This is Amerika?

So, the economic stimulus package has passed. Yipdeedoodle!

Really, I am glad.

But I wonder if those guys who wrote and passed the package have any idea about what's happening on the ground and the needs of us poor slobs working in clinics that take care of people "on the margins." I mean, the people who nobody wants to take care of--homeless, mentally ill, drug addicted patients with a laundry list of chronic illnesses.

My kind of people!

Many nurse practitioners work in clinics in which we have to beg for simple stuff--pens and pencils, ink cartridges for the fax machine, the right kind of medication to treat our patients.... We are working in developing country conditions right here in big cities and rural areas in the land of plenty (or, what was until recently the land of plenty).

When Katrina hit, I was "deployed" to a huge abandoned facility outside of Chicago that housed over 200 Katrina refugees who were moved from New Orleans in the days following the hurricane. Lots of really really sick, really really poor, really really shell shocked people. One woman had sprained a finger and left her insulin behind during the rush to leave her home.

And in this facility, set up by our beloved Uncle Sam, there wasn't a splint in sight. Not a one. I improvised, just like in M*A*S*H, and made a splint out of two tongue blades, some tape and the little bit of gauze I could scrounge up. I felt very pleased with myself for being so creative, but also pissed off that the people were there, but no supplies.

This is the kind of thing many of us do every day in providing primary health care. Improvise. Make do. Get along. Scrape by.

We do it well, but should we have to?

In Amerika?

Now 100% Mom Approved!

It's been a few days since I've posted. Feeling like a bit of a slacker. Yup, that's me, slacker nurse practitioner.

Honestly, I was so plum tuckered out after a few days of tending to patients that I barely crawled out of the clinic on Friday night, cursing the nonfunctioning fax machine and the specialists who don't return phone calls.

Anywho, I told my mother a few days ago about this blogging thing, and gave her the link. She's quite amazing in her ability to not just turn the computer on but really use it--quite a feat at her (ahem) advanced age.

So, she checked it out! I have to admit that I was actually kinda nervous at the prospect of my mother perusing this thing--probably some leftover issues I'll never get to in therapy. But--she liked it! Not only did she like it, but she thought I could give Maureen Dowd a run for her money. Here I come, New York Times. Ha! Aren't mothers wonderful? No matter what kind of crap their children manage to produce, they couldn't be prouder!

Isn't she utterly adorable?

A word about my mother. She is not a nurse. But she is my hero. She is smart, insightful, funny and caring. She took care of my Dad during a lengthy and pretty miserable illness (Lewy Body Disease, the second most common form of dementia after Alzheimer's--maybe one of these days I'll write about it) with her wit and sanity (mostly) intact. I really can't imagine what it was like for her, but she soldiered on and took care of him up until the bitter end. And now she's like a volunteer poster child for the Alzheimer's Association in her home state and is adored by all.

To all those unsung mother caretakers out there:

Viva!

Tom, Tom, Tom

Tommy, we hardly knew ye. Another would-be reformer flushed down the toilet of politics by his own poor judgment.

That would be you, Tom Daschle.

You needed a WHAT? A limousine? Who are you kidding? Do you see yourself as a health care rock star, requiring round-the-clock protection from the poor, uninsured masses? And the 5 million in lawyer-strategist and speaking fees for the health care industry? I mean, really!

But you had such great ideas. A Federal Health Board, that would have power over federal programs, and would assess effectiveness and cost of different treatments. More regulation of health insurance companies. Unlike Obama, you believe that all Americans (not kids only) should have health insurance, and had some neat-o ideas about developing an insurance pool based on the one for federal employees. Oh yeah, you also understood the importance of primary care for prevention of the unnecessary complications of preventable diseases. And if all this weren't enough, you actually acknowledged that health care relies too much on physicians and does not effectively incorporate nurse practitioners, physician assistants, pharmacists and other allied health professionals.

Many have balked at your cojones in suggesting there might be a--gasp--socialist bent in your proposals. Not me, man. Bring it on. If socialism means ensuring that people get the access to the care that they need, that we take a good look at our health care "system" and change our priorities to focus on prevention, if it means loosening the stranglehold that insurance companies have on the allocation of health care resources, then by all means, call me red!

I'm disappointed. Upset, even. Worried that the next candidate just won't
get it and will cave to the powerful, monied interest groups that have eaten away at the soul of health care like a cancer.

In the meantime, I'll just get back to doing my barely reimbursed primary care thing. To the next in a long line of diabetic, hypertensive, obese, depressed patients:

The nurse practitioner will see you now.

Reach out and touch someone

Well, did I ever sound self-righteous in that first blog. Sor-ry!

The truth is, I became a nurse for a bunch of completely self-righteous reasons which I still completely, foolishly, naively, stubbornly believe in. Before I became a nurse practitioner, I worked for a few years for not-for-profit groups in public affairs and public relations. It was fun and exciting and I even was quoted saying insightful things in the media, but it wasn't really fulfilling.

Then I met some very cool nurses and nurse practitioners, and thought that nursing would be a noble yet grounded way to help people.

Yes, help people. I know, it sounds pathetic and girlie, but it's true.

Years later, after being vomited and pissed on and having seen more bodily fluids than I thought the human body contains, I still think so. Maybe even more so. Every patient is like a story, and I feel sometimes humbled, sometimes overwhelmed by the privilege of listening to them.

Oops, self-righteous again. Sor-ry x 2.

Which brings me to the topic of today's post. Finally.

Today, I sat in a computer chair zombie-style for 6 hours entering everything I could find from patients' "paper charts" into a fancy if soulless computerized medical record. Part of me was thrilled to think I'd be able to read what I'd written with the click of a mouse, rather than squinting and turning pages upside down and sideways to try to figure out what the hell I had written in my increasingly heiroglyphic-like handwriting.

Don't get me wrong, I have a thing for computers. They are amazing, wondrous contraptions on which I have come to be very dependent. But they're not a substitute for what makes nursing unique.

Today I reached out and touched, but it was a computer keyboard.

Why florencelives?

Why florencelives?

Working in health care today is: Exhilarating, exhausting, disturbing, confusing, and incredibly meaningful. What better place to try to make some sense of it and let off some steam than a blog?

And--it's way cheaper than therapy!

As health care lurches towards an uncertain future, it helps to have touchstones from the past. I've found them in a couple of florences.

Once upon a time, in a land far, far away, there lived a lady with a lamp. . .Florence Nightingale. She's been credited with founding "modern nursing," was an advocate for social change, sanitation, health care for the poor--and a statistician to boot. OK, so maybe she was an upper-class chick with plenty of family connections who was rumored to have died of syphilis (unfounded) and was far from the saint she has been portrayed to be. But you've got to admit this sister was no slouch!

Not so long ago, right here across the pond, another nurse, the late, great Florence Wald built her vision for the hospice movement. She had an unwavering commitment to social justice--providing care for those most vulnerable (she fought for prisoners to have access to hospice care). She was a scholar, a humanist, and a mover and shaker for what she believed in. Hot diggity! If that's not setting a great example, I truly don't know what is.

florencelives!