Death with Dignity Act
Posted by Kim in In the news, It snows in Seattle but it's still the prettiest place every other day, Kim Live!, Politics, Things you are not supposed to talk about in mixed company on May 22nd, 2009
In Washington State the Death with Dignity Act was passed on November 4, 2008.
The first death under this new law that took effect in March of 2009 was a woman from Sequim, WA. You can read the entire story here (I encourage you all to read the final statements given by the woman). The law is almost identical to the one Oregon state has and Washington is only the second state to have such a law in effect.
It was entirely interesting to do some research on this new law since it was invariably going to be apart of my career. As a medical professional living in Washington state this was going to be a part of the job, whether I want it to or not.
Just to recap the law as I know and understand it:
A person of sound mind who is suffering from a terminal illness with less then six months to live may request the ability to self-administer the fatal drugs provided by a physician.
Then a written request must be made after the first oral request. This request form has to have two witnesses, one of which is not blood or law related, is not entitled to any of the estate or a owner, employee or in anyway associated with the health care facility that has said patient under their care.
The waiting period is significantly long. I say significantly because if you were dying a painful death 15 days between your oral request and when the physician can write the prescription is a long time. Not to mention the 48 hours that must lapse between the last written request and when the physician can write the prescription.
It is also in the act that the patient be a resident of Washington State either by driver’s license, voter’s registration or property owned or leased in the boundries of the state.
There is a lot of talk in the Act about ending one’s life humanly and in a dignified manner. Everyday I deal with patients who admit to not dying in the way they wish to, wasting away into nothing. It is hard on families, on loved ones and everyone involved to see someone who was once vibrant waste away into a person they no longer are.
I promised myself I wouldn’t bring my personal opinion into it, but I think it’s clear how I feel, I didn’t always hold this feeling but the more I researched the more I came to understand.
All of us do not want to see suffering, all of us wish peace upon our loved ones when they pass, I think we all want that for ourselves. We are living in interesting times. Times I am sure where this question of dying with dignity will become more pressing.
The Daily Mule
So lately it seems politics have been a topic here on this medical blog. So I’ve started another political blog. If you know me at all you know I lean to the left but occasionally I agree with the right, thus calling it The Daily Mule. A mule is sort of a hybrid, so is the blog. Most of the time you’ll hear my remarks from the left and sometimes I might actually agree with the conservative side.
This is where I add an addendum to my zombie plan
I was driving to work at 4 am when I started to notice a little something strange, like for example, a throng of undead staggering through the streets and menacingly snapping their teeth at my car window. I figured I probably shouldn’t go into work and wasn’t too concerned about calling in sick especially since I had already “accidentally” run over my clinical manager, I mean, I think I did, I’m not sure the undead all kind of look like Joan Rivers.
So anyway I start panicking because it like appears like everyone in the entire city is undead and I start thinking about all the zombie movies and how they always take place on the coasts and never in the Midwest and I think this has to do because of all the port cities and how since everything is imported from China, it must be China’s fault. So I decide I need to start driving east but I have like almost no gas and I can’t leave my cats behind because good lord when everyone is like not undead anymore they will be so pissed I left them with only one bowl of food and really that is far more frightening then zombies.
So I drive back home which doesn’t actually look like my apartment building in Seattle but more like the one in California but who is to argue when there are zombies chewing on your back tires. I mean really, priorities people.
I grab the cats and head back downstairs to find all the zombies like milling about waiting for me and then act all staggery and moaning when they spy me, total fakers, btw, whatever zombies. Well I start like zig-zagging across the parking lot and they’re all “brraaaiiins” and I’m like “shit, that shit is real”.
Then it occurs to me that the zombies are all at an arms length of me and if they step any closer they all recoil in disgust. I mean I know it’s early and maybe I sweated a little, okay maybe even peed myself a little. Don’t judge, you’ve never been chased by zombies before. Well it turns out the smell wasn’t me that disgusted them but rather the cats and duh, zombies are totally afraid of cats.
And I was in the Feline Cone of Safety!
Then my alarm went off and I was all fuck! I could have totally ruled the world with this knowledge so I called my brother in West Virginia and when he answered I was all “Haha, I defeated an army of zombies with cats, suck it NRA!” then he hung up on me and I was all whatever, he’s just jealous. It probably had nothing to do with the fact I had woken him up at 6 am. I mean if I am up so should the rest of the world.
Anyway this dream totally made me rethink my zombie plan and because I am such a giver I am telling all of you. Zombies are afraid of cats, seriously and I even drew a diagram of the Feline Cone of Safety:
I also twittered here and here about my dream and was like OMG! I need to add twitter into the zombie plan because hello! people would totally tweet that they just saw some zombies. ALSO, I would avoid areas where “Braaaaaiiinnnsss” was a trending topic (yes I thought this through, shut up).
I also IMed a fellow med blogger who wants to remain nameless and basically the conversation went something like “me and my pirate ship would totally pwn your cats” and I was all “pfffttt…tiny kitten scratches are way scarier then your pirate sword” and I dunno I got all confused and was like “whatever you probably brought the zombies over on your pirate ship” and then called him a Zombie Importer.
Which he totally is because hello, Zombies can’t swim, how else did they get here from China?
Yeah, this is what happens when you’re at the end of your first year of nursing school, when you haven’t slept a more then three hours a night and when you can barely function anymore. Also might have taken a xanax before bed and watched a scary movie, whatever, I got my new zombie plan.
* I just wanted to point out that I am completely professional while with the patients, there was no mention of zombie dreams or pirates or ninjas, well except for that one time when a patient had on a T-shirt that said “Ninjas are way better then pirates” and I was like “what about ninja pirates, huh, way better then just plain ninjas” and then he looked at me weird and I said “that would be the trifecta of cool” and I am pretty sure I used the word trifecta wrong. He might of also looked at me weird because that was the day I accidently flashed my co-workers because I was over zealous about going on break, but then again that could be unrelated.
Conscience Clause and Nursing
Posted by Kim in In the news, Your Friendly Neighborhood Liberal on May 13th, 2009
(Now I am just your friendly neighborhood liberal, every thing mentioned below reflects my opinion and only my opinion.)
On January 20, 2009 the collectively entitled “Conscience Clause” was enacted. This clause was put into place by the Bush Administration, you can find the entire manifesto here. I suggest you read it, I suggest you read all 3o-something pages of it.
That being said I think the Conscience Clause has potential. What I mean by potential is that in the end we all have to go home with ourselves at the end of the night, we have to live with the decisions we make on and off the clock.
I guess one could say healthcare professionals wear two hats. We have a professional hat that keeps us from doing no harm. We wear this hat with pride and hold it dear to our hearts. Our other hat is woven with tradition, with morals, with past experience and with our conscience. We go home with this hat, we sleep with it on, we probably even wear it beneath our healthcare hat.
Whether we want to admit to it or not, this conscience hat follows us around where ever we are, whether we like it or not we judge people based on our personal morals. The degree in which we judge depends on personal experiences, how long we have been in the setting we are in and the person that sits before us. It can also depend heavily on our religious upbringing.
As someone who was raised in a deeply religious family, where the fear of sinning is so deeply ingrained into my soul that even though I no longer practice, I still am caught up with the right and wrongs of scripture. There are things I am uncomfortable with, things that make the pit of my stomach curdle, things that undeniably bother my conscience.
I think it is very clear what this Conscience Clause is all about. I think we all know that the last eight years under the Bush administration that birth control has been a heated topic. Abortion has been an even greater topic of discussion, one that will forever be treated with kid gloves and danced around.
The Conscience Clause allows any member of the healthcare team* to refuse to provide care for patients who are receiving treatments the providers find morally objectionable. There is no guidelines for what is deemed “morally objectionable”, this could range from abortion to treating gay and transgendered folks and also as far as not treating a patient who attempted suicide.
Attempted suicide? Well I’d never go that far, one might say. The fact remains that if one was to take scripture literally and read it word for word they might find the very act of “spilling one’s own blood” to be a very grave sin, a moral religious matter. I say this, because for a time, this was something I struggled with.
We are left with so many decisions, so many moral rights and wrongs that it becomes unclear to me what is really important here. We are nurses, doctors, pharmacists, techs, and janitors who arrive at the hospital every day and hope we make a difference. Going into the healthcare profession all of us are aware of the duties we are to perform. We have all had the training, we have the knowledge (whether it be book or per manum) to perform such duties. We are relied upon by the public to care for them.
Personally, I am not sure I would be able to provide the proper care for a woman choosing to abort a baby. I could very well go through the motions, provide an assist to the doctor. But within my heart I could not provide the necessary emotional support this woman will need to endure this. I would go out of my way to find the proper person to do this and if no one was available my need to care for her would overcome my personal feelings on the matter.
I happen to believe if we can no longer morally find it within ourselves to do a job we have chosen then we must reassess where we are. If we work at a Planned Parenthood or such places and find abortion morally unacceptable then should we really be there? The same might be said for the Emergency Department or a dialysis clinic, if we think of blood transfusions and our conscience twinges then what are we doing there? My love of the healthcare field and my own moral feelings would not let myself be placed at a job I knew I couldn’t perform if the two mixed negatively. I wouldn’t allow this because my job is to care for people, even if my conscience hat pokes out beneath my healthcare hat.
With all that being said, this Conscience Clause is far too broad and far to spacious and far to manipulative for my liking. I rely on birth control methods as do many people, I could go as far as saying that my personal health and well-being would be in jeopardy if a pharmacist refused to fill this prescription. I could always go to the next pharmacist and probably get the medicine just as easily, but what if I lived in a small town in the middle of no where? What if there was only one doctor, or one pharmacist?
There is also the matter of patient rights. Take for example a Jehovah’s Witness, they do not believe in blood transfusions, if they were your patient and they had a signed healthcare directive that said no blood or blood products under any circumstances? Would you respect that based on their conscience or would you fight to have it turned over?
As I said before this Conscience Clause has potential, I think it should be reworked, provisions being made so that patients get the care they need in a timely, nonjudgmental manner. We as healthcare providers must also take into account where we work, we must be responsible for our own actions. We must acknowledge that what field we work in can greatly affect our morals, we cannot rely on a Conscience Clause to fall back upon when we feel something is morally wrong. We have to be proactive to not let ourselves be put in an unfavorable situation.
I think this nation is at a very pivotal time, I also feel we are at a time when personal choice and the freedoms we are given are being tested. I have noted many right leaning people feeling that their freedoms are being inhibited by the current administration, but then push this clause which so clearly inhibits other people’s free choice. We all do not have the same God, we all do not think a like, we are all free thinking individuals. Our moral convictions cannot be placed upon the shoulders of others and then hide behind a rule, or at least a rule that is so broad that the welfare of certain patients may in fact be compromised.
* I have provided links to a left leaning article and a right leaning article, to provide both “sides” of the story.
I got nothin’
Posted by Kim in Kim Live!, More videos about her cats but she is so not the cat lady, Ramblings of the stressed out, This needs more xanax, What the frick is she talkin' about? on May 9th, 2009
I may have seriously lost my mind.
For the record, so not the cat lady.
What is it that you do, again?
Posted by Kim in Damn pigs ruining the hotness of masks for everyone, Hemodialysis, Kim Live!, Ramblings of the stressed out on May 8th, 2009
I have one of those jobs that not many people know about, I constantly get asked what I actually do all day. What I do all day depends on who you ask, but this is a broken down list of my ten hour shift.
0415: Arrive at clinic.
0420: Turn on R.O. and turn on all 18 dialysis machines.
0425: Open Bicart boxes and set them on all 18 machines.
0430: Clock in (I know I started work early, 15 extra minutes will save your life if something goes wrong)
0430: Insert Bicart bullets
0445: Do R.O. water checks and backup D.I. checks
0450: Pull supplies for my three patients I have for my AM shift, this includes two saline bags per machine, a dialyzer and blood lines.
0500: Start setting up dialysis machines and open sessions on EMR, documenting everything.
0520: Pull meds for three pts. Meds include heparin, lidocain and normal saline (I know, I know, hush).
0545: Do last minute water checks in back room and start pulling supplies for mid-shift.
0600: Patients arrive, they weigh, take their own temperatures and offer you all the info on a slip of paper. I thoroughly wash hands, don labcoat and super sexy surgical mask and goggles.
0605: Document findings in EMR, apply BP cuff and have them do a standing and sitting blood pressure, also checking heart and lung sounds. Wash hands.
0610: Cannulation time!
0615: “Hook up” patient to dialysis machine. Wash hands.
0620: Document in EMR. Wash hands.
0630: Look at schedule and notice next patient is not due in until 0645 for a 700 “put on” time.
0631: Grab “acids” (a K+ Ca++ bath we use to dialyze patients) from back.
0645: Patient arrives, repeat put on procedure as noted above. If problems arrive confer with charge nurse. Wash, wash, wash hands.
0730: My last AM patient arrives, do above steps. Wash hands and check patients.
0800: Roughly time for my one hour break. This is also the time I thouroughly wash my hands again and check patients.
0900: Break over, check patients, get ice refills. Grab more “acids” for AM shift tomorrow. Draw meds for Mid shift. Empty trash buckets, get more ice, pull up charts, basically run around.
0945: Prepare for first “take off”, Check patients.
1000: Take off first patient, unhook them from dialysis machine, take out needles, have them hold pressure or use “straps”. Strip machine of blood dialysis lines and clean machine with bleach solution. Wash hands. Replace with new set-up including new dialyzer, lines and saline. Wash hands. Document in EMR everything done. Wash hands.
1020: Tape up first patient and start with take off of second patient. Wash hands and check patients.
1030: Take off second patient and repeat the steps at 1000. Wash hands.
1100: Put on patient as noted above. Wash hands and check patients.
1130: Put on second patient as noted above. Wash hands and check patients
1200: Take off third patient, set up new machine, tape up patient, wash hands and check patients.
1245: Check patients and then take second break where one devours lunch as fast as you can because you know this is your last chance until you go home to eat anything, also pee (might be the first time since your first break, depends on the day)
1315: Last patient arrives for you to put on. Wash hands and check patients.
1345: Collapse into the nurses station where I do more paperwork on the EMR and check patients.
1400: Prepare for a take off. Take temperature, document in EMR, wash hands.
1430: Take off patient, repeat above steps, wash hands, set up machine for evening staff, wash hands and check patients.
1500: Report off to evening shift, check patients and wash hands. Gather stuff, clock out and get the hell out of there.
This is just a typical day, things change drastically every day, so you know take this as it is.
Mothers and daughters
This is my mother:
My mother and I are not like Lorelei and Rory Gilmore, we don’t have night long love fests where we talk about boys and first kisses and other dreamland topics that in my deepest heart of hearts I really wish to talk about. I didn’t tell my mom I had a first kiss until it was evident that I had done more then just kiss–if you catch my drift. Alas, another story for another day.
My mother and I are alike in so many ways that it disgusts me. She is me in 28 years, or rather I am a younger version of her, except with vulgar language and a knack for saying everything that floats unfiltered through my brain.
(look at my face, pretty sure my mom’s clenched fist was about ready to pop me)
(No, that isn’t another Kim Face, that’s my mom. Scary, isn’t it?)
When I lived at home, people at the other end of the telephone line would lend a cautious “Kim?” whenever one us answered the phone. In public, people would cheerfully ask if we were sisters. My mother would gleefully acknowledge her youthful look by chiming in that I was, in fact, her daughter, who apparently looks like she is in her 50s. I would roll my eyes and scowl.
We have more then just looks that connect us in this world. My mother has an uncanny ability to know when things in my life have taken a turn. Like one of the (many) car accidents I have been in, every single time she has called and said “are you alright?” as I was being checked out by EMT’s or fuming on the side walk holding an axle.
My mother cares about me far more then she should. There are days I wonder why she even wants to be my friend. Raising me was no easy battle, watching me make the same mistakes over and over again could not have been fun. But here she is, loving me for some inexplicable reason.
She’s my mom and I really wouldn’t want it any other way.
Five years and counting
Posted by Kim in Kim Live!, Things you are not supposed to talk about in mixed company, What the frick is she talkin' about? on May 3rd, 2009
It took a phone call from my mother at 4:55 pm for me to realize what day it was.
Today is my fifth anniversary.
I almost can’t believe it’s been five years since that scared little kid walked into the ER and left seven days later a new person. I almost can’t believe I am able to talk about it today.
If you know me in real life, if you know me on the interwebs, you might not know that five years ago I almost didn’t make it out alive. I made a choice about my life, a choice to no longer be apart of it. I don’t think the details of what happened are really necessary, the fact of the matter is, I haven’t told ANYONE the details of that night, not even my own parents.
I don’t view what I did as cowardly, I view it has someone (I really no longer associate myself with that person) who desperately needed help, attention, perhaps if you want to go down that way, but really it’s all the same to me. I got what I needed and five years later I am someone completely different.
I could say that those seven days in the lock down unit were probably the most influential seven days of my life, I learned so very much in such a short amount of time.
To say I regret what I did would be a false statement. I wish the way it played out would have been different, I wish I wouldn’t have made the choices I made, I wish my parents would not have had to see me the way they did. I wish a lot of things. However, I do not regret any one of them because in the end, I got the help I needed.
Five years later, I am wrapping up my first year of nursing school, I am faced with the grief of losing my brother, a decision about my future at school I must make within a matter of weeks and the knowledge that sometimes things just don’t work out the way they should or how I think they should.
One might think the slippery slope of a downhill spiral is just around the corner, but it took a phone call from my mother to make me realize what day it was, that to me is growth, it proves to me my inner strength.
This is probably one of those posts that I will instantly regret, but I think it’s something that has to be said. I don’t think there is anything to be ashamed of, I got the help I needed, some people regrettably, do not. Those are the people we mourn everyday.
I will not give this day another thought, I am sorry that my mother has to think about it and remember it. I am the one that got off easy, my memory is not so good surrounding those days.
That is probably my only true regret.
Things you didn’t know about Washington State
So here is the deal.
I know, great way to start off this post, but anywho, I was a little bored this morning. As a side note, nothing good comes from Kim being bored, it’s noted and documented in several police reports—just sayin.
So, I went for a little drive past city limits of Seattle towards the local Air Force Base in the Tacoma area and visited a coffee shop I had only really heard about. Some of you who follow me on twitter know what I am talking about.
Apparently here in the beautiful Washington State you can get your coffee served to you by half naked coffee artists (like my new name for them? Classy) don’t believe me click this and this and perhaps this.
Ahem. I will admit to being a bit flustered upon leaving because frankly I didn’t believe it. I may or may not have almost gotten into a car accident upon leaving but that in itself is another story.
I have nothing else.
I am burned out on work, frustrated at school. Seriously wishing I had never moved to Seattle and suffering from insanity of the swine flu. No worries, I am sure I’ll post something more significant later on.
P.s. I like men, just sayin’, but I can appreciate all sexes. Yeah.
