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Alright, so I'm sitting in my regular spot at my regular time in my usual Panera writing papers and getting ready for a quiz tomorrow.

Then this guy shows up.


It's not a great shot, but I can tell you that there's a Ferrari logo on the side of his hat and there's no Ferrari visible in the parking lot and as far as I know there is no racing event going on locally that might explain it.

And there's a logo on the shirt as well.

Based on the lines I can see, the undershirt is a wifebeater, as required by law.

The shorts are cargo shorts and the little inserts in the pockets are white. The shoes (3/4 hightops) appear to match. They have a Ferrari patch too!

I haven't seen his face but I'm betting there's a thin, ratty adolescent mustache happening. Just saw the profile and I'm surprised to learn my guess was inaccurate. Hmph. How about that.

Maybe there'll be a ludicrous gold chain.

Nope. Rats.


But the shoes! They have the logo too!

And now there are matching sunglasses!

As ridiculous as he is, I have to admire his level of commitment. Lugi, the little tire salescar from the movie "Cars" wasn't this devoted. There's not a doubt in my mind about his first stop after he wins the lottery.

I wish I had some musical and lyrical talent. This guy needs to be immortalized in a Bud Lite "Real Men of Genius" spot.

I know it's mean, but really, if you don't want to be mocked by some anonymous guy on the internet then don't go out in public looking like this.

What are your thoughts?

My Favorite Poem

By Paul Gilmartin

Sister Joan, age 54, ignores the desert sun,
The stranded church bus smoking,
no sign of anyone.

Buzzards circle overhead, panic starts to set.
The kids are getting restless, her habit soaked with sweat.

The minutes become hours, she wobbles in the heat.
Then, a distant engine roars, approaching from the East.

She squints through horn-rimmed glasses, her pure heart skips a beat.
Snake McGinty's Harley Hog,
parts the dusty heat.

Black leather-clad from head to toe, his eyelids barely open,
Sister Joan says, "Holy Ghost,
please tell me that you're joking."

He parks his bike, stands six foot four, then gives her a nod.
Through leather pants his manhood shows,
she rolls her eyes at God.

"Havin' trouble?", he barely mumbles. "Yes sir", she replies.
He pops the hood, takes off his shirt, she covers up her eyes.

"Kids", she says, "Back on the bus. Everyone be good."
Her fingers part, her eyes take in
his reflection off the hood.

She grips her rosary tight with guilt and stares down at her socks.
Her mind protects her vows with God,
but her body picks the lock.

He bends to check the fan belt, her nipples say, "Hello".
Her eyes climb up his leather chaps
like a snail with vertigo.

She shuts her eyes and shakes her head, her legs start feeling funny.
"Lord", she says, "For work like this,
I'm making shitty money."

He shuts the hood, "My name is Snake, I'm wanted in five states."
She said, "Snake you're my forbidden fruit,
and I need a little taste."

The kids look on in disbelief. The kiss is slow, then faster.
Cheering rocks the school bus, till she says
"Snake let's ditch these bastards.

As they left, the kids screamed "No", she turned around and waved.
Her next confession killed a priest
and lasted seven days.

For years the scandal rocked the church, but she regained their trust.
She still teaches Sunday school,

but she doesn't drive the bus.

Because the internet needs my opinion

Here's how to fix healthcare in a few easy steps:

#1- Go back to the old model of health insurance being there for catastrophes. Your auto insurance doesn't pay for oil changes, new tires or wiper blades, and your homeowner’s policy won’t pay for landscaping or roof repair.

#2- Stop letting insurance companies manipulate the market by setting the prices that Dr's charge. The Docs and the Hospitals will figure out ways to get what they need (like charging $30 for 10 ml of saline to flush your IV line).

Here's an analogy for what happens now. Let's say you go grocery shopping and fill your cart with all the things you need to feed yourself and family for a week. You go up to the checkout where the groceries are rung up and the total comes to $165. You look at the receipt item by item and decide what you're going to pay. Then you hand the cashier $97.43 and walk out. (This is what insurance companies do when they get the bill your doc submits).

If you did the same thing at the grocery store every week it wouldn't take long before the grocery store started charging cart rental fees, promotional program recovery surcharges, and raising the price of ground chuck to $12.99 per pound.

#3 Tort reform. I kind of like the European model of loser pays. That means that if you sue and lose you have to pay the other guys court costs. If you win, they pay yours. It lessens the likelihood of frivolous lawsuits. Limiting awards might be a good idea as well. Less risk to the Docs would mean less need for defensive medicine and less strain on resources. Not everyone needs an MRI for a sprained ankle.

If we went back to fee for service medicine you’d see more Doc’s going in to general medicine. At the same time you’d be able to see your doc usually same day and he or she would spend more than 3 minutes with you while you were in the exam room. You might even see a return to the old days when there was a town doctor who made housecalls, charged reasonably and still made a great living. And it will be because the docs will charge what patients can afford; just like every other business on the planet does.

Did you know that most pediatricians make about $90-95K per year? For 10 years of extra educations and student loan debt larger than a lot of mortgages? No thanks. GP's don't make much more. That's why med students specialize.

Stop trying to fix things, throw the insurance lobbyists (and the rest of the special interests on both sides of the isle) out of our capitols and let the market control itself.

I guarantee things will get better fast.

And remember to ask yourself “When was the last time the government did something right, or at least better than the private sector?”

I have more, but you get the gist

Helping Hands

Jeff over at The West Virginia Surf Report asked for Good Samaritan stories this afternoon. Here's what I said:

I have two Good Samaritan stories.

The first one happened when I was about 20. I was home from college and my little brother was home sick from school with mono. I went up the road to the video store to rent some movies for him. As I was walking around the corner of the store from the parking lot I spied a little grey tumbleweed across the road.

When I looked closer, it was the top of an old ladies head. She was face down and appeared to have fallen while crossing a side street on the other side of the 4 lane road we were on. She was sort of wiggling around, trying to get up and so I went running over, knelt down and asked her if she was alright.

She looked up at me with a pretty good scrape on the bridge of her nose and said “I’m drunk!” in the kind of old-lady voice that is only possible after years of cigarette and whiskey use.

Crap.

She was wearing a jacket with the logo of a bar across the street, so when someone else stopped to help I went over there and asked if anyone knew her. They did, and said they “hate that old bitch”.

Unbelievable.

The guy who stopped to help was still there when I came back so he helped me get her up and he drove her home.

Story number 2

A few months ago Mona and I were on an interstate going to drop The Peanut off at my mother-in-laws house.

As we approached the cloverleaf interchange to another highway we saw a car up on the embankment just past the off ramp but before the overpass. The driver’s door was open and there was a woman lying on the ground while another woman holding her head.

We pulled over and as I was getting close another guy started rolling up what looked like an envelope and was yelling “Open her mouth!” I asked if she was seizing, was told yes, and told him not to put anything in her mouth and to just let her seize.

I jumped over the ditch and asked what happened.

Envelope guy told me something, and over the traffic noise I hear “shot herself”. Shit. So now I’m looking for blood and I asked him to say it again. He tells me she shot herself up with something and points to the car. On the driver’s seat is an insulin needle and a tiny Ziploc baggie. Shit again. The guy said they saw her just swerve across the road and stop on the embankment.

I knelt down, checked her breathing and pulse and then looked at her pupils. She was OK but very clearly stoned and totally out of it.

A state trooper and the paramedics showed up just then. I just walked away.

Seriously, I know you’re an addict, but even so, shooting up on a road where the speed limit is 70 MPH and most cares are going closer to 80!?! WTF!

It was incredible that she didn’t kill anyone. And I’ll bet she was pretty pissed when the ER gave her some Narcan and totally killed her high.

So apparently I only rescue people with addiction issues.

Word goulash

It's 12:45 AM and I'm sitting here in room 314 of the hospital where I do my clinicals with my Mother-in-law who had a total mastectomy of her right breast yesterday afternoon. My presence here was not part of the plan. I'm here because Grandma Hildegard was freaked out after surgery and wanted someone to spend the night. Her husband, Mona's step-father can't stay (in my opinion it's due to a lack of character and intestinal fortitude), Mona is too tired and my sister-in-law has two kids at home and has to work on the other side of town tomorrow. So I stepped up. I am Iron Man.

I was hoping to get some sleep but I don't think it's going to happen. Grandma Hildegard snores.

Lucky for me it's still semester break, so this isn't going to wreck me for school. And interestingly enough (to me anyway) this is the unit I'll be working on when we do get back. I can't decide whether or not to tell the nurse (or nurses) my story. Part of me wants to just so that I can take some liberties with regard to things like checking charts and asking questions that might be frowned upon were I just some guy off the street. The other part of me wants to keep quiet and scope the place out some. I've never worked on this unit and I like the idea of being able to observe incognito, if you will.

How was school you ask? Fine. Came through the last semester with 3 A's and a B (a freaking B!). That brings my GPA down to a 3.77. I don't want it to go any lower. I hear the last semester is better, so hopefully I'll be fine. I know it's shorter. We only have 8 weeks of classes and then it's off to our preceptorships where we work in the hospital full time with one nurse, covering his or her patients. 180 hours doing that and then I graduate, so the light is definitely at the end of the tunnel.

Then I just have to find a job. And to my great shock and horror, nursing jobs are actually pretty thin on the ground. Hard to believe I know, but that's what happens when the economy tanks like this. And I don't mean like it has where you are (unless you're actually here). I live in the Detroit area. The latest unemployment numbers show nearly 18% unemployment in the metro area and just under 30% in the city itself.

You might think that would have little effect on nursing jobs. People still get sick and hurt right? There's a nursing shortage, isn't there? Well, sort of.

You see, when the auto industry tanked (for the love of God people, start buying American will you?) a lot of people lost jobs. Auto workers, suppliers, tradespeople, vendors, etc. And when if became apparent that those jobs would be gone for a while all the nurses who were staying home while their spouse worked reentered the labor force (burnout and families help to create the perceived shortage) in order to keep the bills paid.

At the same time, nurses who were planning on retiring changed their minds when their 401k's dried up and blew away.

Finally, as more and more people lost insurance and went on Medicaid or simply were unable to pay their bills hospitals were forced to close whole units and floors in order to cut costs. Nurses aren't getting laid off, but they're being moved into unfilled slots or sent to other affiliated hospitals that have openings.

The result is few jobs.

Up until earlier this evening I was toying with the idea of joining the Airforce reserve and working as a nurse there. But it looks like I'd end up deployed overseas somewhere and Mona is not interested in that at all. She's worried I'd get shot. I've suggested to her that I could specialize in obstetrics (which I really enjoyed) which should keep me away from the shooting since mothers in their 3^rd trimester almost never go to combat, but I don't know of that would even keep me inactive. So I don't think I'll be signing up. Had I done this before I met her I think I would. It a job that fascinates me and I like the idea of serving in the military. Maybe I'll just try and work at the VA. That way I can still give back a little.

I drive like a person who has someplace to be. It seems that most of the people who drive on my roads (yes, they're mine, I own them) don't feel the same way. They dawdle. They lolligag. They obstruct. They frustrate me.

Now that The Peanut can understand and repeat things, I have learned to call these prius shaped pylons Yahoos when she is in the car. I tell her things like “Peanut, tell these Yahoos to get out of Daddy's way!” She pipes up with “Get out of the way, Yahoos!” Last week we were all driving somewhere when she asked me “Daddy, why do you say Yahoos?” I looked at Mona and under my breath said “It's because Mommy gets mad when I say MotherF&#*er”

Last weekend Mona and I took a trip to Chicago. There were only 2 things I wanted to do while I was there: go to the Shedd Aquarium and have an Italian Beef sandwich (preferably from Al's). Mission accomplished. I haven't had an Italian Beef since April of 2003. And it was every bit as good as I remember.

What's an Italian Beef you ask? It's sort of like a Philly cheese steak (and yes, I've been to Pat's in Philly so I know what I'm talking about) but instead of putting fried onions on the sandwich they put Italian gardinera, which is sort of pickled hot peppers, celery, cauliflower, sometimes carrots (there's also a sweet version, but I love the hot) and they take the whole thing and submerge it in the broth (sort of like au jus) that the meat has been in all day, wrap it in 6 or 7 layers of waxed butcher paper and foil and serve it. Best sandwich ever. Seriously. I am amazed that they haven't caught on in the rest of the country.

We stayed just a couple of blocks off of the Miracle Mile (the Midwestern version of 5^th Avenue). One day while wandering around the city, Mona asked me to go into a store called the American Girl store with her.

Has anyone ever heard of this place? They sell dolls. Their own line of dolls. You can even pick out dolls that have your hair. Skin and eye color so that your doll looks like you. Then you can buy matching clothes for you and the doll. And doll accessories. Like bunk beds with bedding. For over $200. On the top floor behind all the stuff for sale is sort of a little mall. They have a cafe where you can eat and a “hospital” where your doll can be repaired as necessary. Before you get to the cafe or the hospital you see a line of people all with frenzied little girls standing in a rope line in front of a counter that's about 30 feet long and slightly concave. On the top of the counter are little swivel chairs, and behind the chairs are American Girl employees. It's their job to, for $20, (and I swear this is true) give your doll a hairstyle! Ohmygodohmygodohmygod. It's the end of the world.

Now anyone who has ever read anything I've written should by now hopefully understand that I am an unabashed and unapologetic capitalist. I believe in the free market and peoples right to make as much money as they can within the confines of the law.

But this place is too much, even for me.

A fucking doll hair salon? Matching outfits for your daughter and her doll? Three figure doll accessories? And streams of parents and grandparents lining up to pack the place full of cash? Unbelievable. It was so over the top that I was actually offended by the time we left. It was just immoral. How the hell can anyone, even Bill freaking Gates, justify spending that kind of money on a creepy doll? How?

As much as I rant, I can't do it justice. It's simply too appalling for words.

And it's now 2:07 AM. I'm getting pretty sleepy, so I'm going to try and nod off. You are now more or less up to date.

Almost there

So I took my final in my big class today (the one that combined maternity, child and adult nursing into one gigantic ball of knowledge and stress which was then hurled at our heads like a late winter gravel-filled slushball) and got an 89%. That's enough for a solid B and I'll happily take it.

All the other classes are done. I have two more days at the hospital (which is really just going there to get our evaluations) and I'm off for 3 weeks (four weekends). The Peanut is staying in daycare, so it's going to be an actual break for me. I'm glad, because I think I need it. Normally I don;t need vacations. I used to take them just because I had the time and it was kind of expected. But this one I feel like I earned. It was a long, stressful grind and I'm glad it's behind me. Another 8 weeks of classes to go, then 180 hours working with a nurse one-on-one and then I have to find a job and pass my boards. Anyone want to help me find some gainful employment come January? Hello?

That's the short update. I really came here to post something that I had to write for one of my classes. It was kind of a blow-off class. I called it my pallet cleanser. It didn't require any studying, just showing up and talking about "issues". All in all I enjoyed it. I'm all about issues.

Anyway, one of the issues that we talked about was a trend in hospitals for nurses to cover up their last names on their name tags. We were given a couple of articles on the issue and were asked to write a short position paper. It was really short, but I made it as long as I could get away with without being way over the assignment limits. As a result it's pretty tight and less developed than it could be. But like I said, I think it's an interesting issue. Have a look if you've a mind to, and tell me what you think. Here it is (citations available upon request):

American culture has become less and less formal in recent years. In most businesses employees are on a first name basis with everyone else, right up to the CEO. Business casual is the new dress code in many places, and in some sectors blue jeans and t-shirts are the norm. The president of the United States has revised White House dress codes, no longer requiring suit jackets be worn at all times. Polo shirts and khakis can even be found on tellers and loan officers in many banks, which have traditionally been the most staid and sober of institutions. In hospitals nurses have abandoned the traditional starched whites in favor of a mix of scrubs and logo shirts. It's worth noting here that physicians have yet to discard their long white coats.

In many places nurse have not only abandoned their uniforms, they've given up their last names. Most seem to have done it gladly, accepting the new American informality with scarcely a thought. They introduce themselves by their first name, and in some cases take steps to conceal their surnames. Concealing last names or credentials is an issue being addressed by Nursing’s governing bodies in various states (Powell & Malone, 2002) with a variety of results; but still patients call for nurses using first names and physicians and other staff generally use a nurse’s first name while in a patients room and no one thinks anything of it. Nurses accept and encourage this practice generally.

A physician was asked by the author how she refers to nurses when in front of a patient, and was told that if the nurse is in the room she usually uses a first name. Were she to encounter a nurse who insisted on being address by his or her title and last name in when in front of a patient she would consider that nurse somewhat cold, snooty and pretentious. Conversely, she expects to be referred to as “Doctor”. She feels that patients want their physicians, even the female ones, to take a paternal role, essentially telling patients what they must do, allowing patients to abdicate their decision making rights completely. Nursing, she noted is more maternal and intimate, and the use of a first name makes establishing a relationship easier. The physician suggested that using a nurse’s first name makes patients more comfortable.

Some of her points regarding a nurse’s relationship to a patient feel true. Most of us would address our attorney by their first name, yet they seem to retain their status. But in court, the judge addresses those attorneys with the Mr. or Ms. honorific, followed by their last name. Attorneys of course address the judge by title or honorific, and fail to do so at their own peril. Formality and at least the outward appearance of respect are expected. It would seem that the analogy in this case fails to hold up.

Opposite this, an example that comes to mind is a server in a restaurant. It's not uncommon to be seated at a table and have a waiter or waitress arrive with a name tag that reads “Jennifer C”. Jennifer C then introduces herself by saying something like “Hi, I'm Jenny, I'll be your server tonight. Can I get you something to drink?” Substitute server for nurse and you have a scene that plays out in hospitals all around the country every day. If nurses are unable to separate themselves from the staff at the local Denny's how can we expect the general public to know the difference between the 23 year old college senior refilling their water glass and the 23 year old baccalaureate prepared ICU nurse holding an IV bag and managing fluid and electrolytes at their loved-one's bedside?

The use of last names sometimes brings out strong emotions when nurses are asked opinions on the issue. Most seem to cite the need for security, talking about patients and families who may make threats or become obsessed with the nurse to the point of harassment and stalking. Here again this seems to be less of a concern for physicians, even those who happen to be young and female. Perhaps there is a difference in maturity level between a 20 year old with an ADN (associate degree) and a 26 year old first year resident. Age, experience, education and the almost Olympian authority bestowed by the letters MD may provide a degree of protection that the young nurse does not enjoy. However, while planning this paper, nurses who did cite security always had anecdotes that involved a friend of a friend. None claimed to have been stalked, threatened or attacked personally. Google searches were performed on keywords “nurse attacked”, “nurse threatened” and “nurse stalked” and the first 100 returns were checked. When combined with attacked or threatened, it appeared that it was more often the nurse who was attacking or threatening someone. In the cases where a nurse was attacked, the fact that the victim was a nurse appeared to be coincidental unless the attack occurred in a patient care setting. Stalking does seem to be a more significant issue, but still most of the evidence reviewed was anecdotal with only a few exceptions.

Gordon and Grady suggest that using nurse’s first names while at the same time insisting on titles for physician’s subtlety demeans and devalues the nurse and his or her role in the eyes of the patient, the physician, and within the profession of nursing itself. They argue that using our last names and credentials will help nurses win and retain the position of respect that they have earned (Gordon & Grady, 1995).

The arguments for allowing informality seem fairly weak overall, and nurses need to start recognizing it. In giving up our surnames along with the titles we have earned we give up or fail to gain respect from our patients, their physicians, and most importantly, from ourselves. In concealing our names and credentials we deny our identities and imply that a patient hasn’t the right to know the name of his or her caregiver. None of these things are acceptable. Nurses will stop being treated as second class citizens as soon as we stop behaving like second class citizens.

Wow, its been a while, hasn't it...

First of all, I apologize to everyone who I've been neglecting for a while. I do still stop by your places, but I generally do it on my mobile device and don't have much time for commenting. But I'm lurking and one day plan to get back to being the old, pre-nursing school me.

Yes, I'm still here. Everything is as good as can reasonably be expected and a little stressful. It's manageable, but man, am I busy. I'm also dumping a lot of stuff on Mona because I'm always at the books. She's holding up, but it's tough on her too.

School is ok, grades are generally good with one test that was a B- (I contend the test was poorly written, my grade was top 7 or so) and a lot of busy work and more studying than I care for.

I'm at a local Panera and am taking a break right now from reading for a test on Monday. I'll pass, it's just annoying.

Clinicals are good. I'm on a medical/surgical floor on Wednesdays and doing labor and delivery on Thursday and Friday. Classes are Monday and Tuesday. Med/Surg is what it is. A couple of weeks ago I had a patient poop on the floor after telling me he didn't need to go when I asked him 3 minutes earlier. Then he pooped again. And again. The last 2 times we got him on the toilet. Oh, the glamour.

I am really liking labor and delivery. It's a good atmosphere and the nurses and the doctors all work well together. That's not really the case on most hospital floors. I hear ER is a similar environment in that regard, but I don't think I'll get to find out (long story) while I'm in school. Right now, if given a choice, I would happily go to work on L&D.

In two weeks we leave L&D and go to pediatrics. I think at least some of my time might be in the peds ER, but it's more like urgent care. Trauma and really serious stuff goes to the children's hospital at the big university 10 minutes away. That might be cool. I hear from the others that most of what they are getting is simple stuff and a fair amount of swine flu.

I took a break and went to a nursing message board and read a story about an older student who graduated and then took her Nursing Board (called the N-CLEX) exam. It's something that every graduate nurse and student fears and dreads. And I'm sure it's the same for every profession that requires a licensing exam. I've heard more than one person say they leave the testing center and vomit in the parking lot.

Anyway, I read the little story and a few of the comments and found myself starting to tear up. And then I started laughing at myself. Right in the middle of Panera. Luckily there aren't many people in here.

But that little episode tells me I might be feeling a little more stress than I'm willing to admit. Which is why I'm taking a few minutes to write this all down. Hopefully I can get at least a little of this off my chest.

I am easily in the top third of my class. I am good on the floor and in front of patients. My instructors like me, as do the nurses I work with (I'm basing this on the feedback I get from the clinical instructors).

Intellectually I know that I am going to pass all my classes and I'll pass my boards. As much as there is to know, it's not rocket science. But I still get a little freaked out from time to time. I'll be OK. Really I will.

This semester ends in mid-August. They say the third semester is a lot easier. Right now I just need to make it to August. I will make it to August.

Holy crap, why isn't it August yet??!!

Here's my nursing self diagnosis: Impaired coping related to educational and family stress as evidenced by simultaneously crying and laughing in Panera.