Monday, July 30, 2007

A Reprieve

"Were you the one who called the ambulance last week when I was so sick?" she asked, as I prepared her meds and took out my stethoscope and blood pressure cuff.

"Yes, it was me. You sure didn't argue, that's for sure." I continued to rummage through my things and arrange the tools of my trade.

"I guess I could have died, huh?" She looks at me sort of dreamily.

"It was pretty likely, but we weren't about to let that happen, were we?" I respond, looking up from my tasks.

"I dunno. I barely remember what happened."

"You had thrown up before I arrived. Then, as I took your blood pressure, you grabbed the bucket and got down on your hands and knees on the floor and vomited over and over again. Do you remember that?"

"Yeah, I guess so. The people at the hospital were so nice, especially once the transplant team had me on their floor. I hope that liver comes soon. I'm getting pretty sick."

"You still wear your beeper day and night, right?" I ask.

"Oh, yeah. I wouldn't trade that thing for all the methadone in the world."

"Good. Now, you have a low-grade temp today. What should we do?" I put away the thermometer and other supplies.

"I'll call a cab and go to the doctor's office to get checked out. I really don't want to go to the hospital again if I don't have to."

"Promise to go?"

"Yes, I promise."

"I don't want them to have to scrape you off that floor again if I can help it." I rise to leave.

"Thanks alot. I really appreciate it."

"Hey, you're doing the hard work. I just stop by and check in." We shake hands.

"See you Wednesday, and get to the doctor's office! And no Tylenol! Your liver can't handle it."

"Yeah. See you then. I'll go, don't worry. Thanks."

Last Wednesday I started my day with a bang, sending this poor soul off to the ER, dehydrated, febrile, end-stage cirrhosis working its horrible magic of visceral implosion on multiple organ systems. A new lease on life seems to have been granted, or at least a reprieve of sorts. This patient---and thousands (or millions) like her---walks the thin line between life and death, waiting for a life-saving organ transplant as millions of viable organs are buried beneath the earth or consumed in the fires of crematoria. What a morbid waiting game indeed.

For now, another brush fire has been stomped out as the cirrhotic fire in her liver rages on. It is truly a race with time, and even the hoped-for outcome of a fresh transplanted liver cannot deliver the promised revitalization of health without a large degree of uncertainty and risk. I have seen what havoc organ rejection and infection can wreak, and if life waiting for a transplant seems rough, the other side of the surgery is certainly no picnic.

Still, I could leave that house today secure in the fact that one more sunrise has arrived for this kind person, and yet another opportunity presented for continued life, however challenging. Yet another instance to think to one's self, "there but for the grace of God go I."

Friday, July 27, 2007

Prilosec and NASCAR: Strange Bedfellows?

Just this afternoon I was prefilling a patient's medication box when I opened a package of Prilosec OTC. Now, as far as Big Pharma goes, I have benefited as much as anyone else from pharmaceutical advances over the years, and until just recently my brother worked as a scientist for a large pharmaceutical company which shall remain nameless. (Stock options are going to fund some portion of my niece's and nephew's college educations, so who am I to complain?) I have even taken Prilosec in the past, and now take a generic form of omeprazole daily.

Those disclosures aside, I was very much taken aback when I noticed a label on the Prilosec packaging proclaiming the company's sponsorship and support for NASCAR. This partnership seems to include sponsorship of a NASCAR racing car, LOTS of advertisement, sweepstakes competitions, as well as a website dedicated to Bunco, a dice game apparently popular with American suburban women.

Maybe it's me, but things just seem a little out of hand in the 21st century. If I was visiting from another planet and saw how a sports marketing group managed to pitch the idea of marketing a heartburn medicine through the venue of race cars and dice games, I would be considerably perplexed.

Of course, in this Information Age, marketing is everywhere. Targeted ads on Gmail respond to what you type to your friends and family. Advertisements crowd the smallest spaces on gasoline pumps and bottle caps. People are even paid to wear clothes with the price-tags still attached as a form of advertising. Soon people with shortly cropped hair will rent their scalps and have ads shaved on their craniums. Spare me.

While I appreciate Big Pharma's scientific advances in disease and symptom management, I am disturbed by the lengths their marketing teams will go to reach the public with their product. Maybe I'm old-fashioned, but these unlikely (and, in my mind, unsightly) combinations reek of the worst type of marketing and product placement that money can buy.

Anyway, on the bright side, now that Prilosec is available over the counter, at least all those good folks who go to NASCAR races can control the heartburn caused by all that fast food and beer and soft drinks likely to be sold at such places. After all, the generous people at Proctor and Gamble probably give away lots of Prilosec samples at each event. Now there's a shining example of free healthcare for the masses!

Wednesday, July 25, 2007

There But for the Grace of God(dess).....

When I heard today that six Bulgarian nurses and a Palestinian-born doctor were freed after eight years of captivity in Libya, my first thought was "where have I been and why haven't I heard about this before?" My next thought was, "There but for the grace of God(dess) go I."

Sentenced to death for blatantly false charges of deliberately infecting more than 400 Libyan children with HIV, the seven have been sitting in a Libyan jail since 1999, sentenced to death for their "crime".

No matter that world-renowned AIDS experts confirmed that the strain of HIV identified in the hospital where the seven hostages had worked existed in the hospital long before the seven ever set foot on Libyan soil. No matter that generous healthcare workers roam the world assisting those in need in war-torn and famine-stricken areas where disease and poverty run rampant. These six women and one man were apparently tortured with electric shocks, hung from doors with their hands tied behind their backs, and otherwise coerced into confessions under duress and threat of violent death.

While French President Sarkozy and his wife Cecilia secured the release of the captives, a firestorm brews vis-a-vis Sarkozy's actual geopolitical and economic motives for his efforts on the hostages' behalf.

Be that as it may, seven innocent healthcare workers are now free, although understandably traumatized by their ordeal. With my own plans and desires to some day practice nursing in developing countries where my expertise and training would be most useful to the largest number of needy people, such events are certainly moments to take stock of one's commitment to the inherent risks of such endeavors and weigh the potential consequences of future choices.

Still, I recognize that my inner-city nursing practice itself puts me at a modicum of risk on a regular basis, with other human service providers in our beleaguered city occasionally caught in gangland crossfire, one with a bullet still lodged near her heart. Doing my per diem visiting nurse work on early mornings, I go to a local methadone clinic and pick up methadone to deliver to several home-bound patients. Anyone watching the clinic knows that visiting nurses with badges and lock-boxes leaving the facility are most certainly carrying narcotics. Is this any less risky than practicing nursing in a far-off land?

Risk is a relative concept and term, and we all take risks every day when we drive on the highway. These seven souls freed from certain hell are now reunited with their families and enjoying deep breaths of freedom. My blessings for them in their recovery, and to all those who take risks to do the work that is in their hearts.

Tuesday, July 24, 2007

The Spirit of Recovery

"Y'know, I never told you, but during my recent relapse I was using about forty bags of heroin a day, sometimes more." He looked me squarely in the eye.

"Forty bags a day? Shooting or snorting?" I asked.

"Oh, shooting," he said nonchalantly. "It was crazy. I never want to go back to that again. I feel like a new person."

"I bet. Now what?"

"Oh, maybe work, some volunteering, fix up my new place, hang out with my dog, work out. My appetite is back, too. I'm eating like a horse."

"Well, you look great, my friend. Take this opportunity and run with it!"

"Believe me, I know what's what, and this is something I'm not gonna waste. This is too good to be true!"

I checked his blood pressure, his heart rate, listened to his lungs, felt his belly, looked in his mouth, felt his cervical nodes, and checked for leg swelling. But mostly I was evaluating his spirit, his will to be clean and embrace a new lease on life. The physical exam was a pretext.

His eyes were clear, his voice strong, his resolve apparently firm. Having lost weight during the horrors of detox from heroin and benzodiazepines, his health actually quite good, he has gotten it together, and now seems willing to take his recovery at face value. This gentleman---a truly gentle man---has a fighting chance.

We shake hands at the door, my left hand on his shoulder.

"Y'know, you all have really been there for me and I appreciate that so much. It means alot." He has very kind and calm eyes.

"It's our pleasure. We do it because we care about you and believe in you. That's the bottom line. Keep up the good work. See you next week?"

"Same place, same time, man. See you then."

When I get to the office, I realize I've been smiling the whole way.

Sunday, July 22, 2007

Grief, Mourning, Life and Death

Today we visited a former neighbor whose dog, Amos, was good pals with our dog Sparkey when we lived in their country neighborhood a few years ago. Sparkey died last September (see his blog, Latter Day Sparks), and now Amos has cancer in his front leg and is not long for this world. It was a sweet visit, and Amos was as loving as always, excitedly greeting us and our little dog Tina, Sparkey's surviving "sister" who herself is nearly thirteen.

As my step-father enters the final stages of metastatic pancreatic cancer, grieving and death remain subjects which inform my every day life. Also, as a nurse, death is always in the wings and periodically pays a visit to our office, whether expected or not.

I am currently reading Joan Didion's The Year of Magical Thinking, the chronicle of Didion's life as it was effected by the sudden death of her husband of forty years only several weeks after her daughter had lapsed into a coma from a sudden viral illness. Losing her daughter two years later, her entire immediate family had been claimed by death, and Didion used this book as a means to describe both her grieving, which she calls a passive process that simply happens to an individual, and her mourning, the act of dealing with grief.

Sparkey's death last September 2nd, my best friend's murder in 2001, my step-father's cancer, the aging of Mary's and my parents in general----this all adds up to a fact of life: that death, and the grieving and mourning therein, are inescapable. Additionally, death and death-related processes only become more common as one grows older, facing the loss of family members, friends, colleagues, and other individuals in one's general orbit.

Still, in the face of death, life goes on, and we forge ahead in spite of it all. Life and death are not mutually exclusive, and we must face death and grieving as courageously as we face life and living. Death is neither convenient nor welcome at any time, but we all must accept that it is as inescapable as the wind.

Saturday, July 21, 2007

Almost an Emergency---A Cautionary Tale

I take a relatively large amount of pills twice a day----mostly supplements with a few allopathic medications---and have always prided myself in how I can toss a handful into my mouth and swallow them with a few sips of water. That said, several minutes ago I did my usual morning routine and tossed back my substantial morning meds as I stood in the dining room. My wife and a friend who spent the night were standing nearby and watched as I immediately realized that I had aspirated one of the capsules. Trying not to panic and still able to talk, I said "I think I aspirated one of those." Our visiting friend said, "No, I don't think so." I sat down to assess further.

Taking a few deep breaths, I could distinctly hear a whistle with each inspiration, signaling to me without a doubt that there was a pill lodged in my trachea. A few strong coughs produced discomfort but no results. I continued to try not to panic as Mary and our friend watched with concern. I knew that Mary was ready to act if necessary.

In those few short moments, some of my thoughts were along these lines: "Oh man, if we have to go to the hospital, we won't be able to meet David for breakfast at 10:30!", and "It's so beautiful out---I don't want to go to the ER!", and "I really don't want respiratory lavage."

Apparently, the thought of lung lavage galvanized me to keep coughing, and several strong coughs later I produced a large capsule of magnesium from the depths of my trachea. Our visiting friend was staring right at me from three feet away, her mouth agape in a perfect "O". "Holy shit!" she exclaimed at least once, if not twice. Holy shit is right.

I coughed again and the whistle was gone. Luckily, Mary absolved me of having to take that extra capsule of magnesium. Thankfully enough, now I can go to breakfast, enjoy some coffee and eggs, go about my day, and resolve to take my meds like normal people do---one or two at a time. As for aspiration, I don't recommend it for anyone. Breathing is so much better, and I resolve to continue to do so uninterrupted for years to come.

Thursday, July 19, 2007

A Golden Moment

"I feel like I'm just waking up. I'm sixty years old. I've spent most of my life being afraid of people, of places, of things. I'm only now becoming aware of what I can still do with my life."

She sat before me in the exam room for our weekly appointment to prefill her med box, review her meds, discuss symptoms, and basically check in. We've known each other about six years now, and we have a sweet therapeutic relationship.

"I think about the things that happened to me in the past, and I realize that I don't have to focus on those things. It's like I've been asleep." Her eyes filled with tears.

"You know," I began, "there are times in many people's lives when they begin to see more clearly, and the things that used to limit them seem to lose their power. It seems like you've arrived at one of those moments now."

She shared more of her personal history of trauma and suffering that I don't care to elucidate on here. Suffice it to say that the abuse and trauma that she suffered as a child and young woman would be enough to cause anyone to shut down emotionally and to fear affection or attention. It felt like an honor to be given that honest glimpse, to be allowed that much further into her inner world, and I told her so.

"I haven't shared these things with anyone else, not even my therapist. I trust you and wanted to talk about them with you first." She smiled.

"I'm very honored that you would choose to share these stories and feelings with me, and I advise you to bring all of this to therapy where you can do alot more work than I am able to offer based on my lack of experience in this area. Still, no matter what, I think this opening that you are experiencing will have a very positive effect on your life."

We walked down the hall, my hand on her shoulder. It was one of those golden moments, and I felt myself glow for several minutes afterwards before I was distracted by the next brushfire in need of attention. But those thirty minutes with my patient were so well spent, so worthwhile, and in that moment my work made so much sense. What did I really do in that room? I listened and reflected, nothing more. She did all of the work, and my pride in how far she has come does so much for this nurse's heart and soul.

Sunday, July 15, 2007

Vacation Mind, Worker's Mind

Well, I've been home since Thursday and have resisted the temptation to blog until today, giving myself further time off.

While I felt the urge to write while we were away, I felt a much stronger competing urge to do less rather than more. Blogging and writing have become, to some extent, something I feel I "should" do, as well as something that I enjoy and thrive upon. Knowing the difference between the two is crucial, and continues to be a challenge for me.

Aside from connecting with family and relaxing, time away from work was the most important aspect of these last few weeks. It is so easy for work to become the center of one's universe. Most of us spend an average of forty hours per week at work, as well as considerable time spent preparing, commuting, recovering from the workday, and preparing yet again for the subsequent day. Weekends are spent escaping from the travails of employment, pushing thoughts of work to the recesses of the mind, if only for a few hours. It is often an all-encompassing endeavor, and unlike our European brethren, we Americans enjoy an average of only two weeks of vacation per year, as compared to the European average of six weeks of paid "holiday".

Nonetheless, I am grateful for these last two weeks and the unwinding that they allowed me to experience. This being Sunday, thoughts begin to turn towards the morrow, although I will do my utmost to simply enjoy this gorgeous New England day without allowing dread of Monday morning to negatively color my final day of rest and recovery.

Tomorrow, it's back to the working world, refreshed, relaxed, and relatively tan. With my next full week off probably not until the depths of winter, I'll try to savor the effects of "vacation mind" and carry it into the weeks ahead. I may lose sight of this sense of well-being amidst the general tumult of the office, but I can only hope that it will bring some sense of refreshment to my days, if only fleeting. Above all, I give thanks for the privilege that allows me to be gainfully employed, and to experience the well-earned relief of paid vacation and rest.