Wednesday, December 29, 2010

A Red Scarf and a Cup of Tea

"I know we've met before but I actually don't remember you," she says.

"That's OK. I remember you, and that's what matters. Nice to see you." I sit down at the table after she shakes my hand.

"I'm sorry I don't remember you, but you are very tall and handsome. Are you married?" She gives her ubiquitously flirtatious octogenarian smile.

"Yes, I've been married for 21 years." I take out my notebook and her client folder.

"Oh, too bad. I was hoping you'd stay with me." She sips some tea and folds her hands neatly in her lap again.

"Well, I don't think my wife or my boss would approve," I say, winking at her and getting out my blood pressure cuff and stethoscope.

"Did you have a nice Christmas?" I ask as I wrap the cuff around her arm.

"Oh, was it just Christmas? Oh, yes! I did," she says tentatively. "Thank you for asking." She looks confused.

As I inflate the blood pressure cuff, I watch her closely. Her respirations are normal---about 16 breaths per minute---and she seems at peace, but her mouth is quivering a little at the corner.

"Are you upset about something?" I ask, putting my supplies back in my bag.

"No, I feel fine," she says.

"Are you sure?" I ask again.

"Yes, I think so. I was upset about something this morning, but you know what?" She looks at me sharply.


"I forgot what it was!" She laughs and drinks another sip of tea.

"Well," I say, "if you're ever upset about something, you can always talk to me."

"And what would I talk to you about?"

"Anything you like, my dear."

"Well, that's nice." She hesitates. "Are you going to stay with me?"

"No, I can't. But I'll be back next month, OK?"

"OK. Do you know what I forgot?"

"No, tell me."

"I forgot that Christmas is coming, and I didn't get my daughter anything." She begins to cry.

I hold her hand, and contemplate what to say. At this moment, the home health aide comes in, and intercedes on my behalf.

"You didn't forget your daughter, Mrs. ______. Don't you remember that we went shopping last week and bought her the red scarf? You told me she loved it."

My patient lets go of my hand, wipes her eyes, and looks up at the home health aide.

"A red scarf? You're sure?" She attempts a smile.

"Oh yes, I'm sure," the home health aide says. "You can ask your daughter about it later when she comes home. I think she's wearing it today."

"Oh, good. I thought I had completely forgotten. When is Christmas again?"

"It was last week, dear," I say, and the home health aide nods.

"Oh yes. That's right. Thank you." She sips her tea, wipes her eyes one more time, and it seems we've averted a crisis and an unnecessary dementia-related upset.

"Well, have a happy New Year, and I'll see you at the end of January." I take her hand and squeeze it gently.

"Thank you. I'm sorry you won't be staying with me. Are you sure you can't?"

I stand up and take my coat of off the chair. "No, I really can't. I have to get home to my wife. It's a holiday week and we have a lot to do. I'll be back to see you, though. I promise." I bend down to give her a hug, and she grabs the lapels of my coat.

"You're so handsome. Will you come back and see me on Christmas?"

"No dear, not on Christmas, but I'll be back soon. Happy New Year."

She smiles again, sips her tea, and picks up the paper. It's as if I've already left and she's forgotten that I was ever there.

I give the home health aide a hug and slip quietly out the door. Snow is falling again, and I look back at the house. My patient is sitting in the window, the picture of winter tranquility and coziness.

A red scarf, falling snow, a cup of tea, and the promise of a new year.

Monday, December 27, 2010

One Year Wanes, and Another Dawns

Well, dear Readers, yet another year in our lives has slipped through the fingers of time, and we pause to consider our blessings, count our lucky stars, and plan for the New Year ahead.

For me, this has been a year of great and momentous change. As most of you know, in October of 2009, my wife Mary and I sold our house and most of our possessions, left our beloved New England, and hit the open road in a 29-foot mobile home in search of intentional community. We chronicled that journey on our travel blog, Mary and Keith's Excellent Adventure, and in the course of our travels we visited more than 30 intentional communities in seven months.

Since June, we are settled---at least for now---in a lovely cohousing community in Santa Fe, New Mexico. Looking back, we readily acknowledge that everything we set out to accomplish has been realized: we live in a multigenerational intentional community with many like-minded souls, we are nearby to our son and daughter-in-law, our financial lives are more secure, we work less, we play more, and our quality of life is vastly increased. Speaking of counting one's blessings!

While we are uncertain of what the future holds, we currently have good health, a sense of belonging, a new coaching business, and there is a renewed sense in our lives that just about anything is possible.

As a nurse, I have two part-time jobs that are relatively non-stressful, allowing me more time to develop myself as a coach and as a professional writer. The nursing profession has been kind to me, and I relish being able to pick and choose the positions that are most suitable for me.

For this New Year, I wish all of you much success, health, abundance, love, prosperity, and a sense of peace in your hearts. Thank you for making Digital Doorway what it is, and I look forward to celebrating this blog's sixth anniversary with you next month.

Happy Holidays, Happy New Year, and my blessings to you and yours, now and always.


Tuesday, December 14, 2010

Pediatric Nursing Article on

My newest article for Working Nurse Magazine---on the subject of pediatric nursing---is currently available online. Although the print version has more photos, the article text is identical. Enjoy!

Saturday, December 11, 2010

A Type of Suicide

The other day, I had the opportunity to meet a very kind gentleman in his mid-forties, not one year younger than me. And like most people in our forties, we eventually got around to talking about our health.

During our chat, he pulled out a pack of miniature cigars and began puffing quite vehemently on one of them. I was surprised, and asked him why he smoked at his age.

"Well, I've been smoking two packs of these cigars every day for about 15 years and don't want to quit. I have a chronic cough that just won't stop, and I bust a rib every few weeks because I cough so hard."

I asked him if the coughing bothered him, and this was his reply.

"You see, I'm diabetic, so I'm not gonna live that long anyway. So why give up smoking now?"

I was shocked, and our conversation continued from there.

"Just a few minutes ago, you showed me some photos of your grandchildren," I told him.

"Yeah, that's right."

"Don't you want to live to see them graduate from high school? Don't you want to be there for them?"

"Hell," he said. "I don't control my sugars that good, anyway, so whether I smoke or not, I'm still gonna die. So what's the difference? I won't make it to their high school graduation no matter what I do."

Stunned into silence, I went about the business at hand, and I ruminated on what he had said. Basically, this man chooses to not focus on controlling his sugars, and he adds insult to injury by inhaling at least 10 of those cigars every day. Slightly overweight and sedentary, his ratio of body fat is also not doing him any favors. He is a walking time-bomb, and as he ages, his risk of blindness, amputations, kidney disease, and serious respiratory illness increases exponentially.

There are millions of Americans like this gentleman, millions of people who simply don't understand how (or why) to take care of themselves. Apparently ignorant of the proactive choices that they could make in order to halt (or even reverse) the forward march of their respective chronic illnesses, these individuals are destined for disability and/or institutionalization, costing taxpayers billions of dollars in health care costs that could have been altogether preventable had they willingly engaged in their own self care.

Nursing homes and hospitals are crawling with people who oftentimes make lifestyle choices that fly in the face of logic, poisoning their bodies with cigarettes, nutritionally unsound foods, excessive amounts of alcohol, and a sedentary lifestyle that certainly contributes to their eventual demise.

We are all footing the bill for people like my new acquaintance who simply choose to eschew their own well-being by pursuing a lifestyle that contributes to personal ill health as well as a society-wide health care crisis. When such a critical mass of people are drugged into oblivion by cigarettes, alcohol, TV, bad food and the mushrooming effects of ill health, it is a recipe for a nationwide disaster as well as a personal form of suicide.

Ben Franklin was prescient in saying that "an ounce of prevention is worth a pound of cure", but his admonition regarding the importance of prevention has apparently lost it's impact through the subsequent centuries. Most Americans seem to simply want a pill that will help them to eat less, quit smoking or lose weight, and that reliance on an outside source for the answer to one's personal health concerns is misguided and serves as a poison in the veins of the society.

Our health care system is in crisis, and our population is aging and growing more obese and ill with each passing year. As costs rise and quality of care decreases, a small few profit from the mess as most of us suffer the collective consequences.

The smoking diabetic described above is one of millions of Americans who choose to take the path of least resistance when it comes to their health, and if I explained to him that his choices are actually driving up the cost of health care around the country, he probably would have looked at me as if I had two heads.

Americans may be obsessed with health on one hand, but on a very deep level we seem to have basically given up the ghost. My diabetic acquaintance certainly sees no reason to change any of his habits, and as he slowly commits suicide, his care will consistently tax the system, adding to the sorry statistics that paint a picture of American health care that is anything but rosy. His premonition that he won't live to see his grandchildren's high school graduation is probably accurate, and when his grandsons wonder why Grandpa couldn't be there to watch them accept their diplomas, will anyone use his story as a cautionary tale? Most likely not, and the cycle will probably repeat itself in the next generation in a form of suicide that is, for all intents and purposes, more common than any of us would like to believe.

Sunday, December 05, 2010

Cold Comfort

Recently visiting my father in the hospital and participating in his transfer to an acute rehab facility, it brought home the ironic fact that hospitals and other inpatient facilities are often the last places where one would want to be in order to recuperate from illness.

Although hospitals offer an essential service, they can often be comfortless, cold and unwelcoming places that are polluted with noise, unnecessarily bright lights, the constant interruption of patients' desire to rest, and a dizzying array of providers with whom patients sometimes have little or no personal connection as they are poked, prodded and otherwise examined.

Observing my father in his room in the rehab facility, the first thing I noticed was the fact that he was being constantly barraged by noise that intruded on his well-being and his ability to rest. Staying in a two-person room, a patient is always subject to the vicissitudes of having a roommate, and my father was unlucky enough to be at the mercy of his roommate's intermittent groans of pain and complaint, and also the high volume of his television that was on from the moment he woke up in the morning until he turned out the light at bedtime.

To add insult to injury, nurses and aides laughed and talked loudly in the hallway, carts with squeaky wheels were pushed down the hallways at all hours, and intercoms and buzzers continuously added to the nauseating medical din.

My father, sitting with his head in his hands, accepted the offer of foam earplugs procured from the nurses station, but they sadly did little to block out the constant noise that infiltrated his world and rattled his already troubled brain. The poor guy just wanted to rest, and the very facility promising him "healing" offered an environment completely unsuited to that end.

In my mind, most hospitals, nursing homes and health facilities are built with the convenience and ease of its employees in mind. While the physical layout does indeed need to take the efficiency of health care delivery into consideration, the lack of consciousness around patient comfort is nothing short of appalling.

When it comes to noise pollution, every patient bed should be equipped with wireless (or wired) headphones connected to the television, eliminating the cacophony of two televisions tuned to different channels blaring simultaneously in every room.

Next, every cart and wheeled conveyance used in a health care facility should have the most state-of-the-art solid rubber wheels that provide the most silent movement possible. From mop buckets to gurneys, wheels should be as silent as a whisper.

Regarding nurses and other staff, voices should be as quiet as possible, and while laughter and joviality provide for a more lighthearted work environment, I have observed that many staff frequently seem oblivious to the fact that their place of work is also a place where patients come for rest and healing. Staff do not need to take a vow of silence, but conversational voices can convey information more readily and efficiently than raised voices loud enough to wake the dead.

And then there are the lights and the environment. Where are the full-spectrum bulbs, skylights, picture windows, fountains, options for soothing music, and views of the outdoors that are conducive to healing? Why are rooms not designed in a manner wherein each looks in upon a central courtyard of beauty? Where is the research on the use of color and light to induce a feeling of calm? So many hospital walls are adorned with awful colors reminiscent of the dull and uninspiring hues of vomitus and stale urine. Hospitals are not meant to be prisons.

Watching my father react to the noise, interruptions, bright lights and cheerlessness of the hospital and rehab facility, I was struck by the readily visible fact that many facilities simply ignore the creature comforts of patients, creating environments that neither inspire nor engender restful recovery. Feeling powerless to help him to be more comfortable, my visit came to an end, and it was little comfort leaving my poor sick father at the mercy of an environment ill-suited to his overall well-being.

While there are indeed some superlative hospitals out there that embody the very heart of the nature of the healing environment, most mainstream hospitals offer a pedestrian and uninspiring atmosphere that does little to assist the sick in their process of recovery. Those hospitals that do provide optimal care and a healing environment should be held up as an example to those who simply take the path of least resistance.

Leaving my father sitting alone in that rehab was one of the hardest things I have ever done, and I hope to never again be in the position to leave someone behind who is receiving care in a facility in which I do not have the utmost confidence. While there was one nurse who took a special interest in my dad, that was cold comfort in light of the suffering that he was experiencing, and I'll sleep better when he is safe and sound in his own home once again.