Feeling cynical...

[brandtrn]

Now that I've actually GOT a couple of days to rest and re-group and seriously, have no *real* reason to rant tonight, I'm going to rant, anyway. What IS it with these people who come to the hospital and pack a suitcase as big as a freaking HOUSE??? WTF??? Do they think they're going to freaking move IN??? Lemme tell you folks, just to save yourselves a whole bunch of trouble and preparation. Do not, I repeat, NOT, pack anything which isn't absolutely necessary for your continued existence for the next three to five (at the most!) days! This means your cell phone, your iPad or laptop (if you possess one), a couple of pairs of clean pajamas, a bathrobe and a pair of slippers, your toothbrush and hairbrush, the clothes that you intend to wear home, dentures, eyeglasses and/or hearing aides and, for all you nicotine addicts, an e-cig, since there's not a hospital in existence anymore which allows smoking ANYWHERE on its property! All of these things listed could, conceivably, fit into ONE decent-sized overnight bag! So WHY are so many of these folks bringing in multiple bags, including, in many cases, HUGE suitcases on wheels??? I actually HAD a recent knee surgery patient tell me, when I asked why she brought so much stuff with her, that she expected to remain with us for AT LEAST ten days!! This woman was, perhaps, one of the "innocents" who have no clue what Medicare and/or insurance companies allow...for a knee replacement, you'll only stay, at maximum, for three days barring medical complications, and that, only to satisfy Medicare's "qualifying hospital stay" requirements if you need a rehab facility afterwards. Normally, your average knee replacement is out MUCH sooner than that...usually only an overnight stay, or TWO days at maximum!

While I know that MANY folks actually LOVE being in the hospital and many hold "court" while placed there (when one thinks of it, it's a shame, really, that this is the ONLY time in their lives when many of them actually have visitors!), it's also apparent that many also know the "rules" of the game, i.e. that their insurance company will pay for "x" number of days for a particular surgery/diagnosis and that's it...unless, of course, one manages to "create" a "medical" reason to keep one there a little bit longer. I've had patients who've run up the thermostats in their rooms, cover themselves with multiple blankets, etc., in order to create an elevation in their body temperature that, to those less educated, might possibly pass as a "fever" in order to get themselves an extra day or two in the hospital, where they can continue to treat their nurses as wait staff and servants. It used to fool me, too, until I learned to check the thermostats in the rooms, pull off the extra blankets, get the patient OUT OF BED AND MOVING, get him/her to use his/her incentive spirometer (a most necessary instrument in pulmonary "toileting"), and THEN to re-check the temp! Amazing, how in at least 99.5% of cases, that temp will go back down to "normal" range within 15 minutes or less! I could go on and on, to list the multiple "complaints" that the average hospital "addict" will come up with in a desperate attempt to remain in the hospital for just a few more days, and someday, perhaps, I will. I'm convinced that there's a halfway interesting (but very cynical) book just waiting to be written about my nursing career; but you get the general idea. Sometimes, these folks just DON'T want to leave! They'll be noncompliant with their therapies and act seemingly "helpless," until such time as their Doc finally tells them that they need to think about placement in a "rehab facility" (aka "nursing home"), since there's no longer any "medical" reason to keep them in the hospital. It's always *amazing* (cough) when suddenly, they become MUCH more able and functional, and are usually out the door and on their way home by the time another day passes. I've seen that "miraclous" turnaround more times than I care to count which is, perhaps, why I've become such a jaded, cynical bitch in my old age.

There are many days when I question my cynicism and wonder whether I'm truly suffering from that "compassion fatigue" that we nurses are warned about. And then, I look at the number of surgical complications I've caught over the past several months that many more "complacent" nurses have missed, and consider the fact that I've saved a couple of lives and, in other cases, have certainly saved the "quality" of other lives (in two cases, at least, I've spotted symptoms of a lumbar hematoma in one patient and cauda equina syndrome in another, BOTH of which may well have resulted in the permanent paralysis of said patients if immediate intervention wasn't aggressively sought and obtained! Yes, I've awakened far more surgeons than I care to count in the past year!). Is THIS not some kind or "reward" for putting up with the "hospital addict" BS I've long learned to deal with??!!?? I think so. Yes, far too many of my patients are manipulative, attention-seeking a**holes who treat me as though I'm their personal "slave," and this DOES have a tendency to burn one out on the job. But the fact is, I STILL make a "difference." Not often enough, to be certain, but certainly often enough to know that my experience is still VERY much needed at my current facility and, until I manage to train a nurse (or two or three) on the finer points of spinal and orthopedic surgeries and the very REAL complications which can result from them (which is easier than it sounds -- most "new" nurses come out of school thinking that they know it all, already!), it probably ISN'T time to be changing my place of employment at ANY time in the very near future....

[yogi]

We have been hearing a lot about "big data" lately - the kind places like Facebook collects about it's users' activities. It boils down to statistical analysis that can be used to accurately predict such events as the weather. In the case of Facebook their date can be used to predict what you will buy the next time you ventured into a shop, be it virtual or bricks and mortar. The big data approach is said to exist today to the extent that it can eliminate much of what a doctor does to diagnose a condition. The good news is that this statistical approach removes any bias the doctor might have. Effective treatments can be easily prescribed by the same software, and that leaves the question of do we really need doctors anymore? Perhaps not in theory, but their creativity and personal presence can never be replaced by a computer database.

Insurance companies have been using statistical analysis since day #1. Actuaries earn big money by being able to predict profitable coverage policies. This is good news to people looking for affordable health care. But the down side is that insurance companies seem to be dictating exactly what that health care could and should be. It doesn't seem right that my health care should be a matter of some corporation's attempt to indemnify itself, but the sad truth is that only those people who can afford health care can get it. And it's insurance that makes it all affordable.

So, my gripe is with the sterile approach of statistical analysis and the cost/benefit arguments so popular today. The other side of this coin is what you have pointed out in your rant. Not every patient is a lovely ol' soul. Some need the attention and others are just out to cheat the system. I can see how it would be an incredible stress being a nurse in the middle of all this. It almost seems like a conflict of interests. It should not come as a shock to learn that health care providers also have a human side. In fact, despite the warnings, it's a good thing that they do have compassion, sensitivity, and ethics. It makes us patients all feel better and assures that you will not be replaced by a bunch of silicon chips with artificial intelligence embedded inside them.

[Icey]

Two good posts which I found interesting.

I personally know someone who'd have brandtrn pulling her hair out. This person has, for the past 25 years that I know of, deliberately put herself into hospital on every possible occasion, particularly during the winter months when she openly told me that it saved her a fortune on heating up her home!

She's been removed from doctors' patient lists on numerous occasions, but because our law says that she has a right to see a doctor, she keeps being moved from one medical establishment to another, no doubt making the said doctors irate and frustrated, but they're forced to see her and to try and diagnose the next trumped-up ailment. When nothing turns up, they remove her from their list and she goes back to somewhere else!

The worst one happened at the beginning of this year, but wasn't the first time this woman'd wangled a good stay. Under some pretence, she went through all sorts of tests and scans, and managed to "collapse" on two occasions when she was due to be sent home. Beds being scarce, she was put up in the hospital hotel (meant for close visitors of very ill patients), where she was forced to be frequently examined and put on a list to see a psychiatrist or some such professional. There, she received free meals and was doing "alright Jack", what with her en suite bathroom and free heating, etc. She managed to persuade those in charge that she wasn't fir enough to return home, and stayed there for almost 3 months - I kid you not!

Meanwhile, her time on the wards was spent in laying there with a pained expression and making demands on the nurses which were way out of order. I know one of her visitors, who said she was disgusted to witness what the staff had to put up with from her, and to their over-worked credit, they managed to keep their tempers. I'd have felt like throwing her out, but of course, they couldn't do this. It's the most extreme case I've ever heard of, but, I always think that karma catches up with folk in the end.

This woman's now been put on the waiting list for a hysterectomy. She's suddenly panicking, swearing that she doesn't need one, and saying that it's unfair! Hmm, well perhaps this'll teach her to fabricate and exaggerate her "illnesses". Not one doctor can find anything to substantiate her claims, and after years of playing the same old song, I hope it teaches her to respect the medical profession and shut her up for a bit. Sounds harsh, but in this instance, I think it's deserved.