Pac Profile

Sadly, Mommy Dionisia was left in the cutting room floor.
The best time to rob a bank in the Philippines is when Saturday's fight will be beamed.

Grumpy

When it comes to patient interactions, I usually follow the David Mamet school of acting (and playwriting):
Only NOW matters.
History is in the periphery, if at all.
Took care of a patient I've labelled as grumpy.
In previous admissions, even when he was ambulatory, he was grumpy.
When he was admitted acutely ill, he was grumpier.
Yet, his children has showered him with patriarchal affection.
I have no doubt they really love him.
He's loved by all, except me.
I don't see what is lovable in him.
I know that my compassion reserve has been running low for awhile now.
But I don't believe my feeling that way towards him was from that.
What I needed was to see who he was -
An "aha" from a qualitative research presentation that said having a picture of the patient before his or her illness has helped nurses in caring for the whole person rather than treating the person in the bed as a bundle of symptoms.
Maybe if I knew about him better,
I would've felt about him differently.

Rated A, B, or C

Again, it amazes me that NYC has always been receptive to health-related changes - even if those changes border on over-regulation, e.g. the smoking ban on restaurants, visible displays of food calories.

Starting in July 2010, New York City is requiring restaurants to post letter grades that correspond to scores that it receives from its sanitary inspection. An inspection score of 0-13 is an A, 14-27 points is a B, and 28 or more points is a C. Grade cards must be posted where they can easily be seen by people passing by.

Started noticing the posted grades this weekend. Below a C means they must be shut down.
Would I still walk into a place I frequented with a C by the door?
Probably.
Old habits die hard.

Gut Feelings

We nurses use a lot of our gut feelings -
it's not scientific, but if the Spidey sense tingles, we tend to be more vigilant.
I don't know if I lost that sense the other night.
Called in to consult on a patient that another nurse was taking care of.
She said she doesn't look right and that we should call a Rapid Response or RRT.
I said not yet. I guess I needed to wait and see some thing before we activate the RRT.
More from the other nurse's insistence than my own gut feeling that we activated it anyway. (She had probably more nursing experience than I did).
Everyone else seemed to see something and I did not.
I didn't have that gut feeling this time,
but all around me, the other responders said the patient's vital signs were normal, but there's something quite not right.
Did I second guess myself?
Am I not in tune with my gut feelings anymore?
I felt like Chip in "Beauty and the Beast" when all around him sang, "There's something there that wasn't there before."

Fall Back

Nothing sadder than looking at the automated clock go from 02:59 to 02:00.
Not looking forward to changing the clocks in the patient rooms the rest of the night.

THE SECRET IN THEIR EYES

THE SECRET IN THEIR EYES (2010), d. Juan Jose Campanella

Catching up on this year's Oscar nominees (meaning last year's movies).
I'm going to judge this movie unfairly.
Because Ricardo Darin stars in this,
the ghost of Fabian Belinsky hovers above this movie.
All throughout, I wondered how superior it would be had Belinsky directed it.
The neo-noir story would've been a perfect fit for him.
The twist at the end only made me ache for Belinsky's more assured touch.

Hand-Drawn

THE SECRET OF KELLS (2009), dir: Tomm Moore & Nora Twomey

For those who mourned the loss of aesthetics in animation with the advent of "Toy Story," there was hope in last year's crop of animated films.
Disney's return to the hand-drawn form with "The Princess and the Frog" was an unsatisfying meal for me. "The Secret of Kells" excels in its visual look. It's like viewing illuminated manuscripts. The new batch of hand-drawn animated films advance the old form, such as "Persepolis" and "Waltz with Bashir," mainly for using it to explore a wider range of themes. With the dominant hand of Disney now far from the old form, hand-drawn animation has become more adventurous. Two that I'm looking forward to this year are "The Illusionist" and "Chico and Rita."

Research Day

You can never escape your teachers.
Spent all day on nursing research -
a symposium at work, then class.
Don't know about other professions,
but no matter where you practice nursing,
you are bound to see your teachers.
Nurses in academia conduct their research in order to be utilized in practice. You meet them when they disseminate their findings.
Sitting in front of my teacher from 3 years ago,
being informed about a research she had done (in which I was a survey participant) was surreal.
I thought to myself I hope she wouldn't embarass me in my place of work and I hope I made her proud.

I'm afraid I'm leaning towards being a qualitative researcher.
In class, my research professor, who's big on quantitative,
heard her previous class jeer last week's lecturer who used aesthetic inquiry.
She told her class: "You need more humanities!"
If nursing is a science and art, the art part is lacking and that'll be my part.

Live! Nude! Models!

3 years of bedside nursing and I finally got to see a normal vagina:
on a live human model for a GYN exam in Advanced Health Assessment class.

Still not sexy to me.

PSYCHO

PSYCHO (1960), d. Alfred Hitchcock.

Overanalyzed, yes.
Lost count on how many times I've viewed this.
Each time, certain aspects flit to the top.
After seeing it again this weekend, these things came to mind:

1. Anthony Perkins was masterfully creepy.
The actors are the last thing you notice in a Hitchcock movie.
He treated them like cattle, remember? (I think it's a misunderstood comment.)
Found so many layers in that Norman Bates smile this time.

2. "We all get a little mad sometimes ..."
To extend the theme of dualities,
Hitchcock offers two different types of voice-overs:
Marion's imagined voices while she's driving,
and Mother's voice as heard by Norman.
Never wanted to work in psych, because I'd question my sanity all the time.
There are voices in my head.

3. Water cleanses.
Hitchcock used the act of cleaning to create audience sympathy for Marion and Norman:
Marion showers to cleanse herself of the sin and gets murdered,
while Norman cleans after the crime to protect his mother.

4. Arbogast.
Just a little idea that came to mind:
I'd like to write his backstory -
an origin story of sorts. "The Case Files of Det. Arbogast."
What cases has he tackled before his grisly end?

5. DSM-IV.
It's been awhile since Psychiatric Nursing,
but what are the differential diagnoses for Norman Bates in the DSM-IV?

Still had the same feeling as when I first saw it as a teen,
I will lick stamps for John Gavin.

Old Market Street

In more ways than one, a moving time capsule.
I found the detective work that went into it exciting,
so much so that I think film historians are cool.

The Business of Caring

St. Vincent’s Is the Lehman Brothers of Hospitals
Its demise was only the beginning. An alarming number of New York’s major medical institutions are teetering on the financial edge.
By Mark Levine from "New York" Magazine

An astute blow-by-blow description of St. Vincent’s demise. I don’t think of HHC hospitals as safety nets, because all hospitals are safety nets. Once you walk into an E.R., whether you can pay or not, you will receive care.

“They often come into the hospital through emergency rooms, which are required by law to treat anyone regardless of ability to pay and where the cost of care is much higher than it is in other settings. New York hospital patients tend to stay in the hospital longer than others; the city’s average of 6.6 days per hospital stay is more than a day longer than the national average (older people can’t be sent home to walk-ups until they’re capable, non-English speakers require translators to provide discharge instructions, and so on.”

Spurred on by Joint Commission, there’s a new focus on length of stay. An anecdotal example: Families who reside in the U.S. bring their family member from their native countries to the hospital straight from the airport because he or she is sick. The patient stays in the hospital for the work-up and cannot be discharged because diagnostic tests cannot be done outpatient due to lack of insurance. What happens to length of stay?

There’s a comment about salaries in the article, but no one seems to say outright that the taxes from the salaries pay for the uninsured. To put it differently, I’m paying for you to be cared by me – I’m paying myself to work. And I get your attitude on top of that? Sorry, but I did not get myself to a nunnery.

New York City expects all of its hospitals to be charity wards and not in the business of flipping beds. I’m all for benevolence and indiscriminate caring. However, the business of caring as we know now does not make room for charity. As the article puts it, “In New York hospitals, it helps to be smart, but it helps, above all, not to cater to the poor.”

"It Gets Better"

Good sentiment, Broadway babies. But, it wouldn't convince me to step off the ledge. However, Tim Gunn's appeal works. So do the other "talks" by cast members of Broadway shows. For more, check out other stars' PSAs at www.thetrevorproject.org.

"Big Bambu" at the Met

At Doug + Mike Starn's "Big Bambu" installation on the roof of the Met.

I should have worn my native outfit and I'd fit right in. Tinikling, anyone?

BMTs

Personally, I find allogeneic BMTs frightening for its upsetting side effects. GVHD has horrendous clinical manifestations. But I have to let that go because it is what the patients want. T. Brown, RN on the NY Times' Well blog felt the same distress, but who are we to take that hope away? Below is a feel-good piece that re-affirms why I do what I do. I applaud those who are on the registry. I know of one who's on the registry who worries they might call him one day. Take heart, "walking funny for a week" and some pain seem to be the only unpleasant complaints for a donor post-collection.

The Gift of a Lifetime
How a Woman Who Died in April 1999 and an Infant Diagnosed With Leukemia Became Connected by an Act of Kindness
from "CBS Sunday Morning"

"The Bread of Angels"

"Ethan Frome" was never this hot. (It was steamy in its own way.) Lapham's Quaterly published a blue piece authored by Edith Wharton, circa 1919:

One by one they gained her bosom, and she felt her two breasts pointing up to them, the nipples hard as coral, but sensitive as lips to his approaching touch. And now his warm palms were holding each breast as if in a cup, clasping it, modeling it, softly kneading it, as he whispered to her, “Like the bread of the angels.”

I knew she could write. I guess it should not surprise me that she could write like this. I'll just say I would've had more fun with my literary criticism paper in high school if I were reading this in addition to "The House of Mirth," "The Age of Innocence," and "Ethan Frome."

PE, cont'd

Wouldn't you know it? My teacher brought up the Stanford 25 (previous post) in class because Dr. Verghese was profiled in in the NY Times. I was ahead of the curve.

Physician Revives a Dying Art: The Physical
By DENISE GRADY
Published: October 11, 2010
At Stanford, Dr. Abraham Verghese is on a mission to bring back something he considers a lost art: the physical exam.

I volunteered that I had read this two weeks ago and brought up the limitations chimed in by other MDs in BMJ. She seemed put off by that. I agreed with her though that RNs beat PA's and MD's when it comes to "touch"-ing a patient. Because we're a touchy profession.

PE

On "The Fading Art of the Physical Exam," by Richard Knox from NPR.org

I'm not for going back to the days of Dr. Quinn, Medicine Woman or even Dr. Kildare.

Since I will be a “mini-doc,” as my Advanced Health Assessment prof put it, the Stanford 25 seems like a standard to look up to as a program objective. (There are limitations/criticisms.) Nurses are trained to do a physical exam (PE). Yes, we learned these PE skills in nursing school, but do not keep it up. Depends on where we practice. In a hospital setting, MDs and diagnotic machines are within easy reach, so nurses' PE skills rust. Upon review, not many of my nursing preceptors emphasized PE skills in practice when I was a student. Many of my colleagues do not carry a stethoscope around, so I can bet they don’t listen to breath sounds or bowel sounds and are only forced to use it when they have to take a BP manually.

Backyard Bounty

Almost fall. What lies in the backyard?

Rosemary

Calamansi

Red chilies

Kangkong

Drumstick

Drumstick

Teabonics

I was told to look it up and I did.

For maximum smarts, run it on slideshow and spot the grammatic errors as fast as you can.

For more: Teabonics

MTA

Too true, so they did not pass muster as subway advertisement from the MTA.

"Take Me to the World"

Savor an early Sondheim.
Pre-You Tube, my friend and I went to the Museum of TV and Radio to watch this.
Ah, musical theater gleeks worshiping their idol on Kinoscope.

It's Norman Bates and Liesl from "The Sound of Music."

National Colorectal Cancer Awareness Month

Only hospitals can circulate this kind of memo:
That I should tune in to watch Harry Smith's colonoscopy live on TV while Katie Couric holds his hand.
And in case I missed it on TV early this morning, they sent another memo linking to it:




As an oncology nurse, I'm proud of it.
Will this make my Dad schedule one?
We'll see.

And The Winners Are ...

Losing my touch.
Scored only 60% correct on my Oscar predictions.
Honestly, no one saw that Argentinian movie winning.
I'll cop to my screenplay picks belonging in the "should" column and not the "will win" column.

In other news:



So naive of me. Only thought it was a power button symbol until the filthy comment writers on New York magazine pointed out it could be other things: "This is like when IT people have sex, on a wrapper."

Betting On ...

My Oscar pool ballot would be ticked as follows:

Picture: "Avatar"
Director: Kathryn Bigelow, "The Hurt Locker"
Actor: Jeff Bridges, "Crazy Heart"
Actress: Sandra Bullock, "The Blind Side"
Supporting Actor: Christoph Waltz, "Inglourious Basterds"
Supporting Actress: Mo'Nique, "Precious ..."
Animated Picture: "Up"
Foreign Language: "The White Ribbon"
Original Screenplay: QT, "Inglourious Basterds"
Adapted Screenplay: Jason Reitman & Sheldon Turner, "Up in the Air"

In the Coop

"Native chickens" in the sunroom ...
Where the parakeet also roosts.
I dub it our aviary.
My mother's rationale for keeping them: "If we have to clean 'bird poop,' they might as well lay eggs."

"This Is It"

"This Is It" (dir. Kenny Ortega, 2009).

Held out on its release on the moral grounds that the movie was exploitative. But as soon as MJ got to the chorus of "Wanna Be Startin' Somethin'," I alit my high horse. It was probably meant for the Special Features of the concert movie, but instead became the main event. Surprised by its intimacy and one could see the gears turning in his head on how to entertain a stadium full of fans. Noticed the way he adjusts other performers onstage (the guitarist and his duet partner on "I Just Can't Stop Loving You") - those are generous moves from a star. More impressed by the "slower" sections, like "Human Nature. One could see the transformation - from his view outside of himself (as creator thinking of the audience) to being "in the moment."

St. Vincent's

Photo: My union dues at work.

Saw a line of red-capped NYSNA members streaming into the main entrance of St. Vincent's. They carried laminated signs that said "Save St. Vincent's."

A little background from the NY Times:

Out of Cash, St. Vincent’s Is Set to Close

By ANEMONA HARTOCOLLIS

Published: February 6, 2010

The Greenwich Village institution, which is $700 million in debt and in danger of bankruptcy, has not found a partner and has stopped admitting some patients.

I find this beyond the union's purview. If the hospital stops serving the needs of the immediate community, then it won't survive. It has served Greenwich Village well when the AIDS crisis hit the neighborhood hard. Between it and Bellevue, they were at the forefront of that modern plague. My soft spot for St. Vincent's stems from that. The nuns during those times must have felt like their predecessors centuries ago, tending to victims of ancient plagues. I'm sure the hospital's nurses must have felt that as well. This is a guess: but the hospital has been riding that goodwill for a long time. The population who bestowed them all that good will are dwindling. The community has changed. Its new residents are moneyed and younger and their first choice for primary care and non-emergent surgery is probably not St. Vincent's. Being a Catholic hospital may have something to do with it as well. Do consumers choose which hospital to go to based on its strong religious affiliation? Maybe. And the hospital's heart, its duty to provide the underserved and survive in an urban economy, is part of its undoing. New York has "safety net" providers and St. Vincent's is not one of them. It thinks it is, but it isn't.

I am for saving St. Vincent's. That area of Manhattan needs a hospital. Without it, the nearest E.R. would be all the way on the East Side, all the way downtown, or St. Luke's Roosevelt in the upper 50s. To save itself, St. Vincent's needs to engage the community boards in its neighborhood and assess what they need. March with time and enhance the quality of care (I would emphasize technology here or add specialties - e.g. be a Stroke Center). The other solution is for HHC to swallow it up and become a full-fledged "safety net" provider. We're helping to bail them out, anyway.

Native

Home this morning, greeted by the 'rents fresh from Florida.

Mom (as she's juicing tangerines): Nag-ihaw ko og chicken. [I "barbecued" chicken).

Me: That's nice.

Mom: Yeah. I butchered it. We bought a live one and I butchered it.

She shows me pieces of chicken in a Glad bag, thawing and blood tinged.

Mom: It's native chicken.

Here I was thinking of giving her Michael Pollan's oeuvre as a present, but those are useless to a farm girl. You can take the farm girl out of the farm, but ...

Photo: Calamansi and Calamansi, Jr. - lone survivors of a Florida winter from my Mom's Florida yard.

Snow Day. Again.

I deserve an Olympic medal for trudging all this mess on the way to work and back home. Slip and slide can be an Winter Olympic sport.

Book Envy

In the subway car on the way home,
Envied the commuters reading the books on my Amazon Wishlist:
"The Hunger Games" and "The Immortal Life of Henrietta Lacks."
Recreational reading, how I miss thee.

SpaHa

- You moved?
- No, I'm moving.
- To where?
- SpaHa.
- SpaHa? Where's that?
- Spanish Harlem.

Gentrification begins with coining a "hip" name -
In Manhattan, that usually consists of
Plucking and stringing along the first syllables,
e.g. Soho, Nolita, Tribeca, etc.
Then telling your prospective renters / buyers,
"It's up and coming neighborhood."

Ash

Today is when Catholics advertise themselves.
I know them because of the dirt - I mean, ash - on their foreheads.
Some are distinctly crosses, others are just gray smudges.

Let's Vote, NYC!

This is the Gotham Awards in the category of Best Condom Wrapper Design.

Health Department Unveils Five Finalists in NYC Condom Package Design Contest

After assessing hundreds of possible package designs for a special limited-edition NYC Condom, a panel of judges has selected five finalists. The Health Department has received nearly 600 entries since December 15, when it invited New Yorkers to design a wrapper that would “capture the city’s
distinctive culture while promoting safer sex.” Designs have flooded in from all five boroughs, and as far away as Perm, Russia. New Yorkers can vote for their favorites starting Thursday, February 11 through Sunday, February 28.

To vote, click HERE.

VD

VIP

You know there's a VIP in the building when news vans are parked in front ...

Inclement Weather

Many are so sure of tomorrow's blizzard.
The belief must be that we will not be spared this time -
It's payback.

So sure are they that:

-my dentist's office called me three times about my appointment: to confirm it, to say that they might not be open tomorrow, and to reschedule it later in the day.

-the school department canceled its welcome reception for new students tomorrow.

-"A View from the Bridge" tickets popped up on TDF with the disclaimer: "DUE TO the impending inclement weather, THESE SEATS ARE NOW AVAILABLE AT THE LAST MINUTE. As always, THERE WILL BE NO REFUNDS or EXCHANGES. In addition, NO PAST-DATING REQUESTS will be considered by the theatre's management."

-the best selling item at the mom and pop stationary/toy store was a bright orange plastic snow sled. The owner had the hard job of disappointing little children and their parents, telling them to come back tomorrow at 9 a.m. when they will have the remaining items shipped from their warehouse. He stressed that they should come early because he is sure that he will run out of them by 11 a.m.

Scotland (cont'd)

P.S. to yesterday's post.
While they're at it, maybe they could make the bottles less breakable, too.

From: Coatbridge Journal
For Scots, a Scourge Unleashed by a Bottle
By SARAH LYALL
Published: February 4, 2010
Buckfast Tonic Wine is a symbol of Scotland’s drinking problems at a time when it is debating how to address them.

"Glassing"

How's this for Health Promotion?

From The Associated Press:
British Toast New Shatterproof Pint Glass
Half of all violent assaults in Britain are alcohol-related and drinkers are known to smash glasses and use them as weapons. British leaders say the country will save billions in health care costs by coming up with a glass that doesn't double as a lethal weapon.

Reminds me of the "British coal-gas story" in decreasing suicide.
(Although that was accidental).
Will they clink like real glass?

Some choice quotes:
"Glass feels good in the hand, it feels cold. Plastic is warm."
".... plastic glasses are an insult to beer drinkers everywhere ... "

"Someone in a Tree"

AEA would probably revoke my card for embedding this vid.
But this is like unearthing a treasure -
My OBC's liner notes coming to life.

The scene/song is a one-act play.
And that "someone" in a tree is Long Duk Dong in "Sixteen Candles"!

Oscar Noms 2010

Not since the nascent years of the Academy have we seen a list this long.
Only the National Board of Review and AFI concoct this scroll nowadays.
Expanding it to 10 nominees for Best Picture dilutes the brand.
Years from now, when folks mention "The Blind Side" as a Best Picture nominee -
They will dismiss that descriptor because of its batch's larger pool.
It's the populist Oscars.

Further notes on this year's noms:
-The Fanboys are here to stay. "Avatar," "District 9," and "Inglourious Basterds."
-"The Blind Side" and "Precious" cancel each other out. Aren't they the same movie?
-The Best Animated Feature Film Category is no longer pitiful. Perhaps the strongest yet. But where's "Ponyo"?
-True cinephiles know that the "real" Best Pictures are those cited in the Screenplay categories. No "Avatar" and "The Blind Side."

Of those on the list, I think highly of the movies that start with a "U."
But the one that starts with an "A" will win the prize.

Grades

First day of school for this term.
Already 6 chapters behind.
Cue the circus music ... and the juggling begins.

Coincidentally, from The NY Times:

The Choice: A Tougher ‘A’ at Princeton Has Students on Edge
By JACQUES STEINBERG
Published: February 1, 2010
Some 'Type-A' students on an Ivy League campus worry that the job market may punish them for grades lower than at other institutions.

I can vouch for my school (non-Ivy)-
That those who come to expect an easy A
Are sorely mistaken.
A few classmates from another private university, nonmatriculated,
Took Physics during the summer in my school -
Because they thought our Physics would be easier than their school's Physics.
Also it would increase their GPA at the other university - if they earn that A.
An underestimation on their part. (Not to mention that laws in Physics do not differ from school to school.)
And this was a prerequisite class for med school!

I am Type A.
Grades matter to me.
Up to a point.
An easy A is a waste of time if I learned not a whit.

Away

Packing

A lesson learned from the Italy trip:
Not all pharmacies resemble Duane Reade.
On this trip,
I'm bringing my dolls,
A pharma-cornucopia in a Ziploc bag:
antimalarial
antibiotic
antidiarrhea
antiemetic
NSAID.

Hmm, maybe I need an antihistamine.

Future

"More nursing jobs will be created in the next decade than in any other single profession. The Bureau of Labor Statistics projects that nearly 600,000 new jobs for registered nurses will be created by 2018."

Nursing Offers A Healthy Employment Future
by Tamara Keith, NPR.org

I am for recruiting nurses.
But this is not the way to do it:
"The fact that the wages are pretty high also sort of separates it from many occupations that would be growing";
And "You can work any hours you want ... particularly if you're a bedside nurse."
"Nurse Jackie," "Mercy," and "HawthoRNe" do not tell you everything.

Will there be an inflationary effect?
Because there is a need, the bar lowers in order to meet that need.
(Diploma programs, associate degrees hinder the profession than advance it.)
I don't consider myself as one who eats their young,
But I may have to eat the old.
"Nursing is a young person's game," a professor said.
Entry-level at 40 and above? For 12 hours on your feet? Think again.
By no means am I agist,
But going there for the wrong reasons will send you back sooner to square one.
That is burnout - a source of the shortage not mentioned in the article.

Prophylaxis

Like a pin cushion,
An intramuscular shot on each arm.
Administered expertly - like mosquito bites.
And for malaria chemoprophylaxis:
The first of seven mefloquine tablets,
whose side effects include:
"anxiety, vivid dreams, visual disturbances,seizures, depression, and psychosis."

Rarin' to go.

Soup for a Filipino Soul

Soup for a Wintry Cold Day: Mom's Pancit Molo, leftover from New Year's Eve feast. I can smell the scallions.

Twelve Grapes

A patient's family member gave me grapes at the start of the shift. I did not know the significance until the ball dropped at midnight and I saw a young woman eating a bunch of them. She explained that "it's a Spanish thing." Each person eats twelve grapes before midnight, making a wish with each grape.

I couldn't come up with twelve wishes. Only 6. Maybe 7 if you count my wish that I don't choke on the rest of the grapes.

Another explanation for the custom: "The idea is to eat twelve grapes at the stroke of midnight on New Years Eve. Each grape represents a month of the coming year. The sweeter the grape, the better the month will be that it represents. If you get a sour grape, it may be that the month it represents could be difficult for you." -How to Eat Grapes For New Years Good Luck

No wonder the woman who gave me the grapes earlier said, "They're good. They're all sweet." That's called cheating.