Category: heathcare politics

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heathcare politics Public Health

Drug Treatment vs. Drug War

President-elect Joe Biden was once one of the leaders in the idea that criminalizing drug offenses would lead to control of our country’s massive drug problem. The three-strikes laws filled our prisons with low-level drug offenders while doing nothing to actually get people OFF drugs.

Luckily, we have experienced a massive tide change in how we think about substance use disorders. Many states voted in this past election to decriminalize or even legalize marijuana, while Oregon legalized even “harder” drugs such as heroin and hallucinogenic mushrooms. Biden himself has turned away from a philosophy where law enforcement reigns as the rulers of how to deals with our drug problem, and has instead shifted to a public health perspective in which the focus will be prevention and treatment.

Many, however, are still skeptical of Biden due to his past actions and beliefs. As the data becomes available for how bad it has become during this pandemic, including 2020 overdose death totals, we will be able to see more clearly what is necessary. As a healthcare provider, I know that police involvement and jail time doesn’t help. I also know that at a certain tipping point, treatment may not work either unfortunately.

For example, I once cared for a man, a former alcoholic who had 30 years sober, living a stable life with a job. But then, his girlfriend left him. He went out and got drunk, started a fight, and fell down some stairs. He showed up in my ICU with a subdural hemorrhage (SDH) as well as a small subarachnoid hemorrhage (SAH)– both classic injuries from a traumatic fall. Over his days in the ICU, we talked at length about his sobriety and plans for the future. This was his first fall off the wagon, as you might say. He had a job and a house. He spoke to his boss, who guaranteed to hold his job for him until he got better. He wanted treatment after he recovered from his head injury. I had such hope for him.

He never came back to the ICU. But about 8 months later, I heard from a nurse upstairs “on the floor” that he had died. He drank himself to death, ended up homeless. He probably “lived” in one of the neighborhoods around the hospital, and recognizing him, the medics always brought him back to us. He had declared his “code status” to be DNR, meaning that if he were to experience a cardiac or respiratory arrest (ie, code), he did not want to be resuscitated. And he wasn’t.

In the end, I really think focusing on treatment and prevention will get people help earlier in the disease process, instead of landing them in jail over and over–or worse, finding them dead. We need to treat substance use disorders instead of punishing those who suffer from them.

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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.

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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

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heathcare politics

Institutional and other racism in healthcare I’ve called out this week

Heath care is a strange place where I see silence occur in many forms as a type of violence against black & brown peoples, and especially important to me: women… this week, 2 things. In my career I’ve never been the silent type, but I hope sharing examples of what I classify as racism and sexism in healthcare can help expand our conversation. And if even one more person gets a voice… that is all that matters.

1. We received a patient from the emergency department. I was reviewing the EKGs since she had a funky rhythm on telemetry… and up in the corner, where you can type in demographic info—but you are not required to—I see that this patient is labeled as “Oriental.” I check the other EKG. It says “Asian.” I am floored. Why would you type this in? “Oriental” describes a rug not a person. I speak to a colleague who used to work in the ED and we contact a charge nurse there to follow up on this. Giving this person the benefit of the doubt and not reporting to risk management for now.

2. The second case is more complicated, but one I see in different variations much more often. Details are approximated from several cases. An older Asian woman, a mother of loving involved children and a wife, has been hospitalized in the ICU since April. She has “failed extubation” many times and had a breathing tube for the majority of her time with us. She has also had several cardiac arrests. She has end-stage renal disease and thus has been on continuous dialysis as well.

This is a critically ill patient who due to her multiple conditions and has one nurse assigned only to her— to run her dialysis and keep her safe. Every night at rounds someone offhandedly mentions that we should really address goals of care with the family.

Discussing goals of care (GOC) is one of the main things doctors are responsible for in the ICU. You need to assess how the patient would like to live should she survive to be discharged from the hospital. And this sounds brutal, but upon admission or during the course of an ICU stay, many suffer drastically life-altering medical events. Strokes that will leave you paralyzed on one side and fed through a tube in your stomach. A heart attack that will make you unable to do any activity but walk from your recliner to the bathroom. A kidney injury that will require you to go to dialysis three times a week for the rest of your life. A lung infection that damages your lungs so badly that you need a tracheostomy and rely on a machine to breathe for the rest of your life—thus making it nearly impossible to ever go “home” again.

So it is up to doctors, and sometimes nurses too, to have conversations with patients and their families about these things. Is this how your mom would want to live? What does she enjoy doing and will she be able to do that after her hospitalization??? The answers to these questions can inform then what treatments we provide—but more importantly, don’t provide.

So back to our older Asian mother and wife, receiving dialysis and unable to come off the breathing machine. At this point, she’s been in the hospital 1.5 months. It seems like some GOC discussions should have taken place, right??? Well this week, she received a tracheotomy. During the procedure she received sedation, which they continued for 24 hours post procedure to allow for more comfort during the initial period when she might bleed—so that she could rest, hopefully reducing the risk of said bleeding.

During the second night in which she didn’t wake up, despite being off sedation and on dialysis—which would clear the drugs, I started getting alarmed. What would happen if she never woke up? I went into the chart to review the GOC notes I so naively assumed must be there. You see, I wasn’t her bedside nurse—but instead one of the charge nurses on a busy ICU in a major city.

I could find no GOC notes. No palliative care consult. In a month and a half. Nothing. What the f*ck was going on???

An overly solicitous deference to the family of Asian women for decision making and tacit agreement to “do everything” without a conversation. In these instances, the female patient is most often left out of the discussion altogether. Even if the patient is clearly suffering or clearly doesn’t want the interventions. The nurses often become the patients only voice— forcing the doctors to talk to the family about the patient’s wishes.

This is a practice done out of respect for “traditional” values in Asian cultures, but is ultimately looks to me like racism and patriarchy when it flaunts modern medical ethics and the premise of “first do no harm.”

This patient had no desire for a tracheostomy. In fact, she hated the breathing tube. She hated the hospital. Will she retain her will to live when she is put into a long term care facility? My feeling is no. And so it was my duty to speak up. To ask why there had been no palliative care meeting. To question the ethics of what we’d done already. When I go back to work next week, I hope to find some answers in her chart.