Thursday, October 25, 2007

One Tin Cowgirl......


There won't be any trumpets blowing

Come the judgement day,

On the bloody morning after....

One tin soldier rides away.


("One Tin Soldier", Lambert-Potter)


Sometimes, as life goes about its way of lulling one into the habitual trek of "going with the flow", there comes a time when one has to.....

Make a stand for "what's right".

And let me tell you, in my humble opinion, "doing the right thing" is not always the easiest way to go. Especially for me, since, being a recovering alcoholic--- with my biker chick past--- I have not always exemplified one who is by any means "perfect", noble, or "solid gold" by any means.

I am actually quite a "tarnished" person, if you'll allow me to put it in that generous understatement. I have "done wrong" plenty of times in my life. I have lied. I have cheated. I have done pretty much every sin there is to commit.

But....I have tried many times, with the help of The Lord and the program of AA, to pick myself up off the floor after each of my life's seemingly unending series of ongoing debacles, and dust myself off and go onwards again----and try to do better. I have tried, time and time again, to better myself in order to serve those around me.

Although I don't normally "preach" on my blog, I will tell you that I have, many times, attempted, while working within my own AA "program", to perform at least a tad and tiny bit of one of AA's main goals----which is to make myself of maximum service to those around me----but doing such, this time, will definitely affect my employment... it is.

I was tested-----quite severely-----this week. And it would have been so damn frigging easy to take the easy way out...

Aaaah..... so help me, taking the easy way out would have made things so much more convenient for me. Shit, it would have enabled me to stay much more secure in my job. It would have garnered me a lot more leeway, responsibility, and privilege from my company's owners. And it would most certainly have saved me from a huge amount of "job stress".

But....and I don't quite know how it happened.....something happened in my heart. Something suddenly occurred which caused an overwhelmingly strong and uncomfortable set of emotions to rise up into my gorge which I simply couldn't ignore---NO not anymore! more!

And so I took a stand.

And it was a line drawn in the sand that, once drawn, can never be un-drawn.

And it has made my life vastly more complicated and precarious with the relationship I hold with the owners of my company. So complicated, in fact, that I cannot even bring myself to get my brains together in order to write it here now. I'm not quite able to describe it yet---or my future plans.

But I can tell you the reasons for WHY I did what I did.

I did it for:

1) For friendship. I did it for my friendships with my co-workers--- my two best friends in the entire world, Bonnie and Belinda.

2) Also, I did it because I PROMISED them I would do such. I promised them.

3) And, okay, I also did it because I knew, without a shadow of a dang doubt, that these two gentle and loving souls are so inherently kind and non-aggressive that they would simply continue to allow themselves to get stomped on, tricked, lied to, and taken advantage of FOREVER---- NEVER having the street-cruel ability or meanness of heart to fight any sort of this type of battle for themselves in the vicious, take-no-prisoners way that I am able to fight. No...not they....

4) And, yes, okay, ALRIGHT....I also did it because it was the "right" damn thing to do. (God dang it, I sound like stupid ole Wilford Brimley in an oatmeal commercial here---or whatever his name is...) (And I want to say the F-word, but I won't.)

And once the quite unexpected fight was begun, I continued to stand firm---- and I aimed my truth-arrows straight and true, never faltering or wavering as I voiced my knowledge of the ugly tricks and frauds which my company furiously attempts to hide---strangely calm and strong in my outside facade, even though I felt weak and bruised on the inside----while never knowing (until it was all over) that the strength I had found for the hurtful battle was not even my own. I had absolutely no idea at the time that I was fighting the battle using strength which came, like the Psalm in the Bible says, from "lifting mine eyes unto the hills, from whence cometh my strength---my strength cometh from the Lord."

Yes, the strength for the battle of wits came to me. Unexpectedly. And when the ensuing dust settled, and I realized that I was weakened and distracted, I conjured up an excuse for a few days off from work and fled to my mother's house, over an hour's drive away from Podunk. Once there, in the safety of my mother's home, I told her and my AA sponsor of what happened. And I have been there since, licking my wounds----while preparing myself for the upcoming employment difficulties I have made for myself.

But I do not regret one single word or action. And furthermore, I don't take credit for one single winning thrust or parry in the verbal fencing battle I entered.

For I know---I KNOW, without a shadow of a doubt, that my foe battled not me......but a Greater Power.

* * * * * *

Meanwhile, today, my mother and I did something especially pleasant. We took a drive a couple hours away to a "bigger town", a town which has a shop which sells......yarn!!! Yarn! The calming force of Bo. The balm to soothe the tattered shreds of my war-weary body. The lilting melody of a song of hope for a moment of beauty within the frequently shattered shards of the glass-like fragility of my existence....

And so I bought myself two hanks of some lovely, soft, luxurious, hand-painted yarn by Schaefer called "Anne". I began knitting a shawl with it----a simple, triangular, garter stitch shawl---with a Skacel Turbo Lace circular needle. T'was the Yarn Harlot who inspired me. And although my simple garter stitch will never be as gorgeous as the beautiful lace stitch patterns in her shawls, it is my first attempt at a shawl---and so I know that I must start with a simple enough pattern that I can knit in the evenings after work, in my distracted way of knitting whenever I am "stressed out" by the day's events---in an attempt to calm myself with the comforting feel of the wonderful, gossamer-like, lithe texture of such a beautiful yarn......


When I return to my Podunk apartment, I will gather my wits about me (after this "re-grouping" at my mother's house)----and tell you about my sad little try at making a tragic attempt at bettering the lives of myself and my co-workers----- all while knowing ahead of time that my tiny battle would become uselessly and anonymously entangled within the corruption and dishonesty which personifies the viselike and unendingly adhesive grip on which the world of road nurse companies have upon the Medicare Dollar. And furthermore, I know that my sad little David-Against-Goliath stand will be lost and uselessly irrelevant against the overwhelmingly bad odds of my being just a small, insignificant person adrift in a gigantic world of unjust business/employer practices.

But, so help me GOD---- it will be the LAST damn time that one particular person attempts to best me in such a battle of the wits ----and THIS I know for sure.... *

Wednesday, October 17, 2007

An Announcement From the Message Goat




I SAID ahem!


Ladies and Gentlemen, this is your Message Goat speaking.

And I have an announcement to make about The Bohemian Road Nurse who, in her usual madcap, bizarre, and overly dramatic fashion, reported to me this afternoon the utterly ridiculous statement: "Goat, ole buddy, this has been the damnedest week I ever did see...."

And then Bo (whom I usually don't allow to address me in such an undignified fashion as "Goat, ole buddy") proceeded to ask me to beg your forgiveness for not posting in the last few days--- but she wanted me to assure everybody that she will post very soon--- just as soon as (as she terms it) "the dust settles", whereby she will then "set the record straight on a few things". She politely asks that people try not to listen to, form any judgements about, or even believe one iota of what she calls "idle gossip by the town's most Tongue-Wagging Nosey Parkers" until she has an adequate chance to "explain everything" .

That said, and although I'm really not supposed to give you any details, I will let go of a couple of tidbits I was able to glean from the Podunk Livestock Grapevine about Bo's rather.... shall we say troublesome? .... week.

Now, while it is definitely true that Bo dealt with many honestly difficult situations this week, among them The Great 2007 Battle of the Road Nurses---- and, also, Bo's obsessively compulsive adherence to her new diabetic diet regimen---- it seemed that no matter what she did or where she went, continued to make a complete ass of herself (with apologies to the Donkey Corps.)

But among the week's highlights was one positive fact----that in which Bo was able to "perfect" her compliance with the new diabetic diet----in which I am willing to concede that I am truly amazed that such a small, wiry little idgit like Bo could actually survive and flourish on less lettuce and tomatoes than do the rabbits in Podunk's East Sector.

But, as usual, Bo always seems to have difficulties whenever it comes to doing something new in a quiet fashion--- or else with even one modicum of the Southern Ladylike Dignity in which she was raised.....

Because, Ladies and Gentlemen, there were multiple sightings of Bo muttering vile obscenities outloud to herself in Walmart while reading food packaging labels' information regarding "Total Grams of Carbs".

And also, there were many reports whereby local people swore that they witnessed a weirdly gleeful Bo tossing her unkempt blonde hair while laughing like an evil madman--- as she scribbled with zestful fury the results of her 6-times per day glucometer blood-sugar checks into a log book----all whilst verbalizing strange utterances such as: "I'll fix my doctor's little red wagon, oh Yes-Sir-ee-Bob! Because when that pompous ole fart see's THIS frigging 14-day average, he'll probably pee his fancy white doctor pants!"

And although, Ladies and Gentlemen, I would really like to tell you that the above behaviors were the ONLY "less attractive" aspects of Bo's.....uh.... "bad week" .....I simply cannot bring myself to lie to such longtime, trusted friends.

And so, with great reluctance, I must tell you...... that the mushroom cloud you may have noticed last Monday night over Podunk was NOT the result of a thermo-nuclear war....

...nor was it an explosion of the local chicken processing plant.... was Bo.

Sigh. I was informed by one of my never-fail sources (a rogue hefer tattler employed by the esteemed tabloid publication "Enquiring Cattle Want To Know" ) that Bo was caught dead-eye, red-handed, in the actual ACT----by her AA sponsor and THREE other fellow AA clubmembers, of all people----

---of losing her famous temper in Walmart! event which the management of Walmart is not likely to forget anytime soon since it was the first time in Podunk history that a Walmart customer-rebellion was carried out in bilingual fashion, since there was the presence of a large, multi-family crowd of Bo's Mexican patients--- all of whom proceeded to cheerfully, good-naturedly, and enthusiastically yell "Ole!" after every LOUD expletive and hotly angry declaration of Bo's.... uh... tirade.

But remember, YOU DIDN'T HEAR IT FROM ME, okay??

Anyway, Bo has since been noticed shamefully attempting to lurk quietly within the shadows of Podunk in order to avoid being noticed. She has also been seen using the back roads to her destinations in Belinda's SUV, most likely in a vain attempt to avoid being seen on the town's more populated roads, probably hoping that the brou-ha-ha of her misadventures this week will soon die down. In fact, I overheard her whispering to Minnie-The-Paint-Pony something to the effect of:

"So what can stupid Walmart do about it, dammit? Ban me? Hell, I've done worse than that during a Sunday-After-Church-Lets-Out rush. But I must admit that Friday can't get here soon enough. In fact, the only good thing that happened during this whole godforsaken week is that I actually got a skein of Opal sock yarn to knit out into a green and black leopard print, HEH! And I'm gonna go show it to those stupid sheep over in West Sector and tell 'em 'just think, guys----if you'd eat like I do, you TOO could put out wool like this!'"


And so, Ladies and Gentlemen, that is all the news I have for you tonight. As usual, refreshments will be served in the back pasture.

Goodnight to all.


Wednesday, October 10, 2007

Like The Sand In An Hourglass, So Are The Days In Which I Flip Out....

All the days became so long,

Did you really think I'd do you wrong?

* ("Baby Blue", Badfinger)

* *

Did you ever have one of those weeks when you felt like you couldn't please anybody no matter how hard you tried?

That's how my week has gone......and I lost my cool today. I hate to admit this to you----but I threw a flat-out hissy fit, bawling my eyes out and my two best friends in the world, Bonnie and Belinda.

And what's worse, I did it at the end of the work-day----and now I'm at home, cowering in the aftermath of this ugly episode by not answering my cell phone, which is ringing off the wall with both calls and text-messages.

I know that sounds immature and childish of me---- but hear me out. Because I feel that I'm entitled to this little interlude. Tell me if you think I'm wrong, but I think I deserve this evening of peace and quiet from the day's events, which hurt my feelings pretty badly.

And what really hurts me is that I think that Bonnie and Belinda forgot something very important. Which is, okay, yes, I'm the "boss"---but it's not like I'm some omnipotent and cruel "ruler" who gets to have everything my way while living a carefree life of bossing people around at a whim without any regard for their feelings. I, too, have bosses to answer to----the owners of the company. And so I try to please those company owners.

But I also desperately try to please my friends----Bonnie, Belinda, and my secretary.....

Because only too well do I remember how it was when Bonnie, Belinda and I all used to work at that slave-driving competitor company up the road----and how very miserable it was. And so I've always tried very hard to make things better for us at this current company.

And usually I succeed.

But this week went to hell in a handbasket from Day One. It started when a patient burst through the office's front door and threw (literally threw!) a piece of paper down on my desk and hollered at me to "fix it".

It was a problem with his diabetic supply company, which was late in delivering his diabetic supplies. And it was a simple "red-tape" problem which I had already told him repeatedly that I would take care of. I had also repeatedly told him that if his supplies were delayed that I'd simply GIVE HIM all the necessary supplies he'd need until his order arrived. But he came barrelling into the office to rant and rave to me, and I innocently sat there listening to him vent steam about the whole thing all over again for a solid hour. So I phoned the company and got for him the exact shipping date of his supplies. And then, to my astonishment....he admitted that he DID have enough supplies to last him for the next three months--- but that it was the "point of the whole dadblasted thing" that had made him so angry. And then, as I sat there in speechless shock after his tirade, he stomped out of our office, still grumbling to himself.

Next, our company owner phoned me up to tell me that Jane-Anne is most likely not going to return to our company after her maternity leave. Jane-Anne is considering working two sixteen-hour shifts on the weekends (at a nursing home or somewhere) so that she can stay home with her baby the rest of the week.

And the owner also declared that she feels that our office can operate perfectly well without Jane-Anne----and so she has decided NOT to hire another LVN in Jane-Anne's place.

Immediately upon my informing everybody of that news, Belinda and Bonnie began bitching their heads off at me because, as they stated loudly, they don't want to have to endure being "on-call" every three weeks like we've been doing ever since my absence in July and then both Belinda's and Jane-Anne's maternity leave absences later on. They both stated quite emphatically and resentfully that they each have children and husbands to take care of, and that being on-call that often is causing a strain on their family lives, which I believe is a very valid concern.

And so I told them both the same thing that I've been telling them over and over in case just such a situation occurred----that I'll simply tell the owners that I'll take over Jane-Anne's week of on-call, as well as my own, so that Bonnie and Belinda can go back to only having to be on-call once every four weeks, which was what I had promised when I hired them. I don't mind taking the extra week of on-call because I live by the hospital and don't have a husband or children to consider.

But then, as the two of them began calculating the implications of the disappointing prospect of our office losing a full-time LVN, they started their bitching again---this time more angrily than before. Because, they had quickly figured out, by our office losing that extra "buffer" nurse, it means that we will no longer have any "leeway" in case anybody needs to take time off for "personal days" or sick time.

So, again, I repeated to them the exact same thing which I've been telling them over and over again about just what I would do if such a situation as this arose----that I would then have a serious talk with the owners about allowing me to hire a part-time nurse, an "as-needed" nurse who could work periodically on a "per visit" pay-rate on those days when a full-time nurse needed a day off or called in sick. I even suggested a few of the experienced road nurses I knew around town whom I stated that I'd try to contact to ask if they would be interested in such an arrangement. (Many road nurses in Podunk don't want to work full-time but frequently can be persuaded to consider earning extra money by doing a few visits on a part-time basis---if the price is right.)

But then Bonnie and Belinda immediately poo-pooed my suggestions of certain nurses, stating: "I don't like her---she's lazy" or "I don't like her---she's crazy and undependable" or else: "I don't like her because [fill in the blank]...."

And things continued to go downhill....and futher downhill....and even further downhill.....

Because I next got a call from a retirement community manager asking me if I'd like to take on a new patient with multiple wounds. And since I've been kissing that manager's ass for weeks, begging her to give us new patients like the company's owners are constantly on my back to do, I jumped at her offer and told her that we'd be only too happy to take this new patient. And not only that, but instead of putting that extra visit onto Belinda like I should have (since she's the main Field RN), I had mercy on her and went to do the visit myself--- which took several hours because the first "admitting visit" is always time-consuming in order for the nurse to gather all the information necessary to open the case. And this particular admitting visit took even longer because I also had to take extra time to thoroughly examine the patient's multiple wounds in order to figure out the proper wound care and wound care products we'd need for this man.

And then, when I returned to the office, Belinda and Bonnie began a NEW round of re-harping and bitching about me taking on a "wound care patient"! ----because wound care patients can be a hassle. It means that the patient might need daily visits----which unfortunately means that the on-call nurse will have to see that person on the weekends. (Is there such a word as "re-harping"????) (If not, I just made it one.)

As Belinda bitched, I realized that she had conveniently forgotten that I had not only saved her from having to perform that lengthy visit, but that I'd also taken on one of her other visits today in order that she would be able to have ample time enough to do her breast-milk-pumping, since she's regularly pumping her own milk for her new baby.

Later in the day, I braved a request to Belinda and asked if she could make her visit to a certain patient at around or after 2:30 pm due to the patient having a doctor's appointment in the earlier part of the day. Belinda then proceeded to snap rudely to me: "I'M SORRY---BUT I HAVE TO PUMP MY BREASTS AT 2:30!"

It hurt me that she made that statement in such an ugly tone because I most certainly hadn't meant for her to NOT pump her breasts at the right time. I mean, what was she thinking? That I expected her to NOT pump? But, trying to calm the atmosphere down, I apologized to her for the misunderstanding and said that I had only meant "as near after 2:30 pm as possible" and that of course she could do the visit around her breast-pumping schedule---or else I could always do the visit myself if she couldn't. Sheesh--by now I was beginning to think that I was in the Twilight Zone of Grouchy Road Nurses....

The horrible day wore on. Sometime in the afternoon, I finished up a telephone report to Adult Protective Services about a helpless, weak, and confused 95 year old patient with Alzheimer's Disease and multiple bed sores. I had reported this case to APS because the patient's son leaves the poor woman locked in an apartment alone most of the time--- where she lies soaked in her own poop and pee for so long that inflammed blisters are forming on her buttocks and all the way up to her waistline. And, to my further horror and sadness, neither I nor any of the other nurses have ever witnessed anyone feeding her, offering her fluids, or changing her poop and pee-soaked clothing and bed-sheets on any of our visits. And, in my efforts to keep tabs on her son's "care" of this poor lady, I ruefully began to realize that my suspicions were probably true in that neither the patient's son nor his "helpers" (who are employed by a local State agency) have ever visited the woman often enough to adequately feed her, change her pee-soaked clothing and bed-sheets, offer her adequate fluids, or take any kind of safety measures to prevent the bruises and sores she frequently gets when, in her confusion and fear, she attempts to climb out over the bed's siderails--- and gets herself dangerously tangled up in those side-rails, causing bruising on her feet and legs in the process. And on many of our scheduled days to visit her, we are unable to reach anyone by phone or else get into the patient's apartment, since the door is kept locked.

When I got off the phone with the Adult Protective Services social worker (who plans to take a second worker with her to photograph the patient's squalid conditions and wounds, in an effort to force the son to make arrangements for his mother to be placed in a nursing home or other safe environment), Bonnie did something she's never done to me in all the time I've known her.

She yelled at me.


I was shocked. First of all, because it is not our company's policy to document whether or not a patient's bed-sheets or diaper is wet or soiled when it is perfectly obvious that the pateint has caregivers performing those functions in an adequate fashion. And, at the time Bonnie was talking about, we were mistakenly under the impression that the patient's caregivers WERE taking appropriate care of that task. At that time, we were completely unaware that the caregivers from the State agency are NOT performing those tasks adequately and are, in fact, cheating on their time sheets. I checked with the agency they are employed with and found that they are writing down that they are present for so many hours a day when, in fact, they are NOT---and they are ACTUALLY only there for about 30 minutes, if that! And when I confronted the patient's son about this problem, he denied it all and said that the helpers WERE there at the appointed times.

(I know the above information about the helpers lying on their time sheets and how often they're present at the patient's apartment because..... I had gotten suspicious and began calling the residence every 30 minutes, round the clock, for a few days in a row in order to definitely prove just WHEN these so-called helpers are actually THERE or NOT THERE.)

Thus, Bonnie would not have gotten "in trouble" for failing to document a wet diaper or bed-sheets that day because, at that time, we truly believed the caregivers were performing these tasks adequately and that the patient just happened to be wet during our nursing visit that day.

I was shocked....and deeply hurt by Bonnie's outburst.

And, during all of the above incidents, one of the owners of the company kept phoning me to harp at me that the monthly census report was due, that I needed to make sure and document the report to the APS correctly, and that other things were due....blah blah blah.....

And then, Bonnie suddenly began griping at me again, this time about the fact that she only makes 50 cents an hour more than Jane-Anne, who is a rookie--- when Bonnie is an 8-year veteran and feels that she deserves much more than 50 cents an hour more than a rookie. I personally believe that Bonnie is entirely correct in this matter and I've told her repeatedly that when her "eval" comes due in November that I will aggressively lobby the owners to compensate her for this fact by giving her a substantial raise. But Bonnie exclaimed again, rather sarcastically and nastily, almost threateningly: "I had just BETTER get a DECENT RAISE in November!" And then, with those words ringing in my ears, she left the office for the day, earlier than quitting time as she was going to see a distant patient on her way home.

And then, with a somewhat substantial amount of trepidation (seeing as how the day was steadily going to the dogs) , I quietly asked Belinda if she minded doing an extra visit tomorrow on our new patient, the one I'd admitted today----since he would need wound care with the new products I had just then ordered by phone from our supplier. But Belinda immediately snapped that she "didn't have time". And then she threw in a sassy comment about how she was in a "bad mood" because she is the on-call this week.

This remark about how she hates being "on-call" irked me. Because Belinda knows fully well that I have to take the "RN-call" for the weekends that she is not the on-call. Because in road nursing, some visits can only be done by an RN. Which basically means that if any such visits are required on those weekends on which Bonnie, an LVN, is the "on call"--- then it will fall to me to perform such visits myself--- which is basically two out of every three weekends.

And about her refusing to do the visit tomorrow on the new patient..... Although I really don't have to go out on patient visits during the week if I don't want to, because I'm the Manager and can choose to stay in the office and make the other two perform all the necessary visits, I am not that type of Manager. Thus, I consistently take on a lot of their patient visits in order to lighten their loads and make their lives easier. And, in doing this, I consistently take flak from the owner of the company about it. She's worried that I'm "too easy"on Bonnie and Belinda. And she's also worried that, by my taking those visits, that I'll neglect my office paperwork. And she's also of the belief that I shouldn't have to do two jobs----that of the Manager and also that as a Field Nurse.

But my owner's nagging aside, Belinda's flippant and grouchy remarks were the last straws......and that was when I lost my cool.

And I really lost it.

To my utter mortification, I actually, started bawling my eyes out and screamed: WHY DOES EVERYBODY HATE ME? WHY ARE MY BEST FRIENDS IN THE WHOLE WIDE WORLD HARPING AND YELLING AT ME?


I mean, I couldn't believe it. All day long they had been giving me "attitude" about every little thing. They were acting as if they were the "slave martyrs" and I was the mean old "boss lady"!

I mean, GOLLY GEE! How in the hell can they think like that? HOW??????? Don't they know how much I care about them? I mean, all I've ever done since hiring them is to try and create an atmosphere whereby we three friends can work in peace and harmony----with nobody overworked and everybody having an equal say in how things are done----on a FRIENDSHIP basis!!! Because I have absolutely NEVER acted like I'm the "boss". I LOVE THESE GIRLS! They are my BEST FRIENDS!

I mean, their attitudes were like those we used to hold about our former slave-driving bosses at the old company, a place where we were treated like simple laborers. I mean, at that horrible company, we all fully believed that if we had ever dropped over dead in the field, the bosses would have simply stepped over our lifeless carcasses and gone on about their business without a care in the world.

So anyway, I ranted to a startled Belinda for awhile---- and I ranted at my bewildered secretary for awhile----all the time while bawling and boo-hooing my stupid eyes out. Belinda gave me a half-hearted apology about how she had simply been "in a bad mood" and was "under stress"----and that she'd call Bonnie to tell her that my feelings had been hurt when Bonnie yelled at me.....

But I just told her to forget it---- because I didn't want to talk about it anymore or cry about it anymore. And then I went home.

And here I sit, miserable, while not answering my ringing cell phone, even though both of them have been calling one after the other and text-messaging me to "please call".

And I'm not doing this to be an asshole. It's because I'm the type that needs to back off and "hide" for awhile to get over an outburst of crying. It's the only way I can lick my wounds and cope after such a display of embarassing and stupid behavior. Because if I talked while I'm still this hurt and upset, I'd be very fearful that I might say something ugly which I would greatly regret later. (And also, the crying would most definitely cause me a bad migraine headache.)

So now I'm home petting yarn skeins. Yarn skeins will never hurt me. They let me pet them and pet them......and they never complain or bitch at me.

God, I hope tomorrow is better.....



Tuesday, October 02, 2007

This Ain't My First Rodeo --- Or: "Please Press The Pound Key On Your Keyboard If You Don't Speak Texan"...


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!! 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.