Advocating

I'd like to respond to a comment from the previous blog entry about advocating everyday for my patients. Thank you for that comment. 

I have always believed it is my responsibility to help those who have a difficult time helping themselves. I want to be an advocate for my patients and think this is a necessary part of a nurse's job. Sometimes this means I can help make their life just a little bit easier and sometimes it means I can teach them how to help themselves, thus being a part of a larger and broader social movement. Either way, it is a privilege. 

It can be very draining and sometimes I work the whole day and don't feel appreciated for what I do. Patients have yelled at me, "What kind of nurse ARE you?" or they might hang up the phone on me. Sometimes they speak to me with an edge in their voice that says they expect something and if they don't get it they'll be mad. 

I need to constantly remind myself that they are a product of their upbringing. This doesn't mean it is all right to speak to me or anyone else this way. Their lives are chaotic and most have never been taught how to communicate in an appropriate manner. Maybe they are so used to being looked down upon and treated with little respect that they, in turn, treat others with disrespect. 

I have had many occasions when I've felt I made a difference in someone's life and have felt appreciated. These encounters are part of why I can do this job. Here are examples: a homeless man came to the clinic in a wheelchair. His gout, a very painful disease, had flared up. His leg was red and swollen and he was shaking with pain as he answered the questions I asked. While he was waiting for the doctor to see him I spent a few minutes listening to him tell stories about when he traveled around the world as a musician. I hadn't talked to him in a few months until he called again the other day. His gout had flared up again and his voice was shaking. As I talked to him he said, "For some reason, you have taken  a special interest in me. I don't exactly know why you have but I think you are a very kind person". That one sentence said a lot. Was I the only person who he felt has cared about him? Did he not feel he deserved my kindness? I strive to take a special interest in all my patients and to treat them all with kindness. I thanked him for telling me this but I doubt he understands how important it was for me to hear it. 

Last week, a woman came to the clinic. She was crying because her sister had died the night before from a brain tumor. She hadn't slept in a few weeks,  anticipating her sister's death. She had an appointment at the funeral home later that day and she needed to pick up her six grandchildren from school. She takes care of them everyday so her daughter can work. She was my age but looked 20 years older. Her life has been more difficult than mine. After talking to her I made sure she could see the doctor in the next hour so she could be with her family. About two hours later, I happened to walk by a room from which she was coming out after seeing the doctor. She walked over to me, still crying, and put her arms around me. As she hugged me, she thanked me for helping her. She asked me if she could show me a picture of her grandchildren. She pulled from her purse a picture of six children standing with her, a tree in the background. As she pointed to each of them telling me their names I saw her happy and hopeful.

These are the stories that make me feel like I'm doing a good job.

One View

I open the door that leads from the clinic area to the waiting room. I see 24 people sitting on 24 chairs sitting on dirty blue carpet. Some chairs are covered in old, stained upholstery. Some are covered in old, stained vinyl. All have held years of peoples' lives, years of stories. People in the waiting room are varying shades of color, most are dark. Some are white. Some are dressed in their native country's clothes. There are young and there are old. I see canes and walkers. I see children playing with toys. It is standing room only. I smell old tobacco. I smell alcohol. I smell bad perfume. I smell unshowered people. They look sad and tired. Most have been waiting there for hours. Some of them have appointments and some don't. For a few moments I think I'm working in a clinic in a third world country. Then I remember I'm looking at the poor in a major US city. They all look up at me hoping it will be their name I call to leave the holding pen. When I call one person's name, I want to call them all because I can't stand that they've been waiting so long. It is now only one person's turn to tell me their stories. 

I find out what brings them here, what ails their body and what ails their mind. I try to make sense of their lives. I discuss their illnesses, their medications, their often unimaginable tales. Some speak English, a lot don't. There is often an interpreter in the room. I've heard many African and Asian languages and I've gotten good at figuring out what African country someone is from by listening to them and looking at them. 

Too many times someone's English isn't good and they don't bring an interpreter. It can be painstaking for them to tell me why they're here and painstaking for me to figure it out. It's not just that they don't speak our language but they've come from such a different culture and view their bodies differently. For instance, Somalis often think there is something wrong with their liver or kidneys but when I ask them to point to the pain, it's not where these organs are. 

I try and make sense out of their chaotic lives as I describe their problems succinctly in the computer for the doctor. Now they wait again. They might be here most of their day.

Dardos Awards

When I started working at my clinic, I would tell stories about my patients to my friends. I kept hearing over and over again, "You have to blog about these." So I started Caterpillars to Butterflies. I gave my blog this name because I've always had a fascination with butterflies. Once crawling sluggishly, then trapped in their cocoon, they are rebirthed into something so beautiful. Dressed now in their distinctive colors they gently dance on flowers. So many of the patients I meet feel trapped in their lives. It is a privilege for me to try and help them find their beauty; their own distinctive colors. I hold hope that if found, they too will gently walk down a new path.

It didn't really occur to me that people would actually be interested in reading these stories and when I started getting comments, it inspired me to write more. I write because most people don't ever see what I see everyday. I write because I hope to give these people attention and pay tribute to the stories of their lives. I write because it helps me alleviate some of the stress I feel at this job.

I recently received an award from two different people. Their blogs are fantastic and I am honored to have received an award from them.

The Premio Dardos Award is given for recognition of cultural, ethical, literary, and personal values transmitted in the form of creative and original writing. These stamps were created with the intention of promoting fraternization between bloggers, a way of showing affection and gratitude for work that adds value to the Web.

Here is what Citizen K said:

She hasn't been at it long and I wish she'd write more, but Molly The Dog's Caterpillars to Butterflies is already a must-read for Citizen K. Molly employs plain, repertorial language to tell stories of her experiences as a nurse at an inner city clinic, writing in a way that combines realism with compassion.

Here is what Fox Home said:

Caterpillars to Butterflies is written with passion, compassion, generosity and wisdom about performing some of the most exhausting work in the world, helping those who are at the extremity where they cannot help themselves.

If you follow my blog, please don't forget to add me to your blog list so that those who read your blog will be introduced to mine.

Thank you!

The Trafficker

I saw a patient today who was just released from an eight year prison stay. He came to the clinic because the bullet that's lodged in his back is causing him pain. He's 33 years old. He was shot when he was 16 years old in a fight and he couldn't walk for two years. This fight also left him blind in one eye from being kicked in the face.

He was in prison in another state and just moved back here to live with his mother for a while. He wore a black knit cap over his short afro and spoke in a soft voice. He answered my questions saying, "Yes, ma'am" or "No, ma'am".

I asked him why he was in prison and he said, "Trafficking". Now, you'd think I've heard enough stories that I'd immediately know what he meant. But instead, I started wondering why someone would need to be in prison that long for some traffic tickets. Fortunately, I didn't make a fool of myself by asking him how many traffic tickets earned him such a long prison sentence. He was "trafficking" cocaine.

He used to use cocaine, marijuana, and something called "sherm". "I don't know what it is, but that's the street name", he said. "It's a liquid that you smoke and it's what's used to embalm somebody". After wondering to myself how brain cells he must have killed smoking that, I asked him when was the last time he used drugs. He said, "Man, I been in prison and just got out. I ain't using nothin' no more". He assured me he wants to change his life and he doesn't ever want to go back to the "hell hole".

He has six kids from four different women. Six kids without a father, four women raising kids on their own; loops in the long complicated chain of societal disfunction. He tells me he wants to contact some of his kids and try to form a relationship with them. I told him how great and important that is. I told him maybe he can teach them what he learned from being in prison. He told me he wants to do that. I hope he can.

More gang activity

As I'm taking the long subway ride to work, I wonder what I will encounter during my day. Will I need to call the paramedics? How many times today will I hear heart wrenching stories and be amazed at the survival of the human spirit? I feel a rush of adrenaline as I arrive at the clinic. I try to mentally prepare myself and perhaps one needs to crave a little bit of this rush in order to work there.

On this particular day, I noticed police cars driving slowly back and forth by the clinic. I figured they must be looking for something or somebody. Then, as I was talking to a patient in a room with the door closed, I could hear yelling. I couldn't tell if it was coming from inside the clinic or outside until I heard a police siren. When I was done with my patient, I began walking back through the small and narrow hall which leads to my small and narrow desk when I saw 7 police cars, lights flashing, and 3 gang unit cars. I stood there looking out the window, watching boys and young men, hands spread on the police cars. It appeared there were two cars full of people involved in this mess. The police pulled a bat and something else that was small (was it a gun?) out of one of the cars. I watched as the police repeatedly searched through everyone's hair and patted them all down. Opposing gangs, ready to fight. One of the kids couldn't have been older than 10 years old. Was he the little brother of one of the other kids there? What kind of future does he have? And as I watched this, I thought about how heartbroken their mothers must be.

Two gang shootings happened right there about one month ago. The police must have been tipped off this day and that's why they were patrolling. There has been in increase in gang activity in this area and I fear it will be getting worse. I know when the economy is bad, the crime rate goes up. These kids don't see a future of learning and earning an income and they don't see a future where they feel safe. Their power and safety comes from belonging to their gang and it is dangerous for us all.