Oooh! Excited about a Pen!

oh my.  and oh my.

You heard it!

A Pen!

My cousin gave me an early birthday gift! A Montblanc pen!*

It took me back to the time - 13 years ago - when I was not only nursing, but was doing design work for a cell phone/GPS tracking company - creating interesting "containers" for their product.

To backtrack slightly - in high school I had taken seven semesters of  sewing/textiles classes. (no science or math courses for me!)
 
But - These weren't just any ordinary sewing classes.  We learned how to build our own patterns from body measurements, design different styles of clothing,  and learn dressmaking/tailoring skills.  This included, among other things,  invisible repairs, making clothing out of old coats and replace broken zippers with new ones.  I loved it!

Two of my projects from scratch ( ie: no use of a  pattern )  were a winter coat for my mother and a graduation gown for myself.

I had been sewing and creating clothes and dolls since age 11 - and that continued on, even through my nursing career.  My first purchase after graduation wasn't a car - it was a Bernina sewing machine.

At one point I designed and sold uniforms while also nursing, but realized quite quickly, there was no money in that, and nursing paid much more - if you counted the hours worked. 

Most people don't appreciate the time and effort that goes into sewing something.  No one is willing to pay for the actual hours of designing and sewing anything.  I suppose that explains the sweat shops overseas.

Fast-forward back to 1998.

My little design created a little bit of a stir in Germany at the enormous electronics fair in Hannover - and a writeup was done in the Technology Trade Magazine, with a photo of it right on the front page!  The guys impressed a well-known cell phone company and were invited to their head office for a presentation.

The two guys I did the design work for, pleased at the response at the Trade show, flew me out to Amsterdam.   They caught up to me there and then we flew on to Geneva, Switzerland.

The one guy, Al,  always had dreamed of touring Italy in a Convertible, so when we landed in Geneva, he decided to rent a brand-new Jaguar convertible and we set forth on our road trip. 

Al  had to put up the entire cost of the car as collateral to the rental company because of our intent to travel in Italy.   If you have ever driven in Italy - you would understand why.

Driving through the Alps, we stopped at a Montblanc store to pick up a pen for the other guy - Mike.   At the time, I couldn't believe anyone would pay so much for a pen. 

Thus the surprise and shock to get that pen (she had "wrapped" it up in a Jimmy Choo purse along with a silk Luis Vuitton scarf! - all for me!!) with it's distinctive Montblanc white "star" on the leather case!

Score!

OK, now you are probably wondering about the rest of the trip.

It was quite the wild ride - myself and two guys in a little convertible, driving on to Rome.

Me in the back seat. (have you seen the back seat of a Jag convertible??)

But that's another story for another time.

For today, it's all about The Pen.

*Did I tell you it came with a refill too? :)

Medical Tourism

One week ago an explosion tore through a hotel in Cancun Mexico and killed 2 Mexicans and 5 Canadians - including a nine year old and his dad and a new groom.  

Reports are now coming out that there were, and still are,  problems with leaks of propane and toxic waste at the brand new deluxe hotel, and half the facility has now been shut down.

The part of the news story that I found interesting was the death of the 51 year old grandmother who, at the scene of the explosion, was going in and out of consciousness - but was responding to the gal who attended to her initially. 

What happened after she was picked up by the ambulance is unheard of here in Canada. 

Apparently, as the story goes, en route to the hospital, the ambulance ran out of gas and the family members were asked to pay for the fill up at the pumps before they would continue on.

So now, in my head, I am picturing a severely injured woman in an ambulance  -stopped at a gas station....taking the precious minutes to fill up.   According to the woman's brother, she was also taken to three different hospitals - and it was 3 hours before she was even attended to.  Her daughter,  an R.N., also noticed that the paramedics were using life-saving equipment incorrectly.

The care given may or may not have had an influence on her survival.

Now, I have spent many winter vacations in Mexico since the late 1970s and have never had the misfortune to require any sort of medical care while there.  There is such a thing as the unexpected - such as what happened above  -  but -   what if you chose to have surgery done elsewhere?

There is controversy about having procedures done in another country. 

I have actually chosen to have surgery done in the USA (Radial keratotomy in 1984-when it was not offered in Canada) but I would say that the delivery of care in the USA is comparable to here. Safe enough. Doctors easily researched.  In English.

With Medical Tourism in underdeveloped countries, how do you check out the credentials of a surgeon or the staff?  How do you do research on a facility that you can only go to the website - and not see it in person prior to the procedure - and no reports you can rely on from reputable sources?

How dependable is the accreditation??  How do you assess the quality of care within a country that may not be forthcoming with accurate statistics or information? How do you differentiate the quality facilities from the opportunists?   Can you believe the edited "testimonials" you read? How do you understand any reports if they aren't in English?

Would you choose to have surgery done in a third world country?


Now I get to tell you a sad but true story:



Linda was a fun gal...very pretty, and laughed all the time. As a co-worker she was dependable, efficient and an all-around great nurse.   We spent many shifts exchanging stories and laughs... she was the perfect person to be working alongside - always smiling, always ready to help out or offer a friendly critique.

Her personal life was a tragic one, her husband had died several years ago from an MI - suddenly and shockingly - leaving her to raise her 17 year old daughter on her own.  But - she would come to work and would always be the life of the unit.    We both liked the same area to do our charting and it would be a constant challenge to see who would get to the space first.

Once Linda got her life together - bought a new condo and decorated it *just so*.... the next thing on her agenda was self-improvement. 

She decided to secretly go for some cosmetic surgery.   She never told anyone.   Due to finances... she decided to have the procedure done in Mexico.   Last minute arrangements were made and she flew down south ... the start of what she thought was the beginning of her new life that she had carefully planned out.

Once again - the care given may or may not have had an influence on her survival.

No one at work ever heard from her again. 

The first news we heard of her passing was a phone call to work from her sister back east...  to say she wouldn't be back - that she died in a Mexico Hospital after successful completion of her surgery. 

No other news or explanation was ever given to us.

No news about what happened to the 17 year old, now not only fatherless but motherless too.  No news of what the details were - or even funeral arrangements - if they were made.  Only the last entry on her Facebook page to her daughter,  "I love you sweetie...thanks for feeding kitty for me"....


Occasionally now, I will run across her signature in charts and her face will flash through my mind.... then a wave of sadness......

I miss her.

But then, I am only her co-worker.

What about her daughter....?

RISK - Nursing in a Foreign Land

She was a  Nurse Manager on a unit I worked on at one time, back when we called them  "Head Nurses".  Most of the nurses on the unit didn't really care for her....she was *old fashioned* - and not in a good way, or sensible way.   But - she did have her "posse" that she hung out with and were her "faithful few".

She ruled it MANDATORY that all nurses on her unit were to wear caps! (I didn't even own one)  Also - It was mandatory to wear pantyhose with the uniform-even pant scrubs. Her reasoning? -  to "catch the pubic hairs" when you had to go into the OR - it was a "hygienic" thing she said (although I have no idea what she expected would happen when the alternate-gendered nurses and MDs(both sexes) didn't wear their pantyhose). **

Pink see-through scrub dresses were her choice of scrubs for the unit (crawling up on the bed or bending over was problematic, never mind that one's slip would always ride up and bunch up around the waist with these scrubs-revealing everything).

 She would look down her nose at you if you weren't "somebody" or "wealthy".... although she herself spent money she didn't have like it was water and barely had a pot to piss in due to her extravagant expenditures.

 

In her mind - this is what she thought
the scrubs looked like....

She was judgemental of anyone that didn't spend a fortune on what they wore (as she did),  or didn't socialize in a "particular" social circle(as she attempted to do). 

She would never be caught dead buying anything on sale or going to anything less than a name brand store,  or buying the best..... all while going into debt.  She looked at you in horror if you mentioned Walmart or Target or Dollar Store.

It could possibly be that this enormous debt she piled up with all her outrageous spending caused her to look outside of the country to get her finances in order.

From what I hear....it was a nightmare.

I am thinking she would have carried the same attitude with her as an expat in Saudi Arabia.   I am certain she would not have made very many friends with the way she treated people.   

Apparently she did have one friend there....because it was the friend and herself that got into a whole lot of trouble.

When I travel anywhere, I tend to find out what the laws are and then lay low -  following those laws to the letter.  I also avoid doing anything rashly stupid either.  When in Rome,  they say.....

If one is going to a land that actually punishes the smallest of infractions with cutting off the hand and/or public flogging and quite possibly putting you to death,  sensibility might tell one to refrain from going to that country in the first place.  Especially if one has Attitude and No Common Sense.

I am afraid common sense wasn't a strong suit with this chick.

As the story goes, this nurse and her friend got in trouble for taking photos that they shouldn't have been taking.***  Whatever it was they took photos of,  the "authorities" arrested them, confiscated their cameras and detained them.  



 One of the first things they do when you go to  Saudi to work - they will take away your passport and hold it for you.   So, sans passport and sans contact with the outside world, they were imprisoned. 

They were not allowed contact with anyone.  They did not have access to consulates or other friends or nurses.   They were kept separately in a prison stripped bare of any necessities save maybe a sink and a hole in the ground for a toilet, which to this nurse, was quite an inconvenience I am sure.

For several weeks they were kept in prison - probably one that was a step up from your regular Saudi prisoner but devoid of any niceties.   It was the not knowing what was going to happen to them that ate at them.  They must have been well aware of the possibile consequences.

When you travel to another country, there is only so much that our government can  and will do.  I just got my new passport sent to me from our government and some of the cautions they sent along (an information pamphlet included) are:

1. Your Citizenship offers no immunity
2.  Consular officials do not intervene in private legal matters, do not provide legal advice, do not post bail or pay fines or legal fees.  They do not investigate a crime or death, they do not ask local authorities to give preferential treatment to Canadians.

3.  They do not make travel arrangements, or pay for any expenses, and they do not coordinate and pay for search-and-rescue efforts to locate missing Canadians.

Peeking through the opening through which dinner is served at a Riyadh prison

Basically, they were at the mercy of the Saudi Government.

Luckily for them, due to the Saudi Government's good graces, within a couple months, she was sent home to her country - tail between legs - and unfortunately was given her old job back.  (Question.  Why do they always seem to do that?)

In her absence there was quite the shakeup and major changes made at the hospital back at home.  No longer was it mandatory to wear the white caps.  The pink scrub dresses were still around, but most nurses had switched over to the greens.   She had lost control of *her* crew.  

It didn't take long.....she was ousted quietly from her position....and put in charge of some innocuous area in the hospital where she could do little damage (why do they even bother?).


  I was never so glad as to leave that place for good. 

***************************************************************

**note her evidence based nursing decisions here.....(no need to ask - I am being sarcastic)
***As an aside here, though - I have a couple other nurse friends who have worked in Saudi,  and neither of them say they had any problems whatsoever....and they had taken many photos without incident.   Let's just say that someone ruffled a few feathers of someone with influence....

TRAVEL NURSING DISASTER

I had just finished reading an article online in the L.A. Times about Nurses working in California that have revoked licences in other states due to "misconduct" and yet are practising in CA with their "clean" California license. These RNs number 3,500 - and it is found that at least 2,000 of them are now faced with discipline in California.

It took me back to the "Travel Nurse" stint I did in the mid 1990s after I had moved back to Canada from California. I was hired by a travel agency and was placed at a nationally very well-known and respected institution in Southern California.

Anyway. I get there and go through a 5 day orientation which was mostly testing and classroom work, which was ok with me. Most of my hospital orientations in Canada had consisted of jumping right in - so this orientation was similar to taking a very nice break while reviewing/testing stuff I already knew. I was used to both the American and Canadian system and was ok with whatever they could throw at me.

What I don't understand is how one particular nurse could have slipped through that rigorous testing process.......as you are about to read....

The Birthing Center was a brand new one, expensively appointed - but they were still working out the "newness" kinks. I could see that it was going to present quite a challenge. The birthing unit was supposed to be a swank one that would entice "celebrities" to come and give birth. Unfortunately, that wasn't the case. Most of the "customers" were middle to lower class types with work-supplied insurance or MediCal.

I come from a Canadian system ....everyone in each province carries the same insurance and are treated the same no matter who you are or how much you have donated to the hospital. I have looked after very many wealthy patients, 2 mayors, 2 prominent politicians and several well-known celebrities (2 musicians and one actress still on TV) known all over the world - it didn't matter. They were just like any other patient while in the hospital. There were no admin people falling all over themselves, trying to see if everything was being done to please those "special" clients...or watching their nurses' every move....

I had been acclimatized to the Canadian system of L&D after being specialty trained in an American Hospital, and it was painfully difficult to go back. First thing they did to these poor laboring moms was to confine them to the bed, strap them to the monitors and electronic BP cuff calibrated to read out every 5 - 15 minutes, flat on their back - no hope for mobilization. So much for being a Birthing Center.

I went into the Labor room and found a mom clearly in hard labor all by herself. Hispanic gal, primip, 6 cm and really working at it, slightly out of control. I stayed with her and coached her through the breathing and showed her how work with her body.

When it came time to push I stayed with her and quietly coached her through each contraction. One nurse peeked in the room to check and see what we were doing and to try and get me to come to the desk. "Just leave her...you can watch from the monitor at the desk just as easily".....she tried to convince me.

I believe nothing substitutes for hands on care in Labor. Statistics show that is the most important thing for a successful outcome during labor - a support person to be present with the mom.

When it came time for the woman to deliver....the scrub tech came in the room with the delivery table/instruments. The OB came in last minute and the scrub tech basically handed over every single piece of equipment - as if it were an operating room. Where I worked, MDs got their own instruments off the table.

The patient was all draped out. I had never seen such a "sterile" type delivery since my student nurse days in the 1970s.

Once the baby and placenta were out, the OB - who by the way had not even looked at the woman never mind saying one word to her - not even an initial greeting or a nod of acknowledgement - and, before even waiting to see if there was going to be any bleeding or not - proceeded to reach into her vagina almost up to his elbow to "check for and retrieve clots" - all the while the woman screaming in obvious discomfort, almost crawling up to the head of the bed, trying to get away. I stood with my mouth agape at this scenario.

WHO DOES THAT KIND OF THING????? Horrified didn't begin to describe how I felt. There was absolutely no need for that kind of torture.

It was explained to me later that the OB was upset because he wasn't getting as much for this delivery because she was "MediCal" insured - and besides, she was Hispanic...........as if any of that was a reason for the barbaric treatment of a human being. After I left that job, I wrote a letter to the celebrity whose name was connected with the hospital, hopefully to inform them of what they were associated with and perhaps urge some change. I don't think it did one bit of good.

I was to experience something else that would shock me - and cause me to cut my assignment short and make me high-tail it back to Canada asap.

It was a busy night. Another travel nurse was looking after a PIH mom with an epidural and a pit drip. I had an active patient and was also very busy. The night got slightly out of control as more and more patients came through the door.

There didn't seem to be anyone that was triaging these new patients. Someone had to do something with these women. The in charge had already had as many as she could manage and the rest of us had to take the overflow. We did the best we could to quickly assess and release - or admit - per protocol - while trying to manage our own patients.

In the midst of all this - the travel nurse looking after the woman with PIH/epidural had disappeared. Without telling anyone - not even the in charge - she had left to deal with a "family crisis". She had had a fight over the phone with her boyfriend and left the Hospital to deal with her kids.

Now, I can understand the need to attend to family emergencies as they happen, but at the very least - tell *someone* you are leaving first - would be a good idea - especially when your patient is hooked up to an epidural with oxytocin still running - AND YOU HAVE A LIVE BABY you are supposed to be monitoring.

No one had any idea that she had left....until the OB came around asking for the nurse taking care of his patient. Apparently the MD arrived on the scene to discover the pit running - he had given the order to stop it long before the RN departed. He was upset - rightfully so - and so were we.

What a nightmare. Unfortunately, as can happen anywhere, one of the moms that was discharged through the night developed some sort of complication and was brought back in the next day for a c/s. The hard strip was well documented and tagged correctly but an error at the admitting desk had filed the information on another patient that had been put in that same room before they had time to change the name over.

All of the RNs that worked that night - except for the disappearing RN - were hauled into the office a day later and questioned about the whole incident as if it were our fault.

The disappearing nurse was never hauled in or grilled - and never disciplined - never mind fired. I questioned the manager on this lapse in judgement, nicely and politely. Apparently, because the disappearing RN wasn't there when the other patient came in - she wasn't held accountable. The manager didn't see how the absence of that RN might have contributed to the fiasco.

The next few days I called in sick ( and I never call in sick unless I actually AM sick). The writing was on the wall. I wasn't going to jeopardize my license for a dangerous set up that obviously wasn't going to change.

I put in my resignation as soon as the travel company deposited my last paycheck owing. The rest I wrote off.

When the Travel Nurse company tried to tell me I broke my contract - and threatened how they were going to "come after me" for the expenses incurred - I explained to them that they had obligations also - never mind they had let slip highly confidential personal information about that disappearing travel nurse that just happened to also be under contract with the same company as myself.

Which brings me back to the article I mentioned in the first paragraph above.

Unfortunately the system in the USA seems to fail when a nurse is going between states.

I have a practicing license to work in WA state. I did have to submit to them any license information for any other states I had worked in.

Apparently California and 12 other states - or 40% of the 3.5 million RNs working in the USA- don't participate in the national data base that would alert them of any nurses that have been disciplined and licenses revoked elsewhere.

It got me to wondering about the bad apple that I had run into on my travels.

I happen to practice "Universal Precaution Nursing" at all times anyway.... taking precautions to protect my own license. In other words - I don't assume that someone else has checked what I am supposed check, or use a medication drawn by someone else or assume the hospital is going to protect me or MD is going to stand up for me in any given situation. I practice as if I am all on my own, legally speaking.

I paid a lot for, and made many sacrifices to earn my RN license and I will not jeopardize it in any way.

I am so close to retirement and I want to go out with a clean slate.

As for Travel Nursing? I did do it again. I just used a different company. :)

What would you consider to be an amount of money that would compensate for working in an unsafe environment?
For me: Zero