#and then try to chronically overapply it

[rxttenfish]

my most unpopular + controversial spec bio opinion is that the square cube law isnt all that hard to follow. stop making your creatures be as big as possible all the time. its far more effective and puts the size into far sharper contrast if you actually can compare them to things which you interact with on a regular basis and its far easier to fully utilize and understand every square inch of said creature if youre not trying to challenge Every Giant Land Vertebrate for size.

[naamahdarling]

Hello! I saw your post about inexperienced medical professionals and how disabled/chronically ill people often get under treated because of it. As a nursing student, I want to make sure I provide the best care possible for each of my patients, and was wondering what you need from your healthcare providers and what you want other medical students to know and keep in mind? I want to grow as a nurse and make sure I meet the individual needs of all of my patients

God, I wish I could find the post I made a good while back where someone asked me the same thing. I was a little crabby, but I had an answer.

Nursing is such a vital profession and you have my gratitude. What y’all do is honestly more critical to most patients’ experience than what doctors do.  Voluntarily taking on such a demanding position is honorable.

You are being very poorly educated on issues related to body weight.  It is absolutely critical that you educate yourself.  Medical bias against fat people kills. Period. If there is one thing, just one thing, I need more medical professionals to understand, it is this.  Fat people are HORRENDOUSLY mistreated, medically, and the prevailing wisdom is alarmingly wrong.  You’re gonna have to do the legwork, I’m too tired to dig up starting points, but damn, this is some serious shit.

Some patients have medical trauma. The medical profession is full of good, caring people who do their best. There are also some real dog turds. Those people can cause lifelong trauma very easily. Congrats. The people harmed by asshole medical practitioners are your patients now. You have just inherited responsibility for the awful shit your predecessors did. Is it fair to you personally? No. It really isn’t. Sorry. But that’s how it is. The responsibility falls on your role. You are part of the machine that broke them, it is now your duty to help them to heal.  It’s on you to be super duper fucking careful with them. You have a chance to help people heal from incredibly difficult experiences. Use it.  (I have a major medical phobia and have spent more than one appointment at Planned Parenthood with a trash can between my knees, trying not to puke. Going in for my much needed and very successful hysterectomy was a nightmare. The nurses I had while in hospital turned the experience around 180 degrees by being nice, patient, and understanding of my history. It was a good, healing experience, and I came out of it with less baggage than I went in.  You can do that for your patients, too.)

This whole overapplying the “patient is medication seeking” thing has to stop. The system that is educating you is educating you poorly about chronic pain and addiction. You have to do your own legwork on this, sorry.  You probably cannot trust the information you are being given. Read content from chronic pain patients. Facebook groups, blog posts, whatever you can find. Read about their negative experiences in the medical system and consider at what point you could have helped. Believe chronic pain patients. Do not let the overall cultural issue of addiction be what defines your response to individual human beings in pain. I’m sick of hearing about how my friends suffer because of insensitive, rude-ass medical professionals.  I’m sick of them no longer being able to access therapies that worked for them.  You will have limited control over state/clinic/hospital policies, but you can at least be sympathetic and do everything you legally can. And be understanding when they are frustrated or distraught. You probably would be, too, in their situation.

Some people don’t respond to certain painkillers. I know people who are lidocaine and novocaine insensitive, and they need either huge amounts or a different painkiller. I personally take longer to respond to dental injections.  My response is normal for the dose, it just takes 2x as long to kick in.  From experience being partnered with these people you will also sometimes see reduced/altered response to painkillers in redheads and in people on Adderall.  Research this, it’s real, and your patients will need you to advocate for them.

Some people are allergic/sensitive to crazy shit. Believe them.  “What happens if you take/eat it” is a super valid question, please ask it, but if they report something totally wild, give serious consideration to the idea that they are telling the truth and the human body is just fuckin’ weird.

Some people will have conditions you have never heard of and which sound fake as hell (me, explaining to my neighbor that I have a literal, albeit low-grade, sunlight allergy). Just save everyone time and frustration and believe them.

If someone says that a certain thing makes them sick to eat/ingest, or causes them pain, believe them. A lot IBS triggers, for instance, can seem weird/silly, and some are incredibly particular to the person, who may be able to eat one kind of mac and cheese and not another, or may be able to eat fruit but not if it’s overripe or processed. I can eat KFC mac and cheese safely, but literally no other kind on earth.  Whether you’re in a clinic or a hospital, you don’t want a patient who is in for something else camping out on the toilet or, god forbid, having a containment breach while confined to bed. It sucks for everyone.  Try not to give people diarrhea.

Assume the patient can hear and understand you, even if they are literally comatose!

Check other people’s work if you can, when it comes to marginalized and at-risk groups. Got a trans patient? Ask if they’re being treated well, find out if there have been problems with staff not respecting them. Queer patient?  Make sure that their partner is not having trouble seeing them.  Patient is a POC?  Ask if their pain is being treated adequately. Pregnant Black person? Fight like hell for that patient, because they are almost certainly being treated like shit.  Polyamory is a thing, some people have more than one S.O., so if it’s possible make sure both S.O.s are able to see the patient.  Poor patient sloppily dressed and generally dirty? Your colleagues are writing them off as uneducated and stupid. This is a mistake.  Make sure they are not being condescended to or ignored, and that their concerns are being taken seriously, especially if they are in pain.  If you have any reason at all to suspect that the patient is in a bad home situation, ask if there are people you should try to help prevent from seeing them.  You have the chance to catch your colleagues’ carelessness or active mistreatment of patients and potentially stop it. Never assume that because someone is a member of a marginalized community they cannot be bigoted against members of another (or the same) marginalized community.

If your patient is a teenager, get their parents OUT of there at least once so you can have a frank talk with them.  They may have concerns that they don’t want to share in front of their parents, and the reasons for that will vary from garden variety embarrassment all the way to actual fear.  Your under-18 patients may not LEGALLY be entitled to privacy from their parents, but they are still morally entitled to as much as you can give them, especially if they’re queer. Don’t be the reason someone gets thrown on the street.

Sometimes prescriptions are better than OTC for basic shit.  If insurance will cover a prescription drug but not the OTC thing that COULD also be used, a poor patient may need that prescription because it costs less. My copays are $4 for most meds under Medicaid.

Learn basic techniques for helping people with panic attacks. You’ll need them.

And right now that’s all I got!