Archive for March, 2010
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Posted by torontoemerg in I'd Better Feel Sorry for Myself 'Cause No One Else Will, Life at Home on Wednesday 31 March 2010
AtYourCervix has her own Black Dog — we seem have joint custody of the same pooch, or maybe mine has wandered over to live at her house. Reading her story I was struck by the commonalities — especially the social isolation, which can be truly painful. Totally. Completely. Get. It. Been on that highway, and it both sucks and blows.
I think the worst thing is (and I know, having been there) when you hear of someone else having depression, you’re pretty well at a loss of what to say. Advice is pointless, fraught with pitfalls and actually kind of awful, because a good deal of that well-meaning advice comes across to depressed ears as condescending, or worse. If you have a history of depression, you already know what do, and you really don’t need people pointing out the obvious.
On the other hand, offering to be a willing ear, even if nothing is said, is hugely useful. In other words, listen, don’t talk. Just knowing you can count on someone who understands your situation is a huge relief. The last time I was badly depressed, a few years ago, one of my friends took me downtown — made me go, actually — for dim sum and a long wander around Chinatown and Kensington Market. We didn’t say much. But it’s hard to maintain the posture of sullen introspection among the lychee, sour sops, and lemon grass of Spadina. I won’t pretend it “fixed” my depression, as if depression could be grasped and dealt with in an afternoon! But it made one day a lot better, and when you’re severely depressed, one day counts for a lot.
I wonder, incidentally, if any research has been done on the relationship between health care professionals and depression. Are we predisposed to going into health care? Is there a causative relationship between providing care and depression?
My own black dog has shrunk from being the size of an Irish Wolfhound to something in the order of a miniature poodle: small and yappy and still capable of nipping at your heels. But it’s something you can easily kick away. In other words, better.
In the meantime, I wish you well, AtYourCervix. I’ll be thinking of you — and if you need an ear, I’m yours.
The Resus Room, where we take care of acutely ill patients, was empty. As in five beds, no patients.
On the other hand, I was in the Treatment Rooms, where we usually treat the walking wounded. We were as busy as hell and had a couple of patients who were a just wee bit unstable. Contestant No. 1 was an elderly guy, epistaxis and vomiting blood, who suddenly dropped his BP into the low 60s systolic. Probably having a vasovagal, but given his extensive cardiac history and not to mention his present complaint, who in hell really knew?
So I brought him over to a Resus bed, which you would think would be the best place for your typical unstable patient. The Cutesy Twins —BFF! — were on. Individually they’re tolerable, but their work as a team is characterized by a lot of squealing, giggling and generally adolescent behaviour.
Both of the Twins were madly texting* on their Crackberrys; both were supremely annoyed at the interruption. Why are you bringing him over here? went the whine. What us, work? was the subtext. He’s just a nosebleed. And so on. Wah, wah, wah, wah.
Yeah, a nosebleed. With no blood pressure. And a history as long as my left arm. So can you please shut up, put down you phones, and actually do some patient care?
Contestant No. 2 was a vaginal bleed, probably a missed abortion, and actively bleeding and (again) had no blood pressure. I called over to Resus to tell them I was bringing them another patient.
“Fine. Whatever,” said one of the twins. Click.
I couldn’t believe she whatevered me. WhatEVAH.
Almost immediately I got a call from the charge. Do you really need to bring this patient over to Resus?
What the fuck? I was starting get a little peeved.
“I’m bringing her,” I told the charge. “Resus has four empty beds. Frankly I actually don’t need to justify moving the patient. Tell the Twins to suck it up.”
Much grumbling and dirty looks when I brought the patient over. The Twins were visibly angry.
Was there something I was missing here? Other than the Twins preferring to text their boyfriends to working?
*I’m rapidly coming around to the point of view of banning all freakin’ personal digital assistants from patient care areas — but I’m cranky, and it’s probably impossible to enforce and therefore pointless.
Wish I had Said It: An article in the Guelph Mercury, by Tracie Parr RN, “in honour of her fellow nurses at Guelph General Hospital.” Should be passed out to patients at Triage. Excerpt:
I am the one who keeps you in mind as I look bleakly at our system, and my workload, and the limitations I have to work within. I am the one who often trembles inside with fear and adrenaline yet still choose to give all that I can, while I can, from the moment I walk in the door until my mind allows me to sleep at the end of the day.
I am your target, as your frustration builds from the waiting and uncertainty. I know about discomfort, and I see the frustration as you watch while others are granted entry and the waiting is merciless.
But while you wait, did you know that I am also the one who is caring for someone else whose life is more troubled than yours?
Ankle Update: Up and about on it for short periods of time, but anything more than ten or fifteen minutes is very uncomfortable. Been wathing a colossal amount of television, probably more in the past three or four days than I’ve watched in a couple of years, and I’m stunned by the the equally colossal amount of shit being broadcast. You tend to forget. Good thing I have drugs to dull the pain — and the senses.
From Nuts to Soup: My newest favourite comfort food is Italian Wedding soup. Anyone know a good recipe? I’m almost afraid to ask: making all those tiny meatballs is surely a nuisance.
New Laptop: I’m on the active hunt for a new laptop — old Bessie, on whom I’m writing this post — is increasingly unreliable and unable to deal with the demands of high speed wireless. I’m a bit bewildered by the choices. Any recommendations?
Some typographical issues with Michèle Thorsen’s poem, below, now resolved, having to do with the fact WP is a blog interface, not a word processor.
Please take the time to read her poem if you have a moment — and Michèle, I apologize.
Ah, remember the glory days of the ’90s? Rae Days, Mike Harris (God love him, did you hear he can tolerate natural light now?) comparing nurses to hula hoops, “restructuring”, massive Tory health care cuts, nursing lay-offs, the Hospital for Sick Children cynically firing experienced diploma nurses to save money, Toronto General forbidding “RN” on ID tags, nurses fleeing to the U.S. by the thousands, looking for work?
Good times. And it worked out so well for everyone.
Canada is in danger of losing huge numbers of nurses to other countries as provincial governments struggle to slash deficits by freezing or cutting their jobs, nursing advocates say.
“We are very concerned that nurses are actually going to the (United) States,” said Linda Haslam-Stroud, president of the Ontario Nurses Association. “The States have many recruiters up here on a monthly basis.”
Health experts warn Canada could face a repeat of the 1990s, when health-care cuts by the provinces drove as many as 27,000 nurses to the U.S. alone to look for work. “The ’90s were quite bleak,” said Patrick O’Byrne, assistant professor in the faculty of health sciences’ school of nursing at the University of Ottawa.
Bleak isn’t the word for it. The ’90s nearly killed nursing as a viable profession in Ontario. No, let me rephrase that. Inept and/or openly hostile politicians nearly killed the nursing profession in the ’90s. Nurses, instead of being the vital and professional centre of quality health care, were suddenly a “problem” in human resource management and a drain on the system, and an easy and convenient political target. We were demeaned and degraded as professionals. As one of my colleagues told me recently, “The hospitals and the government treated us like meat.”
The effect of slashing and burning nurses in the ’90s cannot be underestimated. The result was the devaluation of nursing as a profession and which concomitantly impaired the recruitment and education of new nurses, contributing to the present nursing shortage, and bred cynicism and negativity among nurses themselves which in turn unavoidably impacted patient care. Nurses left the profession in droves, and more fled to the U.S. And left, I think, an entire generation of nurses psychologically and emotionally damaged. It was, in short, a disaster
I think (I hope) attitudes have changed somewhat, and perhaps the hideous policy choices of the ’90s can be avoided. Especially in light of the now-overwhelming evidence linking patient outcomes to appropriate and well-funded nursing care.
“The body your arms still long for dead or not. You were intimate with every muscle, privy to the eyelids moving in sleep. This is the body where your name is written, passing into the hands of strangers.”
— Jeanette Winterson
or: a letter to her physicians
her survival snapped,
clashed with the fame of your whiteness
the click of wrists, of hospital bands, a matter of ideology, deafened.
your collective lethargy fused with sporadic bursts of
000000open fire ended her
her cold body to be eventually tagged as
if at a ski lift
but let’s go back:
two years after her diagnosis,
it was winter, the calcium of her in agony
cancer swimming through her bones and
you refused to x-ray dared conjecture:
00000000000moans of post-menopause
and it was months before the shadow revealed itself000000000000too late, too late
a music mother-love whistling near a wick laced
0000and i think of her body00000000000000that is to say, the echo.
fundamentally wanting to live as some other form
0000it was delirious wasn’t it to endure skin as a fading
conversation a repression
. . .
i want to burn your schoolhouse down! these lessons like
taut hair elastics.
because the fundamental is your sit-down wizardry failed to save her her surface shivering.
and so a white-out: her private leopard text, a saturday, dissolved.
0000000000I went to pieces
— Michèle Katrina Thorsen
My semi-annual quasi-political post, written on Tylenol 3s, in case you didn’t know it.
The provincial budget was brought down yesterday — for my American readers, means the provincial government’s fiscal plan for the coming year — and there’s some almost good news for hospitals and some bad news for nurses. The semi-good news: there’s going to be a 1.5% funding hike for hospitals across the province, instead of the 0% funding increase the government had mooted. The bad: a pay freeze for all in the public and near-public service, which would, ahem, include nurses and other health care professionals. In practical terms, the province has said it will honour increases in current contracts — RNs are actually due for an increase on 1 April — and the province-wide contract for hospital nurses expires in March 2011, meaning the impact won’t be felt until negotiations between the Ontario Nurses Association and the Ontario Hospital Association are completed sometime next year.
As I’ve noted before salaries of nurses (and other HCPs) are often targeted as “excessive” — the (unstated) reasoning being that somehow nurses’ salaries aren’t commensurate with their skill level — we’re just nurses, after all. Tim Hudak, the Tory party leader, has gone so far to suggest that opening the contracts and slashing our salaries is the prudent route to fiscal responsibility. (No mention, of course, that his salary be cut, either — or the unmitigated disaster the Tories inflicted on the health care system the last time they had their incompetent hands on it.)
I should say that RNs have good salaries: with a small amount of overtime, I topped out over 88k last year, with full benefits and four weeks vacation. Well paid, yes, but most RNs I know would say we’re not nearly paid what we’re worth, given what we’re responsible for and what we’re required to know to provide safe and competent care. If you have any doubt, do you want your IV started by me or by the porter?
There is, to be a sure, a lot of waste and room for new efficiencies. Two quick thoughts — no doubt more would come, except I’m fairly whacked on Tylenol 3s:
1. Managerial positions have proliferated like bacteria in a warm, moist environment in most Ontario hospitals, with little discernible improvement, to my eyes anyway, in patient care or outcomes.
2. Hospitals waste literally millions of dollars every year in consultants’ fees, again to no apparent effect — I would like to see published, sometime, the aggregate sum spent on consultants in province’s hospitals.
*** *** *** *** ***
Ankle Update: able to put a little weight — just a little, mind — on my foot this morning. Biggest problem: getting up in the night to pee and falling over the dog, crutches and all.
Okay, foreign, as in to a hospital I was not familiar with, which is sort of like (but not really) travelling overseas. Me and my wrecked ankle. Not my Emergency, mostly because some little bird told me a (figurative) bomb had exploded at Acme Regional’s Emerg, and I didn’t want adding to the clots of patients in the hallways. Going to strange Emergency Departments is always entertaining and informative, and so it was.
Arrived at 1034. (I kept notes in the margins of the most recent issue of Harper’s, where, incidentally there’s an excellent article on autism. And also, you might observe, became one of those freaky people who keeps notes about their Emergency Department visits. Emerg nurses will know what I’m talking about.)
Triaged at 1036.
Registered at 1041. Triage Nurse: “Tell the registration clerk to send you directly to xray.”
Taken by wheelchair to radiology from registration by what looked to be a 90 year-old volunteer (who wheezed as she pushed) at 1044.
Four views of the ankle at 1054.
Returned to waiting room at 1101.
Brought in by the doc himself at 1124.
Discharged at 1131. No fracture, by the way.*
I thought: Hot dog, this is how Emergency Departments are supposed to work. Patients shouldn’t be sitting in waiting rooms for hours on end, being tortured by Dr. Phil on the tube and tattered issues National Geographic twenty years out of date?
But most EDs don’t work like this. You see, it was dead quiet, as in bereft of patients, empty, unpopulated, shoot-a-cannon-down-the-corridor-and-hit-nothing, uninhabited, vacant, barren, and void. There were no admitted patients lolling about, taking up space and beds. Actual lumps-and-bumps patients, like myself, flew in and flew out. More acutely sick patients could be seen expeditiously.
We’re told constantly by the Ministry of Health that the issue of Emergency Department waits is complex and layered, which I take is Ministrese for There is No Real Political Will to Fix the Problem.
Actually it isn’t that complex or layered. This is how it works: long term care beds are in short supply, which means that patients waiting for placement are blocking acute care beds in hospitals, which means admitted patients spend days rotting the Emergency Department.
There are fixes around the edges of the problem, such the standard preventative care approach (i.e. healthy people use less services), but also such ideas as facilitating supports for in the community through Home Care, so the frail elderly can stay out of nursing homes and live at home longer — and which has been shown to have better outcomes anyway. But in the end, what’s really required are more long-term care beds, lots more, because the demographics are not on our side. Unfortunately, the provincial government doesn’t seem too keen on providing them.
*And thanks for all the messages of concern and support. Yesterday was a wretch. I’m being told I was a little bitchy yesterday. (Narcs help.) Nurses are the worst patients, aren’t they?
Tripped and fell over on my bum ankle this morning during my morning constitutional— off to the emergency to make sure it’s not a tib-fib fracture. Pretty sure it’s not, but then again it feels different from previous sprains.
Okay, I’m not being wholly truthful. I’m being made to go.
And yes, my nursing colleagues, I have it iced, elevated and tensored. It’s the size of a grapefruit.
Regularly scheduled blogging will resume as soon as I have some narcs on board, because, holy cow, this time it hurts!