In medicine when we review a case it’s usually because all didn’t go well for the patient. It’s part of our on going effort to improve what we do and how we treat patients. If you’re going to be in any aspect of medicine for long, you have to get used to a certain level of scrutiny. Often, looking back at a case we can see where we might have gone wrong. The problem is that we had to go with what we knew at the time, not what we were going to know after the case was over. The less the patient can help us to treat them, the more likely it is that something that would have been extremely helpful won’t be known until later on. If we ever know it.

When we review a case, we look at what we knew about the patient and also what we should have known. That is, did we miss something that we should have seen, or did we not ask a question we should have asked? Did we forget to ask or look for a list of medications or allergies? A good example of this is forgetting to ask a patient, male or female, if they are on any of the medication commonly prescribed for erectile dysfunction. The use of that class of medication has gone beyond helping males to achieve and erection, which is why I included women in my comment. Giving nitrates to patients on those types of drugs can easily harm a patient.

That’s the type of thing we should know about and shame on us if we don’t.

Then there is the type of stuff that we couldn’t know about because there is just no way to know it without the patient telling you or it being written down somewhere. For example, does the patient take drugs that might interact with what we plan to administer? Sometime you just can’t know. Secretary of Defense Donald Rumsfeld referred to two types of unknowns. There were things that you knew you didn’t know, and you could plan around them. Contingencies in case something that might happen, but can’t be predicted actually happen. Then there are the “unknown unknowns”. These are things that you can’t reasonably predict might happen and so it’s hard, if not impossible to prepare for them. Patients are full of surprises, sometimes they just don’t do what the text book tells us that they should do. In which case our treatment plan goes to hell in a hand basket and we have to react quickly to keep things from getting out of hand. Often, after the call, the  missing pieces fall into place and we now know that which would have been very helpful in the heat of battle.

In medicine we refer to a mythical piece of medical equipment known as the “Retrospectrocope”. It’s a wonderful piece of equipment that allows us to see things in the past with complete clarity. The problem comes when other people apply the Retrospectroscope to our actions and scold us for not knowing something at the time that they can clearly see in the present because they have all the information that we would have loved to have had, but just couldn’t. It’s a cheap sort of criticism intended to produce a sense of superiority in the observer and a sense of failure in the provider. It’s a low way to operate and fortunately in medicine it’s not that common.

So now I’ve used about 600 words to describe something that we do in medicine, in a post that really doesn’t have anything to do with medicine.

I told you all that so I can tell you this.

It seems that the Retrospectroscopes are in full use this week in regards to the Boston Marathon bombings and the aftermath.

We find that the FBI knew about one of the bombings and should have done something. The fact that they had no probable cause to arrest him, or even keep him under surveillance seems not to matter to these people. Who, if they found out that the FBI had been keeping him under surveillance, would have complained about the United States turning into a police state and protested that his civil rights were being violated.

The police shouldn’t have locked down Boston and some other cities around Boston. It’s a police state! Never mind that the two bombers were now identified and there was an active manhunt on for them. Never mind that during that manhunt they shot and killed one police officer and shot and critically wounded another one. Or that they threw explosive devices at police and had no hesitation about engaging the police in a fire fight. Or that they carjacked a person and the only reason that they didn’t kill him was that they didn’t think he was an American.

The police were incompetent and the only reason Suspect #2 was caught was because a citizen happened to find him hiding in a boat. The police had been searching for almost 24 hours. They had searched that boat earlier, which to me means that Suspect #2 moved around. Was he hiding in one of the houses? Maybe. The police only searched when they were invited to by the residents. The police had stopped searching for the day, but hadn’t given up. They still suspected he was in the area, they just hadn’t found him yet. I don’t care how many officers there were in the area, it’s damned hard to find someone when they don’t want to be found.

The police were too brutal in shooting Suspect #1.  I don’t have a publishable response to this one. Some people are just so self absorbed and stupid that they can’t be reasoned with. What’s really stunning is that someone pays this nitwit to teach college students. I’m reminded of Colonel Jessup’s speech from A Few Good Men. It’s easy to criticize people when you don’t have to do what they do or pay the price that they do.

Everyone in the affected areas should have/should not have had a gun ready. All the arm chair commandos, both amateur and professional are sure that that THEY would have been able to capture these people if only they were there with their guns. Anyone who reads this blog knows that I own guns. I’m often armed as I go about my daily business. I’m fairly proficient with a firearm, but I’m not a fool. The reason I carry a gun is if all else fails and my life is in danger. If the police were chasing a suspect in my neighborhood, then I wouldn’t run around outside with a gun. No Dr. Keith Ablow the police shouldn’t have told the people in Watertown to “get their guns”. The people in Watertown and likely everywhere else who own guns probably figured that one out on their own. I know a lot of people I know did.

I just wish that people would turn off the Retrospectroscopes and stop making fools of themselves with criticisms which they are totally unqualified to make.

I’ve been critical, to say the least, about the coverage that the Main Stream Media (aka legacy media) has been giving the attack and assassination of Ambassador Christopher Stevens. Much of the early and even later coverage parroted the Obama Administrations often contradictory stories of what really happened there. Then today the Washington Post broke a big story about the multiple security failures before the attack.

Make your own assessment about how much damage this will do to Obama’s re election hopes. Personally, I think it’s just one of many failures of the Administration’s foreign policy over the last few years. Sadly, Ambassador Stevens is neither the first nor the last American to die as a result of the fecklessness of this President.

In Libya, security was lax before attack that killed U.S. ambassador, officials say

Attack timeline

The assault on the compound was launched from three directions around 9 p.m., the Libyan official said. Guards and members of militias friendly to the United States who responded to try to repel the attackers were shot in the legs, the official said, suggesting the gunmen had been instructed not to shoot to kill. Sean Smith, 34, an information management officer, died during that phase of the attack and Stevens, 52, was trapped and mortally injured.

A group of Americans managed to escape to a second compound about a mile away, according to the Libyan official and others with knowledge of the attack. The site was used by U.S. diplomatic and intelligence personnel, according to people briefed on the attack.

Soon after the evacuated Americans arrived there, the second location came under attack, according to the Libyan official and a Libyan fighter who assisted in the evacuation. The fighter — a member of the militia known as the February 17th Brigade, which was friendly toward the Americans — received a call from a counterpart in Tripoli. He said the Americans at the second compound needed help and told him to get in touch with a man named Paul. When the militia leader got the American on the phone, Paul told him not to send his men.

So much for this being a spontaneous event by some people upset about a movie that no one has seen.

The major international news story last week was the attack on the US Consulate in Benghazi, Libya and the murder of US Ambassador to Libya Chris Stevens. While the Administration’s cover story for what happened was busy unraveling, another major event happened that received scant attention. I read a brief account of the events, but gave it too little thought. The major networks reported it, but didn’t give it the emphasis it needed. After all, they were too busy reporting on the “film maker” whose work prompted the “spontaneous demonstrations” that overtook much of the Muslim world and Mitt Romney’s “gaffe” that turned out to be pretty accurate after all. I guess there was either not the time or maybe the intellect (maybe both) to appreciate this event.

Attack on Camp Bastion: The Destruction of VMA-211

Whatever the organizational outcome, the Sept. 14, 2012 attack on Camp Bastion is arguably the worst day in USMC aviation history since the Tet Offensive of 1968. The last time VMA-211 was combat ineffective was in December 1941, when the squadron was wiped out during the 13-day defense of Wake Island against the Japanese. Eight irreplaceable aircraft (the AV-8B has been out of production since 1999) have been destroyed or put out of action – approximately 7 percent of the total flying USMC Harrier fleet.

An attack of that size and success is a major defeat for the NATO coalition in general and the USMC in particular. In a slower news cycle or a Republican Administration, this would have dominated several news cycles and the media, Congress, and the public would be asking hard questions of the President.

The tempo of Taliban attacks in Afghanistan has been accelerating of late and will probably do so until winter hits. In fact the tempo might increase even after winter hits as the draw down of the US “surge” is completed. The Taliban have good reason to believe that NATO and the US especially has given up on the war and that they (the Taliban) will soon be back in control in Kabul. The Administration has done nothing to dispel that impression and it’s reaction to this attack is unlikely to do anything to change that.

Afghanistan was, and probably is, still winnable, although the President and the American people have to want to win. I’m not sure about the American people, but I’m pretty convinced that we have a President that doesn’t care about winning this war or what will happen to the Afghani people if we don’t.

Which is disheartening in the short term, but even worse, damaging to America’s standing in the world in the short and long term.

The Obama Administration steadfastly denied that the death of Ambassador to Libya Christopher Stevens was part of a planned terrorist attack and was an unfortunate part of spontaneous demonstrations against an anti Muslim film that no one has actually seen. Ambassador to the UN Susan Rice supported a statement by White House Spokesman Jim Carney that,

This is not a case of protests directed at the United States writ large or at U.S. policy. This is in response to a video that is offensive.

Rice expounded for almost two minutes that this was all about the insulting movie,

This despite the fact that the President of Libya said that it was in fact a terrorist attack. In a separate statement Rice told the world that the President of Libya doesn’t have the intelligence resources the US has and didn’t really know what happened in his own country. Today we get the official word that not only was it a planned attack, but that the suspected leader of the attack was released from Gitmo and sent back to Libya to serve out the rest of his sentence.

Obama official: Benghazi was a terrorist attack

The Sept. 11 attack on the U.S. consulate in Benghazi was in fact “a terrorist attack” and the U.S. government has indications that members of al Qaeda were directly involved, a top Obama administration official said Wednesday morning.

“I would say yes, they were killed in the course of a terrorist attack on our embassy,” Matt Olsen, the director of the National Counterterrorism Center, said Wednesday at a hearing of the Senate Homeland Security Committee, in response to questioning from Chairman Joe Lieberman (I-CT) about the attack that killed Ambassador Chris Stevens and three other Americans.

The only real question here is if Carney and Rice, and thus the President, were lying or if they are just that gullible, naive, and incompetent. Either way the answer is the same. They are not capable of doing their jobs and should either resign or be fired.

I’m not the brightest bulb on the Christmas Holiday Tree, but when these attacks happened last week I said from the beginning that none of this was spontaneous nor unplanned. Why did the Administration try to deflect the blame onto an individual and a movie? They put that man’s life in danger as well as the lives of the people who were duped into acting in it. That’s just irresponsible.

Incompetence from top to bottom is no way to run a country.