The Opposite of Tenebrific


A career in medicine is one that has many lures–the ability to touch lives,  fascinating medical phenomena, and the knowledge of the complexity that comprises the human body, among other things.  Yesterday, every single one of my patients reminded me again of why I became a PA.  One patient asked my advice on what to do about a lost love connection spanning over 20 years.  Another had such an intricate medical history, it had me stretching my brain for information I’d learned long ago in school.  One funny patient and I talked about our love of words, and I shared with him an app on my phone which gives me a new word to learn every morning. Every patient thanked me for being easy to talk to, and I was loathe to walk each of them to my door because I had enjoyed our visit so much.  It was a day sorely needed. Last week, the last patient of my day made me cry.

As anyone who knows me will tell you, making me cry is not actually difficult. I confess to a small sob while watching the movie Aladdin (which is a cartoon I know, but that Genie gets me every time).  aladdin genie

Someone else crying causes me to tear up.  Even writing a sentence about crying will cause what my son calls my “shiny eyes.” I’ve cried with patients numerous times, with a touching story or in shared grief. But this time, it was different.  I was crying tears of anger.  I am cursed with full-on waterworks if I’m extremely angry, which I would love to be able to control. It’s hard to be taken seriously if you’re wiping away tears while trying to make a point, and even harder to carry on a patient evaluation when you are doing everything you can to remain professional in the face of hostility.

This patient began our encounter angry before he had even met me because his appointment had been rescheduled with another provider. Where I work, I’m used to dealing with angry patients on an almost daily basis.  To some of them, solely on the basis of where I work, I am the face of all of the bureaucratic bean-counting, soul-sucking paper-shuffling nonsense that prevented them from seeking care in the first place. I am part of the system that denied them benefits, told them PTSD did not exist, and denied their right to be seen as a person, and not a number. So I understand the frustration and the anger that comes as part of the baggage of just getting to the appointment.  I understand that part of my job is to lift that burden of frustration, and make them feel like they are seen, and heard.

As patients, we come to our appointments carrying the invisible baggage of our history–the memory of an aunt who died on the operating table, medication reactions, a fear of bad news-“What if it’s cancer?” As providers, we know this, and try our best to gauge those worries and try to alleviate them if possible.   Sometimes though, the actions brought about by those fears and worries are inappropriate, and other times, even criminal.  Fears have been running high in our department because one of our sister facilities suffered a tragic shooting.  A patient shot and killed one of the providers at the hospital in El Paso.  He worked in the same type of department in which I work.   Meetings about safety measures, active shooter scenarios, and how to deal with violence in the workplace have been laced with tension-filled voices.  One of our police officers tried to help us dial back the emotions.  “Let’s not call it a panic button. I prefer the name duress alarm. We don’t want to have panic,” she said.  I’m not sure that changing the name makes a difference, though I do advocate for the power of words.

But the words I mean are those we use when dealing with patients.  As peace-loving as I try to be, I am not immune to the effects of violence. I trained in the city of Detroit and saw the ravages of drugs and violence on the faces and bodies of our patients, treated gunshot wounds and stab wounds, and saw families ripped apart by random acts of killing.   People argue that our patient population is more dangerous because as veterans,  our patients have all been trained on how to use weapons.  I argue that if anything, that makes us safer, because they were also trained in how to defend those in need, in how to stand and fight for those who could not or will not because of an oath to heal or religious convictions or even conscience alone.  I will defend our veterans as patients just as worthy of our compassion as any other patients, if not more, and not to be considered a source of fear.

Last Friday though, I was afraid, and if I were a superstitious type, might have seen the word of the day, “tenebrific,” as a portent, as it means producing darkness. My patient arrived upset, out of control, and angry with me and everyone else in his vicinity.  I stand a whopping 5 foot nothing, and so to me, everyone is tall.  This man though, stood a good foot taller than me, and weighed over 2 times what I weigh.  I tried every tactic I had ever used to deal with a difficult patient, but I could not connect with him.  The power of words failed me.  He kept standing up while I was attempting to gather his history, and the sight of this very large man gesticulating wildly between me and the door gave me a qualm every time he stood up.  Between his wife and I, we tried to calm him down, but nothing seemed to work.  He alternated between insulting me and denigrating the system, and I bit my tongue and tried to smile pleasantly until it reached the point that he started to use expletives.  I firmly told him that this kind of language was unnecessary.  At this point he demanded to see someone else because he thought I was “belligerent and argumentative.”

My hands shook and my heart was pounding as I escorted him to the appointment desk to be rescheduled, and then I returned to my office and promptly burst into tears. I was angry and upset, mostly at my inability to control the situation and at the fact that I had not been able to get him to see beyond me as the face of an organization, to see me as someone who cared about his well-being, and at myself for feeling intimidated by a patient.

I believe strongly that all patients deserve good health care, the best that I can provide if possible.  To come to a point where I could not do so, made me realize that as providers we also have the right to be treated with dignity.  When we in good conscience have done all we can to do right by our patient, we also deserve to be seen and heard. We deserve, as our patients do, to work in a place where we should not fear for our lives for doing our jobs.  My heart goes out to those in El Paso, and especially the family of the man who was killed trying his best to help others.

Today I am thankful for work which allows me to be present in the lives of others in the midst of their pain and suffering. I pray for the strength to continue to be the opposite of tenebrific as much as possible.  And I am grateful for all of the wonderful patients I’ve met along this journey.

I would love to hear any of your stories of how you’ve either dealt with a difficult person or tactics on how to keep the tears from flowing when you don’t want them to.  I hope and pray that you have someone taking care of you with whom you can laugh and cry. Let them know you appreciate them if you do.  They might really need to hear it today.

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Groundhog Day


I’m laying in bed wishing my life were a movie, and unfortunately Groundhog Day is the one that keeps coming to mind. Today was a day when I could not get it right. I could not be kind or patient or even grateful for all the blessings I have. I walked out of the house this morning without even kissing my family goodbye, distracted by all the things I needed to accomplish before the day began, and tired, instead of rejuvenated by the weekend. This Monday felt like the end of a long week, instead of the beginning, after six days with the husband gone elk hunting, and then headed back today on shift at the firehouse, and I could not see my way to Tuesday. If only we could hit the rewind button, or live the day again, but do it better. This is what comes of being a perfectionist, wishing to do things over and over again until I get it right, instead of letting today go, so tomorrow can begin.

Haven't we all wished once we could be Bill Murray, and live our day over again right this time?

Haven’t we all wished once we could be Bill Murray, and live our day over again right this time?

Perfectionists don’t look like you think they might. They are not all perfectly-pressed pristine paragons of pulchritude (wordies of the world unite!). The first time I read that most perfectionists are procrastinators, I felt someone had opened up my half-empty diary and read the scribblings within. This fear of imperfection stops up creativity and progress. This folly is what has my blog littered with drafts “that just need a little more tweaking,” languishing in the junk drawer of my mind. I don’t blame Pinterest or all the other parenting blogs with their professional-looking pictures of crafts I could never master or perfectly clean homes that don’t have piles of clean laundry that still need folding. I was born this way, and have unfortunately passed this trait on to my kids, with Daughter #1 wailing at age 3: “But I can’t make it perfect”, while trying to tie her shoes. I can’t be Bill Murray today, so in an effort to let go of this ideal of perfectionism, I am sharing this sad, largely unedited tale of how I picked my self-pitying self up and kicked myself (metaphorically, of course) in the dupa as the Polish say. (You can’t grow up where I did in Michigan and not pick up a few useful Polish words, another useful one being paczki).

Sometimes, we live the Pinterest life, or at least give the appearance of doing so. Last night we dined on bone china eating grass-fed husband-hunted grilled elk steaks with a side of organic brown quinoa, and garden fresh-picked kale stir-fried with onions and nitrite-free bacon. Here is a picture of that lovely meal.

Pinterest-worthy, don't you think?

Pinterest-worthy, don’t you think?

Most times we don’t though. Today, I picked up dinner from Wendy’s (by request from my little guy–not sure if that makes it better or worse) on the way home so we could get started on the hours of homework I knew lay ahead of us. My kids ate their Kid Value Meals (“with toy from Dreamworks!”) while I prayed that the fumes in my tank would get us through the line at the gas station, hoping the gas light would not start blinking like the robot in Swiss Family Robinson. I’m sure the bacon on the Junior bacon cheeseburger was not nitrite-free. There is no picture of that meal.

When we got home, Dragon Mama reared her ugly head, and the battle of the homework began. My middle daughter has no great love of math, and a summer in which we did not review multiplication tables is bearing all of its tearful fruits now. As I sat there, wishing the husband was home so I could tag out for a few minutes like those old WWF wrestling matches, I wondered if perhaps I am the cause of her dislike of math. Not a great motherhood moment. I walked away to sit on our patio swing, in the hopes that it would give me some perspective. This would be the moment I discovered the dog had found something delightful in the compost to string all over the yard. I have to admit, there was nothing Zen-like about this outdoors experience, and the swing would likely be more calming if it weren’t powered by angry feet, rocking wildly off its foundation.

This is me on a bad day.  Note the mouth made for spewing fire.

This is me on a bad day. Note the mouth made for spewing fire.

My spirits thusly fortified by the brisk swing, I felt up to the homework battle, in which the phrases “No, it would not be easier to add it 36 times, just MULTIPLY!” and “Yes, it is still wrong! Add it again.” were uttered. This is why I would be horrible at home-schooling my children, and why I believe teachers should be paid exponentially more than they are. At the end, we negotiated how to dole out the last 6 problems of Sunshine Math for the rest of the week given a full schedule of baseball, soccer, dance, scouting, and, of course, work. That was when my middle daughter said, “I really hope Daddy will be home for at least some of those days.” “Me, too,” I thought to myself.

In the middle of this, my husband called back to apologize for our earlier conversation in which I had retorted, “I don’t understand why we’re yelling when we agree with each other.” I had the good sense to also apologize, though not very graciously, and then he shared the news which made every single grumpy moment seem ridiculously banal. Our friend has cancer, and the outcome is uncertain.

On a day when I managed to yell at my kids just trying to add and multiply, my husband while trying to agree with him, and the dog for doing what dogs do, this news made me drop my head in shame. I looked at my self-pitying soul, and resolved to live better. We get no second chances, this not being a movie set and all, and so, we said our bedtime prayers, I apologized for being a dragon Mama, and we had a cuddle session which put them past their bedtimes, in the hopes it will all balance out in the end.

Tonight I’m thankful for second chances and forgiveness. I’m grateful for Wendy’s Junior bacon cheeseburgers and elk steaks. And I’m thankful for all the teachers who spend hours a day teaching our children with patience and skill. I’m praying for all the other dragon mamas (and papas) out there who have to parent alone all the time. I’m praying tonight for our friend, and for all of us out there who are struggling to live each day with grace, whether it is our last day or our first, again.

Flight


Embed from Getty Images

“I’m not leaving without my mother.”  Each time I hear those words in this story, the hairs on my arms stand up.  It is the story of the day we left Vietnam.  My brother says we are doomed to lead less interesting lives then our parents.  I think instead we are blessed. Recognizing these blessings is part of this burning away of all that drags us into the mire of living the unexamined life.

I am grateful today not to live in a country where we are in fear of bombs blowing up our homes, where we have to decide what country we should flee to, or worry about never seeing family members again.  This was what passed for normal for my mother and father in Saigon in 1975.  My parents worked for the American military at Tan Son Nhut airbase.  It was a dangerous position to be in, a liability if the wrong side won the war, a risk that could put my parents, and my mother’s family in danger for supporting the cause of freedom from Communism.

The fall of Saigon is officially April 30, 1975. A few days prior, my father came to work and was told to return to Tan Son Nhut Airport with only his immediate family–my mother and me, and one suitcase within a few hours time to insure a safe departure from Saigon.  My grandmother and my mother’s 2 young sisters had come to stay in my mother’s apartment in Saigon after they could not board a boat in Vung Tau to leave the country.  No one knew what would happen next, but my mother insisted that she would not leave Vietnam without her mother.  And so, all of us made it onto that airplane through the grace of God and sheer force of will.

Because of this, I have always been surrounded by strong women–women who have survived war, cancer, and heartbreak.  Because of this, I have always had the example of how to be a good mother, sister, daughter, and wife.  Because of this, I have seen the saving power of grace and forgiveness. For all of these things, I am grateful for a mother who knows how to bend with change, who has been broken and made whole again, and is still beautiful.  She is the woman who has always told me that she gave me wings so that I could fly.

My mother leading the way.

My mother leading the way.

As we start this 40 day journey into leaving behind fear, I’m joining others across the country who are keeping gratitude journals, and invite you to do the same.  The benefits of counting our blessings, so to speak, are manifold:  increased feelings of happiness, better relationships, more energy. . .The trick lies in making this a habit, of course.  Let’s hope that 40 days is enough.

Check out these other blogs for help with your gratitude journal:

http://www.aholyexperience.com/joy-dares/

http://momastery.com/blog/2014/03/06/gratitude-experiment/

And check out this research on forming habits (because I’m still a nerd):

http://www.brainpickings.org/index.php/2014/01/02/how-long-it-takes-to-form-a-new-habit/