I am a Caregiver.

I’m going back to work my last shifts as a nurse soon. I can’t believe I’m going to be done working as an RN. I say done ‘working’ as a nurse because I’m always going to be a nurse. Just with different initials and job duties.

The last time I was at work there was a bit of a kerfuffle. Essentially there was a patient who was dissatisfied with a few of the nurses. They didn’t have any problems with the medical treatment they received, the problem was with the care they received from a few of the nurses, or really, the perceived lack of care.

When I met the patient I realized what the problem was immediately. They were, well, let’s say, a more high maintenance patient. Every patient wants and deserves to be listened to, heard, and respected. This particular person demanded it (literally, loudly, and often), and was very upset when they felt they were not being listened to and not enough time and attention was being devoted to their needs.

It was challenging to take care of them, especially when they were already cheesed off. But I did my best, took the time necessary to listen and validate the patient’s needs and concerns until they trusted me and felt satisfied with their care. Like I said, it wasn’t easy. I worked with my cohort that night, taking turns caring for the patient and ventilating when necessary.

Nurses, and all care providers, are human beings. There are bound to be patients that just rub us the wrong way, or vice versa. It’s a fact of the job. One of the nurses who had torked the patient off said (probably mostly out of anger and fear at the very pointed, personal complaints directed at them) that it wasn’t her job to ‘kiss @ss’ and she had treated the patient just like all the other patients she takes care of.

So what is our job exactly?

Nurse

Noun: A person trained to care for the sick or infirm, esp. in a hospital.

Verb: Give medical and other attention to (a sick person).

Care

Noun: The provision of what is necessary for the health, welfare, maintenance, and protection of someone or something.

Verb: Feel concern or interest; attach importance to something.

Our job is to care for patients. Which means we give medical and other attention to them. We are to care for patients, showing concern and interest, for their medical, spiritual, and psychosocial needs. We are also to care for them as individuals, whose needs will differ, requiring us to adapt our approach to care as needed. As I said, sometimes this can be difficult, and sometimes we need to step away, to get help from a coworker, to ventilate, but it’s still our job.

I’m not writing this to criticize anyone or anything like that. The nurses in the situation I described are all excellent nurses that I’ve had the pleasure and privilege of working with for years. I’m writing this so that I remember as I go on to the next phase of my career. I want and need to remember as I’m caught up in the long hours, the paperwork, the mounting responsibilities and demands, the increasing numbers of patients – that first and foremost, I am a caregiver. And my job is and always will be, primarily, to care.

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Reasons #456 and 457 why I’m doing OB/GYN. OR, Fine, if I can’t be doing OB/GYN, I’m going to write about it.

I’m currently on another surgical rotation where, again, everyone thinks I’m pretty much nuts for going into OB/GYN. Until, again, I mention that I’m considering doing a fellowship in REI (Reproductive Endocrinology and Infertility). Then it’s all “Ohhhhhhh, well that’s smart. (i.e. Okay, maybe you aren’t a total nutter.) You’ll have office hours if you do that. Nine to five that’s the way to go! (i.e. Okay, maybe you won’t turn out like that poor sap I told you about who crashed and burned out after two years of general OB/GYN and now does corporate physicals for a living.) Plus, you’ll probably make lots more money. (i.e. Okay, you probably won’t be sued into vagrancy.)”

Whatever.

It occurred to me recently that a lot of this negativity probably, actually stems from the fact that most people who don’t do OB/GYN, just don’t like it. As my current attending puts it, “You either like OB/GYN, or you don’t.” (Or, as one of the nurses in their office put it “They just hate OB/GYN.”)

And when I think about it, I can recall countless non-OB/GYN physicians grimacing painfully as I excitedly regaled them with tales of deliveries, sections, hysterectomies, pessaries, and pap smears before they (pointedly) changed the subject. I particularly remember one internal med doctor I worked with as a nurse who was so excited to be taking another job where they wouldn’t “have to be doing any of those pap smears anymore!” [pap smears, YUCK, written all over their face and inflection]

OB/GYN = Ewwwwwwwwwww......

Frankly, if some doctors don’t like OB/GYN stuff (fine, that’s cool), instead of condemning me for liking it, I think they should be congratulating me. I mean, they have no desire whatsoever to deal with “crazy pregnant ladies” or “all those ER patients with vaginal discharge [shudder].” Well, I can’t wait to “deal” with them. Heck, that’s all I want to deal with. So make both our days, send them all to me, and instead of thinking I’m nuts for wanting (and totally loving) this work, think I’m doing you a big favor, and throw me a frickin’ party.

I’m just saying.

OB/GYN = Party Time! That's more like it.

Which (sort of) brings me to Reason #456.

I read this article yesterday on NPR’s health blog about doctors talking to (or not talking to) patients about their sex lives. From experience, I have found that many physicians are not necessarily comfortable talking to patients about sexuality. For example in first year, before OB/GYN was even a twinkle in my eye, I watched a generalist complete a yearly physical on a young female college student. They did all the exams – heart, lungs, abdomen, pap, pelvic, wrote a script for birth control, and sent the patient on their way. They did not ask one question about sexual partners, sexual practices, STD testing, nothing. I was very surprised and a little dismayed. Last year I heard about a patient who had expressly been sent to an OB/GYN with persistant UTI’s for further investigation of sexual practices and a workup for STD’s. Later the patient presented with yet another UTI, and per the OB/GYN’s note, none of these things had been done. I completely understood the generalist’s frustration as they read the note and asked me “You’re going into OB/GYN, shouldn’t they address that stuff??”

Yes, yes they should.

Sexuality and associated health concerns are a fact of life, and an important part of a patient’s overall well-being that cannot be ignored. I am sure that patients have a hard time talking about such issues, and probably more often than not, the (sensitive, non-judgmental, well-educated, trustworthy) doctor is going to be the one who has to start the conversation so that any concerns can be properly addressed. We need to be better about this, and I for one, am very happy to be going into a field where I will be a (sensitive, non-judgmental, well-educated, trustworthy) resource doing my best to help patients with these important issues.

And, on a lighter note, Reason #457. (Or, a stolen, precious OB/GYN moment that was the highlight of my non-OB/GYN week.)

A few days ago I walked out of a patient room and one of the nurses beckoned me to the lobby where, to my absolute delight, I found one of the patients I’d delivered months ago waiting to say Hi with their baby. The patient had been a delight to work with, I’d spent all day on L&D with them and their family, and when the baby came I had been just as ferklempt as grandmabear.

The baby was spectacular, all decked out in their best baby duds, snoozing and drooling like a little angel. As I exclaimed and made a general fuss over them, the proud mamabear said she had heard I was in this particular clinic and they just wanted to stop by and show me the baby. And then they handed me a thank you card, and I got ferklempt all over again.

And that is my kind of Pediatrics. I love kids. I do not like having to poke, prod, or otherwise torture children in the name of medicine. And with OB/GYN I get the fun part of Peds, aka the exclaiming and general fuss-making, without all the Bad Guy stuff. (P. S. Pediatrics people you are my Absolute Heros for being willing and able to do the Bad Guy stuff. Seriously.)

Highlight Of My Week. Sniff.

Really, does it get any better?

Follow up: Sanity Prevails.

But not by much.

From the New York Times today……

Senate Blocks G.O.P. Bill Opposing Contraception Policy

By ROBERT PEAR

Published: March 1, 2012

WASHINGTON — The Senate on Thursday killed a Republican effort to let employers and health insurance companies deny coverage for contraceptives and other services to which they have religious or moral objections.

The vote was 51 to 48. In effect, the Senate upheld President Obama’s birth control policy. The policy guarantees that women have access to insurance coverage for contraceptives at no charge, through an employer’s health plan or directly from an insurance company.

The vote generally followed party lines. Senator Olympia J. Snowe of Maine, who said this week that she would not run for re-election, was the only Republican to vote with Democrats to kill the measure.

See the rest of the article HERE.

If you are concerned by the appallingly narrow margin this amendment was defeated by, I suggest you keep that in mind come fall. And do your part to preserve the, apparently tenuous, hold sanity still has on our society.

Because this does not have to be my/your/our future. Just saying.

QOD: Stop the Insanity!

Attending: “Do you know what Canadians are?”

Me: “Erm, Noooo…”

Attending: “Unarmed Americans. With health insurance.”

~ Brief exchange after expressing my despair/fury over the birth control debate, and the old go-to escape plan of moving to a (politically) saner place. I.e. Canada (Or, pretty much anywhere, I just like to use Canada for convenience’s sake. Proximity and all.).

I believe I’ve shown incredible restraint in not expressing my views on the recent debates over insurance coverage for birth control. Besides, if you read this blog for more than two seconds, you can probably surmise where my sympathies on this issue lie (that is, with women), and how I feel about the jackholes who are trying to deny women coverage for a basic human need (that is, I really don’t like them).

As far as religious beliefs, I couldn’t give a rat’s patoot less what people believe. I am totally A-OK with people worshiping whom or whatever they want as long as they aren’t hurting anyone. The truth is, this debate over whether or not employers will be required to provide insurance coverage for birth control has nothing to do with religious freedom at all. It is simply a platform for some religious institutions and Republicans to flex their political muscles and make problems for political opponents during an election year, and in the process, hurt people. Which is when I cannot, morally, remain silent any longer.

So let’s cut through the political crapola and focus on the facts.

FACT: Women need insurance coverage for birth control.

  • Because without insurance coverage, many women will not be able to afford birth control:

  • Because birth control helps prevent Unintended Pregnancies. Approximately 49% of all pregnancies in the U.S. are Unintended Pregnancies. Unintended Pregnancies lead to poorer outcomes for mothers and infants, including death. Not to mention that over 92% of pregnancies terminated by elective abortion are Unintended Pregnancies. That’s right, opposing easier access to birth control essentially means promoting abortions. (USE YOUR HEADS PEOPLE.)
  • Because birth control is not just used for birth control, but also to treat a variety of other serious health concerns:

  • Because this is 2012, not 1912. And I think (at least I thought) it is obvious and well established legally, morally, and commonsensically at this point that women have the undeniable, inalienable rights to their own bodies and fertility.

FACT: This debate over requiring employers is NOT about protecting religious freedom, but it WILL hurt women (and potentially just lots of people).

  • Religious organizations such as churches, who primarily employ practicing parishioners, are already granted the freedom to choose whether or not to cover birth control. Fine, whatever.
  • Organizations such as universities and hospital systems with religious affiliations employ tons of people with any number of different religious beliefs or no religious beliefs at all. And they should have to offer these alternately/non-believing employees coverage for birth control if they choose to employ them. As an added, religiously free bonus, employees who do ascribe to an anti-birth control faith, have the choice to NOT go out and buy and use lots and lots of birth control if they don’t want to. (I know, *gasp*, right???)
  • The so-called Blunt amendment will not only allow any organization with religious affiliations to opt of insurance coverage for birth control, it will allow any individual, institution, or entity to deny coverage for any services or items contrary to their religious beliefs or moral convictions. And that is taken pretty much verbatim from the amendment, if you don’t believe me, look for yourself. I mean, for God’s sake, what if someone up and decides to be morally opposed to congestive heart failure or cancer treatments???? Or worse yet, impotence? (NOOOOOO, not the Viagra, anything but the Viagraaaaa!!!!)

FACT: If you would like help to stop this insanity you need to act NOW.

  • The Blunt amendment is to be put before senate for a vote tomorrow. You can find your state representative’s contact information———–> HERE<————-, by clicking on your state. Email or call your representative(s) to express your adamant opposition to the Blunt amendment, and how very p*ssed you (and all the many, many, MANY voters you are close, personal friends with in their district) will be if they support it.

Seriously people, do your part to stop the insanity, or, guys like this……

Right, well that was anti-climactic. Apparently WordPress won’t let me embed the video I had intended to embed, which is a celebrity parody of all the “Women’s Health Experts” who have come forward to testify about birth control, because it contains language related to Lady Parts. Which, apparently, some people find offensive. But I won’t point any fingers or name any names *cough*Romney*cough*. If you however, have reconciled yourself to the fact that half the world’s population own vaginas (yep, I said it VA-GI-NAAAAAAS) and that they are neither offensive, nor inherently evil, then please, click HERE for something truly freaking hilarious. (Thank you FunnyorDie!!!!!!)

VA-GI-NAAAAAS!!!!