Archive for category Really Bad Food

You Want a Side of Plavix with That?

Doughnut burger: a bacon cheeseburger served i...

Now that's good eatin'. Image via Wikipedia

Now arriving at the Canadian National Exhibition — wait for it — the doughnut cheeseburger*:

The Doughnut Burger made its debut at the Calgary Stampede, where brave revellers downed the sweet and salty snack, despite its high calorie count.

Now the hefty bacon cheeseburger with two maple-glazed doughnuts for buns will be featured at the CNE in Toronto.

The heart-stopping treat packs a walloping 1,500 calories and is sure to draw at least a few curious consumers.

The maple glazed doughnuts are a nice Canadian touch, eh?

Just for comparison, Micky D’s Big Mac (my guilty little secret) packs 704 calories, and a Harvey’s cheeseburger (Harvey’s is a Canadian burger chain) is a “mere” 460.

Can anyone explain the appeal of these? Is anyone actually tempted? I mean, if I’m going to consume empty calories, I think I would save them for something good.

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*Rather like the Lady’s Brunch Burger, sans egg.

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Observations and Assessments

Notions too small for a blog post, all in one place.

Stormy weather. Some of you probably noticed a slight lack of presence here the last couple of days. The wind storm which swept over Ontario last Thursday left us without electricity, telephone and internet service, as well as blowing out an upstairs window and knocking over a fence. The power (or hydro as we say in Ontario) came back the same day; the telephone and internet returned only last night — there was some damage to the local wireless tower as well. The really bad news is that not only are Canadians voting in a federal election today, but that it’s also tax deadline day here in Canada. Because of the lack of internet access, filing was impossible* — and I have, as of writing thirteen hours and ten minutes to find my T4 slip and load up TurboTax.

The Good News. You were all spared — and I am pretty sure my American readers are especially grateful — a blog post about the various parties’ positions on health care. Believe it or not, I did wade through all the platforms, and they essentially ranged from generally sucky with bright spots  to really awful and/or nonexistent. (Hello, Conservatives?) Given the demographic wave which is about to wash over and possibly overwhelm the health care system, and the high priority Canadians place health care as an issue, some sort of debate around this issue might have been useful. Yet we heard nothing at all.

Oh, no, not again. Just so you know, for reasons previously stated, I am ignoring Nurses Week.

New meat. Some shout outs to some new (to me, anyway) nurse bloggers: RNnnnrGrl and Frazzled_razzleRN, The Adventures of a Nursing Student, and in particular Dreaming of Call Bells, who blogs from Moose Factory, Ontario.

Death over the airwaves. A new British television show will show will show footage a terminally ill man dying:

The death of a terminally ill 84-year-old man will be broadcast on British television in May, as part of a series documenting the life cycle of the human body.

A man suffering from cancer and identified only as Gerald will be shown taking his final breath — at home, surrounded by his family — on the second episode of the BBC One series Inside the Human Body.

Speaking to BBC listings magazine Radio Times, host Michael Mosley defended the footage, saying producers did not want to “shy away from talking about death, and when it’s warranted, showing it.”

He acknowledged that the decision to include the footage would inevitably draw criticism.

“I know that there are those who feel that showing a human death on television is wrong, whatever the circumstances. Although I respect this point of view, I think there is a case to be made for filming a peaceful, natural death — a view shared by many who work closely with the dying,” Mosley said.

Similarly, a new documentary shows a terminally ill cancer patient in Oregon taking a lethal (and legal) dose of euthanasia:

I’m not squeamish about death, and theoretically, anyway, I would support physician-assisted suicide. But when confronted with an actual person planning her death, I start having a hard time with it. It seems, well, too cold-blooded. Am I wrong?

Hospital food is awful and bad for you. This seems to be as true in Australia as it is in Canada. Inadequate nutrition is a serious issue in the deconditioning of elderly patients (see here, for example).

Doctors have called for a hospital food review, because patients are being discharged malnourished.

Australian Medical Association state president Andrew Lavender said the below-par quality of hospital food, set serving times for three meals a day, and a one-size-fits-all approach could lead to patients checking out malnourished.

“A lot of patients do become malnourished in hospitals,” he said. “They are trying to improve nutrition, but when you’re cooking for 700 or 800 people the quality is often not up to scratch.”

“Generally, the elderly and those who are sick don’t have an appetite and there isn’t much of a follow-up in terms of what someone doesn’t eat. People having major operations are in a state where their body requires extra nutrients to recover and they often they don’t get that. People do depart hospital down in weight.”

And yet, when looking for increased efficiencies in hospital budgets, the kitchen is often the first place to get the axe.

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*I mean, who does paper returns anymore?

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Caring for Drug Seeking Patients? Well, It’s Complicated

Kim McAllister over at Emergiblog is questioning her role as an emergency nurse. The source of her discomfiture? Patients seeking narcotics, or those we label as “DSIs”, drug-seeking individuals:

Getting patients out of pain [she writes] is one of the most rewarding aspects of emergency nursing. It’s as close as you can get to instant gratification – you medicate, the patient gets relief.

That isn’t what I’m talking about.

I’m talking obvious, blatant, in-your-face drug seeking that is becoming more obvious, more blatant and more in-your-face every day.

But the narcotics still flow.

And it’s getting harder and harder to be a part of that.

She places the blame for the increase in narcotic seeking patients squarely on the Joint Commission, which mandates U.S. hospitals to implement pain management measures when treating patients, and Press-Ganey, a survey company which rates hospitals according to patient perceptions.* Both of these institutions have created an atmosphere where emergency room physicians feel obligated to order or prescribe narcotics for anyone regardless of dependency, first to satisfy government regulation and in the second, to assuage patient perceptions of good care.  (That the perception of good care is becoming more important than actual good care is a topic for another post.)

Kim McAllister’s frustration and sense of ethical distress is palpable. “I’m not helping anyone,” she writes. “I’m certainly not therapeutic in any way.” Emergency department nurses and physicians are not supposed to be an addict’s co-dependants, yet we’re often placed in the position of facilitating the addiction. We aren’t helping these patients by giving out more narcotics. How can I treat these patients ethically knowing that? It’s the moral equivilent of telling a Type II diabetic pound cake and Pepsi is an adequate breakfast.

As one old emergency nurse to another, I get it. But I have no words of wisdom for her. There aren’t any good answers, only judgement based on knowledge and experience. I can only humbly offer up for consideration what I’ve concluded. Your (and her) mileage my vary. For me, of course, it’s complicated. I have to ask myself, to start, who are the people who seek narcotics? If we eliminate those who want narcs to sell on the street, who need to be firmly escorted off the premises, and those who genuinely come to the ED in pain, we’re left with those with a drug dependency. Fine, you might say, send these loser addicts on their way. But notice how all three categories, and the last two especially, can overlap? What do you do with an acute bilary colic with an unwarranted fondness for Percocets? Tell her to suck it up, because she’s made her choices? More than a few times in my years as an emergency nurse I’ve seen physicians refusing to order pain control for large bone fractures because of a previous history of drug dependency. Is this ethical, or even wise? I’m not clear punishing drug addicts for their sins is part of the job description.

Only in the last few years I’ve to some sort of resolution, moving from where Kim is to a place of relatively less self-doubt. First, I recognize the truism that substance dependency is a disease, with its own etiology, pathology, and treatment. Very trite, yes, but something we all tend to forget in a culture that still views drug dependency as a moral failing, and a crime for the righteous to condemn and punish. Keeping this obvious fact firmly in mind allows the distance to see drug seeking as part of a medical condition, and focus on the patient, not the admittedly annoying behaviour. Secondly, I’ve come to realize we can’t fix addiction in the emergency department, during a two or three hour visit, in the same way we can suture a laceration or treat asthma. We never will, and beating ourselves up over this elementary fact is pointless. Addiction simply doesn’t work that way. It requires willingness on the part of the patient, and treatment modalities far beyond the capability of even the most experienced nurse or most sophisticated emergency department. Even getting the patient to recognize the need for treatment is a challenge in the ED: believe me, I’ve tried.

Hence, I am a pragmatist. Most drug seekers will come in with presenting complaints like lower back pain or migraine; these can be (willingly or no) given Toradol (and for those with a Toradol “allergy”,  naproxen) and sent on their way. As for the rest, does it really matter? Giving the known drug addict IV morphine for renal colic (real or supposed) or sending her home with a script for ten Statex until she sees the urologist is not going to make a whit of difference in the course of her addiction. Of course she might sell them; at the very least, it encourages bad behaviour and multiple repeat visits. But again, so what? Is it our obligation to make that judgement? I’ve heard, “Oops, he really had pancreatitis! Maybe he wasn’t faking the pain!” too many times to count, I’m afraid. And do we want to be in a place where we actively discourage people already marginalized from seeking of health care?

I have no firm answers, and in the case of drug seekers, the answers tend to be coloured by experience and personal values. Admittedly, beneath the crusty exterior, I’m the prototypical bleeding heart. I prefer in the end, everything else being equal, to accept a patient’s description of pain at face value. It seems too risky and less ethical to act otherwise. But like I said, it’s complicated.

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*In contrast, many emergency departments in Ontario, if not most, have sternly worded signs at traige that read, in effect, “Your narcotic prescription won’t be renewed here, so go ‘way.” We’re fortunate in Canada, as front-line nurses, not to have to deal with the Joint Commission, whose regulations often defy common sense and indeed occasionally border on insanity. Hospital survey companies like Press-Ganey do exist in Canada, but their influence on hospital policy and procedure are much less than in the U.S.

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Some Days You Just Gotta Post Links Vol. 2

Some links to entertain you while I putter in the garden today —  I may have pictures later. Also, sitting at the keyboard, the topics I want to write about are too complicated to deal with today. Some days are like that. C’est la vie.

  • It can be argued that health care providers who neglect to report illegal immigrants under their care will violate the law and be considered criminals. . . “
  • Government controlled liquor stores are good for you (and excellent for government coffers too.)
  • The Fatigue Factor: “An exhausted nurse is more likely to make errors in giving medication or in judgment calls.”

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It’s The Egg That Makes It

I’m off to the country today. In the meantime, in my quest to bring you the best (worst) examples of North American culinary excess, I present the Lady’s Brunch Burger— and yes indeedy, that’s a glazed donut.

A back-of-the-envelope calculation of nutritional value shows an astonishing 1366 calories and 36g of fat — excluding condiments. I’m guessing anyone who finds this appetizing is already on metformin and a calcium channel blocker.

Or Homer Simpson:

[Homer gasping for air due to being so out of shape]

TV Announcer: We take eighteen ounces of sizzling ground beef, and soak it in rich, creamery butter, then we top it off with bacon, ham, and a fried egg. We call it “The Good Morning Burger”.

[Homer starts gurgling in ecstasy]

(The Simpsons “Bart’s Friend Falls in Love”, 1992)

Life imitating art, or what? Or reality catching up to satire?

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