Archive for July, 2008

anyway, now that i’m here..

{ July 31, 2008 @ 5:17 pm } · { Uncategorized }
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… in medblog mode, why not keep going?

i was thinking that all i post about are the dramatically upsetting or darkly humorous moments in my work world. does that make me a glass-half-empty person? i think just a little burned out. then there is my general aversion to the touchy-feely. but for the sake of balance, here are a couple of poignant moments.. ha ha, literally couple moments.

i have a lady i see who is young (late 30s/early 40s), and in addition to being extremely obese, is terribly disfigured by her disease and has not even been able to leave the house for  a couple of years. i’ve only met her husband once, and he seemed very agreeable/supportive, although i didn’t have much of a sense of him or their relationship. but over the past several months as i’ve seen how they interact with each other and how supportive and willing to help he is, i’ve been so impressed with them and their relationship. she told me one time, “i asked him why he’s still with me, because i’m overweight, and i have this other problem, and he just said, it doesn’t matter how you look, i love you and i’ll always be here to support you, because that’s what you’ve always done for me.” and he truly does that for her. they are constantly laughing and joking with each other, have so much fun and are so comfortable, even in some truly adverse circumstances… and, what makes it even better is that she is one of my few patients who is actually getting markedly better with her current treatment. anyway, it sounds cliche but it was a real lesson for me. i don’t know if i would have the fortitude to walk through something like that with someone… though i hope i would, and hope that if i were ever on the other side that i would have someone willing to go with me, too.

then today saw a patient i’ve had for almost the whole three years – i’ve gotten to know him and his wife pretty well. he also has a variety of serious health problems, most of which have cropped up in the past 5 years. his wife takes such good care of him. i know it’s hard on her, but it’s so clear that she wants to do as much as she can for him herself. they’ve been together for 53 years… hard to imagine. she said today, “after i retired was when we really started knowing each other.” that was post raising their family… funny to think about being with someone for twenty years and then starting to know him (or her).  

the point is, it’s not all maggots and mania… sometimes i’m privy to some truly beautiful things.

medblogs and interior niches

{ July 29, 2008 @ 11:24 pm } · { Uncategorized }
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i’ve been reading medical blogs lately. there is a surprising number of medical professionals out there writing about their lives and times. (a personal favorite is friend M – see link to iambarabas on the sidebar for some honest, articulate, shocking, incisive reflections. he’s on hiatus at present, but there’s material aplenty in the archives. very highly recommended.)

it’s interesting – there are common threads of frustrations with time, the system, patients, entitlement, the feeling of having far to little with which to try to do far too much. there’s also plenty of humanity and compassion to go along with the often dark, wry humor. doesn’t matter the setting… we’re all in the same boat, just different cabins.

meanwhile, i have actively resisted/avoided writing about work here, probably more frequently than i actually have written. of course there is the whole confidentiality issue, trying to mix things or keep them from being identifiable. and for me, with a caseload of 20-25 patients that slowly fluctuates, it’s not isolated vignettes, but relationships that last several months or even years. it’s intense. three years into this, the same things that drew me to community based work (continuity of relationship over time, engagement with people more on their terms than on mine as a health professional, being able to focus on one patient at a time) are the things that have turned out to be hard (the monotony and frustration of chronicity, having to be a general solver of problems – social worker, housing advocate, family mediator – as well as a nurse, feeling like no one ever gets any better, no matter what i do). plus, though i’m actually pretty good at maintaining the professional role (being able to set and maintain that boundary must be one of the most valuable things on a personal level that i’ve learned from this work) there’s still a sense in which the work is always there. not just because i start and end my days in my own apartment, but also because these relationships respresent some of the most consistent interactions i’ve had with people over the course of the past three years.

then.. there’s my own vocational ambivalence. the limitations of this role. the parts of me that feel stifled by it. i wonder when and how they are to be fed. the questions about what a job should or can be. of why i work, how i choose, where i go from here.

maybe that’s what keeps me from wanting to write a work-themed blog. work is a frustrating, fascinating, fraction (though admittedly a large one!) of my world. this, for me, is an expressive undertaking, a specific shape for a piece of my writing life. here i open the small doors to interior spaces, one by one…. some of the same ones over and over, and others once or twice. but it’s a place where those other spaces have room – where i can choose how much room to give them.

some city views

{ July 27, 2008 @ 10:40 pm } · { Uncategorized }
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is it only friday?

{ July 25, 2008 @ 4:28 pm } · { Uncategorized }
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there is definitely a cosmic conspiracy to make fridays the longest and/or craziest day possible. today… a barrage of the full range of entertainment that homecare has to offer! so… if anyone was wondering how i occupy myself on a day-to-day basis, welcome to my friday world…

started the morning with being shouted at by an irate patient. he’s diabetic, although his blood sugars are basically normal. he recently had an hba1c blood test, which reflects his blood sugar over the past several weeks. his was normal, so his doc told him to check his sugar only once a day. patient insists he has to check four times a day (although i know that in actuality he often tests 9-10 times a day – one of his many ways of inappropriately coping with anxiety). two days ago he told me he had 50 strips left, enough (in theory) to last until the end of next week if he checks four times a day. today, he has 25 strips left and was completely over the top when i told him i hadn’t ordered any more yet. it is ALL YOUR FAULT that he is running out of strips and IF I HAVE TO GO TO THE EMERGENCY ROOM AND HAVE A SEIZURE I AM HOLDING YOU RESPONSIBLE. click. whew. this is the same guy who has visited the ER so frequently with no physical cause, the hospital told him that if he comes back again (unless there is a genuine need), he is only getting a psych admission, not a medical one under any circumstances. that is usually enough to keep him sulkily at home b/c he is not a big fan of the PSYCHO WARD, as he calls it. so at least we are cutting back a bit on misuse of resources (hooray! for gatekeeping the taxpayer’s dollars!), even if it means i get more phone calls like this one.

then, off to the next case, a youngish guy compared to most of my patients who informs me that he needs some viagra. for what, i don’t know, since he can’t climb the stairs, is stuck in a 4th floor walk-up, and as far as i know does not have any lady friends. he’s asked for it before, and the doc said she would write for it, but his insurance doesn’t cover it. i told him he can say the word and get the script, as long as he wants to pay out of pocket for it. he just sat there and smirked, so i couldn’t exactly tell what he was getting at. the last time we had this conversation, his brother chimed in to say that the patient doesn’t need a prescription b/c he, the brother, will get viagra for the patient on the street. the brother, meanwhile, is the reason the patient is still stuck in a 4th-floor walkup – the brother had a drug possession arrest so they don’t qualify for city housing. needless to say, the LAST thing he should be doing is involving himself in the, shall we say, informal economy of the neighborhood. ay yi. senator mccain may be able to get out of these conversations. i only wish i could!

next, on to a lady i see three times a week for wound care. she has a few different sites, and i’ve been pretty worried about them. one in particular has not been responding well to treatment. today, though, when i took off the bandage, it looked amazing… visibly smaller than at the last visit on wednesday, with healthy pink skin all around the wound edges that had been really raw and denuded-looking before. her home attendant actually used to be a nurse in her home country, and while i was prepping the supplies for cleaning the wound & doing the dressing change after taking off the old bandages, she was looking at the wound site very closely. all of a sudden she was pointing to it and wanting me to look at something, but her english isn’t very good and i couldn’t understand what she was saying. she went and got a dictionary to show me a word: WORM. i looked closer, closer, and there were a bunch of teeny tiny whitish-yellow worms crawling around in there. i was in total shock – it’s a very clean house and she gets great care, not to mention how often i see her. it was totally inexplicable and completely horrifying … but… weirdly… i think it may actually account for how much better the wound looked. you may have heard that over the last 10-15 years, maggots have been used as a form of biotherapy for non-healing wounds, because they will eat away the dead tissue and actually promote healing. i talked it over with the doctor, who agreed, so we are going to wash vigorously but nothing more drastic, then watch it for a while and see how it does. a very bizarre silver lining to a vermin infestation.

the next visit was to a lady with very poor respiratory status and a wound on her back you could almost stick your fist into… she started breathing badly last night and we ended up sending her to the hospital b/c her blood pressure plummeted (though, predictably, once ems got there, it was nice and normal) and she seemed to be retaining co2 again. it’s so weird to have direct contact with other health professionals in this job. the emt’s are usually these really serious guys who are polite enought but still act like i’m crazy when i tell them how low the blood pressure was when i checked it before calling them. honestly, if only we could make emt’s-in-a-pill for emergency blood pressure interventions, i think it would really work.

i rounded out the day by finding that one of the best home health aides i work with didn’t pass her tox screen (she had disappeared somewhat inexplicably earlier in the week) … all of this leaving me OH-so-ready for the weekend…

around town

{ July 24, 2008 @ 12:19 am } · { Uncategorized }
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little bro was in town last week, which resulted in a dizzying array of nighttime activities, in addition to a heavier-than-usual workload, thanks to a number of coworkers being on vacation. unfortunately, i didn’t get my own name on the calendar soon enough! (may i digress for a moment to the wonderfulness of my boss? no 6-month-in-advance vacation requests – who actually knows what she is doing 6 months from now? not this girl! fortunately, my particular orchestrator of homecare doesn’t care… as long as too many other people haven’t already asked. alas, this week was the first time in 3 years i’ve heard a ‘no’! so… i can’t complain too much.) 

the wonder of visitors is that they push me out to explore bits of the city i might otherwise never find. and i’m actually quite proud of myself for keeping up with mr. 7-years-younger, who, i might mention, was spending his mornings asleep on the couch while i was pounding the pavement!!

some highlights from the week -

**the philharmonic in the park – although massively mobbed, the music was divine, loved the fireworks after, and little bro got to experience a true metropolitan moment.

**local screening of friend F’s film – http://www.prettytothinkso.com/ — i wish i could tell all of you to make sure you see it, but i don’t know that wider distribution is in the works. it’s screened at a number of film festivals this year, but i’m not sure what else is ahead. just in case, i’ll try not to spoil … i had in mind to write a more detailed posting about it (swallowflight goes film critic!), and perhaps still will…. but let me put my bias out there – i think these fellows are rather brilliant and are headed for great filmic success. plus, they are completely matter-of-fact about the whole thing and are pursuing their creative aspirations with enviable grace and angstlessness. so.. with that in mind -

things i loved about the film – first, the intimacy of atmosphere they managed to create. aside from using a lot of images of the actors’ faces, they drew a lot from the (many!) locations that built in images of closeness (sometimes positively, other times negatively charged).

second, there were a couple of sequences that particularly stuck out in my mind from a technical standpoint, conversations between the female lead and each of the male leads. in the first, the camera drifts back and forth between their two faces (the female lead with one of the male leads)- overlaying the dialogue proper with a layer of camera dialectic (hello, montagists! now i am flashing back to a little dalliance with kalatozov and his fellows for a world cinema paper back in undergrad days). the second conversation was shot from above, with the two actors (the female lead again, with the other male lead) on a park bench – for me there was also a level of dialogue between the two scenes, that contributed another layer to the development of the relationships between the two pairs of characters through the storyline.

third – i have no idea how to attribute this, whether to acting, directing, cutting, or (most likely, obviously!) to some combination of the three – i was most struck by the youth minister character, who evoked spiritual and personal crisis so believably. a true believer and at the same time so clearly a ruined human… not often so well combined, or, i think, so well portrayed. one of the most evocative moments for me was when the character boards a bus bound for a destination his better self might hope to avoid…. in his face are the exhaustion of resistance combined with guilty anticipation and desperate resignation… the moment of doing that which he does not wish to do, and both the doing and the wishing present there in their fullness.

i loved how the film approached its religious elements with a high degree of respect but still interrogated them honestly and avoided slipping us in the audience any easy answers. anyone who can place an exact quotation of john 3:16 and the mother of all dirty words in such close proximity and manage to be wry and poignant rather than self-consciously pretending to push an envelope that has already been split wide open deserves some serious credit!

so, it seems this has turned into a film review after all!! back to the (uncomprehensive, as it grows ever later) list of highlights:

**a new-to-me jazz venue – cozy, comfortable, saw halves of two great sets – first some young, latin-infused, experimental stuff, then a weathered sax-led quartet in a more standard vein.

**a trip out to an old italian neighborhood that is gradually hipsterizing but where old traditions persist, this time in the form of the ‘dance of the giglio,’ (story here: http://www.giglio-usa.org/Origin_History.htm)

**and of course, plenty of time chilling with my most laid-back sib

now… in need of vacation from staycation… and some sleep!

thoughts, couplets and excerpt

{ July 11, 2008 @ 11:25 pm } · { Uncategorized }
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–worst summer fashion trend: the gladiator sandal
–best summer fashion trend: rocking the shorts (special props to ms O)

–latest uptown pickup line (5 minutes ago): you go girl!
–most common uptown pickup line: god bless you mami! (“mami” being uptown for “honey,” though uncomfortably close to “mommy”)

though i really should say “piropo” – it’s sort of half pickup line, half expression of appreciation, half being friendly (or, if not friendly, you know). one of my patients (a 94-year-old cuban lady) was telling me about her father, describing what a wonderful man he was, and one of the qualities she described was that “he always used to give the ladies piropos,” which definitely seemed to have a positive connotation to her…. it clearly does not have the negative connotation that ‘pickup line’ does. sometimes it gets a little tiresome, at others (rarely!) it borders on being flattering, but uptown living means just taking it in stride.

summer reading trending toward the consummate storytellers of the american south:
–all the king’s men. a revelation. robert penn warren, though best known for this novel, was (take note!) the FIRST POET LAUREATE of the u.s.
–just beginning carson mccullers’ the heart is a lonely hunter. title alone stunning. chew it for a minute. from the first chapter, of a mute man who has lost his friend:

“Each evening the mute walked alone for hours in the street. Sometimes the nights were cold with the sharp, wet winds of March and it would be raining heavily. But to him this did not matter. His gait was agitated and he always kept his hand stuffed tight into the pockets of his trousers. Then as the weeks passed the days grew warm and languorous. His agitation gave way gradually to exhaustion and there was a look about him of deep calm. In his face there came to be a brooding peace that is seen most often in the faces of the very sorrowful or the very wise. But still he wandered through the streets of the town, always silent and alone.”

–i always love the word languor in all its derivations. a perfect summer word.
–sorrow and wisdom. sometimes sadness brings wisdom.  but- it is also possible to be sorrowful without becoming wise. i do not know why this is so.

love/hate goes postal

{ July 1, 2008 @ 11:18 pm } · { Uncategorized }
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the post office in my neighborhood must surely rank amongst the worst in the nation. featuring:

*lines consistenly requiring a minimum of 40 minutes of wait time

*no automatic machine for weighing/stamping your own packages

*not leaving package pick-up slips, then refusing to release packages to recipients

*surly and unreasonable employees (resulting in one of only two public yelling matches in which i have been involved over the past 3 years) – see also previous

*shifting roster of deliverypersons who are constantly losing the keys to the outside door of our building, resulting in a) no delivery or b) mail shoved in between the gate and door of the downstairs apartment, inclement weather notwithstanding

*misdelivery (resulting in a series of notes from the lady in 519 who wants us to lodge some kind of complaint)

naturally, all this contributes to my extreme avoidance of the post office. which i shall henceforth do with even greater alacrity, now that i have discovered that i can buy stamps online.

i really am much happier with such a pacific arrangement – because deepdown i do love our postal system. maybe those pony express stories from gradeschool imprinted some fondness that i just can’t shake? – because even though they are constantly raising the rates, and even in the face of apathy and negligence (or perhaps especially because of?), i really am thrilled that i can put something in an envelope with a stamp and then in a day or two it arrives at any metropolitan destination, not to mention portland, paris, or anyplace else i might feel inclined to dispatch a missal. and, having lived in places where this is not the case, i can also appreciate the fact that packages arrive without the best bits scavenged. (ahem, eastern bloc?)