Friday, February 22, 2008

Luck Be A Lady

Here is a celebrity quiz.

Who is the perkiest celebrity?

A. Rachel Ray
B. Richard Simmons
C. Vanna White
D. Bindi Irwin

I think it's a toss-up between Rachel and Bindi. Imagine both of them on TV at the same time. I suppressed my nausea long enough to be horrified by this interview.

Bindi? The luckiest kid in the world? Didn't her father die a freakish death like a year and a half ago?

Poor kid.

This reminds me of a patient I know. She would not win a perky award. In fact she is surly, sullen, snarky and sarcastic. After a particularly unpleasant encounter I took off my sensitive, defensive, middle-aged woman hat and put on my empathetic, professional nurse hat and had a chat with her.

Using my best nursing school therapeutic communication I asked some open-ended questions about what was happening in her life. She shared with me that everyone around her keeps telling her how lucky she is. No one wants to hear her talk about how devastated she is that she has renal failure. No one will let her express her grief over what she has lost by being on diaysis - her career, her body image, her health, her faith in God.

No. Everyone tells her how lucky she is because she can still walk, that she has a nice house, that her husband is so nice, that her children are healthy. Those things are true but they don't take away the sting of all she has lost. Over time she was getting sick and tired of not one listening to her talk about her loss. No one wanted to let her wonder why God had abandoned her; why this happened to her. No one wanted to let her ponder what she had done to deserve this. Instead they all told her that it's all part of God's plan and she should focus on the good things in her life.

I'm all for positive thinking, and I know her loved ones mean well. It was painful to see this person having to swallow her feelings and deal with her grief alone.

I wish I could say the talk changed things. It didn't. She's still sarcastic and opinionated, but at least she got a few things off her chest.

I wonder when Bindi will be able to get things off her chest. I wonder when somebody will let Bindi say "I'm sick to death of these crocodiles. I want my Daddy back."

I suppose for some people keeping busy is a way of keeping your mind of your troubles. But I wonder whose troubles are being dealt with in this way. Bindi or Bindi's Mom? If it's Mom, okay. Mom, you go ahead and travel the world making the world safe for crocodiles. If this is Bindi's choice and she loves doing it, I'm okay with that.

But let's tone down the sugar-coating a few thousand watts. Crikey. She's giving me diabetes.

Friday, February 15, 2008

Who's Your Dialysis Daddy?

Ahhh, dialysis. The life-saving procedure invented by a good doctor many decades ago, now perfected to the point where a patient can expect to live longer than ever. Not so long ago a person with renal failure was told to gather their family and say goodbye because there was nothing anyone can do.

So now, thanks to this 3-times-a-week treatment people can live for decades. Some of our patients have been on dialysis 20 years.

Unfortunately many dialysis patients are ungrateful and cranky. The majority of people with renal failure have diabetes or hypertension - a goodly portion of those have both. There is the occasional person who unfortunately blew their kidneys from a drug overdose or a reaction to contrast dye. Still others have problems with their immune system. For those with diabetes and hyperension, often they had been told YEARS AGO that they were heading down the path to renal failure. The problem with renal failure is that for a long time, the person feels fine. They figure that as long as they feel okay, that "stupid doctor" doesn't know what he's talking about. So they chose to ignore it until they woke up in ICU one day after an episode of uremic encephalopathy. In other words, their kidneys quit working, bodily waste built up in their brains, they went cuckoo and they scared the bejeepers out of their families.

Now that that's over, they have plenty of time - approximately 4 hours,3 times a week - to reflect on all the things they could have done to keep this from happening. They go through all the stages of grief - shock, denial, bargaining, anger - well, you know the stages. My two favorite stages are denial and acceptance. When the shit came down they were in shock, and everything they learned about their condition went over their heads. Now that the crisis has passed we can start educating them. I'm all for education, but in this case there seems to come a point of critical mass with education. They finally get enough information and it sinks in enough that now they're pissed.

I love it when they get past this stage and move on to acceptance. Some stay pissed though and those are the ones that I find challenging. They express their displeasure in some not-so-nice ways. Some do it by controlling the details of their treatment. "I must have 12 pieces of tape on my table. I can only have 3 x 3 gauze because the 2 x 2 gauze makes me sad. Stand on one foot, stick out your tongue and spin around twice before you cannulate me." Just kidding. I made the last one up.

Some express it by trying to manipulate their treatment time - often by constantly asking to stop treatment early. Oh, and the excuses they have for ending treatment early! Someday I'll write a book. "I have a flight to catch." Really, where would you be flying to that you have to be back day after tomorrow? "I have people coming over?" And you didn't mention to them that you have dialysis and that you don't get home until X o'clock in the afternoon? "I have a doctor's appointment?" Fascinating. So they only schedule appointments at precisely the same days and times you have dialysis. "I have to go to class." Uh huh. And you never mentioned to the clinic manager that you are taking a class so she could look into changing your appointment day, time or even find another clinic for you that has a chair time available that won't conflict with your schedule? Um hm.

Then we have the hurry-up-and-put-me-on folks. As soon as we open the door in the morning the patient's race to see who will be the first to their chair, because we put patients on in the order they come in. They practically knock each other down trying to be first. One day a patient passed out from low blood sugar on her way in the door. The other patients stepped over her prostrate body to get to their seats.

Some patients are in a hurry because they're smokers and they want to get back outside and smoke. Being a smoker, I symphasize - a little. I wear a nicotine patch during the day so I can wait until I get home to smoke. It takes the edge off. But what I've noticed is that the people who have the least going on in their lives are the most pushy about getting started on time. These patients are going to go home and sit on the couch in front of the TV. The patients who have jobs, children, errands or other activities are more willing to wait for us to get to them, and more tolerant of problems that keep them from getting started - for example machine failure or plumbing breaks. They will curl up in the chair, whip out a magazine or calmly watch television until things are okay again. Meanwhile the people who have absolutely nothing going on the rest of the day will yell at us to hurry up because they're going to miss The Price Is Right - even though they could watch it right there in their chairs.

Then a co-worker of mine told me something very disturbing. She told me that most of the male patients masturbate during treatment.


I have known for a while that most men on dialysis suffer from erectile dysfunction - we can't call it impotence anymore. Usually the circulatory problems leading up to their renal failure also affected their ability to get an erection. It's all connected. So since it's all connected, when we start them on dialysis and their blood starts flowing at a faster rate, it starts flowing at a faster rate EVERYWHERE, including, you know, down there. Once they get on treatment they get the best boner of their lives.

No wonder those fools are pushing old ladies down to get to their chairs. They have a date with the dialysis goddess.

I am not naive but I guess I'm pretty dense. I've been working in this clinic for 2-1/2 years and had no idea this was going on. You might want to ask "License Pending, how dumb could you be that you couldn't see someone spankin' his monkey right in front of you?" Let me tell you why.

All these guys bring blankets with them. Dialysis makes a person cold. When their blood leaves their body and travels through tubing in room temperature air, it lowers their body temperature a bit. We can raise the temperature on the machine to warm their blood, but it only does so much. So most people bring blankets and pillows to make up for what we can't do. So while the guys are all snug and toasty under their blankets, their throbbing member right there begging for attention....well I guess, boys will be boys. I hadn't heard that women experience the same phenomenon. I suppose they do but, being that we are socialized differently, don't feel the need to, um, whatever it is women do to take care of themselves and darned if I can think of a decent euphemism for.

This information both fascinated me and traumatized me. I'm a sex positive person. I'm all for the freedom of sexual expression - in theory. I'm just a little skeeved by the sexual expression of some gnarly old men a few feet away from me. Ewwwww!
Part of me wants to be a looky-loo and see if I can catch them, but my rational side says "no, if you see that you'll ruin it for yourself and never have sex again." So I avert my eyes and go about my business as if nothing is happening.

So I'm in denial I guess. Next is bargaining. I wonder how I will eventually express my anger?

Thursday, February 14, 2008

Papa Was A Rolling Stone

In nursing school I've spent a lot of time learning how the brain and peripheral nervous system work. I've been doing this because, even though it was taught in anatomy, it usually came up towards the end of the semester, after weeks of the professor being bullied by students to push tests back because they weren't ready. So by the time the nervous system came up, we skimmed over it, barely discussing it. So I've spent the last week or so teaching myself about the nervous system.

I don't regret the time. I've learned so much. I was fascinated to learn that some nervous system disorders are not a problem with the brain, but a problem of communication. Either the brain doesn't communicate with the body, or the nerves in the body don't communicate with each other or with muscles.

I remember first becoming aware of cerebral palsy when my cousin had a child with the disorder. Like most people I didn't understand the condition. Like most people I lumped everyone with neurological disorders into the same category - retarded.

One cold winter day some 18 or so years ago, I began watching a movie that came on. The movie was My Left Foot. It is the story of Irish poet, artist and writer Christy Brown who was born with cerebral palsy. What struck me about this story is how devoted his family, especially his mother, was devoted to caring for him. He was 10 of 21 children, and yet his mother gave him the extra attention and care he needed to survive.

This made me ponder the point in human evolution when people looked down at one of their own who needed extra help to survive. Instead of moving on and allowing the person to die, someone decided to put forth the effort and care into making sure the person survived. To me, this is the first step to civilization - compassion.

I am glad that more research is being undertaken to better understand what happens when a person's mind and body are broken. They are helping understand what the parents knew all along - there's a person in there; a person with a mind and spirit, with thoughts and ideas trapped inside them. They just can't communicate them because their muscles won't obey what their brains are telling them.

Then yesterday our instructor shared with us the story of Dick and Ricky Hoyt - father and son team who compete in triathalons with Dick rolling Ricky the whole way. Read their story and watch the inspirational video below and see how Team Hoyt works together. I was very touched by how much this man loves his son. I only wish I could find the same discipline and devotion if it were my child with cerebral palsy.

Thursday, February 7, 2008

Countdown to Graduation

Oh yeah, babe.

I plan to play with it and make it look pretty, but I have to crawl off to bed.

One of my classmates drunk-dialed me earlier. At my age I thought I'd run out of virgin experiences. I so feel like a college student.

Sunday, February 3, 2008

Lime Kool-Aid With Strips of Balony

I don't know which came first - my interest in medicine or the TV series MASH. I don't know if it drew me in because I inately love medicine, or if watching it made me love medicine.

When I watch it now I realize that a lot of what passed as humor was blatent sexual harrassment. The guys were constantly propositioning any female in their vicinity. MASH the movie features or horrendous scene where the whole camp gathered to watch as the shower tent collapses revealing a nude Margaret Houlihan. It was supposed to be funny, but if I were to put myself in her place, the event would have been very traumatic.

But I don't mean to get up on my feminist soapbox. If I were to think it over, it depicts situations as they were in the 1950's when there was no such thing as sexual harrassment. Men could say and do whatever they wanted to women and it was supposed to be viewed as flattery.

What I liked best about the show was it had some of the best writing on television. I tried finding the actual dialogue for the episodes I liked best, but frankly I don't have that kind of time.

Below are some of my favorite lines from the show. They aren't verbatim but hopefully close enough for you to appreciate them.

The scene: Hawkeye and BJ are riding in a jeep. They turn too sharply and the jeep rolls over on it's side. BJ suggests that they could rock the jeep and turn it upright again. Hawkeye and BJ rock the jeep and it turns completely upside down. They both look at the jeep as the reality of their situation sinks in.
Hawkeye: So what are you waiting for? Get in.

The scene: Hawkeye and BJ are sitting together in the mess tent. Hawkeye is smelling the food and making suggestions about what it could be - smelly socks, old cheese. He offers the food for BJ to smell.
BJ: I don't want to smell your food. It's disgusting.
Hawkeye: This from a man who drinks lime Kool-Aid with strips of balony in it.

The scene: Colonel Flag has come to the camp looking for communist sympathizers. He is bragging about his ability to move about without being discovered.
Colonel Flag: I am the wind.
Hawkeye: I told you he was the wind. You said he was the moon.
BJ: You said he was the moon. I said he was the stars.

The scene:Trapper John and Hawkeye are lounging around The Swamp. An announcement comes over the PA announcing that cockroach races will be held later that evening.
Trapper: Are you going to the cockroach races?
Hawkeye: Are you kidding? People just go to those things to see a cockroach crash.

The scene:Radar and Colonel Potter are in the office making a phone call. Potter studies Radar for a moment.
Colonel Potter: How can you see anything through those filthy glasses?
Radar: I know where everything is, sir.