The up side of some confused patient is that sometimes they are pleasantly confused. Last night I had a patient who was adorable, but very confused. Let's call her Mary. Every time I walked into Mary's room she would smile and say, "Oh, hi honey". She is a petite woman and I instantly think she is cute enough and perhaps small enough to carry in my pocket. I check in on her and see how she is doing upon arriving on shift and she instantly starts telling me about her cat, baby. She thinks baby is in bed with her and she doesn't want me to squish him. She has dementia so I don't acknowledge or disagree that there is a cat in the bed; That is kind of a losing battle. After her story about how she found baby, she tells me that she doesn't want to keep me from my work. So I try to make her comfortable and turn off the lights for her to rest.
4am comes and Betty is awake crying. She is crying because she doesn't know when she is going to have her surgery on her knee. It's Friday and her surgery was this past Tuesday. I kneel down next to her and explain to her that she had surgery, it went very well and she just needs to rest so she can heal. She continues to cry and talk about all her family and that maybe they didn't know she had surgery. I let her know her family is well aware of her condition and recovery. I orient her to the time and explain that she may be forgetful due to anesthesia and pain medication. This is not a complete lie. Her confusion is the dementia, but I felt that if I told her the other mentioned reasons for not remembering her surgery, that it may calm her some. I let her know that after the surgery she was very sleepy and may not remember some things. I reassure her again and let her know her knee is doing very well and that we are there to make sure she gets better. Mary puts her hands on top of her head as she sobs and tells me how she hates her brain and hates how it doesn't work anymore. For that moment I knew she knew she was confused ... Looking into her eyes I almost lost it and had to fight my tears. I am not sure why this hit me. Maybe I understood her frustration or maybe because I had seen her so happy and content and here she was having a breakdown. There is nothing in school or this job that teaches you how to deal with these situations or know the right thing to say. I grab her hand and explain everything to her over again, let her know she is doing well and that I am there to help. The sound of her crying breaks my heart. An hour or so goes by and she gently falls back into sleep. I wonder how her family must feel to see her come and go out of confusion. I wonder if she knows who anyone is or what her perception of reality looks like. I imagine her moments of clarity and her frustration with the confusion. It's almost like ALS, or Lou Gehrig's disease... Your body fails you, but you are alert and oriented enough to realize it...And you can't do anything about it...
16 March 2012
15 March 2012
Sundowner
The term "sundowning" refers to a state of confusion at the end of the day and into the night. Sundowning isn't a disease, but a symptom that often occurs in people with dementia, such as Alzheimer's disease. The cause isn't known. Once the morning comes, people who had this "sundowning" episode are more alert. They are no longer that confused patient.
I.
I saw this first hand. There is two meaningful things in this story. The meaning of how It feels to fail a patient. The meaning of how it feels to see this patient sundown at night but in morning, flip a 180 and become a different person completely.
I got report on a patient, lets call her Betty. The report I got was not the report I should have been given. According to the nurse handing the responsibility of patient care to me, the patient had some "bouts" of confusion, but was easy to redirect and orient. She was a post operative patient that needed vitals frequently, medications, IV fluids...The list could go on. I take the report and run with it. I go and see my other patients first, compared to my others, Betty seems like a low acuity and priority.
By the time I get to Betty...Betty has taken off her blankets, her gown, leaving her girls open and lying in her armpits...She has taken off her blood pressure cuff, her pulse ox sticker (That I myself, usually can not get off peoples fingers very easily)...She has removed the cotton IV sleeve and ten layers of tape to find her IV line and pull it out. I walk in and she is calmly rubbing her hands on what ever she can grasp. And I'm like okay...Dress up, vitals, new IV start. I am most excited about the last one. Something about starting an IV makes me happy. I get her dressed because I know it is the best thing to do, but quite honestly she doesn't care if she is naked and I've seen more body parts in the last ten years that it just doesn't even phase me anymore. You'd have to have an extra boob or 2 foot long dick to shock me. I get Betty comfortable then go for my IV. She doesn't budge as I stick a needle in her forearm. She just lays there. She talks about how she is in her sister's bedroom, about how the cats will not stay off her bed, and the door bell ringing that she can not answer. I start trying to orient her to where she is and letting her know there are no cats or door bells. After about 20 minutes of that I decide I am not going to win this. They teach us to always orient the patient in school, tell them truth...But after 20 good minutes I am ready to just talk about the cats so we can go on to another topic. So we do. We talk about cats and how they are all over the hospital room looking for food and beds. Whatever. No harm done. The night goes on. Betty constantly pulls on her Foley (catheter that drains her bladder), her blankets, her attends and pulls on the sleeve I used to cover her IV. Under that sleeve is my hell of a tape job to keep her IV in place, that sucker was going to stay in... and did. She would moan and ask to use the bedpan frequently. It was like a crying baby you could not calm, she would just moan and fuss and pull on things. We'd put her on the bed pan, she would pee maybe 50ml. It was like really? Okay well Betty do you feel better? She would tell me yes and then continue fussing with everything she could get her hands on. There was no communication that you would have expected from someone in her state of mind. As the night went I felt myself getting internally frustrated with her. I controlled my tone and my actions and was never in anyway abusive. I just had had it with her. And I felt like I was neglecting my four other patients. Which madw me feel bad also. I tried to get through the night, try to reassure her, constantly put her back together and at 5 am she finally falls asleep. We tip toe past her room careful not to wake her up. I carry around the feelings with me feeling badly for myself. Why did I get so irritated. The patient didn't know any better. I kept reminding myself "this is someones grandma" and if any nurse was shitty with my grandma, I'd have their ass. It's not like a harmed her, I just was flooded with aggravation and then self defeat making myself believe that maybe I was not a good nurse.
Betty woke up at 6 or so. She stated she needed to have a bowel movement and asked if we could help her to the bedside commode. When the nursing assistant came and got me, I was like really? Ya I guess we can try I thought, but I am only trying because she is 50lbs so I know if she falls or gets unsteady I can hold her. Would you believe this patient got up to the side of the bed and on to the toilet without problem? Her vocabulary was clear and appropriate. She told us she would call when she was done. I didn't trust this at first because she had been on a bed alarm all night for being impulsive and trying to escape her bed. The nursing assistant assured me she had come around and was alert and oriented; I waited by the door since it's my license on the line for little grandma Betty. Turns out Betty was as alert and oriented as you and I are. She called. She cleaned herself up. We got her back to bed. Then I talked to her for about 10 minutes about her surgery, her doctor, her breakfast menu... She was clear as day. She was not confused at all. It was like talking to a completely different person. I was so blown away, I didn't know what to think... Or what to say...
This sundowning is someones way of punking me? It's like God gave these patients two different personalities... Then bam when the sun comes out- The patient's state of mind is back to normal. I couldn't look at Betty without thinking WTF? Betty are you in tight with Ashton...Am I being punked?
II.
Part two of another confused patient I recently had. Was a man. Let's call him Dick. Dick had been nonverbal for his stay at the hospital. He would rather sit in his dirty sheets and not eat than move or talk to anyone. Dick has dementia. None of these descriptions fit when I first started to walk in and talk to Dick. He answered my questions and was appropriate. I don't bug him and try to move him in bed although he looks all lopsided and wrinkled up in sheets. I heard he is a fighter. I offer to help him move in bed, he says no. I hang my IV and go see my other 3 patients. When I get back to check on Dick, he smells like shit. Fuck. Okay guy it's you and me and we are going to get you changed. I try to roll him and gain his cooperation...He fights. We just turned into WWF hospital style #winning. I finally get him over on one side so I can start to clean his sheets and get him off his attends (diaper)... I start to clean his hairy asshole with washcloths, of course Dick has a hairy ass and of course he ate glue because this shit is sticky-er than I have ever seen in my 10 years of patient care. There is not a lot of shit, but what is there is sticky icky icky! I've seen asses and shit but not like this. To make matters worse his pubic hair in front was so long the shit flowed back into his ass so there was all this matted hair with shit stuck in it. Ugh. I don't call for help. I just decided I am going to go for it. I let him know what I am about to do. I start whipping like a mad women. Then he thinks its appropriate to tell me "Stop fucking with my asshole" over and over again. At this point I am like really? Could you shut up and I'll clean you hairy asshole! All I needed was staff to come in and be like... "Um, JJ, what are you doing in here?" ... So I can reply, "Oh nothing I am just living the damn dream in here, care to join?"...Ugh. I quit. I'm sweating my balls off trying to get this guy clean and my back is hurting. I get most of the hairy shit and honestly I left some there, done fighting. I slapped on a new attends, covered him in sheets and went on about my way... Ya right, an hour later the same patient, Dick, tries to pull out his IV. He manages to get all the tape off and gets the lines from his IV fluid unattached. This sneaky little unhook makes two things happen. From the first line, coming from a large bag of normal saline, lots of normal saline ran freely into his bed, soaking his sheets, Yes- love when there is wet sheets. The second line from is vein has blood flowing out onto his shirt. Even better .Now it looks like I murdered him, shot dead in the middle of the gut. Fuck. Okay. I save the IV (get kinda excited about that) then tape the fucking shit out it. That IV is going to last another 30 years. I then wrap a sleeve around it. That is a fight. He keeps asking me "What are you doing?" I reply, "fixing your arm Dick!" Then time to change this mans shirt. I almost went EMT mode on him was gonna cut it off with trauma sheers....but I got Dick to participate enough to lift his head and put his arms up so I could slide the shirt off. Don't worry about the bed, I laid down towels where I could under him and that would be the end of that battle. I got him into a hospital gown wrapped him in warm blankets and said goodnight while turning off all the lights. Go mimis Dick!
It's internally frustrating fighting with adults, specially confused ones. You have to be sneaky, creative and quick! I feel like calling my boss in the middle of the night to let her know the deal for me to stay on her Med/Surg floor for a year is off! But I don't. I give report to the next nurse and tell her "God bless you my child"... I leave the floor and feel like shit. I get so frustrated with these confused patients. And that is just real. I have the ability to control my reactions and words...I don't cause any harm to these patients when I am boiling inside... But I still feel bad after wards, more for myself, because I feel like I shouldn't feel like that...
I.
I saw this first hand. There is two meaningful things in this story. The meaning of how It feels to fail a patient. The meaning of how it feels to see this patient sundown at night but in morning, flip a 180 and become a different person completely.
I got report on a patient, lets call her Betty. The report I got was not the report I should have been given. According to the nurse handing the responsibility of patient care to me, the patient had some "bouts" of confusion, but was easy to redirect and orient. She was a post operative patient that needed vitals frequently, medications, IV fluids...The list could go on. I take the report and run with it. I go and see my other patients first, compared to my others, Betty seems like a low acuity and priority.
By the time I get to Betty...Betty has taken off her blankets, her gown, leaving her girls open and lying in her armpits...She has taken off her blood pressure cuff, her pulse ox sticker (That I myself, usually can not get off peoples fingers very easily)...She has removed the cotton IV sleeve and ten layers of tape to find her IV line and pull it out. I walk in and she is calmly rubbing her hands on what ever she can grasp. And I'm like okay...Dress up, vitals, new IV start. I am most excited about the last one. Something about starting an IV makes me happy. I get her dressed because I know it is the best thing to do, but quite honestly she doesn't care if she is naked and I've seen more body parts in the last ten years that it just doesn't even phase me anymore. You'd have to have an extra boob or 2 foot long dick to shock me. I get Betty comfortable then go for my IV. She doesn't budge as I stick a needle in her forearm. She just lays there. She talks about how she is in her sister's bedroom, about how the cats will not stay off her bed, and the door bell ringing that she can not answer. I start trying to orient her to where she is and letting her know there are no cats or door bells. After about 20 minutes of that I decide I am not going to win this. They teach us to always orient the patient in school, tell them truth...But after 20 good minutes I am ready to just talk about the cats so we can go on to another topic. So we do. We talk about cats and how they are all over the hospital room looking for food and beds. Whatever. No harm done. The night goes on. Betty constantly pulls on her Foley (catheter that drains her bladder), her blankets, her attends and pulls on the sleeve I used to cover her IV. Under that sleeve is my hell of a tape job to keep her IV in place, that sucker was going to stay in... and did. She would moan and ask to use the bedpan frequently. It was like a crying baby you could not calm, she would just moan and fuss and pull on things. We'd put her on the bed pan, she would pee maybe 50ml. It was like really? Okay well Betty do you feel better? She would tell me yes and then continue fussing with everything she could get her hands on. There was no communication that you would have expected from someone in her state of mind. As the night went I felt myself getting internally frustrated with her. I controlled my tone and my actions and was never in anyway abusive. I just had had it with her. And I felt like I was neglecting my four other patients. Which madw me feel bad also. I tried to get through the night, try to reassure her, constantly put her back together and at 5 am she finally falls asleep. We tip toe past her room careful not to wake her up. I carry around the feelings with me feeling badly for myself. Why did I get so irritated. The patient didn't know any better. I kept reminding myself "this is someones grandma" and if any nurse was shitty with my grandma, I'd have their ass. It's not like a harmed her, I just was flooded with aggravation and then self defeat making myself believe that maybe I was not a good nurse.
Betty woke up at 6 or so. She stated she needed to have a bowel movement and asked if we could help her to the bedside commode. When the nursing assistant came and got me, I was like really? Ya I guess we can try I thought, but I am only trying because she is 50lbs so I know if she falls or gets unsteady I can hold her. Would you believe this patient got up to the side of the bed and on to the toilet without problem? Her vocabulary was clear and appropriate. She told us she would call when she was done. I didn't trust this at first because she had been on a bed alarm all night for being impulsive and trying to escape her bed. The nursing assistant assured me she had come around and was alert and oriented; I waited by the door since it's my license on the line for little grandma Betty. Turns out Betty was as alert and oriented as you and I are. She called. She cleaned herself up. We got her back to bed. Then I talked to her for about 10 minutes about her surgery, her doctor, her breakfast menu... She was clear as day. She was not confused at all. It was like talking to a completely different person. I was so blown away, I didn't know what to think... Or what to say...
This sundowning is someones way of punking me? It's like God gave these patients two different personalities... Then bam when the sun comes out- The patient's state of mind is back to normal. I couldn't look at Betty without thinking WTF? Betty are you in tight with Ashton...Am I being punked?
II.
Part two of another confused patient I recently had. Was a man. Let's call him Dick. Dick had been nonverbal for his stay at the hospital. He would rather sit in his dirty sheets and not eat than move or talk to anyone. Dick has dementia. None of these descriptions fit when I first started to walk in and talk to Dick. He answered my questions and was appropriate. I don't bug him and try to move him in bed although he looks all lopsided and wrinkled up in sheets. I heard he is a fighter. I offer to help him move in bed, he says no. I hang my IV and go see my other 3 patients. When I get back to check on Dick, he smells like shit. Fuck. Okay guy it's you and me and we are going to get you changed. I try to roll him and gain his cooperation...He fights. We just turned into WWF hospital style #winning. I finally get him over on one side so I can start to clean his sheets and get him off his attends (diaper)... I start to clean his hairy asshole with washcloths, of course Dick has a hairy ass and of course he ate glue because this shit is sticky-er than I have ever seen in my 10 years of patient care. There is not a lot of shit, but what is there is sticky icky icky! I've seen asses and shit but not like this. To make matters worse his pubic hair in front was so long the shit flowed back into his ass so there was all this matted hair with shit stuck in it. Ugh. I don't call for help. I just decided I am going to go for it. I let him know what I am about to do. I start whipping like a mad women. Then he thinks its appropriate to tell me "Stop fucking with my asshole" over and over again. At this point I am like really? Could you shut up and I'll clean you hairy asshole! All I needed was staff to come in and be like... "Um, JJ, what are you doing in here?" ... So I can reply, "Oh nothing I am just living the damn dream in here, care to join?"...Ugh. I quit. I'm sweating my balls off trying to get this guy clean and my back is hurting. I get most of the hairy shit and honestly I left some there, done fighting. I slapped on a new attends, covered him in sheets and went on about my way... Ya right, an hour later the same patient, Dick, tries to pull out his IV. He manages to get all the tape off and gets the lines from his IV fluid unattached. This sneaky little unhook makes two things happen. From the first line, coming from a large bag of normal saline, lots of normal saline ran freely into his bed, soaking his sheets, Yes- love when there is wet sheets. The second line from is vein has blood flowing out onto his shirt. Even better .Now it looks like I murdered him, shot dead in the middle of the gut. Fuck. Okay. I save the IV (get kinda excited about that) then tape the fucking shit out it. That IV is going to last another 30 years. I then wrap a sleeve around it. That is a fight. He keeps asking me "What are you doing?" I reply, "fixing your arm Dick!" Then time to change this mans shirt. I almost went EMT mode on him was gonna cut it off with trauma sheers....but I got Dick to participate enough to lift his head and put his arms up so I could slide the shirt off. Don't worry about the bed, I laid down towels where I could under him and that would be the end of that battle. I got him into a hospital gown wrapped him in warm blankets and said goodnight while turning off all the lights. Go mimis Dick!
It's internally frustrating fighting with adults, specially confused ones. You have to be sneaky, creative and quick! I feel like calling my boss in the middle of the night to let her know the deal for me to stay on her Med/Surg floor for a year is off! But I don't. I give report to the next nurse and tell her "God bless you my child"... I leave the floor and feel like shit. I get so frustrated with these confused patients. And that is just real. I have the ability to control my reactions and words...I don't cause any harm to these patients when I am boiling inside... But I still feel bad after wards, more for myself, because I feel like I shouldn't feel like that...
03 March 2012
Night Owl
Night shift. It is for the birds. It sucks. I am thankful to be on the same floor as a nurse as I worked on as a tech... I love the actual job itself, I love my bosses, I love the staff I work with... The nurses I worked with as a tech and work with now as a nurse, were some of the most supportive people and my biggest fans while I was in nursing school.
With that said, it doesn't make up for the shift. It's rough. It is basically 11pm to 7am. Granted it is a $4 raise a night and on the weekends a $6.75 raise... To me the money is not worth it. I did get offered a evening shift spot, which is the shift I started on... I am very thankful for this, it will be nice to go back to those hours. Evening shift hours are not too early and not too late. I can sleep in, go the the gym and then go to work...AND then be home at an acceptable hour.
Nights is hard for many reasons. You try to sleep during the day while everyone is awake. I get more missed calls/ texts during the day because I am sleeping, I get woken up by people mowing their lawns, I get woken up by the sunshine and the increased warmth of the day...
The next thing that is rough is when I have a night off...I get off at 7am on my night off, workout, then end up sleeping all day and all night just to catch up. Technically the first night off I have of my weekend I get is consumed with catching up on sleep. The days I try to do something on my first night off...ends up a mess. I probably don't sleep until 2pm then wake up around 6pm or so to get ready. My eyes are red and look like they are about to pop out of my head, I get grumpy and short tempered and by the end of my outing all I want to do is eat and go back to bed...Just like a damn kid. It's hard.
The next thing that is even worse is waking patients up at 11pm to do an assessment/ take vitals/ check on their well being. I very frequently get pretty shitty responses from patients like they are expecting to be treated like they are the damn Hilton. No you can not hang a no disturb sign on your door and come out whenever you feel like for that damn continental breakfast. This is a hospital. It is my job to check on you.
The patients that kill me are the ones that had an "elective" surgery. This means they chose to come in and get a knee replacement...or whatever...and still get pissed off when you wake them up to check on them. I'm just like the next person, I hate to be woken up, but if it was a nurse coming to give me pain medication and check on my well being... I just might be a little more nice. Nope, people are rude. One of the last nights I worked a grumpy middle aged lady asked me, "are you going to be doing these tests all night?" I let her know I would check on her, you know to make sure she was still breathing, but that after my assessment I would let her rest.
I frequently get annoyed and short with these "rude" types of patients...I do my thing and bounce asap. If they are nice I usually stick around to go out of my way for them...I know that probably isn't right, but it's the truth. Why would I want to stick around if you are obnoxious. I don't. I do my thing and jet. Lately I decided I need to not take this type of grumpy patient to heart. It's not me, it's the patient and it's the time of night. Later I thought to myself when that lady asked if I would be in all night...I should have said "Yep, every hour on the hour"...Bitch. Lol okay, maybe not the bitch part, but the rest of the statement, yes.
I love the other types of people that offer to turn on the light, ask me how my night is going and tell me, "I understand you are just doing your job". Evening shift will work out way better for me. I not only get to be around while people are awake, but I get to actually spend more time with the patients. I've learned I actually do enjoy the human interaction and I especially thrive off patient teaching and dressing changes. If the patient is agreeable and well mannered I really enjoy spending the time in the room as a nurse and doing my job. Imagine that.
With that said, it doesn't make up for the shift. It's rough. It is basically 11pm to 7am. Granted it is a $4 raise a night and on the weekends a $6.75 raise... To me the money is not worth it. I did get offered a evening shift spot, which is the shift I started on... I am very thankful for this, it will be nice to go back to those hours. Evening shift hours are not too early and not too late. I can sleep in, go the the gym and then go to work...AND then be home at an acceptable hour.
Nights is hard for many reasons. You try to sleep during the day while everyone is awake. I get more missed calls/ texts during the day because I am sleeping, I get woken up by people mowing their lawns, I get woken up by the sunshine and the increased warmth of the day...
The next thing that is rough is when I have a night off...I get off at 7am on my night off, workout, then end up sleeping all day and all night just to catch up. Technically the first night off I have of my weekend I get is consumed with catching up on sleep. The days I try to do something on my first night off...ends up a mess. I probably don't sleep until 2pm then wake up around 6pm or so to get ready. My eyes are red and look like they are about to pop out of my head, I get grumpy and short tempered and by the end of my outing all I want to do is eat and go back to bed...Just like a damn kid. It's hard.
The next thing that is even worse is waking patients up at 11pm to do an assessment/ take vitals/ check on their well being. I very frequently get pretty shitty responses from patients like they are expecting to be treated like they are the damn Hilton. No you can not hang a no disturb sign on your door and come out whenever you feel like for that damn continental breakfast. This is a hospital. It is my job to check on you.
The patients that kill me are the ones that had an "elective" surgery. This means they chose to come in and get a knee replacement...or whatever...and still get pissed off when you wake them up to check on them. I'm just like the next person, I hate to be woken up, but if it was a nurse coming to give me pain medication and check on my well being... I just might be a little more nice. Nope, people are rude. One of the last nights I worked a grumpy middle aged lady asked me, "are you going to be doing these tests all night?" I let her know I would check on her, you know to make sure she was still breathing, but that after my assessment I would let her rest.
I frequently get annoyed and short with these "rude" types of patients...I do my thing and bounce asap. If they are nice I usually stick around to go out of my way for them...I know that probably isn't right, but it's the truth. Why would I want to stick around if you are obnoxious. I don't. I do my thing and jet. Lately I decided I need to not take this type of grumpy patient to heart. It's not me, it's the patient and it's the time of night. Later I thought to myself when that lady asked if I would be in all night...I should have said "Yep, every hour on the hour"...Bitch. Lol okay, maybe not the bitch part, but the rest of the statement, yes.
I love the other types of people that offer to turn on the light, ask me how my night is going and tell me, "I understand you are just doing your job". Evening shift will work out way better for me. I not only get to be around while people are awake, but I get to actually spend more time with the patients. I've learned I actually do enjoy the human interaction and I especially thrive off patient teaching and dressing changes. If the patient is agreeable and well mannered I really enjoy spending the time in the room as a nurse and doing my job. Imagine that.
Not Just A Nurse...
Nursing care comes in many forms. Sometimes it is the ability to make someone feel physically comfortable by various means. Other times it is the ability to improve the body's ability to achieve or maintain health. But often it is an uncanny yet well honed knack to see beyond the obvious and address, in some way, the deeper needs of the human soul.
~Donna Wilk Cardillo, A Daybook for Beginning Nurses
This quote reminds me of the many roles I've thought I've taken on as a nurse. We are/I am not only a RN... But sometimes I feel like the minute I step into the room I start to fulfill the following roles:
Nurse
Doctor ( I answer the questions you didn't ask/ or your doctor never addressed)
Medical dictionary ( I am expected to know the answer to any health question you have)
Teacher ( I teach you how to take care of yourself and how to prevent coming back here)
Crystal ball ( You expect me to know your outcome, though I am usually only 50-75% sure)
Media technician ( You expect me to fix your TV and mechanical bed)
Mom ( I have to remind you to eat vegetables and drink water)
Dietitian ( Because you don't take care of your diabetes)
Therapist ( I sometimes feel like you talk too much about your personal life and I'm to answer)
Baby sitter ( You let your kids aimlessly roam the hospital)
Marriage counselor ( You announce to me you are no longer intimate with you wife?)
Mediator ( Nothing like a patient and the spouse together in the same room- not getting along)
Referee
Chaplin ( I pray with you when you ask me to)
Security ( My license is on the line if you get hurt on my watch)
Physical therapist
Slave ( You take advantage of me at times and ask me to do things you are very capable of doing)
Belongings keeper ( If you lose something you request I find it or else it's my fault it's lost)
Punching bag ( You treat me badly sometimes...I think because you are scared or in pain or perhaps just an asshole)
Discharge planner ( I assist in coordinating your life at home after your hospital visit)
Friend...
I'm sure the list could go on.
I think the biggest shock is when these roles hit you and you weren't prepared for them, especially since you didn't learn this during school... They don't warn you about all of these roles. You step into them and are expected to know the role and all of the answers. You fly by the seat of your pants. I know now that I can do all of these roles because even though I may not have all of the answers, I know now where to find them...
~Donna Wilk Cardillo, A Daybook for Beginning Nurses
This quote reminds me of the many roles I've thought I've taken on as a nurse. We are/I am not only a RN... But sometimes I feel like the minute I step into the room I start to fulfill the following roles:
Nurse
Doctor ( I answer the questions you didn't ask/ or your doctor never addressed)
Medical dictionary ( I am expected to know the answer to any health question you have)
Teacher ( I teach you how to take care of yourself and how to prevent coming back here)
Crystal ball ( You expect me to know your outcome, though I am usually only 50-75% sure)
Media technician ( You expect me to fix your TV and mechanical bed)
Mom ( I have to remind you to eat vegetables and drink water)
Dietitian ( Because you don't take care of your diabetes)
Therapist ( I sometimes feel like you talk too much about your personal life and I'm to answer)
Baby sitter ( You let your kids aimlessly roam the hospital)
Marriage counselor ( You announce to me you are no longer intimate with you wife?)
Mediator ( Nothing like a patient and the spouse together in the same room- not getting along)
Referee
Chaplin ( I pray with you when you ask me to)
Security ( My license is on the line if you get hurt on my watch)
Physical therapist
Slave ( You take advantage of me at times and ask me to do things you are very capable of doing)
Belongings keeper ( If you lose something you request I find it or else it's my fault it's lost)
Punching bag ( You treat me badly sometimes...I think because you are scared or in pain or perhaps just an asshole)
Discharge planner ( I assist in coordinating your life at home after your hospital visit)
Friend...
I'm sure the list could go on.
I think the biggest shock is when these roles hit you and you weren't prepared for them, especially since you didn't learn this during school... They don't warn you about all of these roles. You step into them and are expected to know the role and all of the answers. You fly by the seat of your pants. I know now that I can do all of these roles because even though I may not have all of the answers, I know now where to find them...
02 March 2012
Scary Monster
Yep- It's a code name for a nurse. A big scary, mean looking, mean acting nurse... Who will make you think her shit doesn't stink, but your shit does and she can smell that shit from a mile away, she'll let you know of this. Big scary monster is big into unions, she speaks up about everything regardless of the topic and regardless if she is right and she is overly opinionated. She has to be heard and seen always... Oh boy is she seen. Her pannus (stomach fat) is so big I am not sure when the last time she saw her juice box, but that is a whole other story! How dare you get me off track and on such an inappropriate track! Hahaha... Not really.
The truth is her attitude is about as nice as her hair, skin, and clothes...It's just all one big ball of OMG! I use to feel bed for her, until the time I became a nurse and had to give end of shift report to her. Wow, I thought my night had gone fine. I sit down, convinced myself "I got this" in a "white girl gangsta kinda way" (Yes I do this) I hardly had a sentence out of my mouth when she growls back...."What did you do that for? Why did you do this? Why didn't you do this? Didn't they teach you to do things this way? Did you call the Dr.? Did you tell this to the patient? Did you try to SAVE THE WHOLE FREAKING WORLD IN 8 FUCKING HOURS?
Nope. In fact scary monster... I started my shift cleaning up left over shit from the shift before me... Calming my patients down, settling them in, did my head to toe assessment I am required to do/ (that I do thoroughly), took vitals, assess labs, looked at doctors orders, assisted the CNA (peeps have to eat and poo!!) ...Of course there are many other nursing tasks that consume my eight hours. I had to give medication/ pain medication mostly, monitor people as they take these new pain medications, make sure my charting was up to date and speed and entered correctly in case someone should take me to court. Then after my patients were all comfortable and settled... You, scary monster, came to my desk to get report and have the audacity to ask me what I did and what I didn't do. Well luckily for my upbringing, I have the balls to tell you I didn't even have a chance to piss and are you f'ing kidding me right now!?!?!... But everything is done for you to start your day-And you're welcome bitch.... At least I think we are ready to give report until her questions begin....Making me feel like an inch tall. Then after my slaughter she laughs and tells me about her over the top wine consumption with her husband after he got off from his job at the local convenient store. Winner she has got there. Ugh I swear she hates her hair (she does, it is long and ratty, but she won't go see my hair stylist, I tried), she hates her job, her life, I'm sure she'd swat at a beautiful butterfly if it flew gracefully on by her. Or maybe I was the butterfly...but I am squished. Not winning.
I took this whole baby mama drama into my boss's office... Come to find out my boss has the same views as me about such scary monster...Which made me feel like I just scored the game winning touch down. I knew better, I knew it was not me, I was never brought up or conditioned to be the person she was making me try to feel like... And at the end of the day I won knowing it's her not me, everyone else views her that way and she is one of those people who will be miserable about everything. So I'll collect my butterfly wings...And move on <3
I don't know how much of this venting actually portrays this nurse. The moral of the story is she forgot what it feel like to be new, maybe to be young, ambitious, to want to do a good job....But missed somewhere along the way that you get along further in life with honey... If anything was missed during my shift, all she had to do is let me know in a not such a "make me feel like I am an inch tall way" instead she could have treated me as a new / eager to learn RN and just explained it to me. OR do like I do... Let the shift before me (who didn't get to a task) know that I will take care of it when I can. Nursing is a 24 hour job. Seriously. I am not supper-women, no matter how much I try and hustle, it doesn't work... But bitch I am gangsta and she should watch out in the parking lot. Hahahahaha.
The truth is her attitude is about as nice as her hair, skin, and clothes...It's just all one big ball of OMG! I use to feel bed for her, until the time I became a nurse and had to give end of shift report to her. Wow, I thought my night had gone fine. I sit down, convinced myself "I got this" in a "white girl gangsta kinda way" (Yes I do this) I hardly had a sentence out of my mouth when she growls back...."What did you do that for? Why did you do this? Why didn't you do this? Didn't they teach you to do things this way? Did you call the Dr.? Did you tell this to the patient? Did you try to SAVE THE WHOLE FREAKING WORLD IN 8 FUCKING HOURS?
Nope. In fact scary monster... I started my shift cleaning up left over shit from the shift before me... Calming my patients down, settling them in, did my head to toe assessment I am required to do/ (that I do thoroughly), took vitals, assess labs, looked at doctors orders, assisted the CNA (peeps have to eat and poo!!) ...Of course there are many other nursing tasks that consume my eight hours. I had to give medication/ pain medication mostly, monitor people as they take these new pain medications, make sure my charting was up to date and speed and entered correctly in case someone should take me to court. Then after my patients were all comfortable and settled... You, scary monster, came to my desk to get report and have the audacity to ask me what I did and what I didn't do. Well luckily for my upbringing, I have the balls to tell you I didn't even have a chance to piss and are you f'ing kidding me right now!?!?!... But everything is done for you to start your day-And you're welcome bitch.... At least I think we are ready to give report until her questions begin....Making me feel like an inch tall. Then after my slaughter she laughs and tells me about her over the top wine consumption with her husband after he got off from his job at the local convenient store. Winner she has got there. Ugh I swear she hates her hair (she does, it is long and ratty, but she won't go see my hair stylist, I tried), she hates her job, her life, I'm sure she'd swat at a beautiful butterfly if it flew gracefully on by her. Or maybe I was the butterfly...but I am squished. Not winning.
I took this whole baby mama drama into my boss's office... Come to find out my boss has the same views as me about such scary monster...Which made me feel like I just scored the game winning touch down. I knew better, I knew it was not me, I was never brought up or conditioned to be the person she was making me try to feel like... And at the end of the day I won knowing it's her not me, everyone else views her that way and she is one of those people who will be miserable about everything. So I'll collect my butterfly wings...And move on <3
I don't know how much of this venting actually portrays this nurse. The moral of the story is she forgot what it feel like to be new, maybe to be young, ambitious, to want to do a good job....But missed somewhere along the way that you get along further in life with honey... If anything was missed during my shift, all she had to do is let me know in a not such a "make me feel like I am an inch tall way" instead she could have treated me as a new / eager to learn RN and just explained it to me. OR do like I do... Let the shift before me (who didn't get to a task) know that I will take care of it when I can. Nursing is a 24 hour job. Seriously. I am not supper-women, no matter how much I try and hustle, it doesn't work... But bitch I am gangsta and she should watch out in the parking lot. Hahahahaha.
26 February 2012
Where The RN Began...
For me...I didn't always wish to be a nurse. As early as I can remember I wanted to be a lawyer, a vet, a wedding planner, a florist, a hair stylist... Then in high school one afternoon I sat in my counselors office at a crossroad. I couldn't decide if I wanted to do on the job training my senior year at the early childhood center or go to EMT classes... When I told my counselor I wasn't sure...She immediately said "EMT" and I agreed. I adored her, she was my volleyball coach, a kind ear that always listened and thought so much of me that in 2001 she nominated me for an award in Anchorage... It was a young woman achievement award. I didn't win, but the nomination meant just as much to me.
I went on my way not knowing what I was getting myself into. Started EMT class right away and loved it. Honestly, I was fascinated by a not so normal career, the rush of trauma, love from the community for being in such a role and learned that I loved nothing more than hauling ass to a fire...Then came the firefighter academy. I was set. I never felt so important to do anything in my life. I loved the job, I loved the people I worked with, I loved the patient care. I not so much loved the "on call" aspect, being sleep deprived and picking up drunks on the Alaska high way in freezing temps. So the most logical thing to me was to carry on in medicine...but in the warm comfort of a hospital and so the venture for becoming an RN began. And holly shit what a venture.
I worked my ass off for at least 4 years doing prereq's and not just doing them, but achieving a 4.0 every minute I could because I was told nursing schools would evaluate me on my GPA. Well taking classes, working full time, buying a house, planning a wedding AND getting a new puppy might not have been the best start... I did it. I got migraines. I was like damn, I should have just stayed an EMT. I got through it.
Then came the shock of nursing school. The first attempt to get into the RN program here in Washington was a fail. I neatly submitted all of my paperwork just to get a "you're not excepted letter"...When I saw this my heart dropped. I knew it had to be a mistake...I had tons of medical hours/experience, that 4.0 gpa, letters of recommendation from my fire chief, boss and co-workers. The next morning I called to find out what happen. Turns out all those big people who sit around and look at these RN program application packets missed the fact that I was a certified CNA (which you have to be to get into the program). The best part is I did my CNA cert at the same damn school...Had someone looked, they would have seen I had my CNA and I should have been accepted then. Whatever. I got in in the next quarter in the fall 2009 after a summer of fun and an outstanding Vegas vaca. I was ready. Bullshit...I was ready up until the point I saw our 5 classes schedule and hit the overload, flip the fuck out mode...I gained 20lbs and lost half my hair. This "venture" made me something I hated. I was stressed out and not happy at all.
Two years later... Gradu-fucking-ation :). I lost the weight, grew some of that damn hair back and felt glad to be done! I had learn to adapt to the bullshit, the unfair teachers, the insane studying schedule and the acceptance of no social life...I made it trough. I look back and am thankful I didn't get accepted the first time, because the class I joined ended up being a great one. I made some friends there that I know I will have for a very long time...As well as some enemies, but they are only enemies for very good reasons.
So here we are 9 months after graduation and I think about all I did to get to this point, all the hardships, the rewards and now the RN job. Don't ever get me wrong in all of this, I am thankful, but I still feel like I am waiting to exhale...I think this will help. Oh and BTW RN school doesn't do shit to prep you for the RN job. When you start the job, it's like doing fucking school all over again...You start from square one. What an incredible, emotional, rough start it's been. I sometimes think if I knew then what I know now I might have stayed an EMT and went to Paramedic school and just sucked up the "on call" shifts and hard weather... But what do they say...? Hindsight is 20/20. So there you have it, here I am and I have a lot to say. Hence the blog eventually, in hopes, book. I feel like there are many lessons to share that they don't tell you in nursing school and if this only turns out to be a blog...So be it, it is my therapy. My free therapy.
I went on my way not knowing what I was getting myself into. Started EMT class right away and loved it. Honestly, I was fascinated by a not so normal career, the rush of trauma, love from the community for being in such a role and learned that I loved nothing more than hauling ass to a fire...Then came the firefighter academy. I was set. I never felt so important to do anything in my life. I loved the job, I loved the people I worked with, I loved the patient care. I not so much loved the "on call" aspect, being sleep deprived and picking up drunks on the Alaska high way in freezing temps. So the most logical thing to me was to carry on in medicine...but in the warm comfort of a hospital and so the venture for becoming an RN began. And holly shit what a venture.
I worked my ass off for at least 4 years doing prereq's and not just doing them, but achieving a 4.0 every minute I could because I was told nursing schools would evaluate me on my GPA. Well taking classes, working full time, buying a house, planning a wedding AND getting a new puppy might not have been the best start... I did it. I got migraines. I was like damn, I should have just stayed an EMT. I got through it.
Then came the shock of nursing school. The first attempt to get into the RN program here in Washington was a fail. I neatly submitted all of my paperwork just to get a "you're not excepted letter"...When I saw this my heart dropped. I knew it had to be a mistake...I had tons of medical hours/experience, that 4.0 gpa, letters of recommendation from my fire chief, boss and co-workers. The next morning I called to find out what happen. Turns out all those big people who sit around and look at these RN program application packets missed the fact that I was a certified CNA (which you have to be to get into the program). The best part is I did my CNA cert at the same damn school...Had someone looked, they would have seen I had my CNA and I should have been accepted then. Whatever. I got in in the next quarter in the fall 2009 after a summer of fun and an outstanding Vegas vaca. I was ready. Bullshit...I was ready up until the point I saw our 5 classes schedule and hit the overload, flip the fuck out mode...I gained 20lbs and lost half my hair. This "venture" made me something I hated. I was stressed out and not happy at all.
Two years later... Gradu-fucking-ation :). I lost the weight, grew some of that damn hair back and felt glad to be done! I had learn to adapt to the bullshit, the unfair teachers, the insane studying schedule and the acceptance of no social life...I made it trough. I look back and am thankful I didn't get accepted the first time, because the class I joined ended up being a great one. I made some friends there that I know I will have for a very long time...As well as some enemies, but they are only enemies for very good reasons.
So here we are 9 months after graduation and I think about all I did to get to this point, all the hardships, the rewards and now the RN job. Don't ever get me wrong in all of this, I am thankful, but I still feel like I am waiting to exhale...I think this will help. Oh and BTW RN school doesn't do shit to prep you for the RN job. When you start the job, it's like doing fucking school all over again...You start from square one. What an incredible, emotional, rough start it's been. I sometimes think if I knew then what I know now I might have stayed an EMT and went to Paramedic school and just sucked up the "on call" shifts and hard weather... But what do they say...? Hindsight is 20/20. So there you have it, here I am and I have a lot to say. Hence the blog eventually, in hopes, book. I feel like there are many lessons to share that they don't tell you in nursing school and if this only turns out to be a blog...So be it, it is my therapy. My free therapy.
18 August 2009
?
Nursing makes me question reasons in life. Patient's lives makes me question my own. I myself question God. Is God questioning me?
14 August 2009
HawthoRNe
Hawthorne is one of the only shows I'm following on T.V. Sometimes I can't even follow it, I later watch it on demand. Cable is amazing that way. Every time I sit down to watch it I expect three things: To cry by the end of the show, To be able to relate to a story with patients I've had, and To wonder about what kind of nurse I'll be. When I say "Kind of nurse I'll be," I don't mean in which department, but how will I be viewed by surrounding staff and patients. If you're too soft people view you in a way that they can take advantage of you. Sometimes being soft and patient makes people appreciated your care. Sometimes it makes them think they can manipulate you. If you're too hard you are a bitch, you're tired of your job or you're lacking in your patient care skills. If your assertive you're viewed as controlling and cold. I've worked clinical settings and I've worked ambulance settings. In any setting it is hard to know the person and for them to know you. You never know how someone is going to react. You never know someones true intentions. You can never tell how they will interpret you. My job is not to worry about that. My job is always about patient care and helping them back to health. If health can't be achieved it then becomes a game of making them comfortable. I always think about people. Sometimes I think to much. The constant worry and thinking has made me appreciated and hated. I love the patients that notice I am doing my best 110% to help them. It's even better when they are thankful and their family is thankful too. That occurrence reminds me why I do this. I love to help people. I don't need a gold star by doing them right. I do them right because I feel it is my duty. I feel it natural that I overachieve and anything less is me short falling. Sometimes caring in this way makes people sick of you. Some people you can't even ask if they are okay more than once and they unload on you. I've had this too. They hate to see you come in and god forbid get a set of vitals. To them, you are a pain in the ass. Maybe they see me young and naive. I hate that. I am damn good at my job and really care. I know what I am doing and if I don't I have no problem asking. Health care is all about customer service. I've learned this quick. Some people will never be happy with everything you do and some will be happy for the little things you do. Nothing makes me think more about my life and my impact on people around me more than this line of work. There is something that gets me when I look into the eyes of someone in this setting. You realize how lucky you may be. You realize how strong someone can me. It changes the way I think and feel about things. I feel like my problems are so ridiculous compared to these people. You can be rich and have everything in this world, but if you don't have your health what does it all matter? I feel so deeply for the people who don't ask for this...or who are born into misfortune in their health. The people that abuse their bodies...I find myself having less sympathy for. This is a whirlwind of thoughts. This is only half of it.
18 July 2009
LESSON 2
I actually like my job. When I think about the patient care aspect and what I actually do for a living...I think is pretty amazing and important. I may not give a fuck about co workers or the shit they try to pull around the clinic... I may dread leaving my husband to tend to my shift...But at the end of most days after working and touching these patients in a way I never thought I would...I realize it is incredible. They are depending on my "job" to continue living their life. Who am I to be shitty there? They don't want to be there either......I'm sitting at a computer at our nurse station and I overhear a patient on the phone in his chair. He doesn't know I can hear him. He is only 40 and very new to dialysis. He is late everyday and can get pretty shitty to staff at times. He is hopefully getting a transplant from a friend if all the test match...He owns several real estate projects that aren't making much money. I overhear his voice explaining how dissatisfied he is with life. He tells the person on the other line how he works a 15 hour day and then has to come to dialysis. He is exhausted. He feels overwhelmed. I see him on the phone with his lap top in his lap and a stack of bills on his table that he is going through and writing checks for. He tells someone on the phone...With a market like this...He is unsure how is will even pay for all of these bills. He shakes his head continuously perhaps at the amount of money he owes or by the callers words. I can only imagine if this was his wife on the phone. I think where is she? Why isn't she helping him? Oh, she is at home with their four kids. She probably has a lot to do also. Could you imagine your husband being so dependent on medical care and also working such long hours to keep your family and home intact. Could you imagine her worry? He hangs up the phone. I have to interrupt him to fix his blood pressure cuff and get a reading on his pressure as he sits there stressed out over life. I feel like a big inconvenience on him so I hurry and apologize. I see a substantial rise in blood pressure and as I look at him sitting there in frustration alone... I can feel the tears whelming up inside of me. He is so engulfed in his moment that he no longer notices I am there looking at his face. This man most of the time has nothing but shitty things to say to me...Even when I have done nothing wrong...Yet I find some way in my heart to be empathetic for him and want to take all of his pain and worry away. I adjust his time slightly so that he doesn't have to spend the whole four hours in that chair and walk away. This moment takes me back like I haven't had happen in awhile. It makes me realize I do still have a heart for these patients even when they are so rude and ridiculous...Here is someones life and they are dependent on me. It becomes somewhat easy to build a wall on my job. You have the same patients every other day. You build a relationship with them. You know what to expect. You unfortunately get somewhat complacent...So it may seem sometimes that we are unaffected or cold towards this high burn out job. I think it is just a defense mechanism. If I took to heart everything those patients felt or discussed with me...I would be a wreck. It's not that we don't care but we put up a little bit of a wall. Ask anyone in health care...I think it's imperative. I can't imagine what life feels like him for right now. It's moments like this that I wish I had more power to heal people. That I really want to take everything negative out of their lives...Times like these I think about my own life and how I can't waste time spending negative emotions on things...Life is so damn short and most people have it a lot better than they think. Most people do not appreciate what they have and take it for granted...They want to fight piss and moan about the little things when they need to think about the bigger picture. I wish sometimes to be someone of importance to make a difference...Then I think that maybe even little me in my small world may be able to make a bigger difference than I had imagined. This is why I'll be on my way to be a nurse...I can't lose sight of that in my struggle through school and hard times on the job. One of the greatest feelings I have ever had is being there for someone and helping them in their time of need. I'll never forget the first time a little girl remembered me in the Wal-mart because I was the first responder to her car accident...Helping her out to safety...I made a difference in her life and she appreciated me more that I would of ever thought when I signed up for this...So I can't change the whole world...I may just change a few lives and provide the care to heal someones daughter or mother...And that in itself seems so amazing to me. (This is unedited and not proof read...Bear with my thought process)
23 November 2008
...
AS MUCH AS I HAVE TRIED TO AVOID FALLING INTO THE COMPLICATED LIVES OF MY PATIENTS...I'VE FALLEN...FOR SOME REASON...FOR SOME UNKNOWN REASON... A LOT OF THEM FIND AND ENCOURAGE THE WILL AND DESIRE TO SHARE WITH ME THEIR LIVES. IT DOESN'T MATTER MY OPINION OF SOME OF THEM..THEY SOMEHOW FEEL THE CONNECTION WITH ME TO SHARE VERY PERSONAL INFO. I TRY TO BE A GOOD LISTENER...AND EVEN IF I DON'T CARE FOR WHO THEY ARE AS A PERSON IN OUR LITTLE SOCIETY OF SEATTLE...I STILL TAKE THE BEST CARE OF THEM AS I CAN...AND I SHOULD NOT ONLY FOR THE CREED I HAVE SIGNED INTO..BUT IN A WORLD OF MORALS AS A HUMAN BEING AND AS A HEALTH CARE PROFESSIONAL. THEY TELL ME THINGS THAT I SOMETIMES REGRET KNOWING AND FEEL THIS INCREDIBLE OVERWHELMING FEELING OF EMPATHY. SOMETIMES THE TRUTH OF THEIR LIVES IS OVERWHELMING AND SURREAL. I TRY TO FOCUS ON WHAT THEY SAY... AND NOT REFLECT THE EMOTION OF TEARS AND HELPLESSNESS THEY DISPLAY. I HUSTLE IN MY MIND OF THE RIGHT THINGS TO SAY TO THEM AND THE WORDS TO MAKE THINGS BETTER FOR THEM OR GIVE THEM SOME KIND OF HOPE. I SOMETIMES KNOW I'VE SAID THE RIGHT THING JUST BY THEIR NONVERBAL LANGUAGE AND I KNOW WHEN I DON'T SAY ANYTHING AT ALL IT'S OKAY BECAUSE SOMETIMES THEY JUST NEED TO VENT AND NEED SOMEONE TO LISTEN TO THEM. ON THURSDAY ONE OF THESE OCCURRENCES TOOK PLACE ON A RAINY MORNING WHEN A YOUNGER PATIENT TOLD ME THEY PULLED THE PLUG ON HIS YOUNGER BROTHER WHO WAS ALSO ON DIALYSIS...HAD A SEIZURE...AND WENT BRAIN DEAD. HE EXPLAINED TO ME HOW HE HELD HIS 25YR OLD BROTHER'S HAND AND EVEN THOUGH HE FELT WARM...HIS LIFE SUPPORTED BY MAN MADE MACHINERY...HE WAS NO LONGER "THERE"...HE SAID A PRAYER AND LEFT HIS BROTHERS SIDE FOR THE SAKE OF HIS KIDS OVERWHELMING EMOTIONS AND TRUE NON UNDERSTANDING OF THE SITUATION. I COULD TELL BY LOOKING AT HIM THAT HE HADN'T SLEPT AND THAT HIS EYES WERE SO RED AND PUFFY... I KNEW HE WAS UP CRYING ALL NIGHT LONG. HIS PHONE RANG JUST BEFORE I CONNECTED TO HIM TO THE MACHINE THAT WAS INEVITABLY KEEPING HIM ALIVE...HE NEEDED TO GET UP AND USE THE PHONE TO TALK TO A FAMILY MEMBER...SO I LET HIM BE AND FOUGHT THE TEARS THAT HIT ME OUT OF NO WHERE LIKE A FREIGHT TRAIN...THINKING THAT IF I WAS HIM AND MY BROTHER WAS GONE...I WOULDN'T BE A DIALYSIS CLINIC BUT INSTEAD IN BED CRYING MY HEART OUT... THIS IS ONE EXAMPLE OF HOW I'M CONTINUOUSLY TOUCHED BY THESE PEOPLE'S LIVES...EVEN WHEN THEY ARE SHITTY TO ME...I TRY TO KEEP IN PERSPECTIVE THEY DON'T FEEL WELL AT ALL...AND THEY ARE DEALING WITH THESE LIFE SITUATIONS THAT WOULD PIN YOU AND I DOWN AND MAKE US NOT WANT TO ADDRESS LIFE AT ALL. THE FACT THEY GET UP EVERYDAY AND KEEP FIGHTING IS MOTIVATION FOR ME TO KEEP ON KEEPING ON WHEN I HAVE PROBLEMS THAT SEEM SO TEDIOUS COMPARED TO THEIRS....
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