I know this is a difficult conversation for you. It is hard for me too. While I was walking down the hall to this room, I was secretly hoping for a miracle, a sign that we had made a mistake and everything was going to be okay.
I have been taking care of your loved one for a while now. We have used every tool we have available to heal him. Unfortunately, it does not appear that he will ever be the person he was before. No, he is not going to wake up and be okay. I understand you believe this is all in God’s hands, but it is time to make some decisions about where to go from here.
His body cannot survive without the machines that are supporting him. I know he has made some progress. His blood pressure and heart rate are normal. However, he is now dependent on dialysis because his kidneys have stopped functioning. He is not going to be able to breathe without the ventilator.
Where do we go from here?
Have you ever had the discussion with him about his wishes?
There is are no further medical interventions left to try. This is the new reality. There are few resources available for people in this condition. What quality of life can one expect in this condition?
I know you had hoped for a different result. Yes, he is a fighter.
This conversation never gets easier. It always hurts and I always wish I could be anywhere else. I often wonder how I would feel if it were my family member, and I try to remember the fear I would feel. I try to imagine what my concerns would be.
I do everything in my power to be able to answer the questions the family has. I make sure I have time to listen. I make sure I am completely honest. I try to keep my personal feelings out of the conversation. This is about this patient. Sometimes acknowledging the reality of the situation is the most important act I can do.
The conversation about goals of care is difficult for many healthcare providers. For some of us, especially early in our careers, it can feel like a personal failure when our patients do not survive. The crux of the situation is that everyone will die someday. Perhaps the best thing we can do is offer dignity and peace when death is looming. Comfort measures does not mean giving up. Dying is a natural part of life. We should feel lucky we have the tools to help ease suffering.
Some people call learning how to communicate more effectively professional development. Really, if you think about it hard enough, it is growing up and learning to be a decent human being who thinks of someone besides themselves from time to time.
I am at a loss for words when I see grown educated people who are unable to carry on a decent conversation in the work place. (Keep in mind, I used to struggle with this a lot more than I do now. Actually, it was not that long ago.) Looking back, I think some of my bad behavior was reactionary, or at worst, retaliatory in nature. Unfortunately, I cannot speak to you like you are scum just because we are not BFFs. I have to communicate in a civil manner. It would not be the end of the world if I were friendly even. When you see someone sitting in front of you, say “Hello.” Or, Hallo! If you want to quote my favorite worm. You see these people every day. Be nice. Find some damn common ground. It cannot be that difficult.
I am often confused when people tell me someone is intimidated by me. Although, my apparent Resting Bitch Face does not help. I do not mean to be intimidating. Actually, if you get to know me you will find I am actually quite riddled with self-doubt and really want to be nice and friendly to everyone. I also assume (apparently also in error) you know all the same stuff I do. I figure you read the same things I read and you have the same innate curiosity. This is not my fault. I do not mean to wonder “why” all the time. I can’t help it. I want to understand.
When I speak to you in a direct and polite tone to inquire about a patient’s condition, you do not get to ignore me or refuse to answer my questions. The same goes for me. If you ask me a question or want to tell me something, I don’t get to refuse to acknowledge you. Sorry, that is not the way adult life works. More importantly, it is not the way professionals behave. Let’s take this out of health care. What if a teacher refused to acknowledge a child or parent who was speaking to them? What if a lawyer refused to speak to the bailiff? We are all adults. You don’t have to be buddies with someone in order to speak to them. It’s your JOB!
I have noticed certain behavior tends to lead to a higher likelihood of possible promotion within any business. You have to be able to get along with all kinds of people. Now, what do you do when you really don’t want to? Perhaps they have done something to insult you. Maybe you just don’t like the pants they wear. It turns out, you have to continue to be nice.
You cannot under any circumstances yell out across the room and demand to know the source of their douchebaggery. Don’t worry, I did not actually do that. (at least not recently.) I only considered it for a few moments. You cannot point out all the ways they have pissed you off. You cannot spell out how wrong they are about what ever topics you believe they are wrong about. You cannot stomp your feet and throw a fit. You have to be nice. Watch your tone. Don’t get defensive or offensive. Stay neutral.
It is hard. Sometimes your inner 12-year-old comes flying to the front of your brain, and it takes every thing you have to hold her at bay. Trust me, this is best.
Throwing a fit or retaliating will only lead to further breakdown in communication. In light of your desire to promote good patient care, you cannot afford to hamper effective communication in any way. So, you ignore your pride. You don’t let your fragile feelings be hurt. You know how to do the right thing. Just be nice. Dammit.
Steve Jobs was not a very popular movie. My son did not particularly like it. I loved it. This is probably due to my persistent romanticizing of any father figure who attempts, however awkward and clumsy, to connect with their daughter. Steve Jobs was not a good parent to his first child. I am left with the impression that he worked to rectify the relationship in his own way, and I loved it. Jobs certainly had issues. I am not sure I would have liked him, okay that’s a lie, I am completely drawn to people like him. He was portrayed both as brutally demanding and fiercely protective of his people. I relate to this. I am often passionate about my beliefs to the point I get a little excitable. It is a bit of a flaw of mine. I am admittedly a little jealous of those people who manage to stay cool and collected all the time. How do they do that??? Secretly, I bet they have skeletons in the closet. Maybe even real ones. People should get worked up about stuff sometimes. It is what makes us human. Dispassionate people scare me. Seriously. However, they seem to be more productive than the erratic ones. That topic is too big for Daddy Issues.
I was also interested by the way Sorkin and Boyle handled the relationship with John Scully. John Scully addressed his relationship with Jobs in 2013 at the Forbes Global CEO Conference. You can watch the video here. I was struck by the amount of regret he still carries in regards to the relationship with his former friend. More importantly, I was impressed by his dedication to being a mentor. There were several times the movie alluded to Scully and Jobs having a father- son relationship. So, essentially John Scully was Steve Job’s Work Daddy. I tend to think most of us need one. At least I do.
My relationships with my former work parents remain strong. I still turn to them for professional advice and guidance. I still rely on their opinion and expertise to help me make good decisions about my future. I am sure they find this exhausting at times, especially since there have been so many potential jobs. I hope I adequately convey my appreciation. I really do understand it is an investment in their time and energy.
I have been extraordinarily lucky to have the relationships I do with some of the most intelligent people I know. They have constantly supported me through my professional career, and it has been a bumpy ride at times. My work parents have taken the time to teach me lessons and to help me grow as a professional, they have counseled me and offered advice, and they have used lessons they have learned to illustrate how they understand my struggles. They never left me hollow and inadequate, they taught me. Just like good parents teach their children. Hence, work parents. (I know, TG says grown ups just have mentors. I have both!)
So, as I continue on this interesting quest for adventure, professional fulfillment, and possibly even enlightenment, I must remember to keep an eye out for people who have something to teach. I continue to be amazed when I meet someone new who likes to impart information and experience. It is even better when they take the time to help me learn how to apply it to my personal and professional growth. People come into our lives, and if we pay attention we just might get lucky enough to benefit from their experiences.
These relationships require a level of vulnerability that can be intimidating for some people. It is hard to allow someone to see your insecurities and faults. It takes humility to allow someone to judge your actions. You cannot allow someone offering you guidance to hurt your feelings. You have to leave your pride out of the equation. This is hard at times. I found myself wanting to defend my actions. Sometimes, it was not even the point I was necessarily wrong, it was just there was a better way to handle situations in the future. It is all about growth and progress. Growing pains hurt.
I still miss my old job. I miss having people I knew and trusted available at a moment’s notice. I am having to learn to operate in foreign environments and I do not always have all the information I would have readily available. I know much more about the EMR there. I know my nurses there. I know all the other physicians. It does make a difference. However, I keep telling myself this is a great opportunity to learn. I am learning so many new things. I can’t wait to see what I learn next. So, while this job is in some ways infinitely more difficult, I get to become a better Nurse Practitioner. This is only going to improve the care I am able to provide. So, I will struggle on and deal with the stress. It will be worth it. I hope.
I find it difficult to articulate my feelings about fear. I spend most of my time with a steady rumbling of mild anxiety vibrating deep within my thoughts. Decision making is agonizing for me. I tend to vacillate wildly from one option to the next weighing each one so carefully I cannot possibly pick one over another. Then, the waitress comes… and asks me if I need a few more minutes. Umm. No. Then I will simply have time to add yet another option to the mix. GRRRR. Someone force me to decide. I will have water. With lemon. Yes, lime is fine.
So, if I am agonizing this much over my beverage options just wait until you see me reading my choices of entrée. Oh, don’t worry. I won’t decide. I will wait until the waitress comes over, takes everyone else’s order, and then panic. As soon as I finally make a choice, I will be filled with instant regret. This is just the way I operate.
I hate going through things that require filling out forms and rounding up paperwork. I hate interviews and questions. I hate credentialing for hospital privileges. I hate job hunting. I don’t like to move. I hate packing and unpacking. All of this makes me a perfect candidate for locum work, right?
Well, yeah. I don’t have to make a decision. I can just do the next thing in front of me. If I don’t like a place or job, I am only committing for 3 months or so.
I am afraid of making decisions. What if I make the wrong one?
Turns out, even if I make the wrong choice there will be another chance to make choices in the future. I am enjoying the prospect of new and interesting places and people to meet. I am afraid I don’t have to be afraid anymore.
What happens when you realize life is meant to be experienced and not just observed? What happens when you stop letting fear stop you dead in your tracks? What happens when you let go and relax a little? It’s not like you really have all that much control over it all anyway. Stop agonizing over all the options and pick one already. And don’t just order the cheeseburger again.
So, what am I doing to make the traveling a little more bearable? I got a new traveling buddy! Meet Boomer, my new traveling buddy.
Living a life full of adventure may not be all it is cracked up to be. Sometimes you just want to sit on the couch with a kitty in your lap, remote in your hand, and a glass of wine within reach. This is exactly where I want to be tonight. I have absolutely no plans to do anything else until morning.
This past week was a nightmare at work. It was not the crazy number of hours it required, it was dealing with some personalities that left me emotionally drained, and unsure of my next move. However, if I have learned anything in my life, it is best to take my time and not make decisions when I am emotional about the situation.
So, I am going to sit back and think about some of the advice I have been given. Right now my favorite advice came from a new mentor. (Turns out that is what they call “work daddies” in the real world-thanks for that T.) Yikes. Not that real work daddy has been replaced. No way. He is stuck with me. Anyway, his advice was to find things you can live with, instead of searching for those you cannot live without. Good advice for me. I have to remove the black and white from situations and be okay with the gray.
People surprise the hell out of me. I find myself forging new relationships and growing more as a person every day, and then I get knocked out by someone who means nothing to me. Why do we let people have so much control over how we feel?
Easy. We want connection. We want to feel like we are valuable. We want to be wanted. We want to be more than someone who can be lived with. Perhaps we even want to feel a little needed. Regardless of what we say, we do want to be loved.
So, in order to live a bearable life, I have to pretend those desires are not there. I have to play it cool. I have to not be too terribly devoted to anything. I am not sure how you find passion in life when you spend all your time trying to quell those passions.
Why does life have to be so confusing? Am I supposed to be searching for my passion, or am I supposed to be calm, cool, and collected at all times? When are you supposed to be excited? Am I allowed to be driven and ambitious?
So, I am continuing to live life looking for my next adventure. I am going to continue to build relationships with people. I will find my passion. I will find people who share my passion. I will feel things as brightly as I can.
As I came to an end of my rant about certain people talking down to me and how much I hate it, I was reminded that sometimes I am not careful with how I react and respond to people either. I know for a fact I have said and done things in the past (not always that distant of a past) in a condescending manner. I wonder why we do that. More importantly, I wonder how we avoid it.
I want to be a good leader and a good teammate. I like working as part of a group with common goals. It is exciting and so rewarding. Seriously, what better way is there to learn things you did not even know you did not know?
I suppose I have some explaining to do. Why would I be a jerk when I hate it so much when people treat me in the same manner? To be completely honest, I think it is a defense mechanism. (Or, I could be an asshat- either way, it is not who I want to be.) Perhaps, it is a normal response to put others down in an attempt to raise yourself up. Well, it seems it would make the distance to the top a little shorter. Seriously, it is just math people.
I wonder why we started losing our responsibility to use manners and to act graciously towards other people. Where did this ‘get ahead at all cost’ mentality start? How do we find the gentle respect we should have for others?
It is almost as if we have regressed in our social obligations to a completely self-driven society. Where did our obligation to help others go? How do we find a sense of community?
Perhaps I am naive. I still find myself daydreaming of a place where the pace is a little slower, and people are quick to strike up a conversation. Maybe a nice english chap who will invite me in for a spot of tea. Doubt I will find him here in Texas. A girl can dream.
For now, I am stuck with people who feel small, and who like to lash out at others to even the playing field. I am choosing to go a different route. What if we all started building each other up? Even professionally, coaching up would be preferable to tearing down. Let’s move away from the guerrilla warfare and collaborate. Leave the ego at the door and open our minds to the possibilities. It sounds all hippy-dippy cheesy, but I think it could lead to good things.
Just be nice. I will continue to work on my tone and attitude. What if we all made that commitment?
We have all had the good fortune to meet the smartest man in the room. You know the one. The guy who feels the need to educate you and correct you on every thing you do. He may have good intentions, and perhaps he does not mean it condescendingly at all (me? yes, I have been guilty of this from time to time.) I am talking about the other guy. The one who has to be the brightest light in any room, however instead of shining brighter, he just walks around trying to dampen everyone else’s light. That guy is an asshat, officially.
Collaborative Teamwork.
Doesn’t that sound like a dream come true? I love working with a team of people who are committed to a common purpose. Each person has their own perspective and part of the problem to solve. Respect and time is given to each member of the team. Everyone has a voice. More importantly, everyone shares common goals.
I want to find a place where this is actually the culture. I find myself trying to engage nurses in conversation about their patients. I tell them what I have in mind, and start asking them for feedback. They have seen the situation from a completely different angle than I have. I trust and respect their insight. However, I am often greeted with a blank stare.
When I do not understand why something is being done, there is a high probability that I do not know part of the problem. Perhaps I just do not have a firm grasp on the situation at hand. Nothing is better than when I am close enough to the physician I am working with that I can ask them about it without them assuming I am challenging them. I have learned to choose my words carefully and to explain my intentions, but these conversations have taught me so much over the years.
I have had so many physicians, nurses, NPs, and pharmacists who have been willing to explain and teach me. There are so many disciplines working together, each one bringing their own level of expertise to the table, it would be ridiculous to not utilize their experience. I love learning about things from a different perspective. It gives me a more dynamic understanding of the situation.
Now, what about the asshat leader who is running amok and telling people inaccurate things? It is perfectly acceptable to be wrong from time to time, however I continue to be astounded by the number of people in the world who cannot admit to this. These same people love to walk around with their chests puffed out and head tilted at a slightly posterior angle, while looking down at you incredulously. They appear to be amused by your attempts to use your intelligence to learn about something new. They have to make inconsequential changes to your plans, just so they can say they did something.
Then, imagine their voice as they come over to talk to you. It all seems so earnest. They pull you aside and the whole conversation becomes very serious. They are imparting secret, magical information that cannot be gleaned from Uptodate. You listen expectantly, holding your breath in anticipation, pride welling up in your soul. Oh, he must have seen I was struggling! Perhaps I should let out a little giggle. I am so lucky to have this big, strong, virile man of medicine to keep me on the straight path. I could never have figured this out if he had not come to save me from my own ignorance.
Then you hear it. He is telling you how he is concerned for your well-being, and how he is so glad he can offer you his expertise. After all, he is a very busy and important man. Oh, swoon. I can’t believe he would take the time to tell me to use two 20 mg vials instead of one 40 mg vial. (Or something else equally ridiculous.) He will explain to you that the current evidence-based guidelines cannot be accurate, he has never seen that side effect the black box is warning against. No, it is not a well-known use of that extremely expensive drug. It is off label. Apparently, all the best cures are secrets. Only the best doctors get access to that information. The elite medical schools train them to pick up signals via a beacon in their neck. That is why they hold their head like that. I swear. I read it in a medical journal. You know, the ones nurses can’t read.
Ugh. All I want is to be able to have a conversation with the people I am working with. I love it when they have time to explain a concept I had never actually seen in real life, or just one I did not know a lot about. Seriously. I love to learn. I love to see the things I am learning about used in real life. For the love all that is good and intelligent in the world, do not expect me to follow archaic guidelines that are not in sync with current evidence based practice. There is a reason we have standards of care. I have found a lot of comfort in having mentors who taught me how to find these guidelines, and how to use them.
Of course, there are situations that may not fit the usual mold. There is most certainly an art to the practice and science of medical care. Sometimes there is more than one way to skin the proverbial cat. Please don’t try to teach me the wrong way to do things. Don’t use the phrase “that is how we have always done it.” I will want to know why. I always want to understand the rationale behind things. I want to know why we are choosing that particular option. Do not try to convince me to use antiquated methods when I have current peer-reviewed evidence at my fingertips. (Yes, I know the research and evidence is always changing… that is a topic I am woefully not able to discuss with anything resembling intelligence.)
Here is the point. Don’t talk down to me. Don’t pat my head like I am a wayward child. I am a professional, and despite my struggles to always portray myself in a dignified light, I am reasonably intelligent. I actually think there are some topics I can discuss with a pretty good level of mastery. I have been taught by the best! I do things to the best of my ability. If I come across a situation I am unsure about, I assure you I will seek your guidance. If you notice something I did not, or you just want to tell me about it, that is great! I love learning from experts. I may even take notes. I can promise you, I will be looking it up as soon as you walk away so I can remember it for next time.
One more thing I have noticed. Don’t listen to every man in the room and make it a point to not listen to me. Am I the only one that notices a difference when some men talk to women as opposed to how they speak to other men? Why am I hushed when men are invited to offer insight? Why am I a bitch when I am just being matter of fact? I hate to break it to you guys, your penis does not make you smarter. I have to be honest though, men are not the only asshats. I have had these strange interactions with women as well. I am not kidding when I say it bothers me when people are so transparently attempting to exert their dominance over everyone in the room.
So, come on. Give a girl a break. Feel free to educate, correct, and guide me. Just don’t be a jerk about it. I promise to continue working on the same thing. Perhaps there is a way to foster collaboration and open discussion without all the egos and BS. Maybe I should google that.
You know, if getting the job done were easy, we would not need advocates.
I find myself in difficult situations sometimes. I assure someone I will help them. I warn them I do not know how to solve the problem, but we will figure something out. At that point it is time to start going through the list of people I know, reading up on whatever the problem is, and basically banging my head into the wall.
These experiences turn me into every case manager and social worker’s nightmare. Here I am muddling in their affairs, promising people things we have no way to obtain, and in general expecting all the stars to align in my patient’s favor. Oh, I assure you I am not a miracle worker. I try to set up the expectation I will fail.
And I do. I fail many times. I am forced to humble myself and repeatedly explain to people I have no idea what I am doing.
It is not a big deal to help someone with something you are an expert in, that is typically just finding the need. Now, try to help someone with something you never even knew could be a problem. You don’t even know you don’t know.
So, I start asking questions. People become exasperated when they give me an answer and I deem it the wrong answer. That did not solve my problem. So, next solution. Will the next step please stand up? Admit it, Slim Shady just popped into your head. I pester people until they finally breakdown and start contacting their super magic resources. Still no luck? Okay, let’s keep bugging people until someone finds someone who knows a possible solution.
I do not mean to indicate I deserve credit for any of the out of the box solutions people help me come up with. If we are being honest, my role is to act like a two-year old and continue to pester with “Why?” Why can’t we try this solution? Why won’t they let us do this? Well, the way I want to do things makes the most sense. What do you mean it is illegal? Oh….. okay. How about this? No? Why? Why can’t we try? Fine. This goes on and on.
Now for the best part. After I have pestered someone all day without a good solution, I make them explain everything again. I plead. I cajole. I ask them to throw me under the bus if it will help get the information we need. Please, tell this person the stupid nurse practitioner you work with has messed everything up, and could they please help you understand the process so you can supervise the stupid nurse practitioner complete the task. You would be amazed at how well that works.
See, if these problems were easy to solve people would not tell me about their issue. If there was already an easy solution one of the other people they had gone to for help would have just taken care of it. Instead, the other people know the difficulty in finding a solution, and they just can’t do it. They may not know anything about it. Maybe they just don’t want to.
Why can’t I do that? Because when I need help with something big for my family, I hope I can find someone who says “I don’t know how to fix this, but we will figure it out.”
**** If you are a case manager, social worker, supervisor, physician, friend, or just someone I call to beg for help… Thank you. I could not have helped without you. You are really the one who worked magic. I just acted as a voice. I suppose that happens when you are an obnoxious loud mouth. You are the best.
Imagine a rugged, gregarious, elderly man. He is quick to tell a story and flirt with all the ladies. He was the toughest cowboy who ever lived. He has never been sick a day in his life. He does not even notice the cut on his hand. He will blush and admit to some memory problems, however he is quick to reassure you that he is doing just fine. He explains all the help he receives from his family and friends. He tells you about all the things he is still doing. This man is healthy as a horse.
It is easy to assume he is doing just fine, until you realize this is the third recitation of the same story. He goes to church every Sunday. He spells out his daily routine. He will regale you with tales of his fishing adventure just last week! Biggest fish he has ever seen! He still drives around the town he has lived in for 70 years. All the while, he keeps forgetting about the cut on his hand. He looks down with a puzzled expression every time the bandage enters his field of vision.
He just wants to go home. Yes, he is well aware that his children want him to move closer to them. He is indignant and proud. He can manage just fine.
Sure, he may have had some difficulty managing his bank account- that darned internet is too complicated for him. It’s not surprising he does not remember which way to turn when he drives down that particular street, they must have changed it all up. There is entirely too much new construction around here anyway. It is just a waste of the tax payers money. They keep changing the roads every week!
He just wants to go home. There is nothing wrong with him. He is fine. He has been taking care of himself for 65 years. He raised four children. Of course it has been more difficult since his wife died. She had always cooked the meals, taken care of the house and laundry, and managed all the finances. He sure does miss her.
Keeping all his medicine straight is difficult, his doctor gives him too many darned tiny pills, and have you ever tried to open one of those bottles? You almost need a hacksaw to get into one of them. It is okay, the lady that cleans his house puts them into a box for him. One says AM and one says PM. Problem solved.
He finds the bandage again. He is getting slightly irritated at the discomfort. He starts pulling off the gauze so he can leave. He does not need to be tied up. Why would he have his hand wrapped up? He needs to get that mess off so he can go home. Besides, that is not his bandage. He doesn’t need it.He does not believe he would care to buy that today. He promises to come buy it another day if I need the sales commission.
He tells you about fishing last week. It was the biggest fish he has ever seen. He reeled in it all by himself. He is demonstrating his manly prowess, and proving he can take care of himself. Sure, he lost his wallet again. Nope, he has no trouble getting where he needs to go. He has never been in an accident or had a traffic violation.
He is quick and sure to answer your questions and concerns.
He can tell the best stories about when he was a cowboy. He still tends all his own fences. He just plowed his garden last week. What on earth could you possibly be saying? Of course he can fend for himself! Besides, he has wonderful friends who drop by and check on him.
He was horribly confused and combative in the night. He pulled out his IV site (more than once.) He spilled his coffee repeatedly. He wanted his pants. What kind of nonsense is this? Stealing a man’s pants? He was not going to stand for this. Fine, you know what? He has money. Where is his wallet? He will buy his pants back from you. He never uses the call light despite repeated reminders. He keeps insisting he is not in the hospital.
You realize he has no idea who you are. You have spent countless hours with him over the past few days, and in fact you were just in his room fifteen minutes ago. Every time you walk through the door, you are greeted joyously. He does not remember the nasty tone of voice he was using with you last time you were in here. He does not remember that you are the one who will not allow him to go home. He tries calling you darlin’ and he gives you a little wink.
It is not too hard for you to redirect him. All you see is a sweet old man. You can even laugh at times. Some of his antics are funny. He is “pleasantly confused” and you are well aware he does not mean any of it. This is not the man who raised you. You have not witnessed his decline from greatness. You are not the one who will have to go home and feel remorse for not being able to make it work with him at home. This is just another day at the office for you.
His son sits with a resigned expression at the bedside. He never interrupts or corrects his father. He only fills in information when his father looks to him to answer the question. I keep trying to give the son an opportunity to pipe up and let his father know he can’t go home in this condition. I try telling this man he can’t stay at home alone at night. I look to his son and wait for him to tell his dad he has to come stay with family. He only asks me how long I think his father will need someone to stay with him. I can see the wheels of desperation turning over in his mind. Oh. He is not always this bad. Okay. The infection could explain it. Perhaps a few days or weeks would be sufficient.
Turns out, Paul Harvey was not going to chime in “With the rest of the story.” (If you don’t know that reference google Paul Harvey.)I am mildly concerned, but feeling a little better. This confusion could be the delirium so many patients experience in the hospital. Nope. Not at all. Charming Grandpa has not been doing well for a while. Ok, no problem. Just get him to go home with his son. Phew. Glad I solved that problem.
It is painful to see adult children struggling with their new role as a protector and decision maker. What do we do when the body still works, but the mind is no longer able to handle the complexities of life? How do you take away your father’s car keys? How do you finally insist they cannot live at home anymore? It is not stubbornness that leads to their insistence to stay home. They are unable to realize and comprehend the reality of their cognitive decline.
So, what happens when they refuse to go to an assisted living, nursing facility, or even to live with relatives who can look after them? How do you compel someone to leave the home they built and raised their family in, when they feel fine? I somehow managed to convince myself patients with dementia actually understood how confused they were. Oh! This is why we perform mental evaluations. People do not know when they are confused. They truly believe everything is fine. Now what? You seem fine in short conversations, you are not physically debilitated, why would I say you need to be forced from the home you built with your own two hands. Yes, I remember you still mend your own fences. Yes, you used to be a cowboy. A real cowboy, not one of those fancy boys.
This is not an easy process. We don’t like to hold people against their will. You can’t just kidnap grandpa because you decide it is the right thing to do. Furthermore, NO ONE EVER TELLS YOU HOW TO DO THIS! Maneuvering through all the rules, insurance regulations, and red tape is maddening. Now, imagine trying to handle all of this if you live and work somewhere else, compounded by the fact that your parent has everyone fooled. He looks great! He is at church three times a week. He does not realize how severe the problem is, and neither does anyone else, until something happens. He gets lost and drives 3 states away. He leaves the stove on and starts a fire. He takes all of his money out of the bank and no one can find it.
There is no easy answer.
However, your grandpa with dementia may be entertaining a group of nurses tonight. He will keep them on their toes. They will watch over him while you try to sort out his affairs. They will nurse him back to health from whatever ailment landed him in the hospital. They will make sure someone is keeping an eye on the guy who likes to Pole vault over the bed rails while they rush to take care of their other patients. There will probably be a bed alarm that shrieks out every time he tries to get out of bed. A gaggle of nurses will rush to the door to protect him from harm. He will not remember the instructions he received 2 minutes ago to use his call light. These nurses will quietly ask you about discharge planning, and express concerns about him going home alone. They will be there to support you while you go through the hardest experience of your life.
He will vacillate between irritated and charming. When he turns on the charm in an attempt to manipulate his way out of this situation, he will capture a few hearts. He will demand he be released from this prison. Charming grandpa will constantly interfere with all attempts to treat his medical condition. He will forget he is sick.
Dementia is hard.
The aging cowboy has no idea this is happening. He will tell you again about his fishing trip. He will rip the bandage off his hand, and try to get the string, actually, those are sutures and I really wanted them there, out of his hand. We have only had this conversation 27 times in the past three hours. The cowboy will become furious at his wrongful conviction, and as soon as he gets distracted the situation never existed. He will politely ask to go home. He feels fine. There is nothing in the world wrong with him.
His son will tell me how his dad is the strongest, toughest, and bravest men he has ever known. He is facing a tough battle. He will have to overrule the ruler. No one will be able to convince him he is not a terrible son for taking his father from his home. Worse, it may not even be safe enough for his father to come live with him. The son will have to vigilant to prevent the cowboy from absconding into the night.
If they live long enough, even the strongest men (and women) are at risk for developing cognitive decline. It will happen in bits and pieces. Things will appear manageable even after they are careening through a mine field. We have to support the families of these super heroes. We have to reassure them, offer guidance, and listen most of all. It is heart-rending to watch.
Basically, there is no easy answer. It is difficult to prepare for this situation because you want to believe it will never be that bad. Your dad is the strongest man in the world, why does he have to lose his independence?
We used to practice on each other and on dummies. I mean, mannequins… We even had ones that moved, talked, and ALWAYS died. Simulation helps- it does not ease the dread of the first time. I have never grinned and posed for a photo when I was defibrillating a real person.
Hospitals are horrible, awful, no good places. Not really, obviously. Well. Kinda. I hate hospitals. I am filled with dread and anxiety when I enter one as a patient, family member, or visitor. The difference in my feelings is astonishing when I am walking those same halls as a healthcare provider.
I am a nurse. I was a nurse first, and I will always be a nurse. The only thing change is I am now an Advanced Practice Nurse, aka- Nurse Practitioner, or midlevel provider. The point is I am still a nurse. I love nurses. They are quite basically my heroes. What other profession is filled with people who constantly provide care for complete strangers? I know, there are lots of them, that is not the point. I am talking about nurses here. Just bear with me. I love all the other service positions too.
Nurses have this uncanny ability to make some of the most humiliating, unbearable, uncomfortable situations tolerable. Imagine being at your most vulnerable state, unable to walk or take care of your most private needs. Nurses step in and deal with the issue. It is no big deal. They have seen every body type and dealt with more situations than you can possibly imagine. All in a day’s work.
I remember the first time I had to give a patient a bed bath. He was a gloriously demented elderly man in a nursing home. Let me just say, it was a MESS. I had never removed clothing from a grown person before, at least not in this manner. They actually teach you how to do this in class. In the class, the patient is always cooperative, docile, and helpful. The process is easy then. Now imagine a 150 pound man, who wiggles around like a toddler. Following directions? Not going to happen. That was the first time I genuinely believed I had made a mistake. Why would I want to do this? It was one of the hardest things I had ever done. For one thing, I was embarrassed.
I was 25 years old and had never seen an elderly person without their clothes on. I felt like I should be giving this man some privacy. He was gleefully not embarrassed, which exacerbated my discomfort. I had no idea of the appropriate social protocol in this situation. Do you avert your eyes? Apologize? Give them a compliment? The answer there is a resounding NO! Do not compliment your patient’s genitalia. It’s not necessary. Now, there are situations outside the professional world where that is welcomed. Just in case you wondered…
I finally went and got some help from some other students, and we were able to complete the task more efficiently. Let me tell you, I felt like a failure. Why was this so difficult? This is only my first clinical experience. I was never going to be a good nurse. This was the first time I considered dropping out of nursing school. I considered it every single semester. I felt incompetent most of the time. I wish they would warn you about those feelings. Turns out, every one feels that way at least part of the time.
Fortunately, I figured it out. There are tricks and processes passed on by experienced nurses. A certain method to the madness of making a bed while a patient is in it. You learn efficiency in your movements. It gets better.
The reason I tell this story is to reassure myself that every thing is hard the first time you try to do it. I am branching out professionally, and I may be placed in the position where I have to learn a new set of skills. These things intimidate me a little. What if I cannot do it? What if I embarrass myself?
Then I take a deep breath and deliberately exhale slowly. I tell my restless mind to calm down and stop borrowing trouble. Then, I go to YouTube and watch another how to video. Yep. There are How To videos on YouTube for medical procedures. If that does not make you feel better, I don’t know what will.
Here is the thing. You learn every thing you can about something, and you pay attention to the person teaching you. You have to trust your knowledge and abilities. Every one had a first time for new skills. I imagine they were scared and felt a sense of dread. Except for those weird adrenaline junkies who love new experiences, but I think they are freaks.
I am working diligently to quell the voices that scream inside my head. I am preparing and telling myself to man up and just do it. I am working to trust and believe the people who tell me I can do anything I put my mind to. I am reminding myself of all the things that used to scare me and are simply routine now. I must remember I am either growing or dying. Today, I choose to grow.
The Accidental Boxer 