Marianna Crane, Nurse Practitioner, published author, and Blogger, drives home the issue of lack of recognition of the contribution nurse make in healthcare.
I wish I worked with people like her.
I know some of you out there that follow my blog are nurses; some of you are nursing students.
Read these posts. It’ll light a fire in your gut! (The good kind, not the “I shouldn’t have tried the hot sauce.”)
After reading What Alice Forgot, by Liane Moriarty, I was on a roll.
The humorous and poignant side of amnesia, deftly embedded in Miss Moriarty’s novel, tickled me and at the same time, made me reflect on some things in my life that I’d rather not remember.
It felt sooooo good to once again make time to read!
I inhaled the story, let the laundry basket overflow, opted for Subway sandwiches in lieu of home cooking, and finished it in a week. Then I went to my Kindle store and typed in Every Note Played by Lisa Genova, the neuroscientist / genius writer that wrote Still Alice. (‘Alice’ – eh, a quirky coincidence).
About the story:
Divorced couple Alice and famous pianist Richard end up living together when his ALS becomes impossible to hide and, of course, makes it impossible for him to live independently. Alice is not portrayed as a martyr, and Richard’s character is given the depth to help readers understand how his love for music left no room for anyone else.
The internal narrative of Richard’s grief as he loses mobility in his hands — hands that once played Mozart, made hundreds applaud — you’ll feel his pain.
Alice, she’s also a pianist. That’s how they met. She made choices, and she had a secret. When it was revealed, the marriage ended. Two years pass before they are reluctantly placed under the same roof. The author does an amazing job pulling you into the story.
She also does a fantastic job of explaining in detail how ALS robs you of everything. However, it doesn’t rob you of the ability to forgive. And when forgiveness begins, love returns.
Alice and Richard’s journey through ALS to the end, it’s not romanticized. ALS is mean. It takes everything from you, right down to your last breath.
Read the book anyway. ALS is not the star of the show, Alice and Richard are.
Get a drink. Sit down and get comfortable.
Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana ,Iowa, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
If you live in any of these states, you can now try Experimental drugs that have only completed Stage I of the FDA review program (proof the medication will not poison you).
The federal ‘Right to Try’ bill first passed the House of Representatives on March 21st then moved on to the Senate. The bill grants permission to try to get experimental medication directly from a pharmaceutical company. The Americans for Prosperity, backed by conservative billionaires Charles and David Koch, supported and pushed for passage of this bill. They gave millions in support of candidates in the 2016 elections and have given more than $100 million to conservative groups.
The Senate passed it on May 22nd then moved it to the President’s desk. He had previously endorsed it in his January’s State of the Union address, saying, “People who are terminally ill should not have to go from country to country to seek a cure – I want to give them a chance right here at home.”
Dr. Scott Gottleib, the commissioner of the U.S. Food and Drug Administration (FDA) expressed his concern about the bill in the past, but stated he would embrace the changes.
Groups representing patients and research groups opposed the initial House bill as unsafe. In a letter Tuesday over 100 of them said the final legislation is worse. Patients would be allowed to try experimental drugs, but nothing in the legislation would make it mandatory for pharmaceutical companies to dispense these medications, assist with the inflated cost, or have any responsibility if the drug resulted in side effects needing additional medical follow up.
“The vast majority of experimental drugs ultimately fail: FDA estimates that for every 100 drugs that enter the first phase of human testing, only five to seven will eventually get approval. The other 95 percent either didn’t work, or had risks that outweighed their benefits, and any patients who took them on an ‘experimental’ basis would have suffered pointlessly.”
The bill only removes legal roadblocks.
Now, the FDA already has a program in place designed to provide patients with experimental medications.
This program, known as the “compassionate use” program, performs essentially the same function as the right to try legislation, allowing patients to try experimental drugs after approval from a review board and panel of experts. In recent years, the FDA has approved 5,816 of 5,849 requests — a 99.4 percent approval rate.
The average American, and I’m not talking about those that lean heavy on current federal programs , I’m talking about those that have tenure, have thousands in their pension plan, lived at the same address for forty years, raised their kids, or are working overtime to set up college funds, won’t benefit.
These people get that devastating diagnosis of ALS or M.S., turn around, take out a second mortgage or move in with their parents or kids in order to pay the difference insurance doesn’t cover for home therapies, medical equipment, and a list of other things.
This bill does not make it mandatory for a company to hand out experimental drugs.
It gives hope to the rich, the very rich.
Insurance companies? They’re not in this conversation because, well, they’re not leaning in that direction. Every year they expand the list of FDA approved medications and surgeries that need pre approval. I don’t see anyone asking insurance carriers to glove up and get in the ring.
Our Chief Executive Officer of the US of A, has trimmed the Medicare budget and is encouraging the House and Senate to complete cuts in the Healthy Start program (For Pregnant mothers, and Children)
This will be touted as a success, a win for the people. I think it’s a ruse.
| Hope shouldn’t be toyed with. It’s cruel to put a plate of food in front of a man with no hands, then walk away. |
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https://www.youtube.com/watch?v=ZqTgFEwICOs
https://www.humana.com/provider/support/whats-new/2018-formulary-changes
https://www.aetna.com/plan-info/individual/legal/limitations-exclusions.html
USA Today , May 2018
Morten Wendelbo, Timothy Callaghan The Conversation May 30, 2018, CBS News
It was a robotic cholecystectomy for a seventy- eight year old floor patient, called over to us from the OR charge nurse at 12:25. Our surgical transport person, Tony, was en route to us already with a prescheduled patient from one of the medical floors.
He arrived at 1235.
I gave him my patient’s name, room number, and a brief report. ( I had gotten report from the floor nurse. Tony deserved assurance that there were no isolation precautions or Oxygen needs)
He returned at 1248. Before he arrived, a coworker offered to jump in and get the monitors on and lung sounds.
The OR team approached our Bay at 1303.
” Patient ready?”
I responded. ” Need just two more minutes.”
I pulled an extra medicine, Solucortef, ordered by the anesthesiologist.
The OR team returned two minutes later and left with the patient at 1305.
My coworker raised her hand to give a me a ‘high-five’ for the in and out service in seventeen minutes. She called it a ‘Drive – By’.
It didn’t feel good or bad.
Being fast only counts if you are measuring how long it takes you to get a defibrillator to the bedside of someone in cardiac arrest. Or cautery equipment to a surgery patient bleeding out. Or Vasopressin to ….
You get it.
Compassion is often the first thing lost when ‘speediness’ is given unnecessary accolades.
Spine injuries. Spine surgery. Cervical. Thoracic. Lumbar.
Loss of strength. Neuropathy. Nerve impingement on the left or right.
It’s all important to measure in the preoperative area. So I did.
Cue to scene in Bay 5 yesterday:
“Okay.” From where I stood at the side of the stretcher, I stretched both hands out towards his chest. “Take my hands and squeeze.”
I sucked in a breath as I felt the pop on my left pinky.
“Oh ooh oh, okay. That’s good. ”
He let go and I dropped my hands fast to my side. I noticed my fifth digit hung a little funny.
“Numbness and pain’s only in your left arm, huh?!”
“Yeah.” He mumbled before turning his attention back to his phone.
Ice and a splint for a few hours fixed my pinky.
Lesson learned .
Will have the male patients squeeze my wrists, not my hands!
|
The first time I took the test, it was because I thought I could do anything. The second time was to please my hospital leadership team. The third time was because I was mad.
________________________
We finish high school, college, some of us – graduate studies, some go even beyond that; taking tests along the way, the obligatory standard to measure our accumulated knowledge.
Despite being pleased about passing the National CAPA exam, I’ve continued to fumble when people ask me about the experience. Academic achievement has never been the kind of thing I’m overly impressed with. I’m more interested in someone’s character, how they treat others, their integrity and social consciousness.
My Dad asked me about a week back, ” What was the purpose of passing the test? I mean, does it change how you take care of your patients?”
I got what he was saying. My parents are already so proud of me, one plaque actually sits at their house, not mine. They don’t like to see me stress about anything. I think his point of view was a technical one, never the less, it triggered a revelation:
I wanted to set the bar higher for myself.
Yes, there was the anger component going into the third attempt. Why am I pushing myself ? Geez, I’m over fifty!
I’m not angry anymore. I think the growing pains ( which I haven’t had in a long time) just hurt some.
_____________
So, anyhow…yep, that’s why I kept at it.
Setting the bar higher once in a while is not a bad thing.
“No. I’m not sure you should.” I looked her square in the eye, giving her the I’m serious look.
Her smile got bigger , dozens of creased lines surrounded her eyes. She’d put eye shadow and mascara for the occasion.
“O.K. This EKG is done. I’ll be right back – need to show it to Anesthesia.”
” I’ll stay here.” She plopped her arms down over her belly and sighed.
I returned with the report signed, hearing on the way back that todays surgeries, more complicated than expected, continued to darken her surgeon’s mood.
“Okay. He should be out soon.”
She was my fourth patient, by far the most spirited, and with an amazing attitude about the decision to have both knees replaced at the same time.
The doors between our department and OR swung open and here he came, scrubs wrinkled so much he looked like he’d slept in them for three days. His jaw slack, his shoulders down, I felt some empathy usually only reserved for patients. I stepped quickly to the bay. I had one chance to make sure he signed everything on the chart.
“Okay. You ready? Your up next. We’re doing both knees so I don’t need to use this skin marker on either leg. Any questions?”
She twisted her mouth then opened it slowly before speaking. I took a deep breath in.
I am not responsible for everything the patients say. I am not responsible for everything the patients say.
“No, but I want to give you some advise young man.”
He raised his eyebrows. “And that is…?”
“Measure twice. Cut once. Advise we quilters give each other. You could use it too.”
My eyes bobbed back and forth between the two of them. She said it so matter of fact.
He cocked his head then dropped his eyes down for a moment.
Then he let out the biggest laugh.
“Darlin’ you just made my day!”
We didn’t see his type often.
He walked in, chin up, thick belly, arms cocked at his side, gave me a smile, a mischievous smile, and I thought , oh well, every now and then, you gotta take care of someone you know is going to be different.
“Hi David, I’m going to be your nurse. We need to get your weight and height right over here.”
He gave me a ‘You must be crazy’ look, but he did comply. I jotted the numbers down and led him along with his female escort to his pre –op bay.
Paperwork completed, I closed the curtain, giving him privacy to change.
A small adult cuff fit his arm, Yay!, the O2 saturation probe picked up fast, and I thought things were going well until the woman with him asked for help.
“Susan, we need to find a channel he likes, like fast!”
I started pushing the channel up button as quick as possible. I didn’t want a meltdown on my hands. He started to scowl. His face turned red. I flipped to high channels then back to low one. Panic was making me inconsistent. Why does the hospital need sixty-eight channels? I just passed a really hard test. I can’t believe how nervous this is making me.
Finally.
Channel 18.
The cartoon channel.
Crisis diverted.
Four year olds are cute, but I’ve changed my mind about being ready for grandparenthood!
Almost two years ago I posted about my failure to pass a specialty nursing certification exam.
It hurt.
Six months later I took it again with the same results. I physically felt like less of a person, less of a nurse.
Over the years, I’ve been repeatedly recognized for the quality of my work. Still yet, I wanted to pass that test. I wanted closure on the dogma that correctly answering at least 140 out of 185 questions legitimized my knowledge in the surgical setting.
So, yes, I took the exam again.
And I passed.
The joy is tempered by the fact that it took me three attempts. Fortunately, it didn’t deter the response of my coworkers.
I’m most thankful for the one coworker that said, “ I’m so proud that you didn’t give up.”
Yeah… just typing that sentence makes me smile.
I’m glad I didn’t give up!
Art and Lifestyle by Brandon Knoll
Art and Books
Musings from medical school
Opines & Fading Memories
The musings of a twentysomething chronic planner on a journey to make her career dreams come true. BSN to DNP. She believed she could.
Unorthodox Marketing & Strategy Blog
Creative coaching, workshop facilitation, and content strategy
Finding the funny in everyday life
Our journey from city to country living and all stops in between.
my 5 week trip to Tabarre, Haiti
