St. Elizabeths Asylum, Washington, DC.

St. Elizabeths Asylum, Washington, DC.

Lo, I did write thee a splendid piece on my visit to the National Building Museum exhibit on Washington, DC’s great Asylum hospital, St. Elizabeths (no apostrophe). But ay I did it waiting for a surgery to close, needing something to do something with my nervous energy. The patient, when asked the standard pre-surgical question “Why are you here with us today?” (assesses orientation, assures that the patient is informed, confirms procedure), answered “I am dying.” Always believe the patient who says they are dying.

Crash cart at my side, fellow nurse and I finished planning our I-hope-this-doesn’t-turn-into-a-code, I typed out a gem. And upon finishing, ran off to do a thing and lost it.

Instead, here is an excerpt of a letter written by Dr. Charles Nichols, superintendent, to Dorthea Dix (nurse, hero) the greatest advocate for mental health that ever lived whose actions led to the establishment of the hospital, on the selection of a site.

The moral treatment of the insane, with reference to their cure, consists mainly in eliciting an exercise of the attention with things rational, agreeable, and foreign to the subject of delusion; and the more constant and absorbing is such exercise, the more rapid and effectual will be the recovery; but many unbroken hours must elapse each day, during which it is on every account impracticable to make any direct active effort to engage and occupy the patients’ minds. Now, nothing gratifies the taste, and spontaneously enlists the attention, of so large a class of persons, as combinations of beautiful natural scenery, varied and enriched by the hand of man; and it may be asserted with much confidence, that the expenditure of a thousand dollars each year, directed to the single object of promoting the healthy mental occupation of one hundred insane persons, with either amusements or labor, would not be so effectual in recalling reason to its throne, as will the grand panorama of nature and of art, which the peculiar position of the site chosen happily commands. The shifting incidents of the navigation of the Potomac, the flight of railroad cars to and from the city, the operations at the Navy Yard, &c., will continually renew and vary the interest of the scene.

It lifts my iron anchor of a heart to read about this period in time, the asylum movement. Started by Quakers and somehow collecting political support for the mission to create a place, tranquil and serene, to house and heal vulnerable, imprisoned, and cast away persons suffering from mental illness. Public funding! Our government and the people it represents setting aside money to better provide for its poorliest members. Acknowledgement that all people have dignity and value.

**I know you’re thinking asylum? You mean those places where people are locked up and tortured and experimented on? Yes, terrible. But I’ll refer you to the many, many atrocities committed against those walking free: people of colorindigent people seeking care at public hospitals. Medical ethics has an awful lot to answer for. It’s my speculation that we pin it all so easily on asylums, place all our unquiet ghosts there, because of the fear and stigma bound to mental illness. Chew on that. I digress.

Asylums were conceived in goodness. Every pure-hearted reformer may know exactly where the road paved with their good intentions will end up, but I’m glad that they’re trying. We keep trying. We should always be trying.

PS- As Dr. Nichols states, I’m in favor of doing anything that “recalls reason to it’s throne.” Especially in this nuthouse town.

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Trauma story

Trauma story

I just visited with a teacher friend who was telling me about his adamant opposition the the ad-hoc trauma counseling the public schools are asking teachers to perform on their at-risk students.

“First we have to sit in a big circle,” he tells me.

“Stop. No no no no sir. Not a circle. There is no safe place in a circle of peers.” I say.

Trauma is the flavor of the DSM V. Who isn’t talking about trauma? We’re all a bunch of traumatized zombies walking around, unstoppable force, inflicting and receiving trauma. Unable to zombie stumble ourselves into an effective treatment for our trauma on trauma on trauma.

Maybe trauma is the flavor of the century. This thing that was never really a thing in centuries past. Before, it was as inherent to living as breathing. Unremarkable. It starts to make itself known in the Western World after the great wars. Life settles, the middle class thrives, and a coherent nuclear family of two heterosexual parents and 2.5 kids emerges. Vaccines keep children from dying, sterile technique and antibiotics extend the lives of their parents. Union strength brings forth OSHA and safer workplaces, risky agricultural labor is given to 6-lane-highway sized air-conditioned combines, and the quagmire land wars in Asia make conscription a political nuh uh. The twentieth century American person is now safe. Safe enough for a man to concern himself with the perilous moments he has lived through. And now we live in enough comfort to reflect ourselves awake all night.

 

I’m flashing back to my greatest lesson in trauma. One I’ve written about before. Part of the advantage of having experienced the bulk of traumatic life events in short sequence as a full grown adult is your ability to remember them. Half of me records the events and their aftermath, the other experiences them. I’ll tell you my two big takeaways when it comes to managing life’s garbage:

  1. Trauma is not concrete. It is a thing perceived. You can live through an act of terror, loss of a loved one, life-threatening diagnosis, and come out the other side a well-adjusted and intact human. Maybe even more grateful, more god loving, closer to family, any positive thing. But like a kid with a skinned knee who doesn’t know to cry until he sees the panic on his mother’s face, being forced to re-tell your story to “debrief” or in crisis counseling may be the point at which you recast yourself in the role of traumatized person and become a victim to it. If people are fine, just let them be fine.
  2. People are excellent copers. Never take away a person’s coping mechanisms without their consent and a thought through plan to replace it. Clinically we categorize coping as either positive or negative. Positive: seeks assistance of family. Keeps journal. Exercises. Negative: Abuses drugs and alcohol. Isolates. Overindulges in TV. Doesn’t eat/eats too much. In real life, it’s usually a mixed bag. But either way–negative coping may be superior to no coping. No coping mechanisms threaten a victim’s survival.

The constellation of coping mechanisms put together by each person is unique. If they are maintaining a functional life, I think of their elements of coping as precariously balanced weights on branching wire arms, like a Calder mobile. Remove one element and you’ll destroy the whole delicately strung installation. Clinically, we’d call this decompensation.

My greatest public decompensation occurred in a literal circle of my closest friends at a mandatory mindfulness retreat in the very posh renovated barn/private events space owned by my prestigious southern university. For me, coping is dependent upon keeping my brain engaged in obsessive, hyper-vigilant work on 2-7 jobs or projects at a time. I also use humor and self-deprecation to be able to maintain a detachment from myself and others. (I’m a criterion D and E girl). The closer I am to my fear of dying, which is not lost on me as poetic and appropriate for a nurse, the harder I go into being a straight A student. I can box out the reliving of various death-sentences I’ve been handed by focusing on the esoteric, the academic, the political, the theoretical. Also, avoiding eye contact is key. Making eye contact is lethal. It is hard to deny your physical existence when you are eye to eye.

So the day of this retreat, waiting on a cancer diagnosis, knowing my marriage was caputskies, worrying about where the money for food would come from that week, the last thing I wanted to do was slow down. The last place I wanted to be was present in my mind.

I was barely through the authentic antique barn doors when I caught a picture of a patron of our University. Her bleached smile and tailored skirt-suit. The pearls. The goddamn real towel hand towel on the vanity beside the photo. The meditative music on the Bose surround. I decompensated. I started crying and kept it up all through silent yoga (drip, drip, drip, sniffle, mournful moan) slipping and sliding through my tear puddle on the rubbery mat. I stifled wails with the real towel hand towels in the bathroom. My psych prof asked me the mandatory question, “are you thinking about harming yourself.”

It took may face two days to return to baseline puffy.

Another salient point from my visiting teacher friend. One he got from a biology teacher in grade school: Species don’t occur in nature. Individuals do. I love a botanical metaphor so let’s work this one. What he was trying to impart, that I in my thirties and my friend a decade older are just now beginning to grasp, is that no individual tree or frog or dog meets all the criteria set for them in the key used to decode what species you is. They’re missing a whorl, they have additional spots, their eyes are too prominent. The the designation of species is arbitrary. The tree’s leaves curl under not over. It’s not wrong until you tell it so. We create a holotype to further our own scientific pursuits, which are noble and even useful at a population level, but the human experience can rarely be perfectly described by a text. Not even the DSM.

This failing to see the individual for the species problem is what makes the mandatory part of trauma counseling so worrisome. There are people in this world who do great work reading a person and healing them without the assistance of a marketed standardized trauma scoring system and matching intervention workbook. I’ve seen priests do it. I’ve seen wives do it for husbands, husbands for wives. Friends for each other. Parents and children. Strangers you meet on a train. Books. Poems. Singing.

The hubris to think you can heal trauma with a tool approved by science is so beautifully American. Intention so good, execution a mess, outcome pretty sad. Please give people the chance to manage themselves. Seek only to change behaviors that harm self or others. Never ask for a change without a replacement coping strategy. Move slow.

And never, ever make people sit in a circle.

International Woman’s Day II: A DAY WITHOUT A WOMAN

International Woman’s Day II: A DAY WITHOUT A WOMAN

I’m punchy today.

I’m cheering on the Alexandria City Public School teachers for shutting it down. Go on with your bad selves, and thousands of VIP parents now have to figure out who’s going to take care of their kids while they make dollars. Disrupt the system.

As for me, I’m working. I’ve got no-union and a no-call-out job, I support a child with my income, and I think we’re discovering the layers to this problem.

BUT MOST IMPORTANTLY here’s what I’ll keep in my head today: Pasteur through Lister, god rest their man-souls, get the credit for the discovery of germ theory which is the foundation of the science behind the successes of modern medicine. This happened between the 1860s and the 1900s. Yes it arrived later in America because we are refractory to evidence, I digress… In 1854 FLORENCE “MY QUEEN” NIGHTINGALE was saving thousands of lives by cleaning up the literal shit. Check this piece out, and beware the unfortunate typo–it’s 1854, not 1954. Blockheads.

The soldiers were poorly cared for, medicines and other essentials were in short supply, hygiene was neglected, and infections were rampant. Nightingale found there was no clean linen; the clothes of the soldiers were swarming with bugs, lice, and fleas; the floors, walls, and ceilings were filthy; and rats were hiding under the beds.1 There were no towels, basins, or soap, and only 14 baths for approximately 2000 soldiers. The death count was the highest of all hospitals in the region. One of Nightingale’s first purchases was of 200 Turkish towels; she later provided an enormous supply of clean shirts, plenty of soap, and such necessities as plates, knives, and forks, cups and glasses. Nightingale believed the main problems were diet, dirt, and drains—she brought food from England, cleaned up the kitchens, and set her nurses to cleaning up the hospital wards. A Sanitary Commission, sent by the British government, arrived to flush out the sewers and improve ventilation.

So keep talking about the end of the world. I’m going to be with every other person called woman getting it done.

ALSO: Florence freaking invented data science and was a persuasive and prolific writer who though she was practically housebound in later years changed the GD world from her desk. *Spikes football*

 

Thank you for marching. Love, Me.

Thank you for marching. Love, Me.

I knew by last Wednesday I wouldn’t make it to the march. My six-year-old had had a fever for 3 days, I was calling out of work and trying to get him to the doctor, and my nursing work schedule included non-negotiable 12 hour shifts on Friday and Sunday.

I was desperately sad when I woke up on Saturday and, like every normal human, pulled my phone from under my pillow and started scrolling twitter. All these beautiful women I love and admire, my friends! Together on The National Mall with their children. Arms linked, posters cutting, experiencing history’s counterpoint to Friday’s stiff and depressing presidential inauguration. And here I was in my PJs. A bad mom for not bringing my son to the momentous even, a bad woman for skipping the rising up of the sisterhood.

But wait, forget that guilt. You marched for me. I’m a single parent of a young child. I struggle with being a mom without a partner or adequate child support, a professional with no job flexibility to accommodate my role as parent, and due to the unaffordable nature of childcare lean on the support of my own mother to help raise my child. Also, I’m a cancer survivor and the ACA keeps me covered with health insurance and free from the fear of medical bankruptcy. Last, I am fortunate in this time of health professional shortages to work with a diversity of talented professionals from all over the world. I worry that through fear mongering or bad policy I will lose these irreplaceable nurse, tech, and doctor colleagues caring for our sick and elderly.

So to everyone who marched–I couldn’t be there on Saturday to show my support. I am forever grateful to you for marching.

Good Lord “Mercy Street”

Good Lord “Mercy Street”

I’m obsessed with our image. On a scale of 1 to Gray’s Anatomy (1 being no pain, Grey’s Anatomy being the worst pain you’ve ever felt in your life), most portrayals of nurses on TV and in the movies land in the 7 region. The faces pain scale really works for this:
Pain scale

A few years ago PBS began airing the BBC period nursing drama Call the Midwife, a darling and coherent if sentimental portrayal of post-war era midwives working from a convent in East End London. I like this one even if later episodes did risk giving me cavities. Maybe it reads as authentic because it it drawn directly from the not fictional nursing memoirs of Jennifer Worth, who lends her stories and her name to the main character. Nursing is a real thing in this series.

I guess it was inevitable that in the wake of its success America would give nurses a stab with the new PBS series Mercy Street, about a Union Civil War Hospital set in (my hometown) Alexandria, Virginia. Oh my hopes were high! This show is, so far, unforgivable. It hurts worst. I could feign indifference when it came to the laughable accents, the absurd and awkwardly drama-less rape scene in the first half of the second episode (give me time to love the characters if you’d like to break my heart!), but the characterization of the only actual nurse as the mean and heartless foil for our two sweet and well meaning hero nurses is so disgusting that it can not stand, man.

The uptight bitch nurse is to be hated because she trained with Florence Nightingale in the Crimean War and is suuuuch an expert at things like sanitation and wound care. She is so bossy about telling new nurses how to do things in a safe and evidence based way! The lady knows what she is doing professionally and seeks to better her field and improve the health outcomes and safety of the soldiers in the hospital’s care. What a B. I bet she hasn’t had sex in forever, she’s such an ice queen. Nope. In the second episode we see her sleeping with her boss, the corrupt doctor! So that’s how she got the gig.

Our two heroes are nurses who have no training or experience, but never you mind. They have the calling to serve their fellow man. To provide comfort in times of need. They have tender feminine hearts and strong womanly wills and as god as their witness they shall never let a boy die without a soft hand to hold! They will try to get some food for these soldiers too!

I said I could overlook the accents, they have nothing to do with nursing, but let me just tell you that the southern hero nurse is a native Alexandrian (a city two miles from DC) but makes sounds like her cotton plantation just caught on fire. Robert E. Lee did not sound like Blanche DuBois. Or Blanche Devereaux. But this woman does.
blanche

So. I’m sure our hero rookie nurses will use their female intuition and woman-in-a-man’s-world grit to become invaluable assistants to the doctors they work with. But I won’t be around to watch.

I’m going to watch Nurse Jackie.

PS- I tried to find the script writers on IMDB to no avail–but there were about 1200 costume consultants. The costumes are fantastic. The script? What script.

Poetry from the AIDS Epidemic, another for World AIDS Day

Excerpt of “Atlantis” by Mark Doty
About his partner with AIDS

 6. NEW DOG
Jimi and Tony
can’t keep Dino,
their cocker spaniel;
Tony’s too sick,
the daily walks
more pressure
than pleasure,
one more obligation
that can’t be met.
And though we already
have a dog, Wally
wants to adopt,
wants something small
and golden to sleep
next to him and
lick his face.
He’s paralyzed now
from the waist down,
whatever’s ruining him
moving upward, and
we don’t know
how much longer
he’ll be able to pet
a dog. How many men
want another attachment,
just as they’re
leaving the world?
Wally sits up nights
and says, I’d like   
some lizards, a talking bird,
some fish. A little rat.
So after I drive
to Jimi and Tony’s
in the Village and they
meet me at the door and say,
We can’t go through with it,

we can’t give up our dog,
I drive to the shelter
—just to look—and there
is Beau: bounding and
practically boundless,
one brass concatenation
of tongue and tail,
unmediated energy,
too big, wild,
perfect. He not only
licks Wally’s face
but bathes every
irreplaceable inch
of his head, and though
Wally can no longer
feed himself he can lift
his hand, and bring it
to rest on the rough gilt
flanks when they are,
for a moment, still.
I have never seen a touch
so deliberate.
It isn’t about grasping;
the hand itself seems
almost blurred now,
softened, though
tentative only
because so much will
must be summoned,
such attention brought
to the work—which is all
he is now, this gesture
toward the restless splendor,
the unruly, the golden,
the animal, the new.

Mark Doty, “Atlantis” from Atlantis: Poems. Copyright © 1995 by Mark Doty.
Source: Atlantis (HarperCollins Publishers Inc, 1995)