The Crackpots and These Women

An Ode to Women with Endometriosis in Their Quest for the Holy Grail of Specialists.  

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I am eighteen years old when I step into the small waiting room of my specialist for the first time at the private hospital on the hill near the river. I admire the comfortable tub chair that I am seated in, much more inviting than the too-soft couch at my GP’s office that often threatens to make me look like an invalid falls risk as I stand to see the doctor. Eighteen year old me is much difference to me now. Her major is still English Literature, not nursing. Her firm belief is that her Masters degree will be in teaching. She is still worried about the physiology class she is missing to be at the appointment. Most differently, she doesn’t think that her pain is anything to worry about and her greatest fear is wasting the time of this doctor and that he will tell her to go home and try yoga or ibuprofen. Little does she know that by the time thirty minutes is up she will have a name for what she has been experiencing since fifteen and a surgical consent form to go and find it. 

I can still remember everything about my first specialist appointment, what time of day it was, what I was wearing, and the class I had skipped to be there. In the grand scheme of things missing one lecture on cardiac muscle turned out to be harmless, especially after going to nursing school and knowing everything I could possibly want to know on the subject. The green blouse I was wearing has since been worn to death, like every item I clothing that I believe makes me look thinner. But I have since memorised every detail of that waiting room because I have been back there so many times. The man himself is a kindly, older gynaecologist with a speciality in endometriosis who is well known for being “one of the best”. I came to him by accident. My GP gave me the referral after she wasn’t satisfied that I had control over my cramps, an issue I’d raised in passing, more of a curiosity than a complaint, at the age of sixteen. I barely bothered her about the pain because I was convinced, with no evidence mind you, of its benign nature and that, like so many other women, it was mine to bear. However when she realised that I’d told her about it first when I was in year twelve and was now in second year university, she was firm in her recommendation that I have a specialist referral. “I know a guy”. Doctors always sound to me like Al Capone when they say this – like their referral list is actually a little black book of “professionals” who will “take care of things”. Whatever, I accepted her guy. I didn’t even realise how lucky I was to have been referred to an endometriosis specialist, a rare bird, who knew his stuff and would have the surgical expertise to diagnose and treat endometriosis when he found it. I didn’t know what I didn’t know. But I was comforted at eighteen by this considerate doctor, who listened to my story and helped me make sense of it, made me realise that behind the reassurances of my mind was a mild yet ever present panic that it wasn’t okay to sometimes wonder if your period would require a trip to emergency (even if every time I came close I talked myself out of it – “it’s fine” she says, even though moving or breathing too hard is really out of the question). This same guy took my hand through surgery, and delivered me my diagnosis on the other side. He reassured me when my pain persisted and sent me for scans so that I could see the proof. When he thought I needed more help with pain he gave me a referral. Her guy did good.

I am twenty years old when I sit in another waiting room at the private hospital on a completely different hill. I have the day off classes because in nursing school you can’t just skip them anymore – all are compulsory. I spend an hour with a knowledgable woman who explains the science of pain to me and gives me medication to help. This is on top of the three new medications I have received from my specialist – I’ve started writing them down to make sure each doctor I see knows the score. I have my diagnosis, I have my treatment – but I’ve never been in more pain. I just want to know why. But going back and asking all the time is an expensive undertaking. I am exhausted, and I wish it wasn’t so hard. I am comforted by my new colleagues who are understanding when I tell them that I have endometriosis, because inevitably it couldn’t be hidden forever. Twenty year old me doesn’t know it yet, but she’ll get through this and her pain will be the best controlled it’s ever been – but it happens by accident, a combination of forgetfulness, reading the nurses’ drug guide, and becoming her own advocate. 

The conversation I have most with other women with endometriosis is about the doctors and professionals we see, because everyone’s got a recommendation and a warning after so long fighting. My list is short and not filled with any horror stories, I love my guy and am just glad I haven’t had cause to bother him for more than twelve months. But others have war stories. Tales of GPs who never listen, of doctors who use “like giving birth” as context for a pain scale (um, rude), and specialists who are brilliant surgeons but don’t know much about what to do with you afterwards. There are also successes. The discovery of a specialist who just “gets you”. Finding a multidisciplinary practitioner like a physiotherapist who has a vast knowledge and experience with endo and wants to work with you to help with long term pain relief. But more often than not these wins are littered with stories of women who had to push on when they wanted to give up, of treatment that makes you cringe at best, cry at worst. Getting a primary health physician to take one seriously is half the battle, but often it doesn’t stop there. Patterns of referral suggest that most women who present to general practitioners with endometriosis symptoms, even multiple time, are not referred to gynaecologists. Management of endometriosis cannot be left to just any gynaecologist, otherwise they are liable to miss things or lack the requisite knowledge to provide women with the best outcomes. But even endometriosis specialists aren’t perfect. There is a great challenge in being a specialist physician, as evidence and recommendations are constantly changing and evolving and responding to this can feel like sandbagging a beach while the tidal wave bears down on you. Some doctors become set in a certain way of doing things, even though evidence may suggest this way is no longer optimal practice. The attitude that endometriosis can be cured via hysterectomy or pregnancy is one that prevails even among specialist doctors, and even more so among those without specialist training. The goal of surgeons is often focused, cut it out and stop the bleeding. Excision, as opposed to ablation, is certainly now the gold standard for helping reduce disease and prevent it growing back and it’s the first step – but it’s not the last. Overall a more holistic approach is required, because endometriosis effects multiple systems within a body.

Has anyone really found the perfect specialist? Do they exist? There is evidence with most chronic disease, endometriosis included, that a multidisciplinary approach is more likely to convey long term success, because no one can know everything there is to know. As a member of a multidisciplinary health team I tend to value this assessment – I can’t do my job in isolation, my patient wouldn’t get the best treatment otherwise. My experience after surgery also helped me realise this. There was a point where my specialist knew he needed to provide me with other resources, and that doctor further provided me with referrals to other allied health professionals based on what was effected. I also learnt a lot on my own, because I came to realise that I had to become my own advocate, armed with facts when I fronted to an appointment. The experience of of having symptoms dismissed or normalised both prior to and after diagnosis gives rise to what is known in literature as the expert patient. This is a story I’ve heard from many women, those who researched and stood up to specialists who dismissed them or told them not to worry. Those who presented doctors with their own research and actually had that doctor listen and respond to them. I had the benefit of learning this skill and gaining confidence as I went through nursing school, because I learnt how to communicate the needs of my patients to doctors and how to advocate for a patient. This was the advice to me of women who had been through so many doctors, learn to be your own advocate and do your own research. It is an unfortunate fact that endometriosis is not well known in the public sphere, despite improvement thanks to a number of organisations dedicated to the cause, and that knowledge about the disease is not consistent among doctors. Research papers are scattered with the stories of women who have felt betrayed by the medical profession, and the feeling of happiness and relief when someone finally understands.

But all of this is hard work, and having to research, pull together your own team of professionals, attend appointments, manage symptoms and still somehow manage to have a professional and social life can be draining. Dr Kate Seear calls this “the third shift” and accounts for another facet of unpaid work by women in addition to domestic duties. We shouldn’t have to work this hard, should we? Evidence points to a need for greater education of doctors to increase both their acknowledgement of symptoms and empathy for patients’ distress, it also highlights a need to respect the patients’ knowledge and recognise them as an expert in their care. This notion is in line with the concept of patient-centred care. Patient-centred care is drilled into nurses from day one of their degree, it’s an approach to health care that is grounded in mutually beneficial partnerships between health care providers and patients – where the patient’s goals and wishes are just as important as the practitioners. This approach recognises patients as capable of being experts in their own care. In the UK, an emerging role is that of the clinical nurse specialist in endometriosis – their role is set out by the Royal College of Nursing and includes postoperative followup, utilising “women-centred outcome measures”, organising referrals to the multidisciplinary team and being available to answer questions and provide psychosocial support to women with endometriosis. The role is not currently widespread and few health services take advantage of this nurse-led model, despite a wealth of evidence that nurse-led programs for various chronic diseases are associated with better outcomes. Perhaps what women need is not the Holy Grail of specialists, but an organiser, a mediator, an understanding ear. Surely we could outsource the third shift to an expert? Having a specialist nurse help one keep track of multiple professionals and act as an advocate when one is feeling lost or dissatisfied with the care they have received. Scope exists for this role currently, most likely in private practice (as with most things they tend to start here to prove their worth before the public system invests). Fertility nurses currently provide a similar role for those undergoing treatment for infertility – the fertility nurse is your go to, they provide you with information, perform tests, organise follow up and ensure you’re seeing the right professionals. They work alongside a specialist doctor, but one gets the benefit of continuity of care, as well as an organiser – a professional patient advocate!

As knowledge of endometriosis grows among the women who have it, it is undoubtable that they will begin to demand more of a system that has historically sidelined them, fobbed them off, and left them wondering if they’re actually insane. The unpaid work and emotional burden of a chronic disease with far less attention and research funding than others is significant and cannot be ignored. These women gather and share battles and victories, about the best, the crackpots, the men and women who changed their lives in the quest for answers. These women are strong and brave because they have to be, and having been both patient and practitioner I know the medical profession can do better. Patient centred care is not a marketing campaign or a company line, it’s in the everyday interactions we have with our patients that prove to them that we put them first above all else, and that when they talk we listen. At eighteen I didn’t know how to make myself heard, or that I even needed to be heard – but I had a doctor that knew my story was important and fought for me. Every patient deserves such a person, and it is my hope that through the hard work of organisations like EndoActive, QENDO, Endometriosis Australia, and Endometriosis UK (to name a mere few) that more people will realise the need for such courage, that the men and women of medicine will fight for their patients to receive their diagnosis and treatment.

More often than not the answer to basic questions in medicine are right in front of you, you just have to know how to listen.

I am twenty-two years old today. In November it will be two years since I had surgery to diagnose my endometriosis. In that time I have learnt so much about this disease and talked to so many women who have walked the same streets and felt how I have felt, they are inspiring and a blessing. I have become a support worker with an endometriosis organisation so that someone else has a sounding board and can become empowered to be their own advocate. Twenty-two year old me doesn’t know what will happen in the future, whether her endometriosis will grow back, whether she’ll have children, whether she can handle if either of those things happen. But she is hopeful, because she has a network of inspiring endo sisters that reach the farthest corners of the world and some who regularly meet just kilometres away, as well as a trusted specialist – the guy, I bet on the right one. 

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What I Do In There

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You’d be forgiven for not knowing at all what a perioperative nurse does if you spend a lot of time watching Grey’s AnatomyHouse MD, or Pulse. In the world of television medicine, doctors do their own jobs as well as a good deal of the role delegated to nurses but balk at hygiene cares  with a terse “that’s a nurse’s job” as though our years of training equip us for nothing more than these (albeit extremely important) tasks. When you move from the ward to the operating room, we become even more scarce. Grey’s Anatomy generally features one scrub nurse and she’s rarely acknowledged (despite the actor being a scrub nurse in real life – a way cooler story!) and scout or circulating nurses are rarely even present let alone allowed speaking roles. House borders on comical in it’s surgical depictions – with House’s staff frequently performing surgery despite clearly being of the internal medicine variety – immunologist, neurologist, nephrologist/infectious disease – and often with no theatre staff. Now that’s a violation of ACORN standards if I ever did see one….

As a graduating student nurse I have spent a great deal of time correcting my own views of what my profession does, delighting as I discover more skills that can be mine and my responsibility. I’ve also spent my training confronting what other people think of my profession and the question “do you even know what I do in there?” . Nurses and students alike are often asked the question of why they want to be nurses, and why didn’t they become doctors – as though not wanting to become a doctor is an intellectual failing instead of a considered choice. Now I adore doctors, how can one not? I work with passionate, hard working physicians who save lives and who, on the whole, listen to the advice of nurses (even me, the humble student) about patients. This is especially true in the middle of the night when we page medical or surgical ward call and beg for a review of a patient that we’re worried about. I also love my doctors, as an endometriosis patient I have to, and I place a great deal of faith and trust in the specialist who delivered me my diagnosis. This appreciation I have for my wonderful colleagues doesn’t change the fact, however, that nurses deserve recognition for the extensive work that they do and that their role isn’t merely doctor’s handmaid. We should be recognise as the autonomous practitioners that we are, and the amount of care we initiate to keep a patient safe and stable before they even sees a doctor But….even nurses aren’t perfect in their recognition of what their colleagues do.

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At the beginning of my final year of university I did a twelve week placement in perioperative services – also known as theatre or “the OR” for you Americans out there. Theatre was this magical place in my hospital, tucked away in a locked department that only certain nurses were allowed access to. If you had a surgical patient on the ward you were allowed as far as the anaesthetic holding bay to deliver, and as far as post anaesthetic care (PACU) to collect – but there was no crossing the line into the place that kept those brightly lit theatres filled with surgery. As a first year student I knew I wanted to be where the scrubs were, just because I wanted to see what it was like behind that red line. I loved the wards I had been on, the things that the nurses there taught me, talking to my patients and helping them recover…but I wanted to see what happened to those patients when I took them to theatre. It was while on placement there that I discovered how much I loved the perioperative nurse role, both in theatre as a scrub/scout or anaesthetics nurse and looking after patients postoperatively in PACU, it was the kind of nurse I wanted to be. I loved going to placement every day, and wished I could have spent more time there. Other student nurses didn’t get the appeal, neither did some of the other nurses I knew. Some people asked me if it’s boring – don’t I just hand things to the surgeon? One person even told me that they wouldn’t feel like a “real nurse”. Just as the general public doesn’t always understand what nurses do and how important it is, other nurses sometimes don’t even know what perioperative nurses do beyond the trope of “handing stuff to surgeons”. This happens a lot. Sometimes one gets tunnel vision when you pick a particular path – perioperative nurses have perceptions about what ward nurses do, ward nurses have perceptions about what mental health nurses do, mental health nurses have perceptions about what practice nurses do…and we aren’t always right about these perceptions – in fact sometimes we’re just plain wrong.

As a scrub or instrument nurse you have to demonstrate skill and knowledge about the surgical procedures you are scrubbing for, your eyes always on the field anticipating the needs of the team, handing instruments is only one part of that. You are also an advocate for the patient, who is unable to speak up for themselves, anaesthetised, and you are in a position where you can prevent a medical error. My preceptor in theatre taught me first and foremost that we were there to serve the patient, not the surgeon, and that I had to be prepared to speak up if I, or someone else, broke scrub or contaminated the sterile field, or if I thought an error was about to be made. As a scout or circulating nurse you keep the procedure flowing smoothly and are responsible, along with the scrub, for ensuring the count is done…the count ensures that all items are accounted for and that nothing has been left inside the patient unintentionally. This is one the most important jobs in surgery, and the responsibility lies with the registered nurse. While scrub nurses seem like they’re having the most fun in the OR sometimes, I’ve learnt that often it’s the more experienced nurse that should scout. The scout can help an inexperienced scrub nurse, but the scrub nurse is effectively trapped in the sterile field – an experienced scout can anticipate what comes next and go and run for equipment in an emergency or if something is suddenly needed if the procedure becomes more complex. Knowing what to get and where to find it can cut the waiting time in half and keep the procedure flowing smoothly, leaving less chance of patient deterioration. These nurses intraoperatively are the least visible, the patient doesn’t even know they’re there mostly, but their role is a tremendously important and often complex one – a far cry from “not real nursing” or “just handing the surgeon things”.

The anaesthetic and post-anaesthetic nurse play an irreplaceable role in the perioperative journey too. The anaesthetics nurse ensures the patient’s safety before they even make it to the operating room. They check for valid consent, ensure the patient understands what is about to happen to them, and screens for any potential complications that could effect the anaesthetic or the overall procedure – they work alongside the anaesthetist ensuring the patient is delivered safely through the procedure. I learnt the most about pharmacology and the many complex drugs involved in keeping a patient paralysed and sedated from these nurses, as well as about positioning a patient. You may not realise it, but the way someone is positioned during a procedure, for hours at a time, can have a massive impact on their recovery. Staying in one place for too long can cause pressure injuries, nerve damage, and musculoskeletal issues- but if you position correctly and use the right techniques, it makes a significant difference. The anaesthetics nurse is often the last person a patient sees before they fall asleep – they are often the calming presence that helps that person feel safe and comforted. Then when you awaken, it’s the PACU nurse that has your back. Some of the most unstable patients prone to rapid deterioration are those emerging from general anaesthesia, and PACU nurses have the skills to manage this deterioration. I started my placement in this area and was stunned by the sheer amount of knowledge these nurses had about so many different subjects. Their expertise ranged from pain management and management of postoperative nausea and vomiting to comfort cares and reassurance, to complex airway management of an unstable patient. They also worked like a well-oiled machine, they knew what each other needed and no one was ever left alone to a patient if it could be helped – there was usually always someone that appeared before you with a SCUDs machine or IV pump, or a warm blanket for your patient. PACU nurses bring you back into the safety of consciousness, reassuring you that you’re safe now and that you’ve made it through the black hole of anaesthesia. They then provide comprehensive handover to the ward nurses to make sure that nurse knows how to properly care for the patient postoperatively. Continuity of care is essential in nursing, and is an another example of a skill not always noticed by patients or the public; but a good handover can save lives. Being in PACU made my handover better on the ward, it made it more organise, more concise, but rich in the essential information that my colleagues would need to carry on the correct cares.

The perioperative nurse role is diverse and challenging, and requires a great deal of training and the acquisition of knowledge – it’s like no other kind of nursing. Every nursing role serves an important purpose, and it’s time that more people knew it. While the ward nurse is a common symbol of the profession, the role itself is often misunderstood by the public and other health professions and as such misrepresented in fictional depictions. However the role of the perioperative nurse, as well as other specialist nursing areas or non-acute areas (such as mental health or practice nurses) is one that is often also misunderstood by our own colleagues. All nurses have the potential to make a difference to those patients they serve, and deserve acknowledgement. To facilitate better understanding of the profession by those outside it, those of us within it should aim to better understand their own colleagues and their value. This week is Perioperative Nurses Week, and  I hope that this post may give a glimpse, through the eyes of an inspired student, into that hidden world of the operating theatres so that more people can understand a nursing role that often goes unnoticed. Bohkee from Grey’s Anatomy, I see you. Shirley from ER, I see you. Every real life perioperative nurse I’ve had the honour of working with, I see you too – thank you for inspiring and teaching me, for making me want to be one of you.

I’ll see you where the scrubs are.

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The 1 in 10 Sisterhood

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March is Endometriosis Awareness month. 1 in 10 Australian women have endometriosis, a condition where tissue similar to the lining of the uterus is found outside the uterus – for example on the reproductive organs, abdominal organs, throughout the peritoneal cavity and even on the diaphragm and thoracic cavity. The disease can effect girls and women throughout the lifespan and causes a myriad of symptoms which may include severe pelvic pain, infertility, pain with going to the toilet, pain with sex, fatigue, gastrointestinal symptoms, and heavy menstruation. The disease effects every individual differently and the average delay from symptom onset to diagnosis is around 7 years (range is anywhere from 5-11 years on average depending on which study one consults). 

I’ve known since I was diagnosed with endometriosis that the disease affects 1 in 10 women, but I don’t think I fully comprehended how many women that was until recently. Looking at support pages and seeing how many women shared their stories in these spaces, I came to realise that my story was similar to many others and so different to even more – and that is why every story is important. Being a student nurse, the pool of women I talk to has expanded in the past year and in this time I have become more and more aware of just how many women suffer with endometriosis. Four of my preceptors have had endometriosis – possibly this number is higher, I only found out when I was having a bad enough day with my pain that I had to tell my supervising RN, and they understood perfectly because they had experienced the same pain. In my most recent placement I was chatting with one of the grad nurses over lunch and found out that we not only shared the same disease but the same specialist. We spent a good deal of time gushing over how lucky we were to be under this doctor’s care, understandably – he’s amazing. But what struck me was how she told me, she used the phrase “Me too sister, I have endo too”. Now we call each other “sister” a lot in nursing, it’s the old-fashioned way to address a nurse and in many environments we still use it either as an inside joke (we call the male nurses sister too, and grin mischievously as we do so) or as way of expressing our gratitude. But it’s a term rarely heard among the grad nurses outside the floor. This was a different sister…it was the acknowledgement that having endometriosis gives you a vast universe of endo sisters across the world to share stories with, share experiences, and feel a little less alone.

In just 12 months endometriosis awareness has come a long way. Celebrities such as Daisy Ridley and Lena Dunham have shared their stories and encouraged young women to be assertive and push for care when they feel they are being ignored or not taken seriously. Mainstream media outlets such as The Guardian and Mamamia have featured a variety of endometriosis stories from women’s endo stories to specialists answering non-sufferers questions about the disease to encourage greater support and understanding. I’m starting to feel that more people understand the burden of having this condition and that when I tell people I have endometriosis they do actually know what it is or at the very least have heard of it. Women like Sylvia Freedman, co-founder of EndoActive, have led the way in promoting education about endo. Endometriosis Australia and QENDO (QLD Association) have similar roles, especially in regards to keeping those of us with endo up to date with research about our condition and the treatments available. QENDO held a fantastic event at the beginning of March with the legendary Dr Susan Evans (among others). Susan is a passionate physician who’s book on pelvic pain and endometriosis was one of the first to take a patient-centred and woman-centred approach that empowered women to be their own advocate. This approach is becoming more recognised as patient care in general becomes more “patient-centred”, but women seeking care for suspected endometriosis frequently face barriers to effective care.

Earlier this year I completed a literature review as part of a research course and I focused my question around the “patient-centredness” of endo care. A groundbreaking European study was conducted where researchers developed a tool to quantitatively measure this, using input from specialists, researchers, and a focus group of patients. The study was the first of it’s kind and extremely exciting as both a patient and a health professional. The other studies I included were less optimistic. In fact they were an indictment upon the medical profession. While the studies provided a glimmer of hope that over time GPs have gotten better at treating women with pelvic pain, they also showed that many women had been treated appallingly. At best some women had been misdiagnosed and told that going on the Pill would solve all their problems, at worse they were accused of drug seeking or told that their problems were psychological. In between there were the usual “suck it up” or “every woman experiences period pain” comments and even the suggestion that pregnancy would solve their issues. These studies were conducted in the last ten years, and it is unacceptable that women still face this kind of treatment and discrimination. It was a very different assignment to the one I did in my undergraduate degree, before I was diagnosed, which centred around how women became empowered by online support communities. Here my research was hopeful, inspiring, and spoke to the sisterhood that’s there to support you once diagnosed.

My hope is for a a profession that is well educated and supportive of women presenting with endometriosis and/or chronic pelvic pain. I hope that as a nurse I can be part of that. It is sometimes uncomfortable as a health care professional to read such an indictment of one’s profession, but it’s one we have to look at and then ask ourselves what we can do to better serve our patients. Every day on the wards or in operating theatres or in community nursing I remember that I myself have been the patient and I was lucky enough to receive the best care I could imagine. It is my duty to provide the same care to all of my patients. Women with endometriosis deserve this care, the same as all patients. It is important that we continue share our stories in an effort to educate as many people as we can. The sisterhood has done so well and we need to keep this effort up. EndoMarch 2018 should see even more progress!

Once again, in celebration of EndoMarch 2017, I encourage you to educate yourself. If you’re already familiar with the condition, up your knowledge…talk to someone with the disease and find out how you can support them. Make a resolution to never use the phrase “Have you tried x?”. We hate that…unless you’re a doctor. And even then, specialist preferred. Keep the conversation going!

 

“Halfway to Heaven, and Just a Mile Outta Hell”: Bruce Springsteen in Brisbane

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Technology has ruined us Bruce Buds. The ability to watch live shows on your own screens from across the world due to the miracles of Periscope and videos on fan pages has given us a glimpse into the intimate relationship between Bruce and his chosen crowd. We see it as it unfurls and, honestly, we get a bit jealous. One might think that makes us less excited for our own live events….UNTRUE.  The excitement was palpable at the Brisbane Entertainment Centre, even in the heights of B reserve where I sat the air was alive. This only reached its climax when many spotted the elegantly dressed strings behind the stage – surely meaning an opening of New York City Serenade.

We weren’t disappointed, Bruce opened with a beautiful NYCS – the stage lit up to reveal The Professor himself with those distinctive opening notes. I’ve seen the song played before, but I feel I will never tire of its enchanting beauty. It was slower, more intense this time around. Though we predicted NYCS, no one could have predicted the stunning transition into Lucky Town – a live rarity. It was the first sign that this setlist would be anything but ordinary (no Springsteen show ever is). The rendition was powerful and energetic in such a way that I and everyone that knew the words screamed them with Bruce. Next up was Bruce’s Valentine’s Day Special. Descending into the pit to pluck signs while we waited with bated breath to see which one he would choose. I saw Meet Me in the City and Back in Your Arms among the plucked, but he held up Janey Don’t You Lose Heart from Tracks. This was followed by a rocking Rendezvous and wonderfully energetic Be True, also from Tracks. For the more casual Springsteen fan (we love y’all!) they would have been an unfamiliar experience, but no doubt an educational one. Bruce was clearly having a great time, dancing, making goofy faces and shaking it with Jake during the Be True sax solo. To make it even more perfect he played a beautiful Back In Your Arms, complete with five whole minutes of “Bruce Talk” (see my twitter feed for the video). It was raw passion and emotion combined with classic Bruce humour – including advice for when “you done fucked up” with your woman. It swung between hilarious and deeply emotional where one could clearly see Bruce was missing his own woman, with Ms Patti absent for the present tour. To make sure all hope was not lost for those of us who had been broken-hearted, Bruce played us Better Days.

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At this point I felt like the set list was made for me, for my day. I had just learned that I gained an elective placement in my chosen area and was on a high, I used the phrase “Bruce concert days are lucky days”. So when Lucky Town started, I felt a little blessed. Time then ceased to exist as Bruce launched into three River Classics: The Ties That Bind, Out in the Street, and Hungry Heart. On Hungry Heart…any true Bruce devotee knows that you have one job during Hungry Heart: show Bruce how epically you can sing that first verse. If you do well, he bestows upon you the honour of singing the first verse again. Brisbane scored top marks. While these songs can be considered the bread and butter of a Springsteen show, last night Bruce approached them with the same energy and finesse of any of his epic anthems. The same can be said of his rendition of Wrecking Ball – fierce, loud, and full of righteous anger. The surprises kept coming with Leap of Faith, of the Lucky Town album which never would have even been on my Bruce wish list and yet upon hearing I realised I had no idea what I was missing. The pit turned blue for an impassioned “The River” performance with Bruce on harmonica.

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The next seven songs were an unbelievable high of energy and wonder. The house was well and truely brought down by Youngstown and the incomparable Nils Lofgren and his guitar solo. Also, can we take a moment to talk about the mighty Max Weinberg smashing it with fervour and stamina all damn night? Youngstown, Rendezvous and Wrecking Ball are just f few of his efforts worth mentioning. Then he introduced Candy’s Room with that crisp, clean roll and all my dreams came true. It was hard to stay seated as Bruce and the crowd roared “baby if you wanna be wild, you got a lot to learn”. Another wish from my Bruce list. From here the band went into a thrilling She’s The One, and beautiful Because the Night. I challenge you not to fist pump and damn near cry during Because the Night. The Rising, Badlands, and Rosalita were met with passionate crowd responses. My little cousin attended her first show last night, and when asked she excitedly told me that she “did the whoah-whoahs” in Badlands, a Springsteen rite of passage. I have done it four times now, and it never fails to make me insanely happy. I never tire of the way it manages to connect every person in the building in inescapable joy.

The encore started with the lights low and Bruce telling us he had a special treat for Brisbane. Charlie played the opening notes of Secret Garden and I couldn’t believe my luck. I never imagined I’d get Candy’s Room and Secret Garden in the same show. While I had hoped maybe for some Jungleland or Backstreets, I could not have been more thrilled with the quiet magic of Secret Garden. I could feel myself shedding a tear, because it was everything I ever dreamed it could be. The rest of the night was the traditional Springsteen encore with an amazing Born to Run, Dancing in the Dark, and Tenth Avenue Freeze Out. Asses were out of seats for fun in Shout with the band intros and Bruce’s new command to every departing guest to go home, wake the neighbours “in their pyjamies” and tell them, that we just saw the heart stoppin, pants droppin, Earth shockin, hard rockin, booty shakin, earthquakin, love-makin, Viagra-takin, history makin, LEGENDARY: E STREET BAND.

By the end of Bobby Jean, everyone was exhausted in the best possible way. My father was speechless, and my little cousin had the glow of a newly inducted Springsteen die hard. I tweeted, a hard task considering how concise one has to be, to the other #BruceBuds: “I am speechless. I have seen Bruce Springsteen channel God himself in an epic, energetic show with surprise after surprise”. It was without a doubt one of the best set lists I ever had the joy of experiencing. After seeing a show, you’ll never doubt that experiences are more soul-enriching than “things”, because Bruce Springsteen takes you to another place and that place stays with you forever. The come down from such a high can be hard…Hannah from “Burgers and Bruce” has been describing it from across the world since she left the Australian tour and even this morning I’m beginning to get that feeling.

But lucky for me, Bruce will rock again Thursday night…and I’ve got two tickets. Happy Valentine’s Day Bruce lovers, we have been loved.

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what I do for thirty seven dollars and five cents

General Practice is worth investing in people. Take it from a hospital-based student nurse who sees the people that could have been kept off my ward if they had been a more frequent visitor to their GP. Worth a read! It was a GP that convinced me my awful pelvic pain could be endometriosis and could be helped.

that lady doctor

The building contractor chatted pleasantly while I checked his blood pressure, waist circumference, recent cholesterol levels, fasting glucose and urine protein. We discussed screening for bowel cancer with “the poo test” versus colonoscopy, with reference to his family history. We talked in detail about prostate cancer testing and I offered to provide him with written information as we were out of time. As I signed his script for the blood pressure medication he winked at me.

“That was easy money for you, wasn’t it?” he said as he walked out.

Thirty-seven dollars and five cents is the value this government places on up to twenty minutes of my time. This figure, the amount a practice receives from Medicare for a standard consultation, has not changed in four years, and under the current arrangement, will not change for another three. I myself receive sixty five percent of that. But are the pennies…

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July Good Causes: Heart Health is More Important Than Ever

While it has been many years since the Heart Foundation released it’s infamous tick of approval to help us all make healthier choices, their work remains more needed than ever before in an era of office jobs, burgeoning technology and more fast food options than ever before. When I scroll through my newsfeed on Facebook or Instagram one of the most common things I see are posts from people who seem to be completely sorted on this whole healthy lifestyle gig. They’re slaying it in spin class, running marathons, lifting crazy weights, and cooking up some very green recipes. Wellness has become a trend, and one that’s worth endorsing because when you get past coconut oil and quinoa (and fancy printed gym tights that would make me look like an elephant in a party dress) eating well and being physically active is a fundamentally positive thing, especially when combined with body acceptance and the ability to be healthy no matter what you look like. Despite this social media smattering that would seem to indicate the country is in pretty good shape, health statistics paint a different picture.

The Australian Institute of Health and Welfare (AIHW) identifies chronic diseases, such as cardiovascular disease and diabetes, as the leading cause of the fatal burden of disease in Australia. Cardiovascular disease is one of the most common, with 1 in 5 Australians afflicted. Additionally, 1 in 19 Australians has diabetes mellitus which is major contributor to the development of heart disease (as well as chronic kidney disease and peripheral vascular disease). In my first semester of nursing school I confronted these statistics head on by reading in detail about the pathophysiology of these diseases and their consequences, both physical and social, as well as caring for patients with these conditions. One of the most confronting things as a young student nurse is to see the burden of disease before your very eyes, the reality of things often considered only in abstract form. During this semester I certainly started to make an effort to do more healthy things every day, whether it was saying no to chocolate (hard for long suffering endometriosis girls!) or dragging my ass to the gym at 5am when I would rather be sleeping in with my cats.

The thing is, a lot of these chronic diseases are extremely preventable through positive lifestyle choices such as good nutrition and adequate physical activity. That’s where good sorts like The Heart Foundation come in. For years they’ve been seeking to use evidence-based practice to improve the heart health and access to equal healthcare to reduce the number of preventable deaths directly linked to cardiovascular disease. They do this by fundraising to help fund research into heart disease, providing guidelines for health professionals regarding heart health, consumer and patient education, and advocating to government and industry. They rely greatly on public donations to do this work and so this month I am fundraising with my FitBit. FitForGood is running from July 11-25th and challenges Australians to collectively take 2 billion steps over these dates to raise money for the Heart Foundation. If this goal is reached, $100,000 will be donated. To raise further funds and reach the $500k goal, individual participants can encourage family and friends to donate to support their step goals.

So I have set my daily goal for 10,000 steps, but hope that I can absolutely smash that and go even higher. I’m committed not only to my fundraising, but to bettering my own health. Recently women with endometriosis were given another consideration to add to our already burgeoning list of health concerns. A study has has linked endometriosis to an increased risk of heart disease, especially earlier than other women. While it’s not clear as yet whether it’s due to the ways in which we may treat our disease (e.g. hysterectomy and oophorectomy which reduces circulating oestrogen, oestrogen which is usually protective for bone and heart function), or a risk associated with having the disease itself (i.e due to inflammation). Either way, it’s a scary thought, and one that means I am paying more attention to my risk by reducing it in every way I can. Using my fitness tracker as motivation to increase my activity every day. The best thing I’ve found so far about student nursing is that an eight hour shift sends my step count sky high. After a shift in an aged care facility this past semester, my step count stood at close to 20,000 steps for the day. Nursing is the greatest work out of all. The best thing to be as a nurse is a role model to patients, and I hope I can be with this challenge. Step goals are crazy motivators, so come July 25th I’m certain I won’t be able to stop. Come join me! Even if you don’t have your own FitBit, it can be your own personal goal to just step more. And you can donate to my Everyday Hero page here: https://fitforgood.everydayhero.com/au/dannielle-for-fitforgood

I would absolutely encourage you to make your own as well. Step your way to better health and donate some dollars to a worthy cause.

Here are some helpful links:

http://heartfoundation.org.au/active-living/get-active/fit-for-good

http://www.heartfoundation.org.au/about-us/what-we-do

Cinnamon, a cheaper way to help reduce pain

*Adds cinnamon to everything and carries it around in little packs like a drug* – Me, from now on 😀

The Endo Lifestyle

Cinnamon is another delicious spice that has many fantastic benefits. It is obtained from the inner bark of several trees from the genusCinnamomum. Everyone surely must have cinnamon in their cupboards at home, now there is actually a good reason to use it every day!

Here’s why:

  • Cinnamon is thought to be able to assist with heavy menstrual bleeding and circulation. It contains a natural compound that naturally increases progesterone.
  • Cinnamon is a powerful antioxidant that not only helps to strengthen the immune system in fighting against forming of endometrial implants and adhesion, virus and bacteria invasion, it also helps to reduce blood flow during menstruation.
  • Cinnamon helps to improve the digestive absorption, which is essential for women with endometriosis because most of us are found to have low levels of vital vitamins and minerals during menstrual cycle due to low levels of stomach acid.
  • Cinnamon also has anti-inflammatory…

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