YOU FAIL!

It has not been a stellar week here in Nursing Student Land.

A little background: without trying to sound like an arrogant prick, I've developed, in the last year and a half of school, a reputation as "The Smart One". School has always come relatively easy for me, and nursing school has not been an exception. I have also worked pretty damn hard to learn as much as possible and develop my skills and knowledge base, because I want to be a good nurse. Would you want the nurse who skated through school taking care of you? Me neither. So I've pushed myself.

Clinicals have been stressful, but I've always gotten through them with relative ease and honestly surprised myself a little with how comfortable I've gotten. But. Now, in the final semester of school, clinicals are all business and intense and we are expected to be getting to the point of professional nurses in this 8-week rotation. And guess who made some significant fuck-ups this week?

Yesterday I went home early, after getting an hour of sleep, doing half-assed assessments, and informing my instructor I was not up to the task. I knew I wouldn't make any med errors simply because she was watching me and would stop me if I was about to do so, but I also knew I wasn't learning anything and she offered me the opportunity to make up the time instead of sleepwalking through the day. I was ultra-professional about it and cried. I cry over literally nothing when I'm trying to function on an hour of sleep.

Today, after ten hours of sleep, I felt great. I got my assessments and meds in on time, helped get one of my patients who was being discharged ready to leave, had a successful IV start, etc. My instructor explained to me the charting that had to be done for a discharge and I nodded and took notes. Then completely forgot to do it. I went home feeling pretty confident about my performance and the day I'd had, until checking my email and finding a note from my instructor. She had reviewed my charting after I left and wrote to tell me that since I hadn't completed the discharge charting that she had specifically told me to do, and had additionally missed some of the "safety" charting (hourly rounds completed, bed in low position, etc.), I would need to go back and do it, and I'd be getting an unsatisfactory grade for this week's clinical in documentation. Can't really argue with that.

So after swearing at myself a little, I went back to the hospital tonight to make the required entries. This misstep bothers me a lot, both on the personal-disappointment-in-myself level as well as just being embarrassing. In the grand scheme of things, it's not a huge deal. No one was in danger because of my charting inadequacies. But it still needed to be done, and it should have been done, and it was simple carelessness that it wasn't done. And it's not the part about getting in trouble that bothers me the most, but the fact that my ego, and my confidence, takes a huge hit when I fuck up. Which probably isn't necessarily a bad thing, but it blows nonetheless.

I'm not going to fail clinicals because of this, and I'm not in danger of failing clinicals generally. There are working RNs who work like this all the time. But I don't want to have another week like this, and I have to figure out how I'm going to organize myself to make sure I'm not missing assessments and charting and feeling like a flailing idiot. And I think the best way to start that, at this moment, is with a big glass of wine.

A little thing called empathy, and how it seems to be in short supply these days

Let's talk about health care for a minute.

I'm one of the 50 million uninsured. I'm not an illegal immigrant*, nor am I a welfare queen with increasing numbers of children to collect my ill-gotten government spoils (psst, by the way, all those welfare queens live with unicorns and leprechauns and gay agenda recruiters in the fevered land of Conservative Imagination), nor am I a shiftless substance abuser who spends all day on her Play Station. I'm a nursing student who is working hard to get through school so I can get a job that will provide health insurance, most likely at outrageous premiums. By this time next year, I should have health care coverage and no longer have to live in fear of injuring myself or finding a lump in my breast. But until then, I'm shit out of luck, a point that was hammered home three weeks ago when I developed an abscess in my throat.

An abscess is a pocket of infection. It can develop anywhere in the body as a result of trauma, illness, or the whims of the gods. Mine was the latter; I hadn't been sick until I woke up with a swollen throat and pressure in my sinuses. Within 18 hours the pain was so bad I had Kevin drive me to the ER. Now, I'm no dummy, I knew this would cost me. I'm also no big fan of using the ER for non-emergencies, but it was 2 AM and I was in incredible pain. I was hoping for strep so I could get antibiotics and clear it up, but the rapid test came back negative and the doctor told me it was most likely viral, gave me a couple of Vicodin for the pain, and sent me home. Time spent from check-in to discharge: 25 minutes. Tally of procedures done: vital signs, strep culture, ear nose and throat assessment, the ubiquitous tapping of sinuses, and administration of 2 Vicodin by mouth. Tally of money owed by me to the hospital at this point: $800.

36 hours later, my throat is worse--it's so swollen it looks like a mushy red ping pong ball back there and I have to psych myself up each time I need to swallow. I'm taking painkillers around the clock. The one community clinic for uninsured and low-income patients (aside from the tribal clinics, which are excellent but serve specific populations only) in the area, which is 25 miles away, can't get me in, so we go back to the hospital to go to their walk-in clinic. Instead of the walk-in clinic, I get triaged back into the ER and I'm hoping this time the strep test will be positive so I don't look like a big baby who can't wait out the virus. Nobody rolls their eyes or calls me a baby. The doctor takes one look in my throat, becomes visibly alarmed, and orders a complete blood count and a CT scan with contrast. The cost of this concerns me until I get a shot of morphine. They start an IV, poke and prod me, flood me with dye that makes it feel like I've just peed myself, and scan my head and neck. This time, I'm there for 2 hours and they flirt with the idea of sending me by ambulance to Duluth for surgery, at which point not even morphine can keep my brain from flipping back to what little I know about the procedure of declaring bankruptcy. They consult by phone with the ENT specialist in Duluth, who thinks it's fine if I just come and see him in his office in the morning. Fortunately, when we show up there the next day, he declares the CT scan results "impressive" but thinks it can be cleared up with some heavy-duty antibiotics and surgery isn't necessary. I can't even tally the procedures done, but I did get IV antibiotics and steroids for the swelling, the CT scan, blood tests, morphine, and some other stuff. Total for this ER visit: just shy of $3000. Total for the 20 minutes I spent with the ENT specialist in Duluth while he looked in my throat and checked out the CD of my scan: $176. 

So you're probably thinking, well, those scans and ER visits are expensive, everyone knows that. True. But since people who have insurance often don't see an itemized bill of their medical visits (and insurance often negotiates for more reasonable fees than we uninsured schmucks have to pay), you might be interested to see how those charges add up. For example, just for walking into the ER with a "mod/high severity" problem, I was charged $325.80. Throw in a doctor to see me at that level and it's another $386.40. And my personal favorite, when I got that shot of morphine, it cost $109.60. Not including the morphine. Just getting the injection cost that much. If I'd have known that, I could have done it myself and I wouldn't have even charged them. Hell, starting the IV only cost half that, which makes no sense since it's a much more skilled task. I think the nurses' union should really be pushing for a cut of this, cause that nurse earned the hospital over $150 for less than five minutes worth of work.

Now, here's the thing that really chapped my ass and made me finally get around to writing this little autobiography/tirade (the tirade's on its way, in case you were wondering). I got yet another bill the other day for the services of a radiologist, for $266. You might think those services would be included in the $1115.75 the hospital's charging me for the CT scan, but you would be wrong. I called the billing person to ask about the bill, saying I had a question about it. She immediately starts firing questions at me about how I'm going to pay for it--Visa or MasterCard? I finally get a chance to break in and ask if I can ask my own question and she graciously allows it, so I tell her I'm unclear as to what the bill is for. She said it was for the person who read the scan. 

Okay. Here's the deal: the doctor in the ER told me I had a peritonsillar abscess. As I found out the next day from the specialist in Duluth, this was not possible, as I haven't had tonsils since I was eight. I did have an abscess and it was in my throat, but placement matters. It matters to potential airway restriction, it matters to whether or not the abscess can spread into other areas, like, oh, maybe your brain (and I realize that sounds like a scare-mongering urban myth but my brother had a friend and co-worker die of such a thing and I would rather not die from something so preventable, thanks). So if, in fact, there was a radiologist on duty who passed that information on to the ER doc (a question in and of itself as it was after hours), he didn't really know what the fuck he was talking about. So I get to pay $266 for some incompetent baseless speculation, which obviously thrills me to no end.

So now all of this ER excitement and billing madness is of course going on at the same time as these heated healthcare debates. And you know what? I'm sitting here looking at over $4000 in medical bills, which is really nothing compared to what it could have been and what a lot of other people have to deal with it, and I DON'T WANT TO FUCKING HEAR ANY MORE OF THIS RIDICULOUS "SOCIALISM" FEAR-MONGERING BULLSHIT. Health care that doesn't bankrupt people is not supposed to be a special treat for a lucky few, and it shouldn't be set aside as a privilege for those lucky enough to have a decent job that offers decent health insurance. Making sure everyone in our country can get and afford health care is not socialism or fascism (and, little tip to crazy screaming people who think only some people deserve health care--socialism is the polar opposite of fascism. Read up on some basic political theory before you get too wild-eyed to read anything). It is called taking care of your community. 

Worried about your taxes going up? To be honest, yes, they probably would go up with single-payer health care coverage, which is the system that Canada has. But consider for just a minute how much you pay in monthly premiums for your health insurance coverage through your employer, assuming you're lucky enough to have health coverage. When Kevin and I did have insurance, we paid $300 a month to cover both of us under his plan, and that is not at all unusually high. $3600 a year, while we were making around 35-40K a year between the two of us. That's 10% of our income! Do you honestly believe that taxes for the average family, simply for health care coverage, would be $3600 a year if we had a single-payer system? You might, and if you do, you've probably fully convinced yourself and I should just leave you to drawing Hitler mustaches on pictures of Obama. But for the rest of you, really stop and think about it. Think about how many people Medicare covers right now, and look at the amount of money taken out of your paycheck for that, then use your head and apply some critical thinking skills.

So numbers are fine, but for me, I just don't like the fact that so many of us think it's perfectly okay that someone can get prostate cancer and his friends have to hold a bake sale to pay for his chemo. I don't like the fact that someone having a heart attack may not just be terrified about whether or not she's going to live, but whether or not this is going to cost her her house. I don't like it. I'm not working my ass off to become a nurse because I think only certain people deserve to be treated without having to worry about how they're going to come up with the money to pay for it. Nobody gets sick on purpose. Throw around all the value judgments you want about obesity and health care costs, but marathon runners have heart attacks too. Yes, we all have an obligation to ourselves and our loved ones to do what we can to take care of ourselves, but the fact of the matter is, sometimes illness and injuries just happen, and it's out of our control, and we all deserve to be able to focus on healing without worrying about finding a decent bankruptcy lawyer.

*For what it's worth, I have no problem with undocumented immigrants, but I know there is much hysteria about OMG those people don't even belong here and they can just waltz into any of OUR hospitals and get emergency health care?!! This is another topic entirely and one that I don't care to get into right now, but let me just say that if you think someone should be allowed to bleed to death because they snuck into this country illegally because it's the only way they could earn any money to feed their family, you are missing a serious chunk of your humanity. That goes double if you call yourself a Christian. 

Blargh post

I have been wanting to write, I have stuff to say, but I'm exhausted and over-worked beyond all reason at the moment and can't even really justify the time spent on this little whine. This is the week from hell and I had to exercise all of my "Oh no you di-int" muscles last night when a fellow student finally crossed the laziness tolerance line (which I don't do unless pushed really really far-- I'm Not Always Nice, but I don't do a lot of confrontation, as most people familiar with me know), and I'm counting down the hours until I get a chance to drink an extra glass of wine.

Just, ugh.

"Bush Doctrine"? Like anyone knows what that is.

Due to the spiking effect she has on my already-elevated blood pressure, Kevin would like me to avoid all things related to Sarah Palin. However, I would like it to be known that for the near future, I plan to answer all questions with a snotty and slightly panicked "In what respect, Charlie?"

I See a Stroke in Someone's Future!

We checked each others' blood pressures in our nursing skills class yesterday. Mine is 30 points higher than normal. I think I might be a little bit stressed.