Shine

I read a book awhile ago that disturbed me quite a bit. It was called 'eat, pray, love'. It was a well-written and engaging story, but it was basically about a woman who went on a narcissistic quest to find pleasure; in the process leaving her husband to find herself. I thought about the book for months because in my mind, it was a very accurate portrayal of our world's concept of finding happiness. You selfishly seek it at the expense of others.
I am no Mother Teresa. At this moment I am lying on the couch typing and snacking while I could be cleaning the house or visiting a lonely friend or praying or doing something focused on someone else besides myself.
However, I am not doing any of those things; (for my own various reasons), instead I'm attempting to explain to myself and you how true happiness finds us.
A verse in Matthew says, “Seek first the kingdom of God and his righteousness, and all these things will be given to you as well.” Another verse in Psalms says “Delight yourself in the Lord, and he will give you the desires of your heart”.
The point is, that as we focus outside of ourselves and run after God and make him our number one passion, true happiness and joy will find us. I think part of it has to do with a subtle changing of our hearts. I was recently discussing yoga with a colleague at work. I told him that I like the yoga postures and stretches, but I wasn't really interested in getting into the religion of yoga. Well, what is that? He asked. I explained that among other things, yoga was supposed to give the practitioner inner calm, peace and happiness. True peace, I explained to him, is found through a right relationship with Jesus. Anything that claims to be able to give you true peace apart from him, is deceptive. You could do yoga for 6 hours a day or sit on a lamppost for 3 years or only eat raw foods or sleep for 12 hours a night or have a live-in massage therapist or get rid of all your teenagers, but none of that would bring you true inner peace.
Inner peace comes from being right with God, knowing that we're forgiven of the things we've done wrong, and being satisfied in him. God wants us to have true peace, which is why he tells us to seek after him.
I wish I could say that I experience true peace and happiness all the time. I simply don't. I tend to worry a lot about finances and how long our truck is going to keep running, and work, and my weight, and I'm very worried right now about the elk roast I have cooking in the oven.
I injured my tailbone riding 8 kilometers on a crappy bike seat, so it hurts to sit, and I'm taking a bit of time off running until I'm better. I don't have a lot of work so I have quite a bit of free time, and last night I walked to the nearest Starbucks and got a pumpkin spice latte and sat and read a book of italian recipes that I'll never make, and a medical journal of surgical procedures I'll never perform. I sat on one side of my hip and then the other, and looked out the window at the full moon and felt content. On my way home Robin came to meet me and he was excited because we have a fridge full of elk meat. We walked back home together and then Brock came over to play video games with him and I sat at the table with headphones in listening to the soundtrack from 'Shine' and putting together my thrift-store jigsaw puzzle. I drank laxative tea just to keep things moving and ate a mandarin and stayed up til midnight only to discover I was missing two pieces.
My favorite song on the cd is Liszt's Hungarian Rhapsody No. 2, and it is so moving that I wanted to jump up and down and shout 'Hallelujah'! I listened to it on repeat for an hour and felt chills down my spine.
Simple beautiful strains of happiness have been pursuing me; in a delicious soft-boiled egg this morning, in a good book, in laughing so hard with Robin I almost cried, in a night-time walk in the brisk fall air; in watching the sun rise while talking to God about how much I love him. I am not grasping after them. They are finding me as I am seeking the kingdom of God.

Anniversary musings

I've now been married just over a year. Robin and I had our anniversary this weekend and it put me in a strangely contemplative mood. (That and the fact that I just read an excellent and deeply thought provoking book called 'Still Alice').
Before I was married it seemed like this elite club, a sort of social nirvana, and I was eager to join their ranks and find my soulmate; the person who completed me and was the half I'd always been missing. But it isn't quite like that, I've discovered. I don't know quite how to explain it, I tried to tell Robin that I didn't feel married, but that's not quite right- I think a better way to explain it is that I still feel like the same Heather I always have been. I suppose as a child I had this illusion in my mind of what I would be like as an adult- a sort of abstract concept of my future self as an object separate from myself. Then, I was surprised to discover the adult me is the exact same person as the child me. I am and always have been and always will be the same girl.
That being said, I do like being married. But I haven't really changed into a different person now that I have another half- in fact, if anything, I understand Robin less that I thought I did when we were first together.
We went out for dinner on sunday night, to the Keg, which was a vast improvement over my cooking. We had an appetizer of sizzling scallops wrapped in bacon and dipped in red sauce. Then Robin had a huge pink slab of prime rib (I do not understand the attraction of rare meat in the slightest) and I had an entire Atlantic lobster. It came on the plate like it had been plucked out of the ocean and it seemed a shame to break it apart and destroy it's beautiful red shell. I've always wanted to have lobster and I finally did. It was messy, and a lot of work, cracking the shell and dipping the juicy meat in melted butter and lemon juice, but oh, so worth it.
For dessert I had warm creme brulee with the smooth creamy inside and crackly sugar top. Divine.
The lobster was kind of like my visions of me as an adult, or what marriage would be like. It was wonderful, but not at all what I expected. We went home from the Keg and played board games and then lay in bed listening to the sound of a bullfrog outside. It reminded me of being in Antigua, lying in the stifling heat and unable to sleep because of the symphony of frogs and crickets and birds outside my window. It brought back nostalgic memories, which are always either good or neutral because of the healing effect of time.
I was pretty impatient to grow up as a kid. I didn't like being a skinny little girl in a world of tall people that didn't have to follow all the rules and who could say and do whatever they wanted. I wanted to be beautiful and have long dark hair and wear mini skirts and have a tall boyfriend. I wanted to have an exciting career, like Florence Nightengale or Maria von Trapp. I remember asking my mom to come take a picture of me as a six year old, and when she came outside with the camera, I was leaning against the tree in my swimsuit and wide-brimmed straw hat, with a coy smile on my face and one hand on my hip. I was ready to be an adult. I wanted to travel and work and get married and fly in airplanes and eat lobster.
Some things in life have been deep disappointments, like never actually growing tall and my first kiss and tasting champagne and realizing I didn't like it at all even though it sounded so glamorous. Other things have been more delightful than I possibly could've imagined, like having nieces and nephews, and studying chemistry, and having a garden on my porch, and getting married to someone who is extremely intelligent and insightful.
I think Robin probably feels the same as me, that we've lived so long being ourselves that marrying another person doesn't automatically erase who we are. I am trying to learn about him but he is like a book written in another language and some of the chapters don't make sense yet. When it comes to lobster, I may or may not have it again, but I'm glad I had that experience once and now I can cross it off my list of things to do before I die. With marriage, I've only just begun.

Frustrations

I've been thinking lately about what God does to get our attention. To be honest, I think I'm fairly good at turning to him when I'm in the midst of a major crisis. However, I have a lot to learn about turning to him with the small daily annoyances of life.
Last week Robin dropped me off at work in Westbank with my bike. I was only working for a couple of hours and the plan was to ride back home on my bike. It was a hot, sunny day, and after trying to teach 1-10 in French to a kid who didn't want to be in summer school, I hopped on my bike to ride home. I had some things to do at home and should have gone straight there, but as I crossed the bridge to come into Kelowna the beach looked just so darn inviting. I biked to the library and looked for something good to read. I bought some ice cream and found a place to sit on a corner of a boat launch. the waves were lapping at the shore and I spread my books out, my bike parked beside me.
A parasailer flew by, towed by a boat, and I looked up at him with interest. It was less than 10 seconds later when suddenly disaster struck. A huge wave from the tow boat crashed against the boat launch and sprayed up at me. I started to get to my feet when suddenly another bigger wave hit. It completely drenched me, all my books, and started to wash my sandals and my bike away. I grabbed at them frantically and tried to stumble away from the edge before a third wave hit. Everything was soaked- from my purse to my new magazine to my Spanish textbook and bible and my clothes. A few people saw my plight and laughed. I began to spread everything to dry on the grass and as I took a step away suddenly I stepped on a bee and it stung me on the bottom of my foot. My immediate response was less than polite.
A young shirtless man was seated nearby and he said, "Hey, how are you? Do you mind if I come over and talk to you?"
I gave him a look to sum up my mood and he said, rather helpfully, "Maybe I can just come over later and talk to you."
There was nothing to do but pack everything up and go home. I rode home in disgust, muttering under my breath. When Robin came home from school I was still grumpy.
Unfortunately my little tsunami disaster wasn't the only frustration of the week. I borrowed a movie only to find there was nothing in the case. I ran to Marlene's to borrow her car only to discover I left the keys at home. I got a stomachache from too many cherries and a neckache from sleeping funny and a brainache from talking to some jerk at work who told me my marriage was doomed to failure.
I have my only little theory about why these particular trials came my way this week. In a general sense, though, I think God is quite good at specificially designing trials that will draw us into relationship with him. He lets us struggle with futility so we will look to him for meaning. He lets us encounter scary situations or not enough money or food so that we will learn to trust him. He lets us experience discouragement in relationships so that we will come to him as the only true and faithful friend and lover. He hurts us because he loves us, and wants us to love him.
So I know I've got a long way to go, but at least after the fact I recognized that God was trying to say something to me that day last week. Not only that, but everytime I took a step the beesting reminded me of what God was trying to say. Now, that's clever!

City, City

I've lived in Kelowna now for just over a year. It's smaller than Vancouver, more laid-back, more relaxed, more low-key. Hardly anyone dresses up and it's not unusual to bump into someone I know at the grocery store or walking down the street.
I like it so much that I didn't realize how much I missed Vancouver, until Canada day last week.
Robin and I drove downtown (about 10 minutes away) to check out the Canada day festivities. There were people everywhere! Booths with things for sale, food, music, a group of break dancers, face-painting, but most of all: people, in large quantities. In the evening we went downtown again with Bob and Marlene and two of their grandsons and their niece, to watch the fireworks. I remember being in English Bay as a teenager and hanging off a lamppost, and as far as the eye could see, people- a churning, milling mass of humanity that was all caught up in the same excited frenzy.
This was reminiscent of other Canada days: although on a slightly smaller scale. I was beside myself with excitement. Kids were waving glowing light sabers around and I could smell mini donuts and hotdogs and teenagers were painted red and white and everyone was waiting for the show. I breathed deeply of the scent of all the people. It was a familiar mixture of bodies, cigarette smoke, food, dirt, just people.
There were two little boys having a sword fight with their glowsticks and there was a young couple that looked about sixteen pushing their baby in a huge stroller. There was a woman who was much too large to be wearing her tight red and white outfit. There were hippies with their hair in dreadlocks and henna tattoos snaking up their arms. There was an old man with a hat almost covering his face, playing guitar with the case open in front of him for some change. There were families of all types and sizes sitting on the grass and the sand and the sidewalks .
We bought light sabers (I couldn't resist!) and sat on the edge of the waterfront, our feet dangling over the water. Off the shore was the barge for the fireworks and the excitement was palpable. We waited for what seemed ages, looking at people. There was a bit of misty rain and the speaker above us kept cutting out, and a beaver and a huge fish and someone's lost shoe all drifted past us in the water. Finally the music started with a rousing rendition of Oh Canada, and the lights shot off the barge like colorful stars lighting up the sky. The crack of the explosions made my chest hum and I joined in the oohs and aahs of the crowds.
When it was all over we walked back through the pressing crowds, stepping over broken beer bottles, and trying to keep track of each other so we wouldn't get lost in the gathering . We got in our vehicles and joined the throng trying to get out of the downtown core. Same old stop, go, stop, go. (Except in Vancouver I would've taken the Skytrain, and packed in with all the other passengers, sweating and laughing and talking.)
I remember being at University, buried in the chemistry lab and the library, feeling disconnected from the world. I would get on a city bus once a week just so I could smell smoke and bodies and look at interesting people and feel connected to the web of life I was part of. Something in me would miss the people, the humanity of it, after spending so much time with books and beakers as my primary company.
There is nothing like a city. Perhaps if I'd been raised in a peaceful, tiny farming community with cows as my neighbors I would be overwhelmed and bothered by the masses of people. But I wasn't. And being part of the crowd and assaulting my senses with the smells and sights and sounds of a whole pile of people all excited about something- somehow it grounds me, and makes me feel content within myself.

My biannual rant

Over the years as I've blogged, I've often been far from home, so I've felt freer to talk about things that happen in my life without worrying that my readers will encounter people from my stories. Living in Kelowna, a much smaller city, poses a distinct disadvantage when it comes to confidentiality. I am constrained by the fact that you may indeed bump into one of my characters if you are in town here. I am limited in my writing by the fact that Kelowna has one hospital, one Save-on-Foods, only 3 Starbucks, and one Costco. If I talk about the mean blond who works behind the counter of some restaurant, you'll probably know who I mean.
I had intended to write in my blog today about funny things that happened over the weekend. But life is not all fun and games. I am generally a happy person and I am not often angry, but today I feel a rage burning in my heart that demands to be spoken. I must put words to my frustration and let someone, somewhere, hear them and take notice. Writing in my blog is a way to give voice to my thoughts without attacking anyone personally. You can take it or leave it; you can read it and walk away or you can block my website on your computer. It's your choice. This is nothing personal against you.
But first, as a slight aside from the sad story I am going to tell you, the first story of my day was slightly comical. A patient came into my office to tell me there was an injured bird outside in the garden and could I come and help. Dealing with birds isn't a typical nursing duty, but I obliged. It was a pigeon, and I picked it up and examined it. It had flown into the window and it's wings were fine, but both legs were broken. I contemplated leaving it and seeing if it would summon the strength to fly away, but then another patient told me it had flown into the window the night before and had been lying on the ground ever since. They had been making him a shelter from the rain out of saranwrap and leaves, and feeding him popcorn.
I did the right thing and took him around the corner where we were alone, and I broke his neck. I told him I was sorry and I snapped it quickly and then I looked down at him, warm in my hands, and he winked at me. Things like that summon superhuman strength and I wrenched at that neck and was a little horrified to see his whole head pop off in my hands. I quickly stuffed him into a plastic bag and I raked gravel over all the blood and I discreetly disposed the bag and went to wash my hands.
“Where's the pigeon?” One lady asked me.
“He's gone to bird heaven”. I told her. “He's better off now.”
Later on I had an older man come to me and he was crying. Alcohol withdrawal and some anxiety issues were at the root of it, but I asked him the problem and he said between tears, “My bird is gone!” I told him kindly it was quick and painless and the bird wouldn't have recovered anyway.
So that was that. And then I was busy with more nursing things. One young lady was very sick and projectile vomited all over her bed, her neighbor's bed, the walls, the bathroom, her shoes and clothes, the lamp, her stuffed animals, the floor, and me. I spent a good deal of time with her, and cleaning up puke on my hands and knees. She had it coming out of just about every port on her body. I never knew one person could have so much output from so many places at the same time.
And the sad part of my story comes here. In the interests of confidentiality I can't tell you what actually happened, beyond the fact that this poor young lady and I had an interaction with a community service (Not the detox where I work, to clarify) that treated her in a terrible way, simply because she was a drug addict.
I am coming to dislike the term drug addict. I've only worked in the area of addictions for a little over a year but I feel it is changing me. I am seeing myself in my patients. They are not drug addicts and alcoholics. They are hurting people that are filling the empty hole inside them with something that is ultimately very harmful. And we all do it, in some way or another.
Statistically, 10% of the general population have a substance abuse problem, straight across the board. That includes doctors and nurses, who also have a 10% rate of drug and alcohol abuse. Yet so many people who work in the industry of caring for others see it as just that- an industry. They fail to realize that it is a calling, not a job, and that when it comes to loving and caring for people, the bottom line is not money, it's the dignity and worth of that person. Jesus did not shy away from touching people because they were lepers or beggars or whatever the social equivalent of that day was. He loved them, he ministered to them, and he let them bless him. My young lady today was denied the medical care she needed and was relegated to a second-class, inferior citizen. She was treated rudely and callously. And while I was on the phone fighting for some help for her, I was rebuked for being too 'aggressive'. I am not aggressive when I am advocating for my patients. Aggression, in my mind, is when someone in a position of authority, like a doctor or nurse, uses their authority to make another person feel inferior. It is when they invade a person's dignity by writing them off and not treating them in a way that reflects their inherent worth. It is when they simply don't care, and just bulldoze on ahead to get the job done without taking into account the needs and rights of another person. It is when they violate a person's worth in some way or another.

Excuse me for being passionate about this issue. We all have pain in our lives and we all deal with it in different ways. I know that loving people is not all about being a push-over and letting them have whatever they want. Sometimes it means being tough, and saying no. Sometimes it means putting a little pigeon out of it's misery, so to speak. But always, it means to do it with respect, and to recognize that we could be in the same position.
As my patients in detox I have homeless people, I have wealthy businessmen, I have successful nurses and massage therapists, I have writers, and musicians, and mothers, and fathers, and store and restaurant owners, and teachers, and farmers. I have Christians and atheists and Sikhs and Catholics and Buddhists. I have had patients as young as 19 and as old as 77. All of them have come to a point in their life where their addiction is unmanageable and they need help with their pain. They deserve compassion, respect, and good medical care. If I can't provide that to them, I shouldn't be doing my job.
I know this blog entry sounds like a rant but I feel it is something that needs to be said. We need to have grace for each other. When I grew up I heard the message from society that drug addicts were dirty people who lived on the streets and were dangerous. They're not the type of people you let into your house or befriend. I'm ashamed to say that I unconsciously succumbed to that thinking for so long. And now I have looked in the mirror of my patient's faces and I have seen myself, and more importantly, I have seen Jesus. When we treat someone as if they are undeserving of our respect and love, it is as if we are treating God's son in the same way. But when we treat them with compassion and love and dignity, and when we fight to honor them and care for them, it is as if we are doing it for God.

Normal people

It's been many long months (okay, maybe just weeks) since I blogged, so I thought that instead of giving you a recap of my life, I'll give you a recap of some of the most interesting people I've met at work over the last while. Between tutoring and nursing, I've met people of all ages who have blessed and inspired me, challenged and grieved me, and given me a window into my own heart and into the heart of God. (Of course, as usual, all the names are changed in case someone reads this and fires me.)

At tutoring I struggled for a long time with a little boy named Mark. He's about 11 years old and he is totally unmanageable. He's behind in math and English so I'm trying to help him catch up so he can get into a regular class. When I ask him to do something (usually math) that he doesn't want to do, he pulls out all the stops. Whines, swears, kicks the wall, flat out refuses, etc. I've tried bribing him with games and jellybeans, threatening him with telling his dad and making him do more math, manipulating and coercing and cajoling but nothing works. I suspected that his home life might not be that great because he always came to tutoring covered in scrapes and bruises and as dirty as a little boy could possibly get.
Finally in despair I talked to my boss for some ideas and she gave me some background about him.
Mark's parents are alcoholics and drug users and he spent from the age of 6 until recently living on the streets. Finally his grandma was able to get him and he's been living with her and going back to school. At first no school wanted him because he was so wild, but he's made a lot of progress and almost caught up with his grade. He has ADD and fetal alcohol syndrome, you name it. His dad has been sober for awhile and takes him to tutoring on the bus and really does love him, but it's Mark who looks after his dad, not the other way around. The kid has been used to fending for himself and looking after others and doing whatever it took to survive.
When I heard Mark's story I knew my approach had been totally wrong. I'd been very task oriented in trying to get his math done. In reality, if we got ten minutes of good work done in our hour together, we were making progress. Mark needed to have fun at school so that he would want to stay in school and graduate. (Education isn't the answer for everything, but it certainly can help break a cycle of poverty and addiction.) I realized also that consistency and discipline were majorly lacking in Mark's life and even though I wasn't a parent, I could help him a lot more by being consistent and not giving in to his whining and manipulating.
He's extremely gifted with writing, despite his terrible punctuation, but we've finally worked out a system of rewards involving purple play-do and board games. We're making progress. Slowly but surely.
While nursing I met an intriguing fellow named Stan. Stan has bipolar disorder and he was brought into the hospital and then detox because God spoke to him (so he said) and told him not to take his medication or wear any clothes. He'd been wandering around town and got taken in. Even after we got him stabilized with some meds he would still appear periodically at the nursing station in his skivvies (or his birthday suit) asking for a chocolate milkshake. He's a gentle-spirited and very polite man and when he's in his right mind he has a little twinkle in his eye and makes wisecracks under his breath to the nurses.
Carl is only 19, which is the youngest age detox will take (there is a detox for youths in BC where they help kids as young as 8 detox off of drugs or alcohol). He looked like 16 and he had a scared, timid look about him. At first he wouldn't look me in the eye, for about two days. Every time I tried to talk to him he avoided my gaze and gave me mumbled answers. Finally one of the social workers was cleaning his room and found a stash of used needles and a spoon with heroin on it. She also found that he'd been wetting his bed and stuffing the sheets into the closets and under the mattresses. I felt myself recoiling from the awkward conversation I knew we had to have.
I told him we'd noticed the sheets and I asked him if he was sleeping too soundly because of the meds we were giving him, and not able to make it to the bathroom at night. He was embarrassed but I told him that we were happy to wash the sheets, he could just bring them discreetly to the laundry room and get new ones, but not leave them in the closets because he had a roommate coming. I asked him about the needles. “Carl, we found some needles in your room. Are they yours?”
He said he thought they belonged to the guy who'd been in the room before him. I did a dipstick urine test but it was negative for drugs. I told him, “Carl, we take very seriously using drugs in detox here. If you are using while here we'll have to discharge you. However, I always give people the benefit of the doubt and if you tell me that you haven't used, I am going to trust that you are telling me the truth.”
For the first time he looked me in the eye.
Sometimes when I'm working I believe that the Holy Spirit gives me insight into people's lives. I've found that with very young people heavily involved with drugs, there is often a history of sexual abuse, and I felt very strongly then that Carl had a history of massive sexual abuse. Sexual abuse destroys trust and respect and is devastating for anyone, but especially a young man who can't easily talk about it. So I looked Carl in the eye. I told him that I trusted him and that I wanted to see him do well here. He actually cracked a grateful smile and later, came and talked to me and the social worker about something else. He held his head up.
He finished detox two days later and went on to treatment and I pray for him that someday he finds freedom from the things that try to chain him down.
At tutoring I appreciate the normalcy in most of the kid's lives. Some of them are so innocent and untainted by life that it's truly a joy to see them discover and have fun learning. I commented on this to my boss and she laughed and said, “well, you like to think they're normal!”
The next day one of my most 'normal' students was missing. Stacy is a pretty blond 15-year-old; a little overweight and shy but we've shared a lot of laughs over French. I asked my boss if she'd heard from her. Apparently Stacy's parents had just gone through an ugly divorce and her dad refused to pay child support and her mom had run up a big debt with tutoring and other activities and finally it had all come to an end. My boss felt like Stacy and I had made a lot of progress in French, mostly in the area of building confidence, so she encouraged Stacy's mom to save the money and pull her daughter out. Suddenly normal didn't seem quite so simple.
Janine at detox seemed pretty normal too. She's the mother of two lovely teenagers who dropped her off at detox and cried when they said goodbye. She has a lilting Newfie accent and while struggling with depression she started drinking, and eventually it got out of control. She talked to her husband every day on the phone and when she was feeling a little better she bleached the whole kitchen and washed all the windows for me.
It seems to me that suffering pain is normal. Doing whatever it takes to survive is normal. Laughing and making jokes even though everything is wrong all around you, that's normal too.

What??!!!!!

Can you believe I haven't blogged in over a month? This isn't really a blog entry per se, I just feel guilty so I wanted to let my readers know I haven't forgotten totally about it. I have had time off work and have been bombing around town on my bike, gardening, reading cook books (I got very inspired by 'Julie and Julia'), playing board games with Robin and enjoying the nice weather. I've met some interesting people and spent time with family and friends and had fun looking after my delightful little nieces and nephew.
I will blog again soon, I promise. In the meantime, stay happy.

Knowledge puffs up

I learned an important lesson at work yesterday.
I was working at the detox center and I had a few sick patients. The doctor was scheduled to come at around 8 but she called me at 9 to say she would be in after lunch. I don't normally give the doctors too much trouble- I get everything organized for them and try not to call them on their cells, especially at night, unless it's an emergency. If I need a lot of orders, I try to group them all together in one phone call so I don't bother them too much. Suffice to say that by the time Dr. Michaels* showed up at 2:30, I had a lot of stuff to talk to her about. (*Names changed, of course, since I'm about to criticize her).
One of my patients, a young man withdrawing from morphine, had been in a car accident and sustained serious nerve damage to his left leg. He was barely handling the excrutiating pain when a buddy gave him a couple of dilaudid pills (similar to morphine) and he quickly became addicted. Now his life was falling apart and he was willing to do anything to get off the drugs. We talked about the pain together and I gave him regular tylenol and ibuprofen but none of it was really cutting it. There is a drug called Gabapentin that I told him about- it is very good for nerve-type pain and it is especially good in the withdrawal pain associated with opiate use. I told him about it and he said he'd be willing to try it. In detox it is one of the more commonly prescribed drugs by the doctors- it is non-addictive and fairly safe and I've had patients tell me that nothing helped their pain until they tried the wonder-drug Gabapentin.
Dr. Michaels came in and I was down the hall and I heard someone calling for me.
"Where's the nurse?" She demanded as I came into the office.
"I'm here." I said, and quickly pulled out all the charts for her to sign. I asked my nursing student (who was shadowing me) to go and get the first patient to see the doctor. Dr. Michael's scanned the orders sheet.
Stephanie had been on a regular dose of dilantin (a seizure-controlling medication) but the doctor the day before had forgotten to order it and I needed her to write it out for me. Kyle needed a physician's signature on his admissions form for a treatment program. James had a bad cough and was asking for his puffers and I needed an order to get new ones from the pharmacy. One of my patients came into the office just then, doubled over in pain and looking like he was about to throw up. While Dr. Michaels was signing charts I whisked him into the examining room and quickly gave him some gravol.
He kept the gravol down without vomiting so I took his blood pressure and opened the med drawer to get him some clonidine (a medication used for opiate withdrawal that takes away a lot of the pain and nausea). The poor guy hadn't had his dose yet that day, as he had been sleeping, and he was in rough shape.
Suddenly Dr. Michaels stalked into the room and stood there, in my way.
"I'm just giving him some clonidine." I explained, checking the dose of the drug.
"Can't you do this later?" She demanded, waving me out of the room.
"Okay?..." I shrugged at my patient and went out of the room. She closed the door after me.
I busied myself copying orders and then went to get another patient lined up to see her. As I was coming back into the room she was sitting with her back to me, and she called out, "Nurse!"
Now, I don't mind being called nurse by my patients, because most of them are sick and there are so many nurses they can't keep it straight anyway, and we're all wearing uniforms.... But when a doctor calls me 'nurse!', especially a female doctor, there is something very disrespectful about it. I felt my blood begin to rise, but I held my tongue and came over to help her.
"What else do you need me to sign?" She asked.
I sat down next to her and went over some of the orders, finishing with asking about the Gabapentin.
"Paul has had nerve damage in his left leg from a car accident and it's excrutiating. I was wondering about getting him some gabapentin for it."
She shrugged, ignored me, wrote something else on Paul's chart about sleep medication and shuffled the papers together.
"I'll leave this form for today, I don't have time to fill it out." I held out the clipboard with her msp forms that required her signature to be paid, and she signed it and went out of the office, putting on her coat.
She had been there for an hour but it took me two to process her orders and clean up the mess. I explained to Paul that the doctor hadn't ordered Gabapentin for him, so we'd try to manage with tylenol and hot water bottles, and the poor guy looked like he was going to cry.
Later that night, after a busy day, I was doing shift report with the night staff. The nurse coming on shift was a veteran- she is a kind older lady with an ever-present smile and a sense of humor. She took one look at Paul's chart and said,
"Why isn't he on gabapentin?
"I asked Dr. Michaels for it today" I said, "but she wouldn't order it."
"What?! We use it all the time for this type of thing! Why on earth wouldn't she order it?"
Suddenly the old nurse smiled knowingly.
"Heather, you have to learn how to talk to doctors." she said to me. "I've learned over the years, you have to treat them like a husband."
I wondered what the heck she meant.
"I know Dr. Michaels," she continued; "she's a type A personality, and from what I know of you, you are too. What happened today had nothing to do with the Gabapentin. It was a power struggle, pure and simple."
Suddenly everything began to clear.
"The way you treat a doctor and a husband," she said, "Is you never tell them what they should do or ask them for something directly. You always make it seem as if it was their idea first. I'll bet anything you said to Dr. Michaels, 'Would you please order gabapentin for Paul?'"
I laughed. "Of course."
"Well, what you should've said was 'I don't quite remember, but is gabapentin the drug you normally order for this type of thing?', or something like that, to make it seem like it was her idea first. If she thinks that you know more than her, or know what she should do, she'll do the opposite."
We all laughed together.
I thought about it all night, though. It shouldn't be that way, but it is. Dr. Michaels (and some other very talented doctors I've met) treat me like a dumb LPN. Part of me wants to look her in the eye and say, "I know what I'm talking about, I've been in college for 8 years and I was in medical school." But part of me also believes that you shouldn't have to get respect by showing off how much you know. If Dr. Michaels can only respect me for my societal rank in the healthcare field (or lack thereof as an LPN!), then it's not true respect. True respect has to do with listening to a person and considering their opinions simply because you believe they matter as a person, not because they have the initials LPN or RN or MD or PhD behind their name.
I remember in nursing school, a very wise teacher told me, "If you want to know something about a patient, whether or not their behavior is normal or how long the strange rash has been there, then ask the care aides. If you want to know where things are or you need somewhere quiet to nap during your break or you have a machine break down or the cafeteria is out of food, ask the janitor. Never underestimate what the people 'lower' than you know and are capable of. They will make or break your career.
I have the same issue going on with my nursing student. She's annoying and not super smart, but I learned something from Dr. Michaels that I can pass on to her in the way I treat her.
"We know that we all possess knowledge. Knowledge puffs up, but love builds up. The man who thinks he knows something does not yet know as he ought to know." I Cor. 8:1-2
There is no substitute for loving and respecting people. And if I truly care about my patients I'll have nothing to do with the hierarchy that demands I treat the people 'lower' than me as if they don't know as much as me. Instead, I'll seek to build them up however I can.... In doing that, people like Paul won't have to suffer needless pain.

Hullaballoooooo!!!!

The other day at work I had a crazy day. It started out kind of bad because I didn't sleep well the night before and I woke up early and it was cold and dark and I didn't feel very upbeat. I drove to work and sat through report with a coffee in my hand. I didn't finish my coffee until 3 in the afternoon, which is probably why things went the way they did. We were short staffed: the social worker was sick and I had a student to help me with things, but otherwise I was on my own.
There are many different types of people who come through detox, but if I was to divide them into the two most general categories, it would be alcoholics and opiate users. Alcoholics of course can be anyone from any walk of life and there is no real typical example. Opiate users, however, are usually working through quite a bit of pain. Physical pain issues underlying their addiction are often things like car accidents or work accidents that left them with excrutiating back pain or chronic migraines, so they started with prescription painkillers and things spiralled down from there. Emotional pain issues are often childhood sexual or physical abuse, loss of close loved ones, bad marriages, etc.
Whatever the cause, when you remove a painkiller from someone, their pain surfaces at an even greater level than before. As a very general rule, people withdrawing from opiates (heroin, morphine, etc.) are in a LOT of pain; thus they complain a lot and are very needy. Coupled with the fact that many of them have subsequently ended up in pretty crummy life situations, many of them have very poor coping skills and very difficult behaviors. Not to mention a high rate of mental illness (depression, bipolar, multiple suicide attempts, OCD, etc.)
A busy day in detox would be 5-6 alcoholics and 2-3 opiate users. I say this all to explain why my day was so busy: when I got to work I had 9 patients; 8 of whom were opiate users.
Some of them were very sick. One young woman named Karen (not her real name) was scheduled to leave that morning. She had made plans with a young guy named Mark to go to his home for a couple of days before heading to a treatment center. Staff tried in vain to dissuade them. She had complex issues that we weren't really able to tell Mark about because of confidentiality. She had multiple suicide attempts and was drinking everything from listerine to glue to methadone and anything in between. Mark was a gentle-hearteded guy and the alternative of her going to a women's shelter for two days roused his protective instincts. The morning was spent on the phone with her parents and his mom and trying to convince him to leave without her. Mark finally confessed that he felt trapped; although he wanted to help her, he didn't really want to take her home with him, but when he tried to tell her she couldn't, she sobbed and cried that she had nowhere to go and wanted to kill herself.
Meanwhile an older man, Jason, had taken his medication for hepatitis and was growing weaker by the minute. I wondered if he had a drug reaction going on. Another lady, Beatrice, was sitting on the floor in the hallway crying and swearing.
The fire alarm went off. My manager came bursting out of the office yelling for me to get everybody out and evacuate. She called 911. I grabbed the census sheet and rounded up all my patients out the door and into the parking lot. It was freezing. We huddled together in the cold waiting for the firetruck to arrive. Jason had a blanket wrapped around himself and he curled up in the dirt, covering his head. Some of the girls were crying. I didn't have a coat and I stamped my feet to keep warm and told them it wouldn't take too long, everything was going to be okay.
The main boiler had exploded and it didn't take the firefighters long to check it out and let us back in the building. But there was no heat now, and no hot water. Me and the student helped Jason up from the dirt and I began filling hot water bottles and getting extra blankets for everyone.
Mark's mom arrived to pick him up and we quickly pulled her into the nursing station and explained what was going on. Karen was such a basketcase that we felt the easiest solution for Mark was to sneak out quietly and we'd deal with Karen after he left. The student distracted Karen; my manager got Mark ready to leave.
Beatrice was still crying. Her room was near the nursing station and she was huddled on the floor under a blanket with an electric heater under it. Her roomate was distressed. "She's going to light the place on fire!"
"Beatrice?" I tried to coax her out from her tent. She jumped out, knocking a glass of orange juice to the floor. She began to cry, sitting down in the juice with her blanket.
"I feel so awful! I'm spilling everything!"
"It's okay." I reassured her. "I'll clean it up. Why don't you go have a cigarette, and then I'll give you something for the pain?"
I hate to recommend smoking, but for people in that much distress it went a long way to calm jangled nerves.
She got up and went out the room. Her roomate, lying on the bed, told me:
"Beatrice asked me for some money because she wanted to get a friend to smuggle some dilaudid in here for her. I don't even know what dilaudid is."
And so my day went. Karen yelled and cried for 3 hours before leaving. We phoned ahead to the women's shelter and asked them to put her on suicide alert. The crowing glory was just after dinner, I heard someone shout my name, and I raced out of the nursing station to find the night attendent holding Jason against the wall. He was white as a sheet and tried to throw an arm around my neck as he slipped to the floor. He was a big guy, about 250 lbs, and I ducked out of his grasp and instead pushed him against the wall as I helped him collapse slowly. Then I got my stethoscope and listen to his falling blood pressure, managed to get him into a wheelchair and then into bed, and then called 911.
The detox center is not an acute medical facility, so anyone that turns critical we have to send to emergency. The paramedics came and put him in a stretcher and whisked him away. As I was trying to finish my charting, Beatrice came in crying and saying that the night attendant had been rude to her in front of the otehr patients and she wanted to make a complaint.
I went home feeling a little stressed. Sometimes people say, "Oh, I could never do a job like that!" My answer is that I couldn't either, if I had to do it full-time. I'm sure I would burn out. Some days are laid-back and easy-going, others are just one giant hullaballoo.

A little coordination goes a long way

It seems these days that anything requiring coordination is giving me grief.
The first thing is the ‘Indiana Jones’ LEGO X-box game. Robin and I have been playing it together the last few days. I’m not sure if it is a relationship-building exercise or a relationship-destroying one, because it is very frustrating for my talented husband to play with me, as it turns out. He gets to be Indiana Jones and I am one of the other characters from the movie (his sidekick). We run around, blow things up, fight bad guys, build things, solve treasure maps and little puzzles, and jump and swing on rocks and buildings. All this with 4 little buttons and 2 toggle switches that you play with your thumbs.
Compared to this, the heart surgery I helped with last summer was child’s play. Inevitably it comes to a difficult move where my little lego man was to swing from a hanging vine, onto a building and then leap in sequence across obstacles and I end up killing myself repeatedly and killing Indiana Jones, too. I asked Robin last night if he thought I’d improved, and he said it was hard to tell.
The second coordination problem is our truck. Now, I personally don’t believe I have a very significant coordination problem, but since we got our pickup this summer it has been a steep learning curve for me in driving standard. The curve has plateaued recently which means that I’m still driving as badly as I ever did. Depending on your point of view, one could say that our recent truck issues are related to my skill in driving.
Last night I was on my way to work when suddenly the truck made a horrible grating noise and then the stick shift moved all by itself and the truck stalled. I managed to pull off the highway and coast to a stop on a side street. It wouldn’t even turn over. I popped the hood and there was a funny smell and everything looked okay, but I knew that was it. I called my boss on my emergency-only cell phone and since I was so close to work, she sent the secretary to come and pick me up. After work I called my brother Sam and asked him for advice. Get it towed home, he said. I called BCAA (let me advise getting a membership- it is one of the best investments I’ve ever made) and the secretary drove me back to my truck to meet the tow truck.
He hooked it up and on the way back to Kelowna we chatted about alternators and solenoids and the weather and families. When we got home he pulled into the parking lot across from our apartment. I jumped out and looked over at our apartment. I could see Robin sitting at the table, looking out the window at us. It was dark but the tow truck lights were flashing and I stood there as the driver unhooked it, thinking how I was going to explain this one.
When I got in he asked, “Was that our truck that the tow truck brought in?”
To make a long story short the truck is still parked there and hopefully my dear brother will be able to fix it for us.
The third area of coordination that is a nightmare is my aerobics class. Today we jumped around and did a move called the grapevine step. I shouldn’t say ‘we’, actually, because I never got the hang of it. Not only were all the people moving their feet in this complicated step, but they were also doing something with their arms. I struggled to keep up but for the entire class I felt like I was going the opposite way from everyone else, stumbling over my own feet. At one point we were marching across the room while waving weights over our heads in some kind of pattern and I heard the instructor say to the class, “Why don’t you make it worth your while and use heavier weights?”
I realized I was the only one with 3-lb weights; everyone else was carrying 5 or 10 lbs. I gave it my best shot, but by the time I was done I had to limp home.
I don’t know if there are any things you can do to improve your coordination, but I’d like to try. I’ve been reading a book about mathematical puzzles and I am struggling everyday to stretch my mind and figure out how to do them. Most of the time I can barely understand them. (And anyway, why would it be fun to try to solve a math problem that no one has ever figured out before?)
Well, I’m going to keep at it. More LEGO X-box tonight, if Robin can put up with me, and I’m going to keep up with the aerobics.

A new year, a new challenge

Along with my requisite two dozen new year’s resolutions, my resolution to get fit and lose weight involved joining an aerobics class at the local rec center. Over Christmas I ate lots of tasty treats and it was just too darn cold to go running, and well, honestly, I’m a bit bored of running alone and the slightest bit lazy. Robin and I just got cable in our apartment and a world of marvelous sedentary delights were opened up to me. He had to teach me how to use the remote control and navigate through the channels, but now that I’ve got it, it’s tons of fun to watch various shows and movies and news and cartoons. I don’t watch a lot, but I definitely am not utilizing my time as efficiently as I used to.
I remember a time when I wouldn’t watch a movie without knitting or flashcards in my hands. I still can’t handle reading a novel- it has to at least be in a foreign language to stretch my mind.
But all that aside, I had my first class on Monday. I walked over to the rec center and into the big room and there were about 30 ladies and 1 lone man. Most of them looked like retirees- and most of them looked deceptively out of shape. I say deceptively, because by the end of the first 5 minutes I realized I had my work cut out for me to keep up with them.
The instructor had bright red lipstick and she bounced around in tune with the music, yelling out instructions for left, right, two steps this way, two steps that way, etc. etc..
I was concentrating so hard on trying to perform the mirror image of her movements at breakneck speed that I almost crashed into the lady behind me. The deceptive flabbiness of all the older ladies had caught me off guard. They were all wearing lululemon pants and sweat bands and they all had towels they wiped their faces with every now and again.
By 15 minutes I felt like my legs were going to fall off. I looked at the clock and realized that there was still an hour to go. At 30 minutes we were allowed to stop for a brief water break. The older man came over to me and said graciously,
“Don’t worry about keeping up; as long as you keep moving you’ll do fine.”
I wondered if it was obvious that I couldn’t keep right and left straight.
Towards the end of the class we did some stretching and as I bundled up to go, dripping with sweat, I realized I would either die, or get in shape.
Today was my second class and right now I’m sitting with a hot water bottle on my sore legs and trying to relax my shoulders so they don’t ache so much. There were less people in the class, and I was smart enough today to wear my stretchy leggings, so I didn’t stick out so much. The instructor had us run laps across the huge room, waving weights over our heads (at least that’s what I was doing), and at one point I realized I was struggling to keep up with a lady who looked old enough to be my grandmother. The embarrassment was complete.
In front of me was a lady who was about 80 lbs, wearing a teeny tank top and even teenier shorts (if you could call them that). I could see the bones on her back sticking out. As soon as the music started, she was off like a little energizer bunny. She looked like she had springs in all her joints, and during the water break she jogged on the spot. I was dying.
I stumbled home today and did housework and got groceries and went to a staff meeting at work and made a lasagna that turned out runny, and watched a bit of tv with Robin and now I’m contemplating going to bed, even though it’s only 7:30. I’m determined to keep it up with the class, and I’m determined to improve the coordination thing. I’ve heard that most women struggle with right and left more than men (hence the reluctance to drive standard in a lot of women), but no one seemed to be having more trouble than me in today’s class. I believe it can be overcome, though. I’ll keep you posted……