I've Moved

I've moved the blog to http://reneemaynes.com/

Please visit me there for medical related topics on Tuesday, lifestyle related topics on Friday, and random posting on other days.

He and the Boys Aren't Playing (Instruments) All Night

You have to love Canobie Lake Park in New Hampshire. In October, a month not known to be kind to New England amusement parks, Canobie Lake keeps the grounds filled by having two events:  Screemfest and Oktoberfest. This year I returned, once again lured by the presence of Mini Kiss, a KISS tribute band, at the Oktoberfest tent. (Well, also lured by the haunted houses and rides, but Mini Kiss is a consideration.)
Mini Kiss is always a great time. They cover Kiss songs as well as some other notables such as "Sweet Child O' Mine" by Guns and Roses. I'm not sure if it's the quantity of beer being served or the novelty of having these mini men singing, but the audience joins in on every song. While singing along with the song "Beth," I pondered the reality of the events in contrast to the sanitized, love ballad version.
At the time Beth was recorded in 1976, cell phones didn't bulge in every pocket. Beth was relegated to (probably) standing in her kitchen on her landline phone hoping someone would answer the payphone at the recording studio. Since there was no caller ID, there wasn't a foolproof method to duck the calls of curious, demanding girlfriends or wives. Some poor sap, a roadie no doubt, would have to physically pick the phone up and figure out who was on the other end of the line. Then he'd have to holler into the recording studio to call Beth's boyfriend to the phone. I can only imagine the reaction of the band to Beth's calls looking for an estimated time of arrival on her beau.
And, as if his staying out late and not giving her a heads up didn't rankle enough, listen to his excuses in the lyrics:
"Beth, I hear you callin'
But I can't come home right now
Me and the boys are playin'
And we just can't find the sound
Just a few more hours
And I'll be right home to you
I think I hear them callin'
Oh, Beth what can I do?"
You can almost hear his band mates crack imaginary whips and call out rude comments  as Beth's man frantically tries to shush them.
And what's with Beth?  He asked "what can I do?"  He didn't mention he was handcuffed to his instrument or being held at gunpoint.  It's his choice to stay with his friends "a few more hours." Instead of listening silently through her tears, Beth could have said,  "Come home in the next fifteen minutes or I'll throw your stuff out on the street." It's domestic warfare, baby, sometimes you have to make threats. But not Beth, the date-able doormat.
When she calls again hours later,  her boyfriend can't even come up with a new excuse.  Now, maybe he isn't very smart or maybe he's impaired by drugs and alcohol, but at least try.  If I was Beth, I'd be happy to hear your absence was because one of your band mates overdosed on drugs or two of them had a fist fight over writing credits and now you're waiting for the cops to show up. When it comes to relationship lies, I believe go big or go home. But no, instead he tells her:
"Just a few more hours
And I'll be right home to you
I think I hear them callin'
Oh, Beth what can I do?"
I'm calculating it's around midnight at this point. If you've ever taken one of these calls in a relationship, you know he has no intention of coming home until he's ready to pass out.  The best thing Beth could do for herself now is to take a sleeping pill and go to bed. Be fresh for the big fight when he staggers in at daybreak. But no, she continues to burn up the phone lines.
By 3 AM, the band has had enough. No one else's girlfriend is calling. No one else is ruining boy's night out. Time for the truth.  Now  he tells her:
"Beth, I know you're lonely
And I hope you'll be alright
'Cause me and the boys will be playin'
All night"
Because at this point he realizes that Beth isn't going to get dressed and come down to the recording studio and she isn't going to stop calling. Telling her he won't be home tonight might not stop the phone calls, but it will put an end to the whip cracking sounds from the band.  Anyway, after he hangs up a helpful roadie will leave it off the hook and Beth can listen to a busy signal for the rest of the night if she desires.
The next morning, boyfriend crawls home, hungover and tired, expecting a nice breakfast from Beth before he drags himself to sleep. She probably makes it for him because back in 1976 that's the price you paid to be with the band.
I don't miss 1976 that much. Now songs empower us to get our Louisville Sluggers and let our men know exactly what we think.  I'd love to hear Kiss sing a song about how quickly the studio empties out after that.

I've Moved Away

I've moved over to Wordpress at http://reneemaynes.com/

Please come visit and leave your questions and comments at my new home.

Yelling is Always Optional

Sometimes things get screwed up. You plan on a sunny day and it rains. You want a laptop for your birthday and you get a vacuum. You think you're dog's well behaved enough to leave out of the crate and he eats your favorite pair of shoes. Shit happens. It's not always someone's fault and it's not always repairable, but life goes on.

Which is why I'm always confused when I get a phone call from an unhappy, pissed-off person who thinks that yelling at me will solve the problem. Wrong. And, I mean, they have to know that on some level. I am not the Queen of the Universe nor am I She-Who-Must-Be-Obeyed. The best you'll get from me is an "I'm sorry" and maybe a promise not to do it again.

But lately I feel that people don't want apologies or excuses. They want to yell at someone, stomp their feet,  threaten physical violence, make a scene. Since those are the things guaranteed to make me either walk away or hang up, there must be some other reason why people use these tactics.

Remember when daytime television consisted of Jerry Springer, Maurice, Jenny, and Montel?  For many of us, it was our first glimpse of people who didn't follow the rules of polite society (well, the first glimpse of people out of diapers who didn't follow the rules). Screaming, interrupting, throwing things, and fisticuffs were all part of the spirited debate. It got to the point where, even with closed captioning on, it was impossible to figure out what was being said as everyone yelled over one another.

When the yelling stopped, the physical fights began. We were introduced to press-on nails, weaves, and the concept of kicking off one's shoes to signal a readiness to punch someone (though Jerry eventually added the dinging sound  of a boxing match bell). We quickly went from expecting a fight, to demanding one.

Eventually, like Jimmy Choo shoes and Coach handbags, the rest of society coveted what they saw on television. If the former baby momma could lay hands on the current one, why couldn't we take out our aggressions against the neighbor who always parked in our spot? If someone cut us off in traffic, why take that silently when we could chase them down and trade gunshots? Instead of a nation of polite discourse and problem solving, we became a nation of loud-mouthed wannabe gangsters and thugs.

And then it was only a hop, skip, and jump til we got to the point where yelling, threatening, and even physically assaulting people became commonplace. Fights don't need to be settled with words when fists and guns are available. In Kentucky, a 12 year old boy was shot in the back after playing ding-dong-ditch at the home of a 56 year old with a shotgun. McDonald's drive thru patrons assault the occupants of the car in front of them when the line doesn't move fast enough. Someone cut you off at the deli counter? Ram their cart and tell them what you think of them.

We are no longer afraid or ashamed to raise our voice or our fists as a first response. And that's not a good thing. Because aggressive behavior doesn't help, it only shuts down the conversation.

So I challenge you the next time you're in the express lane and the person in front of you has more than the allotted number of items, be quiet. The next time someone cuts you off in traffic, keep your hands on the wheel rather than on the horn. The next time a scared fifteen year old screws up your McDonald's order, take a step back and suck it up. There's no rule that says we have to go over the top. We can become polite, courteous human beings again. It's really not hard as long as we're willing to act like adults rather than pissy-panted toddlers.

And who knows, maybe you can attract more flies with honey than with vinegar.

My Grandmother's Abortion

My grandfather told me about my grandmother's abortion long after her death.

A bit of history. My grandmother was mentally ill. Though I have memories of homemade oatmeal cookies and games of Go Fish, I have more memories of profane outbursts, outrageous accusations, and bizarre behavior. Throughout my childhood and teenage years, my grandmother cycled in and out of treatment, tried and failed numerous drugs, and, at times, terrified me with her mood swings.

All the while, my grandfather stood by her.

As she approached her sixties, the good times became more infrequent. By the time she was in her seventies, they stopped. There was no mistaking something was wrong with her. She became a bright-eyed, bird-like woman who twitched constantly and did the Thorazine shuffle within the confines of their single-wide mobile home. Taking her out in public was an unpredictable experience. One day she could be smiling and eating happily. The next, she'd be pinching men in the buffet line and making inappropriate comments to the waitress.

My grandfather endured all of this because he loved her.

For many years I didn't know what had happened to trigger her mental illness. I knew she'd been in Bellevue Hospital in the early stages of her disease. Fifty years later and my grandfather would still get tears in his eyes describing how the orderlies would tie her up, put her in ice baths, treat her cruelly. Prompted by the bruises he saw, he bribed the staff in hopes of better treatment. When she finally was released, he vowed never to put her in an institution again. He tried to keep that vow.

He told me about the abortion only when I'd finally summoned up the courage to ask why she'd been in Bellevue in the first place.

According to my grandfather, she had always been prone to worry and anxiety. She got worse during her pregnancy. The day after the birth, the nurse found my grandmother, with her infant son in her arms, attempting to jump out of the hospital window. She was diagnosed with postpartum psychosis. Whether she had command hallucinations telling her to kill herself and her child or delusions that the baby was possessed, I don't know. Either way, the outcome was the same. Instead of going home with her husband and firstborn, my grandmother was committed to Bellevue Hospital.

My grandfather visited as often as he could. He gave the orderlies as much money as he could spare. He raised my father for three long years before she was released. Life slowly returned to normal.

And then she got pregnant again.

My grandfather, an Irish Catholic, and my grandmother, a Protestant, found themselves in a heartbreaking position. The doctors told them continuing the pregnancy would result in another psychotic break. This time, they told the couple, she wouldn't recover. She would most likely spend the rest of her life in an institution.

Fifty years afterwards, my grandfather still agonized over the choice they'd made. Not the choice to have an abortion. He never wavered in his belief that continuing with the pregnancy would have robbed his son of a mother and put his wife in a hellish place. He agonized because instead of taking my grandmother to a clean, sterile place to have the procedure performed, he was forced to find a back alley abortionist, forced to choose between losing the woman he loved to mental illness or to the possibility of post abortion infection or death.

It was a decision they didn't take lightly. It was a decision made by the two people most aware and most impacted by the consequences.

Today the politicians talk about abortion and, in the case of those who wish to outlaw the procedure, they talk about the parameters that should be used to decide if an abortion can be performed. If, as has been suggested, abortions should be allowed in cases of rape, incest or if the pregnancy puts the mother's life in danger. But who gets to make these determinations?

Will rape and incest victims be forced to provide police reports, medical exams, and sworn statements attesting to their rape?

If the mother's life is in danger, how will that be defined? Will someone compile a list of acceptable medical reasons with rationale? If the mother suffers from mental illness, like my grandmother did, would she be able to argue for the exception or is there some level of certainty that will need to be applied to meet the criteria. For example, if there's a 30-50% chance of a woman having another psychotic break, is that enough to justify an abortion or will the woman be forced to complete the pregnancy and hope she beats the odds?

Because every time the politicians and the right to lifers talk about their anti abortion strategies, I think about my grandparents, a husband and wife who made a personal decision about their lives. The people who must live with the consequences of their actions should be the ones to decide. Not a committee. Not a politician. Not the courts. The people involved.

I'll end with a quote by Frederica Mathewes-Green, a pro-life author and speaker who thinks society should work to prevent the situations that lead to abortion, rather than demonize the women who need one. She said, "No woman wants an abortion as she wants an ice cream cone or a Porsche. She wants an abortion as an animal caught in a trap wants to gnaw off its own leg."

I'm sure my grandmother didn't want an abortion, but when she needed one, I wish she'd had the option of a safe and legal one. 

The Politics of Healthcare, Post Debate Edition

First off, I have no issue with anyone who uses their faith to inform their personal life and decisions. I do it. I believe you should, too.

Paul Ryan's faith believes life begins at conception, therefore abortion is murder. But, if we're going to allow religious faith to play a role in healthcare, let's consider all religions and their beliefs.

Jehovah's Witnesses can legislate against blood transfusions.

Christian Scientists can legislate for prayer instead of medical treatment.

Scientologists can legislate for introspection rundowns instead of antidepressants.

The bottom line is every religion has traditions and prohibitions that impact the healthcare experience of their followers. These items don't need to be legislated, they are a choice. The Catholic Church and Paul Ryan has no more business making my healthcare choices than my employer does.

Wait. Ryan and the faithful believe that employers should be able to financially restrict an employee's access to birth control, sterilization, and abortion in the name of religious freedom. Guess religious freedom means religious employers can make the decisions usually best left to a patient and doctor. Today, birth control and sterilization; tomorrow, restrictions on blood transfusions or psychiatric care?

Because if we want to allow faith to legislate healthcare, let's not stop with the Catholic Church's agenda. Let's champion the beliefs of all religions. Sounds good, doesn't it?

But, taking away healthcare choice from the individual and investing it in the hands of a religious organization is akin to setting up "death panels," except instead of deciding if an individual is worthy of medical resources, these panels would decide what medical resources are worthy of being used.

As much as I believe in religious freedom, I don't think your faith should impact my ability to access medical care and procedures. Do you?

The Moments That Define Us

Last week Nurse K posted on her blog about a patient's last phone call. Read it here.

After wiping away some stray moisture from my eyes and clearing my nose (allergy season, you know), I thought about the moments that define us in our healthcare role.

Hospitals seek out touching stories to bolster their application for Magnet status or adorn their website. Their stories of how the healthcare staff went above and beyond to help a patient usually end up being fairly run of the mill. More in the vein of "the nurse took the time to ensure I knew how to make the bed go up and down" and "the food service staff cheerfully exchanged my tray to accommodate my gluten-free diet" than "someone did something totally unexpected and above/below their pay grade that mattered." In my hospital experience of being on the receiving end of management's praise, I've found the successes I've been credited with are the ones that least define who I am as a nurse.

I was acknowledged once for my help in cleaning up flooded exam rooms after someone left a faucet running over a weekend. The sad truth was administration had made deep cuts in the housekeeping department and there was no one available to clean up the mess. I picked up a mop and started in because we had a waiting room of patients to be seen. Eventually the housekeeping supervisor, embarrassed at his lack of employees, showed up to help. Administration congratulated our team effort to fix the problem. I got official recognition for going above and beyond and a free lunch in the cafeteria. Rather than being thrilled with the "honor," I was incensed. Of all of the things I did in my job that were truly worthy of recognition, I got an attaboy for pushing a mop for two hours. Two hours I wasn't available to triage or educate patients. Two hours I didn't use any of my nursing skills. That is what administration deemed worthy of recognition.  It didn't go over well when I told them instead of praising me, they should be asking themselves why they didn't have enough housekeeping staff to handle emergencies.

Instead of addressing the underlying problem many of us face, too much to do with too little time and staff to do it, hospitals try to boost morale with meaningless honors and remain oblivious to the day to day things that really matter. And though we are more than willing to share our crazy stories, commiserate over the sad ones, and bemoan the incompetence of administration, we're not willing to let down the walls and talk about the parts of our job that hit us in the gut and the situations that make us turn our heads so the patient can't see our tears. We're professionals. That stuff isn't supposed to get to us.

But, it does. It stays with us.

And they are the moments I don't offer up to the public relations machine of the hospital and I suspect many others do the same. Moments that remind us there is more to our job than tasks and checklists and documentation. Moments when we know that our lives will go on, but our patient's will be changed forever. Because sometimes, in the confusion, turmoil and noise of our professional lives, we take a step back and do the right thing.

Those are the moments that define us.

Grocery Shopping Isn't a Spectator Sport

Grocery shopping is my least favorite chore in the world. Stuck in a fluorescent cave where the aroma of freshly baked bread battles it out with the stench of spoiled fish, confronted by carelessly discarded carts and poorly placed products, my anxiety level rises to Mount Everest proportions. As if the entire shopping experience isn't designed to slow your pace to a crawl, lately I've noticed an increase in the amount of people that think grocery shopping is a spectator sport.

You've seen them. While one of them peers at the shopping list and looks for sales, the other dawdles, randomly stopping to block an aisle or access to items. They come around corners at sloooow speed, t-boning the carts of the people who are moving at a brisk pace. They grab a cup of complimentary coffee and then steer the cart with one hand, causing it to veer from side to side and making it impossible to pass them. While their significant other inspects every label on every brand of stewed tomatoes, they block the aisle and watch like it's their job.

I assume the majority of grocery spectators are deaf or hard of hearing. They don't move or otherwise respond to polite throat clearing, the rumbling of an approaching cart, or the plea "excuse me, I need to get by." Once they've found an inconsiderate place to be, they'll stand their ground until their partner moves on.

There are many reasons to hate this practice. For example, grocery store spectating promotes poor time management skills. Two people, one grocery store? Live a little and split the list in half. Or send the cart pusher off for heavy items while the other spirit communes with the cereal until they divine the right brand for their breakfast enjoyment. Better yet, send them to the magazine aisle, no one uses that one much. Or leave them in the car. Maybe they can clean it while you're inside. There are much better uses of time than to be the vestigial tail of a shopping team.

And I don't want to get started on those who take small children on a grocery shopping trip. I hope there's a special circle of hell for them.

How to fix the problem? I don't know whether there needs to be a special Facebook group, a Kickstarter project to educate people against it, or a twitter campaign to alert the masses, but the word needs to get out there - Grocery shopping isn't a spectator sport. If a grocery chain wants to double the size of their aisles, provide viewing areas, and replace the overhead music with sports announcers, by all means, invite someone along to watch you shop.

Until then, come alone.

Forget About It: Worrying about Illnesses You Don't Have

Hypochondriacs are people who obsessed with the idea that they have an undiagnosed serious or life threatening disease. For them, every skin change indicates malignant melanoma, every change in bowel habits signals colon cancer, and every episode of dizziness becomes a fatal heart arrhythmia. Those who obsess about serious conditions are convinced their occasional memory lapses are Alzheimer's, their feelings of fatigue are Lyme Disease, and their lack of coordination is multiple sclerosis. These are people seriously intent on receiving a medical diagnosis for their psychiatric disease. It's easy to become frustrated with them as there's nothing wrong with them, but it can take years of tests and specialists before someone flat out tells them that.

Luckily, the majority of people who worry too much about the vagaries of the human body suffer from, as I like to call it, petite hypochondria. Instead of obsessing over the specter of an undiagnosed life threatening illness, they obsess over minor ailments. This includes the young female who is certain her cough of one day is pneumonia, the older male who wants to describe the color and consistency of his stool because it's not his "normal", the first time mother who is worried her child's temperature of 99.1 degrees signifies a serious infection, and the elderly female who gets dizzy when she stands up too quickly and becomes convinced she's going to die. These patients can be time consuming, but they can be reasoned with.

Then there's the patients who suffer from the disease of the month (or year or decade). Twenty years ago medicine saw an explosion in fibromyalgia, a disease characterized by fatigue, muscle aches, and "tender points." After that, peanut allergies became the rage.  You couldn't swing a bag of peanuts around without someone promising an anaphylactic reaction. Epi-pens were passed out like Halloween candy and peanuts were banned from most public places. Now a terrible epidemic of gluten allergy has descended upon us. Heralded by joint pains, diarrhea, abdominal bloating, and mental fogginess, gluten free diets have become the answer to a host of symptoms that may, or may not, be related to gluten. I think the universe reaches a tipping point on obscure diseases and suddenly everyone is convinced they have (insert name of disease of the month/year/decade). In these cases, the disease becomes a source of pride. It's not surprising that there's never been an epidemic of patients having herpes, hemorrhoids, or yeast infections in their fat folds.

How do you tell if your concern for your health is becoming a little overboard?  I have some easy questions.

1.) Does your doctor's office try to talk you out of coming into the office or presenting to the ER?
2.) Have you been seen by more than three specialists in the last year who couldn't find anything wrong with you?
3.) Do the people who draw your blood have to consult a reference book to determine what tubes your (obscure labs) need to be drawn with?
4.) Do you bypass the over the counter medication for minor ailments because you need to consult with the doctor in case it's more serious than constipation or heartburn?
5.) Do you seek healthcare after vomiting once or for feeling like you have a fever?

If you can answer yes to two or more questions, it might be time to consider redirecting your energy on something other than yourself. Just saying. Leave some room in the healthcare system for patients who really need it.

Don't Put Your Faith in Antibiotics

This time of year sees an uptick in people who present to the doctor's office for one reason, they want an antibiotic. It's amazing how people think antibiotics are the cure for all their ills, even though antibiotics are only useful in treating bacterial infections.

People don't want to hear how their viral illness won't respond to an antibiotic. They don't care that at the rate things are going, antibiotic overuse is going to make most antibiotics ineffective leading to deaths from minor bacterial infections. They certainly have no interest in treating themselves by increasing fluids, staying home and resting. No. An antibiotic prescription is the expected parting gift of the office visit and without it, well, try the Emergency Department. Maybe they'll give you one to shut you up and get you out.

I think it's a type of sickness hysteria fueled by the internet and symptom checkers. Have a sore throat? It must be strep! A stuffy nose for a week? Sinusitis! A cold that's made you tired and run down? Bronchitis!

Problem is 85%-95% of sore throats aren't strep, 90-98% of sinus infections are caused by viruses, and most upper respiratory infections aren't bacterial. Antibiotics will do nothing for these infections. The bitter truth is that it takes time to recover from an illness. Colds, bronchitis and sore throats caused by viruses may last two weeks or more, time we're not prepared to spend taking care of ourselves. It's easier to throw a pill at it.

Instead of rushing to the doctor's office (and exposing yourself to whatever germs are lurking there), the next time you're sick, stay home and take care of yourself. A tincture of time is remarkably effective in curing much of what ails us and it's safer and cheaper than an antibiotic.

Remember, antibiotics kill bacteria, not viruses.

Did You Wash Your Hands?

As part of my ongoing kitchen remodeling project, visitors to my home now have the option to relax on couches and watch me cook. I joke that it prevents me from serving anything I drop on the floor, but my real worry is that I'll forget to wash my hands appropriately (between handling meat and vegetables or the like) and someone will call into question my ability to safely prepare food.

Now I have a pretty good record in that I have no reported instances of my guests contracting a food related infection (at least not that I'm aware of). Unfortunately many hospitals can't say the same when it comes to healthcare acquired infections or HAI's. The Centers for Disease Control (CDC) reports that for every 20 patients in the hospital, one gets an infection. That's two million infections annually. The simple act of handwashing breaks the chain of infection. So why don't healthcare workers do it every time?

A quick scan of articles on the topic show handwashing rates of 37% to 77% for healthcare workers. Interventions to increase these numbers, including education, posters, and even personal hand sanitizer dispensers that monitor the number of uses, have all met with limited success. When no one's actively paying attention to handwashing compliance, handwashing rates drop and infections increase.

Some institutions have encouraged patients to ask healthcare workers whether they've washed their hands before a treatment is given. I contend that the majority of hospital rooms and outpatient exam rooms have sinks or are equipped with hand sanitizing dispensers. It's clear to most patients who has, and hasn't washed their hands, but they're too intimidated to demand only clean hands be placed on them. Since healthcare workers have shown they're unwilling or unable to consistently wash their hands, patients need to demand it whether it's comfortable or not.

No exceptions.

You can be polite:  "Did you want to wash your hands before you examined me?"
Belligerent: "Hey, I don't want the cooties from your last patient. Wash up!"
Indirect:  "Did you see that Dr. Oz episode on handwashing? Amazing how many doctors don't follow the guidelines."
Matter of fact: "I don't want to walk out of here with an infection, so please wash your hands."

It doesn't matter how you want to phrase it, if you value your health, you'd better say it. Every time. Don't wait for your healthcare worker to protect you, protect yourself.

Pray Rain

Recently I read an article about a Pray Rain Journal. Basically you write a daily page about your ideal life as if it's already happening. Here is my Pray Rain Journal for the healthcare system.

Today we were overwhelmed writing prescriptions for acupuncture, massages, and hypnotherapy. Now that insurance pays for this, our providers and patients turn to alternative medicine rather than narcotics. Not once during this entire day did a patient receive a prescription for oxycontin, vicodin, or percocet for chronic, non malignant pain.

Our diabetic patients came in armed with questions and information. They all had their blood glucose logs and their food journals. There was time to review them and work with the patient to make good choices to improve their blood sugar control. They checked their feet daily so it was another month without foot ulcers. Several of our patients had lost weight as they'd instituted an exercise program. No one gained weight today.

Our hypertension patients took their medications faithfully and monitored their blood pressure. A few of them had experimented with biofeedback and meditation as a way to control their stress.  They all knew the correct way to take a blood pressure and insisted it be done that way, politely, of course.

Our patients with mental illnesses continued to work with their therapists and psychiatrists to gain insight into their problems and work through them. Everyone who needed a referral to our therapist, got one, and got in the same day. Our patients on medication acknowledged the role of talk therapy in their recovery. None of them self medicated with tobacco, alcohol, or illicit drugs.

People with coughs, colds, and sore throats came in without the expectation of an antibiotic prescription and left armed with self care tips and the knowledge that their illness would get better with time. They all promised to take time off from work to get well, rather than return to work and sicken their coworkers. 

No one left our office today with a prescription without knowing what it was for, what the side effects were, and what they should look for in order to judge it's effectiveness.

My coworkers and I had a great day of teamwork as we tried to meet our patient's needs in a polite, respectful way. At the end of the day we all went home tired, but we felt good about the job we'd done.

Are We Safe Yet?

Sitting in a hard plastic chair, waiting for someone to show up and pat search me,  I look at the mass of people going through airport security around me and wonder if we're safe yet.

I remember what air travel used to be like.  One went to the airport with a identification and a ticket, checked in at the desk, and leisurely walked to the gate, oftentimes accompanied by family members or loved ones. I have fond memories of my grandparents waving at the window as I boarded my flight in Tuscon. I have pictures at the Manchester airport with my firstborn as she waited to board her first flight alone to college. Back then, airports were happy places. Security, if there was any, was hidden in the background.

When my mother traveled to Italy one year, she was struck by the fact that airports there had security officers that carried guns. Machine guns. My mother was a cop, so it wasn’t the guns that scared her. It was the fact that it seemed reasonable to expect an event requiring an armed response.

Something we thought would never happen here.

And then 9/11 happened and all of a sudden U.S.airports had armed men and woman. I remember the first time flying through Charlotte and seeing men, who I assumed were National Guard or the like, positioned throughout the airport with casually held machine guns and rifles.  It lent a different tenor to the trip, but deep down I was more scared of the men with guns than I was of terrorists. The guns I could see. The tension I could feel. How many times has a simple misunderstanding escalated into violence? Enough to know that men with guns frightened me and had no place in the airport.

The guns were only the first change. Suddenly only “authorized travelers,” meaning those with tickets and boarding passes, could enter the gate areas. Metal detectors and x-rayed luggage became the new standard. We all learned the ever changing rules of travel: Laptops out and turned on, shoes, jackets, and belts off.  No nail clippers, no lighters, no scissors. The area around the screening checkpoint became choked with the belongings we left behind in order to go forward.  We packed our bags and hoped the inadvertent tangle of cords and batteries didn’t get mistaken for a bomb.

We became afraid to say the word bomb in the airport terminal.

Then one sunny day I traveled back from Myrtle Beach and discovered liquids were the new enemy. Forget carrying drinks on the plane, let alone shampoo or conditioner.  Security made us dump them at the gate. Liquids in our carry-on bags were first forbidden, and then “after extensive research and understanding of current threats” (TSA website) were allowed  in 3.4 ounces containers in a ziplock bag. Security checkpoint trashes overflowed with oversized shampoo bottles, liquid foundation,  and discarded drinks.

Then full body scanner machines were introduced. Touted as a noninvasive method to detect items hidden under clothes, we learned to stand with our arms outstretched and our feet on the yellow outlines. We took off our shoes, jackets, belts, hats.  We took our laptops out and put them in a separate bin. Our liquids,  too. We watched as TSA officials scrutinized our identification cards and checked our boarding passes. At least they didn’t have guns. We endured pat downs in public. We endured pat downs in private.  Trigger the metal detector or refuse the body scanner and assume the position.

So as I waited at Charlotte airport recently on a hard black, plastic chair for someone to pat me down, I saw people pass with dogs, cats, small children, strollers and wheelchairs.  Surprisingly, none of them  went through the metal detector or the body scanner. They, and their owners were pulled aside, I assume for a pat down, but what good is patting down a cat? A dog? A stroller? A wheelchair?

If a determined person wants to get a bomb, a gun, or an airborne virus on a plane,  do we have the technology to stop them?  I don’t believe our security can keep up with human ingenuity. If someone wants to do it bad enough, they’ll find a way.

I think of all of the liberties we have given up, all of the dignity we have lost, all of the changes we have endured, and I have to ask, are we safe yet? I think not.

A Little Criticism

Taking criticism is hard. Most of us want to hear that we're special, have great taste, and rock in everything we do. Sort of like Toddlers and Tiaras without the temper tantrums. Unfortunately, life seldom gives us blanket approval for all of our actions.

We misunderstand, we misinterpret, we think we get it, but we don't.  The person that points out these truths  doesn't earn our respect and thanks (not even if our underwear is tucked into our skirt or a big piece of spinach is blighting our smile). Instead, our first response is to turn on them.

Disagree with me and you're wrong, you're stupid, and/or you don't understand.

How do we learn, though, if not by criticism? In education, there's a saying that "you don't know what you don't know."  We're all blind to our faults and our weaknesses. When someone points them out to us, of course our first reaction is a big HELL NO as we put up our guard to defend ourselves and our self image from our attacker.

But, how can we get better if we don't take advice from others?

When I went to nursing school, I knew right from the beginning that I knew nothing. It took me ten minutes to reconstitute medications. Twenty minutes to set up an I.V. Putting in a female catheter? Forever. I accepted criticism because I accepted my ignorance. I listened a lot, I read a lot, I took my lumps, and eventually I became good at my trade. But, if I had been defensive, argumentative, and convinced of my own rightness, I would have ended up a hack. I got good because of criticism.

I maintain the most dangerous people in healthcare, and the world, are those that don't understand their limitations. They will fight to the end of time to defend their rightness. And they are wrong.

I might not always agree when people tell me I'm wrong, but I'll listen, I'll think, and I'll research. Because in this big world full of information, I must accept there are people that know more than me. If I'm not willing to at least hear them out, who's the idiot?

Celebrating Labor Day

Labor Day was created as a way to pay tribute to the worker's of American, particularly those in trade and labor organizations. Today, trade organizations and labor unions are often categorized in negative terms, even while studies show these organizations save lives.

A history of the IBEW notes that: "Some statistics support the fact that one out of two men who entered the industry did not survive their first year." Currently the United States Department of Labor estimates "The annual fatality rate for power line workers is about 50 deaths per 100,000 employees."

An article reporting on a  federally backed study on the hazards of working in mines concluded,  "In the past two decades, there have been 18-33 percent fewer traumatic injuries per miner in union mines than nonunion mines and 27-68 percent fewer fatalities per miner, according to a draft of the study sponsored by the National Institute of Occupational Safety and Health."

An ILR review study purports that "After controlling for patient and hospital characteristics, the authors find that hospitals with unionized R.N.’s have 5.5% lower heart attack mortality than do non-union hospitals."

In Rhode Island "Between 1998 and 2005 there were 354 fatalities at non-union workplaces throughout New England. During those same years, there were 77 deaths at unionized locations, according to OSHA figures."

Whether you like unions or not, there's something to be said for organizations that may very well increase your chances of celebrating another Labor Day. 

MD Doesn't Stand for Know It All

Medical doctors are used to people listening to them. Their words are rarely disputed and oftentimes even the most outlandish beliefs seem reasonable when spoken by a doctor. Case in point, Rep. Todd Akin's comments about rape victims and pregnancy: “From what I understand from doctors, that’s really rare. If it’s a legitimate rape, the female body has ways to try to shut that whole thing down."

Try as I might, I can't find any scientific evidence, even on the internet, that rape victims are able to send out ninja assassin eggs to kill rape sperm or deploy mini razors in their uterus to prevent egg implantation.

But, hey, if a doctor said it, it must be...right?

Every day woman are counseled by doctors that taking antibiotics will lessen the effectiveness of their birth control pill. The early data to support this only related to one antibiotic, rifampin. Even though rifampin is now rarely used, and there's been no subsequent link between the use of other antibiotics and unwanted pregnancies, doctors and pharmacists still perpetuate this myth.

Hyper kid? Your doctor might recommend restricting sugar intake. As we've seen on shows like "Toddlers and Tiaras," filling young children with pixie sticks and energy drinks turns exhausted, ill tempered children into enthusiastic dancers and runway walkers. Scientific research debunks the link between sugar and hyperactivity. Instead parents that believe sugar causes excess energy "see" the effect, even when there is none.

Wear glasses? Some doctors believe it's because you spent too much time reading in dim light. Even though reading in dim light may strain eyes, it won't damage your eyes. In fact, strain your eyes all you want on computers, sitting too close to the television, and not wearing your glasses when you need them. None of these will cause permanent damage.

I could go on with doctor misperceptions about using antibiotics, vaccination side effects, and even the use of thong panties, but I won't. Possessing a medical degree and a title doesn't automatically make someone intelligent and well informed. Doctors have as many crackpot, half-baked, and totally wrong ideas as the rest of us.

Too bad our representatives in Washington aren't smart enough to figure that out.

How Not to Solve the Problem

The Exeter Hospital healthcare worker who picked up unattended syringes of potent narcotics, injected himself, and then either refilled the syringes with saline or replaced them with his own previously used needles, causing at least 32 patients to become infected with Hepatitis C, is not an isolated occurrence. This has happened before and will happen again, unless the real problem is addressed.

The incident is being used as a scare tactic to further a bill requiring certain hospital employees, including lab and medical imaging personnel, to meet national standards in order for the facility to receive Medicare reimbursement.

This will not solve the problem. 
 
People who are entrusted by a hospital to draw up and administer medicine should be held accountable when they don't safeguard the medication. Even if they are doctors. Even if they are nurse anesthetists. Even if they are registered nurses. Leaving syringes of narcotics lying about is irresponsible and dangerous. Blaming an addict for picking up these syringes makes no sense.

Instead let's hold accountable the hospitals that don't follow their own policies on medication security. Let's expect to hear how the hospital disciplined the healthcare front line staff that made this tragedy possible through their carelessness.

It has nothing to do with the presence or absence of national licensing standards. It has everything to do with accountability. Until hospitals and their employees are willing to admit their part in this tragedy, nothing will change.

Pain Free Isn't Painless

There’s no question that, at one time or another, everyone will suffer from pain.  The question is how it will be managed.  In the past, before every ache and pain justified an emergency room trip or visit to the doctor’s office, pain was treated with non-narcotic medications, such as ibuprofen and acetaminophen, as well as rest, ice, and heat.  Now, whether it’s a sprained ankle suffered sliding into home plate or a longstanding backache, pain is routinely treated with the narcotics once solely reserved for cancer.

The choice is not without hazards. Tolerance to the medication (requiring ever increasing amounts to achieve the same effect), addiction (both physical and psychological), and respiratory depression leading to death are all known side effects of narcotic treatment.  Unfortunately, the current mindset that every healthcare encounter includes a prescription combined with the unwillingness to man up, has led to an explosion in legally written prescriptions for narcotics and a corresponding increase in the number of drug related deaths.

In four of the last five years New Hampshire has had more drug overdose deaths than deaths due to car accidents. The majority of these overdoses weren’t from heroin or other illicit drugs, they were from prescription narcotics. 

Why? Obtaining prescription narcotics and selling them is easy.  

How easy? The Union Leader newspaper recently reported the arrest of a suspect with more than eleven hundred 30-milligram oxycodone pills, street value approximately $35,000.00.

Where did the pills come from?  Not from thefts at the pharmacy or factory.

Most likely from thefts of medicine cabinets and the voluntary sale of legally acquired pills. Have a little pain? Get a few narcotics. Need extra money? Sell them. Worried about getting caught? Don’t be.

In New Hampshire, over the counter decongestants are more tightly regulated than prescription drugs. Pharmacies won’t dispense OTC decongestants such as Sudafed or Mucinex D without seeing a photo I.D., noting the purchaser’s name, and ensuing the purchaser hasn’t received more than a specified number in thirty days. You’d think it would be a no-brainer to implement a similar process with prescription painkillers. 

No. There’s no widespread method of keeping track of how many pills someone fills per month. There’s no method to determine if they are visiting multiple doctors, various Emergency Rooms, or using aliases to obtain their pills. Walk into any pharmacy and, with enough cash in your pocket, you can walk out with a bottle of pills with excellent resale value and wide appeal. Convince a doctor you have chronic pain, you can repeat this process on a monthly basis. It’s surprising more people aren’t profiting from this easily exploited system.

Our country regulates alcohol. It regulates firearms. It regulates tobacco. It even regulates over the counter decongestants. What’s so hard about regulating prescription painkillers? Maybe no one wants to force the healthcare system to acknowledge the monkey they’ve put on the back of our society.

I’m thinking it’s easier to just write another prescription.

I'll Settle For A Pat Down

Tomorrow I’ll be taking a flight out of my regional airport and will be forced to choose between a full body scan and a pat down.  It’s an easy choice for me, I have no problem with being patted down, but the Transportation Security Administration (TSA) agents never seem happy.  Each time I ask for a pat down in lieu of a full body scan, they try to discourage me. 

Perhaps it’s because they don’t have enough womanpower to accommodate my request. Perhaps the female workers feel uncomfortable and would prefer everyone choose radiation. No matter.  As long as I have a choice, I’d rather have the known hazards of a pat down (essentially none except for the creepy feeling of a stranger’s hands on my body) than risk the unknown hazards of a new technology that’s been implemented without, in my opinion, adequate time and study.  

The TSA, which refers to the full body scanner as advanced imaging technology states it “is safe and meets national health and safety requirements”  and “results confirmed that the radiation doses for the individuals being screened, operators, and bystanders were well below the dose limits specified by the American National Standards Institute (http://www.tsa.gov/approach/tech/ait/safety.shtm).  The Archives of Internal Medicine reports:  “The estimation of cancer risks associated with these scans is difficult, but using the only available models, the risk would be extremely small, even among frequent flyers. We conclude that there is no significant threat of radiation from the scans” (http://archinte.jamanetwork.com/article.aspx?articleid=227603).

Unfortunately I have a hard time trusting these pronouncements.  

History tells us that many times in the rush to develop and market new technology, risks are either underestimated or unknown until something has been used for a period of years and on a multitude of people.  

CT scans became widely available by 1980. After more than thirty years of use, concerns about a possible correlation between CT scans and brain cancer surfaced.  Now the Food and Drug Administration (FDA) has an initiative to reduce unnecessary radiation exposure and notes that CT scans, fluoroscopy and nuclear medicine imaging exams have benefits and risks and “these types of exams expose patients to ionizing radiation, which may elevate a person’s lifetime risk of developing cancer” (http://www.fda.gov/Radiation-EmittingProducts/RadiationSafety/RadiationDoseReduction/default.htm).  

In 2003, DePuy Orthopaedics introduced a new metal-on-metal hip replacement implant. In August 2010 they issued a voluntary recall after discovering a higher than expected number of patients needed revision surgery. 

Vioxx, a medication marketed for arthritis and acute pain, was approved for use by the FDA in 1999. The increased risk of cardiovascular events, including heart attacks and strokes, wasn’t found until a later study in June 2000. An additional warning  was added to the Vioxx label in 2002, but it took another two years before Merck & Co. voluntarily withdrew Vioxx from the market after a third study confirmed the cardiovascular risks. The aftermarket studies for Vioxx were voluntary studies the manufacturer undertook to look at side effects and additional indications. If not for those, Vioxx may have been on the market for many years before its serious, and sometimes fatal, side effects were discovered.  

In all of these cases, decent, hardworking scientists, academics, and government monitors gave their seal of approval for something that turned out to have unintended, dangerous side effects. In all of these cases the product was in wide use before the danger was known.  

In ten years, maybe I’ll have a different opinion on the full body scanner.

For tomorrow, pat me down.

Why Hospitals Make Great Killing Fields

Someone asked me about the connection between healthcare and serial killers. Well, if bank robbers rob banks because that's where the money is, healthcare serial killers kill patients because that's where the victims are. There are no locks on hospital doors. Anyone can enter at any time. Once inside the room, there's an excellent chance a  patient won't ask too many questions. particularly if the person who enters is confident and dressed in scrubs or a white coat. (Watch TV, people. Scenario after scenario shows the bad guy/gal throws on a lab jacket and does whatever they want).

A patient who is sedated by medications can't question what is done to them. A patient constrained by intravenous lines, bed alarms, chest tubes, etc, can't get away even if they suspect something is wrong. Hospitalized patients and their families quickly become used to a constant stream of people cycling through the room, playing with equipment, taking blood, giving medications. Be as suspicious at a hospital as you are at a hotel when an unknown person comes to your door. Ask questions, verify the answers.

Perhaps the one thing that most elevates inpatients to victim status is the innate desire to be a good patient. Good patients are docile, take direction, and don't ask too many questions. For many people, there is the fear that questioning the doctors or nurses will result in substandard care. I can't cite statistics, but I'll say in many cases I've personally witnessed of people getting the wrong interventions,  (medication, procedure, vaccination) when the patient questioned whether it was appropriate, they were told the doctor ordered it. At those magic words, the questions and hesitation stop. Be a bad patient. Trust your healthcare providers, but verify what they tell you. Ronald Reagan had Alzheimer's, yet he still knew the value of verification.

Still, most people would rather be subjected to an invasive procedure than upset the doctor. The healthcare system has helped to create a population of victims, and they know it. Make sure you aren't one.

 An article in the Journal of Forsensic Science (2006 Nov;51(6):1362-71) provides some relevant facts on the particulars of healthcare serial killers.

Their method:  "Injection was the main method used by healthcare killers followed by suffocation, poisoning, and tampering with equipment."

You're in the hospital, someone approaches you with a needle. If you're hooked up to an intravenous line or have a capped intravenous access, it's not shocking to have someone come to your bedside and inject medication into the line or the intravenous bag. If a patient asks what's going on or what's going in, standard  healthcare response is it's something the doctor ordered. Key point -  No one wants to argue with the doctor. Same if someone walks into your room with a syringe and tells you they're there to administer a medication. Most patients won't argue if the request to insert a needle is prefaced by saying it's something the doctor ordered. I've been in healthcare long enough to know this is a dangerous practice even for a nurse who isn't a serial killer. Patients should be identified, educated about the medication, and verify it's something that's been discussed with them by the ordering provider. I've heard and seen too many patients who have accepted medications meant for others because those magic words, "the doctor ordered it", seems to override the common sense that would kick in under most situations. Doctors write down their orders.  Why shouldn't the nurse let you see it?

Healthcare serial killers breakdown by role: "Nursing personnel comprised 86% of the healthcare providers prosecuted; physicians 12%, and 2% were allied health professionals."

Of course nursing personnel are the majority of healthcare serial killers. They're the ones spending the majority of time with the patients. They're the ones who go in and out of rooms without anyone asking questions. They're the ones who have access to the drugs and equipment to kill people. Why is the percentage of doctor healthcare serial killers so small compared to nurses? Doctors have less alone time with hospitalized patients and spend less hours with them. If your doctor showed up at your hospital bed at 3 a.m. with a syringe, you'd ask questions, wouldn't you? Most of the time,  if a doctor shows up on a hospital floor, the nurses are right beside him trying to get orders clarified and their concerns addressed. Doctors aren't rock stars, but they get plenty of attention. That doesn't make them right.

"The number of patient deaths that resulted in a murder conviction is 317 and the number of suspicious patient deaths attributed to the 54 convicted caregivers is 2113."

Wow, 2113 suspicious deaths, but only 317 murder convictions. Why? Because people die in the hospital. They die for lots of reasons. It takes a lot for an institution to become suspicious that someone's having too many deaths, and if the heat is on, the healthcare provider can easily go to another facility and start over. That's the sad truth. Want a quick and easy way of finding out the caliber of your healthcare provider? Check out how many different facilities they've worked in. The more facilities a provider has worked at should mean the more the little hairs on the back of your neck should stand up. Trust me, hospitals don't deal with problems, they move them along.

How do you protect yourself? Ask questions. Pay attention. Question what's going on. Most patients are probably more suspicious of their local auto mechanic than they are of their healthcare provider. Guess what? Your auto mechanic might sell you something you don't need, but your healthcare provider can kill you.

Still not convinced? Check out truTV's series on healthcare serial killers, conveniently broken down into the doctors, the male nurses and the female nurses. The Angels of Death are out there. Protect yourself.
http://www.trutv.com/library/crime/notorious_murders/angels/index.html

Zombies Wanted, But Are They Dead or Alive?

One of my favorite lines in the Wizard of Oz goes like this:  “As Coroner I must aver, I thoroughly examined her, and she's not only merely dead, she's really most sincerely dead.”  It has a measure of decisiveness and finality. If someone is dead, we’d like assurances that they’re really and truly dead.

In order to determine the relative deadness of a person, there are two different criteria that may be used.  There’s the always popular clinically dead, the medical term for when the heart stops pumping and the lungs stop breathing. Then there’s brain dead, based on neurological criteria, that allows for a beating heart and working lungs (many times artificially maintained by a ventilator or respirator), but a nonfunctioning brain. Brain death determination looks at cessation of cerebral and brainstem functions and demonstration that the changes are irreversible.

Some definitions of death include all three markers, meaning death is defined as the cessation of all vital functions of the body including the heartbeat, brain activity (including the brain stem) and breathing.

And that makes me think of zombies.

Unfortunately, most definitions of zombies include some reference to the supernatural or witchcraft. The Centers for Disease Control Preparedness 101 Zombie Apocalypse home page states: “Although its meaning has changed slightly over the years, it refers to a human corpse mysteriously reanimated to serve the undead.” New theories support the notion that zombies are merely humans infected with a parasite that spreads through saliva. No matter what definition is chosen, a zombie is a human form that has lost the ability to reason and is no longer reliant on a heartbeat or breathing to survive. He or she retains the ability to move, but their movements are slow and awkward (unless one believes in zoombies).  Zombies have brain function, and that is the trait that causes most of us to fear the Zombocalypse.  Luckily their brain function is very limited. Enough for them to stagger around. Enough for them to capture people. Enough to remember that brains are their choice of food. Mobility, lack of brain function, and a hunger for brains is a terrifying combination.

But traditionally zombies are not considered alive or undead.  They are categorized as dead, and though they fit the criteria because of their lack of breathing and circulation, what about their brain function?

Dr. Steven C. Schlozman, an assistant profession of psychiatry at Harvard Medical School, postulates that zombies suffer from Ataxic Neurodegenerative Satiety Deficiency Syndrome or ANSD. He contends that zombie brains have some function, as well as dysfunction, in their cerebellar and basal ganglia. He likens the amount of brain function in zombies to that of a crocodile. Their unpleasant behaviors, including their insatiable appetites, derive from the lack of activity in the parts of the brain that modulate behavior.  But does this make them dead?

Since, at this point in time, medical technology has not created a need for zombie organ donation, devising new definitions of dead are not at the forefront of medical science. If, in the future, a method to safely use zombie organs is developed, I have no doubt that a new definition will arise and it will include the presence of limited brain function in the absence of respiration and circulation. The process will follow the same path to definition and acceptable use that occurred when human organ transplantation became viable. Prior to the need of organs, one definition of death, absence of heart beat and breathing, sufficed. After organ transplantation, a new definition of death, brain death, arose. When the need for zombie organs is great enough, medical science will become interested in ensuring that the answer to the question, are zombies dead or alive,  will become “really most sincerely dead.”

Interested in reading more about zombies? Check out:

http://www.cdc.gov/phpr/zombies.htm

http://io9.com/5286145/a-harvard-psychiatrist-explains-zombie-neurobiology