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MedicalIamA(n) intensive care nurse in a level 1 trauma hospital. I have experience with every specialty except burns. AMA!

Aug 9th 2017 by sinnicleB • 13 Questions • 67 Points

The Exploratorium is a playful learning laboratory in San Francisco with 600+ interactive exhibits. Nicole Minor is the project director and producer for the museum's 2017 live stream of the upcoming total solar eclipse on August 21st. Rob Rothfarb is the Exploratorium's eclipse live stream technical director. He created the museum's FREE Total Solar Eclipse app for iOS + Android. We’ve live streamed six solar eclipse events.

https://www.exploratorium.edu/eclipse

Thanks everybody! We had fun answering your great questions and hope you enjoy clear skies on eclipse day! Please join us online for our live coverage on our app and website, beginning at 9:00 AM PDT / 12:00PM EDT on August 21. If you're in the Bay Area and would like to come watch with us, we're having an eclipse viewing party at the Exploratorium starting at 9:00 AM. -Rob and Nicole

Q:

Are very large patients a problem?

A:

What was the most exciting location to shoot from?


Q:

They definitely are, in a large number of ways (pun not intended). It can be simple, like our rooms and beds being too small. It can also be complex and dangerous: often times, very deconditioned patients have trouble healing from even simple problems. They tend to have a lot of skin damage at baseline and to carry a lot of fungus/bacteria because they have trouble cleaning themselves at baseline. When they have open wounds, you can see how all that is a recipe for infection. If they are on a ventilator and are already septic, their path to healing is long and hard.

Also - even though it's not a good thing - there can definitely be prejudice against larger patients. I know some people feel angry at them for not taking care of themselves, etc. I don't share this view: I think that the fact that extreme over eating is a type of eating disorder (which needs treatment, not judgment) is often missed. But I also sympathize with people who feel angry because large patients can be so difficult to move and it's easy to hurt one's back just lifting a leg or even an arm if the patient is big enough.

It's a strange feeling to look at someone's limb and realize it almost certainly weighs more than you do.

A:

Probably the tiny atoll of Woleai, in Micronesia, for last year's eclipse in March of 2016. We had no electricity, no internet, no nothing. Had to bring it all by boat!


Q:

Great question

A:

I hear you will be broadcasting in Spanish, too -- is this true?


Q:

Also I think I read this wrong the first time and didn't see that you said you had boatloads of respect for me. Thanks so much! Be nice to your nurses when you're in the hospital: I promise, the effort will be repaid in good care and small favors.

A:

Yes! Our live coverage in Spanish, from 10:00-11:00AM PDT will be hosted by Exploratorium astronomer/educator Dr. Isabel Hawkins and Univision's Kira Vilanova.


Q:

Just reading through your AMA, I realized that I've been picturing you as a woman this whole time. Then I remembered that dumb movie Meet the Parents where the parents constantly make fun of the main character for being a male nurse. And I realizing from this thread how ridiculous that whole idea is, just absurd.

So, male or female, would you mind talking about sexism that you may have experienced where you work?

A:

My friends bought sketchy eclipse glasses on the street. They don't seem to be more than 3D glasses. Is there a way to tell real eclipse safety glasses from fake ones or just 3d glasses?


Q:

Awesome question. I love it that you questioned that assumption, because the nurse=woman thing is pretty depressing.

I am a woman, and for the most part I would say that the hospital is a pretty good place as far as sexism goes (aside from patients, which you can't escape). Success in an ICU tends to be more merit-based than a lot of places, for obvious reasons.

That being said, I have complained before that it is easier for male nurses to get ahead. I have seen data showing that while there are fewer males in nursing overall, they still tend to make more than their colleagues. From my experience, this seems likely to be true. Male nurses get a lot of respect from everyone - including their co-workers - when they do basic parts of the job that come across as very caring (e.g. washing a patient's hair). There are definitely male nurses on my unit who are basically universally loved (and they are cool!) for doing things that some of the female nurses do far more and far more competently.

That being said, I think that being a male nurse is really hard. It is far more common for male nurses to be refused than female ones. A lot of patients act as though male nurses are going to be perverted or something, and that is incredibly insulting on a professional and personal level. Additionally, seeing so much death and tragedy is very emotional; I think it's much more acceptable for females to show this than it is for males to do so, and I think it's so sad that we as a society deny men the ability to glean social support in situations like we see daily.

tldr: do I think it's easier to be a certain gender in nursing? Well, I think it's definitely easier for men to climb the ladder, but it's harder for them to gain trust from patients and to find a safe place to show their emotions. So it depends on what you want out of a job.

A:

Only eclipse glasses with verifiable filtering with the ISO 12312-2 level can be used to safely look at the sun. To find reputable sources we recommend consulting the American Astronomical Society's solar filters and viewers guide at https://eclipse.aas.org/resources/solar-filters Please make sure your eclipse glasses come from reputable sources!


Q:

Just reading through your AMA, I realized that I've been picturing you as a woman this whole time. Then I remembered that dumb movie Meet the Parents where the parents constantly make fun of the main character for being a male nurse. And I realizing from this thread how ridiculous that whole idea is, just absurd.

So, male or female, would you mind talking about sexism that you may have experienced where you work?

A:

Also, looking at the sun during the eclipse is not any more dangerous than looking at the sun on any other day. If you're like me, and you enjoy you some sun staring, you're fine.


Q:

Also quick comment to say that for all my stories I will change small details to protect patient privacy. However, the major points of each story will be true.

A:

Here's one of our recent favorite videos - highlights from the 2016 total solar eclipse that we captured in Micronesia: https://www.exploratorium.edu/eclipse/past?media=8239


Q:

What was your nursing school experience really like?

A:

Thanks for doing this! How many eclipses have your live-streamed? Has any group done more than you?

Also, what was the most difficult expedition/broadcast?


Q:

I love school so I didn't realize how miserable I was until I graduated and remembered what life without nursing school was like.

Seriously, though: I went to a very highly rated school and I graduated second in a class of 150. I feel as though I learned an incredible amount in a very short time (I was in a 16 month accelerated program). That being said, the things people tell you about nursing school being hard is true. I love school and always have. It wasn't the academic part that killed me. It was the unnecessary (at least IMO) harshness on the part of the teachers.

An MD I knew during my schooling said that she had heard that nursing school is like boot camp. I haven't been to boot camp but the analogy seemed apt. In nursing school, you will be beaten down and humiliated excessively and you will never hear praise. You will be broken down and learn to doubt everything about yourself and then recreated in the mold that they want.

Despite my extremely good academic performance, I was never given any positive feedback and frequently got negative feedback. At the school I went to, if you got less than a 70% on two exams in any class, you automatically failed the class. If you failed more than one class, you failed out of the program. And yes -- this did happen to people in my class. If you had a family emergency (even close deaths), you were expected to be present for clinicals and tests and to schedule your family issues around those requirements.

I can think of one instance where I made one very small 'mistake' which actually -- at least on the unit I work on now - is considered best practice. The instructor literally yelled at me in front of several other students and an assistant; after a little while, I started crying. She didn't let up -- in fact, she yelled for at least 5 more minutes. At the time, I was absolutely crushed. I thought that I would be a dangerous nurse. I thought that I shouldn't ever be near any vulnerable person. Now, looking back, I realize how absurd and needless the situation was.

My class size dropped by probably about 20% from enrollment to graduation. That being said, it helped make me tough, which you need in nursing. It also - weirdly - helped to teach me not to sweat the small stuff.

tldr: I loved nursing school only a little less than I hated it.

A:

You are welcome, it is our pleasure. We have live streamed 11 eclipses, starting back in 1994 with an experiment. Good question if anyone has done more then us-probably SLOOH. As for the most difficult expedition, probably Western China in 2008, which was very remote.


Q:

what percent of staff would you say is not rested enough to the point where it may be harming patient outcomes?

A:

Can you view the eclipse through a telescope lens safely without the glasses? Would that filter the harmful rays?


Q:

Nurses work 12 hour shifts at my hospital (sometimes 16s if you are feeling adventurous -- I've done it a few times and it seriously blows). 12s are long, but not absurd. In general, I think it is safe to assume the RNs aren't the one who are dangerous. That being said, night shift is really hard and I do sometimes feel like I'm going to fall asleep driving on the way home.

The residents and fellows in different specialties, however, work 24-48 hrs shifts. They might be "on-call" in the hospital, meaning that they can sleep but have to come if they are needed. Because our hospital is so high acuity, they often don't really get to sleep at all. I can't telly you how many times I have worked with an MD all day, gone home around 2000 and returned the next day at 0700 only to see the same MD who never left. And yes - these are the MDs who are making decisions about a critically ill patient at 0300.

I really, really wish that hospitals would decrease the shift lengths for MDs, but I don't see it happening anytime soon. It's inhumane to put MDs throught that (suicide rates are extremely high for medical students/MDs, and I have no doubt that chronic sleep deprivation is a part of that) and it also puts patients at risk.

A:

No, you need a special filter for the telescope lens.


Q:

That's ridiculous. How much time would one get off after a 12/16 hr shift or after a 24/48 hr shift ?

A:

Will it be noticeably different to experience totality with a school grade telescope?


Q:

As a nurse, you work 3 12s a week. If you work a 4th, the last 8 hrs of your 4th shift are overtime. This can be nice because your salary is pretty buildable. You can generally schedule your shifts as you like -- sometimes I do three in a row, sometimes 2 and then one (e.g. Sunday, Wednesday, Thursday). I try to avoid switching between night and day shift too quickly, but some nurses will do something like Sunday day shift and then Monday and Tuesday night shift (7pm to 7:30am).

Honestly the 12s aren't bad. You pretty much go home, shower, eat, and sleep -- especially if you are back to work the next day. However, you get 4 days off every week! And if you want ot schedule yourself for a long vacation, it's easy to do even without taking vacation time. You can just schedule yourself for Sun/Mon/Tues the first week and then Thurs/Friday/Saturday the next. That gives you 8 days off in a row.

I try not to do that too often though, because honestly three 12 hr shifts in a row makes you want to die.

As for the MDs, I am not as clear on how much time they get off after their extremely long shifts. I know it's not long enough - as a staff nurse, I have way more free time than the residents. The residents also have a lot of assignments and stuff to do in their free time. Plus their shifts might not end when they are supposed to. It's not uncommon to see a resident still at the hospital around 11 or noon after they were supposed to get off at 6:30am. And yes -- they are often expected back at 6:30pm that night.

A:

Probably, but it really depends on the magnification and filters.


Q:

Have your own fears changed as a result of working there?

A:

I've seen things written about watching the shadow race toward you if you are viewing from a mountaintop. How pronounced is this, and is it worth it for people to travel to a remote mountain locatoin to see?

Also, a shameless plug for /r/solareclipse for people who have questions after this IAMA is over.

edit: formatting


Q:

Definitely. I am terrified of dying helpless and confused and terrified, thinking I'm being tortured. I think this ranks as my #1 fear now. If people knew how the vast majority of people die in this country, there would be a major outcry.

Also, I used to ride my bike around the city a lot and now I am pretty scared of it.

A:

Hi-I have never witnessed this myself, but I hear it can be quite spectacular. Also, you can likely watch the ISS capture the shadow as it moves along the path.


Q:

would routing less severe cases to other facilities be a better allocation of resources, or do they make the more severe cases tolerable?

A:

Do you have a preference for eyewear? I have shade 14 welders goggles and ISO approved glasses but just had Baader safety film arrive at my place and am going to make glasses out if that. I've never experienced an eclipse but it has been top of my bucket list ever since reading about its impact regarding physics, specifically with relativity. What are your recommendations?


Q:

I have never worked as a bed manager, so I don't have a fully developed perspective on this. However, I can say that for me personally, I am all about the high acuity cases. I like adrenaline and don't want to sit around twiddling my thumbs. So I do find it frustrating when we are boarding a patient just because an IMC (intermediate care unit -- a unit for patients too sick for the regular floor but not sick enough for ICU) has no beds available, for example.

Because we are a very high acuity hospital and we have MDs who are willing to do interventions that other hospitals aren't, we tend to have other hospitals in the area send to us and not the other way around. The only time I can recall where we sent a patient to another hospital, it was because the family members were convinced that we weren't doing enough and wanted to take the patient to another hospital that they believed would do more; ironically, the hospital they went to is a hospital that frequently sends us patients who require more invasive care than they are willing to give, so I'm guessing the family was disappointed at the end of that transfer.

A:

Good question. Images seen with each type of approved solar filter will look slightly different. We don't have a preference other than safety. We made this video to explore the story of Einstein's light-bending concept: https://www.exploratorium.edu/eclipse/video/einsteins-light-bending-concept


Q:

What is one of the most heart breaking moments you've seen while in your line of work?

A:

I'll be on a plane! Flying back to SF from the U.K. :(( Is there a chance I'll see it?! Flight leaves 1130am UK time. Which side of the plane should I sit on?! :)


Q:

This is difficult because there are so many.

A completely healthy mother with very young kids caught an extremely severe case of necrotizing fasciitis and died within 2 days. Seeing the husband and the kids mourning her is something I don't know if I will ever forget.

I have had several patients who were innocent bystanders in gun fights, etc. I had one the day he came in; his spine had been severed and he was paralyzed. He was very, very young and him and his family were incredibly nice. None of the various teams caring for him wanted to tell the family and him the news, and so all morning the family kept asking me when we would start PT to get movement back, etc. I felt like I needed to cry when an MD finally told him.

A very young cancer patient also died on our units after weeks of extreme interventions. Her family and friends had put up hundreds of pictures of her throughout her life and she was so loved. Seeing her parents the day she died was brutal.

There was a patient who had Guillan-Barre syndrome who was also very young. He was completely paralyzed and could only blink his eyes. He couldn't even turn his head. He had been that way for over a year when we had him. Everyday, his mouther would come in and talk about her hope that he (the son) was going to recover and start moving again. Her son could hear everything and was totally aware but was basically locked inside his useless body. His eyes were so heartbreaking.

There is another one that I can recall but I'm afraid its specifics are too rare and might violate HIPAA. Suffice to say that it involved a mother who lost a baby.

A:

Rob here-Hmmm hard to say where the plane will be during the eclipse. Probably sit on the port (left) side in the event that it will fly near the path. Backup plan: wi-fi on plane with our Total Solar Eclipse mobile app or website and watch our live video.


Q:

Who is your favorite fictional doctor and or nurse?

A:

One time I looked directly at the sun, what kind of damage did I do to my eyes?


Q:

I hate Grey's Anatomy but I love Christina Yang. She is so awesome. Also, you gotta love Dr. House, obviously.

I love Nurse Ratched as a character because she is so brilliant and terrifying, although obviously not someone I want to be (haha). In general, I think good fictional nurses are hard to find because the portrayal tends to be so inaccurate. Nurse Jackie was probably one of the more realistic ones, but she had WAYYY to much time to go out to lunch (seriously, no nurses leave the hospital on their lunch break. On my unit that would be a terminable offense) and the way she supposedly got drugs was sort of ridiculous. However, I do feel like that show did a decent job of capturing some of the emotional travails of nursing.

A:

Hopefully none but please consult a health-care professional. Always remember to use a certified filter for viewing the sun directly.


Q:

How hard was it to get the job you have now? Do you ever work with the police with a patient?

A:

How has the technology for live streaming the Eclipse changed over the last 20 years? What are the most exciting improvements in the tech?


Q:

I knew I wanted to go into the ICU so I worked my butt off in nursing school because ICU jobs are competitive. I got hired as new grad on my first interview, which rocked. But I had a pretty good resume.

I frequently work with the police. We have a fair amount of patients who are under arrest, which requires that they have 24 hour police supervision and are handcuffed to the bed. I also answer questions from detectives, as appropriate. I have definitely had patients who were violent offenders that have been on the news. A few times, I have been at home and heard about some violent incident, only to go to work and find either the offender or the victim on my unit. We have had to move patients a few times because we found out that both the perpetrator and the victim were on the same unit, which is obviously a no-no.

A:

In the early days of internet video (mid '90s to early 2000s), we were limited by the bandwidth we could use for transmitting live video as well as the image quality. Now, we can use HD video and multiple megabits/second bandwidth for streaming! This allows us to capture and send high quality video from our telescopes and deliver it to smart phones...a long way from the postage-stamp sized, slow-moving video of the early days!


Q:

That's so cool! What was your most interesting encounter with the police or suspect?

A:

How do you recommend I photograph the eclipse? Any Aperture/shutter speed/iso settings you would recommend? Anything I need to prep for before I set my camera up?


Q:

Haha, well last night as I was brushing my teeth I was thinking of a sort of darkly funny story. We had this one guy who was on a wanted list and he was picked up by the police who found him somewhere in the city incapacitated by a deadly condition. He needed emergent interventions or he would die. At the hospital, he was made to understand that after he was healthy enough to leave the hospital, he would be arrested.

Hearing this, he insisted that he wanted to leave right then and there (against medical advice, or AMA). He didn't want the surgery if it meant getting arrested. He was leaving.

It took like 6 people, including some pretty important management, to convince him that he was still going to be arrested even if he didn't get the surgery. He just couldn't comprehend why they would still arrest him if he didn't have the surgery. It was sort of funny in a sad way.

As far as the most interesting encounter... I can't talk about a few that were in the news because they are googleable. But one that sticks out for me is a GSW victim who had been shot 26 times but amazingly lived. His cousin had been murdered the week before that. Speaking with the detectives, I learned that it was revenge-killing by a well-known international gang. The thing that sticks in my mind is that when the man woke up, he was literally in tears begging to know where his toddler-age son was. He would not believe anyone who said the son was fine and was becoming so agitated that he was going to hurt himself. We had to facetime the son so that he could see that he was okay, and even then he was in a near panic, insisting that his GF bring his son to the hospital and that he stay on face-time the entire time. When I asked if he was worried that his son was in danger, he adamantly denied it. The police asked too. But that is the only reasonable explanation I can think of for his palpable terror.

A:

Here's some good tips about shooting images of the eclipse: http://www.mreclipse.com/SEphoto/SEphoto.html


Q:

I deserve to be downvoted

A:

I mean, I kind of feel like you were trolling and then felt disappointed when no one got mad.

Don't underestimate the social issues that contribute to this problem, though. Growing up as an African American young man in an inner city is... well, to say there is no opportunity is being generous.


Q:

What's the worst drug-related incident you've seen/had to deal with at the hospital?

A:

Hmmm.

I had a patient who died after family members snuck drugs into the hospital for him. He was obviously very sick, and the drugs put him into cardiac arrest and he died.

It is very frequent for patients to come in after overdosing, and - once they have recovered (a lot of the time we can reverse and recover them pretty quick) - they immediately leave AMA (against medical advice) so that they can go get high again. Like literally leaving still wearing a hospital gown with their butt hanging out because they are in such a hurry.

I have had patients hit and scream and yell demanding alcohol, etc.

I have had patients who were so alcohol dependent that we had to put alcohol down their feeding tubes because otherwise their withdrawals would be so severe that they wouldn't recover from the other things ailing them.

I had one extremely sick man come in who had been an alcoholic since he was 9 years old.

I've had multiple patients who OD'd outside the hospital and ended up in vegetative states.

An RN who was a pretty close friend was abruptly fired for opioid abuse. It was very upsetting and shocking because I had absolutely no idea.

All things considered, I think the patients who leave the hospital while still sick so that they can get more drugs are the most sad.


Q:

Thank you for taking care of us on our worst days. My mother was a nurse and so I always have fond feelings for nurses.

What is your opinion on the current state of health care and access to medical? Do you feel that your job would be "easier" if folks had access to preventative care? Is a lot of what you face preventable?

A:

Sounds like your mom has some explaining to do, stuntedatpuberty...

Jk. Thanks for the thanks!

I can get on a bit of a political high horse sometimes, so I will try to be short. I have long dreamed of going into healthcare policy so it's a bit of a hobby of mine. Healthcare in the US can never be affordable when it is ruled by insurance companies. The ACA did help, but it can't stop the progression towards a medical market crash. It only slowed it down (obviously saving lives in the process). So I am pro-ACA, but I think that in a lot of ways Republicans have saved democrats from having to pay the political price for the disastrous path healthcare is on. People wouldn't have been right to blame Obamacare- it actually helped - but they would because people aren't fond of looking at hard data, as I'm sure you have noticed. Republicans own it now, unfortunately for them but fortunately for democrats.

I would say that a very large percentage of patients that I care for had preventable problems. Many patients openly admit not going to the MD until something was so severe that they absolutely had to. What always sticks in my mind is a man that I had who had developed a minor pneumonia. He didn't get it treated because he had no insurance. He then developed an abscess. He still had no insurance, so no MD was willing to do the minor surgery he needed. Within a week, he had developed multiple organ failure and was on the brink of death. He ended up in our ICU for weeks on several massively expensive devices. I have no doubt that he cost taxpayers upward of (at least) a million dollars. If we had been willing to pay for his antibiotics to begin with, it would have cost a lot less.

Essentially, taxpayers are already bearing the cost of the uninsured. You're just paying for it once their problems are so severe that hospitals cannot legally turn them away.

This is an oversimplification, as I am aware. I generally can ramble on for ages about the nuances of this issue. But boiled down, what I have said above is true. I think we should go single-payer. I don't deny it has its problems, but I like to describe it like I do democracy: it's the worst form of healthcare except for everything else.


Q:

Have you ever seen anyone die right infront of you?

A:

If you ever meet an ICU nurse who hasn't, I would be surprised.

For me personally, I have lost count.