Wednesday, March 27, 2013

The New Epidemic

Every generation of physicians has a prototypical disease, the one that wreaks havoc with almost all the organs. Learned professors of medicine would say, “You can learn all of medicine by studying disease X.” For my father’s generation it was syphilis. For my generation it was alcoholism. For the current generation it would be obesity, hands down. It affected every organ. (Dr. Manheimer, 12 Patients)

Given this current epidemic, it is not uncommon for our hospital to have multiple patients who suffer from obesity. The largest patient I took care of this year was 582 pounds. Generally over 50% of our population is 200 pounds or more. This not only affects the patient but it takes a toll on the caregivers. I spend a large chunk of time in each room setting it up to ensure my health and safety. The last thing I want is to be out on “administrative duty” because I hurt my back. I also don’t want my back to limit how I spend my free and, trust me, Zumba is not easy on it but it sure is fun!

The most common mistake nurse aides make is not raising the bed. This seems so simple but I walk into multiple rooms each day and watch aides totally bent over doing a task as simple as putting lotion on someone’s legs. You can ask all my co-workers that my first response when I witness that is, “I’m sorry, but I won’t do that. Wait until I raise the bed.” I sometimes come off as Ms. Bossy Pants, but the extra time it takes to properly position a patient is the key to health especially as our patients are tipping the scales.

As you read each obese patient’s case file you see that obesity is never the number 1 complaint or diagnosis however it effects every part of their disease and recovery. The sad thing is that many of these patients don’t understand that. If I have a 150 pound man come in because of a below knee amputation, I can almost assure that he’ll be leaving about 3 weeks almost completely independent. You add even 50 pounds onto that man and we’re talking severe limitations. One day I walked into a woman’s room, who was recovering from heart surgery. She had an easy 300 pounds on her 5’2” frame. She was lamenting to me about her current health state saying, “I just don’t know why I keep having health problems.” It didn’t even occur to her that her weight was the underlying problem. It’s frustrating but at the same time it is the reality the health care system has to deal with. I find it absurd when we run out of bariatric equipment (bariatric is the medical word for overweight). I’m always scheming with my co-workers about creating bariatric rehabilitation centers that deal not only with the current health problem but the true reason for them. Who knows what will happen in the future, but I’m sure it won’t be any lighter.

the ties that bond

Working in a rehabilitation hospital our patients have stays that are longer than normal. According to the CDC the average length of a hospital stay is 4.9 days. On our unit, the average length of stay is 8-12 weeks. That’s 56 to 84 days. Some have even stayed as long as 168 days. That being said we see these people all the time. I spend more time with my patients than my own husband. On one hand, this is awesome. I’ve met some of the most interesting people that I know and would have never met had circumstances been different. I’ve also got to know these people in very intimate ways. When they are relying on your to perform cares of a personal nature, a bond of trust is formed very quickly. Dr. Manheimer commented on this bond and I found it struck a chord with me.

They would talk to me for hours and ask me questions about my interests. It’s funny, but over a few weeks I came to depend on them and learned about their families, their special interests, places they wanted to visit. It was like a weird Scheherazade. Trading tales from different kingdoms. Each one a foreign language to the other person. I knew more about them and they knew more about me than my own family. I cared more about them than my own family.

I’m not sure I agree with the final 2 sentences, but sometimes they just may. When we see each other everyday very little can change. We discuss even the most insignificant details of our days. And how do we find the time? In their current condition it can take some of them over an hour to get ready for the day. The easiest way for both of us to pass this time is to make idle chatter.

Tuesday, March 26, 2013

Bellevue Hospital

The book that I’m currently reading is titled, Twelve Patients: Life and Death at Bellevue Hospital by Dr. Eric Manheimer. Dr. Manheimer was the medical director at the hospital for 14 years and is currently a professor at NYU School of Medicine. In this book he gives the reader a glimpse not only into this notable hospital but also into the health care system, both its successes and failures.

Bellevue Hospital is 275 years old, making it the oldest hospital in the country. Bellevue has been a leader since the beginning having many firsts: maternity ward, pediatric ward, and C-section to name a few. Over the next few posts I’ll look at few of the more profound comments that have stuck with me.

An area of medicine that is growing at an enormous rate is that of palliative care. The fundamental basis of palliative care is death and the rights that should be afforded to the patient in this process. Quoted from Dr. Manheimer:
How people die and how we participate in their deaths is as much about us as about them. Our own humanity is at stake. In a society that is increasingly mesmerized by efficiency, measurement by numbers and a bottom-line mentality that extols profit and wealth over any other human value, the risk is clear to everyone I work with. When health care is now measured by a “medical loss ratio,” and the percentage of spending on health care is considered a “loss,” then we are really lost.
This comment was prompted by a story he told about a young man with terminal cancer that had lost both his legs and was literally falling apart at every point. He wished to return to his native country, Mexico, to die. Obviously this is not something insurance would pay for nor was it something that anyone would recommend. We are constantly pushed to use every available treatment to keep someone alive despite his or her quality of life. Just because we have the technology to keep someone alive doesn’t mean it is always the right thing to do.
When discussing this very situation in a class I took this fall, a comment was made in our text that often the family needs to see the suffering in order to make it feel real. If they are unable to see their loved one suffering they are unable to process their death. This harkens back to the comment of making death about us. When or why should it ever be about us? Wouldn’t the most respectful thing be to help the dying fulfill their wishes even if that’s not what medicine would tell us to do?

another chapter

I’m thinking of taking a new approach to this blog. As many of you know, Steven and I are no longer traveling. We have been settled for the past year in Lincoln, Nebraska both doing collegiate work. Steven is finishing his undergraduate degree in music and picking up a minor in business. I was taking pre requisites for a nursing program and now, as of May 13th, will be enrolled in the accelerated BSN program at the University of Nebraska Medical Center. The College of Nursing has a campus in Lincoln making it an easy transition.  

I have now been working at a hospital for over a year. It has been one of the most eye-opening years as I’ve experienced a whole new part of the American health care system. My previous experience was in a nursing home setting and as I quickly found out, the hospital rules are very different from that of a nursing home although they are both governed by the Department of Health and Human Services. The differences lie in reimbursements, or so I’ve been told. Those kinds of conversations are usually the ones that have me running and screaming. It takes away the humanness of a person and puts them into charts and numbers, which as someone caring for another human seems totally absurd.

So back to my very first sentence; I’m thinking of taking a new approach to this blog. I would like to share some of my stories and/or thoughts on this entire process. Looking at nursing from the inside and the outside as well. I’ve been reading many interesting articles and books and have had lots of notable experiences, and this could be a good outlet to look at them, so look for new posts soon.