Last week I pulled into a self-service gas station for fuel. I put the gas nozzle in the tank and began filling the tank. I wanted a cup of coffee, so I used the hands-free gadget on the nozzle. I drank coffee; the car drank gas. I paid for the coffee and the gas with a credit card, got in my car and began to drive home. Crunch! I stopped the car after moving about 10 feet, looked in the rear view mirror and, to my horror, saw gas spewing all over the place from the top of the gas pump. Exiting my car about the time the gas geyser automatically shut down, I could see ten feet of gasoline hose lying on the pavement like a Valium-drugged anaconda. The hose snaked its way up the side of my car with the nozzle still firmly lodged in my car’s gas tank opening. I had forgotten to remove the hose before leaving the station. That was not too bright. Demonstrating my true genius, I removed the gasoline pump handle from the car and walked up to the payment window dragging behind the associated 10-foot hose that had been amputated from the pump station. I tapped on the window with the handle and pointed to the pump. “Sorry about this; I think I have created a problem,” I said. The startled clerk was speechless long enough for me to read her thought: “Sir that is the dumbest thing I have ever seen. You know what you can do with that hose now!” I offered to pay for the damages, but she much preferred that I quickly depart before bringing down the whole place like a Blues Brothers’ trip to Chicago. As I wheeled sheepishly into traffic, I caught a final glimpse of the decapitated pump, its dead nose lying in a pool of spent gasoline, and its useless handle pressed against the glass. Dumb things can happen when you fill the tank with fuel.

In medicine, blood transfusions fill the body’s 13-gallon vascular fuel tank. Giving a patient a blood transfusion is not as smart as we once thought. Every year 3 million folks receive about 11 million units of blood. Over the past decades, the risks of viral infections (HIV, Hepatitis A, B, and C) have fallen to miniscule levels due to advances in blood testing. However, the risks of bacterial infections, transfusion reactions due to administrative errors (giving the wrong blood) and now recognized important adverse effects on the immune system, have led the medical community to a much more conservative approach when considering transfusions.

Physicians record a reduced blood volume or anemia in terms of the oxygen-carrying hemoglobin concentration and have historically sought to keep the hemoglobin level in the blood stream above 10 grams per 100 cc of blood. Recent transfusion research reveals that hospital mortality, hospital-acquired infections, and cancer recurrence risks are improved by restricting transfusions to patients with hemoglobin concentrations below the level of 8 grams rather than 10 grams. This change would reduce total transfusions by 52% and improve health care outcomes. Prior strategies for transfusion that include storing one’s blood for use in subsequent elective surgery have not reduced total transfusion risks. New guidelines from the National Institutes of Health recommend the more restrictive hemoglobin level for transfusion as the smartest decision for patient care.

As far as the smartest way for me to fill my car’s gas tank, my wife has given me a list of the full service stations in the area. That’s brilliant.