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.
Wednesday, February 27, 2008
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.
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.
"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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Tuesday, January 29, 2008
When Cancer Spreads Its Wings
Cancer insidiously spreads itself into remote corners of the body, with greedy fingers reaching out where it is most unwanted. With unmatched stealth, it manages to send pieces of itself to distant organs through avenues of lymph or blood. And strangely enough, even if the cancer originated in the lungs, any distant metastasis will always show microscopic signs of its organ of origin if a scientist or doctor cares to check. So, if a brain cancer eventually lodges itself into the femur or spine, there are cellular markers that will actually brand that metastasis as originating in the brain. It's like a postmark by the cancer post office which delivers nauseating information of its original port of entry.
As the cancer nudges its way into various body systems and organs, it chokes off blood supply lines, interrupts normal metabolic activity, and insinuates itself in places where it is wholly unwelcome. Once it invades an area, the tumor will then begin to grow its own blood vessels, co-opting a nourishing blood supply for its own devices. Deprived of adequate circulation of blood, important organs or tissues become compromised and begin to malfunction or die. Chain reactions of metabolic chaos are set off, and delicate biological balances begin to be altered. At a certain point, there is no turning back, and the body begins an inexorable decline.
If treatment is chosen, the damage done by both chemotherapy and radiation can often exacerbate previous symptoms or create new ones. Radiation can permanently damage certain tissues which happen to be in the way of the treatment, and chemotherapy is wholly nonselective in which cells it destroys. For this reason, hair and other fast-growing cells are killed, including the lining of the gastrointestinal tract. Many cancer patients will say that the effects of the treatment are worse than the disease. An ironic reality.
When a patient comes to hospice, no further treatments are planned, and the disease is left to run its natural course. Left to its own devices, cancer spreads its wings and lodges in brain, bone, liver, lung---almost anywhere. And while certain cancers have a predilection for metastasizing to certain distant lands, it will also simply begin to work its way into locally adjacent sites, pushing through tissue, breaking down walls, filling up cavities, destroying connective tissue. If the cancer is in a visceral organ like the pancreas, it will choke off vital blood vessels and take up more and more space in a crowded abdominal cavity. Back pain, nausea, and radiation of pain to the flank will only add insult to injury as the cancer slowly takes over more and more bodily real estate. Running amok, symptom management and alleviation of suffering become the only goal.
As the patient nears the end, all medications are stopped which do not directly treat specific symptoms related to the cancer or its effects. Eventually, much to a family's dismay, medications for underlying chronic disorders (like thyroid diseases or diabetes, for instance) will simply be discontinued. Just as the cancer is allowed to run its course, other underlying conditions are allowed to simply coexist with the cancer, and the management of symptoms and the alleviation of pain and suffering hold sway as the laser beam focus of care.
As a clinician or a family member, this decline of the body as it is taken over by unwanted forces is difficult to witness. Family members and friends may face denial, anger, or any number of reactions as their loved one declines before their eyes. With any luck, skilled clinicians can provide the emotional, psychological and spiritual support which is so needed at this pivotal time. Clergy and other members of the care team can also provide additional support as the situation spirals inexorably towards death.
Countless patients and families experience this series of battles and maddening losses when cancer moves to a stage beyond treatment or cure. With physical illness comes loss of independence, mental decline, spiritual questioning, and psycho-emotional changes. When hope of a cure has vanished, then hope for peace and freedom from suffering become the focus, and a thoughtful hospice team will treat the family as skilfully as it treats the dying patient.
Many of us have walked this road with a loved one or known someone who has. Cancer somehow seems to touch a majority of families, either by direct experience or at least by association. In my own family, every man on my father's and mother's side seems to have died from cancer, and my step-father succumbed to pancreatic cancer less than five months ago.
I have known cancer intimately in my personal life and my professional life, and while it is an acquaintance I don't covet, it is one which has brought me deeper knowledge of the human condition beyond anything I could ever have imagined. Without a doubt, even more learning will ensue as I work in a hospice setting, but also simply from being a human being in relation to other human beings who are facing illness and the certainty of death.
To anyone who has lived through the loss of a loved one to cancer, I offer my sincerest condolences, my prayers for your healing, my prayers for your loved one's soul, and my hopes that your life and family will be further spared unnecessary suffering. In the face of loss and death, we all must face our own mortality and spiritual pain, and I wish you, dear Reader, strength and peace in your own travels down this often turbulent and troubling path of human existence. Namaste.
As the cancer nudges its way into various body systems and organs, it chokes off blood supply lines, interrupts normal metabolic activity, and insinuates itself in places where it is wholly unwelcome. Once it invades an area, the tumor will then begin to grow its own blood vessels, co-opting a nourishing blood supply for its own devices. Deprived of adequate circulation of blood, important organs or tissues become compromised and begin to malfunction or die. Chain reactions of metabolic chaos are set off, and delicate biological balances begin to be altered. At a certain point, there is no turning back, and the body begins an inexorable decline.
If treatment is chosen, the damage done by both chemotherapy and radiation can often exacerbate previous symptoms or create new ones. Radiation can permanently damage certain tissues which happen to be in the way of the treatment, and chemotherapy is wholly nonselective in which cells it destroys. For this reason, hair and other fast-growing cells are killed, including the lining of the gastrointestinal tract. Many cancer patients will say that the effects of the treatment are worse than the disease. An ironic reality.
When a patient comes to hospice, no further treatments are planned, and the disease is left to run its natural course. Left to its own devices, cancer spreads its wings and lodges in brain, bone, liver, lung---almost anywhere. And while certain cancers have a predilection for metastasizing to certain distant lands, it will also simply begin to work its way into locally adjacent sites, pushing through tissue, breaking down walls, filling up cavities, destroying connective tissue. If the cancer is in a visceral organ like the pancreas, it will choke off vital blood vessels and take up more and more space in a crowded abdominal cavity. Back pain, nausea, and radiation of pain to the flank will only add insult to injury as the cancer slowly takes over more and more bodily real estate. Running amok, symptom management and alleviation of suffering become the only goal.
As the patient nears the end, all medications are stopped which do not directly treat specific symptoms related to the cancer or its effects. Eventually, much to a family's dismay, medications for underlying chronic disorders (like thyroid diseases or diabetes, for instance) will simply be discontinued. Just as the cancer is allowed to run its course, other underlying conditions are allowed to simply coexist with the cancer, and the management of symptoms and the alleviation of pain and suffering hold sway as the laser beam focus of care.
As a clinician or a family member, this decline of the body as it is taken over by unwanted forces is difficult to witness. Family members and friends may face denial, anger, or any number of reactions as their loved one declines before their eyes. With any luck, skilled clinicians can provide the emotional, psychological and spiritual support which is so needed at this pivotal time. Clergy and other members of the care team can also provide additional support as the situation spirals inexorably towards death.
Countless patients and families experience this series of battles and maddening losses when cancer moves to a stage beyond treatment or cure. With physical illness comes loss of independence, mental decline, spiritual questioning, and psycho-emotional changes. When hope of a cure has vanished, then hope for peace and freedom from suffering become the focus, and a thoughtful hospice team will treat the family as skilfully as it treats the dying patient.
Many of us have walked this road with a loved one or known someone who has. Cancer somehow seems to touch a majority of families, either by direct experience or at least by association. In my own family, every man on my father's and mother's side seems to have died from cancer, and my step-father succumbed to pancreatic cancer less than five months ago.
I have known cancer intimately in my personal life and my professional life, and while it is an acquaintance I don't covet, it is one which has brought me deeper knowledge of the human condition beyond anything I could ever have imagined. Without a doubt, even more learning will ensue as I work in a hospice setting, but also simply from being a human being in relation to other human beings who are facing illness and the certainty of death.
To anyone who has lived through the loss of a loved one to cancer, I offer my sincerest condolences, my prayers for your healing, my prayers for your loved one's soul, and my hopes that your life and family will be further spared unnecessary suffering. In the face of loss and death, we all must face our own mortality and spiritual pain, and I wish you, dear Reader, strength and peace in your own travels down this often turbulent and troubling path of human existence. Namaste.
Monday, January 28, 2008
Of Hospice and Free Agency
Life as a (per diem) hospice nurse has certainly altered what (some of) my workdays can be like. Instead of answering to the unending demands of more than eighty needy patients as a care manager, I now answer to the rather predictable needs of no more than six residential patients.
What is unusual about my hospice work is that, during any given shift, one nurse and one home health aide must not only provide direct care to six patients in varying states of illness, including medications, bathing, treatments, dressings, and toileting. We are also responsible for preparing meals, cleaning up after meals, feeding patients who need to be fed, doing laundry, answering phones, taking out trash and recycling, and doing general housekeeping. If it sounds like a lot, it is, and I often feel that I am torn in a dozen directions at once.
Just today, in the midst of tending to a patient's lacerations from an early morning fall and calling the medical director about orders, we were toileting patients, passing medications, answering call bells, preparing breakfast, and thinking about how to begin preparing for lunch as we cleaned up from the maelstrom of breakfast. Phew! With several patients who are at risk for falls, and several who may be entering the final stages of life, meal preparation can sometimes seem like the last thing one wants to think about. But it must be done, nonetheless.
Still, as a workplace wherein I come and go, it is still a relief to simply do just that---come and go. The benefits of not being full-time anywhere are still making themselves known. For now, I revel in the fact that there is nowhere I report to day in and day out. And that free agency is a blessing beyond measure.
What is unusual about my hospice work is that, during any given shift, one nurse and one home health aide must not only provide direct care to six patients in varying states of illness, including medications, bathing, treatments, dressings, and toileting. We are also responsible for preparing meals, cleaning up after meals, feeding patients who need to be fed, doing laundry, answering phones, taking out trash and recycling, and doing general housekeeping. If it sounds like a lot, it is, and I often feel that I am torn in a dozen directions at once.
Just today, in the midst of tending to a patient's lacerations from an early morning fall and calling the medical director about orders, we were toileting patients, passing medications, answering call bells, preparing breakfast, and thinking about how to begin preparing for lunch as we cleaned up from the maelstrom of breakfast. Phew! With several patients who are at risk for falls, and several who may be entering the final stages of life, meal preparation can sometimes seem like the last thing one wants to think about. But it must be done, nonetheless.
Still, as a workplace wherein I come and go, it is still a relief to simply do just that---come and go. The benefits of not being full-time anywhere are still making themselves known. For now, I revel in the fact that there is nowhere I report to day in and day out. And that free agency is a blessing beyond measure.
Saturday, January 26, 2008
Awoken by Pain
I am awoken by pain this morning. My pain is like a ball crammed into my right lower back muscles, a most unwelcome visitor. My pain is like a parasite that distracts my attention, sometimes limiting my ability to be present, or worse, shortening my fuse.
I try to not allow my pain to limit what I do, but I have to admit that it already has. Cross-country skiing? Forget it. Sitting comfortably for more than an hour? Generally not possible. Waking from sleep without discomfort? A rare occurrence. And even swimming, that form of exercise that seems the most low-impact? Aches nonetheless.
So what does one do with pain which seems to want to stick around and be a constant companion? I've tried ignoring it. I've tried catering to it. I've talked to it and rejected it. For now, it seems that I'll simply continue to try to live my life as if it weren't there.
I try to not allow my pain to limit what I do, but I have to admit that it already has. Cross-country skiing? Forget it. Sitting comfortably for more than an hour? Generally not possible. Waking from sleep without discomfort? A rare occurrence. And even swimming, that form of exercise that seems the most low-impact? Aches nonetheless.
So what does one do with pain which seems to want to stick around and be a constant companion? I've tried ignoring it. I've tried catering to it. I've talked to it and rejected it. For now, it seems that I'll simply continue to try to live my life as if it weren't there.
Wednesday, January 23, 2008
The New World
What a difference a week makes. From one week to the next, my life has shifted from a eleven-year history of full-time employment to a new paradigm of self-directed part-time employment which is still somewhat puzzling to my reeling brain and mind.
How does one arrange one's days when they aren't built around the 9 to 5 framework? What parameters does one set in order to get things done, balanced with time to not do anything at all? Does one think, "Don't just sit there, do something!" or "Don't just do something, sit there!"?
What does it mean to not have one job that defines one's place in the working world? When someone asks the ubiquitous question, "What do you do?", what becomes your new ten-second elevator speech?
"Well, you see, I'm a newly-minted under-employed nurse slacker, waxing poetic---latte in hand---at a cafe with Wifi near you!" Or perhaps, "I'm a burnt-out nurse with more per diem jobs than I can count."
However one defines it, I know this first week has seen me working a few hospice shifts, attending my new Tai Chi/Qi Gong class and my new writers' workshop, and---dammit---crying uncontrollably during a matinee showing of The Kite Runner. My slacker cup runneth over.
I embrace this new life, even as I must accept not commuting with Mary every day, letting go of my beloved work family, and allowing the uncertain fickleness of this new paradigm to overrun my life. Gaining control of these new reins, I have no doubt that a kinder, gentler work-life will emerge, seeded with challenge yet relatively free of the trappings which so efficiently burnt me to a crispy shadow of my former self.
Here's a toast to newness and all its inherent uncertainty.
How does one arrange one's days when they aren't built around the 9 to 5 framework? What parameters does one set in order to get things done, balanced with time to not do anything at all? Does one think, "Don't just sit there, do something!" or "Don't just do something, sit there!"?
What does it mean to not have one job that defines one's place in the working world? When someone asks the ubiquitous question, "What do you do?", what becomes your new ten-second elevator speech?
"Well, you see, I'm a newly-minted under-employed nurse slacker, waxing poetic---latte in hand---at a cafe with Wifi near you!" Or perhaps, "I'm a burnt-out nurse with more per diem jobs than I can count."
However one defines it, I know this first week has seen me working a few hospice shifts, attending my new Tai Chi/Qi Gong class and my new writers' workshop, and---dammit---crying uncontrollably during a matinee showing of The Kite Runner. My slacker cup runneth over.
I embrace this new life, even as I must accept not commuting with Mary every day, letting go of my beloved work family, and allowing the uncertain fickleness of this new paradigm to overrun my life. Gaining control of these new reins, I have no doubt that a kinder, gentler work-life will emerge, seeded with challenge yet relatively free of the trappings which so efficiently burnt me to a crispy shadow of my former self.
Here's a toast to newness and all its inherent uncertainty.
Monday, January 21, 2008
Happy Birthday, MLK!
Happy Birthday to a man who changed the world by walking his talk, and by empowering others by his example of selfless sacrifice and devotion to justice. Martin Luther King graced this earth briefly, but he left a legacy which is, and always will be, larger than life.
Last year, I had the privilege to visit the burial place of Mr. King in Atlanta, as well as his childhood home and the excellent and moving museum dedicated to his memory. It was a great day for me to visit those hallowed places, and I look forward to visiting again and again.
It is a profound day for our country---and the world---and I pause in thought in memory of one of the greatest leaders in history.
Last year, I had the privilege to visit the burial place of Mr. King in Atlanta, as well as his childhood home and the excellent and moving museum dedicated to his memory. It was a great day for me to visit those hallowed places, and I look forward to visiting again and again.
It is a profound day for our country---and the world---and I pause in thought in memory of one of the greatest leaders in history.
Sunday, January 20, 2008
Three Years
Amidst the excitement of leaving my full-time job after seven years, the 3rd birthday of Digital Doorway slipped right by me on the 18th of January. It's hard to believe that three years have elapsed since I posted my first missive on this blog (thanks to a suggestion from my brother). It has been a satisfying ride, and blogging has opened doors of friendship, camaraderie, creativity, community, and, lo and behold, some paid work as a writer. (Stay tuned as Nurse LinkUp---a new online networking community for nurses---is relaunched, wherein I will be a main contributor of content.)
Thank you to everyone who visits this site, for those who choose to comment occasionally, and for my fellow bloggers who send traffic my way. I am happy to say that blogging comes as naturally as walking these days, and I look forward to three more years of the digital journey.
Thank you to everyone who visits this site, for those who choose to comment occasionally, and for my fellow bloggers who send traffic my way. I am happy to say that blogging comes as naturally as walking these days, and I look forward to three more years of the digital journey.
Saturday, January 19, 2008
A Chapter Closes, a Chapter Opens
As of today, I am no longer employed as a full-time worker. After eleven years of working 9 to 5 as a nurse, I am now a free agent, able to pick and choose when and where I work, on my own terms. With per diem status at four separate agencies, my weeks are mine to orchestrate and conduct. Of course, this means that I must now keep track of a much more complicated personal and professional schedule, and I must hope that I never show up at the wrong workplace on the wrong day. Still, the sense of freedom is incredible, and it will take some time to actually get my head around this new reality.
Of note, one of my greatest losses is the fact that my wife Mary and I will no longer be commuting together every day, and we will no longer be only 200 yards apart during our long workdays, meeting in the park for walks and sitting down for lunch in the midst of our harried days. As director of an inner city senior center just minutes from my former office, we have shared a place in this community for more than a year, and we both feel this palpable loss. I will be visiting weekly, able to actually be more present when I am indeed there, but there is still a loss incurred, and we are both processing its impact.
Yesterday, I was overwhelmed by my colleagues' generosity as a surprise luncheon was held in my honor. According to my wishes, money was collected for a donation to Save Darfur, but my thoughtful colleagues still had to throw in a gift certificate to a local spa and a very personal photo album with a photo of each person accompanied by a personal message. It was a bittersweet day, and some tears were shed (by myself and others). I was, and am, deeply touched by such an outpouring of good will and camaraderie. I will miss my work family deeply. Even though I will help out at the office on a per diem basis from time to time, it will never be the same, and that is clearer and clearer to me even now.
As sad as it has been to say goodbye to so many patients, it is truly a great relief to know that my responsibility for the management of more than eighty individuals' healthcare is over, and I can look forward to new types of therapeutic relationships with patients in varied clinical settings. Change is difficult and inevitable, and I embrace it willingly, even as moments of doubt and grief wash through me like waves.
For better or worse, I have shifts planned for both tomorrow and Monday at my new hospice job, short-circuiting any immediate sense of breathing room. However, there is plenty of time for breathing, and I plan to do a great deal of that each and every day.
For the moment, an inner sigh of relief, and a sense of peace that a chapter has been closed, a new one being written moment by moment, and day by day. I welcome the new, and will certainly cherish the old in a special place in my heart.
Of note, one of my greatest losses is the fact that my wife Mary and I will no longer be commuting together every day, and we will no longer be only 200 yards apart during our long workdays, meeting in the park for walks and sitting down for lunch in the midst of our harried days. As director of an inner city senior center just minutes from my former office, we have shared a place in this community for more than a year, and we both feel this palpable loss. I will be visiting weekly, able to actually be more present when I am indeed there, but there is still a loss incurred, and we are both processing its impact.
Yesterday, I was overwhelmed by my colleagues' generosity as a surprise luncheon was held in my honor. According to my wishes, money was collected for a donation to Save Darfur, but my thoughtful colleagues still had to throw in a gift certificate to a local spa and a very personal photo album with a photo of each person accompanied by a personal message. It was a bittersweet day, and some tears were shed (by myself and others). I was, and am, deeply touched by such an outpouring of good will and camaraderie. I will miss my work family deeply. Even though I will help out at the office on a per diem basis from time to time, it will never be the same, and that is clearer and clearer to me even now.
As sad as it has been to say goodbye to so many patients, it is truly a great relief to know that my responsibility for the management of more than eighty individuals' healthcare is over, and I can look forward to new types of therapeutic relationships with patients in varied clinical settings. Change is difficult and inevitable, and I embrace it willingly, even as moments of doubt and grief wash through me like waves.
For better or worse, I have shifts planned for both tomorrow and Monday at my new hospice job, short-circuiting any immediate sense of breathing room. However, there is plenty of time for breathing, and I plan to do a great deal of that each and every day.
For the moment, an inner sigh of relief, and a sense of peace that a chapter has been closed, a new one being written moment by moment, and day by day. I welcome the new, and will certainly cherish the old in a special place in my heart.
Thursday, January 17, 2008
The Long Goodbye
Well, it's the eve of my final day of full-time work and I can't sleep. Is there really any wonder why? Plus, my stomach has been acting up all week, my appetite is off, my back hurts more the last 48 hours, and my Restless Legs Syndrome is back with a vengeance, meds be damned.
Still, amidst it all, I am maintaining a relatively sunny outlook, and feel enormously good about my decision to leave.
Still, amidst it all, I am maintaining a relatively sunny outlook, and feel enormously good about my decision to leave.
On the phone with a patient this afternoon after having already said our official goodbyes yesterday, my patient said: "OK, I'm not going to say goodbye, because yesterday after we hung up, I burst into tears. So, see you later!" Gulp.
Another patient said, "Man, I'm gonna miss you so much. What am I gonna do without you?"
I also had four no-show's for appointments over the last two days. Avoidance, or just par for the course?
One of the hardest things is having already said goodbye to a patient, and then they call again and again with additional questions, and we have to go through the whole thing all over. Harder still is simply not being able to see everyone face to face, or wanting to make yet another visit to have further closure and simply not being able to do so due to time constraints.
These last three days have been simply hellish in terms of work load, and I have spent the majority of the week feeling under assault, a term my wife used to characterize what my job seems like most of the time.
I am always coming up with new metaphors for what our office is like, and this week it seems like a beach-head where an army has entrenched, digging bunkers and setting up strategic positions. Calls from patients are like shells lobbed into our midst, and the resultant shrapnel is the fallout of each call, sending us scurrying to put out the fires caused by each barrage. As each new call comes in, the administrative staff yell "INCOMING!" at the top of their lungs as we clinicians duck, hoping not to be hit with a bombshell of unmet need.
I am always coming up with new metaphors for what our office is like, and this week it seems like a beach-head where an army has entrenched, digging bunkers and setting up strategic positions. Calls from patients are like shells lobbed into our midst, and the resultant shrapnel is the fallout of each call, sending us scurrying to put out the fires caused by each barrage. As each new call comes in, the administrative staff yell "INCOMING!" at the top of their lungs as we clinicians duck, hoping not to be hit with a bombshell of unmet need.
After seven years of such constant hammering away at my psyche, I'm ready for a rest from case management. I welcome the opportunity to simply go to work, be present for a shift, to give my all, to serve those in need in the moment, and then retire to my home with no further worries or concerns. While I am certain to eventually miss the long-term relationships which do indeed offer such richness, I welcome this change like manna from heaven.
Tuesday, January 15, 2008
A Wall of Need and Shared Humanity
Following a snow-day on Monday which elongated the weekend into a luxurious three days, I was hit straight on today by a wall of need which simply plowed down everything in its path. Like a fly waiting for a windshield on the freeway (a nod to Peter Gabriel for that imagery), I was like a sitting duck as the calls came pouring in throughout the day. Narcotic prescriptions, sick calls, complaints, missed appointments, more sick calls, prescriptions, transportation problems, more missed appointments, electrciity cut off for non-payment, even more narcotics---the day wore on uncomfortably, like wearing a suit that's too tight.
Towards the end of the day, I realized that my days of being responsible for all of these patients and their care are coming to a close. With just three days of full-time employment remaining, this is essentially my "field goal" for the week (note the highly rare sports metaphor). I kept saying to myself: "This is my final Tuesday. This is my final Tuesday." Waves of relief were juxtaposed with alternate (albeit smaller) waves of grief and/or loss.
One patient and I came to some semblance of closure on the phone this afternoon, although since she is the one person who I have actually given my phone number to, the closure had to do with our professional relationship rather than our new friendship. Our boundaries are clear, and I have no doubt that she would never abuse her personal access to me.
Conversely, other patients seem to be extending their needy tentacles towards me as I attempt to extricate myself, and I give non-committal answers when they ask me to "keep in touch", and I generally respond by saying that I'll hopefully see them around the clinic from time to time.
Sitting at the computer in the doctors' area, I print out narcotic prescription after narcotic presciption, and I give thanks that these days will soon come to pass. This narcotic merry-go-round of which I have so recently written really seems to often put me over the proverbial edge. And with 5:00 pm Friday on the not-so-distant horizon, I feel excited at the prospect of so many odious and redundant tasks falling by the wayside.
Still, the human side of nursing is the sweetest, and the blessings and compassion which I receive from the majority of patients warms my heart and lightens my soul. When I choose to share with certain patients that I have been struggling with chronic stress-related illness and pain, the compassion that I feel reflected back to me means more than I can ever communicate in return. Shared humanity is truly the beautiful core of a healthy therapeutic relationship, and I am moved that that beauty is reflected in the eyes of many patients as I bid a heartfelt adieu.
Towards the end of the day, I realized that my days of being responsible for all of these patients and their care are coming to a close. With just three days of full-time employment remaining, this is essentially my "field goal" for the week (note the highly rare sports metaphor). I kept saying to myself: "This is my final Tuesday. This is my final Tuesday." Waves of relief were juxtaposed with alternate (albeit smaller) waves of grief and/or loss.
One patient and I came to some semblance of closure on the phone this afternoon, although since she is the one person who I have actually given my phone number to, the closure had to do with our professional relationship rather than our new friendship. Our boundaries are clear, and I have no doubt that she would never abuse her personal access to me.
Conversely, other patients seem to be extending their needy tentacles towards me as I attempt to extricate myself, and I give non-committal answers when they ask me to "keep in touch", and I generally respond by saying that I'll hopefully see them around the clinic from time to time.
Sitting at the computer in the doctors' area, I print out narcotic prescription after narcotic presciption, and I give thanks that these days will soon come to pass. This narcotic merry-go-round of which I have so recently written really seems to often put me over the proverbial edge. And with 5:00 pm Friday on the not-so-distant horizon, I feel excited at the prospect of so many odious and redundant tasks falling by the wayside.
Still, the human side of nursing is the sweetest, and the blessings and compassion which I receive from the majority of patients warms my heart and lightens my soul. When I choose to share with certain patients that I have been struggling with chronic stress-related illness and pain, the compassion that I feel reflected back to me means more than I can ever communicate in return. Shared humanity is truly the beautiful core of a healthy therapeutic relationship, and I am moved that that beauty is reflected in the eyes of many patients as I bid a heartfelt adieu.
Saturday, January 12, 2008
The Long and Short of Therapeutic Relationships
For the last seven years, I have had the privileged opportunity to build solid therapeutic relationships with patients over the long term. Despite the frustrations and stressors therein, having the time and space to truly get to know patients over such a span of years has many benefits, both for the patient and for me, the provider of care. Long-term therapeutic relationships allow for trust to be built in such a way that I have been able to become, as it were, a part of people's lives.
Making periodic home visits to a considerable number of my patients has also engendered a considerable sense of intimacy and shared experience. Getting to know spouses, children, grandchildren and others during my visits, the web of human contact is strengthened and enlarged. Becoming somewhat of a fixture in someone's home---albeit a fixture who appears and disappears at will---creates a dynamic that simply cannot be equaled during any number of office visits. In terms of getting to know a patient and their life, there is nothing like sitting in their living room and directly experiencing their world by smelling the food cooking on the stove, seeing the room where they sleep, and getting a visceral sense of what this family's lifestyle is truly like. In my opinion, doctors should make house-calls to each of their patients at least once, if only to get a sense of how that person lives, information which is therapeutically priceless.
For myself personally, I have given my all to many of the relationships that I have nurtured with my patients over the years. Over time, that investment has paid dividends which cannot be measured, and I know that my presence has been beneficial to many. Now, as I prepare to take my leave, I can see the repercussions which the severing of those ties can have. For myself, I must process the guilt of leaving, of "abandoning" my patients (as several have described it to me as they react to the news of my departure). For them, they must accept my departure from their lives, and be receptive to a new provider and a new relationship which will have different dynamics and a entirely different feeling. For some, hopefully, that relationship will be equally or even more fulfilling for them. For others, things will just never be the same. But I remind myself that the only constant in the universe is change, and we are all experiencing that constant in this moment, whether we like it or not.
As I move into a new paradigm of work as a nurse, I will embrace the opportunity for more short-term relationships with patients. As a per diem visiting nurse, I may walk into a home for a brief interaction with a patient who I may never see again. With no history, no biases, and no preconceived notions, that moment is wide open for creative and compassionate interaction. As a per diem nurse in a small residential hospice, I may come to work one day and have a deeply emotional connection with a patient, only to return the following week to learn that that person has died. Thus, while a long-term investment is not an option in these relationships, it presents a golden opportunity to make each interaction count, holding nothing back and letting that moment be all that it can be.
While I am grieving the loss of many of the connections which I have nurtured over the years, I am simultaneously celebrating the relief that I feel as I relinquish the enormous responsibility that those long-terms relationships have brought to bear. Human interaction allows for depth and intimacy in many ways, and I plan to use my interpersonal skills in such a manner as to continue to satisfy my need for emotional intimacy with patients, even if those relationships are short-lived.
In this moment, as I write this missive, I feel a pain in my heart as the faces of patients I love pass over my mental movie screen. As I release my guilt and sense of responsibility, I shower each individual with compassion and understanding for their suffering, and wishes for healing and satisfaction with their lives, their health, and the relationships which they have with their medical providers. Even if I am no longer present in their daily lives, what we have shared is something which cannot be erased, and the value of those interactions---and the emotional and spiritual reverberations therein---can still be carried in our hearts.
Making periodic home visits to a considerable number of my patients has also engendered a considerable sense of intimacy and shared experience. Getting to know spouses, children, grandchildren and others during my visits, the web of human contact is strengthened and enlarged. Becoming somewhat of a fixture in someone's home---albeit a fixture who appears and disappears at will---creates a dynamic that simply cannot be equaled during any number of office visits. In terms of getting to know a patient and their life, there is nothing like sitting in their living room and directly experiencing their world by smelling the food cooking on the stove, seeing the room where they sleep, and getting a visceral sense of what this family's lifestyle is truly like. In my opinion, doctors should make house-calls to each of their patients at least once, if only to get a sense of how that person lives, information which is therapeutically priceless.
For myself personally, I have given my all to many of the relationships that I have nurtured with my patients over the years. Over time, that investment has paid dividends which cannot be measured, and I know that my presence has been beneficial to many. Now, as I prepare to take my leave, I can see the repercussions which the severing of those ties can have. For myself, I must process the guilt of leaving, of "abandoning" my patients (as several have described it to me as they react to the news of my departure). For them, they must accept my departure from their lives, and be receptive to a new provider and a new relationship which will have different dynamics and a entirely different feeling. For some, hopefully, that relationship will be equally or even more fulfilling for them. For others, things will just never be the same. But I remind myself that the only constant in the universe is change, and we are all experiencing that constant in this moment, whether we like it or not.
As I move into a new paradigm of work as a nurse, I will embrace the opportunity for more short-term relationships with patients. As a per diem visiting nurse, I may walk into a home for a brief interaction with a patient who I may never see again. With no history, no biases, and no preconceived notions, that moment is wide open for creative and compassionate interaction. As a per diem nurse in a small residential hospice, I may come to work one day and have a deeply emotional connection with a patient, only to return the following week to learn that that person has died. Thus, while a long-term investment is not an option in these relationships, it presents a golden opportunity to make each interaction count, holding nothing back and letting that moment be all that it can be.
While I am grieving the loss of many of the connections which I have nurtured over the years, I am simultaneously celebrating the relief that I feel as I relinquish the enormous responsibility that those long-terms relationships have brought to bear. Human interaction allows for depth and intimacy in many ways, and I plan to use my interpersonal skills in such a manner as to continue to satisfy my need for emotional intimacy with patients, even if those relationships are short-lived.
In this moment, as I write this missive, I feel a pain in my heart as the faces of patients I love pass over my mental movie screen. As I release my guilt and sense of responsibility, I shower each individual with compassion and understanding for their suffering, and wishes for healing and satisfaction with their lives, their health, and the relationships which they have with their medical providers. Even if I am no longer present in their daily lives, what we have shared is something which cannot be erased, and the value of those interactions---and the emotional and spiritual reverberations therein---can still be carried in our hearts.
Friday, January 11, 2008
Broken Hearts and More Goodbyes
The next to last week is over, and I am now looking my final week at work straight in the eye. I had a few tough moments as I said my goodbyes to a few people, and several patients were teary-eyed as we bade our farewells. Even though there's a chance that we may cross paths when I'm covering a shift at the clinic here and there, the relationships we have known over time will never return.
One couple of whom I am exceedingly fond are simply held in a dear, dear place in my heart. I felt choked up as we shook hands the other day, and even though I promised to keep tabs on them, our days sharing laughs together are essentially over.
Another patient with whom I have been through a great deal turned away from me as she began to cry yesterday, and she said "it will just never be the same with anyone else."
Still another patient said, "I've been feeling really bad about it, but I know you have to take care of yourself. Thanks for going the extra mile for me."
Coming out of an exam room this afternoon, the medical director of the clinic looked at me and informed me without a shred of irony or sentimentality that I am breaking many patients' hearts this week.
Gulp.
It is a tough burden to bear when one provides the care that others so depend on. It's even more of a burden when one realizes that leaving those individuals behind is yet another loss in their compendium of loss and grief. Still, these relationships have a value which will carry us all forward, and new relationships will yield even more gifts and learning for each of us. Saying goodbye is a practice and an art, and for better or worse, I'm getting a whole lot of practice these days.
One couple of whom I am exceedingly fond are simply held in a dear, dear place in my heart. I felt choked up as we shook hands the other day, and even though I promised to keep tabs on them, our days sharing laughs together are essentially over.
Another patient with whom I have been through a great deal turned away from me as she began to cry yesterday, and she said "it will just never be the same with anyone else."
Still another patient said, "I've been feeling really bad about it, but I know you have to take care of yourself. Thanks for going the extra mile for me."
Coming out of an exam room this afternoon, the medical director of the clinic looked at me and informed me without a shred of irony or sentimentality that I am breaking many patients' hearts this week.
Gulp.
It is a tough burden to bear when one provides the care that others so depend on. It's even more of a burden when one realizes that leaving those individuals behind is yet another loss in their compendium of loss and grief. Still, these relationships have a value which will carry us all forward, and new relationships will yield even more gifts and learning for each of us. Saying goodbye is a practice and an art, and for better or worse, I'm getting a whole lot of practice these days.
Thursday, January 10, 2008
CPR, STAT!
This morning, I attended a CPR recertification for healthcare professionals, and was surprised at the significant changes therein. The very gung-ho presenter gave us an impassioned speech about the importance of CPR, and drive home the very salient point that most of us professionals who ever use CPR will most likely do so out in the community---at a shopping mall, grocery store, or even at home---rather than at work. Aside from those who work in the ICU or other critical care area, CPR is generally performed when one is off-duty, and we should be determined to get as many civilians certified as possible. Even more urgent is the need for more automatic electronic defibrillators out in the community, and unfortunately there are just not enough of those golden little machines around.
An interesting piece of information that I learned today was that, contrary to what has been taught for decades up until now, we were concentrating way too much on mouth-to-mouth resuscitation and performing woefully too few chest compressions. Statistics clearly demonstrate that the old CPR paradigm was falling far short of the mark, and of the people who actually survived following CPR, less than 40% actually experienced good quality of life. Due to the relative lack of chest compressions performed in traditional CPR, brain perfusion was a mere shadow of what it could have been, thus many survivors were suffering unnecessary cognitive deficits from lack of cerebral oxygen flow.
The new and improved CPR instructions drill home the fact that it is compressions which save a life, not mouth-to-mouth. While keeping an open airway and providing periodic rescue breaths is still an intrinsic aspect of the entire procedure of CPR, it is the act of compressing the heart against the chest wall which perfuses the brain, coronary muscle and kidneys with the oxygenated blood needed to prevent negative sequelae. "Compressions, compressions, compressions" was the mantra that we heard all morning, and by the time we left, the new ratio of 30 compressions to 2 breaths was cemented in our brains, along with the strict instructions that compressions must be "deeper, harder, and faster" than ever before. No more fumbling around, re-checking the pulse and giving two breaths every 15 compressions. Get that heart pumping, and get a defibrillator on that chest stat!
Apropos of the notion of automatic electronic defibrillators (AEDs) we also learned about commotio cortis, a condition in which an otherwise healthy heart stops due to blunt trauma to the chest. Sadly, young athletes---school-age children, teens, and college students---die from this condition every year, which generally occurs when a young athlete is struck in the area of the heart by a ball, limb, or other implement at precisely the moment when the heart is at a specific point in the cardiac cycle. Of note, the use of AEDs by coaches and others involved in youth sports has shown dramatically increased survival rates for young people experiencing commotio cortis. Thus, it is in everyone's interest to lobby schools and youth athletic programs to obtain AEDs and train adults and young people in their correct use.
CPR is a crucial skill which can indeed save lives if used correctly, and especially if enough individuals in the society are properly certified. I encourage everyone to become certified, recertify every two years, and urge family members and friends to do the same. Someday the life that's saved may very well be your own---or that of someone you love.
An interesting piece of information that I learned today was that, contrary to what has been taught for decades up until now, we were concentrating way too much on mouth-to-mouth resuscitation and performing woefully too few chest compressions. Statistics clearly demonstrate that the old CPR paradigm was falling far short of the mark, and of the people who actually survived following CPR, less than 40% actually experienced good quality of life. Due to the relative lack of chest compressions performed in traditional CPR, brain perfusion was a mere shadow of what it could have been, thus many survivors were suffering unnecessary cognitive deficits from lack of cerebral oxygen flow.
The new and improved CPR instructions drill home the fact that it is compressions which save a life, not mouth-to-mouth. While keeping an open airway and providing periodic rescue breaths is still an intrinsic aspect of the entire procedure of CPR, it is the act of compressing the heart against the chest wall which perfuses the brain, coronary muscle and kidneys with the oxygenated blood needed to prevent negative sequelae. "Compressions, compressions, compressions" was the mantra that we heard all morning, and by the time we left, the new ratio of 30 compressions to 2 breaths was cemented in our brains, along with the strict instructions that compressions must be "deeper, harder, and faster" than ever before. No more fumbling around, re-checking the pulse and giving two breaths every 15 compressions. Get that heart pumping, and get a defibrillator on that chest stat!
Apropos of the notion of automatic electronic defibrillators (AEDs) we also learned about commotio cortis, a condition in which an otherwise healthy heart stops due to blunt trauma to the chest. Sadly, young athletes---school-age children, teens, and college students---die from this condition every year, which generally occurs when a young athlete is struck in the area of the heart by a ball, limb, or other implement at precisely the moment when the heart is at a specific point in the cardiac cycle. Of note, the use of AEDs by coaches and others involved in youth sports has shown dramatically increased survival rates for young people experiencing commotio cortis. Thus, it is in everyone's interest to lobby schools and youth athletic programs to obtain AEDs and train adults and young people in their correct use.
CPR is a crucial skill which can indeed save lives if used correctly, and especially if enough individuals in the society are properly certified. I encourage everyone to become certified, recertify every two years, and urge family members and friends to do the same. Someday the life that's saved may very well be your own---or that of someone you love.
Wednesday, January 09, 2008
The Narcotic Merry-Go-Round
The number of patients that I see who are prescribed chronic narcotic medications is astronomically high. Of course, there are many people who have pain worthy of taking narcotics on a daily basis---for cancer-related pain, post-surgical pain, etc---yet so many people abdicate their pain management all too easily to the drugs that will cause them physical dependence, constipation, and somnolence with no end in sight. As a person with chronic pain with an unknown etiology, I fully understand that strong drive to eradicate pain from one's life. Pain overtakes one's psyche, pushes other concerns out of the way, and leaves one desperate for relief.
While it is well-documented that pain is woefully and poorly managed throughout the United States, leaving countless patients suffering unnecessarily, I still find myself having mixed feelings about the ease with which so many providers seem to write those scripts for Oxycontin, morphine, and Percocet. At our local ER, it seems like there's a gum-ball machine near the revolving door, and patients simply have to say they're in pain and a prescription is produced in a knee-jerk reaction of instant gratification.
One of the questions we ask ourselves and each other about these patients on chronic narcotics is how long they will be on these meds? For the patients with failed back surgeries and other serious conditions, we consider that they may very well be on narcotics for life, and that is often the lesser of many evils. For others whose pain has no visible or discernible cause, we often question the intelligence of long-term narcotic use, understanding that tolerance will increase with time, and dependence only continue to deepen, both physically and psychologically. Now, often that dependence (which is different than addiction, mind you) is wholly warranted and acceptable, yet I feel that there is sometimes a lack of judiciousness on the part of the prescribers as they acquiesce to the pressure to write those scripts for controlled substances.
I do not question that narcotics are often needed for patients whose pain is not touched by non-steroidal anti-inflammatories and other non-pharmacological interventions, but sometimes I feel that those prescriptions move just a little too freely, especially when one considers that diversion (the selling of such medications to others for profit) happens on downtown street corners on a daily basis. Word has it, I hear, that our clinic is considered a great place to score some narcotics to sell at the bus station. A nice reputation to have.
Perhaps I feel uncomfortable with the amount of narcotics that fly off the shelves these days because a significant portion of my job these last few years has been fielding calls from my patients who are on chronic narcotics as they seek a new refill of their meds. Since many of my patients are former substance abusers and our level of trust in them is relatively low, some of them need to come to the office every seven days for a one-week supply of morphine or Percocet. While having to come in to see me weekly is inconvenient for them, it is equally a hassle for me in terms of printing up scripts, hunting down docs for signatures, and having all of this ready in a timely manner for frequently impatient patients. As I ready to leave my job of seven years, I quietly revel in the notion that I will soon enough finally escape from this narcotic merry-go-round.
Percocet, anyone?
While it is well-documented that pain is woefully and poorly managed throughout the United States, leaving countless patients suffering unnecessarily, I still find myself having mixed feelings about the ease with which so many providers seem to write those scripts for Oxycontin, morphine, and Percocet. At our local ER, it seems like there's a gum-ball machine near the revolving door, and patients simply have to say they're in pain and a prescription is produced in a knee-jerk reaction of instant gratification.
One of the questions we ask ourselves and each other about these patients on chronic narcotics is how long they will be on these meds? For the patients with failed back surgeries and other serious conditions, we consider that they may very well be on narcotics for life, and that is often the lesser of many evils. For others whose pain has no visible or discernible cause, we often question the intelligence of long-term narcotic use, understanding that tolerance will increase with time, and dependence only continue to deepen, both physically and psychologically. Now, often that dependence (which is different than addiction, mind you) is wholly warranted and acceptable, yet I feel that there is sometimes a lack of judiciousness on the part of the prescribers as they acquiesce to the pressure to write those scripts for controlled substances.
I do not question that narcotics are often needed for patients whose pain is not touched by non-steroidal anti-inflammatories and other non-pharmacological interventions, but sometimes I feel that those prescriptions move just a little too freely, especially when one considers that diversion (the selling of such medications to others for profit) happens on downtown street corners on a daily basis. Word has it, I hear, that our clinic is considered a great place to score some narcotics to sell at the bus station. A nice reputation to have.
Perhaps I feel uncomfortable with the amount of narcotics that fly off the shelves these days because a significant portion of my job these last few years has been fielding calls from my patients who are on chronic narcotics as they seek a new refill of their meds. Since many of my patients are former substance abusers and our level of trust in them is relatively low, some of them need to come to the office every seven days for a one-week supply of morphine or Percocet. While having to come in to see me weekly is inconvenient for them, it is equally a hassle for me in terms of printing up scripts, hunting down docs for signatures, and having all of this ready in a timely manner for frequently impatient patients. As I ready to leave my job of seven years, I quietly revel in the notion that I will soon enough finally escape from this narcotic merry-go-round.
Percocet, anyone?
Tuesday, January 08, 2008
Dangerous Messages
Standing in line at the pharmacy the other day, I was struck by the headlines I saw on several magazines on display near the register. The headlines screamed, and I paraphrase: "Young Starlets Reveal How They Lose Weight Fast!" and "Tired of Winter Fat? Lose 20 Pounds in One Week!"
Living in a college town, I wondered how many young impressionable female college, high school, junior high (and elementary!) students stood in line at this and other stores, reading those headlines, fervently ruing the few pounds they may have gained over the holidays. How do they compare themselves to those starlets and models? What messages are sinking in, especially into the brains of those school-age girls? What are we doing to girls and women in this culture?
As the media proclaim the dangers of obesity (some calling it an epidemic), we also run the risk of running too far in the other direction, sending our young girls (and some boys) into crazed tailspins of body image dysmorphia. As someone who was a chubby youngster, I myself was frequently on the receiving end of jokes and innuendos about my weight from relatives, family, and strangers alike. The resultant misguided self-talk about my body still reverberates in my mind to this day, and I still suffer the psychic consequences of the frequently cruel statements which so often came my way.
In this media-saturated world where there simply seems to be no escape---especially for the young---it is the responsibility of the society at large to monitor its language and the messages which it feeds to its most vulnerable members. From my point of view, we are failing miserably, and the resulting eating disorders and unrealistic body image suffered by young women across this country are the natural result of our stark collective failure. How can we right this wrong?
Our collective failure is, of course, our collective responsibility to rectify. But how can we do so when the powers of the media---and the very culture itself---thwart us at every turn? God help young women as they face this constant onslaught to which they can never measure up, and if we can't stem the tide, we will have no one to blame but ourselves.
Living in a college town, I wondered how many young impressionable female college, high school, junior high (and elementary!) students stood in line at this and other stores, reading those headlines, fervently ruing the few pounds they may have gained over the holidays. How do they compare themselves to those starlets and models? What messages are sinking in, especially into the brains of those school-age girls? What are we doing to girls and women in this culture?
As the media proclaim the dangers of obesity (some calling it an epidemic), we also run the risk of running too far in the other direction, sending our young girls (and some boys) into crazed tailspins of body image dysmorphia. As someone who was a chubby youngster, I myself was frequently on the receiving end of jokes and innuendos about my weight from relatives, family, and strangers alike. The resultant misguided self-talk about my body still reverberates in my mind to this day, and I still suffer the psychic consequences of the frequently cruel statements which so often came my way.
In this media-saturated world where there simply seems to be no escape---especially for the young---it is the responsibility of the society at large to monitor its language and the messages which it feeds to its most vulnerable members. From my point of view, we are failing miserably, and the resulting eating disorders and unrealistic body image suffered by young women across this country are the natural result of our stark collective failure. How can we right this wrong?
Our collective failure is, of course, our collective responsibility to rectify. But how can we do so when the powers of the media---and the very culture itself---thwart us at every turn? God help young women as they face this constant onslaught to which they can never measure up, and if we can't stem the tide, we will have no one to blame but ourselves.
Sunday, January 06, 2008
Second Chance to Live: An Inspiring Blog
Hi Keith,
My name is Craig J. Phillips. I am a traumatic brain injury survivor and a master’s level rehabilitation counselor. I sustained an open skull fracture with right frontal lobe damage and remained in a coma for 3 weeks at the age of 10 in August of 1967. I underwent brain and skull surgery after waking from the coma. Follow-up cognitive and psyche / social testing revealed that I would not be able to succeed beyond high school. In 1967 Neurological Rehabilitation was not available to me, so I had to teach myself how to walk, talk, read, write and speak in complete sentences. I completed high school on time and went on to obtain both my undergraduate and graduate degrees. For an in depth view of my process please read my post,
http://secondchancetoliveThroughout my lifetime I developed strategies to overcome many obstacles and in so doing I have achieved far beyond all reasonable expectations. On February 6, 2007 at the encouragement of a friend I created Second Chance to Live.
Second Chance to Live presents topics in such a way to encourage, motivate and empower the reader to live life on life’s terms. I believe our circumstances are not meant to keep us down, but to build us up. As a traumatic brain injury survivor, I speak from my experience, strength and hope. As a professional, I provide information to encourage, motivate and empower both disabled and non-disabled individuals to not give up on their process. Please read my post, http://secondchancetoliveThank you for your time and your kindness. Have a simply phenomenal day!
Craig R. Phillips, MRC, BA
Subscribe to:
Posts (Atom)