Where have all the Doctors gone?

May 26, 2007 at 10:03 am (current events, issues, kvetching, misers, nursing, sticking my nose where it doesn't belong, whining)

“The accumulation of all powers, legislative, executive, and judiciary, in the same hands, whether of one, a few, or many, and whether hereditary, self appointed, or elective, may justly be pronounced the very definition of tyranny.” ~ James Madison, Federalist Paper 47.

*****

This post, by EM Physician (a blog I read frequently, and enjoy) made a few statements that got me thinking. But before we get started, someone made a comment I feel compelled to answer…

Not even going to touch the rest of your comment, ucalcal, but this?

Where are the nurses on ensuring enough paramedics are available to provide a quick response to 911 calls so sick individuals get to the hospital in time to be saved? (emphasis mine)

WTF? Like the nurses have control over the paramedic companies. You are talking out of your ass, man. Good grief.

That said, the reason nurses are catching so much flak here is because they ARE unionized. Squeaky wheel gets the grease, as they say. The bigger question is, why isn’t everyone else fighting, too? It isn’t the nurses’ fault that they are biased in favor of nurses. In Federalist Papers No. 51, James Madison said, “Ambition must be made to counteract ambition.” But where is the ambition of the docs, radtechs, etc?

If you want to blame someone, start by blaming yourself. Docs are seen as weak because they are weak. Pushed around for the last five decades by an increasing mound of paper, allowing the insurance corporations and government bureaucrats to dictate patient care. Then, someone (nurses) stands up and says, “Hey, we’re not going to take this anymore!” and you cry “foul”? You cast all the blame on the nurses?

That’s crap, and you know it. Get your fellow docs to wake up and DO something. It’s not good for one voice to dominate in any arena, but if no one else will speak up…I guess you’ll have to take what you get.

Oh, and about the quote? I think “tyranny” could justly describe the amount of low- and mid-level government interference in healthcare. We’ve got so much paper to dick with that patient care is prime for a raging blaze.

Look at Yellowstone National Forest. Ever heard of “controlled burn“? Started in 1972. Burning, when done frequently and responsibly, eliminates the underbrush, stimulates growth, removes deadwood, etc. All good things for a forest. When natural burning is eliminated, you get a strangled forest.

That’s the picture of the healthcare system today–massive, overgrown. I don’t even like that phrase: healthcare system. It’s not health care. It’s sick care, or pretending-to-be-sick-so-I-can-score care.

*****

So, what’s the answer? I don’t have one. But I do know where the blame lies: with all of us. With the nurses, for pushing our own interests without an eye for the effect on the system.

With doctors, for ignoring the problem and hoping it’ll just go away.

With other professionals (radtechs, pharmacists, paramedics, etc.) for acting like the problem doesn’t include them.

With specialists, for opting out WITHOUT speaking up to the administration and the government.

With administration, for introducing/implementing policies and procedures willy-nilly, refusing to listen to staff complaints, and passing the buck.

With the numerous “associations”, who take your money but don’t do jack.

With the government, for doing a poor job of governing anything, and printing paper instead, mandating changes without looking further than the next election cycle.

With insurance company CEOs/CFOs/majority stockholders, who screw everyone and spend summers in Montana with Chuck.

And, lastly, with the patients, who are the crux of it all. Without patients, the system doesn’t exist. They are, in a word, essential. Yet they are unorganized, lacking advocates, because they don’t know what they need…which is where doctors and nurses come in. Yet so far, only the nurses have made their voices heard.

So.

Where have all the doctors gone?

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Simplify, simplify; and other random phrases

May 19, 2007 at 9:45 am (Uncategorized)

As Thoreau would say.

I got up this morning and turned on the TV–I was hoping there’d be a little Battlestar Galactica action going on, but I was wrong. DH said, “Do you have to do that first thing every morning?”

“Um, no. I never do. Unless BSG is on.”

I realized that he has no idea what I do every day when he’s not here. I have no idea what he does (though kid-care is certainly part of it, and cleaning is certainly NOT). He has so much stuff that it is possible he spends nearly all of his time participating in leisure activities.

I read books, listen to music, blog, bake, and clean. He…I don’t know. Plays his guitar? Oh, and he likes Hearts. We can’t play cards together, though, because he is so freaking competitive. I like to win, but I pretend I don’t care (just in case I lose, you know) and that REALLY pisses him off. Because I usually win. I’m just good like that.

God. I’m a bad wife, really. I never seemed to get the hang of letting other people win, laughing at stupid jokes, etc. He’s a bad husband–he doesn’t know how to argue. Yes, that is his biggest fault. He gets mad and just says, “You know what? Forget it. Just…get out of my face if you’re going to argue.” OOOOOHHHHH, You DIdn’t!!!

Anyway, I like to argue. I like to be right. He likes to be right. We argue over who is “righter” than the other. I admit, I force him into it. Is that wrong?

I’ve had a zen cleaning thing working for a couple years. I get in the groove and it’s like the house cleans itself. I don’t have to do it, I just float through and everything gets cleaned up. And my daughter, Snicker, follows behind me like a hobgoblin, messing with everything. I look up and WOW where did three hours go? Turn around–and the house is kinda clean. You can follow Snicker’s path through the house. It is a path of destruction. In fact, that is DH’s name for her: “Captain Destructo”.

I’m willing to put up with a lot for a husband willing to be a SAHD (stay-at-home dad), and who will call his daughter “Captain Destructo” versus “Cutie Pie Honey Baby Snuggle Muffin” or “My Little Princess”. Not that there’s anything wrong with those names, but…You know.

DH likes strong women. I like a strong man. It’s a good match, as long as I remain Queen Boudin.

Speaking of, did anyone else see that special on the History channel? Freakin’ awesome! I’m not that tall, I think (being a mere 5′7″), and I was cursed with a high-pitched voice, but otherwise I’m just like her. Seriously. Okay, so I’m not nobility, I’m not of the Iceit tribe, whatever.

Visit Not Nurse Ratched for her take on the “overgadgeting” of society.

PS. My favorite luddite activities:

Baking bread

Making cookies

Drying & Grinding my own spices

Playing the piano

Working equations

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I *heart* cake

May 17, 2007 at 4:20 pm (cooking, grandmother moments, misers, recipes)

I made Teacake today. Scratch, just like my great-grandma taught me. It’s creamy and moist, with a light lemon and almond smell and little crunches of poppy seed. Beautiful. If I had my digital camera, I’d give you a pic but unfortunately, that was one of the many concessions I made in order to regain control of my life.

This is my great-grandmother’s recipe, that she got from her grandmother and so on. Hope you like it.

Teacake (Coffecake. Whatever.)

Preheat the oven to 450 K (that’s like 350 f, or 177 C). In a large bowl,

1 stick softened butter
1 c. sugar
6 oz. cream cheese
3 eggs

Mix these together in order. Beat until glossy smooth. Add

1 tsp. vanilla
the grated rind of one large lemon
the grated rind of one medium orange

Mix gently. In a separate bowl, combine

2 c. flour
1/4 tsp. salt (or as my grandmother would say, a “biggish pinch”)
1 tsp. baking soda
1 tsp. baking powder

and mix these together. Alternate adding the flour mixture and sour cream until gone. (This takes about a 5 oz bowl of sour cream. I like to add a little lemon juice to mine, as well as a few smacks of poppy seed. Spoon this into a buttered bunt or tube pan. The dough will look really thick, and like there isn’t much there. Don’t worry, it’ll rise like anything and give you a moist, fluffy cake. Cook it until it’s done, a little over half an hour.

For the icing, mix together three-quarters of a stick of softened butter (4 oz sticks, okay?), 1.5 c. powdered sugar, 2 tablespoons heavy cream, 1 teaspoon almond extract, the rest of the rind from that orange, and the juice of a couple lemons. Or an orange, or a couple limes. Whatever.

***

My great-grandmother taught me to measure ingredients according to taste, feel, and weight. I know what half a teaspoon of sugar, salt, soda, whatever looks like in the palm of my hand. I taste everything until it tastes “right”. I cook with “double-handfuls” of beans instead of cups, and somehow it always comes out right.

She taught me little tricks, like softening the veggies with salt before cooking will allow them to hide in the background…adding a bit of fresh herbs and parsley at the end of cooking will make the flavors bright…anything chicken will take a citrus punch and run with it…and pot pie is stew-in-a-pastry. I learned how to make homemade biscuits, to bake my own bread, and how to use masa flour and molasses to make sweet cornbread pancakes for breakfast. Giblet gravy with slices of eggs. I wouldn’t have known the ache of kneading, the solid weight of a ceramic bowl, the burn of rapid whisking during hollandaise-induced hypnosis. The pleasures and pains of caring properly for cast-iron–how strong and smooth the pans can be–the tension of arms and wrists when removing from the oven, the warmth that lingers, keeping roast beef ready whilst making the gravy and mashing potatoes.

I wish I had been there when they sold her house, her belongings. I got her wedding china, her tea-set, per her wishes. But the canning equipment and vase-style jars were sold, and the whole of her cast iron went for $30–money I would have gladly paid, and many times that, to keep those receptacles of memory to myself. Her canning jars weren’t the common brand, Mason, that so many American southerners know–these were like vases, fluted, with soaring necks. Elegant in their rows, glass-capped and gleaming. The pressure-cooker, the stacks of red towels and it’s sister-stack of white…Enough to fill a large pantry, gone for $25. The white linen tablecloth and napkins–gone as well, along with the white lace overslip she used for special occasions, funerals.

It was mother’s day this week. Somehow it passed me by–I got a card from the kids, breakfast by DH. I took my mother a Starbuck’s Tuxedo. It was cold by the time I got there, but hey, it’s the thought that counts.

My grandmother is still alive, and I love her dearly. It wasn’t her doing, the sale of the estate. That was her brothers’ doing, and if she knew about some of the stuff she’d…I don’t know what she’d do, but I’m sure blood would be involved, and it wouldn’t be pretty. Her brothers, my granduncles, care more about dollars than they do memories. They had plenty of money–they simply weren’t interested in keeping around all that dead weight.

If I could think of some appropriate profanity, I’d use it. Some things are too heavy for words.

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I came here to complain

May 16, 2007 at 8:33 pm (grandmother moments, husband, whining)

But I just can’t do it.

My grandmother’s advice is too strong. One afternoon a few months after DH and I were married, I was sitting in her office complaining. She listened, smiled soothingly, tsked at the appropriate times. After I finished a twenty-minute diatribe on men in general and my husband specifically, on the account of mounding dirty laundry and no help with dinner, I stopped for breath and a drink.

She leaned forward over the desk, glasses perched on her nose, hands folded gently on the blotter. Eighty-two years old and she still worked every day. Did all her own cleaning. Had a garden. She leaned forward–not a hair out of place–gave me the stern smile reserved for overdue renters and wayward grandchildren and said, gently: “Cut the crap, dearie, and grow a backbone.”

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12 of 10

May 16, 2007 at 4:10 pm (kids, l&d, meds, pain, sick, whining)

I’ve been lurking on several nurse and doctor blogs lately. Apparently, there’s a furor over the appropriate use of the pain scale. Some people have pain that rates two points over the limit, as improbable as it sounds, making the scale less a ruler and more like those “Caution: x speed recommended” signs.

When my son was in the hospital, they had a chart with five faces on it, ranging from happy to death-warmed-over. Seriously. It wasn’t a yellow happy face anymore, it was matte teal with x’s for eyes. (Don’t bother with editing my “x”, by the way. My form may be archaic, but the other way just looks weird.) (Okay, okay, so I’ve used them both. Sue me.)

Some people say that you should reserve “10″ for the absolute, worst pain you could ever imagine. I have a vivid imagination–never mind Saw, I’ve seen worse in my dreams. So that knocks any pain that I could experience in the course of normal life to a five. So, 1 to 5, how is my pain during labor?

I’ve had four kids, all without drugs, because I would rather deal with pain than be a zombie. Unless the pain makes me a zombie.

[mild RANT ALERT] Seriously, folks–for MOST of the female population, we can handle it. Some people can’t, but it’s not bone cancer. It’s a baby. Cowboy the fuck up and deal, so the next time someone mentions anything about the “weaker sex” you can shove his foot down his throat. At the very least, you’ll have bragging rights. And before you tell me about your “immposible, HORIBLE PIAN in my life! that YOU have obvoiusly NEVER FELT!!” let me say–for that small percentage of you that really needs meds during delivery, I feel for you. Honestly, I do. I’m so sorry that you had to take meds to get through, and I don’t think it makes you less of a mother or less of a woman. In fact, I’m in awe that you would do it more than once if it was that bad. Seriously. But for everyone else–obviously evolution (or God) has determined this is the way to go. Humans have survived childbirth for however-long, sans meds, until recently. In fact, it’s only been the last breath (comparatively speaking) of our time here that hospitals & meds have been available. So, if you want to compare giving birth to FUCKING CANCER, do it elsewhere. And cease rolling over the bed and screaming while the nurse is in the room, and texting your lame-ass boyfriend when she’s not. [/mRA]

With the last birth, someone (a CNA or student, I don’t know which, but her scrubs were the wrong color for RN or LPN) came in and asked me my pain level, 1 to 10. I said, “3.2 ranging to 4.” (I’m a science geek, remember?)

“Ooookaaay, and during a contraction?”

“Huh?”

“…You said your pain was 3.2, what is it during the contractions?”

“That is the contraction. 3.2 to 4 at the peak.”

“…”

“Right now it’s a zero. Does your scale go to zero?”

“Um…”

“If not, I’m okay with a 0.7 or something like that.”

“Hold on. You said-”

“Contraction, wait.” Two minutes pass. “Um, yeah. 3.2-4 during the contraction, zero or 0.7 in between.”

Yeah, I’m a weirdy. My husband was trying not to laugh–he said she looked so confused. We got a big kick looking at the read-out of my contractions…I guess they just don’t “register” with me or something.

The real kicker was the girl who brought me Motrin and a stool softener the day after. I was like, I’ve already gone twice, what do I need that for? It’s nothing I can’t handle. According to the staff, I’m the first one they’ve seen go through L&D without at least Motrin or Tylenol. Not that I’m proud or anything, I just handle pain pretty well. And the stool softener, well, I ordered salad and fruit from the cafeteria, so I didn’t have any struggles with that.

I dislocated my jaw when I was in the ninth grade. That’s a 5 on my pain scale. Right below, at 4.9 is the time I dislocated two toes and sprained a bunch of ligaments in my foot with an incorrect slide into home plate (safe, by the way). And directly below that, 4.8, are the multiple jams of my fingers during basketball. The initial jam doesn’t hurt so much as the flexion and extension afterward, ’cause it always seemed to happen to your right hand the day before (just an example) National ACT Day of your senior year. Suckers. You’d think coaches would realize that athletes have to take ACTs & SATs, too. But nooooo, we were always playing in Boondock, or some such place, getting home at 1 am, gotta be up by 5:30 to get to the testing center (decidedly UN-local community college) by 7:15. It’s a miracle I did well, considering.

So, I don’t understand “12/10″ pain. What is that? If it’s that bad, just say 10 and get it over with. There’s no need to go all prima donna and say that your pain is two points higher than any pain you can imagine…unless you’ve got a really poor imagination, or a bad memory. I mean, if it’s the worst pain you’ve ever felt, wouldn’t it be the worst you could imagine? And if it isn’t the worst you could imagine, then it would be an 8 or a 9, right?

Right?

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Eight random things about me

May 15, 2007 at 3:54 pm (meme, tagging)

I have never been tagged before–I was a little uncomfortable at first, thinking about it as I read memes on other blogs. Would it hurt? Would it be messy? Will I be able to face everyone in the blog-world afterward? And the big question: would I be able to do it right?

Fortunately, there are rules: Each player starts with eight random facts/habits about themselves. Write a post about your own random things. Post these rules. At the end of your blog, tag 8 people and post their names. Don’t forget to leave them a comment and tell them they’re tagged.

I should be pretty good at this one. After all, my nickname in school is “random”. If you don’t like it, complain to MonkeyGirl.

1. I like my coffee with two sugars and some heavy cream–not half and half, not milk, not coffeemate–CREAM. I prefer it raw, but there seem to be laws against that sort of thing these days.

2. This one is similar to MonkeyGirl’s “I’m a nerd” confession. I’m a geek. A random geek. In fact, I’m the one who coined the phrase (speaking of cliches) “geeking out”. Or maybe that wasn’t me. You just don’t know, do you?

3. I can carry a 6′1″, 185 lb man on my back. Seriously. Sans epinephrine, just because I wanted to. Oh, okay, so he was hurt. But honestly, I think he could’ve made it.

4. I watch House, MD. And I like it. And yes, at least once per episode, the mind, she boggles. But usually I’m able to skip right over it and continue watching. But I can’t watch Grey’s Anatomy or Scrubs, by God. Some errors are so glaring, I gotta wear shades.

5. My office is in my closet. It’s a walk-in closet, bigger than my cubicle at the SOUL-SUCKING HELL that is a company I cannot mention, lest I be sued. And yes, I think proving malice would be pretty easy…but let’s not get into that. For your information, any company that will refer to a time as “THE union scare”, and upper management will use that phrase as a swear word, is not a company you need to work for.

6. I think GMO’s & cloning should be proven safe in long-term studies, not assumed to be. And no, a single study of shoddy construction and high error rate does not a proof make. Take that, Dr. Must-Not-Be-Named!

7. I use some “alternative therapies”. If you were in pain, and something made you feel better, would you care if it was due to the placebo effect? (Give me a good massage over a Vicodin any day.) Furthermore, lumping people who drink ginger tea when nauseated with those who believe that there’s a government conspiracy to promote AIDS among the black community, is irresponsible, and I reserve the right to delete your comment if you get mouthy. Fore-warned is fore-armed, as my grandmother would’ve said if I’d asked her.

8. I have faith in science. That sounds stupid, but, well, look at the speed of light, for example. In many physics calculations (and some chemistry, for that matter) you need to know that “c”, the speed of light, is 2.998 x10 to the 8th power metres/second. I have never measured the speed of light–I take it on “faith” that 2.998 x 10 to the 8th m/s is, in fact, the speed of light. Put another way, I believe that those who wrote the textbooks and did the original calculations, and reviewed those calculations, did so correctly. Therefore, I have faith in their work, and will continue to use 2.998 m/s without feeling that it is necessary to calculate it for myself. I don’t, however, extend the same faith to the calculations of others, particularly those whom I tutor. I am skeptical of their answers until they are proven to be true.

Now, I’m not tagging anyone. I view memes as the blogging version of spam emails, the spawn of chain letters. And yes, I was the booger who always broke those suckers in dayschool, and I never had bad luck, so keep your “And may be you dont beleive me, but its true!! It relly works!!” to yourself. Tbbpb.

ETA: I don’t have enough “friends” to tag, actually. So there, I’m really just being mouthy to cover for my own insecurities. Tbbpb again.

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Finals Update

May 12, 2007 at 9:10 am (school)

Okay, got through my finals. I have all As, which is great, but the BIG deal is what my professor said. I finished my final, handed in my test, and she smiled and winked at me.

SHE SMILED AND WINKED AT ME.

This is the teacher who scowled at everyone at the first of the semester. Who was irritated at every correctly-answered question. Who was rude, fierce, and I thought hated the world and all the people in it.

I was wrong. And for those of you who know me well, let me say that again: I WAS WRONG.

She’s not rude, or mean, or “out to get” anyone. Her classes are hard, but she is fair. She doesn’t pick favorites–isn’t that the quality we hate the most?–or manipulate. She’s straightforward, with a steely smile and carefully guarded words. No tricks.

She’ll never win a Teacher of the Year award.

Most students take her class twice, some take it three times. Others give up, and change their majors to become medical-office assistants. Some people transfer schools, hoping for an easier class or an easier professor. And a very few pass through, heads down, studying every evening, rewriting notes, constantly looking for ways to apply this sea of knowledge, make it reachable, make it manageable. Those few earn Bs, and some (no more than two or three a year) earn As. My study partner and I were asked to be supplemental instructors for this class in the fall, a high honor as two years ago her s.i. gave answers and helped students cheat.

I’m proud of my A in her class. I’m proud that I will be paid to help nursing students study, take notes, and pass. I’m glad that I have experience, since my part-time job is tutoring science majors (most often nursing students) in chemistry here at the college. But I’m most glad that I didn’t complain about her to the other students. Those who know me are choking on their coffee with amazement…we’ll pause for a minute so they can clean off their monitors.

I have a big mouth. I say what I think–out loud–at the worst times. I’m working on it, really I am, but sometimes the urge to speak is simply too strong.

This is where being a chemistry tutor has helped me. I have to control my tongue as we go over the Ideal Gas Law (PV=nRT) for the nth time: “You see, if I’m solving for T, I have to divide both sides by nR.” Student: “Oooh, I get it! So, I’ll have nR/PV=T, right?” Me: “…No.” The urge to strangle is strong, but I…must…resist…the Force…

Ahem.

So I go over it again. And again. And again, oh god please help me. But that’s all over–chemistry finals are done, so I’m out of a job until the summer semester starts in two weeks.

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Learning to Fly

May 8, 2007 at 2:51 pm (Uncategorized)

I’m sitting here, listening to “Learning to Fly” by Tom Petty and the Heartbreakers.

some say life will beat you down
break your heart, steal your crown
so i started out for god-knows-where
i guess i’ll know when i get there
i’m learning to fly, but i ain’t got wings
… coming down is the hardest thing

That says it all.

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I have no social skills

May 7, 2007 at 9:57 pm (Uncategorized)

No, really. I don’t. This happened earlier this semester and illustrates this truth perfectly:

So we’re in Human Anatomy lab, studying the muscles, working on the cat. I turned to one of my friends (we’ll call her Shiraz). I said, “Do you know what to expect on the next practical?” because I was trying to make nice since I have yet to make any friends. “No, I don’t know,” she replied. “Oh,” I said, “but isn’t this the second time?” Now, in my defense, fully 58 of the seventy-two people in this class are taking it again. Of those fifty-eight, 13 are in there for the third time. I think I can be excused for assuming that one of the girls who always comes in late is in there for a 2nd go.

Shiraz looked at me and said, “Uh, no. I’ve never taken this class before.” Blushing, I tried to recover: “Oh, yeah, because you’re smart like that.” Oops. I did mention, above, that just above 80% of this class are retaking it?

I am an idiot.

Also, a small update to this. It is now time for the final–our class has dwindled from 72 to twenty-one. Of those 21, how many do you think are going to take physiology? This semester physio had 9 people, five of which were taking IT for the second time. This is after taking anatomy twice.

I feel weird. Final on Friday, I’ll let you know how it goes.

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Addicted to Nursing

May 7, 2007 at 5:23 pm (nursing)

“Hi, my name is Miranda. I’m a nursing student.”

“Hi, Miranda,” the class chants. The proctor turns toward me, a dyseptic smile on his pale lips. “Would you like to share anything with the group?”

“Um, sure. I don’t know why I started nursing…Yes, I do. I chose nursing. My life sucked, Milton was kicking my ass, and nursing was easily available. I thought I’d try it once.”

“Miranda, no one ‘tries’ nursing.”

“I know.”

“Nursing isn’t a recreational practice. It’s hard-core. You can’t try it, and you’re kidding yourself if you think you can.”

“I know.”

“What’s the first step?”

“Admit you have a problem.”

“And do you? … You do, or you wouldn’t be here. What is your problem?”

“… I’m a nursing student.”

I’m addicted. Seriously. I admit it. I’m addicted to helping people who are shitting on me. We all are, otherwise we’d become doctors. I have the grades, the smarts, the perseverance, the coffee-pot that can keep liquid-life warm for 12 hours. I was an English major once, and Norton’s didn’t beat me down…so why am I becoming a nurse? This punishment isn’t worth it.

ETA: Yes it is, too. As to why I don’t take my 4.0 and become a medical doctor? All in due time, folks. Nursing is an addiction, you know.

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