Sunday, April 17, 2011

Another Day

So last Tuesday I walked into Celilo Cancer Center about 20 minutes late (due to my own difficulty getting out my door in a timely fashion, plus major construction on the one and only road which everyone who wants to go to or from the Center must use).  Suffice it to say sister Lori and I were both a little stressed upon our arrival.

I try to get a receptionists' attention.   They are both busy.

A young woman pops out of the Chemo Room and says,  Althena?

Althea? I counter.

Oh, I'm sorry, she says.

That's okay, I say, It's only my name...

Oh, I know,  she says. It is only your whole identity I am messing up! 

I leave it at that, because my point was actually that my name is NOT my identity, but she was not taking it that way plus I am feeling a little growly and I don't trust myself to explain with out digging us both in any deeper.

This awkward start might have served as a sign that I needed to slow down and open up. But it did not.

(Turns out this gal was a volunteer taking lunch orders for Infusion patients.  I've never understood why you'd wanna eat hospital food if you did not have to-- or why you'd serve it to a room full of chemo patients who can be extremely sensitive to food smells.  But hey, that's me.  Some folks seem happy to slurp up the ol' split pea...)

When I get the receptionist's attention, I tell her I am running late, and I am here to do labs and see Nina, and I am not sure which they want me to do first.

Well, I'll just let them both know that you are here and we'll see comes out to get you first.

Labs wins the race and I follow them back to their area-- which is just inside the Chemo (or Infusion) Room.  The north wall of the room has three bays or nooks, each separated from the others by a shallow wall but open to the larger room.  There is a nurses station in the southwest quadrant and multiple lounge chairs for Infusion along the big glass windows facing east.  The first bay as you enter the Chemo room is where they draw blood-- which is what is meant by "doing labs".  Still with me?  Good.  SO.

I am motioned to a chair in the Lab nook.  The woman (I would have called her a nurse, which I now know she is not-- she is a phlebotomist, ie,  a person who draws blood) seems a bit flustered.  The phone is ringing, she's asking me about some new orders (ie,  tests to be done with my blood) which do not go into effect until next month. She answers the phone.  I sort out my ipod while she deals with the call.  When she turns her attention back to me, she asks again about my new orders, and if I am "hard stick."  I acknowledge that I am and tell her that my preferred method is to plug in my ipod and look out the window while she does her thing.  I do not stop everything and make her go eyeball to eyeball with me and I do not I give her my whole spiel.

(Oh!  Maybe I haven't shared the story of My Whole Spiel with you out there in blog-land:  The last  couple of times my blood's been drawn, I've made a point of taking maybe 20 seconds to make eye contact with the entity on the other end of the needle-- person-to-person contact--  and saying out loud that I recognize that this is a difficult situation for both of us, that I know they are doing their best, and that closing my eyes or looking out the window, focusing on my breath with my ipod in my ears is just my way of coping-- it doesn't mean I am mad at them or upset about anything.  I admit it can be a tiny bit awkward--I suspect because it's an unusual or unexpected exchange to have with a patient-- but it's made a big difference in the quality of my experience.)

So, you might think I would employ it now, yes?   Uh, no.  Somehow, I get the idea that she's already hip to the situation.  Medical staff-- like the rest of us-- put a premium on appearing competent and on top of things -- after all you are trusting them with your health.  It is part of their professional demeanor.  Breaking through that with out seeming to question their competency can be tricky to maneuver.  And let's face it, I am still feeling a bit flustered myself.  So-- to be clear--  I do not take the time to fully connect with her and encourage her to take the time to connect with me.

When I emerge from my window-gazing, ipod-listening daze,  she is slipping the needle out of my arm.

Whoa, wait, I say.  I am supposed to get an IV!  That's the whole deal-- I am a difficult stick, that is why I don't get my labs done ahead of time.   I come here so they can draw my blood at the same time they put in the IV-- so I don't have to get stuck so many times.  That's the whole point.  

Oh, she says, I didn't know that.  I'm sorry.  The phone starts ringing again.  You need a nurse to start an IV.  I'll go find your nurse!  And she is off.  Enter phlebotomist #2, who answers the phone, then turns to me.

How are you?
I am not very happy right now.
What's wrong?

Phelbotomist #1 is back, super-apologetic, full of blame for herself.  Gail, the nurse who usually takes me back to the doctor's exam room and takes my vital signs, arrives at the same moment, clipboard in hand.  Everyone is looking at me and my unhappiness.

I am not crying and I am not yelling.  But I am upset.  I keep asking,  What do I have to do to make sure this does not happen again?

It's not your fault, says phlebotomist #1.  I was looking at the lab sheet.  The IV would not be on your lab sheet.   It's my fault.

It's not all your fault. There is so much going on in this little space-- it's kind of chaotic and full of distractions.  You had to answer the phone, and---

She interrupts me ----I didn't answer the phone the second time!

Okay.  Clearly she is not really hearing me,  I am not trying to blame her, I am trying to say I can see how easily mistakes can happen in this environment.   I can tell: She feels bad, she feels like it's all her fault, she failed, she is sorry. But no one offers an answer to my question.  I do not know if they can even hear my question.

I know you don't want to hurt me, I know you didn't intend for this to happen.  I just want to know if there is something I can do to make sure it does not happen again...

Gail suggests we head to the exam room now and come back to start my IV afterwards.  I hug phlebotomist #1.  I am still not sure that she gets that I do not mean to blame her.

(Which is not to say I hold no blame in my heart-- cause I do, I can feel it.  I blame the whole system.  I want to know how it works, who I need to talk to, what I need to say or do to make things better for all of us-- patients and staff alike--because this is hard on everybody.  It ain't right-- and you know how I feel about things what ain't right!   So, OK, yes, it is possible that my demeanor telegraphed my readiness to kick ass and take names--- I am a Hukari girl, after all...)

Gail leads me into an exam room where Lori is already waiting.  Lori sees that I do not have an IV, and she sees my face.  Maybe not in that order.

I had a bit of a meltdown, I tell her.

Gail apologizes again for what happened, and makes a joke about how my blood pressure is likely to be higher then usual:  Do you want to take a couple of deep breaths first?

No, I grumble, I am not done being mad yet....

That breaks the tension a bit.  While it is true-- my emotions are still running high-- the fact that I can recognize that I am CHOOSING to not let it go of something so unpleasant is funny even to me. At least a little bit.

After taking my vitals, Gail offers to sit down with me and explain how charting works.  She shows me where someone needs to write on the bottom of a sheet of paper that I need an "IV with lab draw."  These are the magic words, people!  If they do not get written every time on the bottom of a piece of paper, we are all lost.  But now I can proclaim:  I need an IV with lab draw!  At last it can be said!  As long as I  remember those magic words this particular snafu need never happen again.

Nina comes in.  She's heard all about my incident.  Apparently two patients came into the Chemo Room earlier that day with major medical issues that should have gone straight to ER.  The patients came here because this is place and the people they know.  Everything worked itself out, but it put the staff in the Chemo Room off-stride.  Nina is not surprised that further chaos got lumped on top.

This story is yet another argument for bringing the practice of mindfulness into this kind of  environment, is it not?  It takes practice to let go and open up to a fresh perspective.  It's as if we are always dragging our stinky old left overs around with us:  I couldn't eat all this anger at the time, but I'll be damned if I am throwing it away!  That's perfectly good righteous anger!

I think about how many hours of meditation practice I've put in over the last (gulp) twenty-five years.  And I am only now beginning to be able to catch myself in the moment as some powerful emotion takes a grip on me.  I certainly can't claim to do it consistently.  But working with where ever I am in the moment, noticing where ever I am in the moment-- even just the baby-steps I've been able to make in that direction-- has enriched my life immeasurably.  It works the soil so wisdom and compassion can take root.

My yoga teacher Meg calls this "developing the Witness Perspective":  Being able to observe one's body, emotions, thoughts, actions and interactions precisely and without judgment.  Sharon Salzberg speaks about it in her Online Retreat on The Five Hindrances at this way:

The Five Hindrances are obstacles that arise in our meditation practice—and in our lives—that throw us into confusion. They are: Desire (also known as Attachment), Aversion (aka Anger or Fear), Laziness, Restlessness, and Doubt. Each of them has its own way of knocking us off the path of practice, and yet, dealing with the Hindrances is our practice. If we had no negative emotional states to confront, we wouldn't be on the spiritual path at all!

Sharon says that the fact that these "hinderances" (we could call them "mental states" or "energies") arise is not the problem.  They are a perfectly normal, natural consequence of being alive.   It is our or normal or habitual relationship with them that is the problem—we get caught up, overwhelmed, maybe even defined by them.

She reminds us that Buddha said:
 “The mind is naturally radiant and pure.  The mind is shining.  It is because of visiting forces that we suffer.”
These states are not us, they are visitors.  Can we greet these visitors with wisdom, balance, mindfulness, compassion?  Ah, there's the rub, ladies and gentlemen, there's the rub.

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