From the Mailbag

22 Nov 2006

In today’s post, I am offering one of my readers equal time to respond to my rant, “What’s so Bad About Feeling Good.” The reader, Troy Dayton, was the subject of a CNN article about people who use antidepressants even though they are not depressed.

I am publishing his response to my post, followed by my thoughts.

I’m Troy Dayton, the person written about in the original post.

We all do artificial things to enhance our moods.

Most people spend many thousands of dollars extra for a newer, nicer, bigger, or more powerful car than they really need. Why do they do this? Because they think it will make them feel better.

The federal government doesn’t threaten the car dealer for selling the nicer car to someone who wasn’t depressed when he bought it even if the consequences of this purchase could be devestating to the person.

In fact, society has the opposite way of looking at extravagant purchases then it does at medication. People generally look down or pathologize the person who self-medicates their maladjusted moods through purchasing.

The irony in all this is that while most people think having nicer stuff will make them happier, the data consistently shows otherwise.

Conversely, the data clearly shows that anti-depressants really do make people happier. And very few people will ever go broke paying for anti-depressants. Cars, clothes, and houses on the other hand…

The pursuit of happiness is so intrinsic to the human experience that it is the last three words in one the most important documents of this country.

Happiness is a process more than it is a place to get to. It is a fleeting feeling and almost everything all of us do in life are efforts at attaining it.

It’s just that humans are notoriously bad at predicting what will make them happy. New cars, big houses, another drink, more money wagered, a decadent dessert, hating gay people, stopping the dog next door from barking, etc. But those things don’t make people happy despite the ever present belief that they will. But as long as those people aren’t hurting anyone else I would never dream of supporting a law to coerce them to stop those behaviors.

I use data, reason, my faith and a deep inner knowledge of myself to create happiness.

Most people only take antidepressants if something is wrong. Most people only go to a therapist or get a coach if something is wrong. Why can’t drugs and therapy be evaluated on the basis everything else we do in the pursuit of happiness is evaluated?

Do the benefits outwiegh the risks? Does the value outwiegh the costs?

Nurse Ratched and others make it sound as if the risks associated with taking antidepressants changes based on why it’s taken. That is false and an absurd notion. The risks are constant. It is the benifits and the value palced on them that changes with purpose.

It is not surprising that medical professionals who are trained to alleviate diagnosable problems put a high value on that and not a very high value on maximizing human potential.

I’ve studied the risks and benefits of using Wellbutrin. For me and my values, the benifits outwiegh the risks.

I’m all for people having the right to disagree, but when they force their opinions through policy, I rightfully stand in defiance.

You have government coercion on your side. You even threaten doctors for prescribing off label.

How dare you support denying me and my doctor the right to choose the course of therapy we see fit?

Hello Troy, welcome to Nurse Ratched’s Place. I enjoy hearing from my readers and I welcome your comments.

Let me start off by saying I understand you feel that Wellbutrin helps you live a happier and more fulfilling life. However, it’s my opinion that antidepressants should only be used by patients who suffer from clinical depression. The article did not indicate that you are suffering from a mental illness. There are many risks to taking psychotropic medications. If I had a patient who was suffering from major depression and had constant thoughts of putting a gun in their mouth and pulling the trigger, I would advise that patient to take antidepressants because the benefits outweigh the risks. If on the other hand the patient did not suffer from major depression, I would not advise the use of antidepressants. I would encourage my patient to try other options that might make them feel better. You are right when you say that people use many different coping styles to deal with their issues, and as you point out, some of these styles are superficial, but I believe that taking serious pharmaceuticals to get “a lift” is not an appropriate use of antidepressants. There are other options you can use to feel better that don’t have potential side effects.

Does the government have the right to dictate to doctors how to practice medicine? That’s where it gets dicey. I’ve worked with a few doctors during my career who have done some really boneheaded things with their patients, and I believe the government must step in to protect patients from unscrupulous physicians. On the other hand, does the government have the right to bar physicians from prescribing medical marijuana? And what about euthanasia? I know I’m rambling a little, but I hope you get my point. Everyone has a different opinion, and there are many issues that need further examination.

Once again Troy, thank you for responding to my post. Please drop by again soon. I value your thoughts and comments.

Love and the Perfect Woman

21 Nov 2006

In today’s installment of the Perfect Woman, we will discuss Dr. Melendy’s ideas about love, courtship, and marriage.

According to Dr. Melendy, falling in love, courtship, and wedlock are the most important events in a young maiden’s life. Love makes the world go round, and she sternly warns women that if they are not “pure at heart,” they will become an old maid. An old maid is a single gal over the age of 21. In preparation for marriage, Dr. Melendy tells women to look into their souls and rid themselves of unrealistic expectations, such as being happy after the wedding. She said that marriage is about sacrifice and duty, and that it has little to do with happiness.

Here’s how everything was suppose to work. During the courtship, a young maiden was to be coy, and unassuming. The man was to be dashing and respectful. Dr. Melendy describes courtship as the voyage of discovery. During the engagement period the young maiden was to gather items for her new home and make plans for the wedding. The man, again, was to be dashing and respectful. After the wedding a young maiden, now a wife, was to be obedient and empty-headed, and the man was to rule his spouse. Dr. Melendy said women were meant to suffer because Eve screwed up in the Garden of Eden. Gee, thanks Eve.

Dr. Melendy said that marriage would keep a woman safe as long and she knew her place and didn’t rock the boat. She told women never to ridicule their husband if he came home late at night smelling of alcohol. She said that men work hard during the day and that they deserve to go out with the boys, and with the ladies, whenever they want to unwind. Dr. Melendy also said that if a man was a savage, it was the woman’s place to tame the beast. If the man remained a beast, it was because the woman wasn’t properly doing her job. Dr. Melendy wrote, “Kindness and love is the chief glory of woman—it is, indeed, her true prerogative—her scepter and her crown. It is the sword with which she conquers and the charm with which she captivates.” Personally, I would prefer conquering a womanizing husband with a cast iron skillet.

Dr. Melendy said that a good wife gives herself to her husband whenever he wants sex. She said that it’s a wife’s duty even though virtuous women do not enjoy sex. If a woman enjoys sex too much, she’s a slut. She tells readers love isn’t found in a physical union, and that the wife shouldn’t expect too much from her husband. Dr. Melendy said that women shouldn’t look for pleasure in the bedroom. She told women to look for pleasure in little tasks and duties, which when added together make a grand total of human happiness.

In the final installment, we will discuss Dr. Melendy’s ideas on how to have the perfect pregnancy.

What’s So Bad About Feeling Good

18 Nov 2006

The illustration is by Bob Watts, and appeared in Salon Magazine’s article, “Wonderful Wellbutrin?”

I’d climb on my soapbox, but I can’t because I’m still on crutches. This is a rant.

Yesterday, CNN released a story about a guy who takes antidepressants. The problem is the guy doesn’t suffer from depression. He said he takes Wellbutrin because it makes him feel good, really good.

Troy Dayton started taking Wellbutrin when he was kicking cigarettes, but now he doesn’t want to give his little helpers up. Troy said the medication makes him feel great, and that the medication gives him the ability to think more clearly. It sounds like Troy has found pharmaceutical nirvana. Some of my past patients have told me that Wellbutrin gives them a rush, the same kind of rush they get when they take amphetamines.

Now hear this! Antidepressants aren’t sugar pills, they are serious medications that have risks as well as benefits. If you take them long enough, you might become physically or psychologically dependent on them, and they can trigger manic-depressive illness in susceptible people. Troy’s physician, Dr. Feel Good, should be reminded about what happens to doctors who promote and/or prescribe drugs for uses not approved by the FDA (read my post about Dr. Peter Gleason), and be counseled by his or her peers.

End of rant…….

No Dumping Allowed

16 Nov 2006

This photograph was taken by the Los Angeles police department on October 22, 2006, and shows an ambulance crew taking a patient to a homeless shelter in Skid Row.

Hospitals, beware, if you’re caught discharging homeless patients to the streets, you could end up in court. The Associated Press reports that a Los Angeles hospital accused of dumping patients in Skid Row is facing criminal charges. The investigation started last March when a 63-year-old woman was discharged from Kaiser Permanente’s Bellflower hospital and was found wandering the streets of Skid Row wearing a hospital gown and slippers. The hospital is being accused of false imprisonment and dependent-care abuse charges. The city is also suing Kaiser under a state law of unfair business practices.

At first, Kaiser defended their practice, noting that there are social service agencies located in Skid Row that can help patients get back on their feet. Then, after a lot of bad publicity, they apologized. Hospital workers can no longer sneak patients into Skid Row. They have to call Skid Row service providers first before they dump patients off at the provider’s doorstep.

We do not live in a perfect world. As a nurse, I believe it’s wrong to discharge patients to the streets, but as someone who recognizes the economic realities of running a business, and make no mistake, health care is a business, I understand why patients are being kicked to the curb. There are no easy answers, and I think things are going to get a lot worse before they get better.

Take My Kid, Please!

14 Nov 2006

Warning: This post is NOT politically correct. There are two types of kids that are admitted to psychiatric units, those with serious mental disorders who need professional help, and those who need a spanking. This post is about the latter. Before you send me hate mail, please hear me out.

There’s a new diagnosis making the rounds on psychiatric units. The diagnosis is Conduct Disorder, also known to many doctors and nurses as Brat Disease. I’ve never been able to understand how this disorder develops. Let me give you an example of what I routinely see on my unit. Two highly intelligent parents bring their little darling to the hospital because he or she won’t mind their manners. The kid dresses like a thug, uses drugs, assaults his or her parents, and refuses to go to school. The parents are dismayed by what is happening. They stand in front of the nursing station, wring their hands, and say, “We don’t know why our baby is acting like this. We’re afraid of our child. Please, help us.” Meanwhile, the kid is making demands, and telling the parents to go to hell. The parents cower, and give in to the child’s demands. That’s when I step in. I tell the kid that while that type of behavior is tolerated at home, it will not be tolerated at the hospital. I let them know whose boss, and the parents stare at me, slack jawed in disbelief. Yes, Mom and Dad, it’s called setting limits.

I feel sorry for the psychiatrist. The parents are paying big bucks to have their child hospitalized, and they expect results. The kid usually goes home within three days, and like clockwork, the parents are calling the unit the next day, complaining about the incompetent doctor. Of course, the parents are clueless that they are part of the problem, and nothing gets resolved. It’s a no win situation, and unfortunately it’s the kid who suffers the most. I’ve observed that children are cured of Conduct Disorder when they turn 18 years old. After they turn 18, their condition changes into Convict Disorder, and they go to jail.

The Perfect Woman’s Perfect Nurse

13 Nov 2006

She’s back!

In today’s post, Dr. Mary R. Melendy, M.D., PH. D. tells readers what qualities make the perfect nurse.

Dr. Melendy advises the perfect woman that from time to time, she may need to hire a nurse to help care for an ailing family member. She said that a perfect woman must not only be a good mother, but a good wife as well, and that by hiring a nurse she will have more time to cook and clean, and wait on her husband. God forbid that a man should ever be expected to get off his dead-butt and help around the house.

It was hard to find a good nurse in the early 1900s. According to Dr. Melendy, the perfect nurse had a bright and cheery disposition, a light step, and a happy face. Since men were repressing women back then, I’m sure these requirements contributed to the nursing shortage. During the interview process, Dr. Melendy encouraged readers to look for a Christian woman with a pleasant voice, a cheerful smile, good dexterity, a strong back, and good culinary skills. A nurse had to be a whiz in the kitchen so she could whip up a batch of gruel when it was needed. Readers were also told to look for an obedient woman who required little sleep. Dr. Melendy warned readers against hiring anyone who was “croaker” or a “putterer,” saying that they ought to be either “married or widowed.”

It was very important that the perfect nurse know how to setup and maintain a sickroom, because without an ideal environment, the patient would never regain his or her health. Dr. Melendy said that good health depended on superior room ventilation, so the perfect nurse knew to open all the windows, even in the dead of winter. The perfect nurse protected her patient from drafts, removed wilted flowers from her patient’s room, and protected her patient’s eyes from the direct rays of the sun or lamp light. She also knew how to use a mop, and a scrub board when washing her patient’s bed linen. Like today, the perfect nurse could multitask.

As archaic as Dr. Melendy’s ideas seem today, she did give her readers one excellent piece of advice on how to find and retain a good nurse: Follow her advice, pay her well, and most importantly treat her with respect and dignity.

In my next installment of the Perfect Woman we will discuss Dr. Melendy’s thoughts on courtship and marriage.

Transcending Gender

9 Nov 2006

What is abnormal? This book was published in 1964, and its cover illustrates the many misconceptions people hold about those who live an alternative life style. Susan Palwick over at Rickety Contrivances of Doing Good posed the question, “What kind of education do emergency-medical personnel get about gender and sexual identity? If they don’t get any, how can that be changed?”

I was never given any information about or training on handling patients with sexual orientation/gender issues when I was in nursing school. I went to nursing school many years ago, and my school was located in a town where people were routinely wearing white sheets and burning crosses in a public park that was designated for Blacks only. Believe me, no one in that town, or in my school talked about tolerance. I thought things would be different when I graduated from school and moved to a liberal university town, but in 1983 I nearly lost my job for letting a gay man sit at his partner’s bedside after visiting hours. His partner died of AIDS during my shift, and I was suspended for breaking the rules about non-family visitation. I’m not telling you this story because I want you to think I’m a saint, I’m telling you this to illustrate how misconceptions about people can interfere with the delivery of good patient care.

Like Kim from Emergiblog, I have always asked my patients what their needs are, and how I can help meet those needs. There’s nothing magical about taking care of a transgender patient. All you have to do is treat them like everyone else.

The Hard Boiled Virgin

8 Nov 2006

Here’s a picture of the hard-boiled virgin. The man is “testing” her to see if she’s done. I don’t know how a virgin becomes hard-boiled, but some of you have voiced some intriguing ideas.

Men fawn over girls who look like this young woman. I had a classmate named Mary when I was in nursing school. She was a knockout. Leagues of men adored her, and they all wanted to take her out on a date. Mary enjoyed the attention, but she wasn’t a tramp. She was a rare combination of beauty and brains, and she was very serious about her studies.

I never thought that being beautiful would have a downside, but Mary occasionally had problems with sexually preoccupied patients. She approached this challenge with dignity and grace while providing superb nursing care to dirty old men, horny teenage boys, and the sporadic sexual pervert. They would grab at her, and she would bob and weave. They would ask her out on a date, and she would tell them she was their nurse, and nothing more. Some of the men exposed themselves to her and she would just walk out of the room. I was amazed at her unflappability. She was never demeaning when setting limits on inappropriate behavior, and she always enjoyed taking care of her patients.

Maybe the hard-boiled virgin is a nurse. She looks intelligent and kind. She also looks like she can take care of herself. Watch out! I think she’s going to put this guy in his place.

Election Day Painkillers

8 Nov 2006

What does Mother Jones RN and these boulders have in common? We’re all stoned. Get it? Those pains pills I’m taking for my injured ankle are kicking my butt.

I taped up my ankle, took my pain pills, grabbed my crutches, and hobbled to the polls first thing yesterday morning. My husband dropped me off in front of our local firehouse, and then went to park the car. While I was waiting for my prince, several people came up and asked if I need any help. Oh no, I was fine, really fine, because the pain pills were kicking in. Some very nice redneck good-old-boys let me cut in line, and my prince and I were done voting in about 15 minutes. Chivalry is not dead.

Like millions of other Americans, I watched the election results on ABC and Fox. The guys on Fox looked glum. I also heard that Vice President Cheney went hunting on Election Day. I hope someone took the buckshot out of his rifle when the election results started coming in.

Do you remember this?

The Princess Nurse and her Prince

7 Nov 2006

Here I am at home in my favorite red gown. My prince adores me and he’s waiting on me hand and foot. He just polished my tiara. How do I look? Ok, maybe I don’t look exactly like this, but a girl can dream, can’t she?

I am a princess nurse who is very tired when I come home from work at the hospital. My prince appreciates all of my hard work, and he spoils me rotten. I work 16 hours every Saturday, and my prince serves me breakfast in bed every Sunday morning. He makes me French toast, my favorite. My prince supports my dreams of returning to school, and he takes me shopping for books whenever I want. He is kind, considerate, and patient, which is a good thing because I can get cranky when I’m having hot flashes. My wish is his command. He works on keeping the passion alive in our marriage.

When I’m not at work or at school, I kickback and relax by blogging or by reading a good book. Like I’ve said before, I’m not Martha Stewart, and if you enjoy a spotless home, don’t step foot on my property. My house is cluttered, but this doesn’t bother my prince. He just steps around the junk that’s lying around the house. It’s also a good thing that he likes to cook because I can’t boil water. The last time I tired boiling water, the pan caught on fire, but that’s another story. The kitchen is his domain, however, I do have visitation rights to the refrigerator whenever I want a can of Coke. He won’t even let me clean the kitchen when he’s done preparing our meals. The best thing about my prince is that no matter how old and wrinkled I get, he always thinks I’m beautiful. Love is blind.

I think I’ll keep him. I’m the luckiest princess nurse in the world.

Nurse Ratched

There has been a lot of chatter in the blogosphere about medical bloggers and HIPAA regulations so let me make this very clear: I write composite stories about many different people that I've cared for over the years.

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Amanda Trujillo, MSN, RN, DNSc-NP(s) Media & Blogger Coverage