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The contents of this website are for contemplative purposes only. No medical advice will be given, and emails asking for medical advice will be ignored.

Although patient vignettes are based on my experiences with real individuals, I liberally change details to maintain patient confidentiality.

I also reserve the right to change old postings to correct errors, and to delete comments that include obscene language or that I deem abusive to me or other commentators.  If you are looking for a open mind, I suggest you consult a neurosurgeon.

Katrina Blog Project

The Strange Case of Charles Cullen

Over the holidays, I stumbled upon a remarkable news story. A nurse in New Jersey, serving a life sentence for murdering 29 of his patients, has agreed to donate a kidney to an acquintance.

You can check out the story for more details, but I will outline the basics. The nurse, Charles Cullen, decided several years ago that he wanted to be New Jersey’s answer to Dr. Kevorkian. So he began killing older and weaker patients, people he thought were suffering and would die anyway. He did this by overdosing them on medication, typically insulin or digoxin.

In a brief review of Cullen's life, twothings stand out. First, Cullen is a deeply disturbed individual. He as attempted suicide on many occasions and has a documented history of spousal abuse and alcoholism. Divorce records indicate that he also has a history of animal abuse, and most psychologists regard animal abuse as a marker for severe mental distrubance.

Secondly, Cullen got away with his murders for years because again and again medical facilities hired him, unaware of his background. In fact, Cullen was dismissed from several hospitals and nursing homes under the suspicion of having harmed his patients. Although reporting laws have been strengthened since Cullen’s conviction in 2004, it remains remarkable how easily a healthcare professional can move from job to job despite a very poor work record, or even suspicion of malfeasance.

Which brings us to Cullen and the kidney. We usually think of organ donation as the most altruistic of actions – giving up a part or our own bodies and taking a health risk (surgery) to do it, all for the benefit of another. Here is a man who killed at least 29 people and yet wants to help save a man’s life.

Is Cullen just irrational? Or does he think he was doing a kindness by ending the lives of chronically ill people, and thus, the kidney donation is simply an extension of his desire to decrease suffering? One thing is for certain. If Cullen does have some sense of ethics he certainly has them out of order. It is not important simply to have values. A person must have the right priority of values. For instance, it may be ethical to be patriotic. But if a government asks a person to torture an innocent person because it is patriotic to do so, a moral person should at least pause. What is more important, patriotism or the right of an innocent person not to be tortured?

Values do not exist in a vacuum. They sometimes come into conflict (and this is often the case in medicine), and when they do, the people involved have to consider not just what their values are, but also which values take precidence in a given situation.

In the case of Mr. Cullen, perhaps he understood the value of not prolonging unnecessary suffering. But he missed the value of a patient’s right to live, even in suffering, if the patient wants to. It is a conflict of values that a balanced mind would not be likely to miss.

Aside from simply pointing out this very peculiar case, I would venture an observation. It is easy for us to see that Cullen, in his effort to relieve suffering, was doing the wrong thing. He, in his mentally ill state, stumbled over the conflict in values between relieving suffering and respecting a patient’s right to live. The fact that he would want to donate a kidney tells me that he really does have values, albeit very warped by his mental illness.

It is easy for us to see the faults in Cullen’s thinking. But there are tougher moral choices out there than the ones Cullen made. I wonder if our society is warped in its thinking, if we are making terrible moral choices but cannot see them, just as Cullen cannot see his. Our society once condoned slavery, and wife-beating, and lynching, because our ancestors stumbled over value conflicts our modern eyes now see as easily as we can see Cullen’s mistakes. There is no reason to think, having cast aside a few errors of the past, that we are now perfect, though it may be perfectly satisfying for us to be so kind to ourselves.


New Year's Day 2005

The past has claimed another year, and it goes without saying that for those of us from the Gulf Coast it is a year we would rather forget. It is the one mercy of the passage of time that a terrible event, once it has occurred, can only recede.

I was in New Orleans again for New Year's weekend and again impressed at how things improve, slowly but relentlessly, no matter how bad the local government is and how much the federal government drags its feet. But this is the way people always are. The most surprising thing is that anyone doubted it would happen. People plan. They look forward. They always have, or else how would Europe have survived the Black Death in the Middle Ages? A quarter of Europe died in the plague epidemic then. But people just got up and kept on going. As did the world after two devastating world wars, and China after a hideous revolution and Mao's purges thereafter. They all still stand.

A month ago, New Orleans Parish had 80,000 people. On New Year's Day, the new estimate is 135,000. It is predicted that that number will rise to 225,000 in a year. Even more impressive, the metropolitan area, once less than 250,000 shortly after Katrina, now stands at 930,000, and is expected to reach 1.1 million next year. Less than 2 weeks ago a New York Times editorial pronounced New Orleans a dying city. Though the city has many, many problems, far from being moribund, it is again one of America's 40 largest cities.

The hard work of life is not done by politicians, or newspapers, or pundits. It is done by countless, nameless people who make decisions every day. The leaders have a lot less to do with it than they think they do.

I think 2006 will be the year that New Orleans and the Gulf Coast will move on, without the politicians. The good folks down there, including several of my family members, will continue to rebuild, and work, and fight, no matter what the leadership says they should or should not be doing. If the leaders will just see to it that the levees get rebuilt and upgraded, we will see the rest come together, slowly, but almost magically.

The prognosticators need to get over themselves. Katrina was an act of God. Recovery is not an act of Congress; it is an act of the people.


Political Thoughts at Year's End, 2005

I have partisan political views, but for the purpose of this website, I tend to keep them to myself. But this being the end of the year, the time of reflections, it seems like a time to break some rules. We can set things right again next year.

Through the year, with the problems of Iraq, the renewal of the Patriot Act, and now the recent stories about the President ordering eavesdropping on private phone calls in the U.S. without a warrant, there has been a recurring theme. Exactly how much power should a president have? We live in a time when national security, especially from terrorism, is a very great worry for most of us. How much of our civil rights should we be prepared to give away for our safety?

At the heart of this issue is a longtime struggle for power in Washington – the struggle between Congress and the Chief Executive for leadership of America. We all know that the framers of the Constitution created three branches of government, the Executive, the Legislative, and the Judicial branch. It is understood that by dividing power among the three, and giving each branch the ability (and the duty) to check the other, that government will proceed more democratically.

That part is clear to everyone. What is equally important, but I think is less obvious to many, is that the Founding Fathers did not expect the three branches to share power equally. Congress was expected to take the lead.

We can easily see this intent in the first presidency. George Washington maintained a strict policy as President never to comment on legislation before Congress. He believed, as most Americans then believed, that the President’s job was strictly to enforce the laws on the books. He did not submit budgets. He had no “domestic policy” or “economic policy,” as presidents do now. Washington did not even think it was his right to veto legislation simply because he did not agree with it. For Washington, the veto was reserved solely for laws that he felt were unconstitutional. His Presidency was small, and unobtrusive, and it never would have occurred to him that it was his job to set the national agenda. That job fell to Congressional leadership.

Things have changed greatly in 210 years, mainly because of the arrival of the Fourth Branch of government, the Media. As the media in this country became larger and more important, it began to affect national politics. The media can pick and choose among major issues of the day, and in doing so, select which issues will catch the attention of the public. Note for example how Terry Schiavo became so famous that Congress tried to pass a law to save her, while a patient of mine in a New Orleans nursing home with identical medical issues died unnoticed.

Since the media can set the national agenda, this greatly empowers the individuals who can manipulate them. The President is one man. As an individual, he is a simpler focal point for the media than Congress. It is easy to cover the movements and statements of one man. Congress, on the othe hand, has 535 voting members, every one of whom has his or her own opinions and policies. It is much tougher to sum up Congress in two minutes than it is the President. So, over time, the President has been able to dictate the national agenda with increasing ease. He has become more powerful than Congress.

The relative primacy of the President is not necessarily a problem as long as Congress has the strength and the gumption to continue to check the President when he grabs for more power. The real danger emerges when Congress stops thinking it is its job to say no to the Executive Branch.

This has happened. It has happened because half of Congress, the half in the same political party as the President, has decided that it is more in their interest to support the growth of presidential power than it is to defend the traditional turf of Congress. I am not blaming the Republican party here specifically, because it has not been above the Democrats to do the same from time to time, especially in state legislatures. It just so happens that the Republicans have been in power lately, and lately this problem has been getting more serious.

From the point of view of the common citizen, it is critical that Congress and the President regularly butt heads. The Founding Fathers intended this. They also thought that Congress could and should win most of the time because it can make all the laws and is in charge of the money. To them, and to me, this is desirable. Every citizen has direct representation in Congress, and because members of the House stand for reelection every 2 years, Congress tends to be more sensitive to the public will. In general, in a democracy, we want a government that is sensitive to the wishes of the people.

The media have changed this balance. Because the President commands the immediate attention of the media 24 hours a day, because he is both the spokesman for government and the largest celebrity on Earth, singular influence tends to swamp the more divided forces of Congress. Thus the President leads the government nowdays. The members of Congress see that, and those in his party line up on his side, magnifying the power of the executive and reducing the legistative power. They do this because they are more interested in power than they are in keeping Congress separate and intact as a major force in public life.

How I wish the same pains taken to keep Church and State separate were employed to keep President and Congress independent!

We need a strong and independent Congress. Everyone likes to make fun of Congress, to deprecate it as a confused, pandering, illogical institution. Next to it the President looks firm, focussed, and calm. But we need Congress. If Congress is not strong, the voters are not strong. No one is immune to the tempation of power, and if Congress lets the President take all he wants, little by little he will be tempted to do it.

The Founding Fathers were afraid of the presidency. They thought it naturally engendered the characteristics of royalty and dictatorship, and they took great pains to limit it. Today, that job falls to Congress, and we need to make sure that our leaders are up to this important task.


Medical Marijuana

I recently penned a letter to the editor of the McComb Enterprise-Journal that sums up my opinion on medical marijuana. You can read it here.

Briefly, what I said was that doctors should not be used as pawns in the game of legalization of marijuana. Legalization may have its merits, but marijuana's medical uses are few and far between.

Jesus of Bethlehem?

I try not to get into religious issues too often on this site, because I cannot claim exceptional expertise on the subject. But I have read one time too many this Christmas season the argument that Jesus was born in Nazareth and not in Bethlehem, and I am getting tired of it.

I am not a Biblical literalist. I do not think the world was made in 6 days, or that Noah really had 2 of every creature on earth in his ark. But I am a scientist by training, and I do think that if the best evidence we have says something happened a certain way, then we should accept it as having happened.

There are 4 Gospels, or accounts of Jesus' life, in the Bible. Some critics argue that a 5th account, the Gospel of Thomas, also has some claim to authenticity. This is debatable, but even if true, it still means that only 2 of the 4 or 5 accepted gospels recount the birth of Jesus. Only Matthew and Luke tell the Nativity story; John, Mark, and Thomas completely omit it.

The two Nativity stories have some variation in their accounts, with Luke telling the story mainly from Mary's point of view and Matthew using the Joseph perspective.  But both agree that the birth of Jesus occured in Bethlehem.

Scholars base their argument that Jesus was born in Nazareth on two points. First, they say that all biblical references to Jesus refer to him as Jesus of Nazareth instead of Jesus of Bethlehem. Usually, they posit, when a location is used in a person's proper name during Jesus' lifetime, it refers to the person's place of birth. If Mark and John thought Jesus was born in Bethehem, they would not have repeatedly called him Jesus of Nazareth.

The second point scholars make is that the reason for the trip to Bethlehem is historically unclear. Matthew and Luke say Mary and Joseph went to Bethlehem to register for a census. Unfortunately, there is no historical record of any such census during Jesus' childhood. It would be strange for a man to take his pregnant and about-to-deliver wife on a walking trip of over 100 miles for no particular reason. Certainly, they argue, Mary and Joseph would have stayed home during her pregnancy, rather than risk the safety of both mother and child on an arduous journey in the desert. Especially if there was no census, as the scholars seem to think.

These arguments make logical sense. The problem with them is that they are unsupported by evidence. What the scholars are saying is that probably Jesus was not born in Bethlehem because probably there was no census and probably if the other gospel writers thought Jesus was born in Bethlehem they would have said so. That's a lot of probablys in an argument that is supposed to be scientific.

The truth is, we have no proof that Jesus was born in Bethlehem except that Matthew and Luke say so. We also have no proof he was born in Nazareth, except for the arguments of probability. 

Making assumptions from probabilities can get you in trouble in a hurry. The two most common causes of death in America are heart disease and cancer. If I read an obituary in the paper about a poor soul who died in a house fire, I could say to myself, "No, in America fire is an uncommon cause of death. He probably died of cancer or heart attack." Probably. Except he didn't.

We can probably ourselves from California to Calvary about Jesus, but we only have two accounts of his birth, and both of them say he was born in Bethlehem. If you argue otherwise, you are saying the Gospel writers made things up. They could have, but without a third source to dispute them, all doubt is conjecture.

Jesus is a very distant and shadowy figure, from a strictly historical point of view. Almost all of what we know of him is from Christian tradition and the Gospel accounts. The rest is filled in by Christians through faith. But scholars, who claim to be searching for truth through facts, need to stop this stupid oddsmaking. If they have an account, or physical evidence that points to Jesus' birth in Nazareth, then out with it. Otherwise, they need to be quiet.