Tag Archives: nurses

Modernize U.S. military medical training to save lives and money

By Doris Browne, M.D., M.P.H.

Nearly 100 Republicans and Democrats have come together in support of an important bill — Rep. Hank Johnson’s (D-Ga.) Battlefield Excellence through Superior Training (BEST) Practices Act (H.R. 1243).

If enacted, this bill would help doctors, medics and others save the lives of injured military service members by replacing ineffective and expensive trauma-training drills on animals with superior and less costly human simulation models.

I am a service-disabled veteran who spent nearly 28 years as a physician in the U.S. Army Medical Corps, and I currently serve as president-elect of the National Medical Association. I support this effort to modernize military medical training.

Many military medical personnel currently receive Cold War-era training that involves inflicting traumatic injuries on pigs and goats to learn how to repair injuries in humans. Some animals have very different anatomies from humans, which can inhibit successful translation of medical skills across species.

For instance, goats have 13 sets of ribs as opposed to 12 sets in human beings. Compared with humans, goats and pigs have smaller torsos, thicker skin and major differences in internal organs. Goats have a four-chamber stomach compared to the human one-chamber stomach, making goats poor models for teaching human abdominal procedures. Placing an epidural needle in pigs is different from doing this procedure on humans, as the respective spinal cords for pigs and humans end in different vertebral sections, and incorrect placement in humans could cause severe nerve damage.

Goats’ veins and arteries sit on top of the muscle and are easy to visualize, grab and clamp to stop a hemorrhaging wound. Human veins and arteries run through the muscle, and when damaged, they contract, making them difficult to grab and clamp to stop a hemorrhage.

Also, the pressure required to properly apply a tourniquet on a human’s limb is significantly different from that needed to apply one to a small goat’s limb. Failing to learn how to properly stop hemorrhaging wounds can have potential life-or-death consequences.

A recent study found that nearly a quarter of combat deaths from 2001 through 2011 were potentially survivable, and in 90 percent of these cases, avoidable deaths were due to massive blood loss.

Military medics shouldn’t be burdened with translating skills learned on an anatomically foreign, sedated goat or pig to a bleeding and screaming comrade on a chaotic battlefield.

A better training method would use anatomically correct, advanced human simulators that can breathe, bleed and even die just like real people.

The BEST Practices Act would help the military make the transition to using superior human simulation technology in place of animals for trauma training.

A recent Army study found that the agency could even save millions of taxpayer dollars with this transition.

Last month, the U.S. Coast Guard announced that it had suspended all animal use for trauma training. This policy shift will allow medical personnel to master emergency skills on realistic human anatomy, improve providers’ skill confidence and save the agency money.

The Department of Defense should follow suit by giving its medical personnel the human-simulation training tools they need to better save lives and permanently banning inferior, animal-based trauma-training methods.

Doris Browne, M.D., M.P.H., is a retired colonel who served nearly 28 years as a physician in the U.S. Army Medical Corps and is the president-elect of the National Medical Association, the largest and oldest national organization representing the interests of more than 30,000 African-American physicians and the patients they serve.

The “nursing” home

By Rosalie Tirella

“I think she was sick before she got here,” the nurse at the rehab/nursing home (Holy Trinity on Barber Ave.) told me.

I had just left my mom’s room and walked to the nurse’s station at the end of the corridor to voice my concerns to the gaggle of nurses in charge of the care of a couple of dozen “patients” stricken with mild to moderate demetia – including my mom who is also there for “rehab” after a fall in her studio apartment. I am alarmed because I have never seen my mom so ill, so stuck in illness, a tube carrying oxygen to her lungs stuck up her nose, her arm bruised from the poking of IV needles. There she is, in her half of her “new” room (nice roommate) sitting alone in her wheelchair, her head bent forward, snoozing quietly.

When I visit my mom (almost every day), she seems awefully sleepy. Today, when I first entered her room, she was asleep again – totally alone, her head hanging forward again – how uncomfortable! How I missed her old pale pink wingback chair that she parked her little butt in for years as she watched cable news, catholic mass and the Red Sox. You are always in a wheel chair! I told her last time I visited. She said: It’s so comfortable, it doesn’t even feel like I am in a wheel chair.

I did some inspecting and, yes, there was lots of foam, a pillow behind her back, etc. “She’s languishing!” I screamed inside my head. I told myself: This is what people told me would happen if I stuck my mom in a nursing home.

There would be no recovery – only the slow (or speedy) descent into … death.

Where is her comfy wing back chair?!

“Ma,” do you want me to buy you a cute little easy chair for the window?” I ask her one time.

“No, no. I like this.”

“She’s always bounced back,” I tell the nursing home nurse, trying not to show my alarm. I should know! I was her primary care giver for more than four years. Every time she fell in her studio apartment, I sprang into action and rescued her! Saved my mom from the jaws of death. I was always PRESENT, following the ambulance that took her to Memorial Hospital, confering with the doctors/interns (kids) there, being nice to a passel of nurses and social workers, being nasty, threatening with a column when people seemed unresponsive – whatever it took to make my mother well again! I was the miracle lady! And my mom – 85 – always returned home! To her cat, her rosaries, her prayers, her little kitchen and coffee maker.

I don’t want to piss these nurses off, get off to a bad start with them, I tell myself. This could be a permanent thing. They take care of my mother. Her life is in their hands. I want to make them love her one one hundredth as much as I do!

Maybe then, my mom can get well! Well, enough to enjoy a few fruitful, comfortable years at this nursing home, where friends and family can visit and she can be safe. She gets three hot, square meals a day. She has all kinds of nice people taking her blood pressure, taking her temperature, combing her hair, putting her to bed. A time to be nurtured, even spoiled .. like a little baby. My old mother has come full circle.

I am now resigned to the fact that she can never return home. I have the heartbreaking task of closing up her apartment.

I smile at the nurse sitting at the nurse’s station, a lady in her sixties who does seem kind and does seem to like and care about my mom. I tell “Mary” that my mom has had pneumonia before and that several days of intravenous antibiotics usually knoocks out the infection in her lung.

“But we had to give her [oral anibiotics]… so that they would work on the infection on her leg,” Mary explained to me, looking a tad annoyed that me – a mere lay person – has the temerity to stick her nose where it doesn’t belong – in the MEDICAL PROFESSION.

Quiet please! MEDICAL PROFESSIONALS AT WORK! Mary told me she also gave her 50 milligrams of tresedone at night, to calm her down. And mymom gets some during the day. “She gets too busy,” Mary tells me. I am a little worried. My mom has never been sedated like this, and it seems nurse Mary has called the shots. The doctor of this nursing home hasn’t examined my mom. It looks like he rubberstamps what nurse Mary prescribes.

At one nursing home I worked at as an activities assistant decades ago, some nurses there were incredible – most were pretty average. There was even a dud or two – take the head nurse of the dementia unit there. She was always so solicitous of patients when their families were visiting, and then when they left, she would make fun of the patients … or sometimes take her shoes off and paint her toenails!

I can’t help it. My mom, old people have gotten under my skin. Even though I didn’t live with my mom, I took care of her – got her on the Meals on Wheels/lunch bag program, got her home health aides, personal care attendants. I was there every few days checking on her, making shopping lists, bringing in cleaning supplies or toiletries, keeping tabs on everything – the entire freakin’ operation. That’s what it became at the end – a freakin’, time-sucking operation. Exhausting!! – loving my mom! But she had loved me all these years, I told myself, and now foggy-brained and incapable of keeping up her own place, she needed her eldest daughter to swoop in an SAVE THE DAY. She has always expected it – and I have never disappointed her.

I won’t fail ya now, Ma! I tell myself as I watch her … letting go.

So, I want to tell Mary the nurse, I know a little bit about keeping my mom happy and healthy. For you to tell me “she came in sick” is BULL SHIT. Utter buck-passing. I am no fool. I tell her I want a doctor to check my mom and that i will make a special appointment with a gerontologist – a doc who specializes in old people! – to make sure she is on the right meds. Mary frowns. She says he may not even be allowed on the premises, since he is not the doctor in charge at the nursing home – Holy Trinity. I am taken aback. I tell her: I want my mom seen by this excellent gerontologist. “Mary” says he has to be cleared – to make sure he has the right credentials. I want to say: You mean like you, bitch? A nurse PLAYING doctor for my mom and all the other demential patients here? (most of whom look drugged out, as they have their chairs parked around “Mary’s” nurses station – quiet, drugged up little babies. No problem at all caring for such quiet, subdued seniors.

I want to rush into my mom’s room, grab my mom in her wheel chair and roll her out of this place – forever!

But my hands are tied. What can I do? I cannot unhook my little mother from her metal, ugly oxygen tank. I cannot drive her to the hospital and demand the docs “make things happen.” Been there – done that – four times! And Ma can’t go home because THE STATE of MASSACHUSETTS HAS CUT HER SERVICES/MEALS thanks to Elder Services of Worcester, whose nurses/social workers tell me she will be much better cared for at a nursing home. … this nursing home, Holy Trinity, where I can see her looking bloated, drugged up, attached to tubes, arms black and blue …. .

And yet Mom is quietly happy. She tells me the people at the home are so nice, everyone is so gentle with her, they take such good care of her, the food is excellent, they always bring her her coffee. She likes her roommate, too. And she he seems … happy. It’s as if the attention and all the nursing staff and activities staff coming and going is llike a tonic to her. A people person her whole life, my mother now, through her anxiety and tiredness, stresses she doesn’t want to go back to Illyrian Gardens, a place now filled with tight ass staff, a senior citizens complex now run by people who don’t even like senior citizens. I always knew this. My mom did, too, but she repressed her true feeling because she so loved living in her little studio apartment.

Now she calls a spade a spade. She says: “I wasn’t happy there [Illyrian Gardens] – the people … ” and she makes a face. “They [director and staff] were snobs!”

She used the word “snob,” but what my mom meant was that: the staff at Illyrian Garden never cared about her, never stopped by her apartment to say hello or wish her well. No smiles, no pats on the shoulders. Definitely no hugs.

Here at this new place, a nurse told me: “You mother is so nice – we all love her.”

She seemed sincere. I chose to believe her.

Still, the medical care seems substandard.

I have to leave now. I walk back to my mom’s room. “Ma,” I say to her, “I have to go.” I grab her hand off the utility table where she has a plastic cup filled with coffee waiting for her (I will bring her her super duper official huge Red Sox mug tomorrow!). My mom’s little bed side table is covered with the prayer books and photos and perfume bottle I brought for her from her apartment. I notice how warm her hand is. A fever perhaps from the infection in her lung (pneumonia) and in her leg (the bruise from her fall is not healing fast enough). I cannot believe her hand has gotten so gray, so veiny, so bony. Still, I love the warmth I am getting from her. I am loosely holding my mother’s hand in mine. I want to hold it forever.