Feeling like I ought to sleep,
Spinning room is sinking deep,
Searching for something to say,
Waiting for the break of day,
25 or 6 to 4....
("25 to 6 to 4", Chicago)
I've always said that bulls are the stubbornest of the barnyard animals in Podunk.
In fact, the picture up top is a prime example. Those two fat idgity bulls are a couple of the stubbornest and meanest bulls around. But rest assured, I sass them loudly and regularly from the window of my Jeep whenever I pass them. (And then I peel rubber getting the hell out of there...)
One thing about working in rural Texas is that a road nurse can encounter some extremely stubborn and strong-willed patients, too....
Now, stubbornness can actually be a useful personality trait. It can help a person who is ill triumph over the limitations their disease imposes. It can also help their family members get through the difficulties of caring for elderly, ill parents. And having a strong will can certainly help courageous patients endure their diseases' sometimes horrid treatments and/or highly uncomfortable medical procedures.
In my career, I've noticed that those patients who stubbornly fight for life while keeping a positive attitude generally do way better in the long run than those who simply give up and lose hope.
And thus, a large part of my job is to continually attempt to encourage my patients to use their stubbornness and strong wills for their own good in order to foster better results in the ultimate road nurse goal--- which is for them to gain knowledge and improved home management of their illnesses, their medicine regimes, and their medical treatments.
But there's a down side to patient stubbornness.
For example, I've had patients so stubborn that they simply refuse to believe that prescribed medication could help them since they "don't feel any symptoms" ----such as in the cases of those with high blood pressure, adult-onset diabetes, high cholesterol, or other "silent" killers which, although the patient may feel "fine", the disease is still simmering malignantly in such patient's body, merrily going about its way of doing great damage to that body.
I've also had patients who were so stubborn that they refused to "get with the times". I can't tell you how many times I've had a mule-headed old farmer say to me: "If it was good enough for my daddy, his daddy, and my great-great granddaddy---then it's good enough for me!" while using some old folk remedy that I know for certain won't do diddly squat to improve their health.
Nevermind that they're 80 years old and medical science has long since advanced beyond mustard poultices, "Black Ointment" , and garlic necklaces, ya know?
(Okay, I will admit that many old folk remedies work. For example, Podunk doctors believe that anybody with strep throat, a cold, pneumonia, or the flu should rub Vicks Vapo-Rub all over their feet and then cover them with thick socks before going to bed. Supposedly, if you do this, by morning the Vicks will have "pulled the fever out of you".)
(And, okay, but I happen to know that this is true because whenever my doctor nags me to do this, I wake up the next morning and feel fairly recovered from whatever ailment I'd experienced. I don't know why it works but it does, every dang time.)
But strong wills and folk remedies aside, every now and then I find a case of stubbornness so utterly and completely imbedded into a patient that it defies all reasonable logic.
But....we road nurses hold the belief that a patient has the right to decide on whether or not they're going to follow doctors' orders. And if we have educated the patient to the best of our ability, in order that they might make informed choices with the best available knowledge, then it is up to us to allow them their right to choose whether or not to follow such teachings. If they choose not to follow medical advice, we don't judge them negatively---we try to respect their wishes and continue to help them as much as we can within the realm of what they are willing to do.
But I will say one thing about being a road nurse in Podunk that's a little different than in other states.....
Around here, there are certain factors which can cause a road nurse to gain or lose the trust of a stubborn patient--- which naturally can affect that patient's willingness to follow medical advice.
For example, here in Texas, "upbringing", "where you're from", and "who your family is" are the first barriers a road nurse must overcome to get a stubborn old Podunk patient to listen to them. And next up is whether or not you have a Texan accent.
I know it sounds silly, but seriously----many of these country people simply don't trust "city folk" from out of the area, a person who was born north of the Mason-Dixon line--- and especially a person who "doesn't talk right" .
Fortunately for me, I meet the above... er....."qualifications". I can pass muster with even the most stalwart and staunchest local folk, whose families descend from those who settled the West in the 1800's, some of whom still seriously believe that the South Will Rise Again.
But I usually have no problem in this regard because I was born of a Texan father and a Louisianan mother.
And oh yes----I do have a distinct Texan accent.... an accent which I found (in order to make my life easier) I had to turn "off" during the years I attended a convent nursing school in... "The North" .
(Lord, I still remember the days on the hospital floor when, as a student nurse, I would temporarily forget myself and accidentally talk in a Texan accent, the usual result of which some comedian patient would mock me by saying something like: "Oh heh heh heh! You must be from SOUTH Pennsylvania!" )
(Worse yet, I lost my temper one Friday night when one of the house-mothers in the student dorm strongly "recommended" that I change my leopard-print partying pants to regular jeans before a date with a boyfriend---- and I sassily replied: "I ain't-a-gonna-do-it!" .....and one of the nuns overheard me. And she then made me write one thousand times: "I will be respectful to the housemother and speak proper English. I will be respectful to the housemother and speak proper English. I will....) (You get the picture.)
Where was I?
Oh yes, talking about how to deal with stubborn Podunkians.
(I did end up changing out of the damn pants and into some damn "regular jeans". And when my boyfriend arrived at the front desk to pick me up for the date, the housemother launched into a stern lecture to him about how I had been "about to leave the dorm dressed like a trollop" .)
(And I got into further trouble with the nun because I simply couldn't resist retorting to the housemother: "A trollop? What the hell is a trollop?--some kind of a Yankee candy? Like a lollipop with a chocolate truffle on top?" to which the housemother became so flustered and irate that she couldn't think up a decent retort.)
(And yes, I did receive a second punishment for that smart-aleck remark but by then I didn't give a crap because I felt pretty triumphant for "getting the last word" .) (Guess I'm pretty stubborn, too....)
Where was I? Oh yes....talking about how to deal with Podunkians.
Another thing about Podunk is that you simply can't talk to these people like you would in just any state of the USA. You've got to not only have the Texan accent, but you've got to talk "their language"----and you must speak it in that straight forward, rollicking, slang-filled style in which Texans are wont to dialogue.
(And if you can't remember any ear-curlin' good Texan slang expressions, simple cussing will suffice.) (The word "dammit" or any of its variations is fine----in fact, the word isn't even considered a cuss word anymore in Texas. Hell, even the preacher says the word "damn".) (And this is partially because of the phenomenon created by quick-thinking Podunkian children who have escaped quite a few whuppins' when accidentally overheard saying the word---because when caught, a clever child can simply blurt out: "How can you whup me for saying a word that's in every other chapter of the Bible?" , a logic for which no reasonable, old-fashioned, Bible-thumpin' Podunkian parent has ever been able to come up with a counter-logic for, since the kid's been schooled since birth to believe that every dang word in the Bible is completely sacred and holy.) (And the parent surely doesn't want to whup the child simply for being sassy because the damn kid just might just mention the whole thing to the preacher who, like I said, says the damn word himself.)
Anyway, here are a few "do's and don't's of how to talk to stubborn Texan patients:
Don't say: "Mr. Smith, I highly recommend that you take that Digoxin pill that the doctor ordered for your heart. It is a pill which will regulate your heart beat while allowing the heart to beat more effectively."
The better thing to say is: "Mr. Smith---now listen here, dammit---because if you don't take your stupid heart pill your heart is gonna beat itself flat to death and you'll probably croak within 5 years. And I know you don't want to leave your poor wife a wider-woman--- because if you did, then just who in the hell will take care of the farm?"
You see, Texans understand and respect this kind of talk.
Here's some more examples:
Don't say: "Now Mrs. Renfrow, I know you don't think it's important to take your Coumadin, an anti-coagulant medication which will lower the risk of a blood clot embolism breaking away from your heart atrium only to travel through your blood stream and cause you to have a stroke or a heart attack----but I'd like to advise you that it IS very important to take this medication because the doctor wants you to take it so that those negative events don't occur."
What you should say is this (after sighing heavily while rolling your eyes): "Mrs. Renfro, honey-pie---you know dang well that I can tell when you're fibbin'. So it's just best that you go ahead and 'fess up about whether or not you're taking that dang Coumadin--- because I'm about to do a blood test on you which will tell me EXACTLY how much Coumadin you've been taking, dear heart."
And don't say: "Mr. Calloway, I noticed when I arrived that you were eating Keebler's chocolate-covered shortbread cookies just now, and I simply must remind you that the eating of such concentrated sweets is not on your prescribed diabetic diet and will cause your blood sugar to elevate above normal levels."
Instead say (while shaking your head in a disappinted fashion) : "Mr. Calloway, Mr. Calloway, oh my, oh my. You know dang well that you're not supposed to have them cookies. I bet you've been sneaking them thangs every Thursday when your wife goes Big Grocery Shopping. And if she knew you were doing this she'd skin you alive. Now just what are you going to do to prevent me from tattling on you?"
And if Mr. Calloway gets sassy and replies: "Well she won't believe you, Bo--because I'll fix your little red wagon, by golly! Later on I'll just give myself an extra pop of insulin so that my evening blood sugar'll look like I'm following my diet just fine and dandy! She'll never know the difference, heh!"
You must then reply, using your best Texan Poker Face: "That's just fine (pronounced "faaahn" in a Texan accent) , but I happen to know that on your next doctor visit he'll perform a blood test on you called the 'HGA1C'---- a test which will show just exactly what your average daily blood sugar has been for the last THREE months. And your wife will be sitting right there beside ya--- right smack dab in front of the doctor, too---when the doc tells y'all the results of that test! And I know durn well that you didn't remember to take that 'extra pop' of insulin every durn day for the last 3 months, heh!"
I know the above tactics probably make us Podunk road nurses appear to be mean and nasty but, actually, verbal sparring with stubborn Podunk patients is what they expect. In fact, they'd get hurt feelings if you didn't nag and "harp" at them.
(Hickese translation: The verb "to harp" isn't in the Webster's Dictionary but it means to nag and complain to the point that the one being harped at wants to put their fingers in their ears to shut out the noise.)
In Podunk,Texas, "harping" to a loved one about their physical condition is considered a sign of endearment. If you didn't harp at them, they'd think you didn't love them.
And then there's the most difficult of cases. Those who are so stubborn and set in their ways that harping only makes it worse.
In fact, I came across one of these cases just this week....
(And, like what always happens in the road nursing field--- just when I think I've seen everything, there comes a new situation which defies logic....)
Now, understand me, I'm not laughing AT the man. But I definitely believe that he learned a hard lesson about the negative aspects of being stubborn.
Okay, here goes. I'll tell you the story of the stubbornest patient I've ever had. And believe me, he's paying for this sin as we speak.
It happened last Saturday when one of our local paramedics called me.
"Bo, I've got a patient for ya," he said lazily. "I saw him and thought to myself 'now there's a real good patient for Bo's company'..."
"Oh hell, Jimmy-Joe," I replied sassily. "How'd you find me a patient while you were sitting on your lazy butt down there at the Medic's Garage? And don't act like you're all generous-like. Because you and I both know that you want that referral fee for getting us a new patient."
"No, really, Bo," he said, feigning sincerity---but there was no mistaking the mischievious tone in his voice. "I thought of you specifically when I saw this guy. He's going to need a road nurse something awful."
(Hickese translation: The phrase "something awful", when said in this context, means "really badly", as in 'he's going to need a road nurse really badly'.)
(In fact, if you want to bone up on your Texan slang, here's a musical site which will bring you up to par in two shakes of a lamb's tail...)
Anyway, Jimmy-Joe gave me the phone number of the patient and so I called the guy. The phone was answered by the patient's wife.
"Is this Mrs. Hickock?" I asked politely.
"Yes," she affirmed angrily. "Are you the road nurse that Jimmy-Joe said would come take care of my husband?"
"Yes ma'am," I replied. "Providing I can get his doctor's permission, we would be happy to have him as a patient. So.... uh... could you just tell me a little bit about why y'all need a home health nurse?"
"My husband got some sores on his butt," she stated in a disgusted tone. "And the doctor's done already seen 'em and given permission for y'all to come take care of 'em."
"Okay," I replied amiably. "But first I'll need a little information so that I can get specific orders from your husband's doctor in order for me to come out and get him signed up. So... can you tell me how he got these sores?"
I figured they were just your average, every day bed sores, called "decubitus ulcers" in road nurse talk. They are common among weak patients who are confined to their bed. Our goal as road nurses is to help heal them and then teach the patients and their families techniques to prevent them in the future.
And then Mrs. Hickock began telling me the whole long story....
"Well, it happened Thursday afternoon," she started. "He's been purty weak for a long time---lung cancer and everything else---and he's been complaining to High Heaven that he can't hardly lift himself up off the commode after he sits on the pot. You see, our johnny pot is one of them old ones that's pretty low to the floor."
"Okay," I murmured absent-mindedly, jotting down the things she said as I swigged on a Diet Dr. Pepper.
I figured the guy's weakness was causing him to lie in bed a lot of the time, thus risking the formation of decubitus ulcers (also called pressure sores) on his body's bony prominences--- like the bottom of the spine (the sacral area) or his heels and elbows. This kind of wound care is right up a road nurse's alley since we do it quite often and my company keeps a good stock of effective wound care products.
So far so good....
And then Mrs. Hickock continued her story.
"But he made me so mad because he was such a STUBBORN OLD MULE!" she exclaimed suddenly---and loudly, as if she wanted Mr. Hickock to be sure and hear this statement from wherever he was in the background. "I'll swoney if that man is so damn stubborn that I truly believe that if I told him to die he'd live just to be contrary! "
(Hickese translation: The expression "I'll swoney" means "I swear".)
"Okay, okay," I responded gently. I could sense that she was very angry and I wanted to exhibit a calm and understanding concern. And then onward I plunged. "So when and where did he get the sores?"
"Well, like I said, it happened last Thursday," she replied. "He got up out of the bed to use the pot--but then he wouldn't come out of the bathroom! I thought he'd drowned or something---or else I figured he was wasting time reading a stupid magazine like men will do when they're on the pot---you know how that goes, nurse. Anyway, so I opened the bathroom door a crack to tell him to hurry the hell up because supper was ready."
"And?" I urged.
I was getting a little confused---and impatient. I was wondering what in the hell the fact that he'd gotten out of bed to use the toilet had to do with getting sores on his skin.
"Anyway," she stated, "I kept harpin' and harpin' at him to get off the damn pot! But then he started argee-in' with me that he couldn't get up off the dang thing!"
(Hickese translation: The word "argee-in'" is the Podunkian equivalent of the word 'arguing'.)
Now I was getting a little more impatient. What on earth would an everyday husband and wife argument have to do with skin sores? And furthermore, everybody in the State of Texas knows that ALL men sit on the pot FOREVER because they're usually reading a hunting magazine, The Reader's Digest, or the newspaper. No big deal.
I mean, by now I wanted to scream Lord Jesus!---let the poor man take a DUMP in peace for God's sakes!
But then she made a strange statement.
"Do you know, but he sat on that pot for four hours," she stated, to my startled and shocked silence. "And I finally told him that I just couldn't lift him up off that pot because of my bad back. And so if he couldn't get off the pot himself, I'd have to call the Fire Department to come get him up--- just like they did when old man Winnaker tumped himself out of his wheelchair and HIS wife couldn't get him up."
(Hickese translation: the expression "tumped out" means "fell out of" or "fell off of".)
Suddenly I was fascinated with the story----and curious as hell to hear the ending.
"So did you call the Fire Department?" I asked eagerly.
Because what she said was true. In Podunk, when a person who is elderly, ill, or weak falls to the floor and cannot be successfully lifted back up into bed by a family member, the Fire Department is only too happy to send a few of their EMT medics out to do it. They don't mind a bit and there's no charge for it. I've even seen the Sheriff himself come out to pick somebody up off the floor after a "tump".
"I wanted to call 'em," she continued, "But that stubborn old mule WOULDN'T LET ME! He said he was 'too embarassed', if you can imagine that!"
"Huh?" I asked in disbelief. "He wouldn't let you call the Fire Department? So what did he do---just keep on SITTING THERE?"
"Yes, ma'am, he did!" she retorted with a disgusted snort. "That DODO-BIRD refused to allow me to call for help---and so I let him just SIT THERE, by Jingo!"
"Uh.... so then what happened?" I asked with a growing dread---because I was suddenly remembering the mischevious tone that I'd heard in Jimmy-Joe's voice...
"I decided to leave him there and stop harpin' at him," Mrs. Hickock declared with a self-satisfied calmness in her voice. "I wanted to see just how damn long he'd sit there."
I waited a moment to allow her to finish up the story and tell me when she was finally able to call the Fire Department to get Mr. Hickock up off the pot. But she just sat there on the phone, silent, apparently waiting for ME to guess at the ending of the story. And so, hesitatingly, I ventured a question...
"So...uh... let me get this straight," I stated haltingly. "He sat down on the commode on Thursday. And...uh... so just WHEN did you finally call the Fire Department to get him up off of it?"
Yes.... she really said Saturday!! ....as I almost fell out of my chair while simultaneously choking on my Diet Dr. Pepper. THAT POOR GUY HAD SAT ON THAT DANG POT FOR THREE DANG DAYS!!!!!!
"And now he's got sores all along the back of his thighs and his butt," she continued. "In fact, all them sores are lined up and around his butt in kind of a horseshoe shape----the shape of our commode seat. And it's his own damn prideful fault, too, if you ask me."
"Oh, Lord have mercy..." I replied weakly, still in shock. "So THAT'S how he got those pressure sores...."
* * * * * * *
Although I was tempted to call Jimmy-Joe and give him a piece of my mind for not warning me of the strangeness of this situation, I didn't. First, I was glad for the patient referral, however bizaare the reason. And also, Jimmy-Joe once gave me a very expensive stethoscope when I lost the crappy one I'd gotten free from a drug company rep.
And so, I guess the moral of the story is......
Aah hell, I don't have a dang moral to the story.