Wednesday, December 22, 2010

The Case of Sister Margaret McBride

The Catholic Church is taking a big risk by excommunicating a nun, also a nurse, for doing her job. Sister Mary McBride, an RN administrator of a Catholic hospital in Phoenix Arizona, approved a life-saving abortion for a woman who was 11 weeks pregnant at her hospital. The woman suffers from pulmonary hypertension, a condition which would have a greater than 50% chance of killing both mom and baby if the pregnancy was allowed to go on. According to news reports, the Bishop who excommunicated her, later also stripping the hospital of it's affiliation with the Catholic church as well, claims to take issue with the fact that treatment of the mother was never attempted before the abortion was approved and carried out. Well, it basically shows that Catholic Priests have no business practicing medicine, because the TREATMENT for that disease IS termination of the pregnancy. All that delaying the abortion would have accomplished is forcing the mom to go through several more weeks or months of a doomed pregnancy (at the risk of losing her life at any time), only to be forced to perform a later term abortion on a more fully developed fetus.
It is interesting to note that the Catholic church does not feel that the crimes committed by pedophiliac priest/molesters are bad enough to warrant excommunication, yet they feel that a Registered Nurse who is carrying out her mission to heal others is worthy of this most awful punishment.
I am not a big fan of abortions. I would hazard a guess that, in this circumstance, nobody involved found an abortion to be the ideal solution to the problem. However, it was the only solution that could ensure the safety of the mother. An 11 week old fetus is not going to survive outside the womb, so if the mom died the baby would have died too. A double tragedy. As nurses, we are taught during our labor and delivery course that the mother's survival trumps survival of the baby. Sad and scary to think about having to make that decision, makes sense.
I wish I had some way of reaching out to Sister Margaret. As a nurse, as a woman and as a mother. I wish I could tell her that I'm proud to know we have people like her in our profession. I wish I could tell her how much it means, as well, that there are administrators out there who truly put the patient first and then stand up to the world and defend their decision instead of letting someone on staff take the fall (of note, I read a report that indicated she had been "reassigned" to a different position as a result of this incident). Ultimately, I'd like to tell her I'm glad she broke the rules of her religion and answered a higher calling...her own personal conviction of what is right.

Monday, December 13, 2010

Me vs. Medical team

Me: hello dr. Smith. I'm calling you this evening because your patient is in compensated metabolic acidosis. Her ph is 7.34 but she is over breathing the vent and her base excess is -13. I'm concerned that if we don't give her some sodium bicarb, she will decompensate and become severely acidotic. Her calcium is also critically low.
Dr. Smith: why are you calling me?
Me: because you are listed as her primary MD.
Dr. Smith: yes, but she is intubated. Call pulmonary.
Me: but she is in metabolic acidosis. The pulmonologist doesn't want to fix non-respiratory problems. Can I give her some sodium bicarb and another dose of calcium gluconate.
Dr. Smith: the day shift nurse already gave three doses of calcium.
Me: but her calcium is still critically low.
Dr smith: no. It's 2300. Call in-house with any further problems.
One hour later
Me: good evening dr. Jones. Sorry to bother you. I have a patient of yours who has metabolic acidosis, is on several different pressers and an insulin drip and is intubated. She's in SVT with heart rate in the 150's. She's on an amiodarone drip but if I increase the rate her pressure will drop even more and I will have to go up on the pressors. I think she would respond well to some sodium bicarb. Right now her acidosis is preventing the pressors from working.
Dr. Jones: this isn't my patient, I'm just on call. Increase the amiodarone drip until 7 am
and then dr. Moore will take over.
One hour after that
Me: good morning dr. Brown. Sorry to bother you at 1 o'clock in the morning, but I just got a gas on my patient and she is now severely decompensated with a ph of 7.18. Her base excess is now -21. Her heart rate is in the 140's and her pressure is 84/46 on maximum drips. I feel she needs some bicarb.
Dr. Brown: that's not that bad.
Me: I just notified organ procurement due to the fact that she is non- responsive to painful stimuli with no gag reflex. I assure you, it IS that bad. Can I give her some bicarb?
Dr. Brown: she was admitted with DKA wasn't she?
Me: yes. She is on an insulin drip and her sugars are in the 400's despite hourly boluses of iv insulin.
dr. Smith: your doing everything you can. Insulin will fix her.
two hours later
Me: dr chance? Sorry to bother you. I know it's only 3 o'clock in the ,owning and this patient isn't actually in renal failure (in fact, her kidneysnare the only thing that are still miraculously functioning) but I've called every doctor on the case and I don't know what else to do.
Dr. Chance: what's the problem?
Me: my patient's last blood gas was 7.18 and that was two hours ago. I'm afraid to get another one.
Dr. Chance: well, she needs bicarb!
Me: thank you. I agree. Do you want me to give her a bicarb drip?
Dr. Chance: yes! How quick can pharmacy get that to you?
Me: I will call and offer them my first born child. She is two and very cute.
Dr. Chance: better grab a few amps from the accudose and give them as a push. Give 4. Start the sodium bicarb drip at 250 and call me back in 2 hours so we can see if that's doing the trick.
Me: I have a beautiful diamond that my husband gave me. It's yours if you want it.
Two hours later:
Me: dr. Chance? I gave 4 amps bicarb iv push. I started the bicarb drip. The patients blood pressure is 114/66. She is off all pressors. Her heart rate is 115 and her blood sugar is down to 196. Her blood gas is greatly improved and she appears to be waking up.
Dr. Chance: great job. Why didn't you give the bicarb sooner?

This was a fictional account. Nothing like that has ever actually happened to me, any doctors or any patients. I would never offer up my first born or my diamond ring to a colleague. I have never spent the entire night waking random doctors up until I finally find one who will give me the one little thing that I know will help the patient...

Sunday, December 5, 2010

Find Your New Favorite Blog

Ok, so maybe you think blogging is ridiculous and you wouldn't want to waste your time, but do you really understand what blogging really is? Do you have any interests, talents or hobbies, perhaps something you'd like to learn more about. I'll share with you some of mine.

First, the elephant in the room. If you've read any of my previous blog entries, you know that my favorite blog is The Pioneer Woman. But why? I first discovered the blog when my sister revealed several toothsome recipes (including, and this is the actual name)"the best chocolate sheet cake...ever" which had come from her site. I decided to check it out. At the time, I was a new mom, at home for long long hours wih a baby who mostly slept. All my friends were back at work, disimpacting people to their hearts content, and I was ready to go crazy from boredom and my own need to provide colon-emptying support to a mostly elderly population of sick people. I'm sure you've been in the same situation. I had never been much of a cook and definitely had never been a baker at all (due to a habit of frequently forgetting to add key ingredients to recipes such as flour, eggs, baking powder, etc...). The Pioneer Woman has people like me's back, because she takes pictures of the entire process from start to finish. You simply scroll down the page, follow the steps which are described using detailed pictures and instructions, and before you know it, you have a delicious confection sitting in front of you on the counter with no real recollection of exactly how you accomplished the task. I started with the chocolate cake, moved on to the Sleepin' In Omelet ( oh it's too delicious for words) and before I knew it I was a cook and a baker! I was making bread, cakes, cookies, dinner casseroles that didn't have a single can of Campbell's in them, and many other things that I had never even heard of. Clafouti, pots de creme, French silk pie. Domestic goddess I ain't, but The Pioneer Woman at least made me into a functional housewife. The butter and eggs budget went up but the dining out and ordering out budgets went WAY WAY down. Thank you Pioneer Woman. That's from my husband.

The next thing on my list was my unmet healthcare-providing needs. How could I, in the middle of a 4 month long maternity leave, get those needs satisfied, in some small way? Enter Code Blog. This is a blog written by a fellow ICU nurse, with gross stories, drama and ICU nurse tips and thoughts on life. Perfect! I became a follower of that blog. Recently, I even had a story posted in that blog, as a guest blogger, about the time one of my coworkers found a dead cat under her patient. Fun stuff. For anyone interested in any specific niche of the healthcare spectrum, she also has a list of quite a few other medical blogs with links to them. Although I've always been fascinated by the "At Your Cervix" blog, written by a labor and delivery nurse, Thats really more of my sister Val's interest area.

For my newly piqued interest in writing and the idea of breaking into the world of fiction, I found a blog written by a published author and mentor to new and unpublished writers, Randy Ingmerson. He has a monthly newsletter and a blog with tons of helpful advice and encouragement for aspiring writers. He recently co-wrote the "Fiction Writing for Dummies" book, released in print and electronic formats and because I was a follower of his blog, I got a free copy downloaded to my IPad! Being a bloggee pays off in interesting ways sometimes...

I was recently in search of a recipe for a food that Hugo was waxing poetic about from his halcyon childhood days in Colombia. My sister in law Maria directed me to "My Colombian Recipes" a blog written in English by a Colombian lady who married an American and now lives in New England. I surprised Hugo by going to the Latin foods market, buying the stuff, and making him a delicious Colombian meal. All the Colombian recipes I have found online are in Spanish. Not only is this a language that I'm not particularly fluent in, they use metric measurements, which is really, ummm, interesting. You want to make a recipe that calls for 100 gramos of mantequilla? Me neither. I don't even know how you would measure 100 gramos of mantequilla. Do you use a scale? So this lady, Erica, has taken all those recipes and translated them for morons like me. Wasn't that nice of her?

Now that I have shared my favorite blogs with you, won't you tell me what YOUR favorite blogs are? You never know, I might be a devoted follower of that one...

Thursday, December 2, 2010

My Hobby

Yes, I am a blogger. I consider myself to be a very lite blogger, with emphasis on the lite (spelled the way it is, to signify a lack of depth rather than a lack of color). I basically spew out various things onto this format, much as a normal person would write in a diary and then hide it away from the rest of the world. My brand of journaling for anyone who wants to see ( though admittedly few) is a sort of lazy person's way of channeling mild creativity into a media which requires very little effort, no cost, and as little or as much time as the blogger wants to put into it. There are blogs out there on every subject known to man...people passionate enough about food, photography, dieting, exercise, writing, and any other topic you could think of to write consistently on those subjects on a very regular basis. This brings me to my growing affection for and interest in such blogs. Therefore, I'm not just a blogger, but a devoted bloggee.

I'm not the only one you know. Just check out The Pioneer Woman's blog. Her blog, which has won numerous national awards and has caused her to become somewhat of a cooking, photography and homeschooling ( amongst other things) celebrity, is kind of a blog of all blogs. Many of the other blogs that I follow were found through The Pioneer Woman's blog. Recently, just as an example, Ree (The Pioneer Woman's real name) had a contest on her cooking page wherein she gave away 4 expenses paid trips to her guest lodge on her ranch for a cooking weekend. She was going to do it, like, a month later, so she indicated that she thought, due to the short notice of the contest that she wouldn't get a huge number of entrants, which would give those who actually could conceivably do it a better chance of winning than some of her other contests which are extremely popular. My fingers tingling at the thought of meeting Ree, hanging out on her ranch in Oklahoma, cooking with her and becoming best friends (it's absolutely bound to happen if we ever actually meet), I entered. Quit my job if necessary I would, but if I won that contest, I was going. There were 64,000 entrants, or something like that. This was in the space of about 4 hours after she posted the announcement. That's how many people visit her blog on a regular basis and think highly enough of her to want to spend a weekend in her guest bedroom, so to speak.

I like to visit The Pioneer Woman's blog, amongst others, and read her recipes, look at the pictures of her daily life on the ranch, hear about her homeschooling exploits and get the latest on her cookbook, her true life romance novel, due out the beginning of next year, her recent Throwdown with Bobby Flay and all kinds of other related things. It's amazing to think that one woman, a woman with a strong voice and personality who was sitting there on a ranch out in the middle of nowhere with dial up Internet service (at the time, if my thinking is correct) managed to plug into the very new idea of blogging and turn it into a huge big deal. Her fans connect, not only with her but with each other. It's a network of people with similar interests.

It's not always sweetness and light either. Maybe I'm a freak for admitting this, but I read a large number of her posts from beginning to end, including the comments. The comments often number in the hundreds, sometimes the thousands. But it can be a lot of fun. For instance, there's one lady named Suzanne, who has her own blog, who shamelessly promotes her own blog by attempting to be the first to comment on just about every single one of Ree's posts, along with a link to her own blog. Ree doesn't seem to mind people doing this; in fact, as I've said, one can find a plethora of like-minded people out there simply by starting with one good blog and clicking on links in the comments section to travel to other peoples' blogs. Suzanne doesn't really play fair though. I mean, every single post, there she is, with her link and some inane, often generic sounding comment. Not only that but she's found a way of cheating to get herself up at the top even when she wasn't the first person to comment. She simply "replies" to the first person who did comment, sticking her link in there and then up it pops just under that person's comment instead of at the bottom of all the other replies. She's not the only one who does this either, but she is pretty blatant and very persistent and one has to wonder if she spends any time at all working on her own blog, what with all the blog hitching she does over at Ree's site. The hilarious thing though, the thing that has me checking furiously for her ubiquitous comment under every post of Ree's is that someone else, a woman who goes by the name of Gin, no blog link, has appointed herself the police-woman of The Pioneer Woman site. Suzanne and her irritating comments are pretty much ignored completely by Ree, but Gin feels strongly enough about the integrity of Ree's posts to reply to many of Suzanne's more annoying comments and replies with scathing rebuttals. I often wonder if Ree is even aware of the underbelly of her blog, the quiet scandals taking place in the forgotten annals of the comments section. Lord knows, she can't possibly go back and read all, or even most of the comments left on her blog. She posts 4 or 5 new things in the various sections of her blog every day and typically gets at least a hundred replies to each, sometimes many many more. It's a world she created and yet, it has taken on a life of its own. Kind of like the Trekkies or the Harry Potter fans; they overwhelm even the ability of the initial draw to continuously entertain and so they end up having to propagate the fun themselves, in ways the original creators of the phenomenon could never have envisioned. And by my own fascination with that underbelly...POP! I've become a member of the club. What would The Pioneer Woman's rabid fan base be called, I wonder? The Pineys? the Piners. The PinWo's. I'm gonna have to work on that. In a little while though. First, I need to check back at the site. She may have posted something new in the time it took me to write this...