If there’s one thing I feel I can unambiguously brag about, it’s that I’m great with patients who are in pain crises. I’m tenacious and stubborn about lowering 10/10 pain to something more manageable. I got a patient in “25 out of 10” pain at start of shift down to a 4 by midnight and it only took opioids, Tylenol, muscle relaxants, ice packs, warm blankets, fresh coffee, repositioning, an abdominal binder I scrounged up, a phone call to the surgeon to get lidocaine patches ordered, and some serious chit chatting with the patient while we waited for all that to kick in. We didn’t end up needing IV medication, we didn’t have to increase opioids, we didn’t need to add any medication that would potentially delay discharge, and the majority of what I did is all stuff she can also do at home so it’s a sustainable pain management plan. This is my absolute favorite thing with nursing, I love love love managing pain, I know I talk about it a lot but it’s the most satisfying thing in the world. I love watching someone emerge from a horrendous haze of pain until they feel like a person again. Also I’m scheduling this to post well after my shift is done so that I don’t jinx anything, also while I was writing this post I had to take a quick break for two hours half way through because someone started having a seizure. My job is wild. I used to be a barista.
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@irrellavant oops you activated my trap card of asking about something I care about, please enjoy this monologue. Also it’s not comprehensive, can’t stress that enough, this is a just a lil long tumblr post made by a just some nurse who isn’t a palliative care expert and is also writing this on her cell phone on break. Some of this stuff is gonna be pretty obvious! I just would feel remiss if I left it out. And also please anyone who has pain or addresses pain, please feel free to add on. I’m always looking for new ideas and new insights, especially from the patient side so please please do chime in if you like. Okay SO
For me, the biggest thing is conveying to the patient that you care that they are in pain and that you are trying to make it better. I remember I had a patient who was in horrible pain all night, we never got it down, we never got her comfortable, but at the end of the night she thanked me so sweetly for trying and she said that knowing I was taking her pain seriously helped her feel better even if it didn’t make her hurt less. Just because someone is in pain, it doesn’t mean they have to suffer, if that makes sense. I think one of the worst things about pain in the hospital is the feeling that you’ve been abandoned to experience it. Someone gives you a pill (or not even that) and says “okay bye” then you go back to writhing in agony. I make sure that before I leave the room of a patient who is still in a pain crisis, that I let them know what the plan is and what the next step is. “You just got 5 mg of oxycodone, which will take up to an hour to take full peak effect. If your pain doesn’t get better after that hour, I can give you another dose” or “I’m going to go page your doctor to see if I can get you an additional dose” or “I need to step away right now, but I’ll be back in 20 minutes to see how you’re doing and if the heating pad is helping.” I tell the patient “we’re gonna try X, which should do Y, but if it doesn’t, the next step is Z” and then I make sure to follow up with them.
I also try to be honest. I never promise that they’ll be pain-free, just that we’ll keep trying. We aim for small but achievable goals. If it’s acute pain, like you just had a surgery or something, I try to contextualize it for the patient. "We’re not gonna get you pain-free ten hours post surgery, but we can get you more comfortable than you are right now.” Patients are usually fine with being a six outta ten pain if they’ve been otherwise sitting at a nine. Since I’m night shift, I often tell them my goal is for them to get at least a couple hours of sleep and ask them how that sounds.
Then pharmacologically, I look at the meds I do and don’t got. If a patient is having incisional pain, lidocaine patches on either side can be great for just numbing the area up. If the patient can get oxy every 6 hours but routinely gets very painful again just three hours after taking the med, then maybe the dose or the timing is not right. Maybe under prns we’ve got so many opioids and not a single NSAID, and there’s not a contraindication. Maybe their pain is caused by muscle spasms, in which case a muscle relaxer could be a great addition. Maybe the pain is nerve pain that would respond much better to gabapentin instead. Or maybe you need IV dilaudid to quickly get the breakthrough pain down to a manageable level so that the other meds have a fighting chance to do anything. If meds aren’t available, these are things you can page the doc about and discuss with them.
I’m also a big fan of around the clock medications for patients that have had poor pain control. Ask patients if they want to be woken up for pain meds (again, patients that have been that painful usually say yes). Explain how it’s easier to keep the pain low than it is to play catch up after pain spikes. Pain control works best when you avoid the spikes in the first place. There’s no point getting someone out of a pain crisis if you then withdraw all your cares until they’re in a pain crisis again.
I also try plenty of non-pharmacological methods of lowering pain or enhancing comfort. (Sometimes you can’t lower pain! Sometimes all you can do is enhance comfort!) Does the patient have a topical cream that helps with pain? Could it be applied while gently stretching the muscles and really going to town with a foot massage? Has the patient just thrown up and would like a bed bath to feel clean again? Would they benefit from heat? Or ice? Or warm blanket? Ice and then on top of that a warm blanket? Do they want some pudding? Do they need a little candy from the nurse station candy drawer? If their lower back hurts from being in bed so long, can we get them out of bed? Even if it’s three am and we need to lift them with a Hoyer to their recliner, that might still be the best intervention. I had a patient where the only thing that helped her hip pain was going on walks so over the night we went on a bunch of walks. Worked better than any meds.
What about conversation? Do they need someone to cry with? Do they want to talk about pets or their diagnosis or the bizarre TLC show that’s playing on the TV? A lot of this is feeling out conversation, and I don’t have great advice for that besides if you make yourself obviously available and interested in people, they tend to open up to you.
Also I’m a big fan of asking if there’s anything I can do while we wait for the meds to kick in. That’s usually when I do a bunch of those non-pharm interventions, because it’s efficient (we are in fact waiting for the meds to kick in) and it makes the waiting less miserable. I think it also makes the waiting feel less helpless. We aren’t just waiting an hour for the dilaudid to do something, we’re also tucking you in with a warm blanket and giving you the finest jello I could scrounge up.
And obviously, I ask the patient if the pain they’re currently feeling is uncommon for them, either in the type of pain or the intensity. This is good for general assessment stuff and to figure out if the pain itself is the problem to be managed or if there’s something new causing the pain. If the cause of the pain can be managed, that’s my priority with pain medication as a supportive therapy because like if you’re a paraplegic and suddenly you’re complaining of an intense pounding miserable headache, giving tylenol isn’t the right intervention when what I should be doing is assessing for autonomic dysreflexia.
And I ask them about the type of pain they’re having and if they know what works for them to manage it. Plenty of chronic pain patients can tell you what is and isn’t effective. Maybe at home they’re on 50 mg of oxycodone a day, but right now in the hospital they’re only prescribed 40 mg. Or hell, they’re still getting 50 mg but they’re here because they’re sick so their baseline level of opioids isn’t gonna be enough because that’s to manage their every day pain and not their new super hell hospital pain. Or they know aspercreme works like a dream on their legs but not on their back. Or patients know that ibuprofen works better for them for this type of pain than a fentanyl patch does, or they don’t want to take dilaudid because it makes them nauseated, in which case you can try premedicating them with an antiemetic.
Also when your shift is done, write down all the stuff that worked to control pain in your nursing note so there’s a record of it in case someone needs to do it again.
If there’s one thing that I have found successful though, and I know this might sound cheesy, but it is CARING and showing the patient that you care. You care that they are in pain, you are working with them to get them more comfortable, if something doesn’t work you will keep trying, because pain sucks and you care that they are in pain. Even when you have to leave their room, you let them know that you will come back. They aren’t left totally alone to suffer. Again, sometimes you can’t decrease pain but you can increase comfort. I believe there is genuine comfort in knowing that someone is trying very hard on your behalf to make you feel better, even if they don’t make you feel better.
I’ve had chronic pain for 16 years, and this is most reaffirming perspective on pain I’ve ever heard from a healthcare worker. Thank you for caring and doing everything you do; it seems like such little things but to those with chronic pain, it means the world.
My pain tolerance is stupid high, so I’m speaking as someone with acute pain here, but—
I still remember the nurse who refused to give me any pain meds at all, not so much as a Tylenol, because even though I was in my work uniform my shoes were old and she thought I was drug-seeking.
I was wearing the only shoes that would fit over my BROKEN foot. My old patio shoes. I’d taken off my work shoes because the one on my injured foot was full of blood, and because of the swelling from the break and crush injury, I couldn’t get them back on.
The ER doc absolutely read her the riot act and arranged for an opioid. Then he laughed about an hour later when it fully kicked in and he came to tell me they were ready for me in X-Ray and found me holding onto the gurney for dear life, saying I couldn’t let go because I’d fall into the ceiling and can you believe there are people out there who want to feel this way on purpose? I ended up laughing too even though I had no idea what I was laughing at. I was as high as the ISS and hearing someone laugh and lay out next steps made me less afraid.
He did not give me opioids for maintenance, incidentally. I told him I never wanted to do that again. I don’t remember what he did give me, but I know Oxy was on the table and that’s not what I came home with, so we must have had a conversation about it while I was still touring the outer planets.
Thank you for being like that doctor, OP.
This is so incredibly kind and compassionate and I wish all docs were like the OP.
I respect the hell out of the two rheumatologists I’ve had who, when I said “Can I have a prescription for when I need to fill it for cyclobenzaprine? I’ve tried every other painkiller or muscle relaxer my doc could think of for back spasms, and I prefer that one over all the others. It doesn’t make me so tired I can’t work, and if I take it at night I wake up rested and my back either doesn’t hurt or is bearable with a couple Tylenol.” and, unlike some GP or student center docs I’ve had, said, “Yeah, sure. If you have pain for more than a couple days, call so we can talk and see if you need steroid injections or something more proactive.” They didn’t treat me like I was drug seeking. They treated me like I was the one who knew my body, and knew what worked, and could be trusted to take care of myself as long as I had the tool (the one medication that almost always works) to do so.
There’s something about being taken seriously and being trusted to understand your own body even when that body is being absurd (or maybe especially when that body is being absurd) that makes it easier to bear what you can’t avoid. It makes you feel competent even when your body is being ridiculously incompetent.
Small Town Grocery Store Stories: LGBTQ+ friendly edition
Me: minding my own damn business in the grocery store
One of my students and a few of his teammates enter the dairy aisle.
My student is holding hands with one of his teammates.
My student: Oh hey, Professor X!
Me, who has both my student and his girlfriend in my class: …Hello
My student, looking at his hand-holding partner: Oh! Don’t worry. My girlfriend knows. Not that I’m cheating! I’m not cheating. I’m not gay.
Hand Holding boy: Not that being gay is a bad thing! It’s a good thing!
My student: Right! But no, listen. We aren’t together, we just hold hands in public sometimes.
Hand Holding Boy: Especially on Friday nights. And weekends. And at away games.
My student: Because sometimes people will say shit and then we can punch them! And if the fight started because someone was being homophobic, coach won’t get mad at us.
Hand Holding Boy: Always nice to punch a homophobe.And [gesturing to another boy in the group] maybe they’ll think twice about saying something to [other boy’s name] if he ever gets a boyfriend and wants to hold his hand for real.
The Gay One, resigned but smiling: I’ve decided it’s sweet and not really fucking weird.
The group chat has decided that since I’ve only had one sexual relationship and it wasn’t a very good one and I’ve since transitioned, changed my legal name, undergone hormone therapy and now had bottom surgery, that I have ship of theseus'ed my way back to being a virgin
Okay, this is super preliminary, but since we’ve been talking about zoo accessibility I wanted to launch a project I’ve been planning for a couple months.
One of the hardest things about visiting zoological facilities when disabled is the lack of knowledge ahead of time, right? Often the information on the zoo’s website about accessibility doesn’t contain everything folk need to know to plan a visit. I think we can probably help fix that, even if it’s with just crowd-sourced knowledge!
This is a google spreadsheet for recording accessibility information for various zoos. It is super unfinished right now, FYI. That’s partially because I need to fill in more of it from my own experiences, and partially because there are things I didn’t note or experience - which I’d love for y'all to chime in about.
Categories for the spreadsheet so far include rentable assistance options, service dog information, accessible bathroom locations, mobility, vision, auditory and sensory issues (or accommodations), food allergy options, and general notes. I’m also including the information each zoo website provides, and guest assistance phone numbers, so all the information is in one place.
To add to this crowd-sourced zoo accessibility resource:
Send an ask to the blog, or comment on the appropriate cel on the spreadsheet (if the facility you want to comment on is already listed).
Provide the name of the zoo/aquarium/sanctuary and the approximate date you visited.
Tell me your experiences / information, and what categories they belong in.
Feel free to submit photos, if that’s useful info! I’m going to see if I can find a way to host them and link in the spreadsheet.
I’ll take information as it’s submitted and integrate it into the sheet. If the zoo you’ve visited isn’t on the list yet, I still want to add it! This resource is going to stay US-based, however. (I just don’t have the capacity to manage an international one).
Obviously, I can’t personally verify everything people submit, so this is very much a resource and not a definitive guide. Date stamps are crucial important for keeping track of what’s recent and what might have been updated since someone visited.
Let’s make zoo, aquarium, and sanctuary visits more accessible for everyone!
Okay! I think I’ve got almost everything that was added (via ask, reblog, or spreadsheet comment) integrated! Had to take a bit of time off for health reasons, but happy I can come back to it again.
I’ve added a bunch more categories based on your suggestions and contributions, including: parking, multi-lingual support, ride/show/transit accessibility, sun exposure, food & water, low/no cost entrance, support staff policies, options for SDs (bathroom spots, etc), behind-the-scenes accessibility, elevator locations, bench frequency/locations… it’s getting huge but I think it’s super important information.
I’ve done a bit of formatting to try to make the spreadsheet less visually overwhelming. Topics aren’t in any particular order, although I tried to group related concepts together. Grey columns are for information copied from the facility website, and white comments are for the most important part of the spreadsheet: your comments and feedback! That way what’s shared officially can be differentiated visually from what people have contributed.
Please feel free to send me more information and I’ll update it as I have time.
Comments and feedback from personal experience are the most useful contributions. I’m going through as I have time and populating the information from the zoo’s website, so while I super appreciate it when you send me that, you don’t need to duplicate that work. What I want to know is what I can’t find online!
How long are the hills? How’s the path conditions? How did you feel like the staff reacted to your SD? Is the signage at wheel-chair level appropriate for adults, or just kids? That sort of thing is the meat of this project.
Helen Burns, Jane Eyre, Fantine, Les Miserables, Satine, Moulin Rouge, Sylvia Llewelyn Davies, Finding Neverland, Isabel Neville, The White Queen, Mrs. Hale and Bessy Higgins, North and South, Frances Hindley, Wuthering Heights, Mrs. Alma Wheatley, The Queen’s Gambit, Queen Anne,The White Queen
On the one hand, this is legit funny, but on the other hand, I cannot overstate the extent to which everybody had tuberculosis in the past. Before 1950, people who wrote about characters dying of TB probably knew someone dying of TB, and knew half a dozen people living with chronic TB that wasn’t actively killing them right away but could get worse at any moment. Of course it’s not just TB: all bacterial infections posed a huge risk before the invention of penicillin.
A story where a character catches a cold, coughs piteously and proceeds to die might seem melodramatic today, but from a 1800s perspective, it was pretty realistic. (The part that’s not realistic is pretending TB deaths were pretty, and leaving out any mention of phlegm.)
TB was indeed a real issue, I remember reading The Year of my Indian Prince by Ella Thorp Ellis when I was a kid. It was my first introduction to how terrible TB was before effective treatment. Also, it is still a huge problem today in some countries.
However, the humour is that in period dramas especially, a cough is like a Chekhov’s Gun. If someone dares pull out their handkerchief and cough it’s almost guaranteed they will die. This is used even if the character never actually coughs in the book (or real life). Mrs. Hale, for example, never coughs in North & South, whatever she had wasn’t imagined as TB. It’s probably cancer.
a) Very good point.
b) Yes, TB is far from eradicated, and even in affluent countries where it’s mostly gone, it keeps cropping back up in homeless people.
c) Yes, it’s very likely that Mrs. Hale had cancer - but we are never given any real details of her symptoms, only that she dies after long illness, and that she was more comfortable in a waterbed.
c) I recommend that everybody read Illness as Metaphor by Susan Sontag, it’s about the narratives that built around TB and cancer and how serious representations of illness can become melodramatic or even humorous, and how narratives around illness seriously fuck over ill people themselves. Also it’s a very useful book if you ever were ill, or you’re ever going to be ill, which we all probably will.
Being raised by areligious jews with 0 exposure to christianity outside pop culture is so fun. One time I asked my ex-catholic friend why a picture of jesus had a bristle crown and she looked at me like I was insane. One time I heard someone mention the “lance of longinus” and responded, word for word, “Like from Evangelion?” One time during a history lesson my professor described an important monk and scholar as “Dominican” and I spent the rest of class super confused and hung up on it because I was very sure that the Dominican Republic didn’t meaningfully exist as an entity back then, maybe she meant he was a native Taino or something but that’s a weird way to say that and I’m pretty sure this was pre- European contact? Really fucks people up when they realize I genuinely have no idea.
This but it’s my partner taking an art history class in college and the professor looking at them like they grew a second head when they answered “What came out of Jesus’ wound when he was stabbed on the cross” with “…Blood?”
Additions that prove my point by mystifying me because what on earth would come out of a nail wound besides blood. Are you telling me it was something besides blood. What was jesus full of that wasn’t blood. You guys are scaring me
Apparently it was water?? I guess he was also stabbed on top of being crucified (which feels like overkill imo) and water came out, which was a huge deal in medieval symbolism and also to my medieval poetry professor, who was genuinely shocked and upset that I didn’t know. This man fully docked me points because I, a whole ass Jew, hadn’t somehow heard about the secret waterballoon Jesus lore that I guess everyone is supposed to like… intuit
On the plus side, it does lead to some absolutely wild medieval Jesus art of angels tapping him like a fucking keg
OH I HAVE AN EXPLANATION FOR THAT ONE!
Raised non-denominational Christian, not Catholic, BUT the base Martial is close enough that I know this one.
Okay so the way I was told it (and anyone with a medical background, especially post mortem, please weigh in on this because I don’t know if it’s actually true) is that crucification is a very long, drawn out way to go. You basically asohyxiate over a looong period of time due to being unable to pull in a full breath under your own body weight. Awful way to go. But this means that the nails and shit? Not necessarily lethal in their own right outside of infection. That means a pain being executed this way can pass out before they’ve actually shuffled off the mortal coil, Roman soldiers take them down and throw them…. Where ever they the dead people, criminal who can now finally breathe recovers consciousness and books it.
To prevent this, the soldiers would, after a certain amount of time, go around and poke their executed to make damn sure they were dead dead for realsies. If you’re freshly but not TOO freshly dead, your blood platelets will begin to clump together and separate out of the plasma. The “water and blood” is a way of saying look, he was VERY dead when they took him down. You know how dead he was from this evidence of the fact that his biological processes were already breaking down. This is PROOF that the reserection was a 100% genuine Miracle of God, and can not be explained away by the Romans making a mistake here and there.
I wonder how many of Defunctland’s research inquiries hit a dead end because the recipient looks at an email signed “Kevin Perjurer” and just automatically assumes someone is pranking them?
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