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The Vital Role of Medical Devices in Healthcare – And Memories of an Inspirational Change-Maker

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Joel J. Nobel, M.D. – Founder of the ECRI Institute and Patient-Safety Advocate – 1934-2014

Every one of us on a healing journey encounters medical devices as part of our diagnosis and treatment.

This post is a personal remembrance of a pioneer in the decades-long effort to ensure that the medical equipment and hospital practices used in diagnosing and treating patients around the world lead to the successful—and safe—delivery of life-sustaining healthcare.

 


The ECRI Institute in suburban Philadelphia, founded by Dr. Joel Nobel in the 1960s as the Emergency Care Research Institute after a child died from being treated with a malfunctioning hospital defibrillator, offers many services—including equipment testing, publications and alerts, product comparisons, accident and forensic investigations, evaluation of hospital practices and clinical trials, and more—that help ensure the reliable and safe delivery of healthcare around the globe. Although patients may not be aware of it, the ECRI Institute is working on their behalf every day. 

Please read about Dr. Nobel’s remarkable life and legacy at the links below. What follows are some personal thoughts about a former employer whose far-reaching vision enabled me to do what was perhaps my most important work over a varied career.


I started working at ECRI, now known as the ECRI Institute, in the fall of 1985, when my now 30-year-old son was just a baby. For the next decade, I would be the editor of its flagship publication, Health Devices, which has become part of a large system of services. (Please check the links below to read more.)

A couple of years later, I became a single mother after I separated from my son’s father.* This was an extremely tumultuous and painful time for me, and I didn’t hide it very well. One day, Joel—we all called him by his first name—approached my desk and handed me a copy of Judith Viorst’s 1998 book, Necessary Losses, commenting that he was “astounded by the insights” it contained. Joel wasn’t one to mollycoddle or probe into the emotional worlds of his employees; but he cared about their well-being, and this act of compassion has stayed with me all these years. (And I still have the book, which I recommend.)

However, proffering accumulated wisdom of a more general sort, albeit about some very specific topics, was part of Joel’s quest to make individual lives and the larger world better. No subject was beyond his polymathic mind or all-seeing gaze as he quietly (until he spoke) made his way around “the lab” in his green scrubs. In addition to tending to his mission of making the delivery of healthcare reliable and safe, I’ve heard him tell people how to manage their time and to-do lists, raise their children, use a microwave (never cook fish or popcorn in the thing), where to drink coffee and tea (so as not to spill caramel-colored beverages on the office carpeting), learn to speak English, stop shivering when it was cold (especially females, who were “thermodynamically superior” because of their fat stores and had no business complaining that they were colder than their male counterparts when the thermostat was turned down), and even how to walk on water (frozen water, that is, using strap-on cleats—he didn’t believe in having the driveway paved or salted after a snow or ice storm for fear of damaging the asphalt, and saline runoff would ruin the surrounding vegetation; I silently cursed him every time I fell).

But Joel’s most memorable personal counsel to me came sometime after he gave me Judith Viorst’s book. One day in the kitchen (a prescribed area for drinking coffee), he offered me the following advice on navigating my newly single world: “You’ll be approached by a lot of men. They’ll all fall into one of three categories: the narcissists, the ones who are hopelessly attached to their mothers, and the group you should beware of most of all: the ones who consider females to be support systems for their . . .” (use your imagination).

As it turned out, I managed to find all of these types along the way, to my chagrin and distress. But Joel did leave out one important category. I used to say to myself that if I ever found a decent guy again, he would have to come from the other side of the world, given the statistics that women of a certain age in this country were as likely to be abducted by aliens as they were to remarry. Well, I found one and married him. So, Joel, wherever you are, please add this missing category to your list: guys that live with honesty and integrity, promote education as more than the mere accumulation of knowledge, believe that the highest human endeavor is helping others, pursue life with mission and zest, and know that the most important character trait is a good and noble heart. Guys like my husband. Guys like you.

I was saddened to learn that Joel Nobel had died on August 13, 2014, a fact that seems almost unbelievable, given his powerful life force. But it is with fondness and gratitude that I recall the important, most valuable gift he gave me, and gave to all who worked with him: the opportunity to do work that had meaning. The decade that I spent working with amazing colleagues and friends at ECRI was one of the most rewarding of my life. While working on a publication that improved healthcare for countless patients, I felt that my developing skills were being honed for a high purpose. And, mostly, I had a hell of a lot of fun doing it, if you can believe that editing a biomedical engineering journal can be enjoyable. Back then, though, the atmosphere at ECRI, which came down from the top, was one that embraced just about all human talents and encouraged their expression in the workplace and in the world. I will never forget that time or its lasting effects on my life.

Whenever I, or you, or a loved one encounters a medical device that diagnoses, treats, or resuscitates safely and efficaciously, the legacy of the noble Dr. Nobel is made manifest.

Thank you, Joel, for a life’s work very well done. And bravo for a life very well lived.

LINKS

Joel J. Nobel, 79, patient-safety advocate – Philadelphia Inquirer Obituary

ECRI:

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– In Memoriam: Joel Nobel, MD, Pioneer in Patient Safety and Founder of ECRI Institute

– Joel J. Nobel, M.D., Founder and President Emeritus – Bio

– Joel Nobel’s Patient Safety Legacy – James P. Keller, Jr, MS

– ECRI Institute’s History

– Information for Patients

Our tribute to Dr. Joel Nobel – American College of Clinical Engineering (ACCE)

*See My Son’s Father’s Story – Lung Cancer.

My Current Story, Update: Medical Monday for Me–and Also for Mom

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My Current Story, Continued – da Vinci Hysterectomy Scheduled for Friday, December 13

As I mentioned in the November 22, 2013 post, which really wasn’t much about me and was mainly about healthcare delivery and reform (it has important links–take a look), I need to go for my medical clearance visit with my family doctor today to prepare for the hysterectomy in 18 days (see the My Current Story” posts and updates). Last week, I received three phone calls from her office about today’s visit after getting conflicting instructions about whether I had to fast for the blood work–I was given alternating yes and no answers, depending on whom I spoke with. I decided not to take chances and started fasting after breakfast this morning–you need to stop eating and drinking everything but water for 8 hours to be considered fasting, so I should be OK for the 4:00 PM appointment.

Medical clearance by a family doctor includes a brief physical examination; blood work (which is good for 30 days), including a complete blood count (CBC) and a complete metabolic profile (CMP–this is why I have to fast); urinalysis (UA); EKG (which I had done in October before the D&C and is good for six months, so that’s one less thing needed today); and a chest X-ray (which will be good for one year should I–heaven forbid–need another procedure). During the visit I also need to discuss when to stop taking prescription medications before the surgery.

I wish doctors would take a few minutes to educate their staffs about such simple matters as office-visit preparation, but maybe it just doesn’t occur to them (?). I’ll mention it, gently, when I see my doctor today.

Now, I have another story to tell–or at least to begin. This one is about my mother.

P.S. During my visit with the doctor this afternoon, I mentioned the confusion about fasting. She said you never have to fast for pre-op blood work and that a nurse probably told the receptionist I had to fast because glucose level is part of the testing. But the fasting was not in vain because she was also able to test my lipids (for cholesterol) so I don’t have to go back for that in two weeks, when I will be otherwise occupied. Also, I called the radiology center at 1:15 to try to get a walk-in appointment for my chest x-ray at 3:00 and did. So the appointments today went very smoothly for me. And I was grateful for that and for my family doctor, who is new to me (and young!)–she showed the right combination of professionalism and concern.

But things didn’t go quite as smoothly for my mother, as I will describe in tomorrow’s post.

My Mother’s Long Story, Ongoing – Procedure for Arterial Disease Scheduled for Today

Last March, my mother, Marie Bond, had a heart attack, for which she had cardiac bypass surgery. I will discuss heart disease and treatment in a future post–a very important topic.

But this was just the beginning of a very tough year for her. She had a major complication following surgery–not with her heart, which did fine, but with a MRSA (methicillin-resistant Staphylococcus aureus) infection in her feet that she had picked up in one of the medical facilities. This went undiagnosed for a few weeks. I will also be discussing this insidious problem in a future post.

Fast forward to June, after the MRSA had finally been identified and was being treated–but wasn’t healing, and my mother needed an urgent appointment with a vascular surgeon for poor circulation in her right leg. He found no pulses, which is why the MRSA infection wasn’t healing in that foot, and he also said she was in danger of losing her leg. She had known peripheral artery disease (PAD) that had gotten worse. I will also discuss this serious problem later.

The surgeon performed an urgent right femoral-popliteal bypass graft using a vein from the same leg and also a femoral endarterectomy to remove the plaque buildup in the artery to restore the blood flow in her legs and feet, which was successful. (Apparently, she obtained some benefit to her left leg from the surgery on her right leg.) Over the following months, she slowly got stronger. But she needed repeated visits to the Wound Care Center for an open, unhealed area in her groin and for the MRSA that was slowly disappearing from her feet.

Recently, she had an ultrasound to determine how good the blood flow to her leg was. It wasn’t. She saw the surgeon again last week, and today he is scheduled to do a right femoral angiogram, angioplasty, and insertion of a stent by way of her left brachial artery–a long way around from the left arm to the right leg, but he can’t take a chance on reopening the groin wound. The procedure should take about 1 1/2 hours. If all goes well, she will be in the hospital just overnight. Her left arm will be sore from putting the stent through it, but she should be OK to go out to Thanksgiving dinner with us on Thursday.

Thanksgiving 2013

This will be an interesting Thanksgiving. I usually have dinner here, but this year I’m giving myself a break. Next year, all the fancy linen and dishes will come out, and we’ll have a house full of people to celebrate with. And I won’t mind wrestling with the turkey at all (as long as there’s wine–I can wrestle with almost anything if there’s wine).

In the meantime, we do have things to be grateful for–including the medical interventions that are saving our lives. And my son, Matt, will be coming from Boston to join my husband, Farok, and me, along with my mother and her 91-year-old sister, Cecilia Braddock–who also has heart disease, but is doing well. It is worth noting that their mother, my maternal biological grandmother, died of heart diseas eat the age of only 42. My mother was still a baby at the time.

Look for an update on my mother soon, as well as more information about her various medical challenges–these problems affect so many people