Monday, February 16, 2009

Getting to the Heart of the Matter

It's hard for me not to use analogies when talking about the current economic crisis. Since I work in the medical field, my want is to liken the crisis to a patient with multiple problems. Not all are fatal, but many are contributory to the serious situation the patient faces – that of impending death.

When a person's heart stops, it's game over. In medicine we call this a “code”. Sure, there are a handful of things we can try to get the heart going again, but all of these start basically from the premise of having nothing to lose because the patient is technically already dead. We can use various medications, electricity, blood and IV fluids all in an attempt to maintain perfusion, but unless the underlying issue is treated, we just won't succeed. No matter how much time and energy we pour into revival efforts, if we can't get at the core issue (getting the heart to pump effectively), the patient is lost.

The financial system today faces this same situation. It has not yet “coded”, but the heart rate is very slow and not moving enough blood to maintain perfusion. Treatment begins by addressing the most life-threatening symptoms and then assessing as rapidly as possible why they began in the first place. We have already dumped lots of blood and fluids into the patient (cash, guarantees, and TARP funds) – but so far not much good has come of that. There's enough fluid in the body, it's just not getting where it needs to be. Now what? Is the heart beating effectively enough? Is it pumping the blood out to the body systems?

The heart can go into a very disorganized rhythm called ventricular fibrillation. When this happens, the ability to circulate blood is so ineffective that death is very quick indeed. The best thing to do at this point is to use a shock from a defibrillator and allow the heart to reset its electrical conduction system from zero, which may allow it to come back into a normal and effective pattern. This is often done more than once and in conjunction with medications to increase the likelihood of it working. This is the big gun for us. If medications and electricity can't get the heart going after a short period, we call the code (pronounce the patient dead).

Nationalization of the banking system is like using the defibrillator. It will allow a reset to occur in the financial industry, if possible. If it does not work, we can call the code – game over. But until we try it, we will not give the patient perhaps the best chance to reset and begin to function normally. And even if this works and the banks come back, we still need to examine and treat many other contributory factors (co-morbidities we call them) or we will end up back where we are today. Getting the heart working is one thing, figuring out why the patient had the heart attack in the first place is the longer and more complicated part.

But sometimes you just don't get patients to be compliant with treatment until they face death. Sometimes they just have to learn the hard way that they need to be more responsible and take care of themselves – with the assistance of their physicians of course.

Time's getting short to act, and despite what many people believe, seconds never count - but minutes always do.


  1. CO = HR x SV.
    HR or heart rate is production and we have none.
    SV or stroke volume is cash and ours is increasingly useless. Printed crystalloids that in the long run wont do anything to help and may actually hasten demise. Research has shown this.
    CO or cardiac output is nearly null or asystolic. I'm calling it. Are there any objections? Time of death is 2009.

  2. Too early to call it yet, but we are close. We're in V-fib - uncoordinated, ineffective and unsustainable - time for the juice. We've got fluids circulating (but you're correct, our weakened cash like crystalloids / colloids won't carry the oxygen) but the pump needs a jolt to reorganize.

    I say we have nothing left to lose at this point - give it 360j. Everybody off! Everybody clear!

  3. So let's bring the analogy full circle for everyone else who doesn't work in medicine. What would be the "medications" and what would be considered the "shock"? What exactly are you suggesting the administration propose and our congressional and senatorial leaders approve for the "last ditch effort" to save our "patient" the economy? Analogies are great to describe or explain something but offer no workable solutions to fix things. (if they can be fixed) and remind me...what is the survival rate of successful codes 6 months out?

  4. "average of 83% were still alive at six months, 73% at 12 months, and 55% at 24 months"
    Bottomline, we need a viable heart to start with. I propose the current one we have is not sufficient with the focus being on Heart Rate (Production). Every aspect of the entire system (each person) needs to produce something to maintain an output, rather than creating a continued parasitic drag on the economy. If you haven't earned it, you don't deserve it. The negative draw by certain continually enlarging parts of the system needs to be eliminated and replaced by production. The "deserving without production" are the coronary plaques of our society. Alas, the American economy needs a stimulus to be production driven rather than consumer driven. Our profoundly negative trade balance needs to be ameliorated, i.e., another part of the world can take over the brunt of consuming.
    Go America - PRODUCE THINGS!! I want to see a good majority of things I buy in the store say, MADE IN THE UNITED STATES OF AMERICA.

  5. DocBOC -

    No one is suggesting that the lack of production is a good thing. Indeed, we need to begin producing things again as 70% consumerism is as sure a path to death for the economy as any could be.

    We will always have the have-nots and the unproductive. Is the issue black and white? Not really. Lots of gray out there.

    Should we be encouraging people to remain on state aid by cutting off benefits in total if they are trying to work? Is it not better to help the less fortunate by educating them? I would rather pay someone's tuition to a junior college or trade school for 2 years in full than leave them on welfare rolls for decades. Society means all of us - not just the best educated and most fortunate of us.

    But I do agree - those who are able to work should and with any luck the just passed stimulus will help create some much needed jobs.

  6. Are you paying attention to resource depletion?

    We are running low on the ability to produce or consume most of the widgets of modern life.

    Maybe we should put the patient out of it's misery and spend our time nurturing the more viable youth...

  7. I love your analogy with medicine, perfect comparison! I am still laughing at BOC's profile picture! ~Kim

  8. Country Girl -

    BOC and Bovie are competing to be the biggest ass on the blog.