I don't know about yours, but with the advent of Thanksgiving my Facebook news feed turned saccharine. Everyone suddenly experienced a burst of gratitude for their families and friends, their comforts in life, their health, their spiritual practices, their work, and their confidence in a bright future. Thank goodness it's but a one-day holiday closely followed, if not eclipsed, by Black Friday, when grateful people can descend en masse on department stores to slug it out with each other over the right to be the even more grateful owners of brand new big screen TVs, because I don't know how much more of the sickeningly sweet gratitude I could have taken!
Gratitude is in vogue these days. We're exhorted to keep gratitude journals, count our blessings, and focus on the positive. Some believe that the objects of their thoughts and energy grow and multiply, and so spew forth affirmations of gratitude like lava from a volcano, thereby putting the universe on notice that with thanks duly rendered even greater good and bigger gimmes now are past due.
There's an elephant in the room with all this gratitude. Its name is Narcissism, and its language, simply put, is nothing more than the wolf of old-fashioned boasting clad in sheep's clothing of appreciative verbiage. Tedious at best, this big old elephant expends its energy trumpeting about its good life, leaving the rest of us bored while the actual I.O.U. due from the elephant to the universe remains outstanding.
True gratitude is awestruck. Overwhelmed by the magnitude and/or timing and/or convergence of forces for good, true gratitude stands still and small in the face of bounty. And when true gratitude begins to feel its power, that feeling emerges as a call to service. The truly grateful respond to that call, and are much too busy, too enthusiastic, and too outwardly focused in their efforts to deal with, much less become, elephants.
"I am so grateful that my days of roadside breakdowns are over, and for the people at MegaMotors who will deliver my new Porsche tomorrow," or "I thank God for guiding me to the perfect house and for helping me negotiate to buy it for only $3 million," or "I'm filled with gratitude to be the owner of a thriving, successful business that dramatically surpasses growth projections every month" all are clarion calls of the elephant. The elephant in the room indeed would have us believe that as long as it's expressed in the language of gratitude, it's ok to say, "I have have arrived in the world, and in a new Porsche!," or "I'm so well off that I just bought a multi-million dollar home!," or "I'm such a huge success that I exceed even my own expectations every month!"
The elephant, I'm afraid, is not well. Even if its proclamations are modest (a gift or compliment received, a nice vacation), when the elephant trumpets, "Look at how good I have it!" one must suspect that such noise masks underlying, unmet need. There is no shame in needs; everyone has them. But it is sad when genuine need is tamped down and hidden instead of guided gently to the light where it can be met and transformed.
Decades of work in human services, and even longer living in a human body, have taught me that growth cannot be forced or hurried. There first must be willingness to consider that there might be another, better way, and then courage to reach out, to tell the truth, and to try something new, whether it is a new oven cleaner or giving up crack cocaine.
An old friend called early one morning not long ago, waking me up. "Hey, how're ya doin'?" I asked, attempting a cheerfulness to mask both my grogginess and my concern that a call at that hour portended something amiss.
"I'm grateful!" he responded. "My business is doing great. I have a nice home, a wonderful dog, great friends, and good health. How could it be any better?"
Doubting that many people awaken a friend to explain how grateful they are for their perfect lives, I suspect there is an answer to his question, rhetorical though it may have been intended to sound.
While true gratitude need not hide its face, it is not boastful or showy. It finds expression in a combination of humility and service, it tends to be quiet, and it unleashes powerful forces for good. It is the antithesis of cheap thanks, which is focused on the self and expressed as thinly veiled bragging. Cheap thanks tends to be manipulative and deceptive of self and others, and it deprives everyone of the fruits of the full creative potential generously bestowed by a benevolent universe. It is cheap thanks that is
What's Wrong with Gratitude
Sunday, December 1, 2013
Tuesday, June 25, 2013
It's Obvious
It seems obvious that the way to achieve better health outcomes is to solve problems patients actually have, rather than try to make patients have the problems we best know how to solve. Yet so often the obvious is overlooked, and then we wonder why patients don't improve or are "noncompliant."
"Rose" is 89 years old. She has diabetes, heart disease, chronic back pain, and wounds on her feet. One foot has an open ulcer that just won't heal; a toe was amputated from the other foot, and now not only is the surgical site not healing well, but the adjacent toes are showing signs of breakdown. The foot with an ulcer is hooked up to a machine 24 hours a day; this gently sucks drainage from the wound bed and into an attached canister and stimulates growth of new tissue. Rose carries the machine around in a shoulder bag, being careful not to trip over the tubing attaching the machine to her foot. She also requires two canes to walk, one in each hand. So while she isn't getting much worse but certainly isn't getting much better either, every time Rose wants a drink of water or needs to use the bathroom or seeks a sweater to ward off a chill or anything else, day or night, she must hoist the bag-with-machine onto her shoulder, grab one cane with each hand, carefully adjust the tubing so she neither trips nor pulls it loose, and slowly grunt her way through the little apartment she shares with her husband. Many times I have sat in the living room waiting for Rose to make her way to and from the bathroom, listening to her rhythmic grunt. grunt. grunt., one grunt for each step, because her back hurts when she moves, and she is carrying a machine, avoiding long tubing, and leaning on first one cane and then the other as she goes. A trip to and from the bathroom is grueling exercise for her.
Rose needs to see her vascular surgeon, and I need her to see him, because our treatment no longer is working and we need to adjust the plan. More robust but equally elderly, Rose's husband is confident he can get her down the stairs, into the car, and to the big university medical center where her doctors practice, but he's worried about what will happen once there. In the past they have waited up to forty minutes for a transporter to bring Rose a wheelchair, but now Rose barely can stand for four minutes, much less forty. In the past after appointments they have had equally long waits for a transporter to rescue them again and wheel Rose back to the parking garage. Unless they can get a wheelchair, Rose's husband explains, she can't go to the doctor.
The medical center is full of wheelchairs. I know this. I've been there many times; I've seen them. But I also know Rose's husband is sharp and a straight-shooter not given to exaggeration or fabrication. So I called the social worker whose job is "transitional care," that is, helping people span the gap between the hospital and home, seeing that they have the resources they need to manage safely and well when they are discharged from the hospital, and that they are properly "connected" to doctors and other providers for their follow up care.
The social worker didn't know, she told me, what the situation with wheelchairs was, but she would look into it. With Medicare now exacting significant financial penalties when patients are re-admitted to the hospital for problems that could have been prevented, there is particular emphasis on being sure follow up appointments are kept and that post-hospital care goes smoothly.
A short while later the social worker called me back, startled to have learned that there were only five (5!) wheelchairs and transporters assigned to cover that entire area of the medical center. Patients indeed often had to wait some time for a wheelchair to be available. And, yes, this could have a significant impact on follow up "failures," i.e., patients missing appointments because it was too difficult to get to their doctors' offices when they were tired, hurting, sick. . . and most in need of being there. If they waited until they were sick enough to need to be taken by ambulance to the Emergency Department transportation would be assured: EMS will deliver patients directly to the treatment area, and there are plenty of wheelchairs in the ED to take patients to their hospital beds, yes indeed, more follow up failures turned into re-hospitalizations.
The social worker had seen that a concern about wheelchair availability had been duly registered and was making its way upward through the administrative hierarchy. Meanwhile we remember that Rose is 89 years old. The chances of her living long enough to see administrative resolution of this issue are somewhere between the proverbial slim and none.
So there we were, the social worker and I, on the phone together talking about an elderly patient who needed to see her doctor and who could get to the medical center, but once there could not get to the doctor's office. The social worker wanted to help. Under a special program, Rose qualifies for Medi-car transportation from home to the medical center; the social worker could arrange for the Medi-car. I reminded her that Rose and her husband have a car and can drive themselves. The issue was getting her to the doctor's office once there. The social worker could contact the doctor's office and make an appointment for Rose, she said, and even try to make an appointment with the endocrinologist for the same day. Rose and her husband can dial a phone, I noted; they didn't need help making appointments. They needed help getting from one part of the massive medical center to another. The social worker would see what she could do and get back to me.
Later that day she called with her ultimate resolution: An appointment had been made with the vascular surgeon, and a second appointment a month later with both doctors on the same day. I reminded her again that the problem was transportation from the parking garage to the doctor's office, and she told me curtly that there were only five transporters available and people would have to be patient and wait.
Rose's problem was transportation within the medical center; the medical center's solution was transportation outside the medical center and assistance making appointments that Rose was physically unable to keep. Unable to solve the problem Rose actually had, the social worker provided "help" that wasn't needed, or helpful. But although solutions to problems Rose didn't have and not solutions to her actual problem, this "help" was something the social worker knew how to do. And so that's what she did.
And I'm afraid this happens often.
I could retire comfortably tomorrow if I had a dollar for every time I've been asked to see patients because they were "noncompliant" with their medication regimens and needed "teaching." Information and instruction are proper responses to lack of knowledge or misunderstanding. But patients don't take their medications correctly for a host of reasons, most of which have little to do with knowledge.
They may not be able to afford medications, or medications may have unpleasant side effects, real or imagined. Patients may object to the very idea of taking medicine, or may believe they have too many medicines to take. They may simply forget. The prospect of taking medications may leave some patients feeling "old" or "sick" when they prefer to think of themselves as healthy and vibrant. They may hide medications from their families in order to keep their health issues secret and then miss doses because family members are present and would ask questions, or because in effect they have hidden the medicines from themselves, too. Regimens may be too complicated, or interfere with other activities. People may worry about appearing to be "junkies." They may fear needles or not be able to remove protective covers or child-proof bottle caps. Small pills may be too difficult for arthritic fingers to handle, or may be invisible to eyes with fading vision. Patients may believe their medications don't work, or that doctors prescribe them only so patients will have to keep going back for refills, generating more billable office visits for the doctors. They may understand that while taking some medications they need to give up other things they enjoy, ranging from drinking grapefruit juice to driving, and decide that they'd rather "drink and drive" than take pills. Patients may feel too sick to go to the pharmacy to have prescriptions filled. Large pills may be hard to swallow, liquids may have an unpleasant taste, tablets that need to be broken in half may resolutely refuse to break.
And yes, sometimes, people truly don't understand what they should take, when, why, how, and what the consequences should and could be. This latter group is the one needing "teaching." Yet time and time again I see a nurse or other provider explaining medication names, actions, purposes, administration, and possible side effects, and then considering the job done, and calling patients "noncompliant" and the task of teaching them not do-able when patients continue not to take their medications as ordered. The fact is that such teaching is easy; we know the information and can spew it in our sleep, and then we can feel justified that we have done our work and it is the patient who has failed to take proper advantage of our largesse.
In fact, we have taken the easy road, assuming patients all have the problem that we are best prepared to solve, "knowledge deficit," rather than asking, probing, listening, and comprehensively assessing to ascertain what the real issues are in any individual situation, and then figuring out with the patient how best to address them and move forward. I remember a time when patients were expected to follow "doctor's orders" blindly and were not taught; since then it seems we have come to suppose that imparting information is the solution to all problems with health behaviors. But there's not one of us who never fails to act in accord with what we know to be best: We overeat and underexercise,we sleep too much or too little, we smoke or tan or text while driving, . . . and not for want of "teaching." Providing information is what we healthcare providers know how to do; solving the messy problems of complex human lives is a dicier undertaking. So we assume that anyone who doesn't do what we want him or her to do needs to be taught, less because we have identified real learning needs, and more because teaching is something we know we can provide.
I am working to get Rose her own little wheelchair that can be folded and placed in the car; she and her husband aren't yet sure they want one, but it would make her much less a prisoner in that little apartment, and I have a hunch we'll come to an accord. Failing that, perhaps the vascular surgeon will agree to see her in the medical center's parking garage, if only to call attention dramatically to a simple problem that could be resolved expeditiously if the right people were motivated to do so. And if all else fails I can offer Rose the services of a physician who makes house calls and would evaluate her at home.
Yet through all of this, and in so many similar instances, I am struck by the amount of time, energy, money, and frustration expended by so many providers when by assumption and action, deliberately or not, they try to fit patients into the molds of problems they know how to solve (as by teaching, ordering Medi-cars, and making appointments, whether or not patients need those things) rather than identifying and solving the problems patients actually have. And when patients don't respond by changing their behavior and/or getting better the costs are great, the outcomes poor, and everyone dissatisfied and wondering why. But although challenging, it's no mystery. In fact,
It's Obvious.
"Rose" is 89 years old. She has diabetes, heart disease, chronic back pain, and wounds on her feet. One foot has an open ulcer that just won't heal; a toe was amputated from the other foot, and now not only is the surgical site not healing well, but the adjacent toes are showing signs of breakdown. The foot with an ulcer is hooked up to a machine 24 hours a day; this gently sucks drainage from the wound bed and into an attached canister and stimulates growth of new tissue. Rose carries the machine around in a shoulder bag, being careful not to trip over the tubing attaching the machine to her foot. She also requires two canes to walk, one in each hand. So while she isn't getting much worse but certainly isn't getting much better either, every time Rose wants a drink of water or needs to use the bathroom or seeks a sweater to ward off a chill or anything else, day or night, she must hoist the bag-with-machine onto her shoulder, grab one cane with each hand, carefully adjust the tubing so she neither trips nor pulls it loose, and slowly grunt her way through the little apartment she shares with her husband. Many times I have sat in the living room waiting for Rose to make her way to and from the bathroom, listening to her rhythmic grunt. grunt. grunt., one grunt for each step, because her back hurts when she moves, and she is carrying a machine, avoiding long tubing, and leaning on first one cane and then the other as she goes. A trip to and from the bathroom is grueling exercise for her.
Rose needs to see her vascular surgeon, and I need her to see him, because our treatment no longer is working and we need to adjust the plan. More robust but equally elderly, Rose's husband is confident he can get her down the stairs, into the car, and to the big university medical center where her doctors practice, but he's worried about what will happen once there. In the past they have waited up to forty minutes for a transporter to bring Rose a wheelchair, but now Rose barely can stand for four minutes, much less forty. In the past after appointments they have had equally long waits for a transporter to rescue them again and wheel Rose back to the parking garage. Unless they can get a wheelchair, Rose's husband explains, she can't go to the doctor.
The medical center is full of wheelchairs. I know this. I've been there many times; I've seen them. But I also know Rose's husband is sharp and a straight-shooter not given to exaggeration or fabrication. So I called the social worker whose job is "transitional care," that is, helping people span the gap between the hospital and home, seeing that they have the resources they need to manage safely and well when they are discharged from the hospital, and that they are properly "connected" to doctors and other providers for their follow up care.
The social worker didn't know, she told me, what the situation with wheelchairs was, but she would look into it. With Medicare now exacting significant financial penalties when patients are re-admitted to the hospital for problems that could have been prevented, there is particular emphasis on being sure follow up appointments are kept and that post-hospital care goes smoothly.
A short while later the social worker called me back, startled to have learned that there were only five (5!) wheelchairs and transporters assigned to cover that entire area of the medical center. Patients indeed often had to wait some time for a wheelchair to be available. And, yes, this could have a significant impact on follow up "failures," i.e., patients missing appointments because it was too difficult to get to their doctors' offices when they were tired, hurting, sick. . . and most in need of being there. If they waited until they were sick enough to need to be taken by ambulance to the Emergency Department transportation would be assured: EMS will deliver patients directly to the treatment area, and there are plenty of wheelchairs in the ED to take patients to their hospital beds, yes indeed, more follow up failures turned into re-hospitalizations.
The social worker had seen that a concern about wheelchair availability had been duly registered and was making its way upward through the administrative hierarchy. Meanwhile we remember that Rose is 89 years old. The chances of her living long enough to see administrative resolution of this issue are somewhere between the proverbial slim and none.
So there we were, the social worker and I, on the phone together talking about an elderly patient who needed to see her doctor and who could get to the medical center, but once there could not get to the doctor's office. The social worker wanted to help. Under a special program, Rose qualifies for Medi-car transportation from home to the medical center; the social worker could arrange for the Medi-car. I reminded her that Rose and her husband have a car and can drive themselves. The issue was getting her to the doctor's office once there. The social worker could contact the doctor's office and make an appointment for Rose, she said, and even try to make an appointment with the endocrinologist for the same day. Rose and her husband can dial a phone, I noted; they didn't need help making appointments. They needed help getting from one part of the massive medical center to another. The social worker would see what she could do and get back to me.
Later that day she called with her ultimate resolution: An appointment had been made with the vascular surgeon, and a second appointment a month later with both doctors on the same day. I reminded her again that the problem was transportation from the parking garage to the doctor's office, and she told me curtly that there were only five transporters available and people would have to be patient and wait.
Rose's problem was transportation within the medical center; the medical center's solution was transportation outside the medical center and assistance making appointments that Rose was physically unable to keep. Unable to solve the problem Rose actually had, the social worker provided "help" that wasn't needed, or helpful. But although solutions to problems Rose didn't have and not solutions to her actual problem, this "help" was something the social worker knew how to do. And so that's what she did.
And I'm afraid this happens often.
I could retire comfortably tomorrow if I had a dollar for every time I've been asked to see patients because they were "noncompliant" with their medication regimens and needed "teaching." Information and instruction are proper responses to lack of knowledge or misunderstanding. But patients don't take their medications correctly for a host of reasons, most of which have little to do with knowledge.
They may not be able to afford medications, or medications may have unpleasant side effects, real or imagined. Patients may object to the very idea of taking medicine, or may believe they have too many medicines to take. They may simply forget. The prospect of taking medications may leave some patients feeling "old" or "sick" when they prefer to think of themselves as healthy and vibrant. They may hide medications from their families in order to keep their health issues secret and then miss doses because family members are present and would ask questions, or because in effect they have hidden the medicines from themselves, too. Regimens may be too complicated, or interfere with other activities. People may worry about appearing to be "junkies." They may fear needles or not be able to remove protective covers or child-proof bottle caps. Small pills may be too difficult for arthritic fingers to handle, or may be invisible to eyes with fading vision. Patients may believe their medications don't work, or that doctors prescribe them only so patients will have to keep going back for refills, generating more billable office visits for the doctors. They may understand that while taking some medications they need to give up other things they enjoy, ranging from drinking grapefruit juice to driving, and decide that they'd rather "drink and drive" than take pills. Patients may feel too sick to go to the pharmacy to have prescriptions filled. Large pills may be hard to swallow, liquids may have an unpleasant taste, tablets that need to be broken in half may resolutely refuse to break.
And yes, sometimes, people truly don't understand what they should take, when, why, how, and what the consequences should and could be. This latter group is the one needing "teaching." Yet time and time again I see a nurse or other provider explaining medication names, actions, purposes, administration, and possible side effects, and then considering the job done, and calling patients "noncompliant" and the task of teaching them not do-able when patients continue not to take their medications as ordered. The fact is that such teaching is easy; we know the information and can spew it in our sleep, and then we can feel justified that we have done our work and it is the patient who has failed to take proper advantage of our largesse.
In fact, we have taken the easy road, assuming patients all have the problem that we are best prepared to solve, "knowledge deficit," rather than asking, probing, listening, and comprehensively assessing to ascertain what the real issues are in any individual situation, and then figuring out with the patient how best to address them and move forward. I remember a time when patients were expected to follow "doctor's orders" blindly and were not taught; since then it seems we have come to suppose that imparting information is the solution to all problems with health behaviors. But there's not one of us who never fails to act in accord with what we know to be best: We overeat and underexercise,we sleep too much or too little, we smoke or tan or text while driving, . . . and not for want of "teaching." Providing information is what we healthcare providers know how to do; solving the messy problems of complex human lives is a dicier undertaking. So we assume that anyone who doesn't do what we want him or her to do needs to be taught, less because we have identified real learning needs, and more because teaching is something we know we can provide.
I am working to get Rose her own little wheelchair that can be folded and placed in the car; she and her husband aren't yet sure they want one, but it would make her much less a prisoner in that little apartment, and I have a hunch we'll come to an accord. Failing that, perhaps the vascular surgeon will agree to see her in the medical center's parking garage, if only to call attention dramatically to a simple problem that could be resolved expeditiously if the right people were motivated to do so. And if all else fails I can offer Rose the services of a physician who makes house calls and would evaluate her at home.
Yet through all of this, and in so many similar instances, I am struck by the amount of time, energy, money, and frustration expended by so many providers when by assumption and action, deliberately or not, they try to fit patients into the molds of problems they know how to solve (as by teaching, ordering Medi-cars, and making appointments, whether or not patients need those things) rather than identifying and solving the problems patients actually have. And when patients don't respond by changing their behavior and/or getting better the costs are great, the outcomes poor, and everyone dissatisfied and wondering why. But although challenging, it's no mystery. In fact,
It's Obvious.
Sunday, May 12, 2013
It's Nurses Week!
It's Nurses Week, and also the feast days of several minor saints, and perhaps the time to commemorate uncommon species of rodents or obscure varieties of peppers. As holidays, all warrant about the same degree of observance. But my Facebook news feed does show the annual bump in nurse cartoons, nods of appreciation of nurses that for the most part miss the mark, and a few truly humorous tales about Life with Nurses. One of the latter that hit both Facebook and my inbox more than once is said to have been offered up by the spouse of a nurse: Could be, but if so it's questionable that they actually have been married for 25 years, or that she has been a nurse that long. Or perhaps he's just a lovable slow learner, as many of the fine points and much of the true genius of what we do are missing from his piece. Regardless, in honor of this august occasion (Nurses Week. See, you forgot already), this crone from the Land of Nightingale (that would be Florence. She started all of this. At least in the modern era) is offering a p.s. for those married to nurses, friends and family of nurses, and those otherwise personally involved with nurses:
Don't even think about trying to deceive nurses. They routinely get complete strangers to strip naked and reveal intimate details within three minutes of their first hello. They have treated cheating spouses; criminals; people who don't want their closest intimates to know The Truth (whatever that may be in a given situation); ingenious souls who do anything to get more drugs, or fewer; executives and socialites more concerned about their Image than their lives, much less their health; and even teenagers. And they see all of these in their most vulnerable moments. Nurses go into homes, bedrooms, workplaces, schools, and they keep. going. back. (Facades can be sustained only so long.) Nurses see the cracks in the veneer of carefully crafted public personae, and have uncanny ways of inspiring people to let down their guard and get real. Nurses have a spidey sense like none other. If they haven't discerned exactly what your game is it's because in the overall scheme of things your piddly problem just isn't important enough to warrant the effort. But nurses know when something's off, when people are disingenuous. And God help you once you've triggered that alert.
Don't expect endless sympathy and comfort. Nurses want those they serve to be whole and strong, healthy and self-responsible. This means they dispense Tough Love generously and often. They won't do for you what you can do for yourself, although they may spend hours helping you learn. If you have a symptom or a problem they'll ask what you did to contribute to it and what you can do to make it better. You'll emerge empowered, not coddled. Nurses will help. They'll provide resources, encouragement, referrals, and kicks in the backside. They'll be your loudest cheerleaders and harshest critics. But they're not likely to tuck you in and bring you milk and cookies if you're more than ten years old. And those bedpans and shots so common in nurse jokes? Forget it. Nurses will have you walking to the bathroom under your own power and administering your own injections before you know it.
Odd as it may seem, nurses aren't always looking for more ways to help more people, more tales of woe to hear, or more problems to solve. You have your own family and friends; use them. There is someone in your doctor's practice who actually is being paid to take your call at 2 AM; if you truly need attention at that hour, make him or her earn his or her money. The Emergency Room and EMS are for emergencies; you pay for them with your taxes, your insurance premiums, and your hard-earned pocket money. When you need them, use them. If you call your neighbor or friend or fellow church/PTA/club member, or whoever, who happens to be a nurse, and that person chooses to respond and help you, it is because she or he is a true friend, Good Samaritan, and decent human being (and you should reciprocate in kind). It is not because nurses are limitless givers, doormats, or pathetic, bored souls glad for your giving them something to do on Saturday afternoon.
It's Nurses Week. While I can't speak for the saints, rodents, or peppers, if you're inclined to make an appreciative gesture to nurses you're correct in realizing that there is no thank you big enough for lives saved, medical mishaps averted, wisdom dispensed, confidence inspired, small changes caught early enough to prevent big problems, or the sense that someone who understands somehow knew how to get inside your head and body and guide you back to equilibrium and to new levels of self-care such as you never knew were possible. Empty platitudes, jokes about sex, and caricatures straight from the 1950s don't do it. Safe working conditions, opportunities to practice on the cutting edge and to the full extent of our ability and license, and compensation that reflects our value would help. But for one not in a position to effect those? Be a straight shooter, a respectful fellow citizen, and a self-responsible human being. And you'll find nurses will do the same for you.
P.S.: We also accept Starbucks gift cards, spa days, soft robes, spring flowers, and great dinners! After all,
It's Nurses Week!
Don't even think about trying to deceive nurses. They routinely get complete strangers to strip naked and reveal intimate details within three minutes of their first hello. They have treated cheating spouses; criminals; people who don't want their closest intimates to know The Truth (whatever that may be in a given situation); ingenious souls who do anything to get more drugs, or fewer; executives and socialites more concerned about their Image than their lives, much less their health; and even teenagers. And they see all of these in their most vulnerable moments. Nurses go into homes, bedrooms, workplaces, schools, and they keep. going. back. (Facades can be sustained only so long.) Nurses see the cracks in the veneer of carefully crafted public personae, and have uncanny ways of inspiring people to let down their guard and get real. Nurses have a spidey sense like none other. If they haven't discerned exactly what your game is it's because in the overall scheme of things your piddly problem just isn't important enough to warrant the effort. But nurses know when something's off, when people are disingenuous. And God help you once you've triggered that alert.
Don't expect endless sympathy and comfort. Nurses want those they serve to be whole and strong, healthy and self-responsible. This means they dispense Tough Love generously and often. They won't do for you what you can do for yourself, although they may spend hours helping you learn. If you have a symptom or a problem they'll ask what you did to contribute to it and what you can do to make it better. You'll emerge empowered, not coddled. Nurses will help. They'll provide resources, encouragement, referrals, and kicks in the backside. They'll be your loudest cheerleaders and harshest critics. But they're not likely to tuck you in and bring you milk and cookies if you're more than ten years old. And those bedpans and shots so common in nurse jokes? Forget it. Nurses will have you walking to the bathroom under your own power and administering your own injections before you know it.
Odd as it may seem, nurses aren't always looking for more ways to help more people, more tales of woe to hear, or more problems to solve. You have your own family and friends; use them. There is someone in your doctor's practice who actually is being paid to take your call at 2 AM; if you truly need attention at that hour, make him or her earn his or her money. The Emergency Room and EMS are for emergencies; you pay for them with your taxes, your insurance premiums, and your hard-earned pocket money. When you need them, use them. If you call your neighbor or friend or fellow church/PTA/club member, or whoever, who happens to be a nurse, and that person chooses to respond and help you, it is because she or he is a true friend, Good Samaritan, and decent human being (and you should reciprocate in kind). It is not because nurses are limitless givers, doormats, or pathetic, bored souls glad for your giving them something to do on Saturday afternoon.
It's Nurses Week. While I can't speak for the saints, rodents, or peppers, if you're inclined to make an appreciative gesture to nurses you're correct in realizing that there is no thank you big enough for lives saved, medical mishaps averted, wisdom dispensed, confidence inspired, small changes caught early enough to prevent big problems, or the sense that someone who understands somehow knew how to get inside your head and body and guide you back to equilibrium and to new levels of self-care such as you never knew were possible. Empty platitudes, jokes about sex, and caricatures straight from the 1950s don't do it. Safe working conditions, opportunities to practice on the cutting edge and to the full extent of our ability and license, and compensation that reflects our value would help. But for one not in a position to effect those? Be a straight shooter, a respectful fellow citizen, and a self-responsible human being. And you'll find nurses will do the same for you.
P.S.: We also accept Starbucks gift cards, spa days, soft robes, spring flowers, and great dinners! After all,
It's Nurses Week!
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