Humanity, Health, and the Care of Souls

There is an excellent post by psychiatrist Michael W. Kahn  in the New York Times Well Blog that every health care provider should read When Battlefield Humor Backfires. Follow it with today’s post by registered nurse Marcy Phipps for AJN’s blog Off the Charts, and you’ll have lots to think about.

Color Coded for Easy Identification

The White that Binds (Pinning Ceremony) jparadisi 2010

On my other blog, Die Krankenschwester, I explore issues of gender, role, and identity through nursing imagery.  J Doe at Those Emergency Blues wrote an excellent post this morning about titles and power.  Her post runs corollary to the idea of color used as a label of identity in my series of paintings From Cradle to Grave: The Color White. In The Color White series, I question the links between the color white, femininity, purity, and nursing.

In her book Color, author Victoria Finlay (2002 Ballantine Books) discusses the historical association of the color purple with royalty.  If some physicians insist they are the only ones who may use the title Doctor in the medical setting, then perhaps they should be required to wear the color purple in hospitals, which was traditionally only allowed to royalty in ancient times. That way, patients will know at a glance who their doctor is, because name badges and an introduction may not be enough.

I’m just sayin…

Who’s Flying the Plane?

We've Gotten Off Track photo: JParadisi 2009

       Perhaps a change of nomenclature is needed in health care.  Physicians should be called Pilots, and nurses renamed First Officers, like in the airline industry, which the health care industry often compares itself to. The term doctor’s orders would change to instructions. Instead of a nurse requesting orders from a doctor, the First Officer would ask for further instructions from The Pilot. The name changes promote the team approach that more accurately describes patient care. 

     Gallup Poll: Power Elite Believes Nurses Should Have More Say in Policy, Management  posted by Shawn Kennedy on the American Journal of Nursing blog, Off The Charts  quotes that “69% of ‘people who run things in this country’ see nurses as having little influence on health reform.”  The poll ranks nurses at the very bottom of the list of groups influencing health reform, under patients, who lag behind physicians. Listed as the most influential  are  government, insurance and pharmaceutical executives. In other words, the people flying the plane do not control the plane. Decisions about health care policy are made by people who are not on the plane. Sometimes the decision makers aren’t even at the airport. 

         That’s not to say that physicians and nurses should dictate health care policy without thought or consideration of cost for treatment or alternative options. In the short story Voyagers, I write about recognizing the need for administrators, whose jobs keep hospitals solvent and regulated. However, demoting nurses, doctors, and the patients themselves to the bottom of the list of influential voices in health care policy, while allowing corporate administrators to have the most influence, seems a crippling case of the tail wagging the dog.

Just Because You’re Big Enough to Hold Still (patients, pain & procedures)

    I still experience culture shock, since my transfer from pediatric intensive care to outpatient adult oncology nursing , over the difference in sedation use during procedures for pediatric and adult patients. What allowed me to tolerate 15 years of pediatric intensive care nursing (yes, it is as emotionally challenging as you think it is) was the routine sedation of the child going through procedures. 

   Adult patients know that when their healthcare provider says, “You may experience some discomfort during the procedure”, what we mean is  “This is gonna hurt.” Remember, this is an industry that accepts anal leakage as a reasonable side effect of some medications.  Adult patients are expected to lie still.

   Like during a bone marrow aspiration. My patient cried before the oncologist arrived, but the doctor didn’t see that. She cried during the injection of the local anesthetic too. Her family looked concerned, but no one spoke up.  Nurses, because of our extended contact with patients, are the emotional thermometer in the room. It is my practice to request from the physician a small dose of sublingual lorazepam to offer the patient before such a procedure, just to take the edge off, but it’s rarely ordered, unless the patient demonstrates high anxiety levels in front of the physician, which indicates the patient might not hold still. The procedure lasted only minutes (the oncologist was skilled), but I winced to see my patient hurt. This patient made it through bravely. The physical pain was quick, then over, but the pain of the procedure was potentiated by the fear of a blood cancer diagnosis. Lorazepam does not control pain. It does ease anxiety.  She was big enough to hold still.

   Perhaps I’m sensitized to this issue because I have been a patient needing a biopsy for a cancer diagnosis too. I remember the white noise of anxiety drowning out my ability to hear all of the information presented to me during the early weeks that my treatment plan unfolded.  The surgeon, who was very good, wanted to do a biopsy of my lump in his office. It’s done all the time. I wanted the lump removed, under conscious sedation. That required an OR, and an anesthesiologist, the surgeon informed me. “That’s what I have insurance for,”  was my reply. I know too much about procedures.  I trusted my surgeon, and I wanted to be out while he did what he needed to do.  A member of  his office staff chided me about the request: “You’re a baby, I’ve had several lumps removed in this office myself, and went back to work afterwards.” I complained to the surgeon about the inappropriate comment.

   Like a frightened child, I didn’t want to lie still.