Those Nortriptyline Blehs

Nortriptyline, according to Wikipedia,

is a second-generation tricyclic antidepressant (TCA) marketed as the hydrochloride salt under the trade names Sensoval, Aventyl,Pamelor, Norpress, Allegron, Noritren and Nortrilen. It is used in the treatment of major depression and childhood nocturnal enuresis (bedwetting). In addition, it is sometimes used for chronic illnesses such as chronic fatigue syndrome, chronic pain and migraine, and labile affect in some neurological conditions.

A few weeks ago I had a fall (when it comes to falling down, I’m a Viking) which exacerbated an old injury from another fall — bottom line, was in a considerable amount of pain, and what was worse I couldn’t sleep becuase of the pain. So after about a week of sleeplessness and overdosing on AC & C, I finally gave up and went to  my GP. She prescribed some wicked bad-ass anti-inflammatories, and she also suggested I try nortriptyline. Besides being a rather dated anti-depressant, nortriptyline has some pretty nifty pain-control properties as well as the ability of  inducing sweet, restful sleep.

And, I must report, it worked amazingly well for the last couple of weeks. I’ve been sleeping like the dead, the pain is far, far better now, and I can function normally — sort of. Aside from a dry mouth, I’ve had no physical side effects at all.

Take two of these, and your ability to snark will vanish

But there’s this: nortriptyline, as I mentioned, is an antidepressant and mood stabilizer, and I guess I would describe my mood over the last week or so as tranquil, sedate, calm, unstressed, cool, placid, and serene to the point of having to check my pulse for a heart rate. Part of this new found attitude of repose is being completely demotivated to do anything creative at all, including any writing. For the last two weeks I have opened up the blog utility, fooled around a little, and after a half-hour, said, “Meh,” and went back to playing Words with Friends.

It’s plainly obvious, at least for me, having some emotional friction and turbulence feeds the creative daemon. It prods me to write, and I would guess this is true for most people who think of themselves as creative. So an interesting question: at what point would you sacrifice creativity for pain control — or relief of any condition, especially if it’s central to who you are as a human being? And on a larger scale, if everyone is medicated (it seems) for everything, what is it doing to culture as a whole?

Fortunately for me, I’ve finished the nortriptyline. It was a temporary thing. We now, as they say, return to our regularly scheduled moodiness. But here’s the thing: when I was on the drug, not only was I completely uninterested in writing, I didn’t care whether I was writing or not. The fact I could throw over something which I’ve done daily (in one way or another, even if I have written a couple of lines) for nearly three years is remarkable.

Out of Sorts

Don’t know if it’s the crazy weather, but just feeling a little whacked today. Got up this morning, all burstin’ to write an epic post about the RNAO’s new best practice guidelines on restraints, wrote about three paragraphs and went bleh. Didn’t care as much as I thought. So maybe Sunday, if at all.

Other stuff: I made the Sunshine List — one of 79,000 —for the first time ever. For those out of province and out of country, the Sunshine List is the provincially-mandated disclosure of salaries over $100K for public and near-public employees. It makes for hours of entertaining reading. Really. Some of my colleagues made near $150K — and I thought I did a lot of overtime! ( I was a few thousand over.)

Also, some big changes coming soon to this blog. Are you excited yet?

Also: I know the great March heatwave is over, though its still 15C (60F) here as I write — about 8C (18F) above normal. More normally abnormally warm, if you know what I mean.  I went out a couple of days ago to take some pictures to document the tremendously early arrival of spring. Not great pics, but you get the idea something is strangely amiss. 

Daphne mezereum. Usually blooms here first or second week of April.

Maple blossoms. Maybe a month early, at least.

Maple blossoms en masse

Magnolia bud break. About a month early.

It would be foolish to attribute one weather event to climate change, the way anti-science types and assorted denialists think snowfall in Toronto in winter invalidates climate change science forever and for all time. However. . .

UPDATE: Minor syntactical fixes, because my hobbit-editor I bought ran away shouting some crazy talk about a magical ring.

Those Emergency Blahs

I’ve worked as an Emergency Department nurse for something like thirteen years now, and at my present position more or less for ten years.  It’s probably safe to say I’ve seen just about everything from the incredible tragic to the incredible funny, the good, the bizarre and the ugly. As I’ve said before, I’m blessed to have one of the coolest jobs around, and lucky to do something I can (sometimes) feel passionate about. Last few weeks though, I’ve been really out of sorts. The bloom is going off the rose. Can’t quite put my finger on it. Sense of general dissatisfaction? Bored? Just plain tired? I don’t know. My colleagues are really starting to annoy me, where before I could look upon their foibles with a sense of humour and plain tolerance, and I am starting to think I’m annoying the shit out of them as well. I come in some days, look at the staffing line-up and wish I had called in sick. The patients lately seem to be rude and hostile, or more so. Every problem seems to take massive amounts of time and energy to fix, and Acme Regional’s bureaucracy seems more obtuse than ever. Every little piece is taking its toll, and I don’t seem to have the reserves anymore to make up for the loss.

Bleh. 

I’m not tripping the light fantastic anymore.

Fact is, I’m starting to dread going into work at all. Signs and symptoms of burnout? I have ten days holiday coming up shortly. After that break, maybe I’ll have some perspective. But I’m thinking it’s time to go and do something else.

What Breast Cancer Is and Is Not

Susan G. Komen Run for the Cure doesn’t have much of a direct presence on this side of the border, so I could watch the recent public relations train wreck here with a sort of Olympian dispassion and, I have to admit, grim satisfaction. Frankly I’ve never been a fan of  Komen’s “pinkwashing” everything related to breast cancer, which seemed to both infantilize breast cancer sufferers and trivialize the larger social and health care issues related to the disease. Breast cancer sufferers need dignity and real research, I think, not pink ribbons used as a marketing tool for corporations. My mother died of breast cancer, you see, and my mother-in-law had a lumpectomy and radiation therapy six years ago, so I tend to wear these things on my sleeve.

So this video, which is making the rounds on the Interwebs, provides an antidote to all of Komen’s nonsense, and spells out as much dignity and courage as one could want in a YouTube video. Warning: delicate flowers easily offended by surgical scars may want to leave the room, or at least avert their eyes.

 

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UPDATE: Minor editing/typo fixes. The first post by Android phone clearly leaves much to be desired, but as Samuel Johnson says, ”It is not done well; but you are surprised to find it done at all.”  Note to self: grow opposable thumbs. TE.

Under Construction

Meaning me, of course.

I worked a (rare) Night 12 a few days ago. It was the usual dog’s breakfast of high acuity, walking wounded without end lining up at Triage, and the particular Emergency Department hell of having no beds for, you know, emergency patients, the department being a stunt double for a med-surg unit. But there was a small ray of hope. Or rather it was okay news-sucky news situation. We were to get  a bed, the element of suckiness resting on the fact the bed was on 5 North, my perennial nemesis, where, I swear, reside the most obstreperous nurses in the history of the Universe.

(Excuses I have heard over the years from 5 North for not taking patients: too busy, patient too sick, patient too combative, patient [with normal vitals] too unstable, patient a drug abuser, patient HIV positive, on break, short-staffed, still on break, patient restrained, patient not restrained, swabs not resulted, patient unsuitable, no one to take report, too close to shift change, just about to go on break, you just sent us a patient, the bed isn’t clean, the patient hasn’t left the bed, the room needs to be cleaned, too late in the night, too early in the morning, the patient will disturb the patient in the next bed, it’s a male bed and your patient is female, still on break — well, I could on.)

So I told the primary RN to call up report. We need to move some patients in.

They won’t take report, came the reply. All the nurses are on break.

“What the hell?!? All the nurses?!?” I was incredulous. “How can all the nurses be on break?”

I called up to 5 North. “Can I speak to the charge?”

“She’s on break.”

“Can I speak to any nurse?”

“They’re all on break.”

“All of them?”

“Yes.”

“Who’s looking after the patients?” As one might imagine, I was becoming a little agitated.

“I am,” came the reply.

“Who are you?”

“I am,” said the voice on the other end, “the nursing student.”

Dear sweet Lord, I thought. “Let me summarize,” I said.  ”You’re looking after 24 patients all by yourself, because all the RNs are on break?”

“Well,” said the student in a tone which made it clear she thought she was dealing with a plain idiot, “there’s a nurse sitting beside me.”

‘”Oh,” I said, thinking I had misunderstood the entire situation. “Can I speak to her?”

“No! She’s on break. I told you”

After which I lost it, just a bit. “So when your patient in 55 falls out of bed and fractures her hip because she’s been ringing the call bell for fifteen minutes because you’re trying to clean up the patient in 37, what are you going to do?”

“Oh, I’ll call the nurse to help.”

“But she’s on break!” I was nearly shouting.

Click. The student hung up on me.

Well, I thought. That didn’t go well. But then, after I went home and thought about it, wasn’t I guilty of the same bullying behaviour towards this student I have written about so critically? I heard afterwards I had reduced her to tears. Didn’t this make me the poster child for nurses eating their young? The student, after all, was not responsible for being placed in an compromising position, and being made to run interference against a nasty ED nurse (i.e. me) was fairly despicable. I should have recognized the circumstances and adjusted my own response accordingly — regardless of who answered the phone. In the heat and stress of the moments it’s all too easy to engage in awful behaviour and justify our bullying afterward in terms of providing good care or best practice. It’s all a lie. There isn’t ever justification for bullying. All I can say in my defence: I’m a work in progress. Like everyone

[Update: Yes, I misspelled "construction" in the title. I need a sub-blogger minion to proofread.]

A Matter of Hours

I was talking the other day to young, surprisingly old-school physician who bemoaned nurses “doing things” she thought properly done by duly authorized medical practitioners. (She also implied, by-the-by, that when physicians said “Go fetch,” the proper nursely response was a demure “Yes, doctor, and do you want your neck rubbed?)” Clearly, this physician thought, medicine was the senior and superior discipline, and nurses should defer at all times to their judgement, even on matters clearly within the sphere of nursing. Her basis for this line of thought was that physicians got “thousands and thousands of hours” of clinical and classroom education while nurses only had a “few hundred hours of  dubious training.”

My head almost nodded, subconsciously anyway, in agreement. Got us there. It’s a common theme, actually, when you see discussions of nursing versus medicine. Nurses just don’t have the education, it’s claimed, to make the really important decisions in patient care. But then I thought about it for a bit.

Leaving apart the obvious — that medicine and nursing are two different (if related) disciplines — in point of fact, I had 1950 clinical hours and about 2000 hours of classroom study to become a Registered Nurse — and this doesn’t include the hundreds of hours more of post-graduate education to gain speciality certification and also training for things like ACLS and TNCC. I know it doesn’t compare to the extensive/intensive training of physicians. But still, nearly four thousand hours of formal training as a minimal entry to practice is nothing to sneeze at either, and hardly the “few hundred hours of dubious training” imagined by some physicians. At any rate, it makes me wonder why, given our own expertise, education and experience, why some nurses continue to be cowed by claims of physician superiority?

MScN vs. MPH vs. MBA

As I’ve mentioned, I’m thinking seriously about doing my Master’s degree. So which degree? MScN? MPH? MBA? There’s a cool looking MBA programme with an emphasis in community development and public service I’ve seen. Is there any value in getting an MScN if you’re going into management? Anyone have any thoughts on this?

In Which I Perform Tricks Like A Pony

By which I mean I went for an interview for that management position a few days ago. I got out the clothes I wear for state occasions, and marvelled, not for the first time, at how cat hair can get into an essentially hermetically-sealed closet. I bathed for some time in the milk of a ass, plucked out stray hairs, got dressed. I miscalculated the traffic and arrived a half hour early, just so I could had that extra bit of time to work on wreaking my composure. As as I walked to the location of the interview, I thought to myself, “I am such a fraud.”

The interview went well, as far as anyone can tell with these things. I got the usual questions. My strengths. Why I wanted the job. What leadership qualities would I bring. I spoke with conviction, I think, and I hope with eloquence  and even passion. I left feeling somewhat less fraudulent.

I have no idea if I got the position. Professional friendliness and an air of inscrutability set the tone. Two interesting things though. First, though I knew only one of the panel (of five!), they all knew me, or rather of me. Second, the panel deviated from the script of questions a few times — not to trip me up, but because they were genuinely interested in my opinions. I went into the interview with no expectations of actually being hired — maybe that was liberating. In any case, these give me reason to be mildly optimistic. We’ll see.

Merry Christmas

I’m done gone and won’t be back till the 27th, except for some music and some other things to keep the lights on, so to speak.

Have a happy and safe Christmas, everyone.

First up, my mother’s favourite carol. Enjoy!

Gastro x 3 days

‘Nuff said.

A timely reminder, though, for this:

Hey you, wash your hands!

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Also some housekeeping:

A couple of new links for newbie nurse blogs on the right. Check ‘em out!

• Judith Shamian’s Health Care and Home Care Blog. I’ve met Judith a few times doing RNAO things. She’s a great nursing leader, but it’s doubtful if she wants to remember me: I gave her a hard time once.

• Lois Roelofs.

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A whole pile of great submissions for the First Annual

Those Emergency Blues Prize for Writing

have come in. Please keep sending them. I will post the first list of links to submissions tomorrow, and (hopefully) some of the actual posts as soon as I email the nominees for permission.