Can You Hear Me Now?

Vaseline Glass Bowl-Hat

Vaseline Glass Bowl-Hat (Photo credit: Paul Garland)

When I was younger, I thought wearing glasses was the biggest humiliation I would have to suffer. Without glasses I can’t see the computer screen I’m sitting in front of, but glasses have a downside. In cold New England a walk from the chilly outside to toasty inside results in a thick layer of condensation that renders glasses wearers temporarily blind. In the summer, going from air conditioning to humidity does the same thing. Aquatic endeavors require a decision to either see what’s going on (my preference in a lake) or swim blind (my preference in the ocean. I believe if I don’t see the shark, it won’t see me).

PhotonQ-Under the Shark

PhotonQ-Under the Shark (Photo credit: PhOtOnQuAnTiQuE)

I’ve made my peace with wearing glasses, but now I’m confronted by a problem many of my fellow baby boomers are also facing,  hearing loss. Yes, we didn’t wear helmets when we biked/skied/played sports and we didn’t wear hearing protection when we shot guns, listened to our Walkmans at full blast, or spent time in noisy environments. Our youthful ignorance of the damage caused by loud noises has led to an explosion in the number of baby boomers with hearing loss.

The National Institute for Health reports that 18% of adults in the 45-64 year old category, have hearing loss. The percentage of Americans with hearing loss increases in the 65-74 year old group to 30%, and for adults over 75, a whopping 47% of them are struggling to hear.

How many of those hearing impaired people are wearing hearing aids? Less than 15 percent. There’s a lot of people out there who have no idea what you’re saying.

Seems like a minor problem until you read the early studies that indicate adults with hearing loss are 3 to 5 times more likely to develop dementia than those with normal hearing.

Scary.

So why don’t we embrace hearing aids in an attempt to increase our thinking skills and ward off dementia (as well as not blowing out the volume controls on the TV)?

Hearing aid

Hearing aid (Photo credit: Soitiki)

Maybe it’s because hearing aids are equated with old people and we’re a nation dedicated to never growing old.  Not all of us can afford facelifts, botox, or tummy tucks, but we can dye our hair, buy anti-wrinkle cream, and pretend we can still hear.

And most people don’t know how much sound they’re missing. When I trialed hearing aids, I couldn’t believe what a noisy house I lived in. The refrigerator cycled on and off, the dryer had a strange squeak, and with the windows open I could hear my neighbor’s children playing outside. All sounds that hadn’t existed for me before the hearing aids.

I wanted to turn the volume down.

But without hearing aids I struggle to carry on a conversation in certain decibel ranges. I lean in closer and keep a semi smile on my face because I’m not sure if the correct response is to laugh or to  cry. Most of the time I can piece together what’s being said through context, but once in a while I can’t. It’s embarrassing when someone asks me a question and I don’t understand enough words to even guess what they’re saying. It’s like suddenly I’m hearing a foreign language and my ears can’t process it.

As easy as it is to downplay hearing loss or make a joke about it, the sad truth is that it has a profound effect on quality of life and, it seems, the risk of dementia. Maybe instead of being fixated with the idea that wearing hearing aids makes us old, we should think about all of the sounds we miss without them. If it’s a choice between hearing my daughter whisper “I love you” as she leaves the house or looking and feeling old, I think I’m going to choose to hear.

There’s only a finite number of “I love you’s” we’re privileged to hear and I’d like to hear every single one of them.

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I’m a Nurse, not a Saint

Priest

Priest (Photo credit: Wikipedia)

I am continually amazed and astounded by the things patients feel comfortable saying to me. It’s as if they think a nursing degree is equivalent to a counseling degree, a white set of scrub pants akin to a white collar, and a hospital or outpatient clinic room is the same as a confessional. It’s not.

Confessional

Confessional (Photo credit: cliff1066™)

Don’t mistake my words for a renunciation of confidentiality. My lips are sealed when it comes to protected health information and you, but, as in real life, there are times when people provide too much information. I’ve provided some examples so you can judge whether you need to be a little more discreet on your next hospital or doctor’s visit.

When I ask you to undress down to your underwear and cover yourself with a sheet, you don’t need to tell me, “I don’t wear underwear.” That is a surprise best left for the doctor. I’m not coming back in to check that you disrobed appropriately.

If I ask you to take off your shoes to be weighed, don’t apologize for the holes in your socks. Our office is only responsible for checking sock holes on alternate Thursdays in months that end in -Z. Any other time, don’t worry. We won’t be putting it in your permanent record nor will I be calling your mother (or the Emergency Room) to rat you out.

If I come in with an shot for your child, don’t tell them it won’t hurt. Chances are it will. I’ll try to minimize the pain, but since I can’t tell them to “suck it up, buttercup,” I’m hoping you’ll have your big girl panties on and shush them rather them tell them you’re sorry the “mean nurse” hurt them.  The mean nurse can’t do shit unless you give me permission, but I’m not telling your toddler “your mean mom made me do it.”

If I do a cervical check on your pregnant girlfriend, don’t ask her if she’s enjoying it. She’s not. Neither am I. Creep.

Never ask me to rub “extra hard” down there if you’re unable to clean yourself off. There are non-medical devices and non-medical personnel who can meet your needs much better than I can. Once you ask, the only “happy ending” I’ll think of is your discharge or death.

Don’t ask if you can strip down to your underwear to ensure your weight is “accurate.” I personally don’t want to see you half naked and believe stripping down for non-medical reasons should happen in your home, not in the exam room.  You can buy your own scale for the cost of a co-pay.

Going Down?

Going Down? (Photo credit: billhd)

Don’t expect me to believe that you need an early refill on your methadone, oxycontin, oxycodone, percocet or vicodin because the bottle you just filled fell into the toilet with the cap off, ruining all of the pills. Unless a major study at a prestigious medical center proves that toilets have a preference for narcotic painkillers, I’m suspicious. This never happens to anyone’s heart, allergy, or diabetic medicine. If you have to lie, go big or stay home. Don’t let drugs kill your creativity.

Remember I’m a nurse, not a saint.

What We Shouldn’t Do For Love

A heart being used as a symbol of love. Photo ...

A heart being used as a symbol of love. Photo modified by author using Photoshop. (Photo credit: Wikipedia)

Urban legends and medical lore are full of the things people do for love. The 22-year-old girl who lifts the car crushing her father. The mother who rushes into a burning building to rescue her children. The father who doesn’t know how to swim, but jumps into the water to save his drowning son.

There are some things, however, that push us to the edge of what we will do for love. Loving an addict is one of those things. It’s tough wondering when the phone call asking for bail money will turn into the one asking you to identify a body. No one’s morning should start in a bedroom doorway worrying if the person inside is passed out or dead.  Life is hard enough without a daily routine of second guessing whether to argue or remain silent. After a while, silence is easier.

Because, after a while you realize that no matter how much you love the addict, you can never make the right decision, say the right thing, or provide the missing ingredient to keep them clean and sober. No one is  capable of stopping the addiction except the addict. Until they admit their problem and get help, no amount of love will make them whole.

It truly is not you, it’s them.

And when you make the decision to leave, the heartache doesn’t stop. Who will take care of them if you’re gone? Make excuses to the few friends that are left? Divert the phone calls from work? Pick up the slack when they spend days in bed recovering from binges?

The pull to go back is stronger than a riptide. It sucks you back and keeps you in place.  To apologize, to make excuses, to take the blame. It’s familiar, comfortable, and as reassuring and necessary as the booze or pills are to the addict.

Until one day you realize that in order to save anyone, you have to save yourself first. You can’t move the car off a loved one if you’re pinned beside them. You can’t save someone from a burning building dressed in gasoline-soaked clothes. You can’t rescue a drowning man when he’s pulling you down with him.

You can’t.

Read all the fairy tales, urban legends, and medical myths you want on the power of love, not all of love stories have happy endings. There are some things love can’t fix. Addiction is one of them.

All you can do is save yourself.

Want more information? Check out the links below:

Alcoholics Anonymous, Narcotics Anonymous, Al-Anon Family Groups, Nar-Anon Family Groups

Who Gets to Decide to Withhold CPR?

I’m not sure what I’d do if a patient collapsed in front of me and the administrator said, “No CPR. It’s our policy.” Since I’ve been a nurse, I’ve heard of slow codes, where the unspoken agreement is that if the person stops breathing the staff will purposely react as slowly as possible to give the person a chance to die, but I’ve never participated in one. The decision to either be resuscitated or be a DNR (do not resuscitate) is a personal one and the slow code takes that decision away from the individual. That goes against my philosophy of nursing.

English: CPR training

English: CPR training (Photo credit: Wikipedia)

Today’s news involves a nurse who did, in fact, stand by and refuse to do CPR when a patient went down. The facts seem simple. A woman collapsed in the dining room of an independent living facility. A nurse called 911 to report the incident. The 911 dispatcher asked the nurse to start CPR. The nurse refused, stating it was against company policy.

The 911 dispatcher didn’t give up. She asked the nurse to find someone who would start CPR, asking “Is there anybody that’s willing to help this lady and not let her die?” Again the nurse said no. The dispatcher continued to plead, as if the provision of CPR was the only surefire way to prevent this woman’s death.

Seven minutes 16 seconds later, emergency personnel arrived. The woman had no pulse and was not breathing. They started CPR.  The 87-year-old woman was declared dead at the hospital.

This has upset a lot of people. Upset some to the point that the police are trying to figure out if they can charge the nurse with a crime. The belief is that CPR would have saved this woman and the absence of CPR caused her death, and that’s not entirely correct.

According to Dr. Robert Shmerling in a post entitled, CPR: Less Effective Than You Might Think

“As opposed to many medical myths, researchers have reliable data concerning the success rates of CPR (without the use of automatic defibrillators) in a variety of settings:

  • 2% to 30% effectiveness when administered outside of the hospital
  • 6% to 15% for hospitalized patients
  • Less than 5% for elderly victims with multiple medical problems”

Another study that looked at out of hospital cardiac arrests found that successful resuscitation decreased with age. 40 and 50 year olds had a 10% chance of a successful resuscitation while patients over 80 only had a 3.3% survival rate.

No magic bullets here. There is no guarantee that CPR would have prevented this woman’s death. If she’d survived, there’s no guarantee of the quality of life she’d enjoy afterwards.

In this case, the independent living facility (not assisted living, not a nursing home, not a rehabilitation unit) maintains the residents are advised that in the event of a medical emergency staff members will call emergency services, but not provide CPR.  Employees are told the same thing.

The dead woman’s daughter said, “I don’t believe if CPR were done it would’ve helped or changed the result. This is not about my mother or me, this is about the policy of the facility, and we understood the policy, and I agree with what was done.”

Which brings me back to the original question. If the woman collapsed in front of me and, as a condition of living in the facility she’d agreed the staff wouldn’t perform CPR, would I have stood by and done nothing? With an underlying belief that the patient gets to make the decisions, I very well might have.

Patient’s Rights Shouldn’t Be at Nursing’s Expense

Group of nurses, Base Hospital #45

Group of nurses, Base Hospital #45 (Photo credit: The Library of Virginia)

Providing nursing care is an intimate business. Nurses are at the bedside for births, life-threatening injuries, chronic conditions, and death. They become familiar with both a patient and their family. Helping people navigate these life changes takes compassion and empathy. There are days it is damn hard to be a nurse.

Twenty-four hours a day, seven days a week, if you’re in the hospital there will always be a nurse on-site. Budget cuts, staffing issues, increasingly complex machinery and treatments all contribute to the stress that nurses must deal as well as twelve-hour shifts, mandatory overtime, and working holidays and weekends.  Nurses are expected to keep patients safe, use resources wisely, and provide culturally competent care. The nurse is required to respect each patient as a person.

That makes it even more distressing when a hospital disrespects a nurse and her rights as in a recent lawsuit against a Michigan hospital.

The lawsuit alleges that a nurse of 25 years standing in a Neonatal Intensive Care Unit was told by her supervisor she would no longer be assigned to care for an infant because the baby’s daddy didn’t want African-American nurses caring for his child. The man showed the supervisor a swastika-type tattoo in relating his request. According to the lawsuit, the baby’s chart was prominently marked to indicate no African-American nurses were to be involved in this infant’s care. This was honored for a month before the hospital attorney stepped in and had the notation removed.

English: The Neonatal Intensive Care Unit (NIC...

English: The Neonatal Intensive Care Unit (NICU) at Kapiolani Medical Center in Honolulu, Hawaii (Photo credit: Wikipedia)

I don’t know what the hospital was thinking, other than to make the customer happy, but they should have told the man that they weren’t going to allow his hateful beliefs to compromise the care of his child and demean their employees. They could have offered to transfer the child to an institution willing to make those choices, if they could find one. They could have had their Ethics Board review the case and come up with an appropriate plan of care that didn’t imply that African-American nurses were any less competent, worthwhile, or caring than their white, Hispanic, or Asian counterparts. They could have done something.

Woman at work--registered nurse

Woman at work–registered nurse (Photo credit: yooperann)

Instead they bowed down to the demands that were not only hateful, but illegal. If the allegations are true, for an entire month qualified, trained nurses were told they weren’t the right color to provide care and that’s just plain wrong.

Skip the Sex and Spinach

Every time I pick up a newspaper or check out the online news I’m amazed by the new studies that shed light on healthcare myths. At this point, you’d think researchers would be running out of things to challenge, but no, there’s still plenty of information, once thought of as gospel, that now turns out to be nothing but wishful thinking and fantasy.

News this week that made me think “duh”? Green leafy veggies are the most common cause of food poisoning.

Lettuce

Lettuce (Photo credit: photofarmer)

Common sense says why the hell wouldn’t they be? Leafy greens live down at ground level, get submerged in mud every time it rains, and they are hard to clean. Fields of green being planted or picked by migrant workers who probably don’t have ready access to porta-potties (though it makes sense not to set up porta-pottties near food) are the most likely culprits in providing a little e.coli to the mix.  That triple washed on the package may mean triple washed in sewage. Luckily, lettuce is easy to grow at home.

In news designed to infuriate drug makers, another study looked at male erectile dysfunction and heart disease. Forget those commercials with bathtubs and happy couples, the more severe a man’s ED, the greater his risk for heart disease and premature death.

cialis

Doctors are advised to screen and test men for heart disease instead of discreetly passing along a six pack of Viagra.

The New England Journal of Medicine stepped in this week to debunk some myths about weight loss. Turns out having sex does not burn 100-300 calories per participant.  It only burns a measly 50 calories,  equal to 10 minutes of vacuuming or 20 minutes of typing.

"Vacuuming" (93/365)

“Vacuuming” (93/365) (Photo credit: kalavinka)

So for weight loss, skip the sex and grab a vacuum. You might not work up the sweat associated with sex, but you’ll look better burning those 50 calories.

It turns out fecal transplants can be a real lifesaver. Hard to treat c. difficile infections respond better to a procedure involving donor feces infused into the patient’s small intestine than they do to antibiotics. I am not shitting you on this. Doctors who promote this treatment agree that the science bears them out, but the ick factor involved, both having the treatment and harvesting the feces for treatment, make it a tough sell.  fmt

The award for best research goes to the scientists who looked into the killing capability of cats. There is a reason that cats in movies and books are suspected of smothering babies in their sleep and nudging the elderly or infirm down stairs.

English: Young street cats, Portugal.

English: Young street cats, Portugal. (Photo credit: Wikipedia) Cats awaiting their next victims.

It’s well known that cats carry germs that cause depression and miscarriage.  Now it’s revealed that cats kill 1.4 to 3.7 billion birds and 6.9 to 20.7 billion mammals every year. Not only are they killers, they’re serial killers. Feral and outdoor cats contribute to the bulk of the killings, but people with indoor cats should be aware that, quite possibly, their fluffy little friend is plotting their demise.

Thanks, science!

Have any freaky health research studies? Let me know in the comments.