Critical Care

Fight Racism! Vaccinate your kids

2013-06-18T08:25:00.000-07:00

Debates over vaccination, then as now, were often cast as debates over the integrity of science, though they could just as easily be understood as conversations about power. (Eula Biss)

So there has been a lot of discussion about immunizations in the Australian media of late. SBS, the Special Broadcasting Service, released the documentary Jabbed: Love, Fear and Vaccines last month, which is well worth watching if you get a chance to view it. Croakey, the health blog of Crikey.com, has run a couple of fabulous articles, including this review of two recent medical papers on the outbreak of measles. Meanwhile News Limited has been running a "No Jab, No Play" campaign that seeks to ban un-vaccinated children from childcare. Even Sarah Michelle Geller's recent attempts to help cease the spread of pertussis (whooping cough) in the USA has reached our shores (via the inter-webs) and has featured on various Australian parenting websites.

The great thing about most of these presentations is that they try to move beyond the rather hysterical (and frankly rather boring) discussions about vaccination safety and try to unpack some of the issues that get clouded over in the polarizing and often whako debates that ensue. Jabbed, for example, does a wonderful job confounding the common misconception that vaccination is a product of a harsh modern medicine and therefore is somehow 'un-natural' or evil. The documentary elegantly shows how rather than being a modern therapy, inoculation has instead been around since the dawn of time, having been used in traditional African, Indian and Chinese communities. Variolation for example has been used in Indian communities since at least 1000 AD. Similarly, in their Croakey article Julie Leask and Hal Willaby critique the News Ltd campaign suggesting that it risks unintended consequence by polarizing communities, introducing parents who have never considered not vaccinating their children to anti-vaccination hyperbole, and fails to understand why some parents have trouble accessing services. As they point out Australia has one of the highest vaccination rates in the world (currently 92% of Australian children are fully vaccinated) and what initially appears as a worrying decline in the rate of vaccination, is actually more a persistent problem in uptake rather than an increasing trend of rejection. While some parents clearly reject immunization, with so called clusters of vaccine refusers now appearing in regions like the Northern Rivers of New South Wales and the Sunshine Coast, others simply may be overly pressed for time and lack the necessary practical supports to get their kids vaccinated.

In seeking to redress the problem of vaccine refusal Leask and Willaby argue that by withholding access to social services, such as community supported childcare, we deny the opportunity of social engagement with vaccine refusers. "The solutions in these communities should be built around listening, engaging and building trust," they say. "Supporting local health professionals and encouraging peer advocacy are two approaches being explored in Washington State in the United States and are now being considered in Australia". This appeal to the need for social solutions to the problem of vaccine refusal, could equally be argued in terms of the need for more community minded messages in the public promotion of vaccines.

Traditionally, health promotion campaigns regarding immunizations have tended to focus very much on individual mothers, and the individual notion of responsibility for the health and safety of newborn children. If you look at the Sarah Michelle Geller pertussis campaign, for example, here we have a brand new mum speaking out about why she chose to vaccinate her children. She is serene, calm, white; attractive as well as famous. This is a working mum ("I've had a lot of exciting things happen in my life") who has put her career on hold to look after her children ("They all take a back seat to the birth of my two amazing children"). Her surroundings, a child's bedroom, are calm and ordered. The mood lighting and soft beige palette, set a clearly aspirational tone. "Michelle," we are told, "prides herself on being the best mom she can be." While statements such as, "as parents, it's our responsibility to keep babies safe" both individualize the problem of healthcare, but also emphasizes the vulnerability of the child. Vaccination, so the commercial would have us believe, is something that responsible mothers do. "No matter how busy I get, my family and their health will always be my priority."

In an interesting move for public health, the American non-fiction writer Eula Biss has recently challenged this idea of vulnerability as the basis on which to promote childhood immunizations:

"I suspect it might be just as meaningful now for the rest of us to accept that we are not purely vulnerable. The middle class may be “threatened,” but we are still, just by virtue of having bodies, dangerous. Even the little bodies of children, which nearly all the thinking common to our time encourages us to imagine as absolutely vulnerable, are dangerous in their ability to spread disease."

Citing a recent outbreak of measles in San Diego, Biss stresses the fact that while children are often perceived as the "innocent victims" of infectious diseases, they are also more often than not the asymptomatic carriers of disease. When viewed through the rubric of race and class then, this fact can have potentially devastating consequences for particular communities:

"Unvaccinated children, according to a 2004 analysis of CDC data, are more likely than undervaccinated children to be white and to live in households with an income of $75,000 or more — like my child. Their mothers are more likely to be, like me, married and college-educated. Undervaccinated children, meaning children who have received some but not all of their recommended immunizations, are more likely to be black, to have younger, unmarried mothers, and to live in poverty."

Through a radical inversion of our assumptions on childhood, Biss reasserts that the importance of vaccination is not only about protecting individual children, but also about protecting particular communities and society as a whole.

When relatively wealthy white women choose to vaccinate our children, we may also be participating in the protection of poor black children whose single mothers have not, as a result of circumstance rather than choice, fully vaccinated them ... There is some truth now to the idea that public health is not strictly for people like me, but it is through us — literally through our bodies — that public health is maintained.

Yes, "every vaccination is a little victory" as the Irish health promotion campaign picture accompanying this entry suggests; but it is not simply a victory against childhood diseases, or even for that matter against the disease process, it is also a victory against injustice itself.

By way of conclusion, I want to point out that there exists a link here to the success of cancer therapies - which as most of you know just happens to be my bread and butter. Yes I agree, linking childhood immunizations to the treatment of cancer may seem a little tenuous; but each day all over the world cancer patients are sent home to recover and await their next cycle of treatment. Cancer is on the rise throughout the world, and cancer patients are very much part of our community. The effects of chemotherapy are such, that often these patients are without a fully functioning immune systems. They are what we call neutropaenic - that is without enough white cells to properly fight infections. One contact, one brief encounter, in a shopping centre, at home, in the street with someone (even a child) fighting an infection is potentially life threatening. By reducing the burden of disease in society through vaccination then, we thereby also make a stand for the lives and welfare of the immunocompromised.

Fight racism. Vaccinate your kids
Challenge the oppression of elders. Get a flu shot
Support cancer therapy. Support vaccination.

A little bit of housekeeping: New Index for Famous but Forgotten!

2013-06-05T17:57:00.000-07:00

I have been noticing lately that readers of this site have been searching for particular types of famous nurses. Not satisfied with reading just about any old famous nurse, they now want to know about particular kinds of famous nurses ie nurses who were in the military, or famous nurses who are actors. So today, and to help this particular group of hard core readers, I have added an extra gadget to the tool bar (that black line pop out line towards the top right of the homespage). Here you can search and sort Famous but Forgotten by your favorite categories.

To access, just hover your mouse over the black line and click on the pop out menu Index: Famous but Forgotten. Its the third button down

Enjoy, and as always let me know if there is a particular nurse you would like me to profile or another category of nurse you would like me to search out. (Mmmmm am also wondering about whether to sort by nationality/ethnicity ... will have to think about that). Rick

Miriam Yeung - Actress and Cantopop Superstar: Famous but Forgotten XXIII

2013-06-05T06:47:00.000-07:00

“Hong Kong people are brave and professional, especially all nursing and medical staff. We need to pay high respect to these nursing and medical officers. We’re proud of them, especially in Hong Kong.” (Miriam Yeung, BC Magazine)

Miriam Yeung (born 3 February 1974) is a famous Cantonese actress and pop star. One of the most successful Cantonese singers in the world today, Miriam began her professional career as a nurse, working at the Princess Margaret Hospital in Hong Kong for about 4 years. She shot to fame in 1995 after coming third in the TVB 14th annual New Talent Singing Awards competition. She has gone on to star in over 20 feature films, and has released more than a dozen albums in both Cantonese and Mandarin. In 2012 she won the 32nd Hong Kong Film Award for Best Actress for her role in the film Love in the Buff.

In a 2007 interview with BC magazine, Yeung stresses how much she valued her time and experience working as a nurse. Demonstrating a level of self awareness that will be familiar to many nurses, she says that nursing gave her the skills to understand "what she can and cannot do". Her passion for nursing was so great that for a short time she even considered leaving Hong Kong and working abroad. Her life then suddenly took a dramatic turn when she entered the entertainment industry.

For those of you in the West not familiar with Yeung or her work, here is a clip from her 2004 horror movie Three...Extremes (with English subtitles). The movie consists of three different stories, by three different directors, from three different countries. Yeung starred in the story Dumplings, in which an aging actress wishing to reclaim her youth, goes to a woman who makes dumplings that supposedly have regenerative powers. The dumplings, however, also contain a gruesome secret. In 2004 a feature length version of this short was also made, again with Yeung in the lead.

Useful Links
Wikipedia
Discography
BC magazine

Samora Machel - First President of Mozambique: Famous but Forgotten XXII

2013-05-27T15:14:00.000-07:00

Samora Moisés Machel (September 29, 1933 – October 19, 1986) was the first president of Mozambique. He led the new country from 1975 to 1986, after having won independence from Portuguese colonial rule as the military commander of Frelimo. Machel died in 1986 when his presidential aircraft crashed, under suspicious circumstances, into the mountain range that form borders of Mozambique, Swaziland and the Republic of South Africa.

Machel spent much of his early life working and training to become a nurse, one of the few positions open to local people under colonial rule. In 1952, after having worked for six months as an auxiliary nurse in a provincial hospital, Machel moved to the capital Lourenco Marques (now Maputo) where he began working and training to become a registered nurse. Here he earned roughly 1300 escudos a month, a significant amount when compared to the wages of laborers and domestic servants - jobs typically reserved for Africans at the time. As his biographers make very clear, his hospital training was just one of the many ways that Machel experienced the viciousness of colonial rule on a daily basis. Portuguese doctors at the hospital could beat black nurses and other junior staff on a whim. Machel is noted to have intervened at least once. Similarly in his later writings and speeches Machel was to note how poor whites also suffered under the colonial health system along with the African population:

"Eminent doctors and university professors are brought in to treat the capitalist's cold, to cure the judge's constipation, while nearby children are dying, people are dying, because they did not have the money to call a doctor" (Found in LeFanu)

Nursing was the most prestigious profession open to Africans in Mozambique at the time. To qualify, however, was not easy and Machel had to face considerable personal, economic and social hardship in order to do so. As a teenager he had been forced to renounce his faith and become a Catholic. Now working as a qualified nurse, Machel had to deny his heritage once again in order to qualify as a nurse with the level of European standing. To do this he had to assimilate and become assimilado, an official government process that would deny his African heritage and allow him to become an honorary white. According to his biographer Sarah LeFanu there seems to be no official record of whether Machel achieved this status, the request itself was suffice to let him enroll in the one year course.

Machel worked on the malaria ward of the the Miguel Bombarda Hospital until 1963 when, receiving a tip off that he was about to be arrested for his political activities, he fled to neighboring Swaziland.

Useful links
Wikipedia
LeFanu, S. S is for Samora: A Lexical Biography of Samora Machel and the Mozambican Dream

Top Nursing Blog

2013-05-08T05:06:00.002-07:00

My blog has recently been added to Nursing Blogs, which is part of one of the largest networks of blog directories on the Web. Please visit my blog's personal page to vote for my blog and comment to other blog users.

Martha Raye - Hollywood Legend: Famous but Forgotten XXI

2013-05-08T03:50:00.003-07:00

If you were born in the West anytime after about 1945 you are bound to know the woman on the right. Right? That's Judy Garland for sure! But who is the woman on the left? The one with the big mouth and hysterical mannerisms. Any ideas?

Now read this brief account of the Vietnam war, by a medic stationed with the Fifth Special Forces at Pleiku:

"Around 1 November 1966, we were heavily engaged against North Vietnam Regulars and sustained heavy casualties among our Montagnard troops. We evacuated the wounded to the C-team infirmary. A doctor and the C-team medics were tending to the wounded. While treating a young "yard" with a serious arm wound, an American woman dressed as a nurse approached me and asked to assist. She helped with the debridement and bandaging of the wound. I was grateful for her much needed assistance. For hours she continued to assist us in treating the wounded. I remember her going from table to table. She obtained needed instruments and supplies, assisted with debridement and suturing of wounds, bandaged wounds and assisted with the application of casts. After about fifteen straight hours of work, we finished. I walked out in the cool of the night to smoke a cigarette. That same nurse asked for a spare cigarette. She removed her surgical mask, and I recognized Martha Raye." (Memories of Maggie, p107)

Martha Raye (August 27, 1916 – October 19, 1994) was an American comic actress and singer who starred in the worlds of stage, screen and television. A contemporary of Lucille Ball, Bob Hope, Al Johnson, Ed Sullivan, Carol Burnett and Milton Berle, Raye won numerous awards throughout her lifetime including Woman of the Year 1968 (B'nai B'rith International) and an Academy Award also in 1968. Raye is the only American entertainer to have entertained US troops during three wars (WWII, Korean and Vietnam). What is not often known is that Raye also regularly helped out as a nurse, tending to the sick and dying, as part of her three tours of duty.

Raye trained as a nurse's aid in the late 1930s, working at the Charity Clinic of Cedars of Lebanon, Los Angeles (now Cedar-Sinai Hospital). During this time she basically volunteered her labour, as well as working in bars and cafes to earn a living in between her theatrical gigs. She carried this sense of service into her military "career", travelling deep into combat zones, to entertain the troops, lend some moral support, but also help out in any way she could.

Martha Raye visited our camp in the Mekong Delta at SocTrang. We were caring for casualties from a firefight with the Viet Cong. These casualties were Americans. One American had received a chest wound and needed not only a chest tube but also a blood transfusion. Martha Raye heard this and, since she was the same blood type as the wounded trooper, she immediately volunteered to donate blood for him. That wounded American was stabilized due to her compassion and sacrifice. (Memories of Maggie, p131)

Of all the entertainers and celebrities who gave time and effort for the troops in Vietnam, no one gave more, or more selflessly than Martha Raye. No other entertainer traveled further. In fact it was even a sort of standing joke within the military "I was so far back in the boonies that Martha Raye never got there!"

Rumour had it that even the Viet Cong had a price on Martha's head for the hope and inspiration she inspired in the troops.

On November 2, 1993, she was awarded the Presidential Medal of Freedom, the highest civilian award in America by the President Bill Clinton for her service to her country. The citation reads:

"A talented performer whose career spans the better part of a century, Martha Raye has delighted audiences and uplifted spirits around the globe. She brought her tremendous comedic and musical skills to her work in film, stage and television, helping to shape American entertainment. The great courage, kindness, and patriotism she showed in her many tours during World War II, the Korean conflict and the Vietnam conflict earned her the nickname 'Colonel Maggie.' The American people honor Martha Raye, a woman who has tirelessly used her gifts to benefit the lives of her fellow Americans."

Useful Links
Wikipedia
Memories of Maggie

In praise of public hospitals (and shared rooms)

2013-03-13T22:52:00.001-07:00

Hey, sorry for the lack of postings recently. Have been way too busy.

So I have noticed over recent months a lot of interest in my posting about public and private hospitals in Australia. From the web searches that are used to get to the article, I suspect that a lot of you are nurses thinking about employment in Australia, and wondering about which sector to work in. But every now and then I get someone thinking about their own healthcare, or the care of a loved one, and how to proceed with an immanent operation. Take a look at the comments section for example and you will see what I mean.

Well yesterday a beautiful article appeared in The Atlantic which I want to refer you to. Called Human Connection and the Downside to Private Hospital Rooms, Prof Richard Gunderman questions our (western) obsession with privacy in health care. Comparing today's highly technical, individuated private hospital rooms with the communal, nightingale wards of yesteryear, Gunderman suggests that our zeal for privacy may in fact interfere with our care: "short-circuiting opportunities for compassion and community. It is hard to be ill and in pain, especially seriously so, but such burdens are often magnified when we shoulder them alone."

It is something I have often wondered about, noticing how quickly my patients become depressed when they are isolated, often for weeks on end. Similarly for some reason the patients in shared rooms always seem to do so much better. Sometimes I joke that its because patients are desperate to get out, away from the constant snoring in bed 2, or to escape that demented shrieking lady in bed one. For Gunderman, however, it is the isolated room not the communal, that is the modern equivalent of a prison.

In some respects, hospitals increasingly resemble high-security prisons, where we go out of our way to preclude patients from interacting. In our haste to control infections, we isolate them. In our zeal to preserve confidentiality, we prevent patients from getting to know each other. They sometimes begin to feel as though they are being kept like specimens in hermetically sealed containers. To spend day after day in a single room, particularly when visits from family and friends are few and far between, can resemble a form of solitary confinement. Yet patients are not only threats to one another. They can also serve as mutual bridges to companionship and healing.

Gunderman's article is a powerful reminder that humans are social animals. We are dependent on others for our sense of self, our identity, but also our well-being which most dramatically includes our health. So next time you enter a hospital and freak out about your loved one sharing a room; or (horror of horrors) having to share a bathroom yourself with another patient; just consider this: it maybe the companionship, the common understanding of being a patient. and the small act of kindness in sharing that makes all the difference in getting you through.

Which would you rather have while staying in hospital a single or shared room?

Cancer in Illness as Metaphor

2013-01-31T20:17:00.001-08:00

In Illness as Metaphor, Susan Sontag sets out to refute the idea of a "cancer personality". That is, that there are certain people, who because of certain character flaws, are more prone to cancer than others. As she states in the early pages of her thesis:

"According to the mythology of cancer, it is generally a steady repression of feeling that causes the disease. In the earlier, more optimistic form of this fantasy, the repressed feelings were sexual; now, in a notable shift, the repression of violent feelings is imagined to cause cancer." Illness p22

Now from our position at the dawn of the twenty-first century, the sheer idea of such a personality - with its clear focus on victim blaming - seems completely ludicrous. One has to remember, however, that Sontag was in fact writing in the late 1970s and the world as we now knew it, was actually a very different place. Importantly, for cancer research for example, the human genome had not been mapped; and the genetic basis of a predisposition to cancer would not be discovered until 1990. Sontag, therefore, has little need to prove the existence of such a personality but rather points to the work of Norman Mailer and Tolstoy as classic exemplars. She also examines the work of the notorious Austrian psychoanalyst Wilhelm Reich, whose work on Freud and character analysis have become synonymous with the idea of people "choosing" their disease. (Freud suffered a cancer of the jaw). It is not Sontag's argument that I find so compelling, rather the process by which she comes to declare it. For Sontag, using her cultural expertise, takes the unusual step of comparing the literary genesis of cancer to another great 'literary disease': that of tuberculosis (or TB) in the late nineteenth century.

The comparison is highly revealing and highly productive. Take for example her opening remarks where she articulate a simple set of contrasts between the two diseases and their literary representation. Here are a couple of her more obvious (and shorter) examples:

TB is understood as a disease of one organ, the lungs, while cancer is understood as a disease that can turn up in any organ and whose outreach is the whole body" Illness p11

While TB is understood to be, from early on, rich in visible symptoms (progressive emancipation, coughing, languidness, fever), and can be suddenly and dramatically revealed (the blood on the handkerchief), in cancer the main symptoms are thought to be, characteristically, invisible - until the last stage, when it is too late. Illness p12

The TB patient was thought to be helped, even cured by a change in environment ... But no change of surroundings is thought to help the cancer patient. The fight is all inside one's own body. It may be, is increasingly thought to be something in the environment that has caused the cancer. Illness p15

TB is thought to be relatively painless. Cancer is thought to be, invariably, excruciatingly painful.

Illness p16

TB is thought to provide an easy death, while cancer is a spectacularly wretched one. Illness p16

And here is another, longer comparison; to give you a sense of Sontag's style and reasoning:

TB is often imagined as a disease of poverty and deprivation - of thin garments, thin bodies, unheated rooms, poor hygiene, inadequate food. The poverty may not be as literal as Mimi's garret in La Boheme; the tubercular Marguerite Gautier in La Dame aux Camelias lives in luxury, but inside she is a waif. In contrast cancer is a disease of middle class life, a disease associated with affluence, with excess. Rich countries have the highest cancer rates, and the rising incidence of the disease is seen as resulting, in part from a diet rich in fat and proteins and from the toxic effluvia of the industrial economy that creates affluence. Illness p15

Sontag broadens our understanding of the disease, revealing the underlying assumptions that surround it. These too are the mythologies of cancer, as big as any myth of a cancer personality. So enshrined in cultural law, so powerful the image of neoplasms, that even I (a registered nurse working in oncology) have trouble resisting them. Thus I constantly find myself remarking to patients on admission how shocked they must be to find themselves in hospital with a tentative diagnosis of leukemia, when yesterday they were walking around, feeling just fine. As if their own particular "rich list" of visible symptoms (the unexplained bruising, the constant fevers and weeks of sheer exhaustion) were somehow just not apparent! Similarly I still today have to force myself not to see cancer as a disease of excess, of over-indulgence and over consumption, even though the majority of the patients I see come from lower socio-economic backgrounds.

Again it is important to remember here, that Sontag is working at the level of literary representation, and not empirical fact. It is not that these understanding are necessarily false (sometimes cancer does cause great pain), but rather they have come to be understood at the level of undeniable truth even though they are clearly not always present (some cancer patients, for example, never experience any pain at all, particularly in the case of haematology). Left unexamined, these "truths" have entered the level of myth, burdening the lives of patients, their relatives and clouding the thoughts of the health professionals that take care of them.

Its a valuable to lesson to learn for anyone personally or professionally involved with cancer. Our thoughts about the disease, how we understand it, treat it are not just dependent on medical research and scientific reason. There is a whole history of cultural, literary and artistic representation that come before us, shaping and molding our opinions, our understanding and our feelings.

Having said this I think there are also problems with these comparisons, which I will return to later, but next up I want to turn to AIDS and its Metaphors to see what else Sontag had to say about cancer.

Talk again soon.

Introduction: Illness as Metaphor/AIDS and its Metaphors

2013-01-28T23:34:00.000-08:00

OK - first a little bit of an historical background for those who have not read the book Illness as Metaphor/AIDS and its Metaphors; for essentially what we have here is not a book, but a collection of two monographs written over a number of years.

Illness as Metaphor was first printed in January and February of 1978 in The New York Review of Books as three long essays. You can still read the opening pages in their on-line edition here. Sontag was a cancer patient herself, while writing the essay, undergoing treatment for breast cancer at the time.

AIDS and its Metaphors was first published 10 years later as a stand alone monograph. Written at the height of the AIDS epidemic (as experienced in the West), it extends upon the themes established in Illness as Metaphor, but goes on to apply them to the issues (or illnesses) of the day.

As such it is important to realise that neither book is particularly 'about' cancer. There is little discussion of pathophysiology, no discussion of the benefits of relative treatments and certainly no diarising of her own experience. As she says in AIDS and its Metaphors, while reflecting back on her motivations for writing Illness:

"I did n't think it would be useful-and I wanted to be useful-to tell yet one more story in the first person of how someone learned that she or he had cancer, wept, struggled, was comforted, suffered, took courage ... though mine was also that story. A narrative, it seemed to me would be less useful than an idea." AIDS p 101

What we have instead, across to the two works, is a powerful analysis of the role of myth in a whole host of diseases including: tuberculosis, syphilis, the bubonic plague, leprosy, cholera, typhus, HIV and AIDS. And while her approach can seem somewhat highfalutin and academic at times (she references everyone from Lucretius to Katherine Mansfield to Machiavelli) the two works do not detract from what is her very real, very personal, commitment to the lives of cancer patients and cancer sufferers everywhere. For Sontag it is the myths, these metaphors that surround everyday diseases, that have the power to influence patients in their decision making, in their choices, in how to proceed with their treatment.

"My purpose was, above all, practical. For it was my doleful observation repeated again and again, that the metaphoric trappings that deform the experience of having cancer have very real consequences: they inhibit people from seeking treatment early enough, or from making a greater effort to get competent treatment. The metaphors and myths, I was convinced, kill ...I hoped to persuade terrified people who were ill to consult doctors, or to change their incompetent doctors for competent ones, who would give them proper care. To regard cancer as if it were just a disease-a very serious one, but just a disease. Not a curse, not a punishment, not an embarrassment. Without "meaning". And not necessarily a death sentence (one of the mystifications is that cancer = death). AIDS p102

A quick diversion back to the ward

2013-01-28T23:30:00.001-08:00

Each year my ward participates in an annual recruitment drive on behalf of the hospital for new nurses. Its much like any recruitment expo with each ward staffing its own table, highlighting the kind of work they do and handing out relevant information to prospective employees. What makes the expo slightly more interesting, however, is that HR and the hospital encourage us to theme our displays and award prizes for the most innovative and creative stands. One year the team from plastics all dressed up as leeches, highlighting their specialized work in the re-vascularisation of skin grafts. Similarly, its not unusual for the ED department to also stage simulated resuscitations in the middle of the exhibition hall, rushing in and performing compressions and intubations on a gurney, much to the delight of all involved.

For two years in a row now, my ward has chosen to highlight our work in oncology (even though we provide services in general medicine and palliative care). Year one was themed 'Fight Club' (based on the movie of the same name) and had all the nurses dressed up as boxers, encouraging prospective employees to 'join the fight against cancer'. Year two had a military theme, with nurses dressed up in army fatigues, plenty of camouflage adorning the booth and a large sign loudly declaring 'Combating Cancer' as if our ward was some kind of war zone.

For two years in a row now my ward's display also won "Best in Show".

Illness as Metaphor/AIDS and its Metaphors explains why this 'fight' metaphor is so compelling (that is why we win); but why it is also, ultimately, so wrong.

Who is/was Susan Sontag?

2013-01-18T22:56:00.000-08:00

Susan Sontag, essayist, novelist, director, play-write is a giant of American letters. Born in New York city in 1933, she studied at the College of the University of Chicago and did graduate work in philosophy, literature, and theology at Harvard University and Saint Anne’s College, Oxford.

Her work and legacy is prolific. Her titles include 6 works of fiction (including perhaps most famously The Way We Live Now, The Volcano Lover, and In America); 4 plays (including Alice in Bed and a retelling of Ibsen's Lady from the Sea); 6 collections of essays (including most famously Against Interpretation, Under the Sign of Saturn and Regarding the Pain of Others); and 4 monographs (including On Photography, Illness as Metaphor and AIDS and its Metaphors). She wrote extensively for the New Yorker, The New York Review of Books, The Times Literary Supplement and the London Review of Books. During her lifetime she also directed 4 feature films and devoted much of her time to humanitarian causes in Vietnam, Bosnia and the US. The New York Review of Books called her "one of the most influential critics of her generation".

I first read Sontag back in university. I have to admit I was more drawn to her essays and monographs than I was to her fiction. Her ability to unpack the complexities of taken-for-granted, everyday, but necessarily interesting aspects of life and then re-package them in engaging, challenging yet accessible ways, was a revelation to me and I credit much of my early fascination with cultural studies to her. I still remember, for example, her use of Roland Barthes 'punctum' and 'stratum' in On Photography and have used her formulations many times since, in my own writing. Yet it was in her willingness to extrapolate from her own life and in particular her health, that I first truly began to understand the role of culture in illness, medicine and in well-being. For, as we shall see in the coming weeks: culture not only determines health (as in the social determinates of health ie race, class and gender) but culture is the rubric through which all illnesses and health are actually conceptualized.

During her lifetime, Sontag faced the challenge of cancer three times, yet in reading her work one is struck by her unwillingness to tell her own "cancer story". As her son David Rieff points out in his memoir Swimming in a Sea of Death, her two two essays on illness are indeed almost anti-biographical and were in fact written long after her treatments had ended and deemed successes. But the legacy of her writing is clear. For Sontag the personal, even in moments of extreme sickness is truly political; and we have thus all benefited from the workings of her brilliant mind, but also of her body's very physical struggle with cancer.

Susan Sontag died in 2004 of complications from a bone marrow transplant for Myleodysplastic Syndrome. She is buried in the Montparnasse cemetery in Paris, along with many other literary greats

This is who she is, not who she was.

Shokufeh Kavani - Painter: Famous but Forgotten XXII

2013-01-12T21:47:00.000-08:00

Famous but Forgotten: The Secret Lives of Nurses by Critical Care - Reflections of a Male Nurse documents some of the outstanding individuals who have studied and practiced as nurses during their lifetime, but who may not have been recognized as such. To read more in this series just click here. To read the introduction to this thread, and why it is important click here.

Shokufeh Kavani is a famous Australian painter and translator. Of Iranian heritage, she was born in Tehran in 1970 where she grew up and studied until the age of 27. She immigrated to Australia in 1997, where she now lives and works in Sydney. Shokufeh’s artistic and literary works have been produced and exhibited around the world. You can read more about them here and see Shokufeh present her work at the Florence Biennale in the short video at the end of this piece. She has been nominated for Australian of the Year Award four times, in recognition of her ongoing and lasting contribution to Australia’s cultural life. What is not known, however, is that Shokufeh also continues to work as a nurse. Critical Care – Reflections of a Male Nurse interviewed Shokufeh in Sydney, last week via email.

Firstly Shokufeh, thank you so much for taking time out from your busy schedule to speak with us. Could you start by telling us why and how you became a nurse?

This is a long story. I always wanted to study genetics and it was impossible to do that in Iran as they were only accepting boys into the university course. Instead, I choose nursing because I knew it would permit me to migrate to other countries and follow my dream to study genetics. Besides, the human side of nursing had always been attractive to me. Its humanity and the ability to connect to other human beings – regardless of their age, race and gender - through medical and mental professionalism has always been satisfying. So I eventually studied nursing in Iran and migrated to Australia in 1997. My nursing degree was not accepted, however, so I studied it all over again, here. First I worked in the sterile processing unit of the operating theatre. I then became an Enrolled Nurse and continued studying, via correspondence to become a Registered Nurse. It has been a satisfying career for me and has enabled me to live the life I want, and be part of Australian society in a very positive way, especially changing the image of a middle – eastern women.

I am now studying my last post graduate subject of “Genetic Counselling“ and I wish to pursue my dreams further in this field.

And what kind of nursing do you practice?

To be honest, it is a very hard question to answer as I am a nurse who has worked everywhere. My speciality is operating theatre. That is what I have been trained for in Iran and worked most of my nursing years here in Australia. But I have also worked on the ward as a medical-surgical nurse, mental
health nurse, and in ICU; but I consider myself a theatre nurse more than any other kind.

I also worked in a war zone during the Iran- Iraq war for seven months. This was part of my nurse traineeship back in Iran and one of the greatest experiences of my life which I never regretted doing. It gave me lots of insight into life, a love of the people and to learn how to value every second of life. Even now, when I start to whinge (which is very hard sometimes not to do) I remember those days and try to enjoy and value every second of my life. The best part of my nursing experience was that I made friends for life.

What do you love about nursing?

Nursing has opened a window into so many new opportunities for me. It was through nursing that I could migrate, work in a new country, keep my independence and follow my dreams. Especially here in Australia, the door to higher education has also not been closed to me. I can study further and further and do what I like. There is a special humanity in nursing which is reflected in my paintings. It was through nursing that I could meet real people both in Iran and Australia, get to know their culture - as it is a very multicultural business. In nursing I could feel the emotions of others and discover a world which could not be explored through any other profession. It had its ups and downs but gave me the opportunity to meet the most wonderful people and to follow my dreams in life in order to be who I want to be.

Can you tell us anything about healthcare and nursing in Iran?

Yes, of course I can. There are lots of things about nursing and healthcare in Iran which need to be told. Nursing and generally speaking medical sciences have been very advanced in Iran. Nurses have been trained in universities for a long time, during the modernization of Iran and during the first and Second World Wars (ie the last 50 years). Nurses are amongst the hardest workers yet most misunderstood professions in Iran. They have gone through lots of hard times, especially during the 1979 revolution and 8 years Iran-Iraq war. It was through their sincere sacrifices that so many lives were saved and so many soldiers returned home. But they are not respected as much, especially by the government. Their wages are very low in comparison with what doctors earn, especially in these hard financial times. That is why there is a great wave of migration of Iranian nurses, especially to countries such as Australia, Canada, USA and New Zealand.

The best hospitals are in Tehran and the lack of advanced medical supplies is obvious in other cities and remote areas. This is the main reason which brings people to the capital city, although new graduates have to spend some time in their post graduation practice in other cities in order to avoid the overload of medically trained people in Tehran. Lots of young people have studied medicine and nursing after the 1979 revolution, and the standard of healthcare and nursing in Iran is very high.

Links

Wikipedia

National Association for the Visual Arts

Next Up: MDS and the work of Susan Sontag

2013-01-02T22:26:00.000-08:00

Ok, I've got that Oprah's book club feeling coming on again...

In the coming weeks I want to look at the work of Susan Sontag as part of my ongoing series Leukemia 101. For those of you have just joined us Leukemia 101 looks at blood cancers through the rubric of cultural studies. Its fun. So far we have had a chat about Cookies (the kind you eat, not the computer kind), Vampires, drug cheats, and a rather interesting series on APL/APML and Jodi Picoult's novel My Sister's Keeper. You see, it really is fun. Not too much science and just enough zany topics to keep us all interested.

The work of Susan Sontag proves interesting in that she not only wrote about illness and cancer, but she also died of leukemia and myelodysplasia syndrome which her son then discussed in a celebrated memoir. So the two books (amongst other things) that I am going to look at next are: Susan Sontag: Illness as Metaphor/Aids and its Metaphors and David Rieff: Swimming in a Sea of Death. Both are available through Amazon.com, or if you are in Australia why not support an independent bookseller like Readings, they provide an excellent on-line service and you will probably get your book a whole lot faster than if you order them from the States.

It will be a couple of weeks before I start writing, but I just thought I would give you all 'the heads up' for those of you who like to read along. And I promise you I receive no financial kick backs for having becoming an arm of the publishing industry!

Oh and if you are really interested, why not subscribe to this blog via email or by using an RSS reader like google reader. Just click on one of the subscribe buttons on the toolbar that pops out from the top right hand corner of the home page. That way you will never miss a posting.

Talk soon.

Marie Marvingt - The Fiancee of Danger: Famous but Forgotten XXI

2013-01-01T14:37:00.000-08:00

Men have made of the ariplane a machine of sport, commerce, and war. Mademoiselle Marvingt has undertaken the most magnificent of crusades-that of making it serve the cause of charity; medical aviation is called to render the most precious services" Marshal Petain 1931

Marie Marvingt (20 February 1875 – 14 December 1963) is the most decorated woman in the history of France. Yet of all the nurses I have so far researched for this thread; Marvingt's story is perhaps the most shocking. A famous athlete, mountaineer, inventor, novelist, film maker, aviator, and nurse, Marvingt remains barely known outside her native home. Given that her extraordinary legacy includes the invention the air ambulance; the question is why does this amazing woman remain so unheard of?

Born in Aurillac France, Marvingt became known as the "Fiance of Danger" due to her passion for flying in the early days of aviation history. At the beginning of the twentieth century, having already mastered the sport of ballooning, Marvingt fell in love with the fixed wing airplanes of the time and became committed to mastering the new skill. She was the third woman in the world to earn her pilot's license and is credited as being the first woman to ever fly a monoplane solo. Highlighting the extreme danger of the new sport, Marvingt was apparently most proud of the fact that in earning her license she never once 'broke wood' or crashed her plane. In this brief video (and if you understand French) you can hear Marvingt tell of the joys and preparations of flying in those early days, and watch her take one of her first solo flights.

With the outbreak of war, Marvingt had huge dreams for her new love, and for the nascent sport of flying. Having worked extensively as a surgical nurse in Paris, and having briefly fought in the war (hiding her gender as man), Marvingt quickly saw the benefit of airplanes to the war effort beyond their obvious role as fighters. As early as 1910, Marvingt was arguing for the use of planes for the purposes of medical evacuations, supplying medical aid, patient transport and in casualty reconnaissance. A determined woman, she set out to develop what we now know as the world's first air ambulance or in French: 'L'Aviation Sanitaire'.

"I have been for a very long time a diploma'd nurse of the Red Cross and the hospitals. My current dream is to place the airplane in the service of military casualties. My airplane would be a Deperdussin monoplane with three places, powered by a 100hp Gnome motor, and equipped with radio. It would provide information to the senior doctors, and would be able to resupply aid posts ... To construct it I have started a series of conferences around France. Piece by piece, I will accumulate what seems necessary, and I will realise my greatest desire for France. It will be one of the greatest joys of my life" (Evacuation)

Marvingt was as good as her word. By 1912, along with M. Bechereau of the Deperdussin aircraft factory, she had designed the first truly practical airplane ambulance; and through a series of conferences, as predicted, raised the necessary capital to finance its development. Unfortunately the factory failed in 1913, and the money embezzled, leaving Marvingt's plans in tatters. Not perturbed, Marvingt set about organizing a new round of conferences to finance a second attempt.

While only a few actual medical evacuations by aeroplane ever took place during the WWI, Marvingt committed the rest of her life to the establishment of the air ambulance service. Perfecting her concept of the "propaganda conference" to raise finances, she set about a grueling world tour to gather further funds. In 1929 she assisted in organizing the first international congress in medical aviation, with delegates from over 41 countries. In the early 1930s she assisted in the development of the first training course for aviation nurses, a cohort of which graduated in 1935, with Marvingt being the first to receive her diploma. In 1934 the French army asked her to establish a civil aeromedical ambulance program in Morocco, of which she became the first president and was awarded the Medal of Peace of Morocco. During this period she also wrote, acted in and directed two films documenting the history and use of areomedical evacuation.

Unlike most of her contemporaries, who often died young at the hands of early aeronautical technology, Marie Marvingt never slowed down, continuing to follow her love of flying to a ripe old age. You can see a brief documentary of her taking her first helicopter lesson at the tender age of 82 here. She died peacefully in 1963 at the age of 88. Her tomb in Nancy, France, proclaims her as the founder of medical aviation.

"If we have given wings to the world, we have the obligation to ensure that they are the wings of the dove of peace" Marie Marvingt

Selected Awards and Achievements

Palmes Académiques (Academic Palms).
Médaille de l'Aéronautique (Medal for Aeronautics).
Palms du Premier Tireur (First Gunner palms) by the Minister of War (1907)
Médaille d'Or (Gold Medal) for all sports from the Académie des Sports (1910).
Aéro-Club of France's Coupe Femina (Femina Cup) for long-distance flying (1911)
Croix de Guerre 1914 -1918 for her aerial bombing of a German military base.
Médaille de la Paix du Maroc (Medal of Peace of Morocco)
Chevalier de la Légion d'Honneur 1935
Chevalier dans l'Ordre de la Santé Publique (Chevalier of the Order of Public Health) (1937)
Literary prize from the Women's Aeronautical Association of Los Angeles for her books La Fiancée du Danger and Ma Traversée de la Mer du Nord en Ballon (1948-49)
Officier de la Légion d'honneur (Officer of the Legion of Honour) (1949)
Grand prize Deutsch de la Meurthe from the Fédération Nationale d'Aéronautique for her work in aviation medicine (1955)
Médaille d'Argent du Service de Santé de l'Air (Silver Medal of the Medical Service of the French Air Force) (1957)

Links

Marie Marvingt and the Development of Areomedical Evacuation

Wikipedia

Early Aviators.com

Everything you ever wanted to know about having a fever (but were too afraid to ask)

2012-12-24T08:15:00.000-08:00

It's the holiday season! A time of festive cheer and of serious over-crowding in hospital waiting rooms. As a haematology nurse, one of my areas of expertise is managing fevers or temperatures. Its part of my core business, you might say. So, with a view to saving you that four hour wait in A & E, because you or your loved one has a nasty temperature, I thought it might be really good to pass on some really useful information about fevers. What they are and what they are not; not in scientific terms, but rather as practical, plain language, information that you can use, as your loved one glows like a yuletide ember. This is not about fevers in the haematological sense (ie febrile neutropaenia), but rather fevers in the sense of "my child has a fever." Think of it as a seasonal gift, from me to you.

And as always, a disclaimer: advice in this blog is general in nature, if you have any concerns about your health or the health of a loved one, please see your doctor as soon as possible.

A fever is not an illness (neither it is usually dangerous).This is the first important point. Don't confuse the sign with the symptoms. A fever is a sign that your body is fighting an infection. IT IS NOT the infection itself. For this reason it is not bad. Actually its quite good. It shows you that your immune system is working, and that your body is fighting a disease. I think this is really important for parents of young children to remember. Some doctors even believe that the immune system's ability to raise a temperature actually helps rid the body of infection itself ie that it is curative.

38.2C/100F is not a high temperature (neither is 38.6/101F)
Many, many parents I talk to get worried as soon as their children's core body temperature hits 38C/100F. This is misguided. Yes your child is sick, and yes they feel lousy, but this is not a high temperature. It is what we call a moderate temperature, or low grade. A high temperature (for a usually healthy person) is generally considered to be one greater than 39C/102F. A very high temperature is considered one greater than 40C/104F.

Paracetamol/Acetominphen will not cure you of a fever (Neither will ibuprofen)
This the great lie purpetrated by the drug companies: that paracetamol/acetaminophen will cure your child of a fever. Paracetamol/Acetaminophen and Ibuprofen do not cure fevers. They rarely return body temperature to a completely normal range, and they usually only drop core temperature by a full degree centigrade. This is why after the body has metabolised the drug, your temperature begins to creep back up again. Why these drugs are so wonderful, however, is that they relieve the symptoms associated with a fever. They help relieve the bodyaches (myalgia), the headaches and allow you to get some rest.

Most of the time we get a fever, we have a virus.
And really there is not much you can do about it besides bed rest, plenty of fluids and maybe some paracetamol if you feel uncomfortable. You cannot treat a viral infection with antibiotics. As the name suggests antibiotics are useful when you get a bacterial infection (such as pneumonia, klebsilla, or an entecocci). In the community a doctor will usually prescribe antibiotics if a fever is persistant (if it goes on for more than three days) or if it is very high (Usually greater than 40C). In hospitals they usually do a suite of tests to see if they can identify the source of the infection and identify the type of bacteria that is causing the temperature. This allows them to prescribe the right kind of antibiotic for the right type of bacteria.

So can a fever itself ever be dangerous?
Sure. If a fever gets above 41.5C/105.8 the temperature itself (as opposed to the condition causing it) can be dangerous to the patient, particularly to the brain and it does require urgent medical attention. This condition, however is extremely rare, due to the body's unique ability to self regulate.

Some children between the ages of 6 months and 6 years, and particularly boys, are also known to experiences what we call febrile convulsions, or a febrile seizure. For the most part these usually last less than 15 minutes (and usually much less) and cause no serious injury to the child, or pre-dispose them to any future seizures or to epilepsy. Most children who suffer from febrile convulsions usually grow out of them.

Rigors are NOT a seizure.
More often than not when you get a temperature, you feel cold. With children, often their hands and feet feel very cold, even though the thermometer may show them as being hot. This is usually a surprise to patients and to the parents. This feeling of cold usually occurs when the body's temperature is rising. Sometimes when this elevation happens quickly the person begins to shake, sometimes quite violently. This shaking is not a seizure but what we call rigors. Rigors are the body's attempt to literally adjust its core temperature to a new set point. While often dramatic to watch, and uncomfortable to experience, there is nothing dangerous abour rigors.

Hang on ... now I am sweating like a pig
When your body hits the new set temperature you feel warm. This is understandable because you are literally hotter than you are meant to be. Its when your body's temperature drops, however, that you begin to sweat. This is often the result of taking some paracetamol and why we speak of "sweating out a fever". Again, it is important to remember at this point not to confuse the sign with the symptoms. Although you are sweating, you are not sweating out the virus or the infection. All that is happening is that your body is once again re-adjusting your core body temperature as part of the process of thermo regulation.

So what is normal?
As with so many things normal body temperature varies between people, ages, sex, the equipment you use (the type of thermometer), how you test it (under the tongue, under the arm, rectally) and even the time of day. Think about it for a second, when you exercise, you get hot, so your core body temperature will rise ever so slightly. Your raised temperature, however, does not mean that you are unwell.

As a general rule, however, normal body temperature is considered to be between 36.5-37.5C/99.7-99.5F.

Whoah, my thermometer says I am 35.5C ... should I panic now?
Many people often experience a low body temperature. This can also be a concern to parents of young children. Rest assured it does not mean that they are in the advanced stages of hyporthermia (although if you are in the snow, experiencing a blizzard and without adequeate heating, you might well be). More often than not this low reading is simply a reflection of inadequate equipment or poor technique. A useful trick here, for parents who have concerns about a child's low body temperature, is to take a look at them and test the themometer on yourself. Do they look comfortable? Are they happy? Or are they shivering and shaking and have bluish lips? In the case of low body temperature, your parental gut reaction to these signs is usually a far better guide to action than the normal domestic thermometer. And then when you stick your thermometer in your ear, or under your tongue, or wherever it should go, and it comes out low, chances are it means it is not working correctly.

A Happy and Healthy Holiday to all my wonderful readers!

Improving hospital design

2012-12-09T19:49:00.000-08:00

Take a look at this recent article published by US based Good Magazine about improving the design of hosital recovery suite beds. The beds take their cues from first class cabins on international airline flights and I have to say are quite funkyyyy. Apart from allowing nurses to monitor multiple patients, the beds are designed to promote recovery increasing patient mobility in and out of the recovery room. While it strikes me as highly ironic and kind of amusing to take the absurd luxury associated with premium travel as the basis of hospital design, there is something that does make sense here. To make maximum use of resources, planes like operating theatres need to get people in and out as quickly as possible. A functional design that is comfortable, but also quick to clean and easy to maintain does have a natural advantage. While the article also refers to how an aesthetically pleasing design can aid in recovery, I would have to say it also it would also make a much more pleasant environment to work in!

An unusual anthem to buoy the work of palliative care

2012-11-19T13:31:00.000-08:00

By now you may well have seen the hilarious video clip "Dumb Ways to Die": the catchy jingle written by Ollie McGill, of Cat Empire fame. The song was produced for a train company in my home town of Melbourne, and quickly went viral on the internet, notching up 2.7 million hits in less than 48 hours. While it was created as a public safety campaign (to take care around trains); it also strikes me as a wonderful anthem to raise the profile of palliative care and spread some good cheer amongst its workforce. For if ever there was NOT a dumb way to die, it is the capable care of a palliative care team, whose sole aim is to maintain the quality of life right up until the end. I have been humming the tune incessantly for the past two days and hope you will too. Please retweet, like on facebook or google + it if you enjoy.

BYO (Bring Your Own)

2012-11-13T09:11:00.001-08:00

In Australia we have this neat system of Bring Your Own (BYO) alcohol in restaurants. In otherwords if you are going out to a meal with friends and don't want to pay the excessive mark ups on wine that most restaurants charge you can BYO. When I was growing up in Melbourne, most restaurants except for the very top end would allow you to BYO; now its mostly only the suburban and out of town bistrots, cafes and small family restaurants.

So why am I talking about alcohol consumption when I am so staunchly against it? What does a quirky licensing law have to do with hospitals in Australia?

Well to all the patients out there, to all the families and friends of loved ones, how about the next time you go to hospital why dont you BYO? We'll provide the care, we will provide the expertise, but just because you get free medical cover at a public hospital does not mean you get free facial tissues (nor free toothpaste, shampoo, earplugs, nor snacks for that matter). THIS IS NOT A HOTEL. Free hospital care (at least in this country) is a right. IT IS NOT A PRIVILEDGE. This means you can support the system that supports you by not bleeding it dry through making un-necessary but necessarily expensive demands.

If you need tissues, BRING YOUR OWN. If you need toothpaste, BRING YOUR OWN. If you need earplugs, BRING YOUR OWN. And be grateful that we dont charge you corkage!

I hate to sound cheap, but really people, come on ....

Who provides the facial tissues on your ward? Would love to hear about what goes on in hospitals around the country and the world.

Julie Ege - Cult Movie Icon: Famous but Forgotten XX

2012-11-07T22:20:00.000-08:00

Famous but Forgotten by Critical Care - Reflections of a Male Nurse documents some of the outstanding individuals who have studied and practiced as nurses during their lifetime, but who may not have been recognized as such. To read more in this series just click here. To read the introduction to this thread, and why it is important click here.

Julie Ege (12 November 1943 – 29 April 2008) was a Norwegian actress and model who is probably best known for her work with Hammer Films, the English film studio famous for producing horror movies during the 1970s. The winner of Miss Norway, and a Miss Universe contestant, Ege went to England in 1967 as an au-pair and to study English. After appearing in numerous films including the James Bond Classic On Her Majesty's Secret Service, she returned to Norway where she trained as a care worker and in 1998, completed her nursing degree.

For Ege, graduating as a nurse fulfilled a childhood dream, but like others on this website, it also saved her life. While studying for her final exams, Ege discovered the early signs of breast cancer and believed that it was her new found knowledge that helped her detect the disease. Undeterred by the extensive medical treatment, including a mastectomy, she went on to work as a nurse for 22 years, facing the disease head on, including subsequent diagnoses of ovarian and lung cancer. She wrote her autobiography Naked, and continued to attend premieres and events in Oslo while at the Buskerud Hospital in Drammen. “She was a nurse and loved the job,” said her daughter Joanna to The Express newspaper. “You would never have known she had this rich, glamorous past if you’d met her. You would have just been struck by her energy, her smile and her determination to help people." In 1995, she was honored by the city of Oslo with a film festival at the Rockefeller Cinema. She passed away in 2008 at her home in Oslo.

Julie Ege inspired women and cancer sufferers all over Scandinavia. In Norway there is a street named after her in the City of Sandness, the city where she was born. For those of us who cannot get to Norway, however, I thought it would be fun to remember Ege through one of her breakthrough performances. her staring role in The Creatures The World Forgot. While I am sure the producers did not intend to make a comedy, I for one found it hilarious. Enjoy!

Filmography
Robbery (1967)
Stompa til Sjøs! (1967)
On Her Majesty's Secret Service (1969)
Every Home Should Have One (1970)
Up Pompeii (1971)
Creatures the World Forgot (1971)
The Magnificent Seven Deadly Sins (1971)
Rentadick (1972)
Go for a Take (1972)
The Final Programme (1973)
Not Now, Darling (1973)
Kanarifuglen (1973)
Craze (1974)
The Legend of the 7 Golden Vampires (1974)
Percy's Progress (1974)
The Mutations (1974)
Bortreist på ubestemt tid (1974)
The Amorous Milkman (1975)
De Dwaze Lotgevullen von Sherlock Jones. 1975
Dr. of Evil. 1974
Den siste Fleksnes. 1974
Farlig yrke. 1976
Think Dirty. 1978
Fengslende dager for Christina Berg. 1988
Blodsbånd. 1998

Useful Links
Wikipedia
The Guardian
The Express

Maude E. Callen - Nurse & Midwife: Famous but Forgotten XIX

2012-10-23T07:41:00.001-07:00

Maude E. Callen (1898 – 1990) was a nurse and midwife in the South Carolina Lowcountry, USA, for over 60 years. She became famous when her work was brought to national attention in W. Eugene Smith's now classic photo essay, "Nurse Midwife", published in Life Magazine in December 1951.

Maude E. Callen was born in Florida, in 1898, one of thirteen sisters. She was orphaned by the age of six and then was raised in the home of her uncle, Dr. William J. Gunn, a physican, in Tallahassee, Florida. She graduated from Florida A & M University in 1922 and then completed her nursing course at Tuskegee Institute in Alabama. Callen then moved to Pineville, South Carolina in 1923, where she set up practice. She was one of only nine nurse-midwives, at the time, in the area.

Callen operated a community clinic out of her home, which was miles from any hospital. She provided in-home services to “an area of some 400 square miles veined with muddy roads”, serving as 'doctor, dietician, psychologist, bail-goer and friend' to thousands of desperately poor patients. It is estimated she delivered between six hundred and eight hundred babies in her years of practice. In addition to providing medical services, Callen also taught women from the community to be midwives.

In December 1951, Life magazine published a twelve-page photographic essay of Callen’s work, by the celebrated photojournalist, W. Eugene Smith. Smith spent weeks with Callen at her clinic and on her rounds. The photos are visually arresting, both as a haunting record of the time but also as ongoing testament to the power of nursing and midwifery to effect social change. The Life website currently displays some 40 photos, some which were never published in the original essay. I thouroughly recommend them to anyone who may be interested in the history of nursing or the deep South.

On publication of the photo-essay, readers donated more than $20,000 to support Callen's work in Pineville. As a result, the Maude E. Callen Clinic opened in 1953, which she ran until her retirement from public health duties in 1971.

During her lifetime Maude E. Callen received many awards and recognition for her work, including The Alexis de Tocqueville Society Award in 1984, for sixty years of service to her community.

She continued working in a voluntary capacity until her death in 1990.

Useful Websites
Wikipedia
Life Magazine

What is EPO? Does it cause cancer?

2012-10-22T06:51:00.001-07:00

Well thank you I am so glad you asked. So lets be really, REALLY clear about this. I am going to quote the entry from the Australian version of MIMS or the Monthly Index of Medical Supplies. MIMS is the official index used by doctors to prescribe medications in Australia. Not only does it tell you what the drug is, but it also tells you how it works and all its side effects. I am going to quote it, just so as no-one can accuse me of making it all up.

Erythropoietin (EPO) is a glycoprotein hormone produced primarily by the kidney in response to hypoxia and is the key regulator of red blood cell (RBC) production. EPO is involved in all phases of erythroid developm.....

Hang on, hang on. You lost me at ery .. erthy ... eritro. Will you please speak English! And look your a nurse, not a cyclist so how come I am talking to you anyway?

Funny you should mention that as a haematology nurse I administer EPO all the time.

What? You mean its not illegal?

No, no, no erythropoietin is actually a naturally occuring hormone, that we all produce inside our bodies. It's only banned in sport. Actually its an amazing drug that is used in people with kidney failure, but also a lot of patients undergoing chemotherapy for the treatment of cancer?

Cancer? But all the media is saying that it causes cancer. Now you've really lost me.

Yeah I know confusing isn't it. Hang in there with me and I will try and explain it in a way that is not too difficult to understand.

Ok, Ok, but I have to warn you my attention span is really short, and I am not in the mood for any jargon. Ok? Ok. So lets start with the basics. As I said erythropoieten is a naturally occuring hormone that is produced in the human body. In adults it is produced in the kidneys, but when you were an infant and in the womb it was actually produced in your liver.

Yeah I am listening. So what does it do?

Actually a whole range of things. Its usually known for its role in the production of red blood cells, but it has also been shown to have a role in the wound healing process too. It even seems to play a role in protecting the brain when it is about to be damaged by stroke.

So why then am I hearing so much about EPO in cycling, particularly long distance cycling like the Tour de France?

The key here is to remember that red blood cells carry oxygen from the lungs to every other living cell in your body. The biggest limiting factor to an endurance athlete is how much oxygen they can get to delivered to the cells of their muscles. Without enough oxygen their cells simply fatigue, and as we all know fatigue is not good for an endurance sport. Erythropoietin literally increases the number of red cells floating around in your blood, therefore increasing the amount of oxygen available to muscles. For this reason EPO has been used in the history of blood doping in other endurance sports such as distance running, walking, triathlons and even horse racing.

Jockeys take EPO?

No it's for the horses doofus.

Oh right, of course. Then what's the deal with cancer?

Ok the first thing to remember is that cancer is not a disease that infects the body. It does not come 'from outside' like HIV, TB, Influenza or the common cold. Rather it starts within the body and is actually part of you. Cancers are what we call neoplasms, or rapidly dividing cells that are abnormal when compared to the normal cells from which they develop. Erythropoietin is a growth factor. It basically helps red blood cells to grow, divide and multiply. Logically then EPO may well help tumours to grow, or it may affect the efficacy of anticancer therapies. Scientists are n't quite sure.

So EPO causes cancer right?

Mmmmm lets just say that I like to think of EPO as promoting cancer. Its not necessarily the cause but it might help it along the way.

But hang on you are a cancer nurse? Why would you or any doctor decide to give EPO to a cancer patient???? Your trying to cure patients not kill them.

True. But unfortunately there are no magic bullets in any kind of medicine. All drugs have side effects. All drugs have potentially adverse reactions. Many of the cancer therapies we administer are highly toxic and may lead to the development of other kinds of cancers. Research is suggesting that survivors of breast cancer have an increased risk of developing blood born cancers later on in life. Similarly transplant recipients often develop skin cancer as a result of the drugs they must take in order to stop their bodies rejecting the donated organ. As with any therapy, the risks must be carefully weighed up against the potential benefits. In haematology we often give EPO to patients who have a shortage of red blood cells as a result of the chemotherapy they have undergone. In this case it is not a cure for the cancer but rather a way of trying to manage some of the side effects - a side effect that can be potentially life threatening. The present American Society of Hematology and the American Society of Clinical Oncology guidelines stat that Epo use should be limited and patients monitored more closely. Epo is now pretty much only used amongst patients who experience a significant drop in haemaglobin and who are being treated without curative intent.

So did Lance Armstrong develop testicular cancer because he took EPO.

I was wondering when you would get to that. Its hard to say. Maybe. But I can tell you this. Lance Armstrong put himself at serious risk of a whole lot of other medical conditions because he took EPO.

Really? Like what?

Like hypertension, hypertensive encephalopathy; seizures; thrombotic/vascular events such as mycardial infarctions, cerebral vascular attacks, DVTs, Pulmonary Embolisms and retinal thrombosis; thrombocythaemia; headaches; arthralgia; injection site reaction; oedema; gastro-intestinal upsets and fevers. Again I am quoting from MIMs here

I didn't really understand a word of that, but it doesn't sound good does it?

No taking doses of EPO is very risky and highly dangerous. I find it ironic that none of the media surrounding Armstrongs fall has focussed on this fact.

So I should n't consider improving my cycling through a little extra dose of growth hormone?

Put the syringe down Eddy Merckx, put the syringe down.

But I still don't get it. I don't get it. If Armstrong took EPO, how come it did not show up in any of his drug tests?

Well firstly a reliable test indicating abnormal levels of EPO in the human body was only developed in 2000. And second, the reason EPO proved so effective as a performing enhancing drug for long distance cyclists is that it only lasts about 5 hours in the body. Cyclists could therefore optimise the times to take the drug, to avoid being found positive on testing at the end of the days race.

So Armstrong hero or villain?

Armstrong was declared cancer free in 1997, two years before he won his first Tour de France. He then went on to win 6 more titles consecutively, providing inspiration and hope to cancer sufferers everywhere. In 1997 he set up Livestrong, the Lance Armstrong Foundation, a non-profit organisation supporting people and families living with cancer. While Armstrong's cheating and spectacular fall from grace has seen him lose his sainthood status amongst the cycling community; he remains a hero for many people still living with cancer. Much has been written about the man, and no doubt there is still more to come. My view, however, is this: Armstrong "cheated" death, and he also cheated in the sport which made him famous. What is not being discussed and what really concerns me is that he continues to cheat the cancer sufferers and cancer community who continue to idolize him so much. By recklessly and brazenly injecting himself with EPO as well as other banned substances, not only did he put his life at risk, but he may have in fact encouraged the growth of tumours and their metasteses both within himself and in other cyclists who went on to use the drug inspired by his success. He may well be an inspiration, but his remarkable recovery is based on a lie, as long as he fails to publically acknowledge that he engaged in risk taking behaviour that put his health in jeopardy and may have made his prognosis worse. To me, as a cancer nurse, Lance Armstrong's "activisim" is no better than the behaviour of big tobacco or big junk food who continuously deflect the argument away from the damage caused by their products, by big noting all the supposed good they have done as corporate citizens.

*For an excellent introduction to the use of Erythropoietin in cancer treatment see Hedley, B., Allan, A., and Xenocostas, A. "The Role of Erythropoietin and Erythropoiesis-Stimulating Agents in Tumor Progression" in Clinical Cancer Research (2011) 17, pp6373-6380.

Naomi Judd - Country and Western Superstar: Famous but Forgotten XVIII

2012-10-17T08:50:00.003-07:00

Naomi Judd ((born January 11, 1946) is an American country and western singer, performer, motivational speaker, author and activist. With her daughter Wynonna, Naomi formed the highly successful duo known as The Judds, country music's most famous mother–daughter team. The Judds achieved twenty top ten hits and won five Grammy Awards. After retiring from her music career Naomi went on to become the spokesperson for the American Liver Association, and published numerous works of non-fiction.

Judd's career as a nurse has been well documented. You can read about it at length at any of the links provided below. What \I want to highlight, however, is that perhaps more than any other "celebrity" I have profiled Judd remains a passionate advocate for nurses and for nursing in general.

In 1990, post her stellar career in the music industry, Judd was diagnosed with hepatitis C, a disease that she has attributed in a 2001 interview to contracting through her work as a nurse.

Judd said that she’s “pretty sure” a needle stick led to her bout with hepatitis C, but, “I don’t think there’s a way to be completely sure,” she added. However, when she considers her lifestyle—monogamy, no tattoos, no transfusions—and weighs it with the fact that as a nurse who didn’t "glove" prior to administering needle sticks, and the number of times she was exposed to body fluids and sticks while working in the ICU, she tends to lean toward nursing as the cause. “You would continually subjugate your welfare to that of your patients,” she said.

What I find truly inspiring is that rather than blame nursing, or blaming the hospital where she worked, Judd rather ironically sees that it was being a nurse that "saved her". It was nursing that gave her the skills and resources to reach out and find viable and alternative evidenced based therapies.

No, because I loved being an RN. It taught me so much about humanness. I learned that we are all exactly the same. We wear different masks, and we may have slightly different personal histories, but we are all exactly the same. And I learned about medicine. So that now, here a I am a victim of a chronic, potentially life-threatening illness, I have this ability to discern as I open myself up to alternative therapy. I can distinguish between hogwash and legitimate, valid resources. (Ability Magazine)

Yet because of the disease, there is also an implicit warning here, a strong message to nurses to stop, take a step back and examine the very reasons for practice.

Her message for today’s nurse is to “become a detective in your life. Why are [you] in that profession? Question your belief system. Really break it down to your relationships, what’s going on with the kids, and are you honoring yourself?” She added that her mantra for nurses is, “We have to honor ourselves first. As nurses we have to understand that it’s not selfish. It’s not self-indulgent. We’ve been getting mixed messages in this culture and of course women have the disease to please.” (Interview)

For Judd, as nurses we have to care for the carers; we have to care for the nurses; before we can care for our patients.

Useful Websites
naomijudd.com
Wikipedia
The Judds Discography
Academy of Achievement
Ability Magazine
An Interview with Naomi Judd

Famous but Forgotten by Critical Care - Reflections of a Male Nurse documents some of the outstanding individuals who have studied and practiced as nurses during their lifetime, but who may not have been recognized as such. To read more in this series just click on the 'Famous and Forgotten' icon on the header bar of the home page. To read the introduction to this thread, and why it is important click here.

The Patient Experience

2012-10-09T07:53:00.000-07:00

"Cancer is a word, not a sentence"

John Diamond

As a cancer nurse I am very interested in personal accounts of cancer, both the disease and also its treatment. I am interested not only because I think it keeps me honest and improves my practice, but also for the symbollic power and significance that these accounts can possibly engender. As the Ameican literary critic Susan Sontag has famously shown in her classic work Illness as Metaphor, the metaphors and myths surrounding certain illnesses, especially cancer, add greatly to the suffering of patients and often inhibit them from seeking proper medical treatment. For this reason we need to remain vigilant as to how we write about and represent cancer. We need to think carefully about using words such as "war", "fighting", "battle", "suffering" and "victim" in our discussion; and specifically ask of what use-value are these terms to the people who are being treated for the disease and their loved ones.

When the media, for example, announces that a famous celebrity has "lost their battle with cancer" what impact does this statement have on others who are currently seeking treatment for the disease? Why is it "their battle" and not "the battle" or even "our battle"? As written, the statement only serves to strengthen the social isolation and stigmatization that people seeking treatment for cancer often experience. And why use the military terminology (of a battle, or a war) in the first place? I have not personally experienced cancer, and I certainly have not lived through a war, but I can assure you from my experiences on the ward the two are decidely different phenomena. To use metaphors of war to describe cancer treatment not only undermines the experiences of those who endure the former, but only engenders a sense of win/loose and implied sense of ultimate failure to those you undergoe the later. Is it any wonder then that we are so resistant to cancer screenings?

I could bang on about this topic for ages, but instead I want to point you to a recent article published in The Atlantic, which would have to be my all time favourite magazine and news journal. In "Lymphoma and the Insipid Victory", J. W. Oker deliberately resists the military analogies to provide a fascinating account of his experiences undergoing treatment for lymphoma, another blood born cancer but this time of lymphocytes and the lymphatic system more generally. What I find fascinating about his account is not only his instructive segues to a diverse ray of subjects including Egyptology and animal testing; but also his abilty to confound the very terms on which the discourse of cancer is usually based. Without going into the details too much Oker survives "the battle" and fails miserably - and all in a generally upbeat kind of way.

Its a challenging, entertaining, accessible and worthwhile read, that I thoroughly recommend to anyone involved in the process of cancer (be they healthcare provider or patient).

I highlight it here as part of my ongoing introduction to the cultural significance of blood born cancers: Leukemia 101

The Joys of Night Shift

2012-09-20T04:34:00.000-07:00

Yeah, yeah, yeah ... I know, I know, working night shifts is hard. Night shift workers die younger ... moan, moan, moan. So tired, can't get any sleep ... complain, complain. But hey, being a night shift worker I can tell you there is also a lot that is really great about working from dusk till dawn. So in view of a balanced discussion, here is my list of 10 reasons why you should consider night shifts. Would love to hear from you if you have any more.

That moment when your head hits the pillow, as soon as you get into bed. Nine to five workers just have no idea of the joy
Watching everyone stuck in traffic, going to work, as you cruise home to bed
Night shift works great for families. Believe it or not working nights is great if you have children. I go home after working a shift, help my son get off to school and then I am also around in the evening to prepare meals, help with homework and keep up with the household chores. I don't know many dads working 9 - 5 who have the time to do this especially at both ends of the day
Finding a parking spot at work is never a problem.
No office politics
Directing care for the patient in a way that during day shifts is simply not possible. I want to say more about this. When a patient deteriorates over night and I have to page a doctor, chances are the doctor won't know much about haematology. Nor should they. More often than not you will get a second year resident who is struggling to look after several specialised units, groaning with the burden of hospital admissions, and barely enough time to scratch themselves let alone think. As a highly specialised nurse, this is where my experience and training come into their own. I can basically tell the doctor what they need to do: direct them to the relevant protocols; advise them as to the medications that they should consider prescribing, and make sure that nothing falls through the cracks. In an emergency it becomes even more intense as the doctors will not even know the patient, so I will have to give a full run down on their history and presenting condition. To me this is what nursing is all about. Not some kind of glorified cleaner, but rather a fully qualified health professional who directs care, but also implements it. During the day with so many health professionals involved, with so much to do during the average shift, it is often the voice of the nurse that gets lost first.
Afternoon naps. Really, who does n't want to stop everything during a busy day and curl up in bed.
The working week is over more quickly. Night shifts are usually longer than day shifts, so you you get more of your working week done in a shorter amount of time.
It's rare that you have to negotiate with a patient's family
NO OFFICE POLITICS!

Shall I break your ribs now? The myths of CPR

2012-09-07T12:44:00.001-07:00

One of the things I find hard to understand as a hospital nurse, is the eagerness of some families to subject their aging relatives to the full force of the acute care medical system. As a haematology nurse I see this a lot. Seventy, eighty, ninety year olds with the worst kind of cancers being subjected to the most invase and brutal of treatments, all in the hopes of "gaining a few more years", "having one more christmas with the family", or simply because the family cannot let go. Look, I strongly believe in a patient's right to choose, and I think much of the blame can lie with well-meaning nursing and medical staff who fail to outline the real implications of treatment; but why would anyone want to subject their loved one to the realities of twenty-first century health-care, particularly when it is unlikely that the cancer will be their cause of death anyway. Despite our best efforts, modern hospitals are dirty places, full of virulent, antibiotic resistant germs. And while doctors, nurses and allied health professionals perform modern miracles everyday, keeping people alive and caring for individuals, much of it can seem like the worst kind oftorture.

Take Cardio-Pulmonary Resuscitation, CPR, or "chest compressions" as they are commonly known. CPR is a potentially life saving sequence of moves that are performed when a patient's heart stops beating appropriately. If this happens to you and you are in hospital, CPR will most likely be given to you by a nurse. as they are the staff members who are usually always around. Sometimes it is very quick (say 2 minutes worth) - before gel pads are applied for defibrillation; or sometimes it goes on for hours, particularly if your heart is in a rhythmn that is not suitable for shocking. Basically what will happen is that the nurse will heal of their hands on your sternum, and with straight arms push down, stimulating the heart to perform a modified pumping action. Current recommendations suggest the chest needs to be compressed by a third of its depth, with 30 compressions a cycle or roughly 100 compressions per minute.

Now let me tell you this. I am a big guy. I weigh over 100kg and I can easily bench-press 70kgs (the weight of an average human). If your heart stops beating and you arrest, you want me on your team. I have a reputation on my ward for doing it well, and young interns never fail to comment as they monitor the patient whose chest I am pounding. "MMmmm good output Rick" they croon (No joke). The thing is though, it is ugly; really ugly. Chances are I will break one, two, even three of your ribs depending on how old you are. You will also have tube stuck down your throat to support your airway and help you breath, and be stabbed from several sides as doctors try to access your veins. Drugs like adrenaline, atropine and amiodarone will be pumped into your body with no hesitation.With the loss of consciousness and all the physical man-handling, you are likely to wet yourself and/or open your bowels. You will be stripped bare, and most likely you will be alone, without your friends or family. The average survival to discharge rate of someone surviving CPR (that is you get to go home) sits at around 18%.

Does n't sound very good does it? So why is it then patients and families are so hesitant to sign Not For Resusitation Orders? Why are we all not filling out Advanced Care Directives, for a time when we have all become too old and too frail to make informed decisions about how we want to be looked after? I have to say I think part of the reason is unreal expectations and false information about the real nature of CPR and its outcomes, generated in the most part by popular culture.

Take a look at this for example:

The video comes from the American television series 'ER', and frankly as a dramatisation of CPR in the hospital setting, the piece is not that bad. No, patients just don't "wake up" like that; and the are certainly don't look so "post-coital" in their appreciation of their resusitators, but I love the way the 4th year student just wanders in as if nothing is happening. Believe it or not this kind of things happens all the time in emergency codes: with medical staff wandering in and out as if there is nothing going on. (Having said that no health professional would be so stupid as to offer to examine the patient given the emergency nature of the scenario). But the depiction of CPR itself is woeful. The treating doctor has his arms bent and there is not nearly enough downward thrust in order to "massage" the heart sufficiently.

The problem is that seen in this context, the piece promotes unreal expectations about the effectiveness of CPR and defibrillation. I promise you after CPR in the hospital setting, you will not be able to talk let alone roll over and compliment your rescuers. As Diem, Lantos and Tulsky pointed out in their extensive review of CPR on television(including shows such as 'ER' and 'Chicago Hope') 75% of characters shown to be receiving CPR in TV dramas survived in the short term and 67% of characters survived in the long term. This high rate of success simply does not exist. As the Robert Wood Johnson Foundation points out CPR has a very, very small chance of working for people who are are seriously ill or dying.

"One study shows that individuals with overwhelming infection have less than a 3 percent chance of being discharged from a hospital after CPR; those with advanced cancer that has spread to other parts of the body have virtually no chance"

If you are sick and in hospital and you need CPR, you have a very small chance of walking out alive.

But what of CPR as first aid? What chance do people have of surviving when they are NOT in hospital, when they are NOT sick, or NOT aged and infirmed? How does popular culture represent CPR in these kinds of situations?

To answer this question, I want you to have a look at this piece from the popular, now defunct, US seriesBaywatch. The clip shows a young woman being rescued from drowning in waveless ocean; the ridiculousness of which is only heightened by the fact that her cosmetically gifted rescuers have been dubbed into german.

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Let's shout it out one more time folks "EINS, ZWEI, DREI, VIER, FUNF ...."

Compare this to an episode from the first series of the Australian "reality" TV series, Bondi Rescue. WARNING: THIS VIDEO CLIP MAY BE EXTREMELY DISTRESSING TO SOME READERS.

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I have to say that I find the two clips startling in their similarities rather than their differences. It is not that one clip is more 'real' than the other. Both clips start off by sexualising their main protagonists (buff men frolicking in the sun and sand). Both use a range of filmic devices (music, lighting, filters, camera angles and dialogue) to create the drama; and both are full of inaccuracies (Maxalon is a drug to stop a patient vomiting, it does not 'stabilise' a patient). The bondi rescue clip, however, is far more powerful in its depiction of CPR, in that it focuses on thestruggle of the patient to survive, rather than the hero narrative of trying to bring the patient back to life. Notice how although alive, by the end of the clip Takahito's journey is still not over ("Will he have any brain damage?" asks the voice-over guy. "Taka is not out of danger yet"). Similarly his body is not a passive object that is being worked on, but rather he is actively engaged in the process. Even I (a seasoned professional in CPR) find those pictures of his body spasaming, difficult to watch.

Bondi Rescue makes it clear. CPR and defib are vital, life saving techniques. They are not magic. The patient will not get up and walk away as if nothing happened. We need to think carefully if this is what we want for our loved ones when they are in hospital; and we need more informed portrayals in the media.