July, 2009 Archive

July 22, 2009, 7:35 pm

Under Pressure

menopauseI’m sure some women have issues during menopause, but Benzedrine?

Apathy? Psychomotor retardation?

Sounds like me after four night shifts in a row.

And I thought all I’d have to worry about are hot flashes…or in the current PC vernacular, power surges.

Puberty isn’t treated like a disease, but apparently menopause was looked upon as a psychosis! Was it ever listed in the DSM?

Were all the women of the 1950s hyped up on bennies?

OMG – read the fine print – they actually talk about using Benzedrine with electric shock therapy.

Whoa.

We most certainly have come a long way, baby!

********************

Sometimes I think I’m my own worst enemy.

I feel guilty for being angry at a patient’s behavior, shocked by an intensity of rage that is way out of proportion to what they have done.

After all, it isn’t personal; their behavior is a component of their disease.

Or so I tell myself one month (and one post) after the fact.

*****

I feel guilty for tearing up as a patient miscarries.

A week later she would have been far enough along to go to L&D.

The sadness stays with me the entire shift and I cry as I turn out of the parking lot that morning.

I kick myself for not being able to detach; am I not a professional?

*****

I feel guilty for being on edge with co-workers.

Who are only being themselves, but my perception is that of  too much, too loud and too intrusive.

God only knows how I am coming across to them.

*****

When did I become a walking raw nerve?

This isn’t burnout.

When you are burnt out you are apathetic.

I’m almost the opposite of apathetic; everything is very, very acute.

All I know is that this isn’t me.

And I don’t like it.

*****

And I feel guilty for feeling this way.

Why is it so easy to cut other people some slack,

And virtually impossible to do the same for myself?

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July 21, 2009, 11:30 am

Started Out Clean, But I’m Jaded

didnothearcallDoctor Ratched: “Nurse! I’m appalled! This woman has waited five minutes for her ice chips!”

Nurse: “Oh my, how could I be so irresponsible! I should have predicted her dry tongue, left my seizing pediatric patient and run to meet her need for moisture!”

Doctor Ratched: “Well there goes our Press-Ganey scores for the entire month. I hope you are satisfied, Nurse!”

Nurse: “I’m so ashamed!”

Not.

But hey! Don’t let this happen to you!

With the Edwards Nurses Call System you know when a patient needs ice chips!

And look….one hand!

What will they think of next…answering call lights through a speaker in the wall?

********************

Last call for submissions for this week’s Change of Shift to be hosted at Nurse in Australia. Ross is awaiting your submissions at “admin at nurseinaustralia dot com”.

Shhhh! Something is afoot over at Doc Gurley’s blog where Grand Rounds is surrounded by mystery, intrigue, foggy London nights, Peter Lorre running through the posts…..okay, not that last one, but if you are up for a good suspense-filled read, this is where you need to be!

*****

You showed up to the ER.

You presented your case.

You got your narcs.

Good ones, too. Nice, big, fat dosage for the 50/10 pain you calmly reported.

I served it up with a smile next to a side of compassion.

After all, pain is what you say it is and we are there to meet your needs.

Patient satisfaction – we are all over it!

*****

Wait a minute……

What?

You don’t have someone who can come and pick you up?  How did you get here? Oh, your Aunt dropped you off? Why don’t you….oh, she doesn’t carry a cell phone? Huh. That does pose a problem!

No, I’m sorry, I can’t have you walking out of here in the dead of night to the bus station after an injection of that magnitude. It isn’t safe. Why, look! Your sister’s number is right on the chart and she lives right here in this area! Oh…she isn’t picking up the phone at this hour?

Let me go try and see if I can get through for you.

(How odd, as I am walking to the nursing station to make that call, I hear the dialing of the room phone and I hear you say something in a very low voice. I walk back in to see if you had reached someone. No, no, no one is picking up at Auntie’s place. It just rings and rings, you say.)

Funny, when I try the number it’s a solid busy signal. For ten minutes. At three am.

*****

Gosh, I’m really confused!

You see, the ER security tape shows you walking up to the ER alone all the way from the street! Ah, I see that you reply with a shoulder shrug. Interesting. I’m sorry, we don’t have taxi vouchers in the ER. Oh, you have money at your Aunt’s house? Uncle George will have it, you are sure of it? And you want us to call a taxi for you? Well, that’s fine then!

Happy to make that call for you!

*****

Wow – never stiff a taxi driver who has traveled thirty miles to pick you up.  Jumping out of the taxi as they round the building really makes them mad!  And they want us to know that you said you had no intention of paying anything and that you had your car down on the street.

Holy cow! That means you will be driving under the influence of a narcotic! We try to find you, after all, your safety is our responsibility! You made it off the premises so fast you were long gone before we made it to the end of the driveway!

*****

That’s it.

No more.

I can’t play anymore.

I am nothing but a legal pusher of narcotics to addicts who know we know that they know we know….it never ends.

Emergency departments hand it out like candy. We invite this behavior. We abet this behavior. We will give you what you want, when you want it and how you want it even when we know it is bogus!

Why? Because it gets the addict out of the department faster? It’s less hassle to give them what they want? No one wants to confront and say “sorry, but this behavior looks like drug seeking to us”?

It does no good to confront after the fact. The narcotic is given, the fix is in, yadda, yadda, yadda. They scored again.

And they will be back, believe it or not. Even when we confront them with previous alterations in prescriptions, tell them we have personally witnessed them driving away in their vehicles, let them know that taxi drivers will rat them out every time…it makes no difference. And soon it is known all around the area that if you want it, you will get it at Hospital Hotel.

And before I’m accused of being elitist, not knowing the “true face” of addiction, having no compassion, riding my high horse or being a bitch, let me assure you that addicts come in all shapes, sizes, colors, genders, occupations, income levels, hair colors and ages.  None of that matters. They will lie, manipulate and ingratiate to get what they want.

So, please tell me.

When will somebody grow a pair and stop this insanity?

****************************************

Narcotics in the ER is a hot topic that always engenders a hot debate. I have to give a hat tip to girlvet at Madness: Tales of an Emergency Room Nurse for the idea for this post.

Speaking of hot debates, please keep your comments passionate but polite. Thanks.

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July 19, 2009, 10:01 am

Better Health in D.C.: the Panel, the Politics and the Ce-Ment Pond

RyanPodiumThis is Congressman Paul Ryan of Wisconsin, speaking at the Better Health “Putting Patients First” event  in D.C.

I should talk about how passionately he spoke about health care reform (he did), about why he does not believe government should be running health care (he doesn’t) or that he took the time to come and speak at 8 am even though he had been up until 2 am working on the health care bill (he did) or that he spoke right up until he – literally- had to run back to the House to vote (he did).

And I will talk about these things.

But first, let me state the obvious and get it out of the way so that I can go on to discuss the serious nature of the health care reform debate before us.

Whoa.

Seriously, is it just me or are politicians getting better looking?

There. Now I can move on to the meat of the matter.

(I had to say it because you all know I was thinking it!)

*****

This event marked my first time in Washington, and just being there is awe-inspiring. Seeing the White House from the car window took my breath away, literally. I felt like Ellie May Clampett marveling at the ce-ment pond.  The National Press Club is a museum in and of itself.  Mother Jones and I were hoping we’d catch a glimpse of Sanjay Gupta, but he must have been off doing neurosurgery or something.

*****

By now, you’ve probably read who was on the panel (Dr. Wes, DrRich, Dr.Rob, Dr.Kevin, me, and Better Health contributors Dr. Alan Dappen, Valerie Tinley, NP and “token” – his words, LOL – surgeon Dr. James Herndon).

I will tell you straight up that I learned much more than I contributed.

The panel shot from the hip and spoke from the heart. Some of us had notes, some of us illustrated our comments with anecdotes and one of us (*cough*) had no clue what was going to come out of her mouth until that moment.

I’ll give you a hint….it wasn’t Valerie…..

*****

For the record, those of us on the panel were not told what to say, how to say it or what to believe, nor were we chosen based on what we do believe.  Some discussed concepts that should be taken into account no matter what plan we end up with, others were definitely against a single payer plan run by the government (*raising hand*).

The inefficiencies of national health plans of other countries were illustrated/discussed.  This hit me later: we should look at what works in those plans, not just what is wrong with them.  We don’t have to emulate them, just learn from them, and that includes the good and the bad.  It also applies to any universal form of coverage, not just a government-run plan.

Wish I had said that at the time.

So much for thinking on my feet (or on my butt, as the case may be).

*****

There was some controversy about not having any patient bloggers on the panel.  There should have been. I hope that, as a nurse, I spoke for patients, but it was not the same as having someone there who navigates the system as a patient every single day.

patientbloggers

The patient bloggers were in the audience, though, and if you go to Twitter you can find the live tweeting at “#patientsfirst”. There was a pretty healthy debate going on in the Twitterverse while the panel was up on the dais.

Here I am with Lisa Emrich (Brass and Ivory) and Kerri Morrone Sparling (Six Until Me). Duncan Cross was also there, but my pic was blurry!

*****

While health care reform has been a hot topic for awhile, it was especially acute this week as the President was actively promoting a government run health care system and there seemed to be a huge sense of urgency to get what is called “America’s Affordable Health Choices Act of 2009″ passed ASAP.

The bill is over 1000 pages long.

I just downloaded it.

And Congress has not read it.

Folks, our representatives are being asked to pass legislation they have not had a chance to read.

While I will admit to being a bit unsure of exactly what happens in the Beltway (Civics classes and Schoolhouse Rock’s “I’m Just a Bill” notwithstanding), that can’t possibly be business as usual.

Can it?

*****

I’ll say one thing: no matter what we believe, why we believe it or what our role is in the health care system, it is a conversation rife with strong opinions and passionate debate.

And, in the end, because we are all patients in one form or another at some point in our lives, the conversation is about us.

So, when you hear the phrase “putting patients first”, think of it as “putting me first”.

That may help you get a foothold in the morass of information that is the health care debate.

It worked for me.

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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