A Personal Look at the Breast Exam Debate

As the mammography debate is raging on, I want to take a moment to tell a personal story.

Three years ago, during a self breast exam, I found a lump. I happened to have a routine OBGYN visit around the corner and through a simple clinical exam, my doctor also found the lump. My doctor was concerned and sent me to a women’s diagnostic center to have an ultrasound done. My ultrasound revealed that the lump was a fibroid and nothing more—“lay of the caffeine for a month, and it should go away,” said my doctor. My relief was palpable—I was a false positive. It was a traumatic experience, but one I am glad I went through.

The part of this story that still has me thinking about that day, however, was a woman in the waiting room. Let’s call her Judy. Once I had signed in, I was told to put on a gown and wait in a communal waiting area. So here I am, in a room full of vulnerable women wearing nothing but a cotton gown, all with an unknown lump on our body. Naturally, we began to chat. Most of the stories are the same. Our doctors had either found a lump via mammography or clinical exam. But Judy, well, Judy piped up and said she had found a lump 4 months earlier during a self-exam, and had just gone to her doctor. Judy was probably nearing 50. She was a beautiful woman, but clearly, she was scared. She had been letting this lump grow for 4 months! I was scared for her. Now of course, her lump could be benign, it could be a fibroid, it could be a cyst, but with all of those “could be’s” there is also the big BC. And the fact that Judy didn’t feel comfortable telling her doctor for 4 months about her lump is and was terribly concerning to me.

I have no idea what happened to Judy. I hope with my deepest hope that her lump was benign. But her situation begs the question, “What will this latest revision to the breast exam standards do to women like Judy?” By telling a woman like Judy that she doesn’t need to a mammogram until she is 50, and that she shouldn’t even be doing a self-exam, where does that leave her? She was clearly either too unconcerned or too scared to tell her doctor for 4 months. My doctor has always made it a point to insist upon self-exams, and yearly clinical exams. And I thank her for that dearly, because the day I found something, it wasn’t scary. I called her office, moved up my yearly exam, and had the lump checked out. It wasn’t even scary until I had left the diagnostic center and my relief took me over, all because it was somewhat routine for me.

I understand the logistics in place with the task force guidelines, however, from my perspective, my fear is that giving women the chance to ignore the possibilities is far worse than exposing them to a couple of days of stress—or heaven forbid, a couple of years of chemo.

The Holiday Schedules are Upon Us

As we all are well aware, one of the pitfalls of nursing is the holiday schedule. During most of the year, it’s bearable. We take our weekend shifts and night shifts in stride, but when your 25 closest relatives plan to be camped out at your house for turkey and football, well, it gets a little more frustrating.

What can be done to make the holidays a little easier? Well, at the top of the list, as with any job, is management that is willing to realize you have a life outside of work. Perhaps your hospital already has good scheduling karma, but if not, maybe it is time to speak up—respectfully!—and offer some new options for next year’s holiday scheduling.

Here are a few scheduling ideas to get you started:

• Allow everyone to prioritize the days they would prefer to take off. Perhaps Christmas Eve is more important in your family than Christmas Day. By setting your 1st, 2nd and 3rd choice of holidays, everyone is more likely to get what they want.
• If a sign-up sheet method is used, next to the sign-up sheet, post the holidays all employees worked the previous year. If everyone can see that Sarah worked Christmas Day and 4th of July last year, everyone can understand why she doesn’t want to work those days this year.
• Create groups. Group 1 works 4th of July, Thanksgiving and New Years’ Day. Group 2 works Memorial Day, Labor Day, and Christmas Day. Each year, the groups alternate, and groups are static for at least 3 years in advance.

Once the schedule is set however, there are always ways to make working the holiday better:

• Throw a party. Have everyone bring a dish, and have a potluck party. Be sure to invite any families that are visiting patients, as they are missing their holiday celebrations, too!
• Remember that airfare is cheaper just before and after the holidays. If you can’t visit family on Christmas, waiting until after the holidays won’t be the end of the world, particularly if the plane ticket is $200 cheaper!
• And lastly, don’t forget that your patients can’t be at home celebrating with their families, either. When your own troubles get you down, it is always useful to help someone else with theirs. Pay extra attention to your patients at the holidays and make their day a little brighter. It will inevitably make yours better in the process!

The Reality of H1N1 Prevention

As the flu season ramps up, hospitals and doctors’ offices are once again being inundated with potential flu patients. This season, however, the influx is greater than ever. Patients are nervous about H1N1, and their fear is filling waiting rooms. Waiting rooms full of people who don’t have H1N1u.

The CDC has created a laundry list of suggestions for how to prevent the spread of H1N1. They suggest everything from N95 respirator masks, hand sanitizer, and partitions in waiting areas, to ventilation systems and restricted visitation rules. The real question is, however, what is actually being implemented in facilities around the country. Has your hospital taken any drastic measures to minimize the spread of H1N1? Have you created a special triage plan? Or a partitioned waiting area? Are you limiting patient transport if they are suspected of having influenza? Has your hospital come up with any creative solutions that go above and beyond the CDC’s recommendations?

How have these changes impacted your daily work? Or has your routine been unaffected? Perhaps there are some good ideas out there that aren’t being shared between facilities that we could all use to the advantage of our hospitals, patients and staff.

The Pulse November Contest!

Oh what stories you could tell! Well, here’s your chance. Each month, The Pulse wants to hear your best anecdotes. We’ll give you a topic of interest, you give us your best quick thinking, and you get a chance to be heard here on The Pulse. The writer of our favorite wisdom will receive a $50 to spend at Allheart.com!

This month, we want to know: If you were to give a nursing student one piece of advice, what would it be?

Please add a comment with your reply to this post. (Click here post your comment)

Women of All Shapes and Sizes

I just came back from a much needed, and rarely had treat – a manicure and pedicure. Part of the fun in blocking out the world while someone else tackles my hands and feet is the chance to indulge in magazines I never have time to read. As I sunk into the massaging chair and dunked my feet in the swirling water, I started flipping through the pages of the November 2nd issue of People. The first thing that grabbed me was a short blurb on a model who is 5’10, 120 pounds and, according to People Magazine, was fired by Ralph Lauren because she was too large to fit into the sample clothes used in their ads. She is considered too heavy to be a model at a size 4. Too heavy to be a model at a size 4? Have we lost our minds?

As nurses we see women and men of all shapes and sizes and we know that the average woman isn’t a size 0 (how can you be no size at all?). In fact, Wonderquest says the average American woman is just shy of 5’4 and weighs 152 pounds – about a size 14. I’m not commenting about the obesity epidemic in the United States, just the idea that a woman who is 5’10 and 120 lbs could be considered too heavy to model.

So, why aren’t “real women” in our magazines? Next in my pile happened to be the November issue of Glamour where I discovered a “plus-size” model, Lizzie Miller, had been making headlines all over the news because of an almost nude picture in the September issue of Glamour where you see her not so flat belly. A real women’s belly! After getting all kinds of positive attention, Glamour did a photo shoot for their November issue with 7 “plus-size” models. To Glamour’s credit, apparently they had used 6 of these 7 women in the past (and plan to continue the trend). Almost all had stories of starving themselves to fit into the size 0 world of modeling.

After devouring this article, I read the editor’s column. On that page they showed models through the years that included Marilyn Monroe and Elizabeth Taylor – true beauties and women who were on the cover of many magazines in the ‘40’s and ‘50’s. Today, Ms. Monroe and Ms. Taylor would be “plus-sized”…How wonderful it would be to transition the American mindset back to this sort of beauty.

What are your thoughts on how we persuade more magazines to follow Glamour’s lead?