Where is your cape?

 

nurse with woundedThe despair increases daily. Was it always like this?  I suspect in the beginning there was despair over how patients were treated, and thus was born the training programs of the Nightingale.  Cleanliness, nutrition, exercise, fresh air, compassion. Where are these aspect in nursing today?

I had the opportunity to ask a like question at a research day for nursing recently.  A room of fresh young nurses, and a few older ones and we talked.  I asked them when we stopped touching patients.  I asked if they were taught this in school and about half said yes and half said no.  How can that be?  Either this is a basic human need or it is not.  The evidence is there that it is a basic human need, so…

I told them about nursing in the 1970’s.  How the first thing we learned and what every patient received each and every day was a back rub.  I heard from the nurses in the room on possible reasons why this is not a part of what we do.  I talked to them about gloves and how touch in nursing used to mean skin on skin contact and how nurses use gloves now to protect themselves. One student said she heard a nurse tell a patient that she was not giving a back rub because she is a nurse, not a masseuse.  Another nurse, a male this time, said he would never, ever give a patient a back rub. There was talk about societal  understanding of touch, and how it is  more acceptable for a female still today to provide touch. There was caution and discomfort in the men to consider delivering compassionate touch, despite was we all know about the therapeutic benefits.

It is easier to be comfortable with the technologies of nursing, than the basis of nursing.  Touch and compassion is not seen as ‘being scientific’ and nursing carries a great shame of not being seen as scientific.  Compassion requires you to be present, to take some time, to be there for that patient at that moment, without a consideration of what came before or what comes after.

I heard of doctors ordering lotion application to get the patient touched, or hugs.  We still require a physician to direct our practice? This is not the professionalism nurses sought.  This is a façade. We would be better to go back to hospital based apprenticeships.

This drive to ensure a degree  as entry to practice is a dismal failure. We churn out nurses who don’t know and create a culture that can’t care.

But we do know APA.

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Full of sound and fury…

The wailing started yesterday at about 10 am and when I left at 16:00 it was still occurring. A woman of indeterminate age and of middle-eastern origins was allowing the universe to be aware of her grief, displeasure, fear and I frankly don’t know what else…

It is a common enough occurrence; Surrounded by family and health care providers and clergy of every sort the bereaved inflicts upon us all, their personal tragedy.

No stranger to grief, I understanding the pain, fear and complete on my own level, but still wince and clench my insides when the grief wail goes on and on.

Being that I view culture as an expression of biology and so  behaviours an expression of what we do to survive, I wonder what this wailing achieves. In infants it ensures a notification of the adults within ear range that something is wrong and help is needed. Is the adult wail a response to pain so great that the individual has reverted to a helpless infant-like state? Or is it, as some would suggest, a calculated behaviour to bring attention?

Hell I can barely understand my own inner workings. All I do know is that the wail of the banshee draws us down into our core, fearful that she might just wail for us.

Band-aid Health Solutions Inc.

Lately when I finally get home from work I feel like I need to eat chocolate, fat and anything else I can find that is not good for me. Is it a subconscious desire to punish myself for continuing at BHS, or is it I am so used to feeling at the end of my resources that chocolate seems like a reasonable supper choice?

It was another sunny day in the centre of mediocrity where our motto is, ‘We tried’. Handwaving and finger-pointing along with abrupt, raised voice was the strategy used by the aspbergers tainted intensivist to impress upon us all his displeasure. Sure, sure, the night staff screwed the pooch when, as soon as the managerial types were safely tucked in at home  asleep, they cancelled the patient transfer from the icu citing, umm, ah – we can’t possibly take that patient. And sure, sure, the early morning crashing patient on the ward who hadn’t been seen since at least 04:00, maybe 24:00 and was last documented as, ‘sleeping comfortably’, needed an icu bed STAT which wasn’t available because the afore said night staff decided they needed to have their rotating nap schedule adhered to instead of taking the post op ent patient from icu. Sure, sure, admitting the crashing patient to that unit would show them – well not exactly since those night staff have already gone home and now the semi-innocent day shift gets shit on by the physician. And yeah, the physician seeing the 3rd MET call on then ward and it isn’t even 9am yet, was having a hard time being heard over the intense intensivist having a hissy fit over where the patients were on the shifting deck chairs.

sigh. Locked in my office, knowing the trickle down of the level of pissedoffedness out there is going to dribble down to the bedsides and that the sniper attacks will continue through the day and likely the night.

Let the stupidity games begin. What? That RRT brought the EKG machine to the bedside and hooked up the patient and ran the EKG that was ordered? WTF! What kind of world is it where a nurse can’t just be in control of everything – if the RRTs start helping out they it is a sign of nurses being replaced and ‘squeezed’. The blurring of boundaries of role activities is now on the list of nursing concerns.

No, no, preventing hospital acquired infections is not a concern, but boy that RT over there is eying my transducers and damn if he isn’t leveling it! How dare he!

Oh and can you please come up with a consistently enforced practice around patients and families using cell phones in the rooms? Because some nurses let them and some nurses don’t and when I, as one of the don’ts tell them they can’t, it makes me look bad. And why do I care? well, because I neeeeed to be in control. And besides BHS has a policy.

Ah yes, back to BHS. and finally as the day twists down, an email pings and instead of ignoring it and walking out the door, I peek and regret my actions. Seriously. A policy on trust. Someone is getting paid $100,000.00+ per year to make this shit up.

When you get to legislating trust you know you are in deep shit.

So this is 2010?

That is some full moon caught in the windy trees out my livingroom window. If it was even the slightest bit reasonable outside I’d search for some great photo-ops. However, the wind is high and the temperature is low which equals death in minutes and I am not yet willing to risk the tiny bit of warmth and comfort I find this morning for a picture. A fire truck blasts past, siren screaming. Someone, is having a real crappy first morning of the new decade.
My growing dissatisfaction from the past year has not miraculously dissipated. I have however had a slight epiphany this season that I may, possibly be just a bit difficult to live with on a day to day basis. I have, shall we say, a few odd little quirks. Oh nothing like a fear of wooden spoons or the word ‘moist’, but definately a few things that could lead to massive miscommunication and feelings of rejection. I suffer from sensory overload syndrome. SOS. Ironically the help that is needed is to reduce, reduce, reduce. The noise, sights, smells and feel of life around me is enough on most days to cause me to crawl into a cave if it wasn’t so damn cold. Maybe a nice snug warm cave, with a fire, and heated rocks on the floor and a nice open access so as to not feel cavelike. But no wind, or chill.
 
 

Is the magic gone or just hiding?

It’s early Christmas morning. I am up not because of excitement and desire to see what’s under the tree, nor because of children who are bouncing off the walls in a frenzy to see what santa brought, but simply because I wake up early every day and as I age I find it more difficult to sleep in. Hell, I usually just find it difficult to sleep, never mind sleeping in.
I sit, much like every other morning, with my one lactose-free, skim milk, coffee subsitute latte of the day, checking my emails, and because I do have time today, the news. Life is quiet this time of morning and I enjoy being up because of that.
 
But I miss the child-like wonder and excitement of the season. I didn’t shop this year; we all decided that since no one could really afford to spend and the whole gift giving thing has gotten right out of control, we would spend time together over a meal, as we always have done, without the focus on presents. I was fine with that. Until this morning. While the meaning of the season is not the materialism that is blasted out from every speaker and TV station, part of the wonder is the knowledge that something will be waiting for you under the tree. Something that is not a cat hairball. Part of the wonder is knowing, deep down in your child-heart, that magic does happen, at least once a year and that amid the sparkling ice crystals of the new snow and the favourite tree decorations from years past, that magic will appear on this morning.
 
I suspect part of the magic slipped out the door when the kids grew up, became adults with lives and families of thier own. They often now have other obligations and responsibilities on christmas and I find spending another christmas eve alone with only the cats, just too depressing. Yet not so depressing that I would go to work. I gave them too many christmas eve’s and christmas days of my children’s lives. So there is still hope that I can and have realized the value in me time.
 
And yes, although JD is gone far away in that strange land, I did have Alex and Sean here last night after their other obligations were done. So it was not as dismal and sad as some are. And yes, there are a few things under the tree – gifts and cards from co-workers that I placed under the tree just for this moment. So, perhaps I will indulge in an eggnog latte and see what santa left me. The magic is there somewhere, I just need to dig a little deeper.
 

A year of living –

What a difference a year makes – or two. The last time I was here I suppose doesn’t count as really ‘being’ here as I had to leave after just a couple days and return home. By mid-travel this trip I was irritated and moving quickly to uncomfortable. Touching down in Memphis brought it all out to the front of my consciousness – I don’t like being in the US any longer. It is difficult to put your finger on the reason, but one thing I have learned over the past year especially is to pay attention to gut feelings, and my gut tells me this is not the place to be. In all honesty, the minniapolis airport was deserted, so it wasn’t over crowding that lead to my discomfort. It was suprisingly empty for a saturday. Maybe everyone was at the Mall? But it was cold….not in minniapolis, where it was raining, but in the airport where the airconditioning was set on hypothermia. I drank cup after cup of insipid tea just to be holding something warm and wished I had brought my mitts to wear inside. I always forget the american drive to use up natural resources as fast as humanly possible.

And of course the little rain storm made the scheduled aircraft late, so we left the land that time forgot late, arrivng in memphis about the time I was realizing, once again that my joints just can not stand to sit for so much of the day. While in minneaplis I walked from one end of the terminal to the other a couple times, just to make sure I got some blood flow filtering through my lungs. I don’t want any suprises while in the US because, amid all the packing and getting things off my desk at work, I forgot to go get travel insurance. One more thing to dislike about the US – the inability to be ill without preplanning.

Arriving in Memphis full of rising irritability and painful hips I discovered that yes, even in the south, the world revolves around some people. Since air travel began it has been common curtesy to allow the infirmed, handicapped and those needing assistance to get on the plane and settled first and to extend the same curtesy to the other passengers by having those who block the ailse deplane last. Not so anylonger. Up jump their handlers, who may not be even sitting in the same row, manhandling mum and her cane and non-functioning leg into the aisle before the doors open. Elbowing other passenger’s heads to haul down the suitcase and drag dad up into blocking the aisle, these paragons of filial virtue shuffle their charges out obstructing not only the aisle in the plane but also the gangway to the airport. Slow and unsteady these parents of utter twits hobble out of the plane with the rest of the passengers breathing, like the hounds of hell, at their backs.

Bad enough that the passengers clog the exits, but the crew seems unable to control the environment. Used to be they would remind you to remain seated and they would get you the assistance you needed after everyone else got off. Now they have some hapless grond crew fighting the stream of passengers trying to get out while the crew rushes a wheel chair down the ramp and junior tries unsuccessfully to have dad stand here, out of the way. Shit you mensa reject – dad has been sitting for the past two hours, and he is stiff and unsteady, He needs to move slowly and carefully you cast off science experiment on intelligence.

Bad enough the crew cannot control the passengers, but they also cannot control the equipment. Twice this trip they could not seem to get the exit pathway working within any reasonable time frame. I worry for the safety of those inside.

Finally, upon touchdown in huntsville, when once again they couldn’t locate the means to open the door, I arrived and shared with JD my misgivings…..I am not enjoying being in the US any longer – he hit it on the head – everything is just so damn difficult. Perhaps that is what pervades the air down here – the collective sense that EVERYTHING is an ordeal, that nothing is simple or easy to do, it all requires more hours and patience than it is worth.

Too many people, too little brains. Are there more stupid people in the US? Not necessarily, there are idiots aplenty in every country, but perhaps it is that because there are more people the idiots seem more plentiful. Or maybe, as JD points out, it is that they are ill educated AND stupid. A deadly combination in a society. After discussing this and JD blaming it all on the mexicans we arrive at sonic for a burger, where the decidedly white guy behind the microphone still can’t get the order correct (did you know you CAN determine skin colour by voice alone?) and we arrive at the house and I find it has been inhabited by an aged calvin and hobbs.

6AM

The sun is rising now.  Why is it that on the days I arrange to go in to work later, I wake up earlier?  The anticipated joy of sleeping late remains anticipated.  Somehow, I don’t think enjoying a latte in the early morning hours with just the cats and watching the sun rise is equal pay off for not sleeping in….but I could be wrong.  The coffee tastes very good.
 
And perhaps it is just those little joys…a great tasting cup of coffee, a sun rise, a warm cat at your feet, sleeping in, listening to twist and shout on the radio….those things exactly that give the real meaning to our lives.  It is not for others to decide whether our lives have meaning or worth of course, but our culture remains enmessed in external worth.  Still, after all these years what you have determins who you are to yourself and to others.  Perhaps it is a universal aspect of humanity rather than a local north american weirdness.
 
Growing up on the cusp of hippydom I embraced the non-attachment to a certain extent.  Perhaps much more than some ex-patriots from the times that were.  I have given up all my belongings several times in my life, started over with little more than my clothes and a few books and have never given much attention to the little voice inside pushing me to have bigger and better houses, cars, things, things, THINGS!
 
Yet I still have a house – disordered, in need of a paint and a few minor adjustments, but mine – a car – on it’s last legs I am sure each and every day, – furniture – something to sit on, sleep on, read on, and books – ah yes, attachment!  Could I start all over again?  Quite probably.  My real attachment in this life is to people rather than things; the stuff, well, we use it to cushion us from others.
 
The people we cross our paths with – whether for a reason, a season or a lifetime – are our real belongings in life.  Parents, siblings, children – they are the obvious teachers and extensions of our who-ness.  But what of the difficult family at work?  The brief time spent with a terrified mother to explain and reassure her in her fear for her child?  Or the moments taken to talk softly to a crying child and figure out what it is they need?
 
It is so easy to pass through these interactions without really seeing.  So much easier to be irritated, or even upset with the those that seem demanding and controlling than to look through the facade of controls and supports and wires that hold them all together and to see the real behind it all.  To face their fear and pain and to off load it.  A daring move. 
 
And once we have, then what?  Many many years ago I found the world’s pain too much to deal with.  I was hurt by the news on TV, I was bruised by the emotions of others, I was raw from the onslaught of all the anguish swirling around and though human existence.  I retreated into a small circumscribed circle of belonging turning off the TV, refraining from popular movies and the vividness of life.  I needed to learn to bolster my defenses and find the constrast button to turn it all down.  How did I do it?
 
Funny thing, I have no clue, but in the course of learning to mute the world’s pain, I learned to take on more of it without making it mine.  I learned to diminish the vividness of life into managemable little packets of experience and to find that once the damper was in place those experiences of others that were too painful and that cause irritation and upset in me were now a source of connectness and meaning. 
 
I think this is more and more what is needed to be taught and learned as life continues to be vivid, bruising and hurtful.  The new slogan for the new world – Drop out, turn off, tune in and connect.  And the stuff?  Well, quit hidding behind the new chesterfield and take it out to the fire circle.  Plunk yourself down on the cushions and stare into the flames; soon you will find the connections creeping out from around and though your jumble of overgrown defenses.