notageek

I think I may have figured out how to fend off that pre-pharyngitis feeling I get at least quarterly. I present with a scratchy throat, difficulty swallowing due to swollen tonsils, and somewhat enlarged submandibular lymph nodes; it’s a classic sore throat, and it’s probably not bacterial, and I’ve tested positive on rapid strep tests so many times that I suspect I’m a haemolytic strep carrier and don’t get real strep pharyngitis.

Anyway, it’s not echinacea. It’s not liquorice. It’s not Yogi Tea, goldenseal, colloidal silver, the triclosan-contaminated goo known as grapefruit seed extract, nor gargling with ethanol solutions.

Nor is it the rather intuititive pushing of fluids and taking of much rest; it turns to pharyngitis unless I also take cod-liver oil, 15 mL twice daily for 3 days.

YMMV; cross your fingers and hope you can get away with 5 mL or so.

I am happy to defer to the authority of those who have greater skill, knowledge and/or experience. I am absolutely miserable to defer to the authority of those who have nothing but a flowchart to distinguish them. Possibly a misunderstood, discredited flowchart. I have probably been reading too much of Dr. Crippen, because when I saw this title pop up on a recommendation list because I’d bought some of my pharmacology texts, my head exploded.

This business of pathways and protocols and journeys, esteemed colleagues, is utter and irritating bullshit. It builds on itself rather than providing us with a useful framework for organising patient care. If I never saw the transtheoretical model again in my education, it would be too soon.

I should point out that nurses are awesome. I was spawned of a nurse, and skilled nursing care is the reason people I know (and helped care for) had a dignified end instead of a miserable, unsanitary snuffing. Why am I picking on nurses? Because outside of one instructor, all my exposure to this namby-pamby mealy-mouthed tapioca-grounded approach to healthcare (excuse me, wellness maintenance empowerment provision) has been through classes taught by the School of Nursing. This BS is a plague affecting all the healthcare professions, but at least at my institution it seems to have gotten a particular pseudopod-hold in the nursing department.

This is distinct from the complaint that healthcare is getting overly nursified, a complaint I don’t entirely agree with. And protocols have a place in the interactions of healthcare professionals; they can ensure that all the paperwork goes to the appropriate places and all the lines get signed. But this commodification of professional-patient interactions to pathways and protocols devalues our skills and experience. All of us, including nurses.

Drop the crack, RNs of the world. I can talk a good line about educating and empowering patients, and I mean every word of it, but I am not guiding them on their journeys, I am not a team member nourishing wholeness and wellness of human beings, and I am not a a precious coloured shard in the kaleidoscope of modern healthcare. Neither are my patients.

Cranky people in healthcare (not that I know any) like to accuse a lot of institutions of being evil. Drug companies, for one. Hospitals, their administrations, doctors and insurance companies also come under common scrutiny. My own profession seems relatively well-liked by the cranky public, for reasons that probably have to do with me not being a licenced pharmacist quite yet.

A friend suggested that this widespread bundling of everything unsavoury into “the dark side” rather diluted the rhetorical power of said dark side. Rather, he said, there should be different dark colours, each of which representes a side. We were actually speaking of software development, as I was a computer science major in a former life, but I think this applies quite well to healthcare as well.

Currently I’m putting together a presentation for [Insurance Company] about [new drug that isn't fantastic for its approved use], for [same thing the old drug does, except the old drug is even worse at it], so that [Insurance Company] can decide if they want to pay for patients’ suppplies of [new drug]. [Drug Company] of course wants them to pay, because patients will not buy this drug if it isn’t covered by insurance, which is why it boggles my mind that the economic simulation they presented uses a brand version of [old drug] as a comparator for drug costs.

Bite me, [Drug Company]. Join the NDA that is currently nipping my heels. I concede it’s kind of intoxicating, calling up a large company and having someone LEAP to send me more information for my review, but you know what this means?

This means the review process is a billion times more fun to do in Canada.

My husband is leaving town tomorrow for a funeral on Saturday. I’m not a close relation, so I haven’t begged off work myself. My husband owns one suit; it’s the one he got married in, and it’s not properly a suit as the pants and coat aren’t matched. Still, grey and black aren’t out of place for a funeral, so I retrieved them from the closet to go over them with an iron.

He wore the pants for a week or so in September, when his beloved similarly-tailored pair gave up the ghost and while we were waiting for the traumatically-acquired new cohort of pants to come back from alterations. The coat, though hasn’t come out since our wedding.

It had been tucked into a short garment bag; the sleeves and bottom were crinkled. It’s a lightweight fabric; we got married in June. My best friend from high school had come over with a basket full of flowers and we’d sat with my ma at her kitchen table, taping together corsages and boutonnieres. My husband had never taken his boutonniere off, and spores from the year-and-half-old fern bled onto the suitcoat as I fumbled for the straight pins. The rosebud was bent but intact.

The last red rose I’d dried was from the arrangement on my grandmother’s coffin. Before her coffin was lowered into the ground, my dad dismantled the casket spray and gave a rose to each of her grandchildren and great-grandchildren. She had 18 grandchildren and 23 great-grandchildren at the time, and there were enough roses. My flight back from Indianapolis left me without enough free hands to carry a wilting single rose, so I’d stuck it upside-down in my plastic cup from the funeral luncheon, and tucked it in my backpack. It dried an odd lopsided shape, crusty and reddish like old blood, and I later crushed it and sprinkled it on the ground rather than keep such a bizarre-looking keepsake around.

I teased the brittle fern fronds out of the coat fibres; some of them crumbled, and I shook the fern and spores out, then returned to pressing creases into my husband’s jacket. Someday everything we love will be ripped from us.

Onwards.

Let’s get this straight: my ankle hurts most of the time. I am popping narcotics, and I have never been a big fan of the opioid-style high; I find falling asleep when I’m not actually tired to be kind of dull. Half a Vicodin every 8-12 hours is not bad in the scheme of opioid use, but it is not good, either. It is more than I needed when I was first back on my feet after my initial sprain.

This is on top of my prescription anti-inflammatory, and on top of lumping around in an air cast/walking boot for the last two weeks. It hurts a little less, but goddamnit, it still hurts, my MRI didn’t show anything exciting, and it’s getting really really old.

I’m pretty sure this is what my friends mean when they say there’s problems that can’t be solved with violence. Because otherwise, man, I should totally go into palliative care. Get bent, pain!