Nurse Rachett Interview

Louise Fletcher as Nurse Ratched in the 1975 film. Photo from Wikipedia

Dr. Carm had the pleasure of interviewing a real-life nurse, Nurse Rachett (not to be confused with Nurse Retched from One Flew Over the Cuckoo's Nest, seen above.)

Nurse Rachett has been in the medical field for "40 long years" and is currently a registered nurse at a nursing care/rehabilitation center. She was previously a licensed practical nurse and worked in a hospital. Below is the interview that might interest those who are wondering what it's really like working as a medical professional.

What are some differences you can tell us from working in a hospital and nursing care/rehabilition center?
 Hospital: There are acute ill patients, some with chronic diseases. With new admissions and discharges every day, patients are continually changing. You need immediate action to patients' changing conditions. Also, these are patients, not residents

Nursing Care Facility: These are chronically ill residents, who can potentially change to acutely ill. Residents "reside" there, most for years at a time, until they are called to their eternal home. [This is a nice way of saying the croaked.] Most changes in conditions are reacted to in a leisurely fashion, with the promise that the doctor will see them in the morning



How many patients do you work with on a daily basis?
55-60

 When you first started out as a nurse, what was something that you wish you would have known then that you know now?
I should have been a police detective

In your opinion, what type of person should work in a hospital as a nurse? (What qualities should he/she posses?)
#1 Organizational skills
To be able to set priorities
Compassion

In your opinion, what type of person should work in a care/rehabilitation center as a nurse? (What qualities should he/she possess?)
#1 Compassion
Organization


What's the hardest thing about being a nurse?
Worrying that you've done your best


What is the best thing about being a nurse?
The times you are satisfied that you know you've done your best

Any crazy stories that you are able to share with us (that will not violate the Hippocratic Oath)?
An 85 year old lady insisted that she wanted to get up at 1:00 am to go to church. I told her, "It's only 1 am--church didn't begin yet."
She was becoming infuriated. "I want to go to mass!"
I said, "Mass doesn't start until 11 am--it's only 1 am."
She shook both her firsts and yelled, "Damn it!"

Any advice for the future nurses out there?
Always expect the unexpected--never say I've seen everything--you have never seen everything no matter how long you work

The most important question: How does Dr. Carm look today? Beautiful? Gorgeous? Spectacular?
Simply gorgeous in a little leopard print dress and sandals

How sweet of you!

Interview was conducted on July 22, 2012.

If you would like to be interviewed by Dr. Carm, please email her at drcarmelee@gmail.com

If you enjoyed this article, you might enjoy:
Dr. Carm's Interpretation of the Hippocratic Oath 
Dr. Bill's Guest Post on Hiccups
Beware the Butt Cooties

 

Can You Read This?

Does this look familiar?

Only great minds can read this

This is weird, but interesting!

fi yuo cna raed tihs, yuo hvae a sgtrane mnid too

Cna yuo raed tihs? Olny 55 plepoe out of 100 can.

i cdnuolt blveiee taht I cluod aulaclty uesdnatnrd waht I was rdanieg. The phaonmneal pweor of the hmuan mnid, aoccdrnig to a rscheearch at Cmabrigde Uinervtisy, it dseno't mtaetr in waht oerdr the ltteres in a wrod are, the olny iproamtnt tihng is taht the frsit and lsat ltteer be in the rghit pclae. The rset can be a taotl mses and you can sitll raed it whotuit a pboerlm. Tihs is bcuseae the huamn mnid deos not raed ervey lteter by istlef, but the wrod as a wlohe. Azanmig huh? yaeh and I awlyas tghuhot slpeling was ipmorantt! if you can raed tihs forwrad it

FORWARD ONLY IF YOU CAN READ IT

This was an email that circulated a while ago. Dr. Carm can obviously read it because she has a great mind (and many other super qualities.) But, is this as awesome as it seems?

Well, first off there was no study done at Cambridge University. Yep, you read me right! According to FoxNews, the email was originally sent out without even mentioning Cambridge University. It was added "after the Times of London interviewed a Cambridge neuropsychologist for comment."  Here are some points of the article:

~Some letters can spell multiple words.  The example used was "ponits" which could be pitons, points, pintos, potins, and pinots.

~Two and three letter words do not change at all, so they are spelled correctly. In the email almost half the words are spelled correctly. This keeps the grammar in control.

~The email only moves the adjacent letters, which is easier to read. Which is easier? Porbelm or pbleorm?

~People can read the email, yes. However, they read it much slower than if it were spelled correctly. A study at Durham found that "the students read 255 words per minute when the sentences were normal, and 227 words per minute when the letters were transposed, a 12 percent decrease in overall reading speed."

So, sorry that you are not as smart or talented as you once thought you were.  Your brain is not as special as you thought (at least with this.)

Obviously, Dr. Carm is still extremely intelligence. [But, you didn't really need to be told that, right?]

Article can be found at FoxNews.com—If You Can Raed Tihs, You Msut Be Raelly Smrat. Published March 31, 2009.


Did you miss the last interesting fact on Butt Cooties? Click here
Next Interesting Fact is scheduled for September 5th

If you enjoyed this, you might want to read:
Nails 
What Illness do You Have? 
Hiccups by Dr. Bill

Nails

Your nails tell you a lot about your health. Of course, Dr. Carm is talking about your real nails—not the painted or fake ones. Have you ever noticed when you were at the doctor's how he or she either commented on something (like a ring) or examined your hands? This is because he or she was looking for signs of any problems or illnesses.

So, go clean your nails and removed the artificial gunk off for this next posting. 

When looking at these descriptions you want to look near the base of the nail for the coloring. A normal nail should be smooth and clear (meaning you can see the skin underneath the nail—so slightly pinkish.)

Beau's Line Nails

Beau's lines are indentations across the nails. It can be caused by injury or illness that interrupts the growth of the cuticle. It can also be a sign of uncontrolled diabetes, peripheral vascular disease, high fever, measles, mumps, pneumonia, or zinc deficiency.³

Blue Nails

Bluish nails are a sign that the body is not receiving enough oxygen, which is common in lung infections (pneumonia). In addition, some heart problems cause the fingernails to become blue.²

Club Nails

Club nails are enlarged fingertips with the nails curved around it. This may be a result of low oxygen and various types of lung disease. It is also associated with IBD (inflammatory bowel disease), cardiovascular disease, liver disease, and AIDS.³

Cracked or Split Nails

Dry, brittle nails that crack or split are often associated with thyroid disease. If the nails are also yellow, then this is a sign of a fungal infection.²

Dark Lines Beneath the Nail

Dark lines beneath the nail can be caused by melanoma and should be seen by a doctor immediately.²

Gnawed Nails

Nail biting is often a sign of an anxiety disorder and has also been linked to OCD (obsessive compulsive disorder).²

Pale Nails

Pale nails can be a sign of anemia, congestive heart failure, liver disease, and malnutrition.²

Pitted Nails

A small depression in the nails is common in people who have psoriasis. It can also be related to connective tissue disorders (i.e., Reiter's syndrome), alopecia areata (an autoimmune disease), or inflammatory arthritis.^2,3

Puffy Nail Folds

If the skin around the nails is puffy and red, it may be due to lupus or another connective tissue disorder. Infections are also a cause.²

Separated Nails (onycholysis)

Nails that are loose or separated from the nail bed are sometimes associated with injury or infection. However, it can also be associated with a reaction to a particular drug or product (such as nail hardeners or adhesives). In addition, it can be a sign of thyroid disease or psoriasis.³

Spoon Nails (koilonychia)

These are soft nails that scoop out. The middle of the nail is dented enough to hold a drop of liquid. Spoon nails are a sign of iron deficiency anemia or hemochromatosis (a liver condition that makes your body absorb too much iron from food). It can also be a sign of heart disease and hypothyroidism.³

Terry's Nails

If the tip of each nail has a dark band, it can be due to aging; but more serious conditions can be liver disease, congestive heart failure, or diabetes.³

White Nails

White nails with darker rims are a sign of liver problems (hepatitis). In this case, you might also notice your fingers might also be jaundiced (yellow).²

Yellow Nails

Yellow can be a sign of a fungal infection. If the infection is not treated, it may grow worse causing the nail to become thick and then crumble. Other conditions that cause yellow nails include severe thyroid disease, lung disease, respiratory disease (chronic bronchitis), diabetes, lymph edema, or psoriasis.^2,3

Some Final Facts¹:

• Fingernails grow an average of only 0.1 millimeter (mm) each day, whereas toenails grow 1 mm per month. Individual nail growth rates depend on age, time of year, activity level, and heredity.
• Nails grow faster on fingers — especially on your dominant hand — than toes.
• Women's nails grow more slowly than men's, except possibly during pregnancy.
• Nails grow more rapidly in summer than in winter.
• Nail growth is affected by disease, nutrition, medications, trauma, chronic illness, fever, and the aging process.

If you have any concerns about your nails, please see your physician.

¹American Academy of Dermatology (2012). Retrieved from http://www.aad.org

²Martin, L. J. (Sept. 2011). Nail health picture slideshow: What your nails say about your health. Retrieve from http://www.medicinenet.com

³Mayo Clinic (Dec 2, 2011). Retrieved from http://www.mayoclinic.com



Related Postings:
What Does Your Hair Say About Your Health 
Patient #3: Lyra 
Skin Cancer 
Probiotics

Guest Post by Dr. Bill: Hiccups

Dr. Carm would like to welcome a guest poster, Dr. Bill. [Holds up "applause" sign]

 Dr. Bill is not a certified doctor but has medical knowledge from working in a pharmacy. He also has an array of experience with journalism. Today he is going to discuss his medical smarts about hiccups.

Dr. Bill, if you please....

 Hiccups

    The stereotyped drunk hiccupping on a cartoon is not that far off from the truth.  Hiccups can be triggered by drinking too much alcohol, as well as eating too much or eating spicy dry foods, drinking carbonated beverages, becoming too excited or laughing too hard, and reacting to stress or sudden temperature changes.

    Technically speaking a hiccup is simply an involuntary contraction of the diaphragm, the muscle tissue that allows us to breathe.  When the diaphragm contracts, it creates a suction to pull air into the lungs and vice versa, when it expands it pushes air out of the lungs to allow you to exhale.  The “hic” sound of a hiccup is simply a sudden rush of air being pulled into your lungs and the rapid closure of your vocal cords to allow this to happen.  The sudden contraction of the diaphragm also causes that jerky movement you make when having hiccups.
 
    Usually hiccups last only a few minutes.  The longest lasting hiccup endured by a person was by Charles Osborne for 69 years and five months.  Don’t try to beat the world record; hiccups lasting longer that 48 hours need to be addressed by a doctor.  Long term hiccups could be a sign of a brain tumor, kidney failure, diabetes, pneumonia, inner ear problems of the vagus nerve which can cause cardiac problems, stroke, multiple sclerosis and meningitis.  After ruling out these issue, long term hiccup treatment would include Chlorpromazine, Metoclopramide, or Baclofen.  If these drug treatments do not work, surgery to block the phrenic nerve or the use of electric stimulation of the vagus nerve can be used.

    Fortunately, most hiccups go away on their own, or with a little help of home remedies.  The moment a hiccup occurs most people immediate hold their breath until the hiccups stops.  Rarely does this remedy work.  The thought here is to prevent the diaphragm from contracting.  Others insist on drinking large amounts of water.  I find this method worse than the last and poses the problem of hiccupping water into the nose. 

    There are five home remedies that I have found to work the best:

    1.  Put a spoonful of sugar on your tongue and let it slowly dissolve

    2.  Put a spoonful of peanut butter on the roof of your mouth

    3.  Sit in a chair, put your head between your knees and look up to the ceiling

    4.  Sing as loud as you can tolerate yourself

    5.  Laugh loudly

Although these methods will make you look like a lunatic, they seem to work well.  Mainly they work by forcing  you to unconsciously control your breathing.

    Q.  Are hiccups on the same order as a burp?
    A. No. A hiccup is caused by a muscle spasm, a burp is caused by gas released from the stomach.

    Q.  Are hiccups caused by people talking about you behind your back?
    A. No, although when they see you sitting with your head between your knees looking up to the ceiling, they may start talking about you!

    Q.  Was this article helpful?
    A. I hope so….

Disclaimer
This article is not intended to diagnose, treat, or prevent any illnesses. Please seek medical attention by a certified physician for any legitimate concerns




Dr. Carm would like to thank Dr. Bill for his posting and giving her a day off to relax.

Health Insurance and Payments (USA focused only)

Post 1: I haven’t been to a doctor in a while can be found here
Post 2: Checkup can be found here
Post 3: I’m Sick: To go or not to go can be found here
Post 4: Diagnosed but not happy can be found here

Many people need a doctor but cannot afford it. There are some options out there [besides trying to find your answers on this blog. Shocking isn’t it???]

This post contains a few resources (for US residence only) to help. Dr. Carm does not represent any of the following, and unfortunately, they probably would deny Dr. Carm’s existence. Try not to judge them by this foolishness.

Here are a few resources to look into to:

· http://finder.healthcare.gov/
Healthcare.Gov "This tool will help you find the health insurance best suited to your needs, whether it's private insurance for individuals, families, and small businesses, or public programs that may work for you. It was created to help consumers under the health insurance reform law, the Affordable Care Act."

· http://medicaid.gov
Medicaid Each state operates a Medicaid program that provides health coverage for lower-income people, families and children, the elderly, and people with disabilities.
The eligibility rules for Medicaid are different for each state, but most states offer coverage for adults with children at some income level. In addition, beginning in 2014, most adults under age 65 with individual incomes up to about $15,000 per year will qualify for Medicaid in every state.

· http://InsureKidsNow.gov
Children’s Health Insurance Program (CHIP) "CHIP covers children whose families don’t qualify for Medicaid but can’t afford to buy health insurance. CHIP provides low-cost health insurance coverage for children in families who earn too much income to qualify for Medicaid coverage but can’t afford to purchase private health insurance. CHIP is a state and federal partnership program that works closely with Medicaid. Every state operates a CHIP, although most states have unique names for their programs like Child Health Plus (New York), Healthy Families (California), and Hoosier Healthwise (Indiana). In several states, CHIP and Medicaid are combined into one program.”

· Community Health Centers “A network of community health centers across the country provides preventive and primary care to millions of Americans. They provide care for free or on a sliding scale based on your income”

· Self-Employed "If you are self-employed with no employees, you now have several options for insurance coverage. In 2014, those options will expand under the Affordable Care Act….”

o If your state allows self-employed people to buy small employer health insurance, then you have similar options as small employers. Find out if you qualify by visiting your State Department of Insurance. Or find additional consumer assistance in your state.

o If your state doesn’t allow self-employed people to buy small employer health insurance, then you have the same options as someone buying an individual health insurance plan.

· Contact DHHS directly:
The U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Telephone: 202-619-0257
Toll-free: 1-877-696-6775

· Health Resources and Services Administration [mchb.hrsa.gov]
The Health Resources and Services Administration (HRSA) of the DHHS website, Maternal and Child Health Bureau (MCHB), whose goal is to ensure equal access to quality health care in a supportive, culturally competent family and community setting.

· Contact MCHB Directly:
Maternal and Child Health Bureau (MCHB)
Parklawn Building
Room 18-05
5600 Fishers Lane
Rockville, MD 20857
Phone: 301-443-2170
Fax: 301-443-1797
E-mail: ctibbs@hrsa.gov

· Family Voices offers resources and communication opportunities on the Internet for people with cognitive and other disabilities, for their families, and for those who provide services and support. This resource has a special interest in the care of children. Resources state by state.
Family Voices[familyvoices.org]
2340 Alamo SE, Suite 102
Albuquerque, NM 87106
Toll-free: 888-835-5669
Phone: 505-872-4774
Fax: 505-872-4780
Online E-mail Contact Form: http://www.familyvoices.org/contact

· Health Care Choices provides information to the public on selecting and using various types of health insurance and managed care plans.
Health Care Choices
P.O. Box 21039
Columbus Circle Station
New York, NY 10023
Toll-free: 800-368-5779

Related Postings:
Preparing for Your Appointment 
Checkups 
I'm Sick (when to go to the doctor's) 
Diagnosed But Not Happy 
Best Medical Schools

Diagnosed but Not Happy

Post 1: I haven’t been to a doctor in a while can be found here

Post 2: Checkup can be found here
Post 3: I’m Sick: To Go or Not to Go can be found here

Diagnosed but Not Happy

So you are not happy with the results of your doctor's appointment. Apparently, you didn’t see Dr. Carm. That’s okay. We all make mistakes. But anyway, if you think there is something your doctor is missing, talk to him or her. Ask questions and be clear on why they did or did not diagnose you with something. [Not all doctors can be as smart as Dr. Carm. Let’s try not to hold that against them.] Don’t be afraid to express your opinions (politely.)

Try to work with the doctor’s solution(s). Maybe you are missing something. If this doesn’t work or you are still unsatisfied, then look around for another opinion. For example, find someone who has more experience in that particular field.

Also, if you are unhappy with the medication or procedures to your disease or illness, ask for alternatives. For instance, some doctors have more experience with natural remedies than others. Each doctor is familiar with certain medications and treatments, and they tend to stick with them. Most of the time there are other options out there. Understand these options and the consequences with your treatment. If you do not feel right with the given treatment and have discussed this with your doctor to no avail, try finding another physician who may provide you with better options and opinions. [Note: always take medication as prescribed. Do not stop taking medication unless directed by the doctor.]

The important thing is to be honest and open with your doctor. Make sure you understand things. Some doctors may not be aware that you do know or understand a medical term. Just ask! This could help you in the long run and become more satisfied with your appointment.

As always, if you have any questions for Dr. Carm, don’t hesitate to ask. She is the best uncertified doctor out there!

Related Postings:
Preparing for Your Appointment 
Checkups 
I'm Sick (when to go to the doctor's) 
Health Insurance
The Hospital
Can You Read This?

I'm Sick: To go or Not to Go

Post 1: I haven’t been to a doctor in a while can be found here
Post 2: Checkup can be found here

I’m Sick: To Go or Not to Go

Not feeling well? That’s too bad! Could you just take a few steps back? A little more…there! Good! Dr. Carm doesn’t want to get sick. Okay, so you are wondering when you should see a doctor. You’re sick but obviously not dying (yes, I know—it feels like it.) Here’s a simple way for doctors to know if they should see you (besides the symptoms of course):

If they need your money = tell the patient to come in.

If they are too busy = tell them stay home.

Nice and easy, right?

So, let’s talk about you as a patient. First rule, whenever you care in complete doubt as to whether to see the doctor or not, call the doctor’s office.

If you are medically inclined (like Dr. Carm), you can do some research on your symptoms. Unfortunately, most websites will probably tell you that you are dying (which isn’t exactly false) or that you have cancer or some weird disease you can’t pronounce. In this case, Dr. Carm has made a list for you. Here are some signs where you should call your doctor (in no particular order):

·         Repeated episodes (dizziness, sleep problems, fatigue, headaches, weight gain or loss, pain, nauseas, vomiting, diarrhea, constipation, abdominal pain, depression or anxiety, panic attacks, pelvic pain)

·          Possibility of a STD (sexual transmitted disease)

·          Numbness

·          Persistent swelling, nosebleeds, jaw pain

·          Blood in stool or urine

·          Severe and persistent sore throat or coughing

·          Hearing loss

·          Severe injuries (cuts/wounds/animal bites that break skin/puncture wounds)

·          Thoughts of suicide

·          Hearing voices

·          Blurry or double vision

·          Eye pain or excessive eye discharge

·          Sensitivity to light

·          Shortness of breath/wheezing

·          Rashes or welts that do not clear up

·          Serious burns or blisters

·          Mole changes

·          Sore that won’t heal

·          Unusual lumps

·          Bleeding during pregnancy

·          Menstrual changes (prolonged, heavy, missed periods, vaginal discharge)

·          Pain during intercourse

[Remember: If you are Dr. Carm’s patient—don’t contact her, she’ll contact you]

As always, if you have any questions for Dr. Carm, don’t hesitate to ask. She is the best uncertified doctor out there!

Related Postings:  
Preparing for Your Appointment
Checkups
Diagnosed But Not Happy
Health Insurance
Calling Off of Work
Sneeze Record
What Does Your Hair Say About Your Health

Checkups

Post 1: I haven’t been to a doctor in a while can be found here

Checkups

Checkups are important for you and your doctor. During checkups, you take a step towards preventing any diseases or illnesses. You become a master of your own health. If the doctor is like Dr. Carm, then she likes checkups, too. She can get updated information on her patient (and interesting gossip). Doctors care about you—and I’m sure everyone cares about Dr. Carm!

What to expect at you annual exams

Don’t worry you usually don’t have to study, and you don’t usually have to worry about filling in those annoying tiny bubbles on the test sheet. [Dr. Carm hates exams.] Annual exams can include: checking vital signs (blood pressure, heart rate, respiratory system, and temperature), testicular exam, hernia exam, penis exam, prostate exam, breast exam, pelvic exam, CBC (complete blood test), chemistry panel, and urinalysis.

Your age, sex, and medical history determines which exams you need. In addition to the ones mentioned above, you should also be aware:

-If you are 50 years and older (sorry, can’t lie about your age here), you should go for colorectal cancer screenings. A fecal occult blood test (FOBT) should be performed 1 to 2 years for people 50-80 years old. Other testing such as a colonoscopy can be done every 5-10 years depending on health risks. For those who have a family history of colon cancer or other colon-related diseases (such as crohn’s disease), tests are usually done prior to age 50. Catching colon cancer early is essential for successful treatments.

-Annual mammograms should be done for women starting at the age of 40. Dr. Carm knows one place that suggests women start their annual mammogram testing at age 35.

-Cholesterol testing (lipids) should be done every 5 years after the age of 20.

*Blood tests can vary between individuals depending on their medications and health.

What should you do to prepare for your checkup?

Besides making the appointment [doctors usually hate it if you just stop by for a chat and say, “Oh, while I’m here, could I have my checkup?”], you can make a list of items to discuss or questions to ask. You know your body and should be aware of any changes. Well, Dr. Carm hopes you do. We don’t have any aliens inhabiting any bodies out there, do we??? Never mind, I don’t want to know….

What should you list?

Did anyone in your family (blood related) get diagnosed with a disease (for example, your sister is diagnosed with lung cancer or your father is now on cholesterol medication)?

Has something been bothering you? A pain? A cold that keeps coming back? Changes in diet or sleeping patterns?

Have you started taking any medication or supplements recently? (More than likely this should be over the counter medication/supplements. Dr. Carm does not approve illegal drugs. People are usually crazy enough without them.)

If something is bothering you, write down why (why does it bother you?), what (what kind of concern is it? Can you describe it?), when (when did it start? How long does it last?), where (where does it hurt? Do you get the symptoms in certain places?), and how (how have you been dealing with it?).

Last points

Remember you can’t undo a year’s worth of damage in a week! [Yes, those pesky diets to lose weight that didn't work because you didn't actually follow the diet counts.] Doctors (that aren’t even Dr. Carm) are usually smart enough to notice this, although they might not outwardly mention it. So, speak truthfully to your doctor. They can’t help you if you hide information or lie to them.

If you need a follow up appointment, schedule it and keep it. There’s a reason why your doctor needs this information. Let him/her help you!

As always, if you have any questions for Dr. Carm, don’t hesitate to ask. She is the best uncertified doctor out there!

Related Postings:
Preparing for Your Appointment 
I'm Sick (when to go to the doctor's) 
Diagnosed But Not Happy 
Health Insurance 
Pelvic Exam 
Elderly Woman 
Eye Exam