The Patient Nurse by Diana Palmer

As you know, we live in a world where female nurses are often portrayed as objectified sex symbols. As a male nurse (student), I can live with this. In fact, to tell the truth, I, personally, am ready to live in the world of the objectified male nurse sex symbol.

The other day at work, I was waiting for a ride near the Fast Track entrance, where someone had dropped off a box of romance novels. Bored, I started to rummage through it. Then I noticed this book cover. Wow, I thought, this must be a book that presents a male nurse as an objectified sex symbol--this must be a first!! After all, you can see clearly that "the patient nurse" is the unfortunate (but patient) man who has to wait (patiently) for the heroine to figure out that it is really the male nurse she loves...
Ho, ho, hold on there!! You didn't read the back cover, did you? That's no male nurse, that's Dr. Ramon Cortero, and his "patient" is Noreen Kensington, "a nurse with a serious condition of heartache..." Remedy? Why nothing other than "A dose of old-fashioned loving!"

Yeah, baby, yeah!!

Fibers in the skin, but still no Morgellons explanation

Morgellons disease is characterized by skin lesions that contain fibers of unknown origin. Morgellons is often dismissed as delusional parasitosis or Munchausen's syndrome by proxy (now boringly re-named FII, fabricated or induced illness), although the fibers represent an objective finding and their origin is contested if not unknown. Critics insist the fibers are placed or at least synthetic in origin (fabric-induced illness?), while proponents of the disease point to a number possible origins such as production by the Argobacterium or some fungus.

In a provisionally-published paper by Almarestani, Longo, and Ribeiro-da-Silva, chronic inflammation was shown to induce the growth of sympathetic nervous system fibers in the dermis. The researchers injected complete Freund's adjuvant into the paws of rats and subsequently stained tissues after several weeks. Nerves were shown to change typical innervation of the lower dermis to innervation of the upper dermis as well.

Of course, nerve fibers don't really correspond to the fibers present in Morgellons as the images in the PDF demonstrate. My best guess is that Morgellons represents a few legitimate unrelated cases of pathology of unknown origin combined with a lot of DP and FII. It would be interesting, though, to discover a real pathological process at work in Morgellons.

  1. Lina Almarestani, Geraldine Longo, Alfredo Ribeiro-da-Silva (2008). Autonomic fiber sprouting in the skin in chronic inflammation Molecular Pain, 4 (1) DOI: 10.1186/1744-8069-4-56


It's November. Actually, it's well into November and Thanksgiving is drawing close. Here's a photo of the street outside my house at about 5 o'clock the other day. Kind of depressing isn't it?

I hope I pass all my classes this semester...

Ebola Bundibugyo - new virus confirmed

Aetiology posts on the newly confirmed filovirus Ebola Bundibugyo. You can read about the virus on her blog or in PLoS Pathogens. What I'd like to mention is that I know nothing about any possible role of nurses in infectious disease work outside the role of "Infection Control Nurse" at a hospital. Does anyone out there? You can e-mail me if you do. (My e-mail address is in my blogger profile.) Thanks.

Carl Zimmer's tattoos moved

I think I posted on Carl Zimmer's science tattoos before, but now they've moved. This one is from a nurse...

Ilaria Capua

Seed magazine's "Revolutionary Minds" currently features people who are changing the way science is communicated. One of them is Ilaria Capua of the Global Initiative on Sharing Avian Influenza Data:
In 2006 virologist Ilaria Capua was studying samples of avian influenza from Africa. The World Health Organization asked Capua to deposit the genetic sequence of one of her samples into a database to which only a select few laboratories had access. She balked. "I said, 'Wait a minute, we're talking about a serious potential threat to human health. We know very little about how this virus is moving. Not enough scientists have had the opportunity to look at this virus.'" So Capua opted to put the sequence in GenBank, an open-access database, where it was downloaded 1,000 times in a single week. Capua's small act of rebellion was just the spark for a much larger challenge to the system...

Do not call Child Abuse Hotline

--UPDATED @ 22:03 -- After further consideration, my psych instructor has elected to give credit for answers (a) and (b) below. I suspect that means a large proportion of the class gave answer (b). In the spirit of giving credit where credit is due, I applaud her (unexpected) decision in this case. However, I still think my critical comments below are generally applicable.

I just had a quiz in psychiatric nursing. We were told it would be on the reading assigned for today, so I spent last evening going over the readings. On a ten-question quiz, at least 3 of the questions were not on material from the readings, including this one:
"You are at a soup kitchen and see a known pedophile coming out of the bathroom with a child. What is the priority nursing intervention?
(a) to call the child abuse hotline.
(b) to protect the child without intervening the self with the perpetrator
(c) to blah, blah, obviously wrong
(d) to blah, blah, obviously wrong"
So what would you do? In this situation, there is no information about things like, for example, where the telephone is or how many people are in the building. It's possible that the telephone is in an office down the hallway, and the building is filled with people. Would you leave the pedophile and child together to go call the Child Abuse Hotline? Or would you do something to secure the child and then call? The instructor's answer was (a), although I would do (b).

Do you agree with the instructor? If you reasoned that you would ask someone else to keep an eye on the child while you called the hotline, you would, first, be making an assumption about the availability of other people that is not stated in the question and, second, be giving (b) as the de facto answer by justifying your choice by first intervening to have someone else protect the child.

My instructor said that calling the hotline would result in having authorities arrive immediately to protect the child. Is that true? According to the New York State Office of Child and Family Services, calling the Child Abuse Hotline results in an "investigation of each report within 24 hours," not an immediate response. Moreover, according to NYS OCFS, if "you believe that a child is in immediate danger, call 911 or your local police department."

If you see a situation where a child could reasonably be in danger of abuse in the immediate future, your priority should be to protect the child, not to nab the offender. The fact that the situation is a known abuser in a transient public location indicates that the situation is an immediate one, not like seeing bruises on a child who is going home with her parents.

The rationale behind NCLEX questions is that they are "hard" because they demand "critical thinking skills." In my experience, "critical thinking" for NCLEX means correctly guessing what the instructor wants or the correct set of assumptions that the instructor has made about the situation. Note to all those who have not been educated outside the nursing profession: guessing what's the in the questioner's head is not "critical thinking."

The other day in nursing, we were told that those on high have determined that nurses need intern-like immersion experiences in order to be adequately prepared. We also know that there is a lot of shock amongst new grads and a high turnover rate in the profession. Maybe these are all indicators that nursing school does a crappy job of vetting/educating nurses?

Hump day video

In the MTV archive, I was looking for an '80s song I can never remember--something about "physical touches" and "then it tears you apart" or some such, and I found this video of an Olivia Newton-John song "Physical" that I've never heard before. Humorous video.

PSU nursing on TV

Recently, our Fox network affiliate did a report on the nursing shortage and featured PSU nursing. I don't know how long this link to the video will work, however.


I scored a 57 on their quiz...

Moderate ADHD Likely

House is Massive Attack's Teardrop...

(...also, soylent green is people!) I was reading BoingBoing's post on the new MTV video archive, when I noticed that one of the videos they had posted (of a song I had never heard of before), sounded and looked like the opening sequence of Fox's "House, MD." I looked it up, and, sure enough, everybody except me knows already! House uses the song "Teardrop" by the British band Massive Attack as its opening theme.

The only thing I can add to our collective knowledge is that the visual design of the opening sequence appears to be strongly influenced by the music video. Check it out for yourself:

And then there's the question of the lyrics: do they mean anything about the show House?; and what are they? Is it "Feathers on my breath" or "Fearless on my breath"? Is it "Nine night of matter", "In the night of matter", or "Night, night of the dead"? There doesn't seem to be a lot of agreement on the lyrics, and none of them make sense to me, but here's my best guess, as seen on LyricWiki:

Love, love is a verb
Love is a doing word
Fearless on my breath
Gentle impulsion
Shakes me makes me lighter
Fearless on my breath

Teardrop on the fire
Fearless on my breath

Night, night of the dead
Black flowers blossom
Fearless on my breath
Black flowers blossom
Fearless on my breath

Teardrop on the fire
Fearless on my......

Water is my eye
Most faithful mirror
Fearless on my breath
Teardrop on the fire of a confession
Fearless on my breath
Most faithful mirror
Fearless on my breath

Teardrop on the fire
Fearless on my breath

You're stumbling a little
You're stumbling a little

The Atlantic on trans-gender issues

The blog Mindhacks has a link to a long article in The Atlantic on the current trend in transgender issues. According the article, in just the last few years, psychiatrists have a seen a huge increase in the number and extremely young age of children being referred for gender-identity issues. The article chronicles the struggles of some of the children and their families:
School had always complicated Brandon’s life. When teachers divided the class into boys’ and girls’ teams, Brandon would stand with the girls. In all of his kindergarten and first-grade self-portraits—“I have a pet,” “I love my cat,” “I love to play outside”—the “I” was a girl, often with big red lips, high heels, and a princess dress. Just as often, he drew himself as a mermaid with a sparkly purple tail, or a tail cut out from black velvet. Late in second grade, his older stepbrother, Travis, told his fourth-grade friends about Brandon’s “secret”—that he dressed up at home and wanted to be a girl. After school, the boys cornered and bullied him. Brandon went home crying and begged Tina to let him skip the last week.
For another perspective, you can also read the First Things article by Johns Hopkins University Distinguished Service Professor of Psychiatry Paul McHugh. His article is mostly about adult men looking for sex change surgery, however, rather than children:
First, I wanted to test the claim that men who had undergone sex-change surgery found resolution for their many general psychological problems...psychoanalyst Jon Meyer was already developing a means of following up with adults who received sex-change operations at Hopkins in order to see how much the surgery had helped them. He found that most of the patients he tracked down some years after their surgery were contented with what they had done and that only a few regretted it. But in every other respect, they were little changed in their psychological condition. They had much the same problems with relationships, work, and emotions as before. The hope that they would emerge now from their emotional difficulties to flourish psychologically had not been fulfilled.
Sad all around, no? This world is truly a veil of tears.

Express Scripts extorted with patient prescriptions

WIRED news is reporting that prescription manager Express Scripts has contacted the FBI about a letter it received threatening to disclose the identities and prescriptions of millions of patients if it does not pay big bucks.

Patient advocate on open access

Michael Crichton, RIP

I just learned from CNN that Michael Crichton, the author of Jurassic Park, died on November 4th from cancer. He was 66, but check out his photo on the CNN site from 2005 when he was 63. That's one of the most youthful 63's I've ever seen. It makes you wonder if his cancer was induced by some experimental anti-aging self-treatment like HGH. I don't mean that as a slur, though. I think any experiment like that by someone like Crichton would come intellectual curiosity and an exploratory spirit rather simple vanity.

I will remember Crichton fondly. A good friend from high school named Matt Patrick who I have lost contact with started reading Crichton and convinced me to try. (I don't generally read "best-sellers.") The first book I read was Congo. I went on to read Eaters of the Dead, Jurassic Park, Sphere, and Rising Sun. I will always remember my high school days immersed in these novels, riding in cars or buses, and feeling connected to my friend. He was so enthusiastic about these books, it was infectious! I wish I had followed his plan rather than my own and gone into science. Perhaps I would be a virologist now. Anyhow, my dad also read a number of his books, including State of Fear. Crichton may have been on the wrong side of science in the long run, but he was on the right side of the argument. I don't think most people get the point of State of Fear, which is that truth is obscured by propaganda and scare-mongering, even when it is true propaganda.

Crichton should be remembered by health care professionals for at least two reasons. First, in our current world of mega-selling celebrity authors like John Grisham, Crichton was an authentic physician and wrote from that perspective. Second, he popularized a lot of themes relevant to medicine and health such as genetic manipulation and pandemic infections.

I intend to go back and read some of his earlier work, which is oriented at the medical field. I wonder what would have happened if I had read that material as a high school student...

Local woman goes to Washington: Supreme Court's Wyeth pre-emption case

As you may have seen in the news, pharmaceutical company Wyeth was sued by Vermont resident Diana Levine over the labeling of Phenergan (now what drug class is that, nursing students?), and the case is now going to the Supremes (and I mean the ones headed by John Roberts, not the ones headed by Diana Ross).

If you check out the links at right, you will notice that just about any place in Vermont is local for me. Plus, it just so happens that one of the largest employers in the local area is... Wyeth. (Kind of ironic, no?) When I was growing up, Wyeth was called Wyeth-Ayerst Labs, and they had a research facility in nearby Chazy, NY, that employed smart people. (My coolest Boy Scout leader was an avid rock climber named Steve Bailey who was also a statistician in animal research.) The facility produced papers like this one, which was published the year I graduated from high school:
Spontaneous lymphosarcoma, likely of renal origin, was diagnosed in a naive, juvenile, male cynomolgus monkey (Macaca fascicularis). Histologically, renal architecture was effaced by dense infiltrating sheets of plump cells... Serological tests were negative for infection with Simian Immunodeficiency Virus (SIV)...
Now, Wyeth has closed most of the facility and just maintains a manufacturing plant that they are planning to shut down in the near future. That will mean one more blow to the area economy and culture, which has been going downhill since the closure of Plattsburgh Air Force Base. In line with the rest of the area, the local newspaper printed an article about the case on the front page today, but had to use an AP article rather than their own reporter... stop me if I'm boring you...

Anyhow, the case went up to the higher court because Wyeth argued that federal approval of drugs and drug labeling protected pharmaceutical companies from responsibility at the state level for inadequate warnings on drug labels. I'm not a lawyer, but this seems like a pretty decent argument. Certainly not a slam-dunk case of pharmaceutical evil, like other recently uncovered nefariousness (and, by the way, the blog after the link is excellent and a great example of the usefulness of ResearchBlogging).

For those unfamiliar, the nine Supreme Court Justices are very smart and well-informed and read ahead of their cases. Probably their opinions are pretty well made up by the time the lawyers for the two opposing sides get their day in court, which is called the "oral arguments." Nevertheless, the oral argument is the sexy part, so that's when people start paying attention for realz. In Wyeth vs. Levine, the oral arguments started Monday, and you can follow them at the FDA law blog or at the Wall Street Journal law blog. Also, there is coverage the Drug and Device Law blog, including an on-the-scene report of the oral argument, which should be informative for you if you never pay attention to that stuff. In fact, here's a small sample:
JUSTICE SCALIA: Well then, gee, then all of the qualifications you were making earlier about whether it's new information or a new assessment, that's irrelevant. MR. FREDERICK: No, it's -- JUSTICE SCALIA: You're saying whenever it's unsafe, whatever the FDA has approved, you have a lawsuit. MR. FREDERICK: No. What I'm saying is that the information developed after the original label is approved, and it is not a floor and a ceiling -- JUSTICE SCALIA: There -- there was nothing about new information in what you just said. You said it's misbranded if it's not safe, new information or not. MR. FREDERICK: And that's -- JUSTICE SCALIA: Is that -- is that -- is that your position? MR. FREDERICK: Our position is that the duty is on the manufacturer to make a safe label, and if the label is -- JUSTICE SOUTER: But getting to Justice Scalia's point, as I understand your answer to an earlier question, on the day that the FDA approves the label, if there is no further information indicating danger, then any liability that is based upon what the -- the kind of information that the FDA knew would be pre-empted. The only time -- you're saying pre-emption does not occur when there is -- forget the word "new" for a moment -- when there is further information, information in addition to what the FDA was told, whether it's 1,000 years old or discovered yesterday; and if there is liability predicated on further information beyond what the FDA was told, then there is not pre-emption. Is that a fair statement of your position? MR. FREDERICK: That's fair, but let me just make clear that our test would require the FDA to consider and reject the specific basis on which the State law -- JUSTICE SCALIA: If that's a fair statement then you have to retract your -- your earlier assertion that whenever it's not safe it's misbranded. I mean -- MR. FREDERICK: I'm not going to retract that, Justice Scalia. JUSTICE SCALIA: -- which is it? Whenever it's not safe, it's misbranded, or what you just responded to Justice Souter? MR. FREDERICK: The basis -- the basis of the FDA's approval is on the basis of limitedinformation, which Congress has said for public safety reasons -- we are not doing a balancing here; we are doing this for public safety -- And if the label is not adequate for public safety it is a misbranded drug. JUSTICE SOUTER: Okay, but if -- if the so-called misbranding is determined to be misbranding, based upon information which was given to the FDA, as I understand your position, you would admit that there was pre-emption. MR. FREDERICK: I -- I think there is pre-emption, but that does not mean -- JUSTICE SOUTER: Okay. So there -- MR. FREDERICK: Maybe there is no -- JUSTICE SOUTER: In other words, there is that one exception at least to the broad statement that you gave in answer to Justice Scalia? MR. FREDERICK: Let me try to untangle it this way. The fact that there is pre-emption and you cannot bring as State law failure-to-warn claim doesn't mean that the drug isn't misbranded under the Federal standard the FDA -- JUSTICE SOUTER: But the -- but the misbranding is of no consequence to liability. MR. FREDERICK: Well, if -- JUSTICE SOUTER: In other words, I think you're saying if there -- if there would be pre-emption it may be misbranded, but there cannot be any recovery in a State tort suit. MR. FREDERICK: That's correct. The -- the point -- JUSTICE SOUTER: Okay. So misbranding under those circumstances is a purely theoretical concept. MR. FREDERICK: In that very hypothetical, yes. JUSTICE SOUTER: Okay.
Scientific American points out that this case is interesting because it wouldn't normally reach the Supreme Court:
However, the court has granted review in a series of pre-emption cases, and it seems to me that the Court might be attempting to articulate a clear pre-emption doctrine. What we have, at least in the implied pre-emption context, is a lot of ambiguity.
What they're saying is that the Supreme Court has agreed to make decisions on some cases it wouldn't normally hear, probably in order to set precedents.

Anyone in health care should be interested in this situation because the pre-emption issue might have big repercussions in terms of health care costs. You might think the evil conservatives on the Supreme Court are just protecting big pharma from helpless victims, but honestly, if drug labeling can't protect pharmaceutical companies from being sued, they're going to have the bejeezus sued out of them. And do you know who's going to pay for that? All of us, in the form of higher drug prices. And do you know what might happen to drug research if drugs become a huge liability? It might (a) stop or (b) move overseas. Either way, it would mean less pills for you and me. As a nurse, where do you think the greater good for patients is?

Also, you might be interested to know that the physician assistant who administered the Phenergan gave it through IV push into an artery instead of a vein. This case is separate from the settlement that Ms. Levine made with the health clinic where the PA worked.

Election 2008 round-up : run for the hills!!

Well, it looks like Obama won the election, and it'll probably turn out to be by a bigger margin than a lot of recent elections. Right now, I'm in the computing center in Feinberg Library not paying attention to the time, and I found out Obama was projected to win because of the hooting and yelling that started down the hallway, where there is one of those ubiquitous cable televisions mounted on the wall. It carried on for a long time. Then there was a loud bash on the other side of the emergency exit door behind me (I jumped), and an alarm started that has been going off for about 20 minutes now.

A short time ago, a guy came in and said there was nude streaking and all manner of chaos going on outside, so his friend got up and they left to ogle. Now it's just me and a girl, working on a paper, who called her boyfriend at the gym and made smoochy sounds over the fact that Obama won.

I have tried very hard not to pay attention to the election this year. I have cultivated the following feline sensibility:
Care-o-meter Low -Iā€”ā€”ā€” High

Nevertheless, I cannot be happy that Obama won. McCain was not a good choice, but the irrational pleasure over Obama's victory is very scary. Obama is not like Hitler or Mussolini, but his electorate is quite a bit like the one's that sent those fellows to their destiny. "Heal America and change the world..."? Are you really that dumb? Or is it neediness?

Well, anyhow, Obama's lifetime of campaigning without much legislative experience is about to come to an end. I think he's going to find it much harder to get things done than he anticipates, and he can't keep talking about change in the future when he's in office. My guess is that the media is going to sour on him, too. People have short memories, and once Bush is out of office, all the animosity against him that fueled Obama's election is going to be forgotten.

So, we'll see how things go. Mostly, they won't change, I think.

Update @ 12:51 - Shocked!! I mentioned above "all manner of chaos," but I thought that fellow was talking about a little bit of cheer and hi-jinx. But as soon as I opened the library door, I could hear the almost-deafening howl of a crowd of people and see red flashers reflecting off the buildings around the Angell Center's courtyard. Of course, I had to see. The street was filled with students!! The dorms must have all emptied out into the streets, and they were out there yelling, clapping, holding signs, and, from the sounds of it, pushing things over. I decided to leave as it was a scary scene, and as I left, they started to march down the street with cops looking on. What is the matter with people?

Election Day 2008

"Many forms of Government have been tried and will be tried in this world of sin and woe. No one pretends that democracy is perfect or all-wise. Indeed, it has been said that democracy is the worst form of government except all those other forms that have been tried from time to time."
-Sir Winston Churchill, Speech in the House of Commons, 1947

Eighty-one-year-old uncovers government deceit

I was reading a little election coverage over at Volokh Conspiracy when I noticed their post about an elderly woman who was denied a gun purchase until after an investigation. Of course, an elderly woman buying a gun for the first time would make you think of a suicide attempt, which I'm sure is why the purchase was delayed. Is this right? I don't think it is. I see two ways for nursing to intervene in health:
  1. on a personal level, which would mean being directly involved with this woman in this case;
  2. or, possibly, on a systemic level, which would mean interacting with communities with regard to re-payment schemes, pollution, etc., and would be excluded in this case since purchasing a gun is an inherently health-neutral act.
For nurses to approve what actually happened is stepping outside what should be clearly defined professional boundaries. There's a lot of talk in my nursing program about professionalism, but in, for example, law there's no way for lawyers ethically to push themselves into the practice of medicine or nursing. Part of being a profession is drawing a line that both absolves you of responsibility for saving the world and limits you from saving it.

Of importance to note is the fact that if the records had been kept according to the law, the woman would probably have not been prevented. Ah, the intertwining of ethics, letters, and enforcement!

I must confess that I lapsed into "health"-oriented "nurse think" when I first read about this--yeah, the law was broken and someone's rights were probably violated but maybe we saved a life. Luckily, there is the ever vigilant Nurse with a Gun who helped me get my thinking grounded again. Thanks, Xavier.

Churchill on Romans

"I have no doubt that the Romans planned the time-table of their days far better than we do. They rose before the sun at all seasons. Except in wartime we never see the dawn. Sometimes we see sunset. The message of sunset is sadness; the message of dawn is hope. The rest and the spell of sleep in the middle of the day refresh the human frame far more than a long night. We were not made by Nature to work, or even play, from eight o’clock in the morning till midnight. We throw a strain upon our system which is unfair and improvident. For every purpose of business or pleasure, mental or physical, we ought to break our days and our marches into two."
-Sir Winston Churchill, Roving Commission: My Early Life, 1930

Nurses, do not spread urban legends, please

My mother recently received an e-mail forward from a friend who is a nurse practitioner. The content of the e-mail was that you can get necrotizing fasciitits from wearing bras that haven't been washed after purchase. The e-mail contained a number of photos of real breast conditions that were claimed to be n.f. of the breast. My mother was pretty upset and started to research this more on the Internet to get more information. Then she stumbled across the Urban Legends section refuting this hoax e-mail. That made her even more upset.

Nurses can't really do anything about hoax e-mails. However, you as a nurse can stop spreading fear about health by researching information before you pass it on. Any nurse should be able to investigate infection control issues enough to debunk this bra hoax, and a nurse practitioner should be able to debunk it by diagnosing the photos as whatever they are--cancer, furuncles...