Let's Just Think...

"A Person - Not A Patient"

For the last few weeks, I've been training our new apprentice psychiatric clinical navigator in our hospital. It's been nice to have help and show her the differences between the broad strokes and fine touches of our hospital. Yesterday was our discussion about service excellence.

Having help is also beneficial in that it allows me the opportunity to eat better - because it really is 'all about the food'. I asked members of our ED team if they wanted lunch at Panera and took order after order of what everyone wanted. 

When I left the department I had a pocket full of twenty dollar bills for meals which probably would only cost 8 -10. I begged one of the RN's to "please, can't I just take one of these?" (twenties) as I knew having to figure out change was going to take me forever as 'math' has never been one of my strong points. 

"Just have her ring up each order separately" she said.

I did - and was at Panera much longer then I had hoped to be, but the discussion I had with the staff member taking my order was well worth the time.

"I'm sorry" I told the woman taking my order, after telling her I had a huge order which needed to be rung up separately. "That's okay - we do this all the time" she replied. She then took each order and told me how much the change would be for each $20.00 bill she received. 

Looking at my hospital badge, she then asked "Do you work at the hospital?"

When I told her I did, she said "I love that hospital". She told me how her mother had worked as the nurse manager in one of the departments upstairs before leaving to go to work at another hospital before retiring a few years later. "I live in Martinsburg" she said "but I still prefer coming to Jefferson".

When I asked her why this was, she answered:
"Because they treat you like a real person and not a patient".

Alcohol

When I started college, I entered as an English major with a passion for Emerson and Thoreau as well as poetry and Russian literature (an interest that started in high school). I had "a thing" for Anton Chekhov and his short stories, several of which hovered on the topic of drinking and alcoholism and all of the turbulance that accompanies it. 

As my freshman year transcended to my sophomore year, I changed majors again and again and again. It got to the point where I would call my parents and my mother would ask "So, what are we majoring in today?"  - As Jimmy Buffett once said "I may or may not be indecisive".

Having finally ended up majoring in Psychology, I never really gave up my passion for literature and poetry because of the way the novels and stories that I read accentuted the lessons I learned in my Psychology courses: Abnormal Psychology, Developmental Theory and one of my favorite courses of all time - Perception and Psychophysics.

When the topics of addiction and alcoholism came up in our senior Psychology seminar, Anton Chekhov returned to my life.  It was never just "psych" it was the lessons of Erickson, Skinner and James along with those who wrote about relationships, history and  the consequences that came "with a dream deferred".

Over the weekend,  a masterful lesson in Alcoholism extended throughout our hospital in a way that was like a fishing net cast over a wide ocean. In one part of the hospital, a patient was detoxing and trying to communicate her needs through shaking and the slurred speech. She referred to my colleague as her sister and asked her family (none of whom were present in the room), to "push in the chair!!".

Our discussion flowed into a collaborative fusion of our knowledge via lessons learned from our own insightful experiences and lessons learned from alcohol: previous use, abuse, relationship struggles with our families, our children and our own upbringing. Everyone from the physicians to the nurses and techs had both similar and different perspectives of alcoholism and addiction. It was fascinating to watch as the topic seemed to hover like a stormy cloud on the second floor until it got on the elevator and headed downstairs to our Emergency Department. 

The two traumas were called right around shift change. A car accident with two people needing to be "extracted" from their vehicles. 

Like the progression of addiction, the rest of the night became worse as each moment went from one discussion to the next. I looked at my colleagues working feverishly to save each life in the two trauma rooms in our department. Then looked into the faces of the families as we told them the news of their critical loved ones. 

Nothing good comes of alcohol use. 

I walked into the chapel, our Chaplin who had been called in met with one family while the other family still sat quietly in our consult room - waiting for more news. It seemed like everyone was crying.

Our clinical team was steadfast in the way they navigated through hours of care for our patients and their families. In the end, one patient had died while the other remained in critical condition, stable enough to be transferred to receive the continued care he needed. His wife sat stoically in the passenger side of the ambulance. I waved as I walked by her hoping she had the inner strength to get through the next several hours. 

Nothing good comes of alcohol use.

A life once filled with an immense amount of talent and potential was gone. Two families will never be the same. 

Anton Chekhov once said: " We shall find peace. We shall hear angels, we shall see the sky sparkling with diamonds."

Are We Providing Good Care or Fostering the "F"?

If you look at the map, our hospital in WV is about 2300 miles from Tucson Arizona where 1 year ago today we shared our prayers along with feelings of sadness and loss with six families who lost a loved one as a result of the actions of a young man with mental illness. With 13 other individuals wounded in the same event, it is difficult to avoid taking a long hard stare at the way mental illnesses have affected our lives, our state and our nation.

At our hospital, we see patients with mental illnesses frequently. Is this surprising? – No. The National Alliance on Mental Illness (NAMI) website reports that “we’ve all been hit by the worst economic times and highest unemployment in more than 25 years. Those unemployed workers are reporting symptoms of severe mental illness four times more than people who still have jobs. Four times as many report thoughts of suicide.” Additionally, NAMI reports, “returning combat veterans are experiencing very high rates of serious mental illness, suicide, addiction, homelessness, and incarceration related to posttraumatic stress disorder.”

“How are you?” I frequently ask the patients and families in our Emergency Department who have presented with symptoms of mental illnesses. The responses usually consist of a wide range of issues and situations that are not easily solved within the few hours they are with us: “I’m about to lose my house”, I’ve been out of work for the last year and a half and can’t find anything”, “ I just found out I had cancer”, - or – what I think of as the ‘perfect storm’ of emotions and stress:  “my wife and I aren’t getting along – ever since I lost my job, we’ve had financial arguments which are affecting our relationship and the children, the house is about to get foreclosed...we have no where to go”.

Each story seems more heart wrenching then the one that came before it. But what is even more difficult is looking into the eyes of the patients across from me and seeing their ‘heart’; their emotional pain, vulnerability, frustration, fear, anger, hurt, abandonment, disappointment - you name it, the emotions are there. Emotions that sometimes lie buried under situations or dynamics of fighting to keep your family together or pounding the pavement looking for a job only to face rejection over and over and over again.

And yet, as heart-wrenching as these stories are, I’m glad to be having a conversation with each patient as opposed to helping families with locating a funeral home and additional support after the successful suicide of a loved one.

In 2009, the National Alliance on Mental Illness published their report “Grading the States” which listed West Virginia having a grade of “F” (the national average was a “D” – which was the grade given to West Virginia in NAMI’s 2006 report). Arizona – where the shootings in Tucson took place, received a grade of a “C” in 2009. Just under ten miles from the east of us, Maryland received a “B” – one of the highest grades in the country as there were no states that were worthy of an “A”.

But what do these grades mean?

In short, they mean that we (those of us providing care for our patients and families) need to be better then we are. We need to have the open discussions about the provision of care for patients and families who present to Emergency Departments with suicidal ideation, depression, anxiety, bipolar, schizophrenia and addictions and understand that all of these are real, treatable illnesses and not major character flaws. We need to understand that the face of mental illness is not some stranger off the street – it’s the patients and families in our care, our co-workers, our neighbors, our friends, our families and sometimes ourselves.

We need to protect and strengthen out state’s mental health care system and understand that doing so is an investment that will provide real benefits for patients and families in providing them with the care, support and resources necessary to address the illnesses they have.

As providers and as a community, we should also ask ourselves how we can apply the lessons learned from the events in Tucson to our own communities. In his Statement on The Arizona Tragedy and Mental Health Care, Michael Fitzpatrick, the Executive Director of the National Alliance on Mental Illness stressed the importance to “objectively determine every factor that may have contributed to this tragedy so we can act on lessons learned”.

He specifically listed ten questions to begin this process which included asking:
1.      Was there a diagnosis?
2.      What is the full medical history?
3.      When were the symptoms first noticed?
4.      Did family members receive education about mental illness and support?
5.      Did the person or family ever seek treatment only to have it delayed or denied?
6.      Was the person seen by mental health professionals? By whom? How often?
7.      Was treatment coordinated among different professionals?
8.      Was the person prescribed medication? Was it being taken? If not, why not?
9.      Was substance abuse involved?
10.     What may have triggered this psychiatric crisis?

Here are my questions:

What would the care provided for patients and families in West Virginia look like if we asked these 10 questions on every patient in our care? Would West Virginia still have an “F”? What if we implemented similar processes to those of our “B” grade Maryland colleagues. What if we looked at the vast difference in the commitment process for patients in Maryland vs those in West Virginia and made adjustments as needed to insure safe and expeditious access to care? 

I wonder if it is a coincidence that two of the states with the highest grades: New York and Maryland are also referred to as “2PC” states; states which require two physicians to commit a patient where as states with lower grades (including West Virginia) do not have that process in place? I wonder if implementing the 2PC process in West Virginia would be more cost effective then the presently established treatment process?

While I like to think this is an easily attainable goal, sometimes the more important task is just to provide good care for the patients we see instead of letting them (and their families) "slip through the cracks" again and again by not acknowledging the presence of their symptoms or their need for care.

We have to look back at the intricate needs of each state's NAMI report card and the symptoms and goals of the patients and families in our care and ask ourselves:
Are we providing good care or fostering the "F"? 

"Hold Her Until You Fall"

Our patient had overdosed on a substantial amount of over-the-counter medication. He was admitted to our hospital and the next day, the Resident caring for the patient informed me that he wouldn’t be able to leave our hospital until he spoke with me. 

When I arrived to his room, our patient (surrounded by an extremely supportive family) informed me that his overdose was impulsive and precipitated by an argument with his grandfather. While he informed me that he didn’t intend to take the pills, he expressed his frustration with his relationship with his grandfather and the shame involved with having to move back home as a result of the break-up of his relationship and the loss of his job.  He had also recently gained custody of his daughter (an infant).

He informed me that, after the argument, he took the pills, realized what he had done and came to our hospital. 

His grandfather had a slightly different story of the events that took place that day.

He informed me that there had been an argument about an extremely inconsequential topic. That his son became angry and left the room. His wife, upon seeing her grandson lift his cupped hand to his mouth, asked him “did you take those pills?”. 

“No” said our patient. 

When asked again by his grandfather if he had taken the pills, he admitted that he had. He informed his family that he didn’t feel his life had meaning, that it wasn’t worth living. He said he didn’t want to go to the hospital and didn’t want to receive help. As his grandfather recounted the story, the patient looked down at the floor, not wanting to make eye contact with any of the members of his family present in the room at the time. 

The patient’s grandfather had a look in his eyes I will not forget. He looked right at me with fierce determination and said: “I picked up his daughter and put her in his arms and I said to him ‘If this is the last time she’s going to see you, I want you to hold her and look into her eyes until you fall’.”

We all stood together silently in the room; it was almost like a prayer - the legacy and loving support of an entire family surrounding a son - adrift. 

“Then what happened?” I asked

Lifting his gaze from the floor, the patient looked at me and said “I told them to get me to the hospital.”

First We Kidnap All The Walmart Greeters....

"What do you do?" Asks the woman sitting next to me on the flight home from Sarasota FL.

"I'm a Clinical Navigator at a hospital" I tell her.

Silence. (I can feel the processing going on. Wait for it......)

"Now tell me just what that involves" she says.

I explain to her some of the different events of my day and how it relates to patient care, service excellence and conflict resolution and loss and grief. I'm thinking that I also want to tell her about my intense love of pizza and where the best coffee is in the hospital but I decide to hold off. 

She tells me about her previous healthcare experiences at her local hospital in Pennsylvania. About sitting in the ER hearing a patient nearby explain to her physician that she is supposed to be admitted to the medical floor having been referred to the hospital by her primary physician to be admitted. "I heard her ask - several times - 'why is this taking so long? I'm supposed to be here'. It seems like there were problems with communication".

"The Emergency Room in our hospital is owned by a separate company; they don't work for the hospital. We even have a sign that tells you how many minutes you have to wait to be seen in the ER" she tells me, "but it always seems like you have to wait a long time". "I always wonder about that" I tell her, never being sure if the sign refers to the time to be seen by the triage nurse, the physician or just having someone say 'hello' to you when you walk in the door. (My brother and I had passed the sign to Doctors Hospital in Sarasota less then an hour earlier, on the way to the airport, that read "Wait time: 22 Minutes").

I thought about how cool it would be if we could steal all the "Greeters" from Walmart and have them stand just inside the door of the ER and say 'hello' as soon as patients and their families walked through the door. Maybe they would change all the signs: "Wait Time: 4 Seconds".

Not only that but we could also eliminate those fashionable blue vests...

But I digest...

On the plane I heard at least three different stories of healthcare experiences from my friend - all interesting, somewhat negative, and relevant to the same challenges faced by many hospitals. As I glanced at the other passengers sitting near us, it occurred to me that probably every person on the plane (a very full Boeing 717 that held about 115 passengers) probably has at least one story about a healthcare experience they (or someone in their family) has had.

I always wonder about the stories behind the numbers. 

 

Wisdom and Insight

"It's like the ebb and flow of the tides" my mom told me last week, when I had called her to review some of the more challenging events in my life that I have been navigating lately. In learning about the “perfect storm” of foreclosure, relationships that end and autoimmune illnesses, I have learned about the importance of having a tight routine  to stay grounded while making decisions quickly. I also know that relying on family and friends for additional support is always good too.

Long ago I developed a team of people to help me when "life gets in the way" as my rehab professor used to say. So the other day, I contacted my financial planner, Beth Jones at Third Eye Associates to review some of my financial backed decisions as I wanted to make sure I was on the right track. We had a great discussion and after talking to her for the initial few seconds, I "got it" that this call was filled with some of the insight and wisdom I needed to keep on track; I grabbed my pen and started writing. 

Here are her 7 quotes that inspired me:

1.  "You gotta let go of the idea that you are a failure and all of the frustration that goes with it and do what is appropriate today." For me, failing in a relationship has been something that has been difficult. My parents have been married for over 55 years; losing a relationship after 12 has been troubling in that while I would like to learn from the lessons of the past, taking a long hard stare into a failed relationship can be extremely draining emotionally. Additionally, having all of the financial stressors that go with a failed relationship only makes these issues tougher to face.

2.  "Keep it really simple." - Simple right? - I could tweet this.

3.  "Allow your feelings to be there but don't let them encompass you." Speaks to the importance of moving through the feelings and emotions we have instead of getting "stuck" or detatching from them completely. 

4.  "Find a fully, functioning adult and then go play." This was the tail end of a discussion about knowing when you've learned the lessons you need to move forward. While I like to think that I know a lot about relationships, when you're in the middle of one that's not going well, it's not always easy to figure out how to resolve issues and conflicts. It’s also difficult to get back to “you” from the “us” as a couple.

Retrospectively, it reminded me of the time I had attended a conference with Melody Beattie only to hear (at the last minute) that she would not be coming. While I was disappointed, I later heard that her absence was a result of a tragic incident where her son had been killed while skiing. One of her books that addressed this issue a few years later, spoke to the importance of being yourself and not letting people change you, your values or beliefs. In thinking about what makes a great relationship, I wonder if it has more to do with just accepting each other for who we are without having to adjust to become someone you’re not. While I think I learned this lesson in “counseling school”, I think that as “life got in the way” - as my professor used to say, I got a little lost. Or - there’s a huge difference between learning about something in a college course vs. experiencing it firsthand.

5.  "It is what it is: an appropriate action right now in the world that you're living in and with the circumstances you're dealing with." - This when discussing how to navigate a foreclosure. Jimmy Buffett once said "I may or I may not be indecisive". When I make fast decisions under stress, it's not always easy to figure out which ones are the best and if the ones I'm making are appropriate.  This year has been filled with decisions that need to be made without having all of the information needed to make the decision and then having to hold on for the ride. 

    One of my colleagues recently lost her home as well. She told me “I lost my home - wait a minute, that’s not right, I lost my house” she said, and then clarified the difference between the house that had been auctioned to the home where she was now living with her family. Through it all, her story inspired me as she never lost faith - ever. Yes, there were days when she struggled and you could see the pain in her eyes as she decided what to take with her and what to let go. Now whenever I see her, she is cheerful, smiling and happy with where her journey has brought her.  It’s amazing and gives me hope.

6.  “Make it very manageable with very low overhead.” This was the suggestion for finding a new place. And while that’s a very important recommendation with regard to size and living space, here’s what I know for sure: As I sit her in my house / home in Germantown MD, it occurs to me that I am at my best when I am on the back deck of the boat in Brenton Cove (which honestly, my closest friends will tell you in a second). You can take me away from Rhode Island, the salt water, the fog, the high - and yes, the low tide (and the smell that goes with it), the muffled sound of fog horns in the early morning as well as the lobstah, chowdah, steemahs, and grilled swordfish and no matter where I am in this world, I will always live in a home that looks like the interior of a yacht club and my foul weather gear and sea boots will always be tucked away somewhere in a closet. There will be an expensive clam shell door knocker. Someday there will be a nice expensive weather station and a large autographed yacht print from Onne van der Wal. And yes, it would all be nice if it overlooked the beach on Anna Maria but for now, I’ll have to wait. 

7.  “Move forward and prosper - have the living space and peace of mind to create what’s possible.” It’s time.

All this from my financial planner, Beth Jones at Third Eye Associates.  If you’re looking for a financial planner, these guys are the best.  And I’m so incredibly grateful for having people in my life that have an immense amount of wisdom, compassion and insight that is far beyond their chosen careers and talents.

 

All The Dawgs in The House

 

The video above is one of the many songs from The Gap Band - this is one of my favorites. The title of this post is a lyric taken from their CD (at that time, it was a cassette) entitled "Ain't Nuthin' But A Party".

The cassette I had of their music (originally) was given to me by a patient as a "thanks" for taking care of him. "I want you to have it" he told me back in 1994. His illness was in the end stages and it was only a few months later that he died.  My other patient, William, died while he was in our program when he developed an opportunistic infection and was admitted to the local hospital.

While he was in the hospital, he had that burst of energy and motivation that is sometimes seen in patients right before their die. He told me "I want to be an AIDS educator, I want to be able to visit high schools and talk to students and tell them 'don't ever think that this can't happen to you'." I was inspired by our discussion and the interactions I had with both of "my guys" (I always think of them as 'my guys') when they were in the outpatient program that we had developed for patients with addictions and psychiatric illnesses. 

On the evening he was admitted to the hospital, William called to 'check in' and tell me he wouldn't be in group the next day. As we talked he told me about an interview he had had with the local newspaper in New Haven CT where he was from. He said that, initially, he wasn't interested in speaking with them but then changed his mind when he realized he would have the ability to share some of the things he had learned as a result of his illness and the powerful addiction he had developed to cocaine. He went on sharing some of his insights into his illness before he had to end the conversation when the nurse came into his room to give him medications. He said 'good night' and told me he would contact me when he felt better to let me know when he would be returning to the program.

The following morning I arrived to my office and received a message from the hospital that he had died at 4:00am. 

My other patient had successfully completed our program and had left his Gap Band tape with me before leaving for Hartford to stay in a halfway house. He was much quieter then William was, choosing to keep his tapes playing in the walkman clipped to his belt before group started and whenever we were on break from groups. The Gap Band was his favorite, he told me, because the energy in their music motivated him to keep going. 

On the day he left, he handed me the cassette saying that he wanted me to have it as he felt he wouldn't need it and had "all of their music in my head anyway".  I told him I thought he should keep it but a day or so later when I returned to my office (after he had left the program), I found the tape sitting on my desk under a pad of paper with a note on top of it that just said "thanks".

Both of my guys inspired me when I had the opportunity to help them almost 18 years ago.

18 years ago.

Here's the thing about my guys: at least four days out of every week, I drive an hour to and from our hospital in WV. On at least 3 of those 4 days, while driving and listening to XM radio, I hear a song by The Gap band.  It never fails - and it is at once, haunting, sad, inspiring and comforting.

Hi guys.

Steve Jobs & The Art of Being Adopted

 

Yesterday, upon hearing the sad news of Steve Jobs death, I went looking for this video as his commencement speech at Stamford is one of my favorites. There were a little over 6 million hits on this video. Less then 24 hours later, the number of people accessing this video has surpassed 7.5 million which speaks volumes to the impact of his life, his endeavors and inspiring career upon all of us.

My favorite part of this video is when Steve talks about being adopted and the promise his parents made to his biological parents to make sure he went to college. I love the fact that he didn't let his formal education interfere with his love and passion for knowledge and creativity.

Like Steve, there are a few of us adopted kids roaming this planet..wreaking havoc on those "reallies" (our term for children who remain with their biological parents - the ones who are "really" biologically related).  A few years ago, I was working on a crisis team when one of my colleagues (a licensed, independent clinical social worker) learned there was a patient waiting for her (for an assessment) who was adopted. As she gathered her clipboard with her assessment form to go meet the patient and their family, she said "Adopted and foster kids are so screwed up that there's not a lot you can do to help them". 

At once I was torn between wanting to throw up and wanting to slug her; I was beyond apoplectic.

I know (sadly, she didn't) that there are a lot of great people in this world who are (or were) adopted: Eleanor Roosevelt, John Lennon, the poet - Langston ("What happens to a  dream deffered..") Hughes, Larry Ellison, Sharon Stone, Stephen Spielberg, Leo Tolstoy, Presidents Bill Clinton and Gerald Ford, Olympic athletes - Greg Louganis, Kitty and Peter Carruthers and Scott Hamilton and musicians Sarah McLachlan, Faith Hill and Tim McGraw just to name a few.

Yesireebob there are a lot of us walking this planet challenged with the ginormous task of having to teach our adoptive parents to look like us. 

After his gold medal win in the winter olympics in 1988, a Sports Illustrated reporter interviewed Scotty Hamilton and asked him about the challenges of being adopted and not knowing your biological parents and how this may or may not have affected his motivation to "go for gold". His response was that he recognized the importance of being your own person as you may never know where you come from, so you create a path of your own - you create your own legacy.  For him it was part of that drive in creating his own legacy that fostered his motivation to achieve and help others.

Steve Jobs did a masterful job of this - creating a legacy that has inspired and fueled generations of individuals, corporations, schools and teams to go far beyond what they may have realized because of the products that he (and his team at Apple) created. 

..."and it's the ones who are crazy enough to think they can change the world - who actually do." 

That Thingy Over There: A Romp Around Terminology

Dedicated to all my Nurse Buds, Clinical Peeps and the Yacht Club Crew.

Years ago, when dinosaurs roamed the planet, my brother and I raced one-design sailboats. Our purple bluejay “Chicken of the Sea” was a fun little boat to sail but one of us, I can’t remember who (and yes, I wouldn’t tell you if I could remember) had a problem with the names of all of the lines at the foot of the mast. Try as we might, we couldn’t always get it together with that which needed to be raised up or down, pulled in or let out.

There was always yelling. 

“Pull that thingy over there!!” one of us would say.

“Which one?” the other would ask - which just lead to more incessant pointing - “that one, that one, NO - THAT ONE!!!”

(jib sheet, main line, and every halyard subsequently became referred to as “thingy”) 

To solve all of our problems, my mother took all of the lines off the boat and brought them all down into the laundry room of our home. She bought many tie-dye kits and in a matter of hours all of our thingies (halyards and sheets) took on a new life of their own.

The main halyard was green, the jib sheets were purple, the spinnaker sheets were a great shade of orange that faded with the sun and salt water. 

Our world became easier as we raced. I would hear “pull in the purple one, let out the orange one..” it was the sweet color of communication. 

Over the last few years, I have been asked to be more cautious around the clinical terms I use when analyzing people / situations (insert “symptoms and dynamics” here if you studied psych). This has not been easy for me. My colleague and nurse wizard, Kathy Weil used to help me present our psych protocol to teams throughout the hospital where we worked. In the elevator on the way to each department she would say to me “now try not to be so clinical this time” and then interrupt me if, during our presentation, she would witness the glazed over look of the nurses and techs we were presenting to. I struggled (and continue to) with changing the terminology; and I’ve come to know “the look” when it’s flashed my way by my nurse colleagues. 

It’s frustrating as I know none of my nurse colleagues would ever enter a room and say “we’re going to hang a bottle of this water stuff to go through a tube into your arm so that you will not feel so dry”, or I’m going to put a bunch of small, white circular, sticky things all connected to wires over your body so we can connect them to an electronic dohicky and watch your heart beat. Instead we use a bunch of acronyms and sometimes scarey terms like IV, EKG, EEG, MRI, CVA, TPA, TPN, stroke, ‘mets’, 'septic' and the one that freaks me out - “widow maker”.

All of which (I think) are a little more overwhelming then ‘depressed’, ‘anxious’ or ‘symptomatology’ and if I were to bet a nice lobster dinner (with chowdah and steemahs), I’d say that “widow maker” freaks more people out then “bipolar”, "suicidal" or “traumatogenic” - just sayin’. 

And yes, sometimes I’d much prefer to tell people they’ve “drifted a little too far from the mother ship” then tell them that I think we need to refer them to an inpatient unit - but that’s not appropriate. It can be a little frustrating for someone who’s a shrimp fork short of a place setting or half a sandwich short of a combination plate. And it wouldn’t make my NAMI colleagues pleased at all. 

Throw in the fast pace of an ED and the stress that goes with it to the terminology mix and watch what happens. Recently, one of the nurses was performing CPR and wanted to get a little higher over the patient. “I need a footstool” she said. One of my colleagues went outside and came back with one of the stools that the Docs sit on when interviewing patients - the one with the wheels - while another came in with the metal footstool - the one she was referring to. The nurse (who had switched with a colleague from performing CPR) took it all in stride as she was handed the footstool, looked at the stool with the wheels and said “yeah, that might be a little too challenging”.

And it’s all relative anyway. - I have a close friend who is an acupuncturist. One day I went to see her as I had been feeling really tired and she said “yeah, you have a little too much water energy”. A few months before when I had some pain, she had told me “I think you have a block in your triple heater meridian”.

“A block in my triple heater meridian? - you’re kidding right?”

She explained what she meant in terms I would understand (yes, she ‘dumbed it down’ for me) and then put a few needles in my right ankle which made a lot of sense to me given she had just explained that ‘triple heater meridian’ was nowhere near my right ankle.  At the end of it all, I felt much better.

That’s eastern medicine - the one that’s been around for 3000 years as opposed to the “newer” western medicine that has only been around for a few hundred. The closest thing I’ve ever heard to the term “widow maker” in Eastern medicine is what’s referred to an “H/W - husband / wife imbalance” which isn’t all that different when you think about it - based on the acuity I guess.

But in my world of clinical psych, maybe it would all just be a  whole lot better if we got back to colors. “She’s feeling a little blue” (for depression) or maybe “that orange person over there” for someone who’s psychotic and drifted a little to far - who maybe needs their sails pulled in...that’s the purple thingy.