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.
Tag: blacklivesmatter
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:
- The first relates to LIES told to the Drug Enforcement Agency (DEA). Purdue lied about having a program in place to prevent pills from getting to the black market. In fact, they really profited from oxycontin’s widespread sale by people buying it on the street. The company also lied to the DEA regarding false information provided to the agency that helped boost manufacturing
- The company paid someone to provide doctors with patient info (Hello! HIPPA?!?!) that encouraged them to write opiate prescriptions.
- Lastly, Purdue Pharma paid doctors to prescribe oxy. Boom.
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…
Categories
When police violence hits home
Within 20 miles of where I live, Vallejo, California suffers under the most violent police force in the state. According to this fantastic long form analysis by Shane Bauer in The New Yorker, “[s]ince 2010, members of the Vallejo Police Department have killed nineteen people—a higher rate than that of any of America’s hundred largest police forces except St. Louis’s.” In those 10 years, the city has paid almost $16 million in legal settlements, had their insurance raised significantly, and are currently still facing 24 use-of-force legal cases expected to cost upwards of $50 million dollars.
“It can’t be awful if it’s lawful.”
Joseph Iacono, Vallejo Police Lead Force Options Instructor
This is a small city where many black and brown families have moved, often being squeezed out of the historically minority-centered but now rapidly-gentrifying Oakland and Richmond. The police force is staffed mainly by white men who don’t live in Vallejo but get paid top wages, often leaving forces in places like Oakland to find a job where their violence is acceptable.
And you know my refrain… Who suffers when the white man is in power? Always the black & the brown & the women. Also the mentally ill, the senior citizens, the homeless, and any other disenfranchised and powerless groups. Vallejo has gone bankrupt trying to pay the police officer’s increasing wages and benefits, often eliminating funding for roads and senior centers entirely in the process.
This is a city with a public health problem, and that problem is POLICE VIOLENCE. Defunding the police–perhaps even disbanding and restarting from the beginning seems to be the only situation in Vallejo.
All I can ask from you is that you know what’s happening in your area. Are people suffering like this? Can you help? Stand with your fellow citizens!
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.
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:
- 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.
- 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.
- 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.
07/03/2020
My life largely revolves around my work. I go to work; I work; I think about work; I talk to others about my work. One of my roommates is a fellow ICU nurse and the other is an EMT. My best friends are nurses. I talk often in therapy about situations I encounter at work.
My point is: I know medicine.
And I am once again flabbergasted by reports about police practices for “suspect” control that is dangerous, unnecessary, and I’m sure used most often against black men. Police are enlisting the help of EMS to inject those in their custody with Ketamine under the guise that they are suffering from a condition called “excited delirium.”
https://www.nbcnews.com/news/us-news/elijah-mcclain-was-injected-ketamine-while-handcuffed-some-medical-experts-n1232697
I regularly use Ketamine in the ICU and have assisted in procedures in the ED (emergency department) with it. I know why it’s used, it’s effects/side effects and most importantly the adverse effects that can occur with use.
Categories
Mandatory reporter **draft**
07/14/2020
Sometimes I feel like this moniker, which is often applied to healthcare or other frontline people who interface with vulnerable populations such as the very old or very young (teachers, I’m looking at you!), was a part of my personality before I became a nurse. And honestly, I do feel like everyone has a responsibility to help watch out for each other—or at least they should… because if we did, maybe we’d all be a little safer. Sometimes, though, it also feels feels like a burden, which is why I’m sure so many people turn the proverbial blind eye towards unsafe and potentially life threatening situations.
But the question that raises for me— how long can the blind eye truly continue to not see. Does the spirit see what the mind refuses to acknowledge? Is witnessing dangerous situations and yet doing nothing worse for your health than just finally mustering up the courage and admitting that it takes very little time to call someone for help?
I am a person who calls. Who reports. I believe that the consequences of not getting involved will impact me, as well as the victims of whatever violence or harm I am intervening in.
This started when I was in middle school, I realize now. I noticed a girl in my gym class with lots of injuries under her clothes while changing, and I talked to the guidance counselor about it. That counselor then reinforced my instincts about those types of injuries and the types of things I should tell her about. So funny to think back to so long ago to my childhood doing that for a classmate when I probably should have been trying harder to protect myself. But that was a different type of threat I was dealing with.
When I first moved to the “big city” I was also the “naive” girl who called police about the homeless person passed out on the park bench. I would still do the same, but I’d probably try harder to wake him up first, and I now know who to call for homeless outreach before the police (if it’s not a medical emergency).
I’ve had to report suspected elder abuse at work in the hospital… I’ve had to report actual abuse, once a sad case where an elder lady living with her grandson feared for her life and told us she was being forced to use drugs. Patients being abused by their spouses have refused help. I have reported things to Child Protective Services that I definitely shouldn’t talk about.
One thing I always struggle with, however, is how to report dangerous but not criminal behavior of individuals in the community that I think may be a risk to themselves or others. In other words, how do I get help for an acutely mentally ill person acting erratically who may or may not also be abusing some sort of substances?
My general rule is avoid doing anything unless the situation seems immediately life threatening. Erratic behavior +/- mental illness +/- substance abuse +/- person of color is not a good fit to police + weapon + restraint + jail.
But I live in the Bay Area, which has loads of homelessness and with it substance abuse and mental illness. Actually these three things are so linked that it is sometimes hard to tell which came first in any specific individual’s life. Twice I have had to call 911 because I needed highway patrol (the famed CHiPs) to come help a homeless person running around on the Bay Bridge— and no, not the part with a pedestrian path! A person running across 5-6 lanes of traffic on a bridge suspended over an ocean. Someone’s gonna get killed…. Someone might even be trying for that end?
I always have to stop and think before I call, though. Is this necessary? Will this do more harm than good? Is there imminent danger to the person themself or others? If there is immediate danger, I have to call. Even if that means someone spends the night needlessly in jail. It’s still better than a 20 car pileup on a freeway.
Should you call? Are you turning a blind eye? Is someone you know being abused? Are you being abused? Don’t be silent about it. Don’t let domestic violence just happen. Our silence about it perpetuates it. The same with violence against children, the elderly, the ill— whether physical or mental. Take a chance and use your voice. Now that we have learned the damage that silence causes, let us not continue to be silent about these issues. About black lives! About women’s lives! About children’s lives! About the lives of our elders and the mentally ill!
Resources:
National Alliance for Mental Illness
Project Homeless Connect Resources (San Francisco)
How to report suspected child abuse (federal)
National Domestic Abuse Hotline
National Center in Elder Abuse
National Sexual Assault Hotline
Categories
I failed to act in the moment
On my middle night shift this week, a grueling 14 hours with multiple assignments and emergencies and ending in a tad bit of humiliation but NO EXCUSE, I witnessed something as I pulled out of the hospital parking garage that at first I didn’t even really process. But seconds later, as I turned right, the image absolutely set my mind and heart racing.
The exit of the hospital garage is oddly narrow, and this particular morning, there were a few cars coming and going. Approaching the exit, I noticed some security guards huddled together a few feet away from the temperature screening checkpoint. As I turned right at the corner, I kept thinking: Why were there four security guards squatting like that? Were they on top of a person? Was there a code blue happening because there were no doctors or nurses there… do they need help and should I turn around and go back??? Rapid fire thoughts were rushing through my mind. At this point, I was 2 blocks from the hospital. I could still turn around. But if it was a code, wouldn’t the day team have arrived by now and wouldn’t they all be more useful than an exhausted off-shift night nurse???
But then another image came to mind. These were security guards. Four of them. Huddled around and possibly on top of a person laying on the ground. WERE THEY RESTRAINING SOMEONE???? ON THE GROUND? Were four large security guards holding down a person, probably a black man, near our hospital entrance, and was it possible this man could die this way?
In my head was just a stream of panic. Surely something like this could never happen at MY hospital in MY town… by now I was six blocks away. Freaking out and lucky I hadn’t caused a distracted accident, I pulled over and had an idea. I called a colleague on the day shift, the nurse who was acting as our Rapid Response Nurse (RRT) that day and who I had trained personally a few years earlier. I knew she was ballsy enough to get a guy out from under security and skilled enough to save his life is she had to.
She understood immediately and told me she’d get back to me.
I took a few centering deep breaths, knowing I’d taken the fastest action I could based on where I was. But vowing that I would not keep driving next time my brain even hinted to me that something wasn’t right. I need to stop immediately in these situations. I owe it to my fellow humans, to people of color especially who find themselves unfairly targeted in a society plagued by both overt and institutional racism that extends through through every level— from basic human rights and healthcare to policing to employment policies to the way the government as a whole is run.
And I especially owe it to those I work with, if these events are happening where I’m employed. Healthcare needs to be better. We need to set an example for how people should be treated. And personally speaking for our security guards, I want them to feel enabled to find new ways of dealing with people that is less dangerous. Security guards (or officers as they’re called at my hospital) exist in that space also occupied by police where the culture can lean toward a violent military style. But is this necessary? Is this right??? Should this be the first line tactic if most of the people dealt with are 1) agitated & aggressive patients, 2) homeless people living around or seeking inappropriate care at the hospital or 3) family members on drugs or alcohol who abuse medical staff? I think not.
I arrived home that morning to find a text from the nurse that I’d called for help. She told me that when she’d gotten there, the guy wasn’t on the ground anymore. He was sitting in the back of a cop car. “Being arrested, don’t know what for…” her brief note read. I felt a small bit of relief that he’d survived his encounter with being restrained on the ground. But now I also felt another twinge of sadness. I wondered if he was just a homeless person who had been bugging the temperature screeners. Maybe a schizophrenic off his meds? Maybe never on them. I wondered if being arrested was really necessary. I texted this in response. But the message I got in return made me sad: maybe there was a restraining order against him. Maybe, but in this case I’ll never know. Maybe I’m too soft, but I think there are other ways to wait for the police to arrive than with a person restrained on the ground.
Categories
Let’s talk about the carotid hold
Today in California, Governor Newsom announced that he would like to do away with the “carotid hold”—a restraint technique taught to police and a modified version of which killed George Floyd.
https://www.sfgate.com/bayarea/article/News-calls-for-end-to-carotid-hold-15320522.php
Some consider the carotid hold and a chokehold to be synonymous but police departments have differentiated by saying that a chokehold comes from the front and brings with it a possibility of cutting off the airway while a correctly done carotid hold only compresses the carotid arteries, leaving the airway intact.
So, why was the kneeling that we all saw performed by a police officer in Minnesota a type of carotid hold? Because anything designed to compress the carotid artery—which will cut off blood flow to the brain and cause unconsciousness quickly—is this type of “hold.”
And while people are already arguing whether or not this applies to the case of George Floyd, if you watch the video, it is clear that while Mr. Floyd is lying prone on the ground with his head turned to the side, former officer Chauvin is kneeling on the side of his neck directly on his carotid artery. Only occluding one (instead of both sides) would certain prolong the process of cutting off blood to the brain and causing unconsciousness, but a person could certainly still lose consciousness. And here’s the important part: once Me. Floyd loses consciousness, his neck relaxes and any attempt he was making to protect his airway is compromised. So at this point, it is likely that Chauvin had not only cut off the supply of blood to his brain causing unconsciousness but was also cutting off the air supply to his lungs as Mr. Floyd’s neck relaxed and changed position.
The bottom line is this: no oxygen getting to the lungs, no blood getting to the brain. From this point, it only takes seconds (maybe as little as 10) for a person’s heart to stop. So Mr. Floyd then experienced a cardiac arrest, as confirmed by the autopsy. His heart had stopped. The only thing that would have saved his life is CPR and immediate intervention by health care professionals. A delay of more than 3 minutes guarantees at the very least a brain injury and at the very worst the outcome we have.
Why am I so fixated on this issue, you might be thinking??? A few reasons.
- The goal of a correctly performed carotid hold is unconsciousness. Why should this ever EVER be the goal of the police?
- A correctly performed carotid hold should last for less than 30 seconds and once the “goal” of unconsciousness is met, the subject then needs to be correctly positioned in order to not sustain further injuries and he now needs medical attention.
- It is very difficult to perform a carotid hold correctly, which is why some view it synonymously with the choke hold (which purposefully cuts off your air supply by applying pressure to your trachea).
- But accidentally slipping into a choke hold, which seems like it would be very easy (especially if the subject is struggling) is not the only medical danger of of a carotid hold. Applying pressure to the carotid arteries can cause tearing of those arteries (called a carotid dissection) or it can loosen atherosclerotic plaques in the arteries which then shoot into the brain, causing one or more strokes. Let’s look a little closer at these 2 medical complications, shall we?
- Carotid dissection: this is where the artery tears from the rough pressure being applied to it. It can also happen from having your neck adjusted at the chiropractor, vigorous exercises, etcetera… you probably won’t know this has happened right away because despite the fact that we call it a dissection, it is not normal for all the layers of the artery to tear and for you to bleed spontaneously or prolifically into your neck. Usually, only one layer out of three tears, and the body’s response is to send in all your clotting products to fix the small tear. This is the problem, though! In trying to fix itself, your body creates a loose “clot” of platelets and other things which easily break off from the inside of the artery. Because the arteries carry blood to the head at a pretty substantial pressure, this clot, or embolism as we call it, will go up into the brain traveling as far as it can in the arteries until it gets stuck. Everything beyond it then is NOT receiving oxygenated blood flow. You are now having what we call an embolic ischemic stroke. Since it is being caused by a carotid dissection, you could actually have many at the same time as multiple thrombi cut off the blood flow in different arteries in your brain. This complication could start occurring days to a week after the event which caused it— and the early symptoms are quite hard to recognize sometimes..
- Like a dissection, the second complication is also an ischemic stroke at the root— but the cause of ischemia in this case is from broken off pieces of atherosclerotic plaques in the carotid arteries. This is the mechanism for how heart attacks occur as well and was the driving force behind trying to get people to call strokes “brain attacks.” I am glad that never caught on, but I understand why they tried.
- In the end, my thoughts keep returning to this: a medical professional would never screw around with someone’s carotid arteries—why should the police who are not trained to understand the permanent harm they can do.
- The closest we come to purposefully compressing the carotid arteries is a technique for lowering a dangerously high heart rate called carotid massage. Even during this procedure, our goal is not to block blood flow to the brain though—we are trying to “massage” or activate the bundle of nerves surrounding the carotid artery below the jawline which will trigger your heart rate to go down. This procedure is almost always done by a doctor, although an ICU nurse may be trained for this, and it can cause the type stroke I mentioned above. This is a procedure of last resort. And you can listen over the arteries with a stethoscope for a carotid “bruit” which would indicate turbulent blood flow and most likely significant atherosclerosis that is a direct contra-indication to carotid massage. In this case, we would not use this procedure in this patient.
https://www.stroke.org/en/about-stroke/types-of-stroke/ischemic-stroke-clots
First, do no harm. The ethical principle that guides healthcare professionals. we struggle every day to do no harm, as patients kick punch & bite us. As patients berate us verbally, as families demand care for their ill loved ones that we know will prolong their suffering but provide little chance of recovery. We do it with a smile and a gracious heart. Because we are taking care of human beings. People who suffer and make mistakes just like we do. People who celebrate life’s victories and milestones just like we do.
When will the police start doing no harm? Carotid hold & other violent restraint techniques need to end.
Categories
Non-racist vs. anti-racist
Here’s a list of things we can DO to start being anti-racist. Actions to take. It always helps, in times of turmoil, to just DO A THING. Don’t sit around moping, feeling guilty and just wondering how to help. Use your privilege & your skills now to take action.
https://medium.com/equality-includes-you/what-white-people-can-do-for-racial-justice-f2d18b0e0234
Also, another resource of note: an article describing white privilege in quite a bit of depth, with a prologue that defines bias vs. racism, extending to the definition of white privilege and the problems of understanding this phrase in today’s economy, as well as an exploration of power. Take a peek.
https://www.tolerance.org/magazine/fall-2018/what-is-white-privilege-really