Nurse Ratched’s Place

This week at Grand Rounds we are honoring health care professionals who serve their country by serving others. I want to thank Dr. Nick Genes for letting me host Grand Rounds this week, and I also want to thank everyone for all of their great submissions. The number of submissions that I received overwhelmed me, and I apologize that I didn’t have room for every post. The artwork found in this week’s edition of Grand Rounds illustrates the history of military medicine, and the dedication of the men and women who care for patients in military medical facilities and outposts around the world. In the 1944 painting above by Jack McMillen, the artist depicts life at the Forest Glen annex of the Walter Reed Army Medical Center. The annex served as a holding and rehabilitation unit for medical patients, including psychiatric patients during World War II and in subsequent wars.

“Long Binh,” by David N. Fairrington.

Editor’s Choice

This week I want to spotlight three deeply moving posts. Sid Schwab from Surgeonsblog submitted this post about his wartime experiences while serving in Vietnam. His post describes how the Vietnam War affected his life and the lives his patients. He also talks about a young man from his local community that is accused of committing war atrocities while serving in Iraq. Sid bears witness to the simple reality that war destroys the human body, as well as the human soul. You will clearly understand why war is hell after you read Sid’s submission.

911 Doc from M.D.O.D reflects on a recent memorial service that he attended on a military base for several soldiers killed in action. He talks about heroism and the sacrifices that are being made by warriors who choose to serve their country.

I want to welcome LTC Christopher Coppola, USAF, to Grand Rounds. He is a military doctor who is currently serving in Iraq. He is also the author of “Made a Difference for That One: A Surgeon’s Letters Home from Iraq.” Christopher tells readers why he joined the military and what it’s like serving our country during wartime. Chris, thank for your service to our country.

“American Doctor II–Field Force Doctor Examines Vietnamese Child,” by Samuel E. Alexander.

Samuel E. Alexander was a member of the U.S. Army Artist Program and was in Vietnam in 1967. His painting depicts the other functions of U.S. Army Psychiatry in the theater of operations. When not evaluating and treating combat stress casualties, or providing consultation service to commanders, psychiatrists and other physicans routinely provide medical care to the local civilian poplation. Military nurses also provide care to local civilians. As part of her tour of duty, LCDR Tammy Swofford, USNR, NC cared for civilians in Accra, Ghana, West Africa. Read her post about what it is like to be a military nurse.

“Killed in Action,” by Burdell Moody.

Burdell Moody starkly portrays a squad returning to base camp in Vietnam, carrying the body of one of their soldiers. Perhaps the most stressful aspect of combat for a soldier, other than pondering his own death, is the death of another, especially a member of his or her own unit. Witnessing death is a critical event in the life of any soldier and his unit, one warranting immediate debriefing to lessen the likelihood of developing post –traumatic symptoms in the future. Toni Brayer from EverythingHealth writes about a new organization that is developing a national network of mental health professionals that will provide free care for returning Iraq and Afghanistan vets and their families. I urge you to read her post to learn more about Give an Hour.

Adam from NY Emergency Medicine writes a congratulatory note to Boston psychiatrist Jonathan Shay in his column, Shrinking the News. Dr. Shay received a MacArthur Foundation “genius award” for his pioneering work in using literary parallels from Homer’s ‘Iliad’ and ‘Odyssey’ to treat combat trauma suffered by Vietnam veterans. Read about Dr. Shay’s work and how he is helping combat troops.

“Wounded Aboard,” by Lawrence Beall Smith.

Doctors, Medical Corpsmen and ambulances were always present for the “sweating in” of the returning mission during Word War II. Coming in late in the day and often in the heavy weather, any ship in the group, which had wounded men aboard, would drop red flares. This was how they communicated their need for immediate medical assistance upon landing. The key to any successful military action is excellent communication within its ranks. Corporations also know the importance of good communication and are entering the blogosphere as a way of reaching out to consumers and health care professionals. Media relations team members, Marc Monseau and Rob Halper, are writers for Johnson and Johnson’s corporate blog, JNJ BTW. Both bloggers attended the Health 2.0 Conference, and submitted their impressions of the event.

Jan Martens from MedBlog.nl sent in this overview of the Health 2.0 Conference. Check out his post and see video highlights of the event.

Bertalan Meskó from ScienceRoll writes an open letter to the physicians of the world about why to use web 2.0′s features in a medical practice.

“Flashlight Surgery In Saipan,” by Robert Benney.

Prompt medical care by highly skilled specialists, together with improved evacuation services under battlefield conditions have spared countless lives during wartime. Mortality rates hinge on the speed and timing of patient care services. Robert Benney’s picture illustrates army doctors as they perform a delicate brain operation by flashlight during World War II. Sometimes civilian health care providers feel like they are working in a war zone, too. Terry Freemark from Counting Sheep sent in a post about giving anesthesia. Find out why she thinks that giving
anesthesia is like going off to battle.

Bongi from other things amanzi writes that surgery can be summed up in one sentence; “Eat when you can, sleep when you can and don’t f#@k with the pancreas.” I’m sure military surgeons would agree with his assessment. Bongi gives readers advice on how to wake up after you indulge yourself in a quick nap.

Here’s something that will wake you up. GruntDoc sent in this post about how to make coffee. He said that Navy Docs like their coffee.

“Night Vigil,” by Robert Benney.

While the Hospital Train rolls through the lonely night, the Army nurse checks the patients’ charts. At the far end of the car, the medical aidman keeps an alert eye on his patients. Colonel Florence Blanchfield, the Superintendent of the Army Nurse Corps during World War II, said, “There’s no glamour about nursing. Every nurse (in the military) is a volunteer. She is nursing because she wants to. Unless you want to help others and make sacrifices, you have no right to be in nursing.” Nurses of today are no different than nurses of the past. They are mobilizing to improve the lives of their patients. Teri Mills from the National Nursing Organization supports the establishment of the Office of the National Nurse. Teri believes that nurses will volunteer to help improve health care in America.

Nurses are working on other fronts to improve patient care. A group of West Coast nurses have declared war on greedy corporate hospitals. Kim from Emergiblog writes about an impending nursing strike in Northern California. Theses nurses are fighting and sacrificing for all nurses and for the patients we serve.

ERnursey isn’t happy with how hospitals conduct marketing campaigns. Read her post about how using smoke and mirrors to draw in the wrong type of patients is hurting our health care system.

“Purple Heart,” by John O. Wehrle.

John O. Wehrle depicts a serviceman in Vietnam who has received his Purple Heart in a Surgical Intensive Care Unit. In combat settings, traumatic brain injury often occurs in conjunction with other injuries, as shown in the painting. How to Cope with Pain says that it’s becoming increasingly apparent that chronic physical pain is a significant problem for a high percentage of men and women returning from combat. As the survival rate after injury improves because of better protection, the rate of development of chronic pain unfortunately increases also. This article is the first in a series reviewing types of medication that are helpful for chronic pain.

Val Jones MD from revolutionhealth takes and interesting historical look at how war sadly advances the field of surgery, and was the primary cause for the birth of her own specialty, Physical Medicine & Rehabilitation. In her 2 part series on “What the Heck is a Rehab Doc?,” she talks about how the Civil War, World War I, and World War II resulted in the creation of a specialty to handle amputees and to help re-integrate people into the work force after life-altering physical and mental trauma.

One of Dr. Jolie Bookspan’s areas of injury research for the military involved finding ways of preventing back pain caused by running. Disease Non-Battle Injuries (DNBI) caused by exercising and physical therapy is a huge military issue. Read how she is helping people learn about healthful daily movement.

“Pill Call,” by Franklin Boggs.

Soldiers suffering from malaria during World War II received their daily quota of atabrine tablets from the Medical Corps captain. Atabrine was more effective than quinine, and was the army’s first line of defense against malaria. Pharmaceuticals save countless lives during times of war, and they are playing an increasingly important roll in our lives. David E. Williams fromHealth Business Blog sent in this post about the FDA. The agency is considering adding a formal category of drugs that would fit in between prescription and over the counter medications.

“Life-Giving Plasma,” by Ernest Fiene.

In 1945, Surgeon General Norman T. Kirk was asked to name the first three outstanding innovations brought about by World War II, and without hesitation he said, “Surgery, the sulfa drugs, and penicillin.” Other outstanding achievements in military research included dried plasma, which was developed and first used during World War II. Medical research conducted by the military during wartime continues to save countless lives. Research in the civilian world is also saving lives. Dr. Anonymous sent in this post about the American Cancer Society and Breast Cancer Awareness Month. One day researchers will find a cure for breast cancer, but until then Dr. Anonymous is urging readers to learn the facts about the disease.

Emmy from the Pink Tee Shirt is a member of another type of army. She is one in an army of of volunteers who walk and run to raise money for cancer research. Read her story here.

Advancements are being made in all areas of the health care arena. David Harlow from HealthBlawg writes about creative approaches to caring for seniors in less restrictive settings.

The effort to improve the health of patients continues on other front as well. Christian from Med Journal Watch writes about how depression in women might be caused by the War on Obesity.

“Jungle–Ally of the Enemy,” by Franklin Boggs.

The tropical jungles of the South Pacific seemly were on the side of the Japanese during World War II. These jungles were infested with malaria, and strange tropical fevers and skin diseases that had never been seen before by military doctors. When medics weren’t busy attending to wounded men, they moved around the jungle with a bottle of solution and swabs, checking the ravages of prevalent skin disease.

Military doctors have always functioned as detectives to cure unknown illnesses that have plagued the troops. Philip from Past Lessons, Future Theories is a House, M.D. fan and he sent in a post about about a patient on the show who was suffering from Von Hippel-Lindau disease. Dr House can cure anything. He is a medical detective just like the doctors who served in the South Pacific.

Other situations remain a mystery. Steve Sims, a contractor working in Iraq was shipped home because he has diabetes. Was he shipped home for political reasons? Read Diabetes Mine and find out what happened.

Have you ever wondered what it’s like living with type 1 diabetes? Kerri Morrone from Six Until Me writes about her troubling low blood sugar that hit her in the wee hours of the morning.

Here’s another mystery. Does fat and meat impact prostate cancer?Gerald Pugliese from DiseaseProof.com is staying out of the fray, and invites you to voice your opinion.

Do you want to know how to reduce your risk for asthma? Read this post from Allergy Notes. Mystery solved!

“The High Visibility Wrap,” by Joseph Hirsch.

I want to thank all the men and women who are serving in uniform, and those individuals who are taking care of wounded troops around the world. Your service is invaluable. You not only touch the lives of your patients, but you touch the lives of all of us as well.

NY Emergency Medicine is hosting Grand Rounds next week.

Just like Mr. Caveman, Filipinos want a little respect. There is a lot of talk going around the blogosphere about an episode that aired on Desperate House Wives in which Teri Hatcher’s character slams Filipino medical schools. Personally, when I viewed the scene in question on YouTube, I thought, “Did she say what I thought she just said?” I’ve worked with many excellent Filipino doctors and nurses during my days in Chicago, and let me tell you, they are some of the best health care professionals on earth, bar none.

I think that this whole brouhaha centers on two issues; the lack of cultural sensitivity on the part of ABC, and how other cultures view “Ugly Americans.” If you haven’t noticed, most of the world thinks that our foreign policy and our attitudes are pretty cocky, so I’m sure that this incident serves to fan the flames. I’m not suggesting that ABC maliciously decided to demean a group of individuals. That’s bad business. What I am suggesting is that ABC needs some cultural sensitivity training. Maybe Mr. Cavemen can act as their mentor, and get them onto the path of redemption.

I have another excuse to post a picture of Steven Jobs. Yes, I’m obsessed with the father of the Apple Computer. Steven, if you’re reading this post, I want you to know that I’m still looking for a new job, and that I’m willing to relocate so I can work as your corporate nurse at Apple. I’ll work for standard wages and a free iPhone. Think about it and get back to me.

You are so lucky because you don’t need to get a job from Steven in order to get a free iPhone. You have a chance to win a free iPhone from Nursing Voices. Nursing Jobs.org is working withNursing Voices to give away two free iPhones to active and deserving forum participants. I’m not kidding! Here are the contest rules. There are just 12 more days left to play, so go check it out NOW!

After you’re done checking out the contest, don’t forget to check out Change of Shift. Girlvet from madness: tales of an emergency room nurse is hosting this week. It’s The Price is Right Week at Change of Shift. Come on down!

The woman with the tray is about to go ballistic. She’s been slaving over a hot stove all day, and the men are glued to the radio because they are listening to the Doctor Anonymous Show. And who can blame them? Doctor A. is very entertaining. Click here to learn more about his radio show. Tune in this week because Dr. A and I will be talking about the next edition of Grand Rounds. I’m sure that we will discuss other things, too, because I never know when to stop talking. Just ask my husband. The show is airing on October 4th at 10 P.M. EST. It’s a good thing that the show is airing after supper because the lady of the house will kill these guys if they blow off another home cooked meal.

The movie Super Size Me is one on the best movies I’ve ever seen. I think it should be required viewing for everyone who suffer from illnesses that are related to obesity. I rarely eat in fast food now, but every so often I fall off the wagon. Sometimes a girl needs a Quarter Pounder with cheese.

Last night I went to McDonalds, and I learned that people really freak out when you use the words “raw hamburger” and E Coli in the same sentence when you are standing at the counter at a fast-food counter. I was really looking forward to my forbidden treat, but I lost my appetite after I bit into my hamburger. It was blood red in the center. I walked up to the crowded front counter and I asked to speak to the manager. I had just read a newspaper story about a recall of hamburger related to E Coli, and I wanted him to be aware of what was coming out of his kitchen. I’ve cared for patients with food poisoning before, I just wanted to keep people from getting sick. The manager’s jaw dropped when he looked at my hamburger, and customers waiting to place their order turned and walked out of the restaurant. He apologized multiple times, and offered me anything I wanted off of the menu. I told him I wanted a refund, and I went home.

I’m back on my diet now. Thanks, McDonalds.

Nurses are shown caring for wounded soldiers in “Speedy Recovery” by Marion Greenwood.

I’m very happy to announce that Dr. Nick Genes is allowing me to host Grand Rounds on October 9th. Next week’s edition of Grand Rounds will be a tribute to the doctors, nurses, and other health care professionals who are serving in the Armed Forces. Military medicine is steeped in history, and I want to hear from you if you have served, or are currently serving as a health care professional in the military. Please send your submissions to nurseratchedsplace@yahoo.com. I am accepting posts about all subjects, but posts about military services will be given greater consideration. Deadline for submitting posts is October 8th at 8 A.M. EST.

This quote is from one of my favorite doctors. Have a nice weekend.

This post is rated X. Please do not read this post if you have high moral standards. I am describing what happens when a bunch of rowdy nurses get together for another nurse’s bachelorette party. For the rest of you party animals, please read on.

Men think that they have cornered the market on wild parties, but that is the farthest thing from the truth. I recently attended a bachelorette party for a nurse who is getting married soon, and the party was quite festive. The bride-to-be is not a shy little thing, and neither were the 40 other women who were in attendance, most of whom are nurses. Since I’m not a drinker, I was put in charge of making sure that no one did anything that would get them into trouble, or on the front page of the next day’s newspaper. The party was held in the bride-to-be’s home in order to maintain damage control, and to protect partygoers’ reputations.

I had never gone to a bachelorette party before, and I was really amazed by all the products that are made in the shape of a penis. My favorite game involved taking a swing at a penis piñata that was filled with little sex-toys, lotions, and other potions. Partygoers also played toss the ring on the inflatable four-foot penis while the bride-to-be cut into a penis shaped red velvet cake. She gleefully cut into the dessert while she announced that she was circumcising the cake. Do you remember Lorena Bobbitt? The bride-to-be is deadly wicked with a knife, and I hope that the groom hides all of the knives in the house if he and the bride-to be ever get into a fight.

Partygoers were treated to pole dancing lessons sometime during the night. The bride-to-be really got into the swing of things. She took the stripper name of Heidi Deep Thighs. I’m not going to tell you my stripper name, but it had something to do with a big chest. I learned a lot and I was really amazed by our teacher’s performance. Her talents defy the law of gravity. I passed on the pole dance lessons. I didn’t want to risk breaking a hip. A sales person was also in attendance, and she wasn’t selling Tupperware. Partygoers were whipping out their credit cards, and the bride-to-be was awarded $500 in free sexy merchandise based on the total sales. Nurses love to shop. By the end of the night, I had locked up the liquor cabinet, and I called taxis for everyone who couldn’t pass a sobriety test.

I saw the bride-to-be two days later when she came into work. She asked me how she ended up with rug burns on her knees. I told her that she would see what happened when she watches the videotape. She doesn’t remember me videotaping the party. Maybe I should put it on YouTube.

Part of my job as a psychiatric nurse is to help people learn to communicate more effectively with others. This post is for all you guys out there who read my blog. Please read this email sent to me by my mother, and take notes. This information will help you understand how the female mind works, thereby allowing you to live a calmer and less complicated life. Remember, knowledge is power.

Have you ever wondered what the women in your life are really trying to tell you when they speak? This list provides a translation of terms commonly used by women.

1. Fine: This is the word women use to end an argument when they are right and you need to shut up.

2. Five minutes: If she is getting dressed, this means a half an hour.
Five minutes is only five minutes if you have just been given five more minutes to watch the game before helping around the house.

3. Nothing: This is the calm before the storm. This means something, and you should be on your toes. Arguments that begin with nothing usually end in fine.

4. Go ahead: This is a dare, not permission. Don’t Do It!

5. Loud Sigh: This is actually a word, but is a non-verbal statement often misunderstood by men. A loud sigh means she thinks you are an idiot and wonders why she is wasting her time standing here and arguing with you about nothing. (Refer back to #3 for the meaning of nothing.)

6. That’s Okay: This is one the most dangerous statements a women can make to a man. That’s okay means she wants to think long and hard before deciding how and when you will pay for your mistake.

7. Thanks: A woman is thanking you, do not question, or faint. Just say you’re welcome.

8. Whatever: Is a women’s way of saying screw YOU! (in a nice sort of way)

9. Don’t worry about it, I got it: Another dangerous statement, meaning this is something that a woman has told a man to do several times, but is now doing it herself. This will later result in a man asking “What’s wrong?” For the woman’s response refer to #3.

Send this to the men you know, to warn them about arguments they can avoid if they remember the terminology. Send this is all the women you know to give them a good laugh, cause they know it’t true.

Maxine and Gabriele Pauli, a Bavarian politician, have something in common. Maxine is a skeptical fan of marriage, and Pauli, who is a leading voice in Bavaria’s Christian Social Union, believes that the basic approach to marriage is wrong. The twice-divorced official is suggesting that marriages expire after seven years.

I’ve seen a lot of people involved in messed up marriages throughout my years as a psychiatric nurse, and I think that Pauli is on to something. Interestingly enough, many marriages start floundering after seven years. This phenomena is called the seven-year itch. I can’t tell you how many times I’ve heard a husband or a wife tell me that their spouse takes them for granted, and that the spark in their relationship is gone. These people stop growing and get bored with life, and with each other. The grass starts looking greener, and sexier, on the other side of the fence, and people start going outside of their marriage to find new companionship. Maybe the seven-year itch wouldn’t be such a problem if people knew that their marriages were coming up for renewal.

Personally, I’m a huge fan of matrimony, but since everything else has an expiration date, why not establish time limited marriages. Of course, there is a downside to everything that holds promise. I predict that there would be a sharp drop in sales of antidepressants and benzodiazepines, which would not make drug companies and their stockholders very happy, and I predict that divorce attorneys would have to find a new way to turn a buck. On the upside, I could use my psychiatric nursing skills as a springboard to a new career as a marriage broker.

Nurses can always find work.