Recently a measure was proposed to allow APRNs full practice authority in the VA health care system.  With this measure, the embattled VA hopes to help optimize access to health care for our veterans. A measure to help with the firestorm of problems we witnessed unravel at the Phoenix VA system two years ago. Sounds great, right? Nothing is ever that simple in American medicine. The professional organizations are, once again, ...

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Dear medical student, resident, or fellow, You will one day forget something. We are currently in a systematic plot to have everyone forget something important. We are quietly unaware it is happening. We are asked to forget how we got here. I want to remind you. I want us all to remember. You undoubtably were more mature than your peers. You undoubtably sacrificed to develop the persona that one day would impress ...

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Summer is heating up, and so is the election rhetoric. In this year's campaign for the White House, when it comes to verbally attacking each other, neither candidate seems to recognize any limits. Personally, I think this behavior reflects poorly on both candidates. In heath care, it's almost impossible to escape this negativity. The media devours and thrives upon it. In our hospitals, televisions in the doctor's lounge, cafeteria and in ...

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My eyes open. The blackness of the call room envelopes me. Consciousness sets in with a lingering disorientation. A small green light, is speaking … ringing. “Are you standing up?” The resident on the other end knows her attending too well. She’s right not to risk my falling asleep mid-conversation. A woman has arrived laboring at 24 weeks gestation. Records aren't available, but she reports her fetus has a diaphragmatic hernia. ...

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Dear Dad, I often think about the night you passed away.  I was caring for you while you were dying from metastatic colon cancer.  Every hour I woke up to give you Dilaudid so you wouldn't feel pain and Ativan so you wouldn't be scared.  You had only just been diagnosed eight months before.  Despite aggressive chemo, radiation, abdominal surgeries, and all the hope and prayer in the world, the cancer ...

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Ruth was a spry, but frail 98-year-old woman who was stiff and sore following the 6-hour drive from California to Arizona. She had suffered a recent wrist injury and was not recovering well after spending three weeks in a rehabilitation center. She was in the midst of upheaval and discontent -- in the throes of relocated to an assisted-living residence closer to her son. The facility’s coordinator had begun to ...

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Now that the dust has settled in the wake of America’s most recent mass shooting, the odds seem high that history will repeat itself, and our legislature will again fail to enact any meaningful reform. Like it or not, we as a country, through our elected representatives, have decided that we value unfettered access to deadly weapons over an individual’s right to feel safe in public spaces. Why this ...

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The morning my patient Evan tried to end his young life, I woke up early to make banana pancakes. It was a warm spring day, and I pushed up the windows in my kitchen. That same morning, Evan opened his window with a different intent. He had argued with his parents the evening before, not unexpected at 16, yet this was different. Evan is transgender, and his parents were not ...

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In the medical field, it is said that July, not April, is the cruelest month. It even has a name, the July Effect. In June, hospitals hum and smoothly operate after a year of working out the kinks. In July, they welcome, or dread, the arrival of new recruits: newly minted physicians and medical students, eager to prove themselves, yet raw and untrained. For me, as a senior resident, it ...

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I sat across from her and in my most official yet trusting psychiatrist’s tone gave the spiel I delivered many times. “Amanda, I’d like to start you on a medication that might help your depression. Like every medication it can cause side effects, however, many people have no side effects or only have minor ones. This drug can cause weight gain, increased risk of diabetes, and increased risk of heart disease.” A ...

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