Freddie’s Jacket: Old Memes, Death Notes and Over 9000 infections

We love our Mac computer.  After several years suffering through viruses and horrid lag times, we purchased a Mac computer in March of 2009.  My husband Fred and our son Freddie loved it and immediately tried out the photo booth function.  Fred thought it was wonderful.  And one of the greatest tragedies of his illness was the fact that he only got to use his new Mac for 14 days before he was hospitalized.

For the past two years the Mac has patiently endured constant use by either Freddie or I.  And we research arcane topic after arcane topic… and sometimes our topics crash into each other and provide enlightenment for us both.

Is “HAI” a Hospital Acquired Infection?  Or is it Japanese for yes? Or is it lolcat for hello?

Is Portal a video game that was released in 2007?  Or is it the preferred method for patient access to the Electronic Health Record?

And is the IOM Report: To Err is Human published in November of 1999 an “old meme?” 

Perhaps a definition is in order… Old meme is defined by http://ohinternet.com as: “An old meme is any expression or idea that has outlived its ability to be funny, or has become so overused that its use is frowned upon. Old memes are used by moms who just found Hamster Dance yesterday, Cheezburger Network sites, YouTube users who don't know when a joke has overstayed its welcome and /b/tards who just don't know when to quit using all your base.”

Sometimes the term the IOM report and a reference to its content are used so much in patient safety conversations, that the reference loses the original impact and meaning it had upon it the health community.   I explained the content of the report to my 12-year-old Freddie and he decided to be a Walker in The Walking Gallery.

Freddie decided to stir things up a bit.  He thought there was a perfect pop culture analogy to the IOM Report. 

Death Note.

Death Note (デスノート Desu Nōto?) is a manga series created by writer Tsugumi Ohba and manga artist Takeshi Obata. The main character is Light Yagami, a high school student who discovers a supernatural notebook, the "Death Note", dropped on Earth by a god of death named Ryuk. The Death Note grants its user the ability to kill anyone whose name and face they know, by writing the name in the notebook while picturing his or her face.  –Wikipedia

Freddie thought this would be a powerful statement.  98,000 names, 98,000 people dying every year from preventable medical errors, and are people marching in the street about it?  No.  It has become an old and well-worm meme in the world of patient advocacy.  Say “over 9000,” or any other arbitrary high number, in reference to medical error and death, and watch eyes glaze over and minds refuse to comprehend the level of tragedy.

This is why the individual story is so important.  I can speak of my Fred, Valarie Barnes can speak of her Justin, and Ted Smith can speak of his Mother.  Those single stories can help people to self identify. Freddie can speak of a fictional character like Light and explain the anguish a character feels when death is only a name away.  Sometimes he won’t even have to speak.  He can just walk by, and a Death Note fan will understand the powerful danger of being a name in that book.

David Hale saw this jacket a week ago.  His mouth dropped open and his eyes opened wide.  This jacket was geeky chic, powerful and cool.  And that combination can affect people.

Do old memes really matter?  I think they do.  I think there are a lot of Mom’s who are still discovering dramatic chipmunk or finding out about the dangers of MRSA. Last night, Freddie was looking up another old meme: “Chuck Norris” and this is the result of that Google search. 

We laughed aloud.  Freddie promptly typed in “Rick Roll” in the Google search field.  Within moments our apartment filled with the melodic tones of Rick Astley singing, “Never Gonna Give You Up.”

We had just been “Rick Rolled” by Google.

We laughed again.  Freddie and I both agreed we love Google.  We love that that they play with the form and recognize the power of memes.  I also love that when the health staff at Google realized people were using their search engine to find the number for poison control during an emergency, they changed their search page.  They placed the 1-800 number for poison control first on the landing page, not buried within the search results.  They did so with a striking visual: a red emergency phone icon.

I hope Freddie can do the same for the IOM report during The Walking Gallery.  I hope he can be that striking visual that redirects the searcher to the right information, and in so doing, saves lives. 

Collin's Jacket: The Curse of the Black Spot

A few weeks ago I began following Colin Hung on twitter. He is really cool, and following him was a no-brainer as his avatar is a little guy holding a lightsaber and he tweets about health care social media.  It got even better. He liked Doctor Who.  He even managed to tweet a Doctor Who in-joke into a social medial chat two weeks ago.  I had to invite him to join the Walking Gallery.  There is only one problem: he lives in Toronto.

This is the Colin I know: @Colin_Hung view full profile →Toronto Tweeting about healthcare, marketing & tech. VP @ www.rlsolutions.com - improving healthcare thru ridiculously easy-to-use software. Sushi, Syfy & TV fanatic. http://www.togreatersuccess.com

This is the Colin that most other people know.  And I have been explaining to Colin the amazing ways Doctor Who and heath care intersect.

In the fall of 2008, long before I began my journey of medical advocacy I would spend each morning researching the Doctor.  I would type in "Doctor Who" and skip over malpractice suits and break-through drugs and go right to the newest blog or entry on the BBC’s Doctor Who.  He is a fictional alien and time-lord who is around 900 years old.  The show is the longest running sci-fi show in the history of television, and after a hiatus in the 90’s, it was re-booted in 2005.

In the original series the Doctor was always very much in charge and his mostly female assistants or companions existed to further the plot.  In the 2005 re-boot, companions became an equal partner in the Doctor/companion relationship.  It was a great show.  Our whole family fell in love with it.

Our eldest son Freddie decided to make his 10 year-old birthday party a Doctor Who carnival.  He invited 70 of his friends.  And he invited his very best friend, and that child made it to the party very late.  But he came very close to not making it to the party at all.  He came very close to not making it to anything ever again.

A week before the party Freddie’s friend had a small cut on his leg.  At first it just seemed inflamed.  But as the week progressed, the spot became darker and deeper.  By mid-week, the child was running a 104-degree temperature in the middle of the night.  Although his mother had two other small ones at home, she roused the family in the middle of the night.  She took her son to the ER, where the doctors told her the infection was quite serious.  It was good that she had not waited till morning, because the child was infected with MRSA bacteria. MRSA is Methicillin-resistant Staphylococcus aureus; and Freddie’s friend had most likely had the community-acquired MRSA (CA-MRSA).

The staff of the hospital ran two courses of very powerful antibiotics into his body.  It was touch and go for a few days, but by the end of the week he was discharged from the hospital and was able to attend the very end of Freddie’s Doctor Who birthday party carnival. 

Last week, Doctor Who aired its third episode in series 6.   It has been a great season so far, and the American viewing audience has been fully embraced.  The show now airs at the same time in America as it does in the UK, and the first episode was even partially filmed in America.  I wondered if they warned the cast and crew of the hazards, other than snakes, in the American west.  I wondered if they had been warned about the brown recluse or “fiddle-back” as it is known in Oklahoma.  I wonder if they know how a really small bite can lead to a really big hole in your body.    

Episode 3 was “The Curse of the Black Spot.”   I was honestly astounded by last week’s episode, as it was so very applicable to the world of medicine. The episode was written by Stephen Thompson, and in the interest of time I will use the Wikipedia entry explain the basic synopsis:  

“Following a distress signal, the TARDIS and its crew lands aboard a 17th century[2] pirate ship stranded in the middle of a calm ocean. The crew has been terrorized by a Siren-like creature (Lily Cole), which marks people with black spots on their palms after they are injured. “

In this painting, there is a close up of the MRSA bacteria surrounding the familiar characters.  Each bacterium at a cellular level appears as a series of black spots.  There are also two brown recluse spiders, as initially a bite from one of these spiders looks like a case of a MRSA infection.  I also inserted the Tenth Doctor, David Tenant, with a black Spot, beside Eleventh Doctor Matt Smith with his “small” cut. 

“The Siren would then appear and lull her victims to touch her, which would apparently disintegrate them. Rory Williams (Arthur Darvill) receives a cut during a tussle with the pirates and, knowing the Siren is using water as a portal, the Doctor (Matt Smith) instructs everyone to seek refuge in the ship's dry magazine.

There, they find Toby Avery (Oscar Lloyd), the son of the ship's captain Henry Avery (Hugh Bonneville), who stowed away on the ship after his mother died to work with him, unaware of his father's illicit deeds. He too has a black spot on his palm due to a fever. In an attempt to evacuate the crew, the Doctor and Avery board the TARDIS, but find it is acting haphazardly, and are forced to evacuate before it dematerializes by itself. After the Siren in a dry room takes another shipmate, the Doctor realizes the Siren is actually using reflection to appear. In response they rid the ship of any reflective surfaces, including the ship's stolen treasure.

When a storm begins, those who remain on the ship start to set sail. Toby drops a polished crown while bringing his father a coat; the Siren is summoned and takes Toby. Soon, Rory falls into the ocean, the siren takes Rory and the Doctor believing the victims are not dead, convinces Avery and Amy Pond (Karen Gillan) to prick themselves. The Doctor's suspicions are confirmed when her touch actually teleports them to an alien spaceship, invisible in the same spot the pirate ship is located.

The Doctor finds the ship's crew long dead from exposure to a human virus. The trio finds a sickbay where Avery's entire crew, Toby and Rory are in medical care. The Doctor also finds the TARDIS. The Siren is the ship's emergency medical programme, which is caring for the injured humans; the black spots are in fact tissue samples used as references. Amy convinces the Siren to release Rory into her care. Using Rory's nursing knowledge, Amy and the Doctor remove him from life support and are able to resuscitate him.”

To symbolize this concept, the TARDIS, a Police Box, has a small informed consent form affixed to its front panel.  This and the hands clasped above it wearing wedding rings are referring to the moment in the episode when Amy is allowed to touch Rory after proving to the siren programme that she is his wife.   The image of Rory and Amy are repeated with a shocked gaze; they cannot believe that they will have to save themselves.  

There was quite a bit of backlash online about this episode. After all, how could a cut kill you?  Why would the Doctor just stand aside and let the novice Amy resuscitate her unconscious husband?  Why perform tracheotomies on people who are barely ill?  It all makes sense if you view it through viewing glass of the e-patient movement as a commentary on modern medicine. I decided I must do a painting about this episode for the Walking Gallery and I knew the perfect person to wear that jacket:  Colin Hung.

And here it is.  Colin can’t fly into DC for the day, so my friend Will Kemp will wear it that night. But I look forward to the day Colin wears it in Toronto.  He will spread interest about Walking Galleries, health care, and of course, Doctor Who.