Outcome of my trip to the library…

Empathy: from the Greek ’empatheia-em & ‘pathos’ – feeling

Gorgeous nuggets from the collection of essays by Leslie Jamison in her book The Empathy Exams:

1. Empathy is figuring out how to bring difficulty into the light.
2. Empathy requires inquiry as much as imagination.
3. Empathy requires knowing you know nothing.
4. Empathy means realizing no trauma has discrete edges.
5. Empathy means acknowledging a horizon of context that extends perpetually beyond what you can see.

Quirks

We all have a thing, a saying, a cliché comment that you can get away with because you’re not poking fun at anyone, it’s just a cute phrase.

Just this last week, mine came back to bite me in the you know what.

Standing by his left elbow, I watched as my patient signed his consent with a swish, a whoosh, and finished with a dot and a slash across the ‘t’ at the end. Somewhere in the middle were the letters in his first and last name.

” You write like a doctor,” I said matter- of- fact. Not an insult, in my opinion. They are brilliant people with a heck of a lot of responsibility.

Standing about four inches taller than me, my patient turned his head in my direction, his chin down, one corner of his mouth up.

” I am a doctor – one that routinely refers patients to the surgeons that work here.”

Trying not to miss a beat, I responded quick.

” You’re the reason I have a job here. Thank you!”

***

I need to come up with new material.

AI in the Boxing Ring with Nuance and Empathy

Our greatest strength is also our greatest weakness

I’ve heard this above quote by a minister, a writing instructor, and by a nationally recognized public speaker.  After reading a sample of The AI Revolution in Medicine by Peter Lee, Carey Goldberg, and Dr. Isaac Kohane, Pediatric Endocrinologist, I too want to say it out loud.

M.K. thanks for the email and the suggestion to take a peek at this material.

 I also want to thank Shakespeare before going further because what he said was ‘Your greatest strength begets your greatest weakness.’ Um hmm, begets, as in gives rise to, brings about, and that’s what technology has done, brought speed, efficiency, access to more knowledge, and all the foibles that come with it.

In my opinion, ChatGPT language model is the star of the book, but fairly not portrayed as a spotless protagonist.  The potential opportunities for gains along with risks are equally outlined. Being a nurse, some of the technical language is out of my wheel house.  I had a negative reaction to the idea that it could empower patients. Our geriatric population is growing and from my experience as a healthcare provider, I can tell you, the percent of the ‘over 70’ patients comfortable with just the current technology practices for things as simple as checking in online for an appointment, eh, it’s not great. There are also the outliers like my mom, (who just rounded the corner into her eighties) who Google everything they can from lab results and printouts from MD offices!

You put enough patient data in, yes, ChatGPT does appear to be the hero, a timesaver magnum opus.

I also agree 100% with the authors believe that healthcare administrative duties can be significantly reduces. I know all my nursing friends would be on board with that! Will or should it replace us, a breed already dwindling down? Who knows, the nursing world is getting quite shaken up lately.

I do believe that ChatGPT will improve differential diagnoses. Misdiagnosis, failure to diagnose, and delayed diagnosis are some of the most common types of medical errors. There are way too many sad stories of patients waiting months for appointments, then more time for diagnostic testing, then return visits, only to find out they have a complicated medical problem further along then realized.

Will it educate physicians and nurses on empathy, nuance, and context, in this case, the whole patient — as of now, I don’t believe it will.

            I think this is a great read for a specific breed of healthcare professionals.

            I’m just not one of them.

Dress Casual

We do say ” Dress comfortably” and we mean it.

It doesn’t stop some. I’ve checked in some very stylish ‘over 60’ women decked out in their finest dresses, full face make-up, jewelry ( I take deep breaths while they remove each piece and give to their spouse), and shoes I know they are not going to want to go home in!

However, this last week I had a patient who took the instructions serious, and boy do I mean serious.

Entering the waiting area, I called out for *Mr. Smith and redirected my gaze to the gentleman in the far corner who stood up.

Late forties, early fifties, his gait was sure and his smile relaxed. He had on a flannel robe and I hoped shorts and a T-shirt underneath.

“Hi” I’m Susan and I’ll be checking you in.”

I extended my hand to shake his and check his armband at the same time.

“Hi, I’m ready. Let’s do this!”

Bilateral inguinal hernias didn’t seem to have affected his demeanor. You would have thought I was going to sell him a car.

In his pre-op bay, I had the consents laid out on the counter. Signed, I pointed to the gown, cap, and socks on the stretcher bed for him,

” O.K Got it !

He dropped his robe with flourish and seeing nothing but skin, I flung the curtain shut so fast I almost tore my rotator cuff!

I’ll need to add to my dialogue ” Please let me close the curtain before you start changing.” 😳

The Humanity of Nursing

I’ve been struggling with the increasing number of nurses speaking up, some shouting, about the inequities in their workplace compared to other professions. Struggling because yes, COVID brought out the weak underbelly of corporate healthcare AND also struggling because this is a profession in which there are over a hundred types of nursing jobs you can do and there are nurses who are basking in the glory of standing on a pedestal in righteous indignation.

I’m not going to gain any nurse bloggers by this next paragraph, but I have to type it.

Nursing is not a job for anyone who is always assessing whether they are being taken care of, who might have had a little too much narcissism handed to them at birth, or who needs to make sure that they stand out.

I never know how to wrap my thoughts up in a way that extends beyond Nursing, a way to morph my musing in a way that doesn’t sound like I too am being a little self-righteous in my own way.

Maybe I am. Maybe I wear my humility on my sleeve at work. But then, I’m not laying in the stretcher heading into surgery….

And just when I was going to give up on figuring it out, someone I care much about just happen to share a book they were reading by Akiko Busch titled Notes on Invisibility in a Time of Transparency. This highlighted passage was sent to me during a recent call between us:

‘ …the measure of our humanity my be derived not from how we stand out in the world, but from the grace and concord in which we find our place in it.’

Websters: Humanity – the practice of being humane, kindness, benevolence; the quality or condition of being human.

This author speaks of belonging and clarifies the difference between belonging and fitting in.

It’s been added to my To Read list.

What’s on yours?

IV in the Foot was only part of the issue

“You’ll need to start it in my foot.”

I knew she’d had a bilateral mastectomy and then there was the handwritten note from Anesthesia on the front of her medical history questionnaire.

IV must be started in the foot.

A yellow sticky note with a comment from the pre- admission testing nurse added to the unique nature of my first patient start for the day.

            Prearranged with the OR supervisor – all members on this case to meet patient in pre-op before surgery.

I checked the clock. Fifty minutes until surgery. My patient was sitting on the stretcher fully clothed and reading every single line of her consent form.

Here’s the punch line to this scenario: Her surgeon wanted her to have a subclavian nerve block before surgery. ( This is done in the pre-op area).

            As OR team members rolled in to say ‘Hello’ I was hoping the patient couldn’t tell I was clenching my jaw. Finally, gown on, in bed, and all her visitors gone, I got down to doing the IV… in her foot…specifically the anterior saphenous vein. Supplies at the bottom of the bed, her foot prepped with betadine, I bent my head forward, tucked my chin down toward my chest, and traced the pale blue line with my eyes.

            I had one shot.

            My blood didn’t ‘t flow vigorously like it does when Eminem sings that verse. It was more like mush collecting in my stomach.

I started.

I got a blood return.

She yelped and told me to stop.

I snapped back that I was in the vein.

I connected the tubing, covered and taped up the site, then called for the Anesthesiologist to step in so we could do the nerve block. Versed and Fentanyl in small repetitive doses relaxed her.  She never fell asleep. I watched the monitors and her IV site like a hawk. Within ten minutes of nerve block completion, she reported a heaviness and numbness in the surgical arm. Success. Off to the Operating room — eight minutes late, but all things considered, a good start. She left the pre  -op area drowsy from the Versed/Fentanyl and a slack relaxed expression on her face.

It took me another hour to shake of the built-up tension from the unique start to my day.

All’s well that ends well.

Medical Injustice in the US

Important post by Vic Crain – Please read and help promote diligent research before picking a medical professional for your care.

CRAIN'S COMMENTS

We have two more examples this week of just how lax oversight of doctors is in the US compared to other countries.

1. Should it take 16 years to bring a doctor to account for encouraging opioid abuse and trading sex for drugs? Apparently, the State of Ohio thinks that’s OK. Perhaps the doctor was a major Republican donor? Who knows. In any case, his know record of abuse goes back to 2007 and his license to practice medicine was finally revoked on January 16th of this year (2023).(1)

   One patient, or perhaps we should say victim, who became addicted to benzos prescribed by this doctor had to be hospitalized after her weight dropped to a mere 80 pounds. This is an adult, not a child. The doctor ignored drug company warnings and the results of drug tests, and even requests by patients to reduce dosage of opioids.

2. The second case…

View original post 306 more words

A news story I’m so happy to hear:

Federal law makers, state law makers, and most importantly, International patient advocates such as T1 International have applied enough pressure and maintained a dogmatic attitude that has resulted in Mega pharmaceutical giant Eli Lilly in reducing insulin prices up to 70%. Specifically, this includes Humalog and Humulin, both fast acting medications used by millions.

Twenty-two states now have caps on the copay for insulin. Bravi!

With so much low brow coverage of the various new topics out there, hearing and reading about this, well, it just felt good. 

You have non-profit that you support ? Don’t stop! It can make a difference!

https://www.cbsnews.com/news/insulin-prices-diabetes-activists-hashtags/

Some nurses are so angry lately, they’re posting about it – poking fun at their profession. Some have done something even worse, they’ve

taken advantage of a profession that’s always in need. At a tremendous financial cost to themselves ( knowing a career would provide retribution bank wise), they’ve done more than cut corners, they’ve risked peoples lives for their own gain.

Twenty-five educators in Florida, and two other individuals out of state, have been charged in a fraud scheme that created thousands of illegal licenses for nurses.

The counterfeit degrees allowed the purchasers to sit for the national nursing board exams. When audits found three south Florida nursing schools to have incredibly low scores post the national exam, officials were notified. Those three schools were Sienna college, Sacred Heart International Institute, and Palm Beach school of Nursing.

I believe there are opportunist everywhere.

At first all my anger was toward the twenty-five educators that tarnished the image of Florida Nursing schools and Nurse educators. With more thought, I’ve readjusted the focus of my righteous indignation. Someone putting a dollar sign on the trust that someone places in them — I’m overwhelmed with disgust.

Hospitals will pay for educations. Communities have need based scholarships for healthcare students. Come on!

Have some self respect people. Look at the big picture – you can’t really get far. Someone will figure out how little you know. When you decide to pretend you know what your doing, you’re risking someone’s life.

The attention, media wise, might be all on the educator involved, but it could be a different story.

It might be someone’s life taken because an individual thought a fistful of money was the same thing as real hands on experience under the guidance of an instructor; an instructor with the understanding and ethics to ensure she or he sent each REAL graduate out into the world equip to treat each patient like their own family member.

https://www.collegescholarships.com/local/florida-scholarships

https://www.cbsnews.com/news/fake-nursing-diplomas-issued-florida-alleged-wire-fraud-scheme-justice-departme

https://www.justice.gov/usao-sdfl/pr/fraudulent-nursing-diploma-scheme-leads-federal-charges-against-25-defendants

My Top Ten

As I sit here at the computer, a recent commitment to getting back to reading more has triggered a fun post. A selfish one, eh, possibly. However these really are good books. They do lean on the side of pathos, but then, that’s me. That’s how I’m wired.

In no particular order:

The Last Lecture by Randy Pausch and Jeffrey Zaslow

When Breath Becomes Air by Paul Kalanithi

My Stroke of Insight by Jill Bolte Taylor

Gratitude by Oliver Sacks

Almost Everything: Notes on Hope by Anne Lamott

The Five People You Meet in Heaven by Mitch Albom

Being Mortal by Atul Gawande

Atlas of The Heart by Brene Brown

Oxygen by Carol Cassella

Cutting for Stone by Abraham Verghese