Archive for December, 2009

Happy Hogmanay

Anyone want to go to Edinburgh next year? Maybe the best place to be on Earth for New Year’s.

And don’t forget your First Foot gifts.

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Triage Haiku 3

Have Worms In My Brain

it’s serious nothing helps

I need a new script

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Of Rice and Reproduction

Fascinating article on Japan’s rice culture (a term which in this sense has multiple meanings) in the year-end double issue of The Economist. OK, it’s only very tangentially related  to health care, or nursing, but this caught my eye:

Symbol of fertility

Yet this rice is among Japan’s best—the snow, it is said, gives the local rice, known as minami uonoma, a particular purity. Surrounded by the stillness of snow, the most productive rice seeds are kept through the winter months in an outside storehouse. The building is so closely associated with the nurturing of new life that mothers traditionally used to go there to give birth.

A deep cultural connection between the land and the workings of rice production, and human reproductiona motif, I know, common in many cultures over many millenia. The scientific part of my brain dismisses this as nonsense and superstition. But the right brain wonders that with our relentless focus on the technological fix in health care, something ineffable was lost: our connection with the processes of the natural world.

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Sanitizing Old Flo

This just really annoys me because it manages to devalue, demean, trivialize and sanitize Florence Nightingale, all at once:

University of Phoenix Nursing: 5 Characteristics That Made Florence Nightingale Into a Nursing Legacy

Often called the founder of modern nursing, Florence Nightingale’s legacy continues today. University of Phoenix nursing students are learning to emulate her pioneering ways. Contemporary nurses have much to gain by following the five key characteristics that made Florence Nightingale a success:

1. Purpose in Nursing

Early in her career, Nightingale described a “divine calling.” Her resolve to care for patients carried her through difficult times. Having a purpose is crucial for today’s University of Phoenix nursing graduates when dealing with long shifts and busy days.

2. Nursing Study

Nightingale began her career by observing deaconesses at a Kaiserswerth, Germany hospital. She later completed four months of formal training at the hospital. A strong educational foundation is helping current University of Phoenix nursing graduates compete for the best nursing jobs.

3. Modern Nursing Attitude

During the Crimean War, Florence Nightingale led a group of female nurses to a British war field hospital. At the time, this was a bold move, as women had never served in wartime hospitals. The modern field of nursing is continually changing. University of Phoenix nursing graduates are constantly looking for ways to improve their profession. . .

[snip]

And so on, until a terminal barf factor is reached. The real Florence was a hugely more complex, interesting, and ultimately far more ambiguous figure than this crap would have you think. She was a woman bound by Victorian class sentiments who somehow managed to transcend them at the same time. A nurse, yes, who spent 50 years of her life more or less as an invalid, but managed to run the British army medical service for decades in the 19th century. She was a woman whose relations with her close associates bordered on the abusive, yet in the popular mind she was The Lady With The Lamp.  And still she presents a profoundly useful model for nurses, but not in the feel-good saccharine warm fuzzy way implied above. On her role at Scutari during the Crimean War Christopher Gill and Gillian Gill write:

[A]lthough [Nightingale] presumably had no concept of bacteria or viruses, she clearly understood contagion. She saw a clear relationship between the diseases killing her patients and the filth in which they lay, the air they breathed, the water they drank, and the food they ate. To Nightingale, the greatest tragedy of the Crimean War was the British Army’s failure, through bureaucratic inertia, to protect the soldiers’ health or to assist in their recovery. In her words, “The 3 things which all but destroyed the army in Crimea were ignorance, incapacity, and useless rules.

You get the feeling Nightingale wasn’t a warm-fuzzy sort of nurse. She wouldn’t be caught dead with teddy bears on her scrub top, for example. Yet she touches on what was central to her practice and what ought to be central to every nurse’s practice: the ability to act as the patient’s advocate, regardless of rules, bureaucracy or resistance from physicians or others in authority. Indeed, this is one of her central insights and her greatest contribution to our profession. It implies both a certain fearlessness and a touch of spinal steel, as well as a contumacious willingness to challenge conventional wisdom and authority. Might that we all have those qualities! Anything else, including drawing out a largely meaningless laundry list of “life lessons” from Nightingale’s career is really besides the point.

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Drinking the Management Kool-Aid: An Update with Bonus Snark

In case you guys were wondering, the fix was in, as I thought. Applying for that position would have been completely useless.

And more food for thought: with Ontario hospitals facing a 0% funding increase next year, low-level managers ought to be shaking in their boots. They’ll be first to get the axe.

Of course, calls for freezing the wages of nurses and other greedy health care professionals and hospital workers have already started. First up is Robert Cushman, chief of the Champlain LHIN in Eastern Ontario:

“I think it’s certainly worth entertaining,” said Dr. Robert Cushman, chief executive of the Champlain Local Health Integration Network, which has authority over how provincial health dollars are spent in the region. “There should be freezes across the domain — union, non-union.”

Cushman’s own salary jumped from $232,690.84 in 2006 to $259,922.21 in 2008, an increase of $27,231.37 or 8.9% over two years.

Awesome.

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There Will Be No Inspirational Holiday Season Stories Here

There will be no stories of profound wisdom conveyed by patients on their death-beds, or insights into living by that sweet, quiet, elderly lady who reminds me of my grandmother in Resus 3. No words of suffering children drawing life lessons will ever grace this weblog. Pregnant ladies or newly diagnosed cancer patients gently pointing out flaws in my practice and making me a better nurse — no, sadly, their stories will never appear here either.

Sorry. Just don’t have it in me.

I am a sour old cuss who thoroughly believes such saccharine bupkes properly belongs on greeting cards and in the pages of the lower-end nursing magazines and Reader’s Digest.

And I really don’t think the world works like that anyway. The emergency department is filled with stories — sad, tragic, funny, desperate, ridiculous, maddening, empowering, life-altering — some of which I am privileged recount here, and some of which are cause for reflection and learning. But none of them are neatly tied up with a bow, ready for presentation like a gift basket. Not every story has a moral. Some stories just are unvarnished tales with no point at all. Life is too messy, and the ethical and moral lessons, if in fact there are any to be found in the ED, are usually far too ambiguous and make for periods of lengthy thought and hard-won insight.

Not fodder the short, snappy, sickly-sweet story with the moral tacked on the end. Can’t do it. Won’t do it.

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Merry Christmas [Updated]

Dear readers and fellow bloggers and (I hope) friends: I’m on holiday from today till the 28th. Family and stuff and general egg-noggery and tomfoolery and laying around. You know.  Have a very happy Christmas. In the meantime, one of my favourite carols:

[UPDATE (26/12/09): Actually I couldn't stay away from the keyboard. Regularly scheduled posting will resume tomorrow, the 27th.]

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Snowbanks and Alcohol are a Really Bad Combination

We’ve been having a cold snap here in Ontario, and the other day EMS brings in Buddy A, a 15 year-old boy who decided downing a bottle of Bacardi Dark in an hour was a good way to kick off the holiday season. Buddy B, his friend, can’t quite comprehend that leaving drunk, obtunded Buddy A in a snowbank when the ambient temperature was -10c (that’s 14F for you nonmetric types) was maybe not in the best interest of his friend (or himself, for that matter).

A neighbour had the sense to call 911, before hypothermia became a major issue. After we get Buddy A sorted out, Buddy B arrives with his father and the very angry father of Buddy A.

Therefore big scene, lots of theatre.  Weeping and wailing and gnashing of teeth. Buddy B is insouciant, of course, full of teenage bravado and indifference. He’s not grasping the seriousness of the situation. I desperately want to slap him, except the College of Nurses really frowns upon physical violence, even if it’s well deserved.

“You know,” I say after the tumult, “he could have died.” I really mean it. He could have. It happens every winter. Someone gets drunk, falls in a snowbank and freezes. Human popsicles.

“Uh,” says Buddy B. He’s not impressed, and doesn’t care.

And all the while he’s texting this adventure, which judging from from the half-smirk on his face, he clearly finds amusing.

Amazing. Were we all so slack-jawed stupid when we were 15?

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Rhymes with Penis

One of the commenters here yesterday reminded me that Weanus rhymes with penis, which is exactly why his name was chosen, besides being slang for, yes, penis.

Weanus (there are multiple spellings), I just discovered, is also slang for the excess flesh around the elbow. In other words, a bit of useless tissue.

Either way it’s appropriate.

Thought you’d want to know.

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Dr. Weanus on How Nurses Learn

Dr. Weanus clearly treasures his nursing collaborators. So much so that at an Emergency Department medical staff meeting, he stands up and tells his physician brethren (and they were all male) exactly how much he values their knowledge and practice.

So what do you really think of nurses’ critical reasoning skills in the Emergency Department setting, Dr. Weanus?

“Nurses, of course, can’t understand the theory behind ACLS,” he intoned. “They learn it all by rote.”

My favourite internist.

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