Monday, July 15, 2013

On Debts

       When we moved back to California, I thought I had things pretty well together for our move.  Everything was organized long before we picked up the moving truck, we packed things thoughtfully, such as an "unpack first" box with basic essentials, and I left our new address and contact information with our apartment office.  Recently, my husband lost his wallet and we realized that if some helpful stranger found it and mailed it to the address on his driver license, it would go to Mississippi and we'd never see it.  My dad informed me that you can forward your mail through the post office, which I had not known. 

      I set up mail forwarding, but didn't expect to receive anything more important than catalogues.  After all, I had changed my address for everything I could think of -- all my student loan lenders, credit card, the Board of Nursing, etc.  I was a bit surprised, therefore, to see forwarded mail arrive from my old hospital.  When I opened it, I was very unpleasantly surprised to see a medical bill from an ER visit back in the fall.  "Account Past Due" jumped out at me from the page, and the balance of more than $4000 made my jaw drop. 

      At that moment, I was in a whirlwind of emotions.  I was shocked, to be sure, because I had insurance, and had never seen an explanation of benefits that would explain that amount.  I was angry, at myself for not knowing about mail forwarding before and not thinking of asking someone who might know.  I was in disbelief, because I had no idea how I could owe that much on one ER visit.   I was immediately anxious, because we don't really have $ 4000 sitting around, but we've been budgeting and saving up for and dreaming about finally making a trip to Disney World this year, and my dream felt threatened.  I was worried.

      I forced myself to set all this aside, because I had to work that night.  Over and over, throughout my shift, my worries kept coming back to me, and I ignored the pit in my stomach, knowing I couldn't do anything until business hours in Mississippi.  The only thing I could even think to pray was simply, "Please, God, don't let this be real."  When I got home that morning, I dreaded making the phone call that might confirm that I owed them $ 4000, and that would decimate our hopes for a dream vacation.  I called my mom, grasping for consolation, and that helped a little.

      I pulled myself together to make the phone call, utterly miserable, and gave the friendly woman my account information.  She retrieved my account and I waited for the dreaded confirmation.  She then cheerfully informed me, "I'm showing that you owe nothing."  I think I wanted to cry from the relief of my anxiety.  After having her double check, I hung up and just sat on the couch, stunned.

      I know for many people, four thousand dollars isn't that much debt, perhaps isn't that intimidating.  To me, though, it was so much weight added to my already heavy burden of debt.  I have quite a few loans from school I'm trying to pay off, and it seems to be making such slow progress.  I would love to buy a new car (we only have one), among other things, but I refuse to go further into debt at this point.

      Although nerve-wracking, this experience has been such a good object lesson reminder for me.  My emotional state at the thought of more burdensome debt paralleled that of sinners drowning in unforgiven sin and the heavy weight of that debt.  My small but intimidating debt being simply gone reminded me of how it feels to know that Jesus has paid for all our debts.  "Paid in Full" instead of "Account Past Due" and remaining balances.  I was grateful to God for his Providence in our situation, but I am immeasurably grateful for his Sacrifice for all sinners.  What an excellent reminder of how much grace we have to be thankful for as believers, completely forgiven of the debt of sin by a merciful God.  Praise be to God, his love endures forever.

Tuesday, June 11, 2013

On Power

      When I was in nursing school, I had the privilege and opportunity to visit a client during our home health rotation that made a long lasting impact on my life.  This particular client was a former nurse with a rare, debilitating, chronic disease that had nearly taken her life on several occasions, and which left her bedbound, on a breathing support machine via tracheostomy.  For simplicity's sake, we'll call her "Nicole".  Although the tracheostomy limited her communication somewhat, she made it a point to impress upon my classmate and me a few key lessons during our brief visit.  Those lessons have stuck with me, even to now, three years later.  One thing she told us was to always remember that it could be one of us in her place, as the patient, and her in our place, but for the grace of God.  That was powerful to hear, and important to think about.  We should never treat our patients differently as people simply because God's plans for our lives led us to opposite sides of the bed rail. 

      The second point she made was also impactful, and closely connected to the first.  She told us that we healthcare providers easily get in the habit of unconsciously assuming that we have the power in our interactions with patients.  We come barging into their rooms without knocking, telling, not asking, patients to take their medications, or have a test done, or take off their clothes.  It's probably borne out of our intentions to help, combined with the idea that we know better than the patient what they need to do to get better, along with the urgent nature of our busy, demanding jobs.  Still, Nicole wanted us to realize that we hold most, if not all, of the power in our interactions with patients, and we need to remember to give some of it back to our patients whenever possible.  We need to knock first, ask for permission, listen to them, treat them with respect for the people they are, and give them choices as often as we possibly can.  In some cases, it may be that we can only give them a choice between taking their meds with juice or water, but once we start working with the right perspective, we may realize many more opportunities for patient choices arise.  In home health, this is even more important to remember, because you're on their turf.  It would be incredibly rude to come into someone else's home and start bossing them around, acting like they should listen to everything you say only because you're the nurse, without also giving them respect as a person.

      I was reminded of these lessons recently because I took a shift with my old in-home care agency -- my first since moving back to California -- and it was a struggle.  I expected to have difficulty with the wrong things.  Yes, it's harder to stay awake and not be bored when you're sitting in quiet darkness with no one to talk to and far less walking than my usual job.  Yes, it can be hard to remember that I can't do all my usual nursing responsibilities when I'm functioning as a personal care assistant.  What I didn't realize would be the biggest struggle was this shift in power.  In that home, I was not in power.  My usual reasons to do things my way or in my timing didn't apply because my client is on hospice.  I wasn't there to make him better, I was there to make him comfortable.  Since no one but the patient can determine if he's comfortable, it wasn't up to me.  I didn't have any reason to push him to take the meds I know would help his pain or itchiness, because it was 100% his choice.  You may think (or rather hope) that this would not be so very different from my usual job, but in most hospitals, it absolutely is. 

      Patients in hospitals have autonomy, but unfortunately most of the time that power of choice is more theoretical than literal.  If a patient declines a medication, the nurse may try to change his or her mind at the least, and he or she risks it affecting the rest of that nurse's care of him or her at the most if that nurse acts miffed about it.  I had a patient tell me last week that at another hospital, she was handed a stack of forms and told to sign them.  This is fairly standard, but what was not standard was that when she paused to read what she was signing, the nurse basically told her she didn't need to read it, just sign, and then took the papers away and documented that the patient had refused to sign them.  Now, it's not that we don't have good reasons for doing things a certain way, at least some of the time; if I try to change a patient's mind about taking a medication, it's most likely because I know it's important and not taking it could be detrimental to their health.  However, we undoubtedly cross the line, and take this unbalanced power situation for granted.

      It's an unfortunate situation that medical professionals have become accustomed to holding all the power, and using it thoughtlessly, rarely giving any power to the patient.  We need to remember that our patients are people, with autonomy and deserving of respect.  We need to look for opportunities to put the power back in patients' hands, with little decisions and big ones.  We need to remember that our situations could easily be reversed, but for the grace of God.  Last night's in-home care shift was a good reminder to check myself, examine my own habits, and change what needs to change.

Saturday, April 13, 2013

The Move Back

      I’m having a hard time believing we’re already well into April, and that we’ve lived in this apartment, and in California, for two months tomorrow.  The time has flown by, between  the initial unpacking, adjusting to my new job and new schedule, and reuniting with family and friends.  I’ve been meaning to post about my new nursing job for awhile now, but I have difficulty sitting down to write when I don’t have more than one to two days off together, and almost none of them completely free.  I got spoiled by my old schedule of seven-on, seven-off (yes, twelve-hour nights) that it’s more of an adjustment than I expected to try to get things done on only a couple days off in a row.  I suppose that’s for the best, though, since I am now better able to discuss the differences between my old job and the new, having finished orientation and switched to nights – finally!

      I know, some people want to feel bad for me, thinking I’ve been stuck working nights, but actually, I prefer them by far.  Nights are quieter, more laid back, with less people around in general, and certainly less people whose company I don’t miss: doctors, administrators, visitors.  Not that I dislike them, exactly, but… well, I’m sure you get the idea.  More importantly, we have fewer transfers, fewer procedures both at bedside and away (CT, etc), and all of that means I am not so crazy busy.  All of this is pretty much true everywhere.  Now to compare my new job and my old one…

      The first thing that always comes to mind when I talk about my old job versus my new one is the computer charting system.  I really disliked Cerner, and my coworkers and I had a laundry list of things wrong with it (or that we could’ve designed better), and I thought when I left Mississippi that it had to be the worst, most basic, cheapest one on the market, so I couldn’t wait to use the new one at my facility in California.  I don’t think I have ever been more wrong.  I disliked Cerner, but now I would go back to it in a heartbeat!  Not just because I dislike change, mind you, but because CPSI absolutely is the worst, most basic, cheapest EMR system on the market.  I have learned the system now, which didn’t take long since it’s a glorified Excel file, and I still hate it.  You might think this is not that much of a deal breaker, since it’s just the computer system, but you have to understand that that’s like saying it isn’t that bad that your cubicle’s only two feet by two feet.  The computer system we nurses use can really help us – save us time and effort, make lab results and meds easy to find – or it can really frustrate and limit us – make us enter vital signs manually, run slowly, make things take twenty clicks to get to.  Alright, rant over.

      That’s the major difference, and major negative for my current hospital.  On the whole, though, I otherwise like my facility pretty well.  It doesn’t strike me as hugely different than my old facility; the patients are a similar level of acuity, we don’t do trauma, and we’re not a teaching hospital (no residents).  The people I work with are generally cool, helpful, and friendly.  I like having an Omnicell for supplies (charges patients for items as you pull them out) versus having to manually charge for items, usually at the end of my shift.  It’s larger than my old facility, but the area I work in doesn’t force me to go to lots of other areas all the time, so while I’m basically useless if visitors ask me for directions, I’m not too overwhelmed.  There are many more doctors here (I could probably name all the doctors I’d commonly work with in Mississippi on both hands), but thankfully at night I mostly interact with them over the phone, so I’m not expected to recognize everyone. 

      I had a more than adequate orientation period, so I feel like I have the routine down well, and I certainly still have plenty of resources for my questions.  Although the patient acuity level is similar, I’ve still gotten to see new things, and I know I will have the chance to see more new things.  I’m excited to broaden my experience and continue to grow my skills as a nurse.

      Otherwise, things in my life have been much the same as in Mississippi, though we are thrilled to see family and friends here again.  We have a long list of fun things to do, some to make up for things we missed in MS (the beach, the OC fair, the Getty) and some cool new places we've heard about like new restaurants and things.  We'll see how quickly our budget allows us to check out all these new places, though.   

      That has been an adjustment, too, the financial differences between here and Greenville.  Funds are tighter, at least til Andrew starts his job.  He got rehired at Disneyland!  We're excited for his benefits to kick in so we can go to the new Cars Land, Ghiradelli Factory (though we'll miss those tasty fresh tortillas from when it was the Tortilla Factory!) and see the amazing shows World of Color and Fantasmic again.

      We love our new apartment, and new city.  We downsized, so I'm still working on getting rid of a couple of boxes, but I love that our unit is situated in our complex so that we have a barbecue, laundry center, and best of all, jacuzzi, within sight of our apartment!  I've already gotten plenty of use out of the jacuzzi -- I think I went nearly every night after work when I was orienting on day shift!  Now that we got our couch from IKEA (which I've had my eye on for nearly 2 years), we've really enjoyed having people over for dinner and swimming.  Andrew loves that we live so close to downtown Brea, and keeps bugging me to go walk down there to dinner sometime.  I think he has a misperception of how close it actually is, but we'll go to dinner and movie and maybe the farmers' market sometime soon.  Brea is a lovely area, and I like having so many of my favorite places so convenient: Target, Souplantation, Old Navy, several grocery stores, and the regular and discount movie theaters!

      All in all, we're settling in nicely here, and happy to be back.  Greenville was exactly where God wanted us for the last year, and we are so glad we met so many people we love there, and grateful for the lessons we learned while we were away from our network of family and friends for our first year of marriage.  We will never regret moving to Mississippi; it was our little adventure as newlyweds, but we are also very happy that God provided for us to move back home.