Contemplating yesterday's post from Sogyal Rinpoche, a Tibetan Buddhist master and teacher, I am considering my new position as a hospice nurse for which I will begin orientation quite soon. Hospice truly is about the alleviation of suffering when curing has ceased and caring holds sway.
As the individual and his or her family make the choice to no longer pursue treatment, the job of hospice is to provide unfettered symptom management and pain relief as the patient moves towards death. Hospice is also about the care of the family and caregivers. Caring for a person who is evolving towards death can be an exhausting and overwhelming experience, and it is the responsibility of the hospice team to ascertain the family's level of coping, working to alleviate their suffering to whatever extent is possible, as well.
With my developing mindfulness practice and increasing interest in Buddhism, I am beginning to see more deeply how hospice work and the care of the dying meshes seamlessly with Buddhist practices in particular and mindfulness in general. Courses such as Naropa Institute's 17-week Contemplative End of Life Care certificate program for health care professionals and Upaya Zen Center's training program in Compassionate End-of-Life Care offer deeper explorations of these connections.
For now, a focus on basic mindfulness and my initial training in hospice care will suffice as I prepare to enter a new phase of professional development as a nurse. While I have unofficially provided hospice care to patients over the years as both a nurse care manager and a visiting nurse, this new opportunity will allow me to truly be part of a comprehensive hospice team, learning from those who have been developing these specific skills for years.
Dying is the last thing we all have to do in this life, and assisting those who are actively engaged in that process is an honor and a privilege. These are skills that I wish to nurture and develop, both personally and professionally, and I am quietly excited to watch as this door of opportunity opens.
Wednesday, June 04, 2008
Wednesday, May 28, 2008
The Wheat and the Chaff
Driving from patient to patient today in the admittedly not-so-big city, I found myself wondering how much longer I can do this. From pot-holes to one-way streets and buildings close to being condemned, I realized today that this job's days may be numbered. Actually, having just signed on to begin providing per diem hospice and palliative care closer to home, I realized that I very well could be seeing my final days of urban visiting nursing.
Now, of course there is excellent fodder for writing while seeing patients in the city: drug abuse, litter, homelessness, squalor and the like. However, those things exist everywhere, and every interaction, every moment can be fodder for writing if one sees things through that incisive lens.
As far as being professionally challenged, quick visits to the mentally ill in the city do not necessarily provide much in the way of clinical learning, and after quitting my full-time job in January where learning was de rigeur, hospice and palliative care are the place where I feel my clinical skills can truly grow.
So, as The Part-Time-Nurse-With-Five-Jobs, I am seeing that the time to separate the occupational wheat from the chaff is upon us. Has anyone seen my thresher?
Now, of course there is excellent fodder for writing while seeing patients in the city: drug abuse, litter, homelessness, squalor and the like. However, those things exist everywhere, and every interaction, every moment can be fodder for writing if one sees things through that incisive lens.
As far as being professionally challenged, quick visits to the mentally ill in the city do not necessarily provide much in the way of clinical learning, and after quitting my full-time job in January where learning was de rigeur, hospice and palliative care are the place where I feel my clinical skills can truly grow.
So, as The Part-Time-Nurse-With-Five-Jobs, I am seeing that the time to separate the occupational wheat from the chaff is upon us. Has anyone seen my thresher?
Monday, May 26, 2008
Hospice and Palliative Care: A New Opportunity
I have accepted a per diem position with a local visiting nurse agency which provides both palliative care and hospice care to people in our region. Since I became a nurse in 1996, I have worked in the urban areas which are located just under an hour from our home. I have always commuted elsewhere to work, and subsequently have never provided nursing care here in my own county.
For several reasons, I am quite excited about this position. For one, I will actually be able to see patients in and around the town where we live, as well as in neighboring towns and counties, some of which are quite lovely and bucolic. Making home visits in our area---rather than in the down-and-out city---will be a novel and welcome experience, and I look forward to not necessarily having to deal so much with drug dealers, litter, urine-soaked hallways, and other hallmarks of urban visiting nursing (although I will keep my other home care job in the city, as well).
More importantly, I am professionally excited to be embarking on the learning curve of officially becoming a hospice nurse, mentoring with seasoned hospice nurses who can teach me the nuances of a very important nursing specialty. While I did indeed have a short-lived position at a local residential hospice from which I was forced to resign for health reasons earlier this year, I was not there long enough to fully appreciate the breadth and depth of all there is to learn about providing hospice care. In previous positions, I have had the opportunity of supporting patients and families through the dying process, and have even had the honor of pronouncing the death of several beloved patients, but there is still so much more to learn.
Last summer, my wife and I were integral in providing care to my step-father who died surrounded by family in early September from complications of pancreatic cancer. That experience---and my previous experiences as a visiting nurse with terminally ill patients---cemented my desire to become more of an expert in end-of-life care, and I feel that I now may have an opportunity to accumulate the knowledge that I have longed for.
As part of my new position, I will also begin working with this particular agency's palliative care team, which offers symptom management and support to patients living with terminal illness who are still receiving treatment and are not yet eligible for hospice services. This is another area of specialty which intrigues and excites me, and I look forward to the knowledge that will also come from that specific professional experience.
Four months after quitting my full-time job, things are beginning to come together, and I give thanks that I am able to find satisfying and relatively well-paid work in my chosen profession. May other be so blessed.
For several reasons, I am quite excited about this position. For one, I will actually be able to see patients in and around the town where we live, as well as in neighboring towns and counties, some of which are quite lovely and bucolic. Making home visits in our area---rather than in the down-and-out city---will be a novel and welcome experience, and I look forward to not necessarily having to deal so much with drug dealers, litter, urine-soaked hallways, and other hallmarks of urban visiting nursing (although I will keep my other home care job in the city, as well).
More importantly, I am professionally excited to be embarking on the learning curve of officially becoming a hospice nurse, mentoring with seasoned hospice nurses who can teach me the nuances of a very important nursing specialty. While I did indeed have a short-lived position at a local residential hospice from which I was forced to resign for health reasons earlier this year, I was not there long enough to fully appreciate the breadth and depth of all there is to learn about providing hospice care. In previous positions, I have had the opportunity of supporting patients and families through the dying process, and have even had the honor of pronouncing the death of several beloved patients, but there is still so much more to learn.
Last summer, my wife and I were integral in providing care to my step-father who died surrounded by family in early September from complications of pancreatic cancer. That experience---and my previous experiences as a visiting nurse with terminally ill patients---cemented my desire to become more of an expert in end-of-life care, and I feel that I now may have an opportunity to accumulate the knowledge that I have longed for.
As part of my new position, I will also begin working with this particular agency's palliative care team, which offers symptom management and support to patients living with terminal illness who are still receiving treatment and are not yet eligible for hospice services. This is another area of specialty which intrigues and excites me, and I look forward to the knowledge that will also come from that specific professional experience.
Four months after quitting my full-time job, things are beginning to come together, and I give thanks that I am able to find satisfying and relatively well-paid work in my chosen profession. May other be so blessed.
Monday, May 19, 2008
Sunday, May 18, 2008
Alone
"What a lovely home you have here," I say as I walk in the front door.
"Thanks. People always say that when they come here." He seems like any other suburban middle-aged man. We sit in the living room.
"So, what's happening today?" I ask as I open his lock box and arrange his morning and evening medications.
"I don't know. Maybe I'll make some calls. Maybe I won't. I don't have a car right now so I don't know what to do today."
"Well, it's a beautiful day out there. Would you consider getting some sun, checking out the flowers and the trees, and getting some fresh air? I see on your care plan that you're supposed to try to go outside every day."
"Yeah, I could do that, I guess. I hadn't thought of that. I'm pretty lonely, too. I've been depressed."
"I think I know what you mean," I reply. (What I want to say is that I've been very depressed myself, but "therapeutic use of self" does not seem appropriate in this situation. There are times like these when I want to explain how depression also frequently has its grip on me, and reaching out---both to people and to Nature---is often my greatest survival strategy.)
"How about this?" I begin. "Make some calls to at least one friend and one member of your family this morning. Then make sure you get outside for a walk once this morning and once this afternoon. Getting out of the house can be really helpful, even if only for a few minutes. The sun feels so good."
"OK. I can do that. Thanks for the suggestion. Should I take these meds now?" He seems confused.
"Yeah. Take these now and take the evening meds with dinner. And I'll leave your meds for Sunday on the table since there won't be a nurse coming tomorrow."
"Oh, that's right," he replies. "Sundays are hard because nobody comes over. It can seem like a long day, especially when I don't have a car and it's so far to town."
"Well, remember we talked about making those calls today? Maybe there's someone who can come see you tomorrow, especially if they know your car is broken down."
"Hey, that's right. Why didn't I think of that? I'll make those calls as soon as you leave." A smile passes across his face, then disappears. By the time we reach the door, he's smiling again.
"Thanks so much for the visit," he says, shaking my hand warmly. "I feel a little better now."
"So, you'll do some good things for yourself today?" I ask in parting.
"Oh, yes. Absolutely. You can bet on it."
I get in the car and put the key in the ignition. Looking in the rear-view mirror, I see that he has walked over to the garden and is leaning on the fence, looking out towards the hills. The sun is bright and there are a few horses in the fields beyond his house.
My prescription for him was no different than what I tell myself, and in the face of depression and the sense of isolation that often accompanies it, there's no telling how effective those interventions will be. When it comes to the mystery of our minds and the solitude we each experience within our minds, no one can offer an explanation that will wholly satisfy us.
Some of us are blessed with an inner equanimity free of depression and isolation from others. Some of us---myself included---struggle with the demons of depression and other mental afflictions that bog us down and cloud our thinking. Depression can short-circuit decision-making and cause us to pull away from those we love just when we need them most.
And what about my admonition to my patient to call friends and family and get outside in the sun? It was like I was talking to myself.
"Thanks. People always say that when they come here." He seems like any other suburban middle-aged man. We sit in the living room.
"So, what's happening today?" I ask as I open his lock box and arrange his morning and evening medications.
"I don't know. Maybe I'll make some calls. Maybe I won't. I don't have a car right now so I don't know what to do today."
"Well, it's a beautiful day out there. Would you consider getting some sun, checking out the flowers and the trees, and getting some fresh air? I see on your care plan that you're supposed to try to go outside every day."
"Yeah, I could do that, I guess. I hadn't thought of that. I'm pretty lonely, too. I've been depressed."
"I think I know what you mean," I reply. (What I want to say is that I've been very depressed myself, but "therapeutic use of self" does not seem appropriate in this situation. There are times like these when I want to explain how depression also frequently has its grip on me, and reaching out---both to people and to Nature---is often my greatest survival strategy.)
"How about this?" I begin. "Make some calls to at least one friend and one member of your family this morning. Then make sure you get outside for a walk once this morning and once this afternoon. Getting out of the house can be really helpful, even if only for a few minutes. The sun feels so good."
"OK. I can do that. Thanks for the suggestion. Should I take these meds now?" He seems confused.
"Yeah. Take these now and take the evening meds with dinner. And I'll leave your meds for Sunday on the table since there won't be a nurse coming tomorrow."
"Oh, that's right," he replies. "Sundays are hard because nobody comes over. It can seem like a long day, especially when I don't have a car and it's so far to town."
"Well, remember we talked about making those calls today? Maybe there's someone who can come see you tomorrow, especially if they know your car is broken down."
"Hey, that's right. Why didn't I think of that? I'll make those calls as soon as you leave." A smile passes across his face, then disappears. By the time we reach the door, he's smiling again.
"Thanks so much for the visit," he says, shaking my hand warmly. "I feel a little better now."
"So, you'll do some good things for yourself today?" I ask in parting.
"Oh, yes. Absolutely. You can bet on it."
I get in the car and put the key in the ignition. Looking in the rear-view mirror, I see that he has walked over to the garden and is leaning on the fence, looking out towards the hills. The sun is bright and there are a few horses in the fields beyond his house.
My prescription for him was no different than what I tell myself, and in the face of depression and the sense of isolation that often accompanies it, there's no telling how effective those interventions will be. When it comes to the mystery of our minds and the solitude we each experience within our minds, no one can offer an explanation that will wholly satisfy us.
Some of us are blessed with an inner equanimity free of depression and isolation from others. Some of us---myself included---struggle with the demons of depression and other mental afflictions that bog us down and cloud our thinking. Depression can short-circuit decision-making and cause us to pull away from those we love just when we need them most.
And what about my admonition to my patient to call friends and family and get outside in the sun? It was like I was talking to myself.
Saturday, May 17, 2008
Desire and Happiness
Whatever joy there is in this world
All comes from desiring others to be happy,
And whatever suffering there is in this world
All comes from desiring myself to be happy.
SHANTIDEVA
Friday, May 16, 2008
Rural Health Care: A Few Thoughts
Having just interviewed for a position with a home health agency whose territory covers a large swath of rural countryside, I am appreciating the challenges and difficulties of delivering care in such a setting. Whereas the city---where I currently provide home health care---finds patients in an area of high population density and relatively close geographic proximity, serving patients who live in mostly single family homes in far-flung sections of the countryside is an entirely different story.
When considering such matters, I recall how Dr. Paul Farmer, the founder of Partners in Health (recently featured on "60 Minutes"), created teams of trained lay outreach workers to bring care to patients living in rural isolation.
Native American reservations face great challenges when it comes to the delivery of home health care. The Center for Rural Health at the University of North Dakota School of Medicine use their resources to drive policy and develop care models vis-a-vis rural health and the delivery of medical care in rural areas.
Even the Health Resources and Services Administration of the U.S. Department of Health and Human Services has an Office of Rural Health Policy that strives to improve rural health care around the country.
It is now an accepted fact that physicians are leaving primary care and family practice in droves as specialization becomes the ultimate goal. More and more medical students choose specialties other than primary care as the cost of medical school skyrockets and the subsequent debt after graduation becomes even more astronomical.
While much is written about a nursing shortage which is feared to be worsening by the day, a physician shortage--especially of primary care physicians---is also taking hold, and one can easily extrapolate that any nurse or physician shortage is bound to have a devastating effect on rural health around the country. Many articles recount how doctors are in high demand, and strategies to lure health care workers to rural areas are discussed in stories and reports from Australia, Norway, and elsewhere.
Rural health is a subject which has never captured my imagination, yet today's interview and a few clicks of the mouse were enough to make me dig just a little deeper. While strategies and policies to offset the growing national shortage of nurses and doctors are developed and implemented, those living in rural areas are sure to be hoping that they don't get left in the proverbial dust.
When considering such matters, I recall how Dr. Paul Farmer, the founder of Partners in Health (recently featured on "60 Minutes"), created teams of trained lay outreach workers to bring care to patients living in rural isolation.
Native American reservations face great challenges when it comes to the delivery of home health care. The Center for Rural Health at the University of North Dakota School of Medicine use their resources to drive policy and develop care models vis-a-vis rural health and the delivery of medical care in rural areas.
Even the Health Resources and Services Administration of the U.S. Department of Health and Human Services has an Office of Rural Health Policy that strives to improve rural health care around the country.
It is now an accepted fact that physicians are leaving primary care and family practice in droves as specialization becomes the ultimate goal. More and more medical students choose specialties other than primary care as the cost of medical school skyrockets and the subsequent debt after graduation becomes even more astronomical.
While much is written about a nursing shortage which is feared to be worsening by the day, a physician shortage--especially of primary care physicians---is also taking hold, and one can easily extrapolate that any nurse or physician shortage is bound to have a devastating effect on rural health around the country. Many articles recount how doctors are in high demand, and strategies to lure health care workers to rural areas are discussed in stories and reports from Australia, Norway, and elsewhere.
Rural health is a subject which has never captured my imagination, yet today's interview and a few clicks of the mouse were enough to make me dig just a little deeper. While strategies and policies to offset the growing national shortage of nurses and doctors are developed and implemented, those living in rural areas are sure to be hoping that they don't get left in the proverbial dust.
Wednesday, May 14, 2008
Definition and Redefinition
Working a few hours at the community health center in the city yesterday was a good reminder of the things I do and don't like about my current career trajectory. Spending a half-day helping out in my old office also solidified those stark reminders of why I eschewed full-time work four months ago.
Quietly observing my colleagues, I watched as everyone seemed to be running around in circles of frustration and habituated action. Paperwork flew as harried notes were written and typed, prescriptions proffered and recommendations made. Med refills, telephone calls, follow-ups, appointments and prescriptions devour the minutes of everyone's day, and I certainly did not see many happy faces in the course of my work day.
Driving home, I remarked to my wife Mary how I do indeed miss intellectually stimulating interactions with my favorite doctors, and I also do sincerely miss some of the personal connections that I had with a few very special patients. Still, that life now seems to be fading further, and I practice letting go over and over again when I pass through the office or the health center as a per diem nurse. It is a deeply personal process, and my own self-definition is still very much in flux.
As I try to define who I am professionally in the world---nurse, healer, writer, blogger, consultant---I'm struck by how those definitions themselves feel limiting. My identity as a nurse is still quite firmly front and center, and "writer" now feels more real than ever. But there is more to me than those two words, and this mid-life period of redefinition (but not "crisis", mind you!) is a rich time of seeking and asking. As for the answers, they are slow in coming, and the more I grasp for them, the further away they seem to recede.
Quietly observing my colleagues, I watched as everyone seemed to be running around in circles of frustration and habituated action. Paperwork flew as harried notes were written and typed, prescriptions proffered and recommendations made. Med refills, telephone calls, follow-ups, appointments and prescriptions devour the minutes of everyone's day, and I certainly did not see many happy faces in the course of my work day.
Driving home, I remarked to my wife Mary how I do indeed miss intellectually stimulating interactions with my favorite doctors, and I also do sincerely miss some of the personal connections that I had with a few very special patients. Still, that life now seems to be fading further, and I practice letting go over and over again when I pass through the office or the health center as a per diem nurse. It is a deeply personal process, and my own self-definition is still very much in flux.
As I try to define who I am professionally in the world---nurse, healer, writer, blogger, consultant---I'm struck by how those definitions themselves feel limiting. My identity as a nurse is still quite firmly front and center, and "writer" now feels more real than ever. But there is more to me than those two words, and this mid-life period of redefinition (but not "crisis", mind you!) is a rich time of seeking and asking. As for the answers, they are slow in coming, and the more I grasp for them, the further away they seem to recede.
Sunday, May 11, 2008
During the Dream.....
Always recognize the dreamlike qualities of life and reduce attachment and aversion. Practice good-heartedness toward all beings. Be loving and compassionate, no matter what others do to you. What they will do will not matter so much when you see it as a dream. The trick is to have positive intention during the dream. This is the essential point. This is true spirituality.
CHAKDUD TULKU RINPOCHE
Friday, May 09, 2008
National Nurse's Week
In recognition of National Nurses' Week (officially May 6th to May 12th), I want to take a moment to honor the approximately 2.9 million registered nurses who provide skilled and compassionate care to millions of Americans day in and day out. Nurses are an essential component of the healthcare system, and this week is simply an opportunity for recognition of a body of individuals whose work is essential to the health and well-being of so many.
Expanding that notion, I would also like to recognize nurses worldwide, my professional brethren with whom I am connected through our mutual dedication to service and nursing care. All too often, we focus too keenly on our own community or country, losing sight of those in lands beyond our borders. Nurses and other healthcare workers labor each day in refugee camps, on battlefields, at the site of natural disasters, and on the streets of cities the world over.
Many blessings to my fellow nurses, and to anyone and everyone who has ever taken a moment to help another sentient being. May we all be free from suffering.
Expanding that notion, I would also like to recognize nurses worldwide, my professional brethren with whom I am connected through our mutual dedication to service and nursing care. All too often, we focus too keenly on our own community or country, losing sight of those in lands beyond our borders. Nurses and other healthcare workers labor each day in refugee camps, on battlefields, at the site of natural disasters, and on the streets of cities the world over.
Many blessings to my fellow nurses, and to anyone and everyone who has ever taken a moment to help another sentient being. May we all be free from suffering.
Sunday, May 04, 2008
Pain and the Seeds of Compassion
There comes a time in life when one decides to surrender to what is, to acknowledge that one has hit a wall. I have arrived at just such an impasse, and while it's not an easy thing to do, I finally have to admit that I feel powerless over my pain.
Having worked with patients with chronic illness----including chronic pain---for years, I never saw myself as someone with chronic illness. People with intractable pain and multiple diagnoses were always separate from me, living in a world which I did not inhabit.
Now, having quit my job due to the ravages of stress and chronic illness, I admit that I am---at least for the moment---struggling with chronic illness, and that its effect on my life is global and overwhelming.
Up until now, I have consistently said that pain would not limit what I do, that I would not allow the pain to intrude upon my daily activities. However, I am moved to report that I have indeed surrendered some aspects of my life to the cruel fingers of pain, and I no longer do many of the things that I used to. Pain has insidiously begun a campaign of contraction aimed at my life, and I have weakened under the onslaught.
Despite the fact that I have not found a single modality or treatment that assuages my symptoms enough to remark about, I do hold out hope that somewhere, somehow, there will be an answer. Whether it is complete cessation of pain or just better control, I have to feel that there is still possibility and potential.
Nursing brings one into contact with people in all stages of health and illness. I have seen people ravaged by cancer and AIDS. I have dressed enormous physical wounds that would not heal, and I've witnessed the torture of psychological wounds that fester for a lifetime.
I myself now long for cessation of my own suffering, and in my role as a nurse I want my personal experience of suffering to inform and empower my interactions with patients and others who hurt. Shared experience breeds compassion and understanding. May my own experience further nurture the seeds of compassion in me.
Having worked with patients with chronic illness----including chronic pain---for years, I never saw myself as someone with chronic illness. People with intractable pain and multiple diagnoses were always separate from me, living in a world which I did not inhabit.
Now, having quit my job due to the ravages of stress and chronic illness, I admit that I am---at least for the moment---struggling with chronic illness, and that its effect on my life is global and overwhelming.
Up until now, I have consistently said that pain would not limit what I do, that I would not allow the pain to intrude upon my daily activities. However, I am moved to report that I have indeed surrendered some aspects of my life to the cruel fingers of pain, and I no longer do many of the things that I used to. Pain has insidiously begun a campaign of contraction aimed at my life, and I have weakened under the onslaught.
Despite the fact that I have not found a single modality or treatment that assuages my symptoms enough to remark about, I do hold out hope that somewhere, somehow, there will be an answer. Whether it is complete cessation of pain or just better control, I have to feel that there is still possibility and potential.
Nursing brings one into contact with people in all stages of health and illness. I have seen people ravaged by cancer and AIDS. I have dressed enormous physical wounds that would not heal, and I've witnessed the torture of psychological wounds that fester for a lifetime.
I myself now long for cessation of my own suffering, and in my role as a nurse I want my personal experience of suffering to inform and empower my interactions with patients and others who hurt. Shared experience breeds compassion and understanding. May my own experience further nurture the seeds of compassion in me.
Thursday, May 01, 2008
Patient Contact: Missing in Action
My new work life has significantly decreased regular contact with patients, the one-on-one interactions that are part and parcel of most nurses' lives. In a recent post, I mentioned how I'm personally missing some of my former patients and the place that they inhabited in my life. I also find that I am simply missing the types of interactions that can remind me of why I became a nurse in the first place.
My current per diem visiting nurse gig is just not panning out, with several weeks going by without my being needed whatsoever. In my other per diem work, actual patient interactions are few and far between, and when I find myself with a patient in their home, I relish those brief moments of connection.
Due to my health, I am fiercely resisting the psychologically subterranean urge to take a 15- or 20-hour part-time position, but I am applying for two more per diem visiting nurse positions (one with a hospice component) in the hopes that I can have more experiences of face-to-face therapeutic interaction without the nightmare of case management.
So why did I leave my previous job, you may ask, if I miss patient care so much? The fact was that case managing 83 chronically ill people was no picnic, and the detailed coordination of those individuals' medical care---while gratifying and challenging---had such a negative impact on my health that it simply had to end. While I enjoy the interaction, it's the case management and detail coordination that almost killed me.
So, this nurse aches for patient contact but eschews the trap of full-time or part-time work which previously proved so burdensome. Now the secret is to fulfill my yearning while still avoiding burnout........
My current per diem visiting nurse gig is just not panning out, with several weeks going by without my being needed whatsoever. In my other per diem work, actual patient interactions are few and far between, and when I find myself with a patient in their home, I relish those brief moments of connection.
Due to my health, I am fiercely resisting the psychologically subterranean urge to take a 15- or 20-hour part-time position, but I am applying for two more per diem visiting nurse positions (one with a hospice component) in the hopes that I can have more experiences of face-to-face therapeutic interaction without the nightmare of case management.
So why did I leave my previous job, you may ask, if I miss patient care so much? The fact was that case managing 83 chronically ill people was no picnic, and the detailed coordination of those individuals' medical care---while gratifying and challenging---had such a negative impact on my health that it simply had to end. While I enjoy the interaction, it's the case management and detail coordination that almost killed me.
So, this nurse aches for patient contact but eschews the trap of full-time or part-time work which previously proved so burdensome. Now the secret is to fulfill my yearning while still avoiding burnout........
Wednesday, April 30, 2008
Wash Away the Pain
I want to wash the cells of my body with compassion. I want to wash the cells of the muscles that scream in pain at almost every moment of every day. How can I simply cleanse those areas of the aches and pains that dog my every moment? I've imagined removing the offending muscles and scrubbing them on an old-fashioned washboard, then squeezing them out and hanging them to dry in the sun. How I wish that that were possible. But reality reminds me that my muscles are stationary in my body, non-removable and permanent, and for better or worse they are mine for the duration.
Wash them clean? Scrub the pain away? Erase the trauma that lives at the root, at the place where the cells coalesce into scar tissue?
I enter the offending cells, and I identify the mitochondria and other organelles that live in a state of eternal inflammation. The prostaglandins and other chemicals on perpetual alert are sent on a long coffee-break, and I set to work with a scrub brush, burnishing the cells, removing debris with a microscopic dust-pan, sweeping out the physiological corners that are dusty with the detritus of pain. A high-pressure hose of compassionate cleansing clears the decks, and a clean slate of pristine muscle and tissue is left in its wake.
Can I truly do this with my mind?
Wash them clean? Scrub the pain away? Erase the trauma that lives at the root, at the place where the cells coalesce into scar tissue?
I enter the offending cells, and I identify the mitochondria and other organelles that live in a state of eternal inflammation. The prostaglandins and other chemicals on perpetual alert are sent on a long coffee-break, and I set to work with a scrub brush, burnishing the cells, removing debris with a microscopic dust-pan, sweeping out the physiological corners that are dusty with the detritus of pain. A high-pressure hose of compassionate cleansing clears the decks, and a clean slate of pristine muscle and tissue is left in its wake.
Can I truly do this with my mind?
Tuesday, April 29, 2008
Losses and Gains: The Calculus of Change
Spending time in my former office today as a consultant (something I now do on a weekly basis), I was struck by how sincerely I miss a handful of patients, and how much I truly don't miss a small group of my most needy former patients.
After three months of not working full-time following a seven year sojourn of intensive case management, I'm feeling the loss involved in saying goodbye and walking away from a number of close long-term connections. Periodically I think of calling one or another of my former patients, and one of these days I'll probably pick up the phone and do so. Those goodbyes can be hard, and the hellos can now seem equally challenging.
The intimate connections nurtured over those years came to be part and parcel of my life, and while that closeness eventually did indeed contribute to my experience of burnout and compassion fatigue, it also was a part of the fabric of my life, and now it seems like certain threads are sorely missing.
For now, I can sit with the uncertainty and emptiness that those losses have engendered, and I can also sit with the notion that calling and saying hello may be a new way of connecting (if, of course, I choose to do so at all). Providing such intimate and long-term care over time creates dependencies on both sides of the equation, and I am beginning to feel that some of those emotional equations are as yet unresolved. Will I attempt to balance them? Only time will tell.
After three months of not working full-time following a seven year sojourn of intensive case management, I'm feeling the loss involved in saying goodbye and walking away from a number of close long-term connections. Periodically I think of calling one or another of my former patients, and one of these days I'll probably pick up the phone and do so. Those goodbyes can be hard, and the hellos can now seem equally challenging.
The intimate connections nurtured over those years came to be part and parcel of my life, and while that closeness eventually did indeed contribute to my experience of burnout and compassion fatigue, it also was a part of the fabric of my life, and now it seems like certain threads are sorely missing.
For now, I can sit with the uncertainty and emptiness that those losses have engendered, and I can also sit with the notion that calling and saying hello may be a new way of connecting (if, of course, I choose to do so at all). Providing such intimate and long-term care over time creates dependencies on both sides of the equation, and I am beginning to feel that some of those emotional equations are as yet unresolved. Will I attempt to balance them? Only time will tell.
Sunday, April 27, 2008
Return!
We have returned from a wonderful journey to Boulder, Colorado and Santa Fe, New Mexico (as well as a number of points in between, including Ghost Ranch, an old haunt of American painter Georgia O'Keefe).
Traveling with chronic pain and Multiple Chemical Sensitivity certainly makes such ventures more challenging. One of the most difficult things for me was feeling quite limited in the amount of hiking and outdoor activities in which I could indulge without significant suffering in its aftermath. Still, I managed to enjoy the outdoors, take less vigorous hikes, and use medication to assuage my pain.
Now, returning to New England, I face important decisions as to how to earn enough money while not working full time. Pain is a limiting factor, yet bringing income to the table is crucial while still maintaining my health.
Another issue with which I am grappling is how to keep this blog alive and well without the frequent patient interactions which previously provided such excellent grist for my writing mill. I want to remain true to the spirit of this blog by providing commentary on nursing, health and healthcare, while still blogging about my own personal journey.
Suggestions are welcome, and feedback is treasured.
Traveling with chronic pain and Multiple Chemical Sensitivity certainly makes such ventures more challenging. One of the most difficult things for me was feeling quite limited in the amount of hiking and outdoor activities in which I could indulge without significant suffering in its aftermath. Still, I managed to enjoy the outdoors, take less vigorous hikes, and use medication to assuage my pain.
Now, returning to New England, I face important decisions as to how to earn enough money while not working full time. Pain is a limiting factor, yet bringing income to the table is crucial while still maintaining my health.
Another issue with which I am grappling is how to keep this blog alive and well without the frequent patient interactions which previously provided such excellent grist for my writing mill. I want to remain true to the spirit of this blog by providing commentary on nursing, health and healthcare, while still blogging about my own personal journey.
Suggestions are welcome, and feedback is treasured.
Friday, April 18, 2008
Off to the Southwest!
My beloved and I are taking our son and his beloved for a short one-week journey to Boulder and Santa Fe. I may or may not be blogging on the road, so please stay tuned and come back soon!
Happy Spring!
Happy Spring!
Thursday, April 17, 2008
Please Vote Before April 22nd!
I am announcing for the second time that a proposal submitted by my dear friend Imre Kepes in Massachusetts was selected as a top 20 finalist among nearly 5,000 entries nationwide by the Case Foundation for its Make It Your Own Awards, a grant program that "challenges people from all walks of life to discuss what matters most to them, decide what kind of community they want, and take action together". If you peruse the proposals of the 20 finalists, you will see an amazing array of projects which have the potential to change the world by empowering people within their own communities.
I am asking for your support to help Imre Kepes' project be selected by on-line voting to be one of the Final Four to be awarded an additional $25,000. The Case Foundation will also give $2,500 to the favorite charity of the first 10 people who vote for the four projects that actually become the Make It Your Own Awards Final Four.
Imre's project---The Community Vision Project of Holyoke, MA (a struggling post-industrial city which has seen better days)---will develop a team of youth leaders to inspire others and gather input from a cross-section of residents to develop ideas to make their community a better place. Together they will create a Community Vision Map that will graphically express these ideas and help to inform and mobilize the community. Action teams will work to turn these ideas into action. The Community Vision Project is a collaboration between the Holyoke Youth Task Force Youth Commission, Hampshire College and other youth programs and adults in the community.
To vote for the Community Vision Project to be one of the Final Four, please log onto http://miyo.casefoundation.org/node/6736/promote and simply click on the vote button. Voting ends April 22. Please note that after you have selected your "final four", you will receive an email to which you must respond in order to confirm your vote!
Thank you so much!
I am asking for your support to help Imre Kepes' project be selected by on-line voting to be one of the Final Four to be awarded an additional $25,000. The Case Foundation will also give $2,500 to the favorite charity of the first 10 people who vote for the four projects that actually become the Make It Your Own Awards Final Four.
Imre's project---The Community Vision Project of Holyoke, MA (a struggling post-industrial city which has seen better days)---will develop a team of youth leaders to inspire others and gather input from a cross-section of residents to develop ideas to make their community a better place. Together they will create a Community Vision Map that will graphically express these ideas and help to inform and mobilize the community. Action teams will work to turn these ideas into action. The Community Vision Project is a collaboration between the Holyoke Youth Task Force Youth Commission, Hampshire College and other youth programs and adults in the community.
To vote for the Community Vision Project to be one of the Final Four, please log onto http://miyo.casefoundation.org/node/6736/promote and simply click on the vote button. Voting ends April 22. Please note that after you have selected your "final four", you will receive an email to which you must respond in order to confirm your vote!
Thank you so much!
Sunday, April 13, 2008
The Future of Elder Care, Part I
As my parents, friends and I myself age, I've been doing a great deal of thinking about the state of elder care in this country. The nursing home industry has indeed changed over the last few years, with the lion's share of changes having to do with offering specialized Alzheimer's and dementia care, assisted living, and palliative care for those in need. More and more long-term care facilities appear to be offering services which allow residents to move along a continuum from independent living to complete care, based upon an individual's changing needs. This is a welcome change, but there is so much more that can be done.
With the Baby Boom generation beginning to retire, I predict that the care of the elderly will be an enormous field with unlimited growth and employment potential over the next thirty years. Savvy and relatively wealthy, Boomers will alter the landscape of long-term care by demanding services that the marketplace will naturally bend over backwards to fulfill. For those in a position to finance and create specialized facilities for the care of the elderly, the adage of "build it and they will come" is incredibly apropos at this point in time when it comes to this burgeoning field of healthcare.
When this generation of elders begins to need care beyond what can be provided at home, facilities will indeed need to change in order to satisfy the needs of this new long-term care demographic. Gone will be the days of singing "Melancholy Baby" by the piano. Gone will be many of the entertainment and leisure activities enjoyed by the previous generations who came of age in the first half of the 20th century.
Boomers, having cut their teeth in the 1950's and 1960's, will have a whole new set of cultural sign-posts and icons under their collective belts, and their sensibilities and predilections will need to be honored and integrated as these individuals begin to enter long-term care. With James Dean, The Beats, Jack Kerouac, Woodstock, Richard Nixon, the Civil Rights Movement, The Beatles, the Women's Liberation Movement, and the sexual revolution as major cultural milestones as part of their collective consciousness, Boomers will need a new cultural environment within the long-term care setting which acknowledges their generational history.
As we can observe in many industries, the marketplace will follow consumer demand if a cohort of consumers has enough collective buying power to drive changes. I submit that the Baby Boom generation will do just that, and those of us savvy and caring enough to ride that wave will have the opportunity to provide specialized care to an enormous audience of consumers willing and able to pay for our compassionate services.
(I will be exploring this issue over time and welcome your comments and suggestions along the way. Stay tuned, and there will certainly be more to come.)
With the Baby Boom generation beginning to retire, I predict that the care of the elderly will be an enormous field with unlimited growth and employment potential over the next thirty years. Savvy and relatively wealthy, Boomers will alter the landscape of long-term care by demanding services that the marketplace will naturally bend over backwards to fulfill. For those in a position to finance and create specialized facilities for the care of the elderly, the adage of "build it and they will come" is incredibly apropos at this point in time when it comes to this burgeoning field of healthcare.
When this generation of elders begins to need care beyond what can be provided at home, facilities will indeed need to change in order to satisfy the needs of this new long-term care demographic. Gone will be the days of singing "Melancholy Baby" by the piano. Gone will be many of the entertainment and leisure activities enjoyed by the previous generations who came of age in the first half of the 20th century.
Boomers, having cut their teeth in the 1950's and 1960's, will have a whole new set of cultural sign-posts and icons under their collective belts, and their sensibilities and predilections will need to be honored and integrated as these individuals begin to enter long-term care. With James Dean, The Beats, Jack Kerouac, Woodstock, Richard Nixon, the Civil Rights Movement, The Beatles, the Women's Liberation Movement, and the sexual revolution as major cultural milestones as part of their collective consciousness, Boomers will need a new cultural environment within the long-term care setting which acknowledges their generational history.
As we can observe in many industries, the marketplace will follow consumer demand if a cohort of consumers has enough collective buying power to drive changes. I submit that the Baby Boom generation will do just that, and those of us savvy and caring enough to ride that wave will have the opportunity to provide specialized care to an enormous audience of consumers willing and able to pay for our compassionate services.
(I will be exploring this issue over time and welcome your comments and suggestions along the way. Stay tuned, and there will certainly be more to come.)
Friday, April 11, 2008
Mindfulness Journal #6: Mindfulness Conference
Today I attended an all-day conference on mindfulness and meditation with Terry Fralich, a former student of H.H. The Dalia Lama and Jon Kabat-Zinn. The conference focused equally on cultivating mindfulness, the neurobiology of mindfulness, and how to impart mindfulness practices and philosophies to patients and clients when appropriate.
Here are some nuggets:
---Two parents and their teenage son are walking across a barren desert landscape. The father turns to the son and says, "Stop asking when we're going to get there already. We're nomads, for crying out loud."
---If you have time to worry, why don't you have time to meditate?
---In Tibetan, the word meditation means "to become familiar with"
---We live in an age of "data smog" and "techno-stress"
---Mindfulness is full-hearted presence, which translates into presence/intention and kindness towards the self
---The reality of the moment multiplied by my reactions = suffering
---If my thoughts were a movie, I'd get up, walk out, and probably ask for my money back.
Here are some nuggets:
---Two parents and their teenage son are walking across a barren desert landscape. The father turns to the son and says, "Stop asking when we're going to get there already. We're nomads, for crying out loud."
---If you have time to worry, why don't you have time to meditate?
---In Tibetan, the word meditation means "to become familiar with"
---We live in an age of "data smog" and "techno-stress"
---Mindfulness is full-hearted presence, which translates into presence/intention and kindness towards the self
---The reality of the moment multiplied by my reactions = suffering
---If my thoughts were a movie, I'd get up, walk out, and probably ask for my money back.
Monday, April 07, 2008
Shortages: Not Just for Nurses Anymore
Doctors are leaving primary care in droves. That's the word on the street. Even my own doctor is leaving our local health center to become a hospitalist. As malpractice insurance goes through the roof, paperwork requirements become more stringent, and reimbursement rates plummet (even for Medicare and Medicaid claims), it seems that more and more doctors are choosing to specialize, leaving the pedestrian boredom of primary care for the sexy remunerative opportunities of various medical specialties.
Now, I'm sure that the reasons for a primary physician shortage are far more nuanced than I have so flippantly elucidated here, but the sad reality is that millions of Baby Boomers will begin to retire any day now, and they will all be in need of long-term primary care and preventive medicine in order to keep them healthy and out of the hospital.
In this market-based system, it seems that generalist doctors are being forced to specialize as a way of coping with increasing costs and decreasing revenues. In medical schools, interns and residents apparently are also learning how financially unrewarding primary care can be, and when one considers the cost of attending medical school in the first place, it is no wonder that newly-minted doctors want to maximize their earning potential right out of the gate.
Some reports indicate that advance practice nurses (such as nurse practitioners) will begin to fulfill more and more primary care duties as the shortage of primary care doctors grows, and talk of a new Doctor of Nursing Practice doctoral degree may lead to even more nurses assuming a roles historically held by doctors. These moves may help to assuage the crisis, and all options should be on the table as the crisis deepens.
As for me, I will return to the care of a Nurse Practitioner who left our little health center a few years ago for another position and has now returned. I love the care I receive from a nurse practitioner, and see no reason why I should see a doctor when my NP is capable, competent, and clinically skilled. Sure, my doctor is leaving and I wish him well, but for me there's no crisis, just an opportunity for change.
For the country as a whole, a physician shortage is most certainly problematic, and a shortage of primary care physicians could be devastating. Couple this with an ongoing nursing shortage, and you have one big healthcare mess on the plate of the next president who takes office in nine months.
So, the docs fly the coop and we're left holding the primary care bag. Just how to resolve such a crisis remains to be seen, and it is all of us who will pay the price when the proverbial healthcare feces hits the fan.
Now, I'm sure that the reasons for a primary physician shortage are far more nuanced than I have so flippantly elucidated here, but the sad reality is that millions of Baby Boomers will begin to retire any day now, and they will all be in need of long-term primary care and preventive medicine in order to keep them healthy and out of the hospital.
In this market-based system, it seems that generalist doctors are being forced to specialize as a way of coping with increasing costs and decreasing revenues. In medical schools, interns and residents apparently are also learning how financially unrewarding primary care can be, and when one considers the cost of attending medical school in the first place, it is no wonder that newly-minted doctors want to maximize their earning potential right out of the gate.
Some reports indicate that advance practice nurses (such as nurse practitioners) will begin to fulfill more and more primary care duties as the shortage of primary care doctors grows, and talk of a new Doctor of Nursing Practice doctoral degree may lead to even more nurses assuming a roles historically held by doctors. These moves may help to assuage the crisis, and all options should be on the table as the crisis deepens.
As for me, I will return to the care of a Nurse Practitioner who left our little health center a few years ago for another position and has now returned. I love the care I receive from a nurse practitioner, and see no reason why I should see a doctor when my NP is capable, competent, and clinically skilled. Sure, my doctor is leaving and I wish him well, but for me there's no crisis, just an opportunity for change.
For the country as a whole, a physician shortage is most certainly problematic, and a shortage of primary care physicians could be devastating. Couple this with an ongoing nursing shortage, and you have one big healthcare mess on the plate of the next president who takes office in nine months.
So, the docs fly the coop and we're left holding the primary care bag. Just how to resolve such a crisis remains to be seen, and it is all of us who will pay the price when the proverbial healthcare feces hits the fan.
Sunday, April 06, 2008
The Case Foundation's Make it Your Own Award
I am announcing that a proposal submitted by my dear friend Imre Kepes in Massachusetts was selected as a top 20 finalist among nearly 5,000 entries nationwide by the Case Foundation for its Make It Your Own Awards, a grant program that "challenges people from all walks of life to discuss what matters most to them, decide what kind of community they want, and take action together". If you peruse the proposals of the 20 finalists, you will see an amazing array of projects which have the potential to change the world by empowering people within their own communities.
I am asking for your support to help Imre Kepes' project be selected by on-line voting to be one of the Final Four to be awarded an additional $25,000. The Case Foundation will also give $2,500 to the favorite charity of the first 10 people who vote for the four projects that actually become the Make It Your Own Awards Final Four.
Imre's project---The Community Vision Project of Holyoke, MA (a struggling post-industrial city which has seen better days)---will develop a team of youth leaders to inspire others and gather input from a cross-section of residents to develop ideas to make their community a better place. Together they will create a Community Vision Map that will graphically express these ideas and help to inform and mobilize the community. Action teams will work to turn these ideas into action. The Community Vision Project is a collaboration between the Holyoke Youth Task Force Youth Commission, Hampshire College and other youth programs and adults in the community.
To vote for the Community Vision Project to be one of the Final Four, please log onto http://miyo.casefoundation.org/node/6736/promote and simply click on the vote button. Voting ends April 22. Please note that after you have selected your "final four", you will receive an email to which you must respond in order to confirm your vote!
Thank you so much!
I am asking for your support to help Imre Kepes' project be selected by on-line voting to be one of the Final Four to be awarded an additional $25,000. The Case Foundation will also give $2,500 to the favorite charity of the first 10 people who vote for the four projects that actually become the Make It Your Own Awards Final Four.
Imre's project---The Community Vision Project of Holyoke, MA (a struggling post-industrial city which has seen better days)---will develop a team of youth leaders to inspire others and gather input from a cross-section of residents to develop ideas to make their community a better place. Together they will create a Community Vision Map that will graphically express these ideas and help to inform and mobilize the community. Action teams will work to turn these ideas into action. The Community Vision Project is a collaboration between the Holyoke Youth Task Force Youth Commission, Hampshire College and other youth programs and adults in the community.
To vote for the Community Vision Project to be one of the Final Four, please log onto http://miyo.casefoundation.org/node/6736/promote and simply click on the vote button. Voting ends April 22. Please note that after you have selected your "final four", you will receive an email to which you must respond in order to confirm your vote!
Thank you so much!
Friday, April 04, 2008
Martin Luther King, Forty Years and Counting
It was 40 years ago today that Martin Luther King, Jr. was assassinated on the balcony of a Memphis, Tennessee motel. Like so many others---known or unknown---King worked tirelessly for the rights of others, and he was one more who fell unnecessarily to the unforgiving hand of violence.
Race still matters in this country, and it touches every person on Earth, and although King's dream is still not fully realized, we all carry the collective responsibility to see it through. From astronomical rates of incarceration for young men of color to predatory lending targeted at communities of color, there is indeed still a long way to go.
In memory of Dr. King, may we all still stand for justice.
Race still matters in this country, and it touches every person on Earth, and although King's dream is still not fully realized, we all carry the collective responsibility to see it through. From astronomical rates of incarceration for young men of color to predatory lending targeted at communities of color, there is indeed still a long way to go.
In memory of Dr. King, may we all still stand for justice.
Thursday, April 03, 2008
Of Order and Chaos
I enter the apartment building and stop at the security desk.
“Who are you here to see?” asks the surprisingly pleasant security guard. She is a large African American woman, and she regards me with a friendly and curious expression.
“I’m here to see Mr. A,” I reply, fingering the ID badge that's clipped to my jacket. “Visiting nurses.”
“Oh, God bless you,” she says. “Good luck. Tenth floor, turn right out of the elevator."
I travel the ten floors in the briefest of upward journeys, and make my way down the hall, looking at the numbers on the apartment doors. His door at the end of the hall is wide open. I stand on the threshold and peer in. I knock and a voice responds, welcoming me in.
“Mr. A? I’m from the visiting nurses. May I come in?”
“Sure, sure, come in, come in,” says a disembodied voice from inside.
I step inside the studio apartment. To my left is the kitchen, or what once was a kitchen and is now more of a storage closet which only pretends to be a kitchen. Every surface is covered with papers, pens, and trash. Even the counters are covered, and the sink is full of dishes as well as a sheaf of papers and a telephone book.
Mr. A pokes his head around the wall that separates the kitchen from the living room.
“Come in here, please, please,” he says invitingly.
The fax that I received on this patient said that he could be combative, distant, or uncooperative. This gentleman seems so much the opposite, at least at first glance, anyway.
“How are you this morning?” I ask, as I attempt with some difficulty to clear a place on the table to put my bag.
“Oh, not so good, not so bad, but I’m going to visit my sister later today.”
His accent could be Indian, or maybe Pakistani, but I don’t want to ask. His diagnosis is paranoid schizophrenia, after all, and as a nurse who is visiting him for the first time, I don’t want to potentially alienate him from the start.
I take in the rest of his living space. The twin bed in the corner is covered with papers, envelopes, and a few plates of partially eaten food. A rowing machine takes up most of the center of the small apartment, and I marvel at the flotsam and jetsam that covers every surface.
“Did you take your meds last night, Mr. A?” I ask.
“Oh yes, here you are,” he says as he hands me the pill container which yesterday’s nurse prefilled for him yesterday morning. It’s empty.
“How did you sleep last night?”
“Very well, thanks,” he replies. His eye contact is good, although he seems to be uncomfortable sitting still at the table with me.
“Oh, before I forget, could you sign this for me?” I hand him my visit note, which has a place for patients to sign as proof that the nurse was actually there for the visit.
“That’s for them to know you were here, right?”
“Yes sir, you have that right, “ I reply.
He is so conversant, so positive and forthright. He is like the opposite of what I was told to expect.
I survey the remainder of his living space and see piles of papers everywhere. There is trash on the floor, chicken bones, milk cartons, a few cardboard boxes. I wonder what trauma or experience caused him to live like this. Although his eye contact is good, there is a wariness that I am now picking up on, a sense that he is uncomfortable in his own skin. Still, I feel completely comfortable with him, and we smile at one another.
I busy myself filling his med box with his morning and evening pills, reading the list carefully and putting my initials in each little box after I place that particular pill in its rightful place. He watches me closely. Once I‘m finished with the meds, I double-check the list and feel satisfied that I did it correctly. I hand him his morning meds.
“Thanks,” he says as he pops them all in his mouth and raises a large mug of water to his lips.
I check his blood pressure and pulse, listen to his lungs, and questions him briefly about his bowels, his urinary status, his appetite, his sleep quality, all the while looking in his eyes, assessing his skin and getting a general intuitive “read” on his overall health.
“Thanks for coming,” he says, as he walks me to the door.
The floor, covered with trash and papers, is like the elephant in the room that I dare not mention. Were he my patient, I would slowly address these issues over time. But in my position as just one more nurse passing through, I leave the elephant for someone else.
We shake hands and I leave his apartment. Even though I have been to so many homes like this in the past, I am stunned by how this man lives, and by the quiet desperation that I saw in his eyes.
“And how was our friend today?” asks the security guard who blessed me just thirty minutes prior.
“Just fine today, just fine,” I reply. “Thanks for your help.”
“God bless you” is her reply, delivered with a wave and a smile.
The outside air is fresh and cold, and I welcome my reentry into the clean orderliness of the wider world.
“Who are you here to see?” asks the surprisingly pleasant security guard. She is a large African American woman, and she regards me with a friendly and curious expression.
“I’m here to see Mr. A,” I reply, fingering the ID badge that's clipped to my jacket. “Visiting nurses.”
“Oh, God bless you,” she says. “Good luck. Tenth floor, turn right out of the elevator."
I travel the ten floors in the briefest of upward journeys, and make my way down the hall, looking at the numbers on the apartment doors. His door at the end of the hall is wide open. I stand on the threshold and peer in. I knock and a voice responds, welcoming me in.
“Mr. A? I’m from the visiting nurses. May I come in?”
“Sure, sure, come in, come in,” says a disembodied voice from inside.
I step inside the studio apartment. To my left is the kitchen, or what once was a kitchen and is now more of a storage closet which only pretends to be a kitchen. Every surface is covered with papers, pens, and trash. Even the counters are covered, and the sink is full of dishes as well as a sheaf of papers and a telephone book.
Mr. A pokes his head around the wall that separates the kitchen from the living room.
“Come in here, please, please,” he says invitingly.
The fax that I received on this patient said that he could be combative, distant, or uncooperative. This gentleman seems so much the opposite, at least at first glance, anyway.
“How are you this morning?” I ask, as I attempt with some difficulty to clear a place on the table to put my bag.
“Oh, not so good, not so bad, but I’m going to visit my sister later today.”
His accent could be Indian, or maybe Pakistani, but I don’t want to ask. His diagnosis is paranoid schizophrenia, after all, and as a nurse who is visiting him for the first time, I don’t want to potentially alienate him from the start.
I take in the rest of his living space. The twin bed in the corner is covered with papers, envelopes, and a few plates of partially eaten food. A rowing machine takes up most of the center of the small apartment, and I marvel at the flotsam and jetsam that covers every surface.
“Did you take your meds last night, Mr. A?” I ask.
“Oh yes, here you are,” he says as he hands me the pill container which yesterday’s nurse prefilled for him yesterday morning. It’s empty.
“How did you sleep last night?”
“Very well, thanks,” he replies. His eye contact is good, although he seems to be uncomfortable sitting still at the table with me.
“Oh, before I forget, could you sign this for me?” I hand him my visit note, which has a place for patients to sign as proof that the nurse was actually there for the visit.
“That’s for them to know you were here, right?”
“Yes sir, you have that right, “ I reply.
He is so conversant, so positive and forthright. He is like the opposite of what I was told to expect.
I survey the remainder of his living space and see piles of papers everywhere. There is trash on the floor, chicken bones, milk cartons, a few cardboard boxes. I wonder what trauma or experience caused him to live like this. Although his eye contact is good, there is a wariness that I am now picking up on, a sense that he is uncomfortable in his own skin. Still, I feel completely comfortable with him, and we smile at one another.
I busy myself filling his med box with his morning and evening pills, reading the list carefully and putting my initials in each little box after I place that particular pill in its rightful place. He watches me closely. Once I‘m finished with the meds, I double-check the list and feel satisfied that I did it correctly. I hand him his morning meds.
“Thanks,” he says as he pops them all in his mouth and raises a large mug of water to his lips.
I check his blood pressure and pulse, listen to his lungs, and questions him briefly about his bowels, his urinary status, his appetite, his sleep quality, all the while looking in his eyes, assessing his skin and getting a general intuitive “read” on his overall health.
“Thanks for coming,” he says, as he walks me to the door.
The floor, covered with trash and papers, is like the elephant in the room that I dare not mention. Were he my patient, I would slowly address these issues over time. But in my position as just one more nurse passing through, I leave the elephant for someone else.
We shake hands and I leave his apartment. Even though I have been to so many homes like this in the past, I am stunned by how this man lives, and by the quiet desperation that I saw in his eyes.
“And how was our friend today?” asks the security guard who blessed me just thirty minutes prior.
“Just fine today, just fine,” I reply. “Thanks for your help.”
“God bless you” is her reply, delivered with a wave and a smile.
The outside air is fresh and cold, and I welcome my reentry into the clean orderliness of the wider world.
Wednesday, April 02, 2008
Immeasurable Abundance
A dear friend who I've known since I was 13 years old sent me the following text message this afternoon:
This simple phrase was like a sword of clarity cutting through my day, and I felt quite uplifted by it. I've been worrying about money, work, taxes, my health, our house, chores, the endless list of to-do's.
This simple message told me to just take a breath and realize that there is enough time and energy to go around, that it will all get done in good time (and if not, see Monday's post.....)
Even more food for thought for a busy mind in the Information Age.
"The essential nature of the Universe is immeasurable abundance."
This simple phrase was like a sword of clarity cutting through my day, and I felt quite uplifted by it. I've been worrying about money, work, taxes, my health, our house, chores, the endless list of to-do's.
This simple message told me to just take a breath and realize that there is enough time and energy to go around, that it will all get done in good time (and if not, see Monday's post.....)
Even more food for thought for a busy mind in the Information Age.
Tuesday, April 01, 2008
Connection and Wonder
The house was filled with screaming and playing children and I could barely think straight. Trying to fill med boxes and query my patient about her health, I was having trouble concentrating.
All of a sudden, I looked up from my work at the kitchen table to see four earnest young faces staring at me. Sensing an opportunity, I decided to set the meds aside for a moment and check my patient's blood pressure instead. The children watched with rapt attention as I wrapped the cuff around their grandmother's arm, their fascination growing as I began to pump up the cuff and place the bell of my stethoscope on the crook of her elbow.
Finishing with the blood pressure, I knelt down and offered the oldest girl my stethoscope. I guided the ear-pieces into her small ears and then placed the bell of the stethoscope on her sister's chest. She smiled and giggled as she listened to her sister's heart, lub-dub, lub-dub, lub-dub. Each child in succession took turns listening to another child's heart, and by the time we were done, they were calm as can be and simply beaming.
After I left the house, I wondered to myself just how common it might be for a simple experience---like using a stethoscope for the first time---to end up being a crystallizing moment in a child's life, perhaps laying the groundwork for their adult life. Whatever the outcome, I had a great moment with those children today, and whether they remember it or not, we all had that brief time of connection and wonder, and that was worth more than words can say.
All of a sudden, I looked up from my work at the kitchen table to see four earnest young faces staring at me. Sensing an opportunity, I decided to set the meds aside for a moment and check my patient's blood pressure instead. The children watched with rapt attention as I wrapped the cuff around their grandmother's arm, their fascination growing as I began to pump up the cuff and place the bell of my stethoscope on the crook of her elbow.
Finishing with the blood pressure, I knelt down and offered the oldest girl my stethoscope. I guided the ear-pieces into her small ears and then placed the bell of the stethoscope on her sister's chest. She smiled and giggled as she listened to her sister's heart, lub-dub, lub-dub, lub-dub. Each child in succession took turns listening to another child's heart, and by the time we were done, they were calm as can be and simply beaming.
After I left the house, I wondered to myself just how common it might be for a simple experience---like using a stethoscope for the first time---to end up being a crystallizing moment in a child's life, perhaps laying the groundwork for their adult life. Whatever the outcome, I had a great moment with those children today, and whether they remember it or not, we all had that brief time of connection and wonder, and that was worth more than words can say.
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