In the next few days I will be writing entries based on my journal entries from Costa Rica. I'll cut through the personal stuff to bring you some quick and easy anecdotes. But before I do,
I wanted to tell you about leaving.
When I left Tokyo, I felt certain things, which I described in this entry: Leaving Japan.
Looking back at my confidently stated desire to melt into a sea of strangers and anonymity, I think it's ironic that my very brief trip to Asia was the beginning of both my Twitter account as well as my stated intention to write in this blog every day. I loved being unaccountable, but I wanted to share it with everyone. I was surrounded by literally thousands of people every day, and I hoped that they would never know my name, but I wanted them to know my virtually transmitted opinions of everything.
When I got back from that trip two huge things happened for me. I was invited to join Improv Asylum's Mainstage, and at the same time Three Hole Punch began to really take off. This new surge in my stage career called for even more virtual social networking. Suddenly I was updating constantly about shows and promoting events. I was "friending," dozens of new people a month on facebook after meeting them at shows. I began to carefully edit my life online. It makes sense, I thought to myself, if I want to be a public figure I have to live like a public figure.
If Tokyo made me want to be a Nobody, but somehow also made me believe I needed to start saving up for an iPhone*, my short time in Costa Rica was the opposite.
Mom and I stayed most of the trip in the town of Santa Ana. The town is so small that the man who runs the store across from Bar Amigos won't sell my cousin cigarettes because he heard about his recent heart attack. It was calming and comforting to see the same people every day on the street selling fruit or onions.
And as I began to feel the stability of a small town life, as I got used to not having a cell phone and constant internet access, the importance of those things melted away. When I did finally log onto facebook, I couldn't figure out what on earth I used to do on there all the time. Read status updates? Why? And I didn't update my Twitter account once. Not that I wasn't doing interesting things. "Flying through a rainforest canopy on a zipline," would have been a great update. But I didn't feel the need to broadcast it. I shared those experiences with the people (literally) near to me, and then later could share it with anyone who hadn't been there over a couple of drinks or dinner.
As I sat on the plane from Tokyo to St. Paul I wrote "As we rush through Nothingness I believe I can feel the weight of responsibility descending on me." I remember the feelings. It was like waking from a dream into a tumultuous reality.
But as I sat on the plane from San Jose to Houston I had a very different feeling altogether. It was the feeling of leaving home.
I will miss many things about my trip, mostly the people I met. But I also felt a deep ache in my chest for the things I had remembered about myself by living away from my normal life for ten days. A simple example is this:
I don't like eating junk for breakfast. And I don't like skipping meals, but how often do I brag about my ability to go all day on just some fruit and coffee? And I dislike how rude people are to each other in the city. And unlike many of the 20 somethings I know, I honestly like kids. And old people.
In Costa Rica I pledged that when I returned I was going to start cooking breakfast, or at least preparing a substantial meal the night before. I swore I would start spending more time on my porch and less time on the computer. It seems feasible still. After all, my sun burn still stings every time I move, reminding me of the past ten days.
But some day that sun burn will fade.
So what does it all mean now that I'm back? Well. Clearly, I'm blogging again. And I'm back on Facebook. And I can bet that after a few more weeks you'll see my Twitter account jump back into use. It's just the culture here. It's the most useful tool for forwarding the (night) job I've chosen.
But it's nice to know it's part of this particular culture; not my own essence. It's nice to know that all of those luxuries are merely tools with which to exist in a particular time and place. Removed from the culture, I give over the trimmings, but lose nothing of myself.
It just so happens that Costa Rica gave me more glimpses into myself than I have been afforded anywhere else recently.
So on that note... I have already looked into flights back to Costa Rica for mid May to early June.
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* What on EARTH would I ever need an iPhone for? EVER?
Wednesday, April 29, 2009
Sunday, April 26, 2009
con mucho gusto
We are back in Santa Ana after spending four days in Arenal.
The road to Arenal is long and winding. The landscape changes from residential to farmland and finally into wild, green and sprawling cloud and rain forests. ¨Vivid,¨was the word that kept coming into my head. It was all just so damn alive.
I can´t do justice to how beautiful Arenal was. You´ll have to wait for photos. Our room was part of a row of similar bungalo style rooms. There was a small patio leading into the room, and from the patio you could look over a beautiful tropical garden where hummingbirds and butterflies played all day in flowers that looked like Dr. Suess made them up. And rising over the tops of the trees, topped almost constantly with a veil of white clouds, was the Volcano Arenal, the most active volcano in Costa Rica, and the ninth most active in the world. I could have sat on the patio all day long sipping mango juice or beer* and listening to frogs sing. Most nights that´s exactly what we did. Daytime was a different story.
In the past few days I´ve canopied through the tree tops over rivers, and saw the most amazing birds. I rode a horse to the top of a small mountain across from the volcano. I galloped through a primary rain forest, and across rivers that led into a sulphur lake. I saw howler monkies and toucans. I held a giant butterfly that just crawled out of a cocoon so it´s wings could dry. I took a different canopy tour, this one that was built for extreme thrills instead of sport, and went ziplining across the treetops, thousands of feet at a time, hundreds of feet above the ground.
None of the full stories will really do here though. You´ll have to sit with me sometime and I will tell you.
¨
Coming back to Santa Ana really was like coming home. We were greeted by everyone at Bar Amigo as if we were walking into Asgard. When I got home Perrocito was there to lick my face.
Mom and I were supposed to go to Monteverde on Saturday morning but we decided not to because we missed the sun while we were in the rainforest, and didn´t want to run off to a cloud forest. Plus, it was fun to be a tourist for a few days but in Santa Ana we´re having a way more authentic experience. There´s a party at Jack´s today, so I´m going to go get ready.
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* Imperial is the smoothest beer I have ever tried. I haven´t gone a day without it, or without an avacado. In fact, an Imperial and an avacado is a great bedtime snack.
The road to Arenal is long and winding. The landscape changes from residential to farmland and finally into wild, green and sprawling cloud and rain forests. ¨Vivid,¨was the word that kept coming into my head. It was all just so damn alive.
I can´t do justice to how beautiful Arenal was. You´ll have to wait for photos. Our room was part of a row of similar bungalo style rooms. There was a small patio leading into the room, and from the patio you could look over a beautiful tropical garden where hummingbirds and butterflies played all day in flowers that looked like Dr. Suess made them up. And rising over the tops of the trees, topped almost constantly with a veil of white clouds, was the Volcano Arenal, the most active volcano in Costa Rica, and the ninth most active in the world. I could have sat on the patio all day long sipping mango juice or beer* and listening to frogs sing. Most nights that´s exactly what we did. Daytime was a different story.
In the past few days I´ve canopied through the tree tops over rivers, and saw the most amazing birds. I rode a horse to the top of a small mountain across from the volcano. I galloped through a primary rain forest, and across rivers that led into a sulphur lake. I saw howler monkies and toucans. I held a giant butterfly that just crawled out of a cocoon so it´s wings could dry. I took a different canopy tour, this one that was built for extreme thrills instead of sport, and went ziplining across the treetops, thousands of feet at a time, hundreds of feet above the ground.
None of the full stories will really do here though. You´ll have to sit with me sometime and I will tell you.
¨
Coming back to Santa Ana really was like coming home. We were greeted by everyone at Bar Amigo as if we were walking into Asgard. When I got home Perrocito was there to lick my face.
Mom and I were supposed to go to Monteverde on Saturday morning but we decided not to because we missed the sun while we were in the rainforest, and didn´t want to run off to a cloud forest. Plus, it was fun to be a tourist for a few days but in Santa Ana we´re having a way more authentic experience. There´s a party at Jack´s today, so I´m going to go get ready.
----------------------------------------------------------
* Imperial is the smoothest beer I have ever tried. I haven´t gone a day without it, or without an avacado. In fact, an Imperial and an avacado is a great bedtime snack.
Monday, April 20, 2009
Costa Rica Update
Mom and I arrived finally, and safely after a delay in Houston. I am writing this from my cousin Jack´s computer. The keyboard is a bit different, so I struggled to get into my account for five minutes trying to find the @ symbol. One combination of buttons I pushed made the cursor arrow turn into a rainbow. That´s part of why this will be short. The other part is because every minute I spend here is a minute I am not sitting by the pool eating a(nother) mango.
For lunch today we went to "the melon man" and we bought scores of fresh fruit for about two dollars. I can have all the avacados I want.
Jack met us at the airport with his friend Abus, and we took a quick ride up long and narrow roads scattered with pedestrians, dogs and bicyclists to get to Villa Antigua where Mom and I are staying. The owner of Villa Antigua is Denis. Right now we are the only guests there. Denis told us to make ourselves at home because his house is our house. And it´s a nice house. Denis made us breakfast this morning, gallo pinto, and black coffee.
Denis has two dogs, and one of them has taken to following me around. He waited for me this morning at the door of my room, and even followed me to the bathroom. He laid by my feet during breakfast, not begging... just waiting. Yes, I´ve been here two days and already adopted a pet. His name is close to ¨"bobby" but I call him perrocito.
Last night Jack took us to his favorite hang out, Bar Amigo. There we met an amazing cast of characters including the owner, ¨"Weymouth Pete" and a man named Jerry who convinced me to go to the Festival de Cebolla which was going on down the street. We also met Jack´s next door neighbor who is about my age. David is originally from California and teaches English here. He came with us to the Festival later, and then to dinner and karaoke. At the Festival, which reminded me of the stalls and stalls outside of the temples in Japan, I lost myself in the smells and lights and music. I bought a CD of pan flute music. Read this as: I might have been drinking a little bit. We capped the night off back at Bar Amigo where Jack and Mom made me step dance for everyone. You know, because I don´t look Irish enough.
Oh! Did I mention, I also saw a horse tap dancing? It´s just something they do here apparently.
I could go on and on and on but I want to go back outside because David (who called in sick today) showed me some baby basilisks running down the river a little while ago and then he saw an big adult one, but I didn´t. And I won´t if I stay inside.
For lunch today we went to "the melon man" and we bought scores of fresh fruit for about two dollars. I can have all the avacados I want.
Jack met us at the airport with his friend Abus, and we took a quick ride up long and narrow roads scattered with pedestrians, dogs and bicyclists to get to Villa Antigua where Mom and I are staying. The owner of Villa Antigua is Denis. Right now we are the only guests there. Denis told us to make ourselves at home because his house is our house. And it´s a nice house. Denis made us breakfast this morning, gallo pinto, and black coffee.
Denis has two dogs, and one of them has taken to following me around. He waited for me this morning at the door of my room, and even followed me to the bathroom. He laid by my feet during breakfast, not begging... just waiting. Yes, I´ve been here two days and already adopted a pet. His name is close to ¨"bobby" but I call him perrocito.
Last night Jack took us to his favorite hang out, Bar Amigo. There we met an amazing cast of characters including the owner, ¨"Weymouth Pete" and a man named Jerry who convinced me to go to the Festival de Cebolla which was going on down the street. We also met Jack´s next door neighbor who is about my age. David is originally from California and teaches English here. He came with us to the Festival later, and then to dinner and karaoke. At the Festival, which reminded me of the stalls and stalls outside of the temples in Japan, I lost myself in the smells and lights and music. I bought a CD of pan flute music. Read this as: I might have been drinking a little bit. We capped the night off back at Bar Amigo where Jack and Mom made me step dance for everyone. You know, because I don´t look Irish enough.
Oh! Did I mention, I also saw a horse tap dancing? It´s just something they do here apparently.
I could go on and on and on but I want to go back outside because David (who called in sick today) showed me some baby basilisks running down the river a little while ago and then he saw an big adult one, but I didn´t. And I won´t if I stay inside.
Sunday, April 19, 2009
By the time you read this I'll be gone (again)
Mom just arrived with all her luggage. I am about to begin packing my own stuff, and then we'll have dinner and go to church.
At 6am in the morning, when this posts itself, we will be boarding a plane to Houston, TX. From there we will fly to Costa Rica. In Costa Rica I will meet my cousin Jackie for the first time. We're going to stay in Santa Ana, and then travel to Arenal, then Mom and I will go alone to Monteverde and meet Jack back in San Jose.
While I am gone some very awesome improvisers from Tokyo will be in Boston visiting and performing. The only downfall to my vacation plans is that I will completely miss out on seeing them. If you, however are in Boston this week please make it a point to try to get to Improv Boston and catch a performance. I got a chance to work with them while I was in Tokyo last fall. They're very funny, super talented, and it's not a show you get to see every day. Go see them , for me. And take pictures. And then tell me all about it later.
At 6am in the morning, when this posts itself, we will be boarding a plane to Houston, TX. From there we will fly to Costa Rica. In Costa Rica I will meet my cousin Jackie for the first time. We're going to stay in Santa Ana, and then travel to Arenal, then Mom and I will go alone to Monteverde and meet Jack back in San Jose.
While I am gone some very awesome improvisers from Tokyo will be in Boston visiting and performing. The only downfall to my vacation plans is that I will completely miss out on seeing them. If you, however are in Boston this week please make it a point to try to get to Improv Boston and catch a performance. I got a chance to work with them while I was in Tokyo last fall. They're very funny, super talented, and it's not a show you get to see every day. Go see them , for me. And take pictures. And then tell me all about it later.
Saturday, April 18, 2009
How I spent my 21 hours in Chicago
It was mind blowing to look out into the audience at the beginning of the show to see people who had trained us when we were first starting out, as well as friends from Boston we've only started to get to know. At the after party my mind continued to whirl as I realized many of the friends I have kept in different cities actually know one another. And those who didn't already, did meet each other and they clinked cans and glasses and liked it.
As Three Hole warmed up backstage I remembered being in the same space in 2007 while on spring break with Mission:IMPROVable. We were there taking a workshop with Andy Hobgood. I had wondered, as I looked around backstage, if I would ever get to perform there.
For that reason, and for many reasons getting to make stuff up with my best friends at the Chicago Improv Festival was a huge big deal for me. Plus, Three Hole had a set we felt good about, which always sweetens the experience. But the best part of the entire thing hands down was getting to see old friends doing great new things and to meet new people who share the bizarre desire to play let's pretend almost all the time.
After the after party cleared out of the theater everyone walked a few feet to the Green Mill. We squeezed into 1930's style booths and enjoyed some of the most breath taking jazz ensembles I've ever seen. Jon Dick,* Steph and I decided to stay up all night. Although my dear friend Nick (also of Mission fame) discouraged me at first he stuck close by and then drove me and Steph to the airport a few hours before our respective flights where we napped at the terminal. Friends don't let friends stay up all night at cocktail clubs alone, which was evidenced by the large community of other improvisers who seemed to have the same idea.
Other highlights of the trip included a pet store full of puppies, Mick Napier remembering me from the Mission:Improv workshop he taught in 2006**, Nick taking us on the "Batman Run," (where you drive the same roads as in the movie), and finally having a dinner with my college roomie in a city where she lives.
Of course, in typical Jen and Misch fashion we started out trying to meet up with a friend of hers for deep dish, but instead ended up in an entirely different part of town eating Pho. This should surprise no one. Not even you.
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* ... who was the producer of Mission when I was a freshman and is now a member of Dirty Water,
** Mick approached me to shake my hand, and then ended up patting the fur on my coat appreciatively instead. Then he said "thanks for coming over," as if we were having a barbecue and I said "thanks for having us." I'm not star struck, but I was floored.
As Three Hole warmed up backstage I remembered being in the same space in 2007 while on spring break with Mission:IMPROVable. We were there taking a workshop with Andy Hobgood. I had wondered, as I looked around backstage, if I would ever get to perform there.
For that reason, and for many reasons getting to make stuff up with my best friends at the Chicago Improv Festival was a huge big deal for me. Plus, Three Hole had a set we felt good about, which always sweetens the experience. But the best part of the entire thing hands down was getting to see old friends doing great new things and to meet new people who share the bizarre desire to play let's pretend almost all the time.
After the after party cleared out of the theater everyone walked a few feet to the Green Mill. We squeezed into 1930's style booths and enjoyed some of the most breath taking jazz ensembles I've ever seen. Jon Dick,* Steph and I decided to stay up all night. Although my dear friend Nick (also of Mission fame) discouraged me at first he stuck close by and then drove me and Steph to the airport a few hours before our respective flights where we napped at the terminal. Friends don't let friends stay up all night at cocktail clubs alone, which was evidenced by the large community of other improvisers who seemed to have the same idea.
Other highlights of the trip included a pet store full of puppies, Mick Napier remembering me from the Mission:Improv workshop he taught in 2006**, Nick taking us on the "Batman Run," (where you drive the same roads as in the movie), and finally having a dinner with my college roomie in a city where she lives.
Of course, in typical Jen and Misch fashion we started out trying to meet up with a friend of hers for deep dish, but instead ended up in an entirely different part of town eating Pho. This should surprise no one. Not even you.
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* ... who was the producer of Mission when I was a freshman and is now a member of Dirty Water,
** Mick approached me to shake my hand, and then ended up patting the fur on my coat appreciatively instead. Then he said "thanks for coming over," as if we were having a barbecue and I said "thanks for having us." I'm not star struck, but I was floored.
Friday, April 17, 2009
Three Hole Punch Flies (on) Planes
I've scheduled this update to present itself in all its superfluous hyper-link glory right as I am boarding my flight for Chicago, Illinois.
As you read this I am walking next to Stephanie Jones onto a plane. Can you picture it? We each have one bag, my hair is probably a mess and Steph is drinking an Amp. Yes at 6am. We are both doing little dances of excitement and anticipation as we scootch past arm rests on the way to our seats.
But why?
This is why!
Because Three Hole Punch is performing tonight, April 17th at the Chicago Improv Festival!
We'd love to see you at our show, which is billed with Boston's own Psychic Improv at The Annoyance Theatre at midnight. Tickets are here.
Check our website for a list of other groups we're looking forward to supporting while we're out there.
See you in Chicago!
As you read this I am walking next to Stephanie Jones onto a plane. Can you picture it? We each have one bag, my hair is probably a mess and Steph is drinking an Amp. Yes at 6am. We are both doing little dances of excitement and anticipation as we scootch past arm rests on the way to our seats.
But why?
This is why!Because Three Hole Punch is performing tonight, April 17th at the Chicago Improv Festival!
We'd love to see you at our show, which is billed with Boston's own Psychic Improv at The Annoyance Theatre at midnight. Tickets are here.
Check our website for a list of other groups we're looking forward to supporting while we're out there.
See you in Chicago!
Thursday, April 16, 2009
this is why we come here
This week after a 12 hour shift I convinced one of my co workers to come with me to the Asgard for karaoke. The choice wasn't accidental, Colleen and I often burst into song together at work. All day we talked up the night out, inviting anyone else who would listen. Our persistence paid off and we were joined by Caroline and Ashley after their evening shift around midnight.
"That is NOT permission for anyone here to get sick," said Ashley.
I watched my three cohorts carefully. They were smiling and taking it all in, poking me to ask "do you know her?' if someone was particularly outstanding in a performance. As we sat they chatted freely. Each was clearly grateful for the time to unwind relaxing after long day.
Colleen sang a solo, and did a duet with me later in the evening. The others were more reserved, but it was soon so clear that that didn't matter in the least because whenever a familiar song played they sang right along.
We sang wholeheartedly, eyes shut and mouths open wide. We sang at the ceiling and sang at each other, eye open and shining. We sang, sober and tired at the end of the day, with more energy than we knew we had.
There's something about singing together in a huge group of people that transcends stress, anxiety, differences and fear. It's unifying and life affirming, and when it sneaks up on you it's honestly thrilling.
They all want to come back.
Colleen sang a solo, and did a duet with me later in the evening. The others were more reserved, but it was soon so clear that that didn't matter in the least because whenever a familiar song played they sang right along.
We sang wholeheartedly, eyes shut and mouths open wide. We sang at the ceiling and sang at each other, eye open and shining. We sang, sober and tired at the end of the day, with more energy than we knew we had.
There's something about singing together in a huge group of people that transcends stress, anxiety, differences and fear. It's unifying and life affirming, and when it sneaks up on you it's honestly thrilling.
They all want to come back.
The balance rights itself
And on the other end of the spectrum from my experience with "Jane," we have "Jeremiah."
Jeremiah reminded me of the character John Coffey from Stephen King's The Green Mile. He was huge and intimidating, but I knew he was gentle and would never harm a fly. While he was with us he found out he had a form of leukemia. As he left the last time I saw him he flashed his contagious grin at me and cleared his throat.
"I just want to thank you for all your care, and I hope you can extend my thanks to everyone else on the team."
It had a very formal practiced air, as though he had spent time rehearsing what he wanted to say in this moment. "I don't get taken care of very often, and it was nice to let myself be almost," he paused and grinned again, "pampered for a little while."
We barely did a thing. That was the thing.
Jeremiah reminded me of the character John Coffey from Stephen King's The Green Mile. He was huge and intimidating, but I knew he was gentle and would never harm a fly. While he was with us he found out he had a form of leukemia. As he left the last time I saw him he flashed his contagious grin at me and cleared his throat.
"I just want to thank you for all your care, and I hope you can extend my thanks to everyone else on the team."
It had a very formal practiced air, as though he had spent time rehearsing what he wanted to say in this moment. "I don't get taken care of very often, and it was nice to let myself be almost," he paused and grinned again, "pampered for a little while."
We barely did a thing. That was the thing.
Wednesday, April 15, 2009
Dx: mood swings
It was listed under past medical history in her chart, "Dx: Mood Swings." I ignored it because it wasn't relevant to her admission. "Jane" was a very sweet patient, s/p an assault that had left her with some muscle and bone pain but nothing (thank goodness) more serious than that. I was her nurse for two weeks straight and never had a single problem with her.
Until the day she was discharged.
Although she had been told about the discharge well in advance, she let the date sneak up on her. I saw it in her eyes first thing in the morning. She was walking with the NP, on her way to review her discharge paperwork. I saw her, but was on my way to a clinic to help another patient with a treatment.
I promised I'd be back to go over her medications right after I was done. She nodded, but managed to remind me somehow of a caged animal.
When I came out of the treatment clinic, a crowd had gathered near my med station. Jane was there berating one of the other floor nurses. "You're a liar, a good for nothing liar. My nurse isn't in report! Why would you f*&ing lie about that?" I intervened smoothly.
"She didn't know where I was, and so she was guessing. I'm back now, we can go over all your meds."
"She didn't need to lie."
"I'm sorry you felt lied too, but she was just guessing where I could have gone. You knew I'd be back, I told you I'd come back."
But she was too far gone. She was looking at me, but not seeing me. Like the snap of a twig her whole being changed. Her eyes were fierce and the smile on her face was twisted and ghastly. Her voice became high pitched and sickly sweet as she mocked everything I said to her.
"Jane, it sounds like you're feeling a little overwhelmed..." I started
She mimicked me exactly. I tried again.
"Jane, it seems..."
"Awww.. Does it? Does it "seem"? Why don't you just go ahead and write about it in your incompetent little notes then?" she asked as if she was cooing a baby to sleep in her arms. "You've been refusing to give me care all morning. I came here at 8am and overheard you talking about some poor girl in a tutu! Gossiping about patients. You should be ASHAMED, bad nurse!" her kabuki mask face didn't change and her tone dripped with sarcasm.
As early as 7:30am the DON was telling a story which involved an ER in a different town, but did not involve any of our patients. I tried to explain what she overheard and got nowhere.
Another patient standing in the hallway said, "You know, Jane, she's trying to help you out here. She didn't do anything wrong."
Jane continued to coo. "Aw, is she trying to help? Really? By gossiping and then disappearing all morning? Shame on her!"
I took a deep breath and felt someone tap my shoulder. It was the charge nurse.
"Can I help you?" he asked her, looking past me.
"You can kiss my behind," she said brightly, blinking at him. "You and your useless staff."
She refused to let me assist her with anything. I brought her medications to her room, and she grabbed them from my hand. I wished her luck and as I left she smiled beautifully and murmured loudly enough for her roommates to hear, "I hope you don't ruin anyone else's day today."
I was bewildered. I had never had a problem with her in two weeks. The charge nurse asked if she should be written up or barred. "No, " I answered carefully, "she had a completely appropriate admission until this morning."
"Still, that seemed like a pretty real side of her, " he insisted, "maybe a side of her we were just lucky we didn't see before today. She just couldn't shut that off."
I thought about "Dx: Mood Swings," and nodded.
Although I knew she couldn't help what she was saying, and didn't mean the things she said, I still felt the sting of her words. Nurses get dumped on a lot and most nurses develop a pretty thick skin as a result. My skin gets thicker every day. The danger is developing a skin so thick that truth can't get in and compassion can't get out. Care needs to be mindful and patient- focused.
Sometimes it's important to remind a rude patient that I'm a person too, that he needs to treat me with respect. It's a reminder of the dignity of each of us. It's necessary to do that so that the therapeutic relationship between a nurse and patient can be realigned. Plus, a lot of times other patients get distressed if you let someone treat you badly in the hallway. They might feel upset enough to defend you, to start a fight. Everyone on the team needs the nurse to be strong enough to stand up to rude patients, including the rude patients themselves.
I think I do a good job of knowing when to say "I'm not going to speak to you if you continue in this tone of voice, sir."
But... maybe sometimes a human being is called to just be a silent witness to another human being's absolute panic and pain.
I think it's especially true when dealing with patients who can't help it. If a nurse lets a patient act out, and the patient is in control of his or her behavior, the nurse is doing a disservice to everyone involved, including the patient. But this wasn't the case with Jane.
Jane wasn't just being rude. She was experiencing a psychotic break of some kind. Because of her history of abuse, she has clearly created a wall of defense. Her defense is an entire persona she can put on like a suit of armor. There wasn't a single hole in the chain link. Having experienced it, I can imagine it's a very effective defense against emotional abusers. She wouldn't let me, or anyone in at all. In fact, I don't even know if she'll realize how much she hurt me, or how disproportionate her reaction was. She was in a fight or flight zone, and it was clear watching her that it's a zone she lives in often on the outside. She may have survived her most recent assault without any serious physical injury, but I wouldn't say that she survived "unharmed."
So how much of a nurse's job is it to also be abused by this type of patient? It's an impossible question.
As I was walking down the hall contemplating this, the same patient who had tried to reason with Jane stopped me. "You know what I think of when I see you?" he asked. I shook my head.
"A ray of sunshine."
I thanked him quickly and rushed off to the staff area to shed the sudden tears his words had summoned.
Mood swings.
Until the day she was discharged.
Although she had been told about the discharge well in advance, she let the date sneak up on her. I saw it in her eyes first thing in the morning. She was walking with the NP, on her way to review her discharge paperwork. I saw her, but was on my way to a clinic to help another patient with a treatment.
I promised I'd be back to go over her medications right after I was done. She nodded, but managed to remind me somehow of a caged animal.
When I came out of the treatment clinic, a crowd had gathered near my med station. Jane was there berating one of the other floor nurses. "You're a liar, a good for nothing liar. My nurse isn't in report! Why would you f*&ing lie about that?" I intervened smoothly.
"She didn't know where I was, and so she was guessing. I'm back now, we can go over all your meds."
"She didn't need to lie."
"I'm sorry you felt lied too, but she was just guessing where I could have gone. You knew I'd be back, I told you I'd come back."
But she was too far gone. She was looking at me, but not seeing me. Like the snap of a twig her whole being changed. Her eyes were fierce and the smile on her face was twisted and ghastly. Her voice became high pitched and sickly sweet as she mocked everything I said to her.
"Jane, it sounds like you're feeling a little overwhelmed..." I started
She mimicked me exactly. I tried again.
"Jane, it seems..."
"Awww.. Does it? Does it "seem"? Why don't you just go ahead and write about it in your incompetent little notes then?" she asked as if she was cooing a baby to sleep in her arms. "You've been refusing to give me care all morning. I came here at 8am and overheard you talking about some poor girl in a tutu! Gossiping about patients. You should be ASHAMED, bad nurse!" her kabuki mask face didn't change and her tone dripped with sarcasm.
As early as 7:30am the DON was telling a story which involved an ER in a different town, but did not involve any of our patients. I tried to explain what she overheard and got nowhere.
Another patient standing in the hallway said, "You know, Jane, she's trying to help you out here. She didn't do anything wrong."
Jane continued to coo. "Aw, is she trying to help? Really? By gossiping and then disappearing all morning? Shame on her!"
I took a deep breath and felt someone tap my shoulder. It was the charge nurse.
"Can I help you?" he asked her, looking past me.
"You can kiss my behind," she said brightly, blinking at him. "You and your useless staff."
She refused to let me assist her with anything. I brought her medications to her room, and she grabbed them from my hand. I wished her luck and as I left she smiled beautifully and murmured loudly enough for her roommates to hear, "I hope you don't ruin anyone else's day today."
I was bewildered. I had never had a problem with her in two weeks. The charge nurse asked if she should be written up or barred. "No, " I answered carefully, "she had a completely appropriate admission until this morning."
"Still, that seemed like a pretty real side of her, " he insisted, "maybe a side of her we were just lucky we didn't see before today. She just couldn't shut that off."
I thought about "Dx: Mood Swings," and nodded.
Although I knew she couldn't help what she was saying, and didn't mean the things she said, I still felt the sting of her words. Nurses get dumped on a lot and most nurses develop a pretty thick skin as a result. My skin gets thicker every day. The danger is developing a skin so thick that truth can't get in and compassion can't get out. Care needs to be mindful and patient- focused.
Sometimes it's important to remind a rude patient that I'm a person too, that he needs to treat me with respect. It's a reminder of the dignity of each of us. It's necessary to do that so that the therapeutic relationship between a nurse and patient can be realigned. Plus, a lot of times other patients get distressed if you let someone treat you badly in the hallway. They might feel upset enough to defend you, to start a fight. Everyone on the team needs the nurse to be strong enough to stand up to rude patients, including the rude patients themselves.
I think I do a good job of knowing when to say "I'm not going to speak to you if you continue in this tone of voice, sir."
But... maybe sometimes a human being is called to just be a silent witness to another human being's absolute panic and pain.
I think it's especially true when dealing with patients who can't help it. If a nurse lets a patient act out, and the patient is in control of his or her behavior, the nurse is doing a disservice to everyone involved, including the patient. But this wasn't the case with Jane.
Jane wasn't just being rude. She was experiencing a psychotic break of some kind. Because of her history of abuse, she has clearly created a wall of defense. Her defense is an entire persona she can put on like a suit of armor. There wasn't a single hole in the chain link. Having experienced it, I can imagine it's a very effective defense against emotional abusers. She wouldn't let me, or anyone in at all. In fact, I don't even know if she'll realize how much she hurt me, or how disproportionate her reaction was. She was in a fight or flight zone, and it was clear watching her that it's a zone she lives in often on the outside. She may have survived her most recent assault without any serious physical injury, but I wouldn't say that she survived "unharmed."
So how much of a nurse's job is it to also be abused by this type of patient? It's an impossible question.
As I was walking down the hall contemplating this, the same patient who had tried to reason with Jane stopped me. "You know what I think of when I see you?" he asked. I shook my head.
"A ray of sunshine."
I thanked him quickly and rushed off to the staff area to shed the sudden tears his words had summoned.
Mood swings.
Tuesday, April 14, 2009
Packing
The prospect of traveling to another country always brings up some new issues to think about. Yesterday Mom and I checked out a local sporting goods store to buy "hiking shoes," which are recommended for our horseback ride up the volcano in Arenal.
"These are just super expensive ugly sneakers."
"Do you think we could just wear our normal sneakers?"
"I guess so. I mean, as long as you're comfortable walking with them."
"My leg brace doesn't fit into anything else anyway."
"I think we'll be fine."
"Do you think we should buy backpacks with water reservoirs?"
"They have those?"
Clearly, we are ready to fly to Central America for a week.
"These are just super expensive ugly sneakers."
"Do you think we could just wear our normal sneakers?"
"I guess so. I mean, as long as you're comfortable walking with them."
"My leg brace doesn't fit into anything else anyway."
"I think we'll be fine."
"Do you think we should buy backpacks with water reservoirs?"
"They have those?"
Clearly, we are ready to fly to Central America for a week.
Monday, April 13, 2009
Hidden
This is a rare post because it is very personal, and largely un promotional of "Misch" as a savvy RN with a sharp comic wit. Proceed with compassion and caution.
I mentioned recently that my Lenten journey was less than successful this year. After admitting it out loud I upped the stakes a little bit, and tried to find the peace and love that has centered my life in the past.
As I drew Jesus closer in my prayer life, I became happier, healthier and more fun to be around. I stopped feeling burned out at work and began reaching out to old friends. Clearly, my faith had needed some serious healing.
Unfortunately, inspired by this change in myself, during Holy Week I dove head first into a bunch of theology which I found I simply do not have the support systems to be dealing with.
Easter, which is the celebration of the Resurrection of Jesus and the Redemption of humanity through His rising, is supposed to be a day of great joy and hope.
And, it was. But with it came what felt like centuries worth of anxiety and bad feelings.
I was visiting family all day long, and tried to focus on how good it was to be with loved ones. I tried to generate the happiness that spirituality usually brings to me. But anxiety kept building up inside me. Instead of feeling awake and joyful in the Risen Lord, I went to bed at 7:30pm just to escape my thoughts.
As of right now I am in the process of seeking help from several friends in various doctrines.
I have prided myself since leaving college at not having a home parish. I have bragged about how I sometimes go an entire month without mass in the same place two weeks in a row. I go every week, but count several different locations as "my church," depending on the zip code. It's because I refuse to forfeit weekly mass to my hectic schedule as a performer and nurse. It's a system that has for the past two years allowed me to never feel cut off from the Sabbath day even in the craziest of weekends.
But now I find that this system, although convenient, has robbed me of the very thing church was made for. Community.
I have questions. Big questions. Questions that are keeping me awake all night long.
And no one to field them.
It will never be a question for me whether God exists or not. Nor will I question the Divinity of Jesus. Right now, more than almost ever in my life I am questioning the idea of church, religion, and the Bible.
It has happened before. It's not new news. I've struggled a long time with some of the same issues.
People closest to me will remember some of the biggest times of spiritual wrestling in my life. When I was in high school I almost didn't become confirmed*. In college, sophomore year most people will remember how I wanted to become a nun. I even went to a retreat at a convent for women my age thinking of the same commitment. I think fewer people will remember that the very same year I almost left the Catholic Church because I thought women should be ordained. (A good friend of mine who is now a priest talked me down from that one.) After I found peace in my decisions to neither leave the Church nor become a nun my life was calm for a while. Another struggle came junior year.
I don't see myself as particularly strong because of these battles. I can never be sure if I've won over doubt or just silenced a snooze button. In the end I'm mostly just relieved to have the joy of believing without fear or anxiety back in my life.
I am sharing this with you for two reasons. One is so that you can relate.
In the past I have been scared of sharing what I consider spiritual weakness with others. I felt they'd then doubt my leadership in the Church, or doubt my ability to help them with their own spiritual needs. But now I know that it is only through our weaknesses that God can make us strong. I believe very strongly in God. But I know something in my life is being called to change, and I don't know what it is. And if knowing that I'm going through this helps you, then it is good to share it.
The other reason is to try to branch out my community more. If you pray, please keep my troubled heart in your prayers. If you don't pray and you'd like to sit and logic some things out with me, I'd be up for that too. I believe we are called to Faith which means sometimes walking blindly. But it never means walking unthinkingly. It has been a combination of my mind and my heart which has brought me here through God's grace. And that is how I will move forward again.
---------------------------------------------------------------------------------------
* My parents told me that it was my choice to make and they'd love and accept me either way which was very wise. It has prepared me for a lifetime of making informed decisions for myself.
I mentioned recently that my Lenten journey was less than successful this year. After admitting it out loud I upped the stakes a little bit, and tried to find the peace and love that has centered my life in the past.
As I drew Jesus closer in my prayer life, I became happier, healthier and more fun to be around. I stopped feeling burned out at work and began reaching out to old friends. Clearly, my faith had needed some serious healing.
Unfortunately, inspired by this change in myself, during Holy Week I dove head first into a bunch of theology which I found I simply do not have the support systems to be dealing with.
Easter, which is the celebration of the Resurrection of Jesus and the Redemption of humanity through His rising, is supposed to be a day of great joy and hope.
And, it was. But with it came what felt like centuries worth of anxiety and bad feelings.
I was visiting family all day long, and tried to focus on how good it was to be with loved ones. I tried to generate the happiness that spirituality usually brings to me. But anxiety kept building up inside me. Instead of feeling awake and joyful in the Risen Lord, I went to bed at 7:30pm just to escape my thoughts.
As of right now I am in the process of seeking help from several friends in various doctrines.
I have prided myself since leaving college at not having a home parish. I have bragged about how I sometimes go an entire month without mass in the same place two weeks in a row. I go every week, but count several different locations as "my church," depending on the zip code. It's because I refuse to forfeit weekly mass to my hectic schedule as a performer and nurse. It's a system that has for the past two years allowed me to never feel cut off from the Sabbath day even in the craziest of weekends.
But now I find that this system, although convenient, has robbed me of the very thing church was made for. Community.
I have questions. Big questions. Questions that are keeping me awake all night long.
And no one to field them.
It will never be a question for me whether God exists or not. Nor will I question the Divinity of Jesus. Right now, more than almost ever in my life I am questioning the idea of church, religion, and the Bible.
It has happened before. It's not new news. I've struggled a long time with some of the same issues.
People closest to me will remember some of the biggest times of spiritual wrestling in my life. When I was in high school I almost didn't become confirmed*. In college, sophomore year most people will remember how I wanted to become a nun. I even went to a retreat at a convent for women my age thinking of the same commitment. I think fewer people will remember that the very same year I almost left the Catholic Church because I thought women should be ordained. (A good friend of mine who is now a priest talked me down from that one.) After I found peace in my decisions to neither leave the Church nor become a nun my life was calm for a while. Another struggle came junior year.
I don't see myself as particularly strong because of these battles. I can never be sure if I've won over doubt or just silenced a snooze button. In the end I'm mostly just relieved to have the joy of believing without fear or anxiety back in my life.
I am sharing this with you for two reasons. One is so that you can relate.
In the past I have been scared of sharing what I consider spiritual weakness with others. I felt they'd then doubt my leadership in the Church, or doubt my ability to help them with their own spiritual needs. But now I know that it is only through our weaknesses that God can make us strong. I believe very strongly in God. But I know something in my life is being called to change, and I don't know what it is. And if knowing that I'm going through this helps you, then it is good to share it.
The other reason is to try to branch out my community more. If you pray, please keep my troubled heart in your prayers. If you don't pray and you'd like to sit and logic some things out with me, I'd be up for that too. I believe we are called to Faith which means sometimes walking blindly. But it never means walking unthinkingly. It has been a combination of my mind and my heart which has brought me here through God's grace. And that is how I will move forward again.
---------------------------------------------------------------------------------------
* My parents told me that it was my choice to make and they'd love and accept me either way which was very wise. It has prepared me for a lifetime of making informed decisions for myself.
Tuesday, April 7, 2009
This is what you want, this is what you get
Today at work my 365 Days of Nurses calendar had this to say:
Management believes you are overpaid. But management would never work for what they pay you.
I thought this was a bit bitter and uninspiring for a desk top calendar. Shouldn't they stick to things like:
A nurse is compassion in scrubs. ~Lexie Saige
Or jokes about the nurse/patient relationships: "Nurse: I'm just going to grab your vitals.
Patient's Wife: Oh no you don't!"
I'd even rather read the quick and snappy anecdotes that real life nurses have sent in, some of them charming, others eye roll inducing, over a bitter sentiment like today's two liner. As I sat at my desk charting on various medical happenings of the day, and taking off orders the little white square stayed just within my peripheral, slowly fanning the flames of my gut reaction.
As far as the "management would never work for what they pay you," I'm exhausted of the very idea. This post by Nurse K in her blog Crass-Pollination, completely sums up how I feel about the whole management v. staff nursing issue. In essence, I think it's bunk. It's a different job. The CEO of a hospital has the lives of patients as well as the livelihood of even more staff members to worry about. Of course it pays better. If I wanted to be a CEO I would have gone to business school. But I don't. I want to reach out and touch people, and moreover I want to be someone who has the correct answers when someone reaches out and touches me. I want to wear a stethoscope and listen to hearts and then say "This is what I hear and what I know, and this is what we'll do." When I want to wear a suit and manage a facility I will let you know.
As far as the whole "management thinks you are overpaid" part, that's just not true for every facility. In fact, it's probably not true of most facilities. It's true that some nurses are quite underpaid for what they do, but often it's not because the management thinks they deserve even less. It's because they are trying to run a business. But they know what your education, your experience and your work ethic are worth if they are a good manager. They have their finger on the pulse of the medical market. They know what a competitive wage looks like. And they know what your job description is and whether it differs from the job you are actually doing. If they're good.
The people who think nurses are overpaid are not in management in hospitals. They're uneducated politicians who seem to think that the role of a nurse is to change bed pans and wipe butts. Most hospital managers understand that when they hire an RN they are hiring someone with the educational background needed to make accurate medical assessments, often on the fly, and to carry out the necessary interventions to prevent complications and potential negative outcomes while simultaneously promoting positive outcomes for any given individual patient's disease process or health interruption. Period.
The DON was working in the nurse's office with me today and she saw the quote and laughed. She said "I used to be a floor nurse, and I know you aren't overpaid. Plus, there are plenty of floor nurses in other places who make even more than I do as DON of this place."
Maybe it's different because I work in a non profit which happens to be run by genuinely good and honest people. But I think the management gets paid fairly for what they do too.
I crumpled up April 7th's page, resolved to not think any more about it.
Tomorrow's entry on the Nurses calendar is "10 reasons to date a nurse."
Number three is "the uniform," which is a bit outdated,
but number eight is "They won't be disgusted by your toilet habits."
Actually, yes. Yes we will. You filthy animal.
Dear 365 Days of Nurses Calendar,
Please go back to being cute and fuzzy. I can't have you trying to be sassy all the time.
love,
Misch
Management believes you are overpaid. But management would never work for what they pay you.
I thought this was a bit bitter and uninspiring for a desk top calendar. Shouldn't they stick to things like:
A nurse is compassion in scrubs. ~Lexie Saige
Or jokes about the nurse/patient relationships: "Nurse: I'm just going to grab your vitals.
Patient's Wife: Oh no you don't!"
I'd even rather read the quick and snappy anecdotes that real life nurses have sent in, some of them charming, others eye roll inducing, over a bitter sentiment like today's two liner. As I sat at my desk charting on various medical happenings of the day, and taking off orders the little white square stayed just within my peripheral, slowly fanning the flames of my gut reaction.
As far as the "management would never work for what they pay you," I'm exhausted of the very idea. This post by Nurse K in her blog Crass-Pollination, completely sums up how I feel about the whole management v. staff nursing issue. In essence, I think it's bunk. It's a different job. The CEO of a hospital has the lives of patients as well as the livelihood of even more staff members to worry about. Of course it pays better. If I wanted to be a CEO I would have gone to business school. But I don't. I want to reach out and touch people, and moreover I want to be someone who has the correct answers when someone reaches out and touches me. I want to wear a stethoscope and listen to hearts and then say "This is what I hear and what I know, and this is what we'll do." When I want to wear a suit and manage a facility I will let you know.
As far as the whole "management thinks you are overpaid" part, that's just not true for every facility. In fact, it's probably not true of most facilities. It's true that some nurses are quite underpaid for what they do, but often it's not because the management thinks they deserve even less. It's because they are trying to run a business. But they know what your education, your experience and your work ethic are worth if they are a good manager. They have their finger on the pulse of the medical market. They know what a competitive wage looks like. And they know what your job description is and whether it differs from the job you are actually doing. If they're good.
The people who think nurses are overpaid are not in management in hospitals. They're uneducated politicians who seem to think that the role of a nurse is to change bed pans and wipe butts. Most hospital managers understand that when they hire an RN they are hiring someone with the educational background needed to make accurate medical assessments, often on the fly, and to carry out the necessary interventions to prevent complications and potential negative outcomes while simultaneously promoting positive outcomes for any given individual patient's disease process or health interruption. Period.
The DON was working in the nurse's office with me today and she saw the quote and laughed. She said "I used to be a floor nurse, and I know you aren't overpaid. Plus, there are plenty of floor nurses in other places who make even more than I do as DON of this place."
Maybe it's different because I work in a non profit which happens to be run by genuinely good and honest people. But I think the management gets paid fairly for what they do too.
I crumpled up April 7th's page, resolved to not think any more about it.
Tomorrow's entry on the Nurses calendar is "10 reasons to date a nurse."
Number three is "the uniform," which is a bit outdated,
but number eight is "They won't be disgusted by your toilet habits."
Actually, yes. Yes we will. You filthy animal.
Dear 365 Days of Nurses Calendar,
Please go back to being cute and fuzzy. I can't have you trying to be sassy all the time.
love,
Misch
Monday, April 6, 2009
Sicker than Sick
Today at work another nurse was reading a health care related website and he snickered aloud at the conversational tone the author had chosen. The sentence he shared was something to the effect of "as health care workers you are up against higher acuity rates than ever before."
"I feel like they're really talking to me," he joked. I was about to say something equally disparaging about the writing when something else struck me about the sentence instead.
Ever since I started nursing school we've been told that the general acuity of patients is rising. Thanks to advances in the medical field birthrates are increasing, and people are living longer. Diseases that were once fatal are now considered chronic.
The equation looks like this:
more people surviving birth + people living longer lives
+ (maintained health disruptions)x( the number of health disruptions any given person is able to simultaneously maintain) = a "sicker" population.
Especially since I took a job in community health (outside of a traditional hospital setting) I have been told that "our patients are getting sicker." This is a factor of the aforementioned "sicker" population getting discharged from hospitals often before they are completely ready due to insurance coverage limitations. Thus creating a "sicker" group of people who need follow up and outpatient care.
The thought is overwhelming. It's used to impress a sense of duty and challenge in nursing students, and for the dual purpose of comforting and rallying health care workers.
But is it true? Like most things, only relatively. And not in the context that the sentiment is often expressed. In other words, no one should be panicking over people being sicker.
My first thought was of The Black Death. (I know, my mind just works this way in the morning on Mondays.) According to Wikipedia there is a modern day dispute over whether the pandemic that swept through Europe killing literally millions of people was a viral hemorrhagic fever (like Ebola) or whether it was bubonic plague.
I have found no other research supporting that this debate even exists and so we're going to assume here that it was bubonic plague.
Now. If you kindly turn your attention to the mental image of people's lymph glads swelling up painfully, distorting their bodies, their skin turning black and decaying even as the infected person is alive, agonizing pain, the vomiting of blood, the depletion of bodily fluids, the inability to move and astonishingly rapid and effect transmission methods, you might be tempted to think "I'm so glad that's over with."
The thing is, it isn't. Y. pestis, the bacteria that causes bubonic plague is alive and well. It has even been categorized by the CDC as a category A pathogen. But we know how to treat it now. In modern cases of bubonic plague a timely course of antibiotics will do the trick.
In the Middle Ages gentamicin was unheard of.
You probably already understand where I'm going with this, but I'm going to fast forward anyway to the Polio epidemic of the 1950s. People were panicked, and with good reason. Now, four simple doses of the killed virus can protect most people for life.
When the AIDS epidemic started, doctors all over the world were dismayed and perplexed at young, otherwise healthy people dying of generally non-fatal infections such as pneumocystis carinii pneumonia. It would be years before anyone realized the disease itself was causing immunodeficiency which could manifest in a variety of different opportunistic infections. It would be even longer before anyone stopped calling it GRID. And a whole lot of people would die before anyone figured out how it was transmitted or how it could be stopped.
Bigger and better strides are being made every day in the area of antiretroviral medications, which is increasing the life expectancy of many HIV positive people.
So my argument is that people are always sicker than ever before. The push of disease and illness against the advances of modern medicine will constantly lead to that conclusion. Things were never easy.
Hippocrates wasn't walking around thanking Zeus that he had all the answers.
Saying that we're facing the higher acuity rates than ever before is like saying that we all get older every year. It's profound, and might inspire some sort of emotional response but for the most part, it's not newsworthy. Football is football. People talk about strategy and outcome of, they don't sit around explaining to each other what shape the ball is.
People are living longer.
So they have more time to get sick.
Also, people who are sick who would have died years ago are now staying alive.
Therefore, we have more sick people hanging around. And some of them are more complicated than they would have been ten or twenty years ago.
I mentioned before that no one should panic over people being sicker. What you should panic about is overpopulation, doctors playing god and people's basic rights being stripped away from them when they are sick or old or both.
Debates about playing God, life support, assisted suicide and all of that naturally follow all of this.
But are not what I'm getting at.
Technically yes: acuity is up. But the same could have been said of every generation of patients. It's relative. The more we strive to protect, cure and save the more opportunities we create for complications. Acuity has been on an upward trend since the dawn of medicine. We can either examine the trend and change the way we practice (i.e make choices that would lead to decreases in population and longevity), or we can accept that patients getting "sicker," is only relative to our knowledge getting wider. Which makes it much less sensational.
"I feel like they're really talking to me," he joked. I was about to say something equally disparaging about the writing when something else struck me about the sentence instead.
Ever since I started nursing school we've been told that the general acuity of patients is rising. Thanks to advances in the medical field birthrates are increasing, and people are living longer. Diseases that were once fatal are now considered chronic.
The equation looks like this:
more people surviving birth + people living longer lives
+ (maintained health disruptions)x( the number of health disruptions any given person is able to simultaneously maintain) = a "sicker" population.
Especially since I took a job in community health (outside of a traditional hospital setting) I have been told that "our patients are getting sicker." This is a factor of the aforementioned "sicker" population getting discharged from hospitals often before they are completely ready due to insurance coverage limitations. Thus creating a "sicker" group of people who need follow up and outpatient care.
The thought is overwhelming. It's used to impress a sense of duty and challenge in nursing students, and for the dual purpose of comforting and rallying health care workers.
But is it true? Like most things, only relatively. And not in the context that the sentiment is often expressed. In other words, no one should be panicking over people being sicker.
My first thought was of The Black Death. (I know, my mind just works this way in the morning on Mondays.) According to Wikipedia there is a modern day dispute over whether the pandemic that swept through Europe killing literally millions of people was a viral hemorrhagic fever (like Ebola) or whether it was bubonic plague.
I have found no other research supporting that this debate even exists and so we're going to assume here that it was bubonic plague.
Now. If you kindly turn your attention to the mental image of people's lymph glads swelling up painfully, distorting their bodies, their skin turning black and decaying even as the infected person is alive, agonizing pain, the vomiting of blood, the depletion of bodily fluids, the inability to move and astonishingly rapid and effect transmission methods, you might be tempted to think "I'm so glad that's over with."
The thing is, it isn't. Y. pestis, the bacteria that causes bubonic plague is alive and well. It has even been categorized by the CDC as a category A pathogen. But we know how to treat it now. In modern cases of bubonic plague a timely course of antibiotics will do the trick.
In the Middle Ages gentamicin was unheard of.
You probably already understand where I'm going with this, but I'm going to fast forward anyway to the Polio epidemic of the 1950s. People were panicked, and with good reason. Now, four simple doses of the killed virus can protect most people for life.
When the AIDS epidemic started, doctors all over the world were dismayed and perplexed at young, otherwise healthy people dying of generally non-fatal infections such as pneumocystis carinii pneumonia. It would be years before anyone realized the disease itself was causing immunodeficiency which could manifest in a variety of different opportunistic infections. It would be even longer before anyone stopped calling it GRID. And a whole lot of people would die before anyone figured out how it was transmitted or how it could be stopped.
Bigger and better strides are being made every day in the area of antiretroviral medications, which is increasing the life expectancy of many HIV positive people.
So my argument is that people are always sicker than ever before. The push of disease and illness against the advances of modern medicine will constantly lead to that conclusion. Things were never easy.
Hippocrates wasn't walking around thanking Zeus that he had all the answers.
Saying that we're facing the higher acuity rates than ever before is like saying that we all get older every year. It's profound, and might inspire some sort of emotional response but for the most part, it's not newsworthy. Football is football. People talk about strategy and outcome of, they don't sit around explaining to each other what shape the ball is.
People are living longer.
So they have more time to get sick.
Also, people who are sick who would have died years ago are now staying alive.
Therefore, we have more sick people hanging around. And some of them are more complicated than they would have been ten or twenty years ago.
I mentioned before that no one should panic over people being sicker. What you should panic about is overpopulation, doctors playing god and people's basic rights being stripped away from them when they are sick or old or both.
Debates about playing God, life support, assisted suicide and all of that naturally follow all of this.
But are not what I'm getting at.
Technically yes: acuity is up. But the same could have been said of every generation of patients. It's relative. The more we strive to protect, cure and save the more opportunities we create for complications. Acuity has been on an upward trend since the dawn of medicine. We can either examine the trend and change the way we practice (i.e make choices that would lead to decreases in population and longevity), or we can accept that patients getting "sicker," is only relative to our knowledge getting wider. Which makes it much less sensational.
Saturday, April 4, 2009
Leap Blog
Today was the least stressful shift I've worked in a stretch of two weeks. The drama level has been scaled down, I think most of the administrative discharges are complete, and we can settle back into our roles as nurses instead of law keepers.
Tonight Three Hole Punch travels to UMass Amherst for the annual Comedy Jam. Three Hole Punch's first public performance was a Comedy Jam slot, back when the troupe had about nine women in it (all the lady comedians in Student Valley Productions). We're shunning sketch for the night to bring you wholly undiluted make-em-ups. And we'll be joined by group founder Amy Koske, so if you're in the area you'll be in for a rare treat!
Tonight Three Hole Punch travels to UMass Amherst for the annual Comedy Jam. Three Hole Punch's first public performance was a Comedy Jam slot, back when the troupe had about nine women in it (all the lady comedians in Student Valley Productions). We're shunning sketch for the night to bring you wholly undiluted make-em-ups. And we'll be joined by group founder Amy Koske, so if you're in the area you'll be in for a rare treat!
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