Mrs. Forgetful Strikes Again

I just spent 15 minutes looking for my coffee. Good thing stuff like this doesn't scare me or send me running to the doctor for an MRI and some of that medicine I give people who are forgetful...you know the name of it...yeah, that stuff...begins with an A...never mind, I'll think of it later.

Anyhow, I'm not worried because I've always been forgetful. When I was a kid it was because I had my "head in the clouds". When I was a youngER woman it was because I was sleep deprived. One of Ms A's kids nicknamed me Mrs. Forgetful one afternoon I kept missing a turn into a parking lot at Chuckie Cheese. He kept chanting: "Mrs. Forgetful Strikes Again!" each time I missed the entrance to the stupid pizza place. That was more divine interverntion than cognitive deficit so I didn't have to be exposed to the weird plushies and bad pizza. But I digress...

Aricept…yeah that’s it.

What was I writing about? Oh yeah, being forgetful. The other day I couldn't remember how to perform a simple math operation involving decimal points and percentages. That's just sad. Especially since I remembered Forgetful Jones was forgetting his horse Buster before I even reviewed the video. And I know all the words to "I Think I Love You" and "Brandy".

Which leads me on this tangent; I wonder what it's going to be like in nursing homes when everyone there grew up not on the rowdy sounds of Glenn Miller's swing music but rather Lynyrd Skynyrd's "Freebird".

Will I be the old woman in the back of the day room, pantomime lighter hoisted high in the air, swaying back and forth to music only I can hear, chanting the battle cry of 1978? "Freebird! Freebird"

God I hope so.

Can I Go Home Now?

0630: I arrive at work, pick up my assignment sheet and quickly scan the written report describing the five patients the night shift charge nurse has deemed I care for during the next thirteen hours.

A: Morbidly obese, noncompliant diabetic with a really nasty wound on his backside. He’s also known for his verbal abuse. Let’s see how many times he tells me he won’t cooperate and he doesn’t need that medicine because we don’t know what we are doing in the first place. I’ll make it a “Hi Bob” game and get a beer tonight each time he tells me I’m stupid or refers to me as “girl”.

B: Her. Yeah, her. Fuck, I can’t stand this woman. I want to shake her and tell her to fucking get a shrink and get the hell over her childhood trauma that is leading to this chronic existential angst masquerading as belly pain. Twenty-five years old with chronic belly pain. Wow, all this belly pain, how did she manage to get obese? We’ve scanned her, scoped her, opened her up and have done everything but transplant her pancreas and liver. Everything is always normal. Let’s see…she refused the psychiatric consult the last time she was here. But she never EVER refuses the 2mg of dilaudid push every two hours. I thought she wouldn’t be returning to us because we no longer offer IV push phenergan on our menu of treatments at the Spa. Not enough beer if I get to take a swig each time she asks me for more dilaudid and it isn't time yet.

C: Oh for the love of God, this man is back? I knew it! I knew he would bounce back but in three days? Gah we spent hours with this daughter helping her make the decision to place her father because she can no longer take care of him. Hmm….did he fall…no…Oh great. “Weakness” Fuckin’ A we aren’t gonna get paid for this one, are we! Weakness is not a diagnosis it’s a symptom. Shit, I hope his daughter takes a respite day and stays the fuck away from the hospital. He‘s a piece of cake to care for if she isn‘t hovering over him. Such a dear sweet old demented guy. He’s funny and kind, doesn’t scream or hit. Any facility would LOVE to have this guy live with them! I wonder if we can get him a daughter transplant while he is here.

D: Son of a bitch. I thought this guy had died. I could have sworn he died last winter. “Fever” Oh great, this could be anything from liver failure to pneumonia to “I‘m hunger and some asshat beat the crap out of me under the bridge last night so I came here“. I’m voting for pneumonia and an ass kicking because I actually really like this homeless guy and I’m not sure I have the emotional fortitude today to attend to him at the end of his life. please god, let it be pneumonia pneumonia pneumonia“ Maybe I should rethink this whole drinking game so I don't end up with a liver like D's.

E: Nononono NO! We fixed you last time! You were better! And had a home! You agreed to take your meds and live at the half way house! If the case manager didn’t hook you up with enough meds and directions to the homeless clinic: she gets to come up here and sit with you, follow you around the unit making sure you don’t wander off and listen to your endless--oh thank goodness or not, your liver function is off the map. GREAT!! YAY way to go God! The meds killed her liver! Yay! Now we get to find a place for her to live. Yup, she’ll be a resident with us for a month or so because this country absolutely sucks when it comes to mental health care and well there aren’t any beds for people like this poor soul; just streets and alleyways.

After report, I start planning my first cocktail at 1955, should I stick to beer or have something stronger. . . oh yeah, I need to think about my liver.

I take a deep cleansing breath outside of A’s room.

“That goddamned nurse gave me insulin last night for my blood sugar and she gave me ten units! “
“Well good morning to you, too! Hmm…your blood sugar was 450! Of course she gave you insulin.“
“But now I’m only 200 and I feel funny! I’m too low, I’m gonna go into shock!!“

(What I want to say) “Oh boo-fucking-hoo that stupid nurse gave you insulin for a high blood sugar. Why we oughta report her to the state for...I dunno...doing her job you stupid asshat. If you don't want us to treat you then don't come to the fucking hospital and don't call 911! And, Dude, if you go into insulin shock, I will eat your nasty shoes. Yeah buddy you feel funny because your blood sugar averages at 300. But hey, you won’t have much of a brain left in about a year, so make your complaints now while you can string a coherent sentence together. Oh and I hope you aren't too attached to your toes or legs cuz those are outa here too if you keep this up.”

I do the hair patting thing through gritted teeth, and by rote explain to him what a normal blood sugar is and if he would just work with us we would bring his glucose down to manageable levels…“blah blah blah…sir…blah” Is what he hears.

I exit the room and brace myself for B’s room and ask God to deafen me against her whining. She’s sleeping soundly and I weigh not waking her up but I know her dilaudid was given exactly two hours ago and if I don’t wake her and she wakes up in an hour or so, she will see the time and realize it’s been three hours since we hooked her up with a fix and “OMG WTF I’m having a pain crisis!!” I would rather wake her up and get her high than have to explain to the patient over and over again why she can’t have an additional two milligrams of dilaudid.
“B, good morning, I’m your nurse today. How is your pain?”
“OH I DIDN’T SLEEP AT ALL LAST NIGHT I HURT SO BAD I NEED MORE DILAUDID.”
“Really? Your nurse said you were sleeping every time she rounded through the night.”
“I WAS CLOSING MY EYES AGAINST THE LIGHT BECAUSE I HURT SO BAD!”
“Why didn’t you tell the nurse?”
“I DID AND NO ONE LISTENED TO ME” (cue her tears)
“B, I trust the nurse who gave me report. I want you to think and feel carefully; how bad is your pain right now this minute. Is it the worst pain you’ve ever felt or is it just the pain you normally feel.
(cue baby voice added to tears)”It’s not the worst I’ve ever felt but it’s…it’s…really…really…bad!”

(What I want to say)”You know what you need B, you need a shrink. You need drug rehab and a shrink. I shutter to imagine the serial sexual and or physical abuse suffered upon you when you were a child or a teenager. And it makes me sick one person or a few people have broken you like this. But you know what? You are an intelligent 25 year old woman with her whole life ahead of her. Other people have gotten over these things and have gone on to more than look forward to spending a few days in the hospital! So just suck it up and go to rehab and see a shrink and move up and away from the abuse. YOU ARE LETTING THE ABUSER WIN EVERYTIME I GIVE YOU DILAUDID OR BENADRYL OR YOU ALLOW THE GI DOCS TO DO SCOPES AND THE SURGEONS TO CUT YOU OPEN. THE BAD PEOPLE ARE WINNING HERE!” (And yes I want to shout at her, because I am Nurse Tough Love in my head unlike my hero who said it out loud and to the patient. “Oh I forgot, you don’t work and have Medicaid and drug rehabs for people like you--the people who need it--are few and far between. It isn’t your fault the system is broken. So I’ll get your two milligrams of dilaudid, dear. (Insert hand pat)

After medicating B, I find myself outside of C’s room girding up for the daughter with her apologies and excuses for bringing her father back to the hospital. I luck out and she isn’t there yet. I gently stroke the top of his dear head and softly call his name. His eyes flicker open and his smile is distant and vacant. “Where am I?”
“At the hospital and I‘m lucky enough to be your nurse Mr. C.”
“Why am I here? I want to be at home in my chair.”
“I know but your daughter felt like you needed to stay with me a few days.”
“Is she here, where am I?”
(What I really want to say) “She isn’t here; It seems like she is greedy and won't sell your million dollar house in Very Prestigious Hills so you can live at a lovely Alzheimer’s facility. My guess is she is taking a well deserved spa day on your nickel because she quit her job to care for you. So she tells us you have fallen or almost fallen or might have had a stroke or were choking or couldn’t wake up or had a fever or stopped speaking or lost the feeling on one side of your body or something which will lead the ER to admit you to the hospital; when really she needs a break because it must be hard to take care of a frail elderly man who is confused and incontinent 24/7. I know I couldn’t take care of a demented loved one 24/7 for all the million dollar houses in the world. So daughter feels it is her right to contribute to the bankruptcy of the Medicare system with your frequent admissions. So you’ll stay here for 72 hours, get some fluids (when you keep your IV in); we will hover over you to make sure you don’t fall; keep your skin dry so you don’t get a wound; make placement recommendations--which will be ignored--and send you home. Again. Please don’t stop breathing or allow your heart to stop because I really don’t want to do compression on your 90 year old ribs; they will break with the first compression and it will make me physically ill. Find it somewhere in your mind to lucidly explain to your daughter you don’t want CPR because at this point, we must attempt resuscitation. Attempt is the key word here.”

D’s room is as quiet as a tomb. Damn, what if he died in the last hour and he was alone, how terrible for him he always liked lots of peo-- D interrupts my conclusion jumping with a twitch of a leg. I take his hand; it’s hot to the touch, clammy and very edematous. I say good morning and he speaks to me without opening his eyes. “I feel like crap.”
“I’m sure all this fluid is very painful. I’ll do my best to make you comfortable today. You’re burning up, too. Hey, I thought we had an agreement, the next time we saw each other it was going to be downtown on your corner!“
(What I want to say) “You look like crap, too. I think you might just die this time. Dude, you need a new liver. Hell, you need a new body. So I’m going to do my best to make you comfortable, k? And hopefully if your liver doesn’t kill you, the alcohol withdrawal won’t land you in the ICU for a few days. D, I think you just won today’s Most Medically Fragile award! And your prize is I get to treat your fever, your infection, your edema and make sure you don’t have seizure when you finally start withdrawing from the booze. And all of this with--you guessed it-drugs that could damage your liver with a side order of renal failure! Oh and another thing, I thought you were dead when I came in the room. Please don’t die today. I really want you to get well enough to tell me those crazy stories that may or may not be true.”

I press my ear to D’s door; I can hear her chanting to herself. Its quiet and a sing song repetition of the word: “camping”. Sure enough, she’s in the Veil Bed. A huge tent of a thing over the bed. It keeps us from harms way and we can sorta kinda control her behavior with limits and threats to “put her in the bed”. D doesn’t actually mind the bed and the last time she was here (cellulitis or gout or something like that) I remember she quietly approached me at the desk: “Lady I’m going to go off and I need to be put in that there bed so I don’t hurt you or anybody else what’s here today.” After I helped her to bed, she told me thank you and we had a very quiet afternoon until she called and said she felt better. It was a Zen moment. The split second before I awakened her I promised Buddha an orange slice if she had a quiet day because between crowd control in A’s room, liver control in D’s room and pain control in B’s room, E was going to have to give me a break. We don’t have the budget for a sitter so the bed and meds are going to have to keep all of us safe. I was in luck, D was smiling when she saw me and told me she was very hungry and wanted to sit in a chair because “camping” time was over.
“Camping? What do you mean?”
“Nurse yesterdee tol me I was a campin’ in this here bed! I likes to camp! Good thing too cuz wheres I lives is a sayin I cain’t come back there.”
“The group home?”
“Uh huh. The voices made ‘em tell me I couldn‘t live there no more” Tears spill from her eyes and she doesn’t bother to wipe them away. I gently reach toward her, asking, “My I?” and wipe her cheeks with a Kleenex. “I don’t have any answers for you, E but I can get your breakfast set up. The case manager will see you later and you can make a plan with her.” E follows my directions and safely maneuvering around the bed’s curtain and lets me lead her to a chair. Her gait is unsteady and my hands on help keep her from falling when her knees buckle.
“I’m too fat, I shouldn’t eat.”
“It isn’t fat, it’s fluid from your liver and it’s building up around your stomach.”
“I’m not fat?”
“Nope, hardly. You’re very thin.”
(What I want to say)”You’re very thin because sometimes your thought processes are so disorganized you don’t eat. I fear for you and if I dwell too long on what your future is without a group home. I will weep for the injustice of it all because the best place for you, Fort Public Mental Institution, is closing in a few months. We treat our stray animals better than the mentally ill in this country. I’m so deeply saddened your psyche is broken. If I had a magic wand I would wave it around your heart and head and you would have the capacity and the competency to care for yourself.”
“E I will be back in thirty minutes with your medicine.”
“Oh OK lady. I’ll be here.”

*Patients A, B, C, D and E are composites of patients I care for. When I say “care” I sincerely mean this. As much as the drug seekers make me crazy and the Notreallysickjustreallysuffering people make me; I care for them. But I’m allowed to have an opinion about their stupid, self-destructive and dangerous behaviors. If you leave me a nasty comment, I’ll match your nasty. And if you keep a blog, well let’s just say you were warned. . .

I glance at the clock in the hall and the little hand is resting on the eight. Only eleven more hours. . .

I wish I could call my professional malaise burn out but it’s more like caregiver fatigue. For the most part, my fatigue isn‘t from the patients, their diseases and their demands on me but it stems from the system. Our system is hopelessly broken. If I knew the answer I would shout it from the mountains twenty miles to the west of where I’m writing and hope the powers that be hear me.

I’m fortunate my own psyche is such that just writing this blog entry helps me see the value of the work I do which in turn buoys me up I can face the five patients assigned to me tomorrow morning at 0630.

First and foremost, I will do no harm.

An Honest Day's Labor

Today I did real work.

I did exactly what I went to nursing school for: taking care of people. Lately, I’ve been feeling more like a facilitator than a nurse. Sometimes I am the “resource nurse” which simply means for 2 extra bucks an hour I oversee the care of about 20 patients and make sure nothing Bad happens. Juggling five balls in the air while typing on the computer and talking on the phone. I’m also in charge of making sure we meet the budget and don’t have too many staff members working if our patient census is low. Just looking at the description of it makes me want to simultaneously yawn and scream with boredom. Most days, when I am working as a bedside nurse I am in charge of five patients, their medications and their treatments; making sure the doctor’s orders are carried out; following up on lab and test results; following up on status changes. Referring to myself as a bedside nurse is laughable. Lots of computer time. A few months ago I guaged how much time I spent each shift charting at the computer and it was six hours. I spent a total of six hours documenting what I had done for the patient in twelve hours. But really, I had only worked with the patients for six hours. That’s terribly sad, isn’t it? I’m supposed to be a nurse not an administrative assistant. Oldest Friend tells me frequently: “you do real work, so few people can say that about their work life. “ Her words make me feel like a fraud because most days my work is rushed and I’m always always on a strict time based schedule. It’s rare--with administrative duties--I have time to do hands on work delegated to the nurse’s aid (aside from toileting and walks to the bathroom).

Today I worked as an aide on our unit. This sort of work is often thankless and always hard but I relished the difficulty. I had ten patients in varying degrees of healing and illness; a mixed bag of elderly, psychotic, young, brain injured and two living beyond the odds of survival. I have mentioned beforeI find the aid’s duties meditative and calming. My only time limits are making sure I complete blood sugars, vital signs and meals at the ordered times. Usually, everything I do is time sensitive. Without all of the charting, I eased through my day; no need to rush down the hall nor was I interrupted six times an hour with phone calls or requests for help or opinions or complaints. I worked my way down the hall; helping each of the patients with their baths or showers. Bathing someone is particularly intimate and I, being very shy about my own body, try to ease my own tension by talking to the patients’ about their lives.

Three of my patients were six to eight short years away from the century mark and each one of them had a unique story to tell. One grew up on a ranch and has entertained me for years with stories about the horses her father raised; another lived on a reservation and her grandparents had walked the trail of tears; and another was a hairdresser during the 1930’s. She explained the big Marcel wave device while I washed her body. I was rapt. Her memory was absolutely razor sharp and she could recall yesterday as well as an afternoon in 1930. This patient is particularly special to me because a few years ago I was privileged to help ease one of her beloved family members towards death. Attending someone at death is even more intimate than seeing to their most private bodily functions.

I’m sure the other nurses thought I was an extremely inefficient aid and out of my element because it took me at least 45 minutes to wash each of my bedridden patients. But one of these baths went quickly because she doesn’t speak. Diagnosed with schizoid-affective disorder for many years and living on her own until a month ago something snapped in her mind and she just sort of left this plain of existence and lives somewhere deep inside her own psyche.

She has been with us for a few weeks and slowly coming out of her catatonic place. She will follow you with her eyes and answer yes and no questions. It has been necessary for us to do everything for her because she wouldn’t move or couldn’t move. She doesn’t resist these ministrations; she is placid but she does look at us with huge round eyes and it is hard to interpret if she is frightened or confused. Today, her face was more relaxed and she did speak the word yes rather nod her head. Thankfully, the staff keeps her television off so her room has a monastic silence to it and only the ambient sounds from the hallway filter in. Usually mute patients make me feel a helpless and out of control but I feel a great sense of peace when I am in her room.

At lunch, I sat next to her bed, explaining to her what was on her tray and arranged bites. Her catatonic state is so extensive it is necessary for us to not only feed her but to cue her to chew and swallow. I had a container of high protein shake in my hand and she reached out for it. Deliberately. This woman has not spoken anything beyond one word and has not moved on her own for weeks. Finally, she made a need known. She was thirsty. I smiled at her and handed her the container and she drank deep droughts without being reminded to swallow. I looked at the spoon I was about to place on her tongue and returned it to the plate. Making eye contact with her, I asked: “Would you like to do this yourself?” She didn’t nod or speak but looked at the spoon for a few seconds, contemplating it, sussing out exactly what it was for and then she grasped it with a fist, like a toddler, raised it to her mouth and tentatively fed herself a few bites before she drifted away again.

I’m glad she drifted away because it would have embarrassed me if she had seen me wipe tears from my cheeks as I gave her those last few bites.

At last, an honest day's labor.

Forty-seven Going on Twelve

Aren’t I cute? That was taken on my sixth birthday when it was exciting to be another year older. As a suburban child with a Cleaveresque mom we of course had birthday parties. They weren’t lavish pony, clown, and magician affairs, but rowdy backyard parties. Mom thought them out, we always had interesting games to play, I can’t’ remember if we had projects and crafts (like at my boys’ parties). Of course we had cake. Duncan Hines. My favorite birthday cake is German Chocolate. I haven’t had one in years because my favorite favorite birthday dessert is pie. Peach pie.


The bigger digits started freaking me out when I turned 35. (If you thought last weeks crisis was ridiculous, you should have seen me at 35!) In some ways I welcome my birthday. It’s a chance to get to do what I want to do. Plus people give you presents. And they sing to you. This is a fine thing as long as it isn’t in a restaurant amongst strangers.




One of my most amusing memories is the boys’ grandpa Francis 90th birthday celebration. We were at the Olive Garden and the waiter overheard us talking about this auspicious occasion. So what does he do but gather together the wait staff and imprison us at our table singing that highly copyrighted song. I looked over at Francis and he was mortified; The Beav who was all of three years wanted to crawl under the table as did the rest of us. Seven year old Wally looks at Ward and me, daggers in his eyes: “If you ever do this to me, I’ll hurt you.” “No prob son. I don’t like drawing attention to myself.”

That‘s me at 20 and I loved drawing attention to myself. My excuse on my birthday was I couldn’t help myself, after all I was drunk and Adam Ant was playing on the jukebox; that table was begging me to dance on it. Besides, it was my birthday. This is the only reason I wasn’t asked to leave the bar-without-the-cabaret-license. And I was hot.

Speaking of drunken birthday celebrations: When I turned 41, I spent my birthday on this beach . (picture from gohawaii.com) The whole nude thing necessitated the copious amounts of alcohol I consumed that day. But what a hoot! All the people with the pretty bodies were covered up and all the not so pretty bodies, nude. Isn’t that the way it goes? My friend had this awesome beer opener, ever time you popped a top a voice jovially encouraged you: “Oh yeah! Time for a beer!”

Another memorable birthday was my eighteenth. I had this massive thing for Johnny Mathis (image: newlog.com) and he was on tour that spring. My boyfriend at the time was so smitten with me he actually took me to a Johnny Mathis concert! What a great evening. What a dear man. I’ve been looking for this guy for years just so I could tell him his gift became the litmus test for how much you really love me.

I love being the princess…but... sometimes it doesn't always work out that way. I met the boy who handed me my first broken heart, on my sixteenth birthday. My mother threw a party for me and he came with his sister. Funny, as I was looking through pictures for blog images, I found his. I also found the picture of the girl he left me for,too. I had a WTF moment and then without thinking shredded them. It felt great. A good birthday gift to myself.

I made resolutions (which I am happy to say I’m keeping!) this January so I have formulated three goals to reach by next March:
1. Weight what I did in 1993
2. Certified in my nursing specialty
3. Ready to pitch the novel to an agent

Looks like a busy year for me! I’m slated to have a happy happy birthday this weekend. I‘m not sure what The Girl has planned but I know it will be fun! Assuredly it won’t be Maui, or a massive party in the back yard with balloons and pin-the-tail-on-the-donkey, and thankfully not a drunken night in a bar. It will be filled with laughter and people I adore.