I'm ready to blog again. While away from this blog, I was writing elsewhere. I haven't written there in almost 4 months. Mainly because what I want to write doesn't belong there. That blog isn't completely anonymous to many of my friends and family. So I'm coming back to my original home and once again taking on the name of Rain Boots.

I thought mean girls emerged in Jr. High!

Someone is bullying my daughter and I want it to stop. Now.

This girl is an evil mastermind. She personally hasn't said or done anything to L. She gets other kids to do it. L's friends. Even her best friend, who then felt so bad about it that she told her mom (which is how I found out that this is happening). L's best friend told her mom of at least 3 other girls who were being encouraged to tease L about a physical characteristic that she is sensitive about.

When I talked to L about it, she sobbed because she was so upset this was happening and seemed relieved that I knew about it and would step in to try and make things better.

So, even though I wanted to run right over to the school and pound this little brat on the head, I instead did the appropriate thing and called the school counselor to talk about it. (This is the same counselor I talked to two years ago and I felt like she did absolutely nothing to fix the problem. But that was a different situation and I have hope that this blatant bullying will provoke a response.)

I found out about this Wednesday evening. I called the counselor on Thursday morning. I heard back from her on Friday. I told her that I didn't understand the details and recommended that she talk to the friend's mom to get the full story about the girl who was getting other girls to say mean things to L. She thanked me for letting her know and told me she'd follow up on the situation. She's not at school on Monday. She finally talked to L today. Almost a week later.

I asked L how it went and what the counselor is planning to do. L told me that the counselor told her that she has two choices: L can talk to her friend about it and tell her it hurt her feelings or she can let it go and try to forget about it.

WHAT? This seems like a fine solution if it were just that her friend made a mean comment to her. I understand the concept of talking it out or just deciding something's not worth the trouble and just getting on with life. And if this were just between these two friends, I'd agree with this strategy. But this isn't that! I called the friend's mom this evening. The counselor didn't even talk to the mom to get the story, as I suggested. These two girls, who have been best friends since Kindergarten (now in 4th grade), are being manipulated by this outside force, this evil genius who seems bent on cutting others down for her personal enjoyment.

I don't know what to do. A week after the fact, L seems ok with the forgive and forget option offered to her by the counselor. Do I need to let it go now? Or do I need to continue to pursue this so that mean girl learns she can't continue to be mean girl?

Compliance

Lately I've been thinking a lot about how health care workers perceive their patients. Particularly the undesirable ones, the ones we blame for being sick. I know we do it; I'm guilty of it. The heart failure patient who is readmitted a few times a month when her edema becomes so severe she has difficulty breathing but who doesn't take her medication because it makes her pee too often. The asthmatic patient frequently seen in the emergency room for shortness of breath who refuses to get rid of the cat he's severely allergic to. The diabetic patient whose family smuggles donuts to him WHILE HE'S STILL IN THE HOSPITAL. I get so frustrated! If these patients would only be COMPLIANT!!!

But look at all these examples: Would you want to take medication if you knew you were going to have to get up 3 times in the night to pee? What about the cat who is the asthmatic patient's only companion? Would you say good-bye to your best friend just because a doctor told you to? Even the diabetic patient who eats donuts while still in the hospital and seems to be the most self-defeating of all: How would you feel if you contracted a disease that meant you had to completely change your way of eating and give up most of the foods you derive pleasure from?

But we get frustrated, blame them for not changing, send them home, and groan when we see them come through the doors again.

In nursing school we were taught to continue telling these patients that they need to change their ways. Even if they've already heard the same words over and over, we're told that "if we continue to repeat the message, maybe one day they'll get it." Does anyone really think that any of these patients are going to wake up one day and say "Gee, maybe I should _________ like my doctor/nurse/nutritionist told me and then I'll get healthy."

Every time I go to the dentist, the hygienist tells me I need to floss. I've been receiving regular dental care since I was a child and have been told this at every dental appointment for over 30 years. I know I need to floss. I don't hate flossing. I just never think to do it. I leave every dental appointment with good intentions; somehow this time will be different. Not once has a hygienist offered me any practical solutions to get into the habit of flossing. When I ask for suggestions, I'm met with "You just have to do it." I'm sincere in my desire to become a flossing person. It's just that no one has ever guided me in developing this habit and I can't seem to figure it out on my own. To the hygienist, I must appear like a lost cause, a very noncompliant patient.

Maybe no one has come alongside all those noncompliant patients and helped them solve their unique problem that would help them manage their chronic illness. What if Heart Failure had her dose adjusted so that she was taking her medication at intervals throughout the day and her fluid was restricted close to bedtime? Perhaps she could sleep through the night AND maintain an appropriate fluid balance. Asthma could be assisted in finding a new home for his companion where he could continue to visit when his disease is well-managed. Diabetes could be reassured that an appropriate change in diet doesn't mean that he can never have a donut again; a home visit with a nutritionist where his lifestyle and personal preferences are considered and a personal nutritional plan is developed could go a long way to helping him make sound nutritional choices more often.

That's not how we do things, though. We print out the generic heart failure/asthma/diabetes home-care instructions, circle a couple important points and say good-bye to the patient--until the next admission.

This is not the kind of nurse I want to be. Instead of reminding the patient that they need to make changes, I want to come alongside them, discuss barriers to health-enhancing behaviors, and help my patients overcome those barriers. Nagging doesn't work. Let's get down in the trenches with our patients and help them find a way to be healthier.

Now I need to go floss.

Warning! I'm in a pissy, whiny mood and feeling quite sorry for myself.

Last night I went to see a movie with my sister. State of Play, a political thriller. About 15 minutes into the movie, just as the congressman and the journalist meet face to face for the first time, I had to leave to use the bathroom. (That's the polite way of saying that my stomach hurt bad and I knew I had only a short time to make it to the restroom.) I returned to the theater about 10 minutes later but knew better than to sit down as I would probably have to leave again. This time I was able to stay for about 5 minutes, long enough to learn that two apparently unrelated characters had a connection to each other. Looking like a really great movie. But I wouldn't know because I spent most of the first 45 minutes of it in the bathroom, gripped by severe abdominal pain and pooping liquid.

I should have known this might happen and not even tried to go to a movie, especially not one that requires you to actually watch the whole thing to know what's happening. I know that I need to sit on the aisle in case I need to get up to leave. I gauge how I feel before I take my dog for a walk that will take me far from the nearest bathroom.

No, I don't have colitis or IBS. What I have is the side effects of a medication that is supposed to regulate my blood sugar. It doesn't appear to be having any effects on anything except my bowel.

I have diabetes and right now I'm really pissed about that! I'm doing the things I should to control my blood sugar but it continues to climb. So my doctor added in the dread drug that causes the diarrhea, metformin. I've taken it before and stopped because frankly, it's difficult to swallow a pill you know will likely give you severe diarrhea and associated cramping. Usually the side effects pass, but never completely. I've been back on this medication for about 3 weeks and the diarrhea is subsiding. A bit. I leave in 4 days on a roadtrip with my daughter. I'm intending to continue taking the medication while I'm gone but I'm not sure how practical that will be. I'll have to see how it goes. I really want to be "compliant" with my treatment plan to see if it makes any difference in the numbers at my next check in 2 months.

I think I wouldn't mind the side effects so much if I thought my numbers were improving. But, each time I poke my finger, I see little, if any, difference in the number staring back at me. But I keep taking the diarrhea pill in the vain hope that when I go back in a couple months, I'll see a difference in the number that matters, the A1C (a measure of blood sugar control over the past 3 months). I'm specifically trying to not make any other changes to my lifestyle that may affect my blood sugar during these 3 months; I want to know if the metformin actually has any effect on my blood sugar. If the number improves, I want to know it's from the medication, not assume that but know it could be related to dietary changes or increases in exercise. If metformin doesn't do anything positive for me, there's no sense in putting up with the side effects, right?

Back to the movie: My sister graciously suggested that we leave when I finally returned to my seat. I had missed too much to ever figure out what was going on. We stopped at the customer service desk and got a refund. I'd like to try again. But I'm afraid the same thing will happen again. I guess I'll just wait for video.

(I warned you I was feeling sorry for myself!)

20 Years Ago - June 7, 1989

Today I drove my mom to the cemetery where my dad is buried. Strangely, there was little emotion surrounding the day for me. I was actually more interested in looking at the gravestones of other long-gone family members and the names of people from the small town where I grew up.

He's been gone for 20 years. She kept saying, "Wow. Twenty years goes by fast." It does and it doesn't. I can remember the events of that day as clearly as if they had happened last month. On the other hand, in that time I have gotten married, obtained two college degrees, and become a mother. The world has seen two Bushes, a Clinton, and Obama as President, two wars in Iraq, and a rise in global terror. Organic food has become mainstream and the Mariners went to the playoffs 4 times (Dad didn't live to see them even have a winning season).

June 7, 1989. He was 43. My parents had been married not-quite 23 years. I was 19. I've now been without a dad for more than half my life. I'll catch up with him in a few years. Mom has lived as much time without him since he died as she did before they were married. In a few more years, she'll have lived as a widow longer than as a married woman.

These are just the numbers. There is so much more to say that I just don't have the energy for today. About the words and the voice etched into my mind forever telling me that he had died; losing my mom when a part of her died that day; never getting to know my dad from the perspective of an adult; watching my 7-year-old sister grow instantly into a little adult, thinking she was responsible for caring for my mom. The list could go on. I hope I have the energy over the next couple of weeks to write about these things and others.

But for today, I'll just note that it's been 20 years.

Remembering

A friend's blog entry about Memorial Day left me with tears in my eyes.

On a trip to Europe while in high school, I visited the American Cemetery in Luxembourg. At the time, I was mainly impressed with the way all the headstones lined up and that Patton was buried there.

Now, just thinking about the cemetery brings tears to my eyes. I think of the young soldiers who gave their lives to protect my freedom. I think of the families who received a visit to their door or a telegram telling them they'd never see their son/husband/brother again. The bodies that lie below the headstones in Luxembourg were buried across the world from their homes.

20+ years ago, when I saw the symmetrical lines of the headstones, I was reminded of orchard plantings. Now whenever I see an orchard, I can't help but think of lines of crosses, each representing a fallen soldier. I try not to take their (and their families') sacrifices for granted. One day a year hardly seems enough to honor these heroes.

Happy Anniversary!

A year ago yesterday was my first blog post. I started blogging hoping to escape crippling depression. For most of the year, I blogged occassionally, when the whim struck.

I'm not stable on my antidepressant and would say that I'm no longer clinically depressed. By no stretch of the imagination am I always happy. But that's to do with real feelings, not chemicals misfiring in my brain.

So happy anniversary to me and my blog. I'll keep writing and see if I can't find more happy days than sad.