There’s nothing I love more than memes, puns and wordplay! Ok, I might be exaggerating a tad bit… but I like these things a lot a lot. Like, I’m ready to go steady. (You see? I made a funny rhyme?!?!?!)
In a related note, a wordplay meme. I hope you enjoy it even 1/4 as much as I enjoyed making it…
Best part is, the cake was delicious. But it always is at 03:00…
Ok if you insist!!!
You can also view over at Instagram (account is private for job reason, but go ahead and request me!).
Both of my covid tests came back negative. I feel more confident that there were two negative results, but I was still sick for a little more than a week all told–so I’m baffled. I don’t think it was the flu, but it’s possible. Could have been a cold, I guess–just one of those old-fashioned pre-covid coronaviruses? Luckily, I’m starting to feel better because the ICU is busy and I keep getting calls to come in extra. We planned ahead for the winter & holidays by hiring dozens of traveling nurses and new staff, but we’re still short staffed, unfortunately.
Speaking of staffing, there was an article in the LA Times explaining ICU capacity and why it is so important to use as a metric for “shutting down” California. The Bay Area is currently at 17.8% capacity (slightly about the 15% cutoff for mandatory stay-at-home orders), but according to the article, 36 million Californians are living in areas where the ICU capacity has dropped below 15%.
The bottom line when ICU capacity is so severely limited–and I’m going to give it to you straight as a nurse in one of the best ICUs in the Bay Area– is that the only beds left are often beds at small, less busy hospitals. Yes, a bed may be an ICU bed–but the are not all created equal. You see, there are different types of hospitals. General hospitals provide basic emergency services but may need to transfer patients for higher levels of care. Trauma hospitals is where people are taken when involved in an accident with immediate life-threatening injuries and a full surgical team is always available. A tertiary care center is where patients are sent for specialty care at the highest levels. Doctors, nurses, and other staff at these hospitals that perform more complicated surgeries and regularly care for sicker patients and will be more skilled. They simply have more experience, and may also be involved in research studies–thus giving them access to drugs or treatments earlier than other hospitals.
So in a rural area, you may go to the local general hospital, be diagnosed with covid and admitted. But if you decompensate in a small rural ICU, you may find that the ICUs at tertiary care centers where you need to go for specialty care are no longer accepting patients because they are full–or, and this is more likely–they do not have enough staff.
At my hospital, we are lucky because the charge nurses guard the staffing with their lives. They never let the nurses be forced to take more patients than is safe, even if that means that a nurse is only caring for one patient. But no all hospitals are so lucky. In California, ICU nurses can take care of up to 2 patients at a time. In other states, 3 patients is the norm. I cannot even manage taking care of my sick covid patients AND two other sick patients as well.
Stay home if possible. Otherwise, be safe out there & please wear a mask.
I’ve been tested at 2 separate sites operated by 2 separate agencies since Saturday. It is currently 01:28 on Tuesday morning. I have no test results.
I was the first testee of the day at 07:00 on Saturday at an appointment that I was able to make the previous day. There were about a dozen staff and 2 people including me waiting to get tested when the Parkmerced Curative testing booth opened. At first, no one knew the code to get into the iPad used to check people in. Then when I got to the booth, the scanner was not properly hooked up via Bluetooth to scan the barcodes on the lab tubes. That took another few minutes to fix. Then, I followed the directions I’d seen on the video they had sent me to watch— apparently too quickly for the attendant to interrupt me to have me break the swab differently so it didn’t explode and drop on the pavement. A second swab needed to be done.
Let’s just say I didn’t feel 100% confident about my test leaving the site. But they told me 48 hours, so I prepared to wait until Monday morning to find out how it went.
By Monday at noon, I had already been refreshing the test status page every few minutes for hours. I had started looking for a different covid test by about 11:00am because my patience was waning. An email to Curative customer support received an auto-response but no actual response. It said my results might not be ready for 72 hours.
By continuing to check for cancellations, I found a test 15 minutes from home around 1pm with the county agency that had previously gotten me results in 24 hours. I scheduled the appointment and went in.
Later in the day, I did finally go back to check Curative’s website to see if there had been any updates to my test status. And there had been!!!!
Apparently my specimen had just been received at the lab for processing 2 days— actually more than 48 hours—after collection. W. T. F.
Now I’m assuming it’s a dead heat— I’ll probably get both results back at the same time late tomorrow or Wednesday. In the meantime, I quarantine.
I’m not quite sure why 9 months into this pandemic we still can’t get reliable and quick covid tests–especially for healthcare workers who have been exposed–but this appears to just be how it goes in America, land of the trump.
As if the world isn’t shitty enough right now, patients of Dr. Steven LaTulippe can’t even trust that they’ll get good advice from their doctor. Or that he won’t give them covid.
It’s been reported that LaTulippe misinforms patients about masks repeatedly, and if they persist in asking questions–drops them entirely. ((See link at end of post)
Suspending his medical license was the right thing to do.how can he be a doctor if he clearly doesn’t believe in science???
This reminds me of how I feel about healthcare workers refusing the flu shot. I personally think it should be a mandatory condition of employment, unless you have a medical contraindication. There is absolutely no reason to not protect yourself but also your patients and fellow healthcare works from the flu as much as each years flu shot allows.
I don’t want to get sick because you’re an anti-vaxxer. Besides, if you don’t believe in science, should you really work in healthcare???
Speaking of keeping your fellow healthcare workers from getting sick, I received a disheartening call this Friday. My hospital’s covid tracking team was alerting me that I had been exposed to a fellow healthcare worker who was found to have covid. This exposure happened during the week of Thanksgiving.
The funny thing is, I had just heard through the rumor mill, as the saying goes, that I worked with someone who was now covid posit. Literally from one night to the next.
I feel like in that timeframe, this person definitely knew they had been exposed (or had just traveled for thanksgiving g.d.it) and probably had already taken a test–they were probably just waiting for results.
So, I’ve been exposed twice. And it’s not from taking care of patients. It’s from other f*cling healthcare providers. And I’m pretty pissed off. Do you know what I did for thanksgiving? I cancelled all my plans. I worked instead. I did not eat turkey or see my family. I won’t see them for Christmas either.
I’m toeing the line, doing my part not to get sick, not to get other people sick. This is especially important for nurses and other healthcare providers because we put our trust and our health in each other’s hands every single shift.
I should have my results by tomorrow. But then I’ll get tested again later this week. Should I go to work? Well, if the first result is negative, I feel like I could work but that I should definitely wear an N95 all shift. At least until I have a second test to cover the timeframe for the second exposure as well.
Stay healthy. Protect yourself and others by wearing a mask.
A Doctor Who Boasted That He And His Staff Don’t Wear Masks Has Had His Medical License Suspended
— Read on www.google.com/amp/s/www.buzzfeednews.com/amphtml/salvadorhernandez/doctor-masks-covid19-conspiracies-oregon-license-suspended
“You can’t tell me what to do; the is MY room. I paid for it”
—anonymous patient
My response? “This is a hospital, NOT A HOTEL.”
(Note: it was probably her steroids talking but oh. my. god. She gave her surgeon a slow clap while saying bravo bravo the morning after surgery.
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.
During a year when people should be staying at home, gun violence in cities around the country is skyrocketing. Homicides in Oakland, California are up 86% since quarantine started, and just south of there in Hayward, the number of murders in 2020 so far is DOUBLE that in 2019. There are 38% more guns being recovered this year by police, including fully automatic weapons. Part of the problem according to police is the emergency cash-free bail that went into effect since covid, in an attempt to limit prison populations & hopefully prevent further spread of the virus. While this may definitely contribute to the problem, it is NOT the root of the problem as far as I believe. By my estimation, access to guns of any kind is the problem. The manufacturing and sale of guns is the problem. No guns = no problem. Imagine a world with no guns. There would be no gun violence. We can argue about the constitution, rights, crime, & criminals all we want. But at the end of the day, I firmly believe that no. guns. means. no. gun. violence. That goes for everyone.
In San Francisco today, the district attorney announced charges finally on a 2017 police shooting of an unarmed black man in 2017. This coming mere DAYS before the statute of limitations would run out, according to this article on SFist. Racial justice continues to remain foremost in the minds of lawmakers and politicians and thank god–this country cannot keep going killing people. Police violence is a public health problem. I’ve said it before and I’ll keep saying it. But even more so, that leads us to a more basic point: RACISM IS A PUBLIC HEALTH PROBLEM. When black and brown people DIE merely because they are not white, this is not a coincidence. This is racism, and quite frankly, it is a national emergency.
Also in the news today, another public health problem created by white people: the opiate crisis. Purdue Pharma has finally pleaded guilty to several charges related to its role in starting–and maintaining–the opiate crisis in America. Bottom line, the company admitted to 3 basic things:
Of course, there was a fancy explanation for “how” and why all these things were accomplished but the bottom line is Purdue wanted to make money. It did. The Sackler family is still filthy rich, in fact, from drug money earned by the deaths of over 200,000 Americans. The cost to the healthcare system might never be able to be estimated, as the full ramifications have not yet been felt. The East Coast still suffers from a heroin problem but has been hit hard by synthetic fentanyl in the past few years. Here on the West Coast, we’ve typically been more of a methamphetamine place, but synthetic fentanyl deaths are rising now too.
The last full book I read on the subject was Dopesick by Beth Macy. It is an incredibly detailed look at how the crisis began, details of the ways in Purdue Pharma changed not only the marketing of pain medicine but the very way we practice medicine itself. I highly recommend this book if you’d like to know more about this subject.
One of the most disturbing parts of Dopesick was reading about how during Purdue Pharma’s massive “educational” marketing seminars, it promoted PAIN IS THE FIFTH VITAL SIGN as a new concept. This really reinforced the idea that new & stronger pain medications were necessary for the average patient–medications like oxycontin. Surprise! But this mantra regarding pain became adopted by accreditation organizations such as the Joint Commission and the American Medical Association (AMA) itself. In nursing school, it was drilled into my head. Treat the pain, because your patient can’t HEAL if they are in pain.
But all of this helped contribute to our opiate problem as all doctors, including those taking care of hospital patients, felt the need to write more and more prescriptions for painkillers. Patients themselves also tended to not be satisfied that their pain was relieved no matter how much narcotic they received. I mean, we were telling them that they should have NO PAIN.
In 2016, the AMA went so far as declaring that pain is NOT the fifth vital sign, and that new non-pharmacologic measures and cooperative pain management techniques should be taken to manage patients.
As a nurse in the ICU, I have seen an attempt to reduce the use of opiate pain medication. Some of this seems silly given the circumstances–such as a patient on extracorporeal membranous oxygenation (ECMO) only getting IV acetaminophen. I mean–they do have garden hoses jabbing into each groin, plus more usually… But for surgical patients, I am fully on board. You are supposed to be able to feel your incision the day after surgery. And when you cough, it is definitely gonna hurt. While you’re coughing. And then it will stop. Magic!
My personal opinion is that the best treatment for pain and prevention of other post-operative complications is walking. Don’t take a bunch of opiates, get constipated, end up with an ileus and too weak to stand. Get out of bed, sit in a chair, take a walk. Do that over and over throughout the day. Rest in between. You’ll get better faster than your neighbor who takes oxy and complains that it hurts and refuses to get out of bed.
If you have recommendations for other articles or books on the opiate crisis, please leave a comment as I’d love to read more on this topic! Or any topic…