Rules of Engagement

Despite having a re-torn bicep and surely some pain, I noticed he bounced when he walked. When I waved him toward the scale for the anesthesia required weight, he slid off his flip-flops before I could stop him.

“Oh, uh, oh, okay. Bare feet. Got it. Let’s get your shoes back on there.”

He gave me a wide grin before responding. “My toes breathe better this way.”

“Do you need to use the restroom before changing?’

“Nope!”

‘Nope’ rang a bell and I searched for recall. Ah, yes. He’d been here a month ago, under someone else’s care, the voice and devil-may-care attitude, unmistakable.

Anyway…I went through my usual intro and explanation of the preparation that would occur in the pre-op area. Not quite un-expectantly, he started disrobing before I could close the curtain and minimize the risk of a side show for anyone walking by.

I had all the healthy nurse/patient boundaries up until I handed him a pen for signing his consent forms.

“Oh, thanks, I hold pens this way.” He took it with his thumb, index, and third finger. “I’m a writer. I like to write this way.”

As soon as he said “I’m a writer” I was taken back eight years.

I KNEW HIM!

A writing class.

I looked at him wide-eyed.

It was a class that opened my mind to the power of putting my thoughts and ideas on paper.

“Woodstream Writers”

He turned his head sharply, gasped, and said “Yes! I thought you looked familiar!”

Way back during that time, I had been tempted to ask him out. He had a charming upbeat personality.

Now he’s my patient.

Oh well.

 

Patients say the darndest things!

“What a nice heroin thump.”

I’m not sure I heard him right.

“I’m sorry. What?”

“You know, like the drug addict on any crime show or movie, the way you flicked my arm before you wiped that alcohol and wrapped the tourniquet … you did it perfect.”

“Huh?”

“The way they flick the skin with their index finger, come on, you know!”

There’s a compliment in that statement, I guess, but I don’t want to retrieve it. I did laugh a genuine laugh.

“Sir, I’m going to remember this moment.”

He admitted to watching way too much T .V.

And his responding laugh was just as genuine.

You’re not getting a car, your getting on my nerves.

You remember the year Oprah gave everyone in the studio a car for Christmas. She waved her arm around the audience, pointing at random people, yelling, “You’re getting a car and you’re getting a car and you’re …”

For a couple of months now, I’ve driven to work, gotten out of my car, and as I walk toward the entrance, I’ve felt heaviness in my chest. (And no, it’s not my arrhythmia)

I dread work.

Not the patients,

Not being a nurse.

It’s the company I keep.

I want to wave my arm around, pointing to certain coworkers, and holler, “You’re a problem and you’re a problem and you’re…”

You get it.

Here’s the thing with transparency, some of it has a negative impact. When I hear peers say “I gotta look out for me, gotta take care of me first” and “This is just a job, I’ll quit if they expect me to do that,” I get discouraged. Yes, they are being honest, but come on — my favorite is “I’m leaving at the end of my shift; I don’t care how many patients are coming out.”

What?!

I feel very alone.

I understand healthy boundaries and the importance of self-care. I guess I should have some appreciation that a peer feels comfortable telling me exactly how she feels, but what if we all get that way? What happens when everyone wants to do the minimum? If I share with them the impact of their comments to me, am I not in a way doing the same, making it about me, not the patients.

It might be time to look for a new tribe of nurses to work with. It’s a drastic step, but one that needs to be considered at this point.

 

Where is my Hemingway?

Feeling a twinge of guilt for my Saturday visits to Starbucks for mocha lattes, I developed the habit of perusing the newspapers while waiting for my drink. My thought was, well, this is kind of an intellectual outing, I mean, why look, there’s the Wall Street Journal. So, on my last visit, as I always do, I rifled through the papers in the rack. A column in the opinion section caught my eye.

A Lost Love Gave Us Hemingway’s Spare Prose

 Even better, in larger font after the second paragraph:

___________________

A mortar burst and a              

Nurse transferred an ambulance driver

into a great author.

____________________

Professor Robert Garnett of Gettysburg College does a great job of giving a well-articulated head nod to Hemingway and summarizing his humble beginnings as an ambulance driver in Italy during WWI.

What drew me in was the explanation of Hemingway’s unrequited love for nurse Agnes von Kurowsky and how his hopeless affection is braided into his first two novels.

Where was this columnist’s essay going? I wasn’t sure I cared.

I’d love to be given credit for inspiring great writing. My patients recognize my sincerity. Leadership sends me warm fuzzies via certificate of appreciation. (They call them Applause Certificates). A world renowned writer inspired by me — now I’d be close to sitting on my laurels after that. Any nurse would!

I read on.

Alas, the essay tapers to the true point in the last paragraph.

“But the taught restraint style of his early fiction still influences writers today – or it should. To get started, Hemingway told himself, ‘write one true sentence.’ In an era of massive ubiquitous verbiage, from a single year’s 96,000 pages Federal Register to the daily inundation of tweeted banality, the principle still tolls like a deep voiced bell over a million shrilling cicadas. For that we can thank the fortuitous conjunction, 100 years ago, of a mortar burst and a pretty nurse.”

One true sentence.

The need for this in media is strong right now, very strong.

A Nurse I’d have liked to work with:

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.”)

Are Nurses Losing Ground?

Are Nurses Losing Ground? Part 2

If I step away from nursing to write about a book, it means I really liked it. I mean, a lot.

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.

 

The ‘Right to Try’

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 21^st   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 22^nd 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.

­­­­­­­­­­____________________________________

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

We call them ‘Add-ons.’

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.

I asked for it.

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!

 

 

Yay!

From: “Su Gerheim” <sg*****@g*******m> Date: May 15, 2018 at 10:28:36 AM EDT To: ME!!! Cc: “Chris Coward” <c*********@c******.net>, <c*****a@g*****m> Subject: Your Entry, Muse(s), is a Winning Entry in the 2018 Collection Contest, Volume 10 Hi Susan, CONGRATULATIONS! Your entry, Muse(s), is a winning entry in the 2018 Collection Contest, Volume 10, Where Does Your Muse Live? We are delighted that you are a winning author in this year’s collection book. Attached is a copy of the front cover of your new book. Feel free to use it in announcements you’d like to post. Tell everyone. You’re a WINNER! Celebrate.