In Memory of Madeline Spenrath, R.N.

I just found out on Thursday, April 25, 2013 that one of my favorite nursing supervisors had died.  I’d talked to her several times over the last few years when we were both going through various cancer diagnoses, but hadn’t talked to her in a while.  She had been through breast cancer, and thought she was doing well when she discovered she had bone cancer in her thigh and had to have an amputation at the hip (around 2010).  She went through that with a great deal of grace and dignity.  I’m told that she had recurrence of cancer in her lung and spine.  I can’t imagine what that was like for her. Getting used to her leg prosthesis and wheel chair were hard enough; the leg prosthesis drove her nuts.  She was incredibly independent, and needing help didn’t make her smile.  I can just hear her saying “when I go, just toss me out into the pasture with the horses”.  Down to earth, no frills, and knew SO much about nursing.  I will always have a great deal of respect for her.

Madeline  was a no- nonsense supervisor, but also had a heart of gold. I first met her in in  1991, and while there are many people who knew her much better than I did, she left a definite impact on me, for the better.  I worked at Sid Peterson Memorial Hospital in Kerrville, TX on and off for over 10 years.  Madeline had been there much, much longer, and was a ‘staple’ supervisor on the night shift.   She had her own way of getting report on every patient in the hospital for the next shift’s supervisor (or ‘Number 9’, as they were called at Sid Pete, at least at that time). Some supervisors wanted report from each nurse- Madeline wanted the charge nurse to give the run-down.  SO, I talked to her a lot.  She wanted ‘just the facts’, but also had a really good sense of humor, and if a patient needed something, and she could do it, she’d give it her all.

Madeline could get IVs in just about anybody.  Generally, if someone needed an IV started or restarted, the direct care nurse or charge nurses would get them in.  If that didn’t work- or if someone’s veins were just too puny to go poking around when it didn’t make sense, the charge nurses would call Madeline (or whoever was the supervisor that night).  Madeline could get an IV in the butt vein of a grasshopper. In motion.  She was just that experienced and had all of the tricks down pat.

Madeline used to have incredible BBQs for the night shift staff. They were annual and legendary.  I got to go to one in 1991. She had them in the summer, and would have one of her horses saddled up for anybody who wanted to go for a ride around the farm in Comfort.  I still have a photo of me on one of her palomino horses, in my tennis shoes and t-shirt…. I looked SO not ‘Texas’.  But it was fun 🙂

When Coca-Cola changed their formula back in the 80s, Madeline rode her horse to the town store, and brought home as much of the original formula as she could secure to that horse!  I never heard that she ever smoked or had other vices- but don’t mess with her classic Coke !! 🙂

One night, Madeline called me about a predicament with staffing on the telemetry floor.  Uh oh.  Madeline could get me to agree to a lot of things that I’d normally freak out about (like charging two floors on nights when there were simply no other nurses to cover one of the floors- they were back to back units – 4A and 4B- so I just ran between the two that night; one was my usual floor, and I knew the other staff well enough).  The regular charge nurse on the telly floor had some emergent health situation happen, and they really needed a charge nurse.  I really didn’t read telemetry strips !  I knew ‘OK, looks survivable’ and ‘uh oh’. She reassured me that the monitor techs knew the rhythms and there were standing medication orders that the nurses knew about- I’d be fine. They just needed an RN body to check off orders and be physically present.  Scared the snot out of me, but I went.  Everybody survived the shift 🙂

She hated taking bodies to the morgue in the basement of the old hospital. Madeline would do anything she could for anybody in the hospital, but once she was notified of a death, she’d show up like the wind and drop off the keys to the morgue.  She wasn’t a fearful person but that morgue gave her the willies. I have to admit, it was creepy- it was a ‘one occupant’ room, with shelves along all available wall space that had the specimens from various surgeries… there were gallbladders, appendixes, lungs, and just about anything that could be removed from a body bobbing along in preservative liquid in semi-opaque plastic buckets. You could still tell they were guts.  Named, dated, and labelled.  The first time I went down there, I was very distraught.  I was still shaking the next day, and actually had to leave when I got to work (major chicken-poo reaction). Madeline was on that night, and while she wasn’t amused at me falling apart, she never made me feel ashamed of my reaction. Once I knew what I’d be seeing, I was able to go if I had to help take a body there.

When I was diagnosed with diabetes in 1995, I had just started working at SPMH again (and was diagnosed with diabetes through general pre-employment screenings)… one night I said I felt a little funny, and Madeline went bounding off to the cafeteria to get me a pimento cheese sandwich, in case my blood sugar was getting too low; I was still very early on in being treated, and could sometimes have symptoms even when numbers were decent- my body was just used to having much higher blood sugars.  Being diabetic wasn’t seen as a liability, and I had a great deal of support from Madeline and others there at SPMH.

When Madeline brought a meal for a patient admitted later in the evening or night, she’d bring back  a tray full of food fit for a football player…. her theory- never trust a skinny chef, and make sure they get enough food if they’re hungry.  Never knew when someone sick would either lose their appetite, or have the need for some energy stores.

Madeline loved her horses and cats.  She retired from nursing several years ago, and while she was dealing with a lot of health issues, she always talked about how she was doing with taking care of the horses and cats on her farm. She was deeply saddened when that palomino died… it was one of her favorite horses.  She also volunteered at the local VA hospital, and loved going out there.  She had passion about many things, and when Madeline took to something, she did it with a great deal of satisfaction- and she was good at it.

Madeline was a ‘giver’. I never heard her ask for anything for herself, even when she was going through so many life changes with her health.  When she’d call me, she’d sound upbeat- and she had so many reasons to be bummed.  She’d send funny e-mails, and periodic notes- and never complained.

When Madeline would hear of something just not sounding fair in regards to how someone was being treated after some management changes at the hospital, she felt so badly for them.  Madeline believed in people being accountable- but she also knew that sometimes people got a really raw deal… and it hurt her when they hurt.  One other supervisor comes to mind in regards to that.  We both deeply respected that other person.  Madeline didn’t always wear her emotions on her sleeve, but she was an incredibly caring person who wanted the best for those around her.   Sometimes there might be someone (usually someone who didn’t last long) who drove her a little nuts- but she was always fair if anything came up that involved her input with that person.

I’ve worked with some great people in the years I worked as an RN.  Madeline Spenrath is someone who I will never forget, and am forever grateful for things she taught me.  I became a better nurse and person for having known her.

For those who knew Madeline, and would like to leave a comment about your memories of her, please feel free to do so, and I’ll get them added to the comment section 🙂

The End of Life As I Knew It

Nine years ago, on April 6, 2004, life as I knew it stopped.  It was my last day working as a full time registered nurse because of medical disability. I tried to go back to work a few months later, but it was a total failure, even though I was working back into full time hours slowly. My body was broken.  There was nothing to do to fix it.  I entered a world I didn’t really  understand- that of being useless and having no obvious purpose. My life since the age of 21 had been about being an RN (I graduated from nursing school in May 1985).  I had worked so many overtime hours and holidays because I enjoyed working.  And then it was gone.

I’m not sure when the medical problems ‘officially’ started, but I know when they got bad.  About 5 months after moving back to the midwest from Texas, and being subjected to indoor heat, the symptoms of my dysautonomia became severe enough to cause me to start having heart rate and blood pressure episodes that made working impossible at times. Then, over the next 10-11 months, it got to the point  of being totally unable to work.  I’d pass out if I got overheated, and that didn’t have to be all that warm- most people found themselves comfortable when I was turning beet red and feeling like I was going to faint.  Then there were the seizures.  Later, it was discovered that they are more likely to start at the beginning of sleep cycles…but that could be at the beginning of blood sugar fatigue, as well as the deep sleep I’d end up in after one of the dysautonomia episodes. It was a mess to sort out.  My boss and co-workers told me what they’d seen, which helped the doctors at the time.

My employer had started sending me to the emergency room by ambulance when I was found unconscious or seen seizing or collapsing. I was a liability.  It got to be a routine occurrence.  I was sent out more than the elderly residents at the nursing home where I worked (like a dozen times in the last 2 months I was there).  I remember none of the ambulance trips, but I do remember a lot of abusive ER nurses and docs when I would ‘come to’, who thought I was a low-life ‘frequent flyer’. They never stopped to realize that I hadn’t sent myself to the ER- I’d been sent.  ER personnel like to fix things. I couldn’t be fixed, so they took it out on me with name calling and general ‘disgust’ when they interacted with me. There was a rare ‘nice’ doctor or nurse, but I began to dread waking up in the ER.  It got worse before it got better (I found a different ER).

Those initial months and then years of not working were really difficult. In addition to the neurological disorders, I was having drug interactions that dropped my blood pressure low enough to cause small strokes.  It wasn’t uncommon to have a blood pressure in the 40-50/20-30 range.  I was usually still conscious but definitely feeling very unwell.  It was scary.  I eventually figured out a way to put a thin feeding tube in my own nose to put Gatorade through, in order to increase my blood pressure with fluid volume.  It beat going to the ER.  There were also the times when the dysautonomia kicked in and my pulse and blood pressure would go nuts on their own.  I was so frustrated that I couldn’t just ‘make myself’ do things that used to be so normal.  Like work.  Or go out in public, where the thermostats were out of my control. Now, I’m pretty much homebound, aside from monthly trips to the grocery store or MD appointments. I have as much as possible delivered.  It’s just too painful and risky to do much away from home.

It took many years to work through the shock of being unable to work.  I kept thinking I just had to ‘make’ myself well enough.  But I was having trouble doing basic things around home.  My world shrunk to that of my apartment and the monthly trip to the grocery store, or doctors’ appointments.  At the time, I had nobody to socialize with; I had no friends here.  I also didn’t have online access to most people I’d known in Texas, and none with people here.  I had my dog- and she was so important. I also had regular contact with my dad. But nothing with anybody who understood being a nurse, or being disabled.

Things are getting progressively worse when it comes to ‘normal’ activities. I just took the trash to the dumpster (about 12-15 yards away), and am now in considerable pain.  Pain is a trigger for the dysautonomia (along with heat), so I need to get more comfortable to prevent my blood pressure from crashing.  It’s very frustrating to feel like such a ‘wimp’  with normal activities.  Making lunch is also painful.  I have ‘grab and go’ foods as much as possible.   When I have ‘good’ days, I’ll make tuna salad- and then hurt.  I keep trying to do things, and it’s harder and harder.  I don’t know what sort of future I’ll have.  I am trying to find ways just to  make things work here, so I don’t end up needing assisted living anytime soon.  I want to be independent. It’s hard to accept help.  I don’t want to be a ‘whiner’ or not do as much as I can… but when I do, I always end up in a lot of pain, and often pre-syncopal.  I turned the air conditioner on about a week ago, when the night temps were in the 20s, but daytime temps were over 40.  It’s a matter of just being able to survive being at home.

I think about my old life a lot.  I miss working as a nurse. I keep my license active so I don’t have to say I ‘was’ a nurse.  I still am a nurse- unable to work as one, but I’m still a ‘real’ nurse.  Many things have changed in the nine years I’ve been disabled. But there are core nursing things that I still remember. I remember some of the patients  I took care of, and many of the other nurses and personnel I worked with. Those are good memories.  I’m glad I have them.

To those who think it can never happen to them…. you never know what life is going to hand you, or what challenges may come  your way.  Get disability insurance whenever you can.  It can make the difference between living in a decent place, or barely making it at all.  Take time to enjoy things, and don’t work ALL the time.  Jump on all opportunities to experience all you can.  Don’t create regrets.  Do make time to nurture friendships that will last.  Don’t let horrible experiences create limitations that don’t have to be there.  Live as much as you can !

Dementia Wins By A Landslide !

I worked in various nursing homes during the years I worked as an RN, starting in 1985.  I worked as a ‘floor’ nurse, charge nurse, supervisor, and administrative (desk) nurse.  Nursing homes really are quite delightful places to work, and while nursing home nurses are often looked down upon by hospital nurses (I’ve done that kind of nursing too), the skill set required is extensive.  They have to have a bit of knowledge about all medical specialties (except obstetrics, though one gentleman did scream that he was giving birth to a calf in an emergent situation…my guess is that most people in a 3-4 block area knew of his distress; his doc felt that Haldol was a good ‘post-partum’ drug… I don’t like Haldol for the elderly; it was designed for schizophrenics- but it did quiet him down).  There are the medical issues that put people in nursing homes to begin with, and then there are those folks with dementia who can be so totally heartbreaking to watch…or a source of some humor. If we didn’t chuckle, we’d weep.  The following are from some decades ago… some of the rules were a bit ‘different’ back then, though nobody ever did anything to make the situation worse.

One woman I remember was very distinguished in her outward appearance. She was always ‘put together’ in how she dressed and in her appropriate greetings of people she met in the halls, but had no clue about hygiene or changing her clothes regularly.  Usually the certified nursing assistants (CNAs) could get almost every resident into the shower without too much hassle, but this lady was persistent in her refusal.  Nursing home residents have the right to be sloppy…when they are coherent enough to know the risk/benefit of their decisions.  When a green cloud follows them, and people fall like dominoes in their wake, something has to be done.  That’s when the administrative nurses have to jump in and figure something out.

The first thing to do was notify the family and get their permission to bathe Mrs. Cloud, even if she refused. They were the legal guardians since she couldn’t make decisions, so that wasn’t hard- they were thankful we were looking out for her (they were also out of town, so couldn’t be ‘hands-on’). The next thing to do was to figure out a plan.  The assistant director of nurses (ADON) and I were the ones who somehow got blessed with this task assignment, and thought we had a pretty good idea of how to get the job done. We got Mrs. Cloud into her private room, and carried on some generic, though tangential conversations as we got her overcoat off, and then talked about getting her clothes washed (that was usually less threatening than actually talking about showers up front).  OY.  We got the coat. We were doing pretty well with the dress, but getting down to her slip, and undies, we noticed that she had about 4 pairs of caked-on pantyhose. Each of those pantyhose required getting Mrs. Cloud back on her bed, ‘scootching’ the hose down, and then removing them…. x 4. Between each ‘scootch’, she’d bolt up and try to run off, so we’d have to get her seated again, then lying back on the bed so we could continue ‘scootching’.   The ADON and I were sweating by the time that was over.  The slip, bra, and undies were a piece of cake after the pantyhose circus.

So, we get Mrs. Cloud into her shower- after all, if we’re going to clean her clothes, why not get a nice warm shower (sounded like a good line)… she wasn’t happy, but went for it. We had the towels and washcloths ready. But…. oops. I forgot the body wash.  The  poor ADON was left wrangling Mrs. Cloud in the shower as I sped out of the room to find body wash.  I found what we needed, and we finished the shower from hell with no casualties.  A few minutes later, I saw Mrs. Cloud in the hallway, all fresh and sans cloud-o-funk, and she greeted me as if she’d never seen me before- very polite with a superficial smile. She remembered nothing. Crickets.

I also worked ‘the floor’ at night for a while.  One night, another confused little lady was wandering in a sort of frenzy, and was visibly tired. She had a sleeping pill ordered, so I offered her one. She wouldn’t take it.  I opened up the capsule, and mixed it with a tablespoon of orange juice in a one ounce plastic ‘shot glass’ medicine cup. I offered her a little nightcap, and she was so happy to take it.  I had poured some plain orange juice to get rid of any funky taste in her mouth, and she looked at me- dead serious- and said “Oh, Honey- I can only have one”.  She traipsed off to bed and finally got some sleep.

Another night, I was doing my routine work on the 11-7 shift, and one of the CNAs comes flying up the hallway off  one of the ‘pods’ (a grouping of rooms), calling my name as if she’d just witnessed Jack the Ripper field dressing a dozen deer in the back room.   I immediately went racing down to meet her, and follow her to the room in ‘distress’.  I stopped cold when I saw the elderly gentleman (also confused as all get out) sitting completely naked, bolt upright in his bed, grinning from ear to ear with his sheets and blankets all over the place. He was ‘splashing’ the gel from his gel mattress (as much as someone can splash something with the consistency of applesauce).  He had managed to puncture the mattress (used to protect skin), and had that gunk all over the place. It was hysterical.  I didn’t want to laugh at him, but it was hard to maintain anybody’s dignity at that moment. He was having a ball !  We got him cleaned up, and my only comment to the CNA was the need to differentiate between something that is life-threatening and something that is an inconvenience, but essentially harmless.  We didn’t need blood curdling screams in the middle of the night for a little  gunk on the floor (well, OK, it was a lot of gunk).

We also had a  hoarder.  The facility towels and washcloths, junk- didn’t matter. And she was possessive.  Anybody who went to clear out the stuff for laundry to rewash had to have someone else ‘stand lookout’, or the poor ‘lone’ retriever would be yelled at for a good 3-5 mintues, until the hoarder forgot why she was mad. One afternoon, one of the activity aides found a family of mice (mama and babies….LOTS of babies) living in a leftover popcorn bag (from movie and popcorn day), and a cake in a plastic bakery container that was so old that nobody could figure out the original flavor and/or color.

One of my favorite little ladies was superficially appropriate, but 2-3 minutes into a conversation there was no doubt that some bulbs were dimming. She was generally cheerful, and had a buddy she hung out with. She also was not fond of showers or combing her hair (think Einstein plugged in to a household outlet), but would let me check her skin weekly (per required protocols everyone got weekly skin checks- head to toe). The CNAs and I got into a routine of doing the skin checks in the shower room, and since I needed to see ALL of her skin, she’d agree for the CNAs to ‘hold’ her clothing…funny how the shower would get turned on, and she’d get nice and clean- she was always very agreeable once she felt the warm water. One day before getting showered, she walked past one of the mirrors, and saw herself. She literally gasped loudly and stepped back from her own reflection… she looked at me and asked about a hairbrush.  At least she still knew it was her own reflection- some lost that.

Nursing homes get bad reputations, but there are so many nice ones. I had the chance to work at two that I really liked, each for about 2.5 years.  The residents become like extended family, and some of their families also became part of the daily routine.  I’ve worked with CNAs who have been at the same facility for over 30 years…when offered promotions, they refused, not wanting to leave ‘their’ people. ❤  I’m incredibly thankful for the coworkers and residents I met when I was working at those facilities. 🙂

Sad and Scary Magnet

Sometimes I’ve wondered if I’ve got a sign on my forehead that screams “ALL FREAKS, C’mon over” !  I’m sure that everybody has experienced the same sorts of people in different ways…and some days I’m not so sure.  Maybe some of it has to do with being a nurse. People see nurses as helpful and nurturing, when we’re just as weird as everybody else- we just get paid to take care of the lost and vulnerable. And then there are the folks who would fit nicely  on the side of ‘Criminal Minds’ that either gets shot or lengthy prison sentences. The spooky people.  Not all are dangerous to others, but the danger to self thing eeks in there. Regardless, they don’t fit well into a ‘normal’ life.

Let me start with a director of nurses (DON) who had been one in a line of them at a very nice nursing home after the ‘good’ DON had gone on maternity leave. He happened to come along during a time when a new administrator was also getting used to all of us.  Initially, he seemed a bit intense, but not pathological.  One of my duties when I was working on the weekends as the RN Supervisor was to log in the discontinued medications that did little but take up room in the storage cabinets in locked medication rooms. I counted each pill on each card of pills (packaged at the pharmacy for nursing home med carts), bottle of loose pills, or made sure injectable medication vials had a reasonable amount left for what the sign-out sheet said it should have.  Narcotics (or ‘scheduled’ drugs) had to be accounted for separately and documented on specific forms.  It was mundane, but necessary. At one point, the DON asked me for the keys to the file cabinet  in his office where we kept the ‘logged’ drugs.  He was the boss, so I handed them over- no problem.

A few weeks went by, and the nurses on the floors said that nobody had picked up the growing piles of discontinued cards and bottles of medication for a while; they wanted them out of the way. I asked the DON if he wanted me to log the meds in that coming weekend ( I think this was either a Thursday or Friday). He looked at me and closed the door behind me in his office.  Gulp.  He then pulled out a .44 semi-automatic handgun out of the desk. That alone was a huge, HUGE problem. Texas was pretty gun-friendly, but in 1994, guns and old folks weren’t a good pairing.  He pointed the barrel at me as I sat down (which I decided to do before I keeled over), and asked me if I was going to tell anybody about our little talk.  Nope. My lips were sealed. Everything was very cool (as I’m imagining my body being found after the weekend, ripe and smelling up the place).  He handed me the keys and told me to go ahead and log in the meds that were piling up.  NO problem. Happy to do so.  Can’t wait to get started. Did he want coffee with that?

But that weekend, I noticed that every last narcotic form I’d filled out had been rewritten in his handwriting, with no way to figure out what had been removed from the lists I’d been keeping. I had a very specific way of tying the bags when I was done, and how I kept the narcotic sheets separate.  It was a federal law that this all be done according to the rules. I liked following the rules 🙂   I didn’t like having my work screwed with by a gun-weilding nutjob of a boss.

I  didn’t like even knowing about the gun. But I was also initially scared enough that he would shoot me, run off with piles of drugs, and nobody know why I was found belly up until they start looking at the paperwork. By then, he’d be on some uncharted island in the South Pacific, in some hut powered by a bamboo bicycle generator and drinking coconut drinks. The new administrator didn’t know any of us that well, and I wasn’t super tight with the assistant DON, but I had to tell someone. The ADON ‘G’ was outside smoking late that next Monday afternoon after nearly everyone had gone home. I told her about the gun.   She knew me well enough to know I wouldn’t come up with some sordid story about someone.  We agreed that we’d both go to the new administrator in the morning, before the gunslinger got to work.  We did, and told the newbie administrator. By that time, the DON had turned in his resignation, and it was decided he need not complete the two-week notice. He was free as a bird.  I have no idea what else was done about reporting him to the board of nurses (not sure if mandatory reporting was in place at that time), but I was told (after he left)  that before he left, he’d taken it upon himself to just stop some lady’s order for morphine- pills and injectable- and they were never seen again.  That created a HUGE mess with calling the doctor and getting the stuff reordered from the pharmacy for the poor little lady who still needed the stuff. The floor nurses were going nuts counting everything that wasn’t nailed down, and making sure their names were clear (they were).  I’ll never forget the business end of that .44 charcoal gray gun ‘looking’ at me.  “Two in the chamber, ten in the clip”…. whatever that means, it didn’t sound good.

Another time at this same facility, there was a sweet certified nurses assistant who was noticeably quiet, but she got her work done and wasn’t an attendance issue. Those sorts tended to fly under the radar. She was probably in her early 20s, and a member of the ‘fashion isn’t my thing’ club (I also belonged to that club- no judgement from me). We all worse scrubs while working, so looked pretty much the same (in different colors and prints, depending on the department), but when she came to get her paycheck, she dressed ‘depressed’. That was my first clue. I’d talked to her several times, and we had a decent rapport. I could tell there were things going on, but didn’t have any reason to pry. Her work was acceptable. I was part of the nursing management bunch, but did patient assessments and staff training/infection control- not the hiring/firing/counseling stuff.  Anyway, I kept an eye on her.

One afternoon, I got a call from the next door emergency room. They had the CNA there. Her friend wanted to talk to me.  Seems this CNA had slit her wrists. I wasn’t sure why I was being called, but the friend asked if I could talk to the staffing nurse (ADON) and let her know that ‘L’ wasn’t going to be there for her next shift; ‘L’ didn’t want to talk to anybody. I asked where she was going when she was done at the ER (as in what psych facility is going to evaluate her?). She was being discharged home.  With sharp things. By herself.  I didn’t like that at all. I knew ‘L’ lived alone. She never mentioned any family or support system.  OK, not good.   When they left there, I needed to see ‘L’ with my own eyes, so asked them to come over to work, and I’d talk to her.  She agreed via her friend.

In the meantime, I tracked down the social worker (from hell, normally) who was still there; I needed help with this one. And she got nice about it all, which I was thankful for. She got on the phone and started making calls re: acute psychiatric facilities who would do an impromptu assessment as soon as we got ‘L’ over to their facility.  I don’t remember who the DON was at that time, but I think she was gone for the day (it wasn’t gun-boy).  ‘L’ got over to the nursing home in a little while (wrists wrapped in gauze), and agreed to go with the social worker and me to the psych hospital, just to see ‘what her options were’.  I was hoping they’d keep her for a few days, so she’d be safe.  She was worried about losing her job if she checked in to a psych facility, but I told her that being checked out, and getting help was going to help her keep her job. Our administrator (before the one with gun-boy) was very compassionate.  ‘L’  agreed, and the psych facility did decide to admit her. She was in and out of there over the next few months (once after I sent the police looking for her as she had uncharacteristically not shown up for work), and ended up getting shock treatments.  She came back to work eventually, and while a bit subdued, she was doing better.  I learned more about her past, and she had reason to feel overwhelmed and hopeless.  Everybody has a history…

Another coworker (an LVN at an acute care hospital working on the neuro floor) had some ‘issues’.  At work, she was fine.  Not employee-of-the-month, but she did OK when she was there. We were both fairly ‘young’ nurses- as far as time out of school, and also just plain young, in our early 20s.  ‘A’ had all sorts of respiratory problems- mostly asthma. She had some attendance issues as a result, and the hospital had a ruthless attendance policy. She could be admitted in the hospital on oxygen, and it counted against her attendance record.  Anyway, a few months after I’d been raped and beaten in a very publicized case, ‘A’ calls me and says she had been attacked overnight by a former boyfriend, and needed help getting her dog to the vet. Fido had been cut by the boyfriend’s knife per her report.  I immediately agreed and went to pick them up.  Something seemed ‘off’.  Fido was frisky and happy to see me (his  usual goofy, non-traumatized behavior). There was a tiny cut  on his paw (more worthy of a bandaid than a trip to the vet), and ‘A’ had some odd looking cuts on her neck…the depth wasn’t something I’d expect from someone who had been seriously sliced by a rabid ex-boyfriend, and the way it went from deeper to more shallow from left to right looked kinda self-inflicted to me (she was right handed). But I didn’t want to believe that.

‘A’ told me she’d been whacked in the head, and felt horrible, but after going to the vet, how about we go get some lunch and maybe do some shopping.  😮 Everyone deals with stress differently…but another piece of the puzzle wasn’t fitting well. But, I agreed.  We spent most of the day together, and during that time she told me that the police had asked her for this guy’s photo- but she didn’t feel like getting it for them. WHAT? Not helping to apprehend this guy?  I had no ability to understand that ‘reasoning’ at all.  I’d been held in my apartment for 6 hours, finally escaped and called 911, and police ended up shooting the guy in my bedroom when I’d been attacked less than 7 months earlier. Why was she doing this?

I decided I needed to get home, and she suddenly begins to have symptoms of a concussion.  Puking, head pounding, vision a bit blurry…. so she now needs a ride to the ER for a CT scan and neuro evaluation.  The day was getting so very long (and more and more weird). She ended up being cleared for any sort of head injury, and told that basically she was fine.  I dropped her off at her apartment, drove like a bat out of hell to get home, and turned my answering machine off when I got there. She could dial 911 in a real emergency when she was going to cooperate with an investigation.  I was done.  I was no longer working at the same hospital by that time, so rarely saw her… I’ll never think that she was telling me the whole story- OR stop wondering if the police had ever actually been notified of the ‘attack’.  What made me even more mad was that the dog had been involved.

I got much more jaded when crises came up with some coworkers.  I had my own stuff to deal with, and had also become much better at sorting through when someone needed  help that was appropriate for a friend or coworker to handle.  I had times when coworkers helped me through some lousy times, and most of that was when they offered; I didn’t seek them out.  I was always very thankful for their time.  But,  I got careful about that as well, as crises junkies also like to be on the ‘helper’ end, not just the ‘helpee’.  One in particular had been a huge support system during some eating disorder stuff that was pretty serious, but when I got better, she wanted nothing to do with me. That hurt a lot.  There are a lot of people out there who are taking care of people who need keepers themselves.  Or who help to fulfill their own self worth needs.  There’s nothing wrong with finding satisfaction with helping people (professionally or on a friendship level), as long as the needs of  those being helped are the first consideration- not some twisted need for being needed.  Sometimes it’s a fine line.

I can think of others… these just stood out tonight.  Stay tuned for the continued saga of the  wacky side of nursing, and whacked nurses. :/

Moving to Texas

All during nursing school I knew I needed to move away from my home town once I graduated and had my RN license.   I needed a chance to get out on my own and find out my own personal likes and dislikes, and just learn who I really was beyond what was either overtly or covertly expected of me.  I needed my own life.  I decided to move to Austin, Texas since I had biological relatives there. I didn’t know them well, but had met them and been writing to them for over a year.  I really liked them, and was glad to have someone to help me figure out a new home 1200+ miles from where I’d grown up.  They were wonderful to me, and helped me in many ways as I adjusted to living in the Lone Star State.

My mom drove me to Austin from the Midwest.  The car was loaded , and I’d mailed 25+ boxes via the USPS.  I’d  partially moved by mail.  Mom and I had a weird relationship, but we had a great time during the three days it took to get to Austin. We weren’t driving to make exceptional time, and did some things just to goof off on the way down there.  We also discovered some of the wonderful foods of the South that I was clueless about.  Fried okra?  I’d never seen regular okra!  Biscuits?  I’d only ever had toast or rolls for a ‘bread’ at a meal.   We also stopped at a wildlife drive-through park in Missouri, and laughed our heads off as a llama insisted on pursing its lips through the partially rolled down car window.  We had some of the animal feed that was sold at the entrance, and that llama wasn’t letting us go by without getting a few bites. I’ve got photos of that goofy llama somewhere. I’ll edit them in if I find them 🙂

We puttered around in Dallas with a friend of mine who lived there with her husband.  She was about 30 seconds from delivering her first baby when we were there, but she gave us the tour of Dallas, and it was wonderful to see her.  I got photos of the baby a couple of weeks later.  Then we hit the final leg to Austin… I-35 South.  I was only  a few hours away from my new home.

It was night when we got to Austin and made it to my aunt and uncle’s house.  I’d been there on a spring vacation train trip a year and a half earlier, and was glad to see their familiar faces and home.  That first night was generally just getting there, talking for a brief time, and then going to bed.  I planned to get a job and apartment the next day, and I did.  The second night, I was in my own apartment (a furnished,modified efficiency unit on the bus route).  The manager lived on-site, and knew I was a 22 year old kid just out on my own.  She kept an eye out for me.

My first job was at a terrible nursing home (I worked at two amazing ones in Texas later on); I lasted 3 weeks there.  During that 3 weeks, I met more of my biological family (I’d been adopted at 10 days old, and had done a search when I was around 19 or 20 years old to find my biological mom, and did).  We had a great time seeing some of the sites around Austin and Fredricksburg.  I really liked the chance to meet and spend time with my ‘new’ cousins, and hit it off especially well with one of my cousins. She’s one of my best friends to this day.

I got a job at a local hospital and started out my hospital nursing career on a neurology/ neurosurgery floor on the night shift. I loved it.  I met some great people there, and while it was a lousy time in my life (I was raped), I learned a lot as a new nurse.  I’m still in contact with one of my co-workers from there.  I didn’t generally become  ‘friends’ with co-workers, but highly valued the ‘friendly co-worker’ relationships I developed through the years.  I didn’t see someone as a ‘friend’ if our only reason for knowing each other was being paid to be in the same place at the same time for the same reason. But some people stayed in my life.

I worked at some great places in Texas (Austin and Kerrville). Texas has had a legitimate nursing shortage for decades, especially in the smaller rural healthcare facilities (like being the only RN for 27 beds in a hospital, with 3-4 LVNs doing the direct care).  And the people were so much more friendly than where I’d grown up.  It was such a joy to meet new co-workers, and much of the time work was actually pleasant. It was hard work, but the vast majority of the people made it so much easier, even on the crazy shifts.  I’m still in contact with many Texas co-workers since I’ve been back in my hometown (moved back for family reasons), and they are really the only co-workers I’ve ever wanted to be in contact with. They are from the best years of my life, and I want that connection.  They remind me of memories I’ll always be thankful for.

Learning about barbeque was mandatory in Texas!  In the Midwest, during the time I lived there as a kid and before leaving home, BBQ was a soggy mess of stringy pork in sweet sauce that was really only good for putting on a bun. It came in a jar.  I hated it.  Grilling outdoors was called BBQ, but that’s grilling. Grilled steaks are really good, but it’s not BBQ, which is ‘low and slow’.  One bite of the real thing, and I was hooked.  There is nothing better than a Texas brisket or order of ribs. The smoking process is what does it. Sauce isn’t really a part of Texas BBQ; it’s available, but not what adds the flavor.  There is no BBQ without smoke. There needs to be a ‘smoke ring’ on the meat.  And no Texas BBQ pitmaster is worth his/her salt without a big smoke-darkened pit, where the magic happens.  I’ve got the phone number to Buzzie’s BBQ in Kerrville, TX to get my ‘fix’ one of these days; they will ship the real deal to me in Illinois !   My mouth waters at the thought.  No ‘bbq’ (small letters intentional) around here compares. Most of it is baked, and if smoke is used, it usually comes from a bottle of liquid smoke, or a quick trip through a smoker.  That’s just not right !  I’m now called a ‘rib snob’ because I’m so picky, and that’s fine 🙂

Spring in Texas, especially the Hill Country which is west and southwest of Austin, is amazing. The landscape explodes in color as the wildflowers start to bloom, starting with the state flower, the Bluebonnet.  The fields can look so blue it seems that perfect blue water just appeared where there had been grass.  Then come the red Indian Paintbrush,red and yellow Indian Blankets, pink primrose, and other flowers in a succession that tells the folks around there how far into spring they are.  Visiting Texas in the spring is amazing. Living there was even better.

Living in the Hill Country was a totally different experience than Austin.  I love Austin a lot, but the time-warp in the Hill Country was delightful.  Simple things are still appreciated, and there was a sense that I’d been accepted as one of their own.  When I first got to Kerrville in 1991, pay phones were still 10 cents for local calls!  That was unheard of!  There was (and still is, as far as I know) a daily Bible verse in the local paper, and nobody squawks about it.  “Howdy” was the way people greeted each other, and on the road, when someone came up from behind, it was common courtesy for the car ahead to move off to the right so the person behind could pass.  As they passed, both drivers nodded and waved.

There are so many more things that I love about Texas.  Since being disabled my dreams of moving back there are pretty well trashed.  I’m so thankful that I had 17 years there.  I got to know the reasons that  Texans love Texas. It’s not some empty pride- there’s a humility about the privilege of living there, but also a deeply rooted appreciation at the quality of life, friendliness of the people, incredible land, and wide open spaces.  The stars are big at night.  The sunrises are beautiful, especially during the spring and fall when the fog and mist make the sun a big red-orange ball.  People who haven’t lived there understandably don’t ‘get it’.  I’m not sure how they could.

Texas isn’t just a place, it’s an experience.  It’s where I spent the best years of my life, and met people I’m still in contact with, 10 years after leaving.  In Texas, I felt I was accepted, warts and all.

Texas is a place, but it’s also a state of mind.  My heart is still there. ❤

Why Work At A Nursing Home…

If you work at a nice one, there’s no reason not to work at a nursing home. I’ve heard the slams by non-nursing home nurses over the years that somehow nursing home nurses are the bottom of the barrel, but I’ve found this to be quite untrue.  Different types of nursing require different skill sets, and nursing  homes often deal with many specialties under one roof.  There is always the physical maintenance of chronically ill and dependent (in some form) patients. The knowledge of medications is extensive.  Nursing home nurses must be able to deal with psychiatric issues, and know the most effective ways of handling them.  There are always the emergency issues that require adequate assessment to get the resident the proper level of care. Wound care is critical- from surgical wounds to superficial skin tears that are so common in fragile elderly skin.  The nursing home nurse has to be very familiar with various hoses and tubes, and how to keep them functioning.  And then, there are the family dynamic issues that can change on a dime with any one of the nursing home nurses’ typical 15-30 patients and their families.  Time management is crucial.

Then there is the fun part of nursing homes.  I’ve been fortunate to work at some great facilities over the years. My first job out of nursing school was at a facility where I’d done staff relief work as a CNA.  When I started my nursing career there, I was the only RN educated person in the building most shifts I worked.  The ADON (Assistant Director of Nurses) was there until 4-5 p.m. when I worked 3-11 p.m., but otherwise I was in charge- without a license.  I was a GN (Graduate Nurse), and since I had access to an RN 24/7 it was kosher back in 1985 in Illinois. Now, I think that’s nuts.  Fortunately, I’m not so stupid that I didn’t realize what I didn’t know, so was very good at asking questions.  I was typically responsible for 30 heavy care and/or Medicare patients on 3-11 p.m. AND another 30 dementia patients when I worked 11 p.m.-7 a.m. – my actual shift.  I did a lot of double shifts.  That’s how things were done back then. I was 21 years old.

I mentioned ‘fun’.  I had some very entertaining residents.  Most were out to lunch in a very sweet way.  Those were the days of ‘reality orientation’ which is actually quite cruel. It attempted to ‘make’ the demented person come back to the right year and place, and it might have lasted about 3 seconds, and then they were still confused and unhappy again.  Things moved to ‘validation’ some years later (I started using it as the result of frustration… when in Rome…) which didn’t lie to the resident, but acknowledged where they were in their heads.   They weren’t going to be ‘fixed’. Dementia is progressive.  Let them be in 1954.

One of my little ladies wanted to call her mother every night before bed.  This lady was about 89 years old, which in a generous ‘young’ estimation made her mother at least 107. Uh huh. I was still in reality orientation mode, and asked this lady how old her mother was.  She gave me some age that was younger than she was.  This wasn’t going well.  I asked her how old she was. She gave me some number younger than what she said her mother was (well, at least she was keeping up with the story she was sticking to).  This went on for about 2-3 minutes. Finally, I unplugged the phone, put it on the counter, and she called her mother, said “Thank you”, and went to bed.   After that night, we bypassed the inquisition.  She was happy.

Then there was this skinny little man who tooled around in his wheelchair wearing a hat with his name on it.  Going by the nurses station counter, all I’d see is the hat scooting along on the other side .  “Max” was toothless, clueless, and so sweet. He also had an irresistable dopey, toothless grin.   He  was about 5 foot 5 inches, and probably weighed 85 pounds dripping wet.  And he was quite a character.  One day, he came up to the station in his chair, and stopped.  I saw the “Max” hat, parked in front of me. I heard his gravely, soft voice saying “Hey! I want a cigarette.”  Max didn’t smoke. Hadn’t for decades.  I told him “Hey, Max, you stopped smoking 30 years ago.”  He replied “Oh yeah”, and left.  We went through that routine often.  Another night, all hell was breaking loose with numerous patients having to go to the hospital for various reasons. I had ambulance crews coming from all directions at various intervals. While I was waiting for another crew, I was on my way down the hall to see the sick resident when I saw Max walking towards me, naked as a newborn, with his catheter disconnected from the bag, swinging like a pendulum as he took each step.  Max was about as stable on his feet as  a greased pig on glass. The naked part was just not pretty, and with an ambulance crew now in the building and heading towards me, I had to get Max covered up (and keep him from falling on his tail). Too late. One of the ambulance guys looked at me in horror and said “Tell me we’re not here for him” (or something close).  I told them which resident to get, and went to wrap Max in a sheet as I guided his skinny butt back to bed.

Another night, Max’s catheter was clogged, and no amount of irrigating it worked. I had standing orders to change out catheters as needed (we used a lot of catheters back then), but I couldn’t get the balloon deflated. This was a problem.  The catheter was stuck.  I could feel poor Max’s distended bladder against his skinny skin, and knew he had to be miserable.  SO, I called the doctor and explained the situation. He told me I could send him to the ER to get it removed, or do the same thing at the nursing home that the ER would do. I was young and game for a new task, so asked what that involved. He told me that I needed to keep injecting air into the balloon port until the thing blew up.  Uh huh.  Alrighty then.  Well, if that’s what the ER would do, it sure would save  Max a trip to the ER, and me a lot of paperwork to just get it over with.  I got a 60cc syringe with the proper tip, and went to work.  The first  60 ccs went in with no change. Max wasn’t reacting, so I figured it wasn’t bothering him. The second 60ccs also went in with no change. I was getting nervous. The balloon was 30cc and already full of sterile water before I started in with the air.  About halfway through the third syringeful of air, I heard a pop, Max went “Ooh”, and the catheter shot out of him like the bullet from a military assault rifle, shooting pee on the wall about 6 feet from where it was coming from… OK, well, that worked!  I replaced the catheter, and Max went to sleep, much more comfortable.  Now we have bladder scanners that would have told me how much ‘room’ I had before blowing up the bladder was a major concern.

Another resident in that facility was a former missionary. She was now way out to lunch, and had some big issues with her feet that made them look ‘clubbed’. Normally, she rode around in a wheelchair, but with her bedtime routine, she could walk to the bathroom with guidance, and get some exercise while she got set for bed.  She’d go to the bathroom, wash her hands and face, and uncerimoniously hand her dentures to whoever was helping her. Then she’d toddle back to bed, climb in, sit bolt upright, and recite the 23rd Psalm. When she was done, she’d look towards the door (her vision wasn’t so great), salute, and say “Goodnight Everybody”, and lie down.  Every night!

These are just a few examples from one place I worked.  Yes, it was hard work. I had a lot of medications to pass, treatments to do, and paperwork (with a real pen and paper!) to get done on each shift. But the residents were great.  Well, most of them. But if being there and taking care of them meant that even one or two felt better, that was worth something.  I got a lot of great skills for a new grad.  By the time I went to work in a hospital some 8 months later, I could deal with stuck tubes, time management, and  brand-generic medication names with the best of them.  I loved the nursing homes I worked in, because I worked in great facilities. Had I worked in a pit (and I’d seen some as an agency CNA), I’d feel differently- but I never made the choice to settle for those. 🙂