3/7/2015- Adverse Childhood Experience

Aleathia says:

I often listen to TED presentations while I am folding laundry.  I can just put one or two on and go about my business.  Sometimes they are just interesting tidbits, but other times they really make me think.  It has been over a week since I listened to the TED on Adverse Childhood Experiences.

The idea behind it is that children who are exposed to persistent adverse conditions will have a drastically increased risk of cancer, heart disease and diabetes as well as mental disorders.  Large scale studies have followed children through adult hood and what is found is that even if these children lead "normal" lifestyles, they are still physically at risk for the major disease that kill most of our country.

The basic theory is that all humans are born with the innate ability to rev up for fight or flight in dangerous or adverse situations.  This means that our adrenal glands are activated, our heart races, our breathing is faster, and our senses heightened should we need to defend ourselves or run very quickly.  This is meant to be a less often used part of our genetic make up.  Children who live in a household with parents or family members who have mental illness or substance abuse can activate this fight or flight on a daily basis.  The activation of these defense mechanisms causes increased stress on the body, more so than is healthy, and can cause developmental problems as well as social and physical problems.

Being a nurse this is very interesting to me.  How many people fall through the cracks because the right questions have not been asked or they have not been looked at outside of the possibility of mental disorder?  It is also interesting to me because I am a high risk person according to my ACE score which is 7 out of 10.

My own health scheme starts to make some sense.  I had Rheumatoid Arthritis by the age of 18, my thyroid went bad by 33, and I started having hypertension by age 40.  I suffer from anxiety that sometimes develops into panic attacks.  I had an eating disorder in high school and suffered from periods of severe depression.

In my household I grew up with a mother who was herself abused and often verbally abusive to me. She was an alcoholic and a drug addict.  My stepfather was an untreated bi-polar.  I never knew what I was going to get on any given day.

I am in no way feeling sorry for myself, but I did wonder why I had so many health problems when I did not live that kind of reckless life my parents did.  Knowing this information does reinforce the need to reduce the stress in my life.  It also explains maybe why it is so hard for me to relax and why I may have unconsciously chosen to place myself in high stress situations.  My body got used to high levels of adrenaline all the time.  I was used to being in fight or flight mode persistently.

I am posting this because I hope the medical community starts to look at patients differently.  How could we better serve our community?  How could we change the face of prevention in light of this knowledge?  It is something to think about.

OM-11/23/2014 Being Truthful in Healthcare

Aleathia says:

Last week, while shaving my legs, I listened to a Ted Talk by Leana Wen who is a medical doctor here in America.  The video was about transparency between a doctor and their patient and how by doing this a true trustful relationship could begin to form.

She made valid points about patients having to hand over their most personal information, their lifestyle, their body to a person with a degree whom they know nothing about.  Patient's don't know where their doctor's stand in the community, with their beliefs, or their conflicts of interest.  It is like a one-sided conversation.

Leana Wen put forth this idea to a wave of hatred by physicians across the country.  She got death threats and bomb threats and was asked to "move back to her country" despite living in the US since she was 8 years old.

I am not a doctor and the nursing model of care is much different than the physician's.  Nurses are a bit more able to look at the bigger picture and take into consideration all of the peripheral reasons why a person might be sick or act the way they do.  We are also more honest and upfront, because maybe, we have less to lose.  We aren't going to get sued for our opinions like a provider might.

Yesterday I had a patient who had pretty severe cancer and was being seen at a prestigious cancer center that is nationally known.  They told him he had lung and kidney cancer and he was young and was undergoing chemotherapy.  When he came to us he had been coughing up blood which is never good.  When all was said and done, his exam revealed a worsened cancer in the last month and cancer in places that our facility had seen in August that were never mentioned to them by their cancer center.

The patient's wife was furious and in tears, because there at 3 am they were both realizing the severity of the situation.  She looked at me and asked my why won't any provider tell them the truth without sugar coating the outcome.  I told her that I could not answer that question as I am not a doctor, but I looked her in the eye and explained slowly and carefully the true possible outcomes of her husband's disease process as it stood right then.  She cried some more.  He cried some more.  I stood there and cried with them.

I understood first hand the power of cancer's grip to steal those that you love right from under you.  It is so silent at first, so evil in the end.  The wife thanked me for my honesty and my compassion.  We were going to transfer him to a higher level of care and after I finished the paperwork I thought about Leana Wen and I too was angry for this family.  Why don't doctors tell you how it is really going to be?  Sometimes it is because they want you to move forward with their plan of care.  Sometimes people don't want the truth.  Sometimes I think they forget what it is like to be on the other end of the spectrum.

I went into work last night and was told that as my patient was being put into the ambulance for transfer, he died.  His cancer swallowed him whole, so to speak, and he was gone.  I knew the ending to his story, but some part of me had a glimmer of hope that maybe I was being a fatalist or being too severe.  I know now that I was able to give them both a realistic picture as sad as it was.

A nurse's job is very hard.  We have to learn so much about a patient in a short amount of time.  We have to juggle 4-5 lives at a time while making everyone happy.  We get to save lives and watch them slip away. Each one chipping a layer away silently.  Each one embedding themselves in your collective personal graveyard.  Try to remember as patients that we are limited to what the doctor says we can do for you, that though we may seemed rushed, or busy, we really do care about making you better.  We wouldn't put ourselves through this daily torture if we weren't compassionate and loving at the core.

Today, I am looking for meaning in the face of untimely deaths, and I am not sure I find any good reasons.  Love your life while you have it.  Tell people how wonderful they are, don't forget to smile and laugh, and take all the hugs you can get.

Peace.