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Excerpts from my upcoming book:
DIY Medicine
ca. 1993. I come into hospital from home on a Sunday to perform preoperative
anesthesia evaluation for a very sick patient due to have a big surgery the following day. After seeing the patient,
I write anesthesia preop orders, to include a request for the nursing staff to arrange for the patient to have
pulmonary function testing (PFTs), a room air arterial blood gas (RA ABG), and to locate the patient's outpatient
records to send to the operating room (OR) for final evaluation preoperatively (chronic problem with the military
medical system: no outpatient records available, thus preventing appropriate medical evaluation/treatment). The
next day, the patient was sent to the OR with the following written on a piece of paper taped to his chart:
Dr. Jones (in red ink)
1) PFT's can't be done today as they're closed on weekends.
2) Same for RA ABG, which you could do yourself.
3) Old records can't be found today. They're laying carpet in records room and records have been moved to hall
and pt records can't be found.
Thanks,
Cpt. S. (ward nurse)
0 for 3…and no one thought to page the anesthesia senior resident on call to iron these things out before sending
the patient to the operating room. Sigh.
Mentate This
ca 1993. Wilford Hall. Called in the middle of the night by the ICU resident. "The
patient is having an MI and developed a-fib. His pressure is 80 over nothing. We need you to give him sedation
for cardioversion."
I stare at the phone. "Shock him now. Hang up the phone and shock him now."
"Bbbut...he's still mentating."
"Look, if I give him anything, he'll never mentate again ever! He's unstable, and any sedation I give him
might kill him. Shock him NOW!"
"Oh." Click.
See the Light
Drunk as skunk retiree comes to OR in the middle of the night with an ankle fracture.
After the orthopods watch me doing a spinal anesthetic for him (given his full beard, scraggly teeth, bad airway,
and full stomach), they start working on fixing his foot. In the middle of the case, while the patient is snoring
from the effects of alcohol and minimal sedation, he moves his arm a little bit under the drapes. The orthopods
freeze in horror.
"Hey, anesthesia, he's light!" the
chief resident bellows.
I just look at them over the top of my glasses...you know, the LOOK.
"Sir, how are you doing?" I ask the patient.
He wakes up from his stuporous haze. "Ahm fahn. Y'all done yet?"
"Yeah, orthopedics, he seems a bit light. Now please continue."
"OK, So there are no known unknown...um..."
"The patient has no known occult injuries."
--Dr. K., staff trauma surgeon, Wilford Hall Medical Center, Lackland AFB, TX, 24 Apr 94 0300,
That Vision Thang
From mandatory "Quality Forum" implemented at the behest of our Hospital
Commander:
"Maybe we shouldn't have a vision, but now we do."
-- "Quality" functionary giving Quality Assurance (QA) briefing
We're Bugging Out
"If a bug flies up your anus, it's no big deal."
--Dr. H., staff vascular/thoracic surgeon, 20 Mar 1997, on why he was so upset about a fly buzzing around OR #2
when his sterile instruments and vascular grafts were sitting on the back table open immediately prior to a big
revascularization case (AAA or fem-pop, as I recall). His point was that a AAA is not a hemorrhoidectomy.
...
Surgeon A:
11. How late are you willing to operate in order to take advantage
of open time? This is a loaded question. Waiting for an add-on and being at
the mercy of the OR staff and every pregnant lady the (sic) decides she needs an epidural does not mean we are
not willing to work late. It has to be scheduled time. Unlike the OR staff we are not on call doing the cases.
we (sic) are here doing elective cases, after hours and on call at other times (now
that was honest: those damned pregnant ladies! "here doing elective cases, after hours" --RCJ)
"We need a scalpel…the pointy kind."
--Dr. O., GYN resident, 23 Sep 98
"Go clone yourself."
--Col (Dr.) W., responding to my concerns as Medical Director of Anesthesia that there would be a shortfall of
anesthesiologists at David Grant Medical Center in 1999-2000 timeframe, and asking what I could do to be of assistance
in mitigating this problem.
"That shunt thing is kinda cool."
--Dr. K., VA "vascular surgeon", while watching carotid endarterectomy shunt being placed by an AF vascular
surgeon.
"Just tell her she could die."
--Dr. D., staff general surgeon, 16 Sep 98 1415, on how carefully to evaluate a patient preoperatively for a fem-pop
bypass.
"I told you
anesthesia would find out."
--Dr. P., ca. Oct 98, to Capt. (Dr.) Z., his intern and co-conspirator, after I informed him that I found out that
a patient scheduled for elective (non-emergent) gallbladder surgery had a potentially life-threatening sodium level
around 125. I just looked at him in stunned amazement. The patient could have died or never woken up if he had
had his surgery that day, but they were evidently more concerned about getting another notch in their surgical
guns than about patient safety. When I told him that he should start water restriction for the patient immediately
and consult medicine, he replied, "Yeah, that's what medicine said. We started water restriction already."
"We need to get the patient going. She
was an emergency yesterday (emphasis added), but we ran out of time. I'll
take the responsibility if the patient dies in the O.R."
--Dr. "X", staff colorectal surgeon, 28 Oct 98 0915, for whom this potentiality was not merely an academic
consideration. Analysis: "She was an emergency yesterday" is absurd: emergency cases proceed immediately;
had he declared her an emergency the day prior, the operation would have been done already. "We ran out of
time": the surgeons never had any compunctions against operating until all hours of the night when they felt
like it; all they had to do was declare the case urgent or emergent (even when it wasn't…like the "emergency"
breast biopsy cases), and anesthesia was forced to comply. "I'll take the responsibility if the patient dies
in the O.R.": More on this later…but, just imagine: "Your honor, I know the patient died because of an
anesthesia complication, but I'll take Dr. Jones's legal liability, even though I am not an anesthesiologist, and
he is…"
"So, what you are saying is that the system conspired to assassinate the
patient."
--General (Dr.) R., Commander, David Grant Medical Center, Travis AFB, CA, at hospital Executive Committee meeting,
11 Dec 98
After the assassination conspiracy incident, a Joint Commission on Accreditation of Health Care Organizations (JCAHO)
Sentinel Event investigation took place. I was on the committee (see my other book for all the gory details). One
of the conclusions we reached was that communication between anesthesiologists and nurse anesthetists was not good,
especially when it came to the sickest (ASA Class III-V) patients. Thus, the existing consultation policy, OI 160-1,
was reiterated: the CRNA was to to call the M.D. the night before to discuss the anesthetic plan for elective cases
involving the sickest and youngest (age < 2 years) patients. Of course, this policy ignored the Chief CRNA's
political agenda, which was to implement completely independent practice for "her" CRNAs, regardless
of piddly little Medical Group or Air Force Instructions. On to the quotes, and my analysis thereof, which I shared
with my Flight Commander and Chief Anesthesiologist, "Dr. Wrong", to no avail:
Excuses given to me by a junior CRNA who had recently graduated from the Travis CRNA training program why she didn't
call me regarding a sick patient we had that day, in complete violation of the Medical Group, Squadron, and Flight
rules of engagement:
"I wasn't here yesterday."
"It's our last case of the day; we have plenty of time to talk."
"I haven't really had a chance to look at the preop myself."
Analysis I wrote for discussion with my superiors:
1. What is the policy re: calling the anesthesiologist the night before for all ASA III+ patients?
2. Does it depend on case order (which may change suddenly due to patient/surgeon factors)? I.e., is the policy
changed such that only first cases need to be discussed?
3. Does it depend on the presents of a NAR (Nurse Anesthesia [shudder] Resident, formerly known as CRNA students)?
The (civilian CRNA school) NARs are very green and can't really discuss plans cogently.
4. Is it recognized that anesthesiologist sign-off on preop on day of preop is not equal to and cannot substitute
for a coherent anesthetic plan among all members of anesthesia team (on the day of surgery)?
As usual, my objections to the attitudes and behaviors which foreshadowed the impending Civil War between anesthesiologists
and CRNAs at Travis fell on deaf ears. I was basically told by my Chief Anesthesiologist to stop bothering him
and to shut the door on my way out.
"I (state your name) do solomnly (sic) pledge to follow doctors'
orders without question or mental reservation constipation, and I will well carry out without question the orders of the
lowliest intern so help me God.
In addition to these, I will cheerfully answer call bells, empty bedpans, and strive to enhance nursing knowledge
to the best of my nursing abilities."
-- My formal swearing-in oath during my "Hatting Ceremony" to become a full-fledged nurse, 8 Sep 99,
after I showed my new official hospital ID card to the chief nurse of our Recovery Room (PACU). She even made me
a beautiful, folded white paper hat to wear, which I kept for the longest time (still probably have it around here
somewhere [rummaging through detritus in home office]).
Here's the story behind why I was given an official David Grant Medical Center name badge which labeled me as an
RN, despite the fact I was a board-certified anesthesiologist physician:
A few days earlier, a med photo airman showed up with no notice to take digital pix of everyone in the O.R. for
our brand spanking new name badges. He made us sign our names and job titles on a list...BUT the airheaded airman
failed to keep track of which picture went with which name. So, therefore, logically, there were two clear alternatives:
1) a. Admit that you were a moron. b. Delete the pictures; do not print any badges. c. Go back to the O.R. to inconvenience
every single nurse, CRNA, anesthesiologist, technician, and surgeon by taking the pictures again. d. This time,
keep track of which pic belonged to which person.
OR...
2) a. Do not admit that you were a moron. b. Waste government money by printing literally 50+ laminated name badges
with RANDOM assignment of job titles (i.e., label surgeons as technicians, technicians as anesthesiologists, and,
of course, anesthesiologists as nurses). Hope no one will notice. c. When people fall on the ground laughing due
to the stupidity of a system which would allow such egregious incompetence, proceed to steps c and d of option
1.
Obviously, if you are in the Air Force, there is only one correct answer: 2.
Our illustrious pharmacists plastered the hospital with the following fliers in happy pharmaceutical colors (yellow/purple):
Sadly, I didn't keep the e-mail I sent to the Chief Pharmacist, but it went something like this:
As an anesthesiologist, I think I have an unfair advantage in this contest. In order to win the 1st prize for my
wife and myself, all I have to do is give the wrong medications to my next twenty or so patients. For example,
I could give penicillin to penicillin-allergic patients, or just administer vancomycin wide open to cause "Red
Man" syndrome ("Red Person" syndrome in California)...and, voila! I'll be reaping the sweet rewards
of malpractice over some pasta and vino with my honey. Perhaps the hospital should reconsider incentivizing bad
things that happen to patients? Just a thought.
Rob Jones, M.D.
Maj, USAF, MC
"They (the operating room technicians) don't have to be sterile…the last
thing I'm worrying about if I have to do a cric (cricothyrotomy) is sterility…'cause I'd be crapping in my pants."
--Dr. L., staff orthopedic surgeon, 16 May 00 1905, on the policy of keeping the OR techs sterile in case a scalpel
was needed off of the back table to cut the patient's neck in case of airway disaster on extubation.
"We can do a Darwinian extubation on him."
--Dr. I., staff vascular surgeon, 30 Jun 00 1048, demonstrating a significant lack of Intelligent Design with regard
to an extremely fragile 92 year old patient after AAA surgery.
"Grrr. Get off of politics and put a suture in me."
--80 YO retired LtCol patient, 8 Nov 00, to surgeons who were engrossed in discussing the uncertain outcome of
the 2000 election in the OR instead of putting sutures in the patient
Dr. T., female staff general surgeon: "Did she pull the testicle down?",
regarding WRAMC female surgical senior resident's expected maneuver after hernia repair.
RCJ: "Yes."
Dr. T.: "Did she do a good job?"
--Dr. T., 30 Apr 01 1330
Dr. "Weevil", staff vascular surgeon, to patient, while attempting
to assess facial muscle symmetry and thus lack of stroke after carotid endarterectomy: "Show me your teeth."
Patient: "They're in my pocketbook."
Ca. Oct 01
"Sit at attention."
--Col (allegedly Dr.) "Rusty", 4 Dec 01, when I had the temerity to cross my legs during his reading
of my first Letter of Reprimand (the one for potentially saving a 9 year old child's life by arranging his transfer
to Walter Reed for surgery when we had no pediatric ward, no pediatric ICU, no pediatric orthopedist, and no femoral
rod appropriate for the patient [see my other book]). After 15 years on active duty, I had never heard of the concept
of "sitting" at attention. I got the impression that this was an Air Force Academy thing that "Rusty"
had been forced to endure at one point, so he decided to cathart his adolescent trauma on me.
"When I was a resident, my balls were as big as bowling balls and as hard
as cast iron. Since I've become staff, they've shriveled up into little raisins. At some point comes the realization
that I'm not getting paid any extra to put my little shriveled raisins in the shredder."
--Dr. R., staff orthopedic surgeon, 19 Aug 02 0900, on doing risky things in the OR (in this case, total joints
without help). I wish his shrivelization process had occurred earlier (circa November 01), as his ballsy desire
to place a femoral rod into a 9 year old trauma patient without pediatric ward or ICU support and without the patient's
neck being cleared led me to object that his plan did not meet standard of care. Dr. R.'s whining to the tyrannical
squadron commander (Col. "Rusty") that Jones had insisted the patient be transferred to Walter Reed led
the Commander to give me a Letter of Reprimand which effectively ended my military career (see my book).
"Metropolitan Guatemalan Medical Center"
--Orthopedic Surgeon Maj. (Dr.) R.'s canonical phrase for Malcolm Grow Medical Center, after he has been told for
the fifth time in one day that the instrument he needs to do a case is (broken/unavailable/unsterile/approved but
unfunded). Note: I apologize for any offense that Guatemalans may take regarding this quote. In fact, many days
I *wished* that I could transfer patients from Andrews AFB hospital to Guatemala, where they would likely obtain
far better care.
"I am not going to have some young man wake up with my initials on his
scrotum."
--Dr. C. (female), Staff Urologist, 24 Apr 03, 1130 (re: not signing laterality of urologic procedure)
7 March 2003: Response by a colleague to complaints by surgeons and other physicians
that they should not have to sign the preanesthetic evaluation of their patients in the absence of anesthesiologists
(due to sheer poor planning on the part of the Air Force medical hierarchy), even though their signatures are required
by Air Force regulations:
7. The signature on the preanesthetic assessment is required on the AF 1417 (moderate sedation form) and demonstrates
that the physician has evaluated the patient for the proposed moderate sedation. Expecting a physician, who is
about to perform a procedure that requires sedation/and anesthesia in excess of that required for moderate sedation,
to sign a preanesthetic evaluation is and should be a minimum standard. Not requiring a physician evaluation as
the bear (sic) minimum is denying the fact that training and experience do make a difference in medical care. The
"frustration, confusion and irritation" that is expressed by the surgeons and obstetricians is a result
of their training in an environment where the patient was cared for by an anesthesiologist, who used his/or her
training and experience to ensure proper patient preparation and selection. The physicians who are "frustrated,
confused and irritated" may in fact feel unprepared or untrained in anesthesia, but that is the demands (sic)
that military medicine places on them. The "frustration, confusion, and irritation" the surgeons and
obstetricians feel may be the key factor in deciding the in life and death of a patient.
11. Lower the standard in order to emulate a model that has resulted in an increase in death and complications
rate seems rather stupid. If quality medical care is too difficult for the Air Force then perhaps the Air Force
should get out of the medical profession. The evaluation and supervision by a physician is required in all medical
care provided in this country. Certain South American countries do not require physician evaluation or supervision,
who is going to advocate using third world countries as a model of medical care?
(RCJ: The survey says: The United States Military, that's who! See: Independent
practice of CRNAs and PAs in the military; for example:
http://www.qmo.amedd.army.mil/adverse/crna_40_48_rewrite.ppt#17 )
Brand new 3rd year medical student, after botching IV attempt in preop patient:
"It's your fault, Dr. Jones."
RCJ: "Excuse me?"
"I'd been having good luck, but you were looking over my shoulder, so it blew."
RCJ: "In your future career as a military medical officer, you will find that blaming your superiors for your
own failings will serve you well to attain both advancement and adulation. Trust me on this one."
Our department was scheduled to give a Dog and Pony show to a bunch of non-medical
generals (including the hospital commander [sic]) on what we in the anesthesia department actually do. My boss
told me to make a PowerPoint slide that stated we give classes to pregnant ladies on the risks/benefits of anesthesia
"in order to keep OB at (our hospital)". I stated I would not write that, because I did not ethically
feel that keeping OB at our hospital (given the abysmal track record I had seen over 4 years) was in the best interest
of patient care. I stated categorically that I would not write something that violated my integrity. So she said:
"I don't care whether you believe it or not." (implication: do it anyway because I'm telling you to)
Col. (Dr.) Hurtus, 1 Mar 04, 1400
Postscript: When she saw me writing her classic quote down for future use, with time and date, our leader, known
paragon of Air Force Core Values (#1: Integrity First) stated, in the presence of witnesses:
"I'll just deny it."
1 Mar 04, 1402
Obviously, I didn't write the untrue Powerpoint blurb for the generals…I guess she eventually found another lackey
to do it.
At Andrews Base Gym for mandatory workout:
RCJ: "Can I have a towel, please?"
"Sorry sir, we're out of towels."
--Sergeant manning the front desk
RCJ: "Then what's that?" I ask, pointing to a nice, large, fluffy towel sitting on the desk right in
front of the Sergeant.
Sergeant: "I'm sorry sir, that's a VIP towel."
RCJ: "What?"
Sergeant: "We won't have towels for half an hour"
(meaning: tiny little inadequate towels we will deign to give to stinking non-VIP Lieutenant Colonel staff anesthesiologist
physicians) 2 June 04 0800. By early 2005, this issue became moot: In Order To Serve Their Customers Worse, they
decided to do away with the towel service altogether, thus forcing military members with asthma to endanger their
health by putting wet towels in their trunks to fester all day, thus creating allergy-triggering mildew in the
humid Washington summertime. Fscking Brilliant.
A 7 year old patient comes into the hospital at night bleeding severely after
a tonsillectomy several days prior. After we put the patient to sleep, the ENT surgeon allows the PA (physician
assistant) to attempt to cauterize the bleeding. The PA is woefully unsuccessful. When the surgeon finally takes
over, the PA says:
"How could I learn to do this better, the way you do it?"
To which RCJ responds: "Go to medical school, become a physician, do an ENT residency…" --27 Aug 04 2200
The Air Force leadership thinks that they can provide quality care to our troops and their loved ones without providing
highly trained (and expensive) specialist physicians. They think that PAs, nurse practitioners, or even techs with
minimal training can equal the judgment and competence of (most!) residency-trained doctors. They have been proven
wrong time after time (see my other book).
From Typed, Dictated Operation Report 5 Sep 04
"INDICATIONS FOR PROCEDURE: Mr. (sic) (redacted) is a 28 year old gentleman who sustained a blast injury while
serving in Iraq…He is stationed in the ASS at the (sic) Andrews Air Force Base at Malcolm Grow Medical Center.
Orthopaedics was consulted for a dressing change to his right lower extremity and his right upper extremity, as
the patient could not tolerate the pain for (sic) his dressing changes in the ASS."
(RCJ: Hint: They named it the Aeromedical Staging Flight [ASF], not Squadron,
for a reason.)
(But wait, if you order by midnight tonight…)
"He also had decreased sensation along the anterior chin (sic) of his right lower extremity."
(RCJ: I hate it when that happens. You can't drink beer from your leg. Bummer.)
"She's been on terminal leave since 2002."
--Dr. M., 8 Sep 04 1500, on our alleged colleague and boss, Col. (Dr.) Hurtus, aka "The Absentee Landlady"
(see my other book), who was supposed to retire in January 05, but who managed to cling tenaciously to the turgid
teat of taxpayer money for doing no work until April 05.
At first Wing Commander's "Standup" in our new "combined"
officers/enlisted club on base, the various squadron commanders were introducing their fresh meat, er, new officers.
This one Colonel stood up and said:
"The young lieutenant wants to learn how to fly…he wants to be a private pilot…if there are any fliers out
there who can get him sex…er…success…um…Hey, they're not paying me anything to stand up here and say these things…"
"She's an enthusiistic (sic) young officer."
--Security Forces Commander, on one of his newbies. Definitely General Officer material, that one. Probably a master
of strategery as well.
"There is a policy,
But
What it is,
We don't know."
--LtCol (Dr.) C., Flight Commander, Anesthesia Service, 19 Jan 05, creating free-verse poetry regarding the policy
for liberal leave for the following day, Inauguration Day. The United States Air Force: Never before have so many
been led by so many with so few clues. It's not as though Inauguration Day was a freaking surprise; you think SOMEBODY
in the chain of command would have figured out how to arrange to have folks attend the Inauguration downtown at
least a month or so in advance, given that we have an Inauguration Day, oh, well, approximately once every four
years on just about exactly the same fricking day.
Woof once if this hurts, Woof twice if it doesn't...
"I'm the kind of guy who is willing to try local with anything. I guess it's my veterinary background."
--Major (Dr.) H., ENT surgeon and former vet, 28 Jan 05 2023
Patient had a large neck abscess that needed wide excision, not just incision and debridment. The surgeon had suggested
local anesthesia, but, knowing that local anesthetics don't work well in the acidic environment of infected tissues,
and knowing how painful this was going to be, I insisted on providing general anesthesia for the patient.
In Loco Parentis..Muy Loco
Female family practice resident, Capt. (Dr.) W., comes running down the hall from the ICU.
"Where's the short doctor who did the intubation for our patient?"
"Um, is it this doctor," I say, pointing to our muscular but not too tall anesthesiologist on call.
"No, it was another guy, with dark hair…"
"Oh, you mean Capt. C., the nurse anesthetist. How can we help you?"
"Well, the patient is bucking on the endotracheal tube."
Blink. Blink. "Well, who is your ICU attending?"
"We don't have one."
"What? Who is your ICU attending?" Incredulity sometimes makes me repeat myself.
"We don't have one. We have a medicine attending, but she isn't comfortable managing intubated patients in
the ICU, so we're transferring the patient to Walter Reed, but they can't accept her until 5."
At this point, our civilian (ex-LtCol) anesthesiologist, walks down the hall to the ICU to act as a de facto ICU
attending. His sage advice to the unsupervised residents: "Give more medicine until the patient is comfortable."
Surprisingly, this worked. 26 Jan 05 1345
"The SGH has told the internists they have to watch over intubated patients
for 24 hours and not transfer them out, even if they don't feel comfortable doing so."
--Capt. (Dr.) W., 30 Jan 05 1930
One of the hallmarks of the devolution of the Air Force Medical Corps is the insistence by pinheaded leaders (an
allergist, in this case) that competent people under them do things that are tantamount to medical malpractice
(e.g., providing care which the physician himself does not feel is in the best interest of the patient) in order
to avoid admitting the following truths:
Instead, we are constantly ordered to do more with less, until we do everything with nothing. When we stand up to say, "Sir, no sir, that's not safe, sir," we are slapped with career-ending and humiliating Letters of Reprimand (see my book).
Wanted:
Escorts for the Lickoff to "Blue him up" and feed off the outbound brief with a thumbnail
From: Dr. C. Lt Col 89 MSGS/SGCJ
Sent: Monday, January 31, 2005 2:17 PM
To: (anesthesia department)
Subject: FW: Visit with The Honorable Stephen L. Jones D.H.A: Suspense 4 Feb NLT 1200
If anyone is interested in the below, please let me know ASAP
Dr. C.
//Signed//
Dr. C., LtCol, USAF, MC, SFS
Anesthesia / Critical Care
Anesthesia Flight Commander
(phone numbers)
-----Original Message-----
From: C., Col 89 MDG/CD
Sent: Tue 1/25/2005 4:02 PM
To: (people)
Cc:
Subject: FW: BIO The Honorable Stephen L. Jones D.H.A
Just FYI...for now. Capt S. (female
protocol officer), I'm sure this
will be a really big deal so let's look for a POC, escorts...the whole deal.
(RCJ: Heh, he said escorts...)
-----Original Message-----
From: C., Col 89 MDG/CD
Sent: Tuesday, January 25, 2005 4:38 PM
To: Gray Scott BrigGen 89 AW/CC; Germann William BrigGen 89
MDG/CC
Subject: BIO The Honorable Stephen L. Jones D.H.A
Sirs,
I been contacted by the AF/SG's office to set up a tour for Dr
Jones, who is the number two guy in DoD for Health Affairs. Gen Taylor briefed him on the AF health program and
has asked us to 'blue him up'. Gen Taylor will accompany Mr Jones and has asked us to mix both medical and line
exposure. Based on their schedule we have selected 10 Mar 05 as the primary date with a secondary date of 3 March.
Ms Tinsley and I though maybe an 0800 lickoff
(sic!) at the MDG and
then take him to the ASF and perhaps the flightline for an outbound A/E mission. Perhaps we could feed off that
and do a mission brief for the wing in the DV lounge and or arrange a tour for one of the VC-25 or C-32's. Then
we could recover to the MDG and do a brief tour here?
Just some thoughts but they very much would for him to take away
what we do in the AF and at Andrews, in addition to the typical AF
medical facility.
I owe MS Tinsley/Gen Taylor a thumbnail agenda in 10-14 days.
Appreciate your thoughts/direction/assistance.
Gen Germann we have blocked your schedule for both days.
V/r
Jim
----Original Message-----
From: Jones Robert LtCol 89 MDG/SGCJ
Sent: Tuesday, February 1, 2005
To: Dr. C. Lt Col 89 MSGS/SGCJ
Subject: Re: FW: Visit with The Honorable Stephen L. Jones D.H.A: Suspense 4 Feb NLT 1200
Todd,
[quote]
I been contacted by the AF/SG's office to set up a tour for Dr
Jones, who is the number two guy in DoD for Health Affairs. Gen Taylor briefed him on the AF health program and
has asked us to 'blue him up'....
Ms Tinsley and I though maybe an 0800 lickoff at
the MDG and
then take him to the ASF and perhaps the flightline for an outbound A/E mission.
[end quote]
Sorry, I am a dedicated Air Force officer and all, but I think
this is taking hospitality entirely too far, unless our DV is buying me
dinner and taking me out to a movie first. Also, I think I need to know
the definition of "blue him up" in the context of the remainder of the
message.
--Rob
Not asking.
Not telling.
Not pursuing.
---------------------------------------
I should have added:
[quote]
" Just some thoughts but they very much would for him to take away
what we do in the AF and at Andrews, in addition to the typical AF
medical facility."
[quote]
"And this very much for me the literacy level 0-6 of being in Air Force proves does."
"Integrity, um…help me out…"
At Anesthesia Flight Meeting, 23 Feb 05, LtCol Flight Commander anesthesiologist noted that hospital was in deep
trouble with Wing Commander because two aircraft could not take off on time during recent Mobility Exercise (MOBEX)
because people lined up to take part in mock deployment were pulled off the "chalk" for deficiencies
noted at the last moment. These people's mobility bags had already been palletized and put on the aircraft, thus
necessitating (for some stupid reason) that the bags be de-palletized so the rejected member's bags could be pulled
off the plane. I ask what kind of deficiencies were noted: immunizations (which can be given on the flight line),
legal papers/powers of attorney (which can be done on the flight line, as the more organized folks at Travis had
done during a Mobex I took part in around 1997), etc. Well, it turned out that one of our physicians had an incorrect
address on his DD form 93, Record of Emergency Data. When the airman on the flightline during the Mobex asked the
Captain physician if that was a current address, he stated, quite honestly, "No", thus causing him to
"fail" and get pulled from the Mobex, thus causing the deployment team to fail to reach its quota of
deployable humans, resulting in egg on the face of his Commanders from the Group Commander on down.
Dr.C.: "Obviously, he didn't know how things work in the Air
Force. He should have just said 'yes'."
RCJ: "Oh, that's right…what was our Air Force Core Value again…Integrity…um… Integrity…"
Dr. C.: "First."
RCJ: "No, last, evidently."
Dr. C.: "But it was AN address, just a past address, so…"
This is an excellent example of how Air Force leaders, such as our Flight Commander, rationalize lack of integrity,
day in and day out:
1) it is so much easier than standing up for what is right;
2) most people won't notice, because don't care about integrity also;
3) and it's better than making your superiors look bad in any case, so go right ahead and lie so some General gets
good marks for the Mobex, regardless of the Truth.
"Nothing
Has any Basis.
Nothing
Makes any Sense.
There is no
Logic
Being Spoken
Today."
--LtCol D., CRNA, 23 Feb 05 0900, Chairperson, OR Risk Assessment Committee, on the OR Risk Assessment (ORRA) tool
being forced down our throats by the Command despite our rational, scientific and medicolegal objections thereto.
"It's stupid."
--Flight Commander and Chief Anesthesiologist, Dr. (LtCol) C., on the ORRA
One of these things is just like the other…
"e; p; i(= square root of negative 1)"
--How I listed my restedness status on the ORRA for different cases, 23 Feb 05. When quizzed by the OR nurse as
to the implications thereof, I told her:
"They are all irrational or imaginary numbers, so they are perfect for this form."
Later I found out that the CRNA crunching the numbers simply threw out my non-whole number responses, thus forcing
me to list "5s" for restedness for the remaining weeks of my sentence, er, Air Force commitment.
The Strongest, Yet Soon to be Missing, Link
Hospital made us wear stupid "Ask Me" buttons re: JCAHO patient safety week, month, kalpa, whatever.
Of course, being congenitally allergic to propaganda and groupthink, I adorned my mandatory button with the words:
"19 and Out" and a 20 with the international "Not" sign (X). OB technician asked me what was
up with that. I told her that I was leaving the USAF and resigning my commission as a LtCol and not joining the
reserves after 19 years on active duty.
"You're not retiring?"
"No, I am resigning."
"You will get some retirement pay though, right?"
"No, just like the gameshow: He Leaves With Nothing (except prematurely gray hair, lost stomach cells, and
the last remaining, tattered shreds of my dignity and honor)."
She responded:
"The Air Force is losing a good doctor when they're losing you, Dr. Jones."
RCJ: "Thanks. Now if only the Air Force realized that fact."
