MKFaizi

Replying to the post from Chuck: This woman was a physician? For real? Not some psycho off the streets? I mean, my grandma -- no offense to my grandma -- wonderful woman -- could have done a far better job delivering that poor baby than that so called doctor. My grandma at the age of ninety five could have done a better job than that so called doctor. Thank God, I am past child bearing age. If I ever have grandchildren coming into the world, I am going to advise them to get a nurse midwife or somebody. Such barbarism. Childbirth should be -- SHOULD BE -- and can very well be - a good experience. It should never be a tale of horror. I am disgusted by the tales in this thread. If I was pregnant and reading this, I reckon I would go on out to a field and have my baby by myself. I mean, darn. Does anyone ever attempt to advocate for a peaceful, non-medical childbirth? Does Lamaze still exist?

My fifteen year old son is going to take the nursing course in high school this year. They learn quite a bit there. I hope he goes into nursing. My daughter is also interested in being a RN.

Congratulations, nurseinthemaking. Being in school is kind of like being pregnant. You give birth when you graduate. Then, you have the task of raising the child. Takes about twenty years to reach maturity. Please do not take that the wrong way. New nurses are like new teachers. Fresh blood is always welcome, I think. Experience and freshness is a good team combination, if people can be open minded. Good luck in your career. Coincidentally, I had a couple of nurses as patients today. One was a very experienced RN just returning to work after having four kids. The other was a RN student in her late thirties who will graduate in May. We spoke about the torturing process. Most nursing skills are learned on the job. School is just a test to see if you have the guts. My first training was in the army. We had zero practice in giving shots. We spent one morning reading about how to give shots. That afternoon, we gave shots to each other. We were our own dummies. I learned to draw blood and start IVs working with an anesthesiologist. No one ever showed me how. I just had to do it. No dummies. No oranges. No rubber arms.

Then, take the advice of the other nurses and show up at the office and get your blood results. A B12 deficiency can be determined from a CBC or a B12 blood test. I do not think that it was frivolous of your doctor to do an autoimmune check. But Lupus and Scleroderma and rheumatoid arthritis are difficult to diagnose. Many people with an elevated ANA are still not diagnosed with an autoimmune disease. In my estimation, not much has changed in rheumatology since the seventies. Of course, my estimation is basically a layman's estimation. My first husband nearly died from an acute onslaught of Systemic Lupus before he was diagnosed in 1978. He ran high fevers and lost about fifty pounds. Got down to about one hundred twenty pounds at five foot ten from one hundred sixty pounds. But my gut instinct tells me that it is doubtful that you have that but it was still a good idea to look at it. I am sorry that you do not have good insurance. Unfortunately, it often takes a lot of time and a lot of testing to get at the bottom of a physical problem that is not obvious on the surface. Have you had an ultrasound or CT? If the practice is really that bad and that unresponsive, you do need to show up in person and ask nicely but firmly for copies of your blood tests. Going there might be a pain but it is better than continuing to call and to get robot-ed around. Get your blood test results and go to the other doctor.

Interesting topic. No, I do not believe in passing judgement on people in a harsh and bitter way. Addiction itself is a sickness. I have compassion for addicts. Coincidentally, our first patient today was a chronic pain patient I have known for years. He was actually bringing someone else to be seen. He had broken her foot when he fell on her. He had a very hard time getting out of the car. Staggering and reeling. Walking with his eyes closed. It was very bad. Very, very bad. He was driving. He could barely walk or talk. We hated to do it but we actually notified the police because we figured someone in that shape might kill himself or other people on the road. The cops never came, even though the station is very close to the office. When they left, the woman had to fight her way behind the wheel to keep him from driving. But he was driving this evening -- to get crutches for the woman. I called the cell phone and he answered. Sounded bad. Very bad. I just hate to see someone in that shape. The woman asked for stronger pain med than Motrin. Wanted Percocet. We gave her Darvocet. Just a bad situation. I had a very good friend die from an overdose of Oxycontin a few years ago. Chronic pain patient. Good guy. He kept his medicine out in his shed and that is where his eight year old daughter found him -- dead in the shed -- just like that. He was lying on the trampoline. She thought he was asleep even though he had foam at his mouth. She was a kid. She had no idea. He had taken oxycontin for years -- never exceeded his allotment but he could not function without it. Without it, all he did was lie on the sofa. With it, he could work on computers and do things with his kids. Then, he stopped taking his Prozac and blood pressure meds and started hoarding the oxycontin. My son went with him out to the creek the day that he died. Buster said he was acting weird -- picking up snakes and stuff. At midnight, he had his daughters outside playing frizbee. He was dead in the shed about twelve hours before his daughter went looking for her bike and found him on the trampoline. It is wonderful that there are available miraculous drugs for pain relief. I thank God that I do not have the power to prescribe them. I would not want that responsibility. I don't think that I would ever prescribe oxycontin or morphine or Percocet for anyone who did not have certain kinds of terminal cancer. My husband died from cancer and his doctor denied his refill of Percocet. He took Tylenol. My first husband had horrible Systemic Lupus and endured excruciating pain from aceptic necrosis in his hips. Never had any pain med. Pain is a difficult topic because pain is relative and subjective. I would hate to be a chronic pain doctor or a physiatrist. I would rather be a proctologist. Much easier to look into butts all day than to try to decipher what a person requires for pain and to weigh the consequences of the treatment of that pain; non-cancerous pain. Most chronic pain patients have orthodpedic or neurosurgical problems. Personally, I have zero tolerance for narcotic pain meds. I also have a very high pain tolerance. Two childbirths were not painful to me. I have had extensive dental work done without novacaine. The reason I dread the thought of a colonoscopy is not because I fear the procedure. I fear the drugs. I have had very little physical pain in my life and I know that I am fortunate. Pain management is a very difficult thing. I have ample empathy for those who experience a lot of pain. Yet, the consequences of the drugs required to treat pain are enormous. If only there was an absolute blood or other clinical test to measure pain. Maybe then, it could be understood and separated from depression.

The cause of your fatigue could be something as simple as a B12 deficiency. You can take shots for that. You could benefit from an antidepressant. You could have mononucleosis. If you can do it, go back to the same doctor and discuss your results. An eight doctor practice is fairly large. I would rather discuss my condition face to face with a practitioner than to depend on overworked receptionists and nurses. Sad but true. Often a smaller practice is better. I am sorry that you are not my patient. I would call you back ASAP.

Most old records are not that important. It is usual for a doctor to check a BMP and thyroid on patients. Nothing unusual about that. Usual for a doctor to check a CBC. You said that you have switched practices. Sounds like a good move, Tell the new doc about your plight. You can always sign a release for the new doctor to get the lab results. If it is all right with your insurance company, get the new doctor to repeat the tests. You can also file a complaint with your insurance company about the one practice that has not met your needs. If your insurance will alllow it, you might make an appointment with the same doctor for the purpose of discussing your lab results. Sometimes, that is the best way. You have to pay your co-pay but you will get one on one communication. Better, I think, than continuing to call them for results with no satisfaction. Plus, you will have his/her direct attention. If the results are all normal, you can ask him what you should do next. At that visit, you could also tell him/her about your difficulty in getting your test results. It may be worth the trip because he/she might have other recommendations.

Good for you for passing. In my opinion, much of this sort of thing is a torturing process. In LPN school, I never had to do the handwashing thing. But there were other things. One thing that I remember clearly was being tested out on drawing up a shot. Drawing up a shot is pretty simple. I reckon I could teach a chimp to do it. But this instructor made it seem so detailed and complicated and there was no way that I could do it to please her. I have been a LPN for twenty three years now. I have never infected anyone with one of my shots. I draw up Demerol or whatever without thinking terribly much about it -- other than the usual comon sense checks. I have never killed anyone with an injection. That instructor made me feel incompetent. She made me feel stupid. She wanted me to fail. She was torturing me. Harrassing. She followed me into patients' rooms and criticized everything I did. She reprimanded me for my "hesitation." She made me feel very unsure of myself and, then, criticized me for being unsure. Fortunately, my other instructors thought I was all right. I made very good grades. I finished near the top of my class. Don't let 'em get to you. That is the whole ticket because a lot of them will do their best to get to you. Very intimidating. You have to believe in yourself. You have to be determined. Grit is what it takes. In the army, a sergeant taught us that a need gets a got. You need to be a nurse. Don't let anyone or anything stop you. You just need to pass the test. Then, your real learning will begin. Truly an amazing process.

Even drug addicts get sick. In my practice, I saw one drug addict get his appendicitis overlooked and he nearly died from that. Then, he turned out to have Hodgkins Disease and really should have died from that. Very advanced by the time it was diagnosed. He got plenty of Morphine then. He is still alive after about seven years. In prison for his abuse of his daughters. In his case, I don't think he became an addict for any special reason -- like he was abused as a child. He was very spoiled. His mom did everything for him. Spoiled or addicted, the man was still a patient with an acute appendicitis that was overlooked and Hodgkins lymphoma that was eating him alive. Finally found by a pain specialist. I can think of other drug seekers I have known that have since died. None of them died of their addiction. They died from causes that were either never found or found far too late. An addiction should not be fed but an addict should not be ignored. Crazy people also get sick. It is very easy to overlook and miss disease conditions in crazy people and addicts. I do not believe in placating crazies or addicts. But you do need to take a serious look at them beyond the obvious.

I have worked in doctors' offices for years. I do try to call patients promptly with results. Occasionally, I screw up. Not very often but, when I do, I am honest about it. Is this practice a large practice? If so, I know from experience that things get overlooked. I work in a small practice. In large practices, I have answered voice mail that is a month behind. If you leave voice mail once without a return call, you should call back and ask to speak with Dr. Whoever's nurse. Some nurses do not call patients if the results are normal but, especially since you and your insurance company are paying for those results, I think you have the right to know them. Why order the tests if you are not going to be informed of them? Even if it is a large practice, when you call, you should tell the person who answers the phone that you want your test results. You should say that you have waited two weeks and you have a need to know. If you have no other choice, ask to speak to the office manager. Your doctor was good to check your thyroid and BMP. You need the results. That's your right. You will, of course, attract more bees with honey than with vingegar. Be pleasant but pleasantly insisitant.

No, you do not have to be an aide in order to be a good nurse. Nothing is set in concrete. However, some of the best nurses I have known and a couple of doctors have worked their way up from being aides and it seemed to make them more sympathetic to the more "lowly" workers. I worked closely with one doctor who started out as an orderly in a hospital. Then, he became an xray tech. Then, he became a PA. Then, he became a pediatrician. Then, he became an anesthesiologist and made a wad of money. Then, he became a GP. Now, he teaches in a university. The beauty of this guy was that he knew how to clean butts, do xrays, start IVs as an expert, give epidural injections, diagnose, give medicines; prescribe medicines. He could do anything a nurse could do or an orderly or an xray tech. He expected his people to work as hard as he did. But, if you could do it, he treated you like absolute gold. Why? Because he understood very well the rungs of the ladders he had climbed. He achieved but he never became "better" than the orderly. He did not consider the work he did as an orderly to be dirty. He was a team worker. Of course, a doctor does not have time to clean butts on a unit. But, in a pinch, he could. In a pinch, he would. Some won't. Many LPNs in nursing homes won't. I know of aides on night shifts who had to try to attend to sixty patients with no help at all. I agree with the lady above that it really has to be a team effort. I can well understand a nurse with a BSN thinking that she did not get a college degree to clean butts. Unfortunately, cleaning butts is a part of good nursing. No matter what you might do for a patient -- high tech stuff -- all that can be defeated with a patient lying in feces for hours. Bedsores kill.

Cardiac One, So why don't you get the Midwife degree and deliver babies? My nurse midwife was excellent. Perfect. Patient. Coached me in pushing. Gentle. Tolerant of my Pakistani husband. Very attentive. Very personal care. I would have used her for the second birth but, unfortunately, by that time her practice had changed so that she was in with the doctors. That meant that she might not be the one to turn up at delivery time -- could have been any brute. She probably became too popular and could not possibly do all the deliveries. It is a wonderful luxury to have one practitioner follow you all the way through your pregnancy AND deliver the baby. I did not want the usual cattle call. I did not want someone who would encourage me to have an epidural -- whether I needed one or not. I did not want someone overly medical. Pregnancy and childbirth are not diseases or medical emergencies. Pregnancy and childbirth are the elements of life. I would have resented suprapubic pressure from a brute, let alone fundal pressure. Childbirth -- under most circumstances is not a matter of extraction. It is a process that pretty well takes care of itself with little intervention. Women tend to panic with the pain. I don't think a doctor in an urgent care mode helps that. You need a calming and soothing person. Relaxation is very important. I feel so fortunate to have experienced two good and easy births -- no epidurals; nothing. When I was done, I was done. Nothing medical about it. I was free. I realize your point about liability. Too bad. I cannot say enough good about nurse midwives or nurse practitioners.

Sounds horrible. I thank God that a nurse midwife delivered my first child and a lovely Fillopino doctor in a one woman practice delivered my second. Both were perfect labors and deliveries -- no epidural. No drugs. No brute pushing on the fundus. My husband -- now deceased -- would have cold cocked him. He was Pakistani and would have freaked out seeing a man do anything like that. No wonder so many women recount horror stories of childbirth. I am certain that there must be many good male obstetricians who are wonderful at childbirth. But darn. I don't think the dude should be allowed to be birthin' no babies. No one should have to endure that.

Two excellent posts, RN34TX and Nyoko59. Very thoughtful. Hope I got the names right. I have trouble with internet names.

I agree with LPN181 and Coopergirl. I think you should still try for a better job. How long will your license be on probation? My guess is that you would be hired. Even you call it LTC Hell and that is the way I always saw it, too. The only thing I could stomach were two sixteen shifts on the weekends. I did that for four years until I knew that I was making a positive job switch. I would hate to go back to that kind of work, especially if I had invested time and money into becoming a RN. I still also think your supervisor was insulting to you. Coopergirl has a good idea. Try for other jobs and WHEN you get hired, keep your foot in the door there for a while, in case you decide you want to go back. Here in my corner of LPN land, we had a guy nearly code in the office today. Just not something we want to happen. Our equipment is old and ridiculous. Guy did not seem to be in a lot of pain. Thought he had indigestion. Took forever to fill out his paperwork. I asked him if he was okay. He said he was okay. Finally, I took him to a room and checked his pulse. Felt like some kind of atrial fib. I did the EKG immediately. Looked weird. I gave it directly to my NP. She said, "Call 911." I had begged the guy to let me call 911 before he even set foot in the office. He refused and said he would just go back to work. I said, "You can't do that. You are having chest pain and you have to see someone." So, fool that I am, I let him come into the office. I told him that if his EKG was not right, we would have to send him out by ambulance anyway. Should I have let him go back to work and die? As it turned out, he could have died in our office. Fortunately, when we called for an ambulance, they actually came quickly. Not always the case. We got him out but he coded as soon as he came through the ER door -- forty minutes away. Next chest pain, I am not offering a choice. I will call 911. End of the news. A rural family practice is not the place to have a massive heart attack. That happened to me ten years ago. Elderly man came into the office and the son said he thought his sugar was out of control. Sweating like you know what. This was a very rural practice. The doctor was not scheduled to arrive for fifteen more minutes. Just one LPN and a receptionist and no defribrillator. I went to check his pulse and he suddenly clutched his chest and essentially died. Just like that. I was putting him on the floor as I saw the doctor coming into the parking lot so I was starting CPR when the doctor came through the door. Fruitless effort, needless to say. I don't want that to happen again. In my mind; my imagination; I have put a big orange-red X on my office door -- NO CHEST PAIN!! CHEST PAIN, GET THEE BEHIND ME!! Want a job in rural practice? There are lots of rural hospitals that need RNs.

I use Taber's frequently at work. Good book. But I am sure that Mosby's is good also. Marsha Faizi

To Matt's Mom, Excellent post. Most aides are very under-appreciated. If you care about the aides, you care about the patients. If you help the aides in their work, you help the patients. If you work against the aides, you forfeit the welfare of your patients. If you overburden your aides, you burden the patients. If you help your aides, your aides will help you. A good CNA is worth their weight in gold. I think that is how good aides should be treated -- like gold. You must be a rare and exceptional nurse. Marsha Faizi

I don't think there is any dirty work in nursing. It is all the same, I do think that doing a stint as a CNA is worthwhile. In truth, I think that all of us should be capable of all of it. When I was in LPN school, my class encountered several working BSN nurses who had no idea about a Foley or IV lines or many things. I hope things have changed since then. I would hate to be turned loose on a floor with no technical knowledge. Education is wonderful but experience is the teacher. Marsha Faizi

James is probably right. I have worked med-surg and I hate it but that is me. Did you never have such experience? Regardless, I agree with him that you need to find another job.

I have no doubt that being a home mom is a good reason for a gap in employment. Your recent schooling is an asset. There is no reason that you will not make an excellent CNA. I have worked with many, many excellent CNAs over the years. Being a CNA is hard work but essential in a hospital or nursing home. You are responsible for the patient's comfort. You bathe and turn and change patients. The most heartbreaking thing to me is to see good CNAs quit because they can't take the pressure. I never blamed them for quitting. I just hated to see the good ones go because patients needed them so badly -- the kind, intelligent, efficient ones. Again, I wonder about these divisions in nursing. I respect education. But how is one level valued over another when turning, bathing, and changing is just as important as starting an IV? What good is giving medication when a patient gets a bedsore the size of a fist? To be utterly fair, my mother had excellent care on ICU a few years back. She had a red place on her sacrum and I witnessed a RN and CNA turning her to apply miracle cream. With her ruptured esophagus, the decisions of multiple doctors and surgeons were important but it was nursing that pulled her through. Marsha Faizi

As for your manager, well, in my opinion, she is disgusting to say that to you after you took the time and money to become a RN. I think you should gleefully get out. I knew a LPN who became a RN. Her ambition was to work ICU. She graduated and got an ICU job. She lasted one day. One whole day -- because she did not like the way they did things. To my thinking, she stayed in LPN mode. She returned to nursing home nursing as an administrator. I honestly think I would rather die than come back as a nursing home administrator. It's a Beetlejuice thing.

I am a LPN and I loathe working in nursing homes because all you do is pass meds and deal with families and change dressings. As a RN, I would loathe management. Forgive me if I am offending you with my personal feelings about nursing homes. But I consider them to be deadening. Would you ever consider working elsewhere? I think Hospice would be more interesting and get you out of the LPN mode. You would be making more decisions. What about a hospital ER? Again, this is my personal prejudice because I loathe floor nursing of any kind. I like nursing where people come in and people go out. Certainly, getting out of a nursing home would get you into more interesting areas of nursing. Also, in my experience, nursing homes pay LPNS well but they do not offer RNs much more. You are doing the same job. They do not want to pay you a lot more for doing the job that a LPN can do. If you truly love your job at the nursing home -- and I know some nurses do -- then, you will probably have to go into managment and supervision or stay in LPN mode. If I were you, I would gleefully get out. I work on the urgent care side of a family practice. Rural practice. Next best thing to a ER. But doctors are not about to pay RN wages when they can use a LPN. This brings me to another sore subject. Why do we have to have these divisions in nursing? Why can't a nurse be a nurse? I have respect for education. I work directly with a nurse practitioner who is more knowledgeable and as knowledgeable as any doctor with whom I have ever worked. A lot of doctors. A nurse midwife delivered my daughter. She was better than a doctor, by far. But, below that level of education, I cannot help but see nurses as all pretty equal -- depending on experience. I have worked with LPNs who were dazzling with their knowledge and expertise and I have worked with RNs who were just as good. How can the divisions be eradicated?

I do somewhat agree with the person who wrote that dissececting a cat will not necessarily make someone a better nurse. I don't think that it will. Rather, it will simply be a memory from college. However, there will be many repugnant things or things that go against your personal beliefs when you are working. How will you deal with those things, I think, is the larger question. What about the pharmacist who refused to dispense birth control pills because she does not believe in birth control? I am not a religious person but many of my patients are religious. Should I deign to only nurse atheists and agnostics? As to the problem at hand, in that position, I think I would begin the dissection and faint dead away -- or appear to faint dead away. Surely, such action would make clear your repugnance. Would you fail the class for fainting? Marsha Faizi

I know that dissecting anything is repulsive. Here is a l9vely anecdote from China about twenty-five years ago. This was told to me by one physician with whom I worked closely. She spent some time teaching English in China. The prison in the town where she was teaching regurlarly sent over the bodies of executed political prisoners to the local medical school as cadavers for dissection. Eventually, the medical school sent word to the prison that they were quite overwhelmed with cadavers and did not require more. The prison inquired of the medical school, "Then, may we send them over alive so that you can kill them as you need them?" Well, I reckon that is pretty bad. I think the point is that nursing or anything medical is about the betterment and saving of human life, unless you are a veterinarian. Unfortunately, dissecting a cat in A/P class will not be the most repugnant thing that you will ever do as a nurse. Whether you are vegetarian or not, you will witness many heinous things. How will you feel the first time you see a victim of a gun shot wound to the face? When the victim is still alive? How will you feel about heroic measures to save his life? What if you instinctively know that this person will live a few weeks or months in a vegetated state before he dies? You instinctively know that his family will believe in vain in his recovery? What are the ethics involved? Can you deal with the fact that you could be a part of a trauma team that will save a life only to send that life into a vegetative state that is short lived and hopeless? In such a situation of trauma, no one questions ethics beyond the what is immediate -- save the life. Do everything possible to save the life. Very noble intentions. You just have to be ready to live with the outcome. I understand and agree with your ethical horror about dissecting a cat or a rodent or a human being or anything. Kind of disgusting. But at the same time, it is the body of such cat or rodent or human being that teaches you what you need to understand. My guess is that the reason you are vegetarian is because you have respect for animal and human life. But how do you expect to save lives and to perpetuate life if you do not understand the organs and vessels and muscles that do it? In my region of the US as in many regions in the US, deer are very populous. Tons of the lovely animals. Tons of 'em hit by automobiles daily. Pretty creatures. I admit that I would have a problem shooting one. Yet, we have a hunting season in which many deer are killed and I am not above accepting gifts of deer meat from my patients. Excellent roasts. If there was no deer hunting season in Virginia, I reckon the deer would take over everything. We would not be able to walk for deer. The deer would take over the interstate and we would not be able to drive to get to classes or to work very easily. I love cats and dogs. I have three dogs and four cats -- all neutered and spayed. I don't think that psychologically I could eat a cat or dog -- too greasy. That is my cultural conditioning. However, to further my study of the human condition, I could dissect one of each. I agree with someone who posted that people are very irresponsible with pets. Would you feel better about dissecting a deer? Marsha Faizi

I should have added that I also admire your conviction to help humankind. I do admire that. But helping is not pretty. There are not always nice outcomes to helping. Helping often involves the unsavory. I hope that you can overcome the cat hurdle. Because that is all that it is -- a hurdle. I know how you feel. I instinctively brake to avoid hitting squirrels or rabbits or birds with my car. I hate the thought of anyone or anything being killed, even if I do eat meat. If I had to kill my own meat to live, I would have a problem with it. I am that much of a hypocrite. You are not responsible for the death of the cat that you will dissect. I do hope that you continue with your nursing program. Marsha Faizi