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Craziness and Cookies for Peace

This story does not make me look like an angel. Yesterday, I was severely annoyed by a patient. This patient drove me so crazy that I wanted to pull out my hair, ignore her completely, or worse, make her disappear. It wasn’t that bad from the beginning. While I knew she had a psych history, and had been to multiple ERs with the same complaints, and had same tests done and had been medically cleared any number of times, it’s not in my nature to immediately distrust a patient that I have never met. But with a large load of patients already, and a busy day ahead, it soon became clear to me who was the truly ill and who fell to second (or fifth) priority. And with a steady stream of complaints and demands with seemingly no relief, I soon grew exasperated. Probably more so than I have felt ever before in this setting. It is not a good feeling, and it colored the quality of my care for this patient and tinged my mood for the entire day. I was not at my best. Less than super nurse, to say the least. She was with me all twelve hours, my lovely lesson of the day. She was constantly telling me how sick she was – as if I could forget. She told me again and again that the regular doses of pain and anti-nausea medication that I was giving her had done nothing at all and she would rate her pain as ten out of ten, and later twelve out of ten. When I paid attention to her it was almost worse than when I ignored her. I hate to say it, but I realized that I had to be firm and set limits with her so that I could safely care for my other patients as well. It was a hard lesson, but very necessary. And when she was finally medically cleared (with yet another CT scan, that she demanded) she still wasn’t ready to leave. Multiple physicians tried to use reason, and I did my best as well, but we could not get through to her.

Then suddenly, while I was in the midst of drawing up medications for another patient, an old man appeared at my side. He said he was her father. He looked nearly as tired as me. But with a sweet smile, he asked me if she was medically cleared, and if so, could he take her home? Unanticipated, a huge sigh whooshed out of me. I told him that yes, she had been cleared. Another sad little smile and he said, “If she is clear, then I can take her off your hands.” This small stocky man with the unruly grey Einstein-esque hair and disheveled appearance–sweater pulled taut over a slight paunch–was my knight in shining armor. And after a full day of caring for this patient with no relief or remission of symptoms, arguing with her about her diagnosis (or lack thereof) and just generally sweating over her care, she meekly followed her father out the door. That easy? For me, it was. That was one day for me. One hard day and then I get to wash my hands of it. But guess who doesn’t get to do that? Her kind mother who called earlier in the day to inquire about her status and her sweet father who came to escort her home and ultimately ended the circular game of discharging someone against his/her will, sick or not. Mother and father will never wash their hands of their daughter’s illness and neither will this woman herself, who is clearly sick in a way that the medications in our Pyxis simply cannot treat. I left very sad, and frustrated. Our system isn’t very good at dealing with the mentally ill. In fact, I would even go so far as to say that the system failed this patient, despite our well-intentioned efforts, and that makes it fundamentally flawed. Clearly, I don’t know the whole story. I only saw a small piece of the puzzle. But, I know something different should have occurred to stop the cycle of her using the ER like a revolving door. Should she have received a psych consult even though every complaint she had was physical in nature? The clues of prior visits point to yes, although clearly this is not a means to a permanent end since prior psych consults have not yielded answers or an end to the behavior. And should she have been assessed for an addiction? Perhaps. It is hard to say without knowing more of the story than her singular ER visit.

What I do know is that the very next day, while putting a chart away at the charge nurse’s desk, a little piece of me shriveled up inside when I heard her voice behind me saying, “Oh, Rachel…I’m back. This time I am really sick!” There she was, brought in by EMS…AGAIN…on a stretcher. She told me that she was still feeling terrible, and that “they” had called her back because they had seen something on her CT scan when re-reading it. I have to admit, I held my breath and crossed my fingers that our team wouldn’t be assigned to her care. And it wasn’t. But the Communications nurse later told me that the look on my face was priceless when the patient called out my name, she said she cracked up, and only for that reason was the patient not assigned to our team again Only in blog-land can I admit how grateful I was. After another 12 hours of her in the ER, with so many other patients, I may have quit my job on the spot. Obviously, I need to learn to better outlets to control my frustrations, because not every patient is pleasant or kind. I am working on learning not to let my crazy patients make me crazy as well because then i really can’t help them!

And now, a recipe for peace. Tea and these cookies, combined with a little yoga on the side help me stay externally peaceful in the ER.

simple lemony cookies

Ingredients (I doubled this recipe and kept one log in the freezer for later use at a future tea party date!) From: VodKitchen
  • 9 Tbsp. butter
  • 1/2 cup fine sugar
  • 1 large egg
  • Barely less than 1 cup all-purpose flour
  • 1/4 cup quick cooking oatmeal
  • 1/4 tsp. baking powder
  • 1/2 tsp. salt
  • 2 lemons for zest
Preparation
  1. Put your softened butter into a food processor with the rest of the ingredients (save the lemon zest) and process until smooth.
  2. Finely grate your lemon zest. Stir the zest into the cookie dough and mix together well. Spoon on to a piece of plastic wrap and roll into a sausage shape with a roughly 2 1/2-inch diameter. Chill the dough in the freezer for 30 minutes.
  3. Preheat the oven to 375°. Get your chilled dough out and cut it into 1/4-inch thick slices. Place these on two cookie sheets, making sure you leave a good bit of space between the slices because they’ll spread while cooking. Place the cookie sheets in the middle of your preheated oven and bake for about 10 minutes, until the edges of the cookies are golden brown. Let them cool down slightly before transferring to a wire rack to let cool completely.

Also great made with orange zest instead of lemon, and served with tea, coffee, or hot cocoa!

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Healing me

i want my spoon back!

I don’t like being jobless. I guess it’s one job in particular, though, that I am truly missing. I miss my residents. I miss healing. I miss feeling like I am making a difference simply by being a compassionate person. I thought that I would have all sorts of interesting stories stocked up after coming back from my trip. And I do, I suppose. But the truth is, the simplicity of one-on-one interaction and healing kindness is what I am missing. It would be silly to think that the minute I start nursing school, I will begin having these interactions again. I am aware that there will be a whole mess of textbooks and exams to contend with before I get anywhere near a patient. I can only imagine that the memories of my residents will fade further and further into the background, aging gracefully like an antique photograph. I can’t help wondering when this yearning will go away. I know that my upcoming patient interactions will never feel quite like my resident interactions. I am letting myself feel that, and feel sad about that. The uniqueness of providing one-on-one care for hours upon hours, day after day is not an experience that easy to replicate. I know that I want to be in primary care, providing services to the underserved, but I can’t help wondering whether I will find the same sense of fulfillment in a 10-minute encounter as I did with my residents. Having already experienced some of the difficulties associated with providing counseling and building a provider-patient bridge of trust in such a short time span, I wonder how I will fare with this new challenge. I get nervous about how I will do as a provider. Most superficially, I am concerned about blood and guts. I don’t like ’em. But I know I will get over that. You can only practice drawing blood so many times before you get used to it. Staring at abscesses must get easier with time, right? The human mind is miraculous in its ability to grow accustomed to anything. My deeper doubts lie in my ability to heal in a short time. Will I be able to connect with my patients? Will I feel as though I have made a difference? Will I feel overwhelmed by the suffering and my incomplete capacity to heal? This is where healing has many layers, I suppose. I didn’t really heal my residents. I helped them “live” to their full capacity. I couldn’t repair a blood clot or broken pelvis. But I could take the five extra minutes that it required to let a resident button her own sweater rather than hurriedly do it for her. I could respect another resident’s privacy by making sure to fully close the bathroom door, and knocking before reentering. And on the days that I forgot to do every single on of these small but important things, I didn’t berate myself. I looked for the things I did right. I sought to remember the interactions that would allow me to leave at the end of the day feeling like I helped someone. I can’t sweat the small stuff. Or even all of the big stuff. To try to solve all problems at once is not only impossible, but paralyzing. I don’t want to be paralyzed, I want to make a difference. One by one, and maybe someday a light will blink on, and I will know what has to be done to solve a bigger problem that plagues system of providing care. But for now it’s one person at a time and it all starts with me.

On my trip, I bought a small painting that has this Elie Wiesel quote on it:

The start: But where was I to start? The world is so vast; I will start with the country I know best, my own. But my country is so very large. I had better start with my town. But my town too, is large. I had best start with my street. No; my home. No; my family. Never mind, I shall start with myself”

and in Spanish:

Pero, ¿por donde empezar? El mundo es tan vasto, que empezaré por el país que conozco mejor, el mío propio.  Pero mi país es tan grande que será mejor que comience por mi ciudad. Aunque, en realidad, mi ciudad es también enorme. Será mejor que  principie por mi calle. No, por mi hogar. No, por mi familia. No importa, comenzaré por mí mismo.

What a wise, wise man. Hopefully, he will sit on my shoulder in clinic during those moments when I start looking too big picture.

 
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Posted by on April 23, 2010 in Healing Spoonful, Travels

 

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