Science @ Its Best

Didn't think a shrimp could run? Guess again! Apparently, some Marine Bio students at OSU are doing some sort of study on shrimp and water pollution or something and I don't really know how this "treadmill shrimp" came to be, but it serves as good entertainment.

And this relates to nursing because...ummm...oh ja, it's research, which is a part of nursing practice. right.

A Waste of Good Brain

Yesterday was our first real clinical day. For this quarter we're in a nursing home (I figure this is b/c we're less likely to kill people in a nursing home than if we were in an acute setting - i.e. an ER). Though at this point, working in a nursing home is not my first choice, I am grateful to be in a more relaxed setting. It makes it easier to focus on remembering what your supposed to be doing rather than launching us into the chaos & stress of imminent death.

So, clinical is good. We shadowed the CNAs today so we could get to know our residents and their needs. I helped with bathing, dressing, and feeding residents, took some vitals, listened to a woman's lungs who had COPD (Chronic Obstructive Pulmonary Disease). The base of her L lung had crackles on inspiration. 

I also got to talk to some of the residents for a while. The unit I'm in is for those residents who are further along with dementia (i.e. they need more assistance w/ADLs (Activities of Daily Living), their trains of thought and speech are a little more scattered, etc).  What is really amazing (and sad) is the number of these people who have so many accomplishments in their lives. Many of them were nurses, one was a pastor (and he repeats the word "church" all the time), one has a degree in Mechanical Engineering from Texas A&M, another went to Harvard, some others from UW MedSchool (one woman was I think one of the first three woman graduates from UW MedSchool), one woman was an army nurse in WWII in France, and she cared for both the French & US soldiers. She has a photo in her room with all her pins & badges around it, and she has so many! The CNA said she would have been one you would salute. It's

 really sad to see how many really good brains are just dissolving away here. All that knowledge and intellect is just disintegrating into disarray and nonsense.

Here's a little info about Dementia/Alzheimer's:

As people progress through Dementia (Alzheimer's is one of the most common forms of Dementia), their brain just deteriorates, particularly in the memory and language centers. As they get further along, they begin to stop talking. Finding the correct words becomes more difficult, so they get frustrated and just stop. Eventually, they only talk if they have something really important to say...so you'd better listen!  

                                      

P.S. Those holes/gaps in the brain are bad. No wonder people with dementia have trouble with memory & language...there are just chunks missing, like when you pick pieces out of a pie you're not supposed to eat. Well, I tried to Google for a pic of a pie that shows what I mean, but no real luck. Not b/c there aren't photos of partially eaten pies online...there are pages & pages. I mean, My goodness! Why the heck do people post photos of partially eaten pies?!?!?! That's just gross and bizarre if you ask me...so I found a lung cancer steak instead b/c it's just as gross...well maybe a litter nastier. Looks like a tasty steak (minus the tumor. I think that's a tumor. Anyway, it looks like it shouldn't be there.), but I'd rather not have that as my source of O2 exchange.

     

                       

Talking to some of the residents who are in further stages of dementia, it was actually rather difficult, not really because they were having trouble finding words, or because they don't make sense much of the time, but just because you don't really know how to respond. We're taught to just enter into the world of that person with dementia; don't contradict or correct what they say, but just go along with it. So, if a resident asks you if you voted for Nixon in the election on Tuesday, rather than correcting them and saying, "you mean Obama or McCain?", which will just confuse them because their memory doesn't support immediate events as well as long-past events, you just respond "oh, yes. I voted for Nixon." or whatever statement you think will best satisfy them and their question. But I feel like this is hard to do (at least for me anyway). It took me a while to be able go along with it. I found it difficult basically telling straight lies or not validating the truth. When I was talking to a woman yesterday, she asked me "are we all going to the picnic or are just you going?" And of course my immediate thought is "what picnic?" Then I had to quickly remember the condition of the person to whom I'm talking and come up with an anwser. However, the difficult part was that I found myself trying to give as truthful of an answer as possible. So I would say: "I don't think I'm going to the picnic." I don't really know why I didn't just say: "Yes, I'm going too.", because the probability is that she would have forgotten about the supposed picnic and been onto another topic with a minute or so, but it was just weird. It was that Lutheran guilt creeping up on me...thanks Dad.

Oooh, another thing. There was an event. One of the residents is always very concerned about people and wants to make sure no one is being harmed. During breakfast, he saw some of the CNAs helping feed the residents, and this set him off. He was convinced that we were hurting them, and proceeded to somewhat aggressively herd all the staff out of the dining room. He then barricaded the entry and would not allow anyone in or out. When one staff member said, "But Mrs. Jones needs to eat breakfast", he simply stated, "No. No one can come in or out." This went on for a while, until someone finally redirected him by suggesting that he go shave (which he had just finished doing, but he really likes to shave, so he went willingly and breakfast continued without further interruption).

Initiative 1000

Initiative 1000.  Assisted suicide.  Clearly pertinent to nursing.  Coming from a nursing/health care perspective, I think it makes it even more difficult to figure out what I should think about this b/c in some capacity I will be involved in situations where assisted suicide could be a possibility.  

There's the side of "first do no harm" and the point being to save lives, not end them.  But then there's also the whole thing about the patient's needs coming first, doing everything in your power to help the patient, but in the end, not letting him/her suffer.  So what do you do?  Allow a person to end their life prematurely (i.e. even more prematurely than the illness is already taking them), or require that they continue living until the illness/disease takes them. But then again, it's still suicide, making the conscious decision to end your own life, often not seen as a good idea.  

But what about the people who discontinue life support or choose not to receive treatments for cancer, for example.  We don't consider that suicide, just their choice to not endure the hardships of treatment. But in an indirect way, that's technically kind of suicide too because the person (and/or family) is making a decision to either end the person's life or discontinue efforts to sustain life.  But don't get me wrong, I'm not trying to argue that choosing not to endure intensive cancer treatment is dishonorable or sacrilegious or even suicide, but if you really break it down to the elements, in some ways it's a form of assisted suicide, someone (other than God, or science, or whatever) is making the conscious decision to discontinue life, usually based on suffering (i.e. the suffering one may endure through chemo treatments outweighs the benefits of the treatment, so dying sooner, but happier and healthier sounds more appealing).  So, is this assisted suicide initiative, in fact, somewhat similar to a patient choosing not to accept treatment?  I presume that the person choosing assisted suicide is doing so to minimize suffering, time spent in hospitals, and other various burdens (on family, friends, etc, including financial burdens).  If that be the case, I support it.  I don't see that as a cop-out, but rather as a similar decision to "I would rather not endure intensive treatments which will significantly decrease my quality of life".  

But in the end, I don't really know.  How can you really regulate what conditions are eligible for assisted suicide?  So, if it is strictly for medical conditions, terminal illnesses, what about psychological conditions, severe depression, etc.  If you let people end their lives because they are depressed, that's just "regular" (illegal) suicide, but you also can't disregard psychological conditions as medical issues.  But maybe you could say that some physical conditions are not treatable under Western Medicine, and that say, depression, you can "get over" or treat with anti-depressants/anti-psychotics, etc, but maybe you can't "cure" a person with depression and it will "kill" them one way or another. Maybe not physically kill them, but reduce his/her quality of life to the point that it may not be worth living.  So then if depression and terminal cancer both decrease a person's quality of life that much, then they're the same thing and should/could both qualify for assisted suicide.  But I'm also not trying to say that people with depression should just throw in the towel and commit suicide, b/c maybe they can be helped. Maybe the real question is, whether talking about physical conditions or mental/emotional conditions, when is enough, enough? My goodness, my brain is tired now. I will have to think about this more later.