[HSF] Standard of care for lawyers {OT}

[Tea Acuff]

As to question one the answer is clearly yes even without eastern mysticism.
 
As to question two I have not yet given up hope of returning sense to the system. Remember in a cybernetic or homeostatic system the mental or reasonableness comes from or is immanent from the inter play of all the interacting parts of the system. It is not "poured in" as seems to be so popular today. Although i am exceedingly frustrated at times, when I give up completely I will go some where else. i have the vain hope that this format may help. Only small amounts of hope, however.

tea





----- Original Message ----
From: Michael Firstenberg <msfirst at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Saturday, April 12, 2008 6:53:49 PM
Subject: Re: [HSF] Standard of care for lawyers {OT}

using the tao of tea logic......

does one adjust a practice to fit a system or can one adjust a system  
to fit a practice?

or is the key - knowing ones limitations within the confides of a  
system that may be unchangable?
(or at least within the walls of one's sanity?)

Hal - since you are planning on asking for Intensivits, I am sure you  
have a plan for how to integrate them into "your" system once they  
walk in the door - care to share your thoughts, expectations, time  
tables, etc?


-michael




On Apr 12, 2008, at 3:14 PM, hgrmd at aol.com wrote:

> Sounds like your system works pretty well for you.
>
> Hal
> Sent from my Verizon Wireless BlackBerry
>
> -----Original Message-----
> From: Jbflegejr at aol.com
>
> Date: Sat, 12 Apr 2008 15:00:58
> To:OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Standard of care for lawyers {OT}
>
>
> Hal, I am now in an academic setting. I relied virtually  
> exclusively on
> nurses in a previous life and that for 25 years. They did not open  
> the chest for
> tamponading patients and that didn't happen often anyway. I lived  
> four miles
> from the hospital and if I was at home, I could get here in less  
> than 10
> minutes  during the night when no ordinary folks were on the  
> streets. I doubt if
> intensivists would be much use there. The nurses did put in  
> central  lines and
> arterial lines with none of the complications that I see daily in  
> my  present
> setting and could have put in Swans but for some bureaucratic  
> obstacles.  The
> cardiologists charge for S-G, called right heart cath, and could  
> not allow  it
> to become a non-billable nursing procedure. I almost never saw  
> pneumothorax
> during the first two postop days after I started routinely opening the
> mediastinal pleura a little bit so the mediastinal tubes would  
> handle any lung
> leaks that might happen. We had a policy of not leaving any central  
> lines in
> place for more than 48 hours and the nurses changed them. We did  
> not have
> anesthesiologists or CRNA in the hospital at night those early  
> years. Routinely  I
> kept the patients asleep and on ventilator until the next morning  
> after
> operation which eliminated the need for early reintubation which I  
> would have  had to
> do. With the patient ventilated and pacing wires in place the  
> nurses  could
> manage with telephone guidance anything but bleeding. Sometimes  
> when there  was
> a need for take back for bleeding I did it without an anesthetist  
> and just
> gave a big dose of morphine and some curare. Often the anesthetist  
> did not get
> there from home until the case was finished. We did not have in house
> anesthesia  coverage until it was mandated to maintain the  
> obstetrical service. By
> moving to  the university about 7 years ago, I traded a lot of  
> advantages for
> the rather  dubious distinction of being a professor. John Felge
>
>
>
> **************It's Tax Time! Get tips, forms and advice on AOL Money &
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