A Case both FOR and AGAINST Obamacare

Confusing title, I know.

We can't be informed citizens if we can't make heads or tails of the information we're being fed - and that's just the way BOTH sides want it. The Republicans would have us believe that a national healthcare plan that covers all Americans is impossible and fiscally irresponsible. The Democrats would have us believe that a national healthcare plan is possible and fiscally feasible.

Where do the lies end and and where does the the truth begin? I don't know. I don't have time to read all 2,700 pages of the Obamacare bill and I'm willing to bet you don't either.

But here's the catch... whether you like or hate the idea of a national healthcare plan, the fact is we've already got one and it's been in place for years, long before Obamacare was a gleam in the Democrats' collective eye.

Let me explain.

The government has already created laws that state that emergency rooms MUST treat everyone who comes through the doors with a medical complaint. Insurance, no insurance... doesn't matter. Broken leg, strep throat, chest pain, headache, hang nail... doesn't matter. If we fail to do so, the government can and will withdraw our Medicaid reimbursement, without which no hospital in America  survive.

I'm okay with that. No doctor, physician's assistant, nurse practitioner, or nurse could ever look at a person whose leg was broken when his motorcycle got rear ended at a traffic light and say, "Hey, sorry, but you don't have insurance so you have to live with a broken leg." obviously, he would need to be treated regardless of his ability to pay.

Here's the problem... not only do we have to see and treat every person who asks to be seen by one of our doctors, we have to take every precaution to make sure we don't accidentally miss something because, if we do, we will get sued. If someone comes in complaining of a headache, even if the doctor is pretty certain it's just a garden variety sinus headache or a migraine, he or she must order a head CT. If it turns out that it's something more than a garden variety headache, let's say, for example, that the patient is having a stroke or an aneurysm and the doctor misses it and the patient dies or winds up a vegetable, the patient or the patient's family can sued the hospital, the doctor, and the nurse who gave him or her a Tylenol. So, since we live in a litigious society we take every necessary precaution and run every possible test, most of which are completely unnecessary.

Now, if the patient in question is insured, we bill the patient's insurance company and then bill the patient for the amount that the insurance won't cover. Furthermore, we cannot legally turn the patient over to a collection agency as long as he or she demonstrates intent to pay. Say the patient's share of his or her bill is $750. The patient calls (or doesn't call) to tell us that he or she can't afford to pay the bill. We ask them to send us what they can. If the patient send us $1 per month, he or she is considered to be demonstrating intent to pay and we cannot turn the patient over to a collection agency. We can ONLY turn them over if they make no effort to pay the bill at all.

We have a LOT of patients that are only sending in a few dollars per month. And these are the patients who already have medical insurance.

So, what happens to patients who have no insurance? Nothing. We treat them. We get their billing information, we send them bills. Some pay what they can when they can. Most pay nothing at all. Whenever possible, we encourage them to apply for 'emergency' medicaid. Sometimes they do and we eventually get some recompense from Uncle Sam (that's you, by the way, since Uncle Sam gets his money from the tax payers). More often than not, patients who can't pay give us a false name, a false ID, a false address, etc. We usually KNOW we're being given false information, but there's nothing we can do about it - we are required by federal law to treat regardless of a patient's insurance status or apparent truthfulness.

In order to survive, hospitals are forced to raise prices across the board. In other words,  you pay that patient's hospital bill, and I pay that patient's hospital bill, and every tax paying, insurance paying American pays that patient's hospital bill both through higher taxes and increased personal healthcare costs.

Fair? Of course it's not. But it's what hospitals have to do to stay alive.

What about illegal immigrants? What about the homeless and perpetually indigent? We have to treat them, too. We cannot legally turn away any person who requires care. A few months ago, I spent all afternoon taking care of an indigent patient who came into the Emergency Department (I got floated) complaining of chest pain that was radiating down his left arm and up into his left jaw. He showed none of the typical signs and symptoms of a heart attack. He was calm and relaxed. It was raining and had been raining for several days. He was homeless, probably mentally ill and/or addicted to something not medicinal, but he was not stupid. He was cold, and he was hungry, and the local shelter was probably already full, and he was probably mentally, emotionally, and physically exhausted. And he knew we couldn't turn him away if he complained of chest pain. He was just looking for a warm bed and a sandwich, all of we provided for him at your expense. You're welcome.

We can be sued by homeless people and their families. We can be sued by everyone. It makes us edgy and it makes the doctors order a lot of unnecessary tests so they can prove in a court of law that they made every reasonable attempt to give proper care.

I could easily tell you a 1,000 more stories like the last, but I'll spare you. The point is, we have had a national healthcare plan in place for a long time, we just didn't refer to it as a national healthcare plan. When the laws were passed that require us to treat every person the intent was not to create a national healthcare plan. The goal was to prevent hospitals from turning away everyone who was not insured or who was under-insured, which is exactly what would happen if these laws weren't in place.

So, if we have a national healthcare plan, albeit an informal and fatally flawed one, why are we seeking to pass another which, in my too-lazy to read all 2,700 pages of uninformed opinion, is just as ridiculous and fatally flawed? Because President Obama and the Democrats are trying, in all fairness to fix some of the inherent problems of the current plan and make it more equitable. And because they want to look like heros. (Hence, the picture of Utopia at the top of this entry.)

The problem is that our constitution specifically makes it illegal to create taxes that are unfair: "The Congress shall have power to lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defense and general welfare of the United States; but all duties, imposts and excises shall be uniform throughout the United States..."

But who gets to decide what is fair? One would think it would be the majority. But one would be wrong.

Overwhelmingly, these taxes hurt the middle class. The upper class could withstand being taxed more, but they have too much power in Congress. In fact, they ARE Congress - every single member of Congress is in the upper class. They don't want to pay any more taxes any more than any of the rest of us want to pay more taxes. And, money buys favors.

But you already know that.

So, wouldn't a planned healthcare plan make more sense than the accidental healthcare plan? It would. But I am extremely concerned that the current plan is loaded with pork. While I am too lazy to read the thing myself, here are a few links to websites that discuss this in more detail.

http://news.investors.com/ibd-editorials/110311-590517-obamacares-billions-in-hidden-pork-for-unions.htm

http://behindtheblack.com/behind-the-black/essays-and-commentaries/the-pork-of-obamacare

http://www.foxnews.com/opinion/2010/12/10/congress-funds-obamacare-lots-pork-tree-christmas/

But, you're just as capable as I am of Googling Obamacare (a.k.a., The Patient Protection and Affordable Healthcare Act) and reading both sides of the argument and deciding for yourself if it is loaded with bologna and earmarks for special interest groups. 

When Obama was elected he promised us transparency. Obamacare is anything but transparent. We are ALWAYS being lied to and this offends me. The Democrats lie to us. The Republicans lie to us. The libertarians (are there any of them left?) lie to us (or , they would if they still exist, which I'm unsure about). This offends me and it should offend you.

Just tell me the truth. Pass a healthcare plan that is about healthcare. Make it illegal to pad bills. If Obama wants to give money to unions or Verizon, or whomever, do it outright and separately. It should be illegal to earmark funds and stuff them into another bill so that the American public has no idea what is being passed. It should be illegal for Republicans to do this. It should be illegal for Democrats to do this. It should be illegal for Libertarians, if they exist, to do this. If I lie to the government about my taxes, I go to jail. They are ALL lying to us and there are no consequences. This is illegal. If it's not, it should be.

But back to the healthcare plan. Should we have one?

We should.

Why? Why should you and I pay for the un- or underinsured to receive healthcare? Because we already are and, since we are, I would like it to occur in a more controlled and honest manner because I believe this would, in fact, allow us to have greater control over the cost of healthcare.

Furthermore, I believe vision care, dental care, and hearing care should be included in any healthcare plan because they affect overall health and our ability to work. If you can't see because you can't afford glasses you can't even work the cash register at a fast food joint. Hearing, likewise, affects quality of life. Recent research links dental disease and heart disease. People who get regular dental care have fewer heart problems than those who don't. So, as long as we are forcing a healthcare plan on the populace, we may as well do it right.

There are a lot of opinions in this essay and I probably got some facts wrong. But I am speaking as I honestly as I can. If some of my facts are wrong, please know that it was not my intent to deceive, which is more than I can say for the The Patient Protection and Affordable Healthcare Act.

Nurse as Advocate

What is an advocate, and how does this apply to nursing?

Good question! In nursing school the professors spent a lot of time discussing the role of the nurse as patient advocate. There are advocacy questions on every exam. It's something to which we, as students, couldn't really relate. We generally found it boring and unimportant.

According to Merriam-Webster Online, advocate is defined as follows:

1 : one that pleads the cause of another; specifically : one that pleads the cause of another before a tribunal or judicial court

2 : one that defends or maintains a cause or proposal

3 : one that supports or promotes the interests of another

Synonyms include:

exponent, advocator, apostle, backer, booster, champion, expounder, espouser, friend, gospeler (or gospeller), herald, hierophant, high priest, paladin, promoter, proponent, protagonist, supporter, true believer, tub-thumper, white knight

My attitude about patient advocacy didn't change until the first time I actually had to fight for a patient's best interests. Then I got it!

I had an elderly patient that had come in with pneumonia. He got better, and was almost ready to be discharged. However, the nursing team, as a whole, was concerned because he seemed to cough a lot during meals. This was brought to the doctor's attention and she wrote for a swallow study to determine if the patient had developed pneumonia because he was aspirating his food during meals. The doctor told me to call her with the results of the swallow study and, if they were negative, to send the patient home. Unfortunately, the order was written late in the day on Friday. I work at a relatively small hospital and our speech/swallow team leaves by 3pm on Friday and does not work on the weekend. That meant that the patient would have to spend the weekend in the hospital if he was to have the study. This study can be done as an outpatient. However, often when elderly patients are discharged with a prescription to follow up as an outpatient, they never do. Transportation is often an issue and insurance will often pay for things done as an inpatient that they won't cover if done on an outpatient business. This is because our medical system is seriously dysfunctional.

Meandering Moment: For my opinions and insight (or lack thereof) on why the United States' medical system is so warped please read my March 13, 3013 blog. It's completely uninformative, but full of useless insider opinion!

The doctor was quite rightly concerned that the patient would not follow up and would be back within a month with the same diagnoses if, in fact, his pneumonia was caused by aspiration. In the long run, it would be cheaper to keep the patient in the hospital for a couple extra days than it would for him to be readmitted in a week with repeat pneumonia. The swallow study was scheduled for Monday.

I had the patient back on Monday morning. All he needed was the swallow study and he could be released back to his retirement facility. If his pneumonia had been caused by aspiration, the doctor would send him home with careful instructions on what and how to feed him to prevent him from aspirating.

By 10 a.m. no one had come to take him for the study, so I followed up and called the receptionist in our Speech and Swallow Center. I was told that they did not have him on their schedule and they insisted that the study had not been ordered. I told them that I was sure it was because I was standing next to our unit secretary when she scheduled it for Monday. The receptionist told me that she would get him on the list.

Noon rolled around and still no one came. Knowing that the Center would close at 3 p.m., I became worried and called again. The receptionist informed me that her boss said that my patient was not on their schedule because he was not supposed to have a swallow study, that I was in error and he was probably scheduled for a swallow evaluation, which is a different test. I explained that my patient had already had a swallow evaluation and that the speech therapist who had done the bedside test agreed that he needed to have the swallow study.

Believe it or not, there are so many very similar sounding tests and studies that it is very easy to get them confused. I am sure that the nurse who runs the Swallow Center gets tired of nurses sending their patients to the center for what is supposed to be a bedside test. But, in the case of my patient, I knew I was not mistaken. The receptionist told me that she could get my patient on the schedule for the next day. I explained to the receptionist that we had purposely kept the patient over the weekend and scheduled the test for Monday. She said they couldn't fit my patient in, their schedule was already full.

I notified the doctor who was irate. She told me that they had to do the test that day and keeping the patient over night because they made an error was not acceptable, that it was not fair to the patient and would cost the hospital money. She was polite to me, but clearly frustrated by the situation.

So, I walked to the swallow center and spoke directly to the receptionist. She acquiesced and gave me her boss's phone number. I called immediately and left a message explaining the situation and that the doctor was insisting the test be done that day.

1 o'clock. No response. At 1:30 p.m. I called and left a second message. (This woman apparently dose not answer her phone but lets every call roll over to voice mail so she can pick and choose with whom she wants to speak. Must be nice.) 2 o'clock. No response. I called and left a 3rd message.

At 2:15 p.m. a very irate woman in a white lab coat (the director of the Swallow Center) stormed onto my floor and demanded to know which nurse was Sybil. I was at the nurses' station at the time and introduced myself. She started yelling at me, explaining that a swallow evaluation is NOT the same thing as a swallow study and that what the doctor ordered was a swallow evaluation and I needed to learn the difference because I was wasting her time and I needed to STOP calling her phone!

Deep breath...

I explained that my patient had already had a bedside swallow evaluation by one of her highly trained speech therapists, and had failed which is why the doctor ordered the swallow evaluation. She continued to yell at me, "Well, the order was NEVER entered into the system! It is YOUR responsibility to check your orders and make sure they have all been entered! If they aren't entered, they don't show up on our schedule! You can't just call and demand a study - we have to have a doctor's order!" and so on.

Be calm...

I looked her right in the eye and said, "It's order #127. I have checked it 3 times today and had my charge nurse check behind me to make sure it was entered correctly."

She went over to a computer, pulled up my patient's chart, and scrolled to order #127. And there it was... the order that was placed on Friday. "Well, it must have fallen off the list over the weekend. There must be some sort of computer glitch," she stammered.

I am sure she was right about that. I don't believe the mistake was in any way intentional.

It was at that point that she started to realize that she had just belittled me in front of my peers and several doctors. I could see her wheels spinning. Would I write her up?

Meandering Moment: At my hospital, I can be written up by any hospital employee, from the surgeons right on down to the house keeping staff, for treating ANYONE with disrespect. Likewise, I can write up any staff member who treats me disrespectfully, even the CEO. I think this is appropriate. Everyone who works there plays a vital role. No one should be abused and no one should be allowed to be abusive. It's unnecessary, unprofessional, and interferes with patient care. In this profession, it is best to leave your ego at the door.

The Director of the Speech and Swallow Center stood up and said loudly, "Thank you, Sybil, for being such an outstanding patient advocate. You were right to call me because you were acting in your patient's best interest. We will get the study done right away!" She the left the unit.

In less than 5 minutes an orderly from the swallow center appeared with the special chair they place the patient in to do the study and rolled my patient off the floor.

I don't tell you about this to toot my own horn. Nurses are required to be pushy on a daily basis. It's just part of the job. But this situation made me realize that my role as a patient advocate is just as important as my role as a nurse. It's not enough to carry out doctors orders at the most basic level. Nurses are required to fight for the patient's best interest, even if this means disagreeing with the doctor.

I remember a situation in which one of the surgeons wanted to do surgery on a 97 year old patient. The surgery wasn't absolutely necessary to save the patient's life. All of the nurses on the floor were concerned. Older patient's typically don't do as well after surgery as those who are younger and this particular lady was already frail. The family and the patient were also nervous and second guessing their decision to move forward with surgery. They were afraid to tell the surgeon they weren't sure if they wanted to go ahead with the procedure. They voiced their concerns with their nurse (not me), who then voiced them to the charge nurse. When the surgeon arrived on the floor the nurse and charge nurse asked him for a moment of his time and explained the situation. The surgeon heard what they had to say and spent some time discussing the pros and cons with the patient and family. They decided to proceed. We  were all so worried for the patient, but she came through the surgery and did just fine. In this case, the nurse and charge nurse both advocated for the patient and the patient's family by interceding with the surgeon. It is not uncommon for patients and families to be intimidated by and believe it is wrong to question the doctor. It is the responsibility of the staff to intervene on the patient's behalf.

The point is that we do whatever we have to do to make sure our patients get the care they need. This is certainly not limited to nurses. A couple of weeks ago my Clinical Care Partner (CCP) came to me and told me that one of my patient's had a very high blood pressure. I was in the middle of taking care of a patient who was vomiting excessively and ended up having to place a nasogastric tube (NGT). I am ashamed to tell you that I completely forgot about the patient with the elevated blood pressure. My CCP didn't, though, and reminded me once I was done placing the NGT. She was being a patient advocate and I was grateful.

Advocacy is vital to competent, safe, appropriate patient care and it is not confined to the staff. Often the patient's family is the best patient advocate, but more on that another day.

Until then, I remain,
Meanderingly Yours,
Sybil

Just Another Average Day

Actually, there is no such thing as an average day. While nurses have some general expectations, the only thing that is predictable in this profession is that you know that each shift will be wholly unpredictable.

I always try to see my patients in a certain order. I start with the patient who is the  sickest and work my way around to the patient who is healthiest and closest to being discharged. But there are always events that thwart my carefully laid plans. Sometimes the events are small and only sidetrack me for a couple of minutes and sometimes they are huge. It is a constant juggling act.

An example of a small event would be someone calling out for assistance to the restroom. Most patients really do not want to bother the nurse or patient care technician (PCT) unless absolutely necessary. This means that they wait until they HAVE TO GO NOW! Inevitably, your PCT is already helping another patient, after all, everyone has just woken up and the first thing people do is hit the restroom. You have 5 or 6 patients. Your PCT has 12 (there is one PCT for every two nurses most days. Some days we have only one PCT for 4 nurses). Neither of you can be in more than one room at a time, so you take one and your PCT takes another. That's when patient No. 3, your 82 year old female call for assistance, too.

Here's what you need to know about old people. When they have to go, they have to go NOW. Most of them suffer from frequency and urgency. They have been marginalized by society and are often talked down to, which makes them angry and embarrasses them, and compromises their dignity. If someone cannot come and help them immediately when they call for help, they will not wait. They are trying to hold on to what dignity they can and absolutely will not soil themselves. However, they are sick and weak and at much greater risk for having a fall than the 23 year old patient who was admitted for acute pancreatitis secondary to gross over consumption of alcohol. So, someone has to go right away or that old person will get up, get tangled in their IV lines, fall and probably break something. So, you finish getting the 23 year old you were already assisting, when your 82 year old called for help, to the bathroom, tell him that you will be back as soon as possible and not to get up without you. He is undoubtedly on some form of narcotic pain killer and also a fall risk, but is more willing to wait than the 82 year old. Then you RUN to the 82 year old's room.

Meandering Moment: I work on a Gastroenterology floor. We get new pancreatitis patients every Friday and Saturday night like clockwork. Fun times.

Of course, while all of this is going on, what you are not doing is passing your morning medications. You know, the ones you have to administer by 10 am or you will get pinged for not administering them "on time." The important medications, like insulin and anti-hypertensives. You may be thinking that it is more important to give insulin on time than to have someone wet the bed, but you would be wrong. Patient safety comes first and foremost. Of course, if there is someone having a dangerous medical situation, then I may have to let the 23 year old hold it, or wet the bed, but I still have to attend to the 82 year old and the medical situation simultaneously. If another nurse on the floor is available, he or she may be able to help my patient to the bathroom while I deal with the medical crisis. But the other nurses are usually handing multiple crises of their own.

The irony of all of this is that, while we, the nurses, are running around like chickens whose heads have been lopped off, the patients that are not getting their morning meds or being assisted to the bathroom are wondering where on earth their lazy nurse has gone and are thinking about filing a complaint with management. I spend about 10 hours out of every 12 hour shift on my feet. I spend about an hour and a half sitting at the nurses' station, charting on my patients and checking the doctor's orders. Yet, invariably, I walk into a patient's room and he asks, "Where ya been? I been waitin' for my Flomax for 20 minutes. I take it every morning at 8 am and it's almost 9!" Or something like that. I am not kidding.

I am not allowed to tell the patient, who probably thinks I have been gossiping at the nurses' station, that I have been busy with the patient 3 rooms down who had a dangerously low blood pressure and I had to call rapid response and get the patient stabilized and transferred to the ICU before I could bring him his Flomax. I am never allowed to imply that I have been busy helping someone else because management believes that it gives the patient the impression that I am too busy and overworked to take proper care of him. Which is actually the case. Instead, we (myself and the other nurses on my floor) are to carefully choose a therapeutic, calming statement that will make him feel as if he is my highest priority at all times. Something such as, "I'm sorry I wasn't here sooner, but I'm here now and, look!, I've brought your Flomax with me. (smile, smile) Tell me what else I can do or get for you while I'm here. This is when he tells you that he would like a bed bath and a shave... but you still have 2 more patients who haven't received their morning meds and your PCT is busy cleaning up the bedridden 90 year old who acquired C. diff. (a bad GI infection that makes you poop a lot) at her nursing home, and has had her 5th bowel movement since 7 am.

And so on, and so forth. You get the picture.

I cheat. If my manager knew, I would get reprimanded and maybe even written up. It would wind up in my permanent record. God forbid.

A few months ago I had a patient who was just mean. Every time I entered his room he had some disparaging remark. He had already told me that I was stupid for crossing my sevens and that only hoighty toighty nurses did stupid stuff like that! He's probably right about that. I erased the seven, rewrote it without the line, and drew a smiley face on his white board. The smiley face did not make him happy. (Do smiley faces ever make anyone happy?)

Anyway, he was going on about how unhappy he was with me. I apologized profusely and gave him the therapeutic line about him being my highest priority right now and how could I help him, etc.

(Believe it or not, despite my apparent snarky cynicism when protected by the veil of anonymity, I am actually very good at the therapeutic bolongna and get great customer satisfaction reports. It's true! Except from this guy.)

He was not to be deterred from his irate litany and continued telling me how I was lazy and stupid, was probably out flirting with some doctor at the nurses' station (this NEVER happens by the way... EVER. I HATE how nurses are portrayed by the media. But that's another topic for another day), and the nurse he'd had over night and the nurse he'd had yesterday were all a bunch of dummies, too. Plainly put, he was being abusive just to entertain himself.

I put up with it for a while, but by mid-afternoon I just couldn't take him anymore. When he kept on about how lazy I was I looked at him and said, "I'm sorry I couldn't be here sooner,  but I had a patient in another room who was having chest pain." This was true, but a no-no, nevertheless.

So, he asked, "Oh, what were ya doin'? Givin' him mouth-to-mouth? I bet he liked that!"

I just smiled and went about giving him is IV Protonix without saying anything. The silence from me irritated him. Finally, he asked in a very sarcastic tone, "So, did ya save his life?"

I still didn't respond. He said, "Oh, I get it! You won't tell me cuz I didn't like your stupid, hoighty toighty sevens!"

Now, granted, by this time I was fully aware that he wasn't just mean, but probably mentally ill as well. It is grossly unprofessional to mess with the psyche of mentally ill individuals. But it can also be fun if you don't take it too far.

"Why don't you like my sevens?," I asked.

Patient: "Cuz they're hoighty toighty."

Me: "Why are they hoighty toighty?"

Patient: "Cuz they are. Why do you make them that way?"

Me: "Because that's they way they taught me to do it where I grew up. It's so you don't accidentally confuse the 7 for a 1 or vice versa."

Patient: "Only a stupid person could confuse a 7 and1. 7 is 7 and 1 is 1! How hard is that?"

Me: "I guess it depends on how the person writes a 1. Sometimes it can be hard to tell the difference between 7 and 1."

Patient: "If you're stupid."

Me: "Is there anything else you need, anything I can bring you right now?"

Patient: "A normal 7."

Me: "Okay, well, if you need me before I come back, please call me on my phone. The number is on your white board, even if the 7 is stupid."

Patient: "So, what happened with that guy, you know, with the chest pain?"

Me: Look down at my feet and softly shake my head once, then walk out and quietly shut the patient's door.

He was so nice to me all after that. I don't know why. I think he felt bad about being so angry with me for not being there right when he wanted me after finding out that my other patient died...

Only he didn't. I slapped some oxygen on him, gave him 2 doses of sublingual nitroglycerin 5 minutes apart, got a stat EKG, which showed normal sinus rhythm, and a chest x-ray, which was also normal, then gave him some Ativan for anxiety. His chest pain was all related to stress. Of course, I didn't know that for sure at the time. I suspected it, but still had to jump through all of the hoops to rule out something more ominous. Once the Ativan kicked in, he was fiiiiinnnnnneeee!

I don't think I lied... technically. I just withheld the truth. But it made the patient lay off.

Was it right?

Probably not. If you have to ask, then the answer is usually no.

The next morning I was assigned to the mean guy again. I entered his room to put my name and phone number on his white board.

Me: Good morning, Mr. ___"

Patient: "Well, look what the cat dragged in."

I wrote my number on his white board, turned around and smiled at him sweetly, then turned back to the white board, crossed my 7, turned and left his room. I could her him chuckling as I walked down the hall to the next patient's room.

And we had a really good day together.

There is never anything expected or average about my days as a nurse...ever.

Yours Truly (well, most of the time),

Lady Sybil

 

It has been a long time since I've blogged. I spent 6 months working nights and was such a zombie during that time that I just did not have any energy for blogging. On top of that, we moved, my kids have started new schools, and I have discovered that I have hypothyroidism - which, I think, also helps explain my overwhelming lassitude.

The move is done, though the house is still a mess. The kids have been in their new schools for a few weeks and seem to like them. I have started seeing an endocrinologist. Things are finally beginning to return to normal... whatever that may be.

"So, how's the nursing going?," you say?

Thanks for asking. I think it is going well enough. I have now been a nurse for a year and a half and can no longer be considered a Transitional Nurse. If one considers Patricia Benner's 5 Levels of Nursing Skill Acquisition and Critical Judgement (1. Novice (Transitional), 2. Advanced Beginner, 3. Competent, 4. Proficient, and 5. Expert), I believe I am firmly ensconced in the foggy realm between Advanced Beginner and Competent. I don't know if my Charge Nurse and Unit Director would agree, but I doubt they read my blog.

I am now comfortable handling most situations on my own, but am also wise enough to recognize when I need help, and less embarrassed about asking for help. I make fewer mistakes than I made in the beginning. The new flock of Transitional Nurses now comes to me for advice.

Don't get me wrong... I still have along way to go, but I have made leaps, strides, and bounds since my last entry.

"So, what got you blogging again, Sybil?"

Again, thanks for asking!

Two events. First, I had begun to feel silly about blogging since I did not have any followers. It seemed narcissistic to assume that anything I wrote would be interesting to anyone. Especially since I don't consider myself a writer. But I recently discovered that someone I know, and of whom I think highly, also blogs. This person is, in fact, a writer. This person does not seem to care what others think, but seems to write cathartically. For this person, writing heals. I am a healer and so, in his own way, is my friend. For some reason, this helped make the conceit of the exercise less somehow.

Meandering Moment: I recently discovered that I do have one follower. Nigel - I don't know who you are, but thanks. Even if you never read my blog again, thanks for following me, if only for a while. I needed you!

The second event was something that another nurse I know posted on FaceBook. She was complaining about the number of patients we have that come in without medical insurance, who subsist on welfare and food stamps, their hospital bill being footed by Medicaid. They often have multiple offspring by multiple partners, having never been married to any of them, but have the latest expensive phone equipped with Internet access, an iPad, a new laptop, and drive a BMW or Mercedes. Many of nurses with whom this person is friends on FaceBook sounded off about how much we as nurses, and tax payers, find this offensive. This lit my candle, my desire to blog, once again. As an insider in the medical world I believe I do have something to say about the American medical system, its overwhelming flaws, and its hidden dangers. That is why I started this blog in the first place. To tell anyone who might be interested what I know.

So, I'm back. My first order of business is to tell you that one of the reasons the American medical system is perpetually financially destitute is that it is filled with people, like the patient describe in the paragraph above, who scam the system. How can someone afford a $600 phone that costs $60-$80 per month to run, a $500 iPad, and a $1,500 laptop, not to mention the high end cars, but have the gall to tell the case manager they can't afford their prescriptions, they can't afford medical insurance, and so on, and so on, and so on. Yet these people make up about 1/3 of our patient population.

I know what you're thinking: "Wow, Sybil is being cynical and judgmental. She's never been in that patient's shoes! Maybe he was laid off and has run out of COBRA! How horrible for him! She doesn't know him from Paul!" Or something like that, right?

Yes and no. I may not know this particular individual's entire life story, but I hear the same story over and over again, week after week. I hear the same exact story told by so many different people that it is very hard not to marry them all together to create one character to represent the lot. And, I don't particularly like that character. He says he can't find a job, but when you suggest he look for something in the hospital, maybe in food services, house keeping, or as a patient care technician, he has a 1,000 reasons why he could not possibly work in any of those positions. He (or she) has gout, has chronic eczema, has no one to baby sit his 5 kids, is starting his own movie production company, is a poet who is going to become the next great rapper, can't work because the government will just garnish his wages and give the money to his ex-girlfriend to pay his back child support, etc., etc., etc. You get the picture.

"So what!," you say. "It's no skin off your nose! It doesn't affect you, your stability, or how you do your job!"

But it does affect me and it affects you, too. You see, if you are an American and you pay taxes, then you are paying this person's hospital bill. And I am paying this person's hospital bill. And my friend, the writer, is paying this person's hospital bill, though he's knows it not!

Nurses, in general, believe that everyone has a right to medical care. But our current system is set up so that everyone who pays taxes pays for those who won't or can't work. If someone has a legitimate reason that they are unable to work, due to chronic debilitation of some sort, then they have my complete, whole hearted sympathy. It's those who can but won't work, but who are content to live off the backs of others like me that pluck my hypersensitive nerves.

"So, quit your complaining and do something about it! Find a way to fix the obviously broken system!," you say! "Don't just whine about it - I hate whiners! Find a solution!"

I hear you, I really do, but the answer, I fear, lies in socialism. A system in which everyone, regardless of whether an individual works or not, has the same medical coverage. I am not a fan of socialism. I believe in the America in which, if you work hard and put in the time, you can become successful. In that America, if you are not willing to work hard, then you do not reap any benefits and you have no one to blame but yourself. In socialism, you can count on being taken care of by the government and I believe that just makes people lazy. What made America so powerful over the last century was the infinite energy and innovation of the people who believed that hard work would pay off. In the last 20 years or so, as the government has become bigger, we have become less somehow. Less innovative, less creative, less driven. Lazy. Stupid. Less.

This isn't who I am. It isn't how I am raising my children. And it isn't the country in which I grew up. So, I guess I am against Socialism, in general, and I guess that makes me a Republican since our Democrats no longer seem to be Democrats, but Socialists in disguise, though part of me shudders when I type that word: Republican. {shudder} See!

I don't know how to fix the problem. I am torn between my desire to heal everyone who needs to be healed and my contempt for those who knowingly work the system.

All I can think of to say is, "Get a job! A real job! Pay your bills, child support and keep your ____ in your pants!"

And that would get me fired.

But I am open to ideas. In fact, I would welcome your perspective and insight. This problem is too big for me and my feeble mind to fix alone. But, if I join my feeble mind with your feeble mind, perhaps we can develop some solution. I look forward to it!

Sorry I've been gone so long. I hope to be more of a regular around here in the future.

Regards,
Lady Sybil