Brain Dump

This post will probably run around the world a few times in a mostly haphazard way. Which means it will probably make very little sense to anyone.

I’ve been awake for almost 48 hours now and I fear if I do not start writing, and continue writing until either my fingers bleed or my head explodes, I will not be sleeping anytime soon.

My most recent thought has to do with my oldest brother, Jimmy. The year 2009 will mark what would have been his 48th birthday, as well as the 30th anniversary of his death. I’m not sure why this popped into my head because neither date on the calendar has any significance to me any longer. Well, that’s not entirely true I suppose.

The substance seems to be the disbelief I feel that so much time has passed already. These two dates are also crisp reminders of the enormous upheaval in my family around the same time.

The past few days my mind has wandered over the many events of 2008. What a year. What a convoluted freaking year.

Not everything that happened in the previous 12 months was dreadful though. For instance my magnificent grand-niece, Haleigha Kelis was born in January. I was present at the hospital when my niece, Dayna, gave birth to her. Although only Haleigha’s daddy was in the delivery room, my sister, who is Dayna’s mom, and I were able to hear her first screams through the operating room door.

Because Dayna had to have a c-section, she was not able to hold Haleigha right away – which sucked for both her and the baby. But it was such an amazing blessing for me to be standing near my niece when the nurse placed her tiny daughter in her arms for the very first time.

The look on Dayna’s face is beyond words. As Dayna began absorbing the enormity of this event in her life, my sister, sitting on the other side of the bed from me, whispered to Dayna “You’re in love, aren’t you?” Dayna was so bowled over by her daughter that without taking her eyes off the beautiful creature cradled in her arms, the only answer she could manage was a slow nod of her head.

Also in January, on a very snowy/icy night, a very preoccupied woman driver crossed four lanes of traffic (in a four-door Ford Escort if I remember correctly) to turn left in a lane on the other side of me. Although I was in four-wheel drive and traveling at a slow speed, I still locked up the brakes on my four-door Jeep Wrangler Sahara trying my best to avoid hitting her – but wound up hitting her anyway.

We finally had our day in court last summer and the judge all but flat-out called her a liar. The judge had both our police reports in front of him and asked the woman to tell him her version of the events of that night. He listened to her for about ten seconds before telling her, in an annoyed tone of voice, that everything she just related to him was in direct opposition of what her (and my) police reports said. He let her have another go at it so she picked up where she left off a minute before and he stopped her again. I no longer remember his exact words but I remember secretly hoping he would blatantly call her a liar.

The courthouse we were at had every person that had business with the court to wait outside the courtroom. From there we were called in one case at a time so we had a considerable wait.

I pulled into the courthouse parking lot right behind the defendant. The reason I knew it was her was because she had not had her car repaired yet and I remembered her telling me, the night of the accident in the back of the police car, that she did not carry full-coverage automobile insurance. I let her exit her vehicle first and gave her a head start to the courthouse before stepping out of mine and slowly walking toward the door.

I didn’t notice at first where she and her young daughter were sitting but it wasn’t long before I heard a woman’s voice complaining about how she was the victim and could not believe she received a ticket for something I did wrong. It was quite apparent that she was speaking loud enough so I could hear her and I couldn’t help but shake my head and giggle a little at all the untruthfulness spewing from her tobacco stained mouth.

Apparently I wasn’t as quiet as I thought I was and a young man sitting next to me and another young man sitting across from me wanted to know what had me so amused. Being that I am a polite person, I kept my voice low and gave them highlights of what really happened that night. The young men, who were in their early teens, found it quite entertaining to stare and make comments about her.

Let’s see – February…ahhhh…yes…February. For the past several months (since February) I have been a consistent shoulder for a very dear girlfriend of mine to cry upon and an ear for her to vent to. In February Connie met a man and, very quickly, they were swept up in a relationship hurricane. Apparently, the two of them hit it off instantly and they spent hours upon hours on the phone talking or text messaging.

Connie would tell me about the interests they had in common and how each of them had experienced so many similar life events and tribulations that it was spooky. It had been a long time since I had seen Connie, someone I have known forever, so deliriously happy so I encouraged her to enjoy her new friend. It didn’t occur to me at the time that I should also have been cautioning her about giving so much of herself to him so fast.

For as long as I’ve known her, she has almost always protected her vulnerabilities with a wall. Like most of us, she has been devastated in the past by relationships she thought were “the one” and every time one of those relationships failed, the wall around her rose a little higher. For Connie, there was just something about Tom, although she couldn’t quite put her finger on it that made her trust him implicitly – almost from minute one.

Not long after Connie and Tom met, the powers-that-be decided a relationship between the two of them really wasn’t such a good idea after all. Connie was inconsolable and prayed many times a day that the planets would realign and allow the two of them to be together again and, for a brief time, they were.

Boy did that piss off the gods!

I tried my best to continue being a good friend to Connie during all of this but I was preparing to return to school full-time and my free time became limited so we weren’t communicating as frequently as before.

Connie and Tom circled around each other for awhile, sending sporadic emails to each other during July and August. She said the deeply intense feelings they had for each other were stronger than ever and she felt they were still very close. I remember her also being distraught over the fact that they were not able to see each other because each of their schedules was out of control.

One day I received a phone call from Connie – I think it was right around Labor Day. She was in utter agony about an email she received from Tom. The gist of the email was that he was severing all ties to her and their relationship, closing his email account and walking away. I think he wished her well and wished her love, too. Yeah, like that’s going to soften the blow. She replied to his email and knew within seconds that he really did close his email account because her message bounced back to her.

In case you’re wondering, there is a reason why I shared this story about my very best girlfriend Connie and Tom. I was in a (sadly) unique position and able to empathize with her about feeling abandoned because I’ve been there. Done that. More than once. My family started it.

Deserted. Discarded. Forsaken. Dumped. Cast off. These are all words and feelings that have been not only flying through my brain, but regurgitating emotions I thought I had actually worked through. Clearly I only choked them down and buried them.

For me, the most difficult aspect of being abandoned is trying to determine the reason, or reasons, why. It all boiled down to the simple question of “what’s wrong with ME?”

I was hoping I could impart the wisdom of my experiences to my girlfriend to ease her pain a little. Once I admitted to myself that I really didn’t have any words of wisdom to convey to her because I never dealt with my own to become the “wise” one, I realized I had some work to do on myself.

Once upon a time I had a very comparable relationship to the one Connie had had with Tom – except I was infinitely more naïve. Mr. B and I were in turbo mode from the nanosecond we laid eyes on each other. Anyway, one day I received a “Dear Jane” email from Mr. B and, like Tom, “poof” he, too, was gone.

I wandered around in a fog for many days after I read that email, replaying every second of every minute we spent together. I dissected our emails trying to find a sign or hint of what was to come but nothing leaped off the screen at me.

I was stumbling and fumbling in a major way. I couldn’t sleep, I was barely eating. I kept the world at arm’s length. I had poured out my heart and soul to this man. All my secrets, fears, dreams, desires and aspirations were handed to him because I trusted him. Each of us had found out in previous relationships that we totally sucked at being vulnerable to anybody. Up to and including ourselves. Somehow we managed to allow ourselves to be vulnerable to each other.

His “Dear Jane” email dragged up the excruciating childhood emotions of feeling totally and utterly alone. Of being that 10 year-old girl who got herself up and off to school every morning. After school I became the housekeeper, laundress and cook for my dad and two brothers because my mom didn’t live there anymore.

Not only was I alone, but I was lonely, too. Nobody understood me because nobody knew me.

I learned at a very young age that I couldn’t trust anyone around me to take care of me.

I learned to distrust my instincts between good and evil; right and wrong.

I realized, at the age of six, that in order to survive the environment I was being raised in, I had to put the fragile core of my being on lock-down.

Mr. B’s rejection of me had an overpowering impact because not only did he make it a point to assure, and reassure, me that he would always be in my life, but he had abandonment issues of his own. So there we were assuring and reassuring each other.

Although a good deal of time has passed since he walked out of my life, I still feel that same flash of pain in my chest that I felt that day he said goodbye. I tried grieving him, as if he had passed away. I even tried stopping thoughts of him from entering my mind in the first place. Connie and I would put our heads together and work furiously on finding closure and peace for relationships that ended without our input.

Ever since Connie’s Tsunami of a relationship ended I have found myself closed off from the people around me – especially from the Love of My Life, Henry. The eerie similarities of Connie’s relationship with Tom and my relationship with Mr. B really plowed me under. What I can’t understand is why? Why now?

Could it be that for the past couple of months I have not been feeling right in my own skin? I don’t believe it has anything to do with my meds because whatever mood swings I have are controllable. I’m not arcing drastically from one side to the other. In actuality, I mostly just feel numb.

I am not able to define the “mode” I am currently in. Is it purely instinctive? Mindless? Habitual? Routine? Whatever it is, I manage (mostly) to get from Point A to Point B – and sometimes even to Point V.

With the exception of not sleeping (I have now been up for a little more than 48-hours) I’m not manic in the careless-bring-on-the-danger kind of way like I have been in the past. You know what I’m talking about, don’t you? When I’m in the clutches of that type of mania I actually want some jerk to cut me off in traffic so I can drag him out of his car and pummel him. I would, of course, be wearing a dimpled-smile during the entire process.

Right now I am kind of hell-bent on finding closure for my relationship with Mr. B. I have absolutely no idea whatsoever how I will do that, but it’s something I feel very strongly about. My hope is that in doing so I just might be able to resolve all the other issues that bubbled up with my memories of my relationship with him.

It’s been such a long time since our split that I’m not even certain if I will be able to ask him the questions I have. He was such a powerful force in my life once upon a time that there was nothing or almost nothing, that I would not do for him. I feel confident in saying that, at one time, he felt the same way toward me.

In reality, there are several relationships I wish to either reconcile and move forward with or resolve and finally bring to a close.

Newly Graduated AND Employed Medical Assistant!

As of Monday, December 29th I am no longer a "Student" Medical Assistant -- I am a graduated AND gainfully employed Medical Assistant!

I am over-the-moon thrilled at continuing on at the same practice I completed my externship at. I became sad at the thought of not being able to stay there because I became attached to a number of amazing patients -- and they have become attached to me, too.

With the exception of the Office Manager (as far as I know anyway), I was the only other employee with the knowledge that there was a good possibility I would be asked to join the practice after my externship was over. I didn't even tell the patients I was working with. Even after they expressed their disappointment if I became employed elsewhere. That was tough to do, too!

Today I performed a wound care on a delightful 80-something year old woman. In the short span of three days, approximately two weeks ago, she was involved in an automobile accident (she was driving, totaled her van and received a black eye and a cut on her eyebrow) then she slipped and fell in her kitchen and scraped up both of her shins in ways you cannot begin to imagine.

I assisted the physician in removing both of her leg bandages to confirm everything was healing properly and that there was no infection present. Thanks to daily home health care, they are healing beautifully and there is currently no sign of infection.

She also scraped up one of her wrists but I cannot remember if that was from the auto accident or the slip and fall.

Today I learned another venipuncture technique -- drawing blood from a patient's foot. This patient was a retired LPN and when I entered the exam room to draw her blood she let me know right away that she was a difficult draw. She was NOT exaggerating! Her veins teeny tiny AND could not be palpated at least locate even if we could not see them.

I hear that a lot from patients -- "I'm a difficult draw". I instantly think, inside my head of course, "I LOVE a challenge"! Nine times out of ten (in my head, of course!) I prove the patient wrong. Several times I have been either the ONLY MA in our office, or the only OTHER MA in our office do a successful draw in ONE poke.

I almost exclusively use a "butterfly" needle when drawing blood. Mostly because the needle is smaller in diameter, shorter in length and easier to manipulate if a vein "rolls" and I need to reposition it within the patient's arm.

I like the "butterfly" needle so much so that I tell my patients it's my "Magic" needle. I try to time the delivery of that information to occur just before I insert the needle into the patient's arm. As the patient ponders on how a needle could possibly be "Magic", I'm in and out of their vein.

Almost every single time I use my "Magic" needle the first thing the patient says when I've removed the needle from their arm is "That didn't hurt a bit!" I flash them a cheesy, dimpled smile and tell them "That's my "Magic" needle!"

The "Magic" needle is not the only distraction technique I employ when drawing blood. Because the "butterfly" needle is so low-profile, I come in low on the vein. Other MAs come in high on the vein.

Here's the difference.

Coming in Low: Holding the "butterfly" between my thumb and first finger, I make sure that the rest of the hand (palm and three fingers) I'm holding the needle in is lightly resting on the patient's arm. Although I do this to steady my hand, I have found it is also a simple distraction for the patient. Because I have positioned the needle to be as close to parallel as possible to the arm, I allow my thumb and finger to softly drag across the patient's skin as I head for the vein. Instead of concentrating solely on the "poke" to come, they feel the warmth of my hand and the slight pressure of my fingers on their arm while they're pondering how a needle can be "Magic". :-)

Coming in High: I saw this a lot in school. It's not an "incorrect" way by any means, it is just my personal opinion that it is much more painful for the patient. Instead of resting your hands and fingers on the patient's arm, typically only the pinkie finger of the hand holding the "butterfly" makes contact with the patient's skin. The needle is typically positioned at a 20 to 30 degree angle.

Externship - Week 7

Week 7 of my externship flew by!

Tomorrow is the last day of my externship and today the Office Manager pulled me into her office and offered me a permanent position! She was highly complimentary of my professionalism and abilities as a Medical Assistant. She also shared with me the feedback she received from the physicians and patients and it appears I made quite an impression on everyone in the office. Boy did hearing all that feel GOOD!

A few weeks ago I had a slight problem with one of the other MAs. I was in the hallway with a patient when the other MA behaved in a very unprofessional manner toward me -- and in front of the patient. Her comments were out-of-line in general, but she definitely should not have shared them with me in front of a patient.

I stewed for a little while about the incident with the other MA and finally decided to handle it properly -- the professional way.

When I noticed the other MA had finished with her patient and was alone in one of the exam rooms, I asked her if she had a minute to talk and she said yes. I stepped into the exam room, closed the door behind me and in a business-like tone of voice I let her know that she was not only completely out of line, she should never have approached me to discuss anything like that in front of a patient.

That MA met with the Office Manager to let her know of the exchange between us and not only was the office manager completely impressed with the way I handled it, she totally agreed with what I said. Much to the dismay of that MA.

During Week 7 I assisted a different MA with an ear irrigation on a patient with impacted wax. I was not yet ready to perform this procedure on my own -- and this would only have been the second time I have observed -- so I offered to assist instead. It's not that I am not confident that I can perform this procedure, I am just a tiny bit hesitant because it takes very little to puncture an eardrum.

Our patient was a very sweet and funny, average height, but very thin, elderly woman. The MA and I took turns looking into the patient's ear with the scope trying to determine the severity of the situation. Absolutely none of those peeks prepared us for what we finally extracted from her ear.

For starters, the patient had very tiny ear canals -- similar to those of a young child -- which means it took quite a bit more water than usual.

The apparatus we use to squirt water into the patient's ear reminds me of a metal cookie press with a (icing) decorating tip on the end. We also use an emesis basin (a small, odd-shaped bowl you find in hospitals) to catch the water as it drains from the ear.

We draw warm water into the tube, gently insert the tip and, pointing the tip toward the top of the ear canal, begin squirting water into the ear. (Pointing the tip straight into the ear canal can severely damage the eardrum.)

We were able to dislodge small particles of wax and I think we were just finishing our third tube of water when the other MA stopped to draw the fourth. As the patient raised her hand to her ear, the other MA noticed a large object sitting right at the opening of the patient's ear canal and prevented her from touching it.

The MA picked up a tool from the counter to scoop the object out of the patient's ear. Instead of successfully scooping it from the patient's ear it flopped out onto the floor near the MAs feet. By this time the three of us are giggling like crazy, the patient is thrilled she can hear again and the MA scoops the object off the floor and onto a paper towel.

Although my husband may disagree with me, I really do have a pretty strong stomach. (Baby, does last Christmas mean anything to you?) The combination of a hot, stuffy, small exam room, the marble-size, multicolored object on the paper towel, and the smell emanating from it, I quietly excused myself from the room.

The very important thing to remember is this: I did NOT vomit! I was gagging at the base of my throat, but I did NOT vomit!

After taking a few deep breaths and running cold water across my wrists, I returned to the exam room and assisted the other MA with finishing up.

Externship - Week 6

Well, my externship period is quickly winding down. Although most students complete theirs within the six-week time frame, mine will take a tad bit longer to log 180 hours because I am only working approximately 30 hours per week.

Today was an interesting day in the office. Not only were we wall-to-wall with patients to be seen but the incoming phone calls to our area were completely whacked! The volume of phone calls and voicemails were so high that it took one MA almost completely out of patient care to keep them under somewhat control.

My favorite elderly patient (the one who made me realize the inevitable) came in to the office today to be hooked up to a 24-hour Holter monitor. She, and her husband, are two of the sweetest people I know and I always enjoy working with them.

I was blessed to work with a new patient (new to me) today, too. After pulling her lab requisition from the pocket on the wall outside her exam room door, I knocked on the door, then poked my head in to introduce myself and tell her I would be back in just a few minutes to draw blood from her.

She had the saddest eyes I have seen in a long time and I knew it wouldn't take much for the tears collecting on her lower lid to spill over onto her cheeks.

After collecting my equipment and paperwork I returned to her room and sat down on the chair across from her. As I organized the tubes, needle, cotton balls and such, I made small talk with her.

Finally our eyes just kind of locked on each other and very quietly I said to her "You look so sad today..." As she reached for a tissue in her pocket to stop the avalanche of tears, I leaned over to her and wrapped my arms around her shoulders. After a few minutes she was able to tell me the reason for her sadness.

Her husband of 63 years fell recently and broke his hip and was in a nursing home. Because she had had one of her own hips replaced in 2004, she was no longer able to drive and had become reliant upon one of her daughters, who lives nearby, to take her to see her husband. She indicated today that the nursing facility her husband is in would be weaning him off of the trach tube soon.

As if that weren't quite enough stress for this beautiful lady, she is also trying to understand Medicare and the mumbo-jumbo that constitutes their "policy".

So, we just sat there together for several minutes. She poured her heart out and I listened.

I did get around to the blood draw eventually, but at that particular moment in time, drawing blood was not nearly as important to me as it was for me to listen and to be human and compassionate to a very beautiful woman with the sad eyes.

Externship - Week 5

Today was THE busiest day I have had so far on my externship. Bar none. Every chair in the waiting room had a person in it and more than a few times every exam room had a patient in it waiting for something -- the doctor, labs, x-Rays, or EKG's. It was nuts!

I performed a chest x-Ray by myself today and boy was that an awesome feeling. I also performed a knee x-Ray -- with a little assistance from another MA.

Today a very sad realization smacked me hard in the face.

I had the honor of taking a particular patient completely through her visit to our office. From calling her out of the waiting room, through intake and vital signs, EKG, and chest x-Ray.

After calling her name from the waiting room door, I watched her husband stand up and help her to her feet. Taking her hand, they slowly crossed the waiting room floor to where I stood and that's when I noticed how frail her face and hands were.

I could not see much else of her because her head was covered with a very festive red-colored cap and her body covered with a heavy winter coat. When she looked up at me and smiled I noticed she was wearing bright red lipstick and mascara, too. I let her take my hand with her free one and her husband and I led her down the hall to the scale.

I had already looked in her chart and made a mental note of her age (80-something), height (155 cm) and previous weight, something I do with every patient, and in the dictation notes from her last visit in September there was a very prominent note stating she had gained a whopping 9 pounds and, on that day, she tipped the scale at 98 pounds.

As her husband and I helped her out of her heavy coat and onto the scale, I was almost afraid to look to see how little she weighed. Hearing their excited voices about her having gained two ounces -- the scale showed 91.2 pounds -- I became a little confused. After hearing that she weighed 91 pounds in a different physician's office the week before I began celebrating with them.

Having settled the patient in the chair in the exam room I began asking her and her husband standard questions like "what brought you in today?".

She stated she was having difficulty breathing -- which was clearly visible to me -- and when I sat down near her to obtain her blood pressure and pulse, I could also hear a whistling sound as she breathed. The patient also stated that she was having very terrible dreams and that they were waking her up at night. She stated that they felt very real to her and that they scare her badly. (This information was noted in her chart.)

When I finished with the interview I let them know that the doctor would be in shortly to see them.

A short while later I was making my normal rounds and checking the chart holders on each of the rooms to see if any lab work needed to be done when I noticed a request in the chart holder for this patient.

I knocked softly on the door and poked my head in to let them know I would be back in a few minutes to do an EKG and a chest x-Ray on her. The patient was sitting up on the exam table and I let her know she was perfect where she was and gave her and her husband instructions on removing clothing and donning a paper gown.

A few minutes later I was back at her door and I listened for a moment before knocking to determine which state of dress she was in but I could not tell so I knocked softly on the door again and was asked to enter.

Her husband had given a valiant effort in trying to remove the sweatshirt his wife was wearing but it was clear he needed a little help. She had removed her festive hat and I noticed how very little hair she had because it was sticking up every which way.

Her long, thin arms were each tangled in their respective sleeves and it appeared they were having difficulty getting the shirt over her head, too. She looked up at me with her big, bright blue eyes and my heart melted into my shoes. Her husband explained to me that she had had a stroke a few years ago and around the same time was diagnosed with Parkinson Disease.

I took a moment to assess the situation then quickly began running solutions through my head on how best to accomplish this task without hurting her. My solution was to undress her as you would a newborn.

Laying the gown across her lap, I was able to untangle and free her arms from the sleeves of the sweatshirt. The neck on the sweatshirt, however, wasn't as forgiving. I helped her slip her arms into the gown before I began working the shirt over her head. As I was concentrating on not pulling her hair she giggled that she hadn't had a problem getting it over her head earlier in the day!

I continued talking to the patient and her husband as I input information into the EKG machine. While she was still sitting upright I placed the pads on her chest. After slowly reclining the table so she was laying down I placed a pillow under her head and began connecting the leads to the pads. Once the test was complete, the EKG printed, leads and pads removed it was off to x-Ray.

Two views later we were back in her exam room and I helped her dress again. After the doctor gave the "all clear" I helped her husband escort her back to the front desk to check out.

A little while later I was standing in the lab area when it hit me. One of "my" patients was going to die.

Not in the "everybody dies someday" way, but in the absolutely, without a doubt, too soon, kind of way.

Today I was blessed to have had this very beautiful woman and her husband cross my crazy-busy path today.

My heart is full.