Braised Lambchop
a nurse trying to work while suffering with chronic pain - she rambles a bit

Last contact: memorial day weekend

Responds to: E-mail or phone calls, usually, but not in over a month

Reward: Contact proprietors if you have seen her

Update: Lambchop located. Condition upgraded to "cranky."

I'm late reading some blogs because of my new fascination with knitting. Nevertheless, I feel I must do my part, because I like Dori and I think she's beautiful:

Michael S. Cox is a spammer.

May this post live forever in the bowels of Google, and may Michael S. Cox, who in case you hadn't figured it out, is a spammer, become entangled in the crap he sends out and vomited up like yesterday's spoiled egg salad.

So there. Better late than never.

I tried to post this once and MarsEdit ate my entry, so let's try again...

BLOGZOT 2.0 on MacZOT.com is a promotion whereby software is exchanged for publicity. Today's incarnation is for SubEthaEdit from CodingMonkeys, a very highly regarded text editor and collaboration tool.

The price for SubEthaEdit is normally $35, but today the price drops 5 cents for each blog post about the promotion. As I write this, it's down to $19; two hours ago it was $20. If the promotion manages to get the cost down to $0.00, MacZOT and TheCodingMonkeys will award $105,000 in Mac software.

The deal lasts and the price drops until midnight Pacific or until 3,000 bloggers have posted, so if you want SubEthaEdit for less than retail, start blogging.

(Reminder: To read the article referenced by this post or any post, click the headline.)

Oh, goody – there are now hospitals that could be mistaken for four-star hotels. With beds in the rooms for family, and quilted bathrobes, and gourmet food, and carpet, and flat-screen TVs.

I didn't know flat-screen TVs were essential to post-operative cardiac care. Apparently I was wrong. I'll be sure to mention that to AACN for inclusion in the next CCRN exam.

"Specialty hospitals" are opening up all across the country – facilities that concentrate on profitable procedures for profit-minded surgeons. Profitable procedures like CABGs, total knees, lap cholecystectomies (gall bladder removal through 4 or 5 tiny incisions) – you know, the stuff that makes the money for a hospital, instead of the uninsured motorcyclist with half his brain on the pavement and the other half spilling out into the ED's nice tiled floor.

After all, these poor surgeons are just living out their dreams:

It wasn't money that fueled the dreams of a lot of Fresno's surgeons. What they wanted — and built — were hospitals they could call their own. They created the concrete embodiment of their every professional fantasy, places where they could work unencumbered by department bureaucracies and where their patients' care and comfort would be the top priority.

This sounds good to everybody on the surface, but it's not.

These 'heart hospitals' and 'surgery centers' are taking the money away from hospitals that have ICUs and emergency departments and trauma staff. Running a hospital is in many ways like running an NCAA athletic program – the things that bring in the dough pay for a lot of the things that don't. At OU, football pays for basketball, fencing, gymnastics, and everything else. In a hospital, surgery pays for the care of diabetics, cancer patients, and people who come to the emergency department after they've had motor vehicle accidents, strokes, or the flu.

There's very little money in being a trauma center, because much of the trauma care is for uninsured or underinsured patients requiring massive resources, and those resources have to be available 24/7. There's even less money to be made from medical units, like floors that take patients with emphysema and chronic bronchitis or diabetes. Intensive care units don't bring in the dough because they're so unpredictable and so dependent on expensive technology. 'Non-profit' when used with the word 'hospital' doesn't really mean no profits – it means no stockholders. The money has to come from somewhere to pay for the emergency care you expect.

As if that wasn't enough, a huge majority of the patients in these specialty hospitals are otherwise healthy, with no underlying or contributing health conditions, and they have few or no complications. That's good for those patients but bad for everybody else – if the non-profit hospitals only get the sickest of the sick and the worst surgical candidates, they're obviously going to have patients with longer stays that cost more money. The specialty hospitals get the cream of the crop while non-profits pick up the leftovers and have to care for everyone who walks (or rolls) in the door.

The for-profit facilities described in this article sound great for a fussy patient, and they might be very good employers, maybe even as good as the writer seems to believe. But I've got my doubts:

"There was a sense that we were being disenfranchised. It was hard to get our patients in, hard to get the hospital to work with us," says Dr. Robert Chambers, a cardiac surgeon in Fresno who with colleagues opened the Fresno Heart Hospital. "We wanted more nurses, more involvement, more [operating room] time."

In their dream-come-true hospitals, administrators don't scramble to hire nurses. They have the cream of the crop pounding on their doors. Doctors are in charge of scheduling the operating rooms, and when they walk in, they get handed patient files, updates on their conditions — all in an uncluttered work area.

"You walk into a regular hospital, and you have to find your charts. Nurses and technicians have purses and backpacks spread all over, and there's no place to sit. Then you have to try to find your patient, find out who your nurse is," says Chambers.

"Suddenly, you say, 'By God, I'm going to do it my way.' "

I've never seen a disenfranchised surgeon, but that's not the part that bothers me. He insinuates that it's the nurses' fault that life isn't peaches and cream at a non-profit hospital.

If only we'd just hand them their files when they walk onto the unit – as if the world stops when these heroic surgeons stride majestically through the door. We don't have anything else to do at shift change but serve as your handmaidens. (Seriously, that's how some surgeons think the world works. Not the good ones, but some of them.)

If only they didn't have to find out themselves where their patient is – perhaps hospital patient rooms could have some type of numbering system. There could be a database, too, with patient names listed next to their respective numerical code – and if we really stretched, someone could even invent a device to put the patient name and room number on paper.( He's actually upset because sometimes we have to move patients overnight and he wasn't informed. It's a big imposition to walk two rooms down from where he thought Mrs. Hufflegrump was sleeping.)

If only we would put our purses and backpacks away – although I've always worked in facilities that had lockers for staff including technicians. If he has to move our bags, he's just lost.

If only there was somewhere to sit – he wants the RNs, who are busy charting so they can go home and get some sleep, to give up their chairs for him.

If only he could find out who the nurse is – that's not a big secret, although the method for communicating this varies from facility to facility. Usually it involves a dry-erase board. But then he wouldn't be receiving the attention he feels he deserves.

Yes, of course, hospitals should make the doctors happy – all the doctors, including the endocrinologists who have diabetic patients, the gastroenterologists who care for IBD patients like me, and the oncologists whose cancer patients need hope instead of wall-to-wall carpeting. The surgeons go through something during their residency that makes them feel entitled, and I don't know what that is. It's worse in some than in others, but there are dozens of other physicians practicing at a given hospital that don't act as if they have been anointed or something. They are all working together to provide a service to a community, not to themselves alone.

And that's why I've called this post 'the health care future of Metropolis.' We're each living in our own Metropolis, be it on the east coast or the Great Lakes or the southwest. Every Metropolis has a finite amount of health care resources; some people are happy with the emergency departments at Metropolis's hospitals and some tell horror stories of waiting 8 hours for stitches and antibiotics. It's the same story all across the country, with slightly different players. You only think your particular town is better or worse than the rest. Let's play a little game – you live in one particular Metropolis, and I say what happens to you. :-)

You are at your family doctor's office one day because you can't stand the pain in your knee anymore, and your doctor told you last time that replacement was the only option. You're here to be referred to an orthopedic surgeon. While waiting, you look over a brochure for Metropolis Surgery Center (MSC), which opened about 18 months ago. You see the high-end furnishings and the promises of attentive staff and plasma TVs, and you think to yourself that it might feel good to tell your friends, "I'm going to have my operation at MSC, because they have oak cabinets, and beautiful curtains, and it's all carpeted. And there's even a sofa for my husband to sleep on all night." So based on brochures and news articles, when you need your knee replaced you choose a surgeon who practices only at MSC over another excellent orthopedic surgeon who only operates at University Hospital of Metropolis (UHM). UHM is a teaching hospital and a Level I trauma center, meaning that UHM has met a very stringent qualification procedure outlined by the American College of Surgeons and is one of the best trauma facilities in the country. (Level I trauma centers don't grow on trees – Oklahoma has only one, the OU Medical Center, and that is a big reason why Oklahoma's trauma system has been so poor. But back to the game.)

Your surgery goes well, and you're thrilled with the level of attention you receive at MSC: You got a thick, new bathrobe with matching slippers to wear, you had your own personal nurse with no one to care for but you, and for dessert at your last evening meal you had crème brûlée. The other patients you saw as you made your walks were all surgical patients that seemed to be a lot like you – you didn't see any of those "sick people" usually found in a hospital. Your insurance paid for everything and your knee works just fine. MSC definitely provided top-notch care and you're a satisfied customer. You tell all your friends, especially the friends with bum hips and knees and heart disease.

Six months after your surgery at MSC, your 26-year-old son crashes his car late at night trying to avoid an animal that ran out onto the highway in front of him. He is taken by ambulance to UHM, the teaching hospital, where the emergency physician tells you he has a broken pelvis and a shattered right femur (thighbone), among other serious injuries. The doctor goes on to tell you that if your son had had this accident two months ago, he would have had the best care in the region from a terrific orthopedic surgeon, but now they can't give him the procedure he needs – the surgeon left UHM and MSC lost its Level I trauma status. Why did UHM lose it? Because they couldn't afford it anymore – MSC and other facilities like it had taken more than 70% of the elective and non-emergent surgeries away from them, and they had to cut their budget and staff. UHM's beds are now full of COPD patients, diabetics, cancer patients, and patients in kidney failure; they're losing money so fast that they may have to shutter entire units. Your son probably will be permanently crippled from this accident because MSC doesn't take emergent cases and the nearest Level I trauma center is 300 miles from your Metropolis.

Who is to blame?

All of us. We're all to blame for valuing the almighty dollar over what's best for our communities and neighborhoods. We're all to blame for expecting champagne health care on a tap water budget. We're all to blame for thinking the problems of hospitals and clinics are somebody else's problem, instead of our own problem. We're all to blame because we cannot continue to cut Medicare reimbursements and insurance payments to hospitals while lining the pockets of the wealthiest 1% of Americans and the CEOs of managed-care companies.

If you have a choice for a surgical procedure between the teaching hospital and the Metropolis Surgery Center, think about the real choice you're making, which is actually the future of health care in this country: the choice between what's good for some surgeons and what's good for Metropolis. Remember, too, that you're not just mulling it over in your head while reading this blog – you do it with every choice you make, every day.

Yes, it is that easy to change the health care system – for better or worse.

Permalink # - Posted to Country Feedback - Discuss - -

(Reminder: To read the article referenced by this post or any post, click the headline.)

Oh, goody – there are now hospitals that could be mistaken for four-star hotels. With beds in the rooms for family, and quilted bathrobes, and gourmet food, and carpet, and flat-screen TVs.

I didn't know flat-screen TVs were essential to post-operative cardiac care. Apparently I was wrong. I'll be sure to mention that to AACN for inclusion in the next CCRN exam.

"Specialty hospitals" are opening up all across the country – facilities that concentrate on profitable procedures for profit-minded surgeons. Profitable procedures like CABGs, total knees, lap cholecystectomies (gall bladder removal through 4 or 5 tiny incisions) – you know, the stuff that makes the money for a hospital, instead of the uninsured motorcyclist with half his brain on the pavement and the other half spilling out into the ED's nice tiled floor.

After all, these poor surgeons are just living out their dreams:

It wasn't money that fueled the dreams of a lot of Fresno's surgeons. What they wanted — and built — were hospitals they could call their own. They created the concrete embodiment of their every professional fantasy, places where they could work unencumbered by department bureaucracies and where their patients' care and comfort would be the top priority.

This sounds good to everybody on the surface, but it's not.

These 'heart hospitals' and 'surgery centers' are taking the money away from hospitals that have ICUs and emergency departments and trauma staff. Running a hospital is in many ways like running an NCAA athletic program – the things that bring in the dough pay for a lot of the things that don't. At OU, football pays for basketball, fencing, gymnastics, and everything else. In a hospital, surgery pays for the care of diabetics, cancer patients, and people who come to the emergency department after they've had motor vehicle accidents, strokes, or the flu.

There's very little money in being a trauma center, because much of the trauma care is for uninsured or underinsured patients requiring massive resources, and those resources have to be available 24/7. There's even less money to be made from medical units, like floors that take patients with emphysema and chronic bronchitis or diabetes. Intensive care units don't bring in the dough because they're so unpredictable and so dependent on expensive technology. 'Non-profit' when used with the word 'hospital' doesn't really mean no profits – it means no stockholders. The money has to come from somewhere to pay for the emergency care you expect.

As if that wasn't enough, a huge majority of the patients in these specialty hospitals are otherwise healthy, with no underlying or contributing health conditions, and they have few or no complications. That's good for those patients but bad for everybody else – if the non-profit hospitals only get the sickest of the sick and the worst surgical candidates, they're obviously going to have patients with longer stays that cost more money. The specialty hospitals get the cream of the crop while non-profits pick up the leftovers and have to care for everyone who walks (or rolls) in the door.

The for-profit facilities described in this article sound great for a fussy patient, and they might be very good employers, maybe even as good as the writer seems to believe. But I've got my doubts:

"There was a sense that we were being disenfranchised. It was hard to get our patients in, hard to get the hospital to work with us," says Dr. Robert Chambers, a cardiac surgeon in Fresno who with colleagues opened the Fresno Heart Hospital. "We wanted more nurses, more involvement, more [operating room] time."

In their dream-come-true hospitals, administrators don't scramble to hire nurses. They have the cream of the crop pounding on their doors. Doctors are in charge of scheduling the operating rooms, and when they walk in, they get handed patient files, updates on their conditions — all in an uncluttered work area.

"You walk into a regular hospital, and you have to find your charts. Nurses and technicians have purses and backpacks spread all over, and there's no place to sit. Then you have to try to find your patient, find out who your nurse is," says Chambers.

"Suddenly, you say, 'By God, I'm going to do it my way.' "

I've never seen a disenfranchised surgeon, but that's not the part that bothers me. He insinuates that it's the nurses' fault that life isn't peaches and cream at a non-profit hospital.

If only we'd just hand them their files when they walk onto the unit – as if the world stops when these heroic surgeons stride majestically through the door. We don't have anything else to do at shift change but serve as your handmaidens. (Seriously, that's how some surgeons think the world works. Not the good ones, but some of them.)

If only they didn't have to find out themselves where their patient is – perhaps hospital patient rooms could have some type of numbering system. There could be a database, too, with patient names listed next to their respective numerical code – and if we really stretched, someone could even invent a device to put the patient name and room number on paper.( He's actually upset because sometimes we have to move patients overnight and he wasn't informed. It's a big imposition to walk two rooms down from where he thought Mrs. Hufflegrump was sleeping.)

If only we would put our purses and backpacks away – although I've always worked in facilities that had lockers for staff including technicians. If he has to move our bags, he's just lost.

If only there was somewhere to sit – he wants the RNs, who are busy charting so they can go home and get some sleep, to give up their chairs for him.

If only he could find out who the nurse is – that's not a big secret, although the method for communicating this varies from facility to facility. Usually it involves a dry-erase board. But then he wouldn't be receiving the attention he feels he deserves.

Yes, of course, hospitals should make the doctors happy – all the doctors, including the endocrinologists who have diabetic patients, the gastroenterologists who care for IBD patients like me, and the oncologists whose cancer patients need hope instead of wall-to-wall carpeting. The surgeons go through something during their residency that makes them feel entitled, and I don't know what that is. It's worse in some than in others, but there are dozens of other physicians practicing at a given hospital that don't act as if they have been anointed or something. They are all working together to provide a service to a community, not to themselves alone.

And that's why I've called this post 'the health care future of Metropolis.' We're each living in our own Metropolis, be it on the east coast or the Great Lakes or the southwest. Every Metropolis has a finite amount of health care resources; some people are happy with the emergency departments at Metropolis's hospitals and some tell horror stories of waiting 8 hours for stitches and antibiotics. It's the same story all across the country, with slightly different players. You only think your particular town is better or worse than the rest. Let's play a little game – you live in one particular Metropolis, and I say what happens to you. :-)

You are at your family doctor's office one day because you can't stand the pain in your knee anymore, and your doctor told you last time that replacement was the only option. You're here to be referred to an orthopedic surgeon. While waiting, you look over a brochure for Metropolis Surgery Center (MSC), which opened about 18 months ago. You see the high-end furnishings and the promises of attentive staff and plasma TVs, and you think to yourself that it might feel good to tell your friends, "I'm going to have my operation at MSC, because they have oak cabinets, and beautiful curtains, and it's all carpeted. And there's even a sofa for my husband to sleep on all night." So based on brochures and news articles, when you need your knee replaced you choose a surgeon who practices only at MSC over another excellent orthopedic surgeon who only operates at University Hospital of Metropolis (UHM). UHM is a teaching hospital and a Level I trauma center, meaning that UHM has met a very stringent qualification procedure outlined by the American College of Surgeons and is one of the best trauma facilities in the country. (Level I trauma centers don't grow on trees – Oklahoma has only one, the OU Medical Center, and that is a big reason why Oklahoma's trauma system has been so poor. But back to the game.)

Your surgery goes well, and you're thrilled with the level of attention you receive at MSC: You got a thick, new bathrobe with matching slippers to wear, you had your own personal nurse with no one to care for but you, and for dessert at your last evening meal you had crème brûlée. The other patients you saw as you made your walks were all surgical patients that seemed to be a lot like you – you didn't see any of those "sick people" usually found in a hospital. Your insurance paid for everything and your knee works just fine. MSC definitely provided top-notch care and you're a satisfied customer. You tell all your friends, especially the friends with bum hips and knees and heart disease.

Six months after your surgery at MSC, your 26-year-old son crashes his car late at night trying to avoid an animal that ran out onto the highway in front of him. He is taken by ambulance to UHM, the teaching hospital, where the emergency physician tells you he has a broken pelvis and a shattered right femur (thighbone), among other serious injuries. The doctor goes on to tell you that if your son had had this accident two months ago, he would have had the best care in the region from a terrific orthopedic surgeon, but now they can't give him the procedure he needs – the surgeon left UHM and MSC lost its Level I trauma status. Why did UHM lose it? Because they couldn't afford it anymore – MSC and other facilities like it had taken more than 70% of the elective and non-emergent surgeries away from them, and they had to cut their budget and staff. UHM's beds are now full of COPD patients, diabetics, cancer patients, and patients in kidney failure; they're losing money so fast that they may have to shutter entire units. Your son probably will be permanently crippled from this accident because MSC doesn't take emergent cases and the nearest Level I trauma center is 300 miles from your Metropolis.

Who is to blame?

All of us. We're all to blame for valuing the almighty dollar over what's best for our communities and neighborhoods. We're all to blame for expecting champagne health care on a tap water budget. We're all to blame for thinking the problems of hospitals and clinics are somebody else's problem, instead of our own problem. We're all to blame because we cannot continue to cut Medicare reimbursements and insurance payments to hospitals while lining the pockets of the wealthiest 1% of Americans and the CEOs of managed-care companies.

If you have a choice for a surgical procedure between the teaching hospital and the Metropolis Surgery Center, think about the real choice you're making, which is actually the future of health care in this country: the choice between what's good for some surgeons and what's good for Metropolis. Remember, too, that you're not just mulling it over in your head while reading this blog – you do it with every choice you make, every day.

Yes, it is that easy to change the health care system – for better or worse.

Permalink # - Posted to Country Feedback - Discuss - -

We don't go to the movies very often. The last film I saw on a big screen was Harry Potter Drinking Fire, or something like that. Unless it's a can't-miss film, we wait for the DVD release or the premiere on HBO/Showtime/Starz. It's not worth it to pay $50 to see a movie that's going to come to DVD in four months anyway. $50 pays for almost two months of Netflix.

So, I feel kind of left out at Oscar™ time, but this year I really wanted to see Brokeback Mountain before the awards show. Fortunately, tonight I found a perfectly legal way to see it online. If you haven't yet seen the film but would like to, just click here.

If only all the movies were this good...

I went to high school in a town of about 15,000 people, with 176 people in my senior class. One of them was a beautiful girl named Carmen Howell.

Carmen was smart, deeply religious, had a great sense of humor, and was a talented singer. She won all kinds of vocal music awards, and was one of the girls who went to Oklahoma Girls State when I did in 1981. Everybody called her 'Squeaky' because her speaking voice was high and when she got excited she would squeal.

After high school, Carmen married an Air Force enlisted man and became an RN. As Air Force families do, they moved frequently and lived all over the world – at Holloman AFB in New Mexico, at Incerlik in Turkey, and most recently at Langley AFB in Virginia. Carmen always made friends easily and quickly became a kind of community "mom," with neighborhood children always in and around her home. She worked in home health and was a lay minister at her church. Her husband, by then a senior master sergeant, was deployed overseas, leaving Carmen to care for their three girls. And everyone still called her 'Squeaky,' only now it was 'Ms. Squeaky.'

On the evening of February 9, Carmen went out on a routine home visit to one of her regular, daily clients, a disabled man who lived alone in a small apartment. Some kind of argument ensued after she arrived, and Carmen was shot in the chest seven times. She died almost instantly.

I didn't find out about this until this Thursday morning, thus the late post about it. I was looking at the website of the El Reno newspaper (the weirdest newspaper website I've ever seen) about an unrelated issue. I found Carmen's obituary after I figured out how to get to previous issues. There were no details about how she died, but when I told my best friend from high school about it (her husband is also stationed at Langley AFB now), she remembered hearing about the incident on television but didn't put the name and and face together. The link embedded in the above headline will take you to a story with details of the slaying.

I remember riding with Carmen and her mom down to Ada for Girls State, the Sunday before Memorial Day in 1981. I had driven to Ada a few times previously and knew the way. Carmen's mom, who was driving, didn't tell me that she did not know the way. I fell asleep in the back seat, woke up, and we were almost to the Arkansas border. (From El Reno, the easiest way is to first go south to Pauls Valley, then east to Ada.) I think Mrs. Howell just figured she would keep driving on I-40 east and would eventually get run into it. It's hard to convince another girl's mom that she doesn't know where she's going, so I sort of played dumb and asked her to stop for directions. Good thing we left about four hours earlier than we had to. It was really pretty funny – once we got there.

So, I am con dolor today. I'll be con dolor tomorrow, and for a few days to come. Really makes the whole cap issue stupid and silly. I am so angry and full of heartache for Carmen's family, and I'm just as angry and full of heartache that a patient would murder his nurse, and one as good and as well-intentioned as I know Carmen was. Our profession shouldn't require us to risk our lives for $20 an hour, yet some of us are injured or killed every day. How is it that in America – this "beacon of light, illuminating the darkness," supposedly the greatest country in the world – going to work in 2006 still means risking your life? It's not just nurses... it's delivery people and bus drivers and engineers and bank tellers. There is no reason – no good reason – for anyone to die at work, and that's what this was. Carmen died due to workplace violence of the worst kind. I can't imagine what that argument was about, but it doesn't matter – there's no reason to shoot and kill your nurse. A patient vomiting all over you, hurting your back while lifting, a psychotic ED patient kicking you, and the like are things an American RN can imagine happening to them at work. You do not go on a routine visit, identical to the three dozen previous visits to the same patient, and have the slightest inkling that you could be shot. Our PPE doesn't include body armor. Maybe it should.

I'm not sure what's going on with this particular number, but Carmen is the seventh murder victim who I personally know or knew. I don't know if that's a high number or a low one. Believe it or not, Carmen's death is not the most violent of the seven – sadly, that goes to a dear, dear neighbor of ours, Virginia Thompson – but Carmen is the first RN. I guess it's true that only the good die young.

I got turned off to home health nursing during my community health rotation in nursing school, when I and my clinical partner accompanied a home health nurse on a visit to a truly disgusting shack somewhere out in the country southwest of Little Rock, close to Arkadelphia. These people were, and I hate to say this, the result of inbreeding among some of the poorest people in Arkansas – outdoor plumbing (in the 1990s), no running water, unemployed, mentally and physically impaired from the lack of variation in their genes. We were standing and observing in the front room, holding our breath because the stench was so overwhelming, where the patient was lying in feces and urine, surrounded by filthy clothes, dirty dishes – the most nauseating home I had ever entered. Suddenly my clinical partner, who was standing next to me, turned to me and said, "Did you feel that? Is the roof leaking?" It wasn't raining outside, and I said I hadn't felt anything, but then I did sense what felt like a raindrop on my right shoulder. I said, "Okay, I felt that," and while I was looking at my partner I saw something fall onto her arm. It was a cockroach. The place had cockroaches falling from the ceiling.

That was all I had to learn to understand that home health wasn't going to be my thing. I know – I let one bad experience (and another one very similar to it shortly thereafter) poison my attitude toward the whole specialty. It's not just that, though. The risk of going alone to unfamiliar places is too much for me, so I'll never be comfortable in home health. I'm so hyperaware of my surroundings and wary of walking alone to my car that I always hold my car keys so they stick out between my fingers, kind of like brass knuckles with spikes, when I'm in a parking lot. I want to do some serious damage to an attacker if I were forced to defend myself. I'm too concerned about stuff like that. Home health just isn't for me.

But it was exactly the right thing for Carmen. The girl I remember was perfectly suited for it – trusting, kind, loving, and eager to give of herself to others. Carmen was one of the kindest women I've ever been lucky enough to know. Peace to her spirit.

I can't believe I'm going to write a whole post about caps.

Not baseball caps or bottle caps - nursing caps.

I love this. Really. Some of the student nurse bloggers actually think that "caps are cool," that they would "totally go for old-fashioned white caps." They've never actually had to wear one for more than 15 minutes, yet somehow they seem to believe all of nursing's problems with professionalism will magically vanish if we would only adopt the whites and caps again.

I asked them to come over here today to hear what I have to say about this – so I want you to just sit and listen, young student nurses...

When I was in school we had to wear white dresses, white hose, nursing shoes (no white athletic shoes - only ugly shoes allowed), and that damned cap for every single clinical experience. I was expecting Debby in the very middle of nursing school and I wasn't allowed any type of uniform exemption during my pregnancy, so I had to special-order a maternity uniform at significant personal expense. For OR rotations, we had to come fully dressed in uniform, including cap, then change into scrubs, then change back into full uniform before we could leave the hospital. No jewelry, definitely no nail polish (a bad idea anyway in hospitals), and if they thought your makeup was too heavy the clinical instructors simply sent you home and you would be charged with an unexcused absence. And lest you think I'm like, old, or something, I graduated in the early 1990s at age 26.

I call it "that damned cap" because I and several other female students have permanent bald spots on our heads from wearing it. It hurts to wear a cap. It's painful, you ninnies. If you wear your stethoscope around your neck, you're always hitting your cap with it, and then you have to go take off the cap and put it on straight again, losing more hair each time you bang it. You pull out hair every time you don the cap and doff it, and it's almost impossible to escape the sores and scabs on your scalp. Still think you'd 'totally go for' it and that 'caps are cool'?

A new hospital opened near here a few years ago which required all RNs to wear the whites and required caps for females only. (The male nurses get to lose their hair all on their own, but at least it isn't painful for them.) Local news just ate it up - "The nurses look like nurses, film at 10pm!!" - but the management was so concerned with the appearance of professionalism and polish that they couldn't staff the facility. They removed the cap requirement a couple of years later in large part because many good nurses would not work there because of it. I'm one of them.

I truly do appreciate the comments about the lack of professionalism in nursing attire today. When I was an inpatient while recovering from my total colectomy (the removal of my large intestine, the first of the five surgeries) I actually mistook an aide for an RN myself. (Everybody on that floor was wearing white, and dirty grayish whites at that. I think that's the biggest problem I have with the whites - what's white to you looks dirty, dingy, and grimy to me. It has to be a brilliant white or it's just plain ugly and even more unprofessional than some of the newer scrubs are.)

However, my point is that a career in nursing for women does not and should not come with a unique job requirement that places our health and comfort at risk in ways that are not required of male nurses. It even has a special name – nurse's cap alopecia. I didn't become an RN just so I could contract nurse's cap alopecia, and those three years of wearing a cap three days a week seriously turned me against it. I couldn't wait to get a job that did not require me to wear the cap, and I refuse to work for a facility that focuses on the superficial over the meaningful in this manner.

As an RN it is my responsibility to conduct myself and carry myself around my patients in a manner that distinguishes me from the ancillary staff. If I can't do that in green or pink or navy, I'm not going to be able to do it in white with a cap on. Neither will you.

Nursing has changed from the handmaiden days of shoveling coal and mopping floors into a high-tech, professional position. Requiring female RNs to wear a cap isn't like a throwback jersey or a coat and tie. It's not cool. The whole thing is simply a way for a struggling facility or unit to turn the focus from the significant to the inconsequential, causing the nursing staff real physical harm in the process.

Be careful what you wish for, young ones... you may get it.