Drive Thru ER?

Over at the Wall Street Journal Health Blog, there's a post about one way to keep contagious people from swapping spittle around a crowded waiting room -- a drive-thru ED. The idea is that people could be triaged and treated in their cars in the parking garage rather than coming to the ED. Lot's of questions about how this would work, but seems like a pretty great idea in terms of flu like symptoms ... which, frankly, will be hard to treat. In fact triaging out the really sick people is likely to be our hardest job once swine flu hits with full force this fall.

By the Way: Read the latest about swine flu here: http://www.cdc.gov/H1N1FLU/

Nurse Jackie, Flawed Nurse, Good Show

"The Truth About Nursing" has a different take on "Nurse Jackie" as well as a more detailed analysis than my visceral reaction. Their conclusion:

On the whole, Nurse Jackie has the potential to alter the public image of nursing more profoundly than any Hollywood show of recent decades. Even on ER, by far the best major show for nursing so far, the profession was never more than an occasional supplement to the real action, which was dominated by the heroic physician characters. But Nurse Jackie is an unusually compelling, witty character who works at center stage, dispensing expert physical and psychosocial care, saving and endangering lives, raising nurses' and physicians' level of play, deceiving herself and those who love her, making dubious moral choices--and presenting a radically different vision of what a nurse is.

Read the full review here: Nurse Jackie: Henchman of God

Nurse Jackie Review

For a while I've been waiting for a decent TV show that shows the world what nursing is really like. Nurses deal with so much on a daily basis, you'd think it'd be a cinch to come up with a drama where nurses are intelligent professionals, not bed-pan changers and foils for genius-doctor's frustrations. Shows like "House" eliminate nurses entirely, while most other doctor-driven series give us doctors doing many of the jobs that nurses do every day. 

So when I saw "Nurse Jackie" advertised, I decided to give it a chance. Edie Falco certainly looked like the ED nurses I work with (aside from the tight-fitting designer scrubs). Maybe she'd be a modern cipher for modern nursing. We need such a person to give the world a window on the demanding and challenging profession of modern nursing. 

Alas, she's a foul-mouthed, pill-popping, ethically challenged, cheating-on-her-husband "saint."  In other words, in an effort to smash old stereotypes about nursing, the writers have gone to the opposite extreme. This could have worked, but I couldn't help feeling that the writers are being lazy.

There's an old joke among writers. Whenever you see a quote from Webster's Dictionary leading off a story, you know the writer has run out of ideas and stopped trying before the first word. 

That's the impression I get from Nurse Jackie.

In an effort to try to make the lead more "relatable" and human, they fell back on old crutches - drug abuse, infidelity, moral ambiguity, questionable ethics. Instead of the "Hooker with the Heart of Gold" the new  cheap plot driver is a outwardly respected lead character with a multitude of sins -- "Saint with Skeletons in the Closet." Load up all the vices you can think of and you'll have lots of plot lines for future episodes. Particularly for female leads, this seems to be the easiest way to make the protagonist interesting. TNT's got a lot of these shows right now. 

Oh, and the only male nurse is gay. Gee, didn't see that one coming.

Don't get me wrong, I'm all for showing the ethical challenges of medicine and the human side of women professionals ... but why do they always have to be drug and booze addicts? Why does every strong married woman have to be cheating on her husband? Aren't there plenty of challenges in the nursing profession without trying to embody all the worst traits in the lead character? Here's a plot twist, show a hard-charging female professional with her act together. That'd be a something new! I work with and know a lot of these women. I don't know how they Hell they do it.

Other problems with the show? They appear to be working an a converted church or museum instead of a modern hospital. I work in a Catholic hospital -- the daily prayer is piped into all the rooms -- and I can tell you that there are no 20 foot tall murals of tortured saints covering the walls. Sure there's a chapel and a giant cross in the lobby but the nuns don't giggle and tour through the ED in their habits pointing at patient's genitals. 

There are plenty of details to make your eyes roll too -- the trauma patient in a soft-collar was a joke, right?Just a way to telegraph how little the writers know about their subject? No head to toe trauma assessment? Trust me you can still kill 'em tragically in lots of other ways. 

 And where are all the other nurses? It's a busy ER and there are no techs? No wonder she's working 80 hours a week! You'd think that after years of ER, a big budget show would at least one or two technical advisors to help get the simple things right.

Anyway, the show is a good opportunity for Edie Falco to get attention for her dramatic abilities. I'm sure she'll win an award or something. Sadly, we'll still be looking for a modern representation of a modern nurse on television. Apparently there are a number of shows in development, so I'll skip Nurse Jackie and keep looking.

Also see the Emergiblog's review of the show.

A Cheaper Alternative Than the ER

What would you think if I suggested creating subsidized housing for chronic alcoholics? When this was teased on the news the other night, my friends all groaned, but I pointed out "you're already housing them in the ER and paying for it." There's got to be a cheaper, better way.  Now this from the Seattle P-I: 

A  study published Tuesday in the Journal of the American Medical Association and led by a University of Washington researcher, found that the once-controversial 1811 program -- which provides housing and services without demanding sobriety -- saved taxpayers more than $4 million in one year.

"It was perceived that we were opening a party house where people could drink and run amok and generally set their hair on fire," said Bill Hobson, executive director of the Downtown Emergency Service Center. The agency opened the home in 2005, after years of protests.

"This research shows that this is not the case."

Researchers followed 95 chronically homeless alcoholics, who, before moving into the home, had run up a taxpayer bill of $8.2 million in hospitalizations, emergency services, jail time and sobering center visits.

After one year of being in the program, the same group cost taxpayers only $4 million, the study found. Each resident also drank less the longer they lived in the home, and their toll on publicly funded programs decreased as time went on.

"One of the overwhelming sentiments was just how much better life was at 1811," said Mary Larimer, a UW professor of psychiatry and behavioral sciences and lead author of the study.

"Certainly, it is much easier (to change) when you are not cold, hungry and scared, and have a few meaningful events in your life."

Larimer also compared residents against a control group of 39 homeless alcoholics on a wait-list to get into the home. She found that the residents, after six months of being in the home, cost taxpayers 50 percent less than the wait-listed group.

The research represents the first controlled study to look at the Seattle program, which is part of a national model called "Housing First," in which people can live in subsidized homes and get services without having to give up drinking or attend treatment.

Read the Full Study

Medical Music

I've been listening to more music now that I've left the podcasts about the election behind. When I first started in nursing I collected a bunch of songs that had medical themes or classic lines referring to medicine. Here's my current playlist:

Doctor My Eyes by Jackson Browne
Only the Song Survives by John Hiatt
Novacaine by the Eels
Sample in a Jar by Phish
Handshake Drugs by Wilco
Everybody Hurts by REM
Don't Give it to Me by the Proclaimers
Limb by Limb by Phish
Shot in the Arm by Wilco
Your Misfortune by Mike Doughty
My Eyes are Disconnected from My Body by Maestro Echoplex
Dead by They Might Be Giants
Hospital Bed by Ben Kweller
I Only Pray At Night by John Fulbright

Shadows in the Rain by Sting (mostly for the line "woke up in my clothes again this morning, don't know exactly where I am. I should heed my doctor's warning, he does the best with me he can."

I know there's more out there. Any suggestions?

Errors in Oncology

A new study shows that medication errors
are common among children and adults taking chemotherapy drugs at home or in
outpatient clinics.
Researchers reviewed records of nearly 1,300 patient
visits at three adult oncology outpatient clinics and 117 patient visits at one
pediatric facility between Sept. 1, 2005, and May 31, 2006.
They showed that
7% of adults and 19% of children taking chemotherapy drugs in outpatient clinics
or at home were given the wrong dose or experienced other medication
mistakes.
The study, published in the Journal of Clinical Oncology, calls for
improved communication to cut down on errors it describes as "high" in adult and
pediatric cancer patients.

Calculating chemo doseages is tricky stuff -- not just based on weight but on
current lab results, concentrations and clearances. I used to help the chemo
nurses do it for a dozen outpatients ever week -- scared the heck out of me.

Yes WE Did!

It was a creed written into the founding documents that declared the destiny of a nation.

Yes we can.

It was whispered by slaves and abolitionists as they blazed a trail toward freedom.

Yes we can.

It was sung by immigrants as they struck out from distant shores and pioneers who pushed westward against an unforgiving wilderness.

Yes we can.

It was the call of workers who organized; women who reached for the ballots; a President who chose the moon as our new frontier; and a King who took us to the mountaintop and pointed the way to the Promised Land.

Yes we can to justice and equality.

Yes we can to opportunity and prosperity.

Yes we can heal this nation.

Yes we can repair this world.

Yes we can.

We know the battle ahead will be long, but always remember that no matter what obstacles stand in our way, nothing can stand in the way of the power of millions of voices calling for change.

We have been told we cannot do this by a chorus of cynics...they will only grow louder and more dissonant ........... We've been asked to pause for a reality check. We've been warned against offering the people of this nation false hope.

But in the unlikely story that is America, there has never been anything false about hope.

Now the hopes of the little girl who goes to a crumbling school in Dillon are the same as the dreams of the boy who learns on the streets of LA; we will remember that there is something happening in America; that we are not as divided as our politics suggests; that we are one people; we are one nation; and together, we will begin the next great chapter in the American story with three words that will ring from coast to coast; from sea to shining sea --

Yes. We. Can.

--Barak Obama, New Hampshire, January 09, 2008