Melvin & Me, Part 35: How I'm an Accidental Prude

This is going to be one of those cards-on-the-table ones, I think, with some raw stretches that feel maudlin to write but are somehow also true.  Sometimes, I feel I wear my mental health struggles a little too well, which means that I do have to talk about them directly, particularly the places that are hard.  

There are moments at work where we can simply be human, where we can talk about whatever is real to us outside of the fifth floor.  There are spaces to joke and just be people.  One day, someone at the desk asked, "what's that smell?"

Another peer piped up with a glib response:  "Oh, Larissa farted."

I froze inside for just a split second.  There was a spike of panic in my heart, that perhaps my ostomy bag was leaking.  This was quickly dismissed--I knew it was just a silly joke.  Truly something harmless.  And yet.  That panic was real.  There was also a cold emptiness that followed the exit of the panic.  This wasn't a joke I could actually participate in.  Hell, I've had whole existential crises trying to figure out how farting applies to someone with an ostomy.  

I clarified immediately, pulling a face and stating, "Mmm, I don't do body humor."

Naturally, that required some clarification, that I don't participate in body humor because it hits differently with the ostomy and all of the sordid history that I carry.  But my summary was much shorter and the apology was immediate.  I clarified that I'm never mad at someone for not knowing about the ostomy or my preferences in how I discuss it or allude to it, but I would be upset at someone that crossed a boundary that I had deliberately set.  

Lately, there had been two other moments where the group was feeding into a conversation about bodily functions.  "Farts that itch the butthole the one way out," or discussions on along that end of things, a full ten-minute discussion about bodily functions.  This was something that was supposed to be relatable to everyone.  Connecting and humanizing.  

But not me.  With the colostomy, I have no control on what releases when nor do I have an anus anymore--just a memory of what it was once like to have such sensations and worries, exchanged for new ones that most people simply cannot relate to, just a subsect of us.  Know what it's like to have your stomach rumble in a quiet but populated room?  Make the sound wetter and louder...and then normal.  

The longer the conversation went, the more isolated I felt.  I could not connect to the basic experience of, well, sharting or finding a particular place to fart or a number of basic things.  I nodded along, but I had absolutely nothing that I could contribute to that conversation.  It may as well have been in another language.  I felt hollow.  And distant.  Othered.  Quietly hurting behind a mask in a conversation that was intended to build community.  

I thought about it after the fact, wondering if I should have said something to jar the conversation away or bring in my unique take on it, but that wasn't what I wanted.  I'm still not sure what I would want, but I know that I didn't want that, didn't want to just make it about me.  Similarly, I definitely don't want others attempting to point out "well, except Larissa" and then go on a tangent there because pointing out the exclusion can make it worse, particularly when it's by name--a vague mention, maybe, but not a direct one.  In this moment, though, I wanted the rest of the group to have their space, too:  I just didn't know how to be part of it.  

This extends to sex talk.  I don't trust my body.  I have no reason to trust my body, for as much as I have been betrayed by it.  Trusting someone else with it is harder still.  This means talking about sexual experiences and fantasies fall into a similar camp--my brain says it's not safe, equating arousal with danger, since it's all a part of the sympathetic nervous system, such is the joy of PTSD in my case (a bit more on that here).

So the result is I don't engage.  Or if I do, it's only in small doses, because, confusingly enough, sometimes it's completely fine and I don't mind being proxy to the conversation at all--I have yet to figure out the pattern.  And the result on the outside is that I am accidently a bit of a prude.  Not because I think the subject matter is improper or wrong, but because I genuinely cannot engage with it, for the swallowing ache of PTSD.  I am activated, my sympathetic nervous system screaming that I am profoundly unsafe, recalling complicated grief. 

I can't pinpoint what I need in those moments; I can't even identify what I would want said to me.  It's just a moment when the grief surprises me, where a wave rolls up and smacks into me on an otherwise clear day.  The situation is not predictable enough that I can censure anyone or any specific topic--but I have drawn occasional lines ("That's enough") in individual situations.  I feel so obviously broken in those moments, but I would say the bulk of them are wholly under the radar.  Again, I don't necessarily want the conversation to stop just to check in, but in the same breath, that widens the disconnect all the more.  In those overthinking spaces afterwards, though, I do wonder if that is misconstrued, that not engaging means I may be more likely to be excluded from certain conversations or left out of an invitation to play Cards Against Humanity.  

This particular grief stems from a feeling of disconnection, disconnection from "normal" body function, assumptions of the world, accepted ideas of security, perceptions of how the body can be used and enjoyed, and even a disconnection from the sense of self that I used to have.  This grief is a process, another space where radical reacceptance of my situation is needed daily, hourly.  Even as I continue to find good avenues for processing, there will always be spaces that require extra attention--extra energy--than I may have expected for a situation.  

Again, I have nothing actionable to share, no requests for future changes or subject avoidances specifically.  If anything, perhaps a generic "don't assume my motives," at most.  This was more a means to explore and name these feelings, to name another place where my disability has irreparably changed a part of my identity.  Ignoring pain delays healing; labeling the disconnection breathes new understanding; and in the meanwhile, I find my safe spaces to process, titrating peace in chewable increments.

Peterson Family Update, #53401-12A Tau

 What, ho!  It's time for another bulleted list!

• So, the Rivian R1T is absolutely brilliant in snowy weather.  We went to drop off the Volt at the dealership to get checked out on Wednesday morning of the big snow, and it did not care about any of the drifts or whatever else.  Having all of that power instantly, a motor on each wheel, and a low center of gravity, it was unbothered by whatever weirdness was thrown at it.  So we weathered the snowmageddon pretty cleanly.  
• Andy also was excited to participate in a time-honored tradition of owning a pickup truck:  helping a friend move.  He's been delighted to share and answer questions and, yes, he has an Instagram specifically for Tutti.  
• Luna was less thrilled about the snow but did decently well with it anyway, a healthy bit of confused at all the stuff but figured out how to pee again eventually, out of desperation if nothing else.  Sometimes when we go on walks we reenact scenes from Bambi, but she's still happy to go outside.
• I'm getting back in the pool once more, and swimming my last mile I was contemplating how there has to be a fair bit of grace in the movement, each stroke flowing with the water.  Once again, mindfulness of my body in space and how that correlated with the success of the pull, how my energy dissipated into each kick, it made for some quick laps.  
• Mike got a kick-ass new tattoo, and is already planning on the next.
• We got a few new boardgames lately, which has involved some collective, constructive arguing over rule interpretation as we try to figure it out together.  A few names to pull out:  Doomlings, Killbots, and The Lost Ruins of Arnak.  The latter has been particularly interesting.  Major game mechanics heavily features resource gathering and, oddly enough, deck building--research can be fun and very rewarding!  And so can exploring unknown territories.  And fighting monsters.  It's scoring reminds me of Seven Wonders, and turning resources into advancements works like Settlers of Catan.  

Plus, the theming is a heap of fun--still better archeology than Indiana Jones

• Work has been six kinds of nutty, with not only patients racking up the Covid count, but a handful of nurses out for various reasons (vacations, life, etc.).  Staffing continues to be...tricky:  the hospital is FULL.  As soon as one patient leaves, housekeeping rolls right in, and we start working on another admission.  Keep moving; keep running; keep breathing.  And yet, while the busy is a certain flavor of exhausting, it still feels as though I'm in the right place.  More and more, I feel that I'm meshing into my team, feeling more that my unique presence is appreciated and not just having more hands around.  I'm still learning a lot.  I'm getting better at other things.  I'm asking a lot of questions.  
• I made an impulse buy the other day.  I bought a Kalimba (picture below).  It's a small hand piano, a box that fits comfortably in both hands that I use my thumbs to make gentle cords and sounds.  I've found it quite soothing--it's like making my own meditation soundtrack.  I'll figure out how to get a video of it in a future blog at some point.  

• Starting to look toward using some vacation time for, well, actual vacations.  Got a plan to go on a roadtrip to see some friends in March and a family vacation in May that is starting to take shape.  I had forgotten how much I can enjoy planning trips, even small ones.  Andy and I are set to hit our ten-year anniversary in May--we have not ruled out a larger trip at the end of the year, maybe Iceland, to celebrate as we are not strict in our household on celebrating on the "correct" day.  We'll, of course, have to see what the situation with Covid is at that time, since we are continuing to be cautious in this household as we cannot afford to do otherwise.
• It's good to find something resembling a rhythm again after the holidays.

Fledgling Nurse, Part 7: When to Flex

I knew getting into nursing was going to have a specific kind of baggage, and it was during nursing school that I began to see the first few signs of it:  friends and family asking for medical advice.  

It was inevitable.  Some of the questions I redirected to Dr. Google--when it's specific side effects of a particular medication, I do not have a complete compendium of these in my head as of yet though some important generalities are firmly lodged in place, such as NSAIDs and gastric bleeding.  Other questions that are more general knowledge or things that I took for granted as general knowledge, though, I've answered a number of these.  I had only completed my program by a couple of days when I received a call from a family member asking whether they should go to the emergency room (after gathering a bit of information, I suggested PromptCare if X and Y did not improve by Z or go to the ED if there were life-threatening symptoms like trouble breathing).  I've had a couple other friends ask, receive permission, and then send me pictures of different parts of their body.  I've looked at weird skin spots.  I've explained the mechanism of action of various medications.  I've explained what to expect as a loved one regresses further into dementia.  I've re-explained procedures that were only half understood after doctors' appointments setting them up.  These and more, I understood that the questions were inevitably part of the territory.  

As happy as I am to help, I am more cheerfully helpful when persons check for permission first.  It's an important boundary check.  However, I won't deny that I am happy to teach where I can teach.  I like sharing the information I know, to flex those pieces of knowledge to help someone else (while still adding the caveats that I'm not a replacement for keeping their doctor appointment).  

And that has to go in reverse, too:  I have to check before I jump in with unrequested information.  Sometimes someone is just venting and not asking for medical advice.  There have been conversations where a loved one was hospitalized or diagnosed with some kind of condition and it's as though the password was spoken and my empathy is overshadowed by overwhelming curiosity.  I want to ask what medications have been tried, have they approached the topic of X or Y therapy, what were the last lab results on Z, have they also experienced Q symptoms, etc.  I have to stop myself, though, when I realize that my curiosity is not necessarily productive to the conversation.  I have to know when to flex the knowledge that I have.  

This can get especially tricky when I'm at work.  When I'm clocked in, I have given implicit permission to be asked medical related questions.  Hell, we have set reminders to chart education, meaning that I am expected to offer it at the very least daily, not just the information dump before discharge.  But the family member who just signed their loved one into hospice, they aren't interested in how the body will mechanically deteriorate at the moment--their questions of "when are they going to die?" are more about coordinating with the family and finding their own processing space.  Factual and practical information could be soothing or it could induce more anxiety.  Or more confusingly, there can be a balance of information that is helpful before tipping over from empowering to overwhelming.  

There isn't a magic formula to know how much information is too much--it involves a fair bit of guessing and gentle prodding.  I try to ask questions along the way to ensure that the party is open to information or otherwise start with where their questions are, titrating information in pieces as I see them throughout the day.  One of my favorite questions especially during discharge instructions is "I just threw a lot of information at you:  what can I clarify?"  This firstly acknowledges and validates any feeling of overwhelm.  It's also an open-ended question, meaning that there isn't a space for a simple, placating yes or no.  Sometimes we cover the same information again; sometimes we're taking it a step further.  I try to also end with a brief "if you remember anything from what I just told you, remember these three things," in order to bring to the forefront one more repetition as the final say.  

Outside of work, though, there are spaces where the information I have learned is helpful and places where it is not.  There are places where people demand it and places where forget that that experience can be a resource.  This means putting out feelers for what is welcome without overstepping.  It's the same process in offering any expertise, that balance between the excitement of knowing the answer and the awareness that "an answer" still may not be what the conversation partner needs in the moment.  I've learned how to ask the questions that are indirect, probing for what someone might want from the conversation, but this still entails more guessing than I would prefer:  as such, I'm growing more comfortable with directness.  I asked a patient the other day, "Would you like to understand or do you just need to vent?"  I've asked many times "How can I help you best?" whether I'm listening or helping someone with a task.  At home, we are learning "That's not helpful right now," when someone is trying to fix something that we only needed a listening ear for.  Sometimes whole conversations are preceded with a phrase or question to help indicate whether listening or problem solving is the goal--85% of the time, I feel, it's listening.  

Sometimes I think I know someone or a particular inflection well enough to guess whether they want input or a listening ear, yet I've learned that it's okay to check even midway through, confirm those thoughts before there is accidental overstep.  My knowledge base in my field will continue to grow, and I will actively be ensuring that my communication skills--particularly checking for consent and boundaries--sharpen along with it.  

Feelings of Time

There's always something odd to me in those days between Christmas and New Years, the days between when Santa is measuring goodness and before resolutions actually start.  Time doesn't seem to make sense on these days.  In my mind's eye, I see it as a strange void in the calendar, to the degree that each time I land on those days I find myself surprised that they're there.  

Of course, this could be due in some large part to the schedule shifts and pressures of the holiday season.  The first couple weeks of January seem to linger in an odd refractory period.  This is compounded by two things:  the general stress of trying to reacquaint with routine while acknowledging the positive and negative toll of the season and the pressure this time of year to generate new, healthy habits as New Years' Resolutions.  In other words, there is a recovery period where extra energy is needed there on top of the "normal" load itself, still while attempting to carve out new spaces.  It makes for some interesting emotional work.  

I've heard before that it takes about thirty days for something to become a habit.  I cannot say whether this is true specifically on the psychology angle, but at least in my own personal experience that seems about right.  I have been looking at restarting my meditation app, where it has been encouraging me to find the same time every day to do X or a keto restart book that states out every meal for about a month...and all the enthusiasm drains away.  I don't have the kind of schedule anymore that allows for routine.

I work a twelve-hour shift, in a twenty-four-hour field.  The work is never over.  That's become a new mantra in some places for me:  "The work is not over; it's time to stop."  I'm not going to be able to "fix" any of my patients, but I am able to contribute to their success in small increments at a time.  There are certain tasks that must be done every shift, either at a specific time or to be completed by the end of shift, but when they happen in the day, well, there is no pattern.  I try to get at least two patient assessments done before we all meet with the charge nurse at 0800, and then it's off in the flurry of 0900 med pass, completing the subsequent assessments in the morning and working through the huge push of morning medications, all the while my phone seldom stops ringing with patient call lights, doctors' responses, family members wanting an update, a deluge of staff communication, and all else.  The best thing to do is find a way to bend to the most immediate needs and set boundaries or expectations in others (e.g. "I am in another patient's room at the moment" or "I can call back in about an hour"), because, no, I'm not going to leave the patient who has suddenly dropped in blood pressure to bring someone else a glass of water.  There are too many places I need to be at once, which means I have to make some choices.  As such, there is no daily work routine, only outlines.  Usually, I eat lunch somewhere between 1130 and 1530.  I chart in the gaps.  I go home and unpack and jump into the shower to ensure I don't share anything more than I have to with my housemates.  Decompress a bit or set everything up for the next day or start some laundry or whatever else.  Wander to bed sometime between 2000 and 2300.  

So about creating rituals or routine, my workdays are not conducive to that.  And subsequently, my workweeks are also not conducive to finding a daily pattern:  I work three days a week, and which days those are varies by week.  My housemates and I have to meet weekly to talk about groceries (which alternates to different days) and discuss who is cooking when.  We want to establish some better habits for Luna--I cannot commit to specific days because my days move.  Which days I am going to swim changes by week.  When I schedule time to reconnect with family and friends varies.  Weekends don't feel like weekends anymore.  This means I'm out of sync with a lot of the assumptions in the world--when people talk about Mondays, there is no sting of dread in quite the same way.  There is no daily pattern, and there is no weekly pattern.

And somewhere it clicked that I do have rituals and routines, just that they are different now.  There are small habits and rituals that can be grown, and there are larger pieces that can be done on an "X times a week" basis rather than a daily or "every Tuesday" kind of pattern.  It doesn't have to be a set time every day or every week to still be a valid change for myself.  I have a particular workflow in how I perform a patient assessment and how I gear up at the beginning of a shift.  And that isn't nothing.  

The pattern is either in small details or in broader swaths--I have to change how I think about time and how I balance my various needs of it.  Even on workdays and how I think of them, time moves differently on those days than it does on non-workdays because a twenty-four-hour field moves...differently.  There is an odd reframing that has to happen after a couple of days, where the work "stops" (or at least "waits") in the bulk of other jobs.  There is no closing--resting and restocking is a deliberate act of pausing and sharing the narrative and tasks to the next body to continue the work.  

In other words, there are some of those same kinds of spaces where time does not feel right.  And it's simply not going to find patterns that I'm used to--so it's time to rethink that expectation.