Can You Hear Me Now?

Vaseline Glass Bowl-Hat

Vaseline Glass Bowl-Hat (Photo credit: Paul Garland)

When I was younger, I thought wearing glasses was the biggest humiliation I would have to suffer. Without glasses I can’t see the computer screen I’m sitting in front of, but glasses have a downside. In cold New England a walk from the chilly outside to toasty inside results in a thick layer of condensation that renders glasses wearers temporarily blind. In the summer, going from air conditioning to humidity does the same thing. Aquatic endeavors require a decision to either see what’s going on (my preference in a lake) or swim blind (my preference in the ocean. I believe if I don’t see the shark, it won’t see me).

PhotonQ-Under the Shark

PhotonQ-Under the Shark (Photo credit: PhOtOnQuAnTiQuE)

I’ve made my peace with wearing glasses, but now I’m confronted by a problem many of my fellow baby boomers are also facing,  hearing loss. Yes, we didn’t wear helmets when we biked/skied/played sports and we didn’t wear hearing protection when we shot guns, listened to our Walkmans at full blast, or spent time in noisy environments. Our youthful ignorance of the damage caused by loud noises has led to an explosion in the number of baby boomers with hearing loss.

The National Institute for Health reports that 18% of adults in the 45-64 year old category, have hearing loss. The percentage of Americans with hearing loss increases in the 65-74 year old group to 30%, and for adults over 75, a whopping 47% of them are struggling to hear.

How many of those hearing impaired people are wearing hearing aids? Less than 15 percent. There’s a lot of people out there who have no idea what you’re saying.

Seems like a minor problem until you read the early studies that indicate adults with hearing loss are 3 to 5 times more likely to develop dementia than those with normal hearing.

Scary.

So why don’t we embrace hearing aids in an attempt to increase our thinking skills and ward off dementia (as well as not blowing out the volume controls on the TV)?

Hearing aid

Hearing aid (Photo credit: Soitiki)

Maybe it’s because hearing aids are equated with old people and we’re a nation dedicated to never growing old.  Not all of us can afford facelifts, botox, or tummy tucks, but we can dye our hair, buy anti-wrinkle cream, and pretend we can still hear.

And most people don’t know how much sound they’re missing. When I trialed hearing aids, I couldn’t believe what a noisy house I lived in. The refrigerator cycled on and off, the dryer had a strange squeak, and with the windows open I could hear my neighbor’s children playing outside. All sounds that hadn’t existed for me before the hearing aids.

I wanted to turn the volume down.

But without hearing aids I struggle to carry on a conversation in certain decibel ranges. I lean in closer and keep a semi smile on my face because I’m not sure if the correct response is to laugh or to  cry. Most of the time I can piece together what’s being said through context, but once in a while I can’t. It’s embarrassing when someone asks me a question and I don’t understand enough words to even guess what they’re saying. It’s like suddenly I’m hearing a foreign language and my ears can’t process it.

As easy as it is to downplay hearing loss or make a joke about it, the sad truth is that it has a profound effect on quality of life and, it seems, the risk of dementia. Maybe instead of being fixated with the idea that wearing hearing aids makes us old, we should think about all of the sounds we miss without them. If it’s a choice between hearing my daughter whisper “I love you” as she leaves the house or looking and feeling old, I think I’m going to choose to hear.

There’s only a finite number of “I love you’s” we’re privileged to hear and I’d like to hear every single one of them.

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I’m a Nurse, not a Saint

Priest

Priest (Photo credit: Wikipedia)

I am continually amazed and astounded by the things patients feel comfortable saying to me. It’s as if they think a nursing degree is equivalent to a counseling degree, a white set of scrub pants akin to a white collar, and a hospital or outpatient clinic room is the same as a confessional. It’s not.

Confessional

Confessional (Photo credit: cliff1066™)

Don’t mistake my words for a renunciation of confidentiality. My lips are sealed when it comes to protected health information and you, but, as in real life, there are times when people provide too much information. I’ve provided some examples so you can judge whether you need to be a little more discreet on your next hospital or doctor’s visit.

When I ask you to undress down to your underwear and cover yourself with a sheet, you don’t need to tell me, “I don’t wear underwear.” That is a surprise best left for the doctor. I’m not coming back in to check that you disrobed appropriately.

If I ask you to take off your shoes to be weighed, don’t apologize for the holes in your socks. Our office is only responsible for checking sock holes on alternate Thursdays in months that end in -Z. Any other time, don’t worry. We won’t be putting it in your permanent record nor will I be calling your mother (or the Emergency Room) to rat you out.

If I come in with an shot for your child, don’t tell them it won’t hurt. Chances are it will. I’ll try to minimize the pain, but since I can’t tell them to “suck it up, buttercup,” I’m hoping you’ll have your big girl panties on and shush them rather them tell them you’re sorry the “mean nurse” hurt them.  The mean nurse can’t do shit unless you give me permission, but I’m not telling your toddler “your mean mom made me do it.”

If I do a cervical check on your pregnant girlfriend, don’t ask her if she’s enjoying it. She’s not. Neither am I. Creep.

Never ask me to rub “extra hard” down there if you’re unable to clean yourself off. There are non-medical devices and non-medical personnel who can meet your needs much better than I can. Once you ask, the only “happy ending” I’ll think of is your discharge or death.

Don’t ask if you can strip down to your underwear to ensure your weight is “accurate.” I personally don’t want to see you half naked and believe stripping down for non-medical reasons should happen in your home, not in the exam room.  You can buy your own scale for the cost of a co-pay.

Going Down?

Going Down? (Photo credit: billhd)

Don’t expect me to believe that you need an early refill on your methadone, oxycontin, oxycodone, percocet or vicodin because the bottle you just filled fell into the toilet with the cap off, ruining all of the pills. Unless a major study at a prestigious medical center proves that toilets have a preference for narcotic painkillers, I’m suspicious. This never happens to anyone’s heart, allergy, or diabetic medicine. If you have to lie, go big or stay home. Don’t let drugs kill your creativity.

Remember I’m a nurse, not a saint.

What We Shouldn’t Do For Love

A heart being used as a symbol of love. Photo ...

A heart being used as a symbol of love. Photo modified by author using Photoshop. (Photo credit: Wikipedia)

Urban legends and medical lore are full of the things people do for love. The 22-year-old girl who lifts the car crushing her father. The mother who rushes into a burning building to rescue her children. The father who doesn’t know how to swim, but jumps into the water to save his drowning son.

There are some things, however, that push us to the edge of what we will do for love. Loving an addict is one of those things. It’s tough wondering when the phone call asking for bail money will turn into the one asking you to identify a body. No one’s morning should start in a bedroom doorway worrying if the person inside is passed out or dead.  Life is hard enough without a daily routine of second guessing whether to argue or remain silent. After a while, silence is easier.

Because, after a while you realize that no matter how much you love the addict, you can never make the right decision, say the right thing, or provide the missing ingredient to keep them clean and sober. No one is  capable of stopping the addiction except the addict. Until they admit their problem and get help, no amount of love will make them whole.

It truly is not you, it’s them.

And when you make the decision to leave, the heartache doesn’t stop. Who will take care of them if you’re gone? Make excuses to the few friends that are left? Divert the phone calls from work? Pick up the slack when they spend days in bed recovering from binges?

The pull to go back is stronger than a riptide. It sucks you back and keeps you in place.  To apologize, to make excuses, to take the blame. It’s familiar, comfortable, and as reassuring and necessary as the booze or pills are to the addict.

Until one day you realize that in order to save anyone, you have to save yourself first. You can’t move the car off a loved one if you’re pinned beside them. You can’t save someone from a burning building dressed in gasoline-soaked clothes. You can’t rescue a drowning man when he’s pulling you down with him.

You can’t.

Read all the fairy tales, urban legends, and medical myths you want on the power of love, not all of love stories have happy endings. There are some things love can’t fix. Addiction is one of them.

All you can do is save yourself.

Want more information? Check out the links below:

Alcoholics Anonymous, Narcotics Anonymous, Al-Anon Family Groups, Nar-Anon Family Groups

Patient’s Rights Shouldn’t Be at Nursing’s Expense

Group of nurses, Base Hospital #45

Group of nurses, Base Hospital #45 (Photo credit: The Library of Virginia)

Providing nursing care is an intimate business. Nurses are at the bedside for births, life-threatening injuries, chronic conditions, and death. They become familiar with both a patient and their family. Helping people navigate these life changes takes compassion and empathy. There are days it is damn hard to be a nurse.

Twenty-four hours a day, seven days a week, if you’re in the hospital there will always be a nurse on-site. Budget cuts, staffing issues, increasingly complex machinery and treatments all contribute to the stress that nurses must deal as well as twelve-hour shifts, mandatory overtime, and working holidays and weekends.  Nurses are expected to keep patients safe, use resources wisely, and provide culturally competent care. The nurse is required to respect each patient as a person.

That makes it even more distressing when a hospital disrespects a nurse and her rights as in a recent lawsuit against a Michigan hospital.

The lawsuit alleges that a nurse of 25 years standing in a Neonatal Intensive Care Unit was told by her supervisor she would no longer be assigned to care for an infant because the baby’s daddy didn’t want African-American nurses caring for his child. The man showed the supervisor a swastika-type tattoo in relating his request. According to the lawsuit, the baby’s chart was prominently marked to indicate no African-American nurses were to be involved in this infant’s care. This was honored for a month before the hospital attorney stepped in and had the notation removed.

English: The Neonatal Intensive Care Unit (NIC...

English: The Neonatal Intensive Care Unit (NICU) at Kapiolani Medical Center in Honolulu, Hawaii (Photo credit: Wikipedia)

I don’t know what the hospital was thinking, other than to make the customer happy, but they should have told the man that they weren’t going to allow his hateful beliefs to compromise the care of his child and demean their employees. They could have offered to transfer the child to an institution willing to make those choices, if they could find one. They could have had their Ethics Board review the case and come up with an appropriate plan of care that didn’t imply that African-American nurses were any less competent, worthwhile, or caring than their white, Hispanic, or Asian counterparts. They could have done something.

Woman at work--registered nurse

Woman at work–registered nurse (Photo credit: yooperann)

Instead they bowed down to the demands that were not only hateful, but illegal. If the allegations are true, for an entire month qualified, trained nurses were told they weren’t the right color to provide care and that’s just plain wrong.

Not Dealing with Dementia

 

June and Ward Cleaver (Barbara Billingsley and...

June and Ward Cleaver (Barbara Billingsley and Hugh Beaumont). (Photo credit: Wikipedia)

Television moms and dads are kind, generous, clean, independent, and a source of wisdom. Real life moms and dads can be mean, self-centered, critical, and looking for a handout.  Such is the cards some children are dealt.

 

Dementia

Dementia (Photo credit: Fulla T)

These abusive moms and dads don’t miraculously turn into saints as they age, either. Most of the time the dysfunctional behavior they’ve exhibited worsens, rather than improves, as they age. If they’ve abused drugs, alcohol, or neglected their health, they may get much worse.

 

What to do when bad mom or bad dad (or both) are no longer functioning well at home alone? I don’t mean the not able to shovel out their driveway or lift the air conditioner out of the window type problems. I mean when they think strangers are coming in through the drainpipes and they think one of the intruders stole their gun. That scary not functioning well may be dementia.

 

Dementia is a broad term used to describe difficulties in the areas of language, judgment, behavior, thinking, and memory. Some causes of dementia, such as metabolic disorders and tumors, can be reversed. Other causes of dementia, such as Alzheimer’s disease, can only be slowed down, not cured. Repeat, not cured.  Pay careful attention to the part of the happy pharmaceutical commercials that caution,  “All patients will get worse over time, even if they take wondrous dementia drug.”

 

If you’ve had a great relationship with your parents, filled with mutual respect and assistance, it’s easy to say you’ll do whatever it takes to keep mom and dad safe. Even if it means moving them out of the home they’ve lived in for the last thirty years. Even if it means hiring someone to stay with them so they don’t burn the house down. Even if it means hiding the car or car keys to prevent them from driving to their favorite store that went out of business twenty years ago. Even if it means taking time off from work to accompany them to doctor’s appointments or leaving work early to rush home to deal with emergencies.

 

But if you haven’t had a great relationship with your parent, maybe haven’t even talked to them in five, ten, fifteen, or twenty plus years, what’s your responsibility when the neighbors start calling with their concerns? Do you forget the past and hope they’ll become nice? Put on your martyr uniform and hope for the best? Make an anonymous call to Elder Services and wash your hands of it?

 

There is no easy answer to these questions. Letting your conscience be your guide doesn’t mitigate the guilt that comes with the decision to keep your distance from a demented parent. If you decide to re-engage with the parent, there will still be the resentment that comes with putting your own life on hold to care for a parent who never cared for you. It’s an intensely personal decision that each adult child must wrestle with and decide based on all of the myriad considerations and individual details of their life. If you do decide to ride to the rescue, don’t expect the parent to be grateful for your efforts. Age doesn’t make people any less dick-ish, nor does dementia.

 

As someone who has wrestled with this issue, rest assured I don’t take my abandonment of my parent lightly. There’s a better than average chance that I am the best suited of my siblings for understanding and navigating the complexities of having someone declared incapable of making decisions to pave the way for admission to a nursing home. Not just because I’m a nurse, but also because I’m the oldest. Unfortunately I can’t forget or forgive the toxic parent-child relationship that ultimately ended with my decision to stop speaking to my parent over twenty years ago. I can’t let that go, even though part of me says it’s my duty and part of me feels incredibly guilty that I can’t caretake this person who can no longer caretake themselves.

 

I won’t deny that seeing my parent in their current state, even from a distance without saying a word or them being aware of my presence, breaks my heart. I wish I could find it within myself to soften, bend, and do what some would insist is the right thing. But I can’t.

 

And as much as I salute those who can, I acknowledge that there are those of us who can’t. Age and infirmity doesn’t turn a toxic parent into a saint, it only turns them into a old, sick toxic parent. Don’t judge me for turning my back.  It’s like they say when you fly, if the oxygen mask drops down, you have to put it on yourself before you can help someone else. Unfortunately my parent has demonstrated that they would suck up all the oxygen in my world if they could. As bad as I feel about their condition, I won’t let them.

Day 3: flight to Yazd - inflight safety card

Day 3: flight to Yazd – inflight safety card (Photo credit: birdfarm)

 

Plumbing the Depths of Grief

american somme cemetary Bony

american somme cemetary Bony (Photo credit: Wikipedia)

The death of a loved one is an impossibly agonizing, soul-crushing experience that never completely heals and only lessened by time. When my brother died in a car accident at the age of 25, I thought my tears would never stop.  From the moment I first heard the news, until the moment we lowered his body into the ground, I cried with a ferocity and singleness of purpose I didn’t know I possessed.  All the awful details of death, going to the hospital to get his personal possessions, cleaning out his apartment, picking out a coffin and the clothes he was to be buried in, were done with eyes blurred by tears and a voice hoarse from crying.  The procession of people bearing food and flowers seemed never ending, but I only hungered for alcohol and cigarettes.

After he was buried, the dreams started. Dreams of the two of us on a subterranean train system, the only illumination strobes of light that made him and the other passengers appear and disappear to the background sound of a speeding train racing over wooden tracks.  I was the only one who spoke in the dreams. He sat quietly, attentively, listening. I started out by speaking slowly, normally, and as the train raced along my words hastened to match its speed. I’d talk faster and faster, cognizant in my dream that the time to talk was soon coming to an end, and then he’d disappear.

I’d wake up crying, thinking I would pay any price for him to still be alive. Eventually my grief ebbed to where I could say his name without crying, and then to where I could look at his picture without my eyes growing teary, and now I survive without him. Still, 28 years later, I mist up whenever I hear the lines from “White Christmas” that promise “I’ll be home for Christmas, if only in my dreams”  because my dreams are the only place I can hope to see him.

Was I depressed during the grieving period? Yes. Did my doctor put me on antidepressants to numb the pain of my loss? No, and I’m glad he didn’t. My brother’s death was something I had to work through and plumbing the depths of my grief informed how I have dealt with the deaths of all of the loved ones that have followed him.

The American Psychiatric Manual has traditionally warned against diagnosing depression during bereavement, but now psychiatrists with ties to drug companies have helped to remove that warning and the makers of antidepressants stand to benefit from the change. If grief equals depression, grief is a treatable condition. A treatable condition is billable and amenable to interventions, in this case, prescription medications. Instead of providing a shoulder to cry on, doctors will provide a prescription pad to write on. And where does that leave the patient? Once again a normal part of life is medicalized, this time because drug companies want to take advantage of a market that increases every day, with every death.

Recently I heard the story of a mother who stood up at her son’s funeral and apologized because she had nothing to say to eulogize her son. She stood dry-eyed, unable to cry, and said she was on too many medications to feel anything but numb.  I wonder about her now, many  months after her son’s death, and whether she’s allowed herself to experience the pain of grief in all of its snot-drenching messiness. I hope so. I can’t imagine any crueler prison than not being able to let go of that pain.

In mourning death, we open our heart and let it bleed. Even though a scab may form, for a long time every memory rips it open and starts the bleeding again. It’s an unpleasant, unpredictable process, but as Henry Rollins says, “Scar tissue is stronger than regular tissue. Realize the strength; move on.”

The grieving process helps us to do that far more than any chemical ever will.