March, 2010 Archive

March 31, 2010, 2:07 pm

Lesson Over a Latte

I love these old shots!

This one is from the National Archives and was taken in 1946.

This is what I pictured when I thought about being a nurse. Neat rows of charts; clean, antiseptic wards; med cupboards with glass doors; crisp,white uniforms and totally cool caps!

I can smell the Lysol wafting through the decades…

Reality: clipboards flying, accusations that I hoard the charts, sort-of-clean floors punctuated by splats of body fluids, medications in locked computer systems, wrinkled scrubs that I want to peel off at the front door and not a cap in sight.

Plus, the the unique olfactory assault of ETOH and urine, so specific to the ER…

And no, it is not true that I wear my cap around the house.

I just try it on now and then.


One thing hasn’t changed since 1946 and that’s Grand Rounds! Granted, now they are online and this week Evan Falchek at the See First blog is hosting with a Health Care Reform theme. I was a week too early, my post on health care reform was in Grand Rounds over at Suture for a Living (sneaky way to fit in link that I didn’t put in last week!).

Uh. Hey nurses! There isn’t a single nursing submission in ‘Rounds this week! Are we tired or did we just get lazy? Raise your bandage scissors and repeat after me: “I solemnly swear to submit to Grand Rounds!”


(The story you are about to read is true.)

The day was uncharacteristically warm.

The corner Starbucks was packed with seekers of caffeine. Some rushed out, dashing to their cars with Frappacinos in hand; others stopped to smell the latte, enjoying the warmth of green metallic chairs on the adjacent patio.

The couple selected an empty table. They sipped their beverages as two gentlemen at the adjacent table conversed.

Guy – “First of all, man, don’t tell ’em you got a migraine…hear that all the time….back pain…somethin’…an orthopedic injury, that’s what you tell ’em you got… look up a doctor…you wanna “pain management specialist”, but not around here….next county….memorize it, man…name, address and phone number…you got an appointment but the pain is so damn bad you can’t wait, knowhatimsayin’?”

Dude – “I hear ya.”

Guy – “And you got to tell them that you are allergic to some junk…if you don’t…give you something…worth nothing!”

Dude – “What junk?”

Guy – “s’called Toradol…and you don’t want Motrin either so tell ’em you’re allergic…bad reaction to nausea stuff except fenagren…”

Dude – “Tordal and fengren?”

Guy – “Yeah…don’t lie about your name, address or give ’em fake numbers ‘cuz they can check that real easy.”

Dude – “‘Yeah.”

The Guy and the Dude stood up and prepared to go. As they walked away, voices fading, the couple heard…

Guy – “…won’t let you drive…”voucher” for taxi…don’t forget a prescrip…”


This guy did everything but name a specific hospital to visit!

If I had any doubt before, I am now sure that word gets around on the street regarding which ERs are “easy”.

And which ER will give that shot on the sixth visit in two weeks, despite knowing full well the complaint of pain is bogus.

Because it is just easier to medicate than it is to confront.

Every addict needs a pusher.

Just sayin’.

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March 22, 2010, 12:08 pm

Between the Lines of Fear and Blame…

What a nice picture, yes?

A lot of people went to bed last night with this version of health care in their heads.

Many folks see government as these strong, protective hands.

It’s a nice thought.

Until those hands start to make fists.


I wonder how long it is going take before you have to wait weeks to see your primary care provider. (Wait, we already know, it could be weeks!).

I wonder how long it is going to take for the government to dictate payment to providers? (Wait, they already do!).

I wonder how long it is going to take for the number of primary care providers (MDs and NPs) to move to more lucrative specialties because they can’t live/pay student loans as a PCP? (Wait, they already are!)

I wonder how long it is going to take for the government to limit which medications are reimbursed and which are not? (Wait, they already do!) Or decide which treatments are covered and which are not? (Wait, they already do!)


We all need health care.  It is wrong that someone with a pre-existing condition cannot find coverage. It is a tragedy to have someone lose everything they have because of catastrophic illness. It is frustrating to be stuck in a job solely because of the health benefits. It’s scary to lose those health benefits if you are laid off.

It is wrong that the majority of health disparities are directly related to poverty.

It is wrong that providers pay tens of thousands in malpractice premiums every year. It is wrong that they are reimbursed a fraction of what it costs to care for patients. It is depressing that they must limit their time with patients because they have to see more and more of them to break even. It’s ridiculous that providers need to hire specialists to navigate the morass of insurance regulations.

Our system has issues, no question.


So, will the new health care legislation make for healthier communities by providing jobs, parks, grocery stores, education opportunities  and health care clinics to poverty-stricken neighborhoods?

Will the new health care legislation provide incentives for students to choose primary care as their specialty? Family/General Medicine, Internal Medicine, Pediatrics, Geriatrics? Takes a lot of money and time to become a physician or advance practice nurse. Will the new health care legislation make it worth the effort?

On the other hand, will the new health care legislation make it easier to find a provider? To actually get in to see a provider in days, not weeks?

You see, being covered is worthless if you can’t find a provider to partner with.

Will the new health care legislation provide incentives for health research? If profits are limited, is there still interest in researching medications, treatments? Or on the other side, if funds are limited will there even be any available for research and development?

Will the new health care legislation provide incentives for keeping ourselves healthy? Exercise? Normal weight? Healthy diet? No smoking? Judicious use of alcohol? What if you’re a sedentary, obese, smoker?

Will the new health care legislation see us as the chief focus of the new system, or as cogs in a wheel that must be regulated and controlled?

Health care is already rationed (yes, it is…think about it). Is there anything in the new health care legislation that keeps it from becoming draconian?


I have absolutely no answers.

There has to be a way to have coverage for all, protection for those with chronic illnesses and protection from the financial fall-out of catastrophic injury/illness.

I have a deep feeling of dread in my gut that this is not the way to go.

I pray we are not starting on a road to government bureaucracy that will end with the IRS looking like a lesson in efficiency.

The federal government can make treaties on my behalf and provide for my defense.

I sure as hell don’t want it dictating my health care.

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March 18, 2010, 1:05 pm

C’mon Baby, the Laugh’s On Me

Always looking to promote interdisciplinary communication and understanding, Nurse Anne takes the new residents to lunch.

Sparing no expense, she arranges for cookies and milk to be passed around. First year residents are entitled to Arrowroot cookies; the Girl Scout Thin Mints are strictly for Attending Physicians.

In an awkward moment, she realizes she will have to brief Dr. Ima Tyke on the rules concerning the use of off-road vehicles in the hospital.


Be sure to check out the latest Change of Shift at Nursing Student Chronicles!

Many thanks to Laney for hosting!

The next edition will be the April 1st carnival at Dr. Dean’s The Millionaire Nurse Blog. Submissions can be sent to “kdbgyn at bellsouth dot com”


It’s spring break and no assignments are due until next week.

My application to my PhD program is safely submitted and the results should be announced next month.

I had about three weeks to submit the application from the time they were available to the time they were due.

Three weeks of hell.


I had to write essays!

Long, long essays. Two of them were to be no more than 4000 words. Three of them were to be no more than 2000 words.

Oh. My. God.

Now, I love to write, but this was for my future! What I wrote in these essays would determine the trajectory of the next four years of my life and beyond! They had to be perfect. They had to be flawless. They had to be….


I want this so badly, it isn’t even funny.

I immediately contracted a full blown case of writer’s block.


I couldn’t put two words together if my life depended on it.

And it did!

It was like a fecal impaction of the brain; every thing I wrote was…well, you get the picture.

The world revolved around my (lack of) writing.

Co-workers picked up shifts for me or changed their schedule to help me find the time to write, and ignored the low-pitched growl from my end of the nursing station when a patient dared interrupt my creativity. It’s just rude to have gastroenteritis when I am trying to work here!

My husband tried to talk to me, but I’m not sure what he said. I think his birthday was last week. I remember snarling a couple of times when he asked if he could check his email on the computer.

I would have bubbles of inspiration only to have them burst before I could get to the keyboard.

That I slept with.


Those of you who own stock in GlaxoSmithKline may have made a profit this month. I went through three Costco-sized bottles of Tums. In addition to my Protonix.

I self-medicated with other things, too. Oh, I admit it: Starbucks came out with Dark Cherry Mochas – surely this would provide me the catalyst I needed to write what was looming in front of me as The Great American Nursing Novel!

It just gave me transient hyperglycemia.

But the day of submission had dawned. Do or do not, there is no try.

(Did I mention I had auditory hallucinations of Yoda?)

I would stay up all day. I would take these hollow shells of literary effort and turn them into essays never before seen in the halls of academia.

It was time.


I went to Starbucks.

Dark Cherry Mocha in hand, I wrote until my fingers were numb from slamming the keyboard. I poured out my heart, my soul, my passion for nursing and my yearning for higher education.

Hmmm, not bad, actually.

I went to cut and paste one of the essays into the appropriate area on the application.

It didn’t work.

Only the first five paragraphs showed up. I erased it. I tried again.

It didn’t work!

Oh. My. God.


Surely, I misread the instructions. Surely, I was supposed to upload the entire thing somewhere. Surely, I was doing something wrong!

Oh no. Not now!

And then I saw it.

Everything I had read up until that point had said “essays of no more than 4000 words” “List your research interests in no more than 2000 words”.


Except that’s not what it said.

It said “no more than 4000 characters“!!!!!!

Including spaces.

Oh. My. God.


I had written “Les Miserables” when all they wanted was “Green Eggs and Ham”. “Gone With the Wind” when all that was required was the book jacket description.

I spit my Dark Cherry Mocha all over the monitor.

I picked what was left of my stomach up off the floor.

And started to laugh.



So, my application for a doctoral education in nursing consists of sections of my massive opus being cut-and-pasted into the appropriate sections.

I have no perspective on how it looks or how it will come across to those deciding on who will be admitted to those coveted spots.

It’s out of my hands.

All I can do is wait until April and pray that somehow, somewhere in that application they see a qualified PhD student.

In the meantime, I could really use a Dark Cherry Mocha.



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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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