Quote

Air goes in and out, blood goes round and round.

Any deviation from this is not good.

--unknown

Blood, blood everywhere

Blood has historically been a thing of fear and excitement for humans.  It is brilliant in color, shocking in its thick hot stickiness, and seldom seen in great quantities by the average citizen. Which is a good thing.  It makes good sense to keep blood where it should be, on the inside tucked out of sight.

Unlike many animals, humans are able to distinguish the color red, making the experience of bleeding a richer and more compelling one.  We are drawn to the color, if not the other sensory experiences that accompany bleeding, like pain, fear, weakness, and the sound of our own screaming.  

I have noted that humans utilize the color red to indicate danger, the need to pay attention, or to stop.  We call red 'the power color'.  It truly is, on the most fundamental level, that of survival.  It is hard to ignore, overlook, or mistake for anything else when it makes a sudden appearance on one's body.  We begin an immediate search for the cause and attempt to correct it.  We know that we are, or someone else is, bleeding.  It says, "STOP".  And we do.  Not to do so is a poor decision.

In my profession, I see and handle a lot of blood.  Post surgical patients come out of the operating room with drains draining blood, bandages soaking up blood, reinfusion pumps pumping blood out and back in, and bags of the rich red stuff hanging from poles above them.  

Surgery today is really rather bloodless, compared to the old days of even ten years ago.  Ultra sound and fluoroscopy help guide smaller instruments into surgical fields, eliminating in most cases, the need to open a large incision for visual inspection.  Electric cauterizing scalpels instantly stop any bleeding vessel.  Blood that would have leaked from a surgical wound that could not be cauterized, like that from a joint, is recovered via a drain left in the site, filtered and cleaned, and reinfused without coming into contact with outside elements. A wonderful way to salvage the precious red stuff and improve patient outcomes.  But, in PACU, we still have to deal with it.

We measure it, record it, watch the clock to make sure it is still viable for reinfusion, order it for depleted patients.  We meticulously check and recheck, together with another nurse, to make sure the patient is getting the correct blood in the correct time frame, and then never leave the patient's side during the first critical fifteen minutes of transfusion in case of reaction. During that time, vital signs are taken and recorded every five minutes.

We need it, we pay attention to it, we give to those in need, we test it, match it, hoard it, and covet it, like a precious currency or commodity.  Blood is our, well, lifeblood.  

Trust me, I'm a nurse

For the seventh consecutive year, US citizens participating in a Gallup poll have voted nurses the most trustworthy of all professions, based on nurses' honesty and ethical standards (as reported in the New York Queens-Courier, January 9, 2009). Really, that is a good choice.

Nurses are notoriously protective of our patients.  We learn early on that a major charter of registered nurses is to teach.  We teach patients how to cope, how to take their meds, how to change dressings, what to ask their doctors.  We also are primarily patient advocates.  That means against everyone else.  Doctors, administrators, family, anyone who does not have the patient's interest in mind.  It is our job.  And, man, I am telling you, it puts us at odds sometimes.
Often, in the intimate moments that pass between a nurse and her patient, when the body is laid bare and the most fundamental processes are shared, so is the soul.  The fears, the doubts, the mistrust of family, friends, or other healthcare workers all come out. Haltingly, at first, then the patient often pours out the feelings that concern him and distract him from his recovery.  
Often, when the nurse acts on the information, involving social services or informing the doctor of the situation, the family or close friends react with hostility.  We are seen as interlopers, new additions to the mix, with no understanding of the true situation. But, the patient has spoken, and from that moment on, we caretakers need answers and reassurances that the patient's concerns will be addressed.  It is our job, and, usually, our passion.  We want the best for our patient.
I was 'fired' from the care of  patient once, when I was a brand new nurse.  The patient had told me repeatedly of the squabbling of his children, the passivity and vulnerability of his wife, and his concerns about his care should he be released to home.  He called his middle aged children 'selfish sons of  bitches'.  I spoke with the charge nurse, the social service worker on duty, and spiritual care workers, as I am required to do. Ultimately, small town politics factored more greatly than the patient's needs.  The ICU nurse manager, very new to her job, not only listened to the family, but revealed to them that I had expressed concerns, and then she found their demands more compelling than the patient's fears.  As I exited the room near tears, in misplaced shame, and in concern for my patient, the smug family members exchanged glances of triumph.  I met my patient's eyes, and they reflected the fear and dismay we both felt.

He had trusted me, and I had failed him.  But, I would do it all over again, even knowing the outcome. Because it's my job.  I'm a nurse.
Image from Google images

Wet back

There is a doctor who sends out surgical patients who have lost more than their share of blood in back surgery, one who regularly posts 'Estimated Blood Loss' figures of 600 to 1200 mL for a two level laminectomy.  We nurses call his back surgeries 'wet', because they continue to bleed into their drains.  A lot.  Damn.  I hate it when I get one of his patients.  They are always painful, weak, pale, and vulnerable.  There is nothing I can do about it.  

To complain officially is to unleash a maelstrom of accusation, intimidation, investigation; in short, the end of my career.  It is particularly difficult for me as a nurse, given that a doctor killed my mother through negligence (proven in court, 1986).  There are so many gray areas and complex variables related to neurosurgery that the physician could flim-flam his way out of any accusations.  I would be the only loser, other than the patient, of course.  But, we nurses know.  We advise our loved ones to avoid him.

He is currently being sued for malpractice.  Today, he performed a three hour surgery on a 72 year old woman with a sub-normal hematocrit who had significant blood loss.  When I requested an order for a stat hematocrit, she was shown to be even more depleted in red blood cells.  I called him to ask for transfusion parameters, and he told me to ask someone else to follow up.  In other words, 'Not my problem, get someone else involved'.  Performing neurosurgery on a patient in a hematologically compromised condition didn't even factor into his reality.  'Let someone else deal with it.'  Geez.  Not surprisingly, the other doctor who was consulted seemed furious.

Fifteen years ago, before I was a nurse, he performed back surgery on my mother-in-law, who had lower leg numbness and pain.  From the day of the surgery on, she never stood up straight.  She canted over at a 35-40 degree angle, crabbing along on Canadian crutches. I went with her to ask why she had had such poor results.  He replied, essentially,  'Because she is old'.  Of course, he talked around the issue, saying how we just couldn't expect the same results that a thirty year old might have gotten, that she wasn't going to run any marathons, blah, blah, blah.

He had taken a vital, active senior and turned her into a frail, elderly patient.  I hate him for that.  I hope that, someday, someone will take him down, stop his 'give-a-shit' arrogance so that he stops hurting patients.

Some people have called him a 'cowboy'.  I think that's an insult to cowboys.

Global Family

I was raised in a small northwest town.  My five older siblings went to the same schools I did, even had many of the same teachers.  I worked in the fields surrounding the town, helping with the harvest of crops.  Even though I lived sixty miles from the Pacific Ocean, I did not see it until I was twelve.  I left the U.S. for the first time when I was twenty five.

My husband was better traveled, attending high school for a year in Mexico City while his father was on sabbatical as a geology professor.  He traveled to and built a home in Mexico as a young man.  But, he wishes he had seen more of the world.

We wanted our children to be better traveled, fluent in a language other than English, and global citizens.  We placed them in a Spanish immersion school for twelve years and encouraged them to take advantage of opportunities to go to other countries.  We got our wish.  My children have been to Germany, England, Italy, Spain, Mexico, Guatemala, Belize, Costa Rica, Canada and Egypt.  All trips were related to academic learning and mingling with the local citizens.  And I know that they are not all that unusual today.

My children, at 23, 22, and 20, are more informed about the state of the world than most other, much older Americans.  They are rational, fair, and informed.  They are better equipped to cope with tomorrow's world than I could ever hope to be, if I started studying and traveling now.  I am proud of them, and feel good, with a calm certainty that the world is being placed in good hands.

I used to joke that my goal was to raise good, loyal Americans who obeyed the law and paid their taxes, but of course, I wanted more for them.  Now, I have that and much, much more.  I have faith in the next generation to do the right thing, to follow the Code of the West in dealing with the rest of the world, doing what is right and fair.

As I write this, my eldest son is in Florida, contemplating a business trip to Central America, my middle child, a son, is trying out for a pro soccer team in Barcelona, Spain, and my daughter is hard at work on her zoology degree in the next town.  Next summer, she will study in Oviedo, Spain, as her brother did.  In April, my Mexican niece will marry her Indian fiance in two ceremonies, one in Bangalore, India, one in Jalapa, Mexico.

Global citizens, global family, a small piece of a giant puzzle, creating the face of tomorrow's world. 

Circling the Drain

There are designations health care workers use to indicate certain, uhmm, situations.  The following is a glossary of sorts.  But, please don't think that, because we use them, the terms or abbreviations are irreverent.  They keep our hearts from breaking, they place armor around feelings that are micrometer thin, fragile and under assault.

CTD........Circling The Drain

FTD........Fixin' To Die

Train Wreck........A patient with multiple comorbidities, i.e., a mess...

Impulsive........A whack job who is making keeping them alive holy hell, tearing at lines, drains, fighting our efforts

Failure to Thrive........someone who has given up on living, no longer responding to hunger, thirst, responsibilities, love 

Quote

"I've got herpes, I've got AIDS.  I guess you could say I'm an incurable romantic..."

--J.S., AIDS patient

from Heart, Humor, Healing

edited by Patty Wooten, RN

The language of my soul

The language of my soul is spoken in babies' sighs and nuzzles against my breast, in a thousand inaudible words of love seen in the eyes of my graying husband.  It sings in the wind on my face as I stand on a rimrock filling my lungs.  It whispers quietly by on the bow of my boat and between my trailing wet fingers.  It hollers it's robust pride as I watch my son orchestrate daring complexities on the field with his wondrous young body.  It swirls and twirls gracefully around the long strong limbs of my dancing daughter.  It whispers in awed hushed wonder at my eldest navigating a vast technological world, a world I can neither comprehend or visit.  It soothes me as I soothe others; my children, my husband, my friends, my patients.  As I help them, I help myself, and I feel whole.

Assignment from nursing school; what is the language of your soul?  5/04

"Don't say f***"

Image from Google Images

Can you imagine anything more futile than telling a 22 year old man who has just suffered through four hours of brain surgery for a depressed skull fracture from a work accident and is swearing, flailing and fighting restraints, "I want you to stop saying 'fuck' so much!" ?

This from a sixty-something nurse who is both competent and pleasant to work with.  I was amazed.  Aren't we told that emergence can be rough?  Wouldn't we each be scared/pissed/disoriented, and have a right to be so if we were the patient?  I was just glad to see the parts all working.

Later, he apologized to me for his behavior, after he was more alert.  But, in the moment, right after being chastised by the nurse, he reacted predictably; he let fly a torrent of obscenities that prominently featured the forbidden word.  Kids and post-op patients, they never disappoint.

The Code of the West

1.  Live each day with courage.

2.  Take pride in your work.

3.  Always finish what you start.

4.  Do what has to be done

5.  Be tough, but fair.

6.  When you make a promise, keep it.

7.  Ride for the Brand.

8.  Talk less and say more.

9.  Remember that some things aren't for sale.

10. Know where to draw the line.

From Cowboy Ethics, by James P. Owen/Images from Google Images

"Mommy, mommy, don't leave me!"

Anesthesia is a complex event for humans.  There are four major levels of anesthesia, the second being a stage where excitation and agitation occur, sometimes for prolonged periods.  Patients become impulsive, pulling at lines, cords and tubes.  They can be combative, striking out and swearing.  (Refer to the blog about rodeo nursing).  

Today, a 44 year old woman spent several hours squeezing my hand painfully, crying out, 'Mommy, don't leave me!'.  She was in obvious pain, and obvious psychological distress.  Her coping skills were maxed out.  Fortunately, she had a nurse (me) who is at home in these situations.  I stroked her hair, spoke slowly and quietly, and gradually, with human touch, talk, medication, ice packs,  positioning, and patience, she became a rational human adult ready to go it alone on the regular surgical floor.  But, I am now home with a sore and swollen hand, a sacrifice to one patient's recovery from anesthesia.

I have to keep my eye on the goal; I am a nurse, a person who has chosen a field that requires not only sharp medical skills and knowledge, but stellar people skills.  In these situations, I sometimes feel like I am outside myself, speaking a role.  It is the professional behavior adopted by doctors, teachers, psychologists, salesmen, and parents the world over.  Don't react; don't shoot from the hip; behave in a therapeutic manner, placing personal issues aside.  

Despite the bad news one can read in the daily newspaper, our society is not aggressive and hostile.  There exists, just under the street-level chaos, a culture of caring, of acceptance, of forgiveness.  It is in the health care professions that one will find those willing to sacrifice, to accept, to give allowance to, to support without judgement.  We are the folks who hear you and see you in your worst moments, who accept and forgive you.  

Our knowledge of your body and mind allow us to be indulgent to your worst behavior.  We will not joke about, sneer at, or judge you for however you are at your most vulnerable.  We will be your mommy, daddy, friend or ally during your time of need.  And then, when you have regained yourself, we will support and respect you.  We are your nurses, your doctors, your respiratory therapists, your certified nursing assistants.  We are there for you.

And now, I have to go put an ice pack on my hand...

This library will be closed

Why is it that everyone wants to be there when a baby is born, but almost no one wants to be there when someone dies?  A baby hasn't done anything yet, just arrived.

But, the passing of a person is like the forever closing of a library.  No one ever again gets to check out a book or look up a reference.  The material is gone, lost to us forever.

We should honor that passing, savoring the gift of knowledge and experience that person has given the world, even if it is as simple as coaxing blooms from nearly dead plants.

Babies give us hope for tomorrow, albeit unknown hope.  The older person has given the gifts and his contribution is known, and should be celebrated. 

Image from Google Images

New old nurse

I turned fifty the day I began my second year in nursing school.  I was not the oldest in my class.  I had obtained a BS in community mental health administration at twenty-one and returned much later to get a degree in registered nursing.

It was difficult to go back to college, especially in the field I chose.  I had received much other training, but obtaining the prerequisite classes for nursing school forced me to face decades of old fears; those of chemistry, microbiology, and math.  I remember being shocked at an artist's rendition of the interior of a cell.  The last time I studied a cell, you could count the known parts on one hand!  No joke!  I went into the prereq classes with a perception of myself as unable to grasp these subjects, a product of an old educational system that steered girls away from the hard sciences.  I emerged with a perception of myself as possessing a scientific mind.  I even helped my high school and college kids with their science studies.

As I went out into the work world as a nurse, I encountered an unexpected prejudice.  That of others having expectations of me far beyond my training.  Because I present a life-experienced face, I am not considered in need of mentoring, of guidance, of help.  I remember crying once, shocked at how I had been treated when I confessed I had never done a procedure assigned to me.  Another nurse, in trying to explain our coworker's unfair behavior, said, "You don't look like you need help".  Wow.  Ageism at work.  Because I am middle aged, I am robbed of the opportunity to be a novice.

I wonder how I might be different as a nurse if I had become one earlier.  I wonder how my practice might be different, or if I would have more energy at the end of a long day.  Then I share experiences with my younger coworkers and think, no. this is the best time for me to have become a nurse.  I raised my children first so I could more fully concentrate on the academic challenges, I had the financial and emotional support of a long term marriage, and I was more personally secure.

Definitely easier than the first time through college, single, broke, working full time, and still trying to develop emotionally.

I also feel that I bring a rich history of experience to my practice.  I have been through many difficult times in my life and emerged stronger.  I can listen with empathy to my patients and remember how it felt to hurt, to be afraid or apprehensive, to be alone.  I think they can feel that.  I am not afraid to touch my patients, more than I would have when I was younger, because I have raised babies and cared for sick and aging relatives.  I have seen and held death.  I think my patients can feel the connection to the life cycle in my hands and in my eyes.  I have come to honor the end of life as profoundly as the beginning.

I am a better nurse now at fifty-four than I would have been at twenty-four or even thirty-four.  Even as a novice.

Hack up a blog

Blog; sounds like something I suction out of my patients tracheal tube with a Yankauer.

Horizontal hostility; nurses at their worst

I am tired of the way some nurses treat others.  Much is written about the culture of hostility, especially toward new or young nurses.  Nurses are said to 'eat their young', a reference to the terrible way that older nurses traditionally behave toward younger, and/or less experienced nurses.  It is short-sighted, unproductive, and hurtful.  But a cruel reality, I have found.  

As older nurses retire in droves or reduce hours and work load, the need for well-trained replacements is both obvious and critical.  But, these nurses apparently don't/won't/can't see the sad irony in the old undercutting behavior.  Refuse to train replacements?  Well, there's no one to cover days off and vacation shifts.  Make life miserable for new hires?  Why would anyone stick around?  Act like a cut-throat bitch?  Surprise!  You are the last person anyone wants to help or  relieve.  I mean, this is Professional conduct 101 stuff.  But, alas, many nurses still don't get it.  

I have been a nurse for less than four years, despite being in my fifties.  I came to nursing late, partly out of a delayed lifelong passion, partly out of the economic reality of having a retired husband and three kids in college.  Despite my age, I am a newbie.  And I have felt the pain and inflicted damage of being such.  I have shed so many tears and spent so many sleepless nights, I feel like I should have more to show for the agony, other than the ability to doggedly return to work again the next day.  Why do we nurses do this to one another?

Are we so bitchy, insecure, cruel, dysfunctional, competitive (or whatever) that we are unable to overcome to urge to eviscerate our coworkers?  Are we so sure of our own superiority that we cannot tolerate anything less than perfect performance?  Have we forgotten what is it like to be new to a unit, to want to be accepted, to want to be recognized, to need to be mentored?  Apparently so.  At least, that is what I have experienced time and again as I search for a home unit with good people.

I have found good people in my current unit.  They are my support, my touchstones, my foundation.  I return because of them. But, there is a core of four or five disruptive individuals who repeatedly rely on old tactics to fuel their egos and the rumor mill.  They flare, they judge, they manipulate, they create problems for coworkers.  Everyone acknowledges their inappropriate and destructive behavior.  But, they continue their reign of terror and negativity.  Why? 

Quote

"Ancora emparo"

           --Michaelangelo, at age 87

Translated:  "I am still learning"

To My Newly Launched Children

November 15, 2008

Image downloaded from Google Images

When You Come Back Down

by Nickel Creek

You've gotta leave me know, you've got to go alone

You've got to chase a dream, one that's all your own

Before it slips away.

When you're flyin' high, take my heart along.

I'll be the harmony in every lonely song

That you learn to play.

When you're soarin' through the air

I'll be your solid ground

Take every chance you dare

I'll still be there

When you come back down.

I keep lookin' up, expectin' your return

My greatest fear will be that you'll crash and burn

And I won't feel your fire.

I'll be the other hand that always holds the line

Connecting in between you sweet heart and mine

I'm strung our on that wire

And I'll be on the other end, to hear you when you call

Angel, you were born to fly, and if you get too high,

I'll catch you when you fall.

Your memory's the sunshine every new day brings

I know the sky is calling

Angel, let me help you with your wings

When you're soaring through the air

I'll be your solid ground

Take every chance you dare

I'll still be there

When you come back down.

You're Fat and You Hurt My Back

November 11, 2008

Okay, I know that fat people have all the rights of skinny and regular and stout people.  That being said, I am a nurse, in critical care.  I have to assess you, roll you, clean you, lift you.  I have to care for you when you can not do so for yourself.  I nurture you at your most vulnerable.  But you hurt me, and you hurt my colleagues when we try to help you.  I have a sister, an nurse, who is disabled as a result of caring for a fat patient.  I have a niece, a nurse, who had a cervical vertebra fractured by a fat patient.  My mother, a certified nursing assistant, had a foot broken by lifting a fat person.  I go home some nights with tears in my eyes from back pain.

I know you have rights, but so do health care workers.  Most hospitals and care facilities do not provide lift teams and mechanical lifts to schlep your mega-bodies about.  We healthcare workers try to make do, asking for help.  But, usually, our neighbor nurses are as busy as we are in notoriously short staffed facilities.  

We are protective of you, our patient.  We want you to be clean, safe, and well perfused.  We need to move you often to keep you healthy.  But it hurts.

And it hurts your family, the ones who deal with you at home, every day.  They push a heavily weighted wheelchair, balance you as you transfer, help you get up, and try to help you when you fall down, as you often do.  Your weight hurts them as directly as it hurts you.  The difference is, you have a choice.

You can consult an endocrinologist, a bariatric specialist, a physical therapist.  You can call Jennie Craig.  You can 'just say no'.  Help the ones who are helping you.  Love them?  Give them a break.  Respect health care workers?  Lighten up.  We all care for you.  Please care for us....

Family Grace

Back of the loaf is the snow white flour.

Back of the flour, the mill.

Back of the mill, the sun and the shower,

and our heavenly Father's will.

                                     --Dean family grace, from my mother-in-law, Phoebe Dean Staples

Endearments

I dated my husband for ten years before we married.  I was eighteen when I went on that blind date, he was twenty-eight.  It was nearly scandalous.  Circumstances were mitigated by the fact that I had left home at age seventeen and was in my second year of college.  Still...

One friend/coworker ,who met George after knowing me for some months, said "You two are like male and female counterparts of the same person".   Creepy.

After thirty-six years of knowing, we do have a kind of strange connection.   I know when he is hurting, when he will call (even unexpectedly), when he is out of his element, when he is not being truthful.  He mostly makes me crazy.  And he's proud of his ability to do so.

He compliments me, too, passing on little endearments,  I guess that's what they are, anyway.  It helps to know that he intends them that way.  But, well, I leave it to you to decide:

'That was pretty good.  You caught yourself before you fell all the way down'.

While looking at a family album:  "You were so cute when you were little.  Look--your knees look like you were smuggling walnuts!"

"You're complexion is so light, without make-up, you look like you're blind!"

"You are interesting to watch when you try to do stuff."

"It's amazing that sometimes you can be so graceful."

Why I Hunt

Why do I hunt?  It's a lot to think about and I think about it a lot.  I hunt to acknowledge my evolutionary roots, millennia deep, as a predatory omnivore.  To participate actively in the bedrock workings of nature.  For the atavistic challenge of doing it well with an absolute minimum of technological assistance.  To learn the lessons, about nature and myself, that only hunting can teach.  To accept person responsibility for some of the deaths that nourish my life.  For the glimpse it offers into a wildness we can hardly imagine.  Because it provides the closest thing I've known to a spiritual experience.  I hunt because it enriches my life and because I can't help myself...because I have a hunter's heart.                                                               ---David Petersen

Help Wanted

No Irish Need Apply

(Common sign in large cities during the Irish immigration)

Attitude

This is a cat.  A cat named Frenzy.  A cat with attitude, none of it good.  She has single-footedly held three six foot teenagers hostage in the upstairs, refusing to let them pass her down the stairway.  She has bloodied ankles and shredded stockings.  She has launched herself out of nowhere to claim unsuspecting victims.  She has gotten stuck in places that made necessary the destruction or disassembly of stairways, walls and eaves, usually by me.  She has eaten what she ought not and regurgitated it at the worst possible time, usually onto something of mine.

This cat is foul and evil and lawless.  She is six and a half pounds of 'don't give a damn' in a fur coat.  We blame it on her lineage, that of pampered momma family farm cat and wild Montana bobcat.  What a coupling that must have been.  Five on the Richter, 160 on the decibels.

She has my husband mesmerized.  She drapes loosely over his shoulder, looking in dull surprise at me as I recount her many flaws and excesses of the day.  He never believes me.

Wet, cold, dark

Monday, January 26, 2009

We are deep in winter here in Oregon's Willamette Valley.  Which means we are wet and cold.  Which means we are the Oregon mole people; we go to work in the dark and we return home in the dark.  Darkness reigns from five p.m. until seven a.m.  We scurry about, from habitat to vehicle, from vehicle to work, to store, to restaurant, with shoulders hunched and eyes squinted.

There is a special quality of rain here.  It is spit from the sky in aerosol form, fine droplets that defy gravity and swirl around and up, sticking to faces and slipping through the tiniest gaps in clothing.  The droplets make you wet under your umbrella and inside your glasses.

In all the television and print ads for good, fun, healthy, positive things, the weather is always warm and sunny.  At least sunny, even if the ad is for a winter vacation.  Only in ads for cold remedies, cough suppressants or mucus medicine is the weather portrayed as ours really is, five or more months a year.  Wet, cold, dark.

Rodeo Nursing

(Image from CafePress)

Thursday, January 29, 2009

I have a shirt that features a stick figure lying on a crudely drawn stick bed, arms and legs tied to the four corners of the bed.  The figure has a large circle for a mouth.  Tubes and machinery stand nearby.  Also nearby is a stick nurse figure, lariat looped in the air.  Beneath the scene, the comment, 'Rodeo Nursing'.

I am as respectful of my patients any nurse could be, but this kind of humor is a mainstay in our attempt o stay sane and deal with the worst aspects of our job.  I bought the shirt after many sessions of wrestling with an out of control patient, just another day at the office for us.

The reasons a patient becomes impulsive (I prefer this work to the commonly used 'combative') are many; medication reaction, an extended emergence from the excitation stage of anesthesia, claustrophobia, fear, disease related manifestations (such as brain tumor or trauma, epilepsy, or electrolyte imbalance, to name a few).  The reason is real, and a real concern.

All hands are on deck to protect the patient as we struggle to keep him or her on the bed, the tubes and monitors in place, and simultaneously solve the problem.  It is only afterward that we can take a deep breath consider the outrageous positions and feats we have accomplished, and laugh (so as not to cry).  Sometimes I go home with the adrenaline still coursing through my veins, jittery an tense,  My body does not know that the event was not a personal fight-or-flight moment.  It just responds as it is genetically and historically driven to do.

Laughing and being silly with those whose eyes one has looked into across the patient's flailing body is the best way to reenter and reorient.  To get rid of the jitters.  It is not intended as disrespectful to the patient.  I have never heard anyone make a negative comment directly pertaining to the patient.  It is more the event, the efforts, the positions, the play-by-play commentary that send us into gales of laughter.  'We are a team, and we beat the circumstances'.  Win/win.  The patient is safe and we helped keep them that way.  Go, fight, win.

The shirt is a reminder of the absurd and serious complexity of a nurse's life.  It cracks me up and makes me proud.

Too Easy

Friday, January 30, 2009

I was once a Parent Training Specialist (PTS) for, first a school for the handicapped, and then, a county mental health clinic.  In both places, I dealt with kids with behavior problems and their parents (and their behavior problems, usually).  Ironic, since I had no kids of my own.  But that did not deter me.   I knew what worked.  I had these same kids, or ones like them, in my classroom before I became a PTS.

At the county mental health clinic, my caseload consisted of mentally handicapped kids with 'normal' parents, normal kids with mentally handicapped parents, and also the ancillary people, like teachers foster parents, day care folk, caseworkers, sometimes a whole community of support folk.   The skills and advice I gave them worked, and worked quickly.

I was given six weeks to make measurable changes in these lives, a timeline dictated by funding.  And I did it.  How?  With common sense, fair play, and behaviorism.  Yep, the nasty 'b' word.  Didi I take away free choice, did I manipulate or bribe the child, did I create automatons?  Hardly.  There is enough free will, machination, and spontaneity in most of us to compensate for the few areas I addressed.  And manipulate?  Please.  Isn't it better to act from a plan developed to bring order to a suffering family, to bring both known rules and praise to a kid who has been guessing at what's right, and failing, than to parent from the hip, like so many do?  I helped families set priorities, goals, and consequences for really important issues, and then taught them how to follow through.

In my early twenties, I sat in may office and heard parents say that they could think of nothing about their chid that the child did well, or that the parent was proud of.  It broke my heart.  Six weeks later, those same parents had data that they themselves had collected that showed the progress and efforts of the child.  They had to state in front of the child how the behaviors had changed, and make good on the reward.  Often, sadly enough, the reward chosen by the child was just extra time with the parent.  

I came to the conclusion that having a child was too easy for most people.  To them, it was a foregone conclusion, a 'well, of course', a 'it's time', or 'damn, I'm late' kind of thing.  Kids born too easily and not craved for long enough have a rough time of it..  They have parents who haven't grown up enough to lead, haven't screwed up enough to be understanding or forgiving, haven't come to regard the birth of a child as a precious, life-altering event.  The kids become props in the unfolding drama that is their parent's lives.  And they rebel, because kids want to have the lead role in any drama going on in the family.  That's their job as kids.

I was thirty-one before I became a mother.  I had wanted to be a mother for as long as I can remember .  After having been a PTS, I wanted it to be the right time, to want a child to the depths of my soul, to be mature enough to create a life a kid deserves, one starring themself in the main role.  I didn't want having a child to be too easy.

I love to Clean Guns

Today was gun cleaning day.  Without exception, I clean each gun I use after each use, before I put it in the safe.  We do have a couple readily at hand for emergencies, like when predators ate in the hen house or in the quail or pheasant aviary. (Or in case a two legged predator finds his unlucky way into our home).  Those guns are only occasionally cleaned; often enough to prevent build-up that could lead to barrel bulge during firing, but not as obsessively as I clean the others.

I love to clean guns.  It is soothing and gratifying.  It is something I have done since childhood, taking pride =in the metal eventually becoming sleek and smooth.  The smell of the cleaning solvent in the air, the solid snick and click of moving parts, the feel of precisely machined metal under my hands all bring a deep feeling of relaxation.  It is a feeling tradition and pride, pride in the fact that I am a citizen of a country that allows me to own firearms, and pride that, as a woman, I am outside societal preconceptions of what a woman should do, be, and enjoy.

I am enjoying my place in a long succession of women both inside and outside my family who take pleasure in the shooting sports and hunting.  I clean guns that are a century old and were cleaned by other women long since dead.  I owe them for caring for these guns so lovingly.  I owe my daughter and my sons guns through which they can feel the tradition of our family as they use and clean them.

I smile to myself as I clean my guns, the banana scent of Hoppe's No. 9 bore cleaner in the air.  I stop and admire my husband as he cooks dinner for us, oblivious to the nontradional roles we are playing our.  He would rather cook than clean guns.  And I, well, I love to clean guns.

To My Oldest (Living) Sister

Saturday, January 31, 2009  

 Today, you are sixty-five.  Happy, happy birthday baby.  May you have a hundred more.

You have beat the odds that have claimed the women of our mother's family for generations.  You have breezed past the dreaded sixty-three, the oldest any woman in our mother's line has reached in over two generations.  You have steadfastly claimed that you have decided to be more like the women of our father's family, reaching the eighties or nineties.  Still carrying water to the animals---through the snow---uphill---both ways---in high heels---past bears---well, you get it.  You got a helluva start on it, girl.

I remember sharing a bed with you when I was three, four, and five, and you were in high school, in a mobile home too small and cold for out family.  You left our bed to go to your husband's at seventeen.  I don't blame you.  I wanted a way out, too.  But I missed you there so much.  You kept me warm, you kept me safe, you makd me less afraid of our parent's loud arguments.

You meant a lot to me then, you mean a lot to me now.  I am glad you are a part of my life.

Happy birthday, Perry Lee!  San Francisco is missing us!  Slainte!

Frogs, yes. Blackberries, no.

These images downloaded from Google Images 02/08/09

It has been beautiful weather recently, part of what I call the February Fake-Out.  The sun wins the war against the clouds and rain, blue skies kick their blankets off, and the temperature soars to the low fifties.  I believe that it is God's way of keeping all western Oregon residents from moving away or committing suicide.  Really.

So, being an avid gardener who cannot wait for the planting season, I go outside to take stock of the winter's toll on my yard and garden.  Ick.  Time to rake up the leaves that hadn't fallen when I hung up my rake last fall, clean up the dead plants that I failed to prune, and make another pity pruning of my roses.

I check the little rock pond that my son built a s a nursery for native Pacific or Western Chorus frogs (commonly called tree frogs), a hobby of ours that helps a threatened population and gives us hours of entertainment and smiles.  It is black and clogged with leaves and water plants, the plants alive but still clinging to their slimy dead last season leaves.  The pond smells like rotten eggs.  I remove the plants to a nearby concrete pad for trimming and bail the odorous water out onto the lawn.  Next, I hose out the pond and prepare it for refilling.  Only a few of the plants will go back in, the rest I will return to our two acre bass pond or compost.

Now, the nursery is ready for the tiny globs of clear eggs that will show up in the pond after the cacophonous mating season of the frogs.  We literally have to close the windows in the spring to hear on the pone or to get to sleep, the frogs are so loud.  We love it, though.  We have provided a habitat for the ittle guys in every home in which we have lived for nearly three decades.  When my son was thirteen, he slept upstairs, over the pond.  At night he took a flashlight to bed so, if the frogs became loud enough to awaken him, he could shine out the window for a momentary respite from the noise.

Next, I move on to the blackberry vines, a constant and vigorous invader of our area.  The fruit is luscious.  Late July and August mean blackberry picking in the Willamette Valley.  Eaten plain, just off the bine, or in cobblers, pancakes, or syrup--the berries are incredible.  We would miss the fruit if they were to completely disappear.  But, like English ivy and Florida's kudzu, blackberries are a non-native plant that wreaks bavoc on our land.  The plant is dispersed by seeds from bird droppings, create massive impenetrable walls and thick mats of vegetation, and root down to twenty feet.  It covers acres every year, twining into tall trees and stunting or killing them.. It grows over buildings and cars in one season, gobbling ground water and cutting off sunshine to other smaller plants.

Controlling blackberries is like a little war, bloody and requiring strategy and special equipment.  An endeavor not for the timid.  The woody runners can gracefully sweep around and slice up an unprotected face.  The one half to one inch thorns easily pierce leather gloves.  Carrying a pitchfork full of the demons, I feel a hot stab like many cat claws imbedding themselves into the flesh behind my right shoulder.  I cry out in surprise and pain.  Not cat or cougar, but a bloody ambush by the snake-like invader.  I try many times before I can pull the runner from my back.  Where the hell did that come from?

Finally, bloody and tired, I go inside, muttering about idiots long dead who brought in non-native things in order to make this place seem just like the place they just left.  As I sip my coffee and look outside to the grey stubble of the winter ryegrass field, near the pond, I see a pink and grey hunched form skittering along.  'Possum.  Speaking of non-native things.  But, that will be for another blog.  Right now, I need to pluck the tiny tips of the thorns that have gone right through my blue jeans and broken off in my skin.  Battle wounds to tend.