code blog: tales of a nurse

My last post referred to making new buttons for some blogs that I noticed that had gotten facelifts. Makeovers. New 'do's. However you want to say it.

One of those blogs belongs to PixelRN. A web designer in her previous life, she did a great job redesigning her blog. She explains how she did it in this post. She should put out a shingle, maybe redesign the sites for a few other bloggers, don't you think? (hint/wink/hint) :)

Another post she did was about RSS feeds, and it is also very well done. If you are a blogger, you really really really need to know about RSS. For me personally, it doesn't matter how good your blog is... If I can't subscribe to your blog to read in Google Reader, I'm probably not going to read it. There's another side to that. You can choose how much of your post shows up in a reader. Some bloggers make their entire posts available to be read, and some only allow a few sentences to show, thereby requiring the reader to click on "read more of this post" in order to read the rest of it. This also drives me nuts. I realize that we all like to have our stat counts be nice and high, but I almost never click through unless the first few sentences really grab my attention. That is not always easy to do!

(Addendum: Although Rebirth only provides partial feeds in Google Reader, I always faithfully click and read her entire posts. Because she rocks. And I don't want her to stop blogging, as she has recently threatened to do.)

Remember this baby?

Well, he turned into this 1 year old:

I have never done anything so simultaneously frustrating and rewarding. Mostly rewarding :)

I was tagged by PixelRN, so here goes:

1. I have a few goals in life: I want to someday design and build my own house, see the northern lights and visit the 7 wonders of the world. That last one might be a little difficult, though, seeing as how I'm not very fond of traveling.
2. For one summer in college, I worked at Eastman Kodak in a lab. I'm amazed that I can't remember exactly what I did, but I know it had to do with testing the silver emulsion for.... something. Anyway, it was a fascinating job and I still remember my coworkers there, although I don't keep in touch with them anymore.
3. I make mosaics.
4. If I could have any job in the world, I would want to be an astronaut.
5. I was married on Halloween.
6. I love playing video games. I can remember playing Mah Jongg on my dad's old 386 and Missile Command on the Atari. I've graduated to Nintendos and Xbox's now, but it has truly been a life long "hobby."
7. Last and least, I have ADD. I'm sure no one noticed, but I posted only 7 times during my pregnancy last year. That's because I wasn't taking my meds and the desire to write pretty much vanished. I was diagnosed and started treatment in college. One semester I was about to flunk out of the nursing program and the next semester I was on the dean's list. Pretty impressive turnaround. Think what you will about ADD, but finding out how to manage it changed my life.

Honestly, I don't know who to tag - I feel like I've read this meme from pretty much everyone, but I guess I don't remember seeing one from Kevin MD or GruntDoc.

Nursing ratios are very important. When I worked in IL, I once had to take 3 critically ill patients. I had never been so busy at work in my life and I constantly felt as though I was way behind. I was very scared of possibly missing something. There simply was not enough of me to pay very close attention to each patient.

There were a few nights on med-surg that I took 9-10 patients, mostly fresh post-ops. That's a lot of patients. And that was over 10 years ago. Even in the last decade it seems like patients have been getting more and more complicated what with their chronic medical problems.

Here in California, there's a law protecting ICU nurses in particular; it says that we can only take 2 patients in ICU. Even if they require a lower level of care and are overflow from full med/surg units, even if they have transfer orders - if they are physically in ICU, they are to be 1RN:2pts. California has been moving towards staffing ratios on transitional care units and med-surg floors as well.

There's a bill that's been introduced - the Registered Nurse Safe Staffing Act of 2007 (HR 4138). It would provide a staffing system that has input from nurses who give direct patient care. This is a very good thing. It is something that we do in my ICU all the time and I can't imagine it any other way.

PixelRN has also written about this issue, perhaps a bit more eloquently than I. WashingtonWatch.com provides information on the current status of the bill and a wiki where you can put forth your arguments for or against the bill. There's even a link on their sidebar where you can write to your state representative. I plan on doing so right after posting this. They don't know if you support it if you don't tell them! They all have email; it's very fast.

There have been more and more regulations lately from JCAHO, the most recent and notable being those which state hospitals will not be reimbursed for care related to preventable complications such as pressure ulcers and UTI's. We do the best we can with what we have. More nurses = more care = less complications.

This is one regulation from the government that actually makes sense. I'm so glad it's been taken to a national level. We really need to get behind this bill.

When I started out in nursing, the hospital I worked at required CNA's to wear cranberry, RT's to wear teal, and RN's to wear royal blue, etc. We could wear certain scrub tops that were approved and that matched the royal blue pants. The hospital did not pay for them.

When I moved and got a new job, there were no standard uniforms. We could wear whatever we wanted. Some people took this too far and started looking a bit unprofessional - scrub pants with little t-shirts that actually showed off belly buttons, that sort of thing. One or two nurses wore street clothes, but they actually looked fine to me. It wasn't like they were wearing jeans or anything. It looked appropriate in my opinion.

A committee was formed to discuss the possibility of requiring standard uniforms. Most of us in ICU (and the rest of the hospital) were completely and totally against it. We liked our individuality and we didn't want to look the same. I realize that there are professions that wear standard uniforms (police, EMT's, firefighters, the military, etc), but some of us felt as though we should not be told what to wear.

Patients often comment on our scrub tops, usually compliments :). Then again, it was argued that if we told patients at the outset that all RN's are wearing blue, they'd be able to discern who they were talking to. Or, you know, the person could just tell them that they were the RN. Why make things so hard?

Most of us felt it was up to the manager to take care of those who were dressed inappropriately.

The idea was eventually shot down, but I found it most interesting that the hospital was prepared to buy everyone's uniforms for them, the number of which was to be based on how often one worked. I couldn't believe that they'd spend so much money on dressing everyone.

So what do you do? Once again, there's a poll up at Nursing Voices if you care to weigh in there!

To my sweet Secret Pal: YUM!!!!. I had to hide the box from my husband :-)

My interview with Bertalan is up at ScienceRoll!

Get along lil doggies (what does that mean, anyway?)! Change of Shift is up at Nurse Ratched's Place! She's got the niftiest stories of the nursing blog world all rounded up.

As far as gossip goes, Babs RN and Ambulance Driver have announced that they are in sweet bloggy love. If you're in the mood for the down and dirty, visit Babs. But for the long sweet romance story, visit AD. Good luck you crazy kids! :) Might there be live blogging from the wedding?

When a patient is going to have a colonoscopy, the colon has to be cleaned out so that the doctor can see what's goin on in there.

To achieve this, the doctor often orders Golytely, which is an electrolyte solution meant to cause some serious cleaning-out while preventing dehydration and electrolyte imbalances. We sometimes give it in the ICU to patients who are to undergo a colonoscopy the next day. If they have an NG tube, we just mix it up and put it down that. If they don't, they have to drink a glass of the stuff every 10 minutes.

An entire gallon of it.

Think of a really vile salty drink, then imagine having to drink a gallon of it within about 4 hours. Some complain more than others, but I think it's safe to say that it isn't pleasant.

It's highly effective, though.

Apparently I've mentioned the process to my husband before, because one day he was walking around during his lunch break and found what might be a possible replacement for what has up until now been a very uncomfortable process! Instead of this:

People could just eat bags of this:

I found it to be quite an unfortunate name for a candy. And it isn't just the name. Apparently if you're "sensitive" and you eat too much, it really can possibly stand in for the other stuff!

Well, even if you weren't exactly looking for the laxative effect, the bag claims that a serving of these candies actually counts as 1 exchange of fruit.

?!?!?!?!

Since when do lemon oil and tangerine oil count as a fruit??

Image credit

(Click to enlarge!)

That's my boy!

...Is up at Nursing Jobs.org! (The NJO blog!) Kim has done her usual amazing job of rounding up posts by the blogosphere's nurses.

Pixel One, Purl Two is a nurse blogger who decided that we as nurses should take care of each other ('cuz we don't have enough to take care of?!) and has come up with an idea. She's proposing a secret pal for nurses care package exchange starting next month. Details are here! So yeah... in order to get a package, you have to send a package, but I personally think that's fun, too :-)

If you're coming here from Nursing Link and you've already read this article, click here to read my personal review of the movie!

"Ladies and gentlemen, I think we can agree on two things: The American health-care system is busted and Michael Moore is not the guy to fix it."

And thus begins a rather scathing review of "SiCKO" by Stephen Hunter at the Washington Post.

According to Peter Barry Chowka at American Thinker, "The lead up to Sicko's June 29 national roll out was a genuine phenomenon. Prior to its opening, with only a small number of reviews actually published, Sicko had already become the most hyped, and written about, movie of 2007, and possibly of the past decade."

The past decade??

Is the actual film worthy of the hype that was created before its release? That depends on who you ask, of course. Hospital Impact has a very thorough Roundup of SiCKO reviews. As said in the comments, "My doctor recommends tests and procedures and medications, but ultimately, a healthcare insurance pencil-pusher decides what is "medically necessary" and reimburses accordingly." Moore's film reveals that the "pencil-pushers" are not necessarily your average Joe off the street, but instead are physicians who are paid handsomely for their expert opinions in denying your care - oops, I mean denying payment for your care.

Moore wasn't necessarily interested in presenting both sides of the story, either:

"But one aspect missing from the film is the defense. Do not expect to hear anyone speak well of the care they received in the U.S. On the other hand, patients and doctors from Canada, Britain, France and Cuba marvel at their health care."

'Course, Moore's missive doesn't need to include a defense when you can simply get your information biased to the other side from websites such as Free Market Cure. As you can guess, this website is not exactly dedicated to the idea of socialized medicine, but instead puts forth ideas relating to consumer-directed healthcare. And what's wrong with our system anyway? Here's a theory:

"... Americans - whether privately insured or publicly covered - tend to be over-insured, and thus less sensitive to prices. And so we come to a paradox: American health care is so expensive because it's so cheap. That is, with Americans paying just 14 cents out-of-pocket for every health dollar, they have little incentive to economize on health expenses. Americans have access to the most technologically sophisticated system in human history - yet pay pennies on the dollar out of their own pockets. The upshot? A health care system that is heavy in cost but not necessarily strong in satisfaction and uneven in quality."

Several controversial issues are raised in this movie, including personal accounts of insurance companies denying payment for life-saving procedures and 9/11 workers having problems getting adequate health care for conditions they contracted due to working at ground zero. Moore also tackles the incident that happened last year when Kaiser dumped a confused and disoriented homeless patient in the middle of Skid Row. Slate Magazine's Austin Goolsbee doesn't disagree with Moore's assertion that America's healthcare system is broken, but does take issue with his "policy prescription":

"For Moore, though, the answer is not reform of the current system. It is having the government run it all. He sets out on a worldwide tour to show us how great a single-payer system is in countries that have it. And here's where his policy prescription goes into overdrive."

Yes, there are many people flinging their opinions about this movie around the internet, and employees at Google are no exception. A blogger for Google's Health Advertising Blog suggested that the healthcare industry fight back. How, you ask? With ads, of course: "Moore attacks health insurers, health providers, and pharmaceutical companies by connecting them to isolated and emotional stories of the system at its worst. Moore's film portrays the industry as money and marketing driven, and fails to show healthcare's interest in patient well-being and care."

The entry knocked Google off of its firmly neutral stance, and the blogger in question apologized, saying that she was expressing her own opinion, which did not represent the opinion of her employer.

And hey - if you're the kind of person who likes to stay in the thick of it all, consider joining this coalition: "Calling it the "Scrubs for SiCKO" campaign, organizers will recruit registered nurses and doctors to every theater in the nation where "SiCKO" opens to ensure that caregivers - in SiCKO scrubs-are in the audience.

The caregivers will distribute information and urge moviegoers to join the drive for a fundamental overhaul of the nation's dysfunctional healthcare system - as is so brilliantly described in "Sicko." They will urge the audience to help pass single-payer/Medicare-for-all-type legislation such as HR 676 now pending in Congress and several states, and make it a central focus of the presidential campaign."

Whatever your opinion of Moore's movie may be, whether you consider it to be brilliant, misguided, or blatantly inaccurate - even if it doesn't reveal the perfect solution, realize that at the very least, it is creating a national dialogue about the quagmire that is healthcare in America. And there's nothing wrong with that.

Change of Shift is on its second year and is being hosted by Beth over at Nursing Link. It's the first time CoS has been hosted at a site other than a nurse blog! Lots of great posts to read!

Kim at Emergiblog has been writing about the new nursing forums, so I thought I'd chime in, too!

First of all, Nursing Voices is a brand-new forum with lots of categories in which to post. Kim, Mother Jones, and yours truly (username geenaRN) are the current moderators of the forum and would love to see you there! Lots of discussions going on - there's definitely something for everyone!

And Nursing Link is a brand-new site encompassing almost everything having to do with the rapidly expanding world of nursing! Stop over there to peruse the latest nursing news, forum discussions, featured bloggers, and product reviews. Beth of Pixel RN is overseeing the site along with Affinity Labs and there's already a phenomenal amount of information.

I have already spent lots of time on both websites.

I do also want to plug another place for nurses to get together - Everyday Nurses. This is another message board/forum started by Terry of Counting Sheep to share information and get connected with fellow nurses. I have not yet had time to head over there, but hope to soon! I seem to find a new nurse blog almost every day!

Enjoy!

Everyone who hosts Grand Rounds gets an interview and write-up by Dr. Genes in Medscape. Here's mine. Thanks Nick!

(I think subscription is required!)

Welcome to Grand Rounds 3:39! This is my fourth time hosting (The second four-time hostess!) and to commemorate the occasion, I've decided to unleash Henrietta the Healthcare Worker, my inner advice columnist. Enjoy the links!

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DEAR HENRIETTA: I've had a problem for a long time. I've seen many specialists and have had many tests to figure out what's causing my problem. None of the treatments work. Surely the doctors in the ER have seen it all and might know how to help me? --OUT OF OPTIONS IN OKLAHOMA

DEAR OUT OF OPTIONS: GruntDoc puts it best - "Sometimes expectation management is the best we can do, for everyone."

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DEAR HENRIETTA: My child has physical limitations. He's resistant to doing his therapy and everyone treats him as though he's made of glass! How can I encourage him? --DAD TO DELIGHTFUL TOT IN DELAWARE

DEAR DAD: Ambulance Driver has experience with this topic and writes eloquently about how to incorporate exercises into everyday situations: "I let her steer, taking care to keep her left palm firmly pressed to the handlebars. The vibration is good feedback for those dormant nerve pathways we're trying to awaken. We do lots of right turns to, once again, extend that left arm, and we also do plenty of flat spins to the left, to teach her to shift her weight."

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DEAR HENRIETTA: I feel sad and frustrated about the patients who are brought to my hospital because they have intentionally overdosed. I just can't relate. What on earth are they thinking?? --FRUSTRATED IN FLORIDA

DEAR FRUSTRATED: Sometimes suicide attempts are meant to be successful, sometimes not. In either case, drytears tells us exactly what she was thinking: "I was scared, I felt there was no way out, and down went the next two."

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DEAR HENRIETTA: Why can't we all just get along? --ANGSTFUL IN ANAHEIM

DEAR ANGSTFUL: Kim at Emergiblog shares her observations and has a few suggestions for keeping the peace: "May we never forget that there is a person on the other side of that URL."

Rita from MSSPNexus Blog gives some tips for building relationships at work: "You could accurately describe a rose as soft and beautiful or as difficult and thorny; it all depends on your focus."

If you want to walk away from the drama and just do your job, Dr. Emer at Parallel Universes lets us know what patients want: "Human interaction requires skill sometimes, and for overworked and stressed physicians [ed: and everyone else!], that can be quite a challenge."

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DEAR HENRIETTA: I have my own practice and am struggling to make ends meet. A colleague has asked me to buy into a new practice that he's starting. What should I do? --STRUGGLING IN SACRAMENTO

DEAR STRUGGLING: Mother Jones RN at Nurse Ratched's Place has done some reconnaissance work and has some interesting findings: "And I thought nurses were the only ones who could be that malicious to their colleagues." I dunno, Struggling - doesn't sound good!

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DEAR HENRIETTA: My husband was just diagnosed with diabetes and he won't follow his treatment plan! Doesn't he care about what could happen to him? --MRS. NON-COMPLIANT IN KANKAKEE

DEAR MRS. NON-COMPLIANT: Being diagnosed with a chronic illness is a big deal. Most chronic illnesses require major life changes. It takes some getting used to! Kerri from Six Into Me explains how even grocery shopping becomes an internal struggle: "Stomach: Baby spinach, baby carrots. You eat babies. Heh heh. FEED ME. I'm running out of patience."

Chronic illnesses affect both young and old and can interfere with even the most basic human activities. Ann, featured on Chronic Babe, describes the difficulty she had after giving birth due to having been on bedrest during the end of her pregnancy: "The worst, though, was having no strength whatsoever. I couldn't even move myself up on the bed, or get up and attend to my daughter."

We do our best to predict or explain our chronic diseases, as Dr. Lei from Eye On DNA found out when she interviewed Kendra RN, who had a genetic test for diabetes: "I was primarily concerned that if "those" genes were present in my DNA, there would be an increased risk factor for my 3 daughters."

Fortunately, when we have problems managing diseases such as diabetes, there are advocacy groups ready and willing to help us out, as Amy at Diabetes Mine discovers: "DM) OK, so if one of our community is arrested during a hypoglycemic episode we can really call you? MG) We have enough money in our slush fund to get you out of any jail. It's called bail money." Whoa!

And when it all gets to be too much, Rachel from Tales of my Thirties reminds us that sometimes a moment to relax and have someone pamper us can put things into perspective: "Ahhh, she's working on my aching calves. The words metformin, Januvia, and Byetta slip away from my mind."

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DEAR HENRIETTA: I work night shift and am finding it difficult to make it home in the morning! What can I do? --SLEEPY IN SYRACUSE

DEAR SLEEPY: Maybe you could take a page out of TC's (donorcycle) book when the sky goes from navy to pale pink: "Row houses and hospitals, court houses and schools, all come alive again with a rosy light. Look out the corner of your eye and instead of morning traffic, you'll swear you see a guy delivering ice with a team of Clydesdales."

Or maybe you need to start working day shift. Your call!

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DEAR HENRIETTA: My grandmother was just diagnosed with Alzheimer's Disease. What can I expect as this disease progresses? --WORRIED IN WICHITA

DEAR WORRIED: It's probable that the disease will make her regress, as Dr. Val from Revolution Health writes, "But the strangest part of grandma's journey with Alzheimer's was that it took her on a reverse tour of her former life. She seemed to be reliving each day that had had the most emotional impact on her - in descending chronological order."

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DEAR HENRIETTA: I was a patient in the Emergency Room the other day and the person in the gurney next to mine was ranting and screaming. No one paid her any mind and eventually I was discharged home. What was that all about? Why wasn't anyone trying to help her? --CONCERNED IN CONNECTICUT

DEAR CONCERNED: The person next to you may have had a mental illness or was withdrawing from their substance du jour. Sometimes security personnel can keep an eye on them, but sometimes not, as Susan from the Rickety Contrivances of Doing Good relates: "Security will still show up to evaluate each of these patients, and will put them in restraints if there seems to be any danger of violence, but they'll no longer sit with them." I guess I always assumed every ER already operated this way. Henrietta is sad that this ER is cutting back on security services for this patient population which seemed to be serving in the best interest of the patient and the staff.

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DEAR HENRIETTA: I am a consumer of healthcare, not a provider, and am also an avid reader of medical blogs. The other day I came across a blog written by a doctor that included details of a patient's history, including their name and procedure! Is this accepted practice? Should I be worried about my doctor having a blog? --APPALLED IN APPALACHIA

DEAR APPALLED: It is absolutely NOT an accepted practice to divulge any details about patients in any kind of public forum. Mike at Interested Participant describes a recent case in Australia involving this very topic, and muses about how this case would go down in the US. (No quote here - you'll have to read to find out just how bad it might get!)

JC at Health Observances also proffers some advice to healthcare bloggers: "Sure, we all need to let off steam now and then about stressful situations at work, but when it involves intimate details of the lives of other human beings - we have no right to parade those details in a public forum."

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DEAR HENRIETTA: Is there anything in the world that is quite such a lovely phenomenon as the incredible wicking white cotton granny panty? --WONDERING IN WAIKIKI

DEAR WONDERING: MonkeyGirl has just the answer for you!

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DEAR HENRIETTA: I can't stand when bad things happen to my favorite patients! I go home at night and I can't get them out of my head. Do other practitioners have this problem? --DISTRESSED IN DELAWARE

DEAR DELAWARE: Of course they do! It's hard not to become attached to some patients. Bohemian Road Nurse describes a recent event when a home-health patient of hers coded in the hospital, while the agency's CNA looked on: "Jenna was helping Mrs. Turnwater hobble over to a chair next to her bed after her bath, and Mrs. Turnwater suddenly grabbed Jenna with both arms, pinning Jenna's own arms. Then Mrs. Turnwater went unconscious and limp."

And Dr. Bishara from The Doctor Blogger relates a story about a patient that not only has little support at home for her major illness, but is taken advantage of as well: "She is trying not to think about the cancer and "keep going". Weirdly, her son and his family have moved back in with her so she can support them because her adult son lost his job. The family does not believe she has anything really wrong with her and keep telling her "you'll be alright" while still living under her roof and allowing her to work and pay all their bills."

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DEAR HENRIETTA: I don't get all of this single-payer national health insurance business. Some people say it's good, some say it would be a disaster. What is your take on it? --PERPLEXED IN PITTSBURGH

DEAR PERPLEXED: Henrietta is not the person to ask about such things, as they are very confusing to her also! But Bob at InsureBlog has some thoughts: "Seems no one ever mentions the queue in other nations. No one says anything about how some citizens of these supposedly superior systems buy private insurance to supplement the nationalized system or they pay out of pocket or sometimes even come to the U. S. for care."

And here's an account from Prudence of Prudence and Madness regarding a practice in the Philippines - pre-payment for services: "So now comes the almost never-ending haggling. The hospital wanted them to make a deposit of, at least, P10,000 within 24 hours because 2 patients will be having major operations and the money can be used to cover the initial treatments and the units of blood that will be used. The relatives just couldn't make up their minds."

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DEAR HENRIETTA: How can I ruin the birth of my child? --NUTTY IN NASHVILLE

DEAR NUTTY: Dr. Nic at Shoe Money Tonight has 12 suggestions on how to do just that!

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DEAR HENRIETTA: How do practitioners know when new treatment therapies have been discovered? --OLD SCHOOL IN OSWEGO

DEAR OLD SCHOOL: They read blogs :-) Dr. Rosielle at Pallimed informs us about a study published in Neurology regarding early treatment limitations and their effect on mortality: "Translation: don't withdraw/limit life-prolonging care immediately because you may be wrong."

Dr. Schwimmer from Tech Medicine describes aquapheresis as a new therapy for heart failure: "In an attempt to overcome the problems with diuretics and the requirement of a dialysis machine for ultrafiltration, a company called CHF solutions has designed a device for ultrafiltration -- which they call "aquapheresis." (In two parts, link at bottom of part 1)

And Matt at the Behavior Ecology Blog explains results from a study about pre-op hematocrits and surgical outcome: "Unfortunately, in a recent study published in JAMA, and highlighted in ScienceDaily about hematocrit and surgical risk- the 2 relationships are seriously confused..."

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DEAR HENRIETTA: How do practitioners know about new drug therapies or new uses for old drugs? Or how Coca Cola can be used in medicine? --PRO-PHARM IN PENSACOLA

DEAR PRO-PHARM: Again, blogs! Liana from Med Valley High professes this: "Interestingly enough, Coca Cola also reigns supreme as the most commonly used therapy in a small but important area of medicine: the unclogging of gastrostomy tubes." Look for the scientific explanation in the comments.

Girlvet at Madness: Tales of an Emergency Room Nurse muses about the new birth control pill that can stop menstruation altogether: "This feels like another step toward trying to control nature. If it's inconvenient get rid of it. There can be no discomfort in our lives."

Dr. Bookspan at The Fitness Fixer addresses the recent news about a teenage girl that died after using too much Bengay: "Deaths are rare, but salicylate poisoning is not rare or unknown."

And David Williams at the Health Business Blog writes about an interview with Genentech's CEO, who was quite involved with the development of the cancer drug Herceptin: "I think his points are generally right. But he uses a classic technique: talking about the issue in macro terms. I don't know that anyone has said that cancer drugs are bankrupting America."

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DEAR HENRIETTA: I'm a first-year medical student. This is the most stressful year of school I've ever experienced! Tell me it gets easier! --STRESSED OUT IN SANTA FE

DEAR SANTA FE: Ah, I cannot tell you such a lie. And Vitum Medicinus delivers the truth better than I: "I was talking to a doctor the other day who described third year like this: 'You get thrown into it and are just like 'WOAH - I've learned more in my first four weeks of third year, than in my entire last six years of university.' Scary."

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DEAR HENRIETTA: What is this crazy news I heard recently about Dr. Heimlich infecting HIV patients with malaria?? Why would he engage in such madness? --SHOCKED IN SOHO

DEAR SHOCKED: Tara from Aetiology explains how malaria was once thought to cure syphilis, and why trying it out on HIV is fallacy: "And unlike syphilis, HIV doesn't directly attack our heart, or our circulatory system--it damages the very system we rely on to defend ourselves against a host of pathogens."

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DEAR HENRIETTA: Enough questions! Just tell me something I don't know! --FED UP IN FRESNO

DEAR FED UP: Okay! Here are a few things you may not have known!

Mousetrapper at Med Journal Watch delivers some good news in the bad: "Women who are at risk of getting a more aggressive type of breast cancer are also most likely to detect the cancer by breast self-exam."

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The Clinical Cases Blog points us to YouTube, where a pathologist has uploaded hundreds of histopathology videos.

Bertalan Mesko of ScienceRoll shows us what could be in store for the future, wheelchair-wise.

And Jeffrey of monash medical student informs us of how best to eat while training for a marathon and throws in some info about what exactly triggers thirst, a very interesting race photo, and a neat little tidbit about the hippocampus.

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And thus concludes another edition of Grand Rounds! As always, thanks to Dr. Nick (who must have more inbound links than any other medblogger EVER) for his management of this carnival. And send your latest submissions on over to Wandering Visitor, who is hosting next week.

Permalink

I don't prune submissions for Grand Rounds - everyone is included. If you don't see your submission here, see this post for a possible explanation and then resubmit your post if you like - I'll add it in as soon as I can!

I noticed a few months ago that the primary address that I was using for this blog (geena at codeblog dot com) was delivering some emails, but not others. So I got a gmail account and started using that.

Unfortunately, I did not remember that my story submission link went to the previous address until this morning. It has been changed, but if you submitted your post for Grand Rounds via that link, look for a response from me - I have acknowledged every post submitted through the link. If you have no such acknowledgment, please resubmit with my apologies!

To those who used the codeblogrn email - your posts should have come through just fine. I've had no problems with that address!

I've received many great posts! Keep 'em coming!

Hard to believe it's already been a year, but this week's edition of Change of Shift, up at Nurse Ratched's Place is the 1 year anniversary edition. Kim of Emergiblog has done a great job of taking this idea and turning it into a wonderful bi-weekly carnival for and about nursing!

This week's Grand Rounds is up at Dr. Val's. Very clever with the short attention span version and the relax-and-have-a-cup-of-coffee version!

Grand Rounds is hosted here at codeblog next week, June 19th. Send your submissions to codeblogrn at gmail or use the "Submit your story" link above. Please try to get them to me by Sunday at the latest! Thanks!

Universal Health has created a webring for Progressive Healthcare bloggers:

"Progressive Healthcare Bloggers is a brand new web ring that is free and easy to use. Click on the join link, and follow the simple and fast sign-up instructions. The progressive blogging community hasn’t had a healthcare congregation point, and I hope that this will serve as a convenient gathering place for us.
Please send this to your blogging friends and spread the word!"

Head on over and join!

... Is up at Nurse Ratched's Place. Go read this TV nurse themed edition!

As the title says, it's Nurse's Week! I would link to my extra special favorite post that I always link to for Nurse's Week, but I can't get my site to load. Why, you ask? Because I'm visiting my family in the Midwest and the best I can do here at my mom's house is dial-up internet. Not only that, but the fastest it goes is 32.0Kbps! Thus, everything takes literally 5 minutes to load, and my site has pretty much given me the "talk to the hand" every time I try to go there. At least MT still works :-)

Because it is Nurse's Week, there's been some talk about updating the Florence Nightingale pledge for nurses. I assumed that Flo wrote it herself, but in doing some research, I found that it was actually written by Mrs. Lystra E. Gretter as a modified Hippocratic Oath and was then named in honor of Florence Nightingale.

In case you didn't have to recite it at your pinning/graduation from nursing school, here it is:

I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.

It was written in 1893. Nursing has come a long way since then. I personally think that we're plenty mischievous these days! Nothing wrong with a few pranks at work! [And this is where I would link to my "pranks" post, but again - can't get to it. Sigh. How do people live like this???] And we give plenty of harmful drugs in the name of treatment (TPA, chemo, etc.) I'm not so sure about aiding the physician in his work - I think a more modern view of nursing is that we collaborate with physicians in taking care of patients, our work.

Infinia Foresight has taken on the task of finding out what modern nurses think of this pledge, and what we would change about it if we could. Would you change anything? If you'd like to take a red pen to our pledge, visit Rewriting the Nightingale Pledge and find out how you can submit a revised version. A few rewritings are posted here. Some have just a sentence here and there rewritten, and some look all painted in red with revision suggestions.

So go on out there in the big bad world and find a nurse to appreciate. And to my colleagues - happy nurse's week :-)

.... Is up at Emergiblog. Delightful edition :-)

This article, written by an editor of the Wall Street Journal, describes his career side-trip into burn nursing.

The article is extremely well-written and easy to read. It describes this man's foray into nursing starting at age 40. It also does a great job of describing the bewilderment of being a new nurse, which was my favorite part of the whole article.

It also goes into why he had to leave his short-lived career as a nurse to return to the world of "war and Anna Nicole Smith."

Too bad. The way he described himself, he sounds like the kind of nurse we need at the bedside.

(Thanks to PixelRN for the link!)

I have wondered while occassionally watching "Ebert & Roeper" just where the heck Ebert went off to. Well, I found out today: Ebert had cancer of the salivary gland which spread to his jaw. Apparently the surgery to replace the section of his jaw that was removed did not go well.

He isn't letting that stop him from appearing at his Ninth Annual Overlooked Film Festival, tracheostomy and missing mandible be damned.

I think it's fantastic. I think he's taken a smart step in essentially saying, Yeah - I look different from what you're used to seeing, but it's not my problem. Life happens. We adapt and go on.

Good for you, Mr. Ebert.

Well I bet that got your attention!

I don't really mean it. They're obviously a lovely association and do all kinds of good things and create all kinds of awarenesses.

But one of their most recent recommendations has me and a few of my colleagues a bit angry with them.

We in CCU are required to be certified in Advanced Cardiac Life Support (ACLS). ACLS is more or less a set of algorithms to follow in certain scenarios - stroke, respiratory arrest, heart going too fast, heart going too slow, heart stopping, etc. The original class is a 2 day long affair, and you have to pass a test, and then you're good to go. Those with this certification must renew every 2 years with a 5 hour renewal class and another test.

Our renewal class is divided up into stations. There's a mega-code station (cardiac arrest), a respiratory station, tachycardia, bradycardia, PEA, etc. These stations provide a review of what to do in these situations, what drugs to give, interventions to perform, and most importantly they provide education regarding changes to the recommendations that we learned 2 years prior. I have never been to a renewal class that did not teach updated guidelines, because it seems like they change all the time. An example - 9 years ago (when I first took ACLS) Lidocaine was indicated for Vtach/Vfib, and then Amiodarone came on the scene and they changed the guidelines for Vtach/Vfib to include Amiodarone. (Although to digress - I renewed last May. The new guidelines weren't going to go into effect until June 1st. So although research had shown that the new guidelines were more effective, the training center told us that they would not begin teaching them until June 1st. So we were recertified for the next 2 years on old guidelines. I'm sure this was mostly administrative - having to revamp the books, tests, etc, but it still struck me as very odd.)

Every nurse in a hospital needs to be certified in BLS - Basic Life Support. This is where we learn how to do chest compressions, rescue breathing, and the Heimlich Manuever for adults, babies and children. We have to recertify in this every 2 years as well. If you do ACLS, BLS was automatically included, and you took 2 tests at the end and got 2 separate cards.

As of June 1st, the AHA has directed that BLS no longer be included with ACLS. That it should be a separate course. The nurses I know view ACLS/BLS renewal as a necessary evil. No one likes doing it, it's a long and boring day, you're put on the spot by instructors, there's a test, etc. Mention having to renew ACLS at the nursing station and you're guaranteed to garner a few sympathetic groans. At least we got to kill two birds with one stone. Now we have to take a separate renewal course for BLS. Interestingly, I cannot find any information about this on the internet or AHA's website. We were informed of this change through work e-mail. I have not been able to find any explanation for this change.

It used to be that JCAHO made life harder for nurses. Is the AHA following suit? I don't even know why BLS needed to be cut out anyway - there always seems to be enough time to finish everything. What extra information are they going to give us to make up for losing BLS? How much longer are they going to make the BLS recertification process to justify making it a separate certificate? Right now it's about 45 minutes. Maybe I would feel better about it if the change had been presented along with some convincing information on why they decided to do so.

Not a huge deal in the grand scheme of things, but it's just one more thing we have to take care of piled on top of a bunch of other little things. And that seems to fit my blogging theme of the week.

UPDATE: I just got a letter from work. We can do a BLS/CPR course on campus and the AHA has increased the renewal course to 8.5 hours! Yippee... more time to watch the goofy stroke video and practice intubating a dummy! (I ALWAYS intubate the stomach. Always. They've totally given up on me.)

An excerpt from Codeblog has been included in the Winter 2007 edition of Proto, a medical publication of Time, Inc! Also included were posts from Disappearing John and Digital Doorway! These posts were included in the "On The Blog" section, titled Frontline Frustrations. Congrats to John and Keith!

I had almost forgotten that I was contacted last year to be included. A coworker of mine called tonight and told me that his daughter is an editor of this magazine, so he had a copy. He told me that he recognized my blog name. It turns out that it was his daughter that contacted me about using my post - but she had no idea that I worked with her father! Small world, eh?

And lastly, here's a picture of the most adorable kid ever. Just in case you missed it in the last post :-)

Change of Shift is up! Has it been 2 weeks already??

Welcome to the 20th edition of Change of Shift! I know that St. Patrick's Day has come and gone, but I thought it would make a nice theme for this week anyway. That said, I have come up with a limerick for each entry!* Enjoy!

There once was a man we'll call John
Other's failings he'd not act upon.
Until one sad day,
Day shift caused a delay
And his anger could not be withdrawn.

The fiddly little things that we do
Have taken some practice, it's true.
But having to teach
Is no day at the beach
When your pupil is learning anew.

When cooking for a festive affair
It would do you some good to beware
That amidst all your fun
You did not use onion
And your party ended up with a scare.

As nurses we're somewhat protective
Above all to kids irrespective
Of their haunting eyes
And parents whose lies
Are best told to a thorough detective.

Could a celebrity work as a nurse?
She'd have to put down her nice purse!
A fix for the shortage?
Or wanton reportage?**
But an assistant? I'd not be adverse...

This nurse avoids rocking the boat
Her health she's too scared to promote
You need to take care
Of yourself to repair
It's okay to say no (and I quote!)

A woman comes in with a stench,
So bad that your nostrils do clench.
What would you do
If it happened to you?
Her privates you just want to drench!

Regardless of what your attire
You're a nurse to all who'd enquire
Our conduct can show
How to act like a pro
Of supporting our trade we can't tire!

In NICU there're parents galore
The nurses must tell what's in store
But this mom's at fault
For her baby's assault
And maybe should be shown the door.

When searching for an online community
Nurse sites impress some disunity
When lo and behold
A nurse blogger takes hold
In creating a new opportunity!

Here's one from the opth'mology nurse
A tale that's somewhat perverse
An old cure for the blind,
Sure to boggle your mind
When the patients end up with a curse.

When this southern nurse spins a yarn
About bosses who don't give a darn
She relates how it is
To make friends in the biz
The kind that aren't born in a barn.

There once was a man with a health plan
It took 'bout 3 weeks to have tests ran
This did not fly
Then he found he could buy
His own private medicine man.

It's not easy to work with the dying
Especially with one who is trying
To thwart your good deed
When prayer is in need
Good for this nurse who was uncomplying.***

Yet again it will be Nurse's Week
Our profession is not for the meek!
Give our gala a boost
With these plans introduced
Hurry up now and go take a peek!

Sometimes a nurse comes off rude
Unhappiness they often exude
When a patient needs aid,
They should not be betrayed
By a nurse who is in a bad mood.

An ER nurse sees some gross stuff
Some ailments can be quite rough
And when you dig deep,
Beware what you reap
Those nurses must really be tough.

A couple of bloggers submitted multiple posts, but I could only manage to write one limerick per blog (unless the two posts were related)! Here are the other posts that were submitted:

New Army Surgeon General is NURSE Major General Gale Pollock

Mystic Nurse by Patrick Colwell, RN

*I am not a professional limerick writer, nor do I play one on TV. These limericks do not always strictly adhere to the rather rigid meter of a typical limerickian rhyme scheme, and they might not even conform to the anapestic or amphibrach feet so common with this type of poem. (Is that like writing with two anapestic feet? Ha! If you got that, you're either into very subtle humor, or... well, I've digressed here haven't I?) Anyway, I don't even know what anapestic and amphibrach feet sound like, so I have no idea if I've adhered to them or not.

**Yes,"reportage" is a real word.

***No, "uncomplying" is not.

And finally, this edition of Change of Shift has been brought to you by RhymeZone and thesaurus.com. (Not brought to you in a financial sort of way - more of a "those sites were invaluable to the production of this post" sort of way.) As always, thank you to Kim for this opportunity to host and for maintaining the whole darn thing!

Just a reminder that Change of Shift will be hosted here on Thursday. I've come up with a little theme that I hope you will like (the submissions do not need to have a theme).

I wanted to ask that you get your submissions in by tomorrow (Wednesday) afternoon by 5pm PST at the very latest. But the sooner the better.

Technorati Profile

I realized today that I should start advertising the fact that I'll be hosting Change of Shift here on March 22nd, but PixelRN beat me to it!

Send me your stories, anecdotes, complaints, and praises about nursing, nurses, nurses who are awesome, nurses who aren't, or your grand plan to overthrow nursing care plans! I'd especially like to get some goodies about that last topic... :)

ANYONE is invited to submit something, whether you're a nurse, a doc, a unit secretary, a patient, a family member of a patient, a family member of a nurse - whatever. The post you submit just has to be about nursing! Here are some more guidelines.

I'm very excited to be hosting and am looking forward to reading your submissions. Please send them to codeblogrn at gmail dot com, with "change of shift" in the subject. Yes, this is different from the usual geena@codeblog.com. Yahoo's mail server (not Yahoo mail - just the part that hosts the domains) is acting wonky and I don't want to miss anyone's posts! (To explain just how wonky yahoo's mail server is - I got an outbid notice from Ebay 3 days after I received the email that the auction had ended!)

Be sure to check out Grand Rounds this week, compiled by the first four-time hoster, Grunt Doc! (How do you do sparkly lights and fireworks in HTML?!?)

A great edition to read while you're up in the middle of the night feeding a kiddo :) Way to show us how it's done, Allen!

Grand Rounds is up at Dr. Couz's place. The theme is "the people behind the medicine." Very interesting stuff.

AND it's an early Valentine's Day at Nurse Ratched's place for Change of Shift, the (very sweet) nursing carnival. Enjoy!

I haven't submitted anything to Grand Rounds in quite awhile - mostly because I stopped posting during my pregnancy. The next GR has a theme: "medical professionals as people." I'm not sure that I like themed GR's, but this is one I can write about and contribute to.

Dr. Couz asked that we send submissions about what we as medical professionals do to stay sane and maintain balance in our lives. Critical care is a very stressful specialty (as are most specialities in their own way). We routinely deal with sadness, grief, death, and denial. It can start to build up and sometimes it's difficult to shed the aura of despair once I walk out of the hospital.

I try to deal with this by talking with my husband, by writing about situations on this blog, and by getting together with my coworkers. We get together a couple of times a month for breakfast and during these little meetings, we talk about what frustrates us. We get each other's opinions about some of the patients in the unit, policy changes, new ideas. It might seem odd to get together outside of the hospital to sit there and rehash what goes on in the hospital, but it's very cathartic to talk in a relaxed environment with people who know EXACTLY what you're talking about. It's like having our own debriefing sessions. It really helps and brings us closer together as coworkers and friends. I believe that our unit is very close-knit and that closeness with my coworkers is why I stay in CCU. I don't think I could handle the stress of the unit otherwise.

As for creating balance - well, that is a timely topic for me right now. Before I had Gabriel, I fully intended on putting him in daycare and going back to work 4 days a week, just as I had been doing. But after 2 months of spending every day with him, getting to know him, establishing a bit of routine with him - I find myself unable to envision leaving him somewhere else all day. I hate the thought. It took almost 2 years and many medical interventions before we finally got pregnant, and I am having a hard time with the thought of being away from him so much. I'm afraid of missing his milestones - his first word, first step, first time he grabs for a toy. I don't want someone else to be there encouraging him. I want to be there.

This creates quite a conundrum, however. We could manage without my salary, which muddies the waters even more. It would almost be more bearable to need my salary because then there wouldn't be a choice. But the thought of quitting nursing? Foreign. I went to school for 4 years, got a degree. It's a career. I worked hard to become proficient at what I do. I have relationships through work that are important to me. I fear that those relationships will wither if I'm not there anymore.

Yes, I could quit for now and go back later. But things change so quickly in the medical world... I'm afraid of being totally clueless once I decided to return.

I feel like I owe it to my son to be there with him as much as I can, and it's something that I want to do. With the nursing shortage, I feel like I owe it to my hospital to keep working as a bedside nurse. There is a need there, and I have the ability to fill it.

The great thing about nursing is that it can be so flexible. It's possible to work full time or only a few days a month. A nurse can have a very flexible schedule if it fits the unit's needs. I think it would be possible to work every other weekend. That way, I can be with Gabe the majority of the time and still keep my fingers in the pot at work. I haven't yet discussed this with my boss. I hope she stopped reading my blog :-)

It feels really strange to be writing such personal thoughts on my blog. I know I write a lot of personal thoughts about patient situations, but not my own situation. I've tried to keep codeblog a purely medical blog, so I hope you all don't mind this little journey into my life.

Our son was born on November 24, 2006 after an induction for PIH. He's healthy and adorable and I simply cannot keep my eyes off of him :-)

Introducing the Quadruple Bypass Burger - and would you like a side of valve replacement with that?

Don't expect medical care if you experience your heart attack at the grill:

As a courtesy, the restaurant offers its "best customers" a wheelchair service to their cars by waitresses dressed in slinky nurses' outfits.

The idea, however, has not gone down well with the Arizona State Board of Nursing which has expressed concern that some patrons may confuse the waitresses with real nurses.

How do you get to be a "best customer?" Multiple bypass surgeries?

(Added December 12th): Wow, lots of hostile comments!! For the record, I am not "railing" against the Heart Attack Grill or the fact that the waitresses are dressed up as slinky nurses. I was merely putting it out there as something interesting. I'm more or less in agreement with these two bloggers: Emergiblog and Disappearing John. Basically, it's not offensive to me because it's a parody! I actually kind of think it's a funny premise for a restaurant. Unhealthy? Yes, of course, but funny nonetheless.

And hey - I'm all for the health of the masses, but if you ALL were healthy, wouldn't that put me out of a job?

After 4 rounds of fertility drugs, 3 IUI's, 2 years and 1 IVF cycle (none of which even worked), we are finally parents-to-be!!! We had the "big" ultrasound today and found out that this little guy is, well, a guy. I'll spare the whole darn internet the picture which confirmed THAT. :-)

We are beyond thrilled and can't wait to meet him late this year.

This was written and sent in by Joe, who is a nursing teacher and Nursing Science student. I have already made an account with the Nursing Wiki, but have not really contributed anything yet. I think it's a great idea and could be a great asset to the online nursing community. If you want to add your nursing blog to the list on the wiki, go to the blog page.

On May 1st, 2006 a new Internet project for nursing was started. Since then, a community-driven free database with nursing-specific content is being developed at http://en.nursingwiki.org. Anybody is welcome to contribute. The articles, which are written, extended and edited by volunteers, are freely accessible by anyone, and the contents may be used by anyone without charge.

Thanks to the free encyclopedia Wikipedia, this principle of "free information" has been a well-known phenomenon among Internet surfers for a while. Wikipedia's English version has more than 1 Million entries and is being supported by more than 200,000 volunteers. Since not only the contents but also the software that runs Wikipedia (MediaWiki) are available for free, anyone who is interested can start his or her own Wiki project. The "NursingWiki" was started because Wikipedia articles are limited to encyclopedic entries. For this reason articles containing specific instructions (for example for setting up a nursing plan) are not appropriate for Wikipedia entries.

"Wiki wiki" is the Hawaiian expression for "fast - quick" and illustrates the principle of the projects to quickly and easily create new articles and link them to existing articles. No computer programming background is necessary. Anyone who has ever written an online email before should be able to find their way around the way Wikis work. With the offering of the NursingWiki a development is making its debut in nursing that has been established in other areas for a long time. In software development, the free exchange of information has been common for a long time and has turned out to be a great success. Volunteers collaborate on projects and constantly extend and optimize their work. The NursingWiki works in a similar way. Volunteers create new articles, extend or correct existing articles to keep them current, all without any commercial interest. Since articles in the NursingWiki cannot only be read but also edited, there is a certain kind of "self-cleaning effect" inherent in the Wiki way: only things that gain the approval of the large critical readership will be able to survive in the Wiki. All changes - corrections of simple typos as well as complete re-writings - are being logged in the version history of each article. This offers an overview of the history of each page and makes it possible to undo any potential vandalism through the restoration of previous versions.

At this time there are innumerable discussion forums, blogs and web pages offering nursing-specific information on the Internet. NursingWiki's advantage is that visitors can correct mistakes in the articles right away in an easy manner, and they can also add more information from their own expertise. The NursingWiki site is not meant as competition to other nursing sites, but rather a central place for nursing-related information and tutorials.

The NursingWiki volunteers collaborate on this project for different reasons:

* Nursing students put their class notes and papers on the wiki. For their exams they know where to find all the necessary information to prepare for each exam. Chances are high that the entries have already been edited and extended by other users.

* Many nurses and nursing teachers enrich the wiki with their specific expertise and experience, which are often missing from common nursing textbooks.

* Patients and their family members can find information about diseases, therapies and medicine, and can share their experiences with others.

After about one and a half years (March 2006) the German language sister project "PflegeWiki", which started in August 2004, has more than 2900 articles about different nursing topics. For example there are entries with concrete instructions ("How to put on sterile gloves"), special procedures ("Replacing a tracheal cannula"), profiles of well-known nurses ("Patricia Benner"), information about diseases ("Morbus Parkinson"), and anatomy ("Heart") as well as nursing theories ("Self-nursing deficit"), nursing models ("ATL/AEDL") and articles about nursing science ("nursing research"). Many articles contain photographs or other visual aids, which can also be freely used on home pages as well as for lectures as long as credit is given to PflegeWiki.

The English version NursingWiki has been started to give an international touch to the freely available nursing information. These projects are sponsored by the German organization "Verein zur F?rderung freier Informationen f?r die Pflege e.V.", which is officially hosting the web sites and coordinates user activities and does the necessary PR work.

Since NursingWiki has not been around for a long time, many fundamental articles still have to be written. Therefore we need your help:

Be brave. Contribute and make your knowledge available to everyone.

Welcome to this edition of Grand Rounds! I haven't hosted since last year, but this is codeblog's 3rd time around. Without further ado, here we go:

What Is Inside of Dr. Charles?
THE EXAMINING ROOM OF DR. CHARLES—One man's perspective on the cacophonous coffin.

Breaking The News To Your Thanksgiving Turkey That It May Not Make It To The Holidays
DOC AROUND THE CLOCK—Is the Chinese Health Ministry lying about the true number of cases of avian flu? What impact will this have on a potential epidemic?

Founder of Modern Alienism First to Describe Down's Syndrome
MEDGADGET—Had John Haydon Langdon-Down known that his syndromic namesake had been described almost 30 years earlier by Jean Etienne Dominique Esquirol, I suppose we would be calling it Esquirol Syndrome. Doesn't have quite the same ring, though.

Tamiflu Causing Delirium, Hallucinations, Encephalitis...
DR. ANDY—...Oh wait, but so can having the flu. Is olsetamivir safe?

Nurse Realizes Her Family Has No Idea What Her Job Entails
HEAD NURSE—Nurses see death and the dead day in and day out. It's an experience that our friends and family can't fully relate to. So the next time we come home sad - realize that maybe we had to help usher someone from this world to the next. How would you feel about such a responsiblity?

Homeless Alcoholic Finds Refuge in Non-Judgemental ER
EMERGIBLOG—After sleeping in the rain for 4 hours, this patient lucks into an emergency physician who practices compassionate medicine.

White Coat, Wrong Time
SCIENCE CREATIVE QUARTERLY—Do you wear your scrubs/lab coat out in public places? Do you work in a level 3 lab? I sure hope not.

Medicare Part D(isaster)
OVER MY MED BODY—Listen, people - the government likes to make things HARD. "It is going to take time for seniors to become comfortable with the drug benefit." Sure, but it shouldn't take the rest of their lives. When you're done being confused reading about Part D, go ahead and take a practice run.

Eliza Jane Died of AIDS... But Parvovirus B19 is Still A Possibility
RESPECTFUL INSOLENCE—Let's see - the first 10 differential diagnoses are AIDS, but there's always someone out there looking for zebras in a land of horses.

Headway Made On Vaccine For Ancient Disease
AETIOLOGY—Inadequate vaccines could increase the virulence of malaria, but once they figure out that pesky little issue I'm sure the malaria vaccine will be a big hit.

Termination or Reassurance/Preparation?
RED STATE MORON—Results of the FASTER study are out - testing for Down's at 11 weeks is just as accurate as testing for it at 20 weeks. Even if women with "positive screens" opt to use that information to prepare rather than terminate, will that peg them as unethical - knowingly bringing a less-than-perfect child into the world?

When The Pandemic Hits, Make Sure You Bring Your Lawyer When You Get Your Vaccination
GRUNT DOC—There's only one manufacturer in all of the US that can produce influenza vaccine. Hmmmm... I wonder why that is.

37 Year Old Woman Nearly Dies From Heart Attack. Doctors Stunned.
CLINICAL CASES AND IMAGES—The number one cause of death in women is cardiovascular disease - not breast cancer. Follow the link on this blog to read about a young woman who always thought she'd die of cancer, but instead almost died of heart disease.

Nurses "In The Weeds"
PIXEL RN—Even the most experienced nurses find themselves in the weeds. But what if you aren't experienced?

Monsters In The Bedpan Room
IMPACT ED NURSE—We nurses come across all manner of ... fluids. Here's what happens when the fluids leave your room and come into ours.

Just Chill With The Antibiotics Already
PARALLEL UNIVERSES—Do we need yet another reason for judicious use of antibiotics? Make sure to read the follow up post for clarification/correction of several erroneous news articles.

Blogger Instrumental In Changing Someone's Life
DIABETES MINE—How many of you bloggers out there can honestly say that you've changed someone's life?

Doctors Behaving Badly
THE CHEERFUL ONCOLOGIST—What really happens during the "sign out."

Insurance Companies Come Between Patients and Their Doctors
HEALTHY CONCERNS—"You know you've got a disconnect when the doctor asks: 'would you be willing to pay for service?' and I ask:'Aren't I already paying? Where's my $3K going then?'"

What A Sweet Job These Docs Must Have
HEALTH BUSINESS BLOG—Call up a random doctor and then hang out for 3 hours waiting to actually speak to someone.

News Flash: Press Lacks Nuance and Perspective In Reporting on Medicine and Health
NOTES FROM DR. RW—Irresponsible reporting confuses consumers. What could save your life one day could harm you the next.

The Genomic Revolution Persists Despite Pessimistic Review in WSJ
GENETICS AND PUBLIC HEALTH BLOG—Using gene research to tailor someone's medical treatment is futuristic - but does the complexity mean we should stop trying?

Sometimes It's Actually About Helping People
HOSPITAL IMPACT—In a world where the bottom line is usually the only line, some hospitals and clinics are going against the grain.

What Will They Write Next
POLITICAL CALCULATIONS—These are the kinds of things written when one has been up all night. Maybe this is why it's so hard to get one's medical records

Do You Really Want To Know How Much That Urinalysis Costs?
INSUREBLOG—An interview with Aetna's "go-to guy" about their new program to inform insureds about common medical costs.

Peer Review Goes Online
SUMER'S RADIOLOGY SITE—Let's just get rid of those silly little paper journals.

Harvey Cushing: A Life in Surgery
OXFORD UNIVERSITY PRESS—Isn't it amazing that someone had to come up with the concept of monitoring blood pressure during surgery?

Whew! Tune in next week when Graham at Over My Med Body will be hosting!

Nick at Blogborygmi is of course the "father" of Grand Rounds. He's been very diligent in trying to get the word out about our weekly compendium. Most recently, that has included writing an article for Medscape (registration required) called "Pre-Rounds," where you can find out all kinds of information about that week's host and their blog. This week the article is all about codeblog - how this site came to be and what my master plan is all about. :) Welcome, Medscape readers!!

Happy Thanksgiving!

PermaLink

Grand Rounds version 2.08 is being hosted by Doc Shazam this week! Go read the best of the medical blogs for this week.

For next week, Grand Rounds 2.09 will be hosted right here at codeblog! Email me at geena -at- codeblog -dot- com with your submissions by next Monday at 8pm PST. Please put "grand rounds" in the subject line.

...Over at Medscape Nurse Blogs!

They're blogging about Katrina and what they're doing in the shelters and the kinds of people they're helping. Very interesting. Here's an excerpt:

Sunday afternoon, September 4, 2005: I am blessed to be a nurse. I was tired and had been out of town most of the week on business, returning to numerous e-mails and phone calls literally begging with pleas to help. I felt compelled to assist. My first intention was to donate clothes, pillows, etc. So, my 8 year old daughter and I gathered things up and we headed to the Austin Convention Center to drop them off.

As we pulled in, the chaos was immediately evident. Too exhausted to cry, the masses of people stared blankly in confusion after the military aircraft dropped them off. They were ALL in shock and they ALL needed help. I debated whether or not to take my daughter back home but they were in such desperate need for medical personnel that we made the decision to stay. I borrowed a stethoscope from an EMT, dug out the nursing skills I hadn't used in years, and began to triage patients, choking back my tears after hearing horrific stories one after the other.

There's much more!

DaGoddess writes about the loss of her friend Jamie to hurricane Katrina:

"From the moment I saw Jamie, I knew there was something about her I liked. She always appeared to be the no-nonsense kind of nurse I like to work with and she was really sharp. Sharp enough to know I wasn't one of the frightened little bunnies. As a traveler, you have to be highly skilled, work well with others, and be flexible. The fact that she had extended her assignment on our unit twice before I came along was my good fortune."

Read the whole post - it's a very sweet tribute.

I've already donated to the Red Cross. You can, too.

I was thinking the same exact thing.

Good luck to those who were/are in her path.

I've been asked to get the word out about Grand Rounds this week! There's been a special request for submissions from nursing blogs! Send your submissions by tomorrow (Monday) midnight to corturnix1@aol.com.

Grand Rounds this week will be held at Circadiana on Tuesday.

Whilst perusing my list of hits yesterday, I came across this link... And thought nothing of it. Newsweek? Huh, interesting. It wasn't until I mentioned it to my husband tonight that he clued me in - the content on the website is the same content that's in the magazine!!

Yep, right there in the June 20th edition, page 12. Yes, my mother is proud.

Anyway, if you're here for the gritty blood-spattered bittersweet stories, far be it from me to disappoint! Here are a few of my favorite posts:

Looking for something gritty? A Day In The Life could certainly be described as such. It's a very long post, and days like that don't come along often. (Thank goodness!) Or maybe you'd rather read about the difficult conversations that we have in CCU?

Are you more into gore and blood? Watching my first (and only!) C-Section seemed a bit gory, even more so because it was happening to my very good friend. It was fascinating to be on the other side of the sterile drape. A much sadder post describes an exceptionally horrendous call as written by an EMT. This stuff happens every day.

If bittersweet is more your speed, this post about a nurse who took care of her former nursing instructor as she lived out her final hours could qualify. Ummmm, yeah - only one bittersweet post in 2 1/2 years. Sorry!

Have you ever wondered what it's like to be in an ICU sedated on a ventilator? Here's a patient's perspective. I'm surprised she even remembered it.

Of course, it's not all stress and sadness. There are plenty of funny moments to be had in the CCU. Patients who wake up after prolonged cardiac arrest are a real plus. And it's all worth it when the person you coded yesterday is brushing her hair today.

So. Any other medics have any stories to share??

Welcome to Nursing Moments II, the 2nd installment of the Carnival of Nursing! These posts are written mostly by nurses, or by others about nurses or nursing. Because codeblog focuses mainly on personal experiences in the healthcare world, most of these posts follow in that vein. (Ha ha! Get it? Vein!!) Anyway, we have a great array of posts for you to read. Enjoy!

I'm sure most of you know the popular saying that "nurses eat their young." This post from Head Nurse has touched upon a few instances where that wasn't the case, and has some handy tips as well. New grads would be smart to read it.

Mediblogopathy writes about a very smiley baby that followed her from one clinical to the next. As nursing students, you rarely come across the same patient twice, so it's interesting when you do.

Nurse Ratchett's Alter Ego lulls a child to sleep and explains why some children in psych wards fear the night.

Thinking Nurse engages in a debate with RNegade about the extent to which social consciousness should influence nursing, and the degree to which this should be encapsulated in Nursing Theory - for example a 'Theory of Nursing as Human Solidarity'. Thinking Nurse warns that this is "meaty stuff."

Blue pads (or "chucks" as they're sometimes called) come in handy for an array of disasters. The Unlikely RN says she will feel a twinge of aviary sadness when using these pads in the future after what happened to her on a home visit.

About A Nurse describes how easy it is to become overwhelmed as a newbie nurse. Heck, it sounds a bit overwhelming to this not-so-newbie nurse.

Crzegrl is a Nurse Practitioner who was hired explicitly for her "nursing intuition." She relates a scary story about a nurse she came across who lacks this intuition, and how she averted what could have ended up in disaster.

Time To Lean had an especially odd nursing moment involving a patient's mother's fear of the poison fluoride. Yes, you read right - that stuff that's put into tap water.

Next up is a post from The Babalu Bark, written by a woman who is learning to take care of her ill mother. The post that I have chosen is not the one she submitted, because I think this post really describes what it's like to start taking care of someone who used to do the same for you.

Lastly, Coral writes: "Yesterday towards the end of my shift, I wheeled a diabetic patient to the male toilet in a commode. When I wheeled him back and parked him right next to the bed his eyes looked towards the bed next to his bed vaguely and he stated: "There's a pair of legs on the bed" I said, yes, there's a patient, a man on that bed. There was a pause while I looked at him and noticed his eyes were squinting slightly and out of focus.. Then he said, "Well if there's a man on my bed I don't think I want to sleep on it anymore." I showed him that his bed was empty (Uncle, this is your bed) and proceeded to transfer him, but his eyes kept wandering to the other bed longingly... Needless to say I was reminded of one of those stories in Oliver Sacks' book (The Man Who Mistook His Wife For a Hat) about a man who kept insisting that the legs in his bed are not his and would someone take them away from his bed!"

Thus concludes this edition of Nursing Moments! Check out July's edition, which will be hosted by Nurse Ratchett's Alter Ego.

Last call for submissions for the 2nd Nursing Moments carnival! Send to geena at codeblog dot com or use the "story submission" link at the top. Anyone can submit any story as long as it has to do with nursing. I'm hoping to post it on June 3rd.

Grand Rounds have returned at Iatremia: The Chaplin.News. Very quotably, I might add.

Also a mentionable: Kelly at Time To Lean has hosted Morphine's 200th birthday party!

Hi! I just returned from New Orleans, where I went to NTI. It was held in New Orleans this year. New Orleans is a fascinating city; I definitely recommend visiting sometime if you haven't already.

The first edition of Nursing Moments, held at Thinking Nurse, was a hit. It will be hosted here on codeblog next month. Please submit your story for Nursing Moments to me at geena at codeblog dot com, or feel free to use the "submit your story" link. Any stories having to do with nursing are welcome; you don't have to be a nurse to submit. Email me with any questions. Stories are due by June 1st for a possible June 3rd posting.

Just wanted to direct you to Thinking Nurse's blog. He has posted the very first Carnival of Nursing!

I also wanted to point you in the direction of Mediblogopathy's recent post, Flying Solo, Nurse Is Enough. It's about a nurse that was the only "medical professional" that stood up when one was needed on a plane. Quite intriguing!