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.

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 13^th, 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.

Museum of the City of New York

I just got back from a great trip to NYC, Washington D.C., and Annapolis. I managed to squeeze in three museum visits during my trip. In DC Kristin, Ben, and I went to the National Archives were we saw the Declaration of Independence, the Bill of Rights, and the Constitution. We also when to the American History Museum where we saw a food exhibit that included Julia Child's kitchen and the exhibit with the first ladies' dresses. 

After living in New York and visiting multiple times I've covered many of the museums. One that I have always wanted to visit is the Museum of the City of New York and we made it happen this trip. My mother-in-law, Laura, and I really enjoyed this museum which sits on Fifth Avenue and 103rd St. The museum is in the Colonial Revival style and has a stunning entryway with a giant marble staircase and modern chandelier.

We are standing at the base of the staircase. At the top of the stairs is a movie theater that shows a 22 min film about New York history. It shows its movements from a Dutch colony to a British colony to the multicultural mecca that it is today.

Hanukkah

We just concluded the festival of lights, Hanukkah. It was a beautiful eight days filled with many adventures. It started out with a bang at Steven's first horn recital. It was such a blessing to light the first night's candle with Steven's mom and sister, Michelle.

The middle was a little sad as we had to give Ohana back to the vet to find another home more suited for her needs. She was a wonderful, sweet dog but couldn't handle sharing our love with anyone else and Copley was suffering because of that. We knew that we couldn't do that to him or her, so we thought it was best to let the vet find another family, without any other dogs, for sweet Ohana.

The festival concluded with a potluck at the temple. It was a fun affair filled with 27 chanukiyot and a klezmer band. This was the first time I got to hear the songs and watch the children run around screaming. And, of course, the latkes were fantastic!

The Story of Ohana

(side note, I've run out of storage on Picasa so it's not allowing me to put anymore photos on the blog. For now, I'll use facebook until I decide if I want to bite the bullet and pay for storage)

I saw a post by a friend the other week on Facebook that had a picture of the cutest Yorkie and a story about a vet in Waverly, NE that was rescuing adult dogs from a puppy mill. The vet essentially had the backyard puppy mill shut down and agreed to place all the dogs. She also incurred the cost of spay/neutering all the dogs and doing any other medical treatment needed. After hearing the story, I felt compelled to get more information and see if they might have a dog that would fit with our current situation. It so happened that a family who had adopted Ohana had an emergency of some sort and had to return her. The vet tech thought she might be good for us since she was already house trained and a very calm dog. These dogs had never been out of kennels for their whole lives and had really lacked any human interaction. That made us both nervous, but the glowing reviews of Ohana made us feel a little more at ease.
I went and met her several times and then we decided to bring Copley for a little visit. Copley is usually the life of the party at the kennel he goes to so we weren't too worried. They got along really well, so we decided to try a play date at home (which, must to Steven's dismay) turned into a permanent visit. Little Ohana hasn't left since.
There are a few little kinks to be worked out, but we're all doing great. Ohana is having a little trouble doing all her pottying outside. We don't know if it's age/mother related that she leaks a little, but we're hoping to get it taken care of. She has found her night-time spot, which makes the night so much smoother.
The next task is to get her groomed and get them both switched to another food. We're having some allergy issues and hoping the switch cures it.