Author Archives

by

Cats Cause Suicide

Cats cause suicide. Surprised? I was. I always believed the sneaky, furry creatures were more apt to creep onto my face at night and smother me rather than drive me to suicide. This accounts for my scrupulous sobriety any time cats are in my vicinity. I can tell they’re plotting and waiting for someone to get drunk enough to pass out, rendering the victim incapable of responding when the cat-like smothering starts. But suicide?

And using an iPad at night can cause depression. Damn. I thought not having an iPad caused depression or, at the very least, envy.  My friends with iPads always act so happy.  Now I have to consider the joy of owning one may be the public face they’re showing while inside they’re crying.

In Britain, over 500 breast cancer deaths a year are believed to be caused by working the night shift. I worked the night shift for several years. I knew I was at risk for weight gain and insomnia, but no one explained the breast cancer connection. As more companies hire overnight workers, isn’t this a public health concern we should forcefully battle? Particularly as there are professions that demand night work such as police officers, fire fighters, air traffic controllers, flight attendants and hospital employees. Should we ban women from working those hours?

It seems every time I read the health section of a newspaper I find another unexpected and sometimes unavoidable risk factor for a disease I don’t currently have, but may get.  How worried should we be?

Well sexy headlines, like “cats cause suicide,” serve a purpose far greater than alerting the public to a potential problem. Consider that there were no health advisories after the cat-suicide connection research was published to have people with cats checked for evidence of T. gondii, the parasite allegedly responsible for the suicidal behavior. There was no public outcry to ban cats. Instead the researchers cautioned that there were limitations to the study, a larger population needed to be examined, and, even if a direct connection  was found, there were no drugs to treat T. gondii. The study recommendations were to practice hand hygiene and food safety, making prevention options for suicide in cat owners the same as prevention options for food poisoning. Helpful.

What did the headlines and publicity actually accomplish? Generate interest in further research.  Conducting research is expensive. Dollars for research face stiff competition. Sexy headlines attract focus which attract dollars.  Sort of like when a celebrity gets a disease and starts a foundation. Suddenly everyone is lining up to get involved.

Research is good, but attaching it to a controversial or provocative headline may be more about drumming up donors and discussion and less about conclusive results which can improve our health.  Being overly concerned about every newspaper story or article that comes along warning of early research findings that may harm our health is harmful to our health.

If we’re going to believe the headlines, let’s focus on the happy ones. Red wine, chocolate and sex all have reported health benefits. Enjoy those in moderation (and then you won’t have to worry about death by cat suffocation either).

by

Will you still need me, will you still feed me when I’m seventy-four?

When my daughter was younger, she said she loved me so much that when I was old she’d get a wheelchair and push me wherever I wanted to go. Her sister said she’d push me off a cliff. I was in my early thirties when this conversation took place and since then I’ve wondered who will take care of me if I become old and infirm.

As part of my nursing education, I spent a fair amount of time in nursing homes. Afterwards, as a new nurse, I worked in hospitals. Both of these experiences convinced me that the majority of the elderly were frail, sickly, and unable to live on their own. It depressed me.

In the nursing home, the patients with dementia were the most labor intensive. One birdlike woman practically lived at the nurse’s station. She’d yell to each passing staff member or visitor, “Hey, lady. Hey, lady. Get me out of here. I have to go home.” Her idea of home was the home of her childhood and she’d often continue with, “my father will be mad at me. I’m late. Get me out of here.”  Sometimes I’d want to loosen her restraint and take her to this home that was still alive in her memory. Other times I’d sneak around so she couldn’t see me and ask me to help her. What I remember most is that no one ever visited her.

In the hospital, dying patients needed the most resources. Mouth care, turning and positioning, constantly assessing their level of comfort and providing medication were all involved in “aggressive comfort care”  as opposed to “comfort care only.” We knew we were fighting a losing battle, yet wanted to be proactive in preventing further complications and keeping the patient pain free. Sometimes family members would stand vigil, many times the nurses were the only silent witnesses to the winding down of a life.

It wasn’t until I worked in outpatient care that I realized many older patients were self-sufficient, active in their communities, and living at home without assistance. They didn’t need the services of a nursing home and, if they were lucky, the end of their lives happened in their home rather than in a hospital or ambulance. It gave me hope.

As my parents inch past seventy-five, I’ve also realized how many of the elderly live in their own homes and struggle to maintain their dignity while dealing with limited resources. There comes a time when you realize mom or dad isn’t able to manage their own life as they once were. I think that realization, for most children, is slow in coming and it takes even more time before the children try to step in and help.

Why is that? I think on some level we’re ashamed to acknowledge our parent’s physical problems. Intellectually, I understand that the elderly have a decreased sense of smell, touch, vision, hearing and taste. They may not notice the smell of spoiled meat, not see the stains on the dishes they’ve washed, not be aware of the loudness of the television while they’re talking on the phone, and eat the same food day in and day out. Their mobility is limited due to  loss of muscle, disuse, and degenerative diseases like arthritis. Their bowels don’t function as regularly as before. Their skin is easily damaged and slow to repair.

And most of us are busy, damn it. We have children graduating from college or getting married or having their own babies while we try to pay off parent PLUS loans, boost our 401k’s,  keep our marriages or relationships strong and maybe even find time to fulfill our own dreams. All this is going on while our parents start a slow decline and insist they can take care of themselves. They don’t want to be a bother.

So where do we put our time and effort? Into the problems we can fix. Babysitting grandchildren, advancing our careers, spending romantic time with our significant others, doing the things we always meant to do that we now have the time for. And the more our parents say they’re fine, we shouldn’t bother,  it’s no big deal, the easier it is for us to defer to their fine judgement and leave them to their own devices. I mean, really, they’re our parents.

Until the day we go over to their house and realize that they aren’t doing okay. They need our help. All of the things they did for us and taught us to do for ourselves have come full circle. They need help to wash themselves up and keep themselves clean. They need someone to monitor their meals and make sure they’re eating enough high quality food. They need someone to dry them off and look for signs of skin breakdown and intervene early. They need someone to clean their house, check the outdates on their food, and drive them to appointments. Much as they helped us to transition from dependent child to independent adult, we must now support them as they transition from independent adult to dependent parent. It’s not fun.

And for me, and I feel shame as I write this but I suspect others feel as I do, it is hard. It is hard to remind a parent to shower, to go to the bathroom, to wear a depends pad, to take their medications. It is hard because we now become the parents of the person who parented us. It is hard because we know deep down inside that our parents would never want us to see them as weak and in need of help so we must thrust ourselves into their lives and do it matter of factly and decisively. And we must somehow reconcile the parent of our minds, the strong, vibrant, healthy person we remember, with the person they have become from no fault of their own other than the passing of the years. And then we must love them and help them, all the while protecting their dignity and sense of self.

It’s a damn hard dance to do.

But still, I see adult children who do it every day. They stand by their mothers and fathers in the most intimate and embarrassing situations with a grace that doesn’t come from socioeconomic status or education. It doesn’t come from religious guilt or dreams of inheritance. It doesn’t come from a sense of obligation or duty or even payback. It comes from love.

And every time I see an adult child performing the most personal care for their parents with a smile and the attitude that it’s not a big deal, I am humbled. The question isn’t who will take care of us when we age, it is how we can do the right thing for the people who have done so much for us

Pat, August 20, 2011 - Curb

Pat, August 20, 2011 – Curb (Photo credit: pat00139)

.

 

Related articles
by

The Best Time to Get Drugs

If you’re a woman, the best time to get drugs (best defined as that which is the most excellent, outstanding, or desirable)  is, if you’re so inclined during childbirth. Really. When you’re having a baby.

Why you say? Because, in popular opinion, childbirth is incredibly painful. So painful that men, unable to compete in this pain category, equate kidney stones (universally acknowledged to be super painful) to the pain of labor. What do they give you for a kidney stone? Pain pills. What can you get while in labor? An epidural. The power of the epidural is well-known. Many woman ask for it by name, to the point where movies and tv shows have an obligatory scene where the laboring woman asks “is it time for my epidural yet?” as if that is the purpose of labor.

I will digress. Why do men have to equate kidney stones with childbirth as if it is some sort of contest?  When I look at medical technology, I see much care and diligence in ensuring the male healthcare experience is kept as pain-free as possible. The big indignity men suffer is the turn and cough (while pressure is applied to the scrotum) and the finger wave (in the rectum). By contrast, woman must endure a mammogram, which involves flattening the breast tissue  between two plates, and a pelvic exam, which includes the insertion of a  speculum, a metal instrument that looks like a duck’s beak).

English: Mammography in process: Shown is a dr...

Speculum Spectacle

Speculum Spectacle (Photo credit: cote)

Wow. Seems like men might want to compete with some of that pain. Perhaps testicular cancer screening via mammography technology? Let’s see men undergo a yearly squeezing of their testicles until flat. And finger wave? Perhaps the doctor really needs a speculum to get a good look at the prostate. It’s not that I want to see more pain in the world. I only wonder why men seem to get off easier. Is it only coincidence that men dominate the medical field and male-centered interventions seem kinder and gentler?

But back to epidurals. As a nurse who once worked in childbirth, I found my patients divided on the subject of epidurals or other drugs in labor. There were the “give it often and early” adherents and the “ignore my screams of pain because I’m having this baby naturally” proponents. Me? Hey, I tried natural childbirth through back labor, slow progression, and the eventual discovery that my 10 pound kid wouldn’t fit through the birth canal. By the time the decision was made that only a c-section would remove her, I wanted to be put out like a junkie wants another fix.  Fell in love with the anesthesiologist the second he put the mask over my face and told me in a few seconds I’d be asleep. Anesthesia is my favorite memory of that experience.

But some woman outright reject drugs for childbirth. They become fixated on the idea that the only “right” way to have a baby is without medication. They want to work through the pain, even though too much pain can slow down labor.  And, it’s not like anyone is keeping track of who had pain meds and who didn’t. (Well, we did, but only for statistical purposes. We had no access to our patient’s permanent record to add this information.)

And thought it might be a worthy and noble ideal to have a drug-free childbirth, taking something to help doesn’t make you weak or less of a mother. It makes you a normal human being.  Much better to fall back against the pillows, a happy smile on your face, and able to relax between contractions than to be bolt upright, red-faced, and screaming like a foul-mouthed harpy. I’m not advocating an epidural for everyone, but it’s strange how women  enter the labor process determined to turn down drugs no matter how bad things get. Why not see how things go and cut yourself some slack. If you need help, ask.Never having had a kidney stone, I don’t know if the pain is equivalent to labor pain. What I do suspect is that if men underwent childbirth, there wouldn’t be a big discussion about whether pain medications were appropriate or not.  They’d take them if it was painful, refuse them if it wasn’t, and not bother to assign a value to the act. Why didn’t we think of that?

 

by

Pre-Election Thoughts on Healthcare

Back of an Ambulance

Back of an Ambulance (Photo credit: Wikipedia)

Last summer, a member of my family with a chronic disease had an acute worsening in their condition that almost led to their death. My sister calls it a miracle because it is only by chance that we discovered the condition, administered first aid, and got my loved one to the hospital. Not a day goes by that I don’t thank God and guardian angels for the decision to check on this person. Not a day goes by that I don’t think about what my life would be like if they had died rather than lived.  I find myself still feeling thankful that I didn’t have to plan a funeral. It was the most terrifying, out of control, awful thing I’ve ever experienced and I would not wish the situation on anyone. It devastated my family.

Sometimes, in the wee, quiet hours of the night when I can’t sleep and my mind jumps back to that day, I remember how, at every step of the way, the medical and nursing staff assured me that because we had “good” insurance, we had lots of options. We were lucky, they said, even though it’s hard to consider yourself lucky when you’re standing beside an Emergency Room bed hoping someone will live. At that moment I would have paid any price to save them. Mortgaged my house, cashed out my retirement, pawned every last bit of jewelry, sold my soul. I would have done all of those and more. But I had good insurance and that gave us options. I had good insurance because of Obamacare.

Other families have not been as lucky.

Michelle Morse, a full time college student at Plymouth State University was diagnosed with colon cancer in 2004. Unfortunately, in order to remain on her parent’s health insurance, she had to continue at school full time while undergoing her cancer treatment, that or lose her health coverage or pay for her insurance at the higher COBRA rate.  She didn’t have the option of taking time off for cancer treatment.  Since her death “Michelle’s Law,” signed by President Bush in October 2008 has afforded college students with serious illnesses up to 12 months of medical leave without the risk of losing their health insurance.

In 2007, 12-year-old Deamonte Driver,  died from an untreated tooth infection that spread to his brain.  He had Medicaid insurance, but his mother couldn’t find any dentist willing to treat Medicaid patients.  Instead she took him to an Emergency Room, where he was treated with antibiotics and pain medications, and sent home.  Unfortunately the infection in his tooth had spread to his brain and his next trip to the Emergency Room was his last.

It doesn’t take long to find there are plenty of people without options. People who everyday watch their loved ones suffer and die because they don’t have access to healthcare or because they can only get healthcare if they meet certain conditions. But, I was lucky. My family had options.

We didn’t have to worry about the $900.00 ambulance ride. We didn’t think twice about the $3,224.50 Emergency Room stay, the $27,931.11 inpatient hospitalization, or the $5,100.00 and counting outpatient fees. We had good insurance. We had options.

Thanks to Obamacare, many families now have options.  Among other needed changes, the bill prohibited insurance companies from discriminating against people with pre-existing conditions and it allowed young adults up to age 26 to stay on their parent’s policies.

And trust me when I say that having “good” insurance gives you options.  One of them is not having to plan a funeral.  And no matter the outcome of the election, I hope that our country can rally behind the idea that all Americans deserve and should have access to “good”  healthcare insurance.  Too many of our fellow citizens have died from lack of it.

English: President Barack Obama's signature on...

English: President Barack Obama’s signature on the health insurance reform bill at the White House, March 23, 2010. The President signed the bill with 22 different pens. (Photo credit: Wikipedia)

Related articles
by

You’ve Reached Big Patty’s Sex Toy Emporium

English: This is an example of the angst cause...

English: This is an example of the angst caused by the use of a telephone. (Photo credit: Wikipedia)

 

I love to vote, but I hate election time. Being a resident of New Hampshire, the “first in the nation primary,” brings with it a lot of extra, unwanted attention. Most of it in the form of phone calls and junk mail. Starting at 8 am most days, the phone starts ringing with surveys, research calls, and robocalls telling me why I should vote for a candidate because their opponent is an awful, evil person.

 

It makes you want to give up your phone.

 

You’re not even protected by the Do Not Call registry.  One political research marketer said he’d love to put me on their do not call list, but couldn’t because it would violate federal law. Now, the Do Not Call registry states “Because of limitations in the jurisdiction of the FTC and FCC, calls from or on behalf of political organizations, charities, and telephone surveyors would still be permitted,” but really? It’s a violation of federal law to take me out of your databank?

 

Thanks FTC and FCC.

 

In frustration, I finally decided to have fun with the phone calls and callers. I started off simply. Whenever the phone rang and I didn’t recognize the caller ID, I’d pick up the phone and yell “Go!”  Then I’d say absolutely nothing. A few times an apologetic voice would try to identify themselves, but most people would hang up.

 

When that got boring, I decided to answer with, “Who you betting on?” I tried to make my voice a raspy snarl. Again, mostly hang ups, but one brave soul started to do her pitch until I interrupted her to say, “This is a bookmaking line, dummy. You’re costing me money.”  Click.

 

When that got old I switched to the psychic hot line. Mainly because I thought it would be fun, and maybe I’d make a few extra bucks. “You’ve reached the Psychic Hotline,” I’d intone. “Please press 1 for Visa, 2 for Mastercard, and 3 for American Express.” Again, a few attempts at conversation, but mostly hang ups. I also noticed the calls were slowing down. Could the political telemarketers  have some sort of secret communication system I wasn’t aware of? I decided to bring out the big guns.

 

“Big Patty’s Sex Toy Emporium,” I’d answer the phone in a cheerful, peppy voice,  “because bigger is better. How may I direct your call?” This met with silence and the occasional giggle. I think it was because the image of Big Patty, I’m thinking a redheaded six footer who ropes calves in her spare time and has a sexy rodeo outfit, stopped people dead in their tracks. I experimented with different tag lines. “No hole to0 large,” seemed unnecessarily sexual. “We guarantee our toys have never been used,” seemed too obvious.  Before I could perfect my pitch, the phone calls dried up.

 

From a high of approximately 15 nuisance calls a day, my phone now is quiet. Today, for instance, no political calls at all. I am grateful for the silence, but a little sad in that I didn’t get a chance to fine tune Big Patty into a robocall stopping machine.

 

I guess she’ll stay silent until 2016. Until then, if you want to reach me, I’ll be at Big Patty’s Sex Toy Emporium.

 

Related articles

 

 

by

Let’s Call A Dick A Dick

English: "No Swearing" sign along At...

English: “No Swearing” sign along Atlantic Avenue in Virginia Beach, Virginia. (Photo credit: Wikipedia)

For me, fall is a time of reflection and contemplation. I don’t know why fall has such an effect on me, but nine out of twelve job changes have occurred during the fall. While dusting off my resume recently, I looked back and thought about how lucky I am that I can count the number of disruptive physicians I’ve worked with on one hand.

Disruptive physician is code for doctors who are dicks. Whether it’s the surgeon who picked up a nurse manager and put her down in a sink or the neurosurgeon who had to be removed from the Operating Room by the police after flipping out when his request to use unsterilized instruments on a patient was ignored. Some doctors believe they can act in ways that would get them punched or arrested in the real world, but in the hospital, they can do no wrong.

The problem is so pervasive that in 2009  The Joint Commission, a voluntary accreditation agency for hospitals, started requiring hospitals to have standards in place and procedures to deal with disruptive behavior, including physician disruptive behavior.

Unfortunately, some physicians believe there is an ulterior motive to disruptive behavior policies. In 2008  American Medical News.com has these two quotes:

“If somebody’s not a ‘team player,’ individuals will try to remove them from the team, and the disruptive physician policy is one mechanism by which that can be done,” said Dr. Gregory, a general surgeon and trustee at the Muskogee Regional Medical Center in Oklahoma

Interesting perspective. I’ve just never worked in a hospital that targets well-mannered, kind, respectful physicians who aren’t team players.  Oh, unless not being a team player is a code word for a doctor who’s a dick.

During my nursing career, I’ve had a surgeon approach me in the nurse’s station and loudly yell that it was my job to fill out the preoperative consent and, when I refused, accused me of doing it for the other surgeon.  He thought the nurses played favorites.  Luckily that was at a hospital where our policy was to laugh at dicks in person and hang up on them when they called. Really.

I’ve also had a specialist scream at me in a hallway because no one told him I would be observing in the clinic he worked in that day. He (not the owner of the clinic, just another hospital employee) didn’t think anyone should be allowed in the clinic without his permission. Every time I tried to (politely) interrupt, he yelled louder until I walked away.

Did these doctors suffer any ill consequences from their dickish actions? No. Most hospitals will forgive physicians who bring in business. Sort of like your top used car salesman. If he sexually harasses the secretary, do you really want to lose him to keep her?

Instead of trying to get rid of disruptive physicians, most hospital administrators would rather keep the doctor. Even when there are multiple complaints. Even in the face of staff turnover. Even when patients get hurt because of the doctor’s behavior.

When doctors whine, yell, threaten and bully other healthcare workers with questions or concerns, those questions and concerns are going to dry up. Pretty soon no one’s going to be calling them in the middle of the night to deal with a rapidly deteriorating patient because no one wants to take the verbal abuse. Rapid response teams were formulated because too many patients died while physicians blew off concerned hospital staff and family members.  That’s why in a hospital with three wrong side brain surgeries, no neurosurgeons lost their jobs. Instead the nurses were told not to give the scalpel to the surgeon until he verified he was on the right side or the nurse would be punished. When that didn’t work, they hired staff to go into operating rooms and monitor that doctors were properly identifying the correct side.

There is a price to be paid for healthcare’s refusal to address the problem of disruptive physician behavior and the price is paid every day by patients as well as by the people who leave healthcare careers. I think that calling the problem what it is might be a step in the right direction.

Let’s call a dick a dick.