Wednesday, February 27, 2008

The Nurse as Ogre

I enter the exam room with a tray in hand and a smile on my face. The tray holds four vaccinations, and my smile is a nervous one, since I know that in a few short minutes, the child squirming in her mother's arms will hate me.

"The doctor sent me in to give your daughter her shots," I say.

"Yes, she told me. Can you give her some Tylenol too?" the mother asks.

"Oh, yes, I have some here for her." I give the baby some Tylenol, and already she's eyeing me with suspicion.

"Here's some information on the vaccines. Do you have any questions?" Sometimes I hope the parent will refuse the vaccines, just so I can be spared the trauma of administering them, but my trauma is nothing compared to the child's.

I ask the mother to lay the child on the exam table, and now the baby starts to cry because she knows that something unusual is about to happen. She can also probably pick up on Mom's fear and my tension, and by now the child is gripped with terror.

Giving four or more vaccines at a time is always a drag. First, if the child is already walking, we like to give the shots in the arm so that he or she will not be discouraged from walking due to pain, but those young deltoids are so small. If the child is not yet walking, we go for the large thigh muscles, but I'm no fool, and I know that even if they're given in the leg, these vaccines burn like a really bad bee sting, at best.

When I clean the baby's thigh with alcohol, she begins to scream. And I mean blood-curdling. My stress level is already probably high because we just had an 11-year-old autistic boy pinned down in another room in order to give him a shot and draw some blood. He was strong, and he pulled his mother's hair so hard I thought he would rip it from her scalp. The vaccine was fine, but we couldn't draw his blood since he moved so much.

Anyway, the baby is screaming, and I still hear echoes in my head from the caterwauling autistic boy. I steady my nerves, and I give the baby two painful injections in each thigh, about 1 or 2 inches apart. She screams some more, and I apologize profusely and hope that she won't be deathly afraid of men with goatees forever. Maybe she will.

This ogre business is truly awful, and I leave the room feeling bad. These Tuesday nights at the clinic are no fun, and with two pediatricians working, there's no escaping the old vaccine drill. I make a mental note to ask Mary to remind me not to work Tuesday nights anymore----Thursdays are so much more preferable with the lack of pedi providers.

There are just simply things that some nurses hate to do. For one, it's tracheostomy care. For another, it's wounds. For me, it's vaccines on little kids. I just hate being an ogre, and I'd give anything to lay that mantle down once and for all.

Saturday, February 23, 2008

Mindfulness and Mindlessness

In this new iteration of my life, one of my most sincere areas of focus is the development of mindfulness, which Jon Kabat-Zinn simply describes as "knowing what you are doing while you are doing it". He also states that mindfulness "is cultivated by purposefully paying attention to things we ordinarily never give a moment's thought to. It is a systematic approach to developing new kinds of control and wisdom in our lives, based on our inner capacities for relaxation, paying attention, awareness, and insight."

Interestingly, when I began writing the previous paragraph, I rose from my chair in front of the computer to search for my copy of Full Catastrophe Living in order to find the quotes by Kabat-Zinn that I wanted to use. Apropos of the subject of mindfulness versus mindlessness, I ended up wandering all over the house to find where I had last left the book. This was a prime example of mindlessness in action a la Keith.

So, mindfulness can be about meditation, something I am now attempting to integrate into my daily life. But it truly is about so much more. As Mr. Kabat-Zinn so aptly states, it is indeed "knowing what you are doing while you are doing it." When I walk in the door of my house, I always try to be mindful about where I put my keys, my cell-phone and my other important belongings. I have a little wooden box where these things are supposed to live, and when they aren't there when I need them, I waste a great deal of energy on finding them---energy I could be using for more important things. The case of the missing book was very illustrative to me, and serves as a reminder of a continuing need for mindfulness in relation to both the physical, emotional, and psychological worlds.

One might say that mindfulness could be used as an excuse by a person with Obsessive-Compulsive Disorder to more sharply focus on their ritualistic behavior. While this is true, and while I do admit to a personal level of OCD, these two ways of being can be synthesized into a greater whole which serves the individual without pathological underpinnings. My goals are certainly above and beyond personal pathology, and my plan of self-care includes time for formal mindfulness practice, integration of mindfulness into my daily activities, as well as time to simply "be" without any plans or practices whatsoever.

This mindfulness stuff can be tiring and can sometimes feel like work. But once it is fully integrated, I hope that the "work" will be something that happens in the background without as much conscious effort, and mindlessness will become more and more an occasional blip on life's radar screen.

Friday, February 22, 2008

Afraid to Die and Barely Living

"I'm so scared to die." She lays in bed and barely looks at me.

"So, what's most scary to you?" I ask.

"I'm scared that I'll look dead, and they'll think I'm dead but I really won't be. Then they'll take me away and bury me alive. That's what I'm really scared of---being buried alive."

I take a deep breath.

"Well, first of all, I'm going to tell you something. One day, when you die---and we all die---they will make absolutely sure that you're dead. I promise. Now, what do you think they'll do when they take you to the funeral home?"

"They'll make me up and and comb my hair and dress me in the clothes my daughters give them."

"Well, yes, but I'm gonna take a risk here and tell you something that someone else wouldn't tell you. The only reason I'm doing this is because we know each other so well and we trust each other, right?" (She's my former patient and I've been sent to see her as a nurse consultant to assess her increasing anxiety.)

"Oh, yeah. I trust you more than Dr. __________. You can tell me anything." She sits up in bed a little, a sure sign that I have her attention.

"Well," I continue matter-of-factly. "The first thing they do in the funeral home is look over the death certificate and make sure that it's you on the table. Then they check over your body and make sure that you are absolutely dead." (I'm stretching the truth here a little, perhaps.) "Then they remove all of your blood and fill your veins with embalming fluid. Believe me, they would only do that when you're dead." (And no one could wake up after that, I think to myself.)

"So, they won't bury me alive?" she asks plaintively.

"No, I'm absolutely sure. Now that we have that settled, what's going on with this anxiety?"

"I don't know, I don't know. I just wake up in the night and I can't breathe, my chest hurts, I'm sweating, and only my daughter can calm me down and distract me. I call her on the phone---even in the middle of the night---and she talks to me. Or my youngest daughter who lives with me tries to get me to play some stupid game. It doesn't always work. I just feel like I'm gonna die."

"Do you have bad thoughts, or want to hurt yourself, or feel like someone's out to get you?"

"No, nothing like that. I just get so scared---sometimes even during the day, just like that!" She snaps her fingers in front of her face. "I've always been afraid of dying. Always."

"Are you afraid of the pain of dying? What scares you?"

"It's just that I'm scared. I can't explain it. I hope I'll go up there," she gestures towards the ceiling with her eyes, "but I'm not so sure."

"Oh, I can tell you for sure---you've raised all of these wonderful children and grandchildren for all these years. You're goin' to Heaven, my dear, no doubt about that. You can quote me on that one."

She smiles.

We review some simple breathing techniques and talk about psychotherapy. She's housebound, agoraphobic, morbidly obese. Finding a therapist to come to the house is almost impossible these days. Her family is frustrated, and she's just afraid of dying. Period. Well, we could take into consideration childhood trauma and the like, but who's counting. She has a panic disorder, plain and simple.

"You try those breathing techniques I taught you, and I'll make sure Dr. __________ thinks about giving you something that you can take when the attacks are really bad. OK?"

"OK. Thanks. I hope you can come over again some time, but I know you're not my nurse anymore."

"Yeah, you know I don't work there full-time anymore, but I'm coming in to help every week or so. If you need to see me again, I'll come by, OK?"

"OK. See you soon."

"Bye, darlin'."

And with that, the visit is over. She may die today, tomorrow, or in fifteen years. The only thing I'm sure of is that she won't be buried alive and she'll go to a Heaven made just for her. The rest is up for grabs.

Wednesday, February 20, 2008

Eclipse

Lunar eclipse
when the rust-colored orb
graces the sky---
so three-dimensional
as it dances in the shadow of Earth.

I wander the neighborhood
catching glimpses of the stars
and planets
which hang in the cold air
like distant lanterns.

Sunlight on the moon's edge,
a glowing fingernail---
luminescent
and fleeting.

What power
and mystery,
even to the modern mind---
Imagine the terror, the
ignorant blissful terror
when humans first saw such a sight,
primordial fears
rushing from gut to evolving brain.

Now its power
although explained by science
and critical insight
is by no means diminished
as its beauty and stark glow
light the sky with wonder.

Tuesday, February 19, 2008

A Visit

As a part-time visiting nurse, one often enters a home blind, without a notion of what will wait behind the door. Often, the outside will tell a story one tries to quickly decipher before even entering the home. And then the story unfolds.

As I approach the stoop, I notice a shopping cart filled with returnable bottles and cans to the left of the crumbling steps. I climb those steps and look into the yard to the left. Detritus of urban life litters what could have been a yard at one time: hub-caps, an eviscerated washing machine, the fenders of several cars, rotting lumber, moldy carpets. What looks like it may have been a cage for a few dogs now holds bag upon bag of trash. I hate to think how this will all smell in the summer heat.

I knock. I knock again. And again. I'd rather this person answer the door so she can get her meds and I can get paid for this visit. I knock yet again.

The door opens following a short period of undecipherable noise from inside. The room smells of stale cigarette smoke. I put my bag down on the table in what seems to be the cleanest spot. The young woman who sleepily opened the door says, "She'll be right there." I put my paperwork down on the table and I notice that it sticks to the wood. Hmmm.

There is yelling from the bedroom around the corner. "Why do these nurses come so early? I'm so tired!" I note that it's almost 9am and I should have been here at least 30 minutes ago.

"Is she OK? I ask. "I thought her regular nurse usually comes at 8."

"Oh, she just likes to complain." The young woman goes back up the stairs and I'm left to wait. A few minutes go by, and there is rustling and complaining from the other room as I ruminate on the other visits I still need to make.

"I'm coming, I'm coming," she yells, and enters the room in a bustle.

She smells of urine and maybe a hint of sweat and feces. I greet her warmly in both English and Spanish.

"Buenos dias, hello, how are you?" I smile. "Where's your med box and the paperwork?"

She opens a cabinet and produces the box and the all-important folder which any nurse who comes to the home can use to guide him or her as to what to accomplish during the visit. I have a secret piece of paper with the combination to her med box. She can't be trusted with her meds---like so many of our patients---so a locked box is kept in the home.

"Thanks." She smiles wanly and sticks her finger out so I can check her blood sugar with the glucometer on the table.

The machine beeps. "105. Muy bien," I say as I hand her some gauze to staunch the blood from her finger that I just pricked.

The visit is inconsequential as visits go. I am one more face, one more nurse who has come to check her sugar and blood pressure, administer her meds, and then be on my way. The fact that I speak Spanish seems not to impress her. She answers in English no matter what language I use. How tiring it must be to have a virtual stranger in her home each morning. What an imposition when one wishes only to sleep one's depression away. Her blank stare and flat affect belie her underlying mental illness, and I feel compassion for her even as I reel from the smell of urine that surrounds her. I wonder when the home health aide will visit her next, or if her family will make sure she bathes.

Not being a case manager has its rewards, and having relinquished the management of the intricacies of more than eighty people's lives, this momentary glimpse into a life on the edge of chaos reminds me why I so recently quit my full-time job. In my current position---covering for absent nurses and stopping in on patients who need a visit---there is no management, no follow-through. It is simply a visit and nothing more. It is a fleeting clinical glimpse, a hello and a goodbye, and I move on to the next.

Monday, February 18, 2008

Banished

On Tuesday, February 19th, the new film Banished will be showing on many public television stations across the country, under the auspices of Independent Lens.

Between the 1860s and 1920s, 12 counties in 8 states expelled more than 4,000 African Americans from towns which to this day remain mostly white. The film depicts several descendants of those excommunicated African Americans who return to their ancestral homes to learn more of their unsettling history. The film further explores the ideas of reparations and racial cleansing, subjects which even in the 21st century hold very contemporary significance worldwide.

Banished was co-written by our dear friend Maia Harris, a gifted and award-winning film producer, and we urge our friends, families, and colleagues to watch this ground-breaking film. please click here to check for local listings.

Sunday, February 17, 2008

At the Hospice

"There always is an answer," he says, as I spear some pasta bowties and hand him the fork. "I just don't know what it is." I hand him another forkful of food---chicken this time---and he eats it with relish, relinquishing the fork only when he has licked every bit of sauce from the four long prongs. His puzzled mind seizes on one thought, and then the fork and its contents become his universe once again.

I visit another patient in her room, not having seen her for several weeks. "So, what's new?" I ask, as I sit on the edge of the bed. "Nothing that's good," she replies with a sigh. "Can I get you anything?" She reaches out her hand. "Just some black coffee and ice water. That's all." She's lonely, but chooses solitude as her health continues to decline, staying in her room throughout the day and night. I bring her some smiles and coffee, and honor her desire for quiet.

Another patient, quite new to me, asks for little, and does so apologetically. "I don't want to hurt you or cause you pain," she says, "but I'd like to get out of bed." Such a request is always honored immediately, and we reassure her that we are in no way inconvenienced by her requests, large or small. She is so sweet, so frail and thin. Her family visits and they look at photographs of happy and healthy grandchildren. Last time I was here, this room held another who has since left this world. It's a revolving door where death is concerned.

One bed in the house is empty. The last time I was here, that room was the center of attention, with a confused and agitated young patient, a morphine pump, and a devoted family sitting vigil seven days a week. He has since died, and for me there was no time for goodbyes. But working as infrequently as I do here, every leavetaking is a potential goodbye, and we make the best of each opportunity to be kind.

As for my friend eating the bow-tie pasta, he is always looking for answers, but the tangled neurons in his brain insist that the answers elude him. But still, he finds the wherewithal to ask the questions.

Saturday, February 16, 2008

The Table

A story to share, written during my weekly writing group........

The table is made of chestnut. Its sturdy legs are graceful and slightly curved in such a way as to make the table seem much lighter than it actually is. At more than one-hundred and fifty pounds and seven feet in length, it is a bear to move. More than once it has scraped against door-jams and the corners of walls while being maneuvered by frequently reluctant suitors, leaving marks in its finish which tell a tale of decades of use by family, friends, colleagues, movers, shakers, children, and ghosts.

Many have sat here at this table. Many a meal has been served on its surface. Can you see the water rings created by errant glasses sweaty with the cold of summer lemonade? Or how about the spot near the far corner where a pot of soup slipped off of its trivet? These are battle scars for such a magnificent piece of furniture which has supported so many quite unconditionally, no matter the task at hand.

For children, this table has often seemed like a prison. Sentenced to apparently useless homework assignments, the table held small bodies glued to their seats by parental admonitions to finish those math equations in order to see the eventual reward of milk and cookies which would inevitably follow. Homework done, the table would then serve as a launching pad for drawing extravaganzas and endless games of Monopoly, Scrabble, Rummy, and any number of pastimes which might while away the hours of a winter afternoon or a summer evening. When covered with a large enough table-cloth, the table becomes a fort under which the children huddle amidst a forest of chair legs and adult shoes, temporarily safe from the rigors and demands of the outside world.

Speaking of launching pads, what businesses have been launched from this solid wooden base of support! What dreams have been sketched out on legal pads spread across this chestnut expanse! And now, in the 21st century, many a laptop computer has settled here, the tapping of the keys becoming part and parcel of the multiple dances that have flitted across this ersatz stage.

And what of the man who made this table some ninety years ago? He is long in his grave yet his memory lingers in the loving attention he gave to each stroke of his plane. He smoothed the grains of the chestnut planks with such care, knowing that this piece would long outlive his numbered days. He fully understood the utilitarian nature of his creation, yet he also intuitively knew that a table is far more than a place to rest one’s plate, glass, or notebook. It is a mirror, a support, a call to arms, a circle of hope. It gathers, it expands, it contracts, it refrains from judgment. It is solidity itself.

Friday, February 15, 2008

The Diving Bell and the Butterfly: A Lesson in Perspective

On occasion I am profoundly moved by a film or a movie which actually causes me to look at life differently. These moments are few and far between in actuality, but last night on a Valentine's date, my wife Mary and I experienced the profundity of The Diving Bell and the Butterfly in all of its cinematic glory. It is very rare for me to walk out of a movie theatre and feel that what I've just seen has changed me in a dramatic way, and this experience was certainly of that caliber.

For those of you as yet unfamiliar with the story, the film is an adaptation of the book by the same title which was written by Jean Dominique Bauby, a former publisher of Elle Magazine who experienced a massive stroke in the prime of life. Bauby was diagnosed with Locked-In Syndrome, a condition in which the afflicted individual is completely paralyzed---except for eye movement---but is fully cognizant with complete brain function and intellectual capacity. Hence, s/he is considered "locked in". Through the efforts of his caregivers, Bauby was able to dictate his profound insights through blinking his eyes in response to the recitation of the alphabet. Letter by letter, he made his thoughts, wishes, and writings known, and the book was published shortly before his death in 1997.

Visually, the film is almost completely shot from the viewpoint of Mr. Bauby, using soft focus and other techniques to simulate how he might experience his visual field. Dream sequences are used to great effect, as are sequences in which Mr. Bauby consciously chooses to allow his imagination to bring him to beloved places and to relive peak (and less-then-peak) life experiences. Through the film, we understand that Bauby is struggling to come to terms with his maddening physical condition, the challenges of communication with the use of only a single eye, and his desire to make amends with those he has hurt. Unable to hug his children or comfort those around him, his desire to communicate his inner world does battle with his desire to simply relinquish his hold on life and sink into self-pitying despair.

Seeing such a portrayal of an individual's struggle with absolutely debilitating illness puts into perspective my own constellation of infirmities. Taking into account my own collection of diagnoses---which, mind you, is considerable but wholly relative---I am moved to take a fresh look at how much I feel these conditions truly impact my quality of life and whether I can assuage some of that impact by simply shifting my perspective. The powers of the mind can truly help one to rise above the vicissitudes of physicality, and it may be time for me to take further action on that account.

So, what does it mean to experience pain and suffering? And what is suffering when one bears in mind the greater suffering of others? How great is my suffering in relation to that of a Sudanese woman from Darfur who was brutally raped and watched her husband and children be killed? How does my suffering compare to her desolation as she sits alone beneath a plastic tarp in the midst of a refugee camp on the border of Chad? I consider the stress I experience while sitting in traffic, running errands or trying to repair my Internet connection, and I think of that woman sitting under that tarp in the desert, utterly alone. Does this assuage my own suffering? Can I use this as a lesson?

As the sun streams in my picture window and I admire the lush greenness of the rhododendron that peaks through the glass, I also see the richness of my surroundings, the abundance of wealth and comfort in my home, the new cozy couch delivered just days ago. I see the rocking chair, the portable heater, the new computer and speakers, the hundreds of books and CDs, the beautiful art on the walls. All this is mine, and I take it for granted.

Considering that I just quit my job and now have the grace of time to remake my life as I see fit, I remember how large a role the pure power of choice plays in my daily comings and goings. Is it truly a source of stress to decide whether or not to go swim at the pool today? Need I truly allow my mind to worry about whether I forgot to buy cereal or not? How much stress and worry is a broken plate worth? Is a bathroom in need of cleaning or a pile of laundry really that important?

Mr. Bauby's decision to eschew his initial desire for death was born of his realization that he still had something to contribute, and that the power of imagination and memory could take him to the places where he could no longer physically go. Completely paralyzed and dependent, I would say that Bauby had a right to pity himself and to sink into despair, and he surely availed himself of those emotions, especially after first regaining consciousness and realizing his predicament. Still, he did not live in that space for long, and Bauby's greatest achievement is the fact that he shared that journey with the rest of humanity.

For myself, I have a personal goal of purchasing a copy of this profound and life-changing film as soon as it becomes available, and to force myself to watch it at those junctures when I'm losing hope and falling into despair over life's circumstances. Perhaps I'll make it a double feature in which I will also watch Control, a film depicting the life, struggles, and extreme depression of Ian Curtis, the lead singer of the post-punk band Joy Division. Diametrically opposed to Bauby's story---but equally superb in its execution---the film depicts how one young man allowed himself to lose perspective and sink into depression and suicidal ideation just as his life was opening into relative fame, fortune, and new horizons.

Perspective is certainly one of the keys to realizing one's relative place in the world and the profundity of one's own suffering. As the bumper sticker slogan says, "suffering is optional". But are we courageous enough to actualize that reality each and every day? We can only try, and when we succeed---if only for a moment---we can celebrate that moment when we did indeed find ourselves in that timeless space of true acceptance and equanimity.

Thursday, February 14, 2008

Tonglen: Giving and Receiving

Of all the practices I know, the practice of Tonglen, Tibetan for “giving and receiving,” is one of the most useful and powerful. When you feel yourself locked in upon yourself, Tonglen opens you to the truth of the suffering of others; when your heart is blocked, it destroys those forces that are obstructing it; and when you feel estranged from the person who is in pain before you, or bitter or despairing, it helps you to find within yourself and then to reveal the loving, expansive radiance of your own true nature. No other practice I know is as effective in destroying the self-grasping, self-cherishing, self-absorption of the ego, which is the root of all our suffering and all hard-heartedness.

Put very simply, the Tonglen practice of giving and receiving is to take on the suffering and pain of others and give to them your happiness, well-being, and peace of mind.

---Sogyal Rinpoche

Tuesday, February 12, 2008

Sweet Relief and The Great Unknown

I am currently reveling in the reality of no longer being a case manager. Spending time in both my former workplace and in the visiting nurse agency where I work as a per diem nurse, I was clearly struck dumb with pleasure yesterday as I realized the reality of my new professional standing. Working in this manner, I feel completely in control of my work life, calling the shots each week and making decisions with my own best interests in mind. What sweet relief!

The down side of such a situation is that I am no longer in relationship with any of my former patients, and am processing some feelings about having "abandoned" some of them. Also, coming and going from the hospice only intermittently does not afford me much continuity, and from one shift to the next I am generally in the dark as to who has died and who is still in residence. Thirdly, as a per diem visiting nurse, I have no control over who I am assigned on any given day, and while surprise and novelty can be exhilarating, some modicum of normalcy and regularity may at times seems somewhat alluring.

Still, this nurse who has freed himself from relative captivity is a happy man, and no amount of money would get me back on the full-time horse any time soon.

Monday, February 11, 2008

The Power of Compassion

Your compassion can have perhaps three essential benefits for a dying person: First, because it is opening your heart, you will find it easier to show the dying person the unconditional love he or she needs so much.

On a deeper, spiritual level, I have seen again and again how, if you can embody compassion and act out of the heart of compassion, you will create an atmosphere in which the other person can be inspired to imagine the spiritual dimension or even take up spiritual practice.

On the deepest level of all, if you constantly practice compassion for the dying person, and in turn inspire him or her to do the same, you might heal the person not only spiritually but perhaps even physically. And you will discover for yourself, with wonder, what all the spiritual masters know: that the power of compassion has no bounds.


---Sogyal Rinpoche

Sunday, February 10, 2008

Pain and Depression: An Unfortunate Partnership

Living personally with chronic pain and chronic depression, I am seeing manifest in my own life how these two conditions so frequently feed off of one another. These insidious parasites will, if not paid a fair amount of attention, bleed the joy from one's life without a second glance, and anyone who suffers from either knows how, from one moment to the next, life can indeed be turned on its head.

As far as research goes, the jury is in: depression actually can cause pain, and chronic pain can lead to chronic depression. According to some studies, up to two thirds of patients with depression who are interviewed will report moderate to severe pain, with the back, the joints, the head and the abdomen as the most common areas of complaint.

For me, the depression has been life-long, as far back as I can detect---even to childhood. As far as pain is concerned, what used to be periodic back pain requiring intermittent chiropractic and massage has now mushroomed into chronic pain (which is often between 6 and 8 on a severity scale of 1 to 10) and which has begun to limit my ability to do the things I love. A year or so ago, when the pain was really beginning to ramp up in intensity, I made a promise to myself that I would not allow myself to begin that inexorable slide down the slippery slope of loss that pain can instigate. But as I have communicated here on Digital Doorway before, those losses have begun to take place, and I pray that some of those losses will eventually be reversed.

The scary thing about pain which has neurological symptoms is the potential for an underlying neurological disorder such as Multiple Sclerosis. I have seen enough patients with neurological illnesses to know that it is not a fun place to spend one's days, and I am clearly hoping that my forthcoming evaluations over the next few months will reveal a true lack of chronic neurological illness. Still, I realize that this is a potential outcome, and I really should be prepared for anything.

As for depression, it certainly does not make pain any better, and on days when my pain is at its worst---like yesterday, for instance---depression will often deepen. For several decades now, antidepressants, psychotherapy, diet, exercise and a loving and supportive wife have been the cornerstones of my armamentarium against depression. Now, I need similar success in my battle against pain, although up until now, the pain has been winning out.

Stay tuned for news from my own personal medical front line, as I seek a referral to a neurologist in order to delve deeper into the potential roots of my pain. And perhaps, with any luck, I can manifest further healing in my own life, and be of even greater service to others as I greatly wish to be.

Friday, February 08, 2008

Finding My Way

This new life of not working full-time presents many of its own unique challenges. When one does not simply need to report to work every day at the same time, then one must realize that a great deal of thought must be given as to what one is doing when. Juggling various employment responsibilities and home-based business ventures then becomes one's full-time job. The problem with not "punching a clock", as it were, is that the self-employed person must then make choices as to when one is actually "working". The temptation is to always be thinking about work, planning work, making up invoices, drumming up work, and otherwise focusing on it 24/7. If this is the case, then it begs the question, "So, what's better about this scenario, anyway?"

For myself, I'm finding that I actually need to start scheduling "down time" wherein I have nothing to do and in which I explicitly deny myself the ability to do anything work-related. This entails blocking out my calendar for periods of "doing nothing" and then taking the reins of those hours by choosing a self-care activity for that period of time. Whether it be reading, napping, drawing, going to a museum or listening to music, those hours must be used for self-care and healing, otherwise I will most certainly fill them with activity and busy-ness, eschewing self-care for "productivity".

Today, with back pain flaring and physical discomfort at the forefront of my mind, getting someone to cover my hospice shift for tomorrow was my paramount activity. Luckily, a thoughtful colleague took my shift and I will spend some time truly caring for myself tomorrow, and severe pain is something that simply screams "Healer, heal thyself."

With the physical pain has come some grieving that still needs to be processed from losses incurred these last few years. Perhaps as grief slowly heals and changes, the areas of my body that hold such severe pain will begin to release. Until then, self-care must be a constant focus, or leaving my full-time job to decrease stress will have been a wasted and fruitless effort, and that, I must say, would be inexcusable.

Tuesday, February 05, 2008

Calling All Nurses!

Call for Stories from Nurses

True-life stories from nurses who know

Kaplan Publishing, the #1 educational resource for nurses, is launching an exciting new
series of nonfiction books that share the stories behind the relationships, experiences, and issues nurses encounter on the job—whether they work in a hospital, clinic, home setting, hospice, private medical practice, or elsewhere.

These slice-of-life stories are written by nurses from all walks of life and provide
unique personal insights into powerful universal truths. Entertaining and educational,
inspirational and practical, each book will feature 20–25 true stories about the experiences and relationships that inspire and enrich the lives of nurses and all those who come into contact with them.

We are now accepting stories for the following anthologies:

REFLECTIONS ON DOCTORS
No one works more closely with doctors than nurses. What is it really like to work with
them? Share a story about an event that explores:
* A positive working relationship with a doctor
* Dealing with interns
* Power struggles
* Gender dynamics
* What you do if a doctor misses something or makes a mistake
* The challenge of public perceptions about nurses and doctors
Submission Deadline: February 15, 2008
Send stories to: nursesdoctors@gmail.com

FINAL MOMENTS: DEATH AND DYING
Experiencing the death of a patient is a rite of passage for most nurses. Share a story
about:
* Your first encounter with the death of a patient
* A patient who made a life-changing impression on you
* How you have dealt with grief
* The controversies of end-of-life decisions
* The challenges of caring for people as they die
* The harrowing experience of telling family members their loved one has died
Submission Deadline: March 1, 2008
Send stories to: nursesondeath@gmail.com

MEDITATIONS ON HOPE
So many people want to know how nurses do it. Share a life-defining or life-changing
story that explores:
* How you stay positive and focused
* How you maintain hope in the face of patients' suffering, or finding the silver
lining in a dark cloud
* Experiences that have brought you understanding and healing
* A patient, an event, or a day that buoyed your spirits or that required your greatest
reserve of strength
Submission Deadline: May 1, 2008
Send stories to: nursesonhope@gmail.com

GUIDELINES

Payment: $100 if published, along with a complimentary copy of the book.
Story length: 1,000–2,500 words
Point of view: First Person
Nonfiction: All stories must be true, previously unpublished stories from your personal
experience.
Tone: Inspiring, poignant, and, when appropriate, humorous.
Format: Microsoft Word, 12-point Times New Roman, double-spaced
Contact info: Each submission should include your name, address, phone number, and
email address.
Remember: Tell a story that has a beginning, middle, and end. Write from your heart
about a life-changing or life-defining experience. Be sure to make your story
rich by vividly painting the characters, the setting, and dialogue.

Due to the volume of submissions we receive, we cannot acknowledge receipt of submissions or provide status updates. If your story is selected for publication, you will be notified by e-mail. Manuscripts will not be returned. Authors may submit multiple stories for any of the three books.

Before final acceptance, you will receive an agreement that outlines the terms and conditions of publication. All manuscripts selected for publication will be subject to editing.

To Submit Your Story

Typed submissions are preferred, but we will accept a hand-written submission.

Each submission must include your contact information, including your full name, mailing address, phone number, and email address, if you have one.

Each submission also must include a story title and word count.

Electronic (emailed) submissions are preferred; mailed submissions are acceptable.

Email: In the subject line, cite the story title and the anthology for which the story is
intended. Type the story into the body of the email or send an attachment in
Microsoft Word. One submission per email.

Mail: You can send more than one story per envelope. Include one self-addressed,
postage-paid envelope for each submission. Send only the paper copy of the story; do
not send computer disks or CDs. Mail to:

Nurse Stories
Editorial Assistant
Kaplan Publishing
1 Liberty Plaza, 24th Floor
New York, NY 10006, USA

We cannot accept phone calls.

Monday, February 04, 2008

Everything Counts

Whatever we have done with our lives makes us what we are when we die. And everything, absolutely everything, counts.

---Sogyal Rinpoche

Sunday, February 03, 2008

Family Caregivers Are Speaking Up

I was fascinated today while listening to a recent health-related interview on NPR's Fresh Air with Terry Gross. The subject of the interview was Suzanne Mintz, author of the new book, A Family Caregiver Speaks Up, and co-founder and president of the National Family Caregivers Association.

Ms. Mintz is the wife and caregiver of her husband, a man living with Multiple Sclerosis since 1974. Over the course of the interview, she recounts harrowing tales of hospital discharges devoid of planning, of caregiver burnout, of turning to neighbors in emergent circumstances to assist with transfers and other activities of daily living. Ms. Mintz laments the American healthcare system's apparent blindness to the acuity of patients as they are discharged to home with woefully unprepared families and caregivers shouldering the burdens of increasingly complex care.

The subtitle of Mintz's book, "It Doesn't Have to Be This Hard", speaks to the fact that Mintz is a caregiver who cares about other caregivers, and has penned a book with the goal of providing resources and empowerment to those responsible for the care of loved ones living at home. Additionally, The National Family Caregivers Association appears to offer resources, connection, Pen Pal programs, advocacy, volunteers, workshops, trainings, and much more to the tens of millions of Americans who choose to care for their loved ones in this Herculean manner.

During the course of the interview, Mintz lamented the lack of seasoned professionals who can coordinate the care of chronically ill patients and provide support and resources to families. Having recently left my job with a Disability Care Coordination Organization (DCCO), I would like to know what experiences Ms. Mintz and her organization have had with DCCOs---if any---and how her organization and various DCCOs could partner with state and federal government to improve care management programs, and to increase access to such programs for families across the country.

Providing care for a chronically ill loved one at home is no small undertaking these days, and while sick family members were generally cared for at home throughout the early twentieth century, doing so in this current economic climate has become next to impossible for so many families. Hard evidence is available that the majority of home foreclosures and bankruptcies in this country are not caused by frivolous spending and credit card use on the part of homeowners. People in this country are losing their homes due to the high cost of healthcare and from losing their jobs and careers due to illness. Astronomical medical costs, a sour economy, a pharmaceutical industry run amok in the halls of Congress, and a healthcare system driven by profit and market forces have all contributed to untold suffering for patients and caregivers alike. It is a sad state of affairs, and heroic people like Mintz are working hard to assuage that suffering, one family at a time.

Saturday, February 02, 2008

The Savages

Occasionally I see a film that moves me in terms of its honesty and utter closeness to reality. Seeing The Savages tonight was definitely one of those times, and I was completely taken by the film's graceful ability to capture the nuances of family dynamics and aging with absolutely no unnecessary sentimentality.

To avoid giving away major plot points, I will simply say that both Phillip Seymour Hoffman and Laura Linney beautifully and realistically portray the angst that adult children experience as parents age, especially when said children are faced with making choices for aging parents that never seem quite good enough. Phillip Bosco does an amazing job of portraying a man with increasing dementia as he evolves into his disease state, surrendering to it while still experiencing moments of clarity which only serve to make his situation that much more poignant.

To the director's credit, the griminess of low-income nursing homes, diners, hospitals, and urban apartments is very painstakingly portrayed. Equally well-portrayed are the frayed nerves, exasperation, and desperation of children who only want the best for their aging and infirm parents, even when those parents have been less than perfect over the years.

The movie is, in my opinion, simply perfect in every sense, and I expect to see it again over time in order to glean even more from the stellar performances, brilliant writing, and flawless direction.

Friday, February 01, 2008

The Blank Screen

Today, the blank screen glares at me, challenging me to write something pithy and interesting. I stare back, dumbstruck.

I am now in the second week of a five-week writing group which is jump-starting my writing process and adding new ideas. However, a blank screen is a blank screen, especially when one is a blogger who is known for writing about certain subjects and just can't think of anything to say. Go figure.

One thing I have learned in my writing group is a French form of spontaneous short poetry---the "Cinquain"---which is quite easy and fun to try any time. Kind of like French Haiku but you don't have to count the syllables. There are other forms that you can try as well. And a fuller history is given on Wikepedia. But for our purposes, these are your instructions:

1. Write down a noun. Any noun.
2. Write down two adjectives to describe that noun.
3. Write down three verbs in gerund form (ending in "ing") related to that noun
4. Write a four word sentence including the noun.
5. Write down a synonym for that noun.

My first cinquain:

Stone

Grey, smooth

Throwing, skipping, sinking;

There the stone sat.

Rock.

Elementary, but it does make the brain work a little.