Rollercoaster of Life

This has been a rollercoaster week, full of highs and lows both at work and at home.

Last week, my older brother, Jim would have been 50 years old. He has been dead now almost 26 years, I miss him still and always will. I think about what he would be doing, what he would look like as a 50 y/o. My shadow sibling, my parents' "shadow child", always close in our heart and thoughts.

This week was my dear Dad's 82nd birthday, he's still playing drums, studying the stars and the financial markets, and as he told me, "the same woman says she still loves me after 60 years". (Of course, She Does, Dad, she's No Dummy, and Who else would put up with her?? Now, Really.) So, well done, Dad, and yes, I agree, you have wonderful children and grandchildren.

This last past week at work, I've had three patients enroll in Hospice programs for their end stage disease. To put this in perspective, as a RN case manager working with the medically fragile for almost 9 years, I might have 3 patients enroll a year in Hospice. Ommph.

Some really happy stuff came my way in the form of the most gorgeous "crocus" purple cotton short sleeve sweater with beautiful hammered silver buttons made by dearest, artistic, prolific knitter, and hard working Business Analyst, among many other talents, Mrs.Spit!!!! I can't wait to wear it tomorrow when we go to a friend's home for Easter dinner. And Even Better Than This If You Can Imagine is that she is visiting our family next week for a long weekend. Can't Wait!

And if that wasn't enough, in between Mrs.Spit's visit to sunshine and salsa sauce soaked L.A., we are going up to Mammoth Mountain for a couple days skiing.

Thanks for sharing in this pass on the rollercoaster. My best to you and your loved ones this Easter and Passover.

Some Weeks You're the Windshield

Some weeks you're the windshield, some weeks you're the bug. This week at work, I've been both.

That sound you hear is the sound of work getting my bootay. Gosh, no other way to put it...

How do you explain to a patient who pays $20 per month total for her 12 prescriptions that she is contractually obligated to pay this? And the pharmacy is required by law to collect her copay Even when she says she can't afford it? But her $150 cigarette per month habit isn't an issue for her?

Most doctor's offices have no interest, or are too busy, or all of the above, to help patients get needed equipment, medications, and services. I have become an expert at badgering these folks in a nice way to address these patients' needs.

It was the Best of Times, It was the Worst of Times...

The appreciation from many of my patients is amazing, humbling, and inspiring.

There is also a lot of anger here on the front lines of health care, everybody wants every service, medicine, surgery covered without paying for it.

I work hard to remember I am not the one with the illness. I am not part of the problem, I am part of the solution because I listen and care.

People don't care how much you know until they know how much you care.

Notes to Self- Dog, Superbowl, and Work

I found out this weekend after a visit to the emergency vet, that there are serious consequences to having a Dog who is a Foreign Object Ingestor. (Right, Mr. and Mrs.Spit and Delta?) I also learned you can give canned pumpkin and petromalt to a dog with quite effective results. I don't think I have ever been so happy to have my dog do his "business".
Note to Self- No more stuffed toys or dog beds.

Our family hosted the Superbowl party by default because, well, no one else offered to, and that's just the way it goes with our circle of friends who are allergic to entertaining. We went with a New Orleans food theme, serving Red Beans and Rice, and Buffalo Shrimp along with great potluck deliciousness. I watched one commercial and about 5 minutes of the game, but got to catch up with a bunch of friends, so that's the real Win right there. Plus, I am beyond thrilled for my family in N'Awlins and the city too.
Note to Self- Move the Big Screen TV and satellite box a Day or Two before the party, Not Two Hours before.

I am having to bring my best game to work these days. I am dealing with stuff they don't teach you about in Nursing school like how to be present and listen to someone who is going blind or will never get off dialysis. I have learned that I can't fix everything as a RN, but I can empathize and advocate which is also healing.
Note to Self- After 28 years, I think I'm finally getting the practice, art, and science of this Nursing Profession down. But I am still learning.

Any notes to self for you?

Heart Your Heart, Pancreas too

I am getting all clinical over at The Motivation Station today where I discuss such topics as Body Mass Index and Total cholesterol and the risk of heart disease and diabetes in civilian language. Please stop by, your heart and pancreas will be glad you did, and so will I! Thank you!

Staying awake is the hardest part

I have been low key in bloggy commentland because I am in the throes of reading A Case Manager's Study Guide. This book is not gripping reading. If you have insomnia, I highly recommend this book. You will be fast asleep within three pages, in a deep sound sleep. Not conducive to studying, however.

I am taking the test for Case Manager Certification in approximately 8 weeks and all pleasure reading and crafting are on "hiatus". I have been a case manager for over 8 years and I am excited to be getting ready for the privilege of being tested. (And at a handsome sum to boot!) Crazy, isn't it?

I am not nervous, just a little rusty at test taking and areas outside my disease management expertise.

I hope you have been reading something much more "stimulating" and almost as gratifying.

Nursing in a virtual world

It is almost a reflex when you tell people that you are a RN that they ask, "What hospital do you work at?"

When I tell them I am a RN case manager and I telecommute, they often have trouble wrapping their minds around the idea of a nurse who provides nursing care in a virtual environment. Everything I do is over the telephone or internet and I work with patients and families all over the U.S. I take care of a wide range of diagnoses, from Asthma to Zoster infections, Cancer to Cardiac disease, Diabetes to Developmental delays, from premature babies to the very elderly. I am a professional problem solver, empathetic counselor, and clinical educator. My tools are not a stethoscope or EKG machine, but my ability to listen, provide resources, and foster self reliance for patients and families.

Recently, my son asked me what do I say the first time I call my patients? Great question, so much hinges on that first call. You really have to introduce yourself and your role very concisely and meaningfully to encourage people to share about themselves and their health issues to a voice over the phone. I introduce myself as a Nurse from their health plan and I am calling to see how they're doing and what they need for themselves and their families to cope with their disease. I tell them they can call me anytime and here's my direct extension. Then, I ask, "How are you doing? What can I do to help?"

There are many rewards, the child who has finished cancer treatment and can return to school, a severe asthmatic who quits smoking, a terminally ill patient receiving comfort and dignity as their families also receive care and support. Needless to say, I become very attached to some patients and families, especially those I have worked with for years and have been through some very trying times with. It is a privilege.

Yesterday, I signed up to take my certification exam in March to become a Certified Case Manager. After 8 1/2 years in my current and hopefully last job, (because I love it and enjoy it so much), I think I owe it to myself, my 28 year nursing career, and my patients to take this step. Please, wish me luck. ;oD

Shrink Rap

I just conferred with a staff pyschologist about a couple of my marginally functional patients.

I learned a lot, including why I dislike this psychologist.

I won't make the mistake of talking over You, Dear Doctor, ever again.

Some folks are quite taken with themselves, aren't they?

Next time, I'm consulting the Nurse Practitioner.

1909 or 2009??

I wrote a letter to the Editor/Publisher of a community magazine in response to an article written about a local shopkeeper's near brush with death due to an aneurysm.

The writer of the article used the term, "male nurse" in describing how the local man learned of the seriousness of his condition.

Here is part of my letter-


Re: Well Suited Article, Elite Magazine, March 2009

Dear Publisher:

I would like to inform you, your editor, and the writer of the article, "Well Suited", that it is 2009 and both genders have been part of the Nursing profession for many years. I find the term, "male nurse" used in this article to be distracting, demeaning, and outdated. Do you use the term, "female physician" or "male physician" in your publications? Please extend to me and my professional Nursing colleagues the same courtesy.

Signed, Martha K., RN

I will let you know if I get a response. Some people need to be escorted and encouraged to come into the 21st century.

Work and Play Post Inspired by KimboSue

Happy Friday and today's post brought to you and inspired by my blog buddy, KimboSue.

KimboSue expressed an interest in my current work as a Registered Nurse. I have been a nurse since 1982 and have worked in a variety of specialities including Surgery, Maternal/Child, Emergency Room, Home Care, and Pediatrics. I have worked in both large teaching medical centers and small community hospitals.

For the last 7 1/2 years I have had my dream job that I hope to keep forever. I work as a Telephonic Nurse Care Manager working with medically fragile children and their families all over the U.S. I call and talk with parents about helping them help their ill child. My work includes a lot of education of the parents about diseases like Diabetes and Asthma. I also coordinate and set up resources such as Physical Therapy or medical equipment. What I really do the most of at my job for the 3 days a week I work is Listen. It's very rewarding to help parents care for their children and help the child get back to the business of being a kid instead of dealing with Cancer or some other disease. My job is very clinically challenging and I really love the flexibility and autonomy of telecommuting. I consider myself very fortunate on so many levels for my job, especially the opportunity to help families and be able to care for my own family.

Thank you, KimboSue for your interest in my "Job Thing" and yes, I pinch myself daily.

I am looking forward to the "Conference Call"/Online Baby Shower for KimboSue tomorrow. Please email me if you would like the call in information for our "little get together" tomorrow, Saturday, March 7th at 9 am Pacific, 12 noon Eastern time. Please stop by and say hello or Howdy since KimboSue is in Texas. Also, I invite you to please leave some comment love on the KimboSue's Baby Shower blog if you would like. Thank you so much!

Last but Not Least and actually the most important thing in this post inspired by Kimbo is that She Does NOT Have Preeclampsia!!! Yeah!!! She and her baby, Peanut, (she doesn't know if she is having a boy or girl), are Doing GREAT!!!

The Nursing Cap and Pin

After being a Registered Nurse for almost 27 years I've learned that:

The patient is the family, whomever that includes.

My most important skill is Listening.

I am not qualified to take away hope, Ever.