Categories
blacklivesmatter

We Need Mental Health Professionals Not Police

Again, I see an infuriating example of why defunding the police makes so much sense to me–or at least partially defunding. So many calls to 911 are for people causing a nuisance–in the wrong place (black man at a tennis court?), homeless, mentally ill, intoxicated in some way or just plain poor… And let’s be honest, someone is scared of something when they call 911 but these are people AND they are most likely suffering from a mental health issue, a substance use disorder, a severe medical condition, or ALL THREE. As a result, they may be lunging around “acting crazy” & not following commands. You know what happens when you don’t follow a police officer’s commands, right? Especially if you’re black, brown and/or a man? Well, quite simply, the chances that you’ll get arrested, thrown in jail or end up in the hospital (or worse, the morgue) go up astronomically.

“Law enforcement comes in and exerts a threatening posture,” Kimball says. “For most people, that causes them to be subdued. But if you’re experiencing a mental illness, that only escalates the situation.”

Angela Kimball, policy director of National Alliance on Mental Illness (NAMI) to Brett Sholtis, for NPR (link to article at end)

Police work and are trained mainly from a combat perspective. When you think about it, if they are fighting CRIME, they will most likely have to protect themselves. But here’s the kicker. Police are not always or even usually really fighting crime, per se. They’re fighting HOMELESSNESS, DRUG ABUSE, ALCOHOL ABUSE, POVERTY, DOMESTIC ABUSE. Do you think they need combat techniques to fight these things? Hell no. They need non-violent de-escalation training, communication training, training on substance use disorders, medical triage & first aid, mental health triage, psychology, racism, economics, etc etc etc. So basically, they need psychologists & social workers, homeless resources & outreach, domestic violence outreach & resources, food/shelter/medical treatment/basic human dignity.

We should take money from the police if we have to in order to fund these alternative programs, especially considering that developing these alternative services would lead to less need for police in general–and would also provide for less opportunities for fatal “accidents.”

During A Mental Health Crisis, A Family’s Call To 911 Turns Tragic

You know what I’d rather have than police on the streets? Nurses! Shit, we’d get so much shit done. We’re already really good at hassling “the man” until we get what we need for our patients. We’re organized, clean, know what the resources are already. We probably even get paid less too. I see a plan coming together.

Categories
pandemic

The twindemic is unfortunately real for the Bay Area

We have our first case of a patient infected with both covid and the flu!

Get your flu shots!!! Wear your masks & wash your hands! This is not the time to get lazy about stuff. Yes, we want to have family holidays and go out and socialize but y’all! Everywhere I go people are not masked except the service workers (you know “essential”). They deign to put on a mask to enter a store, but the certainly won’t give you six feet. I’m looking at you Marin County. San Francisco’s Marina District. Out here in the East Bay (NOT the Berkeley part), where all the essential workers live, we wear masks outside to talk to our neighbors. Like people who value human life and don’t want to kill each other.

Well, that escalated quickly.

Here’s a link t0 the twindemic / co-infection new article: https://abc7news.com/health/1st-case-of-flu-covid-19-co-infection-confirmed-in-solano-co/7457101/

Categories
heathcare politics

The Supreme Court Is Already Considering Hearing A Case That Could Bring Down Roe V. Wade

After the U.S. Senate voted to confirm Judge Amy Coney Barrett to the Supreme Court on Monday evening, the court announced plans to consider hearing a case on Mississippi’s 15-week abortion ban, also known as “The Gestational Age Act.” Lower courts had previously declared the ban unconstitutional under the precedent of Roe v. Wade, but the Mississippi Attorney General filed the case with the Supreme Court this summer, and the court will decide whether to hear the case this Friday.

— Read on theslot.jezebel.com/the-supreme-court-is-already-considering-hearing-a-case-1845502341

Why does this matter? It is the beginning of the end of reproductive freedom. If the Supreme Court overturns even this small part of Roe v. Wade, it would lead to the states’ abilities to impose legal restrictions on abortion during any part of the pregnancy. ANY PART. Is this where reality finally finishes it’s full transformation to Hulu’s version of The Handmaids Tale. I did not sign up for this.

I do, however, seriously feel like if we ever have to resort to back alley abortions, we need to form a back alley training program too. The nurses of the world can unite to to keep our women safe and healthy, even if we have to do it illegally!!!

Now that sounds like the plot to a futuristic political drama.

Categories
blacklivesmatter

Really, just now an east coast hospital proves that black people are discriminated against during the kidney transplant process?

I could just about die this very serious news article was so funny to me. I say with all sarcasm intended, if you can’t hear my tone. The general theory of article is there is a lab test that measures kidney failure correctly in white people (surprise) and is inaccurate for black people. It’s been causing black people to be overlooked for kidney transplants for years! So once the scientists did a little recalculating, we have a formula for both sets of people that reflects their kidney failure more accurately!

Wired: “How an Algorithm Blocked Kidney Transplants to Black Patients”

You wouldn’t think this would be so hard to figure out, except medicine has been a white man’s game since its inception. Most research on procedures and drugs, even today, is still done primarily on–you guessed it! Men!!! Of the white variety. But other things struck me funny (?) about the article as well. Let me run down my giggle list:

  1. Wired Magazine a quite prestigious news organization for science and technology (and I must admit, must I?, a former employer of mine) is covering this topic. This topic is not new or groundbreaking or pushing forward the field of medicine in any way. I find this interesting.
  2. I literally had no idea that other hospitals (geographic areas? States etc?) did not use the recalculated eGFR to determine the severity of black people’s kidney failure. We’ve been doing this at my facility for at least 10 years… I remember when it changed, but time flies when you’re wiping ass. Our chemistry reports show both values automatically, actually.
  3. Last but not least, I want to mention that getting selected and then listed for an organ transplant is a crazy process, one mainly shrouded in mystery to the average American. But it is not a joke. There are not nearly enough organs for people that need them. Surgeons that do these procedures are in competition to get the organs for their patients, to perform the surgeries at their hospitals. They often have quotas they have to hit to stay certified as a transplant center (both for the doctors and the nurses), and for some organs like livers and hearts and lungs, the patients may be in the hospital for months waiting… not even at home. Also, as this article notes, the process can be burdened by institutional racism. Sometimes it even looks a lot like real racism– for instance the young black men in our advanced heart failure service do not usually succeed in getting a heart transplant. They certainly qualify and are listed. But we had one (and he is a sort of amalgam if patients that serves as an example), we’ll call him Kevin. Kevin was so tall, like 6’4″ and he was like a brick house, weighed maybe almost 300 when he came in the hospital and last 50-60 pounds in the 3 months he stayed in. We waited and waited but we couldn’t find him a heart. There were (per the doctor) about 3 other guys if his size on the transplant list ahead of him. I used to joke that we would need a bus of NFL players to get into an accident for these guys. Typing that now, I realize that is some really dark stuff, but Kevin and I needed a laugh of any kind in those long days where he couldn’t sleep and was stuck in his 12 by 20 hospital room for weeks on end. In the end, he got an LVAD (left ventricular assist device) because it had enough power to help his heart–and it meant he could finally go home and live some life.

Some day I’ll write more about transplants, even though I worry that I’ll be breaking some secret code to just keep quiet.

Categories
heathcare politics

Covid, the ACA, Burnout, the Election: one nurse’s perspective

This nurse began the pandemic working in the ICU, but by June was made the hard decision to switch specialties to surgical services. She did not feel protected at work and feared catching covid19 and passing it to family members.

In this article, Kara-Marie Hall, RN discusses Trump, the HEROES Act, the ACA, and how the federal government failed us:

The pandemic didn’t have to play out this way. I believe the fault lies mainly with the federal government’s mismanagement of the pandemic. From the start, hospitals were left with a limited supply of PPE to protect health-care workers. Further, the Centers for Disease Control and Prevention (CDC) provided confusing and conflicting guidance to health-care workers on how to protect ourselves from this novel virus.

Read more here:

I’m a Nurse—And This Is How the Election Will Impact My Life

Categories
personalstories

Pregnancy Loss & the Stories We Don’t Tell

After the heartbreaking death of Chrissy Teigen’s & John Legend’s unborn baby Jack, I’ve had loss on my mind. The intimate pictures were so startling and truthful.

Over ten years ago, I suffered two pregnancy losses. I began a new year with a resolution to have a baby before I hit “advanced maternal age” at 36. I stopped taking my birth control in January and by early February, I woke up in the middle of the night saying “you better go buy some pregnancy tests because I can feel it in my boobs! I’m knocked up” to my then-husband.

I was right! But oddly so early along that only the faintest trace could be detected on the tests. I went to my doctor for a urine test that did confirm I was about 4 weeks pregnant. And I knew exactly when it happened— on our five year wedding anniversary weekend to Yosemite.

I was unexpectedly excited. I made an ob/gyn appointment and settled into the idea of maybe actually doing this thing! But before even a week could pass, and over a holiday weekend of course, I began bleeding. My nurse training kept me calm. Probably just spotting, maybe even implantation bleeding. I was so so early along. The bleeding became cramping too, though. And without an obstetrician, I was unsure what to do.

Calls to a nurse advice line yielded only the unhelpful “if it’s a miscarriage, there’s nothing we can do—so you should just stay at home.” And I tried. But the Monday of the holiday, as I lay on the floor, having my husband call that same advice line while I experienced the worst pain I’d ever felt, I knew things weren’t good.

Pain is blinding, though. I couldn’t feel any emotions. Just pain. And once I got to the “obstetrical” emergency room, I just laid there waiting to find out my fate. Actually, I think I spent most of my time sitting up, hunched forward, breathing through the pain. Much like Tiegen in that first picture.

I don’t remember anything until the on-call sonographer arrived from home. She wheeled me to an ultrasound room, complaining that she’d just fallen asleep and then had to come back for my case. I experienced my first transvaginal ultrasound, in which a big wand is covered with a condom and lube before being pushed inside you and tilted this way and that, holding pressure against various structures to see the developing baby.

This is a deeply dehumanizing and degrading process. Especially when being done by someone who resents you because you woke them up and made them drive back to work for your emergency.

Towards the end, the sonographer quietly apologized. “I’m sorry,” she said. “ I think it’s ectopic.”

And like that, I was alone to wipe the lubricant from between my legs with the flimsy white paper drape I’d been covered with.

Back in my room, a doctor explained that the reason I was feeling so much pain was that the ectopic pregnancy had ruptured and I was accumulating fluid & blood in my pelvis now. She recommended emergency surgery that night.

And then it was over as abruptly as it started—in the middle of that same night. I begged that the procedure be laparoscopic and that the surgeon do everything in her power to prevent having to cut me open all the way. Anything that would make it so I could go home in the morning.

Ironically enough, for someone who willingly worked at a hospital about five days a week, my only concern was to leave it ASAP.

This was February. Presidents’ Day weekend, ten years ago. I waited 3 months, per my ob/gyn’s instructions before trying again. Then I got pregnant on the first try again and scheduled a five-week ultrasound per instructions in early July.

No heartbeat.

But maybe too early? Here began the frequent ultrasounds and blood draws. First, a weekly ultrasound. Blood every 3 days to see if my pregnancy hormones were rising appropriately. Then the ultrasounds became every three days as well. I couldn’t even joke about them using condoms on the transvaginal ultrasound probe anymore— I’d lost my sense of humor somewhere between forced entries.

I was nauseous, more than just mornings. My breasts were excruciatingly tender and already much bigger. I could smell EVERYTHING. This is not a great superpower for a nurse to have. Second pregnancy bonus: a heart murmur, normal I was told since I was doubling my blood volume.

I don’t remember what week we called it. Sometime between 8 and 9. Maybe 10?There was still no heartbeat in my gestational sac in my uterus. Plus, they thought they saw what looked like another ectopic in my other Fallopian tube. Not rupture this time, so no bleeding or pain. Also no life.

This time I didn’t need emergency surgery. I would get intramuscular injections of methotrexate, a good old fashioned chemotherapy drug that targets fast growing cells (like tumors or … ).

That day of my injections when I left the office, I was in a daze. I had gotten a shot in both shoulders (deltoid muscles) and both butt cheeks ( gluteals). I was told that I wouldn’t feel any side effects or in fact any effects at all from the medication. I was told that I wouldn’t bleed, that it wouldn’t seem like I was having a miscarriage, that there would be no cramping.

Not only would this all turn out to be lies, but the shots wouldn’t work. A “pregnancy” blood test had to be done every three days to make sure my hormone levels went down appropriately. Aka, that anything growing in me died.

I carried myself like a pall bearer to the lab trying not to cry when some unknowing tech asked happily, “oh, are you expecting?” as they drew my blood.

I was still experiencing morning sickness. Still has all the other weird things, heightened sense of smell, tender and enlarged breasts, the heart murmur. Within two weeks, my betaHCG hadn’t dropped enough and I had to get a second round of methotrexate injections.

The every-three-day lab tests continued. Until my hormone level was zero. I can’t remember anything from that time because I dissociated so completely. I was numb. Go to the lab. Go to bed. Like a black hole forming. I was a coffin in waiting. A coffin to be. A coffin.

And do you know what is the ONLY thing I remember my doctor telling me? “Well, you’ve had an ectopic in both Fallopian tubes so you’re done. You can’t have a baby. You can try IVF but you will need to have your tubes tied first.”

There were no conversations about grief, about loss. No ideas about what to do next in order to keep on living. Common knowledge warns that infertility and pregnancy loss contribute quite a bit to divorce. I would be lying if I said it wasn’t true for me.

I never healed, in many ways, from the physical traumas to my body not to mention the emotional trauma. And I certainly didn’t talk about it. Who did? My doctor, who I continued to see, certainly didn’t ask.

I did tell my husband at the time that there was no way I would do IVF, which would involve the every few day blood draws and aggressively invasive ultrasounds. But I’m sure he didn’t really understand the true depth of the emotional and physical trauma those things caused me. I never told him.

But my unwillingness to forge other paths to motherhood certainly played a role in our divorce. That however is a story for another time.

People have tried to bash Chrissy Tiegen for sharing such personal photos—or even for taking them at all. But I find them to be gorgeous. Painful, yes. Triggering? For me personally, yes. Honestly, it’s taken me a long time to finish this post. The weekend those photos came out was pretty dark for me as I relived a very sad time in my own life. But without people like her who are brave enough to share the depth of their sorrow and vulnerability as well as their joy, we could not move this conversation forward. We could not continue to heal as women and demand respect for the very hard work we do in addition to our jobs.

Also, I want to give you a little medical perspective on those pictures now that we’ve gone through my story and (in some ways) I feel the right to reveal this. In one picture, we can see Tiegen leaning forward, her back covered with what could be plastic wrap. There is a doctor behind her, a nurse holding her hand in front. Those of you familiar with the scene will recognize that she is getting an epidural. Which means that she had probably had to give birth to little Jack. And if that doesn’t break your heart into a million little pieces and make you want to scream “nobody should ever have to do this alone” then I just don’t know. I’m grateful she has started more conversations. I hope more women will connect and heal.

Categories
FDA

New! Liver & Kidney Failure in One Drug!!!

I’ve started seeing adds for a new Advil brand product that contains not only ibuprofen but acetaminophen (aka Tylenol) too. I am personally flabbergasted that the FDA approved this drug combo since it seems ripe for causing more fatal overdoses.

Tylenol likes to call itself one of the safest pain relievers but I’m going to be honest about what it really is— it’s an ok pain reliever/fever reducer but it is vastly overused and it is DANGEROUS. Taken in large doses all at once, normal doses by a person who also consumes alcohol, or even just normal doses but daily for long periods of time can cause liver failure. Liver failure is a painful and messy way to die.

Now let’s talk about Advil. Advil is actually a much better pain reliever but unfortunately many people cannot take it. Taken in even normal doses it can cause gastrointestinal bleeding, which can be quickly fatal if not treated. Advil also impacts kidney function and can cause kidney damage leading to failure.

The makers of Advil now claim that this “first and only FDA approved pain relief medication to combine Acetaminophen and Ibuprofen… allows you to take a lower maximum daily dose of each medication and now get up to 8-hours of powerful relief.” (Advil website)

While this claim sounds great and is actually true, I still think that putting these 2 together will lead to more accidental organ damage than savvy & educated patients combining these 2 drugs on their own. But maybe that is just the paternalistic “doctor” part of my brain?

Categories
Quick Notes

Depression in Nurses: The Unspoken Epidemic – Minority Nurse

Depression in Nurses: The Unspoken Epidemic – Minority Nurse
— Read on minoritynurse.com/depression-in-nurses-the-unspoken-epidemic/

Categories
Quick Notes

Just one more meme?

Whoever coined the word “Twindemic” should be forced to work in my ICU during Twindemic season.

Categories
Quick Notes

When you have a lot on your mind, meme…

Instead of writing a good post, I made this for you! Get your flu shots!!!!