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.

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