September: the new year!

I always consider September as the new year. Having been a student for such a long time, I guess that's only normal...and the Fall signals the turning of the seasons to something more introspective than the perfusion of blossoms and warmth of summer, when basking in the sun, enjoying the long days and silken evenings is coming to a close. Although this year, the summer is still in full swing (hot, humid days; flowers rioting in the garden and pond).

The first day of school used to be the moment to step into those plaid, slightly scratchy wool jumpers, long socks, brushed hair pulled back with barrettes... but now, the first day of school will be shorts and tee-shirts, flip-flop sandals. Can't imagine anyone wearing wool in this heat!

And for me, I'm starting a new job next week, so that will be exciting and different... no shorts & tees, but I'll pass on the wool jumper too.

summertime

Mid-summer. All the activities of paring down (the yard sale earlier this month) and relaxing (the Home County Folk Festival, visiting some wineries in the Niagara region) are just the thing for our short time with summer.

When I consider complaining about the heat (it was 33 degrees C. today), I just have to look back at some of the photos of the winter--and this winter was particularly "challenging" in terms of the amount/frequency of snow!! I like winter for a couple of weeks, when the snow is white and crispy. But longer than that, and I'm ready to consider moving to some climate where winter and snow don't drag on.

So the summer heat is refreshing and delightful as I watch my garden unfold in various blooms. The dog lies down beside the pond, cooling his belly on the flagstones. I make sure the bird feeders are topped up, the fountains continuing to burble...and relax in the fragrant warmth of summertime. Too short...

Enrichment

Thinking of a word that somehow brings to light the feeling of more than being happy, of being “enriched” in the way one feels waking up from the best night’s sleep, in a beautiful room, with the light just so—and no bills to pay, no pressing engagements of the day. Waking up to the aroma of coffee.

I spend my life walking around this word, this concept.

perfection is in the eye of the beholder

Walking the dog this morning (a cool Sunday, nice change from the heat/humidity last week) and I, of course, am snooping other people's gardens--at least those gardens that are visible from the sidewalk. Several gardens on my usual route are wonderful: peonies and irises in full bloom with candy-pink and royal purple flowers, along with other pretty plants (although somewhat less spectacularly sized). These gardens are immaculate, with neatly mowed lawns, swept and clean patios, flower beds with tidy borders.

The first emotion, after the bliss of such beauty, is anxiety. I consider my own chaotic gardens and worry that the lack of order somehow reflects badly on me as a gardener. However it doesn't take long to realize that my gardens are fine the way they are; the untidiness is really just an expression of joy at the ability of flowers to bloom, birds to come and fish to dash around in the pond that manages to remain the best part of the garden despite the maple keys that shower into it and a fountain that sometimes sputters to a stop, clogged with debris. The lawn is lumpy, the grass is a bit long, the borders of my flower beds uneven and there are weeds.

But when I'm in my backyard,  I'm happy. No comparisons with those gorgeous gardens on my walk. It's the perfect place to be.

listen to the little voice in your head

I went to the Southwest Local Health Integration Network (LHIN) first Quality Symposium on Thursday (torrential rains, high winds to drive through on the way to Stratford) & was impressed by the themes presented by a number of the speakers--including the provincial Minister of Health, the Honourable Deb Matthews, PhD (her background is demographics, how appropriate!). The "end-note" speaker was Steven Lewis (not to be confused with Stephen Lewis, who would have been equally at home there). But the messages of how to maintain universal healthcare in the face of the increasingly elderly demographic with multiple chronic health issues were reminders of that little voice in my head.

I am the Participaction generation, with medals to prove my ability, as a 10 year old, to be supremely (well, okay, reasonably) fit. But it got me into running, cycling and other activities that have remained part of my life--even if sometimes taking second or third place to other things, like having children and working/going to school.

As a wound care specialist, I have seen the effects of sedentary lifestyle, eating junk food,  high salt consumption, diet pop instead of water or milk, and cigarette smoking. I have patients with diabetes, high blood pressure, lousy circulation, sore joints (ankles, knees, hips) and sometimes joint replacements or other "corrective" surgeries. The majority of these individuals are overweight. And not by just 10 pounds or so, but what we politely call, "morbidly obese". Obesity is an epidemic, we all know, and it's not getting any better.

I look around and think, it's not that hard. When that little voice in your head says, "You don't really need to eat that" or " How about parking the car a block further so you can get some exercise" or " Yeah, that cough IS from smoking. You do need to quit before it kills you". It's time to say "YES, you're right!"

Last year, I listened to the little voice. I lost about 40 pounds, started to exercise (aquafit, yoga, cycling--things I enjoy) and WOW!! How much better do I feel? A million times better. I don't plan to be in that chronic illness demographic as I get older.

Do you?

Having A Space of One's Own

I remember reading Virginia Woolf's "A Room of One's Own" when I was about twenty & considering how important it was to make sure I had my own space. At the time, it seemed easy to do: the extra bedroom would be my "workroom", with the long table, the sewing machine, art, fabric, photos, drawings. The window looking out over the garden...

Years went by and the space somehow disappeared. Children needed bedrooms, toys and books, musical instruments, their art, their imaginative jumble, took over everywhere, and my "space" became smaller and smaller.

There was always an office (and at home, a desk carved out in a corner), but the idea of "space", where creativity was more the focus, was elusive.

Now I find that I am once again in a position to claim "space" for myself. It feels a bit strange, like an almost forgotten memory of something I once did... this won't be the same space as anything I had before, and I feel much more tentative about the creative part of it. But I suspect I will begin to enjoy this place.

A new space. Arms outstretched, I feel the fluttering of ideas.

Do as I say, not as I do.

Yesterday I was vehemently encouraging patients to eat their lunch. My goal was to promote wound healing; and nutrition plays a huge role in providing the energy the body requires to heal. I always tell people that wounds need three things to heal: get rid of the cause (often pressure related), give the body optimal nutrition and last, consider the dressing.
So I spend a lot of time encouraging people to eat.
Yesterday at about 3 o'clock, I was running around the hospital, feeling tired and headachy. Hmm... did I have lunch? Uh, no. How often do I miss lunch because I'm too busy? Hmm...more than I should.

So, telling other people to do things is easy. Sometimes telling yourself the same thing--and following through--is hard!
I had lunch today, though.

The Black Dog of Happiness

Pets are the best. Patients faces light up when their pet comes in to visit--granted, these have to be arranged in advance, the pet has to be "vetted" (ha ha) and have a better health inspection than most of us. But imagine how nice it feels to have that companion with the warm, moist nose and friendly eyes, lying beside you on the bed.

what it's like to be deaf

Over the past six months or so, I have had to face up to the fact that I need a hearing aid. I'm deaf in my right ear. Nearly 60% deaf. It's strange-- I thought it was "just wax" and when Joan, the Nurse Practitioner at the Family Health Network reamed out my ears, I thought she hadn't done a complete job, since I still couldn't hear well out of my right ear. Noooo.... she said, "go to an audiologist". So off I went to Canada Hears and lo and behold, I really couldn't hear. Hearing aid time.

Hey, only old people have hearing aids. Not so, as my daughter pointed out, some of her best friends have had hearing aids since they were little. I felt very Politically Incorrect. And old. But given the family history of osteoarthritis (in the ear???), it's not that surprising. Unlike my uncle Leopold Kohr, who was stone deaf and most annoying -- and must have been frustrated himself, because his hearing aid, that looked like some sort of big recording device he'd hold up to your face (someone at a cocktail party once leaned into it and said "testing, testing, one, two, three" assuming it was, in fact, going to record him, as Uncle Poldi merely was trying to hear him better). Anyway, I'm not STONE deaf, just on the right side.

So, stand to my left, wouldya?

commemorating my mother

My mother was an amazing woman. She was a pharmacist, with a BSc in Pharmacy from University of Toronto in the 1930s, with only a few other women in her class. She was a business woman, entrepreneur, involved in the Canadian Consumers' Association, drove a Karman Ghia convertible, and was working on a Real Estate License when she became ill with what turned out to be ovarian cancer.

She was 54 when she died, a year after being diagnosed. As a 17 year old, I was not prepared for my mother's demise. In fact, I didn't realize she was dying until a few weeks before she actually died. Up until then, I assumed she was just sick & would recover and come home. Almost a year in the hospital, she wasted away until even as a self-centred teen-ager, I could no longer avoid the inevitable truth. She was going to die.

When I look at the list of famous women who have died of ovarian cancer, the most obvious thing is how young they were when they died; mostly in their forties, fifties and early sixties. What does this do to families, whose main anchor is taken away? I know what happened to our family. It was very, very hard.

If I was in a position to create a foundation, it would be in the memory of my mother and other women like her: hard working, loving, energetic role-models for their children and those around them--and taken away half a century too soon.

Some day, I hope I can do this. Ovarian cancer is still the deadly silent killer, that destroys families by taking away mothers, wives, sisters.
What can we do to win this battle?

Palliative care: on death's doorstep??

There seems to be a mis-understanding that if someone needs Palliative Care (in the hospital), they might as well be heading to the cemetery. I have these discussions with people sometimes, where they look anxious & worried when the word "Palliative" is mentioned. As healthcare providers, we work hard to deal with pain in particular, to try to help patients get what they need. And as it becomes obvious to us that someone is likely not going to recover, and is, in fact, deteriorating... that's when the thought of Palliative Care comes to mind.
I have friends who are part of the Palliative Care team and I suspect they feel mis-understood when people refuse the offer of their services, because they think of Palliative Care as being at the very final end of life. But we have many patients who receive much better pain management, and other symptom management (nausea, constipation,etc) because the Palliative Care team are experts in making those subtle combinations of drugs work well--and keep people as functional and comfortable as possible.
As well, they are the ones whose kind and gentle faces, hands and voices are there to provide solace and support during what can be a long, exhausting process of moving from life to death. A natural thing, but still very hard to accept for many people.

passport photos

I went to have my passport photo taken today. My passport is due to expire, and rather than go through the effort (and detail required) to have a whole new passport, I thought I'd actually be organized enough to get the few things I need for the renewal. One of these was the photo.

My friend Christine told me that the little post office around the corner does passport photos for about $10., which was half what Black's charges. So I went there. Had my picture taken by an elderly man who had set up the photo area like a Karsh studio. The lights, the bounce-foil umbrella, the white board to hold on my lap to deal with the shadows under my chin (fleetingly worried that this might be just my chin(s)).

And the result: I look less like a terrorist/escaped convict and more like a disgruntled housewife. Sad, but true. The photographer said, "Try to put more softness in your eyes", since I clearly was forbidden to smile--now that we are all suspect if we look pleasant & happy.

Unfortunately, I don't think, unless you're a trained model, that looking pleasant while forcing a solemn expression somewhere between grim and unhappy, can do the trick. Oh well, at least it's done and I can get on with the next step in the process...

Now I just need to find my birth certificate. Where did I put that thing???

Learned Helplessness

There seems to be a culture of letting the experts make the decisions in healthcare... and it's to the detriment of the critical thinking skills nurses have learned and developed in their educational and experiential programs. I recall Seligman's idea of "Learned Helplessness" as a theory that explained how people seem to give up/allow others to make decisions. Although a good portion of this is in relation to depression, it also applies to how people learn from others who model the behaviour.

Nurses generally work in groups and my observation is that the "new" nurses to the unit want to fit in, and want to develop a style that is congruent with the overall style of the unit (often not an official style, but the way the natural leaders of the unit behave). If it's the norm to defer to the expertise of others, then that's the way it works. While this is fine if the nursing knowledge might actually be limited, I find it puzzling that for chronic wound care, nurses will wait for the MD to write orders before even looking at the wound.

This strikes me as odd, since nurses need to assess the whole patient in order to identify nursing-relevant plans of care & to wait for the doctor to open/assess the wound implies that the nurse can't do this him/herself. Last time I checked, this was within the realm of practice of nurses (in Ontario, anyway). So, why not do it?

I think it's that sense of not really knowing what to do...that someone else has more expertise--even when they actually don't, or when the nurse does have enough knowledge to figure out what might be an appropriate treatment (unless it's a particularly complex situation). But I've had nurses say to me that they "need" an order for a chronic wound dressing, as if they are unable to make observations and suggestions themselves.

Not that I'm trying to work my way out of a job (although that would be gratifying, if every nurse knew what needed to be done, and felt comfortable/confident to do it, for those garden-variety chronic wounds). And I guess, if we could get over the feeling that somehow we just aren't quite capable...

certificates and certification

It's interesting that every  workshop I attend-- whether it's a couple of hours or a couple of days in length-- has a "Certificate of Attendance" (often pretty fancy, with my name in caligraphic font) that I could hang on my wall.

I also provide these for my Wound Care Made Simple workshops, because people can keep these as reminders for their College of Nurses self-assessment, or for their institution's performance review. But I always tell people it's a Certificate of ATTENDANCE, not for any kind of certification. Just means you've been there, warming a seat (hopefully learning something too, but since there's no test, who really knows!). I have heard people say that they have been "certified" by attending some workshop or conference, and that's a bit scary.

Certification means something else: an approved (by an academic/regulatory body, like a College or University) program with a standardized method of evaluation.

So, much as those "Certificates of Attendance" can be quite beautiful to display on the wall, they merely indicate you've been to something. And maybe learned something... : )

I had to change my title...

I was going to write something fairly long about how I had to make sure my academic credentials wouldn't possibly lead to confusion. But I worry that these sorts of things get out of hand, and just cause more anxiety. So, suffice to say, I now have "Tertiary Care Nurse Practitioner Certificate (UWO, 1998)" after my other academic credentials.

I used to joke that I wanted more letters AFTER my name than my name. Hmm. I've succeeded now, for sure. But the point for me is that I earned those credentials & I don't want someone to think because I now have to spell out the whole thing, I'll just give up and go away. Definitely not my style.