The Move Back

      I’m having a hard time believing we’re already well into April, and that we’ve lived in this apartment, and in California, for two months tomorrow.  The time has flown by, between  the initial unpacking, adjusting to my new job and new schedule, and reuniting with family and friends.  I’ve been meaning to post about my new nursing job for awhile now, but I have difficulty sitting down to write when I don’t have more than one to two days off together, and almost none of them completely free.  I got spoiled by my old schedule of seven-on, seven-off (yes, twelve-hour nights) that it’s more of an adjustment than I expected to try to get things done on only a couple days off in a row.  I suppose that’s for the best, though, since I am now better able to discuss the differences between my old job and the new, having finished orientation and switched to nights – finally!

      I know, some people want to feel bad for me, thinking I’ve been stuck working nights, but actually, I prefer them by far.  Nights are quieter, more laid back, with less people around in general, and certainly less people whose company I don’t miss: doctors, administrators, visitors.  Not that I dislike them, exactly, but… well, I’m sure you get the idea.  More importantly, we have fewer transfers, fewer procedures both at bedside and away (CT, etc), and all of that means I am not so crazy busy.  All of this is pretty much true everywhere.  Now to compare my new job and my old one…

      The first thing that always comes to mind when I talk about my old job versus my new one is the computer charting system.  I really disliked Cerner, and my coworkers and I had a laundry list of things wrong with it (or that we could’ve designed better), and I thought when I left Mississippi that it had to be the worst, most basic, cheapest one on the market, so I couldn’t wait to use the new one at my facility in California.  I don’t think I have ever been more wrong.  I disliked Cerner, but now I would go back to it in a heartbeat!  Not just because I dislike change, mind you, but because CPSI absolutely is the worst, most basic, cheapest EMR system on the market.  I have learned the system now, which didn’t take long since it’s a glorified Excel file, and I still hate it.  You might think this is not that much of a deal breaker, since it’s just the computer system, but you have to understand that that’s like saying it isn’t that bad that your cubicle’s only two feet by two feet.  The computer system we nurses use can really help us – save us time and effort, make lab results and meds easy to find – or it can really frustrate and limit us – make us enter vital signs manually, run slowly, make things take twenty clicks to get to.  Alright, rant over.

      That’s the major difference, and major negative for my current hospital.  On the whole, though, I otherwise like my facility pretty well.  It doesn’t strike me as hugely different than my old facility; the patients are a similar level of acuity, we don’t do trauma, and we’re not a teaching hospital (no residents).  The people I work with are generally cool, helpful, and friendly.  I like having an Omnicell for supplies (charges patients for items as you pull them out) versus having to manually charge for items, usually at the end of my shift.  It’s larger than my old facility, but the area I work in doesn’t force me to go to lots of other areas all the time, so while I’m basically useless if visitors ask me for directions, I’m not too overwhelmed.  There are many more doctors here (I could probably name all the doctors I’d commonly work with in Mississippi on both hands), but thankfully at night I mostly interact with them over the phone, so I’m not expected to recognize everyone. 

      I had a more than adequate orientation period, so I feel like I have the routine down well, and I certainly still have plenty of resources for my questions.  Although the patient acuity level is similar, I’ve still gotten to see new things, and I know I will have the chance to see more new things.  I’m excited to broaden my experience and continue to grow my skills as a nurse.

      Otherwise, things in my life have been much the same as in Mississippi, though we are thrilled to see family and friends here again.  We have a long list of fun things to do, some to make up for things we missed in MS (the beach, the OC fair, the Getty) and some cool new places we've heard about like new restaurants and things.  We'll see how quickly our budget allows us to check out all these new places, though.   

      That has been an adjustment, too, the financial differences between here and Greenville.  Funds are tighter, at least til Andrew starts his job.  He got rehired at Disneyland!  We're excited for his benefits to kick in so we can go to the new Cars Land, Ghiradelli Factory (though we'll miss those tasty fresh tortillas from when it was the Tortilla Factory!) and see the amazing shows World of Color and Fantasmic again.

      We love our new apartment, and new city.  We downsized, so I'm still working on getting rid of a couple of boxes, but I love that our unit is situated in our complex so that we have a barbecue, laundry center, and best of all, jacuzzi, within sight of our apartment!  I've already gotten plenty of use out of the jacuzzi -- I think I went nearly every night after work when I was orienting on day shift!  Now that we got our couch from IKEA (which I've had my eye on for nearly 2 years), we've really enjoyed having people over for dinner and swimming.  Andrew loves that we live so close to downtown Brea, and keeps bugging me to go walk down there to dinner sometime.  I think he has a misperception of how close it actually is, but we'll go to dinner and movie and maybe the farmers' market sometime soon.  Brea is a lovely area, and I like having so many of my favorite places so convenient: Target, Souplantation, Old Navy, several grocery stores, and the regular and discount movie theaters!

      All in all, we're settling in nicely here, and happy to be back.  Greenville was exactly where God wanted us for the last year, and we are so glad we met so many people we love there, and grateful for the lessons we learned while we were away from our network of family and friends for our first year of marriage.  We will never regret moving to Mississippi; it was our little adventure as newlyweds, but we are also very happy that God provided for us to move back home.

Doing Our Due Diligence: Part 2

     If you are just joining me, you may want to read this introductory post to better understand where I'm coming from before reading this one.

     The topic I want to address today is a subject that has managed to polarize most of the country, one that many people have very strong opinions about, and which has even led to extreme reactions including violence: abortion.  This post will probably not manage to sum up the entirety of my thoughts on the subject, and I am certainly open to further civil discussion.  I can guarantee that not everyone who reads this will agree with me, but that is likely true of every issue.  I simply want to articulate in writing where I stand, in part for my own benefit as I verbally process my thoughts.  It has certainly become an important issue in this upcoming election, so I think this is timely.

     I was prompted to write about this issue by several things, and this post has been a work in progress for some time now.  First, I had strong feelings about this photo, seen on Facebook.

 

     This photo, and the Facebook page that generated it, distinguishes between "pro-life" and "abolitionism", which I thought was a helpful and significant distinction.  More on that in a bit.

    Another motivating factor for me was this article about congressman Joe Walsh's recent statement: http://www.npr.org/blogs/thetwo-way/2012/10/19/163239925/life-of-the-mother-never-a-reason-for-abortion-congressman-says

     That article is the second example lately of idiotic foot-in-mouth moments, unfortunately by Republicans, regarding abortion. The previous instance, referenced in the article, was Todd Akin's statement that a woman couldn't get pregnant if she were "legitimately" raped.  First of all, let us be clear that both these men are (at best) ill-informed, because there absolutely are cases of pregnancy from rape, and there absolutely are risks involved with pregnancy today, in this country, despite all our advances.  Setting aside their inaccuracies, the bottom line is that both men are trying to be pro-life without exception, right?  Neither one wants to allow any reason for abortion to continue to be legal.  Well, I have a problem with that.

     The photo above differentiated between being "pro-life" and being an "abolitionist".  It also implies that abolitionism is the only possible moral action one can take when one's moral opinion is pro-life.  I am 100% unapologetically pro-life.  I am not, however, an abolitionist.  I believe life is sacred, and all life has value, and I therefore believe that I cannot in good conscience support making abortion illegal without exception.

     Because I believe all human life is valuable and all lives should be protected, I believe the life of the mother has equal value to the life of the unborn child.  Abortion is the tragic loss of the life of an unborn baby, but if abortion was never an option, there are cases in which two lives would be tragically lost.  I believe abortion is evil, and when used without limits it is morally reprehensible, but I also believe it is a necessary evil in some instances.  Ectopic pregnancies, where the fetus is implanted outside the womb, will always or nearly always threaten the life of the mother, and the fetus cannot even survive that way.  There have been cases when a woman finds out she has cancer while she is pregnant, and although some bravely wait to have treatments until after they deliver, that is not always possible.  In that difficult situation, there is no easy answer.  I could come up with more examples, but the fact remains that this issue is not as simple as many people make it out to be.

     Secondly, because of the value of all life, I do not want to revert to the era of seriously unsafe (read: fatal) abortions.  Before abortion was legal, far more women died of infections and botched abortions.  Don't get me wrong, and don't be deceived: they still do.  There are injuries and deaths of women every year because of abortions.  Making abortion illegal, however, is not actually going to eradicate them, and it's certainly not going to help make them safer.  I am a nurse, and as a medical professional I am privy to the fact that there are less than scrupulous medical professionals who do not document truthfully.  As such, it would be incredibly easy for abortions to continue if they are illegal, because some would simply not document them as what they are.

     Many Christians (perhaps the vast majority) are pro-life and/or do not support abortion.  I think it is likely that many of them have not thought it through extensively as far as what it means to be "pro-life", but that is beside the point.  There are many Christians who believe that we must fight against abortion, in part by working to make it illegal.  Yet, we are not here to Christianize the culture, we are here to share the good news of Jesus Christ.  Although our country was founded on Judeo-Christian values, it is not a Christian nation, and will never be God's chosen nation.  By trying to make abortion illegal, aren’t we at least partly relying on the government to change what people do, rather than recognizing God is far more effective at that since He changes how people think and what they value?  I strongly doubt that debates over “rights”, whether to personhood or control of one’s body, or the successful reversal of Roe V. Wade will change people’s hearts.  Arguments don’t change hearts, they merely address the issue intellectually and may even lead to hardened hearts.

     I do think that abortion is incredibly overused.  I believe we as the medical community have failed women in a terrible way by allowing this to happen.  In part, this failure is due to our passing the buck to abortion clinics rather than maintaining a stricter control on abortions, and holding the procedures (and locations) to higher standards of safety and cleanliness, as well as performing honest academic studies on the effects of abortion on the body and particularly its impact on the psyche of a woman.  Regardless of what you think of abortion morally, everyone should acknowledge that this is a surgical procedure, and is not without risk of complications or death.  In fact, I guarantee that the clinics who perform abortions give their patients a waiver regarding these things.  I would fully support legislative changes limiting abortions so that they are not used as a form of birth control and not available to just anyone for any reason.  I’ll be the first to admit I don't know what those regulations would look like.  I do wonder what would happen if some of the people who work so hard to abolish abortion redirected their focus to that effort.  A smaller victory, yes, but I think it would be an effort in which the “pro-lifers” may find some surprising supporters and unlikely allies.

      So, if we Christians shouldn’t necessarily be putting so much of our efforts toward making abortion illegal, what should we do?   Put our “money where our mouth is”.  I once read a comment online from a person who was “pro-choice” who asked something to the effect of, “Who would adopt all the babies put in the system after not being aborted? Would you?”.  It was clear from the tone and comment that this person expected that query to make a “pro-lifer” hesitate, but I mentally answered, “yes! I would!” without pause.  I believe that kind of thing is exactly what we Christians ought to be doing.  We should be standing outside abortion clinics, not yelling in protest, but available to talk, counsel, and deter women from having abortions by giving them other options.  Our efforts through crisis pregnancy centers and community involvement should be so excellent that all women who feel they cannot handle a pregnancy should know where they can go.  We should be lovingly supporting those women emotionally, financially, and providing a place to stay.  Then, once we’ve made an impact with our actions which speak louder than words, we can have the opportunity to share the gospel with them and support and counsel them spiritually.  That should be our goal and is our calling.  Yes, saving the lives of unborn babies is vital, but saving the souls of their mothers as well as giving them the chance for life is better by far.

Doing Our Due Diligence: Part 1

      The first subject I want to address is one that may surprise some people – ultrasounds. 

      Decades ago, people thought x-rays were safe enough to be used in shoe stores and on pregnant women, and the general populace did not sufficiently question the safety of routine use of a technology approved (implicitly if not explicitly) by the medical profession.  Similarly, we have insufficient evidence to conclusively determine that the benefits of routine use of ultrasound technology outweigh its risks.  We as the medical profession have accepted the use of ultrasounds for every pregnant woman, and it is for that reason that nearly every layperson considers them normal and safe.  A simple internet search will tell you over and over that the evidence is lacking, and medical associations do not recommend routine ultrasonography.  According to the Society for Maternal-Fetal Medicine, “a fetal ultrasound with detailed anatomic examination […] is not necessary as a routine scan for all pregnancies” and, “has also determined that no more than 1 fetal ultrasound with detailed anatomic examination is necessary per pregnancy, per practice, when medically necessary (SMFM, 2004)”.  The American College of Obstetricians and Gynecologists stated, "The use of either two-dimensional or three-dimensional ultrasonography only to view the fetus, obtain a picture of the fetus, or determine the fetal sex without a medical indication is inappropriate and contrary to responsible medical practice" (ACOG 2009). [1]   

      Somehow, despite these recommendations, health care providers in the field of obstetrics continue to routinely offer and use ultrasonography.  Perhaps the problem is that we as providers are uninformed, or perhaps it is simply difficult to resist using technology that offers such an amazing view.  There are certainly a great many people who love using technology merely because we have it, holding a “why not?” view on technology.  In doing so, however, we are doing a serious disservice to our patients, who are commonly much less informed than we are and who trust us to provide safe treatment.  

      If you are wondering what the dangers of ultrasonography may be, there is an excellent, detailed article from Midwifery Today describing the risks associated with ultrasounds [2].  The short version is that ultrasound waves have been linked to low birth weights, brain cell damage, and even (possibly) autism spectrum disorders.  I have hypothesized, though I have not yet found any research on the subject, that the excessive use of ultrasonography may one day be linked to the increased incidences of ADHD as well as autism (ASD).

      Please understand, the last thing I want to do is be yet another voice preaching at pregnant women that yet another thing is dangerous to their babies.  As a nurse, I constantly emphasize to my patients that they need to educate themselves and become an informed and participative patient, and that is extremely important for pregnant women too, since we know there are things that can have lifelong consequences for a child exposed in utero.  I have included several links below to help people begin to inform themselves.

Citations:

[1] http://www.aetna.com/cpb/medical/data/100_199/0199.html

[2] http://www.midwiferytoday.com/articles/ultrasoundrodgers.asp

Links: 

1. An article (with references to multiple studies) from the Association for Improvements in the Maternity Services (U.K.), 2004: http://www.aims.org.uk/Journal/Vol16No4/ultrasound.htm

2. A study on ultrasounds from the Society of Gynecologists & Obstetricians of Canada, 2005: http://www.sogc.org/guidelines/public/160E-CPG-June2005.pdf

 Note: Although an internet search on the subject will bring up results in forums, I urge everyone to think critically about the responses and the responders' expertise, background, or lack thereof. Please question commenters who reference but do not cite "research" they use to make their point!

Doing Our Due Diligence in Health Care: Introduction

      Starting with this post, I want to begin to discuss my views on health care.  At this point, I am not going to get into the politics of health care by discussing how our nation ought to pay for it, or how I think the people who make the laws about health care should consult more often the people who actually work in health care.  I may address those issues down the road.  For now, I want to look at how we balance the use of all our medical advances, technology, and medicine, with what we know is healthful for the body, even if it means more low-tech methods and natural remedies. 

      I want to make it clear that I am not like the stereotypes of natural-health people, militantly only eating organic and/or vegan, not vaccinating their children, questioning any use of prescription medications, using home remedies, etc. [By the way, please do not be offended if you feel that I just described you; notice the use of “stereotype”?  I’m not making a statement on my opinion of any of these things.]  I hesitate to put myself in a category at all near the kind of person many consider obnoxious or preachy.  My husband called me an “integrationalist”.  Not the actual dictionary definition of the word, regarding racial integration as opposed to segregation, but in terms of my views on medicine and health care.

      I am both a nurse and a patient, due to my fibromyalgia, so I try to look at everything medical from both perspectives.  Because I went through nursing school, I have the background in medical lingo and research to understand the language of research studies and to know the importance of evidence-based medical practice.  Everything we do in nursing should be evidence-based (most all of it is), and medicine as a whole needs to be held to the same standards.  For the most part, I know it is, but there are some parts of medicine in which I believe we overstep our bounds as health care providers, and some practices for which we do not have sufficient evidence to use routinely and consider safe.  As you can imagine, this is a huge subject, but today I will start by discussing items relating to just one area of medicine: obstetrics. 

Limitations & Counting My Blessings

              On Sunday evening, I had an accident at work.  In the hallway by our supply room, there had been a leak in the ceiling from the rain.  We had put up a wet floor sign and called maintenance, and someone had put down some towels to clean up the water.  I went around all this to go into the supply room, but was on autopilot coming out, and my first step out the door was right onto a towel. I slipped, and went down, making a loud smack on the tile, landing primarily on my left elbow.  Pain shot up into my shoulder, and I stayed sprawled on the floor for a moment, reeling.  My coworkers were there in seconds (we are ICU nurses after all) and I pulled myself to a sitting position.  I cradled my arm and tried to figure out how badly I was hurt.  My coworker cracked a joke that it could have been worse, one of the items from the supply room (that we use to catch and measure urine) could have been full of urine!  They helped me stand and I got back to the nurse’s station, taking some ibuprofen.  I decided I should go to the ER since I couldn’t extend or bend my arm without severe pain.  In the ER, my supervior had me fill out paperwork for workman’s compensation and everyone tried to speed the process along for me as a courtesy.  They took x-rays (positioning my arm made me cry for the first time that night) and sent me home with some Lorcet, telling me to follow up with an orthopedist the next day.  The ER doctor wasn’t sure if anything was broken since it wasn’t obvious but “elbows are tricky”.  On Monday, I figured out that I am allergic to Lorcet (my first medication allergy), and had to get a prescription for another pain med.  Tuesday morning, I saw the orthopedist and got some bad news.  I was told I had fractured the head of my radius, and would be unable to work for up to six weeks. 

              Thankfully, I’ll have all my medical expenses covered by workman’s comp and some income coverage, and my employer is trying to get me back to work in whatever capacity I can as quickly as possible.  Still, I have been frustrated by my new limitations, not to mention my increased level of pain.  I have been surprised by the number of things that are either made difficult or imposssible with the use of only one hand, but I am trying to count my blessings, too, by thinking about what I can still do and how glad I am I injured my non-dominant hand. 

              I can’t get my hair in a ponytail, dry it with a towel effectively, or tie shoelaces.  I can’t crack my back the way I normally do, or much at all.  I have trouble getting dressed or undressed, and with blowing my nose.  I’ve had to change how I shower and how I type.  Driving, preparing food, and even texting (I definitely thought of that as a one-handed task) are all more challenging.  Carrying things is harder and sometimes requires more than one trip [this is how I was before].  I can’t open medicine bottles with childproof caps.  I can’t do much that necessitates I hold an item with one hand and twist or pull with the other since it’s painful for my left arm to give that much counterforce.  Yesterday, some friends from church came and did my laundry because I couldn’t use both hands to carry the bag to the laundry room and my husband is still out of town.  I also can’t wear my wedding rings right now because my left hand is so swollen.

               Despite all this, I am reminded by this experience that I have many blessings for which to be thankful.  I am incredibly grateful that I still have the use of my dominant hand.  I can still feed myself, brush my teeth, hold a book, surf the internet, take care of our cat and plants, and so much more.  I am thankful I hurt my arm and not one of my legs so I can walk around, get in and out of the shower, drive, and not be laid up in bed or stuck with crutches.  I am certainly glad I did not hit my head at all, because I might have had a concussion or worse, lost some mental functions.  I had been missing my husband before, and having him gone was making me appreciate everything he normally does, but now I really can’t wait til he gets home!

              This experience has brought to mind that there are many people who care about me and are available when I need them.  Apparently, I have yet to learn that I need to swallow my pride and ask them for help, so God is using this to teach me that lesson (again).  I’m reminded that God is not surprised by any of this, and that He will provide for us.  I’m glad that this happened at work, because at least I’m not incurring more expenses and I have some help from workman’s comp.  Although it seems to me the worst timing for this to happen, while Andrew is gone, while we’re living on one income, and while I still have so much student debt, God’s timing is His own, and His reasoning is far better than mine.  I hope that in the next few weeks, whatever I do, I can learn some patience, trust in Him, and practice counting my blessings instead of focusing on my limitations.

On Death, From A Nurse

In movies, it is usually the doctor who has to go tell the patient's family when a person dies.  In reality, (with the exception, perhaps, of the ER or OR) it is almost always the nurse.  A patient died in our unit this week, and I did not envy the nurse who had to go tell the family.  It is a difficult task, and yet nearly as difficult is the experience all the nurses on the unit share, of watching family members arrive and react to the death.  Even when a nurse did not know the person who died at all and is not emotionally invested, it is so hard to see people enter and weep.  Everyone handles death differently; some people cry but hold it together and can deal with the issues of funeral homes and paperwork, some people leave after only moments in the room because they can't handle more, and still others react excessively in grief or anger.  It is not uncommon here to see what the nurses sardonically call the "Delta fit", when a family member reacts very strongly: they are loud, lashing out or thrashing on the floor, and we have to call security.  I cannot help but think about death and reactions to it as directly related to how one sees death.  Personally, I do not strongly fear death or desire to avoid it at all costs, because death for me is the beginning of eternity in heaven, a wonderful, beautiful experience.  I theorize that the people who react so strongly to death fear it and want to fight it with every fiber of their being, most probably believing it is the final end.  To them, death is the worst possible thing.  To me, it is the gate to a better life with my beloved Savior and Lord.  So then, how could I possibly hate it?  I must welcome it, whatever God's timing for it may be.