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“You have to help me! He’s out there! He’s in the waiting room and he’ll hurt me, he promised he would. Please just admit me to the hospital or something – just get me out the back door so he doesn’t know ….”

These were the words that greeted me as I swung into the clinic room, hand outstretched, to introduce myself to my new patient. She was gaunt, dirty, disheveled and wide eyed. She looked much older than my papers said she should. As her words tumbled out and she cowered, shaking, in the corner chair I have to admit that my first thought was that she was likely not sober. But there was something about her eyes. Her eyes were wide and clear. She was talking fast, but very coherently. She grabbed my hand before I had a chance to do anything else with it, and held on tight. Really tight.

Well ok, I thought. Where to begin. Are you safe? Has he hurt you? Do you have somewhere to go? Do you really have a cardiology problem I can help you with? Is there anyone in your life who loves you?

As we worked our way through these things (as well as the fact that she had a pacemaker with a soon-to-be outdated battery, and absolutely no medical records with her from her out of state physicians), her story began to slowly unfold.

She had family across the country but she was estranged from them – maybe not permanently, but she wasn’t sure. He was indeed in the waiting room, and he was abusive to her. She was ready to leave him but needed help. He was wanted by the police. Thankfully there were no children involved.

The clinic manager got involved, and the man got ancy, pacing back and forth trying to see down the hall where we were. The police ended up coming to see what was up, and he ran away – turns out he was wanted and didn’t have a license.

The horrible thing was this. There was nowhere for this woman to go.

I called women’s shelters from ten (TEN!) counties around us. I called homeless shelters. Everyone was solicitous and concerned, but nobody had a bed. Some who had beds wouldn’t take her because she was from another county. Nobody had any ideas. Some took up our valuable afternoon time by taking her entire history and promising to call back – but then couldn’t commit to helping her.

It turns out she was diabetic and hadn’t eaten in quite some time, so the clinic nurses brought her food. She was appreciative but seemed so beaten down – like a shell inside her overly tanned, dark skin. It was only her eyes – those beautiful eyes – that showed signs of life.

As the afternoon wore away with my making phone calls in between other patient visits, I started to feel quite anxious. What was I to do if I couldn’t find her shelter for the night? What would become of her?

I called the social worker in our Level I Trauma Center who turned out to be an absolute knight in shining armor. He didn’t know of any placement options either, but he agreed to help. A taxi was sent to fetch her, and we escorted her out the back door of the clinic (in the dark). He met her at the ED, and she was given shelter and direction.

I expected not to see her again. My frustration grew that in our rich and privileged area, we had no options for helping a woman in need that day. Knowing that so many battered women go straight back to their abusers because their self-esteem is shattered and they don’t realize that they deserve better. Sadly, I suspected that she would go back to him. I thought that my quiet words of support and encouragement were falling on ears that had already believed lies for too long.

I left, and went to my warm and welcoming home, with my wonderful husband, children, and dogs. I felt so blessed, but also a little cold inside when I thought of her.

Turns out, there was a miracle. Several months later I got a quick note from one of our EP docs I had referred her to. She asked him to let me know that she was ok. She did NOT go back to him. He left town, and her estranged sister and mother came to help her. She was living with them and had a job. And a new pacemaker battery. And more importantly, she had hope.

Hallelujah.

I usually am an ‘early adapter’ of technology.  This is a term I learned from my geek-husband (said affectionately, of course), who works with such things for a living.  I think that’s one of the reasons (I know, I have to admit it) that I liked loved working in the CCU so much.  All those wonderful gadgets and toys to play with – sometimes had to remind myself to ‘treat the patient, not the monitor’.

Well, for years and years I have used a succession of Treo smartphones with the wonderful Epocrates Essentials reference suite.  In clinic, it’s absolutely glued to my hand (no, not to text my children … to check drugs and compatibilities and make sure I don’t hurt anybody by prescribing the wrong thing).

To make a long story short – the Treo died.  Decided to try the Blackberry.  Well everyone else at my fine institution is sporting them on their waistbands!  SO MUCH TROUBLE SINCE!  My eyeballs are spinning in their sockets from two days of staring at this teeny screen trying to get stuff to work.  The litany of problems goes like this (and this is the abridged version)…

  1. Blackberry doesn’t sync with Mac (I will NEVER give up Mac).
  2. PocketMac doesn’t work with my Mac for some reason.
  3. The Missing Sync worked for mostly everything (guess I don’t really need the calendar anyway), but is expensive.
  4. The Blackberry ran out of battery three hours into the saga.
  5. The only version of Epocrates that runs on BB is the simple one.  Might be ok?
  6. Tried to download PEPID – it’s well-rated but expensive (Epocrates is free to me through my institution)
  7. Didn’t work
  8. Called/emailed/chatted with PEPID people.  Problem with MAC.
  9. Finally got it to work.  PEPID people were lovely.
  10. SO MANY WORDS ON THAT LITTLE TEENY SCREEN.
  11. More eyeball spinning, leading to the maximum allowable dose of naproxen for me.
  12. Deleted PEPID – too expensive anyway.
  13. Downloaded the basic Epocrates.  Oh well, I should know where to look up the other stuff anyway.
  14. Now to figure out the BB and why it keeps telling me I have messages when I don’t.
  15. Do I want to keep this thing?  Or go back to the clunky Treo?  Aargh.

I think the problem really is one of shaken foundations.  I am usually quite adept at the technological things.  Why so much trouble with this?

If you’re reading to the end of this, YOUR EYEBALLS are probably spinning.  Sorry to share my angst with you.  Feels good to write it all down.  Isn’t that what blogs are for???

Well said, Dr. Wes

One of the intriguing blogs I’ve been reading recently is that of Dr. Wes.  His post today about Long QT Syndrome being the ultimate paradox just struck a chord in me.  I tried to comment on his blogsite, but got all tangled up in permissions, passwords and signatures (I’ll have to figure out how to do that someday), so I thought I’d just leave my thoughts here.  Check out his blog today.

Well said, Dr. Wes, well said.

As a cardiovascular NP and the mom of a beautiful daughter diagnosed with Type I Long QT Syndrome at age 17, the goal is – in this journey of ours, Mom, Dad and daughter – to live a normal life with LQTS.  Yes, she is treated with the requisite beta blockers and has an ICD.  Would we not want to know?  And face the risk of sudden cardiac death from this weird disorder where often the first symptom is death?  No, emphatically no.  The trick … the goal … is to live life to the fullest.  I think she’s doing just that.

She’s graduating with a BSN in December, and has a job lined up in the CCU of our large teaching hospital (my alma-mater unit, I’m so proud!).  Oh!  And she just competed in her 6th triathalon.

Life is good.

I would be remiss if I didn’t share my favorite YouTube video with you. This makes me laugh every single time I even think about it. Cheap therapy

Bully Pulpit

Well I learned a new term today. I was reading an excellent article on the current state of affairs with NP’s billing under MD’s billing numbers at reduced rates, and how insurance companies charge the patients the same rate and copay but are ‘profiting’ from the reduction in NP’s income. The article recommended that professional organizations, NP journals and schools of nursing should use their platforms as a ‘bully pulpit’ to explain that reduced NP reimbursement is not saving the patient any money, and in fact only increases the cost of healthcare.

Well I had to look up the definition of ‘bully pulpit’ in the C-Span dictionary because I found the notion so intriguing. Here is is:

This term stems from President Theodore Roosevelt’s reference to the White House as a “bully pulpit,” meaning a terrific platform from which to persuasively advocate an agenda. Roosevelt often used the word “bully” as an adjective meaning superb/wonderful.

Isn’t that interesting? The word ‘bully’ to me has a negative connotation – in my mind it depicts lurking bad guys and big kids who’ve been held back in school for years posturing themselves to pounce on those meeker than themselves (like the kid with yellow teeth in ‘The Christmas Story’). But Roosevelt apparently used the term to mean superb or wonderful.

I would love to think that our professional organizations, schools of nursing and journals were superb and wonderful. I would love to think that they had the pull or the influence to make some of the iniquities of professional practice right. I would love to think that the medical community would be supportive of our efforts. Unfortunately, I think that nursing, while striving to become a profession, isn’t there yet. We’re too busy eating our young and trying to justify our existence while working in the trenches to provide excellent patient care in an environment that doesn’t value or reimburse us according to what we do. We are bent on arguing over alphabet soup after our names, levels of educational preparation, whether or not we are professionals and if so, how to define ourselves as professionals. There’s no time for advocacy.

So here’s the challenge – yet another one. Let’s stop arguing over whether we should get doctoral degrees, be called ‘Dr.’, how we fit into the system, what level of preparation is better than another etc. Let’s look to our professional organizations as ‘bullies’ and put them on a pulpit to advocate for us. We provide excellent, collaborative, evidence-based care to our patients everyday. This should continue to be our focus.

Hello world!

Well the title says it.  I’ve been having such a great time reading about the exploits of my favorite bloggers, and wondering if I have anything at all of interest to add to the world.  I finally decided to do it.  So here is my first pass at blogging.  The etiology of the photo above?  An amazing moment at Wrightsville Beach in North Carolina at Christmastime.

By way of introduction:  I am a 40-something wife of one, mother of two.  About to be an empty nester – should be overjoyed with that but somehow it feels more like trying to dance in quicksand.  DH (dear husband) is a saint.  He’s a highly healthy middle-aged jock with more than his share of patience.  Daughter number one is about to graduate with a BSN and hopes to follow in her mom’s footsteps as a CCU nurse.  Daughter number two is heading off to study something crunchy-granola-environmental.

And the name?  I’m a conflicted … er … multitalented person.  A professional classical flutist for the past thirty years (orchestras, operas, chamber music and stuff) by night, and a Nurse Practitioner at a large university medical center by day.  Keeps the fun in everything.

Ciao babies.

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