Doctor's Orders

I ended up using Teladoc for the first time this summer, and it was a pretty cool experience.  I have been doing mental health calls over the phone without incident since March, but reaching out for something that was strictly physical, that was slightly different.  There are a lot of ways that telehealth can help us connect safely in this time, but also connect to places that maybe don't have all of the same resources:  people might have access to a phone or an internet connection even if there isn't a major hospital nearby, and persons that can't get to the doctor's office because they cannot travel there for one reason or another can still facilitate that conversation.  In short, in removes barriers, even folks who have anxiety talking to a healthcare professional have some additional security. 

So, the nurse I spoke with agreed with my assessment of things and set a prescription rolling to my pharmacy of choice.  And then she ended the conversation with the direction to make sure that I follow up with my primary care physician in X amount of time.  I thought momentarily about my school schedule over the next chunk of time, and had the distinct internal assertion "Yeah, I'm not doing that." 

I've been thinking a fair bit about how I might handle this attitude with my future patients.  I know a lot about my case, and I have taken many, many efforts to understand my case.  I am also in tune with my body in some specific ways, and I express my patient's rights, including the responsibility of being active within my own care.  These are all things I've intentionally practiced and unfortunately have a lot of practice practicing.  And yet, there are still places where I make choices, and I accept responsibility for them.  Therein lies that mindset that I'll need:  everyone is free to make their own choices, but the poor choices they make toward their health will not be from ignorance or misinformation.  I will challenge choices are made on bad science, ignorance, or a lack of information.  Simultaneously, I will let it go when someone expresses that they have taken culpability for their own choice.  

Now, how does this apply to wearing masks?  Wear a fucking mask.  When people advocate for not wearing masks, they're not advocating to have the freedom of choice:  they are advocating for the freedom to put other people at risk.  If you like to drink alcohol for example, I accept your choice to drink or not drink, but I absolutely have things to say about endangering other people by driving drunk.  In other words, saying that you won't wear a mask because you are uncomfortable is the same energy as saying that you plan to drive home roaring drunk rather than call a cab.  Full stop.  

I'll say it again:  the masks are to protect other people, where when we all accept roles in society we mutually protect each other.  Stubbornly saying that you have the right to put other people at risk--to take away their choice--is not okay.  What choices you make for yourself, I won't interfere; but when your choices are actively hurting other people, that's where the censure belongs.  We also agree as a society to obey stoplight signals, for the safety of other drivers--saying that you don't want to wait and blowing through a red light has consequences, not because it is a biblical commandment, but because it was a societally constructed rule created to keep persons safe.  So are mask rules.  This is why the internet is shaming these persons and why we as a compassionate society need to enforce the rules.  

Two additional points: 

• If the mask is truly stopping you from breathing--ignoring a great deal of people erroneously making that claim--then you ABSOLUTELY should not be out, meaning that you are at the greatest risk.  
• For folks invoking the ADA (Americans with Disabilities Act) I want to be very clear that the ADA does not give you carte blanche to do whatever you want.  Instead, it grants you the right to reasonable accommodation.  What does that mean?  It means that you should still have access to the same things, even if this looks slightly different such as curbside pickup for groceries (instead of going into a store), access to the community meeting, a bathroom stall that you can operate in, etc.  In other words, the ADA is a mandate to ensure that persons that need accommodations have those accommodations; it is not to be used as a weapon to demand certain rules don't apply to someone that is mildly inconvenienced.  

Advice

There are a lot of uncertainties right now in the world.  And folks in our nursing program are feeling a very particular brand of this pressure right now.  We could not be in person for this first stretch of class, most notably the labs and clinicals.  It is difficult to, say, practice IV insertion without a manikin arm or needles because they were not something dispersed in our supplies kit, for safety, certainly.  It's not what anyone was hoping for, but it's what we have to do for the time being.  Fall hasn't been fully sorted out yet, for that matter.

We have staff steadily working to design ways to provide both practice and make-up times, pantomiming what parts we can in the meanwhile.  In short, we're focusing very much on that essential nursing skill of flexibility with a touch of improvisation.  I have some folks within my circle that can provide me with some assurances, too, that some hospitals have a specific hiring process for new nurse graduates that involves additional training time that is likely to be altered to reflect these kinds of needs.  It seems that most hospitals have some kind of onboarding process that includes how certain skills are to be done to the facility's policy specifics.  

That said, that's the logical side of things.  Fear isn't always logical.  And with so many things uncertain in this time, well, I've also had some shower conversations with myself.  

I've spun the internal argument to my shampoo bottles a few different ways, ensuring my hypothetical employer that I am worth taking the risk, that I there is less that they will have to unteach me and that otherwise I am a fast learner that is comfortable asking questions.  

And I also think of a piece of advice that I was given a while back now.  There was a man in this group that said there were times he felt inadequate.  Everyone at the table immediately began to insist that he was capable and other kinds of sincere rebuttal, all of which he waved off and continued:  "I may not be the best man for the job, but I'm going to work hard enough that it isn't going to make a difference."  

I have been thinking about this a lot in my current context.  My circumstances in nursing school are no one's fault, and I will still bear the weight of the effects, but I will practice and I will work hard enough that it's not going to make a difference.  

The feelings of frustration are real; so is my determination as well as my resignation that the situation isn't what anyone expected.  All exist in the same space.  

...aaaaaand even with that momentary boost of confidence and certainty, it's time to panic about the three tests I have next week.

Peterson Family Update, #782

Whelp, SOMEHOW, life has this weird way of continuing onward.  I had about a half-dozen different ideas of what I was going to write this week and with all of my course readings, each of them has decidedly fallen out of my brain.

**Time to Deploy the Bulleted List of Random Thoughts!**

• I am still doing all of my class readings.  It's interesting to me to see some folks in the group assert that they don't, as though it were a point of pride.  Simultaneously, I don't think that I'm morally superior for having done the reading (particularly around Sunday evening when there was a lot more skimming happening than when I started).  I do it because I know how I study and have specific goals for what I want out of the program.  Again, no moral judgement, but it strikes me as interesting how doing no readings and doing all readings can be very odd bragging points.  
• Black lives still matter, folks, even when it's not trending on Twitter anymore.  
• Even though we would like to ignore COVID-19, it is, in point of fact, indifferent to our boredom and spreading remarkably fast.  Pretending something doesn't exist does not magically make it not exist.  
• I have had the good fortune of good groups in all of my group projects thus far.  I know that I have jinxed myself terribly for all subsequent terms, but I also needed to express that gratitude.  
• We are in week eight of the term, over the halfway point.  ...and cue the mad laughter.  I feel as though time has flown in the same breath that I feel as though I have slogged through some components impossibly slow.  And then some other moments where I've run fast as I can just to stay in the same place.  
• There was a lot of pressure at the beginning of the program, where professors and other leaders would remark repeatedly on how close-knit these groups tend to be, leaving me in a particular state of "GAH!  Must force friendship now!" in the back of my mind, while the rational part kicked in with a "dude, chill out, and let it develop."  Well, I have definitely found some folks in the program by this point.  I haven't worked with all members of our 38 person cohort yet since we're not all in every class together, but there are some people I've had the chance to actually get to know.  
• I have had some Ah-ha! moments in the material we're learning, places where things connect in a satisfying and applicable way.  In many other places, I simply don't know what I don't know.  It ebbs and flows.  
• Andy is still working from home, on the other side of my wall.  We've been in close quarters for almost four months, and he's still one of my favorite things in this world.  He, Mike, and I have all been doing well together as good roommates.  
• My older brother is staying with us for a week while my folks are working on the initial moving into the new house.  This naturally involves reshuffling of space and the like, but we are doing well with it.
• Andy's gotten a couple of housing projects under his skin:  the deck is about half painted so far, and the light fixture in the dining room is down, the new ceiling fan waiting on some additional consulting since the box was a weird size.  We still have a lot of ideas for that downstairs basement and might be ready to start compiling quotes soon, to at least get a fence around what resources we need yet.  
• I drove down to see my parents' new house this weekend--it was emphatically good to spend some time with them and get some pictures up on the walls.  I also enjoyed the quiet freedom of an hour drive down the highway and country roads, feeling my world start to expand ever so slightly.
• Realizing that I need to balance in some fun reading with my class reading--the tricky part is finding a book that is good enough that I want to keep picking it back up but also not so good that I get too absorbed and I read nothing else, which is where I've found myself a few times in the attempt.  It's partly why I've leaned more toward a movie or a video game as a nightly ritual instead of late.  
• Fall is not officially sorted out with ISU yet--there are a lot of questions that remain, but the sincerest hope of the group seems to be that we'll be in person as much as possible.  The world is evolving too quickly right now to have the answers so readily available.  I have my own suspicions and places where I would quietly place my bets, but it is speculation only.  In any case, the pace of my courses should slow a bit, and I'm looking forward to that if nothing else. I do hope to meet my peers in person sooner rather than later, though (provided we can do so safely, of course).  
• ...and I have a few tests to study for so that's about what I've got today. 

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.