tag:blogger.com,1999:blog-153964332024-03-14T09:42:33.900-06:00Ps 121 Is My FriendThoughts, questions, conversations, and just plain silliness.terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.comBlogger161125tag:blogger.com,1999:blog-15396433.post-36379821983013410202011-08-06T16:41:00.002-06:002011-08-06T16:46:25.496-06:00BEST patient comment EVER!!!!So one day I went to visit a patient in a care facility. I had been told that the patient had health problems that made him pretty confused at times, and also he tended to sleep a lot. I went into the room and his wife was visiting also and said it was fine to say hello to him. The patient was dozing. I walked up to his bed and said, "Hello, Mr. X." He opened his eyes, looked right at me, and said, "YOU'RE A SCOUNDREL!" His wife looked a little horrified, not knowing me. I was delighted. "I am," I said. "How did you figure that out so fast? You're really GOOD." He gave me a knowing, mischievous smile that had a bit of a swagger to it. And went back to sleep.terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com0tag:blogger.com,1999:blog-15396433.post-6426435506520523952011-06-25T16:32:00.002-06:002011-06-25T17:48:54.169-06:00Tangled Web of RamblingI spend a lot of idle time in the blogosphere, because I enjoy good writing and because the actual lives of people have always fascinated me. I read a tweet from someone whose writing I enjoy and respect, that directed me into the drama of a mother in TN whose son died a bit over a year ago of a drug overdose. The mother is a well-known blogger and she has a lot of internet supporters, and a lot of support is what any parent needs at the death of a child. Somehow I can't let the drama go, probably because a lot of it is about addiction, and the impact of addiction on families, and that is a topic about which I have far more first-hand knowledge than I would wish. Drugs and alcohol contributed to the early death of both of my parents. I was raised in a house of addiction. And so I project into this situation, and I react with rage, frustration, bafflement, compassion, every emotion in the book.<br /><br />A summary, hopefully fair: the young man in question was 19. His parents became aware of early drug use when he was, I believe, 14. Eventually he was sent to two residential rehabilitation programs that combined treatment with education so that he could continue high school work. He left rehab when, at 18, he attained legal majority, and returned home, where, within a matter of weeks, he was using once again. From this point he used harder and harder substances, developing an addiction to opiates. I believe I am correct in saying that in the last weeks of his life he was injecting opiates, selling as well as buying drugs, and also selling sex for drugs. He was 19 when he died, having been found in the home of two people who, his parents believe, sold him lethal doses of methadone, were prostituting him and other young men, and failed to call for help for several hours while he was in extremis in their home. At some point before being found in that home, their son was involved in a drug deal gone bad that left him beaten.<br /><br />Their son was taken to hospital where, his parents believe, he was found to have anoxic brain injury from drug overdose as well as from beating injuries. He appeared to recover some limited functionality but eventually succumbed to complications from his brain injury.<br /><br />The blogging mom and many others believe this young man was murdered, based on statutes that allow for those who illegally provide fatal doses of drugs to be charged with murder. They believe that the criminal justice system has failed them and their son by declining to perform an intensive criminal investigation into the circumstances of their son's death, to include the injuries he sustained in the drug deal gone bad, the provision of methadone allegedly at the hands of those in whose house he died, and the failure of those persons to render aid. Further, they believe the criminal justice system has failed to take action on credible evidence (statements their son made while in hospital) about a prostitution ring the couple was allegedly running from their home. The parents have filed a civil suit against those in whose home he died, as well as a methadone clinic from which the methadone allegedly was obtained. Currently, the mother is also attempting to draw attention to alleged improprieties in the medical examiner's office which performed her son's autopsy, an autopsy which, it is alleged, failed to find any evidence of the serious beating injuries the parents believe their son sustained along with a lethal drug overdose. One hardly knows what to think. Could it be true that every single person in the justice system that has encountered this family has been utterly incompetent and unprofessional at best, and complicit in large-scale criminal activities in the city and county? Could the family be the victims of a draconian plot? Perhaps, I suppose--I don't know the county involved and certainly its medical examiner function has been heavily criticized and problematic for years before the death of the young man in question. Perhaps this grieving mother will end up doing good if there is widespread incompetence and she is able to bring about a cultural change in law enforcement.<br /><br />I don't know how much any of the mom's effort at finding justice will help the family, though, and that's the rub for me. (By the way, google "Justice for Henry" to read the mom's own accounting and opinions.) I find myself by turns fascinated, appalled, and irate over the family's view of their son and his addictive disease, and fascinated, appalled, and irate over the information that is out there and accessible that seemingly they never, ever had.<br /><br />One aspect that, I have to admit, sticks in my craw a bit, is that the mom describes her son, over and over, as "fighting a brave struggle against drugs." That phrasing, or similar, appeared in his obit and factors into every aspect of her war for "justice" for her son, and I have to say that I am so utterly ordinary that, if it sticks in my craw, chances are it sticks in other craws as well. Although I acknowledge that I don't know everything about her son's life, what I do know from what she has posted leads me to a far different conclusion: that her son was not, in fact, fighting any kind of struggle against drugs at all. I see a young man who attended treatment programs only as long as he could legally be compelled to do so. I see someone who made no attempt to alter his life for sobriety once home and who, within weeks, was abusing drugs perhaps more severely than he had before leaving for treatment, and who, within months, was on a downward spiral where death was becoming more likely with each passing day. I see, from his mother's own account, a man who resisted even the suggestion of treatment for his addiction to the very end of his life. In short, I see an addict who manifested, in terms of behavior, absolutely no intention whatsoever to change his life, other than talking about hating his addiction. I see also a man who manipulated his family to obtain a place to sleep, food, and a cell phone, and I can imagine him using talk of how much he wanted to change to keep alive the hope that led a family member to keep providing him with those basic needs. I see a man whose untreated addictive disease was not only killing him but destroying the family who loved him and believed in him. And I see a family who continues to hold onto their image of their clearly gifted, charismatic, artistic son as "bravely struggling" in ways that do not allow them to get, on an emotional level, the ways in which he participated in his own illness and, eventually, in his own death.<br /><br />The family seemed never to be aware of the types of danger that awaited their son once out of rehab. Mind-bendingly, they seemed never to know how lethal the opioids were that flowed freely in their community and all over the country. Nationwide publicity about, for instance, oxycontin notwithstanding, they seem to have had no idea that their son had easy access to substances that could and did kill him. They seem to look back with nostalgia to the 60's and to their own youthful years as times when young people could use drugs as more or less a rite of passage, safely, and emerge on the other side better and stronger from the experience. They seem, and their supporters seem, appallingly ignorant of the deaths that have occurred since long before the 60's from addiction to alcohol and drugs. Thus ignorant, they seem to feel that their adult son (this point I do wish to make and make strongly--he was not a minor child) was failed by a social network including a criminal justice system that allowed terrible drug pushers access to lethal drugs and young people in a new and unique manner.<br /><br />The mother and her supporters seem also woefully ignorant about addiction itself, about how addicts behave and about the huge mortality and morbidity associated with alcohol and drug addiction. Would that the same programs which offered to rehabilitate their son, no doubt at staggering expense, have demanded that the parents enroll forthwith in Al-Anon or Narconon, that they might begin to understand what demon gripped their son and how eager that demon was to demolish him and everyone around him. Would that they have been given the agonizing knowledge that neither they nor any other human being or human system would be able to impact their son's life in such a way that he would stop using, <em>no matter what they did. </em>Would that those programs, while working with their son, also told his parents what so many families living with addiction know: that you cannot and must not trust any word that comes out of the mouth of a person who is using drugs--that the beloved person is in fact possessed by a force they cannot control, and that the force of addiction renders the beloved person utterly unreliable and untrustworthy. Would that they have had some preparation for the horrific but not, in the larger scope of the world of addiction, surprising outcome to their son's disease, given their son's refusal until the bitter end to treat his addiction.<br /><br />If I could have offered one piece of knowledge to this family in the last weeks before their son's fatal overdose, it would have been this: <em>Your son is dying. Your son is dying as surely as if he were in a hospital bed riddled with cancer. Whether it happens quickly or slowly, your son is on the path to death, and there is nothing you or anyone else can do. Take the rose-tinted glasses off, look clearly at what he is doing and who he is doing it with. He is not "bravely struggling." It is not "just a matter of waiting until he turns around." You can hope, but his situation is beyond bad. It doesn't matter what you do, or what anyone else does except him; you are helpless in the face of almost certain death. Be prepared.</em><br /><em></em><br />That wouldn't have changed a thing, I know it wouldn't. But, if they could have heard that, perhaps from other parents, they could have had people to walk with them through the truth of those days, to help them understand the law enforcement view, the depth of the injury, the devastatingly poor prognosis. The awful phone call his mother got would still have been awful, but would have been part of a context rather than a lightning bolt out of left field. They would have been able to see the fullness of their son's life--the enormous and real promise, and the enormous and real destruction--rather than holding the promise and understanding the destruction as something temporary which would eventually pass. It has seemed to me that, as the mother grieves over the idea that her son is not seen completely but only as "an addict," she too fails to see him completely. She sees the innocent youth, duped by older evil people into things he would not have done otherwise, rather than, yes, the addict, the man of immense promise whose life had been handed to a demon, a demon with which he, at the end of the day, did not choose to engage. When people say these sorts of things to the mom, she hears us saying he "deserved to die" and "deserved to die a terrible death." That is not what I am saying, really--no one "deserves to die a terrible death," but people with addiction die terrible deaths every day in every city, and it really does not matter whether law enforcement is impeccable or not, whether drug overdoses are prosecuted or not, etc. It is human tragedy and evil at its most immediate and painful. And the roots of addiction are complex and multifactorial and some people die even if and after they choose treatment for themselves, because the disease is so godawful powerful.<br /><br />I tell families of persons dying of consequences of addiction that, if I had a magic wand and the capability to eliminate one disease from the planet, I would choose addiction without a second's hesitation. I have no time for libertarian talk about how anyone should have the freedom to consume any substance they like, on grounds that the harm is done solely to the user. That viewpoint is self-centered and utterly naive. Families, friendships, communities, cultures, economies are ravaged by addiction, and it is at this point impossible to predict who might be able to use something "safely" and who might not. <br /><br />There are no easy answers and no simple places to put blame. I wish this family some measure of peace, and I wish that none of their other family members ends up in the same evil situation. I wish I thought for one moment that the success of their lawsuit would vindicate either them or their dead son, or even that I thought for one moment that their suit could or would prevail. Their lives are utterly and unalterably changed by their loss and it is always thus. I wish them more fullness of knowledge and vision even though I know it may bring more pain. And I wish there WAS an easy answer to what they are going through.terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com2tag:blogger.com,1999:blog-15396433.post-20301765015147560812011-04-19T21:08:00.002-06:002011-04-19T23:31:59.212-06:00Ah, the Royal WeddingIt has been a rough couple of weeks. Owing to an act of colossal stupidity (mine, of course) I wrecked my car... this was awful in every way and I am slowly climbing out of the pit of that. My second (now only) car has been skillfully resurrected by a VW mechanic who (a) does not work for the VW dealer and (b) knows what he is doing. (Could this be a coincidence?) Hopefully the wolfhounds will fit, one at a time at least, in the back of the VW. The tiny dog will fit anywhere in the VW but will of course wish to drive it. I doubt she can manage the clutch, however.<br /><br />Meanwhile, I find what innocent enjoyment I can in contemplation of the Royal Wedding. Now, most people around me find it irrelevant if not utterly boring, but although I am otherwise as unromantic as a cement block, I am vulnerable to the fantasy of Royal Weddings. After all, I did get up at oh-dark-hundred to watch Diana marry Charles, although it was plain as the nose on anyone's face that expecting a 19-year-old virgin and a 32-year-old well-traveled male to have much of anything at all in common was utter lunacy. Fat lot of good it did THEM, my getting up so early.<br /><br />There is after all something archetypal about royal weddings, that's why they hold any fascination at all. One (or even I) project something shining and gold on a royal couple, and the wedding, itself an archetype, holds the weight of great hope and promise. And at least this time the couple are of similar age, met at university, have known one another for more than a month or two, and apparently are able to converse for more than a sentence or so. These factors lend one (or me, even) to hope for better times for them than for the unfortunate Charles and the late Diana, who seem to have been even more appallingly mismatched than I imagined in my wildest dreams.<br /><br />I want them to be happy, William and Catherine, and I want their relationship to be genuine and not a sham, and I want their dreams of spending their lives together to be richly fulfilled. Marriage is at best a sacred calling, a true sacrament, in which ordinary daily experience is infused with the presence of the Divine. I wish that for this young couple, as I wish it for everyone I know who chooses a partner and takes that courage step into life together.<br /><br />And I want to see the dress, and her hair, and whether she wears a tiara, and whether they get to stay on in their rented farmhouse, and whether he loses all his hair by 35, and whether they have babies, and on and on and on. Incurably nosy, that's what I am, especially about lives that mine has never, and will never, resemble. I always have been curious about royal families. I always have wondered what it would be like to grow up in a palace and to have "what you will be when you grow up" decided for you even before you were born. Life in a royal family seems such an odd combo of freedom (from worry about money, especially) and restriction (one cannot plausibly run off and join the circus, really, if one is royalty--Princess Stephanie of Monaco tried it, which says it all actually). I used to think, why would anyone NOT want to be a prince, or princess, or whatever, but now I think of the fellow I once heard of who worked for a Buick dealer and was very successful as a salesman because he believed, truly believed, that Buick was the best car in the world. He refused to check out the competition because he was afraid he might find out that Buick was really no better than Chevrolet, and then where would he be? As a royal one would simply have to believe one was relevant, because if not, how could one bear it? And, as the relevancy of royalty comes under increasing question, maintaining the belief would become tougher and tougher, and of course what about the poor soul born a Crown Prince who is, sadly, a person who yearns to be steamfitter, or a priest, or a phlebotomist, or anything at all really, other than a future King. Like most youthful fantasies, thoughts of royalty become tempered by experience of reality over the years.<br /><br />I still, though, look forward to the wedding. I hope the dress is magnificent, and the day is sunny, and the horses shiny and perfectly groomed, and the vows said without a hitch (let us not forget that Diana, by mixing up two of her husband's names, took Prince Philip in marriage... ) and the balcony kiss enough to make the world swoon. It will be grand.terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com1tag:blogger.com,1999:blog-15396433.post-11465476028102779772011-01-25T22:35:00.005-07:002011-01-26T00:04:31.193-07:00What on earth?????So there are days at the end of which only two options seem valid, the first being a stop at the local hock shop to see what's available in the way of a .38 snubbie and the other being the implementation of a rigorous quality testing program upon one's supply of Adult Beverages.<br /><br />Today has been such a day.<br /><br />Actually, all of the last week has fallen into the same unfortunate category. Sadly, at the end of each day, I have lacked the energy to visit the local hock shop(s) and my level of fatigue has gotten in the way of the attention to detail required for proper quality analysis.<br /><br />This is not fun.<br /><br />There are many things that have annoyed me lately, and about the only one I can discuss without fear of legal ramification is the proliferation of what are properly called Medical Marijuana Dispensaries but more accurately called "dope shops."<br /><br />Mind you, I do think medical marijuana has its place. And I do think people who need it oughtta be able to get it without engaging in clandestine drive-by purchases in questionable parts of town or setting up elaborate systems of artificial lighting in the closets of their guest rooms. But really there are limits--limits on need, appropriateness, and good taste for mercy's sake--and my state has sadly left all of those limits so far in the dust they may as well have fallen off the edge of the earth.<br /><br />How many dope shops does any stretch of city street really NEED to have anyway? I live a few blocks from one of the more dope-shop-intensive streets in town and I can tell you that however many there are right now? Is too many. Waaaayyyyy too many. Honestly I wouldn't mind them nearly so much if it weren't for the AWFUL!!! decor. If I were to pick a color that would subtly allow the customer looking for this business profile to identify same, I would not have picked the sort of sickly greenish-chartreuse that is practically ubiquitous. And, if I were bound by some apparently unpublished dope-shop code of ethics that required I use that color, I would use it in small bits. I would NOT PAINT THE WHOLE FRONT OF MY BUILDING IN A COLOR THAT LOOKS LIKE THE CONTENTS OF A BABY'S USED DIAPER. Honestly. Some shops use a combo of awful green, awful brown, and awful yellow that makes me think of patients with particularly bad end-stage liver disease. Perhaps that is called Foreshadowing, or perhaps the goal is to make the building so depressing to look at that all its neighbors will be compelled to become customers in order to reach some state of hazy equanimity. And let me tell you, the universal Red Cross symbol of Medical Help that appears on a lot of the shops looks particularly disgusting against a sickly yellow background.<br /><br />And oh my God the NAMES!!! The names of the businesses!!! It is difficult to keep track as there is some, shall I say, turnover, but "A Cut Above?" I would have guessed a hair salon, but ooooh no, not unless there is more than one business under the roof. "Bonnie and Clydes Caring Cannabis?" Do you WANT to advertise a connection to crime? "Chronic Wellness???" From smoking marijuana? Listen, I talked to a doc about a year ago who said, with the fervor of a man who sees a pulmonology residency in his future, that in 30 years all the patrons of these businesses will have lung disease worse than those who use tobacco. Because if you are smoking the stuff, unless you're more sophisticated than many, you're rolling it up in ZigZags with NO FILTERS. And if you want to know how good that is for you, look at the inside of someone's water pipe sometime, and think of your lungs. Anyhow, back to the names. How about the Ganja Gourmet Medical Marijuana MMJ Restaurant Dispensary? You can view a menu online. Honest. Which is one of the fascinating things about the Medical Marijuana MMJ business (sorry, couldn't help it) -- you have a Full Range of Products from Which to Choose. Not just leaves and buds, oh no. And no need to bake your own Medical Marijuana MMJ brownies anymore either, you can buy 'em premade (be sure the kiddies don't pick up the wrong batch for birthdays at school, just saying). At the Ganja Gourmet one can buy Medical Marijuana MMJ-infused pizza!!! and beef pot pie (pun intended I am sure)!!!! and rice krispy treats!!!! and double-fudge cookie with hint of espresso (what's the point of THAT, I want to know???) and, yes, "Stoney Road" ice cream.<br /><br />Back to names after the brief gustative diversion: A number of these sickly green businesses include words like "natural," "kind," and "healing" in their business names. I suppose these names are meant to contrast the businesses with purveyors of allopathic health care which is not really fair. I mean, if you are having a big fat heart attack and you are being resuscitated, your immediate concern (if you are perfusing well enough to have one, that is) is less about "kindness" than about the forcefulness of the compressions being applied to restart your ticker. Your concern about "kindess" comes the next day, when you are supposed to start waking up, broken ribs notwithstanding. Maybe sickly green isn't so disgusting then, I dunno. I am beginning to ramble here, but do go back up a paragraph or so and ponder what I said about "lung disease," and think about that in relationship to "kindness." Take your time.<br /><br />There is purportedly a Medical Marijuana MMJ business (I canNOT help it, the redundancy is simply too much) named Releaf. Do they recycle, too, I wonder? And the Rocky Mountain Farmacy. Cute. By far my favorite though is the SweetLeaf Compassion <em>and Wellness Center </em>(italics mine). What the hell? "Good afternoon. I need to purchase some compassion. Also wellness. Do you have a price list?"<br /><br />Which brings me in a somewhat befogged way back to the beginning of my post. I probably do need to purchase or otherwise obtain some compassion, if only for the poor souls that have to write ad copy like the following (for The Giving Tree MMJ Dispensary): "...An established licensed Denver medical marijuana dispensary providing premium compassionate caregiver services and products..." Anyone who has to spend their days writing that kind of purple prose to describe premium products otherwise known as "Afghooey," "Northern Lights," or "Green Crack Medical Marijuana," and probably writing said purple prose while sitting in a sickly-greenish room deserves at least a pound of compassion, SweetLeaf or otherwise. Or perhaps a double-fudge Medical Marijuana MMJ-infused cookie with hint of espresso. Balance in all things, indeed.<br /><br />I don't know about you, dear reader, but I am feeling much better indeed after this little rant about the Medical Marijuana MMJ business. It may be that I can forego the rigors of quality assurance for another day and the .38 snubbie for two or even three. It is good to feel gratitude, even though the quality analysis of a tiny bottle of peppermint schnapps is, if done well, a task worth doing.<br /><br />("Green <em>Crack </em>Medical Marijuana???????????????????????")terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com4tag:blogger.com,1999:blog-15396433.post-89671139089197174902010-12-19T00:30:00.002-07:002010-12-19T01:05:42.174-07:00Stuff, maybe nonsenseSo I have been finding myself more easily angered lately; certainly grief resulting from the death of my friend J a week before Thanksgiving is a huge factor but perhaps there is more to it. I attended a couple of presentations lately where it seemed that large topics were oversimplified and where the speakers' own point of view was presented as fact. This is the sort of thing that can (and did) make me totally nuts. One is reminded that, when the only tool one has is a hammer, then everything tends to look a hell of a lot like a nail. It is so easy not to notice that one has only a hammer.<br /><br />There is much to annoy in current health care discourse and sometimes it seems the job of chaplain brings me to notice those things acutely. At present there is an enormous focus on how patients need to change their lives so as to improve health, with an underlying sense of judgment applied to folks who are perceived as using "more than their share" of health care resources. Consider smokers. You cannot read an H and P (history and physical) about a patient who has smoked or is smoking without that fact being noted, no matter what the reason for the patient's visit to a health facility. Some health professionals are openly scornful of smokers feeling that they have brought some health issues upon themselves and should have known and done better. Which in an abstract sense is true--the dangers of smoking have certainly been widely published and an informed consumer certainly can find the information that suggests quitting would be a Good Thing. I don't know, though, if we understand what it is we ask folks to do when we keep harping on the topic. If I live in a family where everyone smokes, and I work with smokers, and my friends smoke, and indeed some of my social contacts come from "smoke breaks" at work, say, then is it really an individual thing that I can simply stop? Will I not have to do something about my environment if I am taking the dangers of smoke seriously? That's a lot harder than slapping a nicotine patch on and fighting cravings, which is hard enough on its own.<br /><br />I begin to wonder why we don't get as righteous when we deal with people who have a lifetime of participating in sports, from jogging on up, and now are needing joint replacements, physical therapy, etc., related to wear and tear from athletic activity. Are such people not also taking "more than their share?" But hospitals, far from scorning the Boomers with blown knees, are building fancy new orthopedics units and buying fancy new robots for surgeries and competing like mad to get the business. Maybe joint replacements, being procedures, are reimbursed at a more reasonable rate compared to obstructive pulmonary disease, which can involve repeated hospital stays and is ultimately not curable. I don't know--but health care is not neutral in its views of its consumers. I have heard folks blame returns to hospital (that is, patient is discharged but only maintains in the home or nursing home for a day or so and comes right back) on patients' failure to adhere to discharge instructions. I suppose this accounts for some, but the ones I've seen happen with medically complex patients who are discharged because their insurer demands that they move to a lower level of care in a certain number of days. The guidelines for length of stay depend on the main problem for which the patient is being treated. Which is probably highly appropriate and cost-effective for patients whose condition is relatively straightforward, but for patients with underlying health issues may be kind of nuts. Thus we see patients discharged from the hospital on Day X after some procedure, when something may be brewing but it's too early to know, and a day or so after they get to a rehab facility or home, there's a full-blown infection somewhere and back to the hospital they go. That certainly cannot be blamed on patient failure. So better patient education is not going to be the big fix for this problem. The fact is, hospitals discharge patients earlier and sicker than once was the case, and not all patients have the support in the home to recover well, and care facilities are getting sicker patients without in many cases the staffing to care for these patients. No simple fix here, so when I hear a speaker talk about how repeat admissions must be fixed by patients being more responsible I am annoyed to put it mildly.<br /><br />It seems to me that the huge push to reduce employee expenses in aid of controlling costs is nuts. First off, the more people get put out of work, the wider the gap becomes between rich and poor. Also, when people are not working, they are not able to consume the products and services being offered so "efficiently." Cutting numbers of workers has been disastrous in a number of areas--I'd say health care is one. Robots, scanners, protocols can only do so much. At some point none of these can substitute for a set of skilled human eyes that can assess a patient and understand when to use, and when not to use, the tools at hand. I'd also say that food production is an activity that should be more labor-intensive. Perhaps there would be less food-borne illness if more eyes and hands were on the job, and more care taken for quality. Perhaps food production could happen in more sustainable ways if the entities doing it were less concerned with "efficiency--" I don't know.<br /><br />Last night I remember fragments of a dream--I was in a place where there was a fair bit of land and there were gates where I could let my dogs into fenced areas. Somehow a mother bear and two cubs got into the area where the dogs were and I was terrified. I wanted to get the dogs in and away from the bears, but one bear cub got into the house for awhile. Eventually the bears were on a neighboring golf course, and I called the authorities. The authorities could hear the bears but couldn't find them. Eventually they told me I was simply going to have to work on dealing with the bears, finding ways to keep the dogs safe knowing the bears were around. Not the news I wanted by a long shot. Puzzling.<br /><br />Weird times, these are, in the inner as well as outer life. That's all for now--need sleep.terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com2tag:blogger.com,1999:blog-15396433.post-9696699314655388612010-12-04T16:10:00.002-07:002010-12-04T16:34:12.686-07:00back againIt has been tough to figure out how to blog given the responsibility to refrain from posting anything that might allow identification of a specific person or facility. Which I understand, because when your job involves Seeing Dead People it is important not to do anything that causes any more pain to the living people who surround said Dead People.<br /><br />So I will be self-involved and blog about MEEEEEEEEEE!!!!!<br /><br />It has been a rough month or two. Jobs that involve death and dying hold an inherent level of stress and loss, that is if one plans to be actually present to the work. There are lots of ways to avoid doing so, but I think people who are facing loss need human connection more than they need most anything else, so there you have it: an inherent level of stress and loss.<br /><br />If there is one thing I am NOT, it is romantic. When I become more weary I become LESS romantic, less convinced that "things happen for a reason" or that "the right thing happens in the end." I become more likely to be pissy about what has gone wrong or firm about the existence of sin, yes SIN, and evil in the world and in the big systems that surround us.<br /><br />We had a workshop on the environment at work. The worldview behind the presentation is that people are inherently good and need education about what needs to be done. Once educated, people will feel "empowered" to make the right decisions and do the simple things that will change culture and save the planet. The notion is that an industrialized model that relies on continued growth in production and consumption has put the planet and its people in danger (I actually agree with this and have been saying it in one form or another for some time). There is, however, a certain irony in listening to this message from a man wearing a Ralph Lauren shirt. A kinder soul than I suggested maybe he bought the shirt used from a thrift shop, but I think not. The presentation involved some video segments of folks in beautifully and expensively decorated offices. I was in a rage at the romanticism of it all by the end. Would that anything were so simple. Would that we could just make one change that wouldn't hurt ANYONE. Would that everything about indigenous societies was so praise-worthy and possible to implement that the world could simply turn the clock back.<br /><br />I know I am not enlightened. I know I don't do my best every single time. I know I could do better at conservation and recycling and the like. I know in that vein I sin. I also would guess I am not alone. I also would guess that it is very hard to discern what the best choice is in most situations. Out here we don't have water to spare. Is it really better to stop using disposables and use water to wash dishes, cups, towels, the like? Is it better to compost? What IS the best choice? I am tired of romantically smug folks who are SURE they are doing right things and aren't able to see complexity. I am tired of people who are unwilling to confront the fact that evil exists. You work in systems, it is easy to see evil. It is harder to see our own. Am I willing to keep my thermostat set lower in winter? Am I willing to spend more time cooking? What really IS required?<br /><br />I have a much lower anthropology than most people it seems. Maybe because I know myself better, know my own ability to let myself off the hook for things. The presentation was supposed to be enlightening and uplifting. It was not--it made me despair. "Education" sure has worked well for racism and sexism, hasn't it? It sure has worked well for efforts for peace, right?<br /><br />Here's where a doctrine of sin CAN bring comfort: it allows me to say, I am no better than you, and you no better than I. We have a problem. And we already know we will resist fixing it, because that is how we are. How can we work together to find out what to do and sustain one another to do what we can, even if that involves sacrifices we already know we will resist making? How can we help ourselves be accountable? How can we broaden our view and face uncomfortable things?<br /><br />Eh. Enough for today. I am mourning the loss of a good friend who died just over two weeks ago. I am sad for some tough deaths at work and for times of low census that have stressed teams to the max and for tough circumstances faced by friends. I am glad for big furry dogs and a tiny hot-water-bottle of a dog who make me laugh a thousand times in a day. I am glad for holiday lights and evergreen smells and the gorgeous music of the season and new friends at church. And I hope next week's presentation at work doesn't make me mad...terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com0tag:blogger.com,1999:blog-15396433.post-3984196151442127692010-07-11T13:23:00.003-06:002010-07-11T13:42:50.195-06:00AmbulanceFAILSo I heard this one from a nurse who heard it from a member of the family involved: The family had needed a "non-emergent transport" to take a member for some specialized care. As the family member was basically comatose an ambulance transport was called for. The ambulance arrived and pulled up in the driveway. The two medics jumped down from the cab, went to the back, opened the doors, and found... no stretcher. OOPS. They use those big yellow ruggedized pram things and you wouldn't THINK you could overlook one, especially since at the end of the prior run they put it BACK IN THE AMBULANCE, but I suppose one could get busy and forget. Anyhow the ambulance had to return to base and get a stretcher. There is a certain slight swagger that goes with being an EMT or paramedic, but I imagine that was lacking the second time they arrived at the house.<br /><br />There is a time for stupendous silliness in hospice work as I have mentioned before. Some days are beyond stressful for any number of reasons, and a good belly laugh is the best way to release some of that. I was sitting at a nurses' station calling a mortuary to arrange a pickup on one such day, late in the afternoon. The somewhat disinterested answering service operator was droning throught the necessary questions. As she asked, "Name of the pronouncing doc?" I heard a sound and looked up to behold exactly that doc, white coat and all, being rolled past the nursing station in a wheeled Geri-chair (a kind of recliner) by one of the nurses. The doc was reclined back, gazing straight ahead, legs extended and feet crossed at the ankle. I am sure that the answering service operator wondered why I snorted in such an undignified way before answering the question; it was all I could do not to laugh out loud. The nurse had been rolling the chair to put it away, and the doc had apparently popped into it; this nurse, who has a marvelous deadpan, simply kept on going.terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com1tag:blogger.com,1999:blog-15396433.post-47473101018332358542010-05-31T21:20:00.004-06:002010-05-31T21:32:03.130-06:00More Mortuary Bad FunI was relaxing with a friend of mine who is a funeral director, who was serving as a sounding board for my story of a difficult interpersonal interaction I'd had.<br /><br />"I tell you," I said to him, "I felt like putting a gun to my head in there..."<br /><br />"The ol' .38 looking pretty attractive, eh?" he asked, sympathetically.<br /><br />"Even a .22," I answered. "Granted, not a good stopper, but still a good killer."*<br /><br />"It'll do the job," he agreed. "Not much damage, either. You could still have a full viewing."<br /><br />Janet Evanovich would have been proud.<br /><br /><br />* I learned the difference between "a good stopper" and "a good killer" from a firearms expert who was a co-worker many years ago. That's the kind of arcane bit of info that is fun to drop into conversation, especially with friends like this one, who can take it and run with it.terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com1tag:blogger.com,1999:blog-15396433.post-66075581370578241392010-03-28T06:16:00.000-06:002010-03-28T06:30:42.883-06:00Better than HalloweenOn Halloween one can play at assuming an identity of choice. When hanging out with people who are delirious or confused, the element of choice can be lacking.Ob a recent night there were several confused patients on the unit. At some point the team members conpared notes. The charge nurse had been mistakeb for a priest. One of the nursing assistnts was mistaken for a physician.I, the chaplain, was thought to be qa physical therapist. And one patient, trying to reconcile the information that Mike was his nurse with an old belief that nurses are female, asked me if Mike was a bearded lady...terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com1tag:blogger.com,1999:blog-15396433.post-47765062516198325282010-03-22T14:57:00.004-06:002010-03-22T15:38:11.046-06:00Major mortuary bad funThere were a couple of questions about my mention of marketing collateral on my last post. I wasn't exactly thinking about marketing collateral for mortuaries themselves, although I know some businesses market by presenting seminars on funeral planning, bereavement, and the like, and they offer brochures and other small items. I've seen nice pens and notepads, and coffee cups are within the realm of imagination. The products I've seen are well-designed and tasteful.<br /><br />Where marketing gets interesting, though, is in marketing products sold through mortuaries to customers. I learned this when my Mom and later my Dad died. When Mom died, my older brother and I went to the funeral home with Dad to Make the Arrangements. We were assisted by a funeral director who was both very kind and very earnest. He took us to a couple of cemeteries so Dad could pick gravesites for himself and Mom to be buried together. (By the way, if you Make Arrangements for a burial, you'll encounter fees labeled "grave opening" and "grave closing." These fees are for digging a hole, and filling it in later.) After that, we visited what I remember as Giant Roomful O Caskets and we chimed in our support as Dad picked one he thought was right for Mom. (Believe me, you DO NOT want to think much about the plethora of options in caskets. Spring counts for the mattress on which the deceased will lie? Hello--the deceased is DEAD, right?)<br /><br />Afterwards, we went to the director's office, where we were fortified by styrofoam cups of coffee as we faced the final tasks on the huge list of Arrangements to be Made. It turned out that we needed to select a burial vault, which is sort of a concrete box with a top that fits in the grave and contains the casket. The funeral director offered us three choices--basically a Good, Better, and Best of burial vaults. This would not have been really funny, I suppose, except for the fact that as a family we had often joked about the old Sears Catalogue, which offered a Good, Better, and Best option for about anything you might care to buy, from cloth diapers to tractors. We started feeling a bit giggly as we viewed the brochure the director produced. They looked a lot the same, the vaults, and to my non-technical eye it seemed the major difference (besides price) was the length of the guarantee. Each of these choices offered a guarantee to protect the remains of the Loved One from various, erm, degrading influences encountered in the Burial Situation, so to speak. This struck me as rather bizarre and also rather mercenary; after all, who would mark a date on the calendar fifty years hence to go dig up Aunt Ruby and make sure she looked as good as the day you buried her? Odd. I can't remember which vault Dad selected; it wasn't any of my business actually. But we did have quite a laugh when we got out of the place, about the Good, Better, and Best vaults.<br /><br />Some years later my Dad died. The same brother and I repaired to the same funeral home to make the same Arrangements. We may even have met with the same director, though I can't recall. The year was 1976, the Bicentennial. Anyone alive then must surely recall the patriotically-themed products that flooded every market. We learned that the funeral business had gone with the flow when we entered the Giant Roomful O Caskets. Striped linings and star-studded pillows and linings with the Declaration of Independence printed so as to show above the deceased's head were available in abundance. There were metal caskets subtly and not-so-subtly tinted in shades of red, white, and blue. Coffin kitsch, who would have thought? My Dad loved laughing at kitsch, but would probably have haunted us forever had we buried him in it, so we picked a casket that closely matched Mom's, which we knew he would like. (We were slightly taken aback by the price tag, which showed evidence of significant inflation, but pressed boldly on.) We might, had Dad lived until 1977, been able to get a good discount on a bicentennial casket, but the fear of haunting is not one I take lightly.<br /><br />When we went to the director's office to finish the Arrangements, we were presented with the same styrofoam cups of coffee. I wasn't startled when the director mentioned burial vaults, but I must say the marketing collateral for same had been greatly enhanced. Instead of glossy brochures, the director brought out three small scale models, cutaway, each model being 1/2 of a vault, for the Good, Better, and Best options. The models fit in a man's hand. Each included the lid, and if you lifted the lid, a tiny light bulb went on so you could view the interior. Each model had a Good Housekeeping Seal of Approval sticker affixed to the outside. (I don't know whether the Approval had been granted to the models or to the products they represented, come to think of it.) OMG!!!!! Dad would have died laughing if he had not already died of a heart attack. My brother and I could NOT, absolutely COULD NOT, look at each other. The director was terribly earnest as he showed us the models, which made the moment even funnier, not that it needed any help. I'm sure he thought our choked voices as we ordered "the same as Mom's" were evidence of our deep grief. I found myself wondering if I could abscond with one of the little vaults, so I could keep it on a shelf as a lifelong conversation starter.<br /><br />Our favorite mortuary owners have said they might be able to score me a miniature vault. I may have to take them up on it. They also told me that (1) the REAL purpose of the vault is to keep the ground from settling, which helps with appearance and maintenance of a cemetery; (2) all of the vaults do about the same job; and (3) all of them eventually get water in them, so you should bury your Loved One with a snorkel and fins. No need to thank me; when I receive information that valuable, I feel some obligation to pass it along.<br /><br />There are conventions and expos where manufacturers of caskets, vaults, and the like present their products to the mortuary-owning public. I almost wish, maybe I DO wish, that I could go to one of these, although I might die laughing.terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com0tag:blogger.com,1999:blog-15396433.post-39011920606922816642010-03-17T12:59:00.002-06:002010-03-17T13:33:22.980-06:00Odd bits and piecesI have not written in some time, largely because things at work have been busy and I have been tired, and so a lot of bits and pieces of stories are stuck in the bits and pieces of my mind. I've lost a bunch of weight due to modifying my diet for blood pressure reasons, and I like that! My foot is just about totally better--I can walk my big dogs in regular shoes with just a little soreness and no pain, and I really like that!!!<br /><br />We have had rough times at work with very, very sick patients accompanied by very, very stressed families. Some time ago we had a run of patients with liver failure, often involving alcohol consumption. We've also had some patients with cancers that kind of putter along for awhile and then flare up like wildfires overnight. Patients of both types can seem to be doing pretty well for some time and then crash, and families often are just so shocked they can't keep up. "She was fine two weeks ago," they will say, looking at us in disbelief as we begin the process of what is charted as "teaching re: dying process." Sometimes family members become angry and accusative because they cannot, really cannot believe their relative's position is going so very far south so very rapidly. They insist that the staff is overmedicating or underfeeding or any number of other things. They believe that there HAS to be a way to make their relative comfortable but still awake, alert, oriented, and able to relate. The bad stuff is just too bad and coming too fast for them to cope. Thank heavens for our wonderful physicians who are excellent at talking to families and explaining what is going on. Sometimes the families don't believe anyone except the doctor. Sometimes they don't believe the doctor either...<br /><br />One thing that anyone doing hospice work learns fast is that old communication patterns, old relational patterns do not change just because someone in a family is dying. It's not like TV, where suddenly every member of a family is called to be their very best, and to behave in ways they have never behaved before, so that Complete Healing happens. Rather, people and families can be profoundly stressed by a terminal illness and impending death, and react in the ways that are most familiar to them. If a family has never "done" direct communication, that's in most cases not going to start now. If a family has been a welter of conflict since its inception, through multiple generations, that's in most cases going to continue. If a family has reacted to stress by manufacturing chaos, then an impending death is likely going to result in chaos. And, if a family system's preferred reaction is to create chaos, then that system will fairly predictably blow up when supporting institutions are least prepared to respond--that is, nights and weekends. Thus, the job of on-call chaplain for nights and weekends can be very interesting indeed.<br /><br />To be sure, some families make some astounding changes when a member is dying. I have been tremendously moved--for instance, by a son long in conflict with his ill father who said, matter-of-factly, that they had decided they didn't have time anymore for quarreling and it was time to lay everything out on the table and get it over with. And so they did. And I've been similarly moved by other family members who have been inspired to take responsibility for their own participation in estrangements, seek to make amends, and offer words of love and appreciation. That's grace in motion, but to expect it of all families leads only to frustration and judgment. We only get a snapshot of dynamics, and we don't see the future. It is not true that everything has to be tied up with a bow before death--it's not true that that is "the last chance." What is, is. Even if it makes my hair stand on end.<br /><br />So, our favorite mortuary driver showed up last Sunday when it was snowing outside. (The weather forecast, by the way, had mentioned "a chance of rain.") He was in his usual dark suit and long dark overcoat. He was smiling as he said, "It's snowing." I responded, "Yes, but it's not sticking to the roads yet." "Ah," he answered, "But it will be later on. And there will be NO traffic by then, and THE ROADS WILL BE MINE." He had a very sinister gleam in his eye, so I imagine some Very Quiet Passengers got the rides of their lives, or perhaps I should say the rides they never had in their lives.<br /><br />We have a favorite mortuary too, now. The owners bring us donuts. LOTS of donuts. The owners are thin. This seems a little unfair. They are trying to build relationships in the community--hence the donuts--and I like them because they respect hospice work and are (we hear) very nice to families who select their mortuary. We cannot explicitly recommend or disparage any mortuary, especially one that feeds us donuts, but I do like these folks. Especially because one of them told me they could get me all manner of horrible marketing collateral for funeral products, which is another whole post in itself. I may take them up on the offer...terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com2tag:blogger.com,1999:blog-15396433.post-41894648382288185422010-02-09T23:02:00.002-07:002010-02-09T23:29:49.253-07:00These folks are awesomeWhen I work shifts in a hospital, I get called to the emergency department from time to time, and I am always amazed at the work done by the emergency department unit secretaries. The job seems to be an unholy combination of middle school teacher and air traffic controller. These folks, along with the emergency department charge nurse, keep track of who is in what room, despite the fact that there is no one spot where one can see all the rooms. (There's a computer system though.) Paper is flung at them from every direction--from EMTs and paramedics bringing patients in, from nurses and doctors. Phones ring constantly. Various law enforcement agencies appear, either to deliver or pick up patients. And the unit secretaries are expected to know what is going on all over the department. Amazingly enough, they do. When the hapless chaplain shows up, the unit secretaries are always there to set me right.<br /><br />I remember a night when I was called to attend a cardiac alert. The patient was being "worked up," meaning that tests were being run and results returned. The emergency physicians had reviewed results and determined that the patient needed to be taken to the "cath lab" for an angiogram and maybe an angioplasty. The unit secretary had just received and relayed the message that the cath lab was ready to treat the patient. The only thing missing appeared to be a cardiologist, which would seem rather important. I learned that night that in this particular emergency department a cardiologist is called a "card." Thus, I was between the unit secretary and the room, and the unit secretary called over to ask me, "Do we have a card yet?" I peered into the room. "There's a new guy in there," I called back. "What's he look like?" asked the secretary. "Tall, slim, dark hair worn a bit long, expensively dressed, vaguely continental, with a hint of arrogance," I called back. "Ah. That would be the card. Your clue is the hint of arrogance," said the unit secretary. That does seem to be true, and I do think it is somewhat justified, having seen coronary arteries. Anyone who can navigate and repair those little tiny things deserves to be a bit arrogant in my book.<br /><br />Arrogant or otherwise, this hospital has some very fine cards. For my part my fave is the one who brought home-made tiramisu to the cardiac unit's Christmas buffet one year. You've got to love a cardiologist who enjoys something less healthy than celery. Some of them are so intense about their vocation as cardiologists that their bedside manner suffers. A family member once wondered, vaguely, if his loved one's heart attack made him more vulnerable. Unfortunately he wondered this in the presence of a particularly intense card, who spent the next ten minutes lecturing the family member about what HE would recommend and how strict he would be about diet and exercise. I was really afraid the family member would pass out before the end of the lecture. Compared to the ascetic lifestyle the cardiologist was espousing, I think I'd rather have the heart attack.<br /><br />The unit secretaries know everything, though. I don't know how they do it, but they just keep going. They ought to get a raise.terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com1tag:blogger.com,1999:blog-15396433.post-13623690088682878312010-02-06T12:47:00.002-07:002010-02-06T13:17:42.020-07:00Some weeks are just like that......or, never EVER say, even to yourself, "What ELSE can happen?"<br /><br />You can tell that a shift will be intense when it begins with a call from a manager informing you of a loss the entire team needs to know about and asking you to come in and make calls and offer supportive presence. After some hours of telling the story, you begin to feel numb--you realize that you, yourself, have not had any time to react on an emotional level. That's the role, and that's normal. You know you'll have to make a space at some point. When the shift continues with a series of difficult deaths you begin to sense the dwindling of your own resources. That, too, is normal. It goes with the role of "on-call" or PRN chaplain. No one calls the chaplain because things are going SO WELL after all. By the end of a shift you can be completely drained.<br /><br />I had a weekend shift like this last weekend. I had a memorial service to do the Monday immediately following, and this was for a WWII veteran. The military portion of the service took place at graveside. I had been meant to deliver a closing prayer prior to the military portion but things got turned round and I ended up at the end. Military tributes are, to me, heartbreakingly beautiful. It is hard not to tear up at "Taps." In my area, there is a group of veterans that provide tribute over and above what the armed services provide. For this deceased veteran, the U. S. Army provided three young officers for the flag folding and presentation and "Taps." The veterans provided an invocation at graveside and a 21-gun salute. The honors began as the hearse rolled to a stop, with the slow salute delivered to the casket of the deceased. It was all I could do to remain composed. The flag ceremony has such powerful emotion, contained in the precision of the ritual, the two young officers remaining impassive in face as they fold and smooth the flag. The bugler who played "Taps" was exquisite. A windy day, and the haunting last note echoed across the cemetery. The 21-gun salute by veterans not much younger than the beloved soul we were burying. The final slow salute, and retreat by the military. And now *I* am supposed to say something? I got through it somehow, and then watched as the adult grandchildren of the deceased searched through the grass for the spent shell casings from the 21-gun salute, to hold them as final mementos.<br /><br />The next day, a funeral for me to attend as mourner. Got there late, the directions were confusing, the homily baffling, the family and friends mourning profoundly. As I walked through the parking lot to my car, I was thinking about this deceased, grieving the loss, worrying about the family, wondering what was in the mind of the homilist, and I tripped in a pothole and, as it happens, broke a bone in my foot.<br /><br />What ELSE can happen?<br /><br />Well, when I went to have the foot X-rayed, my blood pressure was running quite high. I wasn't too worried--I was stressed out and having a fair bit of pain, so it made sense.<br /><br />The next day I trundled my foot off to work for another incredibly intense shift, one where a particularly beloved patient died. At the end of the shift I asked someone to take my blood pressure--quite high again. I saw my primary care provider the following day and now am making dietary changes and monitoring, but may well end up on blood pressure medicine. Alas. Genetics has caught up to me. I have just eaten a nice bowl of steamed chopped broccoli for lunch and, while I feel virtuous as all get out, I still want a nice big generic diet cola. Nope.<br /><br />What ELSE can happen??<br /><br />Last night's shift? Five deaths. Four new patients. The Grim Reaper must have gotten a special deal on "Incredibly Aggressive Cancers That Kill In Weeks" because we have been seeing a bunch of these, and the impact on both patients and families is overwhelming. Family members are just trying to come to terms with a loved one's diagnosis, and the next call is: Come quickly if you want to see him, he is dying...<br /><br />And I always kind of rue the timing when an ambulance bringing a new patient has to park to the side because there's a mortuary van at the ambulance door.<br /><br />I'm on call until Monday morning. I don't think I want to KNOW what ELSE can happen!terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com2tag:blogger.com,1999:blog-15396433.post-37979326697751358552010-01-28T13:21:00.003-07:002010-01-28T13:36:49.378-07:00WhoaWhen I work shifts in the hospital, I respond to certain overhead pages--codes, of course, and then various "Alerts." A fairly common alert is a Cardiac Alert, which is sounded when a patient displays a suite of medical indicators that suggest the ticker is not ticking as it should. A Cardiac Alert generates a team of individuals who gather at the patient's bedside--portable X-ray, portable EKG, lab, nursing, a cardiologist, and a hapless chaplain, whose job is generally that of escorting the patient's family and friends to the appropriate waiting room. Cardiac alerts sometimes are called in the emergency department even before the patient arrives, which causes the assembled team to stand inside the ambulance entrance like some demented Welcome Wagon group. I feel at a loss there, with no machine or basket of tubes or white coat. I have to bite my tongue to keep from saying, "Welcome to XYZ Hospital.<name> Would you like coffee, tea, or an angioplasty?"<br /><br />One day a husband and wife were in the emergency department because the husband had been taken ill. They were in a room, a doctor had seen them, he was feeling a bit better, and they were watching TV and waiting patiently. Over the loudspeaker they heard the page: "Cardiac alert; emergency department; room 7. Cardiac alert; emergency department; room 7." The husband said, "Gosh, someone here must be REALLY sick." They took a moment to hope the person would pull through. Then the husband wondered, "Is this happening near us? What room are WE in?" The wife stepped out to look at their room number. "Uh... We're in room...7..." Seconds later the cardiac alert team burst into their room. I would imagine that if he wasn't having a heart attack before he had one then. Truly he had no idea; whatever the doctor had said to them, they didn't see this (us) coming.<br /><br />He DID pull through, and what a story for the grandkids.terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com2tag:blogger.com,1999:blog-15396433.post-32556248417286777052010-01-25T22:29:00.003-07:002010-01-25T22:43:48.120-07:00Sometimes marketing baffles meSo there is an Exceptionally Distressing condition that impacts the male of our species, and within the last decade a number of products have become widely available to treat said condition. Apparently the condition is so Excessively Disturbing that the market for such products is great. I expect anyone who has ever had an email account has received spam offering these pharmaceutical products for sale. I am no exception, even though I am the wrong gender to find these products beneficial. (Indeed, I should say that if men affected by the condition relied upon female counterparts to purchase the products sales might well go down.) I noticed, around about the third week of November, a rather drastic increase in the number of emails in my spam folder, and upon looking further, I noticed that the drastic increase was solely accounted for by sales offers for products to treat the Extremely Devastating condition. I pondered this. I haven't changed gender or social activity level, so I began to wonder if the increase was related to the holiday season. Does the condition occur with greater frequency over the holidays, so that sellers are trying to strike while the iron is hot? (or not, as it happens...) Or, does the condition occur with less frequency, so that sellers have overstock they wish to unload? I cannot imagine. The trend has continued, past Christmas, past New Year's, past Epiphany. I'll see if it tapers off after Candlemas, but the approach of Valentine's Day may signal a continued barrage of spam. One determined spammer sends roughly three identical posts a day despite receiving no response whatsoever from my email address. This must be at least a mildly lucrative business given the level of email blitz which, while cheap, is not completely free. I wonder if the products being marketed by the spammers are even real. So often they are not. My favorite spammers send me offers for GENUINE Rolex replicas. Why have a FAKE fake Rolex if you can have a REAL fake Rolex?<br /><br />I suspect I will never know why my spam folder has gotten so overloaded with products for the Eternally Depressing condition. I suppose it could be worse, but I really DON'T need to know how. Give me a good GENUINE Rolex replica any time!terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com3tag:blogger.com,1999:blog-15396433.post-89774207743800235762010-01-23T11:48:00.002-07:002010-01-23T12:12:44.450-07:00Clusters of Bad LuckI know that it is easy to see "patterns" that are actually meaningless. That said, sometimes it appears as if, in our hospice program, certain diagnoses come in bunches. It will seem to me in some weeks that every other patient has pancreatic cancer, or end-stage coronary disease, or lung disease, or something. Perhaps there is some store where the Grim Reaper shops that offers half off on overstocked terminal conditions. A blue light special on anoxic brain injuries?<br /><br />Sometimes it seems as if the kinds of complicating bad luck that families experience come in clusters as well. We may have several families in our program that have experienced multiple losses in the last couple years, or that have out of town loved ones trying like crazy to make it to see the patient in time, or that have other really sick loved ones to care for. We've had weeks where it seems that every other family has a family member who copes by using alcohol in ways that complicate the whole family's efforts. Not surprising given that we live in a culture where advertising would make us think that alcohol makes us better, stronger, and more attractive. Unfortunately using large amounts of a depressant to cope with depressing reality generally makes things worse rather than better.<br /><br />On the other hand we have families that, under the terrible stress of a member's illness and death, show themselves to be wonderful and grace-filled in every way. I've been in rooms where 4 or 5 generations are present including little babies who are passed from lap to lap, and where those most in need are supported with respectful tenderness. One family member was concerned what staff members would make of the laughter that occasionally bubbled out from their doorway into the hall. "We enjoy each other's company," the family member told me. One could imagine the comfort brought to our patient, resting comfortably but not really talking, to hear his family enjoying him and enjoying each other as they always had. I think it's great.<br /><br />I think it's especially great when there are families on the inpatient unit who have things in common, maybe little kids near the same age. They meet in the family dayroom where there's a TV and coffee and etc., and the kids may play together, and the families often care for one another in very tender and helpful ways. It can help us to help someone else, and thus I have seen women about to be widowed reach out to one another, exchanging phone numbers, talking in the hallways, encouraging each other. I have seen musician visitors to one family going to another patient room to play songs or sing with another family. I have seen families who love to cook bring enormous platters of food to the family area, reasoning that "everyone here is going through the same thing, and we all need to keep our strength up." HIPAA makes these shared efforts harder, but it is uplifting to notice that all the privacy regs in the world can't stop people who need to bond from bonding and caring.<br /><br />Even deaths can come in clusters. We've had weekends where no one dies at all, and one memorable one where nine people died in 24 hours. Who knows why? Perhaps mere coincidence, perhaps atmospheric conditions. Perhaps heaven and earth have come very close in what the Celts call a "thin place," and more than one spirit has slipped through.<br /><br />And now I need to prepare for work. This week brings a bunch of families who are trying like crazy to care for their loved ones at home, against great obstacles, and some of those loved ones may end up needing transfers for inpatient care. It also brings family members newly sensitized to questions about hospice, wondering if this choice is really "right" according to their religious beliefs. Hopefully there will be a baby or two to admire, maybe a dog to pat, a joke to share, and a way to make a difference for someone.terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com2tag:blogger.com,1999:blog-15396433.post-44141414730877131172010-01-21T16:10:00.000-07:002010-01-21T16:15:22.448-07:00Wow! Technology!Hot diggety it is possible to blog via BlackBerry! I have finished my fourth and final unit of clinical pastoral education, aka CPE. To celebrate I upgraded my mobile phone and plan.<br /><br />Don't know if this'll format right so I'll end here.terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com1tag:blogger.com,1999:blog-15396433.post-4936920282421327172010-01-17T22:36:00.004-07:002010-01-17T23:04:41.551-07:00Euphemisms, Confluences of Catastrophe, and ObservationsWouldn't YOU worry if a mortuary van pulled up to your ambulance entrance, and you noticed it bore special "handicap" license plates, with the universal little sign that is supposed to represent a wheelchair? I do. I mean, it's not like the passengers will care if they can't park right in front of the supermarket, is it? They're just going to wait in the van regardless.<br /><br />It's not great, but it happens sometimes that, at a hospice, a couple of mortuary vans are at the ambulance entrance when a new patient comes in by ambulance. We hate for their first sight to be a mortuary cot with a Very Quiet Passenger on it, but it can't be helped. On the other hand, if a very anxious and stressed family is touring one of the wings, we ask any mortuary drivers picking up Passengers to wait until that family leaves before heading down the same hallway with the cot.<br /><br />Usually, if the fire department is coming for a random safety investigation, they'll arrive as the charge nurse is trying to take report on a new patient while scanning orders while waiting for a doctor to call back, and while there are tons of people at the desk with questions about their loved ones, and the printer has just jammed.<br /><br />I think every nurse in the WORLD knows what it means when a handoff report (for a patient coming into a unit) includes the sentence, "Oh... and he's been a little bit agitated this morning." BATTEN DOWN THE HATCHES, is what that means. There are all kinds of very good reasons why patients get agitated and unreasonable. And often, once someone has gotten agitated and unreasonable, it takes awhile to get back to calm and reasonable.<br /><br />Sometimes the agitated and unreasonable person in a patient room is not the patient.<br /><br />However, staff members are not allowed to medicate family members, friends, one another, or themselves. So you almost hope the agitated, unreasonable person in the room IS the patient. <br /><br />If anyone came up with a way to deploy Ativan in a room spray, it would be worth a Nobel prize.<br /><br />Telling a grieving little kid that his aunt is going to be SO HAPPY in heaven with Jesus is likely to put that kid off theology for a lifetime. Kids are smart that way.terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com0tag:blogger.com,1999:blog-15396433.post-74461431908818691392010-01-17T22:25:00.002-07:002010-01-17T22:35:23.335-07:00Notes At the End of a Tough Day1. Drinking, as in alcoholic drinking, can kill you or your loved one at a shockingly young age. It's easy to think that one has years if not decades ahead to cope with the problem. Livers and kidneys can go pretty far south as it turns out before they let us know that all is Not Well.<br /><br />2. If your loved one checked into rehab and came home early announcing he was sober and didn't need to finish? It probably isn't true.<br /><br />3. People who are alcoholic do not want to be alcoholic. After awhile, a person addicted to alcohol is not drinking to feel good. He is drinking to stop feeling ghastly. And he doesn't believe there is any way, without alcohol, to stop feeling ghastly. And alcohol isn't working so well anymore...<br /><br />4. If there is one disease that makes me wish in vain for a magic wand, it is addiction. Hell on earth for the patient and everyone who loves him.terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com0tag:blogger.com,1999:blog-15396433.post-57325131928119267112010-01-10T21:02:00.002-07:002010-01-10T21:37:14.718-07:00More PSAGood to know, for your loved ones and maybe even yourself: There really is a difference between a person who makes decisions no one likes and a person who is incapable of making their own decisions. Unfortunately, well-meaning people can blur that difference by forgetting that there is no law that forbids a competent person to choose to live in an "unsafe" manner. It's is a good thing there is no such law, or else we would be arresting everyone who chooses to skydive or mountaineer, and if we got totally crazy we'd arrest everyone who chooses to drive a car.<br /><br />So, if your loved one decides she wants to return home to independent living even though her heart might stop at any moment, say (or any number of other things), and that completely freaks you out, you do have some ethical choices. You could ask the loved one to reconsider; you could scrape up money and hire attendants; you could move in with the loved one or ask the loved one to move in with you assuming you can take care of her. But, if your loved one clearly understands the risk of sudden death (or whatever) and is willing to incur that risk because of her desire to live independently, and can be clear about that, chances are she is not incompetent. You can really disagree with her decision, you can wish she'd go to a nursing home or something, you can try to talk her into doing it your way, but you may not succeed. <br /><br />You can intervene if your loved one is not capable of understanding her risk or is not able to decide whether that is an acceptable risk. If your loved one has dementia such that she cannot understand her condition and its consequences, you can intervene. If you are her designated decision-maker, you can override her wishes in aid of her safety. If she doesn't have a designated decision-maker there are ways of filling that gap. But if she's competent, all you can do is figure out how you wish to cope with the possible consequences of her decisions.<br /><br />The systems in place for determing competence are not idiot-proof and some are not even fool-proof. I recently heard of a situation where an elder was found incompetent because the family felt her choices were unsafe, even though she was clear about her condition, wishes, and risks. She was seen by a mental health evaluator and thought the questions she was asked and the test she was asked to take were stupid and irrelevant, and said so. She was absolutely intransigent and crabby besides. The evaluators couldn't figure her out and decided she wasn't competent. Not so. The patient was perfectly competent to make decisions--she just made decisions other people didn't like.<br /><br />We who work in hospice can fall into the trap of feeling that any sane person would like the care we can provide at end of life. Who on earth would want to be in pain, alone, and unsafe when there are options? Who wants to die in an emergency room or ICU with tubes in every orifice and machines for company? As it happens, plenty of people would make that choice--people for whom, say, agency and independence are much more important than comfort and safety. I met such a person once when I attended a hospice referral. EVERYONE involved--doctors, nurses, family, hospice admission staff--felt that receiving inpatient hospice care was in the patient's best interest. The patient, however, did not agree. And the patient was clearly competent to choose. This patient was a fighter, down to the bone. Remaining a fighter was how the patient found meaning and identity. The patient had a bad disease and knew it, but was not done fighting and might never be. I felt for the family because this patient would be hard to take care of, but we could not give the family the comfort of believing the patient incompetent. Hospice could have provided comfort and support and safely, but comfort and support and safety were not important to the patient as fighter. Our values did not match. I am guessing the patient probably did die in an ICU unit, or will, having stayed a fighter until the very end. And that has to be OK, problematic as it might be for those left behind.terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com1tag:blogger.com,1999:blog-15396433.post-38482433805737272922010-01-05T11:39:00.003-07:002010-01-05T12:03:23.221-07:00DNR does not equal suicideI don't know why this is, but over the last several months I've encountered more families voicing some suspicion about hospice care than I did previously. Perhaps the elevated level of attention to health care (death panels, anyone???) has made people more comfortable asking questions than before; that would be good. Or, perhaps the elevated level of attention given to health care has made people more suspicious of the intentions of health care professionals (that might be good or not, depending on the situation).<br /><br />A couple of people have asked me, as the chaplain, whether or not a DNR (do not resuscitate) order is tantamount to suicide. This is an interesting question, and it may be that in some communities there are recommendations against the DNR--I don't know. But in the cases where I've been asked, I've been familiar enough with the faith tradition to be able to assure the person that a DNR is not considered equivalent to suicide. I think there is a misconception about resuscitation, perhaps based on TV, where rescues are so often so totally and unconsequentially successful. To be sure, sometimes resuscitation does succeed, but if you or your loved one is older and frail, and there's a terminal diagnosis, especially one involving the heart, the chances are that if your heart stops, it won't be in the mood to start up again no matter what is done. Without the DNR, the default position of a first responder has to be to try to bring you back, and that will involve someone slamming her or his weight on your chest about 100 times a minute. If your heart SHOULD be horrified enough to start up again, and you SHOULD eventually wake up, consider that now you will have the terminal diagnosis you started out with plus multiple rib fractures. This will not feel good. You won't be able to breathe well enough to keep your lungs clear, assuming they were clear to start with, and you will have won the battle but lost the war, in a painful way. Having the DNR in place is not suicide in this situation. Rather, it is protecting yourself or your loved one from what is called "futile care" -- that is, care that won't help you. Although, as I say, it may be that some religious communities have a particular opinion about the DNR, I'm not aware of any that believe we are morally obligated to accept care that won't help us.<br /><br />That said, there are some people who need assurance from their own community or denomination when it comes to the implications of treatment decisions. They can't and shouldn't rely on my word as a chaplain. That's when my job is to facilitate the conversation where it needs to happen, and stand with the patient or family member against pressure for a fast decision. It's easy for the medical system's value for speed to take over, but at the same time a patient or family member who is not sure about a decision is one who will carry that unsureness forward throughout the course of the decision, whatever that may be. Especially in a decision for comfort care or hospice, it's normal to have some lingering doubts, which can be very painful and stressful, but if a simple visit with a priest or pastor or leader can take some pressure off or offer some concrete guidance, it's well worth having that visit.<br /><br />Someone once mentioned a desire to "have my DNR tattooed on my butt." If you have a similar intention, let me do my civic duty and warn you that the first responders will not roll you over to check your butt. Have the DNR, and the name of your MDPOA, tattooed on your chest, which is what they will pound on if they feel the need to resuscitate you.terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com2tag:blogger.com,1999:blog-15396433.post-39403666215368641562010-01-04T21:28:00.003-07:002010-01-04T21:36:07.215-07:00Just a Simple RequestWhen a patient gets transferred from one facility, let's call it Health Care Facility A, to another, let's call it Health Care Facility B, flow of information can be critical for proper follow-up for the patient's needs. Often whoever is caring for the patient at Facility A speaks directly with the receiving professional at Facility B, as the patient is being rolled out the door at Facility A. (This is by no means the only communication, because are procedures all along the way including a formal acceptance of the patient by Facility B.) But the last-minute report, usually exchanged between nurses, can be very useful. It can be especially useful if the nurse at facility A has cared for the patient for longer than ten minutes, although this is not always possible.<br /><br />My simple request is this: if, at Facility A, the patient has loudly and frequently voiced a preference for receiving a dozen root canals with no pain reliever while lying on a bed of nails over being transferred to Facility B, could someone include that in the report? It would sure help me do my spiritual assessment... actually, it would help me preserve my hearing while attempting to do my spiritual assessment.terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com2tag:blogger.com,1999:blog-15396433.post-52156838466648843322010-01-04T21:23:00.002-07:002010-01-04T21:27:50.395-07:00Evidence-Based Blog ChangesSo, I have finally selected a different template for the blog, if you can still call it one given the infrequency of my posting. I have finally believed the research that shows that light letters on dark are Very Hard To Read, even though I sort of liked them. Thank heavens for "canned" templates for those of us too lazy to love html.<br /><br />It may now be that I have enough material so that I can blog thematically without having to worry about HIPAA and patient/family privacy concerns. The last thing any blogger wants is to inadvertently post something that makes a patient or family member feel that one is describing them in a particularly intimate time. As it happens, there are plenty of bigger themes that I like to blab about, and there is humor to be found in those as well, and pathos, and the like. So we'll see how it goes.terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com1tag:blogger.com,1999:blog-15396433.post-77225946752074758342009-09-23T13:00:00.002-06:002009-09-23T13:09:44.039-06:00If this is heaven...The other night I was working a shift in the hospital. I was paged to a Code Blue. Most times when I'm paged to those the outcome is bad for the patient and family, so I was trying to get myself mentally in gear as I headed for the department that had paged me. I spotted the typical cluster of respondents--portable X-ray, lab, portable EKG, in a hallway, and joined them. The doctors and the nursing supervisor were in the room. The X-ray technician told me the patient was conscious and talking which is pretty rare. I peeked in and there were plenty of folks round the bed, starting medicines, checking monitors, and the like. The patient was on the bed, which was tilted so the head was downward, and was talking to a doctor. Usually by the time I arrive the patient has Gone to their Reward, is Resting, has Passed, is With the Lord, is In a Better Place, or has Crossed Over, effectively even if not officially. Lying head down? Talking to a doctor? If this is heaven, maybe I'm not so excited about trying to get there.<br /><br />A rare good outcome; hoping things worked out for this patient.terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com1tag:blogger.com,1999:blog-15396433.post-47497524258588188012009-05-31T09:56:00.002-06:002009-05-31T10:33:45.253-06:00These are the stories that lingerNot long ago I saw a patient I'd met months past, an old man with dementia and other severe health issues. I'd seen him a few times before he got better and went to a nursing home, and I loved him. He had not had a very easy life, and I imagine he hadn't always been a very easy man. His family had some conflicts and struggles too. He'd been a stubborn man, and he didn't like asking for help, and he really just wanted to be in his own home, but he needed more care than family members could provide, so he had to live in a nursing home. He came back to the hospital not long ago, his dementia by now very advanced, and his other health problems as well. There had been some sort of accident at the nursing home, a bad one. He had fractures and bruises and cuts, and lots of stitches. I was horrified when I saw his poor battered self resting in a bed. The medical staff had determined they needed to get his pain under control before even doing a full assessment of his condition, so they were waiting for medicine he'd been given to take effect. He was moaning--I got his nurse, who checked him and got more medicine. I sat beside him, trying hard not to cry. So many bruises and bandages and cuts and stitches, no wonder he was hurting so. And his breathing sounded awful. I touched his hand, and he grabbed mine and held it tightly, his face turned slightly toward me. He would doze a bit, awaken coughing, and start wailing, or maybe it was keening, again. I told him we would get him feeling better, but he just kept on keening. On a hunch, I said to him, "We'll keep you safe here. We'll protect you." THAT had an effect--he stopped keening and seemed to settle, only to wake again. I tried the reassurance several times--he always settled to the words, "We'll protect you." He was so frightened. He didn't know where he was, or why, and he was in terrible pain, and I don't know about his accident, perhaps that frightened him as well. Even a healthy old man would have been upset, and this was not a healthy man. A family member came in to be with him. We decided he was chilled, and I went to get him a warm blanket, and told the nurse I thought he was afraid. I told her the words that had calmed him and she wrote them down to use later when she needed to give him more care. Back in the room, I helped tuck the warm blanket around him, very gently so as not to hurt him more. He wasn't afraid of me, it seemed; I could touch his head, his shoulder, his battered face. I murmured more assurance to him, told him we loved him, told him once more we'd protect him. Medicine was starting to work, and he was settling. It was time for me to get out of the way so his family could be with him without interruption. I checked on him a couple times before my shift ended. He had finally been able to rest, but his breathing was even worse. The family had been called back in. Early the following morning, he died.<br /><br />I couldn't get him out of my mind for days. I will never know what all transpired to bring him back to the hospital. He'd had his accident some days earlier and been taken to an emergency room for care, and apparently he'd been taken back to the nursing home to recover, and then been brought back in. I just hated seeing him so hurt, so vulnerable, so terribly frightened. This is not what he wanted or what his family wanted for him. It isn't what I would want for anyone. It isn't the way we'd want anyone to die.<br /><br />We don't take the best care of our vulnerable elderly in this country and culture. They're pushed to the side by the younger generations; they aren't making money anymore; they aren't the demographic that even churches want to attract. Those who care for them in nursing homes are not well compensated. And sometimes, our vulnerable elderly end up like this poor man, broken and bruised and terrified, because their medical needs are too great for care at home. Their friends are dead or dying, their political clout is zero, and in most cases only family members are left to care about what has happened to them. They have become anonymous.<br /><br />So, today, I want to make this man a tiny bit less anonymous. Sure, he was an old man with dementia who could no longer even recognize his family members. When I first met him months ago, his capabilities were already greatly diminished. Nonetheless he was full in personhood to the end. He liked music (big bands, Sinatra). He liked a good meal. He liked company--he liked having his hand held, he liked to laugh. He was a lifelong Baptist who'd been a member of a huge urban church. He liked church music and hymns. He liked the Bible, and he loved to watch religious programming on TV. He liked a kind of religion that was upbeat and gave him hope. He liked the Lord's Prayer. He had a radiant smile and wispy hair that stuck out every which way no matter how often it was combed. He liked being outdoors, watching television, and birds.<br /><br />Now he is gone, and his suffering has ended. May he rest in perpetual light.terri chttp://www.blogger.com/profile/09398808840234914275noreply@blogger.com2