Dear doctors and medical students of all stripes and specialties everywhere:
Breastfeeding is really awesome and also really hard. It’s a huge commitment, especially for working/student moms, to be the source of food for a baby. And American culture undermines it at almost every turn.
Do me a favor and download an app called lactamed. There is a lot of misinformation and “we’ve always done it this way” that can fuck up breastfeeding. Ex: women are frequently told to pump and dump after general anesthesia when they actually don’t have to! Or women are frequently told to pump and dump after having an alcoholic beverage. False!! Not necessary! Many women do not have oversupply, many struggle with undersupply and there are ways to help increase it, both pharmacological and nonpharmacological.
We did not get any education about breastfeeding at my school and many pediatricians and ob’s aren’t much better educated. Nursing women will be patients of everyone. Support and advocate for your breastfeeding patients and colleagues in the clinic and hospital, especially those in resource poor areas. Help them find breastfeeding support groups. I’m part of one on facebook and it really helped me keep nursing, especially in the early days when it is the hardest.
Formula is not evil or harmful, but breastmilk is the best food for babies.
Since I’m in the nursery this month and our hospital is working towards baby friendly designation (so we get extensive training on breastfeeding) I’d like to add a few resources if I may.
Your Guide to Breastfeeding is an amazing resource for new moms and those who want to learn about the basics of breastfeeding. We give this to all our new moms. Also available in Spanish and Chinese.
Lactimed as mentioned above is a great resource where you can determine if certain meds are safe to use while breastfeeding and offers alternatives if available. It’s also available as an app which I feel like is easier to use.
Breastfeeding resources provides breastfeeding basics, common concerns, and trusted breastfeeding resources for mothers.
For those of you who like videos, the ABCs of Breastfeeding is a fantastic resource.
You cannot be successful and help others if you are sleep deprived, malnourished, or out of shape. Take care of yourself. Find a balance and don’t let go of what defines you.
advice from a professor on my first day of grad school (via runningmandz)
When my alcoholic uncle died - and how it impacted my life as a nurse
A recent post from another nurse was so beautifully honest and vulnerable that it made me lose my snark and just get human for a minute. So I will share an experience and I have permission from all involved. I had an uncle who was a terrible alcoholic. It ravaged every aspect of his life, his work as a union tradesman, his ability to be a father or husband and his relationships with his brothers and sisters. My mom and I often visited him when he’d get admitted to the floor. I could never bear to see him in the ER. Dirty, belligerent, withdrawing in the DTs. I was embarrassed because I knew he was a frequent flier. I was embarrassed that I was embarrassed. We tried to drop him groceries and buy his Dilantin every month, but he moved around a lot, mostly renting rooms above taverns. He wanted nothing to do with sobriety. He used drugs when he could, but whiskey was his poison. In the end he only tolerated a few beers a day to keep away the shakes. To any nurse or medic or doc who new him he was a local drunk, but to me he was my uncle. I knew him as a kind loving man as well. I remember family BBQs and him tossing me up in the air as a kid. I remember him showing up drunk to thanksgiving and not making it out out of the car before passing out. I remember the disappointment in my family’s faces. I remember the shame in his eyes. I remember driving around his neighborhood looking at the entrances of taverns to see if he was passed out. I wondered if anyone would know to call us if he died. I wondered if he even had any I.D. But they did call. And I knew when I saw him at age 55 in the ICU Weighing 90 lbs dying of Hep C and esophageal CA that he didn’t have a lot of time left. I was a nursing student and an ER tech but I knew in my heart this time was different. I saw people fear him. I saw nurses treat him as if he was a leper. One yelled at him to be still while she gave him a shot of heparin and he grimaced in pain. Nurses came in one by one to start a heplock and he grimaced in pain. Despite knowing better after the 4th nurse was unsuccessful I begged them to stop and give him a break. My hospital I worked accepted him into impatient hospice. I was relieved. When he arrived I saw the 2 EMTs toss him on the hospice bed and walk out without saying a word while he grimaced in pain. They probably got held over and he probably didn’t seem like an urgent transport. They didn’t want to touch him. I didn’t say anything. I was scared to touch him too. He was emaciated with a huge head and a gaunt appearance. I wondered if he had AIDS. I felt bad for thinking that. I still kissed his forehead and told him he was going to be okay. Because I loved him. He was my family. And then I saw nurses treat him with kindness. I saw the beauty of a non judgemental hospice team make his last 96 hours on Earth a time where he could make peace with his demons. I saw Roxy drops for the first time and I saw him get some relief from the pain of untreated cancer, from the pain of dying. I saw them allow me break the rules and lift his frail body into a wheelchair, fashion an old fashioned posey to hold him up and take him down stairs for his last cigarette on Route 30. I was able to spend my breaks with him. I got to suction him and help give him a bed bath. I got off my 3-11 shift and spend a few hours with him watching a baseball game on replay. I sat with him in silence and I held his hand. I finally knew what people meant when they said the dying watch their life play out in their minds. I swear I could see it happening. I asked him if he was thinking about things he said “yep”. I asked him if he wanted me to stay or go and he said “stay”. So I stayed. I heard the death rattle for the first time. I cried to a veteran hospice nurse and she explained how the Scopolamine patch would help. I finally felt what it was like to be helpless to a family member in need and her words of comfort and years of experience meant everything to me. She said he probably had 48 hours at the most. I read “Gone from my sight” the blue book of hospice by Barbara Karnes. The whole family trickled in. His kids, all his brothers and sisters and nieces and nephews. His children told him they loved him and they forgave him. We kissed his forehead and washed his hair. My mother shaved his face. His daughter said words of kindness that relieved him of any guilt or regret. I saw this beautiful cousin of mine watch me suction him and she asked how I could be so calm and so strong. I didn’t feel strong or knowledgeable but when you are the “medical person” in the family they see things in you that you didn’t know you had. We surrounded him with love and light and he died surrounded by everyone who ever meant anything to him. The nurses even cried. I got to see the dying process for what it was. It was beautiful and at the same time so humbling it brought me to my knees. I have never forgotten that feeling and I pray I never do. Is alcoholism a disease? We debate it as health care providers and wonder about the others whose lives have been impacted by the actions of an alcoholic. The amends that never got made. I guess I don’t care if it’s a disease, a condition, or a lifetime of conscious choices and poor judgement. In the end it’s a human being, usually a dirty foul smelling human being with missing teeth who may or may not be soiled in urine and vomit. Sometimes kicking, hurling obscenities, racial slurs, or spitting. Often doing all of the above at once. It’s hard to empathize with a human being who arrives packaged up that way. It’s hard to care or to want to go above and beyond. And I don’t think you should ever feel guilty if you don’t have those feelings. That is okay. It’s natural to wonder about the damage these people may have done to others. Wonder how many lives they might have ravaged. Please don’t take their pain as your own. At least try not to. It is not your pain to carry. And we all know that is easier said than done. But please, Treat them with dignity. They feel. They hear you. Give them the care you know you are capable of giving. I can tell you I hold a special place in my heart for every nurse who touched my uncle with a gentle hand. Who cleaned him for the fifth time when he was vomiting stool. Who asked him to smile. Who smiled back at him. Who stroked his forehead and put a cool washcloth on it. I am eternally grateful for anyone that saw beyond his alcoholism and saw a person. A human. A child of God (if you believe in God). A father. A son. An uncle. And I believe in my heart he felt the same way, even if he didn’t or couldn’t say it. If you have that patient. That difficult, hard to like, dreadful patient. Don’t think you have to love them or even like them. You don’t. But if you can preserve their dignity and show them the kind of nursing care that anyone would deserve, than you are good. You are the reason we are the world’s most trusted profession. And even though you don’t know it, someone saw and felt it, and it meant the world to them. Go to bed and sleep soundly because you deserve that. - J.R. RN
Gifts your friend/family member who just had a baby really wants
- Day 1: To be left alone. I get it, you are so excited to see the baby. Well she either spent some time and a significant amount of effort pushing it out of her vagina, or it was cut out of her. Both situations are exhausting. Give her and baby and Dad a chance to rest unless she asks you to be there.
- Day 2: Something other than hospital food. And whatever she didn’t bring to the hospital that she needs- a phone charger, a nursing nightgown (I hated trying to nurse in the hospital gown, plus wearing my clothes made me feel like a person instead of an invalid), real coffee, a toothbrush, etc.
- Going home: The first couple days at home are the hardest. This is another time that is less than ideal for a visit. Everyone is adjusting and it sucks. The best thing you can do is to send encouraging texts and order them delivery food. Nobody wants to be doing dishes right now. It was hard for me to arrange visits because I needed to sleep when the baby slept- if you do come over during this period right after going home from the hospital, drop food off, do a quick chore and leave whether or not they are awake. Socializing will come later.
- Week 1-2: Life with a newborn is harder than anything I’ve done yet, and it’s the type of hard you can’t understand until you live it. The first two weeks are the absolute worst. As someone who previously had all their ducks in a row and had their shit handled, this is a time where I had to ask for help. I couldn’t do laundry or dishes, I couldn’t even make myself food. All I did was nurse the baby, and try to sleep when he slept. So, when you go see your friend/family member and the new baby, there is a baby holding tax. Things that are appreciated:
+ food- either a full meal for her and Dad, or food that she can eat one handed while feeding the baby. Some of my favorites are little baggies of grapes and berries, granola bars, and mixed nuts.
+ chores- dishes or laundry or pick up some clutter
+ pay someone to clean their house
+ take out the trash or recycling
+ bring diapers/wipes or groceries
+ take care of their pets- let their dog out or take it for a walk, scoop the catbox or feed the fish.
+ hold the baby while the parents take a shower, take a walk, eat a meal, or take a nap. My baby sleeps the longest when he is being held, and it’s so nice when my mom or mother-in-law hold him and I am able to take a long nap.
+ mow their grass or water their plants. My houseplants really took a beating when we brought the baby home- my airplant died. THE AIR. PLANT. DIED.
+ Snowdrop is our first baby, but if someone is bringing home baby #2 and onward, I’m sure help with the other little ones would be MUCH appreciated. Seriously, I don’t know how people have a newborn and a toddler or preschooler. Y’all are magic.
This is my first baby and I’m only 3 ½ weeks in, other mamas feel free to add anything that you would have appreciated when you brought your babies home!
Yes, yes, and yes. Also, don’t feel offended when/if mom/dad say they do not want visitors at x/y/z times. And if anything on this list feels like too much, it isn’t. Some people (especially new moms) may initially reject help. Knowing your friend/sister/person, push just enough that they know you are sincere but not enough to make them mad. If someone offers something once, I may turn them down. The third or so time it is offered I will be more likely (read: desperate) to agree. Also with dinners/meals, frozen entrees to use down the line are nice. It never fails that once you think you have things down pat something will come up that makes home cooked meals seem impossible. Having a frozen casserole or the like to throw in the oven is a lifesaver in these moments.
Another thing that was super helpful to me as a single mom (if you are able to do so) was having a standing “babysitter” offer. I had a friend that would take my son every Saturday afternoon for an hour or two. It was so nice to be able to look forward to that alone time. Whether it was running errands (shopping with a newborn can get hairy), squeezing in a cat nap, or scheduling some self care (mani/pedi 😍) I knew that I (barring something coming up) would have that short break to look forward to.
I’m on nights in the ED, and last night was an intense shift.
My first patient of the evening was a woman who was sent to the ED by her PCP for an indicentally-discovered WBC count of over 200, with 8% blasts (immature cells). That, non-medblrs, is very high, and she came in the door already understanding that she almost certainly had leukemia. I sat down with her and explained the next steps, and gave her The Talk that I have started to routinely give to people with new, serious diagnoses. The Talk goes roughly like this:
“A lot of things are about to happen in a pretty short amount of time. There will be a lot of people helping to take care of you. It might feel invasive and overwhelming, but I want you to know that you are the driver. If you are confused, ask questions. If something is happening that you don’t like, you can tell us to stop. This is your body and you always get to decide what happens to it. As doctors we sometimes get swept up in treating your disease, and I apologize in advance if you ever feel like we’ve forgotten about the rest of you, but please feel free to remind us. We are experts in medicine, but you are the expert on you.”
I then placed her first IV. It felt like I was firing the starting pistol at a race that this woman really didn’t want to have to run.
Unfortunately, she wasn’t the last person to get The Talk last night. The second person came in with abdominal pain, something we see often in the ED. While this patient wasn’t feeling all that sick, his story worried me, and on exam he had a large palpable mass in his abdomen. As soon as my hands touched the mass I could envision his CT scan in my mind. We ordered the test, and the actual scan looked worse than what I had imagined. There was really nothing that could look like this except for a widely metastatic cancer.
It was a very busy night, and my (awesome) attending was running all over the place. I offered to go tell the patient the bad news, imagining that she would probably want to be there for that conversation. But she just thanked me, and off I went.
I’ve had serious conversations with patients and families, sometimes unsupervised. I had not, however, actually delivered this kind of news before. Of course it was somewhat hedged; cancer is diagnosed by biopsy, not by imaging. But it would have been impossibly dishonest not to tell them that all of the testing we were about to recommend was a cancer workup.
They were fairly stoic about it, which probably made it easier on me, though it made me worry at first that I wasn’t being clear. They asked good questions. They wanted to see the CT scan, so I went over it with them. I gave them The Talk, and they seemed to appreciate it. We wanted to admit him, but they decided to go home and plan further diagnostics as an outpatient, and I felt like The Talk had worked. He wanted to go home, so he did.
I spent the rest of the night sewing and splinting, which is the beauty of emergency medicine: the heavy shit is mixed in with easy, fun, satisfying fixes. But I honestly really love the hard stuff. I love the type of healing that starts – and often ends – with words.
I don't want to do medicine; I'd rather help people...
The only thing keeps me from wanting to pursue medicine is the drive to help others. I also always wanted to travel and be a humanitarian aide worker. I hope to help create social reforms that can relieve poverty and promote social mobility. I also want to help those who have less access to healthcare and education. I can’t communicate well, I am not an effective leader, I panic easily in unfamiliar situations. I don’t know if I’m being realistic enough to pursue medicine, what are ur thoughts? - vivavivalavidala
I’m sorry, but I’m not seeing your point. Why would a drive to help others keep you away from medicine? Helping others is the generic reason most med students give for why they want to pursue medicine. I mean, you pretty much just named half of the reasons why I did go into medicine. Seriously. And I had pretty much all of those doubts when I started.
Lemme remind you about Moses, whose life story, regardless of your religious beliefs, is a pretty amazing study of how a wimp becomes a great leader. Back in Exodus 4, God tells him to go talk to Pharaoh and lead the Hebrews out of Egypt. Did you get that? God literally talks to him and tells him what He is going to help him accomplish. And what does Moses say in reply? “Pardon your servant…I am slow of speech and tongue.” He’s all “yo God, that’s nice that you have put this calling on my life to do huge big things for these people, but I don’t think I’m cut out for it because I got a D in my college public speaking class”. (That’s the Wayfaring International Paraphrase for ya.). But God comes right back at him and says, “Who gave human beings their mouths?…Is it not I, the Lord?… Now go; I will help you speak and will teach you what to say.” How clear is that? God calls him to do something and He equips him to do it.
Life callings don’t come around just for funzies. Your interests and talents are there for a reason, even if you don’t think you’re up to the challenge of pursuing them. If there is a calling on your life to do something, God will provide the equipment you need to accomplish it. He may even make use of your shortcomings.
As for your doubts, I don’t think any of them are good reasons to NOT pursue medicine. I know plenty of introverted, shy doctors who avoid the spotlight and are still great doctors. But just because you don’t feel comfortable in certain situations now doesn’t mean you can’t develop some confidence over time. Come on girl, fake it til you make it.
Communication and leadership skills can be built and acquired over time. I mean geez, the first time I had contact with a patient I ran out of things to say after like 2 questions. That stuff comes with practice.
If you want to be a better leader, observe leaders that you admire and think about what qualities they have that make you want to follow them. You don’t have to be in an official leadership position to practice being a leader. Practice leadership skills in your daily life and people will begin to see you as a leader that needs an official position. Also, you don’t have to be in a leadership position of any kind to be an effective doctor, humanitarian worker, or community activist. Every cause needs good workhorses to carry out the leaders’ visions.
Also, who doesn’t freak out a little in unfamiliar situations? If you had told me as a first year medical student that I would be able to confidently run a code blue, I’d laugh in your face. Back then I couldn’t take a patient’s blood pressure confidently. But I learned and moved on. You know what helps? Pursue scary new experiences. Face your fears. Each small new experience builds on the one before it, and after a while you’ll be doing things you never dreamed you could handle 10 years ago. 10 years ago I got on a plane to go to Central America to “rough it” in a nice hotel and work in mobile medical clinics for a week. It was literally hundreds of miles from my comfort zone. But now I regularly travel overseas and get in crazier and crazier situations every year.
Lastly, you don’t have to be a doctor to do the things you want to do. You could be a social worker, public health worker, humanitarian aid worker, or even a no-title Joe Schmo who chooses to give money, time, and effort to worthy causes. Pursue your calling, not a title.
It has been well over a year - and for good reason. Got hitched. Moved to Australia. Got an RN job down here. Got a puppy. Now expecting a child! But that's still a secret. So shh. Don't tell anyone. My mind has been blown over the differences in medicine between two first world countries. I think I will dedicate the next few posts to eliciting those differences. Cheers 🐨
Hyperactive 4 year old boy (well known to our Urgent Care): *going completely bonker-nuts in the exam room, non-stop screaming and laughing, running into the walls, throwing exam gloves around — basically acting WAY worse than his usual hellacious self*
LOS ANGELES, CA – “We have to halt this study immediately!” was a warning issued by lead researcher, Dr. Hans Willford from UCLA. “Long term mortality rates are sky rocketing over our placebo groups.”
patient satisfaction surveyIn an effort to decrease medical costs and to improve patient care, a multicenter randomized study was launched nine years ago to determine if satisfied patients led to an actual improved quality of care, healthcare cost savings, and increased life expectancy. Contrary to popular beliefs from administrators and politicians, the results were disastrous.
“This is not what we expected at all,” said Henry Hugeprick, CEO of Press Ganey, a healthcare consulting firm. “I mean, we were expecting this study to help launch our patient satisfaction computer programs into every single hospital and medical clinic in America. I’m sure the study is flawed.”
The PISS study, short for Patient Improvement Satisfaction Study, took patients and divided them into two groups. The placebo group would receive routine medical care while the second group implemented patient satisfaction surveys and linked scores to monetary reimbursement. Physicians were told before treating patients which group the patient belonged to. Physician and hospital reimbursement remained normal in the placebo group, but in the survey group, physician salary and hospital reimbursement were tied directly to patient satisfaction scores from surveys.
Patients in the survey group demonstrated a 283% increase in mortality and a 146% increase in morbidity with chronic medical conditions over the 10 year period.
“Patient satisfaction appears to be directly related to increased mortality and morbidity,” said FDA spokesman Dr. Rachel Barthow. “Counterintuitive to many other aspects in life, satisfaction in medical care does not always equate to improved care. As a matter of fact, it may be detrimental to one’s health.”
Gomerblog’s medical correspondent, Dr. Sanjack Goop, gave Gomerblog this analysis.
“The problem with linking reimbursement to patient satisfaction is completely flawed from the start. Here’s an example. A patient that weighs 340 pounds comes into your clinic. We all know the healthiest intervention for this patient is weight loss. However, if a doctor mentions weight loss to the patient and they get upset, guess what? Negative patient satisfaction survey, which could mean decreased reimbursement. A doctor looking for increased reimbursement will possibly tell the patient that everything looks great and just keep doing what you are doing in eating those cheeseburgers. Guess what, excellent patient satisfaction survey.”
Cherry picking healthy patients and avoiding sicker patients was clearly evident in the study. “One physician told a dialysis patient that it was OK to skip a week of dialysis so that the patient could head down to Disneyland,” said an undercover internal medicine physician.”
He had the patient fill out a raving survey before leaving the clinic. A week later when the patient returned with chest pain and peaked T waves, the physician forced his junior partner to see the patient, so that he could see teenager sports physicals. For the physicals he just signed on the bottom line and had all patients in and out in 5 minutes. He received glowing satisfaction surveys from parents due to the quickness of his exams, without ever laying a stethoscope on them.
Dr. Goop continued: “And, as one can see another way to improve patient satisfaction is to decrease patient wait times. Ok, so a doctor who spends less time with patients and less time thinking about their medical problems will lead to decreased wait times. Boom, excellent patient satisfaction scores!”
A medical ward nurse was recently written up for bringing a diabetic patient a ADA approved food tray, instead of the ham sandwich that the patient wanted. “The patient’s blood sugar was in the 300s. I refused to bring him a ham sandwich with chips and I got slapped with a horrible survey!”
A family physician, wishing to remain anonymous had this to say: “Doctors and nurses aren’t paid to be your friend or to sugarcoat things. We are here to give sound medical advice and to treat medical problems. It’s what we were taught to do. Yes, we want to be your friend, but we have to do the right thing for you and sometimes that means telling you things that you may not want to hear or do. ”
“Thinking that doctors and nurses will only do the right thing in medicine by dangling dollar bills in front of us is actually a complete insult, and the companies and governments imposing these stipulations upon us need to redirect their actions towards their own flaws and greed.”
