Just my opinion…

So today an older patient came with his grandson who was translating for him. As the grandson sat in my waiting area while his grandfather was getting his test I witnessed an awkward convo, involving another person it sounded like this:

“He looks Indian!” (referring to the patient)

“Yeah I can see that, we are from Bangladesh.”

“How do you like America?”

“😐…oh I was born here 😑. I’m 21 so America is what I know, but I like it.”

Now, the person asking about where he was from (because he just couldn’t be from here) was an older person. I know that they tend to have a very narrow view of the world. I get that. However, I really hate it when people assume that people of foreign descent weren’t born here. He literally had no accent from any other country. He spoke English as well as any “red blooded American” I have ever met. It’s a bit backwards to me to think that because someone doesn’t look “Caucasian ” or “African American” they just have to be from some other country. We are a country with a multitude of nationalities, that’s what makes things so interesting. I just wish people would maybe think before they speak.

Addiction

Addiction is rough. I witness it with patients everyday.

I encountered a patient with necrosis in the arm and it’s not a small area of necrosis, it’s pretty much the whole forearm.

They still shoot up in that arm.

The addiction is so strong that they are willing to literally risk life and limb for a high.

It’s sad and disturbing.

It makes you realize just how strong addiction is. We in the medical field often blame the patient:

“Why won’t they quit?”

“They obviously don’t care!”

“They should know better!”

“They did this to themselves.”

I’ll admit, I’ve thought that about patients. I’ve been judgmental even when it’s my job not to be. I’ve generalized and stereotyped people.

I am calling myself out for it.

It’s not my place to judge, it’s my job to treat.

It’s not my job to wonder why a person is suffering from addiction, and they are suffering.

It’s not my job to scold and belittle a patient for being addicted.

It is my job to provide the best care I can. It is my job to connect them with substance abuse counseling if they want it. It is my job to provide as much education as possible. It is my job to be their nurse. I’ve got to remember that.

Stop! Rally time!

Monday we had a gun rights rally on the Capitol. It brought back memories…

Bad ones.

I was charge nurse the night of the Charlottesville riot. Some of the people that were hit by the maniac that drove through the crowd were on our unit. Knowing that hatred could drive someone to kill, knowing that an innocent woman died because of hatred, it killed me inside. As a black woman, I know all too well what hatred can do.

I just didn’t want to see it all happen again.

Luckily, the state was prepared this time and declared a “state of emergency” before the rally. This led to increased security and a ban on weapons on Capitol grounds. So far, the rally has not resulted in any injuries. Weapons were out and people were walking around in full tactical gear. That nut job Alex Jones even made an appearance.

No one has been hurt.

That’s what I care about most of all. No one was hurt. Everyone gets to go home and back to whatever “normal” life they have.

As a nurse, rallies, protests, hell even large gatherings have a different meaning to me. I see potential mass casualty. I see potential chaos. I see potential patients.

That day in Charlottesville fundamentally changed me.

Breaking point

It happened.

Grad school pushed me to my breaking point.

I’m talking full on emotional breakdown, anxiety attacks, re-emergence of repetitive behaviors…

It got bad.

For some reason I hit a wall and could not move past it.

I went to work and functioned as if I was ok, however mentally I was losing it!

It all started with one class… Pathopharmacology. Now let’s remember, I’m in school for my masters in nursing education. I was not prepared to cross paths with this class. It hit me like a ton of bricks. The grading rubric was 5 pages long with part “A” consisting of like, 3 of those pages. I hated it. It’s not a class I have ever wanted to take. It did not interest me. I couldn’t retain the information. The paper I turned in was basically a pompous regurgitation of information that no one wants to read.

It sucked.

The sheer weight of the paper that was due gave me anxiety so I procrastinated. The procrastination made me anxious. The anxiety made me procrastinate more. The procrastination gave me anxiety.

It was the feedback loop from Hell.

I almost broke. Quitting actually started to look like a viable option. I was literally in tears thinking about the paper.

It was the beast I could not defeat… or so I thought.

I had to have friends and family really rally around me and offer support to help pull me back from the edge. They managed to get me to take a step back, breathe, and break the monster down into manageable pieces.

I have a great support system, something I don’t acknowledge enough.

After hours of research, coming up with an outline of what was needed, and taking the paper in small chunks, I completed it. I turned in 36 pages of absolutely glorious regurgitated information. It’s what they wanted, so it’s what they got.

I passed the paper and the class.

It was if a 10-ton Boulder was removed from my shoulders. I could finally breathe. I celebrated by drinking wine and playing Final Fantasy Online with my cousin. It was amazing.

I’m now in Health Assessments. It’s at least something I have some familiarity with. I know the advanced practitioner health assessment is far more involved but it’s something I can learn and retain. It’s useful information, I mean I’ll have to teach that to nursing students one day (hopefully). So, I’m nervous about the assessment I have to record. I’m nervous but not panicking. I’m learning to breathe and take things one step at a time. I finally have a plan to move forward. It’s doable.

Alpha-gal syndrome

I learn about new disorders all the time here in MRI. Normally I’ve at least heard the name of the disease or disorder before, or I know a teeny bit about it.

I have never heard of alpha-gal. At least, I’ve never heard the name.

Turns out, I have heard of the disorder before. I had a patient once tell me he was allergic to pork because of a tick bite.

Alpha-gal is a “sugar molecule found in most mammals (except in people, apes, and monkeys)” (CDC.gov, 2019). Turns out there is a tick (lone star tick) that can transmit the molecule in blood from the animal to humans. We humans don’t normally make the molecule but apparently we can make an immune response to it. If we develop an allergy then we can no longer eat meat from cow, pork, rabbit, deer, lamb, essentially the animals work hooves! The odd thing about it, and what makes it kind of hard to diagnose, is the fact that the reaction tends to take place 3-6 hours after the ingestion of meat. It’s hard for a lot of people to make the association between meat and their allergic reactions.

I found a good podcast about the disorder. Lots of information about how it works and the ongoing research around it.

One of the things I realized while looking further into the disease is how important it is to ask your patient about allergies. Alpha-gal is uncommon, however, patients with it can’t have certain medications. Heparin is typically derived from pork. Some insulin is derived from pigs and cows as well. There are quite a few medications that have porcine or bovine derivatives. A nurse would have to make sure to take this into account for their patient with this particular allergy.

Then again, when is the nurse not taking safety into account, right?

Struggling

I’m struggling. This pathopharmacology class is killing me. I have no interest in it so it’s hard for me to focus on it. I’ve been procrastinating terribly. I can’t seem to make myself write the essay that I need to complete the class.

I can’t focus.

I am so aggravated with myself for not being able to just get this class done. I hate that I am in this funk and I’m starting to feel guilty and depressed.

I’ve got to focus. I’ve got to sit down and make sh*t happen!

I’m hoping I can get over this hump…

DiGeorge Syndrome

Have you ever heard of DiGeorge Syndrome?

I hadn’t until I had a pediatric patient with the diagnosis. So what is it?

According to the Mayo clinic, it’s a genetic disorder caused by the deletion of a section of chromosome 22. Patients tend to exhibit heart defects, cleft palate, weak immune systems, developmental delays, and behavioral problems.

I had the most adorable little 7 year old with DiGeorge. She didn’t have the cleft palates that is common with the disease but she did have cardiac issues. In fact, one of her ventricles was huge! She already had cardiac surgery before and it looked like she would need to have it again. Apparently she would be dealing with this for the rest of her life.

Working in radiology I come across at least one disease a day that I have never heard of. I like to look up the disease just for my own medical knowledge. Any diseases you’ve run across that you knew nothing about?

It’s that time of year again…

It’s flu season!

Yaaaaaayyyyyy!

That means it’s time for myths, inaccuracies, and “internet doctors” to try and convince everyone the flu vaccine is evil.

Let’s address some of the foolishness, shall we?

1. The flu vaccine does not give people the flu. If they get the flu after the vaccine there is a good chance they were already exposed to the flu virus before vaccination or right after receiving the vaccine (it can take up to 2 weeks to develop immunity).
2. The flu vaccine is not made with a live flu virus. The virus used in the vaccine is dead.
3. People still need to get the vaccine every year.
4. Vaccines DO NOT cause autism (let’s let this lie finally die, ok?)
5. Yes, there are sometimes multiple strains of the flu virus. That does not mean there is no point in getting vaccinated.
6. While it is recommended for the young and the elderly, even healthy young people can benefit from getting the vaccine for protection.
7. For those people that think getting the flu will help build your immunity better than getting the vaccine, no. Just… no. The flu can be deadly. Don’t play with your health like that!
8. It is considered safe to get the vaccine while pregnant.
9. Yes, the vaccine contains some additives, however, they are in small amounts and considered safe (Here is a list of what’s in the typical flu vaccine and why).
10. Those “essential oils” are not going to effectively protect against the flu.

Flu season occurs every year and every year the same misconceptions pop up. As health care providers, it is our duty to educate and provide as much accurate information as possible. There is a wealth of information (like this, or this, and this) that can help us provide evidence-based information to our patients whenever possible. Of course we won’t be able to convince every patient we talk to but hey, we can try!

Safety first

I feel like safety may be starting to take a back seat to profit and productivity. Nursing is increasingly being pressured to move patients from ICU to the floor quicker. Discharge the patient quicker so that another patient can be admitted. Get patients to this scan or that scan faster. It’s not safe.

As a former ICU nurse, I have witnessed patients being moved to the step-down or the floor before they are really ready. Two days later they were back in the ICU do to a decline in the patient’s status. Typically they were in worse condition than they were when we moved them out. As a former floor nurse, I have seen discharges be rushed because they needed the bed for the next admission. Patient education was minimal at best. As a radiology nurse, I am seeing patients come down to MRI that are in no condition to be inside a scanner for an hour. There is a constant rush to get the outpatients on and off the table.

I understand hospitals need to make a profit to continue providing care. I get that we need to treat as many patients as possible. However, when you rush your medical personnel you open the door for mistakes and safety events. I became a nurse to provide the best care I can provide. I don’t see my patients as just a medical record number and a hospital bill. I see people that are here for our help. I see people that are bracing themselves for a potentially devastating diagnosis. I see people that need my care. I don’t like feeling like I have to rush this person through the process.

What happened to the so-called “culture of safety”? When did safety take a backseat to speed? I refuse to place anything before the safety of my patient. So, continue to look at your numbers, your productivity charts, your profit margins. I will continue to take care of my patients as I was taught and give each patient the time they need.

Guilt

I’m on school break and restart October 1st.

I didn’t have to take a break because of life events or anything like that. I am on term break until classes restart. I finished my 4 classes for the first term and had 5 weeks left until next term starts. If I had finished my last class a little earlier I would have had 6 weeks left which would have been enough time to add in another class. Since there, technically wasn’t enough time left, my advisor told me to take a break until the next term starts.

OK, cool, I earned a break…

Yet I feel guilty… Anxious. I feel like I should be doing something school related right now. I feel like I should be logging in to see if I can get the requirements for the next class. Not doing something school related makes me feel guilty.

I shouldn’t feel like this. I know that. However, I’ve been a full-time nurse and full-time student for so long that I don’t know what to do with free time. I’ve been playing Final Fantasy, enjoying friends, I even picked back up on learning how to knit. Yet I still feel this anxiety about school. My mind keeps telling me I am wasting my time and should be doing something, anything related to school… EVEN THOUGH THERE IS NOTHING I CAN ACTUALLY DO!

I hate that I have used school and work to occupy my time for so long that I feel guilt about free time. That’s not fair to me… And now you see why I’m in therapy…