditch the aircraft. Of the 60 occupants, one flight attendant was killed. The survival rate was 98%.
On August 7, 1980 a Tupolev 154B-1 operated by Tarom Romanian Airlines ditched in the water, 300m short of the runway at Nouadhibou Airport, Mauritania. 1 passenger out of 168 passengers and crew died. The survival rate was 99%.
On April 6, 1952, the prototype de Havilland Australia DHA-3 Drover was ditched in the Bismarck Sea between Wewak and Manus Island. The port propeller failed, a propeller blade penetrated the fuselage and the pilot was rendered unconscious; the ditching was performed by a passenger. The survival rate was 100%.
On September 12, 1993 while landing in poor weather conditions at Papeete Faaa airport, Tahiti, an Air France Boeing 747 registered F-GITA hydroplaned, overshot the runway and ended in a lagoon. All 272 passengers and crew evacuated successfully, even though the engines were still running and there was a risk of ingestion. The survival rate was 100%.
In 1993 China Airlines Flight 605, a Boeing 747-409, ended up in water after it overran runway 13 at Kai Tak International Airport on landing during a typhoon with wind gusting to gale force. All of the 396 occupants donned life vests and boarded the eight slide/rafts. The survival rate was 100%.
On August 21, 1963 an Aeroflot Tupolev Tu-124 ditched into the Neva River in Leningrad after running out of fuel. The aircraft floated and was towed to shore by a tugboat which it had nearly hit as it came down on the water. The tug rushed to the floating aircraft and pulled it with its passengers near to the shore where the passengers disembarked onto the tug. All 52 on board escaped without injuries. The survival rate was 100%.
On November 22, 1968 Japan Airlines Flight 2, a DC-8, landed short of the runway in San Francisco Bay on approach to San Francisco International Airport. There were no fatalities, and the aircraft itself was in good enough condition to be removed from the water, rebuilt, and flown again. The survival rate was 100%.
In October 1956 Pan Am Flight 943, a Boeing 377, ditched northeast of Hawaii, after losing two of its four engines. The aircraft was able to circle around USCGC Pontchartrain until daybreak, when it ditched. All 31 on board survived. The survival rate was 100%.
It is rare. ANY major incident in commercial aviation is rare. I guess those government regulations are keeping us safe after all.
Or, do you give the credit to free enterprise?
Let's see . . . . life vests or management bonuses. It's so hard to choose.
Tiger,
""What a bimbo!" Sarcasm. Get it?"
I'm sure you realize by now that sarcasm often gets lost when in the form of blogging and commentary.
"Oh, really?"
Forgive me, I took that piece of data from a news story and remembered it incorrectly. It's the second time in human history that a passenger JET has crash landed in the water and all survived. Overshooting a runway doesn't count as a landing.
It is extremely uncommon, and if you got your list of events from wikipedia you shoud also know that "the FAA does not require commercial pilots to train to ditch, regulating instead the distance a plane can stray from an airfield." This means that government regulations played no role in Sully's skill here.
"Or, do you give the credit to free enterprise?"
Do you just pull stuff from your butt? I've said time and again that I primarily credit Sully Sullenberger and Sully Sullenberger alone for bringing down that plane safely.
---"Do you just pull stuff from your butt? I've said time and again that I primarily credit Sully Sullenberger and Sully Sullenberger alone for bringing down that plane safely."
Do you read my comments at all? I asked if you give credit to free enterprise, versus regulations, regarding the rarity of ANY major incident in commercial aviation.
I am well aware of your major hardon for Sully, but I don't think he gets credit for the outstanding safety record of the entire industry.
Try reading before responding.
Tiger,
Maybe you should read your own comments over before you post them. More than once have you written in ways which are unclear or ambiguous.
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