fear and fartleks

My Anxiety Blog

Month: October, 2012

Lessons

In my last semester of nursing school, when I was heavily pregnant with child number five, I was assigned a CMO* patient on our very first day of clinicals.  The fact that I was given such an easy patient sounded alarm bells in my brain – what if this instructor thinks I can’t handle nursing school because I’m expecting?  What if she thinks I’m an idiot?  What if I have to drop out because of this baby?  What if I never become a nurse??? (Those of you who know me lovingly refer to this psychotic train of thought as “paranoia” or “insecurity.”  I prefer to think of it as “Type A Hypervigilance,” and, since I’m writing this blog, I make the rules, mkay?)  I was desperate to prove to my instructor that I was not a slacker – that I would not let something as minor as a human being growing in my abdomen stand in the way of providing excellent nursing care.  And so, being the earnest nursing student that I was, I informed the RN to whom I was assigned that I was going to bathe the patient.  I will never forget the look of pleading in her eyes, the unspoken, “Please don’t.  Don’t.  It’s barely 7 AM and I’m still getting report.  I haven’t even laid eyes on this patient who’s death you want to hasten by bathing her. And I don’t even want to think about the post-mortem paperwork.  So can’t you please, please, please just be a normal, lazy, tired nursing student and go eat a bagel in the break room??”  But I couldn’t.  I wouldn’t.  I was adamant that my instructor see that I was more than the baby bump in the white scrubs.  I had potential.  So, I gathered up my supplies, enlisted the help of a fellow student, and began bathing my poor little CMO patient.  I started with her face, as we were taught to do in semester one, then moved on to her upper extremities and torso.  In order to wash her back, we gently rolled her onto her left side*…when she promptly died.

I have been rereading some of my previous blog posts over the last few weeks, and I realized that things have been a bit heavy on the “fear” side and pretty light on the “fartleks.”  So, I thought I would update my loyal readers about my running progress.  I have had quite a few “firsts” in the last month – the Dude and I accomplished a long-standing goal of mine, which was to run 10 miles (yes, at one time).  It wasn’t a pretty run, and the final mile was downright ugly (when we got to our stop point I dramatically stumbled and half-fell/half-passed out.  I was going for the look of that female marathoner in the 1984 Olympics who trips, then falls, and finally crawls her way to the finish line.  In my case, however, there was no collective gasp followed by the thousand cheers of Olympic fans.  Just an empty Starbucks parking lot.  And the Dude.  And maybe a homeless guy.)  The next week we actually ran 11 miles, and I finished in an upright position.  The funny thing is, I thought achieving this goal would make me feel like a “real runner,” but it didn’t.  I was proud of myself, I was happy – but I still battle that constant, nagging suspicion that maybe I’m just faking it.  That one day I’ll just up and quit and never run another step.  That maybe I’ll take up the habit of lounging on my couch all day eating Pringles and watching Jeopardy re-runs.  Maybe I’ll actually grow into said couch and when that bowel obstruction I’ve been anticipating for years finally happens the paramedics will have to cut me out of the house, taking me and my Kane’s loveseat to my former place of employment for care.  Oops.  There’s that “hypervigilance” again.

Also in the last month, I had my first running injury.  I would like to say that it was something exotic and medical-sounding, like a torn ACL or busted vastus lateralis (okay, I totally made that one up), but it wasn’t.  It was a split toenail.  Boring, I know.  But I was super excited about it for two reasons:  1)  I busted my nail by running.  That means, on some level, that I ran so hard and so fast that my little nail just couldn’t take it anymore and split straight down the middle (it also means, of course, that I wore out my shoes/they were ill-fitting to begin with.  I prefer to stick with running really hard and really fast.) 2)  I got to use copious amounts of silk sports tape.  It is a little known fact about me that I love, love, love silk sports tape.  Using it makes me feel all athletic and sports-y.  A few months ago I had a blister on my heel (not from running, mind you.  From wearing high-heeled hooker shoes that were a bit too snug but totally completed my look) and I wrapped that sucker in so much silk sports tape that I looked like Lazarus.*  Everyday I lovingly wrapped and re-wrapped before I ran.  I must have gone through three rolls of tape.  And you know what?  It was worth it.  Because inside, I felt like a combination of Laila Ali and Joe Montana.  When I’m wrapping an injury in sports tape, I AM Roger Bannister.*

Over the course of the last few months, I have been running one morning a week with a woman about a decade older than me and about five minutes faster.  I’ll call her the “Flying J.”  Yes, I know this is also the name of a popular truck stop joint, but it was the best I could do on short notice.  Anyway, the Flying J has been running since, well, her conception and, although I was pretty intimidated to join her, I find that I now look forward to our morning runs.  I have actually learned alot about running – and about myself – from her.  I’ve learned that you can’t underestimate the importance of being well hydrated, especially before a long run.  I’ve learned that those packets of energy gel that I used to think were only for complete tools actually do give you a little boost around mile 8. I’ve learned not to fear inclines, but to attack them, to give them all you’ve got so you don’t feel defeated even before you’ve begun.  I’ve learned that running isn’t just about the run – it’s about exploring your neighborhood, enjoying the wonderful surprises that being alone on a trail/rode/sidewalk can provide.  Until the last few months, I had a few set routes that I always used, depending on how far I wanted to go.  I never varied from them, afraid that if I did deviate from my course it would somehow affect my mileage or my pace.  Lately, though, I have just been taking off running – usually with only a vague notion of where I might go.  I have stumbled onto fantastic sunrises on the Clearwater gulf, long, lonely piers just begging to be run on, wooden trails tucked away in small public parks, and beautiful neighborhoods I would otherwise never have seen.

The biggest lesson I have learned, though, isn’t truly a lesson – it’s more of a revelation, a private admission to myself that surely comes as no surprise to those who know me well: I don’t like to be pushed.  There have been several times over the last few weeks when the Flying J and I ran on some overpasses (okay, she ran, I just tried to keep moving and hold back my hot, angry tears) when I literally felt furious inside.  At her, at me, at this stupid activity where you just don’t stop moving but you’re not actually going anywhere.  And I realized that I am not used to being pushed, because, for the most part, I don’t require it.  All of my favorite (and most effective) teachers/mentors/preceptors seemed to know that I am my own slave-driver.  If it’s something I care deeply about (or just don’t want to look ridiculous at) I don’t require the rod and the whip.  I am my own harshest critic, my own time-keeper, task-master, disciplinarian.  The first paragraph of this post is a perfect example.  I could have taken the easy way out, could have eaten that “everything” bagel with six packs of real butter and two tubes of cream cheese that I so desperately wanted (oops, I mean, the baby so desperately wanted.  And yes, I did put all that crap on it.  Don’t judge), but I didn’t.  I forced myself to bathe that patient, to show my instructor that I was up to the challenge.  So what if I inadvertently accelerated my patient’s voyage across the River Styx in the process?  She was headed there anyway.   What I have learned is that, while my “Type A Hypervigilance” might be frustrating to others, it is what got my through that final semester of nursing school, it is what helped me pass my NCLEX, it is what led to my split toe nail, and it is why, even through my pissed-off tears, I will continue to run.

 

*CMO – “Comfort Measures Only.”  The designation given to patients who are end-of-life and require only palliative care.  This would include, but is not limited to, supplemental oxygen, pain management, repositioning, and, of course, baths.

 

*left side – Where the all-important left ventricle of the heart is located.  Basically I squished her heart’s biggest and best pumping mechanism by rolling her onto her left side, dramatically reducing the amount of blood pumped to her brain and body.  Whoops.

 

*Lazarus – Um, the main character from a story in a really popular book.  It’s in the “B” section of your local card catalog.

 

*Roger Bannister – the first man to run the mile in under four minutes.  Okay, so I’m still at the 9:45 mark on a good day.  But, with sports tape on, I feel really fast.

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Entitlement

A few weeks ago there was an article in the paper about a gentleman (and I’m using that term very loosely here) from a town a colleague of mine has affectionately named “New Port Rickity.”  For those of you reading this who aren’t familiar with central Florida’s West Coast, this is a city located in a northern county which has gained a reputation over the years as being a sort of white trash paradise.  Yes, of course there are citizens who are law-abiding and gainfully employed living there – so, lest I offend half of the nursing staff at North Bay Hospital, I will refrain from giving the name of the county.  Let’s just say it begins with “P” and rhymes with “tabasco.”  At any rate, this area seems to be largely populated by people who, while they may consider themselves  “rednecks” or “country,” habitually participate in activities that only lower-class white people do, such as: cooking meth, chain smoking (without shame) while heavily pregnant (usually outside a medical facility), purchasing their weekly groceries at Walgreens, and declining to watch “Here Comes Honey Boo-Boo” because it too strongly resembles real life.  Well, it seems that this “gentleman” decided that he needed assistance from his local Emergency Medical Services staff.  At this point I can’t remember what the exact issue was, although I’m sure it was life-threatening and not something completely trivial like, oh, I don’t know – needing a Tylenol or wanting the police to arrest your neighbor for “borrowing” your meth-cooking bunsen burner without permission.  So EMS arrives at his door and he tells them to WAIT while he finds a babysitter.  And you know what?  Those sons-of-bitches paramedics had the unmitigated gall to tell him that they were unable to do so, which prompts Mr. White Trash to call 911.  Again.  While the ambulance is literally in his driveway (okay, perhaps I’m giving him too much credit.  While the ambulance is literally in the tire-track ridden section of his “yard.”)  Mr. White Trash is then loaded into the ambulance (for some reason the paramedics suspected that he might be intoxicated.  Profilers!) where he proceeds to, once again, use his cell phone to call for emergency assistance.  The most shocking part of all?  I read this article without the slightest degree of surprise or dismay.  It struck the same emotional chord with me as would reading the weather forecast or Sunday’s “Marmaduke” comic.  I just simply wasn’t impressed.  All I could think was, “That was your best, man?  I’ve had patients call 911 from the ER lobby.” (Just as an FYI, this is, even in dire circumstances, never a good idea.  You will annoy the medics, irritate the ER staff, and succeed only in being transported around to the ambulance bay, wheeled through the ER, and off-loaded in the very same waiting room that you just left.  Only now you will have to explain to your insurance company why, on God’s green earth, you left without seeking treatment.)

The article did make me think about something which I thought I understood prior to becoming a nurse, but which I now realize I had only a dim grasp of.  And that is entitlement.  Yes, I knew the basics – expecting something that you don’t deserve and feeling that you’ve been done a disservice when that something isn’t given.  To illustrate my point, I’d like to share with you a conversation I had the other day with a patient – a conversation that is all too typical, but makes you want to put a gun to your head nonetheless.  Then I’m going to finish up by listing my Top Five Greatest Examples of Entitlement in the ER.

Patient X came to the ER for belly pain.  This was their third visit in as many weeks, and they had been told that, in order for the belly pain to go away, a certain-organ-in-their- GI-tract-which-shall-remain-nameless-in-order-to-ensure-that-no-privacy-laws-are-broken would have to be removed.  The patient continued to allow the offending organ to remain in their abdominal cavity, continued to have pain, and thus continued to enter that great revolving door of medicine otherwise known as the Emergency Department.

Me:  Okay, Patient X, I have your discharge papers here.  It looks like the diagnosis has remained the same.  What did the doctor recommend?

Patient X:  Well, he said that I need to have organ x removed.

Me: Oh, okay (and here’s where my friend Mr. Cerebral Aneurysm starts to stir from his brief but deep slumber, and subtle throbs begin just above my right ear).

Patient X:  But no one will take it out.  I mean, no one will do it unless I pay them. (Subtle throb becomes persistent hammering sound).  I went to see a surgeon about it and I waited for a few hours – but when the office manager looked through my chart and saw that I don’t have insurance or medicaid, they told me they couldn’t help me.  Can you believe that?

Me: Well, surgeons have to get paid, I suppose.  They do go to school for a long time. (reflective pause, where I try to put on my best frank-but-compassionate voice).  Well, have you applied for Medicaid?

Patient X:  I keep getting denied.

Me:  Hmm.  Have you considered getting a job?

Patient X:  Oh, I can’t work.  I’m disabled.

Me:  Oh, so you’re on disability?

Patient X:  No. I don’t qualify (persistent hammering is now just a long, low, mournful wail above which his words are barely audible).

Me:  But I thought you said you were disabled?  I’m sorry.  I’m confused.

Patient X:  I AM disabled.  I have diabetes and glaucoma. There’s no way I can work.

Me:  Diabetes and glaucoma?  I guess I need to review your med list – I didn’t see any diabetes or glaucoma meds on there.  What do you take?

Patient X:  Oh, I don’t take anything for them.  My diabetes is borderline and I control it with my diet.  And my glaucoma isn’t actually diagnosed.  I’m pretty sure I have it, though.  My mom has it, and I have to wear glasses.

And it is at this point that I want to jump up on the stretcher, grab this middle-aged, seemingly healthy person by the shoulders and shout, “WHAT THE HELL IS WRONG WITH YOU?  Stop pretending you have disabling medical problems, put your big boy/girl pants on, go out into the community and find a job.  Oh, and maybe while you’re out there, pick up some self-respect, too.  You are NOT disabled.  You know what “disabled” is?  “Disabled” is having to speaking by typing.  With a straw.  It is peeing and pooping into bags.  It is having to go to dialysis every other day to have every drop of your blood removed, cleansed of toxins, and then put back into you.  “Disabled” is needing to have your chest beaten five to six times a day to break up the masses of mucus collected there.  It is any number of debilitating conditions which severely limit the ability of the sufferer to enjoy or even endure this life, but it is most-assuredly NOT your adipose-induced diabetes and your fake Lens Crafter’s-diagnosed glaucoma!!!”

But I didn’t say any of this.  Not one word.  For one thing, I value my job.  I mean, I do have five children to feed.  And, at the rate we’ve been going, I’m sure at least one of them will require some nameless and random bowel surgery in the not-too-distant future, and I figure I might as well start saving now.  But, more significantly, my statement wouldn’t have made any difference.  You see, for this person, Patient X, the diagnosis of “Entitlement Syndrome” came too late.  The mindset was too entrenched.  When Arrogance and Ignorance marry, they produce a greedy, chubby child called Entitlement.  And this selfish brat doesn’t like to be told “no.”

Well, onward and upward.  I’m sure my fellow nurses who read the following list have their own shining examples of unchecked entitlement, but here, in no particular order, is my own personal Top Five Greatest Examples of Entitlement in the ER:

  1. Any patient who, when given a script, looks at you and says, “You can’t just give me the pills?  Well, how much do they cost?  (I don’t know.  Does this look like a CVS shirt?) How am I going to pay for them?  This is bullshit.  I’m gonna go smoke.”
  2. The patient who claimed he had no money, no friends, no family, no way of getting home and (loudly and with generous amounts of profanity) demanded a bus pass.  Then, as he was putting on his jeans, accidentally dropped his roll of twenty dollar bills.  Oops.
  3. The mother of a pregnant teen who decided it would be a good idea to drag along her three toddlers for a 10 PM ER visit.  The mother stated that she and the children were hungry and “hadn’t eaten all day.”  Five turkey sandwiches, milk, crackers, and pudding were provided…but the mother became irrate, demanding vouchers for the hospital cafeteria where she could obtain “real food, like chicken nuggets or something.”
  4. Pretty much anybody who asks that their turkey sandwich be “heated up.”  Really? Last time I checked, this isn’t an Arby’s.  I feel like I should start offering Horsey Sauce.  Oh, and family members who stand outside their rooms, empty coffee cup held high, and sort of jiggle it around in that condescending nonverbal “I need a refill” way.  Sorry, sweetie – but we’re fresh out of Sanka.
  5. Finally, my personal favorite: the patient with abdominal pain in the waiting room who demands to know why another patient (who happens to be having crushing sub-sternal chest pain and a terrible sense of impending doom and an EKG that looks like shit) got to go in before her.  She has, after all, been waiting over an hour and her pain is 10/10.  You know what?  A bed was just cleaned.  We can take you back right now.  Hmm?  What’s that?  Oh. I see.  Sure, you can have a few minutes to finish your bag of Corn Nuts.

*It know it appears, based on my last few entries, that I may have developed some bitterness/cynicism/negativity towards my job and/or the people I take care of.  I am going to address this further in another post, but I wanted to say here that I love my job.  I truly do.  I can honestly say that every time I clock in I consider it the fulfillment of a life-long dream.  And I care deeply about my patients.  I think about them on my off days.  I dream about them.  I feel sorry for them.  This blog is just my attempt to blow off steam, to vent frustrations.  As such, it presents a skewed view of me, my patients, and the relationship between the two.  So, if you haven’t liked the last few posts, stay tuned and give me some time.  I’m bound to dig up some positivity somewhere.