Branchial arches in action
Caused dysentery, liver abscesses, RUQ pain. Contracted from cysts in water. Can be diagnosed with serology, trophozoites in RBCs, or cysts in stool. Treat with metronidazole and iodoquinol.
Even though we’re considered the bottom of the food chain, and the total scut-monkey of the hospital - I still feel blessed to be a nurse; even through sheer exhaustion, and many hoops to jump through, it’s a pretty damn extraordinary field that allows us to spend a little portion each day with others, and learn their unique stories. I want to remind myself of this in 25 years, if I still have this blessing in my life.
Nurse X (via dancingnurse-ed)
Mr., Pass Through
Occam’s Razor applies.
Written on Dec 5, 2013
I first encountered HIPAA when I worked in the back of an ambulance in Brooklyn. HIPAA is the set of federal regulation that makes it a crime to reveal peoples’ health history. I was asking a woman who I was caring for about her oxygen use at home as we rolled her down a hallway and into an elevator. She said it wasn’t normal for her. The other people on the elevator said, “That’s a HIPAA violation, you gotta be careful. You can’t make mistakes like that.” They were right. I was properly chastised, but something never felt reasonable about it.
Today I watched the news of the death of Nelson Mandela disseminate through the collective mind of the internet and into the world. It makes me think about other human beings who have tried to stop people from being judged not based on how they proceed from one moment to the next, but based only on what they are.
I’ve always heard HIPAA described as a way to guard against the possibilities of discrimination because of illnesses and genetic heritages. You can’t let people find out that you have cancer. You might be judged for your psychiatric history. Cover that rash with makeup. You might not get hired if they know you have HIV. They might not keep you around if they know you’re gay. Don’t give your kid a name that’s too Black. Change your last name to something less Jewish. This cream will lighten your skin.
HIPAA says that the problem is not the discrimination. Or even if it is the problem, it cannot possibly be fixed. Instead we have institutionalized fear of the discrimination. The gay rights movement’s response to HIV, to out themselves immediately and start fighting for their recognition as human beings, created the template that the internet is now spreading to all of the stricken. Their unique combination of life and disease forced them to cross from the stories they inherited from the civil rights movement to the health rights movement that is only just beginning. What illness you have is not something to hide beneath shame. It is not an orientation that defines your boundaries in life. It is a part of your experience. Experience shapes but it does not need to confine.
We aren’t fighting the discrimination, we’re preserving marginalization and shame.
The fear of disclosure is too engrained and has hurt too many people to casually throw HIPAA away. But equal efforts can be made to help people not fear but to celebrate joining another group of human beings, even if they had no role in choosing to be a member.
My side project, The Mosquito & The Monster, published on Tuesdays as long as I can keep myself together :-)
I volunteered for a medical professional community outreach program. Medical students go into a kindergarten wearing white coats and talk to them, demystifying through exposure. The school I was in is mostly poor kids, the majority of whom are immigrants.
I was in the waiting room, which was a space where a bunch of kids would sit around and the curriculum was supposed to be telling them about fruits and vegetables, wear a bike helmet, wear a seat belt, drink milk for your bones, all that. It was declarative. What do you do to protect your head? Wear a helmet. Statements of information with right and wrong answers based on acquired knowledge.
There was one girl who was either held back already multiple times or she was big for her age and being stigmatized for that. She was being yelled at by her teachers to behave. She had attitude. I took one look and knew her story; not seemingly intelligent, lots of punishment and negative reinforcement, one thing leads to another and she’s suffering further from poverty and all the indignities that come with it. There she was in front of me.
I thought naa, I can reach her and teach her something, anything, it doesn’t matter, and I can do it right now.
I had some foam fake fruit, would you like some fruit? ”Can I throw it at that (the organ system mannequin)?” Sure. I gave it to her and she threw it violently and her teacher and one of the medical students both yelled at her. I said to them no no no, thats entirely my fault, I told her she could. In that context she’s out of control.
I offered her more fruit, said you can’t throw it, but you can have more. She didn’t respond, she covered her face, she was ashamed; she’d listened to me say okay and been yelled at anyway. My fault, not hers, but she suffered the small verbal abuse because of it.
I said to her, look at this mannequin, wanna take all its organs out right now? ”Yeah!” We tore all the organs out of it wildly, throwing them all over the place, it was fun. Now she’s engaged again.
I said, ok, how can you figure out how they go back together?
"I don’t know!"
I didn’t ask if you know, I just asked if you could figure out how. She started to put the intestines back in, but was getting frustrated making them fit. I said, you’re getting it! You know they all fit in because you saw it, now you just have to figure out how.
She kept working on it, asking me the names of the parts as she was working. It took her a few minutes, she put some things in, then realized other stuff wouldn’t fit so she took them back out and put them in again in a way that did fit. I could’ve shown her, but that would’ve been useless. That would’ve just been like small talk, giving her information without the process that led to it, not actually teaching her.
When she finished she had a big smile. I said, LETS TEAR IT ALL APART AGAIN! She and I and a couple other kids who were now watching took all the organs out and had a great time throwing them at each other and bouncing them off the floors.
Then I said to her, how can you put them back in again? This time she did it in under a minute, and knew all the names of all of them.
Then I left, and she went back to her teachers who already had decided she wasn’t capable and who were yelling at her. That was in front of me. Imagine how they treat her when nobody else is there. I’m not saying they don’t care, but she’s wild, and they think its intelligence or because her parents are bad or because she’s just got too many things against her. They’ve got two dozen kids to take care of, based on how they’re being asked to teach they can’t sacrifice twenty-three for the sake of one who isn’t keeping up. At least that’s what they’ve been told.
In under 10 minutes she learned the names of the all the organs she could take out of that mannequin. If that mannequin had been more complex she would’ve learned more. No limits. Utterly brilliant. Not special. That kind of brilliance is normal.
I had to help her to think about how to do something. How to do anything. But she figured it all out. It all came flooding out. Learning organ systems for a child is not inherently useful. The thing I taught her was not itself relevant. But that does not matter. She showed that she was brilliant. She experienced her own brilliance.
I don’t think this is limited to children. Any person can be approach this way, and in doing so they will become more intelligent in front of your eyes as they unblock themselves. Ask them how to do something.
- Atlanta Journal Of Medical Illustration