Frogs And Snails and Puppy Dog's Tails

Twenty years ago tonight, about this time I was sitting in our stifling hot living room in a wee bungalow listening to the rain as the fifteen day record setting heat was finally broken. I also felt my contractions start as the weather changed. Our dear friend and neighbor, B, was sitting up with me. She wasn’t sleeping well, the heat coupled with a recent lay-off was insomnia making. I appreciated the company, too. I had been home waiting to have a baby for four days and I was bored even though I was relieved to be on maternity after struggling to continue working. I was a NICU/New Born nurse at the time and had to shuttle between the nursery, the mom's rooms and the labor deck. Each unit was positioned down a long long hall and the distance from the nursery and the labor deck was getting longer with each passing hour as my edematous sausage legs and I trudged the stuffy hot hallway as I checked on the babies and moms. I insisted on having the walking job: hoping the activity would stimulate labor so I could just pick up my bag and drive to the hospital down the street. My sweet patients--most of them Spanish speakers--were prone to leaping from the rocking chairs in their hospital rooms so I could sit in my “delicate” and “advanced” condition. They would cluck and carry on about how huge I was and ask me if I was delivering twins. It never failed to make me laugh despite my misery. B and I discussed my last week at work, the grace these Mexican women brought to my life with their ability to care for their caregiver. We talked about how I had been disappointed I wasn’t having a girl. How much I had wanted a girl but I had come to terms with a boy. Because a girl was going to turn 13 and suddenly hate my guts for a decade a so; a son would only hate me for a year or two. I would try to live vicariously through a daughter: pushing and prodding until she was a puking anorexic mess on a therapist’s couch. I didn't tell her how impossibly young I felt in the face of having a child because I couldn't tangibly name what it was that made me feel so terribly young and unprepared. When I look at that picture of me and Wally, he seventeen days old and me younger than my nephew is now, I am alternatively consumed with relief I am twenty years older and seized with a desire to turn back the clock and fix terrible mistakes. But what frightened me most, that night, how would I relate to a boy? I, being so innately feminine and female…what would we talk about?

I was a quick study: We talked about Bear and how much he loved Wally and about road construction, dump trucks, ambulances, fire trucks, trains and dinosaurs. Snails and puppy dog tails stuff. But it wasn't all fun and games and rubber and steel for Wally. He was a deep thinker, that one. He was about two when he had an epiphany at dinner. Wally thoughtfully and reverently intoned:

“My Dad is not a fire dog.”

A big existential moment, to separate one’s parent into the category of human from beast.




I’m not sure how successful we have been staying in the human category. I know I’ve moved back and forth between the two. Tonight I said as much when I reminisced about sitting up the night before he was born. Wally was polite and indulged me as I told him the story of that evening with B. I also told him how thankful I was I had boys even though I wasn’t sure how well I had done relating and how parenting was a really hard education into adulthood for me. We were in the car when I told him all of this. That forced intimacy of a car ride at night made it easier to talk to him about these things. That, and he was a captive audience, too and listened probably because I was giving him a ride some place. He rarely asks for a ride so I volunteered to pick him up later,too. It won’t be the first time I’ve stayed up late waiting for him. I was doing just that, twenty years ago.

"Fire Bad, Tree Pretty"

picture source

March seems to be about continuing my intellectual break: between the Jersey Girl bounty hunter novels on vacation last month and overdosing on Buffy The Vampire Slayer via Hulu this month I’m thinking my brain has called it quits on thinking/sussing out/deducting/inducting/ or figuring out anything beyond blood sucking demons or bad guys in Atlantic City. I’m not sure if it’s all the crap swirling around me and happening to my family and those I love or if menopause is eating my brain. I’ve been meaning to blog about menopause but I keep forgetting to and then when I remember I just get all choked up about it and grab a cookie instead.

But I have to confess, Buffy is making me happy. I didn’t watch Buffy in the late nineties when it came on television the first time. I wish I could say it’s because I was busy making Dinosaur Dioramas for a third grade project or cupcakes for a preschool. But no I was a Xena girl. Not enough time in my life thirteen years ago for two chop sokey camp-a-thons television shows. Ward blamed Xena: Warrior Princess for the questioning I did about my sexual orientation while I was in therapy eleven years ago. Um…yeah, cuz teevee shows make people gay that’s why everyone who watched Will and Grace have thrown aside their real lives and are in New York City looking for Karen and a cocktail. I wonder if I had watched Buffy all those years ago if I would have gone to a therapist wondering if I were a vampire slayer or a watcher? Good thing I didn’t, my blogging would be from a small room in a quiet hospital.

A padded cell sounds good about now. I managed to ruin both of my sons’ lives last Wednesday before 0730 in the morning! It was awesome! Because everyone knows I live to ruin my kids’ lives: I told Wally he had to get his shit together or he was losing the privilege to drive my car and then I explained to Beav he was going to his dad’s house after school rather than my house (where the PS3 lives). Wow, you would have thought their lives had just become Shakespeare meets Brecht in the level of tragedy I had inflicted upon them both. If I had that kind of power I certainly wouldn’t be exercising it on the likes of them. Hell, I would have sent my favorite president to hate--W--and his little friends up into a roaring puff of smoke about the time Sunnydale was swallowed up by the Hell mouth.

Menopause seems a likely cause for my lackluster intellectual leanings is that it took me AN ENTIRE SEASON of Buffy to figure out the extremely droll irony of a Hell mouth existing under a high school. I had to put the episode on pause so I could laugh and laugh and laugh again when the irony finally sank into my withering gray matter. Then I was halfway through season two when the light bulb went on: Whedon didn’t take the vampire stuff seriously and was poking fun at a genre, himself, and the fans.

I are very smart.

Or maybe I’m taking a brain break because life feels really hard lately. I’m exhausted by a series of bad events taking place in the lives of people I know and love. I’m really tired of worrying I’m coming home to or waking up to a dead dog. I’m sick of nagging a kid about cleaning up after himself or nagging to help around the house (just pick one and I’m nagging at him); I’m sick of the patients who--on some days--feel like Whedonesque demons with bad latex faces and glow in the dark eyes holding me down and sucking my soul out of my open mouth. I think its winter. It’s been dark and gray this winter and we haven’t had as much sun as we usually have. Add a child who feels like a failure at the ripe old age of 19 (Dude, save that for 30 years from now, ok when you‘ve really made some boneheaded mistakes) with a dollop of frustration surrounding the continued disinterest in his sons exhibited by the Asshole I Was Stupid Enough To Breed With, and ice all of that with ever fluctuating hormones and you have the makings of a really hard winter and looking for a friend in Mr. Stabby. Too bad things like a child preceding a parent in death, stage 3 cancer and broken hearts aren’t vampires a slayer could stake in their hearts so they dissolve into a pile of gray ashes.

"Whatever is causing the Joan Collins 'tude, deal with it. Embrace the pain, spank your inner moppet, whatever, but get over it." -- Cordelia

Day Light Savings time has helped tremendously. It’s a pleasure to be sitting here at 1815 and the sun is just beginning to wane. The second Saturday in March springs us forward to summer. Springs me forward to all sorts of things like working in the yard and spanking my inner moppet.

Memorials

We walked the National Mall today. The whole thing. From the Smithsonian to the Lincoln Memorial down and around the Jefferson Memorial and back to the Smithsonian. It was a big walk for these old legs and it was rainy, windy and cold. I'm so glad I did it, too because it was one of the most humbling and moving days of my life. Beav and I saw all of the memorials and I cried at three of them. Which is sort of melodramatic and ridiculous because I've never lost a family member to war. My late uncle was a decorated WWII soldier, my cousin was married to a medic in Vietnam, I have multiple cousins who were in the service, my ex brother-in-law ran the officer's club in Germany in the late sixties (Hooah!). So it isn't like my loss is extreme. I can't imagine the emotions running through people as they saw this and there were people looking for their loved one's names and they wept and prayed over them. There were too damned many names:


If that wasn't enough we stumbled onto the Korean memorial and the artist explicitly depicts a look of betrayal and loss in each of the statue's eyes.

But more evocative is the wall running along the statues with faces which aren't visible until you are very close. At first I wasn't sure I was seeing faces and I thought it was an optical illusion but then I stood very close and I could see the faces which still weren't really clear until I reviewed today's pictures and they are very clear. You only notice them later in the form of memory. Which is exactly how we have noticed the Korean veterans. But they are from the generation that survived the Great Depression and later watched older brothers march off to WWII so it wasn't like them to speak up and say they suffered in Korea and didn't come home whole. It is perhaps the most poignant statement I've ever seen in a work of art. Our shadow veterans.


By this time on our long long walk in the rain, I'm trailing behind the Beav because I'm about to cry and I don't want to embarrass or upset him. Again, I've not lost anyone to war and I barely remember Vietnam. We are plodding along the path when I see a cluster of people gathered and it took a minute for me to realize why they were stopped: The Vietnam's Nurse's Memorial. As crazy as my calling can make me, I am deeply proud to be part of this brave sisterhood and I remember how hard women fought for this memorial to be a part of the National Mall after they have been passed over for medals time and time again. I urged the Beav to follow me as I almost break to a run. I was wet and I was cold and the urge to just find a cab and go back to our hotel was strong but I was graced with standing next to a memorial for my sisters who volunteered to fight in a war most didn't understand and many protested. Aesthetically, the bronze statue is unspeakably beautiful and the tenderness of the nurse's touch is unmistakable. The artist gets to the heart and art of being a nurse. I felt the tears well up and spill onto my cheeks, Beav wasn't sure what the statue was all about and I tearfully explained to him it was hard fought but a well deserved tribute to nurses in war. He had the good sense to walk ahead of me while I sobbed on the path behind him. Had I been alone or with TG, I would have sat on the bench and wept for all the lives lost and the disrespect and discount of the sacrifices made. I doubt I would have been so brave to fight in a misunderstood war. Or any war for that matter.



It was a memorable day.

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.

Pebble In Pebble Out

I've borrowed a fable from the ancient Greek writer Aesop to create a parable you can use in the coming weeks. Once upon a time there was a very thirsty crow. Rain hadn't fallen in a long time, and the creek from which she'd always drunk had dried up. Searching and searching for a bit of moisture, the crow finally happened upon a tree under which sat a ceramic pitcher with some water in it. But the pitcher's neck was narrow, and the crow couldn't fit her beak past it to reach the water. Inspired by desperation, the crow at last got an idea. Why not drop small rocks into the pitcher, making the water's level rise? And that's exactly what she did. How sweet it was when at last she quenched her thirst.

This is becoming a theme isn't it? I swear this is the last time I'll use my horoscope to spin a short essay. But this week's is intriguing. . . Last week, Rob didn't intrigue me but made me scratch my head with this gem of a horoscope. I spent a little time this past week contemplating this fable and what it meant. It wasn't until tonight I realized in a sickening a ha moment how this fable applies to my life.

I think I'm trying to quench my thirst after an arduous ten months worth of life. Most of the time I can prop myself up but frankly it's getting harder and harder. So much has happened and changed in my life over the last 300 plus days. I've experienced a great deal of loss and the people who seem the most blind to it are those closest to me. I've lost my mother, 10% of my income, my son is leaving home and he is estranged from his father; my other son is worried he will be his stepmother's next victim; I am estranged from my sister after the toxic waste that is our relationship escaped from it's safe container I keep buried deep inside; my dog is dying; and my partner has such pain in her right shoulder and arm she can not raise it over her head and it has rendered her sleepless and unable to do much around the house (something immensely more frustrating for her. It just annoys me when other shit is on my plate). The icing on the cake is of course when I'm not at home taking care of people; I'm at work taking care of people.

Is it any wonder I went to the gym tonight (while Beav was at Parkour) and managed to work out all of twenty minutes before I decided the better idea was sitting in my car; crying and eating a 700 calorie snack? I suppose this is better than finding a liquor store and drinking in the parking lot. While the image of doing this gives me the shivers don't think for a minute it didn't occur to me.

It's a good thing I had a "refreshing" break from reality because it didn't sting so much when I returned to a messy kitchen and clean laundry lounging around the family room.

Good thing I have more pebbles.

One edit at 0835 the next day: My problems aren't HUGE life changing problems like having cancer or a chronic illness or a loved one with either of this issues. So maybe I have an extremely low threshold for giving and a low tolerance for drama and upheaval. And maybe I can't continue to give and give and give because ultimately I'm selfish. If this is the case then I guess I'm getting what I deserve.

Delusions Of Happiness

One of my favorite blogs is here. Gretchen provides tips on Wednesday and they are always salient and timely. This week was no different. I had such a bad day on Monday, I was still reeling from it by Wednesday. A sort of numb PTSD feeling like I experience after an emergency that doesn't go well or a difficult death. Because of HPPA, I can't go into the particulars but lets just say I spent most of a twelve hour shift in one room and it wasn't because the patient was unstable and the doctor unwilling to send the patient to the ICU. Nope, this patient was completely out of control and in order to keep him off the floor I had to literally sit at his bedside and reorient him constantly. If my other four patients needed anything, the charge nurse had to come to the bedside while I threw pills and whisked bandages off and slapped them back on my other patients. I could go into a rant about this situation and why the patient was out of his mind and who it is but I would be (deservedly) fined five figures and lose my job. Anyhow, early Wednesday, cruising my blogs when I'm greeted with the "9 Tips for having a good bad day"

"Where the hell were you on Monday" I mumbled into the screen as I begrudgingly started reading. Begrudgingly, because I was in such a place that "bitter" and "angry" was starting to feel like a baseline emotion. Basically, I dumped all the water out of my half full glass so it would be empty. To be really woo-woo about it: I was giving my power over to someone else, namely to a patient with self-inflicted dementia. Who frankly, given how they have cared for themselves don't deserve the level of expertise and compassion they have received in my hospital. Anyhow, by number three (ruminating) I was hooked and realized how fruitless hanging on to the "no good terrible day" had been. To clarify, I didn't spend Tuesday in the midst of whining and moaning about my day at Crazy's bedside. I forced myself out of the house and pulled weeds, deadheaded flowers and decompressed in the dirt. But I did find myself returning to Monday's events and wishing I never EVER had to work as a nurse again. Whenever I contemplate not being a nurse I get a little sick inside. This is my calling and I'm going to let one really fucked up alcoholic borderline personality push me away from the bedside? If I did this, shame on me, I would be giving him my power.

Wednesday afternoon, I looked to number 7: "Act the way I want to feel" Which wasn't hard because we had this unseasonably cool and humid day yesterday and before I even tackled Gretchen's tips, I had been in the garden overcome with joy we have tomatoes on the verge of ripening. But I had the nagging sensation of counting down the hours before I had to return to work on Friday and I did not want to return with dread and a heavy heart. I wanted to return with hope for a better day and a patient who had the right mix of psych drugs on board so his thoughts and actions were a little more organized.

Yesterday afternoon, after Wally and Beav cleaned the house for me (beautiful job they did, too) my Ipod gave me a wonderful song I just discovered and downloaded last week. Too bad it's from a regrettably sappy movie Sisterhood of the Traveling Pants. Bob Schneider is a few years younger than me and maybe he is being Gen X and ironic when he wrote these words but I have taken them at face value:

There is a universe that can't be seen
It's just a feeling if you know what I mean
A delectable dimension undetectable by sight
It'll fill up your heart in the dead of the night
Some say its an astral plane
Can't be described can't be explained

The world exploded into love all around me
The world exploded into love all around me
And everytime I take a look around me
I have to smile

Oh is our life just an illusion
There is no need to figure it out
The separation exists not in your love filled heart
But only in your mind
The real story's all around you
Even now it surrounds you
Even now I feel the power

The world exploded into love all around me
The world exploded into love all around me
And everytime I take a look around me
I have to smile

I contemplated these words for a long time yesterday and I felt my spirits (aka "vibration") lift. Since I have spent eleventy thousand dollars in therapy, I find it exquisitely simple to act the way I want to feel. Once upon a time I thought acting cheerful like some sort of Little Mary Sunshine--you just need to turn that frown upside down and it will be a sunny bright day and all your problems will go away!--sort of dreck was just that: dreck. How dare I live an unauthentic emotion! To feign happiness in the face of bitterness, despair or frustration was lying to the world. Maybe it is a lie. Maybe being happy when things look bleak is a form of delusion. Or perhaps its just a way of looking around the road blocks to the place where love is exploding and the love in one's heart is not separated by the hell living in one's head.

All I know is my heart is full and love is exploding all around me. Thank you Gretchen and Bob.

Warrior Princess, Smorrior Princess. I'm just a mama protecting her youngin's

Long-standing myths are on the verge of mutating. Stories that have remained fixed for years are about to acquire unexpected wrinkles. The effects may be pretty spectacular. I suspect it'll be the equivalent of Sleeping Beauty waking up from her long sleep without the help of the prince's kiss, or like Little Red Riding Hood devouring the wolf instead of vice versa. There's something you can do, Pisces, to ensure that the new versions of the old tales are more empowering than the originals: For the foreseeable future, take on the demeanor and spirit of a noble warrior with high integrity and a fluid sense of humor.

This was my horoscope for last week. Warrior, yes; high integrity and a sense of humor was an epic fail. But it’s a place to start. Always the good thing about the bottom: you can move up. And see the stars and yadda yadda twelve step yadda.

The Beav had his wisdom teeth out last week and was a trooper about it. Wally was deployed from Alexis’ house to my house this weekend, against his will. I guess this will prepare him for the US Army to make decisions for him. Hopefully, he will accept them with more grace. Not that he has a stellar role model for that.

At least, I don’t have to continuing stuffing down how I feel about Alexis Carrington. What I was waiting to say after The Beav graduated from high school just sort of puked out of my mouth and into her ear. After she started to cry, she accused me of being: “mean”? Mean? Are we twelve or fifty here? The more apt verb would be “done”. I'm not being "mean". I'm coming from my unhappy "done" place.

But I started the week “done”. I resigned from doing charge nursing. If I didn’t have a child to finish raising I would have resigned from nursing. Too many never events in one single shift.

But my week hasn’t been without noble warrior moments.

One of my “noble warrior” moments last week was not calling security when the screaming family room physically threatened a doctor because I knew she was (a) crazy and (b) grieving. My second moment was allowing another family see my profound grief while I was at the bedside and shared the news their 48 year old sister--a vibrant, previously healthy, biologist--may never return from her vegetative state.

I owned to Alexis a few hours after my tirade of how thoughtless and self-centered she behaves, that believe it or not, I have an inkling of an idea the balance it would take to be a step parent. I also know it would never be for me. I don’t have the stones for it.

It took courage, telling Ward how Alexis has negatively affected our sons. I’ve been afraid to do this because, frankly, I’m worried about repercussions on them. It was tough to tell him things she has said to them and done to them over the years; things I’ve witnessed; the broken promises; The Beav's fear about being the kid left at Alexis' now Wally is living with me; how sincerely devastated I am to see the man he has become; so alien to the man I once loved. But then, I’m not the woman he fell for either. I’m not the nodding and bobbing “yes girl” who thinks he is an expert in everything and always right about all that is wrong with me. Tap dancing as fast as I can to make sure I change to fit into his specific mold for me because obviously what he thinks I should do and be is absolutely The Right Thing. When Ward married Alexis, he gave her a ring and his spine. I wish I could grow extra spine and gift part of it to him.

It takes a lot of grace to be a noble warrior. My reservoir of grace was temporarily empty but I can feel it slowly starting to fill again.

(I borrowed my girl Xena from boxoffice.com. She's fierce in that ep!. . .)

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.

I Gots Nuthin'. Whats you got?

Kipper doesn't always make the best decisions. Fortunately, what he lacks in intellect he makes up with enthusiasm. Goof-dog insisted on carrying his moose like this. Walking down the stairs was a foolhardy choice and fortunately didn't end in a trip to the vet. Like my dog, I make foolhardy decisions. Most recently I decided to blog every Thursday. You know, exercise my writing muscles, create a habit. But this week the well ran dry and I have nothing to say.

I Got Nothing.

I could blather on about how much I enjoyed Milk and experiencing what it was like to be a gay man in the 1970's. I was seventeen when he was killed and I vaguely remember his assassination as just another news item. But it didn't really mean anything to me, in part because I was seventeen, but largely because I was living in the Bible Belt and most of my peers sided with Anita Bryant and thought those dirty homos were going to Hell. Actually, if I think too hard about Bryant's opinions and how much they threatened to shape my own, I throw up a little in my mouth and cringe for my classmates who knew in 1978 they were gay but didn't dare come out. I didn't have a clue I was queer and even when I ran into a teacher at a gay bar my senior year, it didn't register I should be shocked, upset or outraged. I was completely oblivious to gay people until I was in college and came out for the first time. And I was happily oblivious to discrimination. I suppose it was easier for me in Lubbock Texas because I'm categorized (grrrrr...) as a Femme. So I can "pass" as straight. The whole dichotomy of femme/butch makes my head hurt so I need to change the subject.

Is the gym eating my brain? I've been accused of becoming a gym rat and up until a few weeks ago, I used every excuse in the book to NOT exercise. Hell, I even went to work on my day off to avoid the gym! Now I look forward to my exercise routine and wish I had the energy to go after work in the evenings. But it isn't like I stare blankly into space, feeling the burn when I'm exercising. I listen to uplifting podcasts while I row or walk. I still think riding an exercise bike is a glimpse of Hell. B-O-R-I-N-G. Especially at my gym, where Fox News is the television station of choice. But I love to row. I crave rowing. I remember years ago when I was visiting a dear friend in Kailua Hawai'i and being amazed at the strength it must have taken for the Crew teams to skim those long boats over the rough water. Picturing Kailua as I row lulls me into a peaceful state. It could be the gym...

The economy would be easy to blame but I've chosen to ignore the meltdown and just live my life; go to work, pay my bills, have some fun. TG's industry is changing; health care is changing and how we do what we do now, will be vastly different in ten years. And this isn't a bad thing because I will be forced to grow and change. Like this picture of my chunk of photo optic glass, everything is changed but the end result remains the same.

My life's work isn't eating my brain either. In fact, the mix of patients we have has been interesting and each possess an interesting or poignant story. I wish I could tell them, they would individually make for an interesting blog. It has been a welcome relief to be able to actually manage and care for my patients without feeling as if any minute I was going to miss a crucial detail and fail at keeping them safe. Nor are they aren't a bunch of addicts who ran out of Oxycontin and just need a legally sanctioned fix. We are seeing a lot of abdominal pain. People hurting in their core and usually without a readily identified cause. We take X rays and CT scans and MRIs and ultrasounds and come up with nothing. Like my imagination, they got nothin'. My therapist once told me belly pain equals the fear for survival. It can also be a way the body deals with emotional/sexual/physical abuses. One of our young physicians and I discussed this and how we do a terrible job of screening for these things. Dwelling on their pain makes my heart hurt.

I blame group malaise for all of this belly pain. Everyone on the planet needs to take a day off from the news. Everyone. No one reads the news or listens to the news or looks at the news. And then we all need to breath deeply. Collectively for 17 seconds, concentrating on what is right in our world and in our lives I think the malaise would lift and the economy would begin to improve. The belly pain would resolve without a milligram of Dilaudid IV push. Breathing does so much more to increase the vibration of the soul than opioids.

Tomorrow is the first day of spring. Sometimes we have snow, sometimes we have sun. It looks like sun tomorrow. Frankly,I'm the only person in the US who wasn't upset about the time change. It's chilly here in the evenings but it's light outside so I don't have the dual burden of cold and dark. Just cold. And we are back on the the clock in Kipper's belly so he doesn't start asking for dinner at 5:00.

Flowers are gracing the kitchen table. A birthday present a couple of weeks ago that are now celebrating the equinox. Coincedently we are having dinner with the Divine Ms. A on Saturday. The weather promises to be nice enough to start out on her lovely patio in her garden. Spring is better than Christmas because it's about flowers and lengthening days. Spring means summer--sweet lazy summer--is just around the corner. The promise of summer exchanges limp brain cells for flowers and promises.

Swinging the lamp while I adjust my cap and hear you rate your pain on a scale of one through 10

I started this blog as a creative lark and when I was considering some of the things I could blather on about, my calling was one of them. I could write about being a nurse! And I love being a nurse! I am proud to be a nurse!. . .Yay! . . .er…um…no. To begin with HIPPA makes nurse blogging tricky and I‘m too lazy for smoke and mirrors. Besides that, there is so much more to me than RN. But this week I have decided to put on my cap because a new set of flaming hoops of fire regulations are in town and they are shaking my confidence a bit. I’ve been a nurse for a long time and it takes a lot to shake my self confidence but every so often it happens. My latest dose of humility is this list: The Twenty-Eight Never Events or things that should never happen to a patient. And if they happen, the government and insurance companies can refuse to pay. Mind you, the majority of events on the list are heinous events and breathtaking in their degree of neglect and--dare I say--malpractice it would take for them to even occur. The list scares me, not because I’m afraid of perpetrating one of these events but rather what if I forget to record the measures taken to prevent the event and it happens anyhow? ( Nosocomial infections and falls are the two that freak me out) I do believe this list of events will only make facilities better and nurses will rise to the occasion and become even more efficient in the delivery of safe care. However, I think it is time for the patient to take some responsibility and I have designed a list of twenty-eight things that should never happen to me again or never happen to me in the first place, while I’m on duty. I haven’t decided what the penalty. A begrudging reluctance to take care of the offending party or parties will serve as the penalty.

Never Events According To Edgy June Cleaver* **

1. Laying in your hospital bed, call light in hand , screaming at me as I walk down the hall: “Nurse! Nurse! Nurse!” The more grievous version of this is “Girl! Girl! Girl!”
2. Referring to me as “my girl” or “my little helper.” (is this how you speak to your attorney, accountant or doctor?) I’m almost 50 years old, I haven’t been a girl in a long time.
3. Calling me ugly names because I won’t give you pain medicine more than 15 minutes before they are due.
4. Threatening to have me fired or sued or bought before the state board because I won’t violate HIPPA laws and explain to you over the phone what‘s wrong with your best friend since the third grade.
5. Visitors asking me for “some of the good stuff you just gave him, you know that Dilaudid stuff”
6. Patients or visitors calling me hot and are then upset I don’t think it’s funny or sweet or an enticing invitation.
7. Asking me to baby sit your children, in your hospital room.
8. Asking me to listen to your loved ones heart, lungs, or examine that big growth on the side of their leg . Please don’t embarrass yourself with an angry and insulted response when I suggest a trip to a healthcare provider.
9. Patients or visitors who hit, punch or slap me. Or even attempt it for that matter. You will get to meet a nice police officer if this happens.
10. Patients or visitors touching me in a sexually inappropriate manner. Again, you get to meet a nice police officer.
11. Proclaiming I am a bad nurse because I do not--off the top of my head--know the results of your procedures or tests. Chances are I do know the results but am not a liberty to give you bad news.
12. Calling me--again--three minutes after calling me for pain meds to remind me it‘s time for your pain meds. I’m in the med room getting them for you because I don’t make it a habit of carrying vials of dilaudid in my pockets.
13. Patients or visitors who become angry and don’t understand the necessity of keeping my back and my coworkers back’s safe when we seek help from others to move or reposition them.
14. Patients or visitors who bring their dogs onto the unit. If I had my way everyone could bring their dog to the hospital for a visit. For that matter Kipper would come to work every day.
15. Calling 911 from your room because your nurse is late with your meds.
16. Husbands/boyfriends who ask the labor nurse when their wife/girlfriend is “gonna be able to fuck again” while the obstetrician is repairing a fourth degree tear.
17. Do not balk at my gloves when I must touch you. It is an unfortunate and necessary evil.
18. Unless you are under the age of 15 you may never call your father “Daddy” in my presence. This squicks me out more than sputum.
19. Insist on toileting your 80 year old mother and you are a 60 year old son. This is next to sputum and just before Daddy in the squick department.
20. Threaten to sue me because I won’t give you q2H meds every hour.
21. Calling me a bitch under any circumstances. I may be one but you don’t own the special privilege of calling me by this pet name.
22. Constantly reminding me you have a husband/wife/cousin/uncle/father/sister/brother/aunt/mother whatever who is an important politician/business leader/attorney/judge in town.
23. Throw things at me: particularly full urinals or full water pitchers.
24. Accusing me of being forgetful or stupid if I check your armband every time I give you medicine or perform a treatment.
25. Bringing your booze from home. I realize our palliative hooch isn’t as good as yours but I can’t let you have it. But it beats the Hell out of DT’s.
26. Bringing your hunting knife of pepper spray with you to the hospital. It unnerves me to find them when I change your bed linens.
27. Asking me to not make rounds at 0200 because your husband is sleeping on the cot and he gets grumpy if he is awakened. (I’ll speak to your baby about this in the nursery.)
28. Shouting at me for any reason unless you are deaf and can’t hear yourself or are bereft and angry after hearing dire news.



*I have been a nurse for 25 years and some of these things have happened to me and some of them were witnessed. Please know this list is half tongue-in-cheek and I am not some sort of uncompassionate battle ax who needs to retire.

**If you are demented, these Never Events do not apply to you.

Cloris Leachman's brilliant Nurse Diesel comes to me by way of images.andale.com Thank you!