Archive for May, 2011

Five Feet of Fabulous!

Your colon, of course. What else? A funny, retro animation produced by the Canadian Cancer Society to start a colonversation on colon health. Also features a few fart gags and uses the word “poop”, in case you’re a delicate flower. (And who doesn’t like fart jokes? My mother-in-law does, anyway. Don’t ask.)

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Favourite Poems XXXVIII

Because everyone, even nurses, deserve poetry.

Silent Noon

Your hands lie open in the long fresh grass,–
The finger-points look through like rosy blooms:
Your eyes smile peace. The pasture gleams and glooms
‘Neath billowing skies that scatter and amass.
All round our nest, far as the eye can pass,
Are golden kingcup-fields with silver edge
Where the cow-parsley skirts the hawthorn-hedge.
‘Tis visible silence, still as the hour-glass.

Deep in the sun-searched growths the dragon-fly
Hangs like a blue thread loosened from the sky:–
So this wing’d hour is dropt to us from above.
Oh! clasp we to our hearts, for deathless dower,
This close-companioned inarticulate hour
When twofold silence was the song of love.

— Dante Gabriel Rossetti

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Don’t Tell Your Patient This. Or That.

Jo over at Head Nurse had an interesting question about a month ago. She was prepping for an interview for a Reader’s Digest article called “50 Things Your Nurse Won’t Tell”. It’s a common format for RD, I soon learned after checking their website, and features such articles as “50 Things Your Flight attendant Won’t Tell” and “50 Things Your Waiter Won’t Tell You”. In turn, the articles prompt answers along the lines of “Yes, the waiter will really spit into your soup, and how!” See the comments section in Jo’s post for the nursing version.

But the more I thought about it, the more I thought the question as posed by Reader’s Digest was curiously framed. Nurses are supposed to provide information to patients; withholding information seems like, well, unnecessary power-tripping. In fact, I will tell patients things I am not supposed to mention, like about the cosmic suckiness of hospital food (because it does) and how an ECG looks — but if I bring you in right away after doing it, you pretty well know it’s not good.

So there is very little, in the end, I won’t share. There are some things, however, that are beyond the pale. Here’s my short list of ten things I will never, ever tell you, my patient:

  • Anything that would violate confidentiality of anyone in the known universe. Not only because it’s unethical, unlawfully and probably fattening, but also because it’s none of your fracking business.
  • That your dire medical emergency is not, in fact, likely to be all that dire, though I do understand you may have been misled by the name “Emergency Department” into thinking that since you are here, it must be an emergency.
  • Anything that would tend undermine my physician or nurse colleagues. It’s nasty, and more importantly, I have to work with them.
  • You’re about to die. A situation where a patient is fully awake and aware and whose death is imminent is fortunately relatively rare. Even so, I’m not going go to pipe up and say cheerfully, “I think you’re about to cack, so get ready for the ride of your life.” That, as they say, is way above my pay grade.
  • What I really think of the peculiar family dynamics circling your bedside. Opening up that particular can of worms never ends well
  • About your dirty underwear. Yes, we do notice. No, I will never speak of it.
  • Similarly, your body odour will go unremarked. I will not tell you that you’re perfumed like the thing that rudely crawled under the front porch and expired. Even if you stink, you still have dignity and worth as a human being. But if I come in right after assessing you with a basin of hot water and rather a lot of soap and towels and wearing a bright yellow gown and mask, don’t be surprised and/or offended.
  • That I strongly question a pain scale of 10/10 if you’re drinking an extra large Tim’s double-double while telling me this at triage.
  • Along the same lines, claims of severe migraine will provoke some internal doubt, but nary even a raised eyebrow, if you’re also allergic to every analgesic and NSAID in the known universe except Demerol.
  • Your claims of alcohol consumption will be automatically tripled for accuracy.

I’m sure every nurse has his own list. At the same time, I wonder what patients really want to hear from us.

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Saving the World from Terrorist Breastfeeding Toddlers [UPDATED]

An Atlanta, Georgia suburb is fighting one of the most pressing causes of our era — children who breastfeed past twenty-four months. Because breastfeeding after the age of two will damage human society beyond repair:

On Monday night, Forest Park passed a public indecency ordinance to prevent public nudity. Previously, the city only had a public indecency ordinance that covered adult entertainment businesses.

 According to the law, no woman can breast feed anyone older than 2 years old in public. City manager John Parker called the law a proactive step.

 “It sets up a process whereby we can try to control nudity throughout the entire city,” Parker said.

There was, in response, a public nurse-in ridiculing of the notion of breastfeeding posing a clear and present danger to societal values, and a response to the nurse-in predictably filled with comments from various yobs and jackasses. What I’m not getting, though, is the conflation of breastfeeding (regardless of the age of the child) and public indecency. Or stigmatizing  a practice which is healthy and beneficial for both child and mother, and for 99.9999% of human history was the normal means of providing nutrition for infants and young children and continues to be for the vast majority of the world. Oh, but there’s this bit of enlightenment:

Do you think he — or the Forest Park City Council — knows what projection means?

UPDATE: I was gulled (blush), as Jenn points in the comments, by a hoax. “Citizens Against Breastfeeding,” portrayed in the Youtube clip, as points out, is a prank. Such are the times when even an outrageously obvious hoax is believable — and yes, the point still stands.

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A Poem for Victoria Day

By a poet hostile to her reign. “Good, you were good, we say,” he writes. “You had no wit to be evil.” Probably worth remembering on the commemoration of her birthday Victoria herself was not immune from controversy, and that debate on the value of monarchy is very old indeed. (No nursy or any other blog posts today — doing things traditionally associated with the holiday — planting the garden, a barbeque and maybe fireworks later.)

An address on her jubilee year.

Madam, you have done well!  Let others with praise unholy,
Speech addressed to a woman who never breathed upon earth,
Daub you over with lies or deafen your ears with folly,
I will praise you alone for your actual imminent worth.
Madam, you have done well!  Fifty years unforgotten
Pass since we saw you first, a maiden simple and pure.
Now when every robber landlord, capitalist rotten,
Hated oppressors, praise you—Madam, we are quite sure!

Never once as a foe, open foe, to the popular power,
As nobler kings and queens, have you faced us, fearless and bold:
No, but in backstairs fashion, in the stealthy twilight hour,
You have struggled and struck and stabbed, you have bartered and bought and sold!
Melbourne, the listless liar, the gentleman blood-beslavered,
Disraeli, the faithless priest of a cynical faith out-worn,
These were dear to your heart, these were the men you favoured.
Those whom the People loved were fooled and flouted and torn!

Never in one true cause, for your people’s sake and the light’s sake,
Did you strike one honest blow, did you speak one noble word:
No, but you took your place, for the sake of wrong and the night’s sake,
Ever with blear-eyed wealth, with the greasy respectable herd.
Not as some robber king, with a resolute minister slave to you,
Did you swagger with force against us to satisfy your greed:
No, but you hoarded and hid what your loyal people gave to you,
Golden sweat of their toil, to keep you a queen indeed!

Pure at least was your bed? pure was your Court?—We know not.
Were the white sepulchres pure?  Gather men thorns of grapes?
Your sons and your blameless spouse’s, certes, as Galahads show not.
Round you gather a crowd of bloated hypocrite shapes!
Never, sure, did one woman produce in such sixes and dozens
Such intellectual canaille as this that springs from you;
Sons, daughters, grandchildren, with uncles, aunts, and cousins,
Not a man or a woman among them—a wretched crew!

Madam, you have done well!  You have fed all these to repletion—
You have put a gilded calf beside a gilded cow,
And bidden men and women behold the forms of human completion—
Albert the Good, Victoria the Virtuous, for ever—and now!
But what to you were our bravest and best, man of science and poet,
Struggling for Light and Truth, or the Women who would be free?
Carlyle, Darwin, Huxley, Spencer, Arnold?  We know it—
Tennyson slavers your hand; Argyll fawns at your knee!

Good, you were good, we say.  You had no wit to be evil.
Your purity shines serene over Floras mangled and dead.
You wasted not our substance in splendour, in riot or revel—
You quietly sat in the shade and grew fat on our wealth instead.
Madam, you have done well!  To you, we say, has been given
A wit past the wit of women, a supercomputable worth.
Of you we can say, if not “of such are the Kingdom of Heaven,”
Of such (alas for us!), of such are the Kingdom of Earth!

— Francis Adams

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How to Eat in the Most Obese County in the United States

Let’s start with an appetizer:

One thing you need to know before going to the Mississippi Delta is what a Kool-Aid pickle is — and how to make it.

1. Pour pickle juice from a jar of pickles into a bowl.
2. Add Kool-Aid to pickle juice.
3. Pour pickle juice back over pickles.
4. Enjoy?

Where can you find Kool-Aid pickles? All over the region, including at the Double Quick, a chain of convenience stores, many of which also sell a smorgasbord of fried foods.

The video, produced by the NPR and Oxford Magazine, documents the difficulties eating well in (putatively) one of the richest agricultural regions on earth, where fresh, unprocessed food is the exception. Not surprisingly, there is a close relationship between poverty and poor diet; the devastating sequellae of diabetes, hypertension, heart disease and stroke, it hardly needs to to be said, ends up afflicting those least able to afford the health care, drugs and lifestyle changes necessary for effective management. Note the interview in the grocery store, and the dearth of fresh vegetables, apart from a few over-processed tomatoes and cucumbers.

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Favourite Poems XXXVII

The Apocalypse having been postponed yet again — well, I tend to think sometimes we’re living it anyway.

The Second Coming

Turning and turning in the widening gyre
The falcon cannot hear the falconer;
Things fall apart; the centre cannot hold;
Mere anarchy is loosed upon the world,
The blood-dimmed tide is loosed, and everywhere
The ceremony of innocence is drowned;
The best lack all conviction, while the worst
Are full of passionate intensity.

Surely some revelation is at hand;
Surely the Second Coming is at hand.
The Second Coming! Hardly are those words out
When a vast image out of Spiritus Mundi
Troubles my sight: a waste of desert sand;
A shape with lion body and the head of a man,
A gaze blank and pitiless as the sun,
Is moving its slow thighs, while all about it
Wind shadows of the indignant desert birds.

The darkness drops again but now I know
That twenty centuries of stony sleep
Were vexed to nightmare by a rocking cradle,
And what rough beast, its hour come round at last,
Slouches towards Bethlehem to be born?

— W.B. Yeats

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Friday Night Flicks

Very cute  and funny and features some non-visual gratuitous boobery.

So go watch it already. If you’re reading me, you’re hardly busy.

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More on Meera Bai, Faith and Nursing

I realized after I wrote yesterday about Meera Bai and her work at Insite, the Vancouver safe drug injection site, that she has both a blog called Strong Hands and a Twitter feed — @senoritabai. When I spoke to her on Twitter last night, she pointed me to an article she wrote describing her experiences at Insite, provocatively titled “Why I Help Addicts Shoot Up.” A couple of excerpts:

Something about seeing people at their lowest and most desperate, half-clothed from turning tricks for drugs while hating themselves for it, opens into a profound level of intimacy. I am blessed to enter the darkest place of people whose sins are far more public than those of the rest of us. Constant humiliation makes the people I work with especially vulnerable, and vulnerable in almost every way: to violence, to exploitation, to false hope and finally to despair. When allowed into these dark places, it is my privilege, and that of all InSite staff, to communicate worth and love instead of judgment and scorn.

The day nurse asks me to keep an eye out for a specific participant—a regular who comes in several times a day. She hadn’t been seen yet. Later that night, the woman finally comes in, and she’s beaming. “I went to see my daughter today! And I didn’t use all day! F—, soon I’m gonna get off this s—!” We break out in applause and cheers, celebrating her triumphs with her—as she mixes her drugs to take in a few minutes in our facility. Other participants in the room are excited as well; two of them come over to hug her.

Another regular later chats with me in the treatment room as I dress his abscess, trying not to cringe away from the overwhelming odour he emanates. “It would have been my anniversary with my wife today, if she hadn’t gone missing. We’ve both been down and out, but she took care of me out here. Now, I got nobody to talk to. This is the first human touch I’ve had today.” I look up, startled. I am wearing gloves, holding my breath, cleaning his sores with a 10-inch sterile Q-tip. Even this, my deficient attempt to heal, is taken as love by a man desperate for human connection. I am ashamed.

I finish dressing the wound, clean up, remove my gloves and give him a hug. I hop up on the treatment bench next to him and we sit together and talk for another 15 minutes: about life, love and faith. He says goodbye, and then asks for a referral to an exit program. I give it to him. He knows the referral is merely one point along our journey together, and that I will listen to his story whether he goes to the program or not. As a Christian, I know that his life is part of God’s real story of redemption. InSite is one of the few places where I get to hear it openly spoken, with trust, without judgment.

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Often, participants at InSite are forced to sleep outside at night. Not having a warm, safe bed takes its toll on bodies, and special care is needed for feet. An InSite staff member chats with me behind the desk as he fills up a basin of warm, soapy water. Kneeling on the floor, he gently strips damp socks off the swollen foot of a participant and lowers it into the soothing water.

Washing feet here isn’t an oddity from a discomfiting Bible story, but a regular occurrence. Foot baths are healing—for body and soul. As I fill up another basin, I marvel at the timelessness of this act of community. The humility necessary for all involved in washing feet produces beautiful vulnerability and relationship, which, unsurprisingly, creates change.

But really, go read the whole thing. It’s worth it.

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On the Dying Art of the Bed Bath

Joni Watson (@joniwatson) explains why bed baths are important:

I am a fan of cleanliness, but I’d rather not bathe a complete stranger (or acquaintances for that matter). However, as a nurse, I do know that care is part of my responsibility, and I am thankful to the many great nursing assistants who understand the importance of a thorough bath, too. At times, I have rushed through bed baths, thinking of the growing to-do list and soon-to-be announced priorities. On other occasions, though, I have taken my time, even brushing my patient’s hair as though it was my only duty for the day. I know my patients felt my presence or lack thereof in all circumstances.

In nursing school, bed baths were literally the second practical skill I learned, after making the bed itself. Get the warmed bath flannels, the basin of warm water, the soap, the washclothes, towels, lotion, barrier cream; start from the top, (no soap on the face), work your way down, drying as you go, washing from the distal points up, strategically positioning the flannel to preserves modesty; rub the back with the lotion, apply barrier cream to the bony pressure points, paying particular attention to the sacrum and feet; assess the patient as you go; document.

Ta-da. Done: your patient feels like a million bucks and you get a warm fuzzy for doing a good thing.

Nurses will defend the bed bath as the most elemental nursing skill, simultaneously bringing comfort to the patient while establishing a therapeutic bond and allowing us to assess physical and mental condition. Problem is, in the emergency department, we just don’t do them. Or rather, we try, at least for the admitted patients, but are frequently unsuccessful. We get a new, complicated patient. The patient in the next bed is crashing. A code is called. It’s always something, and bed baths as a priority item of care fall off the plate, because at the end of the day, being unwashed won’t kill the patient. The majority of nurses I work with have just given up trying altogether.

It’s a bit ironic. Anecdotally, nurses will tell you of ever-increasing patient acuity taking time away from basic nursing, yet it’s these acutely ill patients who need bed baths in the worst way. When one adds the time needed for the legion of non-nursing-related activities  and documentation that crowd a nurse’s attention, it quickly becomes clear how bed baths are deemed non-essential. Except that they aren’t.

Bed baths — or the lack thereof — are symptomatic of a larger issue in nursing. The integrity of the nursing profession has been under attack for years. We are constrained from being nurses in the fullest sense by time, resources, and  ill-considered hospital policies. Or worse: attitudes. I have known more than a few nurse-managers and administrators — and if truth be told, front line nurses themselves — who think the entirety of nursing consists of a list of tasks to be performed, unthinkingly and uncritically. When nurses start thinking of bed baths as just another task, like emptying the urine drainage bag, rather than as an essential part of the therapeutic process, we’re in trouble. So bed baths illustrate rather nicely the present conflict in the profession: are we mindless drones just doing the job, or are we thinking health care professionals engaged in a holistic therapeutic process with our patients? If you want to point to a single cause of nursing malaise, it’s this dichotomy, and it starts with being unable to give bed baths properly.

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