Oh patients get hot potatoe’d all the time it’s just usually they’re full code violent dementia patients. OB hot potatoes are just the new fad in overly legally complicated patients no one wants to be officially responsible for when they die. The republican party is the party of the freedom to die in a ditch full of maggots when your death panel insurance review board (chaired by an eye doctor who’s been out of practice for 10 years after committing fraud) denies your chemo treatment juuust long enough that you’re better off dying quickly and getting out of their hair.

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Yeah quitting alcohol will kill you and nicotine is still the hard one for a lot of people. My unofficial psychiatric subspecialty is violence management and nicotine is on my list of top ten reasons people will punch you right in the face along with food, perceived threats to their children, and looking like the person that diddled them as a kid. Interestingly opiate withdrawal actually won’t kill you (at least not directly), you’ll just wish it did. Benzos and barbituates totally will though they work on the same system as alcohol.

Fun fact! Nicotine paralyzes your cilia.

Your cilia are a layer of fine hairlike structures that coat most of your respiratory tract. They whip / beat together rhythmically to push debris filled mucous up and out of your respiratory tract to your pharynx where it can be expelled by coughing or swallowed and processed by your digestive tract. When you smoke, they’re paralyzed, allowing debris to build up (and man is there a lot of debris, on account of, y’know, the smoking).

About a week after you quit they wake up and yell,“WHAT THE FUCK IS ALL THIS SHIT?” Imagine if somebody came into your job and roofied you, smeared diarrhea all over the walls, then left. You’d be mad too. Give your cilia lots of water to help thin that mucous out and make their job a little easier during that stage.

Also read up on the other stages of quitting, it’ll make it much easier once you’re expecting these kinds of things.

It’s also been bred to be waaay stronger over the last couple decades. I see a fair amount of weed-induced psychosis rolling through inpatient, or at the very least weed-exacerbated psychosis. Way worse than the psychosis is the hyper-emesis syndrome. One of the characteristic symptoms is “scromiting” (Scream-Vomiting).

It’s better for you than alcohol. That’s not a high bar. A light mauling from a black bear is also better for you than alcohol. It’s waaay better for you than cigarettes but also most brain cancer starts out as lung cancer and I’ll let you follow the rest of that on your own. Most of my substance abuse patients who are hooked on shit like fentanyl and meth also tell me that nicotine is the hardest drug to quit.

Weed’s not the worst. It’s still drugs though.

My only question is how to best handle children having sex with each other. Do you ban it / try to prevent it from happening at all? Do you set limits on how different they can be in age? Is there an even younger age when it’s never ok but it’s ok if they’re both older AND of similar enough age? Is age not even the right way to do it and more importantly is there a better way? Should you have to pass a class where you can prove you know how to apply a condom and obtain consent from others??? I don’t have any good answers to any of these questions but I do think they’re important to ask and talk about. The more common discussion I wind up in is juvenile substance abuse (should you let kids do drugs as long as they’re in your house so you can keep them safe? Are kids who are raised where everybody 14ish and older can have a glass of wine at the dinner table more or less likely to develop alcoholism due to the increased daily presence but decreased taboo?) but this discussion reuses a lot of the same concepts.

Well you do gotta give Cesar back what he done minted.

Well the downside to the “you break [the virginity] you buy it” mindset (aside from the literal objectification) is that having to formally marry the child also means the child is formally married to (and stuck with) the pedo. At least the informal version is probably less legally complicated to flee from.

Relying on emergency services only wastes soooooo much money. Waiting until problems are acute and they HAVE to be treated under EMTALA means doing way more expensive treatments and clogs up emergency services. Not to mention that not vaccinating or treating bacterial infections results in a bunch of cooties getting spread around the community. And when they’re getting those emergency services they can’t pay for them so the cost has to get absorbed into the bills of the patients who can pay either directly or through insurance.

“I don’t wanna pay for other people’s Healthcare!”

You already are, just in the least efficient and most expensive way possible.

People act like me not getting off the raised republican train until my early 20s is really slow but that’s when as a female child they allowed me to leave the house regularly for things other than school or church.

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Eeeeh. I kinda get why it fell out of favor. For context, the weird thing about the nursing perspective vs the MD perspective is that you don’t get as much of the benefit of large studies, but you also aren’t as sensitive to big pharma marketing studies either which… good AND bad. Like for school I had to take a class on evaluating the validity of drug trials and one of the studies mentioned was taking advantage of the fact that there’s basically no equivalent doses between different antipsychotics but you can also look at the doses from an experienced clinician perspective and be like huh they’re saying this drug has less side effects compared to 20mg of Haldol daily, but literally ANYTHING has less side effects than 20mg of Haldol daily; that dose is insane. The nursing perspective also tends to be more sensitive to variations in the needs of local populations, you’ve lived in an area and worked within that specific demographic and environmental setting for a few decades vs the doctors main body of knowledge often even includes studies from across the world. Just giving some background as to the upsides and downsides of my perspective.

So back to my point, I can tell you I associate lithium with being a last resort med for really sick patients who nothing else cuts it for. I associate it with horrible side effects including crazy weight gain and thyroid problems as well as fluid and electrolyte balances, and depakote and tegretol aren’t gonna cause that last one at all and also do have that advantage of blood level monitoring. I don’t see tegretol prescribed as much but depakote is probably what I see as the most prescribed med even before lamictal. Now lamictal I completely understand why I’m not seeing in the inpatient setting; you can’t rapidly titrate without risking the death rash (SJS/TENS), and the objective of inpatient care is always rapid stabilization with tweaking to occur in the community. And also maybe I’m associating lithium with all these horrible side effects because I’m seeing it used for patients suffering from both the direct effects of severe mania, especially those with the cumulative effect of multiple manic episodes over time, as well as all the other horrible things those episodes put them at risk of such as homelessness, substance abuse, and general increased risk of injury and illness due to decreased capacity for self care.

I guess the TLDR is, it wouldn’t shock me if the inability to patent salt was the reason lithium isn’t preferred, but I also associate it with being a pretty old-school heavy hitter like thorazine is for psychosis, and while my perspective has the advantage of being more experiential, that comes at the disadvantage of being less empirical (but its also often difficult to tell how empirical some studies are due to the influence of capitalism on the development of pharmaceuticals).

Yeah the line between adhd and bipolar is thinner than ppl wanna admit. Lemme find The Infographic.

Well its mixed because he still wants to be able to force his mistresses to get them. He just wants the poor to keep reproducing at uncontrollable rates because the best way to have parents not care that you’re having sex with their children is to make sure they have too many to keep track of.

I am absolutely awestruck by the amount of bravery and critical thinking under stress that it must have taken to understand that you needed to sign a DNR for your 7 year old. Most parents in your situation would barely be able to add up 2+2, let alone comprehend enough of what the doctor was saying to make that kind of decision.

I’m also so happy for all of you that you wound up not needing that DNR. I hope she’s adapting well to her life with those limitations, but often children that age have enough neuroplasticity to work it out. She’s also certainly got parents who know how to put their own emotions aside and make sure she gets the care she needs, so under the circumstances she’s got a lot going for her. <3

And if you’re really dedicated to being a person who saves lives and its a big part of your personal identity, you’d also be risking the lives of the future people you’d be able to help and your identity as a person who saves lives. You can’t help this one person in this specific life threatening situation but there’s other peripartum hemorrhages you could help and many more you could try to keep out of that condition to begin with. But to do that you have to let this one person die despite knowing how to help them too. Absolute shit sandwich.

I’m working on developing a better work life balance but for the longest time working as a nurse has been the thing I stuck around on ye olde mortal coil for. It’s what was worth sticking around to try and get through all that therapy for. I won’t try to say it’s healthy but if I lost my license I don’t really have a whole lot left to stick around for.

Bingo. This is my interpretation as well.

On a related note, I’ve been thinking lately about how many older men have gone absolutely batshit on me for suggesting that they may not be able to safely pee standing up anymore. Its so hardwired in some of them that sometimes even bilateral amputees with enough dementia will insist that they need to stand up to pee. I’ve literally pulled back the blankets to show them their missing legs and they look right back up at me and keep yelling at me to get out of the way.

It’s happened so much at this point that I’m very desensitized to it. They’ll be threatening to kill me and I’m just “ah yes the good ol’ standing piss argument.” It’s practically as developmentally normal as a toddler not being able to share toys or a teenager having an unstable personal identity. Not sure what the female equivalent is, most of the violence I receive from that population seems to relate to trauma / fear related to sexual assault; they have difficulty calmly accepting assistance toileting because they’re worried I’m going to hurt them vs it being less common to be a pride issue with women. Although I suppose the pride just boils down to a fear of being taken advantage of for being weak.

TLDR; loss of independence is rough and in addition to the driving thing there’s a few other interesting manifestations.

I run into troubled young men a lot, unfortunately. I was raised female so I often lack the context to truly empathize with their life experiences, and I’m really hurting for coworkers to consult who can.

You hear this a lot in nursing too when people talk about how nursing assistants should make more. “But that’s what I make and I have more education and am responsible for more!” Correct, your pay should rise as well.