Lost on the Floor

I have multiple problems that I am trying to wrap my head. I'm increasingly getting tired of Blogger, frequent outages, posts disappearing (or getting mangled), tedious template mods and the inability to quickly change a template/theme. I don't have to time I need to fool around the web trying to find a template I like and then taking the additional time to tweak the template and add back in all of the user modifications I've made. I'm a little bit of a design geek, but can't take the time I want to make my blog look like I really want it to, so I settle.

But on the other hand, I like Blogger as I have been using it for so long (not just here). I "trust" Google (about as far as I could throw them), but I realize that they're pretty stable (company-wise). I have my content here adn don't really want to have to shift it somewhere else (or lose it all together). And it's easy.

I want to spend more of my time writing rather than trying to cajole something into working order - I do enough of that at work. Anyone have any suggestions? Is Wordpress better than Blogger? Should I just leave well enough alone? Anyone have an idea how to fix my code so that the sidebar just doesn't run all the way down, but the central section is as long as the sidebar?

Thanks in advance.

I guess Al Gore's recent Nobel win sparked off a minor bit of furor in the medical blog-o-sphere (not to mention elsewhere) as shown by Scalpel and Shadowfax, I thought we all needed a little bit of lighthearted insanity. Zoobomb style. These guys are nuts. What better way to forget about the depressing issues of global warming, ER overcrowding and health care reform than flying down US 26 into downtown Portland on a mini-bike set to the music of AC/DC? Or having a blast barreling down Maryhill on longboards and mini-bikes? Enjoy.

The Hellway


Maryhill Jam

For what it's worth, I believe in global warming and that we should do something, even if it seems futile. I haven't driven to work more than twice in over 8 months, relying on bike and public transit. But that's me.

Update: Yes, I'm an idiot. For some reason I thought it was Tuesday, only to be corrected by my neighbor that it was Monday. The headline is now corrected...

In honor of International Talk Like a Pirate Day, here is my probably already been done pirate joke. Enjoy. Oh yeah, if you've heard it before, enjoy it. Again.

Did you hear about the pirate who was having chest pain?

Turned out he was having a myoc-aaaargh-dial inf-aaaaargh-ction.

Rimshot.

I'll be here all week.

It's just too funny. Maybe it's all that sunlight going to my head.



What med student has that much free time on their hands?

I had a ritual before nearly every exam in nursing school. It seemed to work, I have that magical "RN" after my name. I had so much faith in it that I even did some of it before taking my NCLEX. Usually, I'm not superstitious, but in this case it worked. It was simple. Breakfast and music. I think it was the music that helped clear my head before exams. I know that studies have shown that listening to Mozart during studying and before tests can raise your IQ, but I'm not sold. The music I listened to was mostly loud, fast and sometimes angry. If anything it pumped me up rather than mellowing me out. Call it a paradoxical effect or a placebo effect, but it worked. Music is good, but breakfast is the most important meal of the day.

Breakfast was the best way to prepare for an exam. Ever. There was a core group of about 4 of us who would drag themselves out of bed early to the greasy spoon down the street from school for last-minute cram sessions. Fueled by $3 breakfasts and bottomless coffee we would relentlessly go over the material on the exam. Our textbooks, the 180Lb behemoths that lived in our bags was just one tool. Usually between the group of us there would be a half-dozen different books there on the table, barely enough room for coffee. Between the huge tomes, there was the experience littered around the table. Between NCLEX review books, lab books, med-surg texts, OB texts, notes from the previous year's group and notes/powerpoint slides from class it was formidable amount of information to process. With dogged determination, fueled by the cheap food and the coffee we'd work through the material until someone quit (from overload) or it was time to go.

I have a lot of good memories sitting around that table though. Like crawling out of bed at 4:45 to be there by around 5am on a dark mountain morning. There were the mornings where the sun just was coming up, or that stillness right before first light. It was almost magical. I remember the brisk bitterly cold mornings up there on the mountain, where I spent 20 minutes scraping the outside windows then the 20 minutes of the drive scraping the inside windows, praying the little 12-volt heater would keep the windshield clear enough to see out of. Not to mention the 30 layers of clothes I had on to stay warm in that old VW I drove. (remember Ralphie's little bro in "A Christmas Story?) I used that car as my backpack, at any one time there was more dollar value in books than the car was worth. Usually roll up and see inside the diner, almost like that famous painting, with the warm inviting windows spilling light out into the darkness. Was never the first, rarely the last. It was like a rotating cast though. Some folks would come one week, others the next. Some would show at 5, others at 7, you never knew.

There was the morning where we were quizzing each other on STDs. Nothing says good morning like a conversation about STDs over your eggs, "Now is that grayish and fishy, or yeasty and cottage-cheese like?" Mmmmm. There was the ever present complaining about faculty, assignments, the incredible tediousness of our care plans and the general angst of nursing school. We learned from each other though, everyone had their niche. One guy was a RT, so he was our go to guy for all things respiratory. One gal was an EMT so she was on point for ER stuff. Another was a tele tech at the local hospital and therefore became our rhythm person. Between all of us there was at least one person that understood the material well enough to explain it to the rest. There were the times talking about clinical rotations, how we got to see "X" procedure, or do "Y" task, the crazy person we saw on the floor or the time the student from the other school in town asked the male patient if his diabetes was, "gestational." We laughed. A lot. Frequently.

We all made it through. They were there for me when my wife and I lost our son. We helped everyone through their unique set of problems. Celebrated achievements and commiserated the failures. In the end we all went out separate ways. I headed to the NW. Another went to Tucson, one to Cali. Many stayed in town. There are mornings getting off work where I wish I could go hang out and have breakfast with them again.

Thanks to the Breakfast Club for getting me through nursing school. Never could have done it without y'all.

Other things that helped me through nursing school though: my wife and family, caffeine, telemarketing, music, cheap breakfasts, good study buddies, not sleeping more than 4 hours a night, my VW (seen below), the scrub store in town that gave a discount to students, Strombolli's and Roma pizza, Dominican cigars, Henry Weinhard's Private Reserve, Wal-Mart, Robin Williams:Live on Broadway, that trip to Vegas, the NCLEX review book, Depends and many more...

Peace and love...

In a quest to prove that I have a life outside of nursing, there's a new catchphrase..."nursing, it's not just a job, it's a lifestyle!" Too pretentious? Maybe a bit. Anyways in pursuit of that goal, I have been getting on my bike and riding. Nothing clears the smell of poop and yeasty nether regions better than a spin though a polluted urban core. Mmmmmm, smog.

Being the altruistic guy I am, also figuring I could do the ride for free and get a free T-Shirt (note the theme here...), I signed up to be a medical rider. Really all I was to be was a quick triage nurse, maybe a fixer of minor issues, but for anything major I was to call EMS. No heroics. It was a leisurely jaunt through urban Portland on what is usually and historically one of the hottest days of the year here in Stumptown. Not this year.

I got off the MAX in the morning and it was drizzling. Nothing to even worry about, just that damp haze of a fall morning here in the Northwest. But it was chilly, for summer. Got all settled in, picked up my fancy traffic vest and free t-shirt and headed back towards the back of the staging area. In front were the 40 milers, who were the usual group of hammerheads and folks who believe spandex is a fashion statement. Not us in the back. We were the cruisers. Families, folks hauling trail-a-bikes and kid trailers. We were there to have fun. Which I sure did. Were my medical skills needed? Nope. Only saw an issue once and it was all taken care of by the time I got there. I put my mechanical skills to work, once again wishing for the fable 3rd arm I was supposed to have been issued after nursing school. But that was it. No crises. Never had to call EMS. Never really got out of breath. All in all a fun ride. Even had a free sundae after the ride. How can you beat that? It was too early to grab a pint, so a sundae was the best I could do.



The funny thing is the difference 10-15 years can make on an area. Even though I had spent time in the neighborhoods we rode through before I left town for nursing school, I didn't realize how much of a change had overtaken some of the areas. It can only be described as the inexorable advancement of "progress", or as some will call it, gentrification. I earned my first degree in the middle of the 'hood. Right around where the ride took us. We had drive-by's and stabbings on the nearby blocks all through school. I regularly rode my bike through these neighborhoods, quickly. I got hollered at. I had to high-tail it a couple of times. Saw drug deals, hooker deals, stolen cars, knew the local crack houses (by reputation only!), it was not a great place. But it had a soul, a certain life to it. There was a bright side tot he darkness.

Now approx. 12 years later, it has changed. There has been an influx of folks snatching up the houses whose prices were depressed by the rampant criminal nature of the area and slowly changing the character of the area. The park where you could not walk at night and folks lit up crack in broad daylight in the benches now has families playing there. It's a different 'hood. Folks are more likely to roll the Prius than an Impala. It felt kind of weird being back there. The flavor has changed, but maybe not totally for the better. What happens to the folks that had traditionally lived there? Sure the bad element was pretty overpowering, but mostly they were good folks. I know they've been driven out due to rising housing costs that come along with gentrification. I understand that this happens in urban cores, but it made me feel bed for the vibrant community that had been displaced. But it was nice to be back. It was nice to ride on a grid versus the winding mayhem of suburban hell. I felt right at home. It also made me realize I need to move back there, suburban living is bad for my soul.

I have another couple of posts brewing...I just have to re-read and edit them until I'm happy. Til' later...

Nope you don't have shingles. Hope you don't have what this guy has!

No fooling. My desktop widget shows 91 degrees outside. I moved from Arizona a year ago and I still think this sucks. Yesterday we hit over 100 and it isn't even August yet. And they say global warming ain't real...

I'm just glad I'm off. I've been biking and using public transit to get to work and not pay $3+ a gallon for gas. Only problem is that I get hot, sweaty, sticky and stinky on the way, so when I get to work I smell just like many of my patients. Shadowfax over at Movin' Meat had this post about cycling. I feel his pain. Thinking about moving to the Midwest to get away from them. Ok, not really.

Funny though, since I've started this bicycle commuting thing in April, I've only driven to work twice. Not that I've lost any weight though. But my blood pressure is better. At least until I hit the floor...

Once again, thanks to Digg for an insightful (I know Digg and insightful rarely appear in the same sentence, but sometimes the less puerile part of the community comes out on top) and somewhat enlightening article. Titled "What's Up Docs" it digs a little deeper into the lives and psyches of some docs currently practicing. My favorite part comes at the end where in a poll of 50 nurses, in speaking about arrogance and doctors, it came across that surgeons were the most arrogant of the lot. Not saying anything here. Just found it entertaining.

Over at Musings of a Highly Trained Monkey, she points out this gem of an article about a group of folks I had a little exposure when in nursing school. A little background here. Basically, Colorado City in Northern Arizona and its counterpart, Hilldale across the border in Utah, are the refuge of the Fundamental Church of Jesus of Latter Day Saints - in other words a fundie group of Mormons. They engage in polygamy, child rape/molestation through the marriage of extremely young girls (like 14 years old) to older men, and among other things they control the entire town. The whole place is owned by them. Not outsiders allowed. In effect they are a law and community unto themselves. The interesting thing is the stagnation in the gene pool which the article focuses on. Through rampant interbreeding and crossing of genetic lines, they continue to pass on genetic defects with alarming regularity. Again, not saying anything here. Just found it interesting.

Thanks to Suicidal Tendencies for the title...

Went shopping with my wife the other day (yes, besides work and sleep, I try to find time to do normal human things) and like always there are plenty of people on their Bluetooth headsets. You know the kind, talking to themselves and carrying on a loud conversation at the same time. You have to stop and wonder, "Are they altered? Schizo?" No, just inconsiderate.

I read this article ,via Digg the other day and was met with the news that now it is going to be even easier to link up Bluetooth devices. Yes, there are good things for this...maybe even some that apply to the health care environment. Like vital sign machines that transmit data directly to the computer chart without wires and without the interference of us worn out nurses, or that send the data that a lab has been collected instead of replying to the docs that, "Well, I saw phlebotomy here...they were in the room, so I have to assume they drew the AM Labs, they'll probably be up in a couple of minutes."

I try to remain positive, but I really know that what it means is more people on headsets, talking out loud to apparently no one in particular. I'm just going to have to try harder to not answer them so much...

Thanks to Not Nurse Ratched for pulling me out of my blogging funk and tagging me. So here goes...count 'em, eight random facts/habits about yours truly.

1. I have given up driving. Yes, you heard me. No more driving. Well, as little as I can make it... Until today, I hadn't been behind the wheel for nearly a month and a half. I haven't driven to work for that long relying on my bike and local transit. Y'know, it's funny, I feel better when I get to work and when I get home. Maybe the whole stress/exercise axis really is something. It's not about the environmental thing (which is important), or the fact that gas is well over $3.25/gallon (it kind of is), but it's about my blood pressure, which until recently was fairly high. I'm a nurse, I know why my BP is high. I also know that not driving (and meds/lifestyle changes) have brought it down. But I like it so much more than sitting in traffic.

2. I'm a History Channel dork. In fact, it's on in the background right now. Consequently, no one will ever play trivial pursuit with me.

3. I am a movie buff. If I had time, I could put Netflix's policy on movies per month to the test, but alas I have a job. And a life. Still love the movies though. I love going to the movies, sure I hate paying the prices, but you can't beat the entertainment value.

4. I once built a pornographic snow sculpture. OK, maybe it was only a tasteful nude....

5. I joke that I got through nursing school with the help of the what I have termed the triad: caffeine, nicotine and alcohol. While I have cut way back on all three, I still enjoy a great cup of coffee (I don't classify Starbucks as coffee per se, I like coffee, not warm milk), a glass of 30 year Scotch and a nice cigar or pipe.

6. I like to read. Not books so much, but magazines and the web. For some reason (hmmm...nursing school?) I'm still not able to pick up and full-on book and read it like I used to. But I'm working on that.

7. I miss mixtapes. Yes, making mix CDs is nice, but I miss that tactile nature of recording a mixtape masterpiece for someone. Y'know that whole process of finding and editing the songs just right so they would flow, creating a mood. At one time it was nearly compulsive, but that time is long gone now. In that vein my dream job would still be to work in a used record store. (see High Fidelity).

8. I still own vinyl records. Not lots, but a good collection. Unfortunately since I moved, they do not have a place to live...yet. Really, you haven't listened to "Frampton Comes Alive!" unless it is the the double-gatefold vinyl....

There you have it. I know I have to tag some people now, but I can't think of who to tag yet. But I will. Soon.

As a final parting thought: Can you sue an elderly demented woman for sexual harassment for telling you to "wiggle it a little" as you walk past?

I just read 2 very thought provoking posts. One over at Musings of a Highly Trained Monkey, that reinforced my already dim view of humanity. The second a touching post that went ahead and reaffirmed my faith in humanity can be found over at Nurse William.

Maybe it is a coincidence that these 2 popped up in the same reading session. Maybe someone felt I was getting tired and too cynical about the folks I encounter on a near daily basis. That I was worn out by the ETOH guy, shaking his way down the hall no matter how much Ativan I gave. That my back hurt from moving the 300+lb. woman around in bed because she wouldn't. That the news that a close friend of my wife and I was having a baby sent my wife and I into a spasm of heartache and despair over our own loss, which even 9 months after the fact tears us apart emotionally when we re-live it. Maybe though someone knew that I needed some hope to get through this recent dark cloud. Coincidence? I don't believe in them.

In spite of one night that was incredible busy, the week actually went well. No one crashed and burned. The chest pains turned out to be nothing but indigestion. The demented old woman was actually pleasant and didn't try to get out of bed. In the words of Ice Cube, "Today was a good day (week)".

I leave you with this:



To think the election isn't until next year...

Just recently I wrote about the healing environment of a hospital (you can read it here). I think I got the point across that I'm not a huge fan of doing this just to make it "bigger, better and more luxurious." Lately, due to the expanding coverage of environmental issues, thanks in part to "An Inconvenient Truth" and recent Earth Day, environmental issues have been on my mind. I took stock of my own personal carbon footprint and realized what I was doing and how I was contributing to making the problem of global warming worse. Then I got thinking further.

According to Health Care Without Harm, an organization that is trying to bring "greener" measures into health care, hospitals generate over 2 million tons of waste a year, not to mention the environmental footprint large institutions create. That is more than quite a bit. As I began looking around for more info, I realized that while people are starting to care, it isn't enough. So I began looking locally. Two local hospitals have either been built in the last 2 years or had major additions. One is actually LEED certified, meaning it has been certified as a high performance green building. The other does not seem to be. That hospital, Southwest Washington Medical Center, which was the genesis of the previous blog post, appears to have gone to the bare minimums to create in addition to a healing environment, one that heals its environment. It was far more important to create a "resort" style experience than one that also makes less of an impact on the local environment. As for waste, there doesn't seem to be an accurate accounting, but from working, I know we create a great deal of waste. We use products made of PVC, laced with phalates, coated with BFRs, relying on single-use non-sustainable products. I know many things must be single-use only, but some do not have to be. Not to mention the chemicals we use to clean and the bio-hazardous waste our patients create. I figure there has to be a better way.

Many talk without practicing what they preach. While I know that it will take time and effort to change where I work, I can do thing sin my life to help. I figured that the things my wife and I have done already will reduce our greenhouse gas emissions by over 4 metric tons a year if we continue on the road we have started down. I wonder how much of an impact could be made by large health systems trying to do the same?

-end Public Service Announcement

I saw this story titled: "Hospitals Designed to Heal" on line this morning as I awoke from the slumber of a man exhausted (this is the last time I stay up all-day after the night shift...family first though). While I agree in concept that hospitals are places to heal and that they should provide a healing environment, there are limits to that.

"Southwest Washington Medical Center in Vancouver built its new hospital tower with many design features as comforting as you'd find at a resort hotel." I found the words "resort hotel" particularly ominous. In creating a resort, you place in the patient mind set that this is a vacation, thus they should be served hand and foot, as if they were on vacation. Granted, not all patients will feel this way, but many, and their families will. I am a believer in the active participation of the patient in their health care, if able. That's why I will try to get patients to do things for themselves. Yes, I will be by their side every step of the way, but I will make them do it themselves, again, if able. As an example: we post-CABG patients 2-3 days our of surgery on our floor. These folks need to start moving soon after surgery to reduce any number of complications. We push them, yes, but when they go home, we will not be there to do everything for them. We want to get them out quickly to reduce the risk of obtaining a nosocomial infection or other nosocomial complication. Coddle we don't do. Nurse them, we do. We encourage active participation. If you're on vacation, do you really want to work?

I do understand the importance of quality design and eye-pleasing decor especially when faced with research like that done by Roger Ulrich where he "compared abdominal surgery patients assigned to rooms identical except for the window view: Half overlooked a grove of trees; the other half faced a brick wall. Patients with the tree view recovered sooner, suffered fewer complications and needed less pain medication than wall-view patients." There should be limits though. Do we need to spend millions and millions of dollars to draw patients to one particular hospital? How about when that money is at the expense of current facilities? One colleague related to me a story of the expansion of the Legacy system in Portland into nearby Vancouver, WA. He related how the project for the Salmon Creek hospital went way over budget and how the system diverted money from where it could to make up the shortfall. It meant no extra shifts, reduced staffing, no sitters unless absolutely needed, no new equipment, reduced availability of working equipment, all to create this Valhalla-esque hospital with Italian tile floors in the main lobby. Sure, they operated within acceptable limits, but bare-bones. While he may have had an axe to grind, it made a point to me.

One thing I do believe a great deal in is private rooms. At one point during my time in Arizona, my wife ended up in a hospital and there shared a room with 3 other women. Yes, 4 post-partum women per room. Not cool. Not even close to peaceful, much less anywhere near private. HIPAA was non-existent on this ward. We heard all about how one roommate had Hepatitis C and gang bangers coming after her. A private room would have solved this problem. Semi-privates do work, but still you have to basically live with someone else while in the hospital. What if the roommate has an overbearing or overly large family? Or is a moaner/groaner/screamer/yeller? Not exactly a peaceful healing environment.

Finally though, it comes down to money. Like so many things in life. If the hospital presents a pleasing face, more people will choose to have care there, which equals more money for the hospital. Elective surgeries are where the money is in our health care environment. If you don't get that business, you don't stay in business. Considering that one drug-eluting stent costs around $4,500 not to mention the cath lab, the post-procedure room, nursing and ancillary staff and of course the doc, you can see how it can add up quickly. And this is a simple stent. What about a total hip or knee? Yep, big money.

Contained in the article, although along a different train of thought, was this gem of a thought:

"A study last year by Randall Pozdena, an economist with consulting firm EcoNorthwest, estimated that the metro area has about 1,500 surplus beds. Considering projects planned or under way, the economist projected that unused capacity will expand to 2,208 beds by 2025. That's assuming the addition of 2.2 million residents and a doubling of residents older than 65."

I'd love to know how they figured this one. When we're full nearly every night, it is hard to fathom. I know that is metro wide and that we're not the only floor at my hospital, but it seems very often we have the last bed in the joint and it gets filled quick. Maybe it's all about location, but I don't know. It's an interesting idea to chew on.

Is there an answer? Not really. What would I love to see? Let me show you:
I see a place where it is nice, but not like a resort hotel, more like a 2-star one. Nice, with the necessary amenities, good TVs, internet, decent food. We have plenty of staff and working modern equipment. The patients are polite and pleasant as are the families. We don't have to fluff pillows or pick things off the floor for capable patients. The nurses have a 3:1 patient to nurse ratio, CNAs that do their jobs, colleagues that don't call off for no reason, plenty of staff parking and a coffee cart open all night.

A guy can dream can't he?

According a new article published by the New Scientist on Monday, a new group of enzymes have been found that effectively remove the cellular antigens that are the basis for blood typing. In easy words, they turn any blood type to Type O, which anyone can receive.

Sure this is not going to solve the problem faced in health care due to a lack of blood and blood products, but it should make an impact. The arena where this will probably be seen the most will be in the field of trauma resuscitation where it is not uncommon to burn through tens of units of blood, if not more, in a trauma situation. I think the most blood I've been on-hand to see given when in an ICU as a student where we gave 6 units of PRBCs plus a six-pack of platelets during the 6 hours I was on the unit...which really is nothing. Most I gave in a shift was only 3 units, over a whole 12 hour shift.

The other flip side is that it does nothing to address problems of plasma and platelets, two other common forms of blood products typically given in the in-hospital setting. But, it is progress.

It's like the ubiquitous order of a Diet Coke after the "Double Quarter-Pounder Meal."

As I was walking down the hall on the unit doing midnight rounds I heard it. Faint at first, just enough to prick my ears up, then more distinct, "let me out! Let me out!" in an ongoing chant. I knew that it wasn't anyone on my end of the unit, it had to be coming from the other side, 40-50 yards down the hallway. When I got back to the nurses station, it started again. Someone jokingly said, "sounds like a nurse!" We all laughed.

Later that night, I heard what it was all about. It was one of our patients, screaming out about being kept in the room. Guess she liked to wander. (Later heard that day shift had found her half-way down the fire escape at one point.) In the course of all of this, the nursing supervisor cam by and asked why the door had been closed, y'know, against JCAHO regs and all. They simply told her that the woman's yelling and abuse had finally gotten too much, so they closed the door for a little bit of quiet...maybe to let the other patients sleep.

"Well," she said, "I'll go and see what is going on." She walked over to the door and opened it, stuck her head inside.

The patient looked up and said. "What the f*ck do you want?!" Then began cussing her out, using more four-letter words than the proverbial sailor. The supervisor, quickly exited, closed the door and without another word about it, went on her way. Just smiled and nodded.

I wonder what JCAHO would really have us do in this situation? I know that closing the door is probably not the best thing, but it was what we had to do. (She was being checked on frequently and sitting in a geri-chair, so she was safe at the time.) Really, there is the ideal world that the surveyors and policy makers inhabit, way up in the ivory tower of administration and then there is the reality of life on an acute nursing care floor. Considering the new report out that nearly 5 million adults in the US has Alzheimer's, we better figure this out, or else instead of being greeted warmly by our patients, we'll be asked "what the f*ck" do we want on a more regular basis.