Thursday, April 24, 2008
A trip to the ER
Unfortunately, not the one with Juliana Marguiles and Laura Innes--damn! Though my nurse there was very nice, and put in my IV with a minimum of bleeding and pain, and brought me those warmed blankets that are as good as sex and better than chocolate. (Sidenote: it's time for Name That Arrythmia! Look at it--do you know?)
I haven't been feeling well for a while--crampy, painful muscles; racing heart; general crappiness--and yesterday morning I was feeling really shaky. Lo and behold, I hit the ground like Ike hit Tina Turner (wasn't meant to be a joke; I done fell out). My lovely coworkers called down to the ER and got me on the fast track (one of them is a nurse whom EVERYONE in the hospital knows and loves--seriously, I think she may be the nicest person I have ever met. Not liking Lynn seems inhuman, sacriligeous, like saying you don't like fluffy bunnies or sunny spring days). I know her people skills played a major role, but I think saying "Our little research assistant passed out with no provocation--oh, and she's pale and diaphoretic" probably didn't hurt. Although I will say I wasn't wholly pleased to be described like one would describe a puppy or Precious Moments figurine (I had one of these growing up; even then it creeped me out the door. I'm pleased to say my hipster taste was present from an early age). "Our little research assistant" indeed.
She helped me into a wheelchair and, ignoring my insistence that I was fine, wheeled me down to the ER. By this point I had my wits about me again and felt like a total idiot, being wheeled somewhere I could easily have walked, and where furthermore I didn't think I needed to go at all. Like having someone drive you to your mailbox when not only is it 5 feet from the house, but also it's a Sunday and so the mail isn't even delivered. Once I got there, though, I made a shocking discovery, on the scale of Lister's discovery of antisepsis or FOX News' discovery that people will slurp down propatainment with a spoon and chocolate sauce. Yes, Virginia, I am not always right.
An EKG revealed a significant arrythmia and my bloodwork showed that my electrolytes had taken a big dive. WTF. Reassurance, assuming you care at least a smidgen--no, that's not the arrhythmia I had. It's pretty, isn't it? A trigonometric equation written to describe it would be elegant indeed, I'm sure. However, looks are deceiving: this is called Torsades de Pointes, and one the scale of Things Your Heart Can Be Doing, this rates an "Oh f*ck!" Mostly because it can easily go into ventricular fibrillation, which rates a double "Oh f*ck" and next to, say, asystole, is about as bad as things get. On TV shows, prolonged fibrillation is the point at which folks get the paddles slapped on their chests as Juliana or Laura starts shouting, "Everyone CLEAR!" My Q-T interval just decided it wanted to be long, which means various tachyarrhythmias (screwed up heart rhythms that happen to be faster than 100 bpm).
So I spent five hours in the ER yesterday, chilling in an oh-so-comfy hospital bed (and trying to sneak peeks at my heart monitor without setting off the alarm--apparently passing out without anywhile they hooked me up with IV fluids and potassium. Oh, and a series of EKGs to see how rehydration and 'restocking' my store of electrolytes would affect my heart. And a drinkable orange-flavored potassium supplement. I will not say that the supplement tasted like ass; if it had tasted like ass that would have been an incredible improvement. It did, however, taste quite orange: the color, not the fruit. I used to think that if doctors went to hell, all they would have to drink would be unflavored Ceftin liquid mixed with MiraLax. Ew. Now I know that in addition, their evening glasses of scotch will be replaced with an unstaunchable river of K-Lyte.
Long story short, after all the brewhaha, folderol, and shenanigans, things showed up as more-or-less normal and they let me go. But damn. So a lesson was learned yesterday: do not ignore your body, listen to your coworkers, and be nice to the nurses because they're the ones who can unhook you from all the monitors to let you go pee.
Sunday, April 20, 2008
Friday, April 18, 2008
I've known from the start that I wanted to be a physician...but I've also known for a long time that I want to be able to spend time with my patients/clients, that I want to be able to encounter them as whole human beings with minds and spirits rather than just as inert bodies, not to see them mechanistically as solely automatons with pieces that sometimes break or get out of alignment and have to be set back into place. I've been doing a lot of CINAHL and MedLine crawling lately and it appears that this sort of holistic approach is much more in line with nursing than it is with doctoring; it would appear that for the most part (at least theoretically) nurses are concerned with the whole human being, while doctors are wham bam thank you ma'am, your heart isn't pumping right/your serotonin is low/you need this drug to lower your blood pressure.
Yesterday I came upon a handful of articles about the idea of 'caring presence,' which is apparently a philosophical construct that addresses the interaction between clinician (generally nurse) and patient; caring presence is part of what makes space in the patient's universe for healing. In a way, it's the 'being there' that the clinician offers, the gift of time and self that allows her to act as a conduit for hope and improvement. As the doctor/philosopher/crazy Germanic guy Paracelsus said, "The main reason for healing is love." (Germans? Talking about love? In a sentence that isn't "I love invading Poland" or "While the French are distracted by their wine and cheese and love, we will take Paris"?) To put it in a slightly less threatening way (a lot of people get skeeved out by the idea that anyone would have 'love' as part of her job description), I'll quote Madeline Leininger, a nurse-researcher who said, "There is no curing without caring."
In short, nursing (and by extension, a certain kind of doctoring) can be seen as a creation of safe space for the sick person. It's a process that involves not just trying to make the person feel better, which can be classified as 'being there' for the patient if you're really and truly present--it's 'being with' the patient, sitting with her in suffering, bearing witness to what she's feeling and sharing it, to whatever extent the patient will allow. Being there addresses the problem; being with addresses the person. And, of course, it involves a certain amount of vulnerability--because connection is built on shared experience and authenticity, which means not only does a clinician risk rejection by moving slightly into the patient's sphere; she also has to let a few of her walls down, and show a flash of her common humanity (I think this may be why doctors sometimes shy away from it--they're 'supposed' to be invulnerable, superhuman. They're supposed to fix things, address the problem, not sit with the parts of the experience that are beyond human control. Additionally, they aren't the ones changing dressings, and helping people to the commode, and encouraging people to eat. They aren't as involved in the patient's lived experience, in part due to the constraints the US' current healthcare system has imposed on physician-patient interaction).
I know it'll never happen, but can you imagine the sort of paradigm shift that might occur if there were a billing code in plain ol' medicine for 'therapeutic listening' or 'caring presence' (and not just psychiatry--although, hell, it's even falling out of favor there, too, to be replaced by "If you're not suicidal or homicidal or hearing voices, take this sample of Celexa or Zoloft or whatever the drug reps left this week.")? If clinician-patient interaction were seen not solely as an economic exchange, negotiated behind the scenes by third-party payors and tweaky administrators, but as, you know, a human exchange based on a certain mutuality and trust? Obviously this is a long-shot, a big dream, right up there with my dream "What if I woke up tomorrow and suddenly had seven million dollars in my bank account? And a pony instead of a crappy old car? And the clouds were made of cotton candy?" But a girl can dream, can't she? And I can still go to medical school, and keep my 'nurse-ish' tendencies to myself...(Yes, I know there are doctors who are this way. I don't mean to bag on doctors. If I thought the profession was that cynical, mechanistic and craptastic I wouldn't be trying to get into it. But I have met a lot of MDs and a lot of RNs/NPs in my time, and let me say that if someone told me I had to settle a moon colony with one or the other, I'd be loading the nurses into the space shuttle).
Sunday, April 13, 2008
Also, and somewhat more poignantly, for "How to make people love you." I hope you find someone to love you, person from Toronto.
Googling and Wikipeding (how do you conjugate that verb, anyway? Any cunning linguists in the house?) are indeed important life skills, but equally important is the ability to determine when you've gotten a bum steer and perhaps a website that references Audre Lorde and Gloria Steinem is not where you're gonna find the "lesbian banned nude photos." Though I do have some racy shots of a never-before-seen Bella Abzug/Betty Freidan/Bettie Page menage a trois. I show them to people, then make them pay me before I'll put them away.
I came across notes from a poetry calss I took my freshman year of college, and was astounded to be recall how very very insane my instructor was, and to further note that I took down several of her crazier quotations in my notebook, viz:
(To us, a class of 18-year-olds, on an elderly poet she knew who died in the bed of a much younger woman who was, it must be said, not his wife): "People die during sex quite often. I'd stay away from it if I were you."
(On Van Gogh, and artistic madness in general): "It's better that he was depressed and painted than that he was just depressed."
Also from that notebook, a few poems that are halfway worth something (and quite a few that are not). First, an acrostic:
Follow the path
Out of the woods, but beware of the
Raw loneliness that will greet you as you
Trespass on the plains.
Newly learned to solve the dilemma that will
Emerge on Thursday. Be
Careful not to bound up stairs two at a time,
Or you will show your hand, your
Keep your opinions to yourself;
It's easier to keep quiet than to regain a love
Sunday, April 06, 2008
Tab soda--oh my goddess. I love it so much--during the mid 90s I used to go down to visit my family in West Helena, Arkansas and it seems as though that's the last place I've seen it. Ilovetab.com says that the Greater Kansas City Bottling Co no longer bottles it. Damn.
The blog Crasspollination, by Nurse K. She's an ER nurse with a great sense of humor, a wit sharper than a surgical scalpel, and at the bottom of it all, a good heart.
Animated shows for adults--American Dad, South Park, the Simpsons, the Venture Brothers...and especially Futurama.
This Modern World, a satirical clip-art cartoon by Tom Tomorrow.
Those first beautiful mid-60s days of spring. Especially when I get to be out and running in them.
Washington University School of Medicine in St. Louis. I love you. I want to go to you so badly. I can do it, I swear. I know everything I need to know. I have the cojones, the heart, and the brains. Pleeeeeeease?
Saturday, April 05, 2008
This time, it's authors I like...but not poets. That will be some other time. And again with the missing X and Z!
Ackerman, Diane (A Natural History of the Senses, Deep Play); Allison, Dorothy
Borghes, Luis (Stories); Beuse, Stefan (Die Nacht Der Konige)
Chabon, Michael (The Amazing Adventures of Kavalier and Clay)
Dahl, Roald (Matilda!); Dostoyevsky, Fyodor (Notes from Underground)
Eugenides, Jeffrey (The Virgin Suicides, Middlesex)
Frazier, Charles (Cold Mountain); Franzen, Jonathan (The Corrections); Fitzgerald, F. Scott
Guterson, David (Snow Falling on Cedars, Our Lady of the Forest); Gaiman, Neil
Harris, Joanne (Holy Fools, Chocolat); Haruf, Kent (Plainsong)
Irving Washington (not all his short stories sucked)
Jong, Erica (Fear of Flying)
Kingsolver, Barbara (The Poisonwood Bible)
L'Engle, Madeleine (A Wrinkle In Time, etc); Lamott, Anne
Monk Kidd, Sue (The Secret Life Of Bees)
Nafizi, Azar (Reading Lolita in Tehran); Nobokov, Vladimir
Oates, Joyce Carol (Beasts, We Were the Mulvaneys)
Peters, Elizabeth (Amelia Peabody mysteries...yes, I know...)
Quindlen, Anna (Black and Blue)
Robinson, Marilynne (Gilead); Roy, Arundhati (The God of Small Things); Roth, Philip
Seierstad, Asne (The Bookseller of Kabul, A Hundred and One Days); Salinger, J.D.
Tan, Amy (Joy Luck Club, Thousand Secret Senses, Bonesetter's Daughter, etc.)
Ursula LeGuin (The Lathe of Heaven)
Vonnegut, Kurt (Cat's Cradle, Breakfast of Champions)
Wharton, Edith (Ethan Frome--I actually liked it); Woolf, Virginia
Yamamoto, Banana (Asleep) Yes, that's her real name.
And I've just started--Goddess help me--reading books from Terry Pratchett's "Discworld" series. Am I in fact becoming a hopeless dork? Isn't it preferable to immerse myself in reading rather than worry myself to death over being waitlisted at the medical school I really truly really want to go to (Hello, Washington University in St. Louis! I love you! I want to go to you so badly! I'll do anything you want...anything. *wink*)?
I went for a lovely 6-miler today down around the Plaza and Brush Creek...If I want to do the Hospital Hill run on June 7th (a half-marathon with one of the most demanding topographies of any road race in the country) I'm going to have to start getting with the program. I probably should have done a longer run today, but I had to get ready to go to a friend's housewarming/Final Four party (Rock Chalk Jayhawk! Woo-hoo, 88 to 64, in your FACE North Carolina! That game was ridiculous...in the first nine minutes KU had UNC against the wall at 30-10. Yeah, Roy Williams, you bail out and see what happens?). I'm not usually a big party person, but this was actually pretty fun; yay social activity made easier by the application of alcohol! Yay Bud Light brand social lubricant! Ok, yeah, I'd rather have a Boulevard Beer Zon or an Ithaca Beer Apricot Wheat, maybe a New Belgium Brewing Co. Trippel. I'm a beer snob much more than I'm a wine snob (Thank you, Jamie and Dan Galindo--I hold you fully responsible for this. Zymurgists versus sybarites! Go on, look 'em up...the vocabulary will do you good.) But when you've got a touch of the ol' social anxiety, and there are a bunch of people roughly your age whom you don't know, and it seems like 75% percent of them know each other and have KIDS for Buddha's sake, as in they've actually put their ovaries into use unlike yours which are withering on the vine, and they own a house and talk about buying things like leather recliners and flat-screen TVs and it's obvious you're the only one in the room who isn't an Adult with a capital A, well...Bud Light is actually not bad beer. In fact, when it's right out of the keg and your team is winning and you're getting to see a friend you haven't talked to in a while...it's damn good.
Oh my freaking God. How is he not screaming? "Micardis may not be right for everyone. Talk to your doctor if you experience your arteries glowing like the ruins of freaking Chernobyl as this may be a sign of a rare but serious health problem--namely, that you have become a horrible, horrible mutant."
Is that a threat or a promise? Ew. It's like the part of a horror movie preview where everything appears to be going just fine, sunshine and ponies, and then BAM! There's the voiceover, and the words on the screen..."She never saw it coming." At least we know what's in those bottles on the deck. 100% pure moonshine. Everclear. The kind of alcohol that causes retinal damage if you drink too much or too often. "Shay, Shandra, why donn we rip out the tubsh and put em on the back deck, an' sshit in em bare-ass naked?" Then they got out there and realized they had no way to get water into the tubs, and Sandra saw George looking at her with that sheepish grin and looked over in his tub and...ew.
Normally someone that happy to be cooking breakfast is either manic or at the beginning of a meth and coke binge, before the shakes and paranoia start. Either way, they'd be happy to be doing ANYTHING. Making Darren Stevens his breakfast isn't anything special.
Vintage drug ads are hi-effing-larious, not least because they're aimed at doctors and sometimes make visible the huge chasm between doctors' understanding of patient problems and, well, what the patients actually think.
Not that modern ads, aimed at consumers, aren't often hilarious too. Yes, Bob Dole, I'm talking to you. You too, Yaz women who spontaneously begin to discuss "the birth control method that's right for you" over cosmopolitans. Because I know that when I think girl talk, I think "hyperkalemia" and "deep vein thrombosis." That's all my pals and I have been able to talk about lately.
DrugMonkey has some fun thoughts about drug ads too. He's the bestest.
Even if he does bag on Hillary like she was a red-headed stepchild growing up in Okinawa.
Friday, April 04, 2008
So, the USDA says a product labeled 'organic' has to have at least 95% organic ingredients (excluding water and salt, because let's face it, if you're the kind of person who's bought into he idea of 'organic water,' the pesticides have probably affected your brain function already).
Organic means (in the US, at least) that no pesticides, artificial fertilizers, bioengineering, routine antibiotics, irradiation or sewage sludge (ew) are involved in the production/packaging of the food...but it's possible to comply with the letter of the law, and meet the standards of the National Organics Program Standards Board, without necessarily sticking with the spirit of the regulations. Particularly when large companies are involved, and maintaining the sort of close relationship with the land/animals that family farmers have would involve cutting into profits. Quelle suprise, eh? I'm not saying multimillion dollar corporations are always horrible, or perennially on the take, but damned if I've ever heard of a small farm trying to pass off conventional products as organic, or heard that they don't dose their cows with antibiotics or hormones but keep them in feedlots rather than letting them graze freely. Or trying to sell you organic chicken chunks when the chickens only got to go outside for 30 seconds a day (Yes, Virginia, there is such a product as 'chicken chunks.' I'm sorry you had to find out this way).
Check out this Mother Jones article, "Organic Milk Goes Corporate," or look at the Cornucopia Institute website. I was bummed to discover that Stonyfield Farms, which I like, and imagined was owned by a group of upstart little farmers somewhere, is in fact now run by the France-based multinational Danone group. They still use locally harvested organic milk, however (mixing together milk from a bunch of family farms, which is better than, say, sourcing powdered organic milk from New Zealand, like another company--I'm not sure which--does). As for Horizon Organics, despite the cute-as-all-get-out cow on the label (if there were a T-shirt with the Horizon Organics logo on it, I would totally buy one. Heck, I'd buy underwear with that on it..."Eat organic!" Heh, heh.) it seems that they're run by some slippery--not to say slimy, necessarily--folk. Dean Foods, too. The letter of the law, not the spirit. Meh. Maybe I'll just eat soy yogurt instead.
Note: I edited this from its original form--it turns out I didn't have everything completely straight. Luckily Mark from the Cornucopia Institute dropped by and set me straight. Yay people who care enough to interact with the public and hand out a little edu-ma-cation!