Yesterday's post was a bit heavy, even for me. Let's all enjoy my day off together by watching this.
Fun fact: The last two years of college I lived in a three family house. I used to drum this on the wall of my bathroom and my friend in the adjacent apartment would drum it back on his bathroom wall. Adorable.
And... great video.
Friday, November 13, 2009
Thursday, November 12, 2009
End of Life Care
I spent one day with a hospice nurse at a V.N.A (visiting nurse association) in Western Mass in the fall of 2006. During that day alone I first decided to become a hospice nurse; and then I decided to not become a hospice nurse.
I drove to the V.N.A office the morning of my hospice rotation with determination and an iron will. Having avoided assignments to many dying patients throughout the first few years of school, I was nervous. I was worried that being around dying people would dredge up some personal memories I was well aware of, but not ready to deal with.
Within two hours to my surprise, I thought I had found my calling.*
Each visit I spent with any of these men and women in their homes was an honor. I felt like talking to them, hearing their stories and bringing them comfort was a chance to touch something sacred.
Death is mysterious. Most people have never seen a dead body, unless they have been to a memorial service which involves a viewing of the corpse. By then it has been injected, stuffed and made up and is more of a prop than anything else. Many people have never seen someone die, and never will.
Being with these men and women, the mystery of death didn't scare me; it beckoned me. My own losses didn't haunt me; they fueled me. ** I wanted to understand how to serve people in their final moments. I felt a surge of passion for helping every person die with dignity, and in the way of their choosing. You want Elvis records playing? You want your plants near your bed? Ok. You want me to throw all the plants away? I will. You want a Rabbi? A priest? A Popsicle? I will bring it. You will be a human being until the end.
But you already know that I changed my mind by the end of that one day, because that's how I started this piece. By 2pm I became intimidated and afraid. And what ended up scaring me was one thing and one thing only:
As we were driving away from our last house my preceptor said to me, "In the end we use the morphine more and more frequently. It allows them to be completely comfortable. Sometimes it might be that last push of morphine that slows their respiration rate down completely. That's hard. But you do it anyway."
Essentially, a measure of comfort in the very end can be the thing that hurries death.
Now, obviously, the person is dying. There is a protocol to prevent life saving measures. It's called a DNR. The person is going to die now or in ten minutes and we're not going to prevent it. Furthermore, his quality of life is dependent on the comfort measures between now and then. So does it matter if the push you give pushes him over?
If you kill him to comfort him?
Logically, no. But the idea stopped me cold in all my young nursing student zeal. I tried not to think about it for the rest of school.
Now, more and more often it seems, end of life care is a part of my job. I didn't seek it out, but I also stopped running from it. And then I started to feel the same sense of purpose and honor I had before. And sometimes the choices that fall on health care providers are very, very hard. But someone has to make them; someone has to act in accordance with the patient's wishes when the patient can no longer wish out loud.
It's important to figure out your own feelings before you're on the other end of that morphine. Although sometimes we surprise ourselves in moments of extreme trials, going into them unarmed with knowledge of self is dangerous. It can cause loss of objectivity and emotional panic, which is no place to make life or death decisions from.
I'm curious to know what other folks, both medical and non medical, think since it's a topic that came up amongst my co workers last night.
Keep in mind, although this is sure to open up the topic of assisted suicide, that's not what I'm talking about here. The patient hasn't asked for medical assistance to terminate life. He has asked to be allowed to die, comfortably.
-----------------------------------------------------------------------------
* To be fair, I am kind of constantly thinking I've found my calling.
** Keep in mind, this was all in one shift. In one day.
I drove to the V.N.A office the morning of my hospice rotation with determination and an iron will. Having avoided assignments to many dying patients throughout the first few years of school, I was nervous. I was worried that being around dying people would dredge up some personal memories I was well aware of, but not ready to deal with.
Within two hours to my surprise, I thought I had found my calling.*
Each visit I spent with any of these men and women in their homes was an honor. I felt like talking to them, hearing their stories and bringing them comfort was a chance to touch something sacred.
Death is mysterious. Most people have never seen a dead body, unless they have been to a memorial service which involves a viewing of the corpse. By then it has been injected, stuffed and made up and is more of a prop than anything else. Many people have never seen someone die, and never will.
Being with these men and women, the mystery of death didn't scare me; it beckoned me. My own losses didn't haunt me; they fueled me. ** I wanted to understand how to serve people in their final moments. I felt a surge of passion for helping every person die with dignity, and in the way of their choosing. You want Elvis records playing? You want your plants near your bed? Ok. You want me to throw all the plants away? I will. You want a Rabbi? A priest? A Popsicle? I will bring it. You will be a human being until the end.
But you already know that I changed my mind by the end of that one day, because that's how I started this piece. By 2pm I became intimidated and afraid. And what ended up scaring me was one thing and one thing only:
As we were driving away from our last house my preceptor said to me, "In the end we use the morphine more and more frequently. It allows them to be completely comfortable. Sometimes it might be that last push of morphine that slows their respiration rate down completely. That's hard. But you do it anyway."
Essentially, a measure of comfort in the very end can be the thing that hurries death.
Now, obviously, the person is dying. There is a protocol to prevent life saving measures. It's called a DNR. The person is going to die now or in ten minutes and we're not going to prevent it. Furthermore, his quality of life is dependent on the comfort measures between now and then. So does it matter if the push you give pushes him over?
If you kill him to comfort him?
Logically, no. But the idea stopped me cold in all my young nursing student zeal. I tried not to think about it for the rest of school.
Now, more and more often it seems, end of life care is a part of my job. I didn't seek it out, but I also stopped running from it. And then I started to feel the same sense of purpose and honor I had before. And sometimes the choices that fall on health care providers are very, very hard. But someone has to make them; someone has to act in accordance with the patient's wishes when the patient can no longer wish out loud.
It's important to figure out your own feelings before you're on the other end of that morphine. Although sometimes we surprise ourselves in moments of extreme trials, going into them unarmed with knowledge of self is dangerous. It can cause loss of objectivity and emotional panic, which is no place to make life or death decisions from.
I'm curious to know what other folks, both medical and non medical, think since it's a topic that came up amongst my co workers last night.
Keep in mind, although this is sure to open up the topic of assisted suicide, that's not what I'm talking about here. The patient hasn't asked for medical assistance to terminate life. He has asked to be allowed to die, comfortably.
-----------------------------------------------------------------------------
* To be fair, I am kind of constantly thinking I've found my calling.
** Keep in mind, this was all in one shift. In one day.
Wednesday, November 11, 2009
Tuesday, November 10, 2009
and the sky starts to change
This just in:
Improv Asylum will be presenting a Second City revue in Boston from late April 2010 to late May 2010.
So, for any friends, coworkers or family who aren't improv savvy/geeky, a quick background: The Second City started in 1959 in Chicago and is a comedy theater. A ton of famous people have started their careers there including Bill Murray, Gilda Radner and John Belushi. It now also has theaters in Toronto, Los Angeles, plus multiple touring companies. So... it's big.
So in 2010, from late April to late May, the owners of Improv Asylum are sponsoring a company to come to Boston to create a show that will run for about three weeks. The shows at IA will continue as normal; the Second City show is at a different theater in Boston. IA's producing it; the writers and directors are all Second City folks. They will most likely bring actors from other places, like Chicago...
... but they are also holding auditions amongst Asylum actors and alumni for (at least) two slots on the cast.
Which is very, very exciting.
The most exciting thing about it isn't that, though. It's what this could do to stir up more interest in comedy in general in the city. People who have never heard of "sketch," by that name, or whose only experience with improv may have been a bad one may undergo a conversion.
And when Second City leaves at the end of May they will look to other venues for their comedy fix. Boston is about to become an even funnier place (hopefully).
Improv Asylum will be presenting a Second City revue in Boston from late April 2010 to late May 2010.
So, for any friends, coworkers or family who aren't improv savvy/geeky, a quick background: The Second City started in 1959 in Chicago and is a comedy theater. A ton of famous people have started their careers there including Bill Murray, Gilda Radner and John Belushi. It now also has theaters in Toronto, Los Angeles, plus multiple touring companies. So... it's big.
So in 2010, from late April to late May, the owners of Improv Asylum are sponsoring a company to come to Boston to create a show that will run for about three weeks. The shows at IA will continue as normal; the Second City show is at a different theater in Boston. IA's producing it; the writers and directors are all Second City folks. They will most likely bring actors from other places, like Chicago...
... but they are also holding auditions amongst Asylum actors and alumni for (at least) two slots on the cast.
Which is very, very exciting.
The most exciting thing about it isn't that, though. It's what this could do to stir up more interest in comedy in general in the city. People who have never heard of "sketch," by that name, or whose only experience with improv may have been a bad one may undergo a conversion.
And when Second City leaves at the end of May they will look to other venues for their comedy fix. Boston is about to become an even funnier place (hopefully).
Monday, November 9, 2009
jump start my heart, you.
Friday had been an unintentional marathon of an evening starting with two shows at Improv Asylum followed by drinks at The Field with the cast of Crime Solving Bear 2, breakfast at 2am at IHOP and finally a viewing* of Wet, Hot American Summer for the breakfast survivors at chez moi at around 4am.
I only tell you this because you'd think that Saturday I would have slept all day.
Instead, Saturday morning I woke up restless.
The kind of restless I haven't felt in years, for reasons I will dwell on in a future post.
I tried to watch an episode of Mad Men (I'm still in Season One), and found myself unable to concentrate. I found out my plans in Boston for the night were being deferred to another evening and I only grew more itchy. I alternately cleaned the kitchen and bathroom. I considered and rejected complicated dinner options. I surfed tracks on The Scarlet Pimpernel soundtrack until I'm sure my roommates wanted to hand me over to be guillotined. I switched to The Last Five Years.
Outside the sky was blue, and the tree outside my window, with all its reds and oranges reminded me of Amherst. The first time I listened to The Last Five Years was in Amherst. My trip to Amherst was scheduled for the morning. Man, do I miss Amherst, I thought.
I decided to throw some clothes into a bag for the morning.
Then it was all over.
Once the clothes were in the bag my mind was made up. I began throwing things into the backseat of the car. I felt like a version of myself I hadn't quite noticed gone missing.**
Within fifteen minutes I was in the car belting the words to "I Can Do Better Than That," and cruising in a zen like state*** towards the middle of the state back to a town I've had a love/hate relationship with for years.
The first thing I did at Amy's house was accidentally almost electrocute myself in an incident involving an electric socket in their low set ceiling, and a giant sword. The second thing I did was debate at length about what it would have looked like, and if it would have been appropriate to carve into a gravestone.
The restlessness had dissipated on the road and was replaced with an overwhelming sense of coming home.
-----------------------------------------------------------------------
* We all promptly fell asleep, so it was more like a "putting on for background noise."
**Which is a good thing since most of my life demands a lot more discipline than I used to have.
*** only more driving appropriate
I only tell you this because you'd think that Saturday I would have slept all day.
Instead, Saturday morning I woke up restless.
The kind of restless I haven't felt in years, for reasons I will dwell on in a future post.
I tried to watch an episode of Mad Men (I'm still in Season One), and found myself unable to concentrate. I found out my plans in Boston for the night were being deferred to another evening and I only grew more itchy. I alternately cleaned the kitchen and bathroom. I considered and rejected complicated dinner options. I surfed tracks on The Scarlet Pimpernel soundtrack until I'm sure my roommates wanted to hand me over to be guillotined. I switched to The Last Five Years.
Outside the sky was blue, and the tree outside my window, with all its reds and oranges reminded me of Amherst. The first time I listened to The Last Five Years was in Amherst. My trip to Amherst was scheduled for the morning. Man, do I miss Amherst, I thought.
I decided to throw some clothes into a bag for the morning.
Then it was all over.
Once the clothes were in the bag my mind was made up. I began throwing things into the backseat of the car. I felt like a version of myself I hadn't quite noticed gone missing.**
Within fifteen minutes I was in the car belting the words to "I Can Do Better Than That," and cruising in a zen like state*** towards the middle of the state back to a town I've had a love/hate relationship with for years.
The first thing I did at Amy's house was accidentally almost electrocute myself in an incident involving an electric socket in their low set ceiling, and a giant sword. The second thing I did was debate at length about what it would have looked like, and if it would have been appropriate to carve into a gravestone.
The restlessness had dissipated on the road and was replaced with an overwhelming sense of coming home.
-----------------------------------------------------------------------
* We all promptly fell asleep, so it was more like a "putting on for background noise."
**Which is a good thing since most of my life demands a lot more discipline than I used to have.
*** only more driving appropriate
Friday, November 6, 2009
Improvisers in the (Medical) Workplace
Recently Liz Caradonna of e-liz, posted a blog entry about what assets an improviser might bring to an office workplace entitled "Beyond 'Be Funny!': improv at the office."
Some ideas covered in the piece include the value a good improviser places on trust, and the concept of not overlooking the obvious answers to simple and complex questions.
Her follow up piece How to Listen, expands on the idea of how (good) improvisers may listen differently than others. (I almost just repeated half of her entry here because I love her explanation of this idea so much. But she explains it so well that paraphrasing doesn't do it justice. Do yourself a favor and go read it.)
Because people are generally always asking me if my improv helps me as a nurse, I have had a chance to come to many of the same conclusions as Caradonna.
In fact, almost everything she said about being an improviser in an office job can be said of being an impoviser in a medical field.
I'd like to briefly expand on her ideas in the context of a health care provider's daily work.
1. Trusting/Teamwork. Trust or lack of trust can literally become life or death very quickly in a medical work environment. But even in low stake situations trust is essential to successful patient outcome. In an ideal situation every member of the team, from respite aide to attending M.D is out to provide the best patient care possible while also lifting up and empowering every other member of the team. It's not in anyone's best interest to do anything else. For an improviser, the concept of working with a large group of people towards one common goal is familiar and easy. The give and take of leadership and trust comes naturally, and is an area a good improviser absolutely thrives in.
2. Being a Good Public Speaker. Improvisers are good to have on hand at staff meetings. They have a good sense of how to gauge an audience which makes presentations more effective. But a good improviser is usually also good at private speaking. This means not being afraid to talk to patients, family members and to advocate strongly for their rights while encouraging their compliance with care. You shake hands, you introduce yourself, you make eye contact. You know the patient's history going into the interaction. You are sure of yourself and encourage others to be sure of you as well.
3. Don't Discount the Obvious. Caradonna has a great explanation of why this is an improv skill. My two cents on the medical end is that it's really easy to see a tanked oxygen saturation level on the screen of the pulse oximeter and start to flip out. You want hook them up to 02 2L via nasal cannula STAT. But first you should check to see that the sensor didn't just fall off their finger while you weren't looking!
4. How to Listen. A good improviser is always a good listener. And a good listener makes a good nurse. In nursing school we spent entire lectures learning how to listen. We role played. We took tests on listening. Every therapeutic interaction with a patient is based on how to listen and how to listen well. As an improviser you are trained to listen well, retain information, and reflect and mirror your scene partner. Moreover, you are trained to respond to your partner as fully as possible, by attempting to demonstrate your acceptance of their personal reality.* You seek to understand their perception of their illness in addition to seeing the disease process through a clinical and objective eye in order to gain insight into a much larger picture of the patient's wellness. Providing therapeutic care is going to come very easily to anyone who does these things as a natural part of conversation.
I really wish I'd had the right language to use to describe all of this years ago while I was doing my psych clinical. My instructor was dubious of my ability to be a performer and a nurse. I felt like I was constantly defending my art to her, despite my stellar grades. I was conferencing with her one day and made the mistake of explaining that I approach every interaction as though it were an improv scene.
"No!" she exclaimed, "no, you can't do that. This isn't a joke. These people are sick."
What I meant of course was that I was going to listen to my patients, validate their experiences by accepting their reality, trust my co workers and keep my mind grounded at all times in the truth of the nurse-patient relationship. Which I tried to explain, too late and a bit lamely.
I felt like from that moment on she was watching me as I made my rounds on the homicidal-suicidal unit where we worked, just waiting for me to mime a paintbrush, or burst into free style raps about Prozac so she could report me.
But time soon told what my fumbling words could not: that an improviser's instincts are some of the finest assets an employer can ask for, in any field.
---------------------------------------------------------------------------------
* "...these responses go a step further than "what I hear you saying is..."; they say, "I hear you. I understand the universe that you're living in... and I'm living in it, too." This is the message that radiates from an exceptional listener. "We're in this together." (Caradonna, How to Listen)
Some ideas covered in the piece include the value a good improviser places on trust, and the concept of not overlooking the obvious answers to simple and complex questions.
Her follow up piece How to Listen, expands on the idea of how (good) improvisers may listen differently than others. (I almost just repeated half of her entry here because I love her explanation of this idea so much. But she explains it so well that paraphrasing doesn't do it justice. Do yourself a favor and go read it.)
Because people are generally always asking me if my improv helps me as a nurse, I have had a chance to come to many of the same conclusions as Caradonna.
In fact, almost everything she said about being an improviser in an office job can be said of being an impoviser in a medical field.
I'd like to briefly expand on her ideas in the context of a health care provider's daily work.
1. Trusting/Teamwork. Trust or lack of trust can literally become life or death very quickly in a medical work environment. But even in low stake situations trust is essential to successful patient outcome. In an ideal situation every member of the team, from respite aide to attending M.D is out to provide the best patient care possible while also lifting up and empowering every other member of the team. It's not in anyone's best interest to do anything else. For an improviser, the concept of working with a large group of people towards one common goal is familiar and easy. The give and take of leadership and trust comes naturally, and is an area a good improviser absolutely thrives in.
2. Being a Good Public Speaker. Improvisers are good to have on hand at staff meetings. They have a good sense of how to gauge an audience which makes presentations more effective. But a good improviser is usually also good at private speaking. This means not being afraid to talk to patients, family members and to advocate strongly for their rights while encouraging their compliance with care. You shake hands, you introduce yourself, you make eye contact. You know the patient's history going into the interaction. You are sure of yourself and encourage others to be sure of you as well.
3. Don't Discount the Obvious. Caradonna has a great explanation of why this is an improv skill. My two cents on the medical end is that it's really easy to see a tanked oxygen saturation level on the screen of the pulse oximeter and start to flip out. You want hook them up to 02 2L via nasal cannula STAT. But first you should check to see that the sensor didn't just fall off their finger while you weren't looking!
4. How to Listen. A good improviser is always a good listener. And a good listener makes a good nurse. In nursing school we spent entire lectures learning how to listen. We role played. We took tests on listening. Every therapeutic interaction with a patient is based on how to listen and how to listen well. As an improviser you are trained to listen well, retain information, and reflect and mirror your scene partner. Moreover, you are trained to respond to your partner as fully as possible, by attempting to demonstrate your acceptance of their personal reality.* You seek to understand their perception of their illness in addition to seeing the disease process through a clinical and objective eye in order to gain insight into a much larger picture of the patient's wellness. Providing therapeutic care is going to come very easily to anyone who does these things as a natural part of conversation.
I really wish I'd had the right language to use to describe all of this years ago while I was doing my psych clinical. My instructor was dubious of my ability to be a performer and a nurse. I felt like I was constantly defending my art to her, despite my stellar grades. I was conferencing with her one day and made the mistake of explaining that I approach every interaction as though it were an improv scene.
"No!" she exclaimed, "no, you can't do that. This isn't a joke. These people are sick."
What I meant of course was that I was going to listen to my patients, validate their experiences by accepting their reality, trust my co workers and keep my mind grounded at all times in the truth of the nurse-patient relationship. Which I tried to explain, too late and a bit lamely.
I felt like from that moment on she was watching me as I made my rounds on the homicidal-suicidal unit where we worked, just waiting for me to mime a paintbrush, or burst into free style raps about Prozac so she could report me.
But time soon told what my fumbling words could not: that an improviser's instincts are some of the finest assets an employer can ask for, in any field.
---------------------------------------------------------------------------------
* "...these responses go a step further than "what I hear you saying is..."; they say, "I hear you. I understand the universe that you're living in... and I'm living in it, too." This is the message that radiates from an exceptional listener. "We're in this together." (Caradonna, How to Listen)
Friday, October 30, 2009
rest your weary head, all is well
I was standing in the hallway, torn between two or three tasks.
Fresh in my mind were the events of the morning. A patient at serious risk for a second pulmonary embolism walked out against medical advice. As he stood with me, holding his bag of belongings he told me his cravings for drugs were too strong to resist. The nurse practitioner approached our stand off. She asked him to stay. She told him he could die. He looked at her and said he understood. I raised my eyebrows, pleading with him. He looked right into my eyes and shook his head. Then he left. And I sat at my desk for a long time, not speaking.
But- there was other work to be done, so I found myself in the hall, prioritizing the rest of my shift .
I only saw Mr. M's back as he walked down the hallway with the program director but I sighed inwardly, my thought process temporarily interrupted. Every time he leaves he's in great shape, and when I see him again he's a wreck.
But then I watched, intrigued as the program director led him past the nurses' station into the dying man's room and then left him there.
"He's come back to visit," she said to me as she turned from the door. "I told him we could make an exception."
I watched as he grasped the older man's hand, his face beaming with love. The older man forced his own eyes open and searched the young man's face, slowly recognizing a stranger that he once told us was "like a son to me."
"He's been sober for three months," the director told me, "that's a really long time for him."
I knew that, and I nodded.
"That's incredible," I said, and found myself speechless again.
Things like that can change the entire day.
Fresh in my mind were the events of the morning. A patient at serious risk for a second pulmonary embolism walked out against medical advice. As he stood with me, holding his bag of belongings he told me his cravings for drugs were too strong to resist. The nurse practitioner approached our stand off. She asked him to stay. She told him he could die. He looked at her and said he understood. I raised my eyebrows, pleading with him. He looked right into my eyes and shook his head. Then he left. And I sat at my desk for a long time, not speaking.
But- there was other work to be done, so I found myself in the hall, prioritizing the rest of my shift .
I only saw Mr. M's back as he walked down the hallway with the program director but I sighed inwardly, my thought process temporarily interrupted. Every time he leaves he's in great shape, and when I see him again he's a wreck.
But then I watched, intrigued as the program director led him past the nurses' station into the dying man's room and then left him there.
"He's come back to visit," she said to me as she turned from the door. "I told him we could make an exception."
I watched as he grasped the older man's hand, his face beaming with love. The older man forced his own eyes open and searched the young man's face, slowly recognizing a stranger that he once told us was "like a son to me."
"He's been sober for three months," the director told me, "that's a really long time for him."
I knew that, and I nodded.
"That's incredible," I said, and found myself speechless again.
Things like that can change the entire day.
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