With snow still falling in
Minnesota in May, my graduation on May 4th was a memorable one! PA
school has been a long journey for me and my classmates with its own share of
challenges or "fires" as we called them. It consumed our lives. So, it is a
bitter-sweet moment as we leave the known and move into a new phase in our
lives. This new reality has not quite set in yet, but I feel ready.
As I reflect back on my
educational experience, I realize that I could not have done this alone. I've
been blessed to have people around me who supported me, tolerated my melt-downs
and self-doubt, and still remained by my side. They were the flowers in my
garden! Graduation is a celebration of my accomplishments but most importantly,
it is also a celebration of those who've helped me on this journey.
I hope that you will also
remember and recognize those who've stood by your side (and remained there!). I
will leave you with a quote about gratitude by William Arthur Ward: "Feeling gratitude and not expressing it
is like wrapping a present and not giving it."
that note, thank you all for reading my blog posts and leaving comments. It
always made my day to know that someone took the time to read my words and to
leave a comment. Since I'm no longer a
student, this will be my last post, but I hope to continue contributing to ADVANCE for NPs and PAs in other ways.
Now, go out there and be thankful!
If there's any lesson I've learned in PA school, it is that
mistakes are the fertilizer to grow a healthy clinical year. This month is me
versus the OR (operating room) and if I didn't contaminate my glove, then I
accidently bumped my head into the surgeons or didn't bury the knot correctly
on my suture.
Some of these mistakes I've made four or five times, but by
that fourth exasperated, "OH MAN!
Again!" some synapse in my brain is marred to never ever do that again.
Then there's this mistake: When the surgeon asks you, "What's that?" and you
say artery, but it's really the thoracodorsal nerve right after he pinched it
with a hemostat. Ah, lesson learned. A
guess, or "maybe" is not good enough in the OR.
I'm pretty good at moving beyond my mistakes and not let
them get at my gut. The key is to ask yourself a few key reflective questions: Was
anyone seriously harmed? Did I learn
something? Will this ruin my life
forever? Hopefully, for most of you, as it's been true for me, no one has been
seriously harmed, I do learn something, and my life isn't ruined forever. Thus,
I move on and enjoy being a student. Students make mistakes because students
need to learn.
Clinicals are such a unique opportunity to ask stupid
questions and feel less stupid asking them simply because your nametag reads
"student." Scrub nurses, surgeons, MDs, experienced NPs and PAs have all been
where you've been-clueless and overwhelmed. So stop, take a deep breath, and
finish closing that laparoscopic incision.
My first encounter with homelessness was while living in
Ecuador. Homelessness there is pervasive and hard to miss. It is present on
most street corners and does not discriminate, affecting both old and young; it
is quite merciless and ruthless. I remember seeing kids as young as 3 years old
with plastic cups begging on the streets. They had a job to carry out, day
after day, regardless of weather, mood or age. Their survival depended on it.
Homelessness, however, is not just their
personal problem—it’s a social problem with ramifications that extend past
these people’s individual lives.
During my clinical rotation in emergency medicine, I got to
work with several people who were homeless. I clearly remember one of those
patient encounters because it felt so defeating. “HR” was a 62-year old male
with schizophrenia, alcohol dependence and a history of narcotics abuse who was
living on the streets for many years.
He had presented to the ED with severe tooth pain secondary
to untreated cavities. He was quite upset because this had been his third time
in the ED for the same problem. Each time he was given pain medications in the
ED and sent on his way with instructions to follow up with his dentist. He
never made that appointment. He insisted that we “get your act together” so
that he can be seen and treated before the shelter closes at 6 p.m. Otherwise,
he would be spending his night on the streets.
That day, I did not contribute much to the care of this
patient. On exam, there was no sign of infection or abscess formation, so our
plan was to continue with pain management. We chose to do a dental block of
that tooth to provide the patient with longer pain relief.
After injecting him with the local anesthetic, I realized
that we had only temporarily “fixed” his problem. Again, he was discharged with
instructions to follow-up with his dentist. This time, an appointment was made
for him at a free dental clinic.
Patients often present to us with psychosocial issues that
impact their health or access to healthcare. We’re trained well to address
patients’ healthcare needs but more training is needed in how to best address
the psychosocial issues that often act as barriers to the provision of quality
There is no easy answer. The least we can do is to be aware
of the resources available in the community—ranging from free dental care to
food shelves—and to provide patients with this information. It is frustrating
to both patients and providers, but we need to work
together to stop this perpetuating problem.
For those of you just entering the healthcare world,
you may have noticed that any and every field has a conference. Having lived in
Orlando for 5 years, I know about conferences (Orlando is probably the
conference capital of the east coast). So, why all these conferences? What's
the point, besides the CME for actual professionals? Can't you just learn stuff
on your own or via webcast without traveling cross-country to get to them?
Well, obviously, yes, but perhaps the reason conferences are so abundant and
popular is because they work.
Confession: I love conferences. Just last month I
went to an amazing OB/GYN conference. Last year, at the same one, I met a
preceptor I'll be spending the month of May with. Next month I'm going to a
Wilderness Medicine conference in North Carolina and because I'm too cheap for
a hotel, I'll be tent camping.
I know conferences can seem like "death by PowerPoint"
but usually there's decent food involved, a new setting and the chance to go
out afterwards with cool people you met or traveled with. What's not to like?
Some conferences are overpriced but in order to pick the best ones you have to
evaluate what you want to get out of them.
This time next year I can earn CME credit, but for
now I just look for ones at which I may find future employers or topics that I
really want to be up-to-date about. It's not cheap, but I've found ways to make
it cheaper by going to places I can get free lodging at. For example, at the
AAPA conference this May, I'll be staying with family friends and taking the
metro into the city.
The year is young yet so my advice to all you future
NPs and PAs, get into the conference groove. You might just learn something. And
you PAs, see you in Washington D.C.!
Editor's note: Find our listings of national
conferences to stay up-to-date on all the happenings this year.
Graduation day is just around the corner (but who is
counting?), so I've decided to reflect back on the "lessons learned" during my
clinical year of PA school. It has been a challenging and rewarding experience
for me. There have been ups and downs; both were very much needed. Live and
learn, as they say.
- Avoid asking questions that start with "Why?" It
may seem judgmental. I learned this the hard way.
- Always check to make sure you have the right
patient. I spent 30 minutes interviewing the wrong patient once. How
- Use your patient's name regularly. They will
remember you for it.
- Remember that it is a privilege to serve
patients. We're in the service profession and are not doing anyone a favor.
- Touch is important, but be aware of
circumstances where it might not be appropriate.
- Always check those medication lists. The answer
you're looking for might be there.
- Provide hope, but be realistic in what you can
offer. Honesty is important but it takes practice to deliver it in a sensitive
- Do not judge. Your attitude will reflect that.
that you can't always be in control. Patients will not always follow your
recommendations. It's frustrating, but it is their right.
- Take care of yourself. You can't take care of
others when you're not well (physically or mentally).
- Do not burn any bridges. Some rotations will not
be your thing. Come with a good attitude anyway and do your best. There is always
a learning opportunity.
- Do not
take things personally. Patients are usually not upset at you but at the system
or their illness.
- Remember that you can't please everyone. Some
patients will dislike you for doing the right thing.
- You might feel incompetent at some point in your
training. This is normal; things do get better!
- Finally, remember to have fun!
The real tragedy of getting a medical education is not the understanding of your own mortality or quantification of personal risk factors. It's not even the fact that friends and colleagues want you to look at something awful that is growing out of their body (I was sure that was a myth). It is the loss of good television.
An EMT friend of mine warned me that knowledge came with a price. That price came due this week. One of the heroes of the cop procedural drama I use to ease my mind after work was gutshot. As the ambulance rushed her away, her partner was told that she was in critical condition and would be placed in the ICU.
Two scenes later the woman woke up with a nasal cannula and an IV drip apparently attached in her armpit. I was incensed. To add insult to injury she engaged the nurse in conversation. The nurse had time to teach her a life lesson! In the freaking ICU. Then boom! Our hero is up and walking about to solve the case 3days later.
Since then it has been all I have been able to see. People recovering from the flu hooked up to heart monitors. The complete absence of catheters and CNAs. IV Bags hung upside down. I don't get it. These shows know how to talk the talk. I hear about VTAC and sepsis and how it is never lupus. I wonder if this is how lawyers feel when they watch Law &Order SVU.
Final point: I've been working in health care for 3 years now and not one beautiful surgeon has offered to leave her husband for me, even though she is dying of an incurable disease. Get it straight, must-see TV! Otherwise I'll yell at you like I yell at the news.
Consider this post "part II" in response to faithful
reader of our student blog, Mark Behar of Milwaukee, Wisconsin. His
comment challenged me to follow up on the use of odors and smells to
diagnose, or at least give us clues to how best to treat our patients'
underlying pathologies. I can't refuse a good challenge. Thanks, Mark, because
you made me do a little research that no doubt will help me become a more
First, to help our learning, a brief case study:
An 8-day-old white male infant presents to your ED
with a 4-day history of lethargy and vomiting and the mother complains, "He
smells bad even after I bathe him and he won't eat." The infant was full term
and weighed 6 lb. 5 oz. At the visit today the infant weighs 5 lb 12 oz. The
mother states he has had no wet diapers for 2 days. He is lethargic and vomits
twice while in the ER. He will not take a bottle.
Family and medical history are unremarkable. Child
lives at home with two parents and healthy 2-year-old sister.
On physical exam, the infant appeared dehydrated
with sunken eyes, dry mucous membranes and no fat stores. The infant smells
like sweaty feet or rotten cheese.
After a full workup with lab tests, imaging and
genetic testing, this patient is admitted to the NICU. You emphasized to the
admitting NICU team that they should seek genetic testing as soon as possible
because the smell of the child could indicate an underlying genetic disorder. The
NICU team follows your suggestion, which helps expedite the patient's diagnosis:
isovoleric academia (IVA), a rare autosomal recessive disorder that is pathognomonic
for the "sweaty feet, cheese" smell.
This patient has decreased production of the enzyme
that breaks down leucine. Isovoleric acid builds up, resulting in its secretion,
which leads to the odor on the skin and other effects of metabolic acidosis such
as coma and eventual death. Is there any hope for this baby? Of course. The
mother is instructed on a very specific low protein diet to avoid leucine as
well as administration of carnitine and glycine, which research has shown will help
metabolize the acid.
After a week-long admission and follow-up with a
geneticist and dietitian, the patient returns home. By 1 month, he has returned
to his birth weight. This child's life will be extremely complicated by this
disease, but misdiagnoses could have been fatal.
So, back to Mark's point: smells can save a life. Of
course, it was actually all the labs and the genetic testing that proved the diagnosis but there's some
support that following your nose as a practitioner may not be a bad idea.
IVA is very rare. Most diseases pathognomonic with
an odor are, but a few interesting ones I came across to complete our
Nicotine addiction. (Just kidding, but we all know it's true.)
PKU = Musty, locker room towels
Maple syrup urine disease = (you'll
never guess) maple syrup
Hypermethioninemia = breath smells like
Cystinuria = urine smells like rotten
Methionine malabsorption = malt or hop
Cyanide poisoning = breath smells like
DKA = breath smells fruity
Kidney failure = breath smells like
Ileus = breath smells like solid human waste
Tuberculosis = reported to smell like
Malignant melanoma = smells like
Smelling down your patients is never a walk in the
park to smell the roses because usually sick people don't smell like roses. For
example, I came across a study that money could not pay me to participate in:
smelling the elderly's incontinence pads to detect bacteriuria. It was only 33%
accurate. I wonder if that was just the fault of the researcher's smell
fatigue. I can't blame them.
In medicine, a reality of our jobs is billing: we
have to make money and prove stuff with our money-making tests. For this
reason, diagnosing based on smell is tricky because our accuracy is rather
pathetic if used alone without other costly tests.
Although we humans aren't always the most accurate
sniffers, dogs, who have long been known to exceed humanity's abilities in a
myriad of skills, prove to be super smellers in medical diagnosing. There's
some other interesting research about dogs being able to rat-out a patient with
schizophrenia from their smell. A recent Wall Street Journal piece highlighted
the role of dogs in pediatric Type I diabetics to assist families in avoiding
These dogs don't come cheap and cost between
$18-20K. I'm jealous of our furry cousins because if I could make that kind of
money smelling, my student loan debt would be so much less daunting. Dogs are
definitely where more researchers are putting their efforts, but don't let this
dissuade you from smelling.
This brief post just scratches the surface of all
that lies under the power of our noses. I suggest you do some follow-up
research, especially with regards to "aroma therapy" for reminiscence. You
never can tell what you'll smell along the way.
et. al. The scent of disease: volatile
organic compounds of the human body related to disease and
disorder. Journal of Biochemistry
Review: 2011;150(3):257-26. Available
S.J., Paur R., Lindseth G. Urinary Tract
Infections: does the smell really tell?
Journal of Gerontologic Nursing.
- Pavlou, AK.
Sniffing out the truth: clinical diagnosis using the electronic nose. Clinical Chemistry Laboratory Medicine. 2000 Feb;38(2):99-112.
Available at: http://www.ncbi.nlm.nih.gov/pubmed/10834396
et. al. A neonate with
hyperammonemia. Lab Medicine. 2005 Jan; 36 (1). Available at: http://labmed.ascpjournals.org/content/36/5/292.full.pdf
K. Service Dogs Pick up Scent of
Diabetes Danger. The Wall Street
Journal. 2012 Dec 10. Available from: http://online.wsj.com/article/SB1000142412788732400110457816342312970336.htm
This has been one of the hardest semesters ever. It isn't
just that my clinical hours have doubled, but I am coordinating a couple of
different clinical sites, and the work load seems overwhelming. I feel as if I
am perpetually behind, behind in reading, behind in studying for the midterm. I
rush to enter my Typhon logs within the seven days following a clinical
experience, and barely make the deadline for my discussion posts. I know, I am
whining, I am trying to convince myself that whining is therapeutic.
I am a class and a half from graduation. I repeat this to
myself often. I am a class and a half from graduation. Sometimes it is helpful,
and other times well, other times it seems like I am not any closer to the cap
and gown celebration of the end of this journey.
I had a friend email me this weekend, who is thinking about
continuing her education. She values my advice and my opinions and I didn't
want to let her down. I was thinking, oh no what a time to ask me when I am
feeling so whiny and overwhelmed. A part of me wanted to respond, "Noooo,
runnnnn, don't do it, don't do it." I took a deep breath and tried to focus on
all the reasons I am taking this journey, found an ember of positivity, and
gave her the best advice I could. Yes, it is hard, but it will be worth it, and
we like a challenge, right?
other day, I came across a poem that was written by an older man who was living
in a nursing home. It is a touching
poem, so I've decided to share it with you. Although the poem addresses nurses
specifically, I believe that its message is to everyone, regardless of one's
profession. It is a reminder that, despite our age or state of health, we're
always human beings deep inside.
Crabby Old Man
What do you see nurses? . . . What do you see?
What are you thinking . . . When you're looking at
A crabby old man . . . Not very wise,
Uncertain of habit . . . .With faraway eyes?
Who dribbles his food . . . And makes no reply.
When you say in a loud voice . . . "I do wish you'd
Who seems not to notice . . . The things that you
And forever is losing . . . A sock or shoe?
Who, resisting or not . . . Lets you do as you
With bathing and feeding . . . The long day to
Is that what you're thinking? . . . Is that what
Then open your eyes, nurse . . . You're not looking
I'll tell you who I am. . . . As I sit here so
As I do at your bidding, . . . .As I eat at your
I'm a small child of ten . . . With a father and
Brothers and sisters . . . Who love one another.
A young boy of Sixteen . . . With wings on his
Dreaming that soon now . . . A lover he'll meet.
A groom soon at Twenty . . . My heart gives a leap.
Remembering, the vows . . . That I promised to
At Twenty-Five, now . . . I have young of my own.
Who need me to guide . . . And a secure happy home.
A man of Thirty . . . My young now grown fast,
Bound to each other . . . With ties that should
At Forty, my young sons . . . Have grown and are
But my woman's beside me . . . To see I don't
At Fifty, once more, babies play 'round my knee,
Again, we know children . . . My loved one and me.
Dark days are upon me . . . My wife is now dead.
I look at the future . . . Shudder with dread.
For my young are all rearing . . . Young of their
And I think of the years . . . And the love that
I'm now an old man . . . And nature is cruel.
Tis jest to make old age . . . Look like a fool.
The body, it crumbles . . . Grace and vigor,
There is now a stone . . . Where I once had a
But inside this old carcass . . . A young guy still
And now and again . . . My battered heart swells.
I remember the joys . . . I remember the pain.
And I'm loving and living . . . Life over again.
I think of the years, all too few . . . Gone too
And accept the stark fact . . . That nothing can
So open your eyes, people . . . Open and see.
Not a crabby old man . . . Look closer . . . See
It is tough for new nurses in accelerated nurse practitioner
courses to find a first job. A lot of the places willing to hire new grads want
them full time, which is impossible with the work load our training requires.
There are some employers that require new nurses to sign a binding agreement to
complete a certain amount of hours or pay a steep penalty. Others have an
unwritten policy not to hire students from programs like mine because they are
looking for those willing to make a long term commitment to being an RN.
Many of the nurses in my program got jobs in rehabilitation
and skilled care establishments comment that their job is a hectic med pass
with long hours after shift doing documentation. They complain that they have
too many patients to perform the assessments and care that they would like to.
Some feel as if they jeopardize their license with every shift. On the plus side
the pharm knowledge and real world execution of care in a full speed
environment will serve them well as practitioners.
I did something different. I currently work in a prison
health services unit. I serve as a gate keeper for the nurse practitioners.
Mine is a job of autonomous assessment, detailed documentation and assisting
I triage and assess several patients every day. My work is
to funnel the small percentage who need expert medical care through the
referral process. The assessment is made harder by the fact that many of my
patients are practiced liars and manipulators. The big upside I am finding to
correctional work is that I am allowed to take the time necessary to do a proper
assessment on every patient. Those who come into the health assessment unit are
used to waiting. Corrections work isn't for everyone, but I think it serves as
an excellent transitional job for RNs in an accelerated program.
How will you know if you would make a good corrections
nurse? The advice I have been given over and over is that you need to be a
confident and independent person who does not seek the approval of others.
Also, if you are thinking of going into corrections as a new RN, apply online a
month before you take your NCLEX. The wheels of the state move slowly.
could give any future medical student advice about the ER, my three most
important words would be: Vicks Vapor Rub. When I first entered the ER, I was
prepared to be jaded, but I was not prepared for the smells: abscesses, STDs,
rotten teeth, body odor, mildewed t-shirts, alcoholics, chain smokers,
drug-addicts, and diarrhea diapers, to name a few.
worked in a nursing home, so I have smelled my fair share and this month in the
ER has added significantly to my repertoire because I've learned to expect the
unexpected. I don't mean to sound too facetious, because smells are serious.
Science shows that smells can awaken deeply buried memories and I consider my
"smeducation" essential to my future as a practitioner.
offer the perfect context to practice social justice -- every patient gets the
same level of care and concern compared to any other. If a patient walks into
the ER, they matter, odor and all, and they will get cared for. I didn't think
social justice was a reality anywhere until this month. I thought, "Surely at
the ER they won't treat everyone the same; healthcare is expensive and I'll bet
I'll see subtle discrimination."
pleased to say that I have not, which indicates to me that though the United
States healthcare system has gaping flaws, we are still the world's best. For
example, last week this precious-yet-noncompliant Jordanian patient presented
with a complication from his chronic diabetes. In his broken English he
described how in Jordan, "Doctor sends you home with a shot and doesn't fix
you. Here, I get help." It was beautiful because in the course of his stay, I
noticed a transformation of attitude towards healthcare workers and he even
smiled as he left.
time an intoxicated homeless patient who smelled remarkably like the Roanoke
River (he had apparently fallen in) received a full work-up for head trauma and
an overnight stay, a bill that probably totaled over $3,000.
there's a huge problem with this system, but I'm learning to love the patients
through their smells. The chain smoker you can smell down the hall and hear
coughing because their COPD resulted in another case of bronchitis isn't easy
to genuinely care about. But without your antibiotic therapy, that bronchitis
could literally end the patient's life. I knew I would learn a lot about
medicine in the ER, and I have, but medicine is constantly changing. The
biggest lesson I'm learning won't ever change: treat every patient as you would
want to be treated, smells and all.
Last month during the lull of winter break, I had a sudden
fear that I would not be able to find a job after graduation. I guess it was
because of the lull, no case studies to do, clinical hours completed for the
semester, and final grade deemed passing, that I had the time to contemplate a
life after school. This month, as my classes resume and I look through my
syllabus and assignments, and the clinical hours, I now am struck with the fear
of, what if I can't do this?
After all, the last two semesters were so time consuming and
required such concentration that I felt as if I barely made it through. This semester
is even more difficult -- barely making it through may become not making it
at all. One would think after all these years of nursing education, I would be
accustomed to the marathon speed in which nursing students are required to
attain and maintain knowledge.
I think people underestimate what it takes to become an
advanced practice nurse. I have had people, both in and out of healthcare, ask
where I go to school. When I tell them, and they realize the university is four
hours away, they seem perplexed until I explain I attend class online. Then they
seem to just scoff at me, and not take my education seriously or the time and
dedication that is required to complete it. I want to tell them, "Just because
I don't go and sit in a class, doesn't me what I am doing isn't hard," but I
Taking classes online takes a great deal of responsibility,
maybe even more so than in traditional learning. It can be tempting at times to
shirk some reading or lectures to do something else unrelated to school, assignments
are given, and one must keep track of due dates, test dates, and clinical
hours. Yes, learning online may be harder in my mind, but I am glad for the
If I could not take classes online, I would not be where I
am in now. My children are too young and I have other responsibilities that
would prevent me from sitting in a class all day. Online learning also gives me
the opportunity to attend a school based on merit, not on location.
So, I guess as much as things change, such as how nursing
education is delivered, they also stay the same, such as the dedication required
to make it through the accelerated nature of nursing learning.
"Mr. Lee" is a 35-year old Asian male with HTN, HLP and DMII
who had s/p stent placement in his LAD two years ago. He has stopped taking
simvastatin, lisinopril, Metformin and aspirin, does not exercise, continues to
smoke, and does not check his blood glucose at home. Despite adequate amounts
of patient education (and a psych evaluation), Mr. Lee refuses to adhere to
medications or to implement any lifestyle changes to reduce his risk factors.
His reason: "I'm tired of popping pills. This is America. I can do whatever I
want. If God wants me to live, he'll save me. I don't need your divine
intervention. You're not God." Needless to say, this patient encounter did not
go well. We did nothing for him...how disappointing.
"Ms. Smith" is a 44-year old female with relapsing remitting
multiple sclerosis (RRMS). She stopped taking her medications one month ago.
Her reason: "I want to be medication-free. My relapses are rare and the
side-effects are terrible. My quality of life is good and I want to keep it
that way without being dependent on any medications for it." She is
knowledgeable about MS and about its potential to progress and cause
disability. Despite this knowledge, however, she has chosen to stop treatment.
This patient encounter did not go well either. We did nothing for her...how
In clinical practice, we often label Mr. Lee and Ms. Smith
as "non-compliant" or "non-adherent." In all honesty, I find these patients to
be challenging because they do not let me "fix "or help them. As students, we're taught to always come up
with a plan... a solution of some sort. Patients expect this from us as well. Most
do not want to leave their office visit empty-handed. They need something. When patients refuse to follow recommendations,
it can be quite frustrating. Sometimes, we're not prepared to handle this. At
least, I wasn't.
Are Mr. Lee and Ms. Smith right? Or as my preceptor bluntly
put it, "Is it our role/duty to save patients from themselves?" What I've come
to understand is that medical-decision making is complex. Patients' illnesses,
their reactions and understanding about it change throughout their lives.
Chronic disease is, after all, a dynamic process. What is right for one patient
may not be right for a different patient. What is right now may not be right
ten years from now for the same patient.
Each patient's illness needs to be viewed in the context of
his/her life, values and beliefs. This is no easy task, however, because it can
challenge evidence-based recommendations. It helps to remember that these
recommendations are just that-recommendations or guidelines. After
that, the ball is in the patient's court.
I am sitting in a building erected in a decade when buildings were square and walls could never be thick enough. Brown ivy climbs a brick exterior white-washed so many times that it seems smooth. The old steel radiators chitter like a multitude of sparrows and my seat was built for someone with a smaller number of dietary choices. The nurse who shows me around is a lifer, 18 years in. She is jovial and compassionate as our illusions crumble.
"This place is old, lots of stories AND ... it's haunted. HA! Just joshing. But stick together."
Her comment would not have struck my imagination if it had not been repeated, near verbatim, by another instructor. I wonder if it is the start of some elaborate hazing ritual. But this is a serious place. When we reach the part of the training where they wish again to impress upon me the importance of diversity, my mind wanders.
I remember my first end-of-life case as a CNA. The hospice nurse guiding me instructed me in her thick island accent to leave the door open. ... "So the poor dear doesn't get stuck on her way home."
When I was in the Peace Corps, funeral processions were a regular part of life. Children would run ahead of the march, knocking over chairs and covering comfortable rocks and stumps with flowers. The logic was that the spirit was tired from crossing over and would sit if allowed. Lost without the procession, it might become angry and cause mischief.
Then the memory of my uncle telling a gaggle of cousins about the grizzly bear that haunts our farming clan. The story goes that whenever a man in my family is about to die, it can be heard dragging the trap that drove it mad.
I have no truck with spirits one way or the other. My belief in ghosts can be directly related to how dark it is and how alone I am. I like science and studies and rock solid fact. Still, I remember the first time I heard a death rattle. It occupies some of my more primal nightmares.
I thought I would ask, because I will be working some long, lonely RN shifts in this very serious place. Where does our profession, so familiar in the art and science of death, stand on the subject of hauntings? Any thoughts?
Was it losing weight?
Spending more time with your family? Dragging your body to the gym? Reading
more books? When's the last year you set a new year's resolution? And how far did
you get before you broke it? And why are you so discouraged about trying again
We students in the
medical field are required to study behavior change and learn how to counsel
patients. The classic question, "On a scale from one to ten, ten being very
motivated, how motivated are you to make ___ change?" allows us as the
counselor to gauge how to progress the patient to the next stage of behavior
Two weeks ago I engaged
in this exercise with the 8-10 patients at the free clinic wellness class I
teach, encouraging them to at least set a goal for the new year. What can it
hurt? The scientific truth is that it
can't. According to a landmark Journal of
American Psychology study from 2002, 45% of American's usually make
resolutions and 8% of them are successful.
However, the individuals
who make explicit result ions are ten
times more likely to attain their goals than those who didn't. If you met a
patient and said, "I have a FREE weight loss drug but it only works in 8% of
patients. Want to try it?" I guarantee that most of your patients would give it
a go. Then, if you spent another couple minutes getting an explicit resolution
on paper, you're getting somewhere.
I'll just use myself as
an example. I am going to run a marathon this year on April 20th. I
have to. I want to run this tough race well. Run a marathon well? What does
that mean? Ok. I want to run the Blue Ridge marathon in less than four hours.
Better than that, I want to train on the course three times a week and life weights
twice a week at the gym. There. There's a resolution. It's realistic, specific,
and has short outcomes measurable each week. And of all a sudden, I'm ten times
more likely to keep it than if I off-handedly decided that I want to get in
shape in 2013. I feel faster already.
We Americans are
resolution-weary and pessimistic, yet we still claim to be the nation of
undaunted courage and unprecedented innovation. We are the land of the free,
the home of the brave. Why would we so casually dismiss resolution-making
because of a few decades of failure? This could be it, the BIG YEAR where you, yes
you, are the eight percent. Be brave; make a resolution. Get to the gym, call
your mom, quit smoking, start cooking, save some money. Remember, it can't
hurt, and maybe we can up that decade-old 8% statistic and prove science wrong.
If that's not a good reason, I don't know what is.
Feel free to comment
below with your resolution or past stories of successes and failures. Remember,
the more people you tell, the more likely you are to follow through.
Norcorss J.C., Mrykalo M.S., Blagys M.D. "Auld lang syne: success predictors, change
processes, and self-reported outcomes of New Year's resolvers and
nonresolvers." Journal of Clinical Psychology.
2002 April; 58(4):397-405.