Monthly Archives: February 2019

The Kind of Nurse I am

“What kind of nurse are you?”

I was asked this by the errant wife of a patient I was caring for on a step down cardiac unit last year. The patient had warned me about her personality prior to her arrival to visit him. She was angry the doctor had decided to discharge him with a low grade temperature.

Honestly it was the tone of her voice that took me by astonishment than anything else. I shortly turned tearful as I could not reach the hospitalist in charge of his care. My manager was off and even if she was around I doubt I would get much support from her.

I had resigned, giving my almost three weeks notice a few days before. I was about to start my first nurse practitioner position. I should not have felt so desolate having endured many stressful and blissful moments in the seven years of being a nurse thus far. However the woman’s comments pierced something. It made me feel like a failure despite how many people I have helped before them.

If I ever met them again I know what my answer would be now nearly a year later.  I am a nurse that gives it her all. I am one to wear my heart on my sleeve. I am protective over my patients as if they are family members. I have spent sleepless nights wondering if my patients would survive the night, Would they still be around the next morning when I returned for my next shift?

So yes I may not always have every answer or be on time for everything you need.  However overall I will advocate for you and provide the best care possible in the time I have you under my care.

Many patients appreciate the care myself and other have provided. Unfortunately some forget we are humans too. We may not be superhuman, but as nurses we try our best to be your superheros without a cape.

Sonali Dhir is a new nurse practitioner. She enjoys traveling and spending time with her family and close friends. She has been a nurse for almost eight years and has spent almost a year working in retail clinic as a nurse practitioner.Besides caring for others, she is an avid reader, always looking for new knowledge.

When is a Little Knowledge a Good Thing?

In the summer of 2016 in seemingly good health, I was diagnosed with acute myeloid leukemia through a routine blood test and subsequent bone marrow biopsy.  In 48 hours, I went from a carefree existence to a week-long, 24/7 chemotherapy drip and a 5 ½ week hospital stay.

Although my doctors described my treatment plan, in retrospect it’s remarkable how little I learned about my disease.  This cancer is not “staged,” because it is so unpredictable, and there were no discussions of long-term prognosis, survival rates, or other such matters.  For my part, I made a conscious decision not to surf the internet collecting all sorts of dubious, unverifiable information about my disease.

Instead, I simply trusted my doctors as we moved through my initial treatment one step at a time: induction chemotherapy, temporary remission, infection management, count recovery, and emerging molecular and cytogenic data on my cancer.  Throughout this period, my doctors’ calm, professional demeanor provided reassurance that my disease was a problem they could solve.

It wasn’t until I was contemplating a stem cell transplant that I heard the first hard numbers and survival rates for consolidation chemotherapy versus a transplant. Even the best-case scenarios looked pretty grim, and it dawned on me that I was fortunate to have survived up to that point.

I proceeded to transplant, recovery and survival.  As I got better, I gradually learned even more about the lethality of my disease. I now believe that it was for the best that I did not initially know all the dire things I eventually came to learn about AML. As it was, I could maintain a more hopeful outlook over my many months of treatment.

I don’t claim that this path is appropriate for every patient or disease.  But I was struck to learn of some research on AML patients that is consistent with my story. In the webcast “Coping with the Emotional Side Effects of AML” (available at patientpower.info), Dr. Thomas LeBlanc reports on interview data from AML patients. Among the more striking findings is that the more accurately patients understood the likely outcomes of their disease, the more emotional distress and sadness they experienced.

I would never advocate that ignorance is bliss. But my experience — backed up by this exploratory research — suggests that just a little knowledge can be a good thing when it comes to surviving AML.

 

steve bSteve Buechler is a recently retired sociology professor and cancer survivor.  In 2016, he was diagnosed with acute myeloid leukemia and successfully treated with chemotherapy, radiation, and a stem cell transplant. He has since become a big advocate of writing stories as a survival strategy in the face of life-threatening illness.  His own story is available in “How Steve Became Ralph: A Cancer/Stem Cell Odyssey (with Jokes),” his memoir from Written Dream Publishing.

 

 

On Patients and Emotional Labor

Given my recent posts on the emotional labor of doctors and nurses, it only seems fair to turn the lens on myself and ponder how I experienced and expressed a variety of emotions throughout my treatment for acute myeloid leukemia.

In the early stages of my care, I sought to be a “good patient” and cultivate positive relationships with my doctors and nurses.  I was seeking to transform routine, clinical encounters into more human and humane interactions. But it was also a strategic move on my part to insure I would receive the best possible care.  While patients’ demeanor should not affect their quality of care, nurses and doctors are also people with their own emotional states.  Getting on their good side seemed like a wise course.

In the later stages of my treatment, it became evident that I was on the road to recovery.  As it gradually dawned on me that my doctors had saved my life with their medical knowledge, treatment plan, and attentive care, I experienced a flood of powerful emotions: unbounded good will, heartfelt gratitude, and a deep appreciation for them and how they practiced their craft.

While I expressed this appreciation, I also felt a certain reticence about whether or how to convey the depth of these feelings.  After all, a famous sociologist once argued that professional role relationships like doctor—patient should be “affectively neutral” and that strong emotional sentiments should be reserved for family, lovers and friends.

I’m guessing that this famous sociologist was never successfully treated for a life-threatening disease. But my experience left me seeking some further outlet for the profound gratitude and deep affection that I felt toward my doctors upon my recovery and survival.  The best I could do was pay it forward through my volunteer work and peer counseling with blood cancer patients. In some small way, those activities help me feel like the benefits I received from my doctors and nurses live on in what I try to bring to current patients as they navigate their own medical destinies.

And just in case my doctors stumble across this entry, please know I cannot thank you enough.

Read the other posts in this series:-

On Doctors and Emotional Labor

On Nurses and Emotional Labor

 

steve bSteve Buechler is a recently retired sociology professor and cancer survivor.  In 2016, he was diagnosed with acute myeloid leukemia and successfully treated with chemotherapy, radiation, and a stem cell transplant. He has since become a big advocate of writing stories as a survival strategy in the face of life-threatening illness.  His own story is available in “How Steve Became Ralph: A Cancer/Stem Cell Odyssey (with Jokes),” his memoir from Written Dream Publishing.

 

On Nurses and Emotional Labor

My last post described how doctors appear to rely on a specific feeling norm in managing and displaying emotional states in relation to their patients. The pattern I saw in my own care was initial emotional distance from doctors that gave way to greater emotional availability only when my prognosis significantly improved. In this post, I offer some speculations about the differences between doctors and nurses when it comes to emotional labor.

Whereas doctors may be permitted an initial clinical detachment from their patients, nurses are socialized to be more explicitly caring in their interactions with patients.  This distinction between the emotional distance of doctors and emotional availability of nurses is furthered reinforced by the gender division of labor that leads to male predominance among doctors and female predominance among nurses.

For all these reasons, nurses face even bigger challenges than doctors in managing emotional involvement with patients. This difference in role expectations is reinforced by the daily reality that nurses typically spend much more time with patients across a broader range of interactions than doctors typically do.

The upshot is that whereas my doctors only became emotionally accessible late in the game, most of my nurses were friendly, nurturing and emotionally supportive from the beginning of my treatment and without regard for my prospects of survival. While this is beneficial for patients, it can be challenging for nurses when patients they have come to care about do not respond to life-saving treatments.

In extreme cases, this may lead to the suicidal behavior reported in an earlier post on this site.  But even absent such tragic outcomes, the challenge of managing emotional states looms large for nurses in general and some in particular.

As a final case in point, I recall a conversation about one of my nurses I’ll call Kelly.  Even compared to other nurses, Kelly was unusually warm, nurturing and supportive throughout my extended care. She became my “favorite” precisely because of the emotionally rich bond we formed right from the beginning.

It was only when I mentioned this to anther nurse that I learned of the downside of Kelly’s demeanor.  I was told that when Kelly’s patients did not survive, she was emotionally devastated and took a long time to psychologically recover.  Because my treatment went well, I did not witness this challenge.  But it stands to reason that while such emotional availability can be rewarding for both nurse and patient, it is also extremely stressful for nurses when their patients do not recover from their illness.

It may be that the most profound challenges of nursing lie not in technical mastery of clinical procedures, but in crafting a “feeling norm” that balances caring for others while also caring for self.

 

steve bSteve Buechler is a recently retired sociology professor and cancer survivor.  In 2016, he was diagnosed with acute myeloid leukemia and successfully treated with chemotherapy, radiation, and a stem cell transplant. He has since become a big advocate of writing stories as a survival strategy in the face of life-threatening illness.  His own story is available in “How Steve Became Ralph: A Cancer/Stem Cell Odyssey (with Jokes),” his memoir from Written Dream Publishing.

My Time in Prison.. as a Physician Assistant

Several years ago I took the position of physician assistant at the maximum security unit of the Santa Fe (New Mexico) State Penitentiary. I remember all too well my first entry into the prison. When the guard (or correctional officer, shortened to CO) accompanying me clanged the steel door shut behind me, closing me in, I realized what the inmates there must have felt when they first arrived. The sound had a finality to it. Unless the inmate had to be taken to the Santa Fe hospital, in all likelihood he was there for the rest of his days. I, on the other hand, could leave at the end of my shift and enjoy all my freedoms.

Providing medical treatment to dangerous prison inmates is only slightly different than treating you or your family. The difference is, they have nothing to lose. If they are in there for murder, one more murder means nothing. So when an inmate is brought in to sick bay to be seen by the physician assistant, the COs bring them in chained and shackled. Ankles and wrists are bound by shackles, and both are tied together with a belly chain. All that, plus the accompanying CO, prevents the inmate from acting out.

You can well imagine the challenge of examining someone who is trussed up in chains. Deciding to have the CO release some or all of the locks holding the inmate turned out to be a learning experience. Often the CO helped with the decision. If I asked him to take off the chains and he said it wasn’t a good idea, I’d respect his statement and do my best to work around the obstacles.

I learned another valuable pointer from one of the COs. After I’d asked him to take the shackles and chain off the inmate so I could examine him, he turned to the inmate and told him that if he screwed around with the doc (that was me) he’d never be brought to sick bay again. That turned out to be the biggest gun in my arsenal. No inmate, not even the ‘lifers’ wanted to face the reality of never being seen by a medical person again, which meant for the rest of his life. I have to say, I never had a problem with a single inmate. Of course, that could have changed on any bad day.

The first thing the inmates did when they heard there was a new ‘doc’ in sick bay was to make an appointment to be seen because of some terrible, unrelenting pain. I had an overflowing line-up of inmates for the first two or three weeks. They would count off their symptoms to me, clearly pleading their case to be given pain pills to ease their symptoms.

When I listened to their symptoms and did my exam, the decision to treat them with anti-inflammatory medication like ibuprofen (Motrin, Advil) or the stronger naproxen sodium (Naprosyn, Aleve) rather than pain pills became a no-brainer. They would offer up a list of places around their bodies where they hurt. Most of the time the multiple locations never fit a diagnosis. What was left was muscle pain, so they got anti-inflammatories for their trouble. Truth to tell, I never prescribed pain pills to any inmate. After a while they caught on and stopped trying to con me into giving them some.

I did have one inmate who thought if he saved up a bunch of ibuprofen and took them all at once, he’d get high. It made him violently ill and threatened to shut down his kidneys. He didn’t try it again. Some of them learn from experience. Not all, though.

Of all the injuries I had to treat, the worst was when an inmate got carried into sick bay with multiple stab wounds. The stab wounds were delivered by way of a shank, a homemade knife made from a screw driver, a piece of flat metal stolen from somewhere in the prison, or sneaked in by a friend or relative on visitors’ day. They were usually strong but thin, so they created puncture wounds rather than cutting tissue like a knife would do.

The first time I saw such a victim, with thirty or more puncture wounds in his chest and abdomen, I couldn’t imagine that he’d survive. But survive he did, after a healing visit to the hospital. He never came back to sick bay because of another shank attack while I was working there. Maybe he learned a lesson and avoided another confrontation with the shankers.

I learned more medicine working in that prison than all the other places I’ve worked. I remember early on thinking if I had a problem I wanted to discuss I could call the doctor who signed off on me. So when an inmate was brought in with his forearm laid open to the bone, blood everywhere, I called the doctor. His response? “Why are you calling me? Stitch him up!” Then he hung up.

I stitched him up.

 

charles-DCharles M. DuPuy has traveled the world, seen Africa as a Peace Corp volunteer, been a saleman and a farmer, and a magazine writer and editor, and an EMT. later he studied for and became a physician assistant which took him from pediatrics to geriatrics, and from Maine to the Santa Fe, New Mexico penitentiary where he worked in the maximum security unit. Retired now, he draws on his lifetime experiences while writing suspense novels. His first published novel, EASY KILL, is the first in the series, featuring his kick ass heroine, E.Z.Kelly. The second in the series is due for release in the Spring.