I love my job

A few days ago I had one of those "I love my job" kind of days. These don't happen that often, although weekly there are moments that stick out. Normally a day loving my job involves adoring my patients and them adoring me. Doesn't matter if they are needy, just that we have some type of a caregiver-patient connection.

The day did not start off the greatest but when directly up hill. I walked into my first patient's room to be greated by "you are a terrible person." Excuse me?! This tiny 80 year old women starts into this tirade about how we are keeping her against her will and she has not eaten in two days. Well, I know last night she was hallucinating because of her UTI and that she might have bipolar, but this does not seem to fit. So I ask her to explain and I consult with our nursing assistant who would know if she had eaten. And it turns out she was supposed to get this test that you are not allowed to eat before, but for some reason she didn't get test and therefore no one thought to get her food. She hadn't eaten for about 20 hours, enough to make anyone (especially me) very very cranky. We order here a late lunch STAT (I had no idea we could do this) and her meal showed up in 5 minutes flat. After this we were best friends. She even wanted to send me a Christmas card!

The day just got better from here when I met my 94 year old patient. He looked like the skinny version of the old man in the movie "Up" complete with big bushy eyebrows. He was what I call a "young 94" which means he functions better than most 80 years olds. \He had even put up a new fence this summer! He had come in with heart attack like symptoms and was getting the 1-2 day cardiac workup. His only complaint was "the soap opera on in the next room." He was sharing a room and the family next door was carrying on just like a soap opera. "Well Sir we don't want you to have chest pain again so I will just get you a new room." We were lucky the unit was half empty, and off he went to a different bed. This got me lots of hand holding and cheek kisses. The one bump in the road was getting a call from his son asking about his dad's condition. Turns out Mr Adorable had gotten a little confused about his diagnosis somewhere along the line and had convinced himself that the leaky valves (regurgitation) that was happening to a mild degree in his heart was a leaky valve in his brain that was slowly killing him. We had a long talk and I wrote down in plain English the results of his tests, explainging that the regurgitation with his heart valves was mild and many people live at this level their entire adult lives. My most awesome nurse status was topped off by bringing him a cup of icecream and finding him a National Geographic as the poor guy had been sitting in bed for like 36 hours with one newspaper and was bored out of his mind. There was a lot more hand holding and a little "if I was 65 years younger...." before I took off for the night. When you have such a great rapport with 2/3 patients it doesn't matter if the 3rd is difficult and needy


Sometimes I wonder why I'm not in geriatrics because I love my oldest patients the most. But then I realize that most of the geriatrics I would see are not this healthy and have long long lists of problems. I don't think I have the patience to deal with it yet. I love seeing mostly healthy old people. They remind me of my amazing Grampy who is 92 years old and still incredibly active. While we aren't sure if he will still run races he is sharp as a tack (too much so in the math area, I immediately get lost) and reads voraciously (books I read as well!). His only weakness is fresh ground peanut butter. I think that the best way to be a young old person is to do what you love for as long as you physically can and to kee your mind sharp be reading and discussing. You'd be surprised how young it keeps you!

Pill Pusher

Most days at work I feel like a pill pusher. "Take this orange pill for your high cholesterol, this little white one to lower your blood pressure, these two big white ones for your chronic lower back pain, a big green one for calcium supplementation and this injection goes into your stomach to help prevent a blood clot from forming in your legs that could potentially travel to your lungs or heart and cause huge problems." I got into nursing because I am passionate about preventive health care. Yet here I am "pill pushing," granted I will say when patients question that they need a certain med, after educating then I do inform patients if they are uncomfortable taking some of there they have the right to refuse. But they rarely do because 1) they were already taking all these meds at home, 2) the doctor prescribed all these for them, so aren't they important?

Which leads back to doctors education and the huge HUGE influence US pharmaceutical companies play in which meds people take. Have you noticed the insane amounts of TV and magazine ads offering a pill to treat high blood pressure, atherosclerosis (say that ten times fast), high cholesterol, and depression? I will stop myself here because I could write for hours about all of this. If you are really interested consider reading "Overdosed America" or "The Truth About the Drug Companies", but take a different spin on how drug companies do not report all the research trials they do, just the ones that support the use of their, and these results are published in respected journals that doctors read to learn about the latest and greatest.

Back to the preventive education idea...Instead of giving the aforementioned pills I'd love to say (assuming this is not a critical patient) "Here are some supportive running shoes, walk a mile a day to decrease your blood pressure, lower your cholesterol, and stop eating high fat, highly processed foods, increase your calcium intake through leafy greens. And in 2+ weeks your lower back should not hurt as much, you should feel your mood has improved and additionally you may see you have lost weight, which would make all the problems you were taking pills for better as well. Oh and as for anticoagulant, if you are over 60 or have a history of heart problems take a baby aspirin everyday (as long as you do not have a clotting issue). By eating well and exercising you should see that you save well over $1000 a year in medication costs."

But why don't we do medicine like this? Because it takes more time to counsel someone on lifestyle changes than it does to write a prescription for a pill that might solve the problem at hand. It is not just the doctors and nurse practitioners that are to blame (and some really do benefit form pills). The vast majority of people do not want to put forth the energy to change their lifestyle. Taking a pill is easier, it is culturally acceptable, even encouraged, especially by our media heavy society. But the most healthy are ordinarily those who take the least amount of pills, using diet and exercise to achieve health.

Every few weeks I have a patient in their late 90s. I love them and think we really need to honor older people more than we do. The healthiest older patients I have generally take less than 5 medications, of which 3 of these are vitamin supplements and at least one is a prescription eye drop. They are at the hospital because of an infection that needs IV antibiotics or because they broke their hip, but we don't expect them to stay long.

Sad case: I had a patient who came in with chest pain, so we were working him up as a "cardiac rule out" to see if he had a heart attack or not. He had all the risk factors for multiple health problems: heart attack before he turned 50, high cholesterol, insulin dependent diabetes, high blood pressure, smoker. This man benefits from meds for his conditions. But his health would be greatly improved by diet and exercise. I had a long talk with him about changing his diet to minimize his risk factors for illness. What broke my nurse heart was his response, "I want to eat better, I do try, but with how little money I make I cannot afford to eat fruits and vegetables daily because they are expensive while my meds are covered by insurance." For me this is a reality check. I am so fortunate to be in good health, with reasonably healthy genes, with the financial means to all the fruits and vegetables I want (albeit I cannot afford organic). I do take 3 pills daily: a prenatal (kidless at present, but I plan ahead), folic acid (I was anemic years ago), and Vitamin D (because all people in Washington are deficient in D).

I'm a nurse!

I passed my nursing boards! Take that- NCLEX! And I never have to take it again. And I start work Monday, eek!

This is the first step, of many, to get us back to Honduras. I am still clueless how I will get a job as a nurse in Honduras. I don't have doubts about my ability to do it all in Spanish, but from what Noel tells me hospital nurses are not nice. I will likely need more training, like becoming a nurse practitioner, to get a nurse career in Honduras as Noel tells me there is only one type of nurse as opposed to our levels of ability here (nurse specialist, nurse manager, pediatric nurse, nurse practitioner). I would love to run a clinic . . . but first to master the basics