Peace and Quiet

Sunday is my favorite day to work.  Sunday is usually a quiet day with a lighter patient load.  I enjoy meeting visiting family members and everyone seems more relaxed.  The radio plays hours of Celtic-Blue Grass music as I drive back roads mercifully free of excess traffic.  In general, patients scheduled for a Sunday really have a need to be seen and it's always nice to be needed.    Today even the weather cooperated to put me in a cheery frame of mind.

Often clients ask me about my weekend work, as if it might be a terrible burden or something.  One recent client  remarked at length how pleased she was that a nurse had been able to visit on a Sunday.  "You don't have to work every Sunday, do you?" she asked.  "I work the weekend," I replied, "unless I'm on vacation.".  Her eyes flew open and she exclaimed, "Oh my!  Why do you do that?"  I smiled.

"You remember the old Star Trek movies?  The one where Commander Uhura says," (I put on my best no-nonsense Uhura look and continued)  'Peace and  quiet appeals to me, Lieutenant.'"

http://www.youtube.com/watch?v=_k9Ukm9LaWg

watch for it at 1:38  Happy Sunday!

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 week...so 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 idea...to 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.

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.

Movin' On, Movin' Back

Have I ever talked to y'all about home care nursing?  

I have done a boatload of it.  AIDS patients, IV antibiotics, TPN, dressing changes; I've done them all.  The problem was, I could never make any real money at it.   Back in the day, the only ones with steady employment were the case managers.  

I finally left field work and went into education full-time, but I have always enjoyed being on the road, making creative work of patient care.  

Home care is another breed of cat, and the first thing you notice is this: the balance of authority is different when you are on the patient's turf, instead of him being on yours.   The down side of that is, you become more a partner in wellness and less a director.  Some nurses hate that aspect of it; they also hate the travel, dislike going into strange environments, and are easily frightened by anything out of the way.  

The things I dislike about hospital nursing have to do with the lack of those stimulants!  Lord knows there is plenty to stimulate you on a given hospital shift, but seldom do the stimulants have to do with pleasant surprises.  So, when I was offered a job doing regular home care I thought it was too good to be true.

Now I'm down to the last night of 11-7.  I love the people I work with on nights; they are The Best.   We've shared some truly awesome moments.  They have helped me grow and learn to be a better nurse than I ever was before.   I can only hope to find their equal over in Home Care, but I doubt if I'm going to try.  Some things are irreplaceable.  


So, to Blondie, Mr. Somber, New Kid, and all the rest, farewell but not good bye forever.  I will miss you all.

The Year of Change

Do you ever wonder when things are going to go back to "normal," whatever you conceive that to be?  Me, too.  I thought when the threat of snow was past, things would return to Normal.  Then we had the longest hottest summer in years.  That should have taught me.  We managed to put in furnace/whole house air this year, approximately one week ahead of extreme summer heat.  Talk about cutting it close!

My youngest kid got married in May.  You know what a shambles that makes of your carefully planned routine.  It was a beautiful wedding, though.  Gave me an excuse to buy one of those snazzy imported beaded blouses.  I wrote an Irish-Scottish Blessing for the occasion and had the nerve to deliver it by way of a toast at the reception.  The bride went off in a cloud of tulle and ruching and I thought, what are we going to do for excitement now?  

I assumed things would return to Normal.  (You can see this one coming, can't you?)  What are we going to do, indeed.  Three things happened almost at once; the newlywed kid packed up hubby & household for Florida, Son's wife came down pregnant, and then the Middle Kid followed suit a month later.  "It's hardly fair" Middle Kid said, "We've only been trying for a month and I only took the pregnancy test because I was going out to eat sashimi."  Evidently the savvy Mom-to-be does not eat raw fish.  I don't think I'd know enough to be pregnant these days!  So we're coming up newlyweds and babies this year.  And that's just for starters.  

Truly, it seems that everybody I know has had a crisis or undergone some sort of change since January 1.  Every month a new thing pops up.  The Sainted Rector is retiring and the parish is somewhat agog.  A few friends' family members have died, and we're all going to miss Steven Jobs.  Although I never expected to count the newlywed kid in that number, a few friends are on the move to distant cities where there is more work than one can find in the frozen upper Midwest.  More than a few got living wage jobs, which was a real surprise blessing.  

Congress gives every indication of needing its meds adjusted; and now thousands of passionate but peaceful citizens are occupying Wall Street.  I love it.

What, I wondered, could I possibly do for an encore?  Well, I finally got serious about changing departments and at long last I have a transfer to a department where I will work when it's both daylight and when most other people are awake.  That will be a novelty.  Not that I haven't enjoyed the night shift because I have, but one day recently my brain tapped me on the shoulder and said, "Yo, Mama!  This swinging from day-awake to night-awake every week has gotta stop.  You've abused the privilege."  That's how I knew it was time.  

The other thing I am doing is getting ready to go back to college for a BSN, which shouldn't be too difficult considering I have a BA already.  Don't you love the variety of RN-to-BSN programs there are now?  LPN-to-BSN, RN-to-BSN, RN-to-MSN, RN-with-a-BA-not-in-Nursing-to-BSN, the list goes on.  I'm just grateful to have found a junior college with manageable class schedules for the 4 classes I need to enter the BSN program.  From there onward it's all online, thank the Lord.

We heard last week that Son's baby will be a girl, and we're waiting for intelligence on Middle Kid's baby next month.  Although I'm knitting blankets, don't expect me to turn into a gushy Gramma in a sweatshirt adorned with baskets of kittens.  I'm the intelligence-stimulating-book-buying Grandmama. The Grandmama who wants grandchildren to reply, "yes, Ma'am."  And, I'm having no end of fun.

I hope y'all are having fun, too.

Bad Gut Weekend

We had a 3-for-one special on GI bleeders this weekend. This offer was extended to all of the unit, not just my section, so everyone could share in the fun.  All of the bleeders were morbidly obese and helpless in the face of bloody diarrhea; all of them fractious and feeling like hammered shit.  Naturally PRBC’s and fluids were running in rivers, and lab techs appeared almost hourly to draw another round of H&H. 

There was no CNA on duty of course (no CNA was to be had for love nor money) and so another RN partially filled the role.  Brainy as we are, an RN does not have the same skills as an experienced CNA.  Having an extra nurse made it possible to actually care for the people we charge the insurer for having cared for, and I was relieved that no one’s doctor chewed out the day staff because his patient’s weight or some such was not recorded.  That was nice.  However, think what replacing a CNA with an RN does to the budget then next time you hear a call for budget cuts. 

Add to that one out of control detox patient who appeared to have returned to baseline (cursing, leaping out of bed/falling down, unable to make sense of conversation) and you have the makings of a Full Moon Weekend. Except it wasn't a full moon, it was just a weekend.

Standing Up, Speaking Out

I know two things: first, we are made in God’s image and we break one another's hearts when we forget that.  Second, all that is needed for evil to succeed is for those who see it  to stand by and say nothing.

I do racial reconciliation work.  That alone classifies me as a bleeding-heart liberal.   So be it.  I do a small part of the reconciliation work by standing with brothers and sisters of color against racism and prejudice.  As a white woman, I do most of my racial reconciliation work with whites who, like me, live lives based on the many privileges we enjoy because we are white.  Not surprisingly, it's a whole lot easier to convince white people that racism hurts people of color than to lead them toward the knowledge that racism hurts whites, too.

I do another kind of work.  As a woman who lived for many years with systemic familial abuse within my marriage, I also help other women recognize abuse.   I learned that abuse happens in every level of society, even among the rich and privileged.  Many women are afraid within their most intimate relationship and unsafe in their own homes.  

That was me.  I began this work when my own situation fell apart and I was in shock.  On that day I resolved to find my way to the truth about our marriage and family that had always been covered up.  Once I found the truth I began to tell about it and I went on talking until people I knew lined up into two camps: those who believed me and wanted what was best for me, and those who wanted to shut me up and send me back to the abusive relationship.

I have a story to tell.  It doesn't matter what others think of it.   If I can help just one woman recognize an abusive situation and successfully stand against it, I will count a lifetime of work worthwhile.   

Because it turns out the kindest women among us, the empathetic ones who hold themselves responsible when they hurt the feelings of others, are often at high risk for abuse. Abused women are not always helpless women with few options in life, but they are often women who have stopped believing in themselves.  They internalize the denigrating messages they hear in their intimate relationships.   Funny how the root of the word  applies here, isn't it?  One sort of abuse is very much like another; understand one and you begin to understand them all.

As much as I would like to think otherwise, there are people who cannot see the image of God in others; who are intentionally hurtful; whose hurting intentionally goes on behind closed doors so nobody will see and call them to account.  It is easy to become an apologist for abusive people  because they are tormented souls.  It defies comprehension to learn that abusers want the comfort, but despise the comforter.  They can’t see a single thing except their own need!  Except of course when they snap out of it for a time and show something like kindness and compassion to others;  a kindness directed almost always toward someone who will be impressed by it and expect nothing in return.   

I recall the words of Mother Teresa, who said it is hardest to love those in your own family.  It’s certainly true.  But if you or someone you love simply can’t treat a spouse with kindness and empathy, if contempt is served up with your daily meals and you walk on eggs in your own marriage…it’s time for a hard look at what’s going on.  You could be participating in an abusive relationship.

Nobody belongs in that place; I don’t believe God requires it of us.  Incredible as it seems, getting out and moving on is not the worst thing that can happen.  Wasting a lifetime serving as the scapegoat for the sins and furies of a dysfunctional partner, is.  Allowing a partner to denigrate you before the children until all respect for you is gone, is.  Pretending as if your marriage and family life is normal, and expecting the children to pretend not to see what they plainly do see, is.  If you can't do another thing, at least try to stop doing that.