Re: btp and the fresh rain scent
11-24-2011, 09:08 AM
There are few things as exhausting as arguing with a crazy person.
I'm not sure "respect" is really the right word for that compassion/frustration mixture that you get when working with patients. Don't get me wrong, respect (both kinds) is SUPER important when dealing with people.
You have your "admiration" sort of respect (less common) that you get when you find out something about a person, either by word of mouth or by actually seeing it. Like the cranky old jewish guy who complained about everything and made me run all the way to the cafeteria because the soup here isn't "fit for pigs to eat" but then you find out that he was born in germany and left after WW1 for the US and then marched against them on D-day and suddenly he is an old man who can say whatever the heck he wants because if anyone has earned it he has. (Then later you find out he's actually a pretty funny guy, and that he appreciates it when people put up with him, and you hate your job just a little less.)
But then there's the basic respect that you give people just for being human. That basic set of principles that you figure people should be able to live with. Respect for life, privacy, decency, not-rolling-in-your-own-feces, the sort of thing that forms the baseline for what people deserve separate from who they are or what they've done. That kind of respect is flat out fundamental.
But the "compassion/frustration" phenomenon is the sort of thing that happens where someone says/does/has something happen to them that gives you a simultaneous multi-layered response.
Like, lets say you're eating in a restaurant and you're actually pretty hungry. The server introduces herself and is nice though a little shy because it's actually her first day on the floor by herself (this is just an example - though I do have a decent amount of restaurant related stories for the nine-months I worked at a seafood place but anyway). Anyway she takes your order and is cheerful and double checks what you want on your salad and which sides are right and sure she can see if the kitchen can grill instead of fry that for you. She delivers your drinks promptly and sets everything in the right place, though you can tell that she's getting a little overwhelmed by the stress of being on her own. She tells you your food should be ready in 10-15 minutes, which is a little longer than you'd like because you are actually quite hungry now but that's okay things take time. Then after those 10 minutes of chewing on salteens and eyeing other people's food you see her walk out of the kitchen with a tray full of all your sweet smelling delicious orderings.
And then she drops the whole thing.
This is where "compassion/frustration" hits you. At the exact same moment two different regions of your brain think the exact same thought. "Oh no, she dropped the tray!" The compassion part of this adds "She must be so upset about this, poor thing." while the frustration part adds "Now I how much longer do I have to wait to eat?"
It's that sorry for her vs. sorry for yourself sort of thing that defines how you feel, and really, that sort of feeling isn't restricted to hospital work - but I think it is featured much more prominently.
Both parts think: "Oh no, this old man shat his bed." But one part adds: "I feel so sorry for him." and the other adds "Now I have to clean up more shat."
Or: "Oh no, the bottom of this lady's bedside commode has fallen out due to the weight of the sheer amount of excrement she has placed in it." Followed by: "She is so embarrassed and almost in tears." also "Damn this is a huge amount of mess to wipe up with a towel." Also "some reason this situation is actually kind of funny"
Or in the case of the worried asian wife: "Oh she is worried for her husband." "That is so sweet." "When will she stop asking me these pointless questions."
Fortunately respect is there to keep you in line.
Though when you're working with the demented, its a much different dynamic.
Today there was an elderly lady in my group that I had seen before. She had very bad hearing, and wasn't altogether there. She had a case of pneumonia which I think contributed to her dementia - though I don't know for sure.
Anyway she had recognized me from her last trip to the hospital - her daughter also recognized me and complemented me (which is something I really don't know what to do with) on helping them out last time they were there and what not.
Well as the day progressed the daughter (who was probably over 60 herself) decided she needed to head home to get dinner and a good night's rest after a long day of caring for her mother. This was in the evening.
There is a term you will probably hear after working in a hospital for a little bit of time: "Sundowners". It's a term that will catch you off guard and will leave you unsure of its meaning until you meet someone who is a "sundowner". Essentially, for whatever reason, when staying in a hospital, some elderly patients become very confused after sundown. They'll start squirming and screaming and get violent to different degrees but there is almost a universal theme to their confusion: They want to go home.
Keep in mind that these are often times people who will collapse on the floor if they try to stand up at all. For this just keep in mind that, for hospitals (and really anywhere), FALLS = VERY BAD. But these patients will forget where they are and what they can do. They'll be driven by this idea that they are not where they should be and that they are being held against their will. (which is actually very true) If you try and remind them of where they are or what is going on, they'll continue to invent reasons and delusions (or simply ignore you), all focused around the idea of GOING HOME.
So tonight, I was doing whatever it was I was doing when I heard the bed alarm for this lady's room go off. A few times. I knew this was a bad sign. Compassion/Frustration kicked in with the realization that she was probably wanting to leave, and trying to get out of bed. When I finished with what I was doing (oh yeah I was helping a behemoth patient back into bed - moving fat people is hard guys). I headed over to the room to find (no wait I was changing an elderly woman who was being sent home that evening, and then checking her vitals and then the nurse came in and then I headed over to the room to find) one of the other PCA's (Nurse Assistants, orderlies, ass-butlers) sitting with/holding back that patient.
Now she had already managed to pull out her IV and take off her oxygen and she was demanding to call her home. One thing I had learned from watching more experienced nurses take care of confused patients was that first impression is important. But I did this wrong. I let compassion overrule my actions here and went to her and yelled "kindly" in her good ear. "Do you remember me?"
She nodded yes. and asked in her trembling voice if I could help her call her home.
Now I really did not want to. See last time I let a "Sundowner" call their home they ended up seriously upsetting the person on the other end. Because, they tend to be very confused and even when they get to talk to the person they're trying to get a hold of, the GO HOME theme kicks in and anyone who isn't letting them go home or leave or who-knows-what is suddenly an "enemy".
This lady called me an "enemy" a lot tonight.
"I thought you were a friend, but you turned into an enemy" repeated multiple times by a near crying old woman pleading with you can really wear you down.
The other PCA helping me out had clearly passed the "compassion/frustration" line and asked me if I wanted to take the shoulders and she'll take the legs and we'll drag her back into bed. I wasn't quite ready for that yet. (It took a good five minutes of talking in circles with this lady - who devoutly clutched an extension plug, and couldn't recall her home phone number, and whose blood pressure was getting super high, to let me finally decide to pull her up by, well force.) After getting ready and pulling her up and of course her getting back up and such, I told the other PCA to go take care of her patients and I'll keep an eye on this lady.
Thus began the most exhausting half hour of the night.
I'm actually really tired right now, and having difficulty recalling all the details. But basically, during the course of all that, I began to realize that what this patient needed wasn't compassion, but direction, though I didn't know how to provide that.
Then the charge nurse came in.
Is it wrong if I think of the dog-whisper when I think of the way the charge nurse handled this lady? Walk in, FLIP ON ALL THE LIGHTS. Suddenly you are important, you have authority, LIGHTS COME ON WHEN YOU WALK IN. Then "Calm Assertive Dominance". There was no pleading or arguing or compassion or frustration. "Get back in bed." Spoken while moving her. Choice was taken away and with that the conflict was resolved. Tell her you'll call the daughter. DON'T DO IT. DON'T BRING IT BACK UP. Just say the words and she forgets and is that more compliant. Tell her to sleep until morning. Make sure she stays there for a moment. Then walk out. FLIP SOME LIGHTS OFF. but not before making sure the alarm is on so you know just when she starts moving again.
That alarm went off a couple of more times, but I followed the nurses' lead. Walked in. Moved her. Walked out. Once she saw me walk in and actually started to pull the covers back over her. It made me a little sad because I guess that means she was afraid of me? but she stayed in bed, and didn't fall and didn't get hurt and hopefully
she'll like me again in the morning.
I'm not sure "respect" is really the right word for that compassion/frustration mixture that you get when working with patients. Don't get me wrong, respect (both kinds) is SUPER important when dealing with people.
You have your "admiration" sort of respect (less common) that you get when you find out something about a person, either by word of mouth or by actually seeing it. Like the cranky old jewish guy who complained about everything and made me run all the way to the cafeteria because the soup here isn't "fit for pigs to eat" but then you find out that he was born in germany and left after WW1 for the US and then marched against them on D-day and suddenly he is an old man who can say whatever the heck he wants because if anyone has earned it he has. (Then later you find out he's actually a pretty funny guy, and that he appreciates it when people put up with him, and you hate your job just a little less.)
But then there's the basic respect that you give people just for being human. That basic set of principles that you figure people should be able to live with. Respect for life, privacy, decency, not-rolling-in-your-own-feces, the sort of thing that forms the baseline for what people deserve separate from who they are or what they've done. That kind of respect is flat out fundamental.
But the "compassion/frustration" phenomenon is the sort of thing that happens where someone says/does/has something happen to them that gives you a simultaneous multi-layered response.
Like, lets say you're eating in a restaurant and you're actually pretty hungry. The server introduces herself and is nice though a little shy because it's actually her first day on the floor by herself (this is just an example - though I do have a decent amount of restaurant related stories for the nine-months I worked at a seafood place but anyway). Anyway she takes your order and is cheerful and double checks what you want on your salad and which sides are right and sure she can see if the kitchen can grill instead of fry that for you. She delivers your drinks promptly and sets everything in the right place, though you can tell that she's getting a little overwhelmed by the stress of being on her own. She tells you your food should be ready in 10-15 minutes, which is a little longer than you'd like because you are actually quite hungry now but that's okay things take time. Then after those 10 minutes of chewing on salteens and eyeing other people's food you see her walk out of the kitchen with a tray full of all your sweet smelling delicious orderings.
And then she drops the whole thing.
This is where "compassion/frustration" hits you. At the exact same moment two different regions of your brain think the exact same thought. "Oh no, she dropped the tray!" The compassion part of this adds "She must be so upset about this, poor thing." while the frustration part adds "Now I how much longer do I have to wait to eat?"
It's that sorry for her vs. sorry for yourself sort of thing that defines how you feel, and really, that sort of feeling isn't restricted to hospital work - but I think it is featured much more prominently.
Both parts think: "Oh no, this old man shat his bed." But one part adds: "I feel so sorry for him." and the other adds "Now I have to clean up more shat."
Or: "Oh no, the bottom of this lady's bedside commode has fallen out due to the weight of the sheer amount of excrement she has placed in it." Followed by: "She is so embarrassed and almost in tears." also "Damn this is a huge amount of mess to wipe up with a towel." Also "some reason this situation is actually kind of funny"
Or in the case of the worried asian wife: "Oh she is worried for her husband." "That is so sweet." "When will she stop asking me these pointless questions."
Fortunately respect is there to keep you in line.
Though when you're working with the demented, its a much different dynamic.
Today there was an elderly lady in my group that I had seen before. She had very bad hearing, and wasn't altogether there. She had a case of pneumonia which I think contributed to her dementia - though I don't know for sure.
Anyway she had recognized me from her last trip to the hospital - her daughter also recognized me and complemented me (which is something I really don't know what to do with) on helping them out last time they were there and what not.
Well as the day progressed the daughter (who was probably over 60 herself) decided she needed to head home to get dinner and a good night's rest after a long day of caring for her mother. This was in the evening.
There is a term you will probably hear after working in a hospital for a little bit of time: "Sundowners". It's a term that will catch you off guard and will leave you unsure of its meaning until you meet someone who is a "sundowner". Essentially, for whatever reason, when staying in a hospital, some elderly patients become very confused after sundown. They'll start squirming and screaming and get violent to different degrees but there is almost a universal theme to their confusion: They want to go home.
Keep in mind that these are often times people who will collapse on the floor if they try to stand up at all. For this just keep in mind that, for hospitals (and really anywhere), FALLS = VERY BAD. But these patients will forget where they are and what they can do. They'll be driven by this idea that they are not where they should be and that they are being held against their will. (which is actually very true) If you try and remind them of where they are or what is going on, they'll continue to invent reasons and delusions (or simply ignore you), all focused around the idea of GOING HOME.
So tonight, I was doing whatever it was I was doing when I heard the bed alarm for this lady's room go off. A few times. I knew this was a bad sign. Compassion/Frustration kicked in with the realization that she was probably wanting to leave, and trying to get out of bed. When I finished with what I was doing (oh yeah I was helping a behemoth patient back into bed - moving fat people is hard guys). I headed over to the room to find (no wait I was changing an elderly woman who was being sent home that evening, and then checking her vitals and then the nurse came in and then I headed over to the room to find) one of the other PCA's (Nurse Assistants, orderlies, ass-butlers) sitting with/holding back that patient.
Now she had already managed to pull out her IV and take off her oxygen and she was demanding to call her home. One thing I had learned from watching more experienced nurses take care of confused patients was that first impression is important. But I did this wrong. I let compassion overrule my actions here and went to her and yelled "kindly" in her good ear. "Do you remember me?"
She nodded yes. and asked in her trembling voice if I could help her call her home.
Now I really did not want to. See last time I let a "Sundowner" call their home they ended up seriously upsetting the person on the other end. Because, they tend to be very confused and even when they get to talk to the person they're trying to get a hold of, the GO HOME theme kicks in and anyone who isn't letting them go home or leave or who-knows-what is suddenly an "enemy".
This lady called me an "enemy" a lot tonight.
"I thought you were a friend, but you turned into an enemy" repeated multiple times by a near crying old woman pleading with you can really wear you down.
The other PCA helping me out had clearly passed the "compassion/frustration" line and asked me if I wanted to take the shoulders and she'll take the legs and we'll drag her back into bed. I wasn't quite ready for that yet. (It took a good five minutes of talking in circles with this lady - who devoutly clutched an extension plug, and couldn't recall her home phone number, and whose blood pressure was getting super high, to let me finally decide to pull her up by, well force.) After getting ready and pulling her up and of course her getting back up and such, I told the other PCA to go take care of her patients and I'll keep an eye on this lady.
Thus began the most exhausting half hour of the night.
I'm actually really tired right now, and having difficulty recalling all the details. But basically, during the course of all that, I began to realize that what this patient needed wasn't compassion, but direction, though I didn't know how to provide that.
Then the charge nurse came in.
Is it wrong if I think of the dog-whisper when I think of the way the charge nurse handled this lady? Walk in, FLIP ON ALL THE LIGHTS. Suddenly you are important, you have authority, LIGHTS COME ON WHEN YOU WALK IN. Then "Calm Assertive Dominance". There was no pleading or arguing or compassion or frustration. "Get back in bed." Spoken while moving her. Choice was taken away and with that the conflict was resolved. Tell her you'll call the daughter. DON'T DO IT. DON'T BRING IT BACK UP. Just say the words and she forgets and is that more compliant. Tell her to sleep until morning. Make sure she stays there for a moment. Then walk out. FLIP SOME LIGHTS OFF. but not before making sure the alarm is on so you know just when she starts moving again.
That alarm went off a couple of more times, but I followed the nurses' lead. Walked in. Moved her. Walked out. Once she saw me walk in and actually started to pull the covers back over her. It made me a little sad because I guess that means she was afraid of me? but she stayed in bed, and didn't fall and didn't get hurt and hopefully
she'll like me again in the morning.