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Showing posts from November, 2018

3.16. Tx = treatment

There's always a few individuals in the workplace who are so shady, negative, or incompetent that they are like cancer within the business, institution, or organization. How do we treat these malignant-tumor-type individuals? Surgery, chemo, radiation, immunotherapy, palliative care, and mixed metaphors.

Surgery: cut those people out. Fire them; remove their questionable work and policies as much as possible from the institution (or nation?) to prevent further damage. Everything they have touched, as far as possible, must go--this is termed negative margin. Successful removal of all cancerous tissue amounts to a cure.

Chemo: deliver a heightened level of law & punishment to the entire organization, with the goal of pronouncing the worst offenders guilty and forcing them to go. Multiple approaches may be enforced, making it impossible for the tumor to carry on. The toxicity/strictness of chemotherapies have been specifically designed to target the offending cancer, so while some …

3.15. SIM = simulation

Some days every patient I've ever had, including my mother and all the mannequins and simulations in skills lab, all blend together into one, genderless/all-gender, ageless patient with every disease process possible.

The patient needs mechanical ventilation to breathe, has a nasogastric tube and a gastric tube, a colostomy bag on the left abdomen, a urostomy bag on the right, has a central line in the jugular and in the femoral vein and four peripheral IV lines connecting to six different IV and drip pumps containing propofol & fentanyl (for sedation), insulin, two kinds of antibiotics, and fluids with potassium. Every line except for milky-white propofol is labeled and tagged to prevent confusion in the spectacular nest of tangled tubing that surrounds the bed.

The patient has a history of COPD, heart failure, type II diabetes, coronary heart disease, stroke, preterm labor, cancer, epileptic seizures, lower extremity amputation, hepatitis, liver and renal failure. The patien…

3.14. Metaphorsis

Like a butterfly goes through four stages in complete metamorphosis, registered nursing students go through (at least) four semesters. It's a torturous journey, filled with trips to the underworld, no looking back (or you'll turn into a 1000 ml bag of 0.9% normal saline), slogging away in hopes of a better life ahead.

I. Egg, first semester.
You are a round lump. Circle or oval, an ineffective, three-dimensional, zero. You know nothing. Everything you knew up until now is probably wrong. Apparently vitamin C is more abundant in broccoli than in fruit. Pharmacology makes you wish you were never born. You tumble along, from modern hospital to nursing home to rural hospital. Good thing Mom is there to help, because you are sleepless and starved and cannot survive without support. If you don't make it through this semester, you don't get a second chance.

II. Caterpillar, second semester.
You are a worm. Pathetic, wriggling along on the floor, waiting for someone to stick a…

3.13. NOTES = natural orifice transluminal endoscopic surgery

How would you like your infected gallbladder, which you are quite done with, to be removed and pulled out of your mouth, ! or * ?

Today's medical science has made this possible.

Back in the day, surgeries involved opening up patients on the table so surgeons could see and access target tissue. Now, many such procedures have been replaced with minimally invasive, "laparoscopic" surgeries that involve inserting a tiny, lighted camera and other instruments through small cuts in the body to perform the surgery. An even newer technique involving fewer cuts/holes is natural orifice transluminal endoscopic surgery (NOTES).

In NOTES, a surgeon puts the robot snake with a camera for an eye up or down the natural orifice (mouth, anus, rectum) of choice, and with the guidance of the camera, small incisions are made to reach a target organ. After ligation with a hot instrument, the part (gallbladder, for instance) can be gently retrieved and pulled along the snake's path, until …

3.12. MBPS = Munchausen by proxy syndrome

While many of us will try every wikihow home remedy before visiting a doctor, some patients make themselves sick or fabricate symptoms just because.

A Munchausen's patient may self-medicate to create symptoms due to a desire to be seen as ill or injured. The patient might even undergo risky procedures and surgeries in order to receive the full experience of serious illness.

Nowadays called "factitious disorder," this mental illness was named after the fictional Baron van Munchausen, an 18th century German nobleman known for embellishing the stories of his life and experiences. Tall tales of symptoms, induced or made-up, send doctors on a wild goose chase for differential diagnoses. Factitious disorder may be self-imposed or imposed on others. The latter's a terrifying syndrome, "Munchausen by proxy," made somewhat famous by the entertainment industry.

In Munchausen by proxy, a caregiver or parent causes symptoms in a child through medication, poisoning, or …