It seems like forever ago that I was 9 year-old kid sitting in an orthopedic office listening to the doctor tell me that I would most likely need a hip replacement by the time I was 40 years old. My grandpa had had at least one, if not both of his hips replaced at that point, so I kind of had a general idea of what a hip replacement was. I wasn't scared, I wasn't worried...I think being that young and having a family member who had had the same thing done, and who had recovered really well, left me without a sense of dread or fear. My parents, not even in their 40's themselves when this statement was made, were probably worried. I guess I don't really know.
My hip deformity had been discovered at my 6-month check up when I was just a wee little thing. The nurse noticed while playing with me that one of my legs wasn't moving quite right. So they investigated. Turns out I had a very shallow, almost non-existent hip socket on one side. Nothing to go too crazy over...I was just put in a little leather harness that basically kept me in a sitting position for a few weeks...maybe a few months...I have no idea...that time of my life is beyond my memory. What I do know is that once out of the harness, I was just like any other kid...tearing around, getting into stuff, teething, talking, growing...you know, all the stuff that normal babies do. In truth, my hip deformity has never really slowed me down. It's been such a non-issue for most of my life that when I asked my parents which hip had the deformity, they can't remember. Neither can I, even though I can clearly see in my mind the Xray of my spindly little legs lit up in the doctor's office all those years ago. I'm leaning towards it being my left hip. Then again, it could be my right. I've got a 50-50 chance of guessing correctly.
So I'll be 37 this year. 3 years to that daunting 40-year mark, and 3 years until that predicted hip replacement. For the most part, I still have little to no issues with my hips. Every now and again the left will "lock up," as I like to call it, but a simple stretch and turning my foot inwards usually takes care of that. I don't know that saying it's "locked up" is a correct description of what's actually going on in there, but given a lack of an in-home MRI, it's the best I can do. Day to day, my hips are fine. I do notice them aching and sore after a long run, but a lot of people have sore hips after a long run, especially if they train as little and as sporadically as I do. I don't know what degree of soreness is normal, and what might be attributed to my hip deformity. After a run, my hips ache equally.
I sometimes wonder if running is going to expedite the process of my impending hip replacement, or if it's going to happen regardless of what I do in my active life. The doctor made it sound like I was going to need surgery no matter what, but then again, there was no possible way that he could have known that the 9 year-old girl sitting in front of him would be running up mountains in her 30's. I know that running is hard on a person's joints, any person's joints...doesn't matter if they're fat, thin, fit, muscular...whatever. I think the overall key to running is to listen to your body...it'll tell you if something is amiss, if you need to take a break, if maybe a certain activity just isn't working for you. So that's what I've been doing...listening to these hips, these knees, and these lungs as increase my running along the trails in my pretty little mountain town.
The other day I summitted our local Mount Elden here in Flagstaff for the third time in 2 weeks. The first time I biked (see previous blog), the second time I ran/walked with Simon, and the third time I hiked the entire 12 miles with my friend, Meghan. Today I ran between 7 and 8 miles on the local trails here in town. I don't know what's happening to me in regards to this whole running business, but I really really like it. I'm impressed thus far with how well my body has been tolerating not only the distances, but the elevation gains as well.
In my last post I wrote about how I was spurned into riding my bike up Mount Elden by the owner of Pizzicletta. Well, since riding up the mountain on a bike proved to be an almost epic failure, Simon and I decided to run it last Sunday. It was the same dirt road that we had pushed our bikes up a few days prior, only this time we had only our feet as our limiting factors. It was amazing how much easier it was without the bikes (duh...hahaha!). We weren't able to run the full six miles without walking a bit, and that was expected. I didn't beat myself up about it, although I was a little disappointed that I didn't run more of it. Simon (my cheerleader), had to remind me that prior to taking on this 12-mile run with it's 2000+ vertical climb, I had only run about 3 miles without stopping. So...the fact that I was running at all, and that I was running this particular course, was pretty impressive. So I decided to be impressed with myself. In hiking the entire thing with my friend Meghan, I realized that I worked just as hard as I had running/walking it (although I was slightly less out of breath, which I appreciated), and it only took us about 15 minutes longer than the previous time on foot. So...either Meghan and I are super fast hikers (we're pretty bomb), or Simon and I just took that much time to run it. Or...maybe on that steep of a course, given equal abilities, it's just not all that possible for me to run much faster than a brisk hike.
I am not a fast runner. I am not a competitive runner. I am not a runner who cares about my time, and I don't allow the time of anyone else running along with me to get me down. Although, truth be told, I am impressed by some of the times of the winners of the big races. Those are performances that I could never hope to obtain, and with good reason. Those people run like it's their job. For a lot of them, it is their job. Day in and day out...running. I don't have the body, the stamina, the motivation, or most importantly, the genetics to run the way the professionals do. And that's okay. I'm happy with just getting out and doing something that I wouldn't otherwise do. So it takes me a little longer because I'm unwilling to push myself to the point of failure.
In taking on the challenge of meeting the Pizzicletta folks at the top of the mountain, I just started earlier than the rest of them. I gave myself not only time enough to get to the top by 8:30 in the morning, but to also have time for a stretch break near the top. I don't like to be pressed for time...it gives me anxiety and makes me feel like a failure. If I have to leave my house at 6:30 in the morning to meet them at the top 2 hours later, so be it. So what if most of them do it in an hour or less...they are athletically different than me, and good for them. They are comfortable pushing the limits of their athletic abilities, I am not. But...we all run/hike/bike the same path and get to the top at the same time, where we take a group photo, congratulate each other on a job well done, and head back on down the mountain to begin our days. We are together, but not the same. It's amazing, and it's been such a good motivation for me to increase my running goals.
In just over a couple weeks, Simon and I will be running the half-marathon portion of the Grandma's Marathon in Duluth, MN. I'm stoked, and given the running that I've been doing in the past two weeks and my running goals for the coming weeks (hello, altitude training!), this could be my best half-marathon yet. Or not. It might not be my best, but I'm going to run it and I'm going to finish and hopefully I won't be last and hopefully I won't poop myself...it's good to have goals, am I right? After Grandma's I have the remainder of the Run Flagstaff Summer Series road races, which take place in and around Flagstaff...I'll be able to make it to 4 of the 6 total races. Then at the end of August I have a 10K at the North Rim of the Grand Canyon...the race itself is at over 8,000 feet of elevation, so that one will most likely be a struggle for me, but I'm excited for it. And then...the big one...I'm hoping to register for the Imogene Pass Run this year. 17 miles up and over the Imogene Pass between Ouray and Telluride, Colorado. Without a doubt, this would be the most challenging foot race to date for me, and quite possibly, the most challenging foot race that I'll ever attempt. But I'm going to do it. Assuming I get in, as registration usually sells out in under an hour. My alarm is already set for 4:45am this coming Wednesday...and then a celebratory run afterwards...hahaha! I've already got a crew of people willing to run it with me, which is awesome. It'll be tough, it'll be long, but it'll be amazing. After Imogene there will be a Beat the Blerch race in Vegas in October (still haven't decided on a distance...either the 10K or the half), and the Key West Half Marathon in January of 2017, which I'm also looking forward to...it'll be so pretty.
So there it is...I think I'll be running more this year than all my previous years. Which is funny, seeing as after the last half-marathon I did I made the comment that I need to stop running half marathons...hahaha! As of right now, there are no marathons in my future. People always tell me that I'm going to cave and sign up for a marathon, but I don't see that happening. The half-marathon distance, which is 13.1 miles, is perfect for me. I don't have to be as vigilant with the training, and I know for a fact that a full marathon would wreak havoc on my body in ways that the half-marathon never could. Given all the cool places that they have half-marathons throughout the world, I think I'll have enough races to keep me busy for the next few years. I just found out recently the US National Parks have their own set of half-marathons, which would be the perfect way for me to knock out some of the Parks in my quest to see them all. What better way to see our nation's prettiest places than to run through them? :)
As always, I'm looking for people to run with. Know that I do not run fast, and that I take little walk breaks to allow my lungs to recover a bit. Overall, and despite the walking, I'm told that I'm able to maintain about a 6 mile/hour pace (I don't keep track, remember?), which I'm more than happy with, but might be too slow for more serious, competitive types. If we cannot have a conversation while running, we are running entirely too fast...hahaha! So there's that.
I wish you all a fantastic Memorial Day weekend...remember all our friends, family, coworkers, classmates, and strangers on the street who have served in our military and have done what most us couldn't or wouldn't do. They deserve our utmost respect, on Memorial Day and everyday! Be safe out there!
Sunday, May 29, 2016
Thursday, May 19, 2016
Pride and Crankjoy
About a week or so ago I saw a post on my Instagram feed from one of the local pizzeria owners here in Flagstaff. His name is Caleb, and he owns Pizzicletta, which in my opinion, is probably the best pizza place here in Flagstaff. It's woodfired pizza in a custom built oven, and it is so incredibly good. The ingredients are fresh and locally sourced when possible, and I believe the meats are cured in-house. And the gelato...oh my goodness, the gelato. The best I've ever had. I can't even describe in words how good this place is. Pizzicletta is on our short list of places to take guests when they come into town...provided their idea of pizza is more adventurous than the meat lover's at Pizza Hut. Working right along next to everyone in the kitchen is Caleb. He's been there every time I've been there. For all the good things I can say about the restaurant, I could probably double that about Caleb. Granted, I barely know the guy, but I've interacted with him a few times here in Flagstaff, and I think you would have a time finding a more engaging, genuinely nice person. He makes you feel welcome in his restaurant, and come to find out, in the great outdoors as well.
In celebration of the Giro D'Italia, which is a 21 day bike race in Italy, Caleb has been running up Elden Lookout road in Flagstaff every morning since the bike race started. Today is day 12. He has publicly invited anyone who wants to join, and has a crew of four people who have thus far joined him every morning to hike, bike, or run up the mountain. The best part? A free pizza just for making the trip.
Elden is no joke. The summit is 2,000 above Flagstaff, which sits at a thin-aired 7,000 feet above sea level. Living at this elevation is difficult enough at times; exercising at this elevation will make even the fittest flat-landers feel like they've never exercised at all. I've been living here for almost 4 years now and I still get out of breath with light-moderate exercise. I keep wondering if I'll ever acclimate. Due to the elevation and the moderate climate, Flagstaff is a big draw for professional athletes, particularly runners. It's not all that unusual while out on the trails or at the local coffee shop to rub elbows with Olympic hopefuls and runners sponsored by athletic companies. It's actually really cool. Although seeing them on the trails barely breaking a sweat and having an entire conversation without missing a breath makes runners like me look like we're running underwater. It's inspiring for sure, and also very humbling.
So yesterday I told Simon that I want to try to bike up Elden to meet up with Caleb and his crew. They get up early in the morning and meet at the top at 8:30am. It's about 5-6 miles uphill from the parking lot at the base of mountain. Simon was a little skeptical, given that he's ridden up Elden Lookout Road on his motorcycle and had an idea of how steep it was. Having never been up the road myself, I had no idea what I was getting into, but I thought to myself...it's only 5 miles...I can bike anywhere for 5 miles. Ha! Was I in for a surprise.
To set the stage, I ride a single-speed mountain bike. In the world of mountain biking, this is not the most advisable set-up, nor is it all that common. Given that I don't ride the burliest trails in the world, I found little use for all the gears that come on a traditional mountain bike. I switched to a single speed a few years ago after realizing when I was out on the trails on my bike, I rarely, if ever, switched gears. Having had a fixed-gear road bike for several years, I decided that I wanted to get a single-speed mountain bike as well. So I found a beautiful single-speed Gary Fisher (now absorbed by Trek) with 29-inch wheels on Craigslist a couple years ago, and I'm so in love with it. The bike fits me perfectly, it rides like a dream and it's geared pretty decently to my activity level. At least I thought it was before trying to summit Elden. I should probably also mention that I haven't ridden my bike since last fall, and the fact that I chose this particular ride as my first of the season was probably overly ambitious.
Elden Lookout was a struggle. I made it about halfway up the mountain before realizing that there is a very good reason that people ride bikes with gears, and that reason was staring me straight in the face in the form of a gravel road with a grade angle that was challenging even for a person on foot. Trust me, I spent plenty of time on foot this morning pushing my bike up those switchbacks...it's steep.
I had two goals in mind for this morning...to make it to the top, and to beat Caleb, who I referred to as "The Pizza Guy." Caleb runs up Elden, and he started a full half-hour behind Simon and I. On our way up, we were passed by 2 mountain bikers, but otherwise didn't see another soul. As we were getting near to the top, I thought for sure we would beat the pizza guy up there. And then I heard voices behind me. And suddenly there he was, keeping pace with a biker and having a full-on conversation like he was leisurely walking on flat ground. I was walking my bike at the time, laboriously mouth-breathing, and he passed me like I was standing still. He gave me a quick shout of encouragement and disappeared around a curve in the road, still chatting away to his biking companion. And that's how it is here...the athletes are just on a whole 'nother level. As we were nearing the top, Caleb was coming back down the hill. He explained that he was running back to look for someone else who was on their way up. So not only did he run all the way up, he was running back a ways to find the missing person and then was going to run back to the top to join us there for a photo. It was mind-boggling. I told Simon that we had to get to the top before he got back there for the second time...hahaha! We did accomplish this, but not by much.
We were greeted at the top by the two mountain bikers who had passed us, and a gal who had hiked up the other side of the mountain on the Elden Lookout Trail. The other bikers thought we were insane for trying to ride up the road on single speeds, and truth be told, I think they were a little surprised that we had made it at all. They complimented me on my gear ratio (which I know nothing about), even going so far as to call it 'burly.' Which is kind of funny, given that when they had each passed me, I was walking the bike...hahaha! No matter...I did it, they did it, we did it. Getting to the top is the goal, and no one really cared how we got there, just that we came out and shared that moment with them. We spend a very short time at the top talking and looking around. It was such a clear morning that the guys were convinced that we could see the north rim of Grand Canyon from there. Maybe we could...my geography is relatively poor when it comes to this area, but I definitely was able to see a canyon of some sort. Way, far away.
Throughout all this...the slog to the top, the cramping quads, the burning lungs...I kept going. Mostly due in part to Simon, who is my ever present cheerleader. He kept me going by telling me that there were level spots ahead (there weren't), and by telling me that I was in Beast Mode. I told him I felt like I was in chipmunk mode, and he explained that technically, a chipmunk is still a beast. I commented back that if that's the case, then our lazy pug back home who was undoubtedly taking his 3rd nap of the morning was also a beast...hahaha! I wanted to quit at the halfway point, convinced that there was no way that I was going to be able to get back on the bike at any point from there on up, and the thought of pushing my bike up a mountain for 3+ miles was incredibly unappealing. He encouraged me to keep going, and we rode our bikes on the flatter parts (flat, meaning that it was a gradual incline rather than a steep grade). We walked when I petered out, then rode again for short distances. And somehow, we made it. Granted, we were a little later than the designated time of 8:30, but we still made it, and even though I had to walk some of the way, I had accomplished something. How many other people can say that they summited a mountain this morning before 9am? Well, the 4 people who got there before we did, of course...hahaha!
So now that I've ridden bike up Elden Lookout Road, I've convinced myself that on Sunday I'm going to run up it. And by run, I mean run a little bit, walk a little bit....until I get to the top. It's four-ish miles from where the gravel starts, and again, will be straight uphill. We're going to give ourselves just shy of 2 hours to run it to the top...it'll probably be at least an hour back down. It's weird to be so ambitious about these outdoor activities lately. It feels good, and rather than be too upset about what my body can't do, I have to remind myself to be impressed by what it can do. I was talking to Simon earlier about how I don't want my fitness to be defined by how much time I spend in the gym, how much weight I can lift, how many classes a week I take. I want my fitness to be defined by what I can do, where I can do it, and how well I can tolerate it. So that's my goal. To get outside and do something...and most of all, to have fun doing it! See you on the trails!
In celebration of the Giro D'Italia, which is a 21 day bike race in Italy, Caleb has been running up Elden Lookout road in Flagstaff every morning since the bike race started. Today is day 12. He has publicly invited anyone who wants to join, and has a crew of four people who have thus far joined him every morning to hike, bike, or run up the mountain. The best part? A free pizza just for making the trip.
Elden is no joke. The summit is 2,000 above Flagstaff, which sits at a thin-aired 7,000 feet above sea level. Living at this elevation is difficult enough at times; exercising at this elevation will make even the fittest flat-landers feel like they've never exercised at all. I've been living here for almost 4 years now and I still get out of breath with light-moderate exercise. I keep wondering if I'll ever acclimate. Due to the elevation and the moderate climate, Flagstaff is a big draw for professional athletes, particularly runners. It's not all that unusual while out on the trails or at the local coffee shop to rub elbows with Olympic hopefuls and runners sponsored by athletic companies. It's actually really cool. Although seeing them on the trails barely breaking a sweat and having an entire conversation without missing a breath makes runners like me look like we're running underwater. It's inspiring for sure, and also very humbling.
So yesterday I told Simon that I want to try to bike up Elden to meet up with Caleb and his crew. They get up early in the morning and meet at the top at 8:30am. It's about 5-6 miles uphill from the parking lot at the base of mountain. Simon was a little skeptical, given that he's ridden up Elden Lookout Road on his motorcycle and had an idea of how steep it was. Having never been up the road myself, I had no idea what I was getting into, but I thought to myself...it's only 5 miles...I can bike anywhere for 5 miles. Ha! Was I in for a surprise.
To set the stage, I ride a single-speed mountain bike. In the world of mountain biking, this is not the most advisable set-up, nor is it all that common. Given that I don't ride the burliest trails in the world, I found little use for all the gears that come on a traditional mountain bike. I switched to a single speed a few years ago after realizing when I was out on the trails on my bike, I rarely, if ever, switched gears. Having had a fixed-gear road bike for several years, I decided that I wanted to get a single-speed mountain bike as well. So I found a beautiful single-speed Gary Fisher (now absorbed by Trek) with 29-inch wheels on Craigslist a couple years ago, and I'm so in love with it. The bike fits me perfectly, it rides like a dream and it's geared pretty decently to my activity level. At least I thought it was before trying to summit Elden. I should probably also mention that I haven't ridden my bike since last fall, and the fact that I chose this particular ride as my first of the season was probably overly ambitious.
Elden Lookout was a struggle. I made it about halfway up the mountain before realizing that there is a very good reason that people ride bikes with gears, and that reason was staring me straight in the face in the form of a gravel road with a grade angle that was challenging even for a person on foot. Trust me, I spent plenty of time on foot this morning pushing my bike up those switchbacks...it's steep.
I had two goals in mind for this morning...to make it to the top, and to beat Caleb, who I referred to as "The Pizza Guy." Caleb runs up Elden, and he started a full half-hour behind Simon and I. On our way up, we were passed by 2 mountain bikers, but otherwise didn't see another soul. As we were getting near to the top, I thought for sure we would beat the pizza guy up there. And then I heard voices behind me. And suddenly there he was, keeping pace with a biker and having a full-on conversation like he was leisurely walking on flat ground. I was walking my bike at the time, laboriously mouth-breathing, and he passed me like I was standing still. He gave me a quick shout of encouragement and disappeared around a curve in the road, still chatting away to his biking companion. And that's how it is here...the athletes are just on a whole 'nother level. As we were nearing the top, Caleb was coming back down the hill. He explained that he was running back to look for someone else who was on their way up. So not only did he run all the way up, he was running back a ways to find the missing person and then was going to run back to the top to join us there for a photo. It was mind-boggling. I told Simon that we had to get to the top before he got back there for the second time...hahaha! We did accomplish this, but not by much.
We were greeted at the top by the two mountain bikers who had passed us, and a gal who had hiked up the other side of the mountain on the Elden Lookout Trail. The other bikers thought we were insane for trying to ride up the road on single speeds, and truth be told, I think they were a little surprised that we had made it at all. They complimented me on my gear ratio (which I know nothing about), even going so far as to call it 'burly.' Which is kind of funny, given that when they had each passed me, I was walking the bike...hahaha! No matter...I did it, they did it, we did it. Getting to the top is the goal, and no one really cared how we got there, just that we came out and shared that moment with them. We spend a very short time at the top talking and looking around. It was such a clear morning that the guys were convinced that we could see the north rim of Grand Canyon from there. Maybe we could...my geography is relatively poor when it comes to this area, but I definitely was able to see a canyon of some sort. Way, far away.
Throughout all this...the slog to the top, the cramping quads, the burning lungs...I kept going. Mostly due in part to Simon, who is my ever present cheerleader. He kept me going by telling me that there were level spots ahead (there weren't), and by telling me that I was in Beast Mode. I told him I felt like I was in chipmunk mode, and he explained that technically, a chipmunk is still a beast. I commented back that if that's the case, then our lazy pug back home who was undoubtedly taking his 3rd nap of the morning was also a beast...hahaha! I wanted to quit at the halfway point, convinced that there was no way that I was going to be able to get back on the bike at any point from there on up, and the thought of pushing my bike up a mountain for 3+ miles was incredibly unappealing. He encouraged me to keep going, and we rode our bikes on the flatter parts (flat, meaning that it was a gradual incline rather than a steep grade). We walked when I petered out, then rode again for short distances. And somehow, we made it. Granted, we were a little later than the designated time of 8:30, but we still made it, and even though I had to walk some of the way, I had accomplished something. How many other people can say that they summited a mountain this morning before 9am? Well, the 4 people who got there before we did, of course...hahaha!
So now that I've ridden bike up Elden Lookout Road, I've convinced myself that on Sunday I'm going to run up it. And by run, I mean run a little bit, walk a little bit....until I get to the top. It's four-ish miles from where the gravel starts, and again, will be straight uphill. We're going to give ourselves just shy of 2 hours to run it to the top...it'll probably be at least an hour back down. It's weird to be so ambitious about these outdoor activities lately. It feels good, and rather than be too upset about what my body can't do, I have to remind myself to be impressed by what it can do. I was talking to Simon earlier about how I don't want my fitness to be defined by how much time I spend in the gym, how much weight I can lift, how many classes a week I take. I want my fitness to be defined by what I can do, where I can do it, and how well I can tolerate it. So that's my goal. To get outside and do something...and most of all, to have fun doing it! See you on the trails!
Saturday, May 7, 2016
The Period Blog: Epilogue
Just when you thought the period posts were finished, here I come with another one. Since there's nothing following an epilogue other than a sequel, I guess we're at the end of the road. I just wanted to check in with some updates, as several of you gals and even a few of you guys were somewhat curious about all this period stuff and what some of us women go through on a monthly basis. Is it time for menopause yet? Sheesh...
Okay, so I last left you after having deciding that I was going to get a uterine ablation, which, to recap, is the procedure in which the uterine lining is permanently damaged causing scar tissue to form, thereby making it nearly impossible for a fertilized egg to attach, and resulting in decreased or non-existent periods. I found a doctor here in town who came highly recommended not just by women who had had procedures done by him, but by nurses who worked in the operating room alongside him. There is no better recommendation of a doctor, in my opinion, than by the nurses who work for him or her.
I had it in my head prior to meeting this doctor that I was set on ablation. What I appreciated the very most about him, is that he took the time to sit with me and to talk to me about all the options out there. Birth control medications, IUD, Ablation, Hysterectomy...all those options were on the table and we sat and discussed all of them in depth. Oddly enough, it turns out, all four of those options carry significant risks, and the odds of the risks really don't change from method to method, but the risks are very different depending on which method you choose. I hadn't thought much about that prior to making my appointment, and I was really glad that he took the time to go over all of that with me. So we made an appointment for me to get an ultrasound, as anatomical variances will outright eliminate certain options. More specifically, the IUD or the ablation.
So I got the ultrasound. Not going to go too in depth about that whole procedure, but I'll just tell you, the wand they use looks like a big white dildo. Turns out, I have a heart shaped uterus, known as a bicornuate uterus to those of you in the medical field. Cute right? A uterus shaped like a heart? Not so much. Basically what that means is, I have almost (but not quite) two uteruses...uterii...whatever the heck you call more than one uterus. So the uterus is normal at the bottom, and rather than opening up into one larger reservoir, it branches off into two separate reservoirs. I still only have 2 ovaries though. In humans, this is considered a malformation. However, if I were a rodent or a pig, this would be completely normal. Unfortunately, I am neither a rodent nor a pig...although sometimes I feel as though I take on their behaviors depending on my current mood (lying in my own filth, hoarding...things of that nature). So what does this mean for me? A few things, actually. It's very likely a significant cause of my very heavy, somewhat irregular, devastatingly crampy periods...so I'm not just being a whiny wimp. ;)
Having a bicornuate uterus is actually quite rare, occurring in 0.1-0.5% of women. A bicornuate uterus could very well be the reason I've never had a pregnancy scare, as women with this type of malformation tend to have a lot of trouble getting pregnant, depending on the severity of the malformation, of course. Women with bicornuate uteruses (uterii) also tend to also have a higher incidence of recurrent pregnancy loss, spontaneous abortion within the first 3 months, birth defects, preterm labor, and breech births...all of which are undesirable in regards to pregnancy...breech birth being the least undesirable in that list, as most of the time, breech babies are just healthy babies who happen to be oriented in the wrong direction for vaginal birth. Most if not all pregnancies in women with a bicornuate uterus are considered high-risk. There are procedures that can be done to correct a bicornuate uterus to make it a more hospitable environment for a developing fetus, and from what I've read, those procedures have been very successful. But that's not of interest to me. At all.
It could almost be assumed that I was never intended to have children in the first place. There's a weird sort of peace that comes along with this diagnosis. If having children was something that I had really wanted, it would have most likely been a very long, very difficult, very stressful process for me to conceive and to deliver a full-term healthy baby. Honestly, knowing this about my body makes me feel better about the choice I've made to not have children. All this time I've felt that I was throwing my lack of desire to conceive into the faces of those women who simply couldn't...turns out I'm most likely one of those women who can't easily conceive, and all that feeling bad was most likely for nothing. Not that there was any reason to feel bad in the first place, but it was hard for me to watch my friends and family struggle with getting pregnant while I sat there all viable and with no desire to have children at all. Turns out I'm not as viable as I thought. Sigh of relief, actually.
So what does that mean for my birth control and period options? Well, the bicornuate uterus causes a lot of problems in that area as well. An IUD is basically out, as it won't sit properly in my uterus and would most likely be pushed out. The uterus in general is pretty sensitive, and doesn't take well to having things in there that don't belong, particularly if that thing is ill-fitting. My doctor said that we could give it a shot just for curiosity's sake, but he's not confident that it would be successful. If he's not confident, I'm not confident, and given that I'm the one paying for this service, I'm not about to embark on something just for curiosity's sake. Hysterectomy is out, and truth be told, wasn't ever really in, as that's kind of a last-ditch effort when all other methods have failed. Birth control medication is out...not having anything to do with the shape of the uterus and everything to do with the fact that I didn't tolerate the hormones when I was on them in my 20's; there seems no reason to think I'll tolerate them any better now. The ablation procedure is still on the table, although my anatomy would pose difficulties with that as well. During the ablation procedure, a little device is inserted into the uterus that heats up and basically scalds (cauterizes) the lining of the uterus. Typically, the device does all the work...in a normal shaped uterus. My doctor explained to me that this device likely wouldn't be successful for me, and that he would have to go in manually and scrape away the lining of my uterus with one tool, and cauterize with another. Sounds a bit like peeling and then burning a carrot. It also sounds complicated and rather miserable, and carries with it a little higher risks than the aforementioned ablation device. Also, given that I'm under the age of 40, there's a 20% chance that my uterus will just heal itself, and my only option after that would be the hysterectomy. He was completely confident and has done this particular ablation procedure before on women with malformations just like mine, so I trust his judgement and his abilities. But...I'm hesitating.
I hesitate because I'm a nurse and I know that a procedure, any procedure, carries with it some significant risks. I would have to be put under general anesthesia for this procedure, meaning that I would be completely knocked out, breathing tube in, the whole 9 yards. I know that surgery in healthy people has less risks associated with it than less healthy people, but the risks are still there. Over the years I've kind of adopted the idea that if you don't need surgery to save your life, then maybe it's best not to do it at all. It's silly, I know, but there's a part of me that's terrified of having significant negative outcomes in the interest of an elective procedure. Are my periods really that bad to outweigh the risks of an elective surgical procedure?
So here I sit. Doing nothing about my periods other than what I was doing before. It wasn't a total loss though...I found some great natural period products and I learned a lot about my own body. It's weird to feel so good about knowing that the process of having a child would be difficult for me. I don't know why that makes me feel better, but it's almost as if now I have a physical reason to back up my choice to not have children. As if choosing to not have children was never a good enough excuse to those who don't understand or can't empathize. So now I can say, "My uterus is weird! That's why I'm not having children!" That's as good a reason as any, right?
So there it is...the final chapter (for real!) on this whole period thing. Can't wait for the menopause blogs, right?? Thanks so much to all who have supported me along the way and have asked questions and given advice. It was all very welcome and very helpful. :)
Okay, so I last left you after having deciding that I was going to get a uterine ablation, which, to recap, is the procedure in which the uterine lining is permanently damaged causing scar tissue to form, thereby making it nearly impossible for a fertilized egg to attach, and resulting in decreased or non-existent periods. I found a doctor here in town who came highly recommended not just by women who had had procedures done by him, but by nurses who worked in the operating room alongside him. There is no better recommendation of a doctor, in my opinion, than by the nurses who work for him or her.
I had it in my head prior to meeting this doctor that I was set on ablation. What I appreciated the very most about him, is that he took the time to sit with me and to talk to me about all the options out there. Birth control medications, IUD, Ablation, Hysterectomy...all those options were on the table and we sat and discussed all of them in depth. Oddly enough, it turns out, all four of those options carry significant risks, and the odds of the risks really don't change from method to method, but the risks are very different depending on which method you choose. I hadn't thought much about that prior to making my appointment, and I was really glad that he took the time to go over all of that with me. So we made an appointment for me to get an ultrasound, as anatomical variances will outright eliminate certain options. More specifically, the IUD or the ablation.
So I got the ultrasound. Not going to go too in depth about that whole procedure, but I'll just tell you, the wand they use looks like a big white dildo. Turns out, I have a heart shaped uterus, known as a bicornuate uterus to those of you in the medical field. Cute right? A uterus shaped like a heart? Not so much. Basically what that means is, I have almost (but not quite) two uteruses...uterii...whatever the heck you call more than one uterus. So the uterus is normal at the bottom, and rather than opening up into one larger reservoir, it branches off into two separate reservoirs. I still only have 2 ovaries though. In humans, this is considered a malformation. However, if I were a rodent or a pig, this would be completely normal. Unfortunately, I am neither a rodent nor a pig...although sometimes I feel as though I take on their behaviors depending on my current mood (lying in my own filth, hoarding...things of that nature). So what does this mean for me? A few things, actually. It's very likely a significant cause of my very heavy, somewhat irregular, devastatingly crampy periods...so I'm not just being a whiny wimp. ;)
Having a bicornuate uterus is actually quite rare, occurring in 0.1-0.5% of women. A bicornuate uterus could very well be the reason I've never had a pregnancy scare, as women with this type of malformation tend to have a lot of trouble getting pregnant, depending on the severity of the malformation, of course. Women with bicornuate uteruses (uterii) also tend to also have a higher incidence of recurrent pregnancy loss, spontaneous abortion within the first 3 months, birth defects, preterm labor, and breech births...all of which are undesirable in regards to pregnancy...breech birth being the least undesirable in that list, as most of the time, breech babies are just healthy babies who happen to be oriented in the wrong direction for vaginal birth. Most if not all pregnancies in women with a bicornuate uterus are considered high-risk. There are procedures that can be done to correct a bicornuate uterus to make it a more hospitable environment for a developing fetus, and from what I've read, those procedures have been very successful. But that's not of interest to me. At all.
It could almost be assumed that I was never intended to have children in the first place. There's a weird sort of peace that comes along with this diagnosis. If having children was something that I had really wanted, it would have most likely been a very long, very difficult, very stressful process for me to conceive and to deliver a full-term healthy baby. Honestly, knowing this about my body makes me feel better about the choice I've made to not have children. All this time I've felt that I was throwing my lack of desire to conceive into the faces of those women who simply couldn't...turns out I'm most likely one of those women who can't easily conceive, and all that feeling bad was most likely for nothing. Not that there was any reason to feel bad in the first place, but it was hard for me to watch my friends and family struggle with getting pregnant while I sat there all viable and with no desire to have children at all. Turns out I'm not as viable as I thought. Sigh of relief, actually.
So what does that mean for my birth control and period options? Well, the bicornuate uterus causes a lot of problems in that area as well. An IUD is basically out, as it won't sit properly in my uterus and would most likely be pushed out. The uterus in general is pretty sensitive, and doesn't take well to having things in there that don't belong, particularly if that thing is ill-fitting. My doctor said that we could give it a shot just for curiosity's sake, but he's not confident that it would be successful. If he's not confident, I'm not confident, and given that I'm the one paying for this service, I'm not about to embark on something just for curiosity's sake. Hysterectomy is out, and truth be told, wasn't ever really in, as that's kind of a last-ditch effort when all other methods have failed. Birth control medication is out...not having anything to do with the shape of the uterus and everything to do with the fact that I didn't tolerate the hormones when I was on them in my 20's; there seems no reason to think I'll tolerate them any better now. The ablation procedure is still on the table, although my anatomy would pose difficulties with that as well. During the ablation procedure, a little device is inserted into the uterus that heats up and basically scalds (cauterizes) the lining of the uterus. Typically, the device does all the work...in a normal shaped uterus. My doctor explained to me that this device likely wouldn't be successful for me, and that he would have to go in manually and scrape away the lining of my uterus with one tool, and cauterize with another. Sounds a bit like peeling and then burning a carrot. It also sounds complicated and rather miserable, and carries with it a little higher risks than the aforementioned ablation device. Also, given that I'm under the age of 40, there's a 20% chance that my uterus will just heal itself, and my only option after that would be the hysterectomy. He was completely confident and has done this particular ablation procedure before on women with malformations just like mine, so I trust his judgement and his abilities. But...I'm hesitating.
I hesitate because I'm a nurse and I know that a procedure, any procedure, carries with it some significant risks. I would have to be put under general anesthesia for this procedure, meaning that I would be completely knocked out, breathing tube in, the whole 9 yards. I know that surgery in healthy people has less risks associated with it than less healthy people, but the risks are still there. Over the years I've kind of adopted the idea that if you don't need surgery to save your life, then maybe it's best not to do it at all. It's silly, I know, but there's a part of me that's terrified of having significant negative outcomes in the interest of an elective procedure. Are my periods really that bad to outweigh the risks of an elective surgical procedure?
So here I sit. Doing nothing about my periods other than what I was doing before. It wasn't a total loss though...I found some great natural period products and I learned a lot about my own body. It's weird to feel so good about knowing that the process of having a child would be difficult for me. I don't know why that makes me feel better, but it's almost as if now I have a physical reason to back up my choice to not have children. As if choosing to not have children was never a good enough excuse to those who don't understand or can't empathize. So now I can say, "My uterus is weird! That's why I'm not having children!" That's as good a reason as any, right?
So there it is...the final chapter (for real!) on this whole period thing. Can't wait for the menopause blogs, right?? Thanks so much to all who have supported me along the way and have asked questions and given advice. It was all very welcome and very helpful. :)
Friday, May 6, 2016
The Idiot's Guide to Driving in Flagstaff
*It should be noted that all of these behaviors have been witnessed by me personally, typically more than one on any given day.*
1. I've found that it's most helpful to begin any driving excursion in Flagstaff by firming inserting one's head into one's butt. There seems to be no other explanation for the majority of driving behaviors that go on in this little mountain town.
2. Have your phone in one hand at all times, even when you're not using it. Make sure to check it as often as possible to be sure that you haven't missed a text, a facebook update, or a tweet in the last 3 seconds.
3. While texting and driving, make sure to use both hands.
4. Poorly steer with your knees while texting, and tell your passengers in the car that you're "really good at texting and driving."
5. Make left turns out of the right lane, and right turns out of the left lane.
6. When possible, be sure to stop directly in the lane of traffic to be sure that you are still, in fact, going in the right direction.
7. If you are not going in the right direction or have missed your turn, stop immediately and block traffic with a poorly executed K-turn. Trust me, your vehicle will be incapable of a standard U-turn on a four-lane road. It should be noted that if you pass your turn or are going the wrong way, there will be NO place further down the road to pull over and safely get yourself oriented in the direction you need to go. You must stop and execute the K-turn immediately.
8. In parking lots, there's no need to slow down or yield to someone backing out of a parking space. In fact, it's preferable to drive behind them as quickly and as closely as possible. They'll most likely see you...if they're not texting, shoving a giant burrito down their gullet, or have not already inserted their own heads into their rectums.
9. It's perfectly acceptable to drive up the shared middle turn lane, regardless of how far up your turn happens to be. Make sure you go past at least 3 driveways, if not more.
10. When driving on a 2-lane road with a shared middle turn lane, it's encouraged that you get into the shared turn lane to pass any slow motorists that might be in your way. Give them the finger or honk at them for their audacity to go to the speed limit.
11. Make sure to drive as fast as possible while going up or down any and all hills in town, regardless of whether or not they are in a residential area or contain a pedestrian crosswalk.
12. Always make the widest left or right turn possible. It is preferable if you could also give the pedestrians on the sidewalk a good scare while executing your turn.
13. Make sure to drive 5-10 miles under the speed limit at all times, unless you are going up or down a hill (see #11).
14. Count to six before taking off at a green light...or just finish texting your boyfriend.
15. Hit your brakes frequently for no apparent reason whatsoever.
16. If your traffic light is green and the next one in your direction of travel happens to be red and traffic has backed up, by all means pull forward and make sure to block the intersection.
17. If you can't decide which lane you need to be in, just straddle the dotted white line and drive in both of them. It is important to note that you should drive slowly while doing this, and that you should swerve from side to side randomly to keep other motorists from going around you.
18. The use of the blinker is strongly discouraged, and should not be done for any reason.
19. No need to be aware of motorcycles, bicycles, or scooters...those two-wheeled idiots should be on the sidewalk or the bike path.
20. With the first winter storm, there is no need to slow down or change your driving habits whatsoever, especially if you have four-wheel drive. Continue texting, eating, swerving, and generally driving like an asshole. Our fellow first-responders and hospital staff will thank you for the business.
21. When pulling over for an ambulance or fire truck, make sure to immediately leap back out into the lane, blocking those who had pulled over in front of you from getting back on the road.
22. Four-way STOP? What's that?
23. In general, drive like you and only you are the only person on the road at any given time, and you'll have mastered the art of driving in Flagstaff.
1. I've found that it's most helpful to begin any driving excursion in Flagstaff by firming inserting one's head into one's butt. There seems to be no other explanation for the majority of driving behaviors that go on in this little mountain town.
2. Have your phone in one hand at all times, even when you're not using it. Make sure to check it as often as possible to be sure that you haven't missed a text, a facebook update, or a tweet in the last 3 seconds.
3. While texting and driving, make sure to use both hands.
4. Poorly steer with your knees while texting, and tell your passengers in the car that you're "really good at texting and driving."
5. Make left turns out of the right lane, and right turns out of the left lane.
6. When possible, be sure to stop directly in the lane of traffic to be sure that you are still, in fact, going in the right direction.
7. If you are not going in the right direction or have missed your turn, stop immediately and block traffic with a poorly executed K-turn. Trust me, your vehicle will be incapable of a standard U-turn on a four-lane road. It should be noted that if you pass your turn or are going the wrong way, there will be NO place further down the road to pull over and safely get yourself oriented in the direction you need to go. You must stop and execute the K-turn immediately.
8. In parking lots, there's no need to slow down or yield to someone backing out of a parking space. In fact, it's preferable to drive behind them as quickly and as closely as possible. They'll most likely see you...if they're not texting, shoving a giant burrito down their gullet, or have not already inserted their own heads into their rectums.
9. It's perfectly acceptable to drive up the shared middle turn lane, regardless of how far up your turn happens to be. Make sure you go past at least 3 driveways, if not more.
10. When driving on a 2-lane road with a shared middle turn lane, it's encouraged that you get into the shared turn lane to pass any slow motorists that might be in your way. Give them the finger or honk at them for their audacity to go to the speed limit.
11. Make sure to drive as fast as possible while going up or down any and all hills in town, regardless of whether or not they are in a residential area or contain a pedestrian crosswalk.
12. Always make the widest left or right turn possible. It is preferable if you could also give the pedestrians on the sidewalk a good scare while executing your turn.
13. Make sure to drive 5-10 miles under the speed limit at all times, unless you are going up or down a hill (see #11).
14. Count to six before taking off at a green light...or just finish texting your boyfriend.
15. Hit your brakes frequently for no apparent reason whatsoever.
16. If your traffic light is green and the next one in your direction of travel happens to be red and traffic has backed up, by all means pull forward and make sure to block the intersection.
17. If you can't decide which lane you need to be in, just straddle the dotted white line and drive in both of them. It is important to note that you should drive slowly while doing this, and that you should swerve from side to side randomly to keep other motorists from going around you.
18. The use of the blinker is strongly discouraged, and should not be done for any reason.
19. No need to be aware of motorcycles, bicycles, or scooters...those two-wheeled idiots should be on the sidewalk or the bike path.
20. With the first winter storm, there is no need to slow down or change your driving habits whatsoever, especially if you have four-wheel drive. Continue texting, eating, swerving, and generally driving like an asshole. Our fellow first-responders and hospital staff will thank you for the business.
21. When pulling over for an ambulance or fire truck, make sure to immediately leap back out into the lane, blocking those who had pulled over in front of you from getting back on the road.
22. Four-way STOP? What's that?
23. In general, drive like you and only you are the only person on the road at any given time, and you'll have mastered the art of driving in Flagstaff.
Tuesday, May 3, 2016
Is Every Patient Deserving of Compassion?
*Patient details have been changed to protect patient privacy*
So I've had this nagging thought bouncing around inside my head for some time now. Are all patients in the hospital equally deserving of compassion? It's a weird question, given that nurses are pretty universally known for their caring and for their compassion. Some outside of the hospital might be surprised to hear that as nurses, we actually don't have an unlimited supply of compassion, and that we struggle to perform our job while dealing with personal biases.
I'll give you an example. Some time ago, I was working with a new nurse, and she was informed that she was going to be getting a patient from the Emergency Department who had been involved in a car accident. The patient's injuries were significant, but not life threatening. It was amazing to me to watch this nurse prepare herself for the arrival of the patient. She literally came alive, firing questions at me, getting the room ready, bustling around and making sure that her other patients were all settled and comfortable as she knew that her new patient was going to monopolize her time for a bit. Trauma patients are frequently that way...they're time consuming due to their high degree of pain, injuries, and mental stress in dealing with whatever event landed them in the hospital. It was neat to see this new nurse getting in the zone in anticipation of receiving this challenging patient. It gave me pause to wonder when I had last gotten keyed up about the arrival of a patient. There was probably a time when I did get excited over the prospect of a challenging patient, but it's been quite a while. Am I jaded? Or am I just more comfortable with whatever gets slung my way? Maybe it's a little of both. Don't get me wrong, I spring into action when the need arises, but I don't find myself getting excited about it like I used to. I tell myself that it's because someone has to remain calm when things start happening on the unit...might as well be me.
Upon reading through this particular patient's chart, I felt my disdain for this person rising up in my throat like bile. This particular patient had been driving drunk and was involved in a one-car rollover. Luckily for this patient, no one else was involved. If there's one thing I have zero-tolerance for, it's drunk driving. I've known too many people in my personal and professional lives who have been affected in one way or another by a drunk driver. I try to understand, I try to be compassionate, I try to separate the person from the act that got them into my care, and most of the time, I can't. I can't forget that this person knowingly and purposefully got behind the wheel of their car while under the influence of alcohol. I can't forget that an innocent family was affected by a person's careless choice. I can't forget that in drunk driving accidents, the drunk driver frequently survives while the others involved are injured or killed. I can't separate it, no matter how hard I try. Believe me, I've tried. I know that no one aspires to become an alcoholic. No one sets out with the intention of killing someone else with their car while under the influence. I know that alcoholism is a disease and should be treated as such, but there is a level of intention with direct consequences towards others with alcoholism that you don't see with diseases like cancer or heart disease. An innocent bystander will infrequently be mortally affected by someone else's heart attack. For Pete's sake, if you're going to drink, do it at home. Call a cab. Call a friend. I feel like as a society, we have had the ramifications of drunk driving shoved down our throats for as long as I can remember...how can people still be doing it and act surprised when there is a negative outcome? So while my new nurse coworker was buzzing around attentively caring for and reassuring the patient, I assisted blank-faced and detached, too caught up in my personal bias to be as compassionate as she. Truth be told, I was more of a helpful presence to my coworker than I was to the patient.
When a patient arrives into my care having made these choices, I find that I'm cold and indifferent to them, but I still provide care that myself, my coworkers, and even the patient themselves will be satisfied with. I still take their vitals and make sure they are comfortable and safe and stable. I dress their wounds and I wash the blood off their face and hands. I make sure their broken limbs and battered bodies are receiving the attention they need to promote healing. And I do all of this without uttering barely a single word to them unless they address me specifically with a question, a complaint, or a request. If they want to talk, I listen, but rarely will I be the first one to speak about things outside of the care I'm providing. I fear that to engage in conversation with a drunk driver would be detrimental to my care, as I'm not sure I could hold back all the disdain and disgust I feel for people who make the decision to drink and drive. So I treat them in silence, because that's the kindest thing I can do for them. Is it compassionate? Probably not, but it's kind, and I guess that's similar enough, at least personally for me. I'm sure they must feel my emotions, assuming that they are aware enough to notice. They see it in my body language, my lack of eye contact, my clipped sentences and silent shuffling about.
I had the opportunity a while back to take care of drunk driver who had killed someone. This person veered into oncoming traffic and hit another car head-on, killing at least one occupant in the other car. Frequently when we receive accident victims, regardless of cause, we know little to nothing about who else was involved or how many were injured or killed. In this particular case, the patient had been interviewed by the police regarding the incident and mention of that had been made in the chart. The patient had been in the Intensive Care Unit for a few days prior to coming to my unit and being assigned to my care. This patient was a mess. Broken. Not only physically, but mentally and emotionally. The patient arrived on the unit in tears. When asked to rate his pain on a scale of 1-10, the patient instead responded with, "You mean how stupid do I feel on a scale of 1-10? 10. Fucking 10." He then withdrew into himself and didn't speak to me, or anyone else for that matter, for the next several hours. It was at that point that I felt my resolve crack. I had initially approached this patient with caution in regard to my personal bias as I knew that he had driven drunk and killed someone. I hadn't expected his remorse. It sounds weird to say that most drunk drivers that I've dealt with in the past have shown little to no remorse in their actions. The reasoning is sometimes multi-factorial...sometimes they are still drunk and can't comprehend what's being done to them outside of wanting their neck brace removed; sometimes their memory has been impaired from the accident and they don't remember anything; sometimes...I don't know, sometimes they just don't seem to care, which I think is where most of my disdain comes from. Even if you don't kill someone when drunk driving, the odds are so high that you might. To be flippant or indifferent about it makes my blood boil. In regards to the patient above, he knew he had killed someone, and it was tearing him up inside. Had it been possible for him to trade places with the person he had killed, I had no doubt in my mind that he would have. Without a second thought...at least at that moment in time. I don't know if he remembered the accident or not, as I didn't find it appropriate to ask and really didn't feel it would contribute positively to my care of him. I still think about him with a heavy heart. I wonder how he's doing. I know deep down that he was a good person with a supportive family, a good job, and for the most part, a good life. I couldn't help but think that he was a good person who'd had demons that were already causing him to drink, and now that he had killed someone while under the influence...what did that do to his psyche? I'll probably never know. Given the propensity for survivor's guilt in situations like this, perhaps I don't want to know.
Aside from the mental and emotional strain that caring for these patients presents, most of the physical abuse I've sustained in the hospital has been at the hands of alcoholics. Abuse isn't something that they told us about in nursing school, but it's amazing how often we are subjected to physical, verbal, psychological, and emotional abuse. It's a felony in most states (probably all states at this point) to assault a healthcare worker, but patients who assault healthcare workers are very infrequently ever prosecuted. I've never prosecuted a single patient that's hit, punched, pushed, bent my fingers back, grabbed, pinched, spit on, or attempted to bite me. Alcoholics, whether still drunk, going through withdrawls, or suffering permanent brain damage from drinking, are very unpredictable, and frequently become violent. A lot of the time, they don't even realize that they're doing it, and once sober or fully detoxed, have no recollection of their abusive behavior at all. How does a healthcare provider go about prosecuting someone who has no cognitive memory of their behavior? Perhaps had I been more injured, I would have pressed charges...but should the degree of injury and the mental state of the patient at the time of the incident really be factors? Shouldn't all assault be viewed equally regardless of the outcome? There has only been one incident when a patient got me good right square in the chest with a closed fist. I didn't press charges against her, mostly because I knew her time here on earth was severely limited due to her severe alcoholism and the irreversible organ failure that went along with it, and I felt that to be punishment enough for what she had done to me. It's safe to say that she was definitely not in her right mind at the time of the incident, and rather than understand that we were trying to help her, she responded with physical violence. All compassion I had for her went right out the window. I wasn't prepared for how angry I became when she punched me, and I was glad that I had another coworker in the room with me at the time of the incident to deflect the attention of the patient from me...and mine from her. Not that I would have responded in kind with physical violence, but I was extremely angry and it was all I could do to keep myself from punching her right back. Expletives were forced through my clenched teeth. I've never punched anyone in my life, but I've never been put in a position where I've wanted to so badly either. I called out the next night from work so I could mentally process what had happened. I learned not long afterwards that she had passed away during that same hospitalization, and the relief I felt was palpable...no longer would she hurt anyone else who was trying to help her. I didn't feel guilty about that, which was new for me. Typically I felt something when I learned a difficult patient had passed, but because she had hurt me, I felt nothing. I'm still not sure how I feel about that...the feeling of nothing...am I losing my humanity? Or am I just calling a spade a spade...a person like that was doomed to die from her addiction, and maybe she's better off...maybe we're all better off. Some people just can't be helped. Obviously, the situation has stuck with me...not to the point that it keeps me up at night and I assume that every alcoholic is going to punch me or deserves to die as a result of his or her addiction, but I give them a much wider berth mentally, physically, and emotionally, now than I used to.
I feel as though I've emphasized substance abuse thus far in this blog, and while those patients with addictions make up the majority of those patients whom I struggle with compassion, they aren't the only ones. There are patients in the hospital who are completely alert and oriented who are mean to hospital staff. Not just mean, but callous, uncaring, abusive, and disdainful. They are so disdained at the state of their own health and the lifestyle that landed them in the hospital that they take their anger out on nurses, doctors, and other healthcare workers. I've witnessed patients who were completely alert and oriented attack my coworkers verbally, physically, and emotionally. Patients are upset, they are angry, and are extremely disappointed that we can't fix 50 years of bad habits. I had a patient and his family verbally abuse me because they felt that his bed wasn't comfortable enough. As if I personally was responsible for the construction of the mattress. They surrounded me on all sides and were all yelling and aggressively posturing, which made me feel threatened and uncomfortable. I felt myself escalating, and had to remind myself that all of this anger, all of this aggression, had less to do with the bed and more to do with their unrealistic grasp of the patient's illness and debility. He threatened to leave the hospital on account of the bed. I gave him the paper to sign to indicate him willfully leaving the hospital against medical advice and showed him the door. Upon realizing that it mattered not one iota to me whether he stayed or went, he changed his tune and decided to stay. But the tone for the night had been set. I was determined not to waste what little compassion I had on this angry little man and his family members. I said as little to him as I had to while providing care appropriate for his diagnosis. At the same time, I spent a fair amount of time conversing and chatting with his roommate, who, if I recall correctly, was far more ill but far more pleasant. Compassion for days for those willing to receive it and in turn, give it back. The roommate, I might add, actually apologized to me for the mattress-hater's behavior. The patient himself never apologized, but made a few comments that revealed that he was embarrassed by his behavior and that of his family. At the end of the day, he was still too prideful to admit that he had treated me badly and had behaved inappropriately.
Over the years I've had patients who have touched my heart in ways that still give me the warm fuzzies today. The number of patients who are decent human beings far out-number the ones who feel entitled to abuse me and treat me poorly. But I've come to the conclusion that it is possible to give adequate care without sacrificing my compassion on patients who have shown that they neither appreciate nor deserve it. It isn't in my job description to stroke egos and empathize with every single malady or behavior that a patient might present with. I view compassion as icing on the cake to care that will be appropriate no matter the patient's attitude or behavior. As I've gotten older and farther into my career, I've realized that I have a finite amount of compassion to give, and patients are not equally deserving nor are they entitled to it. I dole out compassion as I see fit, and I'm learning that that's okay.
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