Vancouver 24 hours

I happen to be lucky enough to live in the most beautiful place in the world.

Although people say it is very wet here...I don't notice it much. That's what fireplaces are for! Keeping warm while watching the rain come down.

Most of the year you can run around in a tee shirt or just a sweater. The summers can be hot depending on where you live. In the 10 years I have lived here (moved from Central British Columbia) I have lived in 7 different communities.... and every place had its merits.

The one place that stole my heart was downtown Vancouver - The West End. I lived 2 blocks from the beach and every night you could pretty well depend on a gorgeous sunset. I loved the atmosphere, the people, the salty air.....it was wonderful.

I lived in an old brick building built in 1912. You could put a marble on the floor and it would roll to the other end of the room. If it was too cold in the apartment in the winter you could turn on the oven. If it was too hot, you could open the sliding windows.

It was safe to walk to and from work,  which was only a block away. At night you could go downstairs and meet all kinds of people....it felt very small-townish. Every other storefront was a coffee shop or a restaurant - any ethnicity you would want. You could always sit outside the shops and drink your coffee - even in the middle of winter.

I miss those days.

My cousin lived several blocks from me.   He overlooks Burrard Bridge and watches the comings and goings of False Creek....looking towards English Bay and the UBC Endowment lands. He still lives there....while I have moved on.  This is what he sees:

Posted by A NURSE at 9:41 PM

Rating MDs: Round 2

I was thinking about the previous posting and hoping that people think that I don't believe patients shouldn't express their health needs and goals. I do believe that patients should take charge of their bodies and take more responsibility for their health. I have always advocated for my patient, often in the face of an angry MD.

I just believe that a site like Rating MDs dot com doesn't really help doing what it says it does - finding a good MD. The opinions expressed by the commentators are totally subjective. For one thing - I don't know how a patient could possibly rate an MD's "Knowledge"- which is one of the categories, by the way.

 They could give an opinion based on what knowledge they have gleaned elsewhere (suspect if taken from a source that is questionable) or from what another professional has stated. But, sometimes one MD's opinion will differ with another....not that either are wrong - it is just that medicine is not an exact science.

For example - on what basis of knowledge can patients judge whether a test should or shouldn't be done? And, how many times have comments by an MD or RN are either not heard, taken out of context or even interpreted and passed on incorrectly.

Here is more food for thought. I quote one article about the site:
"Doctors say that the Internet has forced them to manage their images instead of spending time, say, reading medical journals. The review process could affect how doctors interact with patients--putting more emphasis on making sure patients like them than on assessing medical problems and how to fix them."

I am thinking that the first sentence of the quote is a little exaggerated - I can't see an MD abandoning all learning due to a website. But I can see an MD doing the latter - sprucing up the image and making all efforts to be personable - while spending less time on the all-important things.

Certainly a patient can make a comment on their experience, how they were treated, how long they had to wait or what they have observed as behaviors in staff....but even then, that observation may be open to interpretation. What one patient observes as "rudeness" may be "friendliness" to another. I can see that in the comments on my own MD's site. Opinions are strong on both sides -attack and defense.

All I know, is that if someone starts up a site rating RNs - I know that there will be patients who will spill their guts on the site. Statistics, my friend! And - I am not so sure I would like my name on there.

Not everyone will have a good experience in the hospital. Not everyone has a great outlook on life. Not every druggie will get their fix on the hour like they want. Sometimes it is so busy, I can't get to the next patient in a timely manner like I should. Sometimes I will forget that medication that I promised to get for you because of that code in the next room. Not every day is going to be a good day for me either - and hopefully I don't take it out on anyone else - but we are all only human. Poop happens.

And, I certainly would take offence at comments made about my knowledge base. Remember that RN that abandoned her patient in my post previously? Mostly, her patients loved her. I know some RNs that are very good nurses but because they aren't social butterflies - the patient doesn't warm up to them. What kind of rating would they get?

It's only my opinion but I would prefer that patients give feedback -- both positive and negative -- to me personally. That way, I can try to correct something I have done or explain a little better to the patient to ensure they understand.

In the end, though, sometimes, you just can't please everyone - and I just wouldn't want that reflected on the internet where the world can see.

Rating MDs dot com

There is a site on the internet where laypersons can go and rate their MDs. The site actually allows people to do this anonymously.

Looking for Dr Death

At first glance it sounds like a good idea. One would hope their MD is the best in their field and we all do our best to figure this out. But what happens when patients who don't really have a reason to - start to complain? What if people start submitting comments that are not true? Or for whatever reason they feel slighted or they don't like the way their MD does something so they start to make comments, and you as an MD (or as an RN if they start up a site like that!) cannot debate the points made because of our confidentiality laws? It is a one way street.

I just looked up my own MD and to my surprise: her rating is BAD. In fact - "frowny-blue-face-bad".....which is the worst.

My MD is a female age approximately 40. She is very fit and looks great. She is a very positive person. Her physiotherapist husband shares office desk duties with another gal receptionist. When I come in for my appointment, my MD has her laptop in front of her and she takes copious notes (hey this is the 21st century people!) as she asks questions. She examines me thoroughly in whatever area is in question at the time. She is punctual, I never have to wait more than 10 minutes - but mostly she is on time. She jokes a bit and laughs easily, she is no nonsense and comes right out and says what she thinks.

Besides her family practice ( and by the way, no - she doesn't do deliveries) she also does certain "beauty treatments" on the side, which women pay cash for....such as botox or filling in lines - which is not covered under our medical system. Some of her "patients" apparently look at that as a bad thing. Personally, I hate needles so wouldn't even consider it - but that is my choice - just the same as it is another woman's choice to have these procedures done. My MD does not push it - only displays pamphlets that it is available as a procedure in her office.

Some of the comments people are posting are totally off base and very personal attacks. I would actually venture to say: Defamation of Character and libellous. If these patients have a concern about an MD, instead of posting it in a public forum, why not take it to their professional governing body rather than Cybershred an MD in a public medium where the MD cannot defend themselves at all.

Here are some of the complaints posted on this site about my MD:

(my comments in blue)


1. "this MD has a 'personality disorder' ". Hmm. I thought you have to have a degree of some sort to diagnose this. I worked in psychiatry and I certainly do not detect any comparable "personality disorder" in my MD. I did note that the "patient" did rant in a way that one could suspect transference on the part of the patient. I would say that this is a Libel-worthy lawsuit and would hold up in the B.C. courts of law if the MD decided to go forward with it.

2. "this MD has a one complaint/one visit policy, and I don't like that" Since the MDs only get paid per visit...I would be inclined to side with the doc on this one. Fact is, all MDs have this policy. Otherwise docs would have patients coming in for an hour or more with millions of little complaints in their allotted time slot. I don't know of any MD that allows unrestrained complaints. I know that I have been reasonable with my "complaints" and organize them - even going as far as writing down in point form prior to my appointment. I often find that my MD will then extend the "one complaint" policy to more than one. The MD doesn't have time to hold everyone's hand and listen indefinitely. There are other patients waiting....and... there is only so much time in a day, and time is money, as much as a patient doesn't like to think of that. Which brings me to the next complaint -

3. "this MD is in the 'business to make money' "....um...like no one else works for money? I really don't understand this complaint at all. I would like to see that patient work for free. I wouldn't do nursing if I had to do it for free - unless I could afford it - and then it would be nursing to those who are in desperate need - ie: third world countries. It costs money to live, never mind the cost to get there - education is expensive.

4. " the doc didn't give her a referral to a specialist when she asked and complained when the doc told her she didn't give "knee-jerk referrals". This MD is only telling this patient what she should. There are a lot of GPs that have excellent diagnostic skills....THEN - if they need to - get a referral to a specialist. That's the way the system works here in Canada. Most minor complaints can be dealt with in a GPs office. There is a time and a place for a specialist, but most of the GPs I have known can cope with routine complaints. Your little tiny complaint usually isn't that *special*.

5. " the doc made many references to the Government not wanting to pay for tests every year, such as yearly pap tests." I think this is called-making the pt aware of what is/isn't covered and how frequently you can have them. Last I heard it wasn't an offense to let the patient know what the government allows under it's medical plan.

6. "I don't feel "cared" for as much as my previous physician. Not anything I can put my finger on, but I don't feel like I can confide in her, and I don't feel very comfortable with the manner she has." OK. If you have a personality conflict - go elsewhere. Easy. You really don't have to post this complaint in a public place. The MD is not responsible for your incompatibility. Also, in my experience, patients feel they aren't getting adequate care unless an RX is given or test is done. I can't tell you how many times I have heard complaints about the MD that saw a patient who "*only* took a BP,Temperature, listened to my chest and then told me I was ok" . What is the complaint here? Were they looking for a voo-doo magical experience? Xrays in the office?

7. " I saw her often for a few year for a chronic disease and she only remembered me for a prescribed BOTOX procedure (unrelated to my disease). She runs her practice like a business and makes no qualms about it. I do agree with those who are in support of "XXX", that she does know her stuff and is very efficient, that is a good quality in a doctor." Personally, I can't remember a patient from one delivery to the next. That doesn't make me a bad nurse - it only means I am not good at remembering the millions of faces that pass by every day. I don't see the need for an MD to memorize absolutely everything on your chart verbatim either. I don't see how they can. There are lots of more interesting things to put in a brain. That's why my MD is typing on her computer....so she is noting everything about you so she won't have to remember. Besides, if you feel your MD is doing her job, is efficient and "knows her stuff" - why complain at all? I would like to see some of these patients try to remember as much as an MD has to remember.

8. "She was rude, insensitive, had an extremely poor bedside manner and just typed on her laptop the entire time without really paying attention to me. " Thank goodness the MD was taking notes. Or maybe the patient would feel better if the MD went back to the good ol' pen and paper? This is the 21st century and computers make lives easier - never mind that no one has to try and decipher bad handwriting. As far as rudeness or insensitivity goes.... see point 6 above. Our government is pushing completely electronic medical files. Get used to it.

9. " She was always firing her staff which is not a good sign." Actually, one office gal changed jobs due to an offer closer to her home. That is the only change in staff I saw the entire time, and I have been with this MD since the beginning of her practice in that city.

I was curious as to how other MDs I knew and worked with rated, so I looked them up.

I remember an MD I worked with that was downright dangerous, yet his patients loved him and would swear by him because he held their hand and went along with everything the patient would say. He would give abx whenever a patient requested whether it was needed or not. Most of his patients were on tons of medications - even ones that conflicted. That MD has all sorts of yellow smiley faces by his name.

My sis in law actually went to an MD that had been suspended by the government to practice when he billed for a dead patient - on more than one occasion - then skipped the country and, when the publicity died down, returned to his practice. I don't see any blue frowny-faces after his name.

I worked with another one that ran out of the country without paying his bills...yet he was in good stead with his patients. Lots of smiley faces there.

I worked with an OB that was terrifying to work with. He was abusive to staff, he freaked at any emergency and did some very questionable things that were caught by the nurses. It could have been bad for the patient. Yet - yellow smiley faces.

If the patient is going to complain, there are processes and procedures - so why not do it in the forum that allows an MD to defend themselves rather than an anonymous posting? I would hate it if there were a website that allowed patients to post bad things about me and because of HIPPA or FOIPAA laws, I could not defend myself. I can just visualize in my mind what could be printed by whomever. Yet, this is being done all the time on this site under actual Md's names.

There is such a thing as free speech, but when it comes to the infringements of personal rights and when it can have an impact on their means of support......there needs to be a line drawn.

Our Court system is a little fuzzy when it comes to Laws of the Internet, but this does need to be addressed. For now....it is a very grey line.....

History: It's a part of us...

Since we are on the subject of aeroplanes.....

My birthday happened to fall while my husband and I were vacationing in Palm Desert for a space of time this spring.

My husband graciously gave up his twice-per-day golfing excursions for a day to spend it entirely with me- doing something that I wanted to do. He thought I might want to go to the Palm Springs Follies.

Nope. Not me!

So what did we do?

I chose to go to the Museum of Flight at the Palm Springs Airport. :)

I love anything that is historical. When I lived in the Bay Area, I flew out to Indianapolis to visit my sister and her family. My favourite local attraction?  The Hall of Fame Museum at the "Brick Yard".

Yup. The History of Auto Racing. Loved it. The kids were getting a little impatient at Auntie having to stop and read. Every. Single. Posting. At. Every. Single. Old. Car. But it was heaven. All that history. Pretty cool. If you have a chance, and are in the area....go and check it out. I might even be able to entice my husband to go again!

But if you are ever in P.S. – check out the Flight museum.The planes were amazing. But the history – even more so. If you have a LOT of time – watch some of the first hand recorded accounts by the WW2 vets. Listen to the history lessons. Their DVD library is amazing.And here's to the women who contributed to the war effort back then, of which my husband's aunt was one of them - a real live "Rosie the Riveter"....

 And of course there were the nurses of WW2. There were a lot of revolutionary things going on in the field of medicine at the time - one of which was the development of Penicillin which improved the survival rate at the end of the war. Another field of medicine was the newly developing plastic surgery. Here is an interesting account from an RN during WW2:

"Theatre became my own special field and I became most interested in the revolutionary plastic surgery being carried out at this time. I was also privileged to work with some of the surgeons who pioneered this work. There was no such thing as nylon sutures of course, and my fine red hair was often called into use. After being sterilised it was used to repair median nerves which had been damaged in forearm injuries caused by shrapnel. It evidently had the advantage of being both fine and strong! We carried out different types of skin grafts, the results of which were painstakingly slow. Seldom did the theatre staff see the end results of our efforts, but many badly burned pilots were supported psychologically by the young nurses who cared for them post-operatively"


If you ever have time, take a peek into history - it is quite an eye-opener.....There are so many stories - and now with the Internet - those stories are now being told.

CO of the VAW-77 - Happy July 4th!

My cousin's son has been a pilot with the Navy for years - had served in the Gulf war as a pilot off the carrier Kitty Hawk. He now is flying this.... a E-2C Hawkeye...............

Nothing like a Fly-By on July 4th.......

This year my husband celebrated Canada day......today is just another day in Paradise Canada...but my family's American Connection has me posting the above....in respect for our neighbors to the south, half my family.....and my husband's heritage.... :)

Now, put your drugs away.....my cousin's son is on patrol........

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

VUVUZZZZZZZZZZZZZZELA!

A little bit of history here. The vuvuzela isn't a new concept in the world of sports. My brother owned one in the 1980's, which he took to every game 'round about the time that Pamela Anderson was discovered in the very same bleachers at a B.C. Lions Football game.

He had always been an avid Football (not soccer) fan, having played on the high school team and then a farm team - and then briefly marrying a B.C. Lion's Cheerleader....which isn't a big deal in a country who's university/college games are attended by a very sparse crowd - mostly relatives.

You have to understand that Football isn't as big as it is in the U.S.A. Our star players aren't treated quite like the stars of the American teams. (btw: the present minimum salary of a professional football player is $41K - only a very few make the $4.2 Million cap -  just to give you an idea as to how much most of these guys are making - less than me!) My brother once ran into 5 members from the Professional league on the local beach.

Of course, Doug being Doug, upon recognizing them, introduced himself and asked where they were staying. It was the middle of summer and the beach town we lived in was like Waikiki Beach at the height of the season. Hotel rooms were at a premium.

"Oh, we don't have any rooms....they were all booked up - I guess we will be staying on the beach." they lamented.......but not with a privileged whine.... no one even thought to throw their weight around to make a vacancy and definitely, no one was offering.

" WHAT?! Don't do that! Come on home with me" my brother volunteers. "My parents will let you stay at their place! They won't mind..."

So that is how it ended up that I had 5 hunky guys sleeping on the floor of our basement, just outside my bedroom door. Nice guys. ;)

Anyway. My brother owned this BRIGHT ORANGE Vuvuzela-type horn which he would take to every B.C. Lions Football game. He had his Season's pass, so every game would find him in the same seat with the same people around him. You would think he would know better.

If you have been watching the FIFA games, you can see how annoying those noisemakers can be.
This following video illustrates what happened next:



Except - not the punching out part....the guy sitting in front of him grabbed his vuvuzela and snapped it in half over his knee. Surprised my brother. Although - it shouldn't have. If that was me sitting in front of him, I would have done the same thing.

Sometimes I wish there were a whole raft of people like that at the 2010 FIFA games...... it's really getting annoying.

ORANGE ALERT!

So my team is in the semi-finals. YAY Netherlands!

But oh my! What drama...all those *fake* injuries just to get a penalty kick. It is almost akin to watching Wrestlemania!

Meanwhile, here is a cute ad, soccer (and L&D!!) related:
The link in case you can't see

BostonMed

I don't often like to watch "medically oriented" shows on tv. Don't care for Grey's Anatomy , House or any of those shows that depict a far-from-accurate picture of what really goes on in a hospital.

Reality TV such as "Birth stories" make me feel like I have done a whole shift and if I watch it before going to work, it is just like doing a double shift. I am exhausted. Plus a lot of the "stuff" that goes on.......well, some of it is just too interventional plus they cut out all the "real" stuff.

But one show that is somewhat like reading some of the medical blogs in blog world is "BostonMed" on ABC. Intoxicated patients telling nurses to "F* off " and then vomiting all over her....well, that's real stuff. Sure it is highly edited, but you get a more true picture of what goes on.

Love it.

If you want video to go with the blogs you read on the internet.....try watching BostonMed.

It's Life.

Project in the Works / Happy Canada Day!

 Got home from the AGM and am very pleased at the way things are going. Nice to know we, as a non-profit, are doing really well financially and continue to be not only self-sustainable but can move forward with expansion plans.

We have a project in the works for building another high-rise apartment in downtown Vancouver to supply the demand for low cost housing for seniors....which will add more than 100 extra apartments to what we already have - more than 1000 units all told.

Here is another one of our present buildings:

188 units, spectacular view......