Not In My Hospital, You Don't!

Dang, here goes another health care bent....

I have been with my mom this week as she underwent a total knee replacement.  Of course, they didn't do it at my preferred hospital, Children's Mercy, since she's, you know, an adult.  It was an eye opening experience and it reminded me of a few things. 

I take care of post op patients regularly.  Sometimes they are post a fracture reduction, post feeding tube placement, post kidney transplant, post spinal fusion.  Ideally, I see the patient several times in the first couple of hours, check their comfort, check their pain control, check their wound.  But that's me and that's my hospital.  It's kind of an expectation, you know, to look in on your patient after they have had a surgical intervention.  Sometimes things go wrong after surgery, like bleeding, puking, pain.  But again, that's just me and my overprotective nature.  When I get to the hospital after Mom's surgery, about 2 hours after coming out of the OR, Mom says, "No, the nurse hasn't been in here since I got to the room."  WHAT?!?!?  You haven't seen your nurse, I ask.  Nope, nada, negatory....  Great.  Of course I can't help myself from looking at her dressing, looking at her iv fluids, the PCA, etc.  Somebody needs to. Guess who's feeling a bit bitchy about now?  Yep, I'm a little ticked and guess where the nurse is??  Lunch.  Do you want to hear the cherry on top of this little shit cake?  Her IV pump was beeping and continued to beep infusion complete for, I kid you not, 30 minutes.  Her roommate...her IV was beeping as well, for 20 plus minutes.  So that's at least an hour of that incessant beeping!!  GRRRRRRRRRRRRRrrrr!!!!!!!!!

NOTES TO SELF:  Continue to be the attentive nurse post op. Continue to answer my alarming pumps promptly and continue to keep the high level of care that is expected of me at CMH.  Note I said continue.  I never want my patients or families to be as annoyed as I was over something as simple as checking in with my patient and answering alarms.  And the pisser of it all, any time I went to the nurses desk, her nurse and the others were at the desk talking and surfing their phones.

I've been a nurse for a bit, 15 bits, er, years, as a matter of fact.  Most of my coworkers know this, but I don't routinely tell my families this.  Sometimes it'll come up in conversation and sometimes, I will tell a family in a lame attempt at reiterating that I know what I'm doing and I can handle the placement of an IV or something.  It's usually that family that is having some control issues that I find the need to bring it up. This week, my mom had a nurse who had this compulsion to tell us how long he'd been a nurse.  It was funny how the story went from being a nurse for 18 years to being an Army nurse for 13 years to being a nurse here at OPRMC since 2004.  Basically, I had his resume memorized by the end of my visit.  Really??!  Is it necessary to impart this useless information??  Do you think I think you're a better nurse because you report you've been a nurse for 18 years?  Do you need to pin these comments onto the end of your excuses for not having placed the compression stocking on my mom's affected leg as ORDERED BY THE PHYSICIAN???  Really?!?!?!

NOTE TO SELF:  The number of years isn't as important as the direct care that I provide.  No one is impressed by the nurse with 20 years of experience but can't get anything done.

I've been on the night time side of pain medication administration to a sleeping individual.  On my part, I kind of don't like giving pain medications to patients who are sleeping.  We've all heard the complaint:  "They woke me up to give me a sleeping pill (or pain medicine)!"  But, a reality check this week unfortunately at the expense of my mom's comfort.  She texted me at 0521, "Had terribe nite dohg xr.bxw...".  Course, I didn't see this text until 0730 when I got up.  Crap!!  I was worried.  When I talked to her, she said she had a lot of pain in the night and is still hurting.  She couldn't tell me when she got her pain med in the night and she didn't know what it was. This is about 16 hours since her PCA was stopped.  "Did they give you something in your IV?" I asked.  "I don't know, I just hurt!" she said.  My fears: they didn't give her pain meds "scheduled" and her pain got out of control.  When I finally made it to the hospital, I had an opportunity to talk to the nurse.  He looked up the pain med in the eMAR to see what times meds were given.  She had received her every 4 hour medication after 5 plus hours and this was after crying out, then got her next dose in 3 hours 15 minutes.  In conjunction with decreased movement from sleeping for 5 hours and the 5 hour time span, her pain got out of control.  What was the nurse thinking?  "Ah, she's sleeping, I won't disturb her" or "I don't want to give her too much medication, she could get addicted to the pain pills."  Who knows what the murse was thinking and unfortunately, I've seen myself having the same internal dialog.  Ultimately, though, I am a family member in this scenario and I was pissed that my mom was so uncomfortable.  Why did she have to be suffering and "waiting" for her pain medication after literally getting her knee amputated then rebuilt?  Why didn't that nurse anticipate the pain as an ortho nurse on an ortho floor??

NOTE TO SELF:  Administer pain medication as a rule not as an exception.  Why wait until my patients are in pain to get pain medication.  Duh.

I think it's important to stop and take a second look at what I'm doing day in and day out and make sure that it meets the standard of my personal expectations and values.  I can't let myself get lax and complacent.  I have to remember that every one of my patients deserve the level of care that I expect for my own family.  A message that I plan to remember in the coming days of my scheduled shifts.

A Healthcare Crisis

I think I picked up my husband's unhealthy habit of waking in the middle of the night with a brain in full gear, thinking to a fault, and I can't go back to sleep.  Not so rough when you are at home and can pop on the TV and watch some boring show until you get sleepy or crack open a book to dull the raging thought processes.  But, unfortunately, better yet, fortunately, I am sitting on my house boat, moared in a little cove with little more than a battery operated tablet and a little dog keeping my feet warm.  And I just can't stop thinking. 

I had a blog idea earlier in the day while driving with my mom to come to this very house boat.  We were talking about the state of health care.  More specifically, the state of my parent's financial situation now that their health is beginning to become more of a challenge.  It was then that I decided that that topic sounded like a little blog to vent.  But damn if tonight, my mind says, "A  little blog?  Hell NO!  It's a giant blog, a huge problem, an elephant in the room of our society!"  Thus the 0426 middle of the night blog session.

I'm lulled into a false sense of respectable and decent health care by being an inpatient nurse at a non profit children's hospital.  We don't turn anyone down for the inability to pay.  Families come from all over the mid west to bring their kids to our hospital because the believe they can count on us to provide top notch care even if they can't afford it or don't have insurance.  It's a lull because, as an inpatient nurse, I don't have to deal with the aftermath of bills that still arrive on the door step, even if you don't have insurance.  I don't have to deal with the follow up care and costly prescriptions that may come as a result of the hospital stay.  I don't have to deal with a devistating diagnosis that at only 3-4 months of age, a coworker and friend's baby is suffering and the costs are just beginning to mount.  I provide the top notch care that is expected of me, I try be cognisant of the limited resources that the hospital works with and I try to end my work day feeling like I've done something good for my families.

Then, I visit with my mom.  I become reoriented to the plight that so many retired and non retired adults are facing every day of their lives.  Now, my parents are great people.  Their marriage began when they were both in their late 30's, early 40's after previous marriages.  They had challenges to face even before they got together.  My mom is smart even without the certificate of an advance degree; my stepdad, a hard working, responsible man.  They have encounted experiences in their marriage that that didn't lead them down the yellow brick road of secure financial retirement.  My stepdad suffered a devistating job loss in his mid 50's when his company went bankrupt.  What does a man in his 50's with a particular set of skills do when his job of numberous years ends?  There certainly isn't a demanding market for a man in his situation.  But they carried on as best as they could.

I'm sure they thought about retirement and how that might look.  My mom had her job and some 401K, they both had social security to rely on (not so much an option for our generation, folks!  Be ware.)  And that is a conservative lifestyle at best, without any health care issues.

Now pan to today's reality.  My parents, being raised in the 50's and 60's didn't have the "luxury" of knowing that the diets and lifestyles they had then, would negatively impact their lives down the road.  A silent heart attack later, my stepfather's coronary function is not half what it should be and years of smoking is beginning to effect his breathing.  He takes a plethera of mediations for his heart function, blood pressure, breathing, diabetes, cholesterol and so on.  My mom, lucky in that she knows that there is a family history of heart disease, takes statins for her resistent, herediarily elevated cholesterol.  Many medications in comparison to some individuals, few medications, compared to others.  They live on a fixed income and pinch in so many ways to accomidate this.  And here it is; it's a huge struggle.  It makes me angry when she tells me, "well, honey, we couldn't afford to buy my medications this month."  Or she tells me that her medication, of which there is no generic, is so expensive, they have looked into purchasing the medication from Canada, because, there, they do have a generic and it will save her 2/3 the cost.  It pains me to think that they don't go to the doctor when they really should because they can't afford one more office visit copay that month, on top of the others they have already paid.  It hurts me to see that they have to struggle.

But the truth is, their story is really no different than so many other people in the middle and lower class here in the great ole country of the United States.  So many people are just one paycheck away from financial ruin.  So many people are one copay away from not having money for food!  So many people are one bottle of medication away from treating their pain or prolonging their disease process.  And yet, we are lulled into some security when we keep our blinders on, focusing on our narrow view that is our life.  There are stories much worse than my parents, I'm 100% certain of it.  There are people, everywhere, with so much less.  And of course, because we are the land of possibilities,  home of corrupt politics and center for self serving bureaucrats, this plight of so many draws nigh.  There will be a time in my parent's lives that something will have to give; they will not pay a bill because my stepdad is sick and needs more medications or my mom can't do those odd jobs she does because her bum knee is too painful to help suppliment their income.  They will stress about the $50 copay to see the cardiologist when all they saw was the nurse practitioner.  They will sell their belongings to help pay the rising cost of their prescriptions.  They will enjoy their much anticipated retirement years less and less. 

And our fucked up healthcare system, widening, YAWNING gap between the rich and EVERYONE else and self serving politicians will remain, will worsen before it gets better, will see great people suffer and die because they can't afford to stay alive, will see parents struggle to provide anything and everything they can for their precious baby. 

We are lulled.  We think there is nothing we can do.  We think that our one vote, our one voice won't be heard.  And as one person, it likely won't be heard.  But our essense of humanity is more than being one voice, one person.  Our RESPONSIBILITY as humans, as soulful, thoughtful, moral people is to put our voices together to raise the volume to be heard.  To care for one another, to be a community, to be a society.  We are better than what we are doing for ourselves right now.  But as the citizens of this country, we are lulled to believe that we really can't make much of a difference, we are lulled to believe that the bureaucrats will take care of us, at some point.

Not gonna happen, folks.  Not until we become one loud voice of reason and demand that there is equality among healthcare, fiscal responsiblity, exclusion of wasteful, greedy politicians, transparency and humanity among our leaders.  Because, the truth is, our "leaders" are leading us to our own demise, sheep to the slaughter.  And until we begin to take responsibiltiy for one another, care about one another, operate as an evolved society, our futures will be mired in struggle.  I don't want to struggle; I want to live and I want my family, my friends, my coworkers, my aquantences, my people, my society, my country, my specie to live.  Do you?

By the Hair of My Chinny Chin Chin

I guess that I will admit that I am one of those gals with various hairs sprouting from my chin and upper lip.  Don't laugh, you have some too.  You just haven't taken the obsessive compulsive route to addressing those hairs just yet.  Or maybe you have and you know how I feel.  It's just pure crap, I tell you.

Hubba hubba!!

Facial hair is among one of the many things that looks great on men.  Gray hair makes a man look distinguished.  George Clooney, Sam Elliott and Morgan Freeman are among the distinguished graying men.  Muscles make a man look strong.  Enter hottie with a six pack.  Not a problem to look at.  Chin and upper lip whiskers, well, they can make a man look rugged. 


Then, there are things that don't look great on men.  Breasts don't look good on men.  They're never perky and spry; they're usually flabby and spread out.  A big ass doesn't look good on a man.  I'm always taken aback by a man with a pear shaped body.  Long nails don't look good on a man either.  Now, I appreciate a well groomed man with neatly clipped and clean, reasonable length nails.  He cares about himself and his love when he takes good care of his nails.  But when the nails go beyond the tip of the finger, well, that just looks creepy. (I’m projecting here; I have a creepy uncle who keeps his nails long and the two together, creepy and long nails, well, it will always be a red flag for me.)

Now, looking back, have you ever noticed that the things that look great on a man, don't look so great on a woman and vice versa.  Breasts on a woman, good call especially if they are perky.  Many women long for bigger, perkier breasts.  Remember the preteen exercise we all did.... "I must, I must, I must increase my bust!"


And a big ass on a woman, well, many men appreciate this trait.  J Lo  has built a career around her ample backside.   Long nails on a woman, help a gal to complete a seductive look.  

Sexy???

But conversely, gray hair on women, not so much an appreciated characteristic.  That's obvious when you look at the exponentially greater number of boxes of hair color at Walmart compared to men's hair color. 


Muscles on women, well, that is a little debatable.  Certainly a woman with a lean and defined body is attractive; shows her dedication to being healthy (a problem I don't have).  But muscles, big, ripped, bulky muscles are just plain weird on a chick. No matter how you slice it, how much saline is placed in her breast implants, the muscled physique of a pumped up, body building female is just disturbing.  There are things our minds can't get wrapped around, and big muscles on a woman is one of them.

Then there's hair on a woman's face.  Now, it really sucks, because most of us can't help this.  It's often there as a result of an underlying medical condition.  Some women are just genetically predispositioned to have more hair and as they grow older, it moves to their faces.  I often warn my 10 year old, who has a strong Italian background, as she points out the hair on my upper lip, that she too will experience this in time.  (If she'd stop pointing it out, I'd stop being mean about it!)  


But it's a burden that some women have to carry, hair on our lips, our chins or overgrowth between our brows.  And the pain and personal torture that we endure because of this overgrowth is nearly unbearable.  Plucking, waxing, ripping, laser treatment - all in the name of beauty.


I guess in the end, the scales of justice are equal when it comes to men and women; each sex has its drawbacks and trials.  Acceptance of our bodies, unfortunately, is based on a prehistoric, often unattainable social expectation and a highly skewed ideal portrayed in magazines and film.  Maybe someday, our society will be able to look beyond the graying mane of hair and stray whiskers of women as well as the sagging man boobs and re ceding hairline of men to appreciate the most important aspect of our humanness, our souls and what is within....