What's in a Name?

I knew how to spell my older sister's name before I learned how to spell my own.

When we were growing up, playground introductions went something like this:

"Hi!  I'm Susan!"

 

"Hi!  I'm Cathy!" 

 

"Hi!  I'm Becky!" 

"Hi!  I'm Lisa!"

 

My sister would say, "Hi!  I'm Calina!"

"What?  WHAT'S your name?"

"Calina..."

"Colleen?"

"No...CALINA."

"Katrina?"

"Calina.  C-A-L-I-N-A.  Calina."

When I entered first grade, the teacher told us we were going to learn how to spell our names.

I stood up and announced that I ALREADY knew how to spell my name!  "C-A-L-I-N-A"!

 

She told me to sit down.

Nurse's Note:  Thus began my long Icarusian fall within the education system.

Smart VS Work Ethic

My cousin Kevin and I like to discuss weighty subjects.  One day we were debating what is the most important factor for success--intelligence or industry.  Is it better to have a high level of natural smarts or a strong work ethic?

Kevin used to live in Hawaii, where there is a large homeless population*.  Once, while he was standing in line at the library, there was a homeless woman standing in line in front of him.   Her clothes were filthy, people were holding their breath from her smell and Kevin glimpsed something crawling in her hairline.  

At the front of the line she asked, "Did that book by Solzhenitsyn come in?"

Now, both Kevin and I love to read, but neither of us have EVER read Solzhenitsyn.  Other than my husband--who's CrAzY--I don't personally know anyone who HAS read Solzhenitsyn.

So obviously the woman was extremely intelligent.  But, she was also homeless.

Kevin said, "Give me a good work ethic any day."

*Nurse's Note:  If you're gonna be homeless, where would you rather be?  Hawaii or Alaska?

The Good Life

Last night a nurse asked me why, in this day and age, all homosexuals aren't "out".

I debated bringing up religion or public scorn--but I thought about it and said, "Because of the myth of what is 'A Good Life'."

And I drew him an image of A Good Life  (actually a "Good Life" might require you to have more fingers, but my drawing skills are poor...)

Here it is:

Nurse's Note:  Same sex marriage banned in most states, abortion restricted and/or prohibited in many areas, United States money and Pledge of Allegiance both mention "God", most male infants circumcised to make their genitals look more appealing despite multiple medical studies showing no benefit in cutting a child's penis.


What constitutes a "Good Life" has changed throughout human history.  Let's look at the year 980, the Song Dynasty, China

Nurse's Note:  Husband has an opium pipe, first and second wives are used for slave labor, third, most expensive and favored wife had her feet broken and bound as a child for aesthetic reasons so she can barely stand, women cannot vote or control their reproduction.


 Mississippi, 1790

Nurse's Note:  Husband hoping for many sons, wife must have tightly corseted waist, women cannot vote or control their reproduction, interracial marriage prohibited, slaves imported from Africa.


American West, 1840

Nurse's Note:  Native Americans slaughtered and their property stolen.  Women unable to vote or control their reproductive processes, interracial marriage prohibited, homosexuality punishable by imprisonment.



Middle East,  2013

Nurse's Note:  Husband has many wives, some of them children.  Women forced to hide behind walls and clothing, unable to go to school, vote, control their reproduction, women's clitorises cut off, homosexuality punishable by death.

So, we know that our perception of what constitutes a "Good Life" changes.  We think that the way things are today is the way they have always been and will always be, because humans have natural myopia.  But, Octavia Butler says, "The only lasting truth is change." 

I predict that science will discover genetic causes of homosexuality. Then all the red-faced preachers with their obsessive fears and secret yearnings will have egg on their face.  I don't think being gay is a choice, and I don't know any intelligent people who do.   

When I was growing up there were no gay people in the world.  Not anywhere!  There were eccentric people like Paul Lind and Elton John and entertaining people like Liberace and Michael Jackson.  But "gay"?  It was unthinkable!

Now there are gay people all around me.  They are leading the way to make being out and openly gay "normal" (whatever THAT is).   Part of, "The Good Life". 

"We must be willing to let go of the life we planned so as to have the life that is waiting for us."  Joseph Campbell

!!ALIEN INVASION!!

Recently, a patient watching a "science" channel told me we should all be preparing for an alien invasion.  

I asked him why.  He told me that there are billions of stars out there with life on them. 

I'm not sure about stars--they're awfully hot--but there's almost certainly life on other planets.  I've seen Carl Sagan do the math.  But that doesn't answer the question of why aliens would WANT to come to Earth.  The universe is so vast---what could an alien species want from Earth that they couldn't get closer and easier?  There are moons with seas of methane gas, asteroids made entirely out of diamond, and ice balls in the Oort cloud with enough water to fill a hundred thousand oceans.  Why come to Earth?

The patient said, "Maybe to make slaves of us."  

I thought that was pretty anthropomorphic, since humans have kept slaves everywhere they've ever existed (one out of every three people in the Roman Empire was a slave).  But any civilization advanced enough for space travel would find it easier and cheaper to make nano-robots than to come all the way here and make slaves out of us.  How would they feed us?  How would they "breathe" us?

He said, "Maybe to take our women."

Well, I guess that might be true.  Maybe the aliens are after our women.

 I guess we need to be careful.

Nurse's Note:  There are millions of animal species on the planet.  That's not including the plant, fungi, monera and protist kingdoms.  It's pretty arrogant to assume that an alien visitor would come all the way here just to steal a human female.

I Believe in the FDA

A fellow nurse told me recently that she only eats organic food.  This confused me--I thought ALL food was organic.  Doesn't "organic" mean that it was once alive?  Other than salt, I think that everything that humans CAN eat is organic. 

She also said that she doesn't eat genetically modified foods.  But--I thought that nearly everything Americans consume has been genetically modified.  See if you recognize any of these foods:

Granny Smith Apple

Idaho Potato

Holstein Cow

The reason that they are recognizable is because they have been genetically modified. 

 How about these non-food animals:

Dachshund Dog

Clydesdale Horse

Apples, potatoes, cows, dogs and horses should be as widely diverse as humans are and not recognizable as a "breed".  But genetic manipulation has selected for a few characteristics.  That can be good because it can keep the desirable traits.  But it also can be bad, because it can keep the undesirable traits, too.  This is genetic modification.

The same thing could be done with humans.  If we heavily line bred humans, they would be as easily recognizable as the dog breeds.

Here are a few of my proposed human breeds and some of their typical characteristics:

The Ernie:  Intelligent, creative, temperamental, can be difficult to house train, requires lots of attention and daily walks, late bloomer, needs a dominant owner, howls at the moon if lonely.

The Monque:  Quiet, can be highly strung at times, bonds tightly to one person, great voice, does best with steady routines, discipline with rolled-up newspaper if needed.

The Finny:  Friendly, outgoing, very social, great family pet, loves the outdoors, retrieves and fetches, will sniffs crotches and hump legs if bored.

The Peterie:  High energy, must be kept busy, not good with small children, easily distracted, will chew the furniture and pee on the carpet if frustrated, not recommended for police work.

Nurse's Note: the fashionable trend of eating "organic" food may be making some businesses rich, but it consumes more  time, energy and water and is not realistic to feed 7 billion people.

Nursing Pentathlon

The Olympic Committee is introducing a new event: the Nursing Pentathlon.  Five exciting tests will evaluate the fitness and readiness of nurses!  The nurse with the highest total score will win the gold!

The Nursing Pentathlon is traditionally completed with no breaks for food, drinks or toileting.  Here are the five events:

CT RACE

The nurse and respiratory therapist take an intubated patient on four drips down and through the CT scanner and back.  The first team to get the patient back to their room and reattached to all the monitors wins*!  

*patient must survive transport

FOLEY SHOT

The nurse must place a foley on an obese female--alone--while a judge watches and evaluates the sterile technique.

CHEST COMPRESSIONS

The nurse must do continuous chest compressions at a goal rate of 100 beats a minute for one hour while the physician explains repeatedly what the chances are for recovery to the family.

IV IQ

This test evaluates the nurse's ability to think critically.  You have a patient with a single lumen PICC* and a 22 gauge peripheral line.  How do you arrange the following drips to ensure compatibility and safety?

*anyone who puts in a single lumen PICC should be shot

CHARTING CHALLENGE

The final event in the Nursing Pentathlon is the Charting Challenge!!  Everything done up to this point must be charted on accurately.  No eating, drinking or bathroom breaks allowed!

Go for the gold!

Fairy Lane

I had he opportunity to drive around downtown Seattle recently.  The traffic was monstrous--one-way roads, trolleys, bus lanes, bike lanes, pedestrian lanes and lanes with the words, "FERRY ONLY" painted on them.  After being stuck in a "FERRY ONLY" lane for an hour, I started thinking, "Don't the goblins, nymphs and ogres get irritated that only fairies get their own lane here in Seattle?"

DIV ORCE

A nurse told me once, "I'd rather come from a broken home than live in one."  That's the best argument I've ever heard for divorce.

Divorce is unpopular.  Little girls dream of their wedding day.  Wedding Barbie is a runaway hit...

But Divorce Barbie doesn't sell well at all...

No one plans their divorce day.  But no one plans on getting open heart surgery, either.

Think about other major relationships in your life.  Friendships, for example.  Most of us have had friends--really close friends--who we are no longer friends with.  Why?

People change.  They grow apart.  Do they need to STAY friends out of some sense of tradition?  Are they bad people if they don't?  Is the whole friendship now a FAILURE because it ended?

What about jobs?  How many people stay at their first job?  Our first job is usually has two critical qualities:

1. it's close
2.  it's willing to hire us

Do we need to stay at that job out of some sense of loyalty?

The same is true with marriage.  We marry some person who pays attention to us.  Since we've never been married before we have no idea what to look for.  Most of us marry when we are young.  Our hormones are raging our judgment is nonexistent.

But time passes and we grow.  And change.  We become more aware of what makes us happy and what doesn't.  

I'd rather come from a broken home than live in one.

Self-Scheduling

One indication of how far nursing has come is the idea of self-scheduling.  Not long ago, nurses had their whole lives on hold, waiting for the next schedule to be posted.  They weren't sure month to month if they would be able to host a birthday party for their child on a certain day.  

Self-scheduling has its problems.  Like concerns that the skill mix will not be adequate or that the weekends will be skeleton crews. 

But somehow, the empire has staggered on.

Statistics

Statistics help us get a grip on our fear and uncertainty.  Consider these true but unpopular facts: 

Peanut butter kills more people every year than terrorists.

You are more likely to be shot by your dog than to use your gun legally on an intruder.

  

Statistics are easily manipulated.  They can "prove" that something causes something NOT to happen.  Like elephant repellent:

Here's another questionable correlation/causation case:  statistics clearly show that when ice cream sales start to rise, drowning deaths also rise.  Does ice cream cause drowning?

There are things we SHOULD fear:

And things we should not:

 

Compassion Fatigue

Nurses are vulnerable to compassion fatigue.  Our capacity to care can be severely challenged by patient's behavior. 

For example:

Patients who unplug their IV's and sneak outside to smoke

Obese patients on insulin drips who call patient relations because their nurse won't get them another bag of candy

Patients who leave AMA, go to the bar across the street, stagger back and pass out drunk in front of the hospital

And patients who smoke meth in their hospital bathroom, causing their monitored heart rate to double  

Nurse's break rooms should have a special vending machine for compassion rejuvenation!

Swan Dive

Doctors are as vulnerable to fashion trends as any other herd of people. The Swan-Ganz catheter is an excellent example.

When I first became an ICU nurse, swans were wildly popular.  Most ICU patients--regardless of their diagnosis--were swanned.  Swans generate a flood of esoteric numbers, so they MUST be beneficial, right?  ICU's had so many swans back then, they resembled aviaries!

The nurses spent a lot of time leveling, wedging and bolusing.  And charting all those numbers.  It was all paper charting back then--there was no such thing as downloading values from monitor to chart with a simple keystroke.  We faithfully charted EDVI, SVI, SV, CO, CI, PAS, PAD, PAM, PAWP, PVR, SVR, SVRI, MAP, RAP and CVP into tiny cramped flowsheet boxes while call lights went off and patients called out for help.  But, since this was IMPORTANT, we prioritized and charted on!

The result?  Did the attending physician call at two in the morning to check on the pulmonary artery diastolic and add dobutamine?  Did the cardiologist stop by, see the cardiac output and tweak the fluids?  What was the impact of all this writing, flushing, leveling and wedging? 

Not much.

I felt like someone who makes seven course dinner for guests who never show up.  Why were we doing this?  Is anybody there?  Does anybody care?

Then studies started coming out demonstrating clearly that swans do not improve patient outcomes.  In fact, with the combined risks of infection, overwedging, valvular damage, thrombus and pulmonary artery rupture, swans actually result in worse patient outcomes.

Younger physicians, current on the data, left the swans to fly in the wild (the cath lab and operating room).  To evaluate sepsis and cardiogenic shock, they used less intrusive means. 

When a swan is sighted now, it's almost always partnered with an old doctor too deaf to recognize the swan song.



Team ICU

ICU nursing is a team sport.  Some nurses don't get that.  They are too insecure to admit they need help, so they try to do everything themselves to prove their competence.  Offers of aid or advice can cause them to boil over with intense anger.  

Would you go into a basketball game and yell, "I got this!  Stay out!  I can do it myself!"

Your co-worker's eyes and ears and experience are like silver in a mine.  Use them.  A group is always stronger than an individual.  We are all learning and growing.  Policies, protocols and equipment change constantly.  Don't be afraid to say, "Will you take a look at this Arctic Sun and see if I've got it set up right?"  or, "I can't figure out why this balloon pump keeps alarming," or, "I'm concerned that I'm missing something here--got any ideas?"

And if a co-workers says, "Hey, that's not how this Swan is supposed to be hooked up," or, "Do you want your dopamine  running at this rate?" or "The heating coil should be on this return line," be strong and secure enough not to take it as a personal affront.  People who reach out with constructive criticism are trying to HELP YOU.  Getting angry and defensive and making stupid excuses will make you co-workers go silent, step back and let you fall. 

Take a deep breath and say, "Thanks for catching that!"

Together, we make a great team. 

Mos Def, be Les Dum

There's an online video showing the rapper Mos Def attempting to tolerate having a small-bore feeding tube placed.  I have to say this to his outraged audience:  you don't need to go all the way to Guantanamo Bay to see this.  Poke your head out your door and peer down the street at the nearest hospital.  There are dozens of patients right there with feeding tubes.  

Besides that, brides pay big bucks to have feeding tubes so they can lose weight before their horrific weddings and exercise fanatics proudly wear them to control every calorie.   

I have placed plenty of feeding tubes, mostly in frail, elderly people.  But I've NEVER seen a wild, sobbing breakdown like Mos Def's.  Only about 10 cm of his tube went down--but I guess that's more than this delicate flower can handle.  Where's his murderous public persona when it counts?  Man up, Mos Def!  Be Les Dum!   

I've also never seen handcuffs disappear like they do in this video, (although it allowed his hands to flail around desperately and then cover his eyes while he cried piteously).  And how did his head strap come loose from the chair where it was clearly shown in the first take?

Mos Def--you're a bad actor and you have a very bad film editor. 
.
About Mos Def's statement that this was the worst pain he's ever experienced--what a sheltered, petted life he must have!  What if he had to give birth or something that is actually uncomfortable?


Nurse's Note:  To the upset people posting comments about how "the doctors" were trying to get the feeding tube down:  doctors don't place small bore feeding tubes.  Nurses do.