Unapologetically Pretty

Phwew!!  I am on the struggle bus.  I spent 300 dollars at the grocery store yesterday and I swear 1/2 of it was useless carbs.  I bought six bags of chips, bubble bath and bath bombs, two boxes of brownie mix and ice cream.  This is stuff  I would never normally buy.  I did  buy fresh flowers tho and they have brightened up my home.

What I really want to talk about is the elephants in the room.  Things that I fear will still be there when this is over and things that in my mind are criminal and ethically unconscionable.

The country is staying afloat by people who don’t make a living wage.  People that sell you your groceries, deliver your packages, deliver your food.  When this is over we will have done nothing to improve their way of life.

People of color are dying disproportionately from covid-19 because they suffer from health inequity.  This is not a new concept.  If you don’t know what this is, look it up! It is  something that has been an issue for decades.  When this is over we will have done nothing to ensure this does not continue to happen!!

Our health care system is a business based on profit.  The focus is elective surgeries for people who are well insured.  Prices fluctuate depending on who you are and how you pay.  We have been told that cost is high to help off set the cost of the uninsured.

17 million people have filed for unemployment, losing their employee based health care.  What is going to happen to the cost of health care for the insured?  Will the expectation be to pay a higher cost to offset the uninsured.  When this is over we will have done nothing to address our critical health care issue and ensure this will never happen again.

We have learned that we have an inept system for handling a public health crisis!!  Many agencies that overlap, do not communicate with each other and fight for resources.  We have no system that ensures medical equipment, medication and personal protective equipment for health care providers be easily and readily accessible.  When this is over we will have done nothing to ensure that this doesn’t happen again.

We do not appreciate and protect all forms of business.  Some are expected to go months without income, health insurance, and the ability to sustain housing.  When this is over we will  have done nothing to grant people the necessities for survival and ensure that it never happens again.

The virus is exposing our weakness, our weakness in health, in a living wage, in access to quality health care, in our ability to survive.  Our inability to care for each other as equals.  I am emotionally exhausted.  I will retreat to my brownies and ice cream and  hope for better things to come.  To a world that will look to the big picture.  The picture of humanity, survival of the species, and the human spirit.

 

 

 

 

 

 

 

Dan and I were talking about social distancing the other night and I said “it reminds me of the days of educating people on why you should wear a condom”.  Nobody wants to wear one because it’s less pleasurable and “it’ll never happen to me.”  We’ve all heard the rules of squares right?  Your intimate encounter could potentially expose you to 150 contacts.

I would like to use this same analogy for our current situation.

Sally has a harmless cup of coffee with Jane.  She and Jane are co-workers.  They’ve been around each other for years.  Jane is Sue’s work wife. What harm is there in that?

Guess what? Jane cheated on Sue.  She had a sandwich with Rick and Virginia two nights ago.  Rick and Virginia are both essential employees at Walmart and Jane has been watching their two year old because the daycare is closed.  Virginia’s mother, Lois, is also watching the two year old occasionally.  Virginia’s husband, Steve, drives a a truck  for UPS.  He is also an essential employee.  God knows how many things Rick,Virginia and Steve have touched or how many people they have come in contact with.

Sally’s cup of coffee has turned into an epidemiologist’s nightmare.

Now having said that, let’s be careful about passing judgement or throwing stones at Sally or Jane, or the whole crew.

In a perfect world we say “stay at home” “limit your exposure” but when you’re essential, make minimum wage, have no daycare, no leave and limited resources,

you do what you gotta do.  Once again we are asking our most vulnerable to choose between absolute necessities and something that may or may not happen.  This is a no win situation for many.  So the next time you see someone who you think is doing something they shouldn’t be doing, you may not have the entire story!

buttttt wash your hands!!

 

 

I stayed home sick today.  I have a cold with cough and  with the recent Corona virus people would not appreciate me coming to their home.  Three months ago I would have gone.  The truth is health care professionals often don’t do as we say.  We go to work sick and contagious because the team suffers if we aren’t there.   Let’s be real….We aren’t supposed to get sick.

So we have this super virus that has got people in a panic.   My thoughts are, this was expected.  Things like this happen, and I am puzzled why we are responding in this way.  There have been super bugs in the past, that killed people, caused babies to become deaf, caused brain damaged and permanent mobility issues.  Super bugs that wiped out entire populations.  We responded, created ways to combat these diseases and improved health.  I am talking about things like measles, polio, small pox.  The weapon was vaccines.

I am in no way minimizing the threat.  Just puzzled at the understanding or lack there of.  So it is here, and people are going to get sick and people are going to die.  The elderly, immunocompromised and people with chronic medical conditions are at the greatest risk.  This includes people who are under-insured, have not been able to treat their medical conditions appropriately because of cost, or poor insurance coverage.  Maybe their community lacks providers and they don’t go as often as they should.  But wait.  We don’t have a problem with this.  Oh yes we do.

I see it DAILY!!!  People rationing their medication or missing necessary appointments because of a co-pay they can’t afford!  These are people who have paid into a system that was supposed to cover them when they retired.  A system that isn’t adequate because there are loop holes, coverage limitations etc.  Problems that were not supposed to exist when it was originally designed.  This is not the patient’s fault.  It is a system that isn’t working.

This leads me to my next rant.  Corporations are taking a financial hit due to the super virus.  Businesses are losing money and somehow that seems to be a top priority.  I do have compassion for small business owners, it could be devastating but I have a problem with bailing out huge companies.  Companies that don’t pay their fare share of taxes.  Families are often ridiculed for living pay check to pay check.  Why don’t you have money in savings, a cushion for the unexpected?  Point taken, but there is a huge difference between 30 thousand dollars a year and a company that make billions of dollars and pays their CEO’s 6 and 7 figure salaries.  I’m sorry, where is your cushion, did you not plan for something like this?  Guess where the money for these bailouts is coming from?  The money that funds Medicare and Social Security!!  Umm go back to the previous paragraph!!  What is happening.  Have we all lost our minds?

Sooo Wash your f’ing hands.  Vaccinate your children.  Take the flu shot.  Insist on healthcare for all, healthcare that is a right not a privilege.  Talk to people and hear what is really happening.  Have compassion and vote for crying out loud!!

 

To the above question, I don’t know but it sure deserves some attention.  There are a lot of adults with ADHD that never got an appropriate diagnosis.  There are also a lot of people who have suffered chronic trauma.  The symptoms are often similar and it is hard to decipher which is the correct diagnosis.  Truthfully it may not matter if we treat the symptoms but patient’s need to be appropriately assessed.  This will require some time and questions.  Probably more than a 20 minute trip to your PCP.

Does this mean that PCP’s can’t treat or diagnose either, of course not.  I consider myself primary care and could treat these conditions BUT..sometimes it takes a few visits or counseling or a trip to a psychiatrist/psychologist to get to the root.

One of my recent patients was on an antidepressant and I asked what she took it for, depression, anxiety, bi-polar?  Her response was “I am not sure…depression I guess.”  She appeared very nervous and made poor eye contact.  Over the course of our visit.  I felt like we had the rapport where I could delve a little deeper.

She tells me…

” I just can’t seem to get organized”

“I know what needs to be done but I just can’t get my brain to tell me where to start”

“I find that I avoid places and people”

“When I was a kid I wondered if there was something wrong with me.  I had trouble making friends and always had trouble at school.”

“I never had the things I needed in school like paper and pencils”

“My mother did weird things and truthfully I had a terrible childhood.”

The list went on and on but she definitely has signs and symptoms of multiple things.  My heart broke for her.  I tried to reflect back to her what I saw and give my own perspective.

” did you find your struggle with organization made you feel overwhelmed?”  “did it cause you to feel sad or depressed?”   ” did those feelings cause you to avoid others?”

Her father was abusive and mother was most likely mentally ill.  She has never had anyone ask her questions about her depression or past history.  She has been on an anti-depressant for years yet has never had counseling or a thorough assessment.

She agreed to talk with her Dr. about getting a referral for a psychologist or psychiatrist and was open to counseling.  It will take awhile to sort it all out but I told her I thought her life could definitely improve.

I could tell she felt heard and less burdened.

When we work with humans we need to recognize the possibility, high possibility, that there has been some form of trauma and that this effects our development, well being and health.

 

*my beautiful son and grandson.

 

I absolutely loooove to dance.  My current girlish figure makes my dancing look more like a sack of squirrels but I don’t care.  It is good for me and my attitude.

I am not going to write about that kind of dancing tho.  I am talking about the mental dance that I do every day as a home visitor.  I am currently seeing elderly and disabled patients in their homes.  This proves to be very entertaining and requires a lot of mental quickness and skills.  I am serious.  My brain is exhausted when my day is done.   I rarely listen to the radio or talk to anyone between visits.  It gives my brain the quiet it needs.

Here is an example of a typical day and the skills I am talking about.  My first visit of the day involves a patient with three small dogs who apparantly never learned the skill of being house trained.  There are small treasures (turds) scattered around the room.  My job is to complete a thorough assessment, while keeping these gems in periferal vision so they don’t become smashed into the sole of my shoes.  It is much more challenging then you think.  On to visit number two.

This visit involves a patient with bipolar disorder who is currently not on any medication.  He provides a lot of information but none of it is in any type of context. He is easily frustrated with me when I ask for clarification and often is on to another subject before I get the answer to the question that frustrated him.  A fifty five page assessment turns into a two hour visit.  It is definitely a dance to get the infomation I need without ruffling feathers, seeming frustrated or non empathetic.  After completion there is definitely no radio while enroute to visit number three.

Patient number three greets me at my car and asks that we meet outside.  She has a very possesive dog and feels for the dogs sake and mine we should sit on the porch.  Great, except it is 30 degrees and raining.  I know the dog story is likely not the true reason and the bugs crawling out of the medication bag confirm this.  I have self talk that includes,  “you’re almost done”  and “your fingers will be ok, they will warm back up”  “disregard the hues of blue and red, your fingers are still working!!”

I encounter minature donkey’s, 8 day old puppies, a patient who attributes her ability to quit smoking to cocaine and a cat hoarder.

If you ever encounter me and I appear as tho I may have had a mild stroke, have no fear it is just mental exhaustion from a typical day as a home visitor.

 

 

 

This upcoming weekend is haunting me more than I thought it would.  Monday the 17th it will be 17 years that my sweet Jaymee Jo left this earth.   She left Friday morning, Valentines day and never returned.  She was killed Monday morning, February 17th, Presidents day, on her way home.   It is a kind of “Groundhog Day” occurence.    My brain is showing me images I haven’t “seen” in years.  It is how grief and trauma work.  They have their own agenda sometimes.  It could also be that I am more affected due to the emotional climate of the world.  The recent death of Kobe Bryant, which was painful to many for many reasons, the local trauma of the 6 children in Moore OK, and the political intensities and general unfriendliness.

I heard that they are considering releasing the body-cam footage from the Moore police officers that responded to the accident that involved 6 adolescents.  I find this disturbing and wonder if we as a society need to see this.  I know when I saw a drawing of the accident that killed Jaymee, even years later, it was like a punch in the gut.  I think family  of the victims should have the choice to see these images but do we, as the general public, need to be exposed to this.  I worry it causes desentisization and creates a culture with a lack of privacy.  Is it knowledge or information that will benefit us?  Will it create more trauma for friends and family?  Is there a potential that some will learn things from a cold and insensitive exposure to media coverage?  We are inundated with images and words that are negative and painful.  We know that negative energy is much more powerful than positive.  It takes less to do damage and the damage it creates can be horrific.

I woke up in the middle of the night last night and my mind was flooded with images and thoughts of the horrific days that occurred 17 years ago.  I hugged my dog and was eventually able to fall back asleep.  I took this picture to show both the metaphorical and actual self comfort.  I am holding myself, finding some comfort and solace in a world of ugliness and injustice.  I know this moment will pass.  I will hold you in my heart if you need me to and I will hold myself as well.

I try to stay positive, optimistic and think about ways that I can help instead of hinder.  My job can be daunting and the world does not want to see or hear about the underbelly I call work.  Returning to hearing the stories again forces me to shift my mind into a place where I compartmentalize, do what I can, and leave the rest alone.  It can be especially difficult when you see that disbelief and fear in parents eyes, when they realize what has happened.  Some people truly never know of the darkness that is out there.  I want to share a couple of things to help keep you and your children safer.

Do not take your children with you when you socialize with other adults.  Adult socialization, especially if it includes alcohol, should not include children.  I know this sounds harsh.  As a grandma of two little guys I truly know the need for an adult conversation and a glass of wine.  I also understand that finding someone you can trust to stay with your child is difficult if not impossible.   What harm can come from hanging out with a few other couples and their children?  This is often the scenario that presents itself to me, in the course of an investigation.  I won’t go into detail but we are not as capable of protecting our children when we are altered.  We also do not know the history of these other families and children.  It is not worth the risk.  Let grandma watch them and go have your glass of wine.  If you are worried about hurting the hosts feelings, make something up.

Do not force your child to hug or show affection to someone they don’t want to.  Our personal boundaries are sacred and are there for a reason.  Do not teach your child to disregard them.  It also gives the message  what the child feels is wrong.  Let’s face it some people are creepy and we wouldn’t hug them.  Don’t make your child.

Listen to you inner voice.  If something doesn’t feel right it probably isn’t.  Simple.  You don’t need to explain it and please don’t rationalize it away.  If by chance you were wrong, no harm no foul.

The positive.  Most people are good.  Most strangers are safe.  People are survivors and resilient.  The world is not a horrible place and a little perseverance goes a long way.

The picture shows the purity and perfection of nature.  I try to see that in us as well.

 

 

A fellow nurse practitioner shared this phrase with me.  Her psych instructor in Nursing school told her that grief is like a slinky.  It bounces up and down.  I thought this was a great analogy.

I lost my daughter 15 years ago and most days my slinky is pretty tight.  I think about Jaymee everyday but it is reminiscent, positive, and warm.

But there are times when my slinky goes down two flights of stairs and I don’t even realize it.

I have been feeling stressed lately.  Seeing parents neglect their child’s emotional well-being and their lack of protective factors takes its toll.  I had planned to use my vacation as a way to decompress but I continued to feel uneasy.  I was doing a lot of reflecting and then the unthinkable happened.  We learned that a friend of my son had taken his own life.  We pushed it back and enjoyed our final days in Mexico.

The day after our return I was standing at the mirror putting my make-up on and had a complete melt down.  Tears ran down my face and I could not stop.  I partially attributed it to menopause.  I was having a lot of hot flashes! But what the hell.  I am usually pretty even-tempered.

The funeral was at the cemetery where Jaymee was buried.  I had not been there in years.  I felt guilty because we had not taken flowers out there.   It was a difficult day.

I had five days at work and then left again to attend a conference in Las Vegas.  It was during the flight out there, I realized my slinky had been stretched to capacity.

I had visited Vegas three months after Jaymee’s death.  The combination of the impending trip, the death of a child, (he was an adult but my son’s age therefore a child) and the funeral at the cemetary where Jaymee was buried

was the trifecta.

I like to think I am intuitive and in touch with my personal feelings but I’ll be damned if that grief slinky didn’t whack me up side the head!!  It bitch slapped me!!

I share this because I know it has happened to others.  Grief does not have to be from death.  We can grieve the loss of a relationship, status, mobility, or cognitive ability.  Sometimes we have grief from physical pain, emotional pain or empathy for a loved one who is grieving.

Those days when you think “what the hell is wrong with me?”  Pause and reflect.  Maybe it is grief.  Allow the tears to flow and allow your slinky to stretch.  It will re-coil.  If it doesn’t, reach out to someone.  If you feel alone, I am here!!

 

I am on my way home from a business trip and we have stopped to re-load in Phoenix.  I have chosen to  stay in my current seat, near the back of the plane in a window seat.  How full can it be?  Who wants to go to Oklahoma city?

The people start to file in…hmm it is looking pretty full.

Then I see them.  The little people.  More and more of them.  Varying ages but many under the age of two.  By the time we are ready for take off there are 12 children in the surrounding seats and five are under the age of two.

Seated next to me is a Hispanic woman, grandma to the child across the aisle.  Seated next to her on the aisle seat is a middle-aged woman and her 14 month old.  I wonder what the story is.  She looks more like grandma.  Not that it matters, I just find interest in the story and there are so many grandma’s raising grandchildren.

She asks if I mind if she sits there and is apologetic.

“She’s just learned to scream and she does it all the time.”

She looks stressed and we haven’t even taken off.

“That’s normal and it won’t bother me a bit.”

She’s a sweet little baby with big blue eyes.  She is tiny and has that head shape that tells me she was probably premature.  This is  irrelevant but it is my nurse brain.  She is smitten with me and reaches out, offers me her mimi, and squeals with delight when I talk to her.

She is not happy with the confinement of the plane seat and grandma’s lap.

The cabin lights are dimmed and we take off.  The baby behind us starts to cry and the little guy in front of me is melting down too.  The couple across the aisle and one row forward smile with empathy.  Their little guy is three or four and doing great.  I am sure they have been where these other parents are.

The little gem in my aisle is a trooper and reads the safety cards from the seat pocket.  I try to avoid eye contact with her, this seems to increase her excitement and the decibel of her vocalizations.  She is a master at the shrill scream and I catch myself laughing out loud at her.  Poor grandma is beside herself and looks pretty overwhelmed and stressed.  For the majority of the flight the rest of the wee ones are great.  No screaming, crying or meltdowns.

As the flight approaches its end the gem in my aisle is done.  She is not crying but the squealing has risen to a new level.  She is throwing her head back and I know the meltdown is close.  Grandma is nervous and worried about everyone else on the plane.  She attempts the pacifier, a bottle with water in it, and shushing.  It is not working.

Before I can stop myself I hold my arms out to the little gem and she reciprocates.  “I can take her if you are OK with it?”

“She’s pretty crabby”  grandma says.

“Let’s try it”  I say

Grandma passes her over, I set her in my lap and we look out the window.  She pats the window and oos and aahs over the lights,  she love the coldness of the window pane, and is mesmerized by my bracelets and bright orange finger nails.  She looks up at me and then back at grandma.

“She’s still there.”  I tell her.  Baby’s who reference mom are secure.  She knows grandma is the safe person but is also trusting enough to venture out a little.

Little gem, settles in and I slide the mimi in her mouth.  She puts her head on my chest and continues to fiddle with the bracelets.  Her eyelids are heavy and I can feel her body relax.  She never falls asleep but she is definitely comfortable and calm.

The time passes quickly and we land.  She doesn’t move a muscle.  The forward momentum is intense and she is completely unphased.  The cabin lights come up and she is re-energized.   I hand her back to grandma.

“Thank you so much for taking her.   That was very kind of you.  I really appreciate it and I know everyone on the plane appreciates it too.”

“You are very welcome.  I love babies and love that I could help.  Traveling is hard on big people so you know it has to be hard on little ones.”

What I wanted to say is “I didn’t do it for the other people on the plane.  They can get over it.  I did it for her and for you.”

I know that screaming babies are annoying.  That sound can unravel anyone.  Let’s remember that it is a sound of distress and that should be our focus.  Little people don’t understand that they can’t walk the aisle, throw their mimi across the seat and touch the person next to them.  They don’t understand that their parent is worried about how you will react, how they are going to juggle a diaper bag, stroller and make their next connection.

My challenge to you is, the next time you travel offer a helping hand, a friendly smile, or whatever you can do to make the trip better for that little gem in the seat next to you that has mastered the squeal and scream.

 

I am kicked back on my chaise lounge chair and the ocean breeze is blowing on my face.  I am in the middle of a much-needed vacation in Playa Del Carmen.  Lunch was fabulous except for the raw clam that I couldn’t choke down.  I used to like them but I just can’t do it anymore.

My husband went back to the bar and the boys are tending to a phone call.

The warmth is intense and I am filling full filled

“Lisa-He killed himself”

“no, no he didn’t”

The phone call had brought unbearable news.

We sit in silence.  I find the boys, they aren’t boys I just call them that.  My son and his friend are grown, they are seated in the sand, bent over, crying.

The pain of seeing your adult child broken-hearted is gut wrenching

We muted our grief the next three days.  It is still there and can be felt but we press on.  I know what is in store and I hate it.

Grief will run its course and I will be consumed with painful empathy.

The things the outside world will misinterpret.

forgetfulness, fatigue, loss of appetite, over indulging, poor self-care.

sadness, anger, denial, guilt and guilt and guilt.

I wish I could do it for them.

I am sickened with the thought of how his parents will feel.  How long the process is.  How you have days you can’t get out of bed, you can’t breathe, can’t survive.  I pray they do because some don’t.

I hope that someday they can find a way up and out.  That they can use their trauma to empower themselves for growth, empathy, and supporting others.   I know that some can’t.

I hope that the boys can process it as healthy as possible.  That they don’t internalize their pain and let the guilt go.

That they continue to love and nurture others.  That they can someday find the strength to talk about it and use their voices to create change.   I know that many don’t.

Check on your people, love them hard, hold them, and help them if possible.

If you are concerned ask and ask again and again and again.