A Visit to the Doctor

The case manager and I have brought our client to see his new doctor, who enters the room smiling, his gray lab coat worn over a white shirt and tie decorated with multicolored stethoscopes and faux ECG readouts. He shakes each of our hands, in turn.

"So, you're Mr. __________. Very nice to meet you. I believe your son is my patient, as well."

My client is solicitous, friendly and smiling as the doctor greets him. "That's right. Nice to meet you."

"You seem very healthy for a man of your age," the doctor says. "We should all be so lucky."

As we talk, review our client's history and relate our concerns and needs, the soft-spoken doctor listens----really listens----and reflects back to us what he hears. Performing a cursory yet thorough exam, he listens to our client's heart and lungs, prods his belly, inspects his limbs, checks his eyes, and otherwise gives him the once over with gentle and learned dexterity.

"I think you're all doing an excellent job caring for Mr. _________. He's a lucky man to have such a team looking after him 24 hours a day." He leans over and speaks very loudly into our client's ear. "You're a lucky man!"

Our client smiles broadly.

After the exam, the doctor recommends a tetanus booster and a pneumonia vaccine, and we're stunned when he comes back into the exam room to prepare and administer the vaccines himself.

"I'm sorry," I say, "but I've never seen a doctor give an immunization before. Do you always do this?"

He looks up at me as he flicks one of the syringes with his finger to remove any errant air bubbles. "Oh, when the nurses are busy I like to help out. It's no big deal, really." He leans down and administers the two injections deftly, one in either deltoid. Mr. _______ never flinches.

"Well, it's a big deal to us. Most doctors would never dream of doing such a thing," my colleague says to him as he places the used syringes in a sharps container. "You've been very kind and attentive."

"It's my pleasure, truly." The doctor shakes each of our hands once again, hands us prescriptions, referrals and a signed application for a handicap placard, and slips quietly out the door.

"That is one fine doctor," my colleague says to me, shaking her head. "What a positive experience."

We wheel our patient to the elevator, all of us quiet, knowing that we have just had what might be seen by some as a very unusual experience. The doctor was efficient, kind, thoughtful, thorough, paid great attention to detail, and listened to everything we had to say. As nurses, being really listened to by a doctor is simply a coup d'etat, and we left that office beaming with our collective good fortune.

A fine doctor, indeed.

A Kind of Life

He stares out the window, fumbling with his belt and drumming his fingers on the arms of his portable wheelchair. Wheeling himself to the table, he leafs through a magazine, the pages worn from days of similar activity, the corners greasy from his fingers. Unwilling to draw, refusing to be read to, staring past the TV towards the empty wall, eschewing the Play-Doh that we thought might be a fun and therapeutic diversion, engaging with him is significantly challenging. Throughout our 12-hour shift, he generally refuses food, readily accepts water or juice, and otherwise chooses to keep to himself with occasional brief conversational interludes.

And so the days pass.

Recently, he was saved from a deplorable situation where he was taken advantage of by acquaintances looking for money or alcohol, rarely washed or bathed, and lived a life that most people would find appalling in its squalor. Now, living with family in the countryside, he is safe from ill-meaning neighbors and so-called "friends", yet he pines for that other life with all of his might. Stripped of his freedom, his drivers license and his car, he is at the mercy of nurses and social workers who mind his every move with a keen and earnest intent to help him stay clean, dry, well fed, hydrated and happy.

It is without a doubt that this individual was truly a danger to himself and at risk of injury or death without the proper intervention. Still, assessing his current situation, it's also quite clear that his quality of life leaves a great deal to be desired. We do our best to provide for him, keep him comfortable, and afford him some level of contentment. Still, it's so difficult to witness a person who seems to glean so little enjoyment from life, made even more keen by the sudden loss of his independence. Yes, it's a life, but how can we make it better? How can we bring him joy? And how can we make up for the changes that have stripped him of his ability to make decisions for himself? These are not easy questions to answer, and as we grapple with the possible answers, he stares out the window wishing that things had never changed.

Change of Shift Turns Five!

Change of Shift, everyone's favorite nursing blog carnival, has just celebrated five years of publication with it's most recent edition. Congratulations and gratitude to Kim at Emergiblog for being a tireless advocate on behalf of the many talented nurse bloggers who pour their hearts out and share their stories time and time again.

Happy 5th birthday to Change of Shift, and may there be many years to come!

Home Health and Hospice

My latest article written for Working Nurse Magazine is now published both in print (in Southern California) and online. The article covers the specialty of home health and hospice nursing, and features interviews with three special nurses.

My next article for Working Nurse (on the specialty of nursing informatics) will be published later this month, and in August I will be providing yet another article on the specialty of oncology nursing.

I am very grateful to Working Nurse Magazine for these opportunities, and am pleased that my writing career continues to flourish, even in these uncertain economic times.

100 Blog Posts That Will Make You a Better Nurse

One of my blog posts from 2009---The Nurse as Sisyphus---has been featured in a list of "100 Blog Posts That Will Make You a Better Nurse" over at NursingSchools.net. I greatly appreciate being included on this list, and hope that some inspiration is indeed gleaned by those who peruse the many offerings included there.

Change of Shift, Santa Fe Style!

Well, after a long hiatus, I'm finally hosting Change of Shift once again, and I'm happy to do so from the comfort of our new home here in Santa Fe, New Mexico! (For those of you unfamiliar with Change of Shift, it is a nursing blog carnival wherein nurses from around the blogosphere are featured in an "online magazine" that is hosted on a different nursing blog every two weeks.)

For those readers who are new to Digital Doorway, my wife and I sold our home in Massachusetts last summer, sold or gave away most of our things, bought an RV, and have been traveling the country for seven months and almost 10,000 miles in search of a new place to call home.

For the moment, we've settled (perhaps temporarily, perhaps not) here in Santa Fe, New Mexico, and you can read about our travels here. That said, this episode of Change of Shift (that most venerable of nursing blog carnivals) will be peppered with photographs from around northern New Mexico for no other reason than the fact that they're nice to look at, entertaining, or simply a visual break from all of those pesky words that I'm making you read (unless, of course, you just look at the pictures!).

My thanks, as always, to Kim (of Emergiblog fame) for making Change of Shift a reality, and for putting nurse bloggers on the blogosphere map. Let's hear it for Kim (cue virtual applause, please).

So, without further ado, here are the participants in this week's edition of Change of Shift, Volume 4, Number 26..........

For whatever reason, it seems that lists are incredibly popular these days, whether it be for iPad apps or the best ways to darn socks, so here's a list of blog posts that feature lists about things that their authors think are worth our while to peruse........

At NursingSchools.net, we learn 50 things you never knew about babies (who would have thought that babies cry before they're born?); while over at The Health Harbinger, we are privy to 25 online startups that are democratizing medical data and information.

Speaking of iPad applications, CNA Class Online shares 5 Excellent iPad apps for "Dr. Mom".

And while we're talking about new technology, RN to MSN Programs submitted a list of 10 awesome Android apps for nurses (Android being Google's answer to Internet-based applications for cellular phones, more or less).

Sadly, we all do indeed need to think about the oil spill in the Gulf of Mexico, and NursingSchools.net submitted a sobering list of the 10 biggest health dangers behind the oil spill, which includes neurological disorders (and chemical sensitivity, I'll add) among the workers dealing directly with this toxic nightmare of the century.

Thinking globally, The Health Hawk shares with us 17 intriguing infographics about global health, which, apropos of the oil spill, describes the fact that the average American driver uses 500 gallons of gasoline per year! (And we wonder why we're still addicted to oil?)

And the lists go on.......

Aging Healthy submits a list of the top 50 aging and gerontology blogs for those of us who want to prolong our time on earth (oil spills or no oil spills....), and NursingSchools.net submits yet another post for our enjoyment and enlightenment, this time with 100 entertaining and inspiring quotes for nurses, one of my favorites being "Health is the state about which medicine has nothing to say" (W.H. Auden).

And speaking of NursingSchools.net, we received yet another list (don't they work over there?), this time regarding the 100 best blogs for exploring alternative medicine.

Moving away from lists towards actual prose (cue English teachers cheering in the background), we were happy to receive a submission from Barbara Olson of Florencedotcom fame, this particular piece on "Good Reads About Medication Misadventures" being recently published on Medscape (for which a username and password may be necessary in order to gain access).

And when it comes to those of us who might like a career change from direct care, Master of Health Administration shares with us "The Ultimate Guide to Health Administration Careers" (and the salaries don't seem half bad.......). Alternatively, Online LPN to RN delivers The Ultimate Guide to Nursing Agencies for those nurses who would like some assistance in landing their next job or plotting a career move.

Nurse Teeny at The Makings of a Nurse offers a very personal post about "transition shock" and a new job, something we can all probably relate to.

And over at Nurse Me, the author struggles with a situation wherein a patient's religious beliefs impact her ability to deliver the care that's needed in a post entitled Science vs Jesus.

Author Peggy McDaniel at The American Journal of Nursing's Off The Charts blog chimes in for a post entitled "Protection or Harm----What Are You Doing at the Bedside?", and there is much sobering food for thought here vis-a-vis poor hand hygiene and hospital-acquired infections.

In a post entitled "Fingerprints, Ad Nauseum", yours truly posits that there is utter bureaucratic insanity behind the need to be fingerprinted for every job application and license change that one must undergo (especially here in the Western US). Can't there be a central databank of fingerprints, or does the FBI just adore receiving multiple fingerprint cards for the same person over and over again? (It's your tax dollars hard at work, folks!)

And from the Land Down Under, Nurse In Australia shares a post entitled "Sheepish, Demure Nurses Pander to Inflated Egos". The nurse-doctor relationship is always something worth talking about, isn't it?


Our final two posts for this edition of CoS are well-written missives that address two very important issues worthy of our individual and collective attention.

First, Katie Morales of NursesNetwork.com (where my blog currently feeds automatically via RSS) discusses the legal and ethical notion of how companies profit financially with the use of our tissue and blood, whether we donated it willingly or not. In her post entitled "Not Much Has Changed, Katie offers several examples wherein companies benefited significantly from the cells or tissues of private citizens who then have no rights whatsoever to also benefit from the millions of dollars made from tissues harvested from their own bodies. What's the matter with this picture?

And last but certainly not least, our beloved Kim McAllister, the maven of Emergiblog and the creator of Change of Shift itself, delivers a passionate and convincing open letter to the American Nurses Association that rightly questions the ANA's refusal to endorse the creation of the Office of the National Nurse.

HR 4601 is an important piece of legislation currently making its way through Congress that would elevate the Chief Nursing Officer of the Public Health Service to the position of The National Nurse, a move that would bring nursing to the fore in terms of preventive health and the public's understanding of what nurses actually do. In March of this year, I wrote a blog post delineating how the National Nurse would benefit the country in myriad ways, and I invite you to read that post, read Kim's letter, visit the website of The National Nurse organization, and get involved in this important fight for recognition of nursing's rightful place at the American health care table.

Teddy Roosevelt once coined the term "the bully pulpit" to signify a position of authority or rank that gives it's holder the right and privilege to pontificate and share his or her opinions without reserve. While I hold little authority or rank in society as a simple nurse and writer, this blog is my own bully pulpit, and hosting Change of Shift is yet another opportunity to speak my mind and reach a larger audience, if only for a fleeting digital moment. I am grateful for your attention, and I urge you to contact your member of Congress about wholeheartedly supporting HR 4601!

Thank you to Kim for this opportunity, thanks to those of you who are taking the time to read this, and a special thanks to the bloggers and writers whose contributions made this edition of Change of Shift what it is.

And in the words of Garrison Keillor, "Be well, do good work, and keep in touch."

Fingerprints, Ad Nauseum

Since coming out West, it seems that I can barely do anything at all pertaining to medicine or nursing without having to get my fingerprints taken.

When I applied for my Texas nursing license, I obediently went to the local sheriff's department near my in-laws' home in Georgetown and had three FBI fingerprint cards done by a clerk who seemed relatively uninterested in the proceedings.

Six weeks later, I received notice from the Texas Board of Nursing that those prints were poor quality and unreadable (no surprise there), and was thus requested to have them done yet again. Since my wife and I were traveling at the time, I stopped into the court house in Silver City, New Mexico where a friendly but overworked sheriff's deputy expertly took my prints and sent me on my inky way. (Those prints were subsequently accepted and I received my Lone Star State license soon thereafter.)

Following my licensing fingerprint debacle, I applied to be a board member of a new medical marijuana clinic in northern New Mexico (they needed a nurse on the board), and of course, yet another set of fingerprints was demanded for the privilege of applying for membership. Still traveling, I stopped into the Sedona, Arizona police station where friendly volunteers happily collected my money and greased up my fingers yet again.

Now, having settled in Santa Fe, New Mexico, I have applied for several nursing jobs, and each of those positions requires a set of fingerprints to be sent to the FBI, and these sets were luckily simultaneously taken on an electronic machine that creates a digital facsimile that can be transferred to paper.

Maybe it's just me, but there appears to be an enormous waste of resources involved in sending multiple individuals for repeat fingerprint screenings ad nauseum. When one considers the human hours wasted, the gasoline burned, the reams of paperwork filed and the extraordinary effort and energy expended in the name of bureaucracy, perhaps there's some addiction to bureaucratic chaos (a la the Terry Gilliam film, Brazil) that precludes the powers that be (local, regional, state and national) from creating a central database in which each individual's fingerprints could be simply recorded once.

I'm sure there are those whose trust in the government has waned to the point at which even submitting to fingerprinting in the first place would seem absurd at best (and dangerous at worst), but since I've already allowed my personal information to be submitted to the FBI innumerable times, I would thus have few qualms allowing my prints to finally sit in an electronic repository for access by potential employers and others interested to know that I am indeed who I say I am.

With these latest sets of prints behind me, I have no doubt that I'll once again be visiting the state police or a local sheriff when the next demand for fingerprints rolls around. Til then, I'll give thanks that my spate of fingerprinting adventures is over for now, and my ink-stained digits can finally rest on their (positively identified) laurels.

Jobs Galore

After living here in Santa Fe for just under two weeks, it seems that Craig's List has provided exactly what I needed in terms of part-time work as a nurse. Even when the local newspaper demonstrates a dearth of open positions, online sources of job postings are apparently where employment can be found.

Now, after the byzantine process of obtaining my Texas nursing license (our permanent domicile is currently in Texas), jobs here in New Mexico themselves provide a plethora of hoops through which to jump in order to receive that first paycheck. From having to obtain yet another set of fingerprints to having to take several different exams to further (and unnecessarily, in my opinion) test my knowledge of nursing practice, obtaining employment as a nurse here in the Wild West entails a labyrinthine to-do list that threatens to eat up leisure time like there's no tomorrow.

Still, finding remunerative and (hopefully) satisfying work is very nice, and I'm grateful to have made it through the application and interview processes relatively swiftly. My new jobs should prove to be interesting and relatively well-paying (but less than my previous hourly wages as a nurse in Massachusetts), and I hope that the experiences are also fecund fodder for blogging and writing (with complete adherence to HIPAA, of course!)

Working as a nurse again will be interesting after such a long hiatus, and I look forward to writing about the experience as it unfolds, so stay tuned.....

Pounding the Virtual Pavement

Now that my wife and I are living temporarily in Santa Fe after 7 months and 10,000 miles on the road, I am beginning to search for work as a nurse here in what's known as "The City Different".

Having never worked in a hospital, my specialty has been case management, home care, hospice and community health centers, so I am focusing my search on these professional areas. So far, there are several case management positions available in the area, and I surmise from my initial research and conversations with local Human Resources personnel that competition is indeed stiff.

While the nursing shortage appears to still be a nationwide phenomenon, I hear tell that many new grads are scrambling to find jobs after graduation, whereas many of us finishing nursing school in the early 90s had our pick of jobs before we even took the boards.

Many fellow nurses have told me over the years that not having Med-Surg experience is like committing professional suicide, severely limiting my access to well-paying jobs that are almost always in demand. However, having Multiple Chemical Sensitivity (MCS) makes working in hospitals quite dangerous to my health, taking into consideration all of the cleaners, chemicals, deodorizers, floor waxes and other industrial-strength products that are sprayed with wild abandon all over hospital units, ad nauseum. Thus, the field is narrowed not only by my lack of hospital experience, but also by my physical limitations.

Finding work here in Santa Fe should be interesting, and my hope is that something remunerative and part-time will manifest sooner than later, and regular paychecks will begin rolling in again as I don my scrubs and embody my nurseness once again.

Licensed by the Lone Star

It's finally official. My nursing license from the state of Texas has arrived! Having been on the road for seven months, I have had the blissful experience of not needing to punch the clock, and the only paid work I have been doing has been writing content for BlackDoctor.org and Working Nurse Magazine.

Now that we will be suspending our travels and spending the summer in Santa Fe, New Mexico, it's time to look for work, float my resume, and translate that new license into action and income.

Some of you may wonder how I can work in New Mexico with a Texas license, and the answer is quite simple. A licensure compact exists between 24 states of the US, allowing for reciprocity between each state for nurses who hold a current license in one of those jurisdictions. With my legal domicile in Texas and my current (perhaps temporary) living situation in New Mexico, this licensure compact makes earning money and finding work much easier, a fact for which I am extremely grateful.

Having my new Texas license is a goal I have been moving towards for months, and I feel gratified that I have finally completed the lengthy application process. The job market for nursing positions is tighter than one might surmise, so having that license in hand is one of the important steps in enabling myself to pound the virtual pavement and find meaningful and remunerative work that utilizes the skills that I have honed for more than 15 years.

Stay tuned as the itinerant nurse searches for work in his temporary New Mexican home!

Change of Shift at "The Makings of a Nurse"

The latest edition of Change of Shift is now up at blog called "The Makings of Nurse". After a hiatus, I actually managed to submit a blog post for this edition, and I look forward to hosting Change of Shift myself at the end of June.

Nurses on the Run

Recently, I was honored to have two chapters published in Nurses on the Run: Why They Come, Why They Stay, a new collection of nurses' stories edited and compiled by Karen Buley, RN, BSN and published by Dog Ear Books. Nurses on the Run is available on Amazon, and is also now listed on Google Books. If you happen to purchase a copy, please consider posting a review on Google Books.

My thanks again to Karen for including me in this exciting project, and please consider ordering a copy or asking your local library to do so!

New York City Is Now a Home Birth Backwater

After the closing of St. Vincent's Hospital in New York City on April 3oth, the thirteen midwives who have provided home births to women choosing this option in this city of 8 million people can no longer do so legally. New York law requires that midwives have an obstetrician or hospital as backup when providing home birth services, and the American College of Obstetricians and Gynecologists has stridently opposed home midwifery and home births for years, discouraging their members from supporting or providing medical coverage for midwives.

With one third of all pregnancies in the United States now ending in Caesarean Section, many midwives and supporters of natural childbirth feel that birth has become yet another cash cow for the American medical industry, with home birth becoming more rare (and less legal) as the decades pass. Some American cities and towns have even made public breastfeeding a crime, adding further insult to injury for women who choose natural childbirth and breastfeeding as a lifestyle choice in the interest of the health and well-being of their baby.

Despite the fact that home birth and midwifery are quite popular in other industrialized nations with advanced medical infrastructures (30% of babies in the Netherlands are born at home), the United States medical establishment still vilifies home birth as foolish and dangerous. In fact, the US has one of the highest rates of maternal mortality in the industrialized world (16.7 per 100,000 live births) as compared to The Netherlands' maternal mortality rate of 7.6% or Italy's rate of 3.9%. Amnesty International has even called the United States' childbirth track record "a human rights crisis".

With the current situation in New York City, home births are now illegal and midwives providing maternal care in the home do so at their own risk and without legal or medical support. As one of the most famous and progressive cities on earth, New York City has now become a home birth backwater, creating a crisis for the midwives and families who choose this natural alternative to the American medical industry's industrialization of childbirth.

Change of Shift at Muse, RN

A Nurses' Week edition of Change of Shift is now up at Muse, RN. Please pay her a visit and read some of the best nurse blogging around.

Everyone's Going to Nursing School

Just today I learned that one of my cousins is getting ready to enter nursing school. With three aunts who were nurses (one of whom served with General Patton during World War II), there is certainly a precedent in our family for some of us to pursue a career in nursing, and a laudable precedent at that. My cousin is yet another person realizing the potential economic benefits of being a nurse at a time when many Americans are searching for a new recession-proof career.

As older nurses continue to retire and the Baby Boomers enter their golden years, the demand for nurses certainly seems to continue unabated. Recent reports, however, indicate that a strained economy is forcing many nurses who used to enjoy part-time or per diem work back into full-time positions, making competition for jobs more challenging for new nurses entering the field. And with nursing schools overwhelmed with applicants and short on professors to teach those fledgling nurses, many would-be nursing students may turn to other allied health professions like Occupational, Physical, or Speech Therapy.

A recent article published in the South Florida Business Journal cites a new study by The Florida Center for Nursing which concludes that attrition from the nursing profession is far greater than the influx of new nurses. For example, in the last two years, the number of nurses in Florida increased by 27,000, however more than 50% of that gain was offset by nurses leaving the field, making the net gain of nurses around 11,000.

With more than 3 million registered nurses in the United States at this time, it's clear that the profession is still holding its own as one of the backbones of the health care industry. Still, with a shortage of qualified professors due to a large wave of retirements and few willing to replace them due to better salaries for clinical positions, all signs indicate that the overall shortage of nurses will continue to plague the United States---and most of the world---for some time to come.

In my view, geriatrics and long term care are sure bets for future nursing job opportunities, and those who are willing to pursue an advanced degree as Nurse Practitioners specializing in geriatrics will likely be readily employable in most regions of the country, especially those areas most popular with retirees.

I am thrilled that my cousin is pursuing the family legacy of a nursing career, and I pray that she will be accepted to the school of her choice and be readily employed upon her graduation. Still, one must be realistic that the calculus of the nursing shortage and the opportunities for employment have indeed changed since the days when new grads waltzed into jobs demanding any salary they pleased. Despite the shortage, competition for jobs is stiff, and the competition to get into nursing school equally as difficult.

For myself, having taken almost a year off for travel and writing, I am readying myself to look for a job in the Santa Fe area where my wife and I plan to spend the summer, if not the next year. While I may be fluent in Spanish and have a relatively impressive resume (home health, community health, hospice, and public health), I have never worked in a hospital and thus am somewhat limited in the type of nursing jobs I can pursue. I do not anticipate finding work to be overly challenging, but in the current climate, I realize that it may not be as simple as it once may have been. And with new grads flooding the market and willing to work for less than seasoned nurses accustomed to higher wages, perhaps finding the perfect part-time nursing job may be more challenging than I originally anticipated.

There's no question that nurses are highly trusted professionals who are sorely needed by an aging population. But in the current economic climate, can enough well-paying jobs be created for the seasoned nurses and new grads who are more than willing to don their scrubs and get to work? Only time---and economic forces---will tell.

Some Notes During Nurses Week

With Nurses Week happening this week, there is a great deal being written and said about nurses in the media. We are indeed one of the backbones of the medical establishment, and while Nurses Week is often glossed over with trinkets, flowers, Hallmark cards and other ephemera, it is indeed helpful to be appreciated and acknowledged from time to time.

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During Nurses Week, Dr. Dean over at The Millionaire Nurse Blog is running a 100% anonymous survey with the goal of gathering data on nurses' salaries, investment habits and savings habits in order to help him develop products and services to benefit nurses financially. You can take the survey by clicking here. Everyone who completes the survey will be entered in a drawing for several prizes, so why not give it a try?

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Also, coinciding with the 100th anniversary of Florence Nightingale's death, Black Dog Publishing is releasing Nurse: Past, Present and Future---The Making of Modern Nursing, edited by Kate Trant and Susan Usher. This new book examines the evolution of nursing internationally, and readers of Digital Doorway have been offered 40% off the purchase price. If you would like to take advantage of the offer, please email jess@blackdogonline.com and mention Digital Doorway, or simply email me directly.

Here is a description of the book from their website:

Nurse: Past, Present and Future: The Making of Modern Nursing examines the culture of nursing on all levels, from its historical development to its status today. The book highlights the power and value of nurses worldwide, and traces the evolution of nursing as a career.

Nurse: Past, Present and Future discusses the importance of nursing to economics across the world, the impact of nurse migration patterns. The book traces the evolution of the nurse’s social standing, appearance, education and skill set, and examines some of the key debates now underway. These are put into context with a look at how nursing has progressed through the twentieth century in response to changes in medicine and society.

Includes essays from key figures in nursing and first hand accounts from nurses working today. Thoroughly illustrated, comprehensive and global in scope, Nurse is the first book of its kind, dedicated to the past, present and future of the culture of nursing.

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Happy Nurses Week to all, and remember that every patient deserves a nurse!

101 Blost Posts Every Nurse Should Read

On the blog known as "Online Nurse Practitioner Schools", a new post entitled "101 Blog Posts Every Nurse Should Read" is now published and available. I am humbled that my post, "The Nurse As Sisyphus", is included as #4 on the list. My gratitude to the publishers for this honor.

The Elderly and Medications: At What Cost Health?

Recently, my elderly mother moved from the Northeastern to the Southeastern United States in order to live closer to my sister. A widow for several years, she is on what would be classified as a fixed income, and her medical insurance premiums and prescription drug plans eat up a great deal of her monthly budget.

When it comes to some of the more pedestrian prescription medications, co-pays can range from just several dollars to perhaps $20 or $30 per month. But heaven forbid that an American elder needs a medication that is not quite so generic in nature, and the monthly payments for such drugs can skyrocket through the roof, wreaking havoc with even the most well-planned budget.

We have all heard stories of senior citizens having to decide between groceries and medications, or turning off their heat in order to pay their health insurance premiums. These stories are not uncommon, and although many of these elders may be under the media radar, we all know that there are still millions of Americans struggling to retain their health insurance, obtain health insurance, or simply get by without any coverage whatsoever.

While the debate about the new health care reform legislation rages on, we must remember that many seniors like my mother are regularly raiding their hard-earned piggy banks in order to pony up enough money to purchase costly (and admittedly life-saving) medications. While the need for pharmaceutical companies to earn money and support new research is understandable, vulnerable Americans like my mother cannot continue to be placed economically between a rock and a hard place and simply offered a pillow of pity as compensation.

I agree that reform is contentious and painful, but so is making a choice between food and prescriptions. When a senior citizen skips a meal in order to fill a prescription or pay an insurance premium, it is once again illustrated that something is wrong with this picture. And when yet another uninsured child misses her annual physical and vaccinations, this flies in the face of the Surgeon General's message of the crucial importance of preventive medicine to the over all health of the nation and its citizens.

I don't have the answer to fixing this enormous challenge that our nation faces, but I can hear in my mother's voice over the phone that this simply has to change. The United States ranks behind many other industrialized nations when it comes to important markers of public health (like infant mortality, for example), and the fact that so many Americans continue to languish without health insurance would be laughable if it wasn't so tragically sad.

Every generation strives to leave a hopeful economic and social legacy for its offspring, and my mother's generation, who lived through the Great Depression, is no slacker in this regard. But when we see octogenarians eschewing good nutrition in order to pay for their basic health needs, we must realize that we are forgetting the sacrifices that our elders made for us in decades past. Change will come, but what cost we pay in the interim certainly remains to be seen.

Change of Shift is Here Again!

The newest edition of Change of Shift, the premier nurse blog carnival, is now ready for your reading pleasure by clicking here. Enjoy, and one of these days I'll actually get around to contributing regularly again, myself!

The Misguided State of Arizona

The new immigration law enacted in the state of Arizona earlier this week is an egregious act of backwards thinking that sets the tone for draconian measures that will negatively impact millions of Americans and non-Americans for years to come.

This law, which commands that Arizona law enforcement officers demand to see the papers of any "suspicious" person who might, by some chance, be in the country illegally, will cause many individuals to be searched and questioned for no good reason other than the color of their skin. In an article by Robert Creamer on "The Huffington Post", the author correctly likens this new law to the legal climate in Alabama in the early 1960's.

Beyond requiring officers to question any individual who might be deemed as potentially illegal, the law also allows private citizens to file suit against any officer who they feel is not fully enforcing the new law, thus deputizing citizens to join in a witch hunt that will hurt families, children, communities, and the very economy of the state of Arizona.

Many law enforcement officials also believe that families with undocumented members will now choose to not report crimes for fear of being targeted by police under the new law.

In terms of health care, one of my main concerns is that injured or sick individuals in need of medical attention will choose to forgo medical care for fear of racial profiling. Most hospitals and medical institutions will treat needy individuals with or without proof of citizenship, and this new law will now send chills down the spines of sick or injured persons in need of urgent medical attention, and the human cost of such untreated illness is simply gruesome to consider.

No one can fully foresee the true human, moral and economic cost of this legally misguided and immoral act by a governor who is certainly sewing the seeds of his political demise.

Rabies!

Today, while walking in the outskirts of Silver City, New Mexico, I was charged by a trio of dogs, one of whom managed to bite me on the inner thigh as I tried to turn and walk away from their barking ferocity. Normally a dog lover ( I have a dog myself), I am rarely frightened by dogs and generally have a way with them, but this triumverate were none too friendly, and I limped back to our campground as I called my wife on her cell phone and asked her to boil some water and ready the First Aid kit. (My wife and I have been traveling in an RV for six months, chronicling our adventures on our travel blog.)

Here's a photo of my wound.....


Interestingly, the Silver City Animal Control Officer was reluctant to come to see me at the campground, although he indeed paid a visit to the dogs' owner, who accused me of trespassing, a conclusion which I summarily rejected as false. Trespassing or not, a loose dog without a collar, identification or civilized manners had charged me and managed to sink a few teeth into my tender flesh, and the only thing truly on my mind was rabies.

According to the CDC (and most other authorities on the matter), if a person is bitten by an animal whose rabies vaccination status cannot be determined, that individual should receive a series of five rabies vaccinations (Post-Exposure Prophylaxis, or PEP) beginning on the day of the bite (also referred to as "Day Zero"), followed by vaccines on days 3, 7, 14 and 28. Rabies immune globulin (RIG) should also be administered as a second vaccine on Day 0, with up to half of the RIG vaccination injected into the tissue surrounding the site. Rabies is a serious illness with serious consequences, including contractions, high fever, confusion, agitation, coma and death.

As one can imagine, aside from administering First Aid to the site, and flushing it with hot soapy water and hydrogen peroxide, identifying whether or not a rabies vaccine series was necessary was first and foremost in my mind. Luckily for me, once we involved the local Sheriff's department in the case, we were informed within two hours of the incident that the canine in question was indeed up-to-date on his vaccinations, a conclusion that was obviously a happy one for us travelers.

Needless to say, dear Readers, rabies is a serious illness and must be taken seriously. If you or someone you know is bitten by an animal of unknown origin or vaccination status, prompt First Aid and rabies Post-Exposure Prophylaxis is paramount. Act quickly, seek medical attention, and be sure to follow all recommendations for treatment of such an injury, and you will be happier and healthier for it!

Change of Shift at Nurse Me

Nurse Me, yet another nursing blog worth perusing, is hosting this week's edition of Change of Shift. Change of Shift is, of course, everyone's favorite nursing blog carnival.

Sugar Coated

This afternoon, my wife and I were shopping at Whole Foods in downtown Albuquerque to stock up on supplies for the next leg of our travels. What struck me today was that added sugar has now crept into every aspect of the health food industry, and I am aghast at the ways in which extra sugar is now a ubiquitous ingredient no matter where one may look.

Back in the day, it seemed that the only form of added sugar that we needed to watch out for was high fructose corn syrup, that most processed of sugars that seemed to be added to everything under the sun. Now, with increasingly savvy consumers more aware of such sweeteners, companies have apparently decided that "evaporated cane juice" and other more "natural" sugars are the way to go.

Based on my readings, it seems that the "evaporated cane juice" now apparently used to sweeten the majority of products on health food store shelves (including ketchup, mustard, cereals, crackers, soy milk, etc) are just as guilty of contributing to obesity and other health problems as those containing good old-fashioned sugar, although some may debate me on this notion.

While health food stores try to dress up their processed foods as being "whole foods" by using organic milled cane sugar or evaporated cane juice as sweeteners, they are still simply adding millions of empty (and nutritionally useless) calories into the bloodstreams of ignorant (and not-so-ignorant) consumers, contributing to the overall rise in obesity, diabetes and related conditions. According to some nutritionists, sugar cane does indeed have some nutritional value, but mostly if you just went out into the field and chewed on it, benefiting from the fiber and other nutrients therein.

Searching through the health food store aisles, I am often hard-pressed to find products that are sweetened with fruit juice, barley malt, brown rice syrup or other natural sweeteners that have a lower glycemic index and some intrinsic nutritional value. Increasingly, I read labels ad nauseum, rejecting product after product when I see "evaporated cane juice" or some other unnecessary sweetener in the list of ingredients. Sigh.

I am frustrated with how the health food industry has sweetened the pot, as it were, adding natural-sounding sweeteners to a plethora of products, making shopping more difficult and maintaining a low-sugar diet a challenge. Sugar in some form or another finds its way into most everything these days, and when one looks more closely, it becomes increasingly difficult to avoid it, no matter how hard one may try.

Hate and Healthcare

With physical intimidation, racial epithets and other threats being aimed at lawmakers who voted for health care reform, a newly appalling era of American politics seems to have dawned.

As members of The Tea Party call Representative Barney Frank a "faggot" and scream the "N-word" at Representative John Lewis, a true Civil Rights-era hero, the level of debate in the country has certainly taken a decidedly downward turn.

The controversial vote on health care reform has indeed made many enemies, and it is widely agreed that there is no way that this legislation will please everyone. While some on the left feel that the "reform" is nothing but a capitalist grab at health care dollars, many on the right opine equally strongly that "socialism" is now simply lapping at the shores of the country against the will of the majority of voters.

Never having purported to be terribly politically astute, I have admittedly had a difficult time sorting through the fact and fiction about the legislation in question, and my personal jury is currently out. While I am glad that Congress took bold action, I have concerns about provisions that may line the pockets of some insurance companies, other provisions that could hurt small businesses, and the glaring lack of a single-payer option similar to that of other industrialized nations.

Misgivings about the legislation aside, there is no room in such a debate for hateful speech, legislators being spit on, bricks being thrown through windows, physical intimidation, and other tactics which underscore the divisiveness of the issue with a complete lack of intellectual prowess or forethought. As we learned during the Civil Rights era, change is painful, and those who resist change can sometimes resort to actions and words that are hurtful, divisive and sorely regrettable.

Racial slurs and homophobic language have no place in this debate, nor do threats of death and injury. Heckling is one thing, but the foul language and violent actions of those protesting health care reform have no place in our society.

No one knows how the health care debate will unfold, and neither can we predict how the political fortunes of its authors and supporters will be changed. What is crystal clear to me at this time in history is that there are still elements within the United States who are willing to use intimidation and hateful speech to make their discontent known. Such angry action and speech is a waste of breath and energy, and will most likely only backfire on those who use it. Shame on those who stoop so low, and shame on those who sit back quietly without protest as such ugliness spills into our streets.

An April Fools Change of Shift

Dr. Dean over at The Millionaire Nurse Blog has just published an April Fools Day edition of Change of Shift, everyone's favorite bi-weekly nursing blog carnival. And lo and behold, I even managed to submit an article this time! Pay a visit if you can!