Zager & Evans: "In the Year 2019"

I thought this blog should have some nonsense. In July 1969 the Eagle landed on the moon and a song by two Americans ( 'Zager and Evans') called "In the Year 2525" was number one on American radio. The dystopian lyrics included such lines as

Ain’t gonna need to tell the truth, tell no lies
Everything you think, do, and say
Is in the pill you took today
Ain’t gonna need your teeth, won’t need your eyes
You won’t find a thing to chew
Nobody’s gonna look at you
Your arms are hanging limp at your side
Your legs got nothing to do
Some machine’s doing that for you
Ain’t gonna need no husband, won’t need no wife
You’ll pick your sons, pick your daughters too
From the bottom of a long glass tube
— In the Year 2525

The song is from another time of books, typewriters, hand-held phones, film based cameras, black and white television (in Australia), vinyl records and hand written medical notes. When doctors wore white coats and nurses wore uniforms (like ants trapped in the amber of the nineteenth century), but were ignorant of the benefits of computer-based surveillance and the promises of privatization. Where most health carers would spend time talking to, and laying hands on, patients. Where there were no personal computers, or smart phones, or CAT scanners. Where the working conditions were harsh and punishing, bullying was part of the environment, and Socratic type questioning on medical rounds (bedside questions to challenge or assess knowledge or make a teaching point) was routine and accepted as a way of teaching accountability (1).

Those times were different. And what about now, when we are nearly in the year 2020? Let's carry out this thought experiment. Imagine a hospital environment where medical care is based not on a clinical "Golden Hour" of lifesaving intervention (as introduced for Trauma Care in the 1980s) but instead is designed by administrators trained in the University of Pol Pot. Administrators who are smart enough to understand that a 'Year Zero' approach of "no families, no sentiment, no expression of love or grief, no books, no learning, no holidays, no music: only work and death" is inefficient.

But these new generation experts 'know' that computer based rules of engagement with (the inconvenient objects called) patients are better than uncontrolled ethical or humanistic or clinical interactions, because they produce improved numbers that benefit the administrators and politicians. So in Australia we saw the adoption of (the abomination called) the Four Hour Rule in the Emergency Department. This was agreed to in principle In the Year 2010. In the rest of this blog I will not discuss the relative success or relative failure of this decision, but I will indulge in a Zager & Evans fantasy about the possible outcomes.

In the Year 2025 - in a imaginary hospital called St Cuthbert.
There is a 3D hologram above the entrance to the Emergency Department that reads: "The Four Hour Rule Frees Us All".
The Coronary Care Unit is called The Donne CCU, with this inscription at their front door:
"Where Billing and Saving Lives are Never Donne"

No CCU is an island,

Entire of itself.

Part of our billing

Adding strength and health
To our private wealth.

Any uninsured life
Or times past four hours
Diminishe thee and me.
For I am the cash flow ace
Master of the procedural interface.

Therefore, send not to know

For whom the bonus tolls,

It tolls for me, not thee.

The importance and value of books for learning has been rediscovered, and there are a mixture of old and new books in the John Doone Library of ECG Books. There are cryptic inscriptions or jottings on the pages of some of the older books:
"Plato's Nouse" is often seen - perhaps this refers to the adventures of a philosophical mouse.
There is an occasional 'Fr?d' and a strange term 'keto diet', sometimes followed by the letters AM. Debate rages about whether this a corruption of "keto diet is" or "keto diet was" or "keto diet for breakfast."
Here are some of the more requested books (2):
• Beyond Fear of the ECG
• Codependent No More - Internet Free ECG Interpretation
• Myths of ECG Interpretation
• Cognitive Therapy and Laddergrams
• The Gestalt of Frontal Plane QRS Analysis
• Emotional Intelligence and ECG Interpretation
• (Essentials of) Hypnosis for ECG interpretation
• (Mindful) or (Gentle) ECG Interpretation for Generation Z
• Everyday ECG Survival Guide
• Why Smart People Do Stupid ECG Interpretations
• Facing Shame: Wrong ECG Interpretation
• ECGs and How to Survive Them
• PTSD and the The Goldman-Hodgkin-Katz Equation
• Experiential ECG Interpretation
• Gender Issues and Einthoven's Triangle
• How to Describe ECGs Over the Phone (So Others Understand & Believe You)
• In a Different Voice: Psychological Basis of Arrogant ECG Analysis
• The Psychology of ECG Over-interpretation
• Using NPL for ECG Analysis
• That's Not What I Mean: Dealing with ECG Disagreement
• The Jungian Interpretation of ECGs in Dreams
• The Rhythm Strips of Desire
• Adventures of Randy Andy the Naughty Cardiac Action Potential
• Retrograde Memories - Diary of an Inverted P Wave

1. As is well stated here:
"This brings up a very strong and often overlooked point. I hear my administrators say all the time that residents should be more accountable. Accountability must be clearly defined and, at times in medical education, it is not. Sure, we have ACGME benchmarks and standards of what a “normal and average resident should be achieving by the time of independent practice.” At times, the sense of urgency and accountability seems to be lacking within the millennial generation. Learners expect to be spoon-fed lectures with important concepts and have protected time to learn those concepts, yet a very few seem to really possess that internal drive or accountability to own medicine, own the concepts, own the pathophysiology and disease process, and own their patients, because ultimately it is about their livelihood."
“Pimping”: Malignant or Not? By Joseph Cooper, MD
January 5th 2017 Published in Insights on Residency Training
2. My wife Julia Linaker was a clinical psychologist, and these titles are pastiches of her books. Silly but fun, and some of the titles identify real issues in the interpretation of the ECG
Linas Dziukas