The Secrets Nurses Keep: 2/2

In the November, 2011 issue of Reader's Digest-- there was an article entitled 50 Secrets Nurses Won't Tell You. I mean, of course, I am going to read this. As a nurse, as an author, and as a blog editor-- I'm going to see what it has to say. Please, take some time to check out the full article.

I thought I'd give my thoughts here on whether or not I agree with the trueness of these statements. I'm not sure that's truly a word-- so don't use it in Scrabble or anything. The items are taken directly from the article-- so credit is given to Reader's Digest for these.

You can read about my first post here.

Item Four: "When a patient is terminally ill, sometimes the doctor won't order enough pain medication. If the patient is suffering, we'll sometimes give more than what the doctor said and ask him later to change the order. People will probably howl now that I've said it out loud, but you have to take care of your patient." A longtime nurse in Texas.

Hmmm.... this one is painful-- no pun intended. First, let me say that I understand where this nurse is coming from. I've been in situations where the patient has needed more pain medication than the physician is willing to order and it is really frustrating because you're the one whom the patient is staring at, begging for relief.

However, the nurse is right about the howling part. Put simply, this is illegal. A nurse who chooses to do this is operating outside her scope of practice. She would be giving a narcotic without an order. An uber-big no-no. She is at risk for losing her license.

Personally, I would not choose to do this. I've never done it nor has it even crossed my mind. What I have done is called the doctor relentlessly and summoned the physician to do a bedside exam so they can SEE exactly what I'm talking about.

Item Five: "Every nurse has had a doctor blame her in front of a patient for something that is not her fault. They're basically telling the patient, 'You can't trust your nurse.'" Theresa Brown, RN.

Sadly true. I've had this happen. I spoke a little bit about this in the last post. A nurse would get in a lot of trouble for doing the same of a physician so there is a double standard. All corrective conversation should never be done in front of a patient, at the nurse's station, etc--- only a private room with reasonable discussion.

Item Six: "Never talk to a nurse while she's getting your medications ready. The more conversation there is, the more potential there is for error." Linda Bell, RN

True...true...true. In fact, this is becoming part of training videos for fellow staff-- to not talk to your co-workers when they are calculating and drawing up meds. It is fine to ask medication questions-- in fact, you should. But wait until you have your nurse's undivided attention.

What do you think of these items?

 

Ten Myths About Drug Addiction 1/2

Dr. Rita Hancock, a specialist in pain management, is stopping by Redwood's Medical Edge to discuss the Top Ten Myths about drug addiction. Today, we're covering the first five. On Friday, we'll finish off with the last five.

Welcome, Rita!

Myth #1:

If you claim a character in your story is "addicted," make sure you know the accurate definition of the word. People confuse the terms "physiological tolerance" (meaning your body gets used to the medicine and, over time, you can need more and more medicine to get the same amount of pain relief), "physiological dependence" (meaning if you don't take the medicine you go through physical withdrawals), and "psychological dependence" (THIS means "addicted," i.e. you're dependent on the medicine to cope with stress, anxiety, etc).

The first two are normal physical phenomena that happen in ALL patients who take heavy doses of narcotics, but only the last one is abnormal/pathological. Thus, if you claim your character is addicted, his or her behavior should show at least a few pathological psychological features (bad relationships, inability to hold a job, stealing to pay for fixes, lying to doctors for drugs, etc.).

Myth #2:

You don't become physiologically tolerant and/or physically dependent on ALL drugs. Thus, you don't necessarily go through withdrawals when you come off certain controlled substances (e.g. hallucinogens like marijuana and PCP don't cause withdrawals). And not all withdrawal symptoms are the same. They depend on the drug in question. E.g. withdrawals symptoms and overdose treatment for alcohol/benzodiazepines/ barbiturates are similar. However, the symptoms of stimulant withdrawal and overdose will be totally different. The point is the writer needs to research the specific overdose and/or withdrawal symptoms for the individual drug his or her character is hooked on.

Myth #3:

Only SOME people are susceptible to addiction to controlled substances (don't make the mistake of thinking that ALL people who take controlled substances eventually become addicted). People susceptible to addiction tend to exhibit addictive tendencies early on (teenage or young adult addictions to smoking, alcohol, etc). In general, young people are more susceptible to developing addiction because their coping skills aren't yet developed and they can learn to rely on drugs for dealing with the underlying anxiety that leads them into addiction.

Myth #4:

I see many elderly people with severe, painful joint pathology who don't want to take narcotics b/c they're afraid of getting addicted. But if they've taken narcotics periodically during their lives for e.g. root canals, fractures, etc, and have never had a problem getting off the drugs, they're at lower risk for addiction. As noted above, though, they will (especially if they're on large doses) eventually become physically dependent).

Myth #5:

There's a difference between pain and suffering. Pain happens when an inciting event causes pain receptors to fire (e.g. a burn, a sprain, a pulled muscle, etc.). However, that physical pain is interpreted by the brain in the context of the person's emotional state. A highly anxious patient or one with a volatile psych history (history of abuse, etc.) is more likely to experience psychological "suffering" with a low level of pain.
Thus, if the person tries to medicate his or her subjective experience with pain using pain pills, he or she is likely to over-medicate to quell the anxiety. You're not supposed to treat your anxiety with pain pills. That's how you become addicted. Many, many chronic pain patients suffer with psych issues, and often those psych issues long pre-dated their chronic pain. Psych issues are a definite risk factor for chronic pain and addiction.

***********************************************************************

Dr. Rita Hancock, a full-time physician and author of Christian health books, writes about how emotional and spiritual factors contribute to physical disease through the mind-body-Spirit connection. According to Dr. Rita, “Once these underlying barriers fall away in the healing light of God’s truth, patients automatically feel less physical pain, experience fewer stress-induced symptoms, lose weight, and shed addictive behaviors more easily.” Dr. Rita is the author of The Eden Diet (Zondervan, 2008) and an as-yet untitled release with Charisma House, pending January 2013. She resides in Oklahoma City with husband Ed, and two wonderful children, Lindsey and Cory. 

CJ Lyons Interview: Part 1/2

I'm honored to have had the chance to interview CJ Lyons, past pediatric ER doctor and now full-time author extraordinaire. If you haven't checked out CJ's books, now is time time, particularly if you're a fan of medical thrillers.

Today we're going to focus on aspects of medicine in writing. On Wednesday, we'll focus just on the writing craft.

Jordyn:  Thanks so much for stopping by. It’s my great honor to have you here. Redwood’s Medical Edge is all about dispelling medical myth. Along those lines, what do you see as the most common medical mistakes perpetuated in fiction writing?

CJ:  The most common (and irritating) mistakes I see deal with the characters. For instance, the popular TV show Grey's Anatomy has interns, who'd be maybe 25 years old, sleeping with "world renown" surgical attendings…well, to be a "world renown" neurosurgeon you'd have to have 12 years of primary education, 4 years of college, 4 years of medical school, 7 years of residency, probably another 3 year fellowship, and then be in practice a long time, at least 5-10 years…so the 25 year old intern's love interest would be old enough to be her father! Gross!

Not only that, a surgical intern doesn't have time to sleep or bathe (interns eat on the run) so sex isn't the first thing you think of doing when you finally do make it to a call room.

Don't even get me started on stories where a "doctor" can do everything from take x-rays (99.9% of us wouldn't even know where the "on" button is) to diagnose rare diseases from glancing into a microscope to doing brain surgery one minute and heart surgery the next…while I love the idea of doctors being heroes, let's at least make us human.

Oh, and I've only met two physicians who drove Porsches, both orthopedic surgeons, freshly divorced and shopping for new wives. At the community pediatric practice where I worked, the guys who plowed the snow were paid more than we were. So just because a character is a doctor doesn't mean they're rich.

Jordyn:  What about the most common medical myths?

CJ:  Those magical "blacked out" incidents. Where the character is hit on the head and wakes eight hours later in perfect condition, ready to chase after the bad guys…or the Taser hit that instead of lasting the five seconds it does in real life, knocks someone out for a prolonged time.

Sorry. In real life, your guy with the head injury would probably be dead or dying of a brain bleed and people who are Tasered don't black out at all (although they might wish they did)—in fact some of them stay perfectly functional while being Tased, much to police officers' dismay.

Jordyn:  I read with interest that you had worked with a community group of pediatricians that served an Amish community. Amish books are selling briskly on the inspirational market. Do the Amish have any medical beliefs that differ from western medicine? What are some of the unique aspects of working within the Amish community as a doctor?

CJ:  We had a variety of patients when I was working at a community pediatric practice in Pennsylvania, including Amish. But also Chinese, Russian, Pakistani, Turkish….and every demographic from the very poor to millionaires who kept their family home in our idyllic mountain setting and flew their privates jets to and from their offices in DC or NYC every week. It was a great experience, because like the ER, you learned very quickly not to judge anyone because of their appearance or accent or attitude.

Jordyn:  You spoke once about how you had a fascination with ghost stories. Speaking as a physician, do you have any thoughts on near-death experiences and what they might mean?

CJ:  I think there's more going on in the universe than we understand or can imagine. It's hubris to think we have all the answers—or ever will. As for near-death experiences, I actually used one in Borrowed Time to set things up for the main character. She's a cop, shot and killed in the line of duty on page 3, and brought back to life by a trauma surgeon. But she's now seeing things, visions of other people's deaths, and suddenly everything she once had faith in: her abilities as a cop, her trust in herself and her fellow officers, even her sanity is questioned.

Jordyn:  What are three things you’d like President Obama to know about the healthcare system after serving families for seventeen years as a physician.

CJ: Not just the president, but everyone. First, just because kids don't vote shouldn't mean that their health care is put last. It should be top priority along with education and feeding them. Without healthy kids energized to learn the skills they need to take us into the next century, we have no future.

Second, there is no universal formula doctors can follow. Yes, we need evidence based medicine to help us tailor our choices, but it can't be about cost, it has to be about effectiveness, about what's best for the patient in front of us here and now.

Third, from my point of view as a physician on the front lines, the HMOs already cut all the fat from the medical field and put that cash into their own pockets decades ago. The only place left to cut now is trimming the bureaucracy. Which would not only save money but improve health care quality because then doctors would have time to spend with patients instead of wasting it arguing with administrators.

**********************************************************************

As a pediatric ER doctor, New York Times Bestseller CJ Lyons has lived the life she writes about in her cutting edge Thrillers with Heart.  

CJ has been called a "master within the genre" (Pittsburgh Magazine) and her work has been praised as "breathtakingly fast-paced" and "riveting" (Publishers Weekly) with "characters with beating hearts and three dimensions" (Newsday). You can find out more about C.J. by visiting her website: http://cjlyons.net/ 

Medical Myth: Lacerations need a Plastic Surgeon

Over the next three Fridays, I'm going to dispel some pretty popular medical myths that are perpetuated in books, on TV, and on film. Today we're focusing on the skill of the plastic surgeon.

Here's a common ER setup. A child comes in with a simple laceration to the face. Let's assume for the purpose of this blog post it's a one inch cut to the face that is not through any critical structures. I, your happy triage nurse, bring you into the triage room for your child's weight and vital signs and the first thing the parent says is, "We're going to need a plastic surgeon for this." My happiness bubble has burst.

First of all, anything that requires suturing is going to leave a scar, no matter who stitches it. It's the nature of how your body heals. The amount of scarring left after suturing depends more on you than the doctor assuming the doctor does a nice job stitching. Did the wound get infected? How does your body normally scar? Some people develop very heavy scars called keloids. Did you protect the skin from sun after the stitches were placed? All these factors play in to the amount of scar that is seen. It will take anywhere from 6-12months to know what the scar will look like.

 Secondly, there seems to be the general impression that if a plastic surgeon closes the cut, it will not scar. Let me pose this to you. If this were true, why do plastic surgeons hide their incisions up in the hairline, behind the ear, etc? Why not cut right down the middle of the forehead? They hide their incisions because they know a certain amount of scarring is going to happen. Surgical incisions are deep cuts. Just clean ones.

Lastly, plastic surgeons are generally unavailable to come to the ER for minor laceration repairs. We don't even have plastics on call for our ER. Emergency physicians are very adept at closing lacerations, even complicated ones.

The conflict arises when I begin to outline all of the above. What do you mean, there isn't a plastic surgeon? If you're unhappy with the repair, you can always consult a plastic surgeon at a later date for a scar revision. But, have some faith that the ER doctor will do a great job. They do stitches every day. If they think it is beyond their capability, they will let you know.

Are you afraid of your child having a simple scar on the face? Why?