Opining Online

There’s not much that’s more exciting than spending six or more hours in an ER when you’re pretty sure you don’t need to be there. This is especially true when the ER staff discerns that you don’t need to be there either, but they can’t let you go until they get permission/instructions from a doctor.

Thanks to the internet and my knowledge of my past medical history*, I was 94% sure the radiating chest pain I’d been experiencing was not due to any cardiac problem.

Six percent lingering doubt is enough for a primary care physician to send one to the ER to rule out an emergent condition.

Blood tests, EKG, and chest x-ray ruled out the heart as the cause of my pain as I was almost sure it would do. I knew the pain was more than ordinary acid reflux and, after much reading, decided esophageal spasm was the best fit to my symptoms.

Yet… the chest pain I was experiencing didn’t involve difficulty swallowing, correlate to eating, position, or exercise, or involve regurgitation or a ”sour taste” in my mouth. Then again, I didn’t have any nausea, vomiting, or shortness of breath that might be associated with a cardiac problem. 

Thus the doubt and the need to rule out a problem requiring some action more proactive than taking a pill.

All I had was a recurring, intermittent, and sometimes severe chest pain that radiated to both arms and almost into my jaw.  Yep, that’s “all”. It is scary to hurt that bad in that part of your body and I don’t blame my PCP for sending me to the ER. As she stated on the phone, “We can’t do an EKG and our lab can’t do cardiac enzymes.”

What annoyed me the most about my ER visit is that a cardiac problem was ruled out within an hour of my arrival. The tests had been run and all returned normal. The next five hours was waiting for someone with the title and authority to tell the ER to dismiss me.

When that guy finally showed up (and I realize I was not high on his priority list because he also knew I wasn’t in danger of having a heart attack) he assured me that my heart was almost positively A-OK. 

I’d had a cardiac cath in mid 2006 which showed zero blockage and he told me that a blockage developing in 3 1/2 years severe enough to cause symptoms was highly unlikely.

(I am overweight and have high blood pressure, so was required to take a stress test to join a fitness center… and I failed. The docs said that it was probably boob size that caused the failing reading, but the only way to make sure was cardiac cath.)

He was more than happy to write me a 3 month prescription for Nexium — which is what I intended to ask my PCP for when I was lucky enough to get an appointment with her.  So…

Is all well that ends well? This time, for me, certainly.  

*my past medical history includes banded gastroplasty, which always creates gastro problems while not even close to always resulting in weight loss… but that’s an entire blog’s worth of rants that I don’t really feel like going into right now, especially on this blog.

The most amazing news to me is there’s such a specialty as neuro-urology. This is like life imitating a dirty joke. The author of Shocking Treatment Helps Erectile Dysfunction, and perhaps even the researchers just can’t seem to help themselves, even though the treatment sounds exciting, er… I mean interesting.

I admire the way researcher Yoram Vardi describes the parameters of the strength of the shockwaves in language the average layman can understand:

“These are very, very low energy shock waves,” Vardi said. Each shockwave applied roughly 100 bar of pressure — some 20 times the air pressure in a bottle of champagne, but less than the pressure exerted by a woman in stiletto heels who weighs 132 lbs. (60 kg). 

“This sort of energy is completely different from what you would get in a massage, although everyone can do what they want,” Vardi said.

This is just perfect material for a Neurotopia Friday Weird Science post.  

My husband had his first treatment for bladder cancer yesterday. This is his third primary cancer and, of course, he has asked, “Where next?”

Two biopsies were performed, but neither got enough muscle wall tissue to rule out the spread of the cancer there. It was a transitional papillary tumor at the top of the bladder which makes it more difficult to get a “good” muscle wall sample. Location, location, location.

His options were to assume that the cancer had not spread to the muscle wall or to assume that it had. After talking it over with his doctor, he chose to assume it had not. Removal of the bladder is still an option, but hopefully it won’t have to be done.

What is fascinating to me is the treatment when the assumption is that the tumor has not spread to the muscle wall. It consists not of chemotherapy, but of immunotherapy. In a nutshell, BCG (Bacille Calmette-Guerin), a tuberculosis vaccine is inserted into the bladder to “call” the immune system to battle the cancer.

See: Bladder cancer, Treatment and Drugs, Mayo Clinic. Also, NCCN Clinical Practice Guidelines. Registration is required, but it’s free.

Because the biopsies were inconclusive, my husband was faced with the choice of trying the immunotherapy or with surgical removal of his bladder. Surgical removal is sort of a guaranteed cure, but it is also a drastic cure. My husband chose the less drastic, but less certain treatment.

We shall see.

Finally, the appendix gets respect.

And we learn that a system that sees its need reduced just might cause problems. It’s odd to think that because we have learned sanitation techniques that we are underutilizing our immune system so that it attacks something else that it would have ignored previously because something more dangerous was there.

This is just so interesting on so many levels and analogies can just fly off the shelf.

But it makes sense. Haven’t we all read about the absolutely horrific (to our modern standards) sanitation was hundreds of years ago? I have often wondered how anyone survived. Now it’s possible to think their appendix was doing great things for them.

Now I’m wondering just what benefits I’m not receiving from not having a gallbladder and tonsils that were removed because they “might” cause me trouble rather than because they were.

It is designed for ambiguity.

“It will be of little avail to the people, that the laws are made by men of their own choice, if the laws be so voluminous that they cannot be read, or so incoherent that they cannot be understood…” – The Federalist #62, James Madison (a founding father, the primary author of the Constitution, and a founder of the Democratic Party)

The topic is HR 3200, the proposed health care/insurance reform bill under discussion at numerous locations across the nation.

Dr. Rich’s explanation is better than any I can come up with and it illustrates my concerns accurately. Read it, please.

For background, see here, here, and here. 

This morning, my father, brother, and I met with several St. Michael’s staff, including the director of the medical staff and the director of the nursing staff. It was a very cordial and informative meeting for me, and I hope it was for everyone else. We all left the room on the same side, so I’d call that success.

Of course, one thing that helped from our point of view was that the St. Michael’s staff was obviously very upset that such things had happened and were anxious to tell of us ways they’d already worked on to prevent such in the future. This, basically, is what we wanted.

The nursing supervisor on duty when my step-mom fell was devastated that something like that had happened on her watch.

We, as patients, learned a lot about how some hospital systems work. For example, we learned that when we need to call a nurse to be sure to say what we need, as they can get the message to the right person more quickly.

The director of medical staff explained some of the problems they were having implementing a hospitalist program and contracting with a separate firm for ER physicians. It was quite honest of him to say that these two groups of physicians do not always cooperate in a timely manner and explained how the hospital was working on this problem.

When we asked whether charges for the x-ray after the fall would be included in the bill, we were told it didn’t matter whether they were or not. Now this was upsetting at first – it seemed like the hospital was not taking responsibility for something they admitted was their fault.

But we were oh so wrong. That’s not it at all. My step-mom has Medicare and no matter what tests or procedures or how long she was in the hospital, they were going to paid the same, based on her problem at admission. To my way of thinking, that just ain’t right.

The final conclusion I have come to is that if the hospital staff had all got together and planned to have my father and step-mom treated as they were, they could not have planned it to be quite as bad as it was. These episodes are likely random ones and we were the unlucky family that lost the coin flip twice in a row.

My symptoms.

I’m not even sure the site linked above is a reliable one. The design sucks, but that’s not an infallible indicator of bad information. Nor is bad spelling and grammar, but it makes one wonder.

However… dammit, except for PTSD, every one of those things is happening or has happened to me. I had VBG – vertical banded gastroplasty about 16 years ago. Oh yeah, I lost weight at first, but now I weigh about 5 lbs less than when I had the surgery.

Until recently, I didn’t even consider that any of my health problems were related to that surgery. I was diagnosed with fibromyalgia before the surgery, but tended not to say anything about that to anyone because it was not really accepted as a “real” problem at the time.

Several years after the surgery, I found I had a small meningioma which finally grew much larger. It was treated with radiation when it got larger. Many of the symptoms listed in that link, I attributed to the tumor.

I’ve seen neurologists, neurosurgeons, gastroenterologists, psychiatrists, rheumatologists, and… of course, my primary care docs. I recently had a hernia repaired which was due to the incision made by the VBG surgery. Ever since then, the diarrhea is much worse.

Honestly, I don’t know what to do. None of these symptoms alone are serious enough to worry about or cause much trouble, but taken together, they do cause problems. And they’ve become much worse over the past 3-4 years. But how am I — or a doctor — to know what causes what?

I also had a bad fall about 3 years ago. Both knees were injured, but my right knee has never been “right” since then. It was x-rayed and nothing is broken, but it is still very tender and painful at times. My left knee is “unreliable”. Sometimes it just doesn’t work, but it was that way before I fell. It’s just worse now.

Though I’ve joked about losing 25 IQ points, it’s really not funny. I am blessed that even with that loss, I’ve still got at least an “average” IQ and supposedly can express myself well.

Well, not as well I once did and not as well as I want to. I hate the inability to concentrate. Once upon a time, I read two books a week, now it’s a book a month, at best. This is a serious blow to my sense of well-being.

One of the main reasons I have this blog is to try to keep my mind as sharp as I can. It’s also why I read certain blogs daily. But frankly, sometimes I’m a little bit frightened that I can’t communicate the way I want to, whether in a post here or a comment elsewhere.

See update here. 

A few weeks ago I wrote about an excruciating and medically scary 24 hour adventure my father experienced in an unnamed hospital. Read here and here, for that background. It’s time to name the hospital now:

Christus St. Michael in Texarkana TX.

I mentioned in that story that my step-mom was in the same hospital that my Dad was transported to. She’d had a hip replacement and was in rehab. She got out of rehab a few days after the ER fiasco and was doing pretty good getting around the house with a walker.

One morning a little over a week ago, she woke up with chest pains and too dizzy to stand. At the ER, it’s discovered she’s got a blood clot in her leg. It takes hours and hours (just like with my Dad) after the decision to admit her to actually get her admitted and out of the ER.

When she’s in her room and settled, my father goes home. Talking to him a few times that day, I chuckled at the thought that he was having some very mild PTSD symptoms from memories of his recent visit.

My step-mom is, of course, labeled a fall risk and she’s instructed by the doctor (not the same one my Dad had) to not try to get out of bed herself. Later that evening she has to go pee and presses her buzzer for assistance. And presses it and presses it and nobody answers.

She’s soon faced with a decision: Do I wet the bed or do I try to get up by myself? I don’t think anyone will be surprised that she decided to get up. And she fell. Fortunately, she wasn’t injured worse than a nasty bruise on her shoulder, but the hospital did x-ray her shoulder to make sure.

And then they addressed the issue of why no one answered when she buzzed. It was simple to fix — all they had to do was plug the buzzer in. The initial neglect in not making sure it worked when my step-mom was moved to the room is bad enough, but it was fixed now so there should be no problem, right?

When I wrote about my Dad’s experience, I made sure to compliment all the staff except the arrogant doctor and the maintenance people who didn’t show up in a timely manner. Now I don’t know whether my Dad was really lucky or whether my step-mom was just really unlucky. She didn’t get the same quality of care from the staff. Nowhere near it.

You’d think that after her falling the first night there, that the staff on that floor might have been a little extra-vigilant about answering her buzzer and responding to her requests to go to the bathroom. But that wasn’t the case. The buzzer was answered and she was told somebody would be there, but often no one showed up in what could be called a timely manner and sometimes no one showed up at all.

This hospital uses a blackboard to note patient information. In addition to noting she’s a fall risk, there’s a notation about warm packs to be placed on her legs three times a day and this was not ever done during her week long stay. Perhaps the doctor changed his mind, but the blackboard was never updated.

Shortly after coumadin was started, my step-mom started having stomach pains. She described her stomach as being on fire. Four days later, this pain was finally addressed and eased. I can’t imagine what took so long.

For two days, she and Dad pointed out to nurses that her IV was no longer working. While they all looked at it, no one did anything to fix it.

I’m not quite sure what all the problems with her bed were, but it was not comfortable. She used multiple folded blankets to try to make it better, but finally got to the point where she demanded a new bed. She got it and was then given medication to help her sleep. Or, as my Dad suspects, to “knock her out and make her shut up.”

Anyway, they tried to use the IV she’d been telling them wasn’t working for this medication, but of course it wasn’t working. They crushed a pill and gave her the medication orally. I don’t know what it was and am wondering why it needed to be crushed. She’d been taking other medications by mouth.

Ah… wait. Let’s back up a little bit. Before demanding a new bed last night, my Dad called the customer service representative that we (my sister and I) have emailed and talked with concerning the problems my Dad had while he was there. He got voice mail, of course, and left a message requesting she call him or come up to the room and talk with them.

She called him back a short time ago, approximate 20 hours after his request and five hours after my step-mom was released.

This morning when the doctor told my step-mom that her coumadin levels were good enough to be released, my Dad packed up her stuff and took them to their car. He got a wheel chair on his way back to her room and told the nurse she could mail the release paper work to them. She asked him to wait and talk to her supervisor about their problems. A half hour later, the supervisor got there and listened to their complaints and said the problems would be addressed. By that time the paper work was done and they left.

So, maybe we should just drop this right now, but we’re not. One reason is that my parents (and many many other folks) rely on this hospital. They’ve been going there for years and the problems seem to be getting worse.

My father had a stent inserted there (I’m guessing) 8 years ago. While I was sitting with him, his monitor started flashing bright colors and beeping. I looked at it and noticed his blood pressure was low. It went back up a little and the beeping stopped. But it started again soon and didn’t stop. The door to his room was open and his bed was less than 10 feet from the nurses station where his nurse was chatting with her co-workers.  I had to walk up to her to get her attention, and could clearly hear the beeping while standing beside her.

Frankly there are many other little incidents I could post about, enough to make me wonder if there’s a “systemic” problem with patient care there. Enough to make me want it further investigated before any more of my relatives are hospitalized there.

The title of this post is a saying I’ve heard from my father over the years. And it’s truth becomes more evident as time passes. The saying does not address getting the money, only the severity of the problem. If your problem is that your shoes have holes in them, money can get you a new pair of shoes. 

If your problem is poor health — say you have cancer — no amount of money can buy a cure. That’s a Real problem. Money may buy you years and because of that, a “cure” is defined, medically or statistically, in years. Five years, usually.

If your problem is a cluster of diseases possibly or probably caused by somewhere you were 45 or so years ago, no amount of money is going to buy a cure.

If you’ve got a problem that money can solve, then your goal should be to earn that money. It may seem impossible, but it probably is not. If money can’t solve your problem, ponder that infamous creek and missing paddle.

I’m not a doctor or scientist, just a science junkie and have been ever since I picked up a Scientific American in 1983. As a result, I’m slightly better equipped than the average Jane when it comes recognizing woo.

About this same time, a co-worker gave me a book on homeopathy and well… you know at the time, parts of it almost made sense? A good background in English helped me out there as much as any knowledge of science. Bad writing often equals bad logic.

I was also influenced by my family doctor – John Ellis. Whether his research on B6 is worthy, I honestly don’t know, but he was a good GP. He didn’t prescribe B6 for anything I ever went to him for. He was basically a country doctor in a small town, who people called on for advice about their cattle as quickly as they did their children.

I wanted to believe that everyone promoting a vitamin or herbal remedy was the same kind of person — well-intentioned at the very least. That is simply not a workable everyday ideal. Some people are out to make a buck by selling you worthless concoctions or contraptions. Unfortunately some may even be harmful.

I have a nephew with severe autism and developmental disorders. He’s a beautiful boy and I was well aware of the anguish my brother-in-law and his wife were going through trying to help their daughter raise him. After seeing Jenny McCarthy on TV, I emailed them about her book. I didn’t research it, I was grasping at straws for them. While they may have read the book, they stuck with their doctors and never mentioned it to me. For that reprieve, I’m grateful.

Do you see how even a not really quite completely stupid person can be so easily taken in? I swear I’ve learned my lesson! I question everything now and try to apply what little learnin’ I’ve got. I thank Orac and PalMD (and others) for the lessons. In my defense, the episode about Jenny McCarthy I saw concerned restricting gluten, not blaming vaccines.

I remember waiting in line in the 50s for my polio vaccine. I remember older relatives who got the disease instead of the vaccine. No one has to convince me that vaccines are worthwhile. But gluten restriction? To a layman, that sounds like something sort of reasonable.

What do you do about people like me? I’m not an enemy of evidence-based medicine (though I am leery of government bureaucrats deciding what evidence is worthy) and I’m certainly not a believer in something as silly as crystals and pyramids. How do you get the word out to people who are basically like me, but not necessarily science junkies? Look how long, how much it took, for me to really learn to discern. (I must add that it’s anthropology that really grabs my interest.)

Most of the stuff on HuffPo that Orac and PalMd post about would not fool me. My goodness, these people are not only scientifically illiterate, but also logically illiterate to the point that anyone with a minimal understanding of the logic of language should be able to see through their non-valid arguments.

I should also point out that I don’t necessarily agree with scientists about everything. I often wonder how their superior abilities at logic lead them to lean strongly toward the left politically. This doesn’t mean I’m right wing (because their logic is also less than superior, IMHO). Basically, I can’t find a political ideology that fits my ideas. Perhaps I’m a centrist, if that can mean I find both “sides” equally unappealing.

This post is probably no help at all in the quest to find a way to present evidence-based science to the general public, but I hope that it will give the scientists some idea of how at least one small part of the public reasons.

There is nothing that you do that does not require the use of stomach muscles. This includes moving your eyeballs from left to right.

What gives relief from pain in one area will eventually cause pain in another.

After you wake up a bit from the surgical anesthesia and get a dose or two of strong narcotics, you may be fooled into thinking everything is going to be just fine and want to go home.

A small incision is one that runs from the bra line to the belly button.

They don’t serve margaritas in the recovery room, but they’ve got some really good stuff in syringes.

Eating a cracker with zero saliva is very unpleasant.

I will survive.

Tomorrow I will finally have the hernia surgery that I’ve been putting off for a year or so. When I’ll feel like sitting in front of the computer again, who knows? Probably several days.

All day I’ve been wondering why it isn’t called a hisnia.

I only get to see this guy when my assigned PCP is overwhelmed at the MTF (Military Treatment Facility) to which, as a Tricare Prime patient, I am enrolled.

I want to make it clear that any of the following which might seem derogatory toward military health care is derogatory only toward SYSTEMS. The people involved are wonderful and trying their very best to be the best medical providers. What I criticize are the rules/regulations/etc.,  and the hoops they and their patients must jump through.

This guy is good for me. He’s emotionally and professionallly honest with me. He calls me on my bullshit, but doesn’t make me feel like a moron. This is probably personality more than medical training — but we are able to communicate with each other.

This ability is priceless. MasterCard, Universal Health Care, Electronic Medical Records and all the other technological advances in medical care cannot replace the physician/patient relationship.

My MTF assigned PCP has this ability too, but she’s restricted in her ability to follow-up and follow-through with her patients. It’s just too damned hard to get an appointment with her and she has as little input into the availability of appointments as I do. This is a system failure, not a physician failure.

I got lucky. Through conversations with the non-MTF appointment person and billing agent, I learned which hoops I needed to jump through within the MTF referral process. Oh yeah, the MTF appointment clerk I worked with after learning the right words — ie, words she could “respond to” without repercussions led to EIGHT (that’s right, 8!) referral numbers, each with four authorized follow-ups. Folks, that translates to almost unlimited access to this non-MTF physician.

This freedom of medical treatment comes at a price. I must pay $12 bucks each time I see my new favorite PCP. (Please don’t tell Congress or the DOD that I consider that one fantastic deal.)

Yes, I finally realized I wasn’t going to kick this head cold/sinus infection/allergy/bronchitis shit with Mucinex and Zicam. I went to the doctor today. I fit nicely into the chorus of coughs and sniffing in the waiting room.

Finally, into the exam room where the blood pressure machine malfunctions and my arm is squeezed three times. Amazingly after all that, my blood pressure was fine. I had a fine nurse who was really apologetic about it all.

Then, in walks the doctor who stands directly in front of me and stares directly into my eyes and says, “I’m so sick of snot.” Then he told me that it wasn’t all bad because at least he knew what to do. We then had a truly disgusting conversation about the volume, consistency, and coloration of my particular snot. We actually discuss, with no seriousness whatsoever, the palate of snot and what sort of artwork it could be the medium for.

I was one of the more interesting snot patients he’d had that day (or so he told me) in that I had two segregated colors of snot. I really think he was just humoring me because I laughed at his snot jokes. He made up his mind what I needed — a snot shot and two snot pills, one for the obvious infection and one for the accompanying allergy.

The worst part of this visit was that every time I laughed, I broke into a spasm of coughing. This continued all the way home as I contemplated the gallery opening of the Snotty Series, A Study in Natural Media.

Robert Novak writes How a Tumor Is Changing My Life. 

Could it be simply the ability to play?

My father, age 85:

My father, age 85

My granddaughter, age 18 months.

I’m driving slow, and that’s most certainly not an efficient use of my time (or energy) considering the vast improvements in technology since 1974. I’m not using any off-label or illegal drugs, so I should relatively safe.

Social Policy Hindsight: is it merely a thought experiment or should we actively analyze and use such information. Would driving 55 today have the impact it did in 1974? Why or why not? Would limiting physician’s ability to prescribe off-label impact patient care adversely? I wonder if prescribing birth control pills as a fertililty treatment might not now be considered off-label.

Obama goes out of his way not to plainly say… anything. Consider Obama in charge of freeway exits signs. ::shudder:: (via Amba) Now is the time to merge together and exit, for it is this spirit that leads you… somewhere.

Be sure to use the proper fuel and good maintenance for greatest efficiency, in your car and in your body.

We’re winning the Iraq war and Bush drove us to it! If you hit a bump in the road today, rest assured that it’s Bush’s fault.

Of course reading on the internet counts as reading. Just don’t engage with text while driving, but if you do, at least make it interesting.

It’s Sunday. Take the scenic route. However, Monday will come, and this device might be handy for the commute and at least until Friday.

Should your drive take you near any summer camps, watch out for hovering helicopters. Drive carefully around full-blown addicts too. Most of them will probably be on a trail somewhere, but I’ve seen them on the side of the road.

I’m stopping at the Carnival of Cars. See ya!

First thing I read today was in a doctor’s office waiting room. I was thrilled that he’d put out a recent copy of the Southern Medical Journal. Surely, I didn’t understand some of the terms used, but if I’d chosen Glamour, I wouldn’t have understood why any of the content was important.

One article was about a 17 year old Hispanic male who had a reaction to concurrent treatment for HIV and active TB. I was mainly horrified that one so young led such a life where he was exposed to either. So very, very sad.

Another was about a 61 year old woman who unknowingly aspirated a hazelnut. I think I remember the nut and the age of the woman correctly. My first question was how one could unknowingly do that. Then it noted that other than the breathing problems that prompted her to get treatment, she had no other health problems except schizophrenia. Perhaps that explains the unknowing part.

The take-home message for me from that article was that aspirated foreign objects are relative rare in adults, but quite common in children, especially ages 5 and under. The most commonly aspirated objects are nuts; the most common nut is the peanut. Note to parents: no nuts until after age 5.

Online, I’ve been reading mostly health or science topics too. Crooked Timber has a great post, Fat Hominid, on fad diets and evolutionary psychology. The comments are good too. If you can stomach reading about eating rodents and insects.

Then I surfed on over to ScienceBlogs where I eventually found a link to Encephalon #49 at Neuroscientifically Challenged. It’s always amused me that we must use what we’re studying to learn about the brain. And yes, I’m easily amused.

Unbelievable. In order to decrease the number (ie, costs) of emergency C-sections, UK news reports that statins will (?) be prescribed in the last three months of pregnancy. Supposedly, a low cholesterol count increases the ability of uterine to contract decreasing length of labor.

Oh, and did I mention that this is for obese women? Because of course your cholesterol is high if you’re obese! Why, it’s just a given, right? And did anybody mention that an increase in cholesterol and triglycerides is normal in pregnancy regardless the mother’s weight?

But what is the cost of slightly reducing the number of emergency C-sections? Why it’s just deformed babies, some so severely they die within a month of birth.

It’s time to put a stop to the “war” on obesity. It’s killing us.

How I would have loved for The Anchoress to be wrong. Her prediction:

Someone – probably Keith Olbermann or Chris Matthews – will go completely over the top and say that the Kennedy illness will not mark the “end of Camelot…how fitting that it is being revived this very night by Barack Obama, Ted Kennedy’s handpicked successor to the enduring legacy,” or some such gag-inducing nonsense.

Unfortunately, she was not wrong. She accurately predicted the media malignancy that will make Ted Kennedy’s serious illness “all about Obama.”

Brain tumors, malignant or benign, are not about politics. This is a man’s life, his future quality of life, the ordeal his family will endure – that’s what we’re talking about here, not his past mistakes and foibles and certainly not about the next Democratic nominee, whoever that might be.

I’m also a bit disgusted about the “pre” eulogizing being done by some of Kennedy’s democratic colleagues. He’s not dead yet and from all the reports seems to be as alert and cognitive as ever. Imagine what it must feel like to hear your funeral years before it might happen.