Tag Archives: Medicine

Crying

Standard

crying

I was reading over on Kevin, MD about a photo that was captured by a paramedic. (http://www.kevinmd.com/blog/2015/03/why-did-this-image-of-a-crying-doctor-go-viral-heres-why.html )  The photo shows a young doctor crying over the death of a patient.  The photo has generated quite a lot of internet buzz.  Should healthcare providers cry? Does crying make us unprofessional? Are we supposed be detached? What kind of person is able to remain emotionally detached doing what it is that we do?

I am not sure if it is a nurse thing or not. I cry.  I cry in front of patients. I cry with patients. I cry with families. My last cry was happy tears while hugging a patient who had been told that the diagnosis of “metz” to his lungs was a mistake and he was going to be just fine.  Yes, I cried with him when he got the original bad news.

I cry because I genuinely care deeply. It makes me a good provider for the most part. It makes me sit up reading every thing I can find that might help.  Sometimes, there is nothing I can do but care about the other person.  Sometimes that is the most important thing.  Being human.

I laugh with patients. I joke with them.  I encourage. I tease. Sometimes, I am the ice princess.  But that is rare.  The emotions I don’t share are angry ones. At least, I try not to let it show that I would like to dump a glass of ice water on the head of a patient that is yelling at me or insulting me.  So, there are limits to being fully expressed.

It makes me sad to read about physicians being expected to “suck it up”.  I imagine all that compartmentalizing is crazy making and it may be one of the reasons that physicians have such a high suicide rate.  I don’t know why their training is so harsh.  I don’t think it makes them “better” as health care providers.  Their crazy high divorce and suicide rate should let them know it isn’t good for their health.

Do you remember Rosie Perez in White Men Can’t Jump? I love the part where she was trying to explain that she didn’t want the boyfriend to get up and get her a drink of water when she said she was thirsty.  She could get it herself.  She wanted him to just understand or care. She wanted him to say ” I too, have been thirsty”.  Sometimes, our patients don’t want a pill or advice. Sometimes, they just want someone to say: “Yeah, parenting a teen was so hard for me too”.

I hope that more physicians are talking about the “disconnect” from emotions. I hope that they start encouraging each other to talk about their feelings long before they consider suicide.  I think of all the young residents that I knew while working in that huge hospital.  It breaks my heart to think that they will feel so isolated from the rest of the world that they think that sedation or suicide is the only way to cope.

One of the physician blogs that I follow is “Behind the White Coat  beats a real human heart”.   We all need to keep that in mind, don’t you think?

Snitches Get Stitches- Protecting the Guilty

Standard

For weeks, I have been conflicted about talking about a situation in my work world. I am not sure what the “right” thing to do is. No, that is a lie. I know right from wrong, damnit and what is going on is wrong.  I worry about big scary words like slander and liable.  I know that my vocation calls me to protect my patient from harm. Sometimes, that harm is another health care provider.

On the other hand, we all have this not quite unspoken code of keeping our mouths shut when we are all aware of another health care provider who is dangerous.  We talk among ourselves. We roll our eyes. We call someone to the computer and say- “Did you see this?”.  We ask each other how that person gets away with this. Of course, that is as far as it goes, right?

There is a physician who is routinely seeing 70 patients in 5 hours. We joke that on the evening he works later, the whole waiting room looks like a scene from the Walking Dead.  I found myself humming the Leper’s song from Jesus Christ Super Star.  They are all there for Norco, Xanax, and Soma as a cocktail along with more other drugs that I can count. We know this is wrong.  We worry. We whisper. No one says anything to him though.

Yesterday, I shared clinic hours with him. In my defense, I was in and out of rooms too, and doing some much needed catching up on four inch stack of labs and images. I was working as hard as I could to stay on task and focused. Once, I walked into the common nursing area and heard folks talking about “not responding right” and he was standing the doorway and I assume this is his patient and he is a physician who has this handled. I went back to office/charting area a few doors away.  In the hallway I heard someone say something about an ambulance and again, assumed he was taking care of his patient and had called the ambulance. I was only mildly concerned because I had worked in clinics where it is just protocol to call 911 for things as minor as elevated blood pressure. I briefly wondered if one of the COPD patients was having a very hard time.

I went back to the nurses station area to get some forms as ambulance was arriving, the physician wasn’t in sight, so I assumed he was in the room with the patient. I had called 911 in other clinics and stayed with the unstable patient until care is turned over to the paramedics.

But no. Later, several assistants came in the providers charting area and asked me if I knew what happened. The physician walked into the room, the elderly female patient seemed groggy to him. He came out after a minute and told the assistants- “She won’t answer my questions” and said something like she had probably taken too many medications. He gave no orders, no concerns and moved on to the next patient. It took a few minutes for the assistants to figure out to go in the room and check, and they found her nodding out and barely responsive. One got a blood sugar of less than 30 and called the ambulance. On their own because he was ignoring the whole situation.  They didn’t come to me, because HE is the DOCTOR.  He continued seeing all his patients and ignoring the whole scene and the patient who became completely unresponsive before the ambulance arrived.

I find this out after the ambulance has gone.  We are all not as shocked as we pretend to be. We know he is horrible. We know he doesn’t examine patients. We know. We talk. We DO nothing.

I came in this morning and looked for a trusted colleague and he told me he had just heard the whole story. I told him, I am not staying silent. I am going to the clinic director.  We each spoke with her today.  I doubt anything will happen. Not for her lack of trying, but he is a powerful person in this community.  This is not the first or even second time I have been to a clinic that is so scary.

I am scared for his patients.  When I see them and update the problem and medication list, explain that some medications are not safe to be taken together or shouldn’t be taken with their condition, or that they need some tests and I do a physical exam, they tell me that it is the first time someone has touched them or examined them in 3,5, or 7 years.  I am quiet.  I don’t criticize other providers.  I think I am a coward.

Who are we protecting when we stay silent? Are we protecting the other provider? Are we trying to protect the patient? Are we protecting ourselves?

I am the locums. I am the outsider. I was raised that tattling is the worst thing you can do. No one likes a tattletale. “Snitches get stitches”. “Not my circus, not my monkeys”

What do you tell yourself when you protect the dangerous provider with your silence? We all know these “bad apples”, don’t we?  Have you confronted them personally? Do you think administration will handle this?  What do you do? I really want to know.

Mad Scientists

Standard

http://www.amazon.com/gp/product/0143113100/ref=as_li_qf_sp_asin_il_tl?ie=UTF8&camp=1789&creative=9325&creativeASIN=0143113100&linkCode=as2&tag=doegas-20&linkId=DZ4D4HZFZYWCD6O5

As fascinated as I am by neuroplasticity, I don’t know if I can finish this book.  I had just finished this author’s book, The Brain’s Way of Healing and I liked it so much I ordered extra credits on my Audible just so I could listen to this on my drive.  I was a little creeped out by the way he kept referring to any sort of kink as a perversion with its roots in childhood medical illness with painful procedures. I thought Okay, this guy is a little old fashioned using the word “perversion” to describe so many sexual acts that are not normal intercourse between a man and woman.

But then…

He started describing those experiments that Taub conducted on monkeys. I was interested in the research as it pertains to neuroplasticity, especially in stroke victims. But as Dr. Doidge described in more detail how Taub, severed nerves in the poor creatures, amputated their fingers, repeatedly opened their skulls and restrained them for weeks/months as you see below,  I couldn’t concentrate on what the whole point of the studies might have been.  I actually yelled ” What the F…” while I was driving.

When I got home this afternoon, I Googled the creep:

index

I want to go grab Taub and shake him.  We had a pet monkey, Pepe, when I was young. He was like the most annoying sibling in the world but he was child like in his affections ( and tantrums). That monkey in restraints looks so much like Pepe. I can’t imagine putting any living thing through that sort of torture, but this just breaks my heart.   I know that this horrid man advanced the field of neurology and the information gained has changed the lives of so many human victims of stroke and other CNS injury. But can we honestly believe that there was not another way to get this knowledge?

images( He looks like such a nice guy, doesn’t he?)

The book may be a great source of information, but I don’t know if I can go back to it. The author seems to be excusing Taub’s methods. I just had to turn the book off for now.

What do you think? What limits should be there be in using other animals in research? Does the good outweigh the bad?

Provider Boundaries

Standard

 dearheart3

I freely admit that I have always struggled with boundaries. I take things personally.  I worry about my patients when I should be taking care of my own health. I want to help my patients feel better, to move toward “wellness” whatever that means to them. I want to share everything I know about pain, depression, Big Pharma in the 10 minutes that I have with my patients.

Unlike the parent who can never admit that they have a favorite, I have no problem telling you that I have favorite patients. Of course, I enjoy the well-read, pleasant wellness focused patient who wants to avoid medications as much as possible. But some of my favorites are the cranky, rude, demanding patient who over time lets me see their broken and sad parts.  They are the ones that challenge me with their demands and don’t quickly accept my reasons for the proposed healthiest way to treat their illness.

Some of them hate me at first and they let me know that later.  One of those patients who hated me at first told me that he didn’t want me to violate principals that I hold dearly and so he was going to get his Ambien, Xanax, Soma and Percocet from the other provider, but wants to see me for everything else. He started to read the books I recommended. He started to talk about his fears of a life without all of those medications. We would make progress every visit on healthier choices. And we laughed a lot.  I looked forward to the visits where I could see those baby steps happening.

I have recently grown fond of a patient who actually convinced me to give him Ambien-( Including that patient I still have written fewer than 10 prescriptions for that drug in the past 7 years ).  We have this sort of inside joke about “playing the cancer card”.  I have been fighting with his demon insurance company trying to get a medication approved for several weeks without success. I actually wrote a  letter to the crazy insurance folks explaining why he needed a particular form of a medication he could use at home instead of coming in the office for injections and get exposed to all the contagion that floats around in community health clinics. So when I saw the name on the schedule I was surprised since I had just seen him a few days before. This time the “cancer card” got him. Very bad news, my MA cautioned me outside the door  I took four deep breaths outside that door before entering.  Still, I  took one look at his face and cried when I hugged him.

I am going to worry. I am going to search the inter webs in a vain search for some miracle cure that all the experts just happened to have missed. I pulled up the imaging that I don’t even know how to read and tried to imagine that they mixed up the films. Maybe all those spots are just some weird artifact. I am going to sit and cry more than once over this one.  I am going to send cards and books.  I am going to cheer lead. My heart is going to break.

Do I want to change this about me? I used to want to change it sometimes, but only for a moment or two. I do what I do because I feel deeply and passionately that we need to hear their stories. We need to understand their lives. We need to get close enough to be able to lead them out of that dark place of chronic illness when they are unable to even imagine that there is light at the end of that tunnel. When I meet them in that dark place, I get to celebrate that dance in the light when they fight their way back to health.

Yes, it hurts a lot today. But real life is messy. Problems don’t get fixed in 43 minutes and 8 commercials for fast food and faster pharmacological treatments for the diseases of fast food. So, tonight, I am practicing what I preach.  Having a cup of herb tea and a good cry before bed.

Measles Panic?

Standard

people_measles7 Many of my social media friends and real world friends work as pediatric providers and nurses. Much of what I read in the blogosphere and my custom news feeds focuses around healthcare. If I knew how to filter out the word used the most often, I have no doubt that it would be measles. The past few weeks I have had several very concerned seniors asking about getting a measles vaccine. The coverage of this measles outbreak is ridiculous and disproportionate to the threat involved.
2013:

41,249 people committed suicide.
33,854 people died in motor vehicle accidents
2,800 people died from medical complications
10 people died of malaria, ( yes ,malaria)
46,717 people died of drug overdose ( many of them prescription) and
29,000 of an alcohol induced deaths.
Measles? ZERO. Really. ZERO. There were 159 confirmed measles cases from Jan-Aug of 2013 and no one died.

This coverage and the resulting near panic is because measles is just sexier to the news folks than the 249,000 folks that die from diabetes related causes each year. Showing pictures of a measles rash gets the CNN endless loop of coverage. My physician friends are furious at the anti-vaccine crowd in a way I never see them at parents who feed their kids junk food, which will kill so many more than measles.

There is a viral video of pediatrician saying he will not allow the non vaccinated or the alternate vaccine scheduled kids in his practice. This sort of over reaction serves no one. We should always be careful with our patients with compromised immune systems. We need to put down our pitch forks and torches and let the measles monster go so we can direct out time and talent to much more pressing health concerns.