I have in mind a post about healthcare reform, since I've been thinking about that frequently this week. However, tonight I'm just a bit too distracted for such an intellectual posting. That one will have to wait.
Tonight I'm writing my little book project (I've hit 60 pages now... and the ideas are coming fast, it's just finding the time to actually write that is slowing me down.) and relaxing because I'm supposed to run a 5K in the morning.
I'm tired from working too much this week, and wondering why I allow myself to be dragged into work when what I should really do is rest, or play with my kids. Sadly, I think the answer is that it's all about the money. Got to have the money to do the fun things in life. Like eat.
When I have a week like this, it makes me think that the modern world just cannot continue this way. People (like me) are getting torn in too many directions by the things that are deemed 'necessary' to modern life. We have to have a full time job. A full time family. We work until we're exhausted and then come home and do household shores until we fall, exhausted into too short an amount of sleep, only to wake up and do it again the next day. When we finally get to vacation, we take a whirlwind trip somewhere that is usually just as stressful as our everyday life, and come back tired to start it all again.
And for those of us who choose not to work, then in almost every case, money is a big concern.
Modern life is so exhausting. It's no wonder everyone is on antidepressants these days.
I think I'm going to take a nap.
Saturday, July 25, 2009
Friday, July 10, 2009
Being in the Healthcare Profession (caution to those with weak stomachs)
makes for a very specific, under-appreciated sense of humor. I'm moved to post today in the honor of the fact that I will be going out to lunch with some colleagues of mine, and it occurred to me to invite my husband who is not yet in the profession. And then I took a moment to think. 3 nurses sitting around a lunch table will not give a second thought to having a very graphic conversation about the time that someone's patient had explosive diarrhea and it shot 6 feet across the room to land in someone's hair. Or the time the we watched some unfortunate soul yank his fully inflated Foley catheter out, and then describe the wine-colored urine that the patient had for a week following said incident. Each story is, of course, punctuated with laughter and interspersed with eating with great appetite. Nursing humor goes way beyond potty humor. So I'm thinking that I won't be inviting my husband after all... He won't appreciate the hilarity. Not yet anyway.
He will soon be joining the ranks of the twisted humor society aka the healthcare professional. In a few weeks he'll be starting EMT classes, and ready to roll by December. He'll soon have his own bodily fluid stories to share. I'm so proud of him. I'm also very glad that I will soon be able to bring home the stories of stool that smells like buttered popcorn and looks like sweetened condensed milk, urine with large black chunks floating in it, and various other disgusting exploits that one encounters when taking care of the very ill.
Hope I didn't actually cause anyone reading this to lose their lunch!
He will soon be joining the ranks of the twisted humor society aka the healthcare professional. In a few weeks he'll be starting EMT classes, and ready to roll by December. He'll soon have his own bodily fluid stories to share. I'm so proud of him. I'm also very glad that I will soon be able to bring home the stories of stool that smells like buttered popcorn and looks like sweetened condensed milk, urine with large black chunks floating in it, and various other disgusting exploits that one encounters when taking care of the very ill.
Hope I didn't actually cause anyone reading this to lose their lunch!
Friday, April 10, 2009
What's wrong with our healthcare system
Yeah, so that's a big can of worms. I am not an expert just because I work in the medical field. The only thing prompting me to write this is that there are several things on my nerves this week. Here's the big one:
Why spend so much money prolonging a life we know we can't save?
For those who don't know, my specialty (if you can consider me specialized after only one year) is burn. One of the first things we learn is that your odds of surviving a burn are based on your age and your percentage of burn. It's easy. Add 'em up. If you are 40 and you are a 20% third degree burn, you're 60% likely to die. It's quick and dirty, and far from perfect, but generally the older the patient, the worse they do. SO when we get a 76 year old with 70% burns... well... I'm sure you see where I'm going here.
The thing is that we can't give up. The families don't want us to. And so we don't, or we'd get sued and loose our licenses and other awful things. So we have patients that linger for days, and sometimes weeks in an ICU bed that costs upwards of $5,000 a day - just for the space, not for the monitoring, the nurses, the therapists, the ventilators and oxygen therapy, the drugs. One drug that we use, albumin costs $500-$600 per bottle, and we go through 5 bottles a day for new patients. Also we give blood and blood products to these patients, which not only costs but also can possibly keep some more viable patient from getting the blood they need.
The hospital I work for accepts all patients, regardless of their ability to pay. One can hardly wonder why it's been running to bankruptcy like an Olympic sprinter towards the finish line.
This happens all the time: Grandpa was smoking a cigarette with his oxygen tank nearby, fell asleep, an BOOM - we've got a 76 year old male with a history of COPD, heart attack, and vascular insufficiency with 30% third degree burns to his face, neck chest, and arms. Now we're tasked with trying to keep this man, who realistically had another 4 years left in him anyway, alive. We intubate him because his neck will swell from the burns and he won't be able to breath on his own much longer. (Again, you may not know this - but once someone with COPD is intubated it's incredibly hard - very unlikely in fact - to get them back off the vent). We start IV therapy, fluids, tube feeding and a Foley catheter - all invasive and likely to increase the already compromised patient's chances of getting an infection. We give them IV pain and sedation medications all to keep them from feeling the pain that they wouldn't be feeling anyway if we'd just let them die.
Why? Why do we do all this?
We do it because it's our job, because we'd want everything done if it were our grandfather, because we can. We do it because the doctor's ego says "I want to show off to my collegues just how brilliant I am." And the patient suffers, lingers in an amazingly expensive room, and then dies despite all we do. This happens over and over, dozens of time in my unit alone, thousands of times a year across the country. ICU care eats up almost 20% of the nation's health care costs, according to this article. It's sad, because so much of this cost could really be eliminated by simply letting people die when it's their time to die.
I know some people argue that by deciding who lives and dies we are trying to 'be God'. But we already do that everyday. We treat people who would have died 20, maybe even 5 years ago, and we 'bring them back'. Good for us. But when we decide to let someone die, someone that we don't have the knowledge or technology to save - then we're playing God? Can't have it both ways... either we're always playing God - every time we treat an infection with antibiotics, or suture a wound, or perform CPR - or we aren't. Either way, I argue that the best way to reduce the patient's suffering and the family's (and society's costs) is to let people go on with their business of dying without resorting to heroics when we know that we can't save them.
Why spend so much money prolonging a life we know we can't save?
For those who don't know, my specialty (if you can consider me specialized after only one year) is burn. One of the first things we learn is that your odds of surviving a burn are based on your age and your percentage of burn. It's easy. Add 'em up. If you are 40 and you are a 20% third degree burn, you're 60% likely to die. It's quick and dirty, and far from perfect, but generally the older the patient, the worse they do. SO when we get a 76 year old with 70% burns... well... I'm sure you see where I'm going here.
The thing is that we can't give up. The families don't want us to. And so we don't, or we'd get sued and loose our licenses and other awful things. So we have patients that linger for days, and sometimes weeks in an ICU bed that costs upwards of $5,000 a day - just for the space, not for the monitoring, the nurses, the therapists, the ventilators and oxygen therapy, the drugs. One drug that we use, albumin costs $500-$600 per bottle, and we go through 5 bottles a day for new patients. Also we give blood and blood products to these patients, which not only costs but also can possibly keep some more viable patient from getting the blood they need.
The hospital I work for accepts all patients, regardless of their ability to pay. One can hardly wonder why it's been running to bankruptcy like an Olympic sprinter towards the finish line.
This happens all the time: Grandpa was smoking a cigarette with his oxygen tank nearby, fell asleep, an BOOM - we've got a 76 year old male with a history of COPD, heart attack, and vascular insufficiency with 30% third degree burns to his face, neck chest, and arms. Now we're tasked with trying to keep this man, who realistically had another 4 years left in him anyway, alive. We intubate him because his neck will swell from the burns and he won't be able to breath on his own much longer. (Again, you may not know this - but once someone with COPD is intubated it's incredibly hard - very unlikely in fact - to get them back off the vent). We start IV therapy, fluids, tube feeding and a Foley catheter - all invasive and likely to increase the already compromised patient's chances of getting an infection. We give them IV pain and sedation medications all to keep them from feeling the pain that they wouldn't be feeling anyway if we'd just let them die.
Why? Why do we do all this?
We do it because it's our job, because we'd want everything done if it were our grandfather, because we can. We do it because the doctor's ego says "I want to show off to my collegues just how brilliant I am." And the patient suffers, lingers in an amazingly expensive room, and then dies despite all we do. This happens over and over, dozens of time in my unit alone, thousands of times a year across the country. ICU care eats up almost 20% of the nation's health care costs, according to this article. It's sad, because so much of this cost could really be eliminated by simply letting people die when it's their time to die.
I know some people argue that by deciding who lives and dies we are trying to 'be God'. But we already do that everyday. We treat people who would have died 20, maybe even 5 years ago, and we 'bring them back'. Good for us. But when we decide to let someone die, someone that we don't have the knowledge or technology to save - then we're playing God? Can't have it both ways... either we're always playing God - every time we treat an infection with antibiotics, or suture a wound, or perform CPR - or we aren't. Either way, I argue that the best way to reduce the patient's suffering and the family's (and society's costs) is to let people go on with their business of dying without resorting to heroics when we know that we can't save them.
Sunday, April 05, 2009
Puppy's first class
I took my puppy to her first obedience class on Tuesday. It was interesting, as there were only two puppies, and three mommas there. The other puppy belonged to one of the most tense people I've met. She and her mother, whom she dragged along, both shrieked (really - no exaggeration) when our puppies jumped on each other and started to play. Our puppies are within one pound of each other, mine being a little bigger, and yet you really might have thought that I had let my Great Dane puppy attack her Yorkie if you judge by the noise they made.
But really I learned several things from my first puppy class. I learned that I need to make sure that I always walk through a door first - this tells the puppy that I'm in charge. Also, to solidify my 'alpha' status I need to put food in her dish when she can see me, and only allow her a limited access to the food. I got a clicker, which Tali almost immediately linked with food treats, and then I taught her to focus on me and not the treat in my hand. She's a very quick learner, my little rocket dog. We are working very hard on walking on a leash without pulling (and also without dashing under my feet and either tripping me or getting broken legs). You know, it's a lot harder to have a small dog than I thought. It's nice and convenient and all that they take up less space. Unfortunately, that also means that they're much easier to break when they get underfoot... which is always.
I haven't gotten to practice much with her this week, poor thing. She went for spaying and hernia repair the next day, and hasn't been quite as perky... which is to say that she only jumps 1 foot straight up in the air, as opposed to 3 feet. If I didn't have 3 active boys who already want to join every sport under the sun, I'd think about training her for agility. I might do it anyway... just because I like a challenge.
Friday, March 13, 2009
So it turns out...
that I'm not very good at remembering to post. However, I just learned how to link my blog to my facebook page, which means that I can post here and there together. This might mean that I make more than one entry every 6 months. Maybe.
I'm waiting for my jeans to finish in the laundry so I can go outside and play with my puppy. What's ridiculous about this is that I have only 2 pairs of jeans and they are both dirty from our swamp camping trip, and that it's so cold outside that I have to wear jeans, while 2 days ago it was 80+ degrees and I was wishing I had shorts.
Actually, there might not be anything ridiculous about only having two pairs of jeans. My closet is overloaded as it is. I often wonder how it is that I can have so many clothes and nothing that I like to wear. I fight off the urge to give everything away to Goodwill at least twice a year.
Since I just posted nearly 50 pictures to Facebook, I think I won't add any pictures to this post. Also, I need to get back to laundry, so that's it for this time. Here's hoping I post again soon!
I'm waiting for my jeans to finish in the laundry so I can go outside and play with my puppy. What's ridiculous about this is that I have only 2 pairs of jeans and they are both dirty from our swamp camping trip, and that it's so cold outside that I have to wear jeans, while 2 days ago it was 80+ degrees and I was wishing I had shorts.
Actually, there might not be anything ridiculous about only having two pairs of jeans. My closet is overloaded as it is. I often wonder how it is that I can have so many clothes and nothing that I like to wear. I fight off the urge to give everything away to Goodwill at least twice a year.
Since I just posted nearly 50 pictures to Facebook, I think I won't add any pictures to this post. Also, I need to get back to laundry, so that's it for this time. Here's hoping I post again soon!
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