Wednesday, February 08, 2006

Keeping Up the Pace

Keeping up the pace is the challenge. The distress calls keep coming, and it makes me wonder what all the people do who don't have someone like me to look after their healthcare. Some of them get by, some get worse, some simply succumb. It's a rough world out there when you're sick and the system works against you, often thwarting your very efforts to seek the care you need.

Sometimes the advice comes that I should not work so hard, not care so deeply, not do as much for my patients. Yes, there are places where I do indeed draw the line, but what do I do when my patient's wife calls me in tears? She is at work in the next state, her husband needing desperately to get to his oncologist's office for assessment of some nasty post-chemo symptoms. And then a lonely and isolated woman with a new arm fracture calls, weeping over her inability to get to the pharmacy to fill the prescriptions given to her at the ER. Also, her sling has come undone and she can't manage to restore it with only one working hand. She has no family, no friends, no car, no money. Shortly thereafter I arrive at the home of another woman--her new home in a trailer park with her husband. Her respiratory disease is obviously at its worst right now. She looks terrible and I have to convince her to go the ER.

Each call generates documentation of the call itself, not to mention the further activities or interventions necessitated by that initial call. Med refills, a letter, a conversation with a doctor, a new symptom, a relapsing cancer, a mammogram needing follow up, some nasty looking bloodwork. It's just a miasma of need and preoccupation, never-ending and continually spiralling into even more to do. The lists and Post-Its multiply---multi-tasking ad nauseum. What's a poor nurse to do in the face of such overwhelming odds and endless tasks? This evening's remedy: dinner out with my beloved, then a movie. Simple mid-week pleasures to soothe a furrowed brow, a tired mind, a heavy heart.

No one told me to do this. I am here of my own free will, this path is of my own making, of course, and I'm free to alter my trajectory at any time. By choosing to continue on the current path, I choose to face the learning and growth available to me at this time, in this context. And in this very context, I struggle to remain sanely afloat. When the time comes, I'll choose to relinquish this role, but for now its hold on me has lessons within its chaos, and I have something to give. So I remain in the well-worn groove which does indeed fit quite nicely in so many ways. As Michelle Shocked once said, "The secret of a long life is knowing when it's time to go". And at this moment in time, there's nowhere to go but here.


mary said...

I am here of my own free will, this path is of my own making

Well, we could argue about the path being your own making, and whether or not there are other powers at work in the world that place certain people in certain places. Argue about acceptance of mission, etc. But Lord, I hear your tired frustration amid your dedication.

There are relatively few nurses doing this hard (and hard-to-define) kind of "case management". While you are doing it, you are developing an expertise on the systemic problems poor, sick people face. Problems you did not create and which, in one-on-one work, you cannot solve. You can only heal or save (or try to heal and save) one soul and body at a time. But adding your voice to those you feel are working on solutions to entire system problems with your hard-won expertise, that is the key.

How to find all those other legitimate voices, that may be a problem.


Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

Sure, I agree that powers unseen may be at work in guiding our destinies to some extent. That said, I think my reason for writing what I did is in order to take 100% responsibility for my life. Anyone could read my blog and think, "Why doesn't he just stop complaining and get another job?"

Your comments are both thoughtful and helpful. Thanks so much.