Gory Stuff

I am starting to realize there is quite a fascination with "Gory Stuff".

Like Huge accidents along the side of the road. It is amazing how the non-accident side of the road will slow to a crawl when there's one on the other side. You shouldn't look - but you do.

I guess that's the way it is with blogs too. If you mention blood and guts or some other type of gory subject or even just something remotely like that - one is compelled to look.....such as "Don't look at these photos if you are queasy" or "Removal of sutures".

Funny how my blog posts with those types of headings got the most posts since day one. :)

And now, we have to run and show our apartment and get a tenant lined up......

Suture Removal

So it is time to remove my husband's sutures.

I find an old (not rusty) pair of disposible suture scissors and my tweezers and clean them with a good scrub of soap and water then disinfect them with a long soak in alcohol.

After cleaning then stabilizing my husbands hand I grab the one end of the loose end of the knot with my tweezers and I am *just* getting ready to snip the suture in much the same way I have done for the last, oh, thousand years to a million-or-so patients - right next to the nail where the suture goes in. You know, the proper way.

My husband jerks away his hand: " No no no not there......you have to cut it up there at the top - just cut the knot off" - giving me instructions as if this were my very first time.

Me: "Are you a nurse? A doctor? You know I have been doing this for 30-some years, right?"

We both start to laugh.

He's lucky I didn't cut off his fingers.

:)

Pesky Little Visitors: The Government

Come on Politicians/Government workers in Ottawa:
Don't you have something better to do with your time than read blogs? After all, it's my TAX DOLLAR that pays your way. Get out of my blog and go somewhere else. You aren't welcome here. I don't blog at work, nor do I schlep on the computer in Blogland during working hours and definitely don't do it on Company Computers. You should have the same courtesy.
Unless, of course, you have a VERY GOOD REASON for being here.
Let me know if you do and I will apologize. For now, the above applies.


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Information Smorgasbord

We have several rental properties. Right now our "retirement" property by the ocean is up for rent and so I am mid-process in finding new renters. (View below)





What people don't realize is how much information they put on the Internet for anyone to find or piece together. We, as bloggers, are pretty well anonymous (we hope!) however, many people don't seem to care - until they realize how it can affect them.

Let me tell you about our rental process and you will see what I mean.

First I put an ad out on Craigslist. I have a gmail address set up specifically for this, with no identifiers. I put a link to my gmail photo album which has at least 100 photos of each property.

This gives those searching a good idea as to what the property and amenities look like - no need to give a tour and I only get the serious inquiries.(the photos below are from the apartment 2 doors down, identical to ours) This cuts out those who are the "looky-loos".


When the prospective renter emails me asking whether the apartment is still available, I email back and ask for them to tell me a little more about themselves and ask - " what can you tell me about yourself that would have you stand out from the rest of the applicants?"

I eliminate those that don't sound like the type we want, then email the rest with an application form attached. When they send the info back...or even if they don't - I have information to research.


I google their name, phone numbers, address, email address and search on Myspace, Facebook, Linkdin and any other search engine or Networking site.

If I can find them on Facebook and their settings are set to private, I look at all their friends. I can always count on someone giving up info! Usually I can find something written by the prospective tenant somewhere.


You can speculate what they are like by what groups they have joined or interest connections. I have found full blogs with names attached, work information, personal details, pet's names, where they work, comments on the Internet, ads of items for sale complete with responses - you name it.

In Canada you can look up court records, court cases both civil and provincial and also appeals online with only a last name.

By this time I have weeded out the undesirables. This time it left me with 10 applicants. I arrange one showing only - at the convenience of the present tenant and my self - and then as I meet each prospective tenant, I make notes in my book.


Then, finally, I research their actual application information they provide - the personal and work references . If there is anything that is red flag material, I delete.


I then send the chosen "new tenants" the tenancy agreement by email - which our province has online - and get them to fill it out and drop it by with a 1/2 month deposit and first month rent.




It is a slightly time consuming process but a very interesting one - and I must admit that I have been surprised at some of the prospective tenants and the information that surfaces.....I am not sure that they realize how much information I can glean from so little offered.



I have discovered lies about occupations, people that are blatant partying aficionados with questionable photos online, I have uncovered deep dark secrets and stories.

The best one was a couple who were both lawyers. I found her "online diary" from her days in University which described her family, her dog, her then boyfriend and now husband, the wedding, everything!

Good news is - We have yet to place a bad tenant.

For a similar reason, I find it is a good rule of thumb to google one's own name every once in a while to see what is out there. Lots of info out there on your name is good for me - but personally, I just don't like to see too much out there on me.

It's just one big smorgasbord of information out there !

EATING CROW

If you read the story about going to the ER on Friday, you will remember that I was definitely going to follow up with the Manager of ER at our local hospital, the Administration - and perhaps even further up the chain - today.

First I called ER to give the Manager the story. I presented it in a calm and factual way and requested a copy of their "visitor policy" for their ER. What I got was a sincere apology. Apparently there have been quite a few complaints about the same thing happening to other patients.

The RULE has been in place since forever and it has only just now been resurrected and enforced since the "new" ER opened up this year with their brand new shiny LOCKED DOORS in place. No one can get in and out of the triage - unless you happen to have a pass card. The only way to get a pass card is - if you are an employee.

The manager stated to me that there have been some RNs that have been on a power trip and have arbitrarily been enforcing The RULE without using common sense or compassion.

After the apology, my call was transferred to Administration where my I left my phone number and name. Approximately a 1/2 hour later I got a call back. The administrator taking my complaint was also very apologetic.

They are taking it very seriously. However, I did let them know I was still writing letters and I would be expecting a follow up call.

The Manager states that they are going to have the Educators explain to the RNs in that department that they don't have to be so uncaring and unfeeling about enforcing The Rule. What I don't understand - why haven't they already done something about it if there have been as many complaints as they say?

Surely they can keep a few rogue nurses in line?

Apparently not.

I suggested that having the policy in the first place is a very bad idea.......

We will see where this goes.

The INJURY :( Don't click on this if you can't stomach an injury

This is what my husband's fingers look like today when I did his dressing change just now:





Basically, the resident stitched the nail back on. They say the nails can be saved. Who knows. At least it doesn't hurt as much as it did at the time....but you can imagine the pain....ripping the nails off......... :( Both nails were off, the one without stitches sat back on the nailbed ok, but the other one was flipped inside out so the curve wouldn't allow it to sit down....so they had to stitch it... =^@

Why I will Retire to A Different Community

Ok, yeah. I was gonna stop my blog.

But something happened today that has me pretty upset....and I wanted to run it by my ER RN blog friends.

I got a call from my husband's work. The reception was sketchy and mostly static and I could barely make out what the person was saying -

" mmmffff*CRKL*ffsto-the-hospital-ffftt*crkl!ft-husband--fftd*-hand-crkl-injured-kfhtt-sheared-off*fftcKL"

WTFlip?????? My husband had an accident at work. I couldn't hear how bad, what was going on...all I knew was that he was taken to the hospital - immediately. So after calling in to work for time off part of my night shift tonight, I frantically drove to the local hospital to find out what was going on and to be with him - like most concerned wives would do. Worried sick.

A volunteer stops me in the reception area. Asks me where I'm going. I explained that my husband was brought in injured and I had to find him. I distractedly scanned the waiting area in case he was there, still waiting.

She knew who he was.

I told her that I was his wife (didn't mention I was an RN) and could I please go see him.

Remember that at this point he could have had a severed hand for all I knew. I know I must have looked worried. Very worried. I had been in tears on the phone to my work about it when I called in notice.

The volunteer wandered into the reception area which is behind a semi-circular reception desk and spent 10 minutes talking to the receptionist.....and it wasn't about finding my husband. It was about a knitting book and magazines etc. Finally she got the receptionist to do a search.

You have to picture this "brand spanking new" Reception area that is for both receiving and triage: The half moon desk is 1/2 reception, the other half nurse triage. A huge 1/2 inch plate of curved glass that starts 6 inches above the desk surface - carries on right up to the ceiling. The partitions between each receiving "cubicle" is also glass. When the RN/receptionist takes your vitals and/or asks questions it is in the open in front of all the other people in the ER. Absolutely no privacy. My husband said that when he was giving his information, the 1/2 inch glass blocked out the verbal exchange between him and the nurse/reception - so that he had to speak VERY LOUDLY. He wasn't very comfortable with presenting his medical history to the Whole World in the General Waiting area.

"Sorry" the Volunteer says " the Rule is - no one goes in with the patient"

"Pardon? But - he is my husband. I have no idea what is going on. I don't know how he is. I don't know what happened. I need to see him. Where is he? Please."

Oh, she says (remember - this is the volunteer) I saw his fingers, they didn't look that bad and he is ok. WTFlip? A. How the hell did she get to inspect his wound or find out what is going on with him? and B. Who is she to be deciding his prognosis? I guess FOIPPA (HIPAA to Americans) doesn't mean much in this ER. Still, I kept my mouth shut.

Why wouldn't they let me in to see how he is? I was starting to think all sorts of things - maybe he was telling them not to tell me because it was worse than it actually was.......my husband is like that. Downplays everything.

If I was a drug addict, or acting like a crazy person, or raising my voice and hysterical, or being VERY demanding or rude, looked like a derelict or had an entire entourage with me - I could understand not letting me in. But, I have worked in ER before and know not to fuss....and if you have read my previous blog...you know how I patiently waited 6 hours to be looked at with 8/10 abdominal pain, in the very same ER a year ago. I just don't like to create scenes.

The Volunteer wandered into the ER bed area to see if the nurse would allow me to see my husband. I could see the RN wildly gesticulating a "ABSOLUTELY NOT" to the volunteer. I guess the Rules mean more than anything. The volunteer came back through the doors -
"No - you can't go and see him, he is waiting to see the MD then he will be sent to Xray and then you can see him for 2 minutes and that's it"

No explanation. No report on how he is. No telling me what's going on. For all I knew - he still could have been lying there in pain with whatever. (Fact was, he was in awful pain. I gleaned this information from one of the other patients waiting in the General Triage area - her words exactly, which didn't make me feel any better - "your husband was in horrible pain while waiting to be seen..."

Finally the nurse sees me at the double door and talks to me. " He's had 2 nails pulled off, he needs to be sutured and then xrayed and bandaged. He's ok". This is the first "official" word that I get on my husband's condition. All right. He's OK??? I have had a sliver shoved under my nail and that hurt like stink. Two nails pulled off - well, it is not a hand laid wide open or a cardiac arrest, but still.....

I don't know if he's ok. I still haven't seen him. I plead with them. I told her that I can understand why they don't want loads of people coming in there and the problems it could create. So she would understand that I knew how to behave - I did, at this point, slip that I was an RN. At this point I haven't seen my husband at all, haven't been able to talk to him and I was worried.

I also happened to see the MD treating him - it was the same one that misdiagnosed me a year ago - I had reason to be concerned.

Finally she said: "well, you can go in - but ONLY FOR ONE MINUTE - and leave. Then, when he is finished with the MD and everything - you can see him for 5 minutes only. And that's it". Haughty tone.

I go around thru the doors and to the end of another hall where my husband is waiting in the "observation area" in a chair - waiting for a free stretcher bay. He is still in pain - 8/10 he says - one hour after coming to ER. My husband said it felt as if someone had taken a pair of pliers and yanked off 2 fingernails. He is a very stoic guy. Apparently, in this ER, if you aren't writhing around in pain - rolling around on the floor screaming and crying ...they figure you aren't having any pain.

Does that tells you what kind of customers come through these ER doors?

The waiting area reveals a very different scene. All the patients (only 6 of them) waiting in the triage area were quietly sitting scattered among the empty seats. No one was complaining. Everyone was quietly and calmly waiting their turn. No histrionics. No loud people. All Patiently waiting. Even the woman who was gasping for air. Even the little boy with the big bandage over his eye. Even the woman doubled over in pain in the wheelchair. Hardly a peep. Same scenario both times I visited the ER in the past.

They had given my husband a 3 page form to fill out. Poor guy was in so much pain, never mind it was his Right hand that was damaged. I glanced at the sheet he had tried to fill out. His handwriting is normally better than mine. Sort of - girlish. What I saw before me was a childish scrawl. They wouldn't let me stay with him to help him with the form, so I was sent back to the waiting area to try and fill it out on my own. There wasn't a question that I could answer without asking my husband.

In the minute and half I saw my husband - I had asked when his last tetanus shot was since this was obviously a very dirty wound. Seven years ago apparently. He told me that they told him he was good up to 10 years. I informed him - Absolutely NOT - I told him he needs one if it's been more than five with a dirty wound. I told him he wasn't to leave without one. Now I am really worried. I am sent outside because I overstayed by 30 seconds. I am now going to be punished for that transgression. They don't let me in ever again.

I stood outside the doors. The RNs that came through the doors seemed to know who I was.... I guess they already were talking about the RN wife of the husband patient who insisted on trying to Circumvent Their Rules. Smug knowing faces staring down their noses at me as they walked by. "I know who you are......" one nurse says.

I could see he was led to his own area. I waved and smiled at him, he gave me one thumb up.....and the nurses still wouldn't let me through the doors. He was only 4 feet away. At this point I am sure they were just trying to drive home their point. I could hear the MD talking to him through the door, and I know that whatever instructions or information given to my husband at that point were not going to be absorbed. That is just the way he is. In pain or distracted - he just doesn't hear anything.

I wait another while - they stitch him up, clean him up....put the dressing on.

Finally, he was released. The whole visit really didn't take that long as far as ER waits go. Most of it was waiting. I don't mind waiting. I could have waited six hours or more. ( I don't think my husband could have, he was in so much pain) What I minded was not being allowed to be with my husband. I had begged to go in. I promised to sit quietly - and I would have.

Instead, I was made to worry needlessly.

And what I didn't understand - they had allowed several other people in to accompany other patients. I guess maybe because my husband's injury was something "minor"in their eyes - it wasn't ok for anyone to be with him. Or involve family in the post discharge care and instruction, never mind I am the one that this is going to fall on.

OK. So my question to you -

I have worked in at least 12 different hospitals, some of that in ER. NONE of the ERs in any of these hospitals had a rule that No one is allowed in with a patient. Have any of you heard of this? I know there are times that we would LIKE this to be the rule.

I phoned up my Nurse Manager Sister-in-law, and 2 other nurse aquaintences.......none of which had ever heard of this type of restriction. The nurse that works at this hospital said - and his words exactly - "That's BS....when did THAT change?"

Was it wrong of me to want to see my husband? To be reassured in that way to know he was ok?
He means the world to me, and we have only each other.

Right now my dear husband is OK - now that he is home and fully medicated.

And me? I am now going to finish off the rest of my night shift.

WHAT NOT TO POST ON THE INTERNET

While we are on the subject of internet Paranoia.....

Here is an ad on our local TV station for the PNE Playland....if you have never been there...you have to go. The Roller coaster - a wooden construction, was built in 1958. I can remember as a little girl - going to the Playland. It was always so fun. If I close my eyes I can still smell the smells - popcorn, cotton candy, doughnuts - and hear the sounds - screams, laughter, carny calling.........lots of fun.

So when the PNE put this ad out in this year's ad campaign.....I couldn't resist posting it! :)

JOB INTERVIEW: FAIL




Here is the history of the building of the Rollercoaster: You don't need to watch the whole thing, just the narrative at the beginning...the rest is the progression of construction

Alternate Blog

Awww. I was just reading all the comments this am as I sat feeling sorry for myself.

Thanks u all for all your support. Funny how you can feel a camaraderie through the "blogworld" when you haven't even met anyone. Even Frank, the jerk, turned into somewhat of a mascot of sorts.

The blogs of "old" nurses like me crack me up because I can so relate. The younger nurses that have worked for a while - same -- plus I can feel for you - you have a lot more years to slog through...and the future is looking a little...well... difficult. Finally - the nursing students - you are the future of nursing when I am long gone. Thank Goodness for you.

I really think nursing is getting more and more complex and difficult (never mind the higher ups making it darn near impossible to do a good job). The main thing that I liked is knowing that there are others like me out there in that "Sister-Brother-hood" that is nursing, because - really - there is just no one else who understands like another nurse.

Blogging really helps with getting through the crap times and has us high-fiveing the good times. Being able to express frustration or share elation when we are actually able to do a job-well-done. It used to be enough that our patients rewarded us in the small ways that matter. Thankfulness. A word. A smile. Knowing that what we do really matters and changes lives and that YES - we make a difference in this world. But it seems - those are few and far between.


We are wanting more of a ...... connection.

So - now with blogging - we get support from other nurses who by their encouragement or just sharing their own experiences - or just appearing on our site and reading what we have to say, then quietly leaving - - - - - it's become the new way to communicate.


Unfortunately, there are ethics and government and confidentiality and .....all those other things to ponder......

....so maybe I will write about things other than nursing.



It's a thought.



After all, nursing isn't my whole world.



Only a very, very small piece of it.

WAAAAAAAAAAAAH!

I miss my blog. *Sniff*

And my blogger "friends".

Good news is.....I am getting a raft of stuff done.

Still - it just isn't the same............

Proof Positive: yes, they Troll the Internet to find EVIDENCE

Yes, they are always on a witch hunt. Beware of anything you post. Even if it is innocent and contains no information: they are on a mission. They are not there to protect the nurse.

And - if this person trolling around isn't on a witch hunt.....it means they are spending MY money that I pay out ( $450 per year to register as an RN - I only pay $75 per year in WA state) casually looking around at blogs. Either way, I am not happy.

Call Me Nurse
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Paranoia

Call me paranoid but something happened today that creeped me out. All of you that have been following my blog KNOW that I never say anything outside of the FOIPPA and HIPAA laws. I don't talk about patients or my present job even. HOWEVER. Something tells me that there are certain things Certain People don't like mentioned. Namely, *marijuana* - never mind all I posted was documented/researched info - direct quotes - some of it even coming from our Own Blessed Government.

I happen to have 2 site meters on my blog....one public one tells me (you see to the right) who is on and from where- fairly general info with a fun presentation....the other is invisible and it shows me who exactly is on and their IP addresss and a lot of other neat stuff like what Browser the visitor is using, who their provider is, what kind of equipment they have....you know. Everything interesting and revealing.

I usually get -oh, maybe anywhere from 7 to 80 visits per day depending on the subject. Mostly it averages 15 to 40. My comments are fairly boring to anyone outside of nursing, and even then I am probably stretching it.

Mostly I blog about my nursing experience from more than 30 years ago, my Grandmother the nurse, my surgeries and our occupational type subjects from published sources. Sometimes I just comment on other goings on in my neck of the woods outside of work.

Most of my visitors come and go - read one page, then leave. After all, most of my stuff is Yawn material, really. Mostly no one comments. Sometimes I am pretty sure they alight on my blog for only a second and then move on - without even reading anything.

That is - until today. Today I saw an interesting ID appear on my site meter. Big Brother. From the "House of Commons" to be exact. Not just one visit - but three consecutive visits. Then - a visit from the Governing Body for Our Occupation in our delightful province shortly thereafter. Ya - I mean YOU. Hmm. Interesting. Why the sudden interest? It isn't like I am revealing anything new or unpublished ..... or even interesting. I haven't broken any laws. Nothing I said was outrageous.

I know this is a "public" blog. Nothing on here is worth reading anyway. But something makes me paranoid when there are several visits in the space of a couple hours from sources that has the ability to make my life miserable.....and I didn't even say anything that is worth all the fuss.

*RED FLAGGED*.

So...I am sorry to say, I am closing up shop. I will be lurking in your blogs....but I won't be creating any - until I retire. Then I can do and say as I please with no one breathing down my neck - and that, my friends, will probably be in a couple of years. You know, wearing purple and all that.

So, all of you out there, if you had ever read my blog entry "It's a Small World Story"......now you know how true it is. Believe me.

6.5 Billion people are not enough to get lost in.

Speaking of Reefers... Jimmy Buffett and the Coral Reefers

Speaking of Reefers...

Jimmy Buffett's Grandfather escaped from Nova Scotia, Canada as a kid and settled in the Southern States....his song "Son of a Son of a Sailor" pays tribute to this history.
Just thought I would share a little of his music while we are on the subject....



And one more for the road...because that is when I enjoy his music the most....

The Posting that Got Me Into Trouble....

This is the posting that had me remove my blog for a while.  I have since edited it...and hopefully it will keep the powers that be away.....

My Friend Mary...Wanna..

I notice that prop 19 in California may not only decriminalize marijuana but also legalizes the growing and producing of cannibus. It also allows the government to tax said recreational drug. I suppose California is in such a bad financial state that the government needs the extra cash it assumes this will generate.

Massachusetts has already decriminalized it.

The USA is sounding more and more like B.C. all the time.

What are my thoughts on this? Well, those who are my age I am sure that at one time or another have "inhaled".......or eaten that brownie - at least once. (Ok. Except maybe my friend Jan) Especially in this province well known for it's "B.C. Bud".

Which brings me to this funny story - Or maybe not so funny:

I was preparing to work in Washington state approximately 10 years ago. I transferred my license from California to WA state and then applied at a Nurse Agency, I had to go to Seattle, write a plethora of exams and then - submit to a drug test.

Now, in B.C. there is no regular or initial drug testing required for any nursing personnel. I know some occupations here do, but not nursing. Actually - that's interesting, come to think of it.

Anyway.

I gave the typical sample for testing. The gal did her thing, then squinted carefully at the results. Apparently it came up "equivocal". I looked over her shoulder, oblivious to what the interpretation meant. Since it was my first time (drug testing) I wasn't sure of the problem. Or the results.

"Hmm? What does that mean?"

"TCH" she said

"Does that mean I am positive?"

"Well, not really, sort of - borderline"

I laughed. Thought it was funny. A joke. There was absolutely no way. My husband even laughs at me because I don't recognize the smell of that funny smoke.  "Whew....there's a skunk around here...."

Luckily the girl shrugged it off and said - " Oh well, I guess it's OK....."
I must have sounded naive enough.  Which I was.

Then I thought of where I was on the weekend prior to the testing. Could it have been affected by inhaling second hand smoke? Most resources say no. HOWEVER. They DO say they wouldn't rule it out completely if it was inhaled in great abundance second hand.

I happened to be out the evening before at a bar for a drink with my then husband. There was heavy smoke in the air - being that this was before the outright ban of smoking in public areas. Some of it was that funny smoke. Or should I say - most of it.

From what I understand.....if one is in an enclosed area (which I was) and it was filled with so much smoke that the eyes were bothered by the smoke (which they were) there is a possibility of registering positive (which I wasn't). Testing is dependent on the "threshold" for positive.

That makes sense. "B.C. bud" is in abundance here. It is the provinces' unofficial number one industry and export. It is openly used. Police don't even bother with you if they see you smoking a joint, as long as you look like a reasonably law abiding citizen and give them no cause.

And - It wasn't as if I had "flunked" the test, after all. It was just equivocal. And definitely I know I haven't touched the stuff lately.  I am in need of every brain cell I can corner and corral. I am not wasting one synapse needlessly.

Then I came upon this test kit site that claims there can be false positives for Marijuana if you take these drugs: Aleve, Ibuprofen, Ketoprofen, Promethazine, Riboflavin, Marinol and if you happen to have a kidney infection, liver disease or diabetes. Ya, any one of the first four, I could have taken.

But - gone were the good ol' days when we would have Baileys in our coffee in the am at the nurses station while the girls lit up their cigarettes - when we would go out all night and come to work in the same clothes we left in - all smokey.......but now ? Not a chance. I don't even drink a glass of wine 24 hours before a shift never mind sneak a toke - ever.

And what about the legalization of MJ?

I think in the past convictions for one ounce and under has created a criminal record for a lot of people who did stupid things when they were younger and now regret having a permanent history that shadows them 50 years later. This is unfortunate and can be tragic (almost kept my husband from immigrating to Canada from the USA!) and I don't think this lapse of judgement should be held against them.

I see a lot more abuse with alcohol than I do with MJ. Definitely there is more violence associated with alcohol abuse than with MJ.

I don't advocate it for underage groups. I don't advocate it in public places similar to the regulations for cigarettes and alcohol. I don't advocate its abuse in the same way alcohol is now abused ie. - I don't condone operating vehicles or going to work under the influence of anything.

I do see that it is medically useful in some cases, and in fact I remember to giving it out in pill form (nabilone) for nausea back in the early 1980s. I can see that the decriminalization will free police time that is spent on one-ounce-cases so it can concentrate on the more serious crimes. There is no point in clogging up the courts/justice system with minor things like this - never mind the expense involved.

Yet, what message does it send?
Are we heading down that steep and rocky slope of flagrant drug use?

Coming from a province that has typically a long history of shrugging and turning the other way when MJ is in use.....I am not shocked by the introduction of these laws and removal of criminalization. Even my parents, who are law abiding, very strict religious people (church 3 times a week!) are pro-decriminalization - and these are people who adamantly speak up against drinking beer or hard alcohol (a glass of wine is fine though!) and won't step into an actual Government Liquor Store.

It will be interesting to see what happens this November in California.

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.