Month: December 2022

Christmas Without Christ
mom of boys

Christmas Without Christ

lesbehonest20171 Comment

I grew up going to church. Until I was confirmed and somewhat older and realized there were a lot of holes in this Christianity situation.

My ex was raised in a more conservative and cult orthodox church. So when we had kids, we were both fine with not bringing the boys to church. I did like the community aspect to church and the community support. Growing up we became very close with many members of the church- I in a healthy way, my ex in a cult-like depend on us and only talk to us and no one else ever type of way- but regardless- it provided connections to people.

In terms of the holidays it provided context and some structure and fun events. There was always a kids pageant and then an adult run nativity pageant that was done outside. With real sheep. The sheep got loose one year. My Dad was a Shepard. It was hysterical.

Now I’m raising boys who have never been inside a church. It’s weird. They ask random questions about God and I try and explain and it usually devolves into us getting into a fight about whether God is a man or woman. I had finally sort of explained a genderless concept of the Christian God. Preface to this next bit- I also had explained sperm donors and that you need a piece of a man and a woman to make a baby. Trust me that is important.

Up goes my nativity scene that was handcrafted by my Dad (who died in 2019). I am looking at it rather nostalgically and one of my sons asks who the people are. I start to explain the story of the birth of Christ. It went something like this, “In the Christian religion there is a story of the son of God being born. Christmas is the celebration of the birth of the son of God. Mary, right here, is Jesus’ mom. Then Joseph is his, well, sort of stepdad I guess, and then these are the wise men, they are three kings who travel far to see the birth of Christ, and then here are the shepards with the sheep, and they all meet up in a stable where Mary gives birth…” “But why do they have to have a baby in a barn?” “Well there are many people, bad people, like bad kings, who are threatened by the birth of Christ so they are kind of in hiding, and there is also no room for them anywhere else,” “Bad kings like Donald Trump?” says one of my sons. … “Um, I don’t think I have ever described DT as a bad king…so kind of not like DT, but, okay, so then,” “So Joseph is the dad?” Me- “Well no, Jesus is the son of God.” “But Mama, you told me that God is not a man.” Me- “Correct.” Skeptical eyes regard me, “So if God is not a man and you need a piece of a man to make a baby then who is Jesus’s Dad?” … “Um here’s your stocking. Why don’t we hang up your stocking?”

Apparently Christianity understands how whacked their story is because they prefer to indoctrinate people from birth. Because my kids questions were all totally solid. And honestly, if you’ve read Mathew, Mark, Luke and John, well the whole birth of Christ story is a bit hodgepodge. One linear narrative would have been very helpful. And the whole “The spirt of the lord came upon her” is just not a satisfactory explanation to a seven year old and in fact is kind of creepy post the whole #metoo movement.

I never thought the story of Christ was creepy before I had to explain to a 7 year old boy though. I also never thought I would have to be the one explaining it. I guess I assumed I would raise my kids in a church. I don’t regret not doing it but it makes religious based conversations rather challenging. There are concepts and storylines I just accepted because I was raised from birth hearing them. But when they are being explained for the first time perhaps at age seven…when I’ve spent the first seven years educating them in a very logical, science based, concrete way…well it gets interesting.

I’ve tried comparing God to Santa Claus- not that God is like Santa Claus, but that we believe in Santa and we have faith he exists, and that’s sort of how people feel about God. That we have no evidence He exists but that many people have faith that He does. “But Mama, you said He’s not a boy,” “I did say that yes, I just revert to calling Him ‘He’ sometimes because that’s how it’s referred to in the bible,” “So He’s a boy?” “Well no, He was written about by boys though in a way to subjugate women, so it makes sense that they gave Him a more masculine presentation…” Then they stare at me.

Listen parenting is hard. Explaining the concept of God to an adult let alone to a black and white concrete thinking 7 year old….it’s rough. There is a part of me that feels they are missing out on an experience by not being raised in a church. But it also feels hypocritical to partake in Christianity when I believe it was a religion made for very political purposes and the holidays are clearly based off Pagan holidays and paganism was women driven. I probably should not have attended a religious college because the deeper I studied religion the more skeptical I became.

If my kids grow up and attend church and engage with religion though I will support them 100%. Unless it’s one of the cults. Then I’ll be moderately irritated and likely have to infiltrate the cult in order to produce an expose documentary which will include saving my children from the cult.

In the meantime I do the best I can piecing together the stories of Christianity, interjecting Pagan traditions, and trying to educate myself further on Judaism. Because enter a discussion about Chanukah. “Mama, can we celebrate Chanukah?” “Well we generally don’t because we are not Jewish.” “But we don’t go to church and we celebrate Christmas.” …. Touché my children. Touché. I have a year to study up. I told them it would not mean more presents. They seemed okay with that proclamation and were more focused on wanting to see a menorah lit up.

This year I anonymously ‘adopted’ a family of three children from my town and the boys and I went to Target and overfilled two carts with Christmas presents for the three kids. Throughout the store the boys had to be reminded a couple times that we were there to help a family who needed our help and this was not a shopping trip for them. When the total rang up the boys asked if I would have any money left to get them presents. I told them even if I didn’t they should be grateful that we are helping out a family. They helped me wrap the presents, it took awhile, and a lot of gift bags and tape, and a list of what was in all the bags…and then I got an email there are a few tags left that had not been taken. I brought a check with me to cover at least three more tags along with the presents for the family we shopped for.

I did all of this rather quietly but those boys see all. Flash forward three weeks to this morning, Christmas morning, we finished unwrapping our presents and one of my sons said, “Mama, you know those families we helped, I bet they are happy too. And they don’t even know who we are and we don’t know who they are! That’s so weird.” I smiled, and hugged him, and said, “Weird but good right?” He smiled back and said, “Weird but very good. You helped people and that’s what Christmas is all about; that and being grateful. I’m thankful for my family and it only matters that we are together.” And it’s those moments when I think, you know what? I’m doing okay.

“What Are You Looking For?” On Every First Date Ever.
Divorce and Separation · politics

“What Are You Looking For?” On Every First Date Ever.

lesbehonest20173 Comments

You ever do the dating apps? OH and I had to replace the damn fresh cut tree (yes I also did a second freaking cut when I got it home…asked literally every person who ever has gotten a live tree)…but I’ll get to that.

I’ve talked about my dating misadventures in previous blogs. To summarize: men suck. So do women. My dating experience has been limited to: men who live with their parents, men who are super passive even though it says in my dating profile not looking for passive…because that doesn’t go well with me. Literally had a guy say at a second date “You’re going to have to slap me in the face to make anything every happen.” First off…I don’t even know what that means but I won’t be slapping anyone in the face. Thanks. There was no third date. But there was a text that he thought we could be good friends. Puke.

But I digress. With all the bad dates. And there have been many. Many. I’ve had to think about what would make up a good date. Or perchance a good relationship. Because what I thought was good in my 20’s landed into not good in my 30’s with my ex. So I’ve thought a lot about this. What is a good relationship? And the cliche first date question is “What are you looking for?” I have a response now. I just am not sure that it exists. In one person. Maybe I’ll have to go poly.

I’ve whittled it down to two short paragraphs. The first is from The Line. You ever listen to the podcast or watch the documentary on AppleTV? I’ve done both. Blew my mind both times. Because I normally do NOT side with Republicans. In fact I still feel mind-fucked to even be considering their side. But that’s not really what this is about. It’s about the wife of Eddie Gallagher. Eddie killed an Isis soldier and then was arrested and charged for it. I know. It’s counter-intuitive. He was in Iraq to kill Isis soldiers. But there’s a whole documentary about it- war crimes, etc.

Eddie is generally unlikeable on the podcast- he is more likable or perhaps more understandable on the documentary. But I’m not looking for an Eddie. I’m looking for the loyalty his wife and his brother show him. I mean, talk about a partner having to literally give their all for their partner. I generally find Andrea (his wife) unlikeable. But, even I can admire her tenacity in fighting for freedom for her husband. So when some one asks me what I’m looking for? That. I’m looking for a partner who would move the sun and the earth to fight for me. And some one I would do the same for because I believe in them, in us, so hard that I’d do anything for them.

It’s hard to put that into words though; especially if they have not seen the documentary or listened to the podcast. But I guess loyalty, love, and a fierce protectiveness.

My second metaphor or analogy or whatever is a look. It took me until I was in my late 20’s to recognize a look of lust. I’m kind of dense. It also took me until my late 20’s to realize some one is flirting with me. But now in my late 30’s…I get it…I still may say something awkward like “Ooohhh you’re flirting!” Then they get embarrassed. Then I walk away.

But the point is; I recognize it. It still surprises me because, I’m generally looking exhausted running around with my kids, but I do recognize when it happens.

The other thing I’m looking for in a partner is the look you give and you get when you make eye contact across the room and you just know you want to hop into the nearest closet/car/bed and rip their clothes off. And vice versa. I want to be wanted and I want to want some one else that badly. Some could say passion has led to some bad decisions in my life. But that doesn’t mean I should give up on it. I want the lust as much as the love.

The problem with me saying that to a guy…is they think I want to hop into bed. On the first date. Because as I said…men suck. But so do women. So I’ll be single. With my pup. And my two cats. And the damn Christmas tree.

I got a fake one. The real one died. Literally died. Needles everywhere. Ornament transfer. Dragging dead tree out of house…that’s it. That’s the end. Love. Lust. Loyalty. Republicans. And a fake Christmas tree.

A B*&$H About Benzo’s
Nursing · politics

A B*&$H About Benzo’s

lesbehonest2017Leave a comment

I watched Xanax on Netflix. It’s a documentary about anxiety and Xanax.

I had a lot of feelings come up as a prescriber.

I think the commentary on the mental health system and race was good and certainly accurate. I think the commentary on why we as a society are anxious is also good/accurate. But it misses why Xanax is a problem.

Benzodiazepines are meant to be used short term. The psychiatrist does say this. She does not go into why though people end up on them long term.

There are a number of reasons; starting with there is a shortage of mental health prescribers. Primary care physicians and APRNs end up bridging this gap. They are comfortable starting some one on Xanax because they are actually taught to do this in school. The line they give is “I’m going to prescribe you a 7 day supply, and give you time to find a mental health prescriber.” Now, it takes more than a week to get an appointment. At my practice we are booking out 2-6 weeks depending on provider. The prescriptions then may get extended and by the time a patient lands in front of me they have been taking Xanax daily for six weeks. As prescribed by their primary.

This is not meant to knock PCPs. They are doing the best they can in the system we exist in. But there is no education about it. There is likely no discussion about what will happen when they see a mental health provider- aka we are not going to continue it daily and we are going to recommend a daily antidepressant medication. And once you’ve had xanax- well Prozac just does not feel as nice. Thus begins a person chasing the “calm” aka “high” that Xanax induces and being really angry at the mental health prescriber who won’t give it to them.

The documentary then spent less than ten seconds on the pressure on prescribers to do what the patient wants. And at the end of the day- that’s what matters- because without that pressure prescribers would have the balls to prescribe safely and ethically. I had to leave a top hospital in our country system to prescribe safely and ethically. Let that sink in. I had to leave a top hospital in the country to be a good and ethical prescriber.

Here’s why.

You ever hear about Press Ganey? It’s a company that puts out those nice little surveys all patients get after a hospital stay. My raise and reimbursement and ability to advance in the corporation was dependent on my Press Ganey scores. Yes, much of my present and future career at the hospital was based on feedback from patients. I worked on an inpatient psychiatric unit and usually half my caseload were hospitalized involuntarily. Then about 1/8 of those people had to be medicated involuntarily through a hearing with a probate judge.

Guess how many of my patients gave me and my team good reviews? Potentially half. The other half, well I was lucky to not be sued by them; which was threatened daily.

Let me tell you a story. Patient X is on Methadone 120 mg, Xanax 1 mg TID, Quetiapine 800 mg nightly, and Lithium 450 mg ER BID. Patient X is admitted on this regimen for depression and suicidal ideation. They are noted at the table in the morning eating breakfast falling asleep. Legitimately falling asleep. Food falling out of their mouth mid-chew.

They are now a choking risk. And within six months of me starting I had some one on Methadone choke, and need to be resuscitated due to their airway being completely blocked. It’s a real thing that happens.

Me being the responsible APRN I am, consult with my Attending MD, they agree, we need to lower their sedating medication especially AM dosing when they are eating right after. We also review the EKG, shows significantly prolonged QT interval- due to Methadone/Quetiapine combination- prolonged QT interval can lead to Torsades which leads to sudden cardiac death. Again- kind of a big deal.

We go sit with the sedated patient, who barely responds to us verbally, and tell them we are going to start tapering their Xanax and Methadone. VERY SLOWLY. We will not put patient into withdrawal but it is unsafe how incredibly sedated they are. Patient mumbles as food falls out of their mouth.

Next day. I walk onto unit. Patient screaming about doses being lowered. Thus begins a very unhappy week for myself and our team and our patient. But. They did not die, they did not have any observable or measurable withdrawal symptoms. And they were able to actually be awake for mental health treatment by 10 AM and engage in groups and therapy. They left on lowered doses of Methadone and Xanax with a lower QT interval and not a choking risk. But they gave me a complete crap review and wrote a novel about how we sucked.

I had to have a sit down with my manager about that case not because of the inappropriate prescribing done by their outpatient team, or the good job in looking out for their respiratory and cardiac health- and preventing another preventable choking potentially fatal situation on our unit- but because I got a bad review. I had to review the chart with my manager and go over the case step by step defending my actions along the way. Amen for my stellar documentation, the withdrawal measures (which were all negative), and the objective data provided by group leaders, EKGs, vital signs, etc. that showed patient had a decrease in depression, decrease in SI, and increase in attentiveness, concentration, and ability to engage in treatment.

My manager wanted me to sign a form saying that basically we had spoken about my negative review. I declined. I requested a meeting with HR. So the cycle began. I provide safe care in conjunction with the treatment team including an MD. I get a negative review. I have a meeting with my manager then with HR. This is not unique to me. This is common among any prescriber working for a corporation that favors patient satisfaction over safe and ethical treatment.

This is not the only reason hospitals cannot retain good doctors and APRN’s. But is definitely in the top three reasons. At least it was for me, and for many of my colleagues.

It is not safe to be a competent and ethical prescriber when working for a healthcare corporation that measures my present and future success by patient reviews- especially when working in psychiatry and addiction medicine.

This does not just apply to inpatient work. It applies to outpatient centers also. My pay being directly linked to patient satisfaction is a problem and the reason I do not work for a hospital corporation any longer. Because working with patients who ran out of their Xanax early, their outpatient prescriber says they are going to be cut off, now I have to forcibly taper them off of it- doesn’t go well for me in my reviews. But that’s part of the work inpatient, and it’s part of being a prescriber. Making tough calls, and especially inpatient working within a team of clinicians to do right by the patient.

So me being ethical and legal…didn’t go so well. And that’s what the documentary failed to expound on. Not only are there these patient reviews- but these patient reviews dictate how much money we make, our performance reviews, and how and if we can advance…and that, my friends, is a fucked up system that invites prescribers to make bad decisions to advance their pay and their careers.

I still get negative reviews on Google for my practice. And they still irk me. But they do not impact my ability to advance my practice or myself. I also can look at them objectively and say, well that patient didn’t get the 3 mg of Xanax they wanted, and got mad, pulled a knife on me- and then wrote a Google review. True story. The google reviews don’t bother me because they do not impact my career and to date they have all been reactive to me setting boundaries and prescribing ethically and legally.

I still have a full caseload, a growing practice, and rock solid clinicians who work for me who know I have their back to be good, ethical, competent clinicians and that I will not let a bad review by an angry patient who we held a boundary with impact their pay or merit or my respect for them.

I agree with the psychiatrist in the documentary when she says benzodiazepines have a place and a time and I am incredibly grateful for these drugs to have been invented and utilized by clients who need them. Because I do prescribe them when appropriate with a lot of education, a urine drug screen, an informed consent form with risks/benefits that the client must sign, and what the expectation will be going forward in terms of treatment.

I have full control over my caseload whereas before I did not. Until our healthcare system changes from a for profit, patient satisfaction oriented system- there will be more irresponsible prescribing and irresponsible treatment. There will also be a lack of retention of prescribers in areas they are needed most such as mental health and addiction psychiatry. The two are linked and need to be addressed nationwide.

*****This blog post covers a very small portion of the issues and dangers of benzodiazepines and is not meant to be fully comprehensive of every issue prescribers face in relation to benzodiazepine prescribing.