Newer Docs Might Be Driving Up Health Care Costs

Image courtesy of iStockphoto/prosot-photography

Health care spending increases have slowed over the past couple years. Still, we are spending some $ 2.6 trillion–that’s trillion with a “T”–a year on health costs, which is a higher percentage of our GDP than any other developed country. And we don’t seem to be getting that much healthier. So economists and policy researchers are looking for ways to staunch the bleeding while ensuring that care remains good. One group who can have a great influence on the overall cost of health care are the doctors–your primary care physician and your specialists. They are often the ones deciding how many tests and procedures to order and whether to follow evidence-based recommendations on the most effective options. Until now, little research had been done examining how much doctors differ in the costliness of their practice styles–just how much their work was costing insurers. A recent report conducted by the RAND Corporation, a nonprofit, nonpartisan policy institution, shows that the biggest predictor of a doctor’s overall costs to the health care system is how long he or she has been practicing. “It is possible that one driver of health care costs is that newly trained physicians practice a more costly style of medicine,” Ateev Mehrotra, an associate professor at the University of Pittsburgh School of Medicine and a researcher at RAND, said in a prepared statement. Doctors, including primary care physicians and specialists, who had less than a decade of experience had annual costs more than 13 percent above doctors who had more than four decades of experience, according to the new analysis. The findings were published online November 5 in Health Affairs. Other characteristics, among them physician gender, size of practice, credentials (such as being board-certified) and previous malpractice suits, did not seem to affect overall costs or mean cost per patient. Moreover, the higher-cost practicing styles of the less experienced physicians did not necessarily translate into better care. The researchers analyzed insurance claims filed in Massachusetts between 2004 and 2005 (before Governor Mitt Romney instituted the state’s individual health care mandate), covering 1.13 million patients (ages 18 to 65) and 12,116 physicians. They were then able to generate more than 600 types of “episodes of care” (based on categories such as similar illness, severity and procedure and controlled by age, gender and comorbidities) to see how billed costs for similar “episodes” compared across doctors of the same specialty. Health plans often use this same type of reckoning to evaluate costs. On a population scale, doctors with fewer than 10 years of experience had mean per-patient costs of about $ 14,906, whereas those with more than 40 years had mean per-patient costs of $ 10,104. Both government-run and private health insurance plans are looking for smarter ways of reducing costs while providing for quality health care. Facing a budget shortfall in 2016, for instance, Medicare is looking to adjust how it pays for services based not just on what is proscribed (tests, treatments, and so on) but also on how well that service works–whether it is the most effective and affordable option available for the given situation. Why is there such a large difference between these groups of doctors? It is possible, for example, that those fresh out of medical school are more familiar with–and more inclined to use–newer, more expensive treatments and tests (regardless of how effective they are). The authors also suggested that perhaps “lack of experience and uncertainty translates into more aggressive care,” they wrote. Additionally, this newer generation of doctors might simply continue to use higher-cost medicine even as they gain more experience. These data also suggest that unless they work to reduce costs, physicians with less experience might have a more difficult time being included to receive as much business from insurance companies and government programs that are looking for best-value providers. The findings “underscore the need to better understand physician practice patterns and what influences that behavior,” Mehrotra said. He and his colleagues recommend considering additional training programs for new doctors “to educate physicians on their responsibility to be good stewards of health care resources.”

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Wall Street rises in thin trade day before election

NEW YORK (Reuters) – Stocks advanced modestly on Monday in light trading in one of the year’s quietest sessions on the day before the presidential election.

Whatever the outcome of the race between incumbent President Barack Obama and Republican challenger Mitt Romney, the election’s resolution will finally end the uncertainty that has kept the market stagnant for the past few weeks.

“No one’s going to make big bets today,” said Perry Piazza, director of investment strategy at Contango Capital Advisors in San Francisco.

Just 5.16 billion shares changed hands on the New York Stock Exchange, the Nasdaq and the NYSE MKT on Monday, below this year’s average daily volume of 6.5 billion.

” has been directionless over the last few weeks because of what fiscal and tax policy looks like next year. You could argue that just having the uncertainty behind us could lead to a bit of a relief rally,” Piazza said.

The Nasdaq was the strongest of the three major U.S. stock indexes, helped by a rally in Apple Inc , the most valuable publicly traded U.S. company. Apple‘s stock rose 1.4 percent to close at $ 584.62. The stock has fallen 17 percent from its closing high of $ 705.07 on September 21.

Once the election is over, the market will turn to the “fiscal cliff,” the $ 600 billion worth of tax hikes and spending cuts that could hit the economy hard in 2013 unless Congress comes to an agreement that will soften the blow.

“I guess, academically, you could convince yourself a president doesn’t generally doesn’t have that much influence over the economy near-term, but the fact remains, they could impact the market,” said Jack Ablin, chief investment officer of Harris Private Bank in Chicago.

A budget crisis in the United States could hamper growth around the world. On Sunday, economic leaders pressed the United States to avert the fiscal cliff in the interest of avoiding a large-scale economic slowdown.

Another drag on trading volume was the residual impact of Hurricane Sandy, which has left about 30,000 to 40,000 Americans homeless. The superstorm wreaked havoc on infrastructure and housing in the Northeast.

“I think Sandy is still affecting volume a little bit,” Piazza said. “Folks we deal with in New York seem to be back at work now, but they were out most of the week last week, and still have other things on their minds.”

The Dow Jones industrial average <.DJI> advanced 19.28 points, or 0.15 percent, to end at 13,112.44. The Standard & Poor’s 500 Index <.SPX> rose 3.06 points, or 0.22 percent, to 1,417.26. The Nasdaq Composite Index <.IXIC> gained 17.53 points, or 0.59 percent, to close at 2,999.66.

The CBOE Volatility Index <.VIX> or VIX, Wall Street’s favorite barometer of investor anxiety, rose 4.72 percent – a relatively big move compared with the S&P 500 – to end Monday’s session at 18.42.

“It’s just a few people taking positions ahead of the election, to protect themselves against a pullback,” said Randy Frederick, managing director of trading and derivatives at Charles Schwab. “I think this will go on tomorrow as well,” adding that he believes the market will be flat while the VIX is likely to show “a bigger move, as it’s just the nature of hedging ahead of big news like the election.”

The PHLX semiconductor index <.SOX> rose 1.6 percent and bolstered the Nasdaq.

An index of housing-related shares <.HGX> gained 1.8 percent.

In the energy sector, the S&P energy index <.GSPE> gained 0.7 percent following a gain in crude oil futures prices and third-quarter earnings from two major energy companies.

Transocean Ltd , which operates the world’s largest offshore oil drilling fleet, gained 5.6 percent to $ 48.64, a day after the company reported a higher-than-expected adjusted profit for the third quarter.

Shares of Southern Co , the second-largest U.S. power company, fell 2.5 percent to $ 44.62 after Southern posted third-quarter earnings.

The S&P utilities index <.GSPU>, down 1.66 percent, was the worst performing of the 10 major S&P 500 sectors a week after superstorm Sandy hit New York City and surrounding areas.

Shares of Time Warner Cable , the second-largest U.S. cable operator, lost 6.4 percent to $ 91.93 after the company reported a quarterly profit that missed estimates as it lost more video subscribers than expected.

BioMarin Pharmaceutical Inc surged 31.2 percent to $ 49.07 after the company said a late-stage trial of its experimental drug for a rare genetic disorder could improve patients’ walking ability when the medicine is administered weekly. The rally in BioMarin’s stock helped drive the Nasdaq biotech index <.NBI> up 1.7 percent.

Despite the light volume on Monday, the market’s breadth was positive. Advancers slightly outnumbered decliners on the New York Stock Exchange by a ratio of 15 to 14. On the Nasdaq, about three stocks rose for every two that fell.

(Reporting by Atossa Araxia Abrahamian; Additional reporting by Chuck Mikolajczak and Angela Moon; Editing by Jan Paschal)

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Methane warnings ignored before NZ mine disaster

WELLINGTON, New Zealand (AP) — A New Zealand coal mining company ignored 21 warnings that methane gas had accumulated to explosive levels before an underground explosion killed 29 workers two years ago, an investigation concluded.

The official report released Monday after 11 weeks of hearings on the disaster found broad safety problems in New Zealand workplaces and said the Pike River Coal company was exposing miners to unacceptable risks as it strove to meet financial targets.

“The company completely and utterly failed to protect its workers,” New Zealand Prime Minister John Key said Monday.

The country’s labor minister, Kate Wilkinson, resigned from her labor portfolio after the report’s release, saying she felt it was the honorable thing to do after the tragedy occurred on her watch. She plans to retain her remaining government responsibilities.

The Royal Commission report said New Zealand has a poor workplace safety record and its regulators failed to provide adequate oversight before the explosion.

At the time of the disaster, New Zealand had just two mine inspectors who were unable to keep up with their workload, the report said. Pike River was able to obtain a permit with no scrutiny of its initial health and safety plans and little ongoing scrutiny.

Key said he agrees with the report’s conclusion that there needs to be a philosophical shift in New Zealand from believing that companies are acting in the best interests of workers to a more proscriptive set of regulations that forces companies to do the right thing.

The commission’s report recommended a new agency be formed to focus solely on workplace health and safety problems. It also recommended a raft of measures to strengthen mine oversight.

Key said his government would consider the recommendations and hoped to implement most of them. He would not commit on forming a new agency. Workplace safety issues are currently one of the responsibilities of the Ministry of Business, Innovation and Employment.

In the seven weeks before the explosion, the Pike River company received 21 warnings from mine workers that methane gas had built up to explosive levels below ground and another 27 warnings of dangerous levels, the report said. The warnings continued right up until the morning of the deadly explosion.

The company used unconventional methods to get rid of methane, the report said. Some workers even rigged their machines to bypass the methane sensors after the machines kept automatically shutting down — something they were designed to do when methane levels got too high.

The company made a “major error” by placing a ventilation fan underground instead of on the surface, the report found. The fan failed after the first of several explosions, effectively shutting down the entire ventilation system. The company was also using water jets to cut the coal face, a highly specialized technique than can release large amounts of methane.

The report did not definitively conclude what sparked the explosion itself, although it noted that a pump was switched on immediately before the explosion, raising the possibility it was triggered by an electrical arc.

The now-bankrupt Pike River Coal company is not defending itself against charges it committed nine labor violations related to the disaster. Former chief executive Peter Whittall has pleaded not guilty to 12 violations and his lawyers say he is being scapegoated.

An Australian contractor was fined last month for three safety violations after its methane detector was found to be faulty at the time of the explosion.

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CBS making $1 million donation to Sandy, announces employee match

NEW YORK (TheWrap.com) – CBS is making a $ 1 million dollar donation to Hurricane Sandy recovery as part of a wider effort that includes PSAs and matching employee contributions through the end of the year, TheWrap has learned.

CEO Les Moonves announced the company’s Red Cross donation in a letter to employees obtained by TheWrap, in which he thanks CBS staff working in hurricane-stricken parts of the Northeast and details its charitable plans.

Other networks are pitching in as well: ABC is devoting its programming day Monday to fundraising, and its corporate parent, Disney, has donated $ 2 million. Fox’s parent, News Corp., has donated $ 1 million. And NBC is holding a telethon tonight. All of the networks are also making viewers aware of the recovery efforts through means ranging from crawls to PSAs.

Moonves singled out employees from all corners of the company who worked through tough conditions to keep its television and radio stations going.

“I am announcing today that November, the month of Thanksgiving, will be dedicated at all our operations to supporting the Hurricane Sandy relief efforts of the American Red Cross, with whom CBS has a long partnership in times of crisis,” he wrote. “Our local TV and radio stations, and their online counterparts, will work both individually and together… to employ our unique resources to lend additional support to those relief efforts through telethons, phone banks and comprehensive PSA campaigns. Those efforts have already begun, and are expanding as you read this.”

CBS, he noted, is producing special PSAs featuring its stars. The first, with Gary Sinise, aired during “The Big Bang Theory” on Thursday. More will air during football over the weekend.

Additionally, “Entertainment Tonight” is enlisting stars to appear in PSAs that will run in syndication on affiliates of all networks airing the show. CBS will also dedicate billboards to the relief effort.

“There will not be one division of our company that does not contribute to this effort, each in its own way, and in ways to be determined by each,” Moonves wrote.

“As a cornerstone of this month-long drive, CBS Corporation will make a $ 1 million contribution to the American Red Cross,” he added. “In addition, we are also making a commitment to match your individual contributions to any Sandy-related relief efforts by making corresponding additional gifts to the American Red Cross. The match will apply to contributions that may have already been made as well as to new donations through the end of the year.”

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Bypass tops stents in diabetics with diseased arteries

LOS ANGELES (Reuters) – Diabetics with more than one diseased artery fared significantly better if they underwent bypass surgery than those who received drug coated stents following artery clearing procedures to improve blood flow to the heart, according to data from a five-year study presented on Sunday.

After five years, the bypass group had a lower combined rate of heart attacks, strokes and deaths of 18.7 percent versus 26.6 percent for the stent group in the 1,900-patient study funded by the U.S. National Institutes of Health.

The result was deemed to be highly statistically significant, researchers said.

Previous studies had demonstrated the superiority of bypass surgery over the use of bare metal stents – tiny mesh tubes used to prop open cleared arteries. Researchers suspected that newer stents coated with drugs to prevent reclogging might negate some of the bypass advantage, but that turned out not to be the case.

“The advantages were striking in this trial and could change treatment recommendations for thousands of individuals with diabetes and heart disease,” said Dr. Valentin Fuster, from Mount Sinai School of Medicine in New York, who presented the findings at the American Heart Association scientific meeting in Los Angeles.

There was a higher incidence of stroke in bypass patients — 5.2 percent versus 2.4 percent. Stroke is a known risk of the surgical procedure in which a piece of a healthy blood vessel from another part of the body is grafted on to re-route blood flow around a blocked heart artery.

But deaths from any cause were significantly lower with bypass surgery than those who received artery clearing angioplasty and a drug eluting stent – 10.9 percent compared with 16.3 percent. There were also twice as many heart attacks among diabetics in the stent group within five years – 99 vs 48, which Fuster called “very significant.”

More than one million bypass surgeries or stenting procedures are performed in the United States each year and some 25 to 30 percent of those involve diabetics with multiple diseased arteries, researchers said.

If the results of this study alter clinical practice, it could eat into lucrative profits of the companies that sell drug coated stents, such as Abbott Laboratories, Boston Scientific Corp and Medtronic Inc. Boston Scientific and Johnson & Johnson supplied the stents used in the study, but J&J has since exited the stent business.

Dr. David Williams of Brigham and Women’s Hospital in Boston, who was not involved in the study, called the results “very convincing.”

“I think the (treatment) guidelines will recognize this and I do think it will be adopted,” he said.

However, Fuster cautioned that longer term follow-up of patients was necessary.

“We always want to know how long the effects last,” he said. “The gap could begin to close or the results could get better and better.”

(Reporting by Bill Berkrot and Deena Beasley; Editing by Marguerita Choy)

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Asian shares ease on caution before U.S. elections

TOKYO (Reuters) – Asian shares fell on Monday, tracking a sell-off in global shares late last week, as investors continued to shed risk ahead of the closely fought U.S. presidential election and looked past a strong U.S. jobs data to fragile economic growth worldwide.

The MSCI index of Asia-Pacific shares outside Japan <.MIAPJ0000PUS> fell 0.3 percent after climbing to its highest since October 23 on Friday.

Australian shares <.AXJO> were down 0.4 percent and South Korean shares <.KS11> opened down 0.7 percent.

“There is an absence of upward momentum, but economic data such as U.S. jobs were better than forecast last week, so the main index is expected to remain boxed in range before the U.S. elections,” Cho Sung-joon, an analyst at NH Investment & Securities, said of Seoul shares.

Japan’s Nikkei average <.N225> opened down 0.6 percent after closing at a one-week high on Friday. <.T>

The political uncertainty in the world’s largest economy made investors wary of holdings risk assets, and their safe-haven bids buoyed the U.S. dollar to two-month highs against a basket of major currencies <.DXY> on Monday.

U.S. President Barack Obama and Republican challenger Mitt Romney were neck-and-neck in opinion polls in the final 48 hours before Tuesday’s vote.

Obama’s re-election is perceived as negative for equities, while markets see Romney as stock-friendly, analysts have said.

After the U.S. election, Congress must deal with a “fiscal cliff” – up to $ 600 billion in expiring tax cuts and spending reductions that are set to kick in next year – which threatens to hurt the U.S. economy.

“Investors hate uncertainty, so there will be a sigh of relief when the election is over. Provided there is a clear election result and no change in the divided Congress, then traders and investors will see it as ‘business as usual’,” said Craig James, chief economist at CommSec.

Other key events this week include the Chinese congress starting November8 that will usher in a generational leadership change and policy decisions by the Reserve Bank of Australia and the European Central Bank.

The dollar was also bolstered by a report showing U.S. employers added 171,000 people to their payrolls last month, far above forecasts, and 84,000 more jobs were created in August and September than previously estimated.

Demand for U.S. factory goods also rose in September by the most in over a year, but a gauge of business investment plans showed lacklustre momentum.

The dollar steadied at 80.50 yen, near a more-than-six-month high of 80.68 yen scaled on Friday.

Bullion was undermined by the strong dollar. Spot gold ticked up 0.3 percent to $ 1,680.54 an ounce on Monday after a 2 percent plunge to a two-month low of $ 1,673.94 on Friday.

“For now, the liquidation in gold is likely to leave investors licking gaping wounds rather than focus on the benefits of a gently growing economy especially as it is currently set back in the shadows of the fiscal cliff,” Andrew Wilkinson, chief economic strategist at Miller Tabak & Co said in a note to clients.

Hedge funds and other big speculators shed U.S. commodities by $ 8 billion last week, the biggest weekly drop in nearly six month, with gold seeing the largest outflow of net long money for a second week running.

U.S. crude futures eased 0.1 percent to $ 84.82 a barrel and Brent was down 0.2 percent to $ 105.48.

The euro edged up 0.1 percent to $ 1.2823. It hit a one-month low of $ 1.2816 early in Asia on Monday, undermined by not only the U.S. data but also Friday’s survey showing euro zone October manufacturing shrank for the 15th straight month as output and new orders fell.

Finance chiefs of leading economies gathering in Mexico urged the United States on Sunday to avert a series of spending cuts and tax hikes that could hurt global output, though some countries saw Europe’s debt crisis as the No. 1 danger.

China offered some comforting news on Saturday, with an official survey showing the country’s services sector rebounded in October from a two-year low in September on stronger activity in the construction and retail sectors.

(Additional reporting by Joyce Lee in Seoul and Ian Chua in Sydney; Editing by Michael Perry)

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Newspaper discloses new Cameron text messages

LONDON (AP) — A British lawmaker says he’s asked the country’s media ethics inquiry to consider newly disclosed text messages sent between Prime Minister David Cameron and Rebekah Brooks, the ex-chief executive of Rupert Murdoch‘s British newspaper division.

The Mail on Sunday newspaper on Sunday published two previously undisclosed messages exchanged between the pair, who are friends and neighbors.

Brooks is facing trial on conspiracy charges linked to Britain’s phone hacking scandal, which saw Murdoch close down The News of The World tabloid.

In one newly disclosed message, Cameron thanked Brooks in 2009 for allowing him to borrow a horse, joking it was “fast, unpredictable and hard to control but fun.”

Opposition lawmaker Chris Bryant has asked a judge-led inquiry scrutinizing ties between the press and the powerful to examine the messages.

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Say Farewell: Apple’s Skeumorphism Hall of Shame [PICS]

iBooks

Check it out: It’s your own personal bookshelf, much like the one you probably have for your collection at home.

Click here to view this gallery.

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Like the look of stitched leather around your Contacts app? Ever regarded the torn pages in your iCalendar as nostalgic, or are they just antiquated?

Former Apple Human Interface chief Scott Forstall was the man behind iOS and arguably some of these digital imitations called skeumorphisms. Apple‘s skeumorphism use is prevalent throughout many of its apps and interfaces. Forstall created the iOS that we use on our iDevices today. But the interface with which we’ve become so familiar and comfortable may soon see major changes.

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On Oct. 29, Forstall stepped down from his position after criticism of the latest Apple Maps snafu. Enraged by the loss of the ever-popular Google Maps, customers were not impressed with what they deemed a rushed release. Taking his place is the design genius and iPhone father Jonathan Ive.

A skeuomorph is “an ornament or design representing a utensil or implement” which can be about anything. Take for example the hover effect on Google Chrome tabs, or the raised buttons when hovering over the navbar of most websites. These effects simulate real-world interactions, functions that make sense in the physical world and only lend to aesthetics in the digital realm.

For years Ive had decried the use of skeumorphisms, saying that design is simple and minimalistic (see: iPhone, iPad, iPod, Macbook). Now that he will head the department that oversees iOS development while continuing his role as Apple’s Industrial Design chief, major changes in interface design are surely forthcoming.

Will you miss these wooden/leathery contrivances? Let us know in the comments.

Homepage photo courtesy iStockphoto, Tolimir.

This story originally published on Mashable here.

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Colin Firth, Michael Fassbender set for A. Scott Berg adaptation ‘Genius’

LOS ANGELES (TheWrap.com) – Colin Firth and Michael Fassbender will star in “Genius,” directed by Michael Grandage, with Film Nation handling international sales, the company announced on Thursday.

Based on A. Scott Berg‘s biography “Max Perkins: Editor of Genius,” the tells the story of the relationship between Thomas Wolfe (Fassbender) and editor Max Perkins (Firth), the screenplay is written by John Logan.

“Genius” will be produced by James Bierman for the Michael Grandage Company, launched at the end of 2011 by Grandage, the former artistic director of London’s Donmar Warehouse. Bierman served as executive producer at Donmar and co-formed MGC with Grandage. MGC is producing Logan’s new play, “Peter and Alice,” to be directed by Grandage, as part of a season of plays in London in Spring 2013.

FilmNation is selling the film at the AFM. CAA will arrange the financing and represent the film’s North American distribution rights. Principal photography is scheduled to start early in 2014.

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Nurses Who Saved NICU Babies Remember Harrowing Hurricane Night

Nurses at the Neonatal Intensive Care Unit at New York University’s Langone Medical Center have challenging jobs, even in the best of times. Their patients are babies, some weighing as little as 2 pounds, who require constant and careful care as they struggle to stay alive.

On Monday night, as superstorm Sandy bore down on Manhattan, the nurses’ jobs took on a whole new sense of urgency as failing power forced the hospital’s patients, including the NICU nurses’ tiny charges, to evacuate.

“20/20″ recently reunited seven of those nurses: Claudia Roman, Nicola Zanzotta-Tagle, Margot Condon, Sandra Kyong Bradbury, Beth Largey, Annie Irace and Menchu Sanchez. They described how they managed to do their jobs – and save the most vulnerable of lives – under near-impossible circumstances.

On Monday night, as Sandy’s wind and rain buffeted the hospital’s windows, the nurses were preparing for a shift change and the day nurses had begun to brief the night shift nurses. Suddenly, the hospital was plunged into darkness. The respirators and monitors keeping the infants alive all went silent.

For one brief moment, everyone froze. Then the alarms began to ring as backup batteries kicked in. But the coast wasn’t clear – the nurses were soon horrified to learn that the hospital’s generator had failed, and that the East River had risen to start flooding the hospital.

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“Everybody ran to a patient to make sure that the babies were fine,” Nicola Zanzotto-Tagle recalled. “If you had your phone with a flashlight on the phone, you held it right over the baby.”

For now, the four most critical patients – infants that couldn’t breathe on their own – were being supplied oxygen by battery-powered respirators, but the clock was ticking. They had, at most, just four hours before the machines were at risk of failing.

Annie Irache tended to the most critical baby — he had had abdominal surgery just the day before – as an evacuation of 20 NICU babies began.

“[He] was on medications to keep up his blood pressure,” Irache said, “and he also had a cardiac defect, so he was our first baby to go.”

One by one, each tiny infant, swaddled in blankets and a heating pad, cradled by one nurse and surrounded by at least five others, was carried down nine flights of stairs. Security guards and secretaries pitched in, lighting the way with flashlights and cell phones.

The procession moved slowly. As nurses took their careful steps, they carefully squeezed bags of oxygen into the babies’ lungs.

“We literally synchronized our steps going down nine flights,” Zanzotto-Tagle said. “I would say ‘Step, step, step.”

With their adrenaline pumping, the nurses said, it was imperative that they stay focused.

“We’re not usually bagging a baby down a stairwell … n the dark,” said Claudia Roman. “I was most worried about, ‘Let me not trip on this staircase as I’m carrying someone’s precious child, because that would be unforgivable.”

When the medical staff and the 20 babies emerged, a line of ambulances was waiting. A video of Margot Condon cradling a tiny baby as she rode a gurney struck a chord worldwide. But Condon said she had a singular goal.

“I was making sure the tube was in place, that the baby was pink,” she said. “I was not taking my eyes off that baby or that tube.”

Like other nurses, she did not feel panic. Her precious patient helped keep her calm.

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