Tag: nurse

“Tilt When You Should Withdraw”
Nursing

“Tilt When You Should Withdraw”

lesbehonest2017Leave a comment

You know you’re a millennial when…the movies of the late 90’s and early 2000’s still define who I am as a person. And they are grossly underrated by all these twats coming after us. You know I’ve met multiple people (mostly my clients in their early to mid-20’s) who have never see Lethal Weapon or Bad Boys? To be fair Lethal Weapon was 80’s but Bad Boys?! None of them! Do you know how many times I’ve referenced a line and they stare at me blankly or worse like I’m old?!

Despicable. But the worst is if they have not seen A Knight’s Tale. Not only is Heath Ledger probably one of the best actors to live (and die far too young) but it’s hilarious, sad, poignant, and action packed.

It’s also historically relevant because it’s loosely based on Chaucer’s A Knights Tale. There are many parts of this movie that speak to me, essentially the whole movie. Because it’s an underdog story of a young man being told he can’t. But then he does. I have always felt that. As a girl I was told I was too smart, too loud, too opinionated, as a woman I’ve been told the same.

All William wants to do is joust. And he’s rather good at it. He builds a team ultimately who believe in him and who stand in front of him in the stocks to block the rotten food being thrown at him. That’s when Prince Edward unveils himself and steps up to William who is dirty and weak and bent in the stocks.

Prince Edward (who is also kind of hot) leans over and says “What a pair we make huh? Both trying to hide who we are, both unable to do so. Your men love you. If I knew nothing else about you, that would be enough. But you also tilt when you should withdraw…and that is knightly, too.”

Tilting exposing a knight’s face and leaves them vulnerable to injury but it also gives them the most advantage in striking their opponent.

That scene gets me every time. I’m usually crying by the time he pulls William out of the stocks and he shakily kneels in front of the prince.

It’s quite a thing to be seen. To truly be seen. If you think about it there are very few people we come across in life who see our true selves for all that we are. Who have the patience, the insight, and the ability to see who you are.

That scene gave me hope as a teenager that I could be something more. That I could “change my stars” and along the way I would meet people who truly do see me.

I had to grow into a person I was proud to have people truly see. It was hard in nursing as a confident, smart, and direct woman. The feedback was mostly negative. And the message was to do my job and not question management even when nurses were being assaulted and abused. God forbid I ask for mental health services after a major assault or updated TdAp vaccines for the entire staff after two pertussis exposures to me personally and twenty other staff members.

It took distance and time and therapy for me to realize that what I sought was not wrong. I’m allowed to take up space and ask for reasonable accommodations, help, and support from my employer especially when working in high acuity and dangerous areas.

People seemed to listen when I spoke. I was told by a manager after I became an APRN that I was an “unofficial leader” because they knew everyone would listen to me but that I was not actually in charge. That surprised me. I didn’t realize people paid attention to me honestly.

That conversation opened the door for me to open my own practice. I was not wrong to be smart and confident and direct. I was not wrong to expect a safe work environment. And I could get that. But I’d have to do it on my own.

Five years later I am safe and I’m surrounded by people who truly see me and appreciate me personally and professionally.

It’s been validating to be in business for myself and treat employees the way I wanted to be treated and to see their appreciation and the loyalty that it builds. I’m not perfect. I’m still too direct. And I am impatient sometimes. And maybe too patient other times. I also tilt when I should withdraw- I fight the fight for clients, employees, I fight insurers, and my favorite line is “I’ve got nothing but time,” whenever I’m told that something is not possible…I make it possible. And my friends, family, and co-workers see this.

They see me and finally that what were perceived as negative traits are actually positive and have helped me grow a business and expand mental health services for the Queer community.

I’d like to think if I was in the stocks I’d have some people who would stand up to block the rotting vegetables from hitting me.

That’s a good feeling actually. Knowing I have people who see me and who think I’m worth protecting. They also would probably make very sarcastic remarks and jokes to work off their anxiety in the moment but they’d be there. (You know who you are;)

Because that is what’s important right? To have people who would block the rotten vegetables from you.

And every Gen Z-er reading this…this is why you are missing out. You don’t even know one of the life goals you are supposed to have. Lord have mercy.

My Thoughts on Treating Murderers signed: a nurse.
Mental Health Stigma Suicide · Nursing

My Thoughts on Treating Murderers signed: a nurse.

lesbehonest2017Leave a comment

Working in private practice people sometimes make the assumption I only treat the “worried well”. Every prospective employee I interview I tell them- while there are serious perks to private practice including total control of your schedule and fully remote work…we still treat sick people. You may get an easy straightforward anxiety…but you likely will have some serious cases that will push you.

For me, I’ve treated…a lot. I’ve treated sexual abuse victims, incest victims, victims of DV, and many other incredibly intense cases over the years.

What has been surprising for me, and what no one ever discussed when I attended school and training- were treating patients who committed murder. Working both inpatient and outpatient I’ve treated roughly 40-50 patients who have committed murder in some capacity.

There are many different kinds- negligent homicide is something like a drunk driver who hits a car and some one in the other car dies- basically an unintentional homicide but caused by the person’s negligence. There are homicides that are intentional, or perhaps just witnessed but the witness is held responsible for not stopping it or for contributing to it, and the saddest are probably the murders committed by people in a psychotic state such as with postpartum psychosis- those are probably the most publicized in the media.

We learn a lot about transference and counter-transference in school- and we do talk about how it would feel to treat a perpetrator of a sex crime but for some reason we never touched on treating some one who commits a murder.

But it’s an important conversation to have.

Working in mental health has caused me to take stock of my values, ethics, and core belief systems…and made me re-evaluate all of those things repeatedly at a very visceral level.

I remember working in the pediatric emergency department. There was a certain coldness projected toward the parents that overtook all of our demeanors when we realized the child we were treating was the victim of abuse- whether sexual or physical. At some point the truth always comes out. And I did treat some children who died of their injuries. And if you could have bottled the rage in the room from the healthcare providers…well that would be some potent nuclear energy.

So I had that background going into mental healthcare.

Then I sat across from my first patient who committed a homicide. I did not have that rage encompass me though. I still do not. I think they expect it. But as the mental health provider treating the perpetrator of a crime, well they are still my patient, and I treat all my patient’s the same. With respect and I try to come from a place of empathy and understanding.

In reflecting on murderers I’ve thought of my Dad. Was he a murderer? Not by my our standards I suppose. But he did kill people when he fought in Vietnam. He was a gunner on a helicopter- one of the big ones where the sides are open…hopefully you’ve seen enough war movies you know what I mean. I asked him one day when I was old enough to realize what a “gunner” meant “Dad does that mean you killed people” and in typical Dad fashion he said, “Well I killed more cows than people hon,” and that was that. My Dad was excellent at non-answers. Especially about Vietnam.

So I suppose the first “murderer” I sat across from at a table was my Dad.

So you can see why I have a stronger response to pedophiles than to murderers? Murder I’ve had to assimilate and rationalize because I grew up the daughter of a combat veteran. There ain’t no assimilating or rationalizing pedophilia though. That’s never okay. Not even in war.

I am speaking somewhat facetiously because the double standard is absurd. Murder is never okay. Pedophilia is never okay. But we live in a society that is more okay with murder than any other type of crime. As evidenced by the lack of gun legislation in America after the first mass school shooting. We receive the message from the highest level of politicians and courts that murder is justified as long as it’s with a gun that you should be free to carry.

We also live in a society with combat veterans who have committed legal murders. And we praise them, respect them, salute them. I am not saying we shouldn’t do all of that. I am grateful for all the people who have served and continue to serve our country because I see the sacrifices they’ve made in my work every day in the veterans I treat who carry such shame, guilt, and trauma.

I used to be very black and white in my thinking. Back when I was 22 and thought I could be part of the solution in saving the world. I’m 37 now. I’ve seen children die at the hands of their parents- intentionally and unintentionally. I’ve treated men and women who have been raped and who have killed.

I also grew up with a Dad who was a Vietnam veteran and deeply committed to the love of his country.

Through all of this I’ve come to realize there cannot be a black and white version of myself or of mental health treatment. I’ve treated rapists who I did trauma work with who were deeply wounded humans perpetrating in the cycle of their own traumas. I’ve treated incredibly brave and resilient victims and supported them through court proceedings to bring their perpetrator to justice. I’ve treated murderers who carried the deep wound of taking a life. And I’ve treated murderers whose murders were legal in the face of battle but who have to make the decision to live every day because the incredible wounds they feel internally drive them so close to suicide.

There is no black and white and there is no right or wrong. What I’ve discovered in myself is that I have to present myself with empathy, understanding, and I have to listen to my gut and bodies responses. If my body is telling me that there is no remorse here, and potentially sociopathy, our consultation appointment is just that. A consult. And I will not be following up with them.

But those are rare. More common is the person who is just a person. Trying to survive. Who was thrust or who put themselves into unthinkable circumstances and who are spending the rest of their lives trying to not be defined by that one moment. There is grief for the person they once were, compassion for who they are in this moment- vulnerable and seeking a non-judgmental space- and hope for the person they can become.

Fifteen years in and I still love being a nurse. I love this field, I love that it pushes me to see beyond society’s expectations and norms. I love that it makes me examine my own weaknesses and prejudices and challenges me to do better and be better. In these cases it’s pushed me to examine my beliefs about “murderers” and what I found is they are just people with a story. Stories that deserve to be told and to be heard.

p.s. #banguns #fucktheNRA

p.p.s. For all those asshats saying you should have the choice to not treat people who are LGBTQ…you are assholes. If you continue in that vein for your “religious freedom” shouldn’t you also not treat adulterers, murderers, pedophiles…etc? How come you can decide to not treat one population of people but not all the rest? How come you are more comfortable treating a heterosexual murderer than a law abiding non-rapist and non-murdering lesbian? Y’all need to have a Come to Jesus moment. Cuz you make no sense. Just own it and say you are homophobic and transphobic.

This Traumatized Nurse
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This Traumatized Nurse

lesbehonest2017Leave a comment

Part of my practice that I never planned on but am incredibly grateful for are the nurses. Nurses sticks with nurses. So it makes sense that many seek treatment with nurse practitioners.

Nurses are a crazy bunch but we wear our crazy on our sleeve. I’ve said to nurse clients many many many times…”You have a high tolerance for crazy because of your work, so I’m telling you, what’s happening in your life- insert something crazy here- is not okay, and you are tolerating it because your ‘crazy’ tolerance is way too high.” This is actually generally well received and then we process how to address whatever issue they are dealing with.

So here I am in my therapy session today. I said, listen, there’s been a lot of crazy in the last couple weeks, but I need to focus on these panic attacks I’ve been having. I’ve never had panic attacks before, and I kept forgetting I was having them because they were so infrequent.

The first one was two years ago. I was working inpatient and a patient became agitated and stood over me and threatened me. My heart raced, I completely froze, then when I finally left the room I couldn’t calm down. I had to go outside to my car, not speak to anyone, and just sit there and let myself freak out.

When I tell you this is not me…this is not me. I was an ED nurse, I’ve worked inpatient psych, and I’ve had a lot worse situations come at me. Like actually come at me. I went home that day and forgot all about it. Thought it must have been a fluke. Then I worked inpatient again. Similar situation except this time a patient told me he was picturing shoving a knife in my throat while standing over me. Again- this was not out of the ordinary for inpatient work.

Then recently I had music playing and at the end of the song there are two men who become agitated and start fighting. I forgot the song was playing and all I heard was two men yelling at each other, and I freaked out. I looked all over the house and out in the driveway thinking there were actually people getting agitated. Heart pounding. Etc. So I tell all this to my therapist and I say, we gotta do something about this. Because I’ve never had this happen before and it keeps catching me off guard.

She asked me to describe what happened. I did. Then she said, “You know those experiences where you have people physically and verbally threatening you- it’s normal for a person to have their heart race, it’s normal to feel threatened because you were being threatened. Those are not typical panic attacks, they are normal reactions to a stressor.”

Dude. I actually argued with her. I was like, uh no, those are normal occurrences when I work in the hospital. Then she argued back, and then we literally argued about me being threatened. And of course I was threatened. Of course those are normal bodily responses to feeling threatened. What’s messed up is that I literally never thought that.

I thought there was something wrong with me for reacting to people threatening me.

Sit with that for a moment.

That’s what happens to nurses who work in high acuity settings. We are led to believe that there is something wrong with us for expecting to feel safe. I argued with my therapist about my reacting to being threatened. I tried to rationalize that being threatened is normal and there’s a problem with me- not the setting.

Is it any wonder that nurses are fleeing the profession? Why do I feel weak for having a normal physical and emotional response to being threatened? Why do I feel less than and ashamed? Because I have been trained to feel that way. I have been trained to see the problem within me instead of in the messed up hospital systems who do not protect us.

I have been- kicked in the ribs, bitten, spit on, rushed at multiple times, had a chair and a laundry basket thrown at and over my head, had a knife pulled in my office (twice), been verbally threatened countless times including outpatient “I will drop your ass” “I will fuck you up” and so much more. I have witnessed horrific assaults. I have witnessed horrible takedowns. I had a patient, most memorably, leap across a table and land on his knees nose to nose with me, hands fisted on either side of my head and say, “All it takes is a punch. And poof. You’re fucked.” I sat there and stared back at him, and as the entire staff gathered outside the door because the whole unit saw what was happening I calmly leaned in closer and said, “You done yet? Take a fucking seat.” Without blinking. When the laundry basket got tossed, I said, “Dude you are not,” He said, “Ma’am, you better put that pretty head down.” I ducked. He threw it. Not aimed at me.

So many more stories. So many more memories. So you see, when a patient stood up agitated, and I epically panicked, I thought there must be something wrong with me. Because I’ve been through so much worse so many times. I never got time off after any of those events. Except the kick in the ribs. And literally only because there was some minor damage to my liver and a visible large bruise over my right ribs. I never got debriefed after most of these events. I certainly never got a raise or hazard pay.

And in fact when I got time off for the rib kicking- my manager and co-workers made negative comments about it. As if I was weak for being told to take time off by occupational health.

It was all a day in the life.

But now that I do mostly outpatient, and I’ve had space and distance and time to heal. My body and my brain are telling me this is fucked up. When I go back to inpatient and am threatened I apparently react appropriately now. I’m not in survival mode, so I can’t just compartmentalize it out.

I am not sure what the answer is. I do not want to give up inpatient. But my therapist seems to think it’s kind of a messed up place to work. And after much reflection I don’t disagree. It makes me sad to realize that this work I used to love is actually totally ass backward and so detrimental to people’s mental health. Nurses. To nurses mental health.

Even writing this feels bad. I feel shame? for having such a perceived weakness. Then I think this is soooo messed up that I think a weakness is having a normal physical reaction to being threatened. I’ve been told it’s not a panic attack when it’s a normal stress response to being threatened. So my not-panic attacks suck. Being threatened sucks. Being a nurse who thought there was something wrong with me for having an emotional and physical response to being threatened…is just tragically sad.

To all my nurses. It’s not you. It’s them. You are not wrong or bad for demanding safety in your workplace. You are not wrong or bad for having feelings in whatever capacity about being unsafe in your workplace.

The Broken Hearts of Nurses
Mental Health Stigma Suicide

The Broken Hearts of Nurses

lesbehonest2017Leave a comment

Sometimes when I write my patient notes I actually have to pause in between them. On busy days when I do three intakes I likely still have three intake notes to finish late at night after the boys go to bed and it’s just me and the laptop. Intakes can range from easy to me curled up in a ball on my bed watching The Office trying to forget the horror I heard today.

I remember working in the emergency department and documenting abuse cases. I tried to write as little as possible, as I didn’t want there to be any conflictual information between my notes and the MD’s notes. And good lord I didn’t want to be subpoena’d.

I’ve had my charts subpoena’d now. It happens eventually in healthcare. I’ve been called on the phone by judges who just found my chart in the middle of a trial who demand to speak with me about a patient I saw four years ago and asking about a note I wrote and did I think they would actually harm some one.

I’ve spoken to district attorneys and defense attorneys and divorce attorneys and DCF workers. Inpatient I spoke with the Secret Service, the Federal Marshal’s Office, the FBI, and several police departments.

Working outpatient mental health now I generally can avoid the Secret Service and the FBI so that’s a plus.

But sometimes the hardest cases and the toughest stories are the ones who never were reported to law enforcement. Because I know and they know that they suffered and that no one stepped up and protected them. No one made the call for them.

Now here they are all those years later telling me their story. All I can do is listen, document it, and support them now in that moment. I’ve learned a hollow “I’m sorry” doesn’t cut it. They’ve heard that before.

My general response is a poker expression, so they keep talking, and/or if they are looking for some verbal confirmation that I’m listening, “That’s fucked up.” or “That’s horrible.” I’m sorry isn’t enough. But when you acknowledge that it was fucked up with a straight face that looks like maybe you would fuck a person up for this client for what they’ve been through. That had I been there all those years ago I would have called the police for you or DCF or both…that’s when they make eye contact and really see you.

They can really see that your heart breaks for them.

I always see articles about nursing being the most trusted profession. Then commentary on why it’s nurses and not MDs. I’m always thinking why would it be MDs? Why not nurses? Do people even know what nurses do every day?

I’ve had a long week. Hard week. I’m also approaching my first birthday without my Dad. That’s been weighing on me in the background.

But this week in between being yelled at, threatened, etc. by patients and former patients, I’ve had parents call and tell me “They wanted to fire you and I told them oh hell no because she’s the only one who gives a shit about you and your medications. She’s the only one that’s done a damn thing for you. So she was what? Brutally brutally honest with you?! Good. You freaking deserve to hear the truth and she’s too real to not tell it you. They are coming back to see you. Because I don’t trust any one else to see them.”

Some times I need to hear that.

There’s a Frasier episode when he starts private practice. His first day of course is a disaster. He starts by trying to welcome’s each client. By the end he says just come in a sit down. That’s how I felt by 3 PM Friday. Just get in here and sit down and let’s get through this.

But you can’t do that. I can’t do that. I had to be there. Present and accounted for. I did a lot of intakes this week. I kept thinking about how to welcome them into my practice. I find though that I’m an acquired taste.

I had a few clients disagree with me this week. What’s great is that they keep coming back. I teach through modeling that it’s okay to disagree. That I disagree without judging their opinion. That we can disagree about certain aspects to their diagnosis or treatment and still work together often by reaching a compromise and often by me working hard to understand and validate their point of view.

Psychiatry is hard. Nursing is hard. Because at the end of a week like this week I don’t want to spend time with my kids. I don’t want to be a wife. I want to curl up and watch The Office. Space out. Forget and not feel. But if I do that. If I numb out I don’t feel my heart aching for some of my clients. That would defeat the reason I became a nurse.

Instead of numbing out with tv or alcohol or anything else. I am writing my notes. Charting. In between my notes I’m writing this blog post. To feel. To process. To know it’s okay for my eyes to well up when I think of the experiences some people have lived through. It’s okay for me to feel something for my work for my people. Because if I didn’t feel that. If I lost my empathy then I’d be useless at my job.

That’s why nursing is the most trusted profession. We allow ourselves to be vulnerable with patients. We feel their pain we work ourselves to exhaustion trying to help people. It’s also why we have incredibly high burnout rates but…that’s a different blogpost.

Tonight my heart aches for people who were never helped by anyone but themselves.

Tonight my cheeks may be wet with tears as I chart notes from this week.

Yes tonight my heart breaks with the pain that I bear witness to each day in my office.

I don’t regret my job I don’t even hate it. I love it. Which I suppose makes me a bit of a masochist. But all the notes don’t make me cry. Just a few. There are many more that report “significant improvement in symptoms” and a call from a parent who had to tell me they would never trust anyone else with their child.

Why This Nurse Cares.
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Why This Nurse Cares.

lesbehonest2017Leave a comment

In my time as a psychiatric nurse practitioner I’ve had people react to me in many different ways. I often say people either love me or hate me. There’s not much of an in between. But that’s wrong; I am learning the in between exists.

There’s a gray area where some people live where they just don’t understand me and are scared to hope that I might be real.

It’s taken me some time to recognize this particular response to me as it presents as hate some times. Often times. I’ve had clients scream at me, “BUT WHY ARE YOU BEING SO NICE?! I FUCKED UP!” I’ve had clients say, “BUT WHY DO YOU CARE?! YOU AREN’T MY RELATIVE SO WHY DO YOU FUCKING CARE?”

It surprised me the first couple times. Why would I not care? Why would I be in the profession I’m in if I didn’t give a shit?

I’ve reflected a lot about this particular reaction to me.

Clients that stick with me; who have been with me through divorces, marriages, bearing children, gender changes, sexual orientation changes, sobriety and relapses, and any other major life event you can think of…these clients know that I’ve got their back. They may hate me sometimes. When I’m not doing what they want me to do and I may push them in ways they don’t want to be pushed. But I’m there for them through it all.

I tell clients I don’t get mad at them, I just try and understand where they are struggling and why and work through it with them. And it’s really true. It takes too much energy and would require taking things very personally if I was to get upset with clients and sort of counterproductive to my role.

A client who recently questioned why I cared about them with skepticism said it must be because I have to care because it’s my job because I have to care about everyone who walks through the door. I immediately shook my head no. I do not keep every one who walks through my door. I do not take on everyone who calls. And certainly not everyone keeps me.

It has to be a good fit on both sides. We don’t necessarily have to like each other but we have to have respect for one another and we have to feel safe with one another. I’ve discharged people who threatened me or who were too acute for a private practice. And people have discharged themselves when they don’t get what they want or need from me.

But my peeps, my clients and my patients, yes I care about them. I don’t know any other way to be. I don’t know how to sit with some one and hear their story and try and partner with them to move forward and not feel something toward them. Empathy. Compassion. Because it is from those clients who I learn the most. The clients who take steps forward when the world pushes them back; they are the people who inspire me. They are the stars to see, to feel, to experience, and to be witness to that brings me joy like nothing else.

I saw a client recently and we got in really deep about something and they teared up, and we had this moment, and I’m like you just got therapized. But it’s not just them it’s me who learns from them. Me who learns that it took almost two years to get a tear from them to watch them progress toward feeling the hard mushy feelings.

I care about people because I couldn’t sit in the chair I sit in and not care.

I trained with an APRN who was amazing. She taught me tremendous amounts about everything but mostly she taught me how to see patients as people. She said she did half hour follow-ups instead of the standard fifteen minutes a psychiatrist does because, “Ya know. I like to talk to my people.” I agree with her. I like talking to my people. I like to know them, and although caring about each and every one makes me vulnerable it’s also what makes me good.

It makes people trust me because they know I am prescribing to them in a way that I would prescribe and treat my own family member.

To wonder why some one would care hurts me. Because it means that person has been wounded. Deeply.

Why the fuck do you care?

My answer is because I can. Because I do. Because I see you and you are worthy of being cared about. My question back would be why are you scared of being cared about?

Stop the stigma.

Top Five Most Memorable Nurse Moments From The Emergency Department…Part 1/5
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Top Five Most Memorable Nurse Moments From The Emergency Department…Part 1/5

lesbehonest2017Leave a comment

The most memorable moment for me in the emergency department was unfortunately not a happy one and it haunts me to this day. In fact I avoided writing this for awhile as I just didn’t want to. But it’s a story that needs to be told. Over and over. Because I don’t sweep bad stuff under the rug. I broadcast it.

I was in triage. The panic alarm went off, which meant something was happening with the psychiatric patients. I work in mental health now. I love it. However, it was the reason I left the emergency department. In the ED it’s containment, not treatment. It’s dangerous. I had been kicked in the ribs already, and had friends punched and kicked and bitten. But nothing could have prepared me for that night.

I turned the corner and two nurses who I knew very well, one of them who I had helped train, were bleeding, screaming, crying, in the hallway outside a psychiatric patient’s room. They had been horribly physically assaulted.

I worked in pediatric emergency, but a pediatric patient can still be over two hundred pounds and over 6 ft tall. There were too many people watching, patients, families, staff. I grabbed them and put them in a big walk in closet near by with an Attending who was trying to comfort and assess them.

Then I called a nurse manager I knew was in the office, I told her to go to the ortho closet now. She did. They thanked me later for doing that. Getting them out of the craziness and into a closet. It felt wrong to shove them in there so I was grateful later to learn that they appreciated it.

With my heart pumping I walked into the room of the patient. There were about six security guards holding the patient down. The patient was still straining and fighting. There was blood on the faces of at least two security guards. One had his glasses broken and hanging off his face. These were all people I had worked with for over five years.

With tears brimming in my eyes I used gauze to dab at the blood so it wouldn’t drip down their faces onto the patient. I tried with all my might to ignore the clumps of hair and scalp on the floor from my friends now in the ortho closet. There was blood spatter on the walls.

The worst part. The ultimate horror of that night was seeing the fear in my all of my co-worker’s eyes. Fear and anger and hurt and knowing there was not a damn thing we could do about it.

The patient was under eighteen. And with documented mental health diagnoses. No one would press charges against them. We had been down this road before. This horrific crime that left two nurses injured for months with neck injuries from being thrown around the room by their hair, punched in the neck, and more…it would go unpunished. Forever.

All the nurses that were there that night; we all quit within six months.

It was too brutal. Too real. Too fucked up for us to forgive and forget and brush under the rug. It also showed how the hospital would never have our backs if assaulted in the line of duty. It showed how the system just lets that go.

I can tell you the patient was in their right mind. Not psychotic. I can tell you that though every single person who worked in our department wanted revenge we swallowed our rage and took excellent care of that patient for the next week they were in our department waiting for an inpatient bed.

I never had to wipe the blood off my co-workers before, and while I have unfortunately, had to do it again during my career in inpatient psychiatry it was never quite so traumatizing as that night in the ED.

I returned to work the next day. There was another nurse standing outside the ambulance bay doors. Just standing there staring. She had been there with me last night. We stood there together for several minutes. Not talking. Building up the courage to swipe our badges to go inside. We never spoke. We didn’t need to. Eventually she swiped her badge. We went inside.

I realized in the days following that it reached a point where I was scared to go to work. Every time I heard the panic button I saw the image of them sitting screaming and bleeding. We were all more cautious, more jittery, more likely to give a PRN (as needed medication) for agitation much faster than we ever had before.

Eventually they came back to work and I was incredibly awed by their strength and bravery. Balls of steel was my actual thought. I don’t think I could have done it. Come back from that.

It shouldn’t be this way. Nurses should not be assaulted/attacked/abused. But we are. On a daily basis.

That day should not be my most memorable. I have fantastic memories of so many funny times and good friends and good talks and pranks on night shift and moments of absolute teamwork that can only be done in an acute care setting. Moments when everyone comes together like a well oiled machine to save the lives of children who were dying. Those moments were breathtaking.

I remember when I was new in inpatient psychiatry. There was a medical emergency. I yelled out what I needed and held my hands out and waited…and nothing. I looked up and there were psychiatric nurses staring back at me like I was nuts. I realized then I missed the ED. I wouldn’t have even had to speak in the ED. We all just would have done our thing. It’s a security blanket I didn’t realize I had until it was gone.

Yet the night I remember most wasn’t saving a life. It was watching lives being shattered. Watching my co-workers and friends broken with their blood on my hands. Literally.

When you ask some one what’s the craziest thing they’ve seen as a nurse. They won’t tell you these traumatic memories. But it’s what we are thinking.

I didn’t leave the emergency department because I didn’t love it. I did. I didn’t leave it because I even wanted to. I would have stayed forever. But not after that night. That night changed something inside of me. Changed my perspective of nursing and how our society treats nurses. That night broke me a little.

To all my fellow emergency department nurses out there. I see you. I know you. I value you. You are epic.

Life With a Nurse
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Life With a Nurse

lesbehonest2017Leave a comment

I have the good fortune of having met my wife while working in the emergency department. She was an EMT/tech and I was an RN. She’s been exposed to healthcare. So she gets it on some level when I’ve had a bad day. She’s also been there when kids have died. So she got it when I worked in the ED too.

There are a few core differences to being married to someone in healthcare than to someone who works in an office with no needles or blood.

Let’s start with bad days. When my wife has a bad day…I mean now she works in management in retail. Stressful for sure. But no one walks in bloody and dying. My bad days have evolved from trauma in the emergency department, to insanity on an inpatient psychiatric unit, to a different sort of bad in outpatient psychiatry. I hear horrible stories of abuse, rape, murder, and often it’s not random. The abuse is by a parent. The sexual abuse or predator is a relative. They are horrific, soul-deep stories.

Over time I’ve grown a thick skin. And doing medication management for some people means I won’t hear the actual detailed story. But for my clients I do therapy with. Yeah I’ll hear it.

I also, even in the prescriber role, end up being the first person some one has told something. Often a kid. Often sexual abuse or physical abuse. They could have been in therapy for awhile, and for some reason, it’s just happened a lot, they tell me in our intake. I don’t know why. But it happens. Then I have to tell the parents. Then I often have to tell DCF. Then it totally backlogs my packed day.

So yeah. Bad days in my eleven year career have evolved from death and dying and abuse to abuse but in a different presentation. I’m not collecting the rape kit now I’m helping with the emotional healing after the rape.

It’s heavy stuff. Some times it gets to me. My wife knows. She doesn’t ask anymore because I don’t tell her. Obviously. I can’t. But she knows. She knows because I scoop up my sons and hold them and she sees the tears prick at the corners of my eyes. She sees me on my laptop until late into the night catching up on notes and billing. She knows I’ll put on something hilarious on the tv, or something that will make me cry so I have an excuse to let it out. I’ll pick up more hot yoga classes. I’ll make an effort to connect with a friend for a drink.

The bad days are bad when you are married to some one in healthcare and the recovery can be emotionally taxing on every one if you do not practice self care.

A couple other things: I have a high tolerance for bringing my kids to the doctor and I do a lot of self treatments at home. Which my wife thinks I’m totally nuts to do. e.g. An ingrown toenail. I’m opening that baby up, getting the pus out, and treating that at home. Rashes- unless it’s something I know is bad, we stay home and slap on some aquaphor. Head and mouth injuries- the boys have had a few- with lots of blood. Unless something is dislodged (like a tooth) or a bone is broken, we aren’t going. And the one time I went to an urgent care clinic for asthma that I tried treating at home- well I was taken by ambulance to the ED and evaluated by the ICU doc’s in the emergency department because they thought they were going to have to intubate me. I don’t mess around.

She can’t watch medical shows with me. I can’t tolerate them and she can’t tolerate me. Doctors never do blood draws, and nurses are sorely underrepresented, the whole situation generally just pisses me off. And I can usually guess the mystery diagnosis, which irritates my wife. So we don’t watch them.

I am a human lie detector. I don’t know if that’s a nurse thing, or specifically an emergency department/psychiatric nurse thing. Because all the ED nurses I know are scary and also are human lie detectors. So it’s definitely a thing. It means my clients can’t get away with a damn thing. Neither can my kids or my wife;)

I have interactions with law enforcement and attorneys regularly regarding clients. I’ve had high profile clients and cases and through it all at the end of my day I have to shut it off and go home and make dinner and pretend I’m normal, and that the case on the 5:00 news is complete news to me, not a case I’ve spent all day dealing with. After a day full of what feels indescribable and insurmountable acting “normal” just seems impossible.

Life with a nurse is interspersed with bad days, but it makes the good days that much sweeter. Because I walk with the worst regularly I relish the best. I give so much of myself to my clients that sometimes it’s hard to have anything left for my family.

But the days I have with them means I am present. I am there and I bask in the fun because I know all too well how quickly life can change. There is a darkness hanging over nurses, an edge, because we truly know that life is precious and we’ve seen people waste it, abuse it, lose it, and we don’t take our own for granted. I’ve seen people’s brains and insides. I’ve taken care of people who are murderers, rapists, and I’ve taken care of the victims. Those are things that can’t be unseen or unheard or forgotten. We’ve seen the worst of humanity in every possible way.

In Adrian Monk’s words, “It’s a gift, and a curse.” And it truly is. Nursing makes me smarter, tougher, kinder, more open and more educated. But it also makes me more cynical and more suspicious. Nursing brings out the best and the worst in me, and always pushes me to be better. I can’t speak for my wife, but I can hazard a guess. Life with a nurse is never boring, always a little unpredictable, and lots of fun- because for real, we are pretty fun.

 

 

 

Violence Against Nurses
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Violence Against Nurses

lesbehonest20172 Comments

So I’ve been MIA for a little bit. I’ve been dealing with a lot personally and professionally. Professionally it’s brought up a lot of memories from when I worked in the emergency department as a staff nurse. Warning- this blog post has nothing to do with me being a lesbian mom- it’s a memory and commentary on violence toward women and the state of our health care system. Seeing our current administration downplay and ignore the #Metoo movement pisses me off. Feeling scared and vulnerable also pisses me off. So I’m going to tell a story as to why we need to have discussions around violence.

I had been working at the ED for over six years, almost seven. It was a crazy night, I was in triage. We had a lot of psychiatric patients in the ED, which is NOT the place for them, but there is no place for them, so there you go.

We had a lot of medical emergencies, and then they panic alarm went off. We use that to alert security and staff that we need bodies with the psychiatric patients because some one is escalating. There always has to be a nurse in triage. So my partner went to the back to check it out, security guards ran by, the rest of the nurses were in a medical emergency. I was in the middle of a triage assessment when I heard screaming. Not patient’s, but staff. Lots of screaming.

I followed the screams and rounded the corner and saw a pretty gruesome scene. Two nurses had been physically and violently assaulted by a patient. There was blood, clumps of hair, and what would turn out to be permanent injuries. There were about six security guards holding the patient who was still fighting. There was blood running down the faces of at least three of guards. The nurses who were attacked were screaming and crying, and in shock and I dragged them into a closet because all the patients in the ED could see them. It’s all very open. There was a doctor with them who also went into the closet. It was a big closet. I remember I grabbed gauze and held it over the blood on the guard’s faces because it was pouring into their eyes.

This was as bad as it sounds. No charges were pressed against the patient even though both nurses tried, because of a variety of reasons the police would not do it. It was quite possibly the worst part about the whole experience. They had permanent injuries and they would never obtain justice. It’s also sad because who wants to press charges against a psychiatric patient? No one. But in that moment, when I had known all of those staff members for over six years, and we were friends and we had each other’s back, to see them hurt was fucking awful. It was painful, and made us all feel pissed and vulnerable and scared.

I had to go back to work the next day. I don’t know how I did it, but I did. And when I got to the doors two nurses were standing there. They had been there the night before too. They couldn’t go in. None of us wanted to. We all wanted to walk away, erase that memory. Erase the fear. We all didn’t even say anything, at some point though one of us badged open the doors and we all silently filed in for our shift. We didn’t need to speak.

The part about going back after seeing something horrific is that today it could be us.

The week of my wedding, a couple years earlier, I got kicked in the ribs by a patient. I was bending over to pick up something on the floor and they just kicked me. I had a bruise on my ribs about 4 inches in diameter while my family tied me into my corseted dress.

I was no stranger to the violence of working in the ED, and it’s something that when you are there you have to kind of put out of your head otherwise it would just break you.

I don’t know what the solution to this problem is. But I know it’s a problem. I also know hospitals don’t like to talk about it, and they don’t like to take responsibility for it, and management likes to minimize it and it falls to the RNs on the front lines walking in every day not knowing if they are going to leave with a black eye or worse.

If you know a nurse thank them. Because you cannot possibly imagine the shit they see and face on a daily basis.

If you are a nurse. Keep fighting. We need rights, we need protection, and we will get none of it if we let these things keep happening with no recourse.

Thank-you to the state of CT who passed legislation making it a felony to assault a healthcare worker in the line of duty. Don’t be scared to utilize it.

What I consider a hard day as a nurse.
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What I consider a hard day as a nurse.

lesbehonest2017Leave a comment

This day occurred two or three years ago.

I walked in at 7:30 AM to the inpatient psychiatric unit. I found out quickly I was the only provider for twenty-six patients. We were already short one, then one call out and one psychiatrist working in the interventional suite. I had a team of three residents and two medical students, and myself, so we all just buckled down and started seeing patients.

It was kind of wild in general on the unit that day. We had a run of manic/psychotic patients who were loud, up generally all day and night, refusing medication, and one out of all of them who was particularly rude and verbally aggressive in their unmedicated state.

The other part of the culture on that unit was there was a very anti-nurse practitioner view by patients. They always wanted to see the doctor. But that day they didn’t have a choice because there were no Attending physicians to be had. It was nice always having a resident with me because I could at least say there was a doctor with me, but I ultimately was the one making decisions. So, there were a lot of irrational unmedicated patients. Some were angry about being involuntarily hospitalized and they really had no time for me because they wanted to see the Doctor.

I was in the middle of a particularly trying interview with a patient who was becoming verbally threatening around not being discharged when I saw a nurse run out of a patient room. He looked frazzled. On impulse I got up and went out of the interview room mid-sentence and stopped the nurse who told me a patient was seizing.

I was now in charge of a medical emergency. We called for transport to the emergency department. I started an IV and we gave Lorazepam (an anti-seizure medication). The patient was large, and it was hard, and we were doing this all in a psychiatric room which is not at all equipped or set up for medical emergencies. I was literally holding the oxygen mask on the patient after just pushing in the IV Lorazepam when some one tapped on my shoulder. “What?” I asked with somewhat of an attitude, as I was clearly busy.

“Um, you need to come out to the front.” I heard the voice of a tech.

“Kinda busy here,” I replied irritated.

“Um, the Secret Service is here.”

I sort of stopped and turned my head.

“You’ve got to be fucking kidding me?” I said. But I knew they weren’t. Because at that point I worked there for a few years, and we had been visited by federal marshals, sheriff’s, and the FBI, so really all that was left was the Secret Service. Psychiatry is nuts.

The ambulance stretcher rolled in. Thank God for paramedics. I gladly gave over my patient and walked out the door to go talk to the goddamn Secret Service.

My day didn’t get better from there.

After all of that we still had to write twenty-six notes. We discharged four patients, and admitted four patients. We reviewed labwork, EKG’s, medication doses, changes, etc. etc. etc.

We had to do all the normal shit healthcare providers do on top of rescue a seizing patient and deal with the Secret Service while working with one provider on a unit where there was supposed to be four. We did all this while one of the patients yelled racial and religious slurs at all of us. All day.

It was a Friday.

I vividly remember this day. I remember thinking I don’t get paid enough to keep my brain sharp enough to deal with this shit. I remember thinking NFL players get paid way too much to get their brains turned to shit. I remember feeling thankful I had my colleagues: the nursing staff, the residents, the social workers, everyone was a team. That’s the benefit to working in a hospital setting. I remember feeling burnt out; physically and emotionally exhausted, and also gross because the seizing patient puked and I felt like I had flecks of vomit on me all day. I hope to God I didn’t. But it was a possibility.

I remember mostly though that whole day no one cared or thought to ask about my sexuality. It didn’t matter that I am a lesbian when I threw the IV into that patient’s arm and pushed the anti-seizure medication. The families I met with to review discharge plans for their family members, the patients who screamed and swore at me for not discharging them, and all the staff. No one could have given two shits that I was married to a woman. Because I was competent and I got the job done. I’d like to think I got it done well.

The religious right says the homosexual agenda is to “normalize” homosexuality. Well duh. Because my identity as a lesbian has nothing to do with the ability to perform my job as a nurse practitioner. It has nothing to do with my ability to be a wife or mother or daughter. Being homosexual is normal. For me. I am a normal person who happens to be gay. If that was your relative seizing, and I was the one running the response, would it really matter to you if I am a lesbian or not?

Would you want me to step back and let a straight person who might have less skills as a nurse step in because they are straight? Gotta be honest even if that’s what you want I wouldn’t let it happen. Because my duty as a nurse and a human being would not allow me to let someone potentially die because of some one else’s ignorance. I’d tell you to shut the hell up and get out of my way most likely.

My ability to function and to be a contributing member of society has nothing to do with my sexuality. And this debate over whether people have the right to refuse services to others based on sexual orientation or gender identity infuriates me.

Illness eventually touches everyone. Illness does not discriminate. Remember that every single person will at some point be in a hospital. Think long and hard about whether you want to give your nurse, doctor, tech, surgeon, anesthesiologist, the right to discriminate.

 

 

 

Only when you’re a nurse.
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Only when you’re a nurse.

lesbehonest2017Leave a comment

Tonight I had these two tender moments one with each of my sons. One of my sons crawled onto my lap with an afghan in his hands to pull over us, and then he laid chest to chest and put his hands around my face. He smiled and babbled because he still doesn’t talk coherently. I’m sure he was telling me a wonderful story. We had a fire going and it was just lovely. Then later my other son came and stood next to me on the couch, and wrapped his little arm around my neck and just leaned into me to cuddle. These small moments in life are just precious and if we had not been able to conceive I would be missing out. Big time. It made me start to reflect on how we conceived.

IVF sucks. I’ve talked about it here. The egg retrieval requires sedation by an anesthesiologist. My anesthesiologist was an anxious man with broken English. He sort of flitted around me when he was starting the IV (blood spurted out on the floor while he fumbled with the tubing- luckily I’ve started probably hundreds of IVs so I just put my finger over my vein and pushed hard to stop it while he figured out the tubing) and then when I was going off to sleep he told me to count backward from 99. I was extremely nervous and not really paying attention so I started counting forward from 99, he became more agitated and said no backward and literally didn’t give me the drugs until I started counting backward.

As I was coming into consciousness afterward I saw my wife. Eventually I was mostly coherent and the nurse told me what happened when I was waking up. She told me I cried and said over and over “I lost a patient, I lost a patient.” She knew I worked on an inpatient unit and asked if perhaps we had literally just physically misplaced a patient.

I had no recollection of my hysterical emergence from anesthesia. I had indeed lost a patient that week. They died. Not at the hospital and not related to psychiatric issues, but a long time patient we all knew well, and a rather traumatic death.

I remember feeling so floored by the questions from the recovery nurse. I hadn’t thought I was affected by that loss. But apparently that was the first thing on my mind waking up.

About six years ago I was still working in the emergency department and I was there for a code. The child died. I didn’t cry. I thought there was actually something wrong with me. It was the first death I was present for that didn’t cause at least some tears. I remember worrying that I was losing my empathy and compassion. I left for a vacation the next day. We went to New York City for a few nights. I was up around 1 AM reading a book, If I Stay, I got to a scene in the hospital. I remember I started to well up in my eyes. Then I started sobbing. I thought, “Aha, here it is,”. My wife woke up and was like what the hell? I just shook my head as I sobbed trying to tell her it was okay, this was good, this meant I wasn’t a cold hearted asshole who doesn’t cry when a kid dies.

This is the shit. It still happens. Nursing is hard work. Caring and empathy and then we have to come home and care for our own kids and families. It takes so much out of me.

Many people have funny stories about coming out of anesthesia. They hit on the nurse or they think they are on vacation. It loosens our inhibitions and opens us up to emotions. For me it allowed me to be in touch with grief. We take our patient’s losses and gains home with us.

When I went into psychiatry I thought it would be less emotionally draining than the emergency department. It is but in different ways. There are funny times too. People think because I’m a nurse I’m an expert in rashes. I don’t know why. I’m not. But people lift their shirts, drop their pants, and text me pictures asking my opinion about various rashes. I generally tell them to put their clothes on and stop showing me because I treat psychiatric illness not skin.

People tell me about their mom who’s a nurse or their cousin, as if all nurses just naturally know one another. One of our neighbors when we met said, “Always good to have a nurse around”. I thought that was weird. Why? Why is it good to have me around? Just in case some one needs CPR? An emergency rash that I can’t identify? I don’t know. People just feel safer when there’s a nurse around, more secure.

I know I am privy to more information about people than they may share with non-nurses. I don’t take that for granted but it is also exhausting. I refuse to go to the grocery store. Because whenever I go someone stops me and tells me their life story. Some times I just want to run in and grab bananas and run out but inevitably I hear about some one whose spouse just died or who just called DCF on their family member. I don’t solicit these conversations at all. I make no eye contact and I generally try to look completely unapproachable. But it still happens.

What’s fascinating to me is that none of these experiences have anything to do with my sexual orientation. When people are in crisis they don’t care if I’m married to a woman or not. It doesn’t enter their mind to even wonder. I saw clients for a few years before some knew I was married to a woman. It just doesn’t come up because it’s not about me. But I also know I’ve cared for homophobic clients and families over the years. Nothing about my care taking changes when I have homophobic patients. I treat every one the same. But apparently if a homophobic patient of mine has a business they want the right to be able to refuse my own business. This makes no sense to me. It’s okay to allow me to care for you often in the most vulnerable aspects of care taking but you can’t bake me a cake?

I don’t get it. As a human being and as a nurse with a brain and a heart I would never refuse care to some one even if they are the most homophobic person on the planet. Because it just goes against my value system and my duty as a healthcare professional.

But we can’t have it both ways.

I’m not sure what the solution is. However I’m very aware there is a problem.