Loading...

Messages

Proposals

Stuck in your homework and missing deadline? Get urgent help in $10/Page with 24 hours deadline

Get Urgent Writing Help In Your Essays, Assignments, Homeworks, Dissertation, Thesis Or Coursework & Achieve A+ Grades.

Privacy Guaranteed - 100% Plagiarism Free Writing - Free Turnitin Report - Professional And Experienced Writers - 24/7 Online Support

Pierce the spaceman reading skill sheet answers

15/12/2021 Client: muhammad11 Deadline: 2 Day

Neil Ernst won the MCMC residency program’s first Faculty Teacher of the Year award. Peggy Philp became Merced’s County Health Officer, a post her father had held more than forty years earlier. They continued to share their pediatric practice as well as housework and child care, scrupulously negotiating what one of their Christmas letters described as “a blur of laundry, lunches, cleaning, patient care, newborn resuscitation, and resident teaching.” Their understanding of the Lees, and the Lees’ understanding of them, deepened significantly when they, too, experienced a child’s grave illness. During his last month of third grade, their elder son, Toby, was diagnosed with acute lymphocytic leukemia. When Neil tried to tell Dan Murphy about the diagnosis, he cried so hard he couldn’t talk. After one of Lia’s checkups, Neil wrote me:

Mrs. Lee had heard that our son had leukemia. It was truly amazing how quickly she heard of this. When Peggy saw Lia in our clinic, Mrs. Lee was very concerned about Toby’s health, how he was doing etc. There was very genuine concern expressed by her questions and facial expression. At the end of the visit Mrs. Lee was hugging Peggy and they were both shedding a few tears. Sorrows of motherhood cut through all cultural barriers.

Toby underwent three years of chemotherapy and achieved what seems to be a permanent remission. “Lia’s mother continues to occupy a special place in our thoughts,” wrote Neil in a later letter. “She always asks about Toby. Our contacts with her are very infrequent because her family provides excellent care for Lia, but they are special nonetheless.”

Since Lia’s brain death, whatever scant trust Foua and Nao Kao had once had in American medicine had shrunk almost to zero. (I say “almost” because Foua exempted Neil and Peggy.) When their daughter May broke her arm, and the doctors in the MCMC emergency room told them it needed a cast, Nao Kao marched her straight home, bathed her arm in herbs, and wrapped it in a poultice for a week. May’s arm regained its full strength. When a pot of boiling oil fell from the electric stove onto Foua’s skirt, setting it on fire and burning her right hip and leg, she sacrificed two chickens and a pig. When Foua got pregnant with her sixteenth child, and had an early miscarriage, she did nothing. When she got pregnant with her seventeenth child and had a complicated miscarriage in her fourth month, Nao Kao waited for three days, until she started to hemorrhage and fell unconscious to the living room floor, before he called an ambulance. He consented to her dilation and curettage only after strenuous—in fact, desperate—persuasion by the MCMC resident on obstetric rotation. Nao Kao also sacrificed a pig while Foua was in the hospital and a second pig after she returned home.

Before she was readmitted to Schelby, Lia was routinely vaccinated against diphtheria, pertussis, and tetanus. At about the same time, she started to develop occasional seizurelike twitches. Because they were brief, infrequent, and benign—and also, perhaps, because he had learned from bitter experience—Neil decided not to prescribe anticonvulsants. Foua and Nao Kao were certain that the shots had caused the twitches, and they told Neil that they did not want Lia to be immunized ever again, for anything.

Dan Murphy, who became the director of MCMC’s Family Practice Residency Program, once told me that when you fail one Hmong patient, you fail the whole community. I could see that this was true. Who knew how many Hmong families were giving the hospital a wide berth because they didn’t want their children to end up like the second-youngest Lee daughter? Everyone in Merced’s Lee and Yang clans knew what had happened to Lia (those bad doctors!), just as everyone on the pediatric floor at MCMC knew what had happened to Lia (those bad parents!). Lia’s case had confirmed the Hmong community’s worst prejudices about the medical profession and the medical community’s worst prejudices about the Hmong.

At the family practice clinic, the staff continued to marvel at the quality of care the Lees provided to their clean, sweet-smelling, well-groomed child. But at the hospital next door, where the nurses had had no contact with Lia since 1986, the case metastasized into a mass of complaints that grew angrier with each passing year. Why had the Lees been so ungrateful for their daughter’s free medical care? (Neil—who did not share the nurses’ resentment—once calculated that, over the years, Lia had cost the United States government about $250,000, not counting the salaries of her doctors, nurses, and social workers.) Why had the Lees always insisted on doing everything their way? Why—this was still the worst sin—had the Lees been noncompliant? As Sharon Yates, a nurse’s aide, told me, “If only the parents had given Lia the medicine, she wouldn’t be like this. I bet when she came back from that foster home, they just didn’t give her any medicine.”

But I knew that when she returned from foster care, Foua and Nao Kao had given Lia her medicine—4 ccs of Depakene, three times a day—exactly as prescribed. Hoping to clear up some questions about Lia’s anticonvulsants, I went to Fresno to talk with Terry Hutchison, the pediatric neurologist who had overseen her care at Valley Children’s Hospital. I had noticed that in one of his discharge notes, written nine months before her neurological crisis, he had described Lia as “a very pretty Hmong child” and her parents as “very interested and very good with Lia.” I had never seen phrases like that in her MCMC chart.

Bill Selvidge had told me that Dr. Hutchison was “a known eccentric,” beloved by his residents for his empathy but dreaded for his insistence on doing rounds at 4:00 a.m. He had an exiguous crewcut and on the day I met him was wearing a necktie decorated with a large bright-yellow giraffe. A sign in the hall outside his office, hung at toddler eye level, read:

KIDS ZONE

ENTER WITH CARE AND LOVE

When I asked him about the relationship between Lia’s medications and her final seizure, he said, “Medications probably had nothing to do with it.”

“Huh?” I said.

“Lia’s brain was destroyed by septic shock, which was caused by the Pseudomonas aeruginosa bacillus in her blood. I don’t know how Lia got it and I will never know. What I do know is that the septic shock caused the seizures, not the other way around. The fact that she had a preexisting seizure disorder probably made the status epilepticus worse or easier to start or whatever, but the seizures were incidental and not important. If Lia had not had seizures, she would have presented in a coma and shock, and the outcome would probably have been the same, except that her problem might have been more easily recognized. It was too late by the time she got to Valley Children’s. It was probably too late by the time she got to MCMC.”

“Did her parents’ past noncompliance have anything to do with it?”

“Absolutely nothing. The only influence that medications could have had is that the Depakene we prescribed might have compromised her immune system and made her more susceptible to the Pseudomonas.” (Depakene occasionally causes a drop in white blood cells that can hamper the body’s ability to fight infection.) “I still believe Depakene was the drug of choice, and I would prescribe it again. But, in fact, if the family was giving her the Depakene as instructed, it is conceivable that by following our instructions, they set her up for septic shock.”

“Lia’s parents think that the problem was caused by too much medicine.”

“Well,” said Dr. Hutchison, “that may not be too far from the truth.”

I stared at him.

“Go back to Merced,” he said, “and tell all those people at MCMC that the family didn’t do this to the kid. We did.”

Driving back to Merced, I was in a state of shock myself. I had known about Lia’s sepsis, but I had always assumed that her seizure disorder had been the root of the problem. The Lees were right after all, I thought. Lia’s medicine did make her sick!

That night I told Neil and Peggy what Dr. Hutchison had said. As usual, their desire to ferret out the truth outweighed their desire—if indeed they had one—to defend their reputation for infallibility. They immediately asked for my photocopy of Lia’s medical chart, and they sat together on Bill Selvidge’s sofa, combing Volume 5 for evidence, overlooked during the crisis, that Lia might already have been septic at MCMC. Murmuring to each other in their shared secret language (“calcium 3.2,” “platelets 29,000,” “hemoglobin 8.4”), they might have been—in fact, were—a pair of lovers exchanging a set of emotionally charged intimacies.

“I always thought Lia got septic down at Children’s when they put all those invasive lines in,” said Peggy. “But maybe not. There are some signs here.”

“I did too,” said Neil. “If I’d thought she was septic here at MCMC, I would have done a lumbar puncture. I didn’t start her on antibiotics because every single time Lia had come in before that, she was not septic. Every other time, the problem was her seizure disorder, and this was obviously the worst seizure of her life. I stabilized her, I arranged for her transport, and then I went home before all the lab results were back.” He didn’t sound defensive. He sounded curious.

After Neil and Peggy went home, I asked Bill Selvidge whether he thought Neil had made a mistake in not recognizing and treating Lia’s sepsis, even though Dr. Hutchison believed that her fate was probably sealed before she arrived in the MCMC emergency room—and even though the increasing severity of her epilepsy might eventually have led to serious brain damage if sepsis had never entered the picture.

“Neil leaves no stone unturned,” said Bill. “If Neil made a mistake, it’s because every physician

Homework is Completed By:

Writer Writer Name Amount Client Comments & Rating
Instant Homework Helper

ONLINE

Instant Homework Helper

$36

She helped me in last minute in a very reasonable price. She is a lifesaver, I got A+ grade in my homework, I will surely hire her again for my next assignments, Thumbs Up!

Order & Get This Solution Within 3 Hours in $25/Page

Custom Original Solution And Get A+ Grades

  • 100% Plagiarism Free
  • Proper APA/MLA/Harvard Referencing
  • Delivery in 3 Hours After Placing Order
  • Free Turnitin Report
  • Unlimited Revisions
  • Privacy Guaranteed

Order & Get This Solution Within 6 Hours in $20/Page

Custom Original Solution And Get A+ Grades

  • 100% Plagiarism Free
  • Proper APA/MLA/Harvard Referencing
  • Delivery in 6 Hours After Placing Order
  • Free Turnitin Report
  • Unlimited Revisions
  • Privacy Guaranteed

Order & Get This Solution Within 12 Hours in $15/Page

Custom Original Solution And Get A+ Grades

  • 100% Plagiarism Free
  • Proper APA/MLA/Harvard Referencing
  • Delivery in 12 Hours After Placing Order
  • Free Turnitin Report
  • Unlimited Revisions
  • Privacy Guaranteed

6 writers have sent their proposals to do this homework:

Professor Smith
Financial Solutions Provider
Engineering Help
Top Grade Essay
Instant Homework Helper
Math Guru
Writer Writer Name Offer Chat
Professor Smith

ONLINE

Professor Smith

Being a Ph.D. in the Business field, I have been doing academic writing for the past 7 years and have a good command over writing research papers, essay, dissertations and all kinds of academic writing and proofreading.

$75 Chat With Writer
Financial Solutions Provider

ONLINE

Financial Solutions Provider

I am an experienced researcher here with master education. After reading your posting, I feel, you need an expert research writer to complete your project.Thank You

$68 Chat With Writer
Engineering Help

ONLINE

Engineering Help

I am a PhD writer with 10 years of experience. I will be delivering high-quality, plagiarism-free work to you in the minimum amount of time. Waiting for your message.

$56 Chat With Writer
Top Grade Essay

ONLINE

Top Grade Essay

This project is my strength and I can fulfill your requirements properly within your given deadline. I always give plagiarism-free work to my clients at very competitive prices.

$73 Chat With Writer
Instant Homework Helper

ONLINE

Instant Homework Helper

Being a Ph.D. in the Business field, I have been doing academic writing for the past 7 years and have a good command over writing research papers, essay, dissertations and all kinds of academic writing and proofreading.

$60 Chat With Writer
Math Guru

ONLINE

Math Guru

As per my knowledge I can assist you in writing a perfect Planning, Marketing Research, Business Pitches, Business Proposals, Business Feasibility Reports and Content within your given deadline and budget.

$64 Chat With Writer

Let our expert academic writers to help you in achieving a+ grades in your homework, assignment, quiz or exam.

Similar Homework Questions

Austwide wholesalers pty ltd - Sexual harassment assault response prevention training test answers - Reply 1 and 2,150 words each one ,citations and references by 08/08/2020 at 6:00 pm - Help 1 - Tm 11 5820 1500 13&p - Is sodium sulfate ionic or covalent - Week 10 Discussion - Supply and demand test questions - 4th order butterworth bandpass filter - Homework - Book: Forensic and Investigative Accounting Chapter 15 - Center the worksheet horizontally on the page - How to Avoid Plagiarism in Academic Writing? - Level 3 ready access - North herts recycling centre - Agency problem example and solution - Bullock and batten 4 phase model - Persuasive speech against physician assisted death - E24 2 post balance sheet events - Two way communication using udp in java - Hush lash studio mackay - Environmental Factors and Health Promotion Presentation: Accident Prevention and Safety Promotion for Parents and Caregiver of Infants - Jems job evaluation system - Give examples of applications of ipsec - Question - Steps of test construction in psychology - A nurse is reviewing the daily intake and output - Assignment: Roles and Responsibilities of Agencies and Officials in Disaster Response - 14.3 gizmo weather maps answer key - Scm globe simulation - Why should investors be cautious when a split occurs - What gives rise to the currency exposure at aifs - Write a program that calculates and displays a person’s body mass index (bmi). - Examples of critical analysis - High scope conflict resolution poster - Cost of bank cheque cba - Discussion 8 - Why I want to be a Nurse - Automate informate transform - As nzs 7000 2010 - Hey google talk to headspace - I need 1600 words on Instruction contract. - Law institue of australia - 2 http www sec gov edgar searchedgar companysearch html - Task risk assessment example - Meta Themes Draft - Journal Article Summaries - Filipino arts and crafts - W8 Research Case - Response to Discussion 6 - Https www youtube com watch v z2mf8dtwwd8 - Year 9 english past papers - Pdms 2 age range - Arduino accelerometer step counter - Search lrn of students - 30/8 woody views way robina - From cruelty to goodness by philip hallie - Monotype corsiva history - Colonial families of maryland bound and determined to succeed - The lottery by shirley jackson setting - The 3 branches of science - Cardinal winning secondary school - Ikea the japanese misadventure and successful re entry - Discussion: Risk-Taking Behavior Among Adolescents - Top down network design by priscilla oppenheimer - Girl code episodes watch online - Synopsis summary - University of virginia health system case study solution - Professional Development Plan - Charles grodin bbq sauce - Economic concentration evaluation - Milton gordon seven stages of assimilation - Zakariyya bari abdul rahman - Node voltage method with dependent current source - Eyebrow threading during pregnancy in tamil - Vo2 max lab report example - Pit boss pizza oven attachment - Impact of language - Nrs 490 capstone project change proposal - Quiz - Is the earth closer to the sun in the summer - Representation of class in media - Reflection and Discussion Forum Week 4 - Split ring connector design - Ato tax file declaration form - How to factor perfect square trinomials - A gringo in the lettuce fields main idea - The body - What is time value of money in capital budgeting - Pearson mastering physics answer key - Silicon manufacturing process video - The most accurate statement about workplace safety is - Q1 formula for grouped data - EP WK6 - Describe the management style at rondell data corporation - The motion of billiard ball is motion - According to the rokeach value survey - Bell rock loop track - Magnesium fluoride bohr diagram - Marketing Analysis - Grun1 time calculator