Sunday, December 11, 2011

Fearfully and Wonderfully Made

I was driving the back roads this morning playing The Chieftains Christmas CD, "Bells of Dublin."  (Browse here to hear their fine fiddling and piping.)  "The Bells of Dublin" gladdens the heart on a dreary December day; I truly look forward to hearing it each year. By the time I reached Heart Man's house, I was in an excellent mood and whistling an Irish tune. 

Maybe you have this conversation with your patients; the one that begins, "As we age..." and concludes with trying to get the patient to make some sensible accommodations for having grown old and frail.  Heart Man is  physically frail, but his faith has never been in better health.  He sees God in almost all persons and places.  I suspect he makes daily, even hourly, contact with the spiritually numinous; the thin places where we come close to God.  His spirit is lively and faith makes him unafraid of death.  Yet, he has a hard time living with the limitations of his body.  

How soon can I plan on going one last time to Europe?  he asks.  "Can you walk upstairs without needing oxygen?" I ask gently.  Then I review the rigors of air travel.  "Do you think you could do that without getting totally exhausted?"  Of course the answer is no; but he did so hope to go just once more. 

I have another patient, recently diagnosed with elevated triglycerides, stroke, and new hypertension, whose life and diet have suddenly, radically, changed.  It was easy for Trig Lady to maintain a heart-healthy diet when it was served from Dietary three times a day, but now that she's home she wonders what to cook, because she never was much of a cook when it came to vegetables.  And, what should she do with 8 pounds of bacon and sausage she has stored in the freezer?

Do I really have hypertension now, Trig Lady asks; I've always had a low blood pressure before. So should  I really give up the bacon?  I haven't had any for a whole I shouldn't worry about eating healthy anymore.  Right?

Before this begins to read like an NCLEX test question, I should  tell you the most merciful answer is the swift and terrible one, couched as a question if possible.  To Trig Lady I said,

"With your condition/on your diet/to lower your cholesterol, you have to limit saturated fats.  That means choosing foods that give you good nutrition and less fat.  Bacon has three things you don't need/want: sat fat, sodium, and nitrates.  It doesn't have much food value (protein, vitamins) beyond that.  What breakfast foods could you eat that have good nutrition and less fat than bacon?"

Of course, even after your pep talk the patient may not do as you direct; she may talk herself into that bacon after all.  Imagine how she will go about replacing that high sat-fat with something better.  Make sure she has a plan for meals and a way to get the foods you suggest.  If that fails, you can always suggest to husband/daughter/friend that a freezer raid is in order.

It turns out Heart Man had only a vague understanding of how the circulatory system works, despite a history of  major cardiac deficits.  I learned this as I was covering normal body circulation and how cardiac deficit impairs it.

"...then the left ventricle squeezes the blood out the aorta and sends it to the whole (peripheral) body," I said, wiggling my fingers and shaking a leg to demonstrate.  Seeing his wondering face, I concluded, "It really is just like the Psalmist says, we are fearfully and wonderfully made."  

The patient gazed at me and then lit up with a smile.  "Imagine all that!" he said.  "I had no think that's how God made us.  All those blood vessels.  Praise the Lord!"   I tell you, we were having church right there in the living room.

I found myself wishing someone could make travel possible for him, all the while knowing it was a forlorn hope.  On the Prayer Team at church we learn it is our place to ask for healing in body, mind, and spirit; the rest is up to God.  Whatever God chooses, I suspect Heart Man's praise will be unceasing. Let mine be, also.

Thursday, December 1, 2011

Cupcake Walking?

"...and they asked her how she liked doing Home Care and she said, 'It's a cupcake walk!'"  The Super shook her head and asked me,  "Now that you've been out there for awhile, do you agree with her?  Is Home Care a 'cupcake walk'?"

I cast my mind back over dozens of visits, the parade of faces passing in review; Mr Train Wreck, Kitty Man, Lung Lady, the Edema Twins, and their kind, concerned, families and friends.  "A cupcake walk?" I said, "Not hardly!  I don't know where or how she was practicing, but is sure wasn't here and now."

Home Health is nursing for sole proprietors-at-heart, requiring a sort of entrepreneurial spirit and a love of the open road coupled with nerves of steel and a head for infinite detail.  Add to that tolerance for reams of government paperwork and scheduling.  Bring with you a fondness for human quirks and a self-assurance that you know your patients, nursing-wise, better than anyone but God.  There you have a Home Health Nurse.

Personally, Home Health Nursing puts a smile on my face that I seldom had in Hospital Nursing.  Just being able to talk with my patients, to establish a relationship with some of them, help solve their problems, figure out where their learning deficits are and teach to the gaps in medical information, nurtures me in return.  Hospital Nursing is far more high-tech and treatment oriented, because they see medically unstable patients.  No one pays for a patient to lie in hospital unless something pretty technical is being done for him.  So, hospital nurses spend their time executing orders for Medication and Treatment in a timely manner; review plan of care, meds, labs, and imaging; manage acute problems, and chart it all accurately.   Add to that at least one patient to be admitted or discharged (another blizzard of orders) per shift, and you're lucky to get a lunch.   There is less time to talk and teach in a hospital setting.  Sometimes it's difficult even to get a bathroom break.  Maybe the Hospital Nurse of the Year is able to accomplish both technical care and talking/teaching, but the rest of us are only human.

Do not imagine--for one moment--that Home Health Nursing goes at a slower, healthier pace; it does not.  Home Health Nurses do everything Hospital Nurses do, only their patients are (at least somewhat) stable and scattered across the community.  My bulky bag is the modern equivalent of the one carried by fictional character Sue Barton, who remarked on the weight of the heavy black bag on her arm marking her as a nurse among the Henry Street patients.  My car has become my supply room.  I chart with government requirements always at the back of my mind.  I set up and change the visit schedule as necessary.   Whatever the patient needs, if I don't do it/ask for it/order it, the patient goes without.

As friend Little Mary says, "God is in the details."  If you enjoy independence, glory in nature, and have a desire to walk with patients/families through difficult times, you're going to do just fine.  That's the beauty of Home Health.