Melvin & Me, Part 30: Being Seen

I honestly had not expected to get to the topic of ostomies so quickly in nursing school--at most, I thought they might be a short lesson in one of our later classes.  I mean I certainly brought up the topic quickly, because I have a ready answer when someone asks me what kind of nursing I want to go into, but it was quite edifying to have a voice or two in the program that is passionate about wounds and ostomies, too.  Another "I have found my people" moment, frankly, and otherwise when I was making the decision to go into the program a rather firm shove that I was heading in the right direction.  So, in addition to being a lecture topic, we also had a guest speaker come to bring their experience to the table--I am making some further efforts to talk with this person. 

And me being me, I reached out to my theory and lab instructors to ask if there was anything they should like me to bring or even videotape regarding my experience, if there was any further enrichment I could offer.  Thus, I recorded a poorly angled video of my ostomy bag change.

This isn't the first time I've shown my ostomy in public (specifically, here's the old blog post).  It's a risk in a few ways, sure, even in an educational environment.  And yet, it is a wonder to be seen.  This produced two prominent feelings for me--empowerment and a lesser but still present sense of vulnerability.  It is incredibly cathartic to me to teach, and I recognize that not everyone is capable of sharing something so intimate this bluntly, making it all the more important to do so.  On the other hand, my disease and my disability are relatively invisible, and I have now lost part of that shield.  The vulnerability is not because my intestines or stomach were visible, but more because a hidden part of what makes me me was on display.  

And that is the tension.  I want to be seen, to have ready empathy in the places I need them in the instances that I need them, but I also want to be invisible, to have choice in when I'm seen and self-manage peacefully.  I think it's the same for folks with anxiety, depression, grief, lupus, fibromyalgia, and all kinds of other conditions that aren't immediately obvious.  Myself, I'm not great at asking for this space in those crisis moments.  I'm bad at it, to be more direct--I can ask for clarification or help on a great number of things, but a direct ask for empathy can be difficult.  I find that a lot of people I know are excellent at acute empathy--folks that will make a beautiful gesture of love and support in those critical times--but I only know a few people that are good at chronic empathy.  This understanding makes the asking harder still.  There is a part of me that resents having to ask in the same breath that I recognize it's not fair to expect someone to read my mind--another tension point.  And because I'm high-functioning in my depression (meaning I don't pause because the engine seizes but instead crash once the teeth have been worn off the gears through continuous use, even though the engine still sounded like it was rolling along fine), I am cognizant of trying not to take up space for those that are obvious in their need or state it first, yet another point of tension.  

If I hold the button down, which option is that?

I have tactics.  I have outlets.  I am growing in self-compassion and allow myself moments to crumble safely and experience emotion that I've been putting off.  Yet, with being seen, I'm very much testing the waters to see what I need and how I need it.  With my old job, I had persons with me in transitioning to my new life with a permanent ostomy--now I'm in an entirely new group of people and sorting out what it means to establish oneself in this group, trying to sort out how and when it is necessary to be seen and where it is helpful to be seen and where it detracts to be seen, all while still making space for everyone to express their own way.  

It's another set of unspoken complications in life with an ostomy.  Tension, balance, time; seeing and being seen in turn.  ...and allowing myself the grace to mess up a few times in the meanwhile.  

Gory Details

So, I was in class the other day.  Well, I'm in class every weekday these days, so perhaps that isn't terribly helpful, but we were talking about skincare.  That might sound like it's going back to my Bath & Body Works times, when I tried to find people the right kind of scent to match their preferences, but, nope, we were looking at a LOT of pictures.  By the time we got to the full-thickness pressure injuries (not a Google search for the faint of heart), I was very much ready with questions when the instructor was ready to leave space for them.  I asked about packing wounds, a bit on debridement, and we discussed the mechanics honestly.

And in my excitement, I had a thought that sliced through, shining like a brilliant beacon, and I basked in a moment of beautiful light.

In my head, I had been already apologizing and ready to help the conversation move on to another topic.  I...didn't have to do that here.  My curiosity was welcome here.  I didn't have to shut down that joy in learning.  I didn't have to worry about changing the subject because it was making someone queasy or uncomfortable.  That energy was welcome here. My weird questions like "can a person with an ostomy take a suppository?" or "how would you take blood pressure for someone without arms?" or "how do you pack a wound in x situation with y drainage?" are welcome in these places.  My fascination in how the body is working on a functional and cellular level doesn't automatically make me a weirdo and/or serial killer. 

I'm often the guy in the middle

That part of me is welcome here.  I can be fascinated and talking in long, rambling sentences about my new discoveries and dive deep into how the body works and what happens when the body breaks down and I didn't have to stifle that part of me or swiftly change the subject.  There have been pockets of persons, but I haven't felt this particular license in such a large group in a while.  And it is beautifully freeing.  

Blood Rules

We're settling into an interesting groove, now, with the nursing program, and the most complicating piece of the whole process is how we try to find a way to preform the mechanical skills and receive feedback about them while everyone is online only.  This process involves lots of awkward camera angles, pretending, use of stuffed animals, videos, and no small amount of creativity.  I did a recording of myself a week or so ago with my brother as the patient I was helping turn to his side and I told Andy his role was to be bedrails, placing his arms down next to Mike to make two ninety degree edges.  I used my lapdesk as a backboard to help the patient onto the stretcher that we didn't have.  Changing the sheets in an occupied bed involved a couple of fitted sheets on an easy chair.  And oddly enough, we had fun with it.  Some of the banter during the bedbath was the right kind of ridiculous, in particular; Andy was happy to be my pretend patient for that one, until it occurred to him I was going to be professional about it.  

As we look into procedures and their pieces, I have made three important observations.  

So there is the book way of doing things, the step-by-step process and why each step happens in this order as opposed to any other and why it needs to be done.  There are parts that are left intentionally vague, stating that different facilities will have different policies.  This leads to an important realization:  these steps are composites, the culmination of practices and policies from all kinds of different places and attempts to be applicable to all of them at once and account for all kinds of different scenarios at once.  Inevitably, some are left out--for example, the rectal suppository steps didn't have much to say about ostomies, which caught my attention because I was looking for it specifically.  (The answer, by the bye, is it depends somewhat on what it is, but in my case since I have no anus and no rectum to speak of, we'd be looking into a different route.)

And then we had some discussion in lab, where our instructors have stated in different words that there a lot of these steps that we will be doing simultaneously in the future or we will otherwise be moving with the situation at hand (i.e. if your patient can't breathe well, trying to get a laundry list of questions completed as the first step every time isn't exactly feasible).  In a couple of steps, some have even said directly that "no one does that in the real world."  This means that there is the book way of doing things and the real world way of doing things.  

Then the medication chapter hit.  Suddenly, the book way of doing things and the real world way of doing things took on a severe and marked parallel.  Giving a bath, that can move with the situation and the patient's need to rest and what materials you have on hand.  With medication, there is no playing around--those rules are written in blood.  Every rule is there because someone's direct or potential suffering brought it to the table.  Even the tone that our instructors brought to these areas shifted:  most everyone knows a story of when the blood rules were not honored and the calamity that followed.  And that sounded more Lovecraftian than I meant it, but, truly, where someone did not do the proper checks and what happened or what could have happened, there are some truly horrifying possibilities, elder gods aside.  

So in short, regarding all of the mechanical pieces that I will be expected to perform as a nurse, the following three things appear to be true:
1.  The book rules and guidelines are composites, an average to establish a pattern and the best collective way to perform a task.  
2.  The real-world way allows style and preference to come in to play, provided it stays within certain parameters.  
3.  Anywhere the real world way and the book way are in lockstep with one another, these are the blood rules that must be adhered to with reverence and no small amount of fear.  

The tricky part is right now I don't know which parts are blood rules and which ones allow for style--the book way is presented as the blood rule, and I won't know otherwise until I have some experience, meaning that I need to assume all rules are blood rules.  Some parameters can be moved, but at this point I need to assume that they cannot be, until I am hired by an institution that directs for a particular variation or evidence leads us to make some necessary changes.  In short, I have to feel for the right places to be flexible, but assume a constant rigidity, which is an interesting balance of thoughts while still mimicking the person we're following as best we can.  

It's going to take some practice yet.

Update #2465 Beta

Already in week four of my nursing program, meaning that I'm a third of a way through the summer.  

I still feel like I'm going to wake up one morning and clock back into my old job.  It's just...weird.  

So, how am I doing in the program?  Great question.  Glad I pretended that you asked.  

I am pendulating hard right now.  I have moments where I feel ready and confident and certain and "hells yeah, I belong here." And then I have moments where I wonder why ANYONE would trust me with the well-being of another living thing, and I feel my stomach roil and churn under a quiet smile.  I have the first slew of tests under my belt, now, so at least some of the "you don't belong here" element is calming slightly.  Both of these states are fine on their own--I have the coping to work within both--but the violent oscillation between the two of them, whipping back and again between the two of them, that's exhausting.  That's where I'm tired.  

I mean, there were twenty chapters of reading to do for the first week, but, again, it's the circumstances coupled with this steady wearing-down that makes the tired hit a little bit differently at the moment.  

There are lot of things happening in our world right now that I don't feel I have the emotional capital to address to the degree that A) I would like to and B) that they rightfully deserve, particularly when silence is taking the side of the oppressor.  And thus, the world and what's going on with it adds another dimension to the pendulum swinging, the "how can you be worried about yourself when there is so much injustice in the world?" direction, too. And on the X, Y, and Z axis, whelp, it gets all the more dizzying.  

Or maybe something more like this

In short, I'm adjusting.  There's a lot to suss out with this change, yet, and I am confident that I will find my feet in time in the same breath that I can be gentle with myself while doing so.  I am thoroughly determined to learn as much as possible with this opportunity and have specific goals in that which will be accomplished, one way or another.  There will be different, unexpected blocks along the way, and I will be allowed to be frustrated in those moments while still ultimately confident in where I will be--all pieces exist in the same space, and I'm allowed to feel the complexity of that.  There will be peace as the swing arm slows down a bit, and there will be grace until it does.