I haven't seen or read much lately that would bring me out of my winter blues isolative and stuporous behavior until I clicked on my normal newspaper readings this morning.

Brian Dickerson of the Free Press is ragging on the "uppity class". Seems Brian is still a sore losing Dem because he starts off his article with this:

We have way too many lawsuits in this country. Everyone says so. Well, OK -- maybe not everyone. But the people getting sued are plenty upset, and now a president flush with political capital (and political debts to deep-pocket defendants) is rushing to their rescue.

Come on Brian get your tunnel vision off the Republicans, jump off your whine throne and ask Joe Blow America how "frivolous lawsuits" are affecting them. Wait let me offer up a few lawsuits I am involved in or have been involved in over the last three years:

1. Employee found sleeping on the job and terminated. Over $10,000 in attorney fees.

2. Employee witnessed physically and verbally abusing a patient and terminated. At $15,000 and climbing at this point.

3. An alert, oriented, competent patient refuses to eat, drink or move out of bed despite intense family, medical and psychiatric intervention. Patient finally becomes dehydrated and delusional enough the durable power of attorney kicks in and family over rides the advance directives and sends the patient to the hospital. Patient dies 7 days later. Family sues nursing home. Cost? Tens of thousands and climbing.

4. ( I have 2 of these suits pending.) Alert, oriented, competent patient falls and fractures (leg, hip). Family sues just because they can.

5. Employee refuses to do a routine assignment, physically threatens supervisor and is terminated. $15,000 in attorney fees so far and climbing.

I could go on with at least 5 more, but what's the point. The above amounts is just attorney fees that I know of so far. Not counting in lost time and wages for employees who has to testify or give depositions etc.

So Brian as your tunnel vision is only looking at the big boys at the top of their game, don't forget the smaller businesses that's that backbone of this country. Don't forget the Joe Blows.

Damn I forgot to mention insurance premiums. Oh well, maybe next time.

Via Dean's World I stumbled across a new to me blog: RangelMD. Check it out, Dr. Rangel is hosting other medical bloggers with some very interesting posts. I've finally found out why I really eat a couple of ice cube trays a day for the past 4 years, I really wasn't buying that sexually frustrated line. Sheesh.

I'm sitting here sipping the first cup of coffee of the day...the best one I might add, and read this little gem.

DRINKING coffee can substantially reduce the risk of developing diabetes, scientists have discovered. A major study involving more than 14,000 people in Finland, which has the highest rate of coffee consumption in the world, has revealed that those who drink most have the lowest incidence of adult-onset or type 2 diabetes. When people drank three to four cups of coffee a day, their risk of developing diabetes fell by 29 per cent for women and 27 per cent for men.

Now isn't that the best damn news I've read all year. I'm so glad I'm an addict.

Nothing shocks me anymore when I read something new has been found that is probably linked to cancer. This study now links aspirin use with pancreatic cancer. More reading on the subject.

When are we going to get it through our thick skulls that when we put things in our bodies that doesn't belong there, it's a crapshoot. I could definitely write a whole essay on this subject, but it needs to be kept simple.

What are you putting in your body that doesn't belong there? I think most of us have a list.

I think for anyone in healthcare, this is some very scarey shit.

MRSA and VRSA.

I was reading a post over at Far From Perfect about Doc's lame attempt at giving himself a flu shot. You are right Doc...it's not easy to poke yourself. Maybe next year will be easier.

I'm with Doc on seeing the biggest burly guys whimper, whine and tremble with fear from the thought of a shot. I've had to prop them against walls because they are afraid they are going to pass out. One guy I remember in a matter of two minutes was so frightened he literally soaked his shirt in perspiration. I just love to give men shots. Always brightens my day.

No, women do not act this way.

So Doc, even if you had to close your eyes...you are a hero to many.

Being a nurse for too damn many years I've ran across this too much. From new born babies to definitely the elderly where I am now.

Sweet Jesus I have alot to say about this, but it makes me feel sick to even think about it. As a director of nursing I have the final say of what goes down in my facility and withholding food and fluids etc. will never happen where I am. I either ship them off to the hospital or help the family find immediate alternate placement. That is something I can not live with. I am a caregiver to someone's final moments. I will not play the executioner.

My heart goes out to the family and caregivers of Terri Schiavo , that's not a place I would want to be in, or my family to be in.

If you do not have advance directives , what are you waiting for.

There is no excuse.

Save your family, caregivers and possibly the judges from needless pain.

Enuff said.

In answering a letter to Joni I realized I need to give some time to the flip side of the medical world.

Yes, there are some incompetent, lazy fools in the medical profession. I employ a few. We make mistakes at work. I own them and try to learn from them, teach and scare the shit out of others about them. I fire these people as fast as I spot them. Sometimes it's after they fucked up unfortunately. I wish to God I had a bullshit meter that functioned better.

I am THE Bitch from Hell when one of my loved ones are in the hospital. Not too long ago my mother was taken to the ER with slurred speech, dizziness and nausea. When my brother called me from Iowa in route to the hospital I told him then, it sounds like a CVA (stroke).

A couple of hours later he calls back, they admitted her. The ER MD "felt" it was probably her cancer resurfacing "with metastasis to the brain from her prior breast cancer". What? I yelled at my brother. My mother had beaten the cancer 20 years ago. I asked if they seen that on the CAT scan. He said...they didn't do a CAT scan, just admitted her for observation. After all it was a Saturday, they'd call in the cardiologist on Monday.

I told my brother to go to that MD and quote me word for word: "If you don't do a CAT scan immediately, my sister is going to sue your ass."

Well he did, and the MD promptly shipped her off to a hospital in Des Moines, where she had a CAT scan immediately and of course was in fact having a stroke. Prompt attention there stopped further brain damage.

The exact same scenario happened with my aunt. Yes, there are incompetent MD's.

Last year my Grandmother was taken to the hospital and had emergency surgery for a perforated bowel. Two days after surgery, she was recouping fine...so I did not fly back. Damn it. Damn it. Damn it.

My mother called me that second day, said Grandma was doing great, the only complaint she had was leg pain. WHAT? Any damn nurse or MD knows if a patient after surgery has leg pain, it's probably a DVT (deep vein thrombosis) aka blood clot. I called the nurses station...the nurse was busy. I called Mom back and said go to the nurse and tell her to check for DVT's.

Mom didn't do it. The "nurse was busy and she's nice, she knows what she is doing". Grandma pitched a clot to her brain 12 hours later and never woke up. Yes, her legs had been full of blood clots.

This is Nursing 101. I should of flown my ass back there, but it wasn't a good time at work. I'll never, ever make that mistake again.

Maybe today I'll cut those families some slack.

Remember the poor guy in Singapore?

Ok..it's not SARS, wait yes it is. Maybe we should just wait and see?

Probably is, but who the hell knows.

For cryin' out loud, make up your damn minds!

Think we are ready if it is?

Obviously I didn't go to work today. So I'm stumbling through the news and I come across an article just a few hours old that says WHO says SARs may resurface...that it is still out there.

So as I back click to the main page, lo and behold it's been updated to read:

SARs May Have Resurfaced

Singapore became the first country to report a possible return of SARS on Monday, saying tests showed one man might have caught the potentially deadly disease, hours after the WHO had warned the virus could reappear.

Now I'm not done stumbling around and I come across this article from Friday:

Quick Test For SARs Developed in Singapore

Now I know I read way too many thrillers and have always admitted to being a tad bit paranoid..BUT Friday they announce a test and 72 hours later they have their first potential victim in the same place? What's the chances?

Q. What does HMO stand for?
A. This is actually a variation of the phrase "HEY MOE." Its roots
go back to a concept pioneered by Moe of the Three Stooges, who
discovered that a patient could be made to forget about the pain in his
foot if he was poked hard enough in the eyes.

Q. I just joined an HMO. How difficult will it be to choose the doctor I
want?
A. Just slightly more difficult than choosing your parents. Your insurer
will provide you with a book listing all the doctors in the plan. These
doctors basically fall into two categories - those who are no longer
accepting new patients, and those who will see you but are no longer
participating in the plan! But don't worry; the remaining doctor who is
still in the plan and accepting new patients has an office just a
half-day's drive away and has a diploma from a Third World Country.

Q. Do all diagnostic procedures require pre-certification?
A. No. Only those you need.

Q. Can I get coverage for my pre-existing conditions?
A. Certainly, as long as they don't require any treatment.

Q. What happens if I want to try alternative forms of medicine?
A. You'll need to find alternative forms of payment.

Q. My pharmacy plan only covers generic drugs, but I need the name
brand. I tried the Generic Medication, but it gave me a stomach ache.
What should I do?
A. Poke yourself in the eyes.

Q. What if I'm away from home and I get sick?
A. You really shouldn't do that.

Q. I think I need to see a specialist, but my doctor insists he can handle
my problem. Can a general practitioner really perform a heart transplant
right in his office?
A. Hard to say, but considering that all you're risking is the $15
co-payment, there's no harm in giving him a shot at it.

Q. Will health care be different in the next century?
A. No. But if you call right now, you might get an appointment by then

One of my biggest fears in running a healthcare facility is a fast moving virus. Around ten years ago I was working in a facility in Iowa, where the the week after Christmas we wre hit with a respiratory virus. We lost 13 patients in 10 days.

Patients that were up, walking an talking in the morning, had raging fevers of over 104 and difficulty breathing by bedtime. The ones most severely stricken were dead within 48 hours. The healthier patients and staff were just down and out...quickly. No investigators were sent in even though the hospitals in our communities were over run. No one ever knew what virus the community was dealing with.

So when I read this article this morning about a nursing home hit with a virus in Vancouver I get this nauseated feeling.

Two-thirds of the patients, and one-third of the staff was hit. The virus is genetically identical to the SARs virus. The article is a little unclear of the deaths, they mention 7 dead in "recent weeks". It's easy to see they are being very careful of what is being released. Yes, seven deaths in few weeks is alot. My facility doesn't lose that many to respiratory infections in two years. A WHO investigator has been called in but it could take weeks to find the answers.

Keep your fingers crossed, that this just fades away...and SARs is actually a thing of the past. I'll take a 2 day power outage anytime over this.

I just read an article in the Detroit News how 3 kidney tranplant surgeries happened simultaneously at John Hopkins University. Damn that made my skin crawl. My first thought was..wow, wonder what got fucked up.

One thing I didn't delve into in my rants yesterday and I want to be upfront and honest about is that there are too many nursing homes out there that are pieces of shit. In the two years I consulted in this area I seen them upclose and personal. One in Detroit that I had to work for one day I was centered out of a room inhabited by mice and God knows what else. When I left there that day I had flea bites. People live there still do.

All I have to do is remember these places and when I hear about crimes against humanity in places like Iraq or where ever and it even further disgusts me. I'd like to slap a few people and say take a look at what is going on in your own back yard. Fools.

The current survey process of nursing homes in this country is useless. The rule in a nutshell states every nursing home will have a surprise visit every year within 9-15 months of it's last survey. They come in spend 3-5 days and think they've got a good picture of what is going on. If they come in and decide to cite a deficiency it can have different scopes of severity, to an isolated incident to widespread. No actual harm to actual harm. It's all in the surveyors and their bosses - who might not even come into the buildings- determination. A lot rests on how knowledgable the surveyor is. I've seen many that are lazy and don't know shit. We are talking state employees here. Wouldn't it be a good idea to hire someone to survey that actually knows the business? Finally in this century they are just beginning to grasp the concept but nepotism and knowing the right person will probably always prevail.

I could write volumes on this, but this is where I get a little squeamish while I am still employed. If anyone in this large department would find out who just wrote the above would be finished in this business. No matter how well the facility is ran. So yes, surveys can be tainted and driven by ass kissing. I think that's called politics isn't it? The American way.

I read this article when it first came out. I saved it, because it pissed me off. The few articles I've read from BET seems to incite and promote anger, touting and preaching racism. I can't stand it when bullshit is reported like the gospel, especially about nursing homes. Especially from some asswipes who probably can't even recognize one when they drive by let alone be inside one.
Let me share some bullshit.

Psych consultants are brought in as soon as any signs of anorexia rears its ugly head. The physician and pharmacist review the medications for side effects causing anorexia or dysphagia. Tube feeding is the last thing on the list when all else fails.

Bullshit. You didn't survey my nursing home or any facilities in my corporation..which is in the 100's.

Nursing home operators do not give a shit who is hand fed. They do have one thing right, tube feeding does not help a dying patient. They are dying you dumbshits. Tube feeding has helped many who have suffered say from cerebral vascular accidents (stroke) and temporarily lost their ability to swallow. The tube feeding is removed when the ability is safely regained. This happens all the time.

Do you have any clue why? Could it be because of this racial propaganda like this article is spreading? What elderly black male or female who reads this shit and has to go in the nursing home thinks they might end up starving and being fed through a tube because you are telling them white medical professionals basically don't give a shit.

Caring for tube feeders is quite expensive and time consuming. I try to refrain from even admitting a tube feeder. Not only do they require 12-16 hours of feeding usually via pump per day or bolus fed, but they require several water flushes through out the day. Medications are given via tube. The ostomy site (where the tube enters the abdomen) has to be cleansed and cared for twice a day. Renal function, total protein and albumin tests have to be done routinely and a dietician review and document her assessment. Tube feeders are extremely time consuming. Reduction in staff my ass.

I am so sick of hearing what the hell white people do to the blacks. I'm sick to death of their racism and crying poor "us" with lies to keep smoke where there isn't even a spark. Isn't it time to pick a new damn target besides the white establishment?

More men are entering the nursing field the last decade. I do believe men would have in greater numbers years ago if the wages and benefits had been decent.
Thanks to the nursing shortage employers have been forced to offer things men have taken for granted for decades: health and life insurance, retirement benefits, etc.
If I told you how many years I've worked as a nurse full time and have never had any form of a pension or retirement plan until the last 2 years you would be shocked. Hell I'm still shocked and wonder what the hell is going to happen to me when I hit retirement age, I guess as long as I can walk and talk I won't retire.
I have very few men on my staff maybe 7 total out of 130 or so. That number increases dramatically when my boss is gone and I have to oversee other departments. In general men do not take directions well from females. They will agree mostly to anything you say or want them to do, then damn near every time will go do what they want. Grrrr. Then when I have to call them on it...I'm not exaggerating here, they try to put on the charm. Oh puhleeze. Over the years I've finally decided they don't even realize they are doing this. Maybe it's a knee jerk response to handling females from their personal lifes.
If I'm being honest here, it's my knee jerk response to respond to being charmed. What a word. It used to really catch me off guard, not any more. Also I don't counsel or discipline men alone.
About a year ago I was trying to reach a male nurse by phone to arrange an appointment to fire his ass for gross negligence...failure to feed tube feeders. He knew what was coming and before I reached him by phone he showed up at work. He was drunk, high or both and came into my office and shut the door. Damn...I'm supposed to be between them and the door. He backed me right up against a wall. He was very calm and quiet and reasoning was not working. So I was the one that got loud and belligerant. Go with what works...he backed off, I fired him, and haven't seen him since.
Anyway, I love working with men as co-workers, but damn I hate to supervise their asses. If it ends this nursing shortage then I can do this, just not alone.

I think this is amazing. I only have three words to say.

Please, take mine.

I had to read this article twice because I literally could not believe what I was reading. I have two questions after reading this. Why? Shouldn't this be illegal?

I posted this under "Medical and Nursing" but it should be titled sick and freakish.

I bet ya, bet ya, bet ya...you can't even read the first two paragraphs of this article without having the urge to scratch.

Obviously I haven't been following or seeing SARS much in the news the past week..so when I received mailing from the CDC today I didn't open it right away.

Well I just opened it to see there is 412 cases (probable and suspected) in the US now. Here is the site, check it out.

I guess I should get my head out of my butt and pay more attention. Sheesh.