Dr. gives deadline to smoking pts

rncountry · Mar 4, 2002

Mario,

It offends you that I called you Honey? Sorry!!!!! It simply is actually the way I talk when I am trying to lighten the mood. I have obviously touched quite a nerve with you, I was trying to explain myself and be nice, not be inappropriate or nasty.

I thought I was trying to nicely say what I will now say bluntly. You are not a nurse. You likely have not experienced watching someone not be able to breathe even on a vent, because their lungs will not oxygenate. Because they continued to smoke and smoke heavily, even after they had been on the vent and weaned not once but twice. Even after having a pneumothorax from coughing so hard. You have not likely experienced the frequent flyers who refuse time and time again to take any kind of responsiblity for their own healthcare and while they moan and groan expect you to wave a magic wand and make them all better. And be their private duty nurse while you are at it.

My comment to you was because of your "live and let live" philosophy. It is easy to have that when you have not watched what I have described or watched the mother of a 24 year old kid who died from a brain hemmorrage after being hit by a drunk driver lay in bed with him and sob her heart out. And that was the point I was trying to make.

The lady who died on the vent died while I was holding her. She was so scared, no family in yet though called. Normally you would give a patient like this morphine but she had declined hoping to be with it when her family got there, but they just didn't make it in time. Mario, when you hold someone and feel them breathe their last, and you cry when it happens, knowing that death did not have to be that horrid, then you come back to me and tell me live and let live.

rncountry · Mar 4, 2002

And mario, my teenage son is a great guy. You don't know it but being compared to him is not a bad thing. He is smart as a whip, funny, cultured and very well read. He can think most things though better than many adults I know. He has managed to juggle band, football, musicals and dramas, choir for church, youth group, working, friends and a girlfriend and still maintain a 3. 5 grade point average. He listens to the words in music and that is what makes it important to him. He plays trumpet in band as well as baritone. He plays electric and acostic guitar, self taught. It was your many references to music that made me think of the comparison first. So while it upset you to be compared to a young man, I am sorry. He is a wonderful, wonderful young man to be compared to.

mario_ragucci · Mar 4, 2002

You are all right RN Country nurse :-) Maybe you don't know, but I am going on 38. In response to your doubts about my experience, Mario has experienced EXACTLY what you describe. It was the WORST event (period) in my life, and I always feared it. The memories are vivid, till this day. It's been a few years, but life only gets better after that period in my life. And I say live and let live!!!!! Maybe you haven't seen the worst thing that can happen in your life, and your still afraid. Thats okay. Don't (even attempt to) say I haven't seen the worst. Don't. Maybe I am immune now, which is why I have a positive and free outlook.

Thank you for comparing me to your son, although I am >2x his age. He must be quite a guy, someone you love very much :-)

Perhaps, one day, if you die of an illness, your son will be with you all the way, because he loves you very much. Some sons stay with and care for their parents when they are ill, and dying, and they see, feel, and remember the kinds of things you don't think I have ever seen. RN's are not the only people who see life/love become death. Careful wichaw assumptions now :-)

Life gets better, everyday :-) So let folks live. Let folks enjoy their life. Thank you. :-)

rncountry · Mar 5, 2002

Mario, I used to work Neuro-trauma ICU. I have seen many horrible things. The guy who was scalped after having the crap beat out of him. The woman who was attacked, raped and left for dead. The drug dealer who was shot execution style, and lived. The father of 3 who tried to kill himself and managed to blow off the bottom part of his face instead. The newlywed who hit a patch of ice, rolled his truck, went out the side window(no seatbelt)and had the truck roll over on his head. While cleaning him up I actually ended up with his brains in the washcloth because they were leaking from his ears. Some of these people I will never forget. It isn't fear that bothers me. It is the intense sadness and anger that the family left behind has to deal with. Once upon a time I thought a semi was going to hit me head on, I had an intense moment of great fear and then the most peaceful sensation that I couldn't begin to describe. I have never feared dying since. To me the worst thing in the world would be for one of my kids to die. I left ICU when I was consistantly having nightmare's about my kids being on vents. 95% of my patients were vented. But it is not fear of maybe the worst thing, it is an very strong belief that people should be responsible for the choices they make in life, to not say "I can't, it's too hard" because can't never did nothing. And especially a belief that one should not expect someone else to do what you should and could do for yourself. Helping someone is one thing, carrying them is something else.

Went to work today to find someone there that has been with us two times before. The second time he left AMA because the doc had cut off his narcotics. He is there with a flap to heal a massive decub. Again. He is paraplegic because he rolled his car while drunk driving and running from the cops. He refuses to be compliant with therapy, is an active herion addict, you would not believe the pain med he is on now(different doc this time around) and guess who is paying for all this? Medicare. He is after all disabled from his accident and therefore qualifies. He is so noncompliant that he literally cannot find a doc in Kalamazoo to take care of him. So now he is making the rounds of the docs in Battle Creek. Neither hospital in Kalamazoo is willing to admit him again. It is patients like this that I say there is simply a point where enough is enough. Dr. Ross felt that way after he took care of a lady with lung CA who then went back to smoking. I just can understand the sentiment. How I wished I did not need to take care of this guy today. I do wound care now, and this is the third time around for the same area because he simply will not be compliant with his particular needs. To me it is a waste of my time, a waste of the healthcare system and taxpayer money. This patient has gone the gambit of psych care too. I may sound harsh, but it is frustrating at the max to have to spend my time with a patient who doesn't give a rip whether they actually get better, when I have one down the hall that needs me too but wants to get better and go home.

Mario your ok too.

mario_ragucci · Mar 5, 2002

My brother feels like you do. These are YOUR frustrations, and you are absolutely entitled to them. Should they effect the care you a person is also up to you. People go round and round with this. Sometimes, its even a religious belief that can get in the way of proper treatment, among others.

Mario cares for everybody, not even a smidge of judgement would pass my hippocampus when it comes to anyone needing my care. Well, there would be exceptions (to everything) but you know what I mean. Mario also says "live and let die." This topic is some can of worms, huh. JMP had to get the can opener going :-)

**canoehead, BSN, RN** · Mar 6, 2002

Geez, if you are a nurse with PTSD please go get counselling, but don't put down other people's opinions because they haven't gone through what you have. Everyone has gone through something, and we all deserve respect. So if Mario requests you address him a certain way either do it or don't, but don't try to get all righteous about it.

It's so frustrating when these debates get bogged down in one or two people trying to prove that their opinion is more valid than the other's, for whatever reason. There is no law that says there has to be ONE right answer to every question, variety and different points of view are what makes the world interesting.

JMP · Mar 6, 2002

Well, we certainly have managed to get way off topic. Typical. Mario, why do you insist on refering to yourself as though you are talking about someone else? "Mario thinks this.....Mario thinks that".

I wonder how long it has been for most you ( Mario this might not have even happened yet for you) since you sat in a class and understood what happens when people smoke. Smoking is a known carcinogenic, and if you think about to nursing school and remember those lectures about smoking, I hope it will all come back to you. I believe ONE of roles as health professionals is to prevent people ( kids) from STARTING to smoke. That is KEY. It is a uphill battle, kids think they are going to live forever. Change is slow to happen, but that does not mean we should give up, roll over and let the " lie and let live" types take hold.

Prevention is key. Yes, we need also to talk about healthy diet choices, moderation when using alcohol, getting regular excercise. Lets not give up the fight to save our young ( and middle aged and older) pts from the pain and suffering of the long term effects of tobacco.

I posted Dr. Ross's stand so perhaps we, as health professionals, could exam our own ideas and perhaps long held beliefs about smoking. We can not give up. I believe we can win the battle, one person at a time. Dr. Ross, as I have read in follow up stories, has an obligation to find his smoking pts ( who do not wish to try to quit) another Dr. So it is not abandonment.

If you care about your fellow man, fellow health professionals, whenever possible, encourage pts to quit, young ones not to start and commend those who do not, or have quit smoking.

mario_ragucci · Mar 6, 2002

JMP - I grew up in America, and went to school in AMerica. In America, all grade school students are educated about smoking, how it damages, and so on. In fact, they even have eloborate models that show you what a lung looks like after it smokes. If you think your enlightening anyone...your not, but I commend your words. You don't hafta to make it into an RN program, then complete 2 years of study, to be privy to smoking/health related information/issues. Right?

In answer to your query as to why I use first and third person when talking about myself, well, I like to. I know it can disturb some people. I just am copying another person's style because I am not the first, or the last person who will use third person. It's like, I can have an out of body experience, without leaving my body :-) Try it.

micro, RN · Mar 6, 2002

:( I have been holdin off replyin here because this is another soapbox of mine.....no not this dr. but this mindset of SUPER HEALTH CARE PROVIDERS :rolleyes:

YES,I am a nurse and have been one for a few years........there are nurses I have worked with less skilled from me and many, many, many that I have worked with that I want to sit at their feet and take lessons from the masters.....both technical and caring skills.........BUT I AM A NURSE AND I am also a person.........

Oh my goodness.....this elderly gentleman shouldn't receive any further treatment for his sleep apnea and heart condition because he used to smoke like a fiend and still bit overweight.......he is not swimmin the channel every day.........

bonk to that.....you could be talking about my dad!!!!!!!

Gee, this patient doesn't have any insurance.....and he smokes.....if he has money to smoke, when why?????????

bonk.........not my place to judge.....my place to nurse........

gee, this lady still doesn't get it.........if she would just...........

bonk to that.......you could be talkin about me!!!!!

we are in health care to help with people's health and lives.....not be their judge and executioner.........unless maybe I missed it.......

when I took my boards and continue on with my CEU's I missed the part that said must be superhuman with no faults whatsoever.............

thk goodness my PMD accepts me for patient warts and all!!!!!

let alone my parents.........

hey, I feel flattered.........60+ here and I love the beatles music and then much, much more.........tehehehehehehe

Let it be!!!!!!!!! Let it be!!!!!!! Whisper words of wisdom!!!!! Let it be!!!!!!!!!

so to end: smokers quit or cut back, drinkers quit or cut back, overweight lose weight, underweight gain weight, diabetics control your diabetes, heart conditions do what told, if you have dx of mental illness--you are more than the diagnosis---just do what you need to do, if you haven't had sex and you are teen, don't and if you do use a condom>>>>>>>>>oops opened a whole nother can of worms here didn't I.........

teach and educate yes............. judge and excommunicate no

care............. micro always learnin and acceptin and most of all acceptin self(micro self) first......

perfectionism-----not all it is cracked up to be.......micro knows.....it leads to migraines, ulcers and .............and then the perfectionist isn't doing enough to be perfect.......vicious cycle.......

rather be micro and nurse and care about patients and people

live and let live all,

micro

micro can't shut up.......

1) teach, help, support encourage patients and families.....

2) teach, help, support each other..........

and yes, I have seen much.....in my nursing career and in my life as many here have..............

sorry all for bit of micro usually pretty chilled;)

mario_ragucci · Mar 6, 2002

JMP - tell me - would you care to comment about eugenics?

Should we prevent people with the "live and let live" gene from having kids? "Prevention is key" so, shouldn't we be preventing?

micro, RN · Mar 6, 2002

eugenics.....yiikes.....then micro wouldn't have been born.....

sorry, JMP, micro doesn't know micro's place,

this ??? directed your way.......

isn't discussin "fun"

JMP · Mar 6, 2002

Mario

Actually, no I would not care to comment on it. And for the record when I made the comment about regarding smoking and classes, I was NOT talking about what they teach you in high school for God's sake! I was talking about the medical side of the topic. Prevention is key, as I have said before. I have taken a philosophy course, and if I remember correctly, it was in 1999, and your comments would be well directed to someone, not me, who is interested in such philosophical questions. Since philosophy is not simmply concerned with telling us what to beleive but rather considering the reasonableness of various possible beliefs. Maybe you should change your mind regarding RN education and find out more about philosophy. Your comments ( and not just this recent one) tell me it might be right up your alley.

I stand by my comments that we should SUPPORT pts who want to quit smoking, encourge smoking pts to TRY to quit ( usually takes 4 or 5 times) and TEACH young pts not to start. Radical? Not in my view.