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.