Our Ten Dollar Bill, In Rememberance, Prelude to November 11

Our paper money is known to be quite colorful. 

One of the most common denominations of our paper currency, the $10 bill is a commemoration of those who have sacrificed their lives for our country.

On the far right you can see Robert Metcalfe - a British soldier during WW2 - pictured standing at attention at an Ottawa Cenotaph.

Amazingly he survived the German Blitzkrieg on the European mainland albeit wounded in the legs with shrapnel.  En route to the hospital, his ambulance was ambushed by a German tank.   He was evacuated via Dunkirk - and out of the 3 ships that sailed, his was the only one that survived a severe hit by the enemy. 

On his recovery, he was sent to fight with the allies in Italy and North Africa.  En route, his ship was chased by the Bismarck.  They made it to North Africa and he served under General Montgomery, fighting against the "Desert Fox" Rommel.  It was there that he met and married a Canadian Physiotherapist.

After the war, they moved to Chatham where he was involved in politics, then retired to Ottawa.

For the next 60 plus years he volunteered - raising money for Veteran's causes, speaking for the Royal Canadian Legion to high school students, and acting as a volunteer guide in the War Museum bringing to life the sacrifices made by the Canadian troops.   He hosted trips (often at his own expense) by veterans and their families to the different cenotaphs, battlefields and cemeteries in Europe.

When he was 80 he wrote a book about his experiences.

"One day Metcalfe received a call from a government official asking him to go downtown for a photo op. He wasn't told what the photo was for, or why they chose him. “He had no idea he would be on the bill,” his daughter said."

A month ago Robert Metcalfe passed away at age 90.

Breast Feeding

I was over at the Man-Nurse Diaries reading some of his past blogposts. I ran across this one - "Dad's Prefer Breast Feeding" and had to chuckle - especially when I looked at his pie chart on why....

It reminded me of a story my mother told me once a while back (she would kill me if she knew I was repeating this, but, uh,  oh well - there isn't anyone I know reading this anyway, except for my girlfriend Jan- and she knows everything about my screwball family so it's gonna be no big news to her!)

 It is one of mom's own breastfeeding stories.

My mother breast fed all of her children - all five of us - in an era that encouraged bottlefeeding - the 1950s.  Or - should I say - actively discouraged breast feeding, so I am quite proud of mom for doing what she thought right when there was so much pressure around her to give it up or made to feel somehow that it was wrong.  It seems that milk production was not a problem for the women in her family.  She took to it really well.

So well, it seems, that at times she sometimes had too much milk - if there is such a problem. (which I don't believe!)  What to do when there was no baby around to feed and there is a little bit of excess and she isn't (for some unknown reason) wanting to pump and save?

So - fast forward to many years later when mom was in a group of women from her church who were discussing breast feeding.  The Pastor's wife had just had her baby and it seems that she had the very same "problem".

Of course she asked my mother, being the experienced and wise sage in the women's group,  what she did when the milk was overflowing and there was no baby to put to the breast.

Mom paused, slightly embarrassed.

"Oh, my husband took care of that" she replied sheepishly with a little smile.

 Way to go Mom.   Not the visual I really wanted.

White Coat, Black Art

I often listen to CBC (Canadian Broadcasting Corp) radio in the car as I am driving places..... and there is an MD that comes on regularily that gives interesting talks on various subjects.

Here is the plug.

I enjoy listening to his program when I get the chance.
For example - here is an interesting programme on "Healthy Design" from November 5th (repeated Nov 6 and 8th).   You can listen to the sound bite - which expands on the actual intro  by clicking on the audio beneath the article introduction.

It discusses errors made due to electronic devices to the design of hospitals that require RNs to take more steps than they should in the course of a shift to the changes made in psychiatric facilities.

He presents medical topics in a way that is clearly understood and interesting.

Check it out.

In Addition to.............

Emergency Blues made a very good point in this blog entry.

 I came to a similar conclusion - that your employer may throw you under the bus to save themselves -  with my blog entry in October - Murder in the Hospital.


Listen to this free advice from a Lawyer:






And now the police - agreeing with the lawyer, by the way:

Passion for Nursing

I found Digital Catharsis via Emergency Blues.....
He is a Nurse working in the United Emirates.  His site is worth checking out.

He posted this Youtube Video, which I loved:




It got me thinking about what nurses do.....and what a difference we can make in the lives of others.  I suppose in the past I have taken for granted what people in the "world out there" experience, and although it is all "routine" to us - to those we come in contact with - it is more than routine....it can be  life-changing -  the height of joy and the depths of despair - depending on where you work and who you are taking care of.

The older I get, the more I appreciate my calling.

When I was younger, I have to admit that I did take it all for granted.

Being a Nurse.

There is nothing more reassuring to a patient than a Nurse that is passionate about his/her profession.

Obstetrical Emergencies BC

I was wandering around on the Internet and I stumbled across a Workshop Presentation by  Perinatal Services BC in May 2010.

 It's a great presentation by an RN and 3 MD specialists - one of which I knew as a Resident when I was working as an L&D RN at a particular Hospital.  She was fabulous and when she decided to go into Obstetrics as her specialty....we were all thrilled (Yay Jen!).  The hospital that has her practicing there is very lucky. 

Also, in the audience, I recognized at least 3 of my former co-workers.  

Here is the presentation.

  It is at least 3 hours long, if you have the time - it is well worth a look.  Hopefully, if you are in the USA, you are able to view it.  It is a great presentation for student nurses as well as RNs.  I would use a little caution if you are a pregnant mom and have no medical background because some of the things discussed, you may not want to hear.

The first part by the RN was a bit of a snooze - but a good refresher nonetheless - the physiology of a Normal Delivery.   Following her are 2 Obstetricians and a Neonatologist giving very interesting presentations backed by numerous studies.

  Here are a few of the highlights in case you are interested : 


- You don't need to do an episiotomy to deliver a shoulder dystocia.  It is not a 'muscle' or 'tissue'  problem but a bone on bone problem.  You also don't need to do an episiotomy for an assisted delivery.  Studies have shown that increased peritoneal trauma occurs with routine episiotomies.  Be patient!!!  Allow the perineum to stretch on its own!

-  Mom pushing on all fours is desirable and is helpful in a dystocia and also with malpresentations.  Delivering on all fours is generally a good idea.

-  Second stage starts when a woman is fully dilated AND has the urge to push.  Take care when diagnosing prolonged 2nd stage -  2nd stage is diagnosed incorrectly if woman is pushing without the urge to push.

-  Physiologic pushing is best and we should modify how we encourage moms to push.  In other words, shorter pushes without breath-holding  - which the mother does instinctively -  until the very end.   We need to do away with those 2 hours of 10 second-breath-holding-counting-to-ten pushes with each contraction.  All it does is exhaust the laboring mom.

-  "Rotisserie" of mom is a good thing.  In other words....keep changing positions throughout labor.  Moving and mobilization is desirable and is proven to be beneficial to mom and the delivery of babe.  There is a drop in interventions in labor when a woman is allowed to mobilize.

-  Mom is the best incubator if you have to do a transfer to another hospital.

-  With careful case selection  and management, it is reasonable and safe to deliver breech.  Vaginal breech delivery is now an option for some Canadian women.

-  Low dose asa is being revisited as a treatment for prevention of preeclampsia.

-  It is beneficial to delay cord clamping.

-  IV oxytocin should not be given IV push post partum unless mother is on a cardiac monitor.

-  Treat a mother presenting with intrauterine demise (IUD) as a DIC unless proven otherwise.


Most of the information above doesn't surprise a lot of us L&D RNs....except that it is coming from Obstetricians.   In BC we are lucky to have a Perinatal program that seeks to optimize Neonatal, Maternal and Fetal health care throughout the Province.

Travel Warnings: True Horror Stories

While we are on the subject of  Real Life Travel Horror Stories,  our Canadian Government has a couple of stories of Imprisonment on their website.   They don't sound real to me...but there is one story of a nurse "Lucie" who smuggled drugs.....     www.travel.gc.ca/truestories   not that anyone would do something as foolish as that.

But - you don't have to necessarily be doing something obviously illegal to be detained.  There are countries where you can be imprisoned for the most minor infractions of local customs.  The statistics below show numbers but they don't show any breakdown or explanation.

Doing time abroad: Foreigners filling prisons

So beware, for even a friendly kiss or texting explicit messages can get you into trouble.

And then, as if that isn't a cautionary tale as it is....there are other things that can go terribly wrong.

I have done a lot of travelling in my day,  but I will tell you one thing..... I do my homework before going anywhere. 

RISK - Nursing in a Foreign Land

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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



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

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

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

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

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

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

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

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

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

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

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


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

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

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

Suffocating at Night: Or, Your Dentist Does More than Look After Your Teeth

My husband had a snoring problem for years.  Previous partners had complained about it, but he never thought much about it.  

All he knew was, that in the morning he was a write-off until he had had at least 6 cups of coffee.  He couldn't carry on a simple conversation first thing in the am.  He was so tired - he fell asleep everywhere -  coffee breaks at work, watching TV - and he was always dog-tired no matter how much sleep he seemed to get.

One day while having his teeth cleaned at the Dentist's - he fell asleep and started snoring in the chair.

 The Dentist woke him up and asked if he was OK.  He was having one of his apneic spells.

He asked him if he was always like this. Asked if he was given the choice between doing anything else (well, not everything - after all, he is a guy) and sleeping, what would he choose?

Sleep, of course! was my husband's emphatic reply.

The Dentist suggested my husband see an MD friend of his that specialized in sleep disorders.

Tests ensued and he was given a CPAP to take home and try....one with a microchip that recorded his whole sleep history that could be removed for analysis.

Apparently he was having extreme episodes where he wouldn't be breathing for a minute and more....up to 20 times per hour  - and if he were in the hospital - so the doc said - there definitely would be "medical intervention" due to the low O2 sats and lack of respirations.

My husband found that since he has been using the CPAP....he doesn't need the gallons of coffee that he has been drinking to wake himself up, and he is feeling much more rested.  

His snoring doesn't keep me awake when we go to bed, and there is an absense of the apnea that would scare me to death - because the CPAP is taking over watching his respirations.  I no longer have to smack him awake thoughout the night to remind him to breathe.

Even though the snoring would keep me awake when we first went to bed  -  the sound was actually reassuring.   I knew that as long as I was hearing the snoring - he was breathing- and he was alive.   
Nothing worse than reaching over at night feeling a stone cold chest (from the cold in the room) and not feeling it go up and down with respirations. 

APNEA FACTS:

- Potentially a life threatening condition, untreated Sleep Apnea leads to High Blood Pressure, Stroke, Diabetes,  Heart Attack, Higher accident risk due to sleepiness, depression, irritability, memory problems, men - impotence.

- Basically, sleep apnea is suffocation while asleep.  Most people don't even remember - they wake up to start breathing again and their sleep is interrupted but they don't wake up enough to know that this is what is happening.

-CPAP (Continuous Positive Airway Pressure) can stop symptoms - it doesn't cure it - but gives a restful sleep and can possibly prolong life.

Links : Heart Disease and Obstructive Sleep Apnea

The link between OSA and coronary heart disease (CAD),  heart attack and stroke is still unclear.
Obstructive sleep apnea is very common in patients with heart failure. For heart failure patients, OSA can make their condition worse because of the stress it places on the heart during sleep.

People with OSA usually also have high blood pressure (hypertension). Doctors do not know why these conditions may be linked, but many patients who get their OSA under control will also see small decreases in their blood pressure.

People with OSA are also much more likely to develop abnormal heart rhythms (arrhythmias).

 "It showed that people with sleep apnea who refused treatment had a three- to fourfold increased risk of cardiac events."

Doctors have also found that some patients who have recently had a heart attack are at greater risk of OSA. Because of this link, some doctors are now recommending that heart attack patients undergo screening tests for OSA.


It is thought that more than 1 in 4 adult Canadians are at risk to have sleep apnea per a survey taken   as a component of the Canada Community Health Survey by Statistics Canada.   Out of all those people, only 5% have been tested for it.


Here is a quick test you can take to determine whether you suffer from sleep apnea - provided by the Lung Association.  It could be that YOU have this disorder and don't even know.

All I can say is,  my husband and I have both gotten a better sleep since he was diagnosed and is now using his CPAP routinely.    Hopefully, he will live a longer life as a result.

And -  I have my husband's Dentist to thank for recognizing it and convincing my husband to go for treatment.

Trip to Emergency. Again.

I've been throwing PVCs lately and I have finally decided to do something about it.

I just got back from Emergency......

My girlfriend from work called and asked if I could pick up her mom.  Her mom lives just a couple blocks from me in an apartment building.    Just moved in this spring from another community.

I had never really met her before,  but my girlfriend from work talks about her a lot.  The way she talks about her, you would have wrongly assumed she was a little old lady.....but no.   She is younger than I am, but she has multiple medical problems of which I won't list here. She also has a cardiac history.

Apparently my girlfriend's mom had been having squeezing chest pain  starting last night - pressure in the chest going up into her neck.   She didn't want to bother anyone so she continued with the chest pain all night and when my girlfriend called her this am - she finally let her in on it.

My girlfriend who lives an hour away, calls me in tears.  Her mom absolutely refuses to call an ambulance and has no way to get to the hospital.  She still doesn't want to bother anyone.  Her closest friend lives a half hour away and can come and get her, but would I mind......could I please pick up her mom and take her to Emergency? 

I am still in my jammies at that point, enjoying my early morning chai tea latte  -  so I run and throw on a pair of jeans and my raincoat and run out the door - hop into my car and drive the several short blocks to the apartment where her mom is waiting for me outside.   On the way,  small talk ensues and I try to find out if there is anything else I should know in case there is a cardiac arrest in my car.

We get to Emergency - ya the same one I visited this summer when trying to visit my wounded husband - and I drop off my girlfriend's mom, park the car and run back to Emergency.  She's nowhere in sight. 
I ask at the reception if a middle-age (I wince here) woman with chest pain has come through just now.  Emergency reception area has only 4 other people waiting. 

Around the corner walks my girlfriend's mom - someone directed her to the opposite end of the hospital. I usher her to that famous Glassed Off Area and announce to the receptionist that here is the woman with "chest pain".

 I may as well have said "tiny sliver". 

She has my girlfriend's mom sit down - and proceeds to take all the medical insurance information.  Five minutes later....the receptionist redirects her to the waiting area - pointing to the large vacant seating area -  and tells her to go there to wait for a nurse to triage her.  By this time she tells me she is feeling nauseated.

Ten minutes later - which seemed an eternity  - one of the nurses calls her up to the Glassed Off Window and has her sit down and takes vital signs through The 6 inch Space under the Glass Window and asks questions and after approximately another five minutes or more......the nurse walks her around The Glass Wall into the Locked  Emergency Department. 

I am requested to "give information" to the receptionist to complete the admission process.  I suppose that 5 minutes my girlfriend's mom spent with the receptionist earlier wasn't enough time to give all the info they needed.   I tell the receptionist that up until a half hour ago, I didn't even know her name, don't know her phone number and definitely don't know her address..... I am of no further use, and I walk out of the building.  I know from previous experience that I wouldn't be allowed admittance past the Locked Door.

I call my girlfriend and tell her that her mom is now admitted to Emergency and they have taken her *safely* Beyond the Glass Partition.

I drive home....back to my house.   I reflect on my visit to the hospital in Washington State when I had my gallbladder pain....along with referred chest pain.  Totally different experience.   I was scooped up in the reception area immediately upon walking through the door - with a wheelchair by an aide, barely stopping to give my insurance info and whisked into a waiting stretcher and was hooked up to an EKG pronto.  All within less than five minutes.  I was never redirected into the reception area or told to wait for someone to assess me.

So, this is why I am now reflecting on my PVCs.....and subsequent chest pain....and thinking....I gotta stop drinking all that coffee...........I don't want to ever go to that Emergency Department again - especially as a patient.

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



On another note:  I had 200 trick-or-treaters come to the door by 7 pm last night when I ran out of candy (last year was cancelled by H1N1 and the year before we had 139 kids...) - I had no warning there would be that many...... oh well.