Narcotics Anonymous

"Lord, please bless those that are suffering from addiction. Please help them to find an outlet for their pain in You, rather than in needles. Please help heal their suffering: take away the pain that many of them are feeling from the loss of their friends, parents, children. Please help those recovering deal with the pain of addicted children and addicted spouses. Help them become a rock and give them power to overcome these things. Please help us find out more about this disease so that we can help treat and take away some of this pain. And please Lord never let me find myself in this situation with any of my family. Protect my children from this type of exposure. Keep them healthy in mind, body and spirit. In Jesus' holy name, Amen."

That's all I have to say about that.

10-4 God. Loud and Clear. Over.

God works in mysterious ways. We hear that all the time but now…I know. He really put me in my place yesterday and you won’t believe that He used my patient to do it.

Before I start I guess I should give you a little background on the situation. I have been running on fumes for the past few weeks. I’ve been working to meet the demands of school and my family, have been fighting a double ear infection for the past few months, and to be quite honest, I haven’t been sleeping well no matter how early I go to bed. All of this has left me…well…cranky and emotional the past few days. Wednesday night (I won’t get into specifics) I turned into a cranky maniac with Manny. I snapped at him for who knows what (I think he was asking me too many questions or something…) and then, even though I knew I was totally out of line, I refused to apologize.  “I’m just tired and overwhelmed,” I said. To which Manny replied, “If that’s the way you apologize, I don’t want an apology.” Ouch. But I deserved it…truthfully, I did. But was I going to tell Manny that? Um, no. I like to think of myself as the perfect breed of Besecker/Strauss that has this innate unwillingness to admit when I’m wrong because, let’s face it, I’m not usually wrong (you see what I mean?).  So I went to bed in a huff and woke up in a puff and was out the door without saying goodbye or whatnot. I never do that. I was trying to prove a point. I think I was doing scientific research to see if you act mad enough if you could make the other person apologize eventually regardless of who is truthfully wrong. I’m not sure…I was too tired to think rationally and was testing the boundaries of common sense.

Anyways, so now it’s Thursday morning and I am at my clinical site where I have been assigned to “Joe” (for privacy’s sake). Joe is an 80-ish man who has just suffered a stroke. While his long memory is intact, Joe has lost his short term memory. And by losing his short term memory I don’t mean he forgets what happened yesterday…he forgets what happened every minute. I told him my name about once every 1-2 minutes. Well, Joe has a habit of walking around naked and what not so I have been assigned to him to kind-of distract him. 

The first time I meet Joe he says, “Did I have a heart attack or a stroke?” I tell him that he’s had a little stroke. “Are you an RN?” he asks. I’m on my way there I tell him and he looks right at me and says, “Did I have a heart attack or a stroke?” He doesn’t remember what I just told him. So I spend my day working with Joe and trying to help him re-train his memory. But he asks the same questions over and over. I have to point out that Joe has long term memory. He can tell me when he was married, what his kids names are, he brags to me about his wife and when he was converted to Catholicism but once he is done telling me a story he asks again, “So did I have a heart attack or a stroke?”

A really quick sidenote: This guy is officially one of my favorite patients thus far – so sweet and really entertaining. Asking him what year it was he quickly stated, “It’s 2010.” I said, “No, Joe…look at the date I’ve written on the board.” “2012?” he gasps. “Oh my God, I’ve been in a coma for two years?!?!?” Seriously funny.

Anyhow…we do the dance around the heart attack/stroke question for almost three hours. All the time I am talking to him I am fingering my phone in my pocket going back and forth between texting Manny or not…it’s at this point that I’m starting to hate my Straussecker stubbornness. I want to text Manny but that would entail saying I’m wrong and that would make me weak or who knows what I was thinking. So I didn’t. I just kept checking the phone to see if he text me because we ALL know that whoever texts first is the loser. Right? Ok maybe not but, like I said, I was tired. 

Anyhow, I take Joe’s vital signs, go to chart them and come back to spend time with him. When I come back in I am expecting the now-routine adage of “Did I have a heart attack or a stroke?” but he looks right at me and says (and this is the dead honest truth)…”Do you know what makes a marriage work?” I ask him to tell me. “You have to know how to say sorry,” he says. “You have to apologize when you’re wrong no matter how much you want to be right.” And then, as if that wasn’t enough, he continues. “Sometimes we are so stubborn you know? We just don’t want to admit when we are wrong and you have to know how to do that to make a marriage work. It’s not love, although that’s important. It’s knowing how to say you are sorry. It’s that simple.” Wham! Gasp! Ouch! I had to catch my breath. I seriously wanted to ask him, “Did my husband put you up to this?” I half expected to look over my shoulder and see Manny standing there, laughing. But I knew what was going on…God was putting me in my place.  When he told me that, I knew I needed to text Manny and apologize. And I did.

Well, he didn’t stop talking. He told me about the four H’s that are the key to life: humility, honesty, humor and happiness (who knew we could boil it down to that). He told me that raising your kids with God is the right way because they will be strong, faithful and true. He told me about caring and that you can’t expect everyone to care for you if you don’t care for anyone else. “Peace be with you” he kept saying. He then started to talk to me about how he had sinned and how he knew that God forgave him and that God loved him. He started to tell me about his wife and how great she was to him and how much of a better mother she was than he was a father. And he even started telling me how he hoped people didn’t remember him in a bad way once he passed. 

I have to tell you that at this point I’m getting a little worried. I’m appreciating and truly soaking up everything this man is telling me, but I can’t help but realize how much of a change it has been since this morning. I’m starting to get scared. Yes, scared. Is this man telling me his last words? Are these his last reflections in life? Now, I’m starting to bargain with the main upstairs…“God…please, if you are ready for Joe to come to heaven with you I totally respect that but please PLEASE wait until after 4 p.m. Thank you. Amen.” That's the last thing I need right now.

 Anyhow, Joe soon came back from the reflection period…he asks me, “Are you married?” I tell him yes and tell him I just got married in October. “Are you pregnant yet?” he asks and laughs. I tell him I have two boys, a 2 year old and one that is going to be one next month. “Wait a minute!” he says, “When did you say you were married?” I tell him October. “Oh it’s ok, God will forgive you.” LOL…Thanks Joe…for someone who can’t remember the last minute, he remembered that. I’m sure that was God putting me in my place again. I laughed, to which Joe responded, “Did I have a heart attack or a stroke?” Thank goodness…

On another note, Joe’s wife came to visit him in the afternoon. Joe kept repeating his questions to me and his wife kept leaving the room because she was getting irritated with him. When she came back in she told Joe to stop asking me questions over and over because I have things to do and he was keeping me (I didn’t mind at all). He was sure he didn’t ask me that question before and asked me again. She became angry with him. Then he asked me again. She became more frustrated. I know she is having a hard time dealing with the situation. “Stop it! She doesn’t want you asking her the same question over and over!” she yelled. Joe apologized to me and seemed visibly upset. “Don’t apologize to me,” I said. “I enjoy every minute with you and you can ask me the same question over and over and it won’t bother me at all.” And then I turned to his wife and said (in a very pleasant voice), “Joe was telling me all about you this morning…how lucky he was to have you as a wife and a mother to his kids. He loves you very much. I’m really happy that Joe has such great memories of you. Even if he lost his short term memory, he will always remember you and your family. He remembers everyone’s birthdays and names and  ages and even your anniversary date. And not everyone that suffers a stroke is that lucky. Imagine if he didn’t remember you at all…if he didn’t remember the last 59 years with you or your children or your family.” Now THAT is something to think about isn’t it?

Alcoholics Anonymous

Today I had the opportunity to attend a local Alcoholics Anonymous meeting. No, I just didn't decide to go. In fact, it was a class assignment. Needless to say I was very nervous and apprehensive about the experience. I had no idea what to expect and to be honest I was -in many ways - scared. How would they feel about a nursing student attending their meeting? Would they be upset? Or would I be able to blend in? Would I have to talk? Would they single me out? Would they be mad? Would they be happy? I just had no idea what to expect and the unknown was wrecking my nerves.

First off, let me tell you the first thing I noticed: if you aren't an alcoholic or if you've never been an alcoholic you AREN'T going to fit in. It’s as simple as that. It’s not that they all looked the same: they didn’t. There was a range from those business-dressed to those that looked like they couldn’t afford any clothes at all. In fact, I was amazed at how many homeless find their way to AA every week. But it wasn’t the clothes that singled me out: I simply couldn’t fit in because of my face. Those recovering addicts wore something on their face that I didn’t wear…and I really couldn’t put my finger on it at first. The only thing I knew was that I just looked…different. It  wasn’t until the end of the meeting that I realized these people wore hope on their face.

I don’t want to get much in to the specifics of the meeting. I found the meeting to be kind of, well, sacred – and I don’t want to ruin that feeling for me. I will tell you what I did come out of there with though – I came out of there with so much respect for these people. They appreciate every day and live their life with such belief and conviction. Why don’t I live my life that way? All of them attribute their reverence to the twelve steps of the program and to their recovery. Maybe some of you are familiar with those steps, but I never was. I found myself reading and re-reading the twelve-step plaque on the wall. Let me tell you something – we might not be alcoholics, but if EVERYONE followed some of those steps the WORLD would be a better place.
Steps 2-11:

WE:
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

Therapy

As most of you know, the past year has been a year of incredible change for me. Yesterday, while in my Mental Health clinical, I came to the realization that I have come very far in just the past semester of nursing school: my world has grown in many new ways and directions and most importantly I have been enlightened on SO many things I never even considered. Maybe that’s one of the biggest blessings of working with people in a healthcare setting: you become witness to things you never would have had you not been in these situations. Needless to say many days I have left my clinical sites angry, sad, frustrated, upset and sometimes incredibly happy. 

Yesterday, in the course of one day, I found myself having waves of happiness mixed with waves of frustration and anger. I began questioning so many things that are going on the world. When I left clinical I called Terri and asked the one question that had been begging my attention all day, “How do you do this for your entire life?” And I didn’t ask that question because I think this job is horrible or that I couldn’t do it: truth is, I want to. But the part in me that aches for many of the patients I have met wonders how a nurse can deal with things that often seem unfair or unwarranted. How do you not become run down, frustrated, upset or how do you go through life as a nurse without questioning God about why things are this way for some people? Of course I had a great conversation with her and my Poppa and then I was home – where my family becomes my therapy from all of these things that I am beginning to question. 

I’ve found myself trying to talk about the things I’ve been thinking – the things I’ve been feeling, wondering, questioning. What I’ve found is that sometimes the words that come out of my mouth don’t truly convey what I am feeling. Writing has always been my therapy but in the past few years I have often put it on the backburner. Lately I’ve come to think that now is the perfect time to start again: not only can I find a place for reflection but I think if I come back to this again in ten years I will be amazed at how much I have grown on this journey. And most importantly, writing will convey what words can’t always express. So with that said…

Yesterday was my last day of my first weekend of clinical in Mental Health: overall it was a great day with many great experiences.  It was also a day of great reflection for me. I found myself questioning so many things when I encountered so many of my patients which ranged from those with depression and those in detox to those with schizophrenia and psychosis. My patients weren’t crazy: they were suffering – suffering from some sort of chemical imbalance or, in many cases, suffering from deep emotional pain or trauma. 

Take my schizophrenic friend, for example. He’s homeless. He’s been in the facility more than once. He comes in, is stabilized and then is released to the world where he once again “relapses” and returns back to the facility to be stabilized again. Why, if stabilized on his meds, does he relapse? Well, what homeless man do you know of that can afford medication? Not many if you ask me. But he also has a bigger problem: his wallet was stolen. He doesn’t have any form of identification – he is only who he says he is but with no proof. Can you imagine going through life without ANY form of identification? I never thought of that – I’ve always had an ID or a way to get a replacement. He can’t get his ID from the DMV because he needs his birth certificate and social security card: he has none and doesn’t even have the money to pay for a replacement, much less a stamp. Most importantly, he can’t apply for help getting his meds because he doesn’t have an ID, or a social security card. It doesn’t quite seem fair to me to release someone back into the world without the ability to pay for or receive their medications. It’s like asking for a relapse. I did, however, learn of a wonderful program in Orlando called IDignity, which aims to provide identification for the poor. My schizophrenic friend has been adopted by them. I am grateful for that. 

I’ve learned that meds are touchy subject. Yes, I’ve heard people talk about them but being right in the center of it has given me a darker reality of the battle with medications. Many of the patients I met were depressed – they knew they suffered from some form of depression and many of them VOLUNTARILY checked themselves in to protect themselves from, well, themselves. I can’t tell you how many times I heard something like, “I couldn’t afford my medications so I had to check myself in before I hurt myself”. They KNOW they have a problem but they can’t afford to treat that problem. Which begs the question: are those with money, or insurance, more important than those that aren’t? What if this was my family member, my friend, my husband, my son, my daughter? I don’t know if universal healthcare is the answer but something has to change. No one is more entitled to health than anyone else.

The AMOUNT of medications that are prescribed definitely doesn’t help either. Take addiction: it’s a nasty thing. Whatever the addiction may be, the detox is twice as bad. Everyone knows this right? So, instead of dealing with the nasty parts of the detox process, let’s just medicate our patients so much that they can hardly even stand up: we don’t have to worry about them being combative, we don’t have to hire extra staff to deal with them and we don’t have to pay much attention to them at all right? How is this fair? You put someone detoxing on a regiment of eight or nine medications so that they can’t feel the “pain” of their detox. Doesn’t make much sense to me because now we are just trading one addiction for the other: these people are craving meds, meds, meds and guess what? In three days, when they are released, they will stay on those eight or nine or ten meds. And when those eight meds run out and they can’t afford them they will substitute the next best thing that they can afford. Overmedicating DOES NOT treat addiction, it BREEDS addiction. And they wonder why so many of these people keep coming back?!?!? 

Truth is, I care. These people have stories. Some of these stories are incredibly hard to stomach. What if I had gone through those things? What if I had been raped my entire life and then my parents were murdered and then I had lost my children? What if I had grown up in an orphanage in a war-ravaged country and had never received the love/acceptance that every child needs? Did you know that many orphans from the war in Poland who are now reaching their teens and early adulthood are increasingly showing signs of mental illness? Many people believe that they grew up in such dire conditions in orphanages (warehouses) that they never received the love and acceptance that they need to thrive as adults (remember the monkey/motherly love experiment?).  I made an extra effort (although it doesn’t take much effort) to hug my babies last night.

I’m brought to another point of frustration in my experience: burnout. I’ve met some pretty great nurses, but I’ve met some - for lack of a better word -bad nurses. I don’t know what’s going on in their lives but their patients suffer from it. Being a nurse isn’t just about going through the motions. It’s not just about the physical part of care.  It’s about CARING. Why was my patient on Thursday covered in pressure ulcers when her nurse has been taught and knows about the importance of turning and repositioning a non-mobile patient? Instead, her nurse lets skin and muscles deteriorate until there is an open gaping hole in her back. Why? I’m not sure. One part of it is burnout. I know it. There often aren’t enough nurses to care for the amount of patients they have. It’s a hard job sometimes. In many cases we need a smaller ratio of nurses to patients, otherwise, quality of care is affected. Some nurses are just in the profession for the money and that truly affects how they view their patients. I’ve seen it. I’m writing this down for one purpose only – in ten years when I come back to read this I hope I can look at myself and say, “Thank God I am not one of those nurses!” Let’s hope. 

One thing is for sure: the past few months have left me with such a deep appreciation for the things I did and do have. I will never take the health of my mind, body or spirit for granted. Nor will I take my family for granted – they are a therapy like none other and are probably much of the reason that my mind, body and spirit remain healthy. They keep me whole.  

And maybe, as I work more and more with patients they will keep me whole too. When I left my patient on Saturday I told her that I would be back on Sunday. "Will you?" she asked. "Yes, bright and early." I said.  Sunday morning, with excitement, she said, "Wait here..." and ran to her room. She came back with a painting and said to me, "Not many people in my life come back when they say they will. I made this last night and told myself if you came back like you said I'd give it to you." A glittery barrage of paint became one of my favorite pieces of art.