And on April 16th, we recognize the 5th Annual National Healthcare Decisions Day. Seems like good timing, yes? 

 This date was created to “inspire, educate and empower the public and . . . → Read More:  Death is Not Failure]]>  Somehow it seems appropriate a few days before April 15th to write that the two things absolutely certain in our lives are death and taxes.   

 And on April 16th, we recognize the 5th Annual National Healthcare Decisions Day. Seems like good timing, yes? 

 This date was created to “inspire, educate and empower the public and providers about the importance of advance care planning.”  

 And yet, despite all of the attention that has been given to discussing and planning end of life treatment, it is estimated that only 29% of us have a living will. That is just not enough.  Why are only 29% of us thinking about planning for the end of our life when we know for sure that it will happen? 

We in the United States are paying an enormous toll, both financially and emotionally, by maintaining the taboo against talking about death and dying in this country.  

Many healthcare providers view their inability to “cure” their patient as a professional failure and are therefore reluctant to suggest palliative care even when they know there is little hope of recovery. 

Consider that in 2009, Medicare paid $55 BILLION just for doctor and hospital bills for the last two months of patients’ lives.  Some estimates say that 20-30% of these expenses may have had no meaningful impact. When patients are finally referred to hospice for end of life care, it is within the last two weeks of their lives. 

Likewise, most patients and family members have no idea how to discuss the reality of death with each other.  While other societies educate their members about death and the process of dying, we are left to figure it out for ourselves. Many of us don’t know what to say, what to do, or how to cope. Words fail us. 

We do not do our loved ones any favors by not planning or communicating to them what we would want should a situation arise where clinicians need to know what our wishes are. 

And when we do talk about death, we use phrases like “He lost his battle with cancer,” or “She fought bravely, but Parkinson’s won.”  As though patients weren’t trying hard enough, or they failed. What if we didn’t use those phrases?  What if we began to understand that in many clinical situations, death is inevitable.  Perhaps it might be more humane to talk about the patient’s quality of life rather than the quantity?

The bottom line is that we need to get past the stigma that death is failure.  It is not.  We all will die someday, that is for certain.  None of us are immune so, knowing that, let’s start the conversation.  Even if that conversation takes places quietly in our own heads. Think about:

Have you experienced the death of a loved one? If so, what was that like for you?  How did it change you, if at all?

1. Think about your deepest beliefs about life and death.  Understanding what those beliefs are may help you to understand your own end of life care—-and what do you want that care to look like?
2. Who should you appoint to make those care decisions for you knowing that that person will carry out your wishes?   
3. What do you want those wishes to be? 

And then, when you are ready and confident of what you want, please take the important step of documenting your wishes in some way.  After experiencing many personal and professional experiences with dying patients, including my own parents, I have learned that this is quite possibly the most caring gift you can give your family and friends.   

Besides, of course, paying your taxes.

At the event . . . → Read More:  What a difference 25 years makes!]]> This week I hosted a reception for filmmaker Kathy Douglas, an RN producing a film about the roles of nurses.  The energy generated by the 25 nurses at the event was very positive and as Kathy spoke to the group about her motivation for the film, it was hard not to feel inspired.

At the event were several friends and former nursing colleagues.  As the crowd thinned, one of those colleagues, Lucy, with whom I had worked 25 years ago, shared with the remaining guests a story.  The story was about me, when she was mentoring me in the CCU with a very challenging, very complex patient.  He was the most critically ill patient in the unit at that time and so a ‘good’ patient to learn from. She told of the day that she was going to let me “fly on my own” and after we got report from the night shift, she said, “OK, he’s all yours.”  Sensing my fear and nervousness, she said, “You’ll be fine, go ahead.”  I turned and walked toward room 8, stopped after a few steps, turned back to her, and said, “But what if…” to which she said, “Go ahead.”  A few steps more and the same.  A few steps more and when I turned back, she never said a word, but the look on her face said it all, “Get IN that room, NOW!”  And in I went.  And the rest, as they say, is history.  She knew I’d be fine.  And I was.

We all got a pretty good laugh out of that story.  None of us, least of all me, could imagine that today I wouldn’t have just breezed into that room, but it is 25 years later and I have a great deal of experience upon which to draw.  

Thanks to Lucy for mentoring me all those years ago.  And thanks to all those patients who allowed me to learn from them and grow as a nurse.   What a difference 25 years makes!

This past week I attended a fundraiser for the Philadelphia Chapter of the ALS Foundation at the Adventure Aquarium in Camden, NJ.  Part of the event allowed guests to roam the aquarium and enjoy the sea creatures.  . . . → Read More:  Introducing: The Nurse Shark]]> Imagine my surprise when I learned this week that there is such a creature called a Nurse Shark! 

This past week I attended a fundraiser for the Philadelphia Chapter of the ALS Foundation at the Adventure Aquarium in Camden, NJ.  Part of the event allowed guests to roam the aquarium and enjoy the sea creatures.  I, however, was happy just to enjoy the company of my fellow humans! 

However, a bartender explained to me that the sharks are fed regularly thus minimizing their interest in hunting for dinner inside their tank. She also explained that the shark laying at the bottom of the tank, right in front of the air vent, was a “nurse shark.” I said to her, “Did you just say “Nurse Shark?” And she said, “Yep. That’s what she’s called.” 

Though I was not able to find a staff person to help me understand, I have done some research. 

The scientific name for the nurse shark is Ginglymostoma cirratum. Actually the name is a mix of Greek and Latin and means “curled, hinged mouth” to describe this shark’s somewhat puckered appearance.

The origin of the name “nurse shark” is unclear. It may come from the sucking sound they make when hunting for prey in the sand, which vaguely resembles that of a nursing baby. Or it may derive from an archaic word, nusse, meaning cat shark. The most likely theory though is that the name comes from the Old English word for sea-floor shark: hurse.

They can live up to 25 years and grow to a size of 200 to 33o pounds!  Nurse sharks are nocturnal and will often rest on the sea floor during the day in groups of up to 40 sharks, sometimes piled on top of each other.

I don’t know about you, but that sounds like strikingly similar to a bunch of night nurses with whom I once worked!

“We partnered with Betty . . . → Read More:  “For Betty and Her Team, It’s Personal.”]]> The other day I was giving a presentation to a new client and his account management team.  Following my presentation describing our services, our success with clients and how new referrals would work as we begin our new partnership, I was surprised when the company’s president interjected his summary to the room.

“We partnered with Betty and her team at Guardian Nurses because for them, it’s personal.  Helping patients and families is what they do–formerly as staff nurses and now as nurse advocates.  We offer alot of services to our clients, gift cards, enrollment assistance, but honestly, it’s all $#*&)@!.  What Guardian Nurses offers is the real stuff.”

I was stunned by his unsolicited endorsement but flattered as he really seemed to “get” why I started Guardian Nurses and why we do what we do.   I was also proud of our team, of the work we have done and continue to do and grateful that we get to work with clients who realize our value.

Health care IS personal.  My team gets that.  We are nurses and for us, it’s ALWAYS been about patients!  But sometimes it’s awfully nice to hear it from our clients.

Gratitude promotes physical and emotional well-being, improves one’s ability to cope with stress and bolsters positive interaction with others. Furthermore, research shows grateful individuals report having more energy and . . . → Read More:  Can a Grateful Heart Enhance Your Health?]]> Can a grateful heart enhance your health? A growing body of research says, “Yes.” Gratitude, as a conscious practice, offers a whole host of health benefits.

Gratitude promotes physical and emotional well-being, improves one’s ability to cope with stress and bolsters positive interaction with others. Furthermore, research shows grateful individuals report having more energy and less physical complaints than their non-grateful counterparts.

Positive emotions enhance heart health by interrupting the stress response caused by negative emotions. In short, the practice of gratitude offers a method for a more harmonious life.

So, how do we choose gratitude? And, is it ok to “fake it”? Sure, go ahead.  Our emotions follow our thoughts; we can “act as if” we feel gratitude by concentrating our thoughts on things we are truly grateful for. In time, the real feeling of gratitude will follow. As days turn into months, a shift in our thinking will occur, leaving us more content because we are focusing on the goodness in our life. And, typically, what we focus on becomes our reality.

Here are a few tips to get started:

• Set aside a little bit of time each day. If you’re a morning person, give yourself 5 minutes after you get dressed to focus on gratitude. Night time works well for some – a few minutes at the end of the day to think about gratitude. Any time of day will do, just try to keep it consistent.
• Get a small notebook to record your gratitude thoughts. Writing your thoughts down helps them to stick. Writing also is a reflective activity; we have to think about it.
• Make a short list (3 – 5 items) of things you are grateful for. Little things count – a lot. It can be something as every day as “I’m grateful for warm gloves,” or “I’m grateful for my glass of hot cocoa with marshmallows,” or “I’m grateful for knowing the sun is shining above these gray winter clouds.”

The results of one study done on keepers of gratitude journals indicated that daily gratitude exercises resulted in higher reported levels of alertness, enthusiasm, determination, optimism and energy. Additionally, the gratitude group experienced less depression and stress, was more likely to help others, exercised more regularly and made more progress toward personal goals. According to the findings, people who feel grateful are also more likely to feel loved. The researchers also noted that gratitude encouraged a positive cycle of reciprocal kindness among people since one act of gratitude encourages another.

So, in a way, I guess my mom was ahead of her time when she would say to me “Count your blessings.”  She just forgot to mention the journaling part.  Once again….sigh…my mom was right.

1.  The total # of . . . → Read More:  A Week’s Worth of Health Care in Honduras]]> A dear friend of Guardian Nurses, who also happens to be a family practice physician, ventured to Honduras last week on a medical mission.  Upon hearing her compelling stories of her week providing primary care to thousands of rural residents, I thought it would be good to share some of them–in no particular order. 

1.  The total # of patients that the Family Practice team (2 attendings, 4 residents) saw during the week was 2,300.  Yes, that is not a typo.  2,300 patients.  YOWZA!!  What allowed them to see so many patients was that there was no demographic forms to fill out, no HIPAA forms to review, just a number.  And no documentation of the visit.  Just, “Next!”

2.  The total # of patients that the Surgical team (ortho, ob, vascular and general) operated on during the week was 52. (Slackers.)  The OB attending taught the staff at the hospital how to do a C-section using a lateral incision (side to side, better for recovery) rather than what they had been using—a vertical incision (not so good for recovery).  The general surgeon also showed the local surgical team how to perform laparoscopic hernia repairs (again, much better for recovery) rather than the traditional open approach. 

3.  Most memorable cases:

• The 60-ish year old woman who came in with her wrist wrapped in a tea towel for the last month. She had fallen and broken her radius and had no treatment until seen by the team.  She was sent to the hospital for surgery the next day. (But…she had to buy her own hardware—pins, screws, etc—for the surgery at the ‘big city’ prior to having her wrist repaired.)  Patients also have to bring their own blood to the hospital if their surgery is expected to have a lot of blood loss).
• The patients were “Crazy for glasses!”  Please know that the Lions Club glasses’ collection really does go somewhere.  There were boxes of glasses at the mission that the team distributed throughout the week and the team confirmed that ”The teenage girls really still wanted the stylish ones.”
• The 30-ish year old man who had shingles on his back who had his rash wrapped up in banana leaves.  We do not encourage this.
• Breast feeding was everywhere. One evidence of this was a young man riding a bicycle with a woman and her infant baby between the handlebars—-she was breastfeeding as they traveled!
• The young 2 year old who presented with “jewels in her ears.” She had broken her bracelet and put the ‘jewels’ in her ears.  The young patient had her ears flushed out while her very grateful grandmother stood by.  The toddler never made a peep during a rather difficult procedure.
• A five-month old baby with a cleft lip and palate but only the lip had been repaired.  The baby appeared about 2 months old because he has not been able to suck a bottle so his nutrition has been affected.  The team made arrangements for a special nipple to be sent down so that the boy could eat and grow.

4.  What we in this country think of “drug seeking” looks like patients wanting Percocet, Oxycontin, et al.  In Honduras, it’s Tylenol, ibuprofen, parasite medicine, and multi-vitamins.  Apparently multi-vitamins are a HOT commodity.

Overall, the family practice team had “An amazing week.  So overwhelmingly positive and heartwarming.  We felt like we really made a difference.”  No doubt they did. 

“Le deseamos buena salud” (Wishing you good health)

Take for instance the sentence, “The liver is unremarkable.”  This sentence was part of an abdominal . . . → Read More:  “The liver is unremarkable”]]> As I have made mention of in previous posts, I love language and words.  And the occasional humorous terminology as it is used without intending to be humorous, in healthcare.   I guess only nurses like me find it funny.

Take for instance the sentence, “The liver is unremarkable.”  This sentence was part of an abdominal CT scan report that I reviewed recently on one of our patients.  As the radiologist reported on the other organs in the abdomen, she noted some abnormalities but in referring to the patient’s liver, she wrote, “The liver is unremarkable.” 

I thought to myself, “No, actually, the liver IS pretty darn remarkable!  In fact, there is no artificial organ or device capable of emulating all the functions of the liver—thought to be up to 500 separate functions (usually in combination with other systems and organs).  I’d say that’s pretty remarkable stuff!

The liver is the largest glandular organ in the body, weighing about 3 pounds.  It is responsible for producing substances that break down fats, convert glucose to glycogen, produce urea (the main substance of urine), make certain amino acids (the building blocks of proteins), filter harmful substances from the blood (such as alcohol), storage of vitamins and minerals (vitamins A, D, K and B12) and maintain a proper level or glucose in the blood. The liver is also responsible for producing cholesterol. It produces about 80% of the cholesterol in your body.

I don’t know about you, but I’m exhausted just reading this! 

So the next time someone tries to tell you that your liver is unremarkable, tell ‘em that yours is fabulous!