International advocacy

June 8th, 2018 No comments

KenyaWorldMap-2in42u7-632x365So, this was a twist.  I got a message from my sister in law, looking for advice for her friend, who runs a mission in Kenya with her husband who is a pastor.  He had suffered with an infection in his lower leg for many weeks.  The doctors called it cellulitis, then he got a large sore that opened and drained a lot.  They saw a doctor and were given oral antibiotics after they did a culture and sensitivity of the drainage  to determine the correct medicine. According to his C/S report, he was on the correct antibiotics.  He was not responding. He developed another small sore and more redness,  his drainage didn’t stop and he had more pain.  She posted this photo.  I have seen this kind of thing so many times.  I offered this advice.  Go back to the doctor. Ask about IV antibiotics. Cover it so the children they care for in their home/mission do not get MRSA (staph).  Don’t mess with it because it could affect bone and the joint.   She got a ton of other advice, some much more technical on her FB page.  The next day he went into the hospital.

His infection was surgically cleaned out and he was put on IV antibiotics.  Today,, only 2 days later,  his lower leg is the normal size for the first time in many weeks.  This is definitely a blessing.

These incredibly generous and loving people have shared their story and experience and agreed to let me post some photos of the hospital they are at in Kenya.  This hospital is the best one there according to this woman.  I am sharing all of this because we often complain and worry about our own hospitals, and care and safety while getting care  This is not unfounded worry, but sometimes we forget what we have.

After this pastor had his surgery, his wife found him in a hallway, alone, and out of it.  They anticipated local anesthetic, but instead he got general anesthesia for his surgery. This wasn’t surprising since it is so  hard to anesthetize infected areas.   He was not being monitored, no pulse oxymetry, no nurse around.  His eyes were open but he had no idea what was going on.  This was extremely scary for this couple.  Think about post op arenas here in the US…with cardiac monitoring, nurses close by, , pulse oxymetry and pain control.

I am sharing these photos to show how stark and minimal the hospital setting is.  We are very fortunate here in the US.  I know not all of our facilities are equal, and I know that patient safety is a huge issue, but we must be thankful for what we do have. Despite the spartan surroundings in this Kenyan facility, this young Pastor is healing.

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They have only recently gotten this clear tape for IV ports.  They used white adhesive before this with bad results..not being able to see the site well, slipping etc.

 

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“Amenities????. Slippers, toilet paper, toothbrush, Colgate (any brand of tooth paste is Colgate here), body soap, mafuta (Vaseline) and a bath towel (it is the size of a hand towel). Oh and if you run out of any of these things during your stay you are required to purchase your own”

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“Toilet, shower and sink all in one small space. Notice there is no toilet seat/kid, that is the Kenyan way.”

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“The shower side and for the most part they keep this hospital very clean!”
I was so happy to help this couple.  They love and care for sick and malnourished children every day.  The response to a request for help came back to them in spades.  And it seems that he is now over the hump with this serious infection.
UPDATE:
He much better and he is being discharged.   She shared his bill with me.  This bill is in shillings, which is equivalent to a penny in the US. So, the total bill for 3 days in the hospital, surgery with general anesthesia, and IV antibiotics was a around $1400.  Here is a photo of the second page of his bill.
She also shared that she believes that the reason his infection went on for so long is that there is no real medical record, and if they see a different doctor for the same problem, there is no communication from one doctor to the next, thus no continuity.
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The Power of Our Patient Safety Action Network (PSAN)

May 10th, 2018 No comments

 

Networking

Networking

The most gratifying and inspiring part of my Patient Safety work is when I can help someone who has been harmed by their healthcare. Although I am a retired RN, I certainly do not have all the answers to people’s questions.  That is where my expert patient safety colleagues come in.  https://www.patientsafetyaction.org/

Last week a friend asked if I would talk with Jane (fictitious name), who is a friend of her sisters.  Jane lives in New York State and had a robotic radical hysterectomy for endometrial cancer.  She is 70 years old.  Her surgery was nearly 2 years ago, and she is still working on her recovery, with Pilates and trying to improve her abdominal muscle tone.  She has come a long way in her recovery, but she isn’t done and 2 years is a long time for recovery from Robotic assisted hysterectomy.

I had the same surgery and it went very smoothly.  I recovered in a very short time, and I had no complications or lingering disability.  I was operated on one day and I went home the next.  I only took Tylenol occasionally for very mild pain.  In just a few weeks I was back to my old self.

Jane had a completely different experience, although she planned on one like mine.  During her surgery the robot failed. Her doctors exact words were “The f*^#ing machine just stopped working”.  As a result, her vena cava (assuming it was her inferior VC) was nicked, and she had a serious hemorrhage.  In order for the surgeon to find the bleed, her belly was opened from  the bottom of her sternum to just above her pubis.   She woke up in the ICU after a 6 hour surgery.  She  has suffered with brain fog and a number of physical issues that required a lot of rehab and physical therapy.  She has a long zipper like scar from the top to bottom of her abdomen, unlike my own 5 barely visible  scars.  After hearing about her experience, friends advised Jane to seek legal recourse.  Three attorneys have looked at her case but have not taken it anywhere.  So, Jane did not know where to turn next and she felt very alone.

Obviously, I can’t fix Jane’s problem, but because of my network of patient safety experts in PSAN, I knew who to ask for help.

1. I messaged a PSAN member who is an expert on patient harm data from the volumes of reports to the FDA.   She gave me info for Jane on where and how to report her experience. Jane was astounded to learn  that there are over 20,000 FDA reports on the Davinci Robot.  Jane felt totally isolated  with her problems, until she learned about this.  Her doctor told her she was the only one he was aware of.  That may be true, but she is certainly not the only one in NY or the US!  https://www.accessdata.fda.gov/scripts/medwatch/index.cfm?action=reporting.home

2. I wrote a brief email to the Consumers Union Safe Patient Project Email listserve with a brief description of what had happened to Jane and asked for suggestions. This email listserve will soon transition to the PSAN.   I got responses from 3 esteemed colleagues.

The first response came from a man who has also been harmed under the Davinci Robot.  and he also recommended that Jane report on the FDA website, and to check if her hospital has reported this robot  failure to the manufacturer.  If not then they are in violation of reporting requirements.

Angie recommended that Jane join the Unplug the Robot group,  http://unplugtherobot.blogspot.com/  and sent along the email address of the leader of that group.  This puts Jane in touch with other women who have had very similar experiences as her.   The group also has information on expert attorneys who handle the same kind of harm that she has suffered.

Then a PSAN member who is an attorney emailed me.  He offered to talk with Jane.   He  told me that there is no class action lawsuit against Intuitive (makers of the Davinci Robot) which was a surprise.  He said the robots are used for too many different kinds of surgery to do a class action.

Four amazing colleagues in our network responded to me about Jane’s dilemma over 2 days and I have passed on all of this information to her.  I guarantee that she no longer feels alone.  There is nothing any more isolating than being sick or in pain, and knowing it is because of a failed device, or a preventable human error.   People who have not experienced anything similar are uncomfortable with this kind of conversation and there are no local community support groups.  Efforts are made by doctors, hospitals and device makers to keep these things under wraps, and that is even further isolating.

In this quest to help Jane,  I have learned so much.  This is what our PSAN network does.  We learn, we share and we help.  We are a family of expert patient safety advocates.   The value of that in our Patient Safety work ,our own lives and the lives of those we help is immeasurable.

Thank you.

 

 

Insulin Pricing

March 10th, 2018 1 comment

Rising insulin prices

March 11, 2018

A Patient Safety Dilemma

Patient safety awareness week is March 11-17, which this year occurs at the same time as the Right Care Alliance campaign targeting insulin prices. At first glance you might not think these two events are related, but as an active patient safety advocate and member of the Right Care Alliance, I believe that insulin prices are a patient safety issue. Here’s why.

When I graduated from nursing school in 1970, the price of a vial of insulin was just a couple dollars. Insulin is a life, limb, eyesight, heart, skin, foot saving medicine for diabetics who are dependent on it. Without it, the heart and circulation are harmed and many patients lose limbs.  Patients can go blind and kidneys can fail.   Skin integrity can be compromised in the form of skin ulcers.  Healing is sluggish or impossible. Infections are common and harder to treat.   Diabetes is a pervasive disease, but it can be treated and well controlled with medication (insulin), diet and exercise.  Type I, insulin dependent diabetes can affect people of all ages including children, and is the most severe form of the disease.  About 7 million Americans rely on insulin.

We have had insulin for almost a century.  It was developed in 1921.  The patent rights were sold just a few years later for $3.  The PATIENTS rights to affordable insulin were sucked up by big Pharma in the past few decades.

During a talk with healthcare professionals and patient advocates Dr Kasia Lipska, a Yale School of Medicine Endocrinologist, shared  “a patient’s recollection that a vial of insulin cost $1.49 in 1972, which would be $8.86 now when adjusted for inflation. In 2004, that same vial would cost $60, and today it would go for roughly $300, she said. Improvements in performance are no longer justifying those spikes in prices, she said.”  http://insulinnation.com/treatment/how-insulin-became-so-expensive-a-history/

So, we have gone from a couple dollars for a vial of insulin to $200 or $300 for that same vial.

This is such an egregious abuse of patients and their pocketbooks.  Like dialysis, patients cannot live without it.  They will suffer the effects of uncontrolled diabetes and probably death if they are Type I diabetic and they cannot afford Insulin.

This is a huge Patient Safety issue.  The industry that produces this medicine deserves to make money.  They are making life saving medicine after all.  But, do they have the right to price it so high that many patients are forced to go without or to ration it?  Should patients suffer or die because they can’t afford necessary medicine? Certainly not.  Even with prescription insurance, benefits cap out way before the end of a year and then patients are forced to pay most of the costs themselves.

There have been baby steps to cover more patients for this kind of life saving care and medicine.  The ACA allowed kids up to 26 years of age to stay on parents insurance coverage, and they eliminated the preexisting conditions exemption or up pricing.  But, even with that, most average citizens 26 and over, cannot afford an additional $300 to $600 a month for insulin and diabetes supplies.  Even copays cap out and they may end up paying out of pocket before the end of the year if they have prescription coverage.

No Insulin dependent diabetic should be forced stop taking or rationing their insulin. This guarantees a bad outcome or death.  This is the worst and most preventable Patient Safety breach of all, and just to feed the greed of big pharmaceutical companies.

Perhaps it is time for Federal regulators and CMS to look at Type I diabetes the same way they look at Chronic kidney failure.  Insulin for diabetics is the same as dialysis for CKF patients.  It is a means for survival.  Everybody should be covered for that lifesaving care through Medicare, regardless of age, and the price of treatment should also be regulated.  We must find a way to control corporate greed and to stop manufacturers from pricing medicine so high that patients in need cannot afford it.

We in the Patient Safety movement have worked toward transparency and accountability in healthcare. We have pushed for increased reporting of healthcare harm and we can do this with the pharmaceutical companies.  We can go after State or Federal legislation that requires reporting of any patient who has died because they could not afford their insulin.  We have networked so that we can always find a voice for any relevant newspaper, TV or radio news interview or investigative report on a patient safety issue.   We have infiltrated all pertinent government committees, private and public conferences and events, by submitting abstracts, and becoming part of the program when possible. Sometimes we simply attend and we aim to bring the patients voice to the conversation.  We have picketed outside of hospitals and events where we were not particularly welcomed. We have worked with Federal and State agencies who write the rules and recommendations and who fund them. We volunteer on patient advisory boards for government agencies, Hospitals, and medical organizations.  We work independently and with each other to help the work toward elimination of healthcare harm.  It’s time to pull together and target the Pharmaceutical Industry, because their greed is harming patients.

 

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Comity in Patient Safety Advocacy

February 5th, 2018 3 comments

 

anger

 

 

 

As a patient safety advocate, I have dealt with a lot of discomfort.  My early encounters/discussions with organizations and others about healthcare harm were frustrating and enraging at times.  Others in the room didn’t know how to take me or even what the heck I was doing in their special  inner sanctum.  I was often dissed and interrupted rudely, but I refused to walk away.  The reason for my work and the source of my passion was my father’s preventable death from an infection he caught in the Hospital.  I had heard enough of Dad’s doctors’ lame excuses and I knew that half of what they said was either to cover up their hospitals carelessness or outright lies.  The biggest lie of all was when they said “These things happen and there isn’t much they can do about it”

When I set out, my attitude wasn’t great.  I told others that my father’s hospital would regret what they did.  I was hell bent and I was going after my perceived enemy.

My first important foray was helping my local Maine representative write a legislative proposal for the prevention of MRSA.  It was time consuming extremely detailed work.  I was driven and I loved it.  My State legislator recommended asking my old union, Maine State Nurses Association, to lobby my bill.  I did that.  I attended a meeting of their leadership and shared Dad’s story.  I asked for their support.  They granted it.  The media was there and we all answered questions about why I was doing this.

Without the help of those nurses, I’m not sure where that legislation would have gone.  With their help, we got a law passed to screen hospital patients for MRSA.  My representative and the nurses taught me the law making process, which I was clueless about.  Some of the nurses in that leadership group were nurses from my father’s hospital.  That was extremely confusing and uncomfortable for me and for them too.  It muddied my attitude toward the offending hospital.  A few of them would not walk with me at the State House and lobby beside me because they weren’t sure if they wanted to support my proposal or not.  It was hard to deal with at that time, but it also made me begin to dissect my thinking and anger.

I have become friends with many of the nurses from my father’s hospital.  They now support my work and my goals.  I have helped them, the same as they have helped me.  I attend the annual MSNA conference and bring the “patient’s voice”.  My voice is different, because this patient is also a nurse. But, the difference is that I am a liberated retired nurse and I can use my voice in ways and in places that an employed nurse cannot.  It could jeopardize their livelihood if they spilled their guts publicly.  When the nurses expressed their concern about a corporate dialysis company coming in to take over my local clinics, I created a campaign to try and stop the purchase.  I was convinced that it was not good for our community, the nurses or the dialysis patients it would affect. That corporation was known for hiring cheaper staff, having poor RN to patient ratios, and being a blatantly PROFITS over PATIENTS organization.  The corporate business attitude spills out in a lot of destructive and dangerous ways.   That purchase went through regardless of our campaign, and it affected a number of my nurse colleagues.  It’s my understanding that all of those MSNA  dialysis nurses who worked in my local dialysis clinics, left their specialty work and their new corporate employer within the first year under the new ownership.

At last year’s annual MSNA meeting, I gave a passionate comment about how important it is for them to DEMAND safe staffing levels, and NOW is the time. I told them I am getting old and I want safe staffing levels when I am a patient in the future. I encouraged them to go after mandated nurse to patient ratios at the State and National levels.    I worked for decades as an RN in places that understaffed and endangered patients.  I don’t see the point of continuing to endure those kinds of working conditions and patient safety threats.

I am still angry about my Dad’s death, and that he died because of a hospital acquired infection.  But, I no longer let the anger consume me and control my work.  I don’t let it influence who I partner with to get the work done.  The work is about making healthcare safer and that means we have to work with people who are inside the healthcare system and people who regulate it.  Exactly how far would I get if I was angry all the time, raging, yelling and interrupting conversations.  How many conferences meetings, councils, committees and summits would welcome me at if I didn’t LISTEN as well as SPEAK?  How much would anyone pay attention to me at all  if I didn’t use my sense of humor and come across as a caring human being?     How can I get respect if I don’t give it?  If I alienate the very people who can make necessary changes and put them into practice, how far would I get?

I have learned to never prejudge entire groups of people or entire facilities because they are associated with the harm that my father and so many others have suffered.

When I started out I had two goals.  They were to stop MRSA infections in Hospitals, and to make sure no one else would ever suffer and die because of preventable harm, like my father did.

Today, 9 years later, I wouldn’t be one step closer to my goals if I had allowed my anger to control my work.

 

 

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I’m a nurse and my country needs me

January 17th, 2018 1 comment

Our TV drones on day after day with more and more outrageous stuff from Washington DC.  He said , she said, he lies, she forgets, he says one thing, she says another.  What is the cure for all that?

My Country calls me.  It is time for this old retired RN to come out of retirement and to serve our country.   I must do this while I still have hair on my head.  Pulling  hair out of my own head is a daily thing now.

Here are some excellent nursing measures I can use when I go to DC.

earirrigation

 

 

 

 

1.”I didn’t hear that” seems to be a pretty regular response to Senate, Congressional and FBI questioning. I can do a mean ear irrigation.   Things are said, some things much saltier than others, and crass and gross.  I always hear that stuff.  I don’t have difficulty hearing it when it is around me, and I am darned near 70!   So, if those Secretaries, and Senators and Congressmen, and aids cant hear,  I have a nursing measure.  I will bring a large irrigating syringe, an ophthamoscope, some peroxide and basins and I will irrigate those ears so they are sparkly clean and clear.  Wax be gone!  If that doesn’t work, they I will get them  hearing consults and hearing aids.

 

memory

 

 

 

 

 

2. “I don’t recall that“  This is the top response to questioning in DC. Is there something in the air or water down there.  Is there an outbreak of selective dementia?  Every one of those respondents who say that should get a memory assessment…I can do that.   I don’t have a nursing cure for selective memory loss ,except maybe putting your cell phone on record, so your defective collective memories don’t have to be intact.  Unfortunately, there is no irrigation to clear the fog between your brain synapses.

 

inserting IV

 

 

 

 

 

 

3. “He/she didn’t say that”  Lies are another thing altogether!  Lying is bad and it gets us nowhere. It hurts the liar and it hurts the listener.   The only cure for lying is an opposing truth.  Tell the truth.  The American people deserve it and that is who you work for.  If telling the truth will lose you your job, that is pathetic.  Is it worth it for you to lie (sell your soul) to keep a job?   Another cure for lying is starting an IV and injecting so called  “Truth serum”.  I can do that.

 

soapmouth

 

 

 

 

 

 

 

4. Smut talk, like S hole, S house, F this and that.  My mother and the generation before that had a cure for this kind of talk.  Potty Mouths got their mouths washed out with soap.  A newer trend is eating laundry pods.  Either way, mouth soaping may be a reminder to our leaders, who should be an example for all of us, including our children, to keep the language respectable and clean.   Please note that this is not a recognized nursing procedure.

 

 

enemakit

 

 

 

 

 

 

 

5. FOS.   Old nurses remember HHH enemas. I can do those!!!   “High Hot and Hell of a lot” enemas could clean out the fullest, most impacted bowels.  We mixed up a soapy solution with steaming hot water, hung a bag full of it on a pole, hooked up and inserted a lubricated tube.  Let loose…to let it loose.  After we were done, the recipient was no longer FOS.  That doesn’t mean it is clean enough to kiss or to crawl up in there and to lose your own perspective.   I think this may be the most important nursing measure we could use in DC…because there seems to be way too much S floating around, figuratively, and in important discussions about the future of immigrants and all of us in this country.

 

 

Immunization1

 

 

 

 

 

6. Immunizations.  Inoculating our leaders for contagious and infectious diseases may be another way to stop the rampant widespread lying, deafness, forgetfulness, and foul stinky language.  I’m not sure there is a vaccination for that, but certainly we can call on the CDC to help develop one.   I can give 49 or 50 shots an hour…  Yes, I can do that.

Just line em up.  I promise to be gentle.  This old nurse is ready to use her skills and get our leaders in tip top shape.  We need them that way to help us to move forward.

 

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Do you know what an SIR is?

November 5th, 2017 2 comments

I am both a retired RN and a healthcare consumer.  I have attended dozens of meetings about Hospital and Healthcare associated infections, or HAIs. I do this because I think it is essential that healthcare consumers (simpler term is PATIENTS) should have a voice in the decisions surrounding HAI prevention, transparency, reports and policy, and over the past decade, the State and Federal governments came around to believing the same thing.  I am an official member of the State of Maine CDC HAI collaborative and I represent consumers.   A few days ago there was a member of the public in our meeting  I tried to listen to the conversation through her  ears.

This is what happened.   Right off the bat, acronyms were used that she, and possibly others in the group do not understand.  Beyond that, some of those acronyms are used in public reports.

It isn’t intentional when professional infection prevention professionals speak in complicated lingo, it is their everyday language.  But, when consumers are part of the conversation, the very least that could be offered is a printed glossary of terms for newcomers, and for some of the people around the table who do not do this work every day, like me and a few others.  I know for a fact that other regular members of our collaborative don’t understand all of those acronyms or terms that are tossed about during our meetings. .

So, what exactly is an SIR?  It is an acronym for “Standard Infection Ratio“. It is a way that the CDC, both State and national, reports infection rates.  The SIR is a risk adjusted number that is reported that includes the number of expected infections,  by facility or by State, or Nationally.  For example, if a big trauma center that accepts the most complicated patients has a higher number of “expected” infections, that is somehow formulated into their SIR. There is also a risk adjustment for teaching hospitals.   WHAT???!!!!   The actual number of infections is not reported when using an SIR.  The mean is the number 1, and anything under 1 like .48 is on the better side of 1 and anything above 1 , like 1.4,  is on the worse side.  Under 1 means fewer infections, and over 1 means more infections. Contrary to most reports, a higher score does not mean a better score.   So, is that now as clear as mud?   After all my years of these meetings, I’m still not 100% sure this explanation is totally accurate, but it is close enough.

So, what does having an SIR in an infection report mean?.  Well, one thing that it means is that Hospitals (or entire States)  can actually HAVE an expected number of infections and that is figured into their SIR report.  That is how the final reported SIR numbers are risk adjusted.   REALLY??  It seems to me  that expected number of infections should always be ZERO….always.   Zero expected infections is exactly what I and I assume all patients expect from any Hospital, so why can they have anything above that as an expectation, no matter what or who their patient population is.  I know this will stir up some discussion and anger from the larger hospitals that claim they care for all the most complex patients, but they also have the resources, the staff (we hope!), and the experts that smaller facilities do not.  And, it is their job although challenging, to keep all of their patients infection free. Nobody ever said elimination of infections would be easy.

This incomprehensible methodology is routinely used to create public reports on infections.  Then the experts who create these muddy reports have the nerve to say that patients do not understand infection reports.  Of course they don’t. A lot of doctors and nurses don’t understand them either.  They don’t know what an SIR is.  Creating a report that even some professionals don’t understand is a disservice to patients and consumers.  How about this approach for a change?  Report actual numbers, not SIRs.  For example,  report the number of hysterectomies the hospital performs every year, and the number of those patients who get a surgical site infection (SSI) as a result.   Hospital A does 1500 hysterectomies (all varieties) every year, and 3 patients get an SSI.  Or, Hospital B performs 50 such surgeries and 3 patients get an SSI. Even with my limited mathematical skills, I can figure out which hospital generally gets the best results regarding infections.   This type of report is useful in two ways.  It gives the volume of procedures done, and it also gives the number of infections that occur, both very important pieces of information for patients.  As a patient, I don’t particularly appreciate or understand “risk adjustments” that help hospitals have a better infection report, I just want to know exactly what my personal risk is with a particular facility, doctor or surgeon.

If Hospitals and entire States are going to publicly report infections, as they absolutely should, make the report useful to everyone, not just to infection prevention professionals and other savvy experts, who actually understand these wonky reports.  Consumers will use that public information to make choices that could very well affect their lives and pocketbooks.   Preventable infections cause horrible suffering and sometimes death,  and they can tack on a huge amount to an already high hospital bill.  We want clear, accurate and easy to understand information about infections.  Creating a public report that only infection professionals can decipher is not really a public service.  It only serves the experts who can understand it.

This has been my brief but spectacular explanation of and opinion about the SIR!

http://www.maine.gov/dhhs/mecdc/infectious-disease/hai/documents/2016-hai-annual-report-maine.pdf.pdf

http://www.comparemaine.org/

http://www.leapfroggroup.org/hospitals/search/list/states/Maine

https://www.cdc.gov/hai/surveillance/progress-report/faq.html

https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/nhsn-sir-guide.pdf

 

Healthcare.Benevolent human service or exclusive, discriminatory and profitable business?

September 26th, 2017 No comments

I have been a nurse for almost 50 years.  I trained in a  Catholic school. My training was similar to the military in that you start out very low on the totem pole and gradually build up.   I was very proud of my work and accomplishments.  Nursing school was no easy task.

I learned a lot from a nun that was an instructor.  I loved this very smart and tolerant woman.  She did not believe in birth control except for rhythm.  But, she gave out information about other forms of birth control.  Because of her dedication to Jesus and her beliefs, she couldn’t in good conscience teach us details, but certainly as nurses we should know the basics. Every patient deserved the care of a well educated and non judgemental RN.   Other things I learned as a student nurse were that regardless of race, religion, nationality or background, we were to treat everyone equally and with respect and regard.  We were given the privilege of holding the lives of human beings in our hands and caring for them.   Why can’t that simple concept play out in our current healthcare discussions?

When people say they don’t want to pay for anyone else’s healthcare, most especially people who are fat, or who smoke, or immigrants, or drug addicts, it makes me cringe.  Who would be the gate keeper for such discrimination?

Consider this.  I worked as triage nurse in an ER for many years.  Of course in an ER, nobody is turned away (which is exactly as it should be).   What if I had to sit at triage of the entire healthcare system.

#1 Patient.  60 year old male, overweight, short of breath, cyanotic.   High blood pressure, rapid pulse.  He recently quit smoking, was until recently  employed in a challenging paper mill job, and is on his second marriage with young chldren at home.  Because he lost his job, he and his family are currently without health insurance coverage.  Going by the rules of haters, I would have to deny this man healthcare because “someone else would have to pay for it”.   And he would not be able to ever get insurance again, at a decent price because he is now a “preexisting condition”.

#2 Patient.  12 year old female.  High fever, flushed face, rapid pulse.  Lethargic.  Not responding to commands appropriately.  Parents recently immigrated, and do not have insurance. Although this child is obviously very ill and may have sepsis, I have to turn her away because “someone else would have to pay for it”

#3 Patient. 30 year old female, 34 weeks pregnant, no insurance, no Medicaid because of recent cuts, no prenatal care. Very high blood pressure, and headache.  Fetal heart strong.  I would have to turn this pregnant lady (and her viable fetus) away  because “someone else would have to pay for it”   Her pre eclmapsia may kill both her and her baby.

#4 Patient  24 year old male, recently ODed on heroin.  He was saved on the street by a cop using Narcan.  He knows he has hit rock bottom and he seriously wants to go through a rehabilitation program and get clean.  Nope, he can’t come in because “someone else would have to pay for it”

#5 Patient.  92 year old woman, who has dementia. Recently kicked out of her assisted living facility because her money ran out.  Because her Governor refused to expand Medicaid and her President pushed for a plan to cap, block grant and reduce it, she has no coverage for her needed Dementia care.  Her routine and her care  is disrupted.   She is confused and agitated, because that is what happens when a dementia patient’s routine and surroundings are changed.     I wouldn’t turn her away, because she is my mother and my husband and  I would have to pay for it and do the best I could to care for her ourselves.   This rolls the cost of care rock downhill because we will spend our savings on her care. Good luck to us when our time comes.

#6 Patient.  55 year old male, pimple on his butt and runny nose.  Wants immediate care.   Great insurance coverage, and tons of money.  Come on in!

The thoughts of ANY patient being refused care are very upsetting to me.  It is against the nature of a well trained nurse or any well trained healthcare provider.  We didn’t go into our line of work to reject human beings from the “system”.

Exactly how many people would suffer, get sicker or even die if we started turning away very sick patients who are under or uninsured.  We are human beings for crying out loud.  We as part of the human race should be looking out for each other and taking care of each other.  I truly believe that everyone in this country deserves  healthcare benefits and access to quality affordable healthcare.   Our taxes would be better invested in human beings than in Wall Street.  Rather than sending billions  or trillions of dollars,, skimmed off the top for healthcare profiteers, we should be investing in the health  and care of Americans.  With proper governmental regulation, and oversight, and kicking corruption and profiteering to the curb, we can do this.

It’s time to turn our healthcare back to an everybody in and nobody out human service.

Medicare for all.  Healthcare is a human right.

addendum:  All except one of the above “patients” are fictitious, and they could have benefited from regular care in a doctors office rather than reaching a healthcare crisis.

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What did we learn from Alex Wubbels?

September 4th, 2017 No comments

If you are a nurse and you are paying attention, you have seen the video of Alex Wubbels RN, super nurse hero, getting assaulted and handcuffed by a bully cop.  Now I don’t hate cops.  In fact I have loved a number of them in my lifetime.  I had a favorite uncle who was a cop.  I had cops help me when I worked as an ER nurse.  Cops have stopped at traffic accidents that I have stopped at and helped tremendously.  Cops do dangerous and difficult work on a daily basis, but it does not put them on a pedestal.   They are not allowed to make up the law as they go along and they cannot harass and assault innocent citizens “just because”.  The cop in this video was a bully and a jerk.   If he had half the professionalism that Alex Wubbels had, this would not have happened.

What have we learned from what happened to Alex?

1. Nurses MUST know their hospital policy about patient’s rights to safety and privacy.  Without that, you don’t have a leg to stand on.  You can’t just say NO because something doesn’t feel right.   Patients, when you are alert and able, you should also know your rights.

2. If you are being assaulted by ANYONE, yell and scream and object loudly.   Not that this did Alex any good at all. I think her coworkers and the hospital security in this video were dumbfounded and maybe did not dare to step in.  I’m giving them a lot of credit here, because I think they should have stood around their coworker while someone called administration AND the police chief.  Of course I wasn’t’ there, and I am just a distant observer.   I have to ask…would that cop have done this to a man?  (makes the cop even more of a jerk in my eyes)

3. Keep saying  “I have done nothing wrong”.  She did this and she was right.

4. Make sure your administration has your back.  NEVER EVER face off with a cop especially one that is like the one in the video, on  your own.  Have your administrative back up right there, not on a speaker phone.  Just as when facing a violent patient, a cop can turn.  This cop turned.

5. Allow the aftermath process to take it’s course.  Alex is doing that. She is incredibly wise and patient.  She has accepted the apologies of the Salt Lake City mayor and police chief.  There is an internal and a criminal investigation now.  She will not say she wants that cop fired (like I have said repeatedly to anyone who will listen to me).   She is waiting until the process is finished, and in the meantime she has left all of her personal options on the table, like legal action.  She is a very smart and generous person.  I want her for my nurse if I am ever sick in SLC.

6. She is using her personal and traumatic experience to help teach other nurses and police about the rights of patients and and about the hospitals policies regarding that.  Alex has a lot to teach them.

7. Nurses are like protective mothers in the wild guarding their young…don’t threaten a vulnerable, and in this case unconscious patient on their watch, because they can and will take you down (unless all the proper paperwork and policies are in order of course).

8. Nurses stick together and they will fight as a pack against injustices and bullies.  Nurses will generally come out on top, because they know what they are doing and they are by in large very responsible and respectable people.  Alex has every staff nurse in the country (who has seen this video) on her side.   My bet is that this exact issue will be reviewed in every hospital in the country.

9. Stay calm in the face of craziness….Alex did this. She never raised her voice (until she was assaulted).  She was respectful and organized.  She presented the necessary policies verbally and in writing. to the cop in writing.  She got her supervisor on the phone (although he should have been there beside her). She did not disrespect anyone.  She rightfully protected her unknowing, unconscious patient by being his voice and advocate.   She didn’t expect anything from anyone other than mutual respect.

10. Alex taught us what herosim is.  She is an excellent example of nurse strength and courage.

Nurses encounter crazy business every day they go to work.It can come out of the blue, just like this cop did.  It can come from a patient, a visitor, a doctor, a boss, or another coworker.  Nobody expects it to come from a public servant, like a cop.

Appreciate your nurses because they will always have your back.  As patients, we should all be so lucky as to have a nurse like Alex Wubbels.

 

 

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Ode to Louie

August 1st, 2017 No comments

louie

 

 

 

 

 

Louie in wagon

 

 

 

 

 

 

 

 

Our Louie is almost 15 years old. He is truly a geriatric dog.  He still has a puppy face, and many people are shocked to learn his age.  But look closer.  He has arthritic joints, a sway back, rheumy eyes, a small growth on his left lower eyelid and a lipoma on his chest. He is also very deaf.  His front legs have been badly bowed since he was very young.  It was a birth defect that we didn’t notice when he was just 12 weeks old, when we got him.   He looked perfect to us, and he was.  Those crazy front legs served him very well all this time.  Now when he walks, especially after lying down for a long time, he staggers, and sometimes one back arthritic leg, or the other just slips out from under him.   But, he recovers quickly and keeps on walking.  Sometimes his puppy persona takes over and he is downright frisky, jumping and running about.  That burst of puppiness doesn’t last long these days.

Seeing signs of aging in our beautiful pup is so hard.  We all remember his crazy wild puppy play.  He would run in circles or chase a ball forever. If nobody was paying attention he would nudge his ball into our pool and stand at the edge and bark until he engaged someone in his game.  He would get so worked up he would ram into furniture, bounce off and keep going.  He could jump 3 feet off the floor for the right treat.  He had a high pitched bark or yip, and he used it often. He jumped up on furniture to watch out the window and guard our house.  He was a ‘never fail’ alarm for incoming guests.  And, oh, did he love to travel.  We have taken him on countless camping trips.  He is a real camping trooper, except that he is scared to death of campfires.  And, he is petrified of fireworks and thunder, except for now, because he is deaf.

A few months ago, I watched my patient son and husband separate and rescue entangled squirrels. I knew about Mike’s tenderness toward animanls.   Every day I watch my husband go off with Louie, for a short walk, and now he pulls a red foldable wagon.   Louie doesn’t/can’t walk all the way around our block anymore.  He goes far enough to do his business, and Mike pulls him in his wagon the rest of the way.  He loves it.  Louie that is.  Mike was a little self conscious when he first started using the wagon for his crippled buddy, but not anymore.  I believe they have become well known in the neighborhood.  It is such a heart warming sight to see my boys coming up the street, Mike pulling the wagon, and Louie riding in it.

I asked Mike recently, “will you take such good care of me if I need it”   My younger son immediately said “I doubt it”.   Mike has the patience of a saint with Louie and it is something special to witness that.  I worry about him when Louie has to go over the rainbow.  There will come a day when he won’t be able to stand on his wobbly legs.  Will that be the time?  Or will Mike get Louie a doggie wheelchair?   It could go either way, but if Louie is suffering, I know we will both agree on what is best for him.

We voluntarily bring these sweet animals into our lives.  Then we fall in love, just like when we have our human babies.   They become part of us, our days and our home.  They mark their space in every possible way.  Louie knows he rules the roost. He communicates with Mike and Mike responds.  Sometimes I think Mike understands dog speak better than human speak.  Louie’s yip, whine, sneeze, cough, or cry elicits almost immediate response from Mike, whereas, my yelp, whine, or complaint many times falls on deaf ears.

I love all of my boys…Mike, Louie and my sons, but the special relationship between Louie and Mike is something to behold.  There is a love and codependency like no other.  I wish it would never end.

 

 

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The Day Hearts, 4 baby squirrels and their Mamma

May 25th, 2017 No comments
Andrew Day

Andrew Day

This is a story about two men in my family and a squirrel family.  I have been married to Mike Day, for 45 years this year.  He is a quiet gentle man who  has the patience of a saint.  He has stuck it out with me and that speaks for itself!  My son Andrew Day is my youngest and he is also a special and big hearted man.  None of us expected notoriety for their patience and kindness but then last Sunday a weird thing happened.

Andrew was visiting us at our Pearl Street home in Bangor and he was about to leave when he looked out our front window.  He said, “Uhoh, there is some cat/squirrel action out there”.   At the end of the driveway across the street, there was a big old orange cat, stalking what we thought was a single squirrel on our side of the street.  We thought we were seeing an injured adult squirrel.  He went outside to find FOUR baby squirrels, all joined together at the tail by a weird ball of debris.  Oh no, what to do!!!  They couldn’t walk or run because they would all pull in different directions.  They couldn’t climb a tree because one or two of them would weigh the others down.  Mother squirrel was on the side of a tree across the street and she was frantically screaming and crying for her babies.  The babies all huddled in a crevice at the base of one our maple trees.

Andrew called for the Bangor, ME animal control.  The dispatch told him they weren’t available on a Sunday, so they put in a call for us to the Game Warden service.  We knew these babies were in jeopardy.  The Game warden called back and he couldn’t come right away, because he was at a remote pond.  When we described our predicament, he said he would just use his pocket knife to cut away the debris, and he would need our help to do it.  So, based on that, my men decided they could do this themselves.

They gathered up some rudimentary tools.  We got a large plastic rake, a soil cultivator tool,  3 foot deep box, scissors, long leather gloves (no bites or scratches for them!), some branch trimmers, and a grabber which is used by handicapped people to pick things up or reach things.  Mike got the rake under the squirrels and Andrew used the claw like cultivator to gently help them into the box.  The little buggers had picked up a number of long branches during their excursion, and Mike cut away all of those.  Andrew then spent almost an hour and a half cutting, trimming and picking away at the ball of stuff that cemented the babies together.   At the end of this operation, they used some Dawn detergent to lubricate and condition the remaining small tangles and then they were separated.  Whew!

andrewheadin box

The tails were tattered and skinny for lack of hair, but they were intact.  The little guys were stressed and tired, and they curled up around each other and rested under an old blanket while I called the warden.  We couldn’t see the mother squirrel anywhere and were uncertain about the next step.  He told me that their only chance for life was with their mother, and to let them out of the box.  We did.  They ran off immediately, and separately, for the first time I think!   Two went up the tree where their nest was, and the two others went in different directions.

About an hour later, we saw Mamma squirrel nudging one of the babies up the tree.  We were all happy and relieved that the little family was back together.  Andrew’s friend Peg dropped by to support Andrew and a couple of neighbors stopped to satisfy their curiosity.  We were all pretty triumphant that these little guys would make it.

THEN! Andrew posted his video of the babies, before they were separated, on YouTube.  A friend of a friend who writes for the Bangor Daily News asked to do a story for the newspaper. http://actoutwithaislinn.bangordailynews.com/2017/05/22/recreation/four-baby-squirrels-with-tails-tangled-together-rescued-by-bangor-men/

WLBZ Channel 2 news asked for an interview.  http://www.wlbz2.com/life/a-tale-of-4-squirrels/442317489

Mike’s and Andrew’s big hearted heroism had spread far beyond our family, a friend and a couple of neighbors. In fact, the story went viral and so did the video.  After only 3 days, there are almost 150,000 hits on his video and numerous media reports.

I love this story and telling it, because it just plain warms my heart.  But, both Mike and Andrew are a little embarrassed by all of the attention.  Neither of them think they did something heroic.  I beg to differ!