It’s an oldie (from 1980), but a goodie: John C Grammer’s Living Arrhythmias – an unfortunately soundless video showing ECG activity demonstrated through dance.
Check out the sequence from about 4min 20sec.
Astound your colleagues on night duty with your knowledge of cardiac electrophysiology by busting a move!
Honestly people… If I tell you to stay still while I perform an ECG on you, and if I specifically say “don’t move”; this is not an open invitation for you to jizz around in the bed like you’re auditioning for So You Think You Can Dance.
The look on the patient’s face suggests that he is not entirely happy. The bulge in his pants suggests otherwise…
Call me paternalistic, but the people in the bed (or on the trolley) that I am charged with looking after are my patients.
They are are not, as far as I am concerned, “clients” or “consumers”. To me, these labels are pissy PC labels that unknown wankers have decided are more appropriate; designed to give patients a sense of control in what is otherwise an alienating system. By labeling patients in such ways, it gives the sense that they are somehow customers who have the ability to pick and choose the type of care and the place that they recieve it. It gives the sense that such “consumers” are empowered to make the sorts of decisions about their health akin to those made when going out and making a consumer purchase like a TV or lounge suite.
Now granted, in the Australian context, if you’ve got private health cover you have the ability to choose your doctor. But really, unless you really know anything about the doctor you choose, and about the implications of choosing them over another doc, this really doesn’t mean much.
Then, I begin to wonder. Should we treat our patients as consumers? Check their credit before dispatching an ambulance, as in the novel Jennifer Government?
I’ve looked after a lot of lovely people. But given the number of complete tards that I have nursed, I can assure you that “the customer is always right” does not cut the mustard with me.
I guess my biggest objection to such terminology is the idea that such labels mean that patients are somehow falsely empowered with the notion that they truly have choice and control over their “health transaction”. The drunk guy with the sub-dural that comes through the doors is incapable of exercising his consumer power – he needs to be cared for. Little Esme who has tripped over in the garden and done her NOF isn’t in hospital to shop for a new hip, followed by a coffee and boob job. She is there to receive medical attention and be cared for. I look at the patients that come into ICU and do not see a single one who is there out of choice, or who is capable of shopping for a treatment in their size & colour.
When I look after someone, they are my patient.
When I am sick, I would rather be someone’s patient, than their customer, consumer, or client.
And as if these terms didn’t irritate me enough, now there appears to be “guest”. WTF? That’s right. I came across this one recently in a journal article:
Reishtein, J. (2005) ‘Sleep in Mechanically Ventilated Patients’, Critical Care Clinics of North America, vol.17, pp251-255.
Hospitals are infamous as places where people cannot sleep, and critical care units seem to be the worst offenders in denying thier guests rest and sleep.
I don’t want to be looked after by a doctor or nurse that thinks of me as a “guest”.
I wonder whether the doorman, concierge, or manager at the next hotel/motel/resort that you stay at will have as much concern/responsibility for the the health & welfare of you, as their guest, that a doctor or nurse has for their patients.
Somehow, I think not…
Even before he opened his mouth, it was obvious that he was frightfully British. He and his wife were wandering in the hallway near the library and were obviously lost.
“Excuse me”, I said. “You look lost. Can I help you?”
“Why, thank you” he said in the voice dripping with gin & tonic, stiff upper lips, and the majesty of the Empire. He turned to his wife and continued, “here we are Margery, this young doctor will steer us in the right direction.”
“Actually sir, I’m not a doctor. I’m a Registered Nurse. But that aside, where are you heading?”
“Well young man, we are looking for our friend who is a patient. The poor chap has broken his hip. Could you please direct us to the encyclopaedic ward?”
“The encyclopaedic ward?” I asked. “Are you sure you’re not after the orthopaedic ward?”
“No, young man. I am quite sure that he told us to come and visit him on the encyclopaedic ward.” He turned to his wife, “Isn’t that right, Margery? Yes, I am quite sure. The encyclopaedic ward, if you please.”
As I pointed down the hallway towards the library entrance, I said, “Sir, I believe that you’ll find the entrance to the encyclopaedic ward just down there on your left. Now, if you’re unable to find your friend in there, may I suggest taking the lift to level 2 and looking in orthopaedic ward.”
I should point out that one of my pet hates is when people leave urine bottles on bedside tables. It makes me get all Bruce Bannerish. Seriously, who in their right mind would want a bottle of pee left where they eat. It’s just poor form – use a bottle hanger instead.
And no, I have no idea why someone would be drinkng from a urine bottle…
I’m deliberately not watching the news today, as the phrase “Our…” as in “Our Nicole”, “Our Kylie”, etc makes me want to puke. I could do without the queasy feeling that will come with hearing “Our Heath” over and over again in reference to Heath Ledger’s posthumous Oscar win.
Despite all the hype of the Oscars, another awards ceremony has taken place; and I have been honoured with winning the inaugural 2009 Australian Medical Blog Award.
There are a few thank yous that need to be made.
Firstly, thank you to everyone that voted for prn penguin. It’s a strange feeling to realise that people actually read what I write. After being inspired by ImpactED Nurse, I had originally started writing simply as an exercise in reflective practice, with no expectation of any audience.
Thanks also to DrCris at AppleQuack for putting the whole awards thing together.
Finally a thank you to the other medical bloggers out there. This award process has opened my eyes to a few Australian blogs that I was unaware of. Now I’ve seen some pretty self-indulgent, crappy blogs before – honestly, who gives a rat’s arse about your back porch renovations – but there are some great health blogs out there. Some offer humour. Some offer education. Some offer insight. I personally enjoy the ones that offer all three.
So in celebration of my glorious victory, I’d like to turn the spotlight on what I consider to be some of the best bits from my fellow Australian health bloggers.
ImpactED Nurse
My favourite blog, and what I personally consider to be the best medical blog in Australia. Yeah… if there were an ImpactED Nurse fan group on Facebook, I would have probably joined… Some of the best bits:
The Dragonfly Initiative
This one is written by a medical student. Some of her pearls are:
Outback Ambo
I’ve got a lot of respect for ambos – this one is a Territorian:
Aeqanimitas
Critical care & toxicology. There’s lots of interesting stuff here, especially if you are interested in jellyfish and other marine nasties. I personally can’t go past A picture worth a thousand words… VI
It just tickles my fancy in a way that keeps me smiling.
Degranulated
A timely story about a youngster’s introduction to the world of medicine. Timely in the sense that a patient of mine was grossly O-sign positive the other night. When the docs asked me how he was, I let them know. I was advised to notify them if he became Q-sign positive. I instantly thought of Degrannulated’s post…
Life in the Fast Lane
I’m a visual person. I like pictures. This ED doc’s blog has some quite interesting articles, but I can’t go past the imagery:
Nurse in Australia
I only discovered this one the other day. Check out:
And finally, I offer what I consider to be my better posts:
So thanks for reading and thanks for voting. I hope I can continue to write something worth reading, and hopefully make it look more presentable with my award prize.
It’s the same story, over and over again. Someone is admitted to hospital. They have abused their body for years. They are broken. And they and their families expect us to fix them and magically undo the damage that years of neglect have caused (or at least majorly contributed to).
The obvious examples are the smokers who come in with cancer, or with problems breathing; the alcoholic who has smashed their liver or pancreas; and the DKA admission who does nothing to manage their diabetes and continues to chug full-strength Coke by the litre. Or the 160kg patient who requires a bariatric bed and 6 people to roll them, who’se normal diet would make Morgan Spurlock look like a health nut.
Do these people know that they are making poor choices? Do they have any idea of the health implications?
Some wouldn’t. Some would.
If you did know, why wouldn’t you do something about it?
The answer is disturbingly simple: because it is hard. Anyone who has tried to make major lifestyle changes like giving up smoking, exercising more and eating healthier will attest to this. Changes like these – getting your “2 & 5“, kicking the fags, and giving up drinking, are all hard. Very hard. Too hard for many. I would argue, too hard for most.
I have a lot of respect for those that are able to make these changes. Which brings me to another ICU nurse,The Hungry Addict.
The first entry on his blog is as follows:
Welcome to my Blog. I am a 36 year old fat guy who is about to embark upon a journey to change my diet, lifestyle, and emotional state. I am an addict. This is no joke. My drug of choice is fast food and fried anything. Nothing relieves the stress of a bad day more than a greasy double cheeseburger and some hot salty french fries. And I eat this sort of food everyday, usually two to three times a day. A buddy at work has commited to be my personal trainer and dietician for the next 12 weeks. I am reluctant to abandon my old ways. I have been diagnosed with Metabolic Syndrom X. This syndrome comprises some of the following traits: abdominal (or visceral) fat, low HDL cholesterol levels, high triglycerides, and hypertension. I decided to have a coronary calcium scan. The scan showed calcium deposits in the LAD and circumflex, two large coronary arteries. Faced with this increased risk of early demise, I have signed a contract with this friend to commit to his program. I don’t want to abandon my wife and children to heart disease. I have let down all pride and posted pictures of my fat ass to set a baseline. At the end I shall, hopefully, post pictures of a healthier me. Thanks for following. I hope to become an inspiration to someone out there.
This guy is essentially attempting to do what many should do, but are unwilling or unprepared to do. He is trying to change his eating and exercise habits. He is trying to lose weight and reduce all of those risk factors that combine and conspire to put you in a hospital bed or in an early grave.
Will he succeed? I don’t know. I hope he does.
Will he inspire others?. I hope so. I personally am now been compelled to question whether I really do want that delicious, bubbly can of ice-cold Pepsi, or whether I want the healthier choice of cold water.
Whatever the outcome, you can follow his progress here. Good luck, Hungry!
Years ago, after the wetness behind my ears had started to dry, I decided to do a couple of agency shifts to earn a little extra money. Apart from the extra cash, I also gained an appreciation for my normal workmates and for my normal workplace.
My very first agency shift was the shift from hell – a carnival of WTF moments that made wonder if someone was playing some kind of joke on me and if I was being filmed. It was a shift that would end with me refusing to ever work in a particular hospital again; and questioning how it is that private patients really think that they get superior care in private hospitals.
I arrived on the medical specialty ward and set out to find one of the nurses to introduce myself and find out where I could stash my bag.
There were no nurses to be found. This was, in hindsight, to be an ominous sign…
After checking the entire ward, and knocking on a few doors, still no staff. So I went and waited at the nurses’ station. An orderly came along and asked me if I needed anything. I explained to him that I was the angency nurse for the afternoon and that I couldn’t find any of the nursing staff.
As it turned out, neither could he.
This was not good…
So the orderly decided to show me around the ward and point out the pan room, treatment room etc and how the call bell system worked. He showed me were I could leave my bag. Still there no nurses to be seen.
After the tour was over, I asked him where I could find the emergency trolley. He had no idea, and told me that I would have to ask one of the nurses.
I would, of course, have to find one first.
Finally a nurse appeared. I introduced myself. Her response was less than reassuring; showing the same flaccid interest that would be expected from a room full of blokes forced to watch feminine hygiene commercials. I asked her what I needed to do.
“I don’t know…” was her response. The shrug of her shoulders thruly was the icing on her cake of apathy.
“O…K…”, I was trying so hard to be pleasant, “can you tell me where I could find the emergency trolley then?”
“The wha’…?”
Oh my god, she was a dopey one.
“Can you tell me were your emergency trolley is?”
All I got was a blank look. I continued. “Your emergency trolley, dear. Crash cart? Crash trolley? The defib?”
A lightbulb went off in the dim recesses of her head, “Oh… that…”
“Yes. That. Where is it?”
“I dunno.”
The blank look of ineptitude on her face made it perfectly clear that she was, indeed, serious.
I left her and tried to find someone who had some idea of what they were doing. I found someone. Or so I thought. “Hey there. I’m Penguin. I’m your agency RN for this evening. Can you tell me where I could find the emergency trolley?”
She looked me up and down and replied, “You’re gunna haff to speak to Rhonda – she’s in charge.”
“OK… where can I find Rhonda?”
“I dunno.”
I could see a pattern forming… “Well, while we wait for Rhonda to appear, could you tell me where the emergency trolley is?”
“The what?”
“The emergency trolley… the defib?”
“Ohh… naaah…” was the response.
I was certain that this had to be some sort of joke. “Do you normally work here?” I asked. She did. And aparantly it was not of any concern to her that she didn’t know where the emergency equipment was.
At this point the delightful Rhonda appeared. Introductions were made, and before we could discuss allocations, I wanted to know exactly were the Packer Whacker and all the emergency goodies were. I asked where the emergency trolley was kept.
“The what?”
God fuck me dead, it was Groundhog Day. “The emergency trolley, Rhonda. Where do you guys keep your emergency trolley/crash cart/defib? Where, exactly?”
“What do you you want that for?”
As my right eyebrow soared into orbit, I tried to remain as diplomatic as possible. “Rhonda, in the interests of patient safety, I need you to show me exactly where I can find the emergency trolley, should it be required for an emergency this evening.”
“Oh, it’s down the hallway somewhere.”
“Rhonda, I don’t mean to be obtuse, but your use of the word somewhere does not fill me with confidence. Show me exactly where it is kept.”
You’d think that I pissed in her corn flakes by making her amble down the hallway.
“I think it’s in here”, she said as she opened up some sort of utility cupboard.
No darling, that’s not it.
Nor was it behind door number 2.
“You can’t be serious…” Oh, but she was.
Third time lucky…
I stood there wide-eyed, shaking my head. As politely as possible, I let dear Rhonda know that it was totally unacceptable for all three nurses on a ward – especially the Nurse-in-Charge – to have no idea of where the emergency tolley was kept. I couldn’t believe what I had just seen. In the back of my mind was a little voice, saying “eject eject eject”. Part of me thought that I should have just pulled the pin and refused to work in an area that appeared thus far to be hopelessly unsafe. The other part thought that I should stay for the sake of the patients.
I decided to stay. I wish I could say that things got better.
They did not…
Voting for the 2009 Australian Medical Blog Awards is now open over at Apple Quack. You can vote for your favourite Australian medical blog here.
I have been privileged to be nominated in the short-list of 5 finalists which are:
So check out the competition, and head over to here to cast your vote.
As I couldn’t vote either of my favourite Australian medical blogs (ImpactED Nurse & The Dragonfly Initiative), and because I thought it poor form to vote for myself, my vote went to Aequanimitas. If the videos about homeopathy don’t tickle your fancy, maybe this will.
Remember that, unlike in the United States, voting is compulsory in Australia. So go and exercise your democratic blog reading rights and vote before the polls close on 20 February 2009.
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