Archive for July, 2007

As some of you may know, the Bulgarian nurses returned safely home on July 24th after 9 long years of imprisonment and torture in Libya. The Center for Nursing Advocacy has been covering this story from the beginning and they are to be commended for that. However, I read something on their site the other day that dumbfounded me. As they reported the release of the nurses, they requested that we send letters, THANKING LIBYA FOR THEIR RELEASE.

I don’t know about you but thanking someone for imprisonment and torture doesn’t quite make sense.

In case you have not been following this story, here is some background from Wikipedia:

In 1999, 5 Bulgarian nurses and one Palestinian doctor were working in a hospital in Libya when the largest documented nosocomial breakout of HIV occurred. An emergency WHO team was called to investigate the matter and meanwhile the 5 nurses and doctor were arrested and imprisoned in Libya.

The WHO issued a report in which, “No evidence has been found for a deliberated injection of HIV contaminated material.” And the report suggests that the outbreak was largly due to a lack of sterile supplies including sharps containers, sterilizers, and protective gloves and also, “the practice of using in dwelling intravenous catheters for injections in hospitalized children and sharing the same syringes, without appropriate sterilization, would appear to be possible causes of the outbreak.”

Nonetheless, the 5 nurses and 1 doctor have been imprisoned and allegedly tortured to produce confessions. In May of 2005 the prisoners were interviewed by Human Rights Watch and reported the following:

• Dr. Ashraf Ahmad Djum’a al-Hadjudj reportedly lost an eye and one of his hands has been paralyzed.
• Snezhana Dimitrova declared that her hands were tied behind her back and she was hung from a door dislocating her shoulders, and that she was told to “confess or you will die here”.
• Nasya Nenova testified that “We were alone there with those men who did everything they wanted to do”.
• Valentina Siropulo, told Human Rights Watch “I confessed during torture with electricity. They put small wires on my toes and on my thumbs. Sometimes they put one on my thumb and another on either my tongue, neck or ear,” “They had two kinds of machines, one with a crank and one with buttons.”
• Kristiana Valceva, said interrogators used a small machine with cables and a handle that produced electricity. “During the shocks and torture they asked me where the AIDS came from and what is your role,” She said that Libyan interrogators subjected her to electric shocks on her breasts and genitals. “My confession was all in Arabic without translation,” … “We were ready to sign anything just to stop the torture.”

The thing that really bothers me is that these nurses were being tortured in Libya and meanwhile the media was covering false stories like the one about the interrogator who allegedly flushed a Koran down the toilet at Guantanamo Bay.

Dear Patient:

I am so sorry that I broke your ribs last night. I really wish I hadn’t. You see, someone made a decision on your behalf that if you stop breathing, we won’t put you on a ventilator, but we will do chest compressions if you don’t have a pulse. The problem is that when you stop breathing, your pulse will eventually stop. I am sorry someone did not do a better job of explaining this to you and your family.

I could tell by looking at you that you were trying to die and if it were up to me I would have just knelt down and held your hand and let you die in peace. But it wasn’t up to me at all. You weren’t even my patient.

I think you might have gone to heaven because as a I looked up at the monitor and watched your heart slowing down, I felt that prickly, tingly chill go all the way up and down my spine.

I hope you are resting in peace.

Sincerely,
A Nurse.

******************************

Dear Resident:

Please don’t ever go to bed without clarifying a code status.

Sincerely,
A Nurse.

******************************

Seriously, can anyone think of any situation where it makes sense to code someone with an irreversible disease who does not wish to be intubated?

The other night was my first night shift in a long time. After fighting the ball game traffic and arriving on the unit at exactly 3 minutes until 7PM, I headed to the report room. I heard someone yelling down the hall.

“Can I get a cigarette?”

“Yo, Babydoll. You got a cigarette?”

“Sorry, dude, no smoking in the ICU.”

“Aw man.”

Bed 22. Not quite sick enough to be in the ICU, but I guess there were no beds available to send him to.

Sure enough, he ended up being my patient.

Sometimes it’s nice to have a patient who’s not so sick. We talked. He told me about his “job” panhandling, and how much money he made. He was suffering from dementia and was in an out of orientation. He knew I was a nurse but he thought we were just hanging out together in the shelter.

“How come you a nurse and you live on the streets?”

“Guess I just really like nursing,” I told him.

He seemed pretty calm so I left him alone for awhile. He had some lower extremity paralysis and so he couldn’t get up and walk away. There was an order for restraints but I felt that if I made him wear the restraints it would make him more confused and agitated.

Except for one thing. He still had a central line in. And he pulled it out while I wasn’t in the room.

One of the aides came and got me to tell me he was bleeding. I got to the room and there really wasn’t too much blood after all. Praise the Lord because when I got him cleaned up and settled down, I remembered that he only had 13,000 platelets. (Normal is 150K-400K). Hmmm. Maybe platelets aren’t so great after all.

I guess the experience made me wonder if I should have restrained him simply because he had a combination of low platelets, dementia, and a central line. Restraints have a way of adding insult to injury, though, particularly with a disoriented IV drug user who lives on the streets.

He was a nice guy, though. He was starving and for some strange reason the docs had him on “clear liquids.” I got his nutrition status changed and tracked down a lunch box for him. He then thanked me by offering me half of his sandwich and a plum. Although later, when I was reprimanding him for cursing at the nurse’s aid, he was very quick to remind me of his previous generosity.

Ah, the MICU. So good to be back.

It’s official. I’ve left my position at NursingLink. Let’s just say my philosophy and the company’s philosophy were never really aligned. Or to put in nursing terms, I just wasn’t on board with the “plan of care.”

What was the deciding factor that made me resign? My boss actually told me that he “detected an attitude from me.” I haven’t heard anything quite like that since I was a senior in Catholic High School and Sister Mary caught me cutting class to hang out at Dunkin Donuts. Anyway, I’m a nurse. I save lives (sometimes) and when I’m not saving lives I am helping people through some of the worst times of their life. And I’m good at it. So of course I have a G.D attitude. Show me a nurse who doesn’t.

(So can you see why I never made it as a web designer? How can someone with an attitude like mine ever expect to pay their dues among the enlightened few who choose to work for internet start-ups?)

A glimmer of light from this whole experience? I no longer look down at my scrubs and feel like an impostor. Now I look down at my scrubs and realize that being a nurse is what I was meant to do.

My future plans include taking care of my baby, working part-time at GHOAT, and blogging, so expect more brilliant and enlightening stories of life and death in the MICU.

Seen in the Guardian, a Prince Edward Island local newspaper:

As I read this I had a premonition of “Bob Dole from PEI.” I envisioned this short fat sweaty guy with clammy hands and he’s laughing like a hyena as he types his comment in. His hands are slippery because the sweat on his forehead has dripped down to his keyboard. He also has a piece of cheese stuck to his front tooth.

For sale on Etsy:

Arizona XDR-TB patient transferred to Denver.

No trips to Europe for him! I wonder if he’s co-habitating with Andrew Speaker.

Sequence of Events:

6/27/07
Google creates a Health Advisory Board and announces it on their blog.

6/28/07
Kim At Emergiblog posts about the fact that Google has failed to include nurses.

6/28/07
Kevin, MD posts a summary of reactions from the medical blogosphere to Google’s Health Advisory Board. A lively discussion ensues on various medical blogs.

6/29/07
I pick up Kim’s lead (crediting her appropriately) and create an article for NursingLink.

7/18/07 (19 days later!!!)
The American Nursing Association publishes a response to the Google Health Advisory Panel.

By now, everyone has already blogged about it, and no one’s talking about it anymore. And the ANA doesn’t use a feed reeder on their website so the chance of their “news” being picked up once again and bringing this story back to life are nil.

Maybe it’s time the ANA creates a Nurse Blogger Advisory Council.

Looks like trash-talkin your rivals is the latest Internet sport for CEOs.

Whole Foods CEO John Mackey is taking heat for posting about his rival, Wild Oats on some financial messageboards.

On that note, make sure you pay a visit to the NursingLink message boards today. We are much more civil over there.

A funny thing happened the other day. I was watching TV and a commercial came on for One Flew Over the Cuckoo’s Nest. I saw Louise Fletcher and my immediate thought was, “Hey, it’s NurseRatched, the blogger!”

Yes, folks, I know it wasn’t actually NurseRatched the blogger, but my subconscious told me otherwise. And then I realized something very cool - NurseRatched, the blogger has officially replaced Nurse Ratched, the movie character, in my psyche. Bravo, MJ, for taking an iconic movie nurse and turning her into your own symbol!

What’s even more interesting is the other night I actually had the pleasure of speaking with MJ over the phone - my first actual conversation with a nurse blogger - and the whole time I was envisioning that Louise Fletcher was on the other end of the line.

Funny, huh?

It reminded me of something I learned in an art history class a long time ago. When someone criticized Picasso for painting a portrait of Gertrude Stein that didn’t really look like Gertrude Stein, Picasso’s reply was:

“Everyone thinks she does not look like her portrait, but never mind, she will”.