Match My Hustle...

Ok. Time got away from me.

But consider this my holiday blog entry. Hope it holds you over until the New Year.

Before I go there, though,  I have a couple of things I need to get of my chest.

#1 F*** Publix

I wrote a letter to the Publix Foundation asking them for a donation so that we could put on a holiday dinner for my patients at the shelter. You know? Just to give them a respite from that grool that they get served everyday.

So a couple of weeks ago, I get a letter from their corporate headquarters telling me that due to the overwhelming requests that they had received just like mine, they would not be able to honor my request.

Cool. That much I can understand. But the letter goes on to say that my request also fell out the Foundation's funding priorities which are education and...

Wait for it....

The plight of the homeless and hungry...

Well damn. I didn't know it had gotten that hard out here in deez screets.

How homeless and hungry do you have to be, to be considered homeless and hungry??

#2  Jacking holiday decorations seems to be the new millenium hustle. The problem is that I can't see where it could be very lucrative. Plus, (and my faithful blog readers will say it with me) ain't nobody got time for that.  The time it took you to take all those lights and wreaths down could have been spent ringing a Salvation Army bell outside Wal-Mart for $8.00 an hour. And the plastic Black Baby Jesus you kidnapped out of his manger? I mean, why? WHY?!!!

Ahh. I feel much better.


But my real purpose for this entry is a little different than usual.

Its not so much about my patients.

Its more about my patience. And how its been tried by folks saying what they can't do and what they aren't supposed to do.

I want to take you back to April 11, 2012, Day 1 of the homeless clinic operation.

It was me and KB in one room the size of bathroom with 17 patients lined up in 3 foot wide hall waiting to be seen. We worked 14 hours that day. We scheduled the patients. Checked them in. Took their vitals. Charted their health histories. Ordered their medications. Picked their medications up. Delivered their medications . We picked up our own supplies. Stocked our own exam room. Cleaned our own exam rooms. Did our own referrals. Drew our own labs. Took our own labs out for courier. Called our own patients to give them lab results. Drove our own cars. Burned our own gas.

We went home that night and did it all over again...everyday for the next few weeks.

Just the 2 of us.

And we did it gladly.

Because someone had trusted us enough to give us the opportunity to build a thing from scratch. This was our baby. From the cradle to whatever grave it might eventually end up buried in if we failed, it was our baby.

So you have to excuse me if I become indignant and even a bit belligerent, when I hear someone say, "I can't do that."

Or "I don't do that."

Or "That's so-and-so's job."

Please excuse my over-inflated ego if I am offended to hear you say that a thing can't be done because it would require an extra bit of work on your part.

I voluntarily sacrificed a cushy role as a traditional healthcare provider, in an over-staffed, well-equipped office to run what some people would consider a losing race.

I'm in it up to my eyeballs. Bathing in it. Reeking of it at the end of a long day. Brainwashed. Sprung off it. Its cool, though.

Because I'm clear on what I'm doing here.
But I understand that you may not be.

So I give you permission to avoid the mistakes I made on the way to having this life consume me.

Don't fall in love with it.


Dismiss the idea that you might find your purpose in it.

Resist the urge to let its potential overwhelm you with hope.

But do me this one solid while you pass through here:

Understand what it means to so many others and respect it enough to always match my hustle....


You see, I consider myself to be an artist.

So I'm sensitive about my shit.

This message is meant for who this message will reach....
Towanna

This ain't FUBU...

Imma just get right to the point.

Some of us have no idea what the hell we are playing at.

I get on my FB timeline this morning and more than anything else, I see some of us with our ghetto shout outs and street-themed photo mock-ups of President Obama and it makes me sick.

Political cleverness requires that one be informed about the issues. And yes, I do throw innuendos about black culture into politics. Escalades, BBQ and my man, 2Chainz, for example. But I am completely cognizant of the context in which I mesh these subjects into politics and it is always to illustrate a larger point. That, my confused, misdirected people, is one thing....

But its a whole other thing to act like this man is somehow just a homie who made it out of the hood and one-upped the white man in a presidential election.

We get mad at the white folks for saying that we only voted for him because he's black.

But then we turn our black asses around and perpetrate a fraud against the fabric of who President Obama really is as a man and as President of the United States.

For some reason, whenever one of us "makes it" out, we have some kind of sick need to keep them on our level. To keep the perception that they are "down" with us.

I don't want no "down ass" President. Black or white.

As long as he is President, I don't need (or want) to know that he likes 2Chainz. I don't give a damn if he wears Jordan's or rocks Ray-Bans. I don't ever want to see him at anyone's backyard cookout unless its his family's or at least somebody in his tax bracket. He don't need to know the dang "Wobble" or the "Electric Slide." Beyond his wedding band and a good watch, I don't ever want to see him rocking any "bling." And I would hate to know that he ever drove a vehicle with anything other than factory rims on it.

My dude is President of the United States. Not Hood Ambassador.

Tupac and Biggie gone. Some of y'all want to try to make us believe otherwise, but I'm almost sure they ain't coming back.

See the way it sounds, some of us feel like President Obama being re-elected is some kind of pay back for what you think D. White Man has done to you.

Sad part is you overlooked what the hell you've done to yourselves.

D. White Man, who I don't really know, might have done a few dirty things to me in my lifetime. But guess what? D. Black Man, who I know very well, has done some dirty stuff, too.

But color don't matter. ANYBODY that gets in the way of my progress can get it. Twice.

I ain't never been no slave.

I don't never plan to be one.

I ain't never been a nigger.

And I don't never plan to be one.

It's not what they call you. It's what you answer to.

Y'all sit right there and pay too much attention to these right wing, Tea Party, extremist mother-effers and let them get under your skin and pull you into their efforts to divide this country and make it harder for President Obama to do what people with good sense elected him to do.

Black folks make up roughly 12% of the population of the United States. Study your damn math and you'd realize that there is no way that just black folks had a hand in his re-election.

This ain't FUBU. When is the last time you seen somebody rocking FUBU anyway?

Its white folks out here, struggling just like us. Unconcerned with color. And only concerned about feeding their families. Just like us. Dummy.

Let me put y'all on to something.

Its Mr. Barack Obama, President of the United States.

Not Mr. Barack Obama, Black President of the Black United States.

What I am saying does not excuse the poor behavior of those who disrespect the man and the office with their hateful, racist remarks.

But until we recognize that as his supporters, we downgrade him in the same way when we try to paint him simply as "one of us," we have no right to be upset.

Y'all better get right.

*drops mic...*

On second thought...

*picks mic up, exits stage left*

Just in case I need to come through here again.

Towanna

Duality: Run Your List

Where do I begin?

Its been a while, so I have a few things on my mind that wanted to include in this entry. But I figure that since the election is only 5 days away, I'd hop on my medical/political soap box.

This one is for the ages.

When most folks finish reading this blog entry, they will probably shrug their shoulders. And keep it moving.

Some of you will silently mumble "Hallelujah" or "Amen." And keep it moving.

And the rest of you will become offended. Wonder who I think I am. Make a mental note of all the skeletons that you think are in my closet and go off to Twitter, Facebook....or Dunbar, and consume an unreasonable portion of precious time trying to justify your feelings.

I'm not judging anyone. But the truth applies to even the greatest among us.

So stop playing.

And get something from what I am about to say.

If you lived in this world for any reasonable amount of time, you've probably formed an opinion about abortion, one way or the other. So that you get a good understanding about my perspective on the situation let me quickly share my stance with you.

Personally, I think that the miracle of being pregnant and giving birth is not one everyone will be able to experience and I think it to be horribly arrogant to so easily dismiss it. It's not an option for me. And personally, if I had to offer advice, it would be to choose life.

But professionally, my only goal is to educate and inform them of their choices. And professionally, I have no dog in another woman's fight.

Simple as that.

And people will say, "Oh, what about "Thou shall not kill." Well, what about the other nine? Matter of fact, what about all the other things that the Bible forbids, that we do anyway?

Let me run my own list.

Fornication. --- check
Lust --- check
Greed --- check
False witness -- yup
Covetousness (that's "hating" to the folks that don't know) -- check

Technically, I've stolen things. And yes, taking supplies from work is stealing. Its called "industrial theft."

I'm sure I've disrespected my mother and father as various points in my life in different ways, shapes and forms. Its the only way to explain all the ass whippings I got growing up.

Violated the Sabbath? Yes. On night shift at Waccamaw Community Hospital. All the time.

Excessive anger.

Grudge holding.

Raise your hand if you pay 10% tithe every payday? I know there are some of you out there. I admit that I'm inconsistent. It means that I am effectively robbing God.

I am a sinner. Whose probably going to sin again.

But I've gotten better at this thing by and by...

Enough about me, though.

Now.

Run your list.

You don't have to share.

I just want you to have your own reference point for where I am coming from. God made us imperfect. We live in an imperfect world. I don't know about you. But its an everyday struggle for me to do my best by Him.

But back to this...

Don't get me wrong. People who use abortion as their primary form of birth control are not covered under this particular argument.

Nor is the patient who used to come to me on an almost monthly basis to get the morning after pill when I worked at the health department. By the 3rd time I saw her, I told her plainly that I had judged her insane for indiscriminately having unprotected sex. Because any woman who knows how to have a baby, also knows how to NOT have one. (You young college guys, with those bright futures ahead of you remember that when
these females act like it was an accident).

When President Obama endorsed gay marriage, the religious community was in an uproar.

And I get that.

But what these church folks need to get is that President Obama, every president before him, and every president after him, has to live with the same duality that every other human being on the face of this earth will struggle with before our time here is done.

We love the Lord. We live to serve.

But we also live in the flesh.

President Obama did NOT endorse gay marriage as an affront to God's doctrine. In my opinion, his endorsement of gay marriage took nothing away from who he is as a God-fearing man. It was from my perspective, merely part of the earthly oath of office he took to uphold the constitution of the United States and advocate for liberty and justice for all.

So if a Hispanic man, with a deep-voice, and a beard, wants to buy a white man with a deep-voice, and a beard, a diamond ring, stand up with him at the alter, kiss him in the mouth with tongue, then call that "marriage?" Cool. If the Hispanic man wants to put his white husband on his health insurance, adopt a little black baby girl, and pay a Japanese surrogate to try for a baby boy, then call that "family?" That's what's up.

Right or wrong?

They will have to figure that our one day in a major way.

But, you see, what they eat won't make me go #2. For real.

As a medical provider, my message to a gay teenager having unprotected sex is the same as what I would give to a heterosexual teenager having unprotected sex.

But the message to MY teenager, gay or straight, having unprotected sex might be delivered with fists attached.

My message to a 30 year old pregnant patient, with a good job who is considering abortion would be the same as the message I'd give to a 15 year old pregnant patient, on welfare who was considering abortion.

But my message to my pregnant daughter (of any age) who was considering abortion would be to tell her to erase the thought from her mind. And if she decides to keep the child, I would acknowledge the fact that my intervention would obligate me to be a major part of my grandchild's upbringing (although, shouldn't that be the case for grandparents, anyway?)

But if my daughter decided to go through with an abortion, the consequences are solely hers to bear because I know I'd shown her what I believed to be the right thing in the situation.

Indeed. I see the conflict from where I stand.

But in my purpose, I am steadfast in the belief that God has made prior arrangements for me to be able to have compassion for my fellow man despite their sin and still work for His glory. Had He not made those same arrangements for Jesus, where would any of us be? Where would I be?

But your salvation is between you and the Lord.  Not you, me, Blue Cross, Congress, Nicki Haley and the Lord.

Love is given in spite of...

But as for me and my house, we will serve the Lord...

#duality

Towanna

Never Scared....

Long time. Almost 3 weeks.

My cousin Nooney's passing took a little something out of me, I guess.

So this blog is going to be a little bit rambling.

KB posted a scripture from Ecclesiastes 1:18 on her Facebook page the other day:

For in much wisdom is much grief: and he that increaseth knowledge increaseth sorrow.

It took me back to a conversation I had with my cousin that does the Throwing Salt blog not too long ago about how there are people in the that the Lord wired with an all too heightened sensitivity and insight into where the things that happen in this world can take us.

Take a young child for instance. You know some people are so very proud of the fact that they have a 4 or 5 year old that is not afraid of anything. And then there are people who are frustrated at the fact that their 4 or 5 year old is afraid of everything. What most people don't know is that those children who tend to have a greater fear of things are thinking about the consequences of an action or an event in an abstract manner, which requires a higher level of brain function. Some child psychologists identify this fear as one of the traits of a gifted child.

I remember when I was little,  my preschool class went on a field trip to the fire station. At the end of the tour of the station, we got the opportunity to get sit inside one of the fire trucks. All of my classmates lined up and jumped right in. I, on the other hand, just couldn't bring myself to climb into the big menacing red thing. Why? Because in my mind, as soon as I jumped into the seat between those two bearded firemen, they were going to get a call to go fight some raging inferno, they wouldn't have time to let me out of the truck, and I would end up in the midst of a deadly fire somewhere in McClellanville. Far away from Brown's Ferry School. Mrs. Pressley. And my Mama. Irrational? Yes. But also pure imaginative genius at that age.

That hasn't changed a whole lot in my adult life. Its the reason why I don't swim in the ocean. Its why I don't  let my child use the escalators in the mall. Why I don't just make friends, but choose my friends. And yes, there is a big difference. 

Its usually not about what is happening. But more about what could happen. 

Do I agree that my thoughts are irrational at times? Yeah. I do. Part of it is that I am an anxious personality. Its like when I ask my supervising physician about a treatment plan for a patient and tell him that I am uncomfortable with giving a certain medicine or doing a certain procedure. His first question is always to ask me, "Why?"

My answer is always, "What happens if I screw up?" His response is always, "What happens if you don't?"
Easy to say when you've been doing this for 40 years, right?

You want to know the worse thing about all of this, though?

Its watching a majority of the world go about their business as usual, seeming to not have any clue about what's really going on. Am I the only one that understands how bad things can really get? Sometimes it makes me think that maybe I have ties to Illuminati. I've long suspected that my grandmother has affiliations. Maybe I'm the next legacy. Maybe one day, I'm going to blindfolded and  kidnapped to some secret, medieval palace in Upper Bavaria where they will untether me from the secrecy and let me loose to save the world.

Nice right?

But if I really believed that, it would mean that I am insane.

And on most days, I am sure that I am not.

Instead, I choose to believe that God needs histrionic, emotional people like me. Insightful people like my blogging cousin. Powerful people like KB. Super-tender hearted people like HL. Who, for the fact that our thoughts are skewed from the norm, feel things maybe more deeply, probably differently, maybe even on a different plane. So that what perceive ourselves to know, reveals to us, directly, the sorrow in the world that needs to lifted.

I used to think of  it all as "fear." It was a bit disappointing before I knew what it really was. But then I realized its not fear. Its "knowing."  And there is a price that comes with that "knowing." Its gift and a curse, but this "knowing" guides my steps forward and is a big part of the value of my purpose.

Plus,I ain't never scared...






 

Nooney, my dude...

Good Morning.

This entry is a little early.

But I needed to get some things off my chest...and out of my head.

We lost my cousin Stephen "Nooney" Lance yesterday. The funny thing is that when I heard that he had been in a bad accident, it never crossed my mind that it meant he could die. Especially since right after the accident, reports said that he was already dead and I know how fast (fake) bad news travels at home. So when I finally spoke to my Mom to see if she had heard how he was and she said he had been airlifted to MUSC but they thought he was going to be ok, it seemed like it was going to be like the scrapes Nooney has had before. My dude even went "missing" for a few days once. But the reports of his demise have always been greatly exaggerated. I figured this would be the same situation. And when I went home this weekend, I'd look across the trees and see him in the backyard and hear him yell my name and say "What's happenin' cuz?" in that goofy voice of his or see him drive by in the GMC, tucked low and leaning to the side.

I guess you get to a point where life is so full of our daily comings and goings that we don't think about death as a part of everyday life. But it is.

I realized this morning that in my short time as a nurse practitioner, the thought of death and dying, as it relates to my patients, has never really crossed my mind.

It strikes me as a little weird. And I am trying to figure out how I, as a medical provider, that I don't think about it more.

Is it selective amnesia for my own comfort? Indifference? Am I out of touch? Desensitized? Suffering from a god complex?

I just don't have a good explanation. 

When I worked as a floor nurse right out of undergrad, I treated every patient as if they could die at any minute. At the time, I was just that terrified of what I had chosen to do as a profession. Better safe than sorry, right?

I remember the first time a patient died on my watch, I was about 6 months out of nursing school. The shift changed and the report that I got from the day nurse gave every indication that the patient was ok. I remember clearly hearing her say, "He is dehydrated and anxious. Just give him some Ativan and he will be ok."

What I have always had is an internal instinct to cover my @$$ in those situations, so I ALWAYS reviewed each of my patient's charts at the start of my shift for things like new orders, labs and/or test results. So after report, I pulled the patient's chart and noticed he'd had an abdominal CT done. I don't remember the results specifically but the report basically said that the patient's belly was full of "sludge" and his organs "could not be adequately visualized."

All of my other patients were stable for now. And because the off going nurse never mentioned the CT to me, something told me that it meant the doctor did not know about it either.  I brought it to the charge nurse's attention. She paged the doctor while I went to assess my patient.

When I walked into the room, he was sitting on the edge of the bed, on 2 liters of oxygen, but still completely short of breath. He skin was cold and pale. He was sweating non-stop. His pupils were dilated. His pulse was racing. And his belly....

His belly.

That's what let me know something was terribly wrong.

I laid my stethoscope on his stomach and heard absolutely nothing. He was so bloated that I could plainly see the veins dilate and stretch across his swollen belly. I could not palpate his abdomen, because the skin was stretched taut like drum. And the beautiful tympanic sound that you should hear when you tap on someone's belly, was replaced by the dullest "thud" I had ever heard.

I didn't know what was wrong, but I knew we needed to figure it out quick. I yelled for the charge nurse to come in. We didn't have a Rapid Response Team at the time and it wasn't technically a code situation. But we had to do something. She still had the doctor on the phone, so I asked her to get orders to move him to the ICU.

The patient's wife was in the room and we explained to her what was about to happen and she seemed relieved. She said that she'd been asking all day for something to be done, but everyone seemed to think that he was ok where he was. She thanked us and just as the charge nurse and I turned the corner to walk out of the room, it happened.

It sounded like the patient had belched really loudly. Then I heard his wife scream. I turned on my heels and looked back to see the patient projectile vomiting what I could only describe as black bile. Inhuman amounts of black bile. The charge nurse screamed for the secretary to call a code blue and we made it over to him just before he fell forward onto the floor. God gave the us the strength to get him back in bed and on his side so he would not choke on the bile. As we cleared his airway, turned him on his back and started CPR, the code team rushed into the room and took over. This all happened in the matter of about 60 - 90 seconds, but it felt like a lifetime.

His heart had stopped. The monitor showed pulseless electrical activity or PEA, which meant that there was some electrical activity, but no heartbeat. Epinephrine. Vasopressin. Atropine (it was still on ACLS back in 2005). Paddles. No change.

They intubated him and moved him to ICU. The doctors explained to the wife that the patient was brain dead. The vent was breathing for him and once it was removed there was virtually no chance for survival. His wife agreed to have the vent removed, but asked that they allow her children time to come in from out of state before it was removed. They agreed.

I didn't hang around the ICU long enough to know what else happened. My shift had started at 7:15 that night and all of this transpired before 8:30. I had 5 other patients that I had not laid eyes on yet. I had to get my brain to shift gears from the thoughts of the dead, who I could do nothing for, back to the living who needed my care.

I think something happened to me then. I'd never seen anyone die before. To that point, it was enough that I'd seen someone dead in a casket. But to witness them passing from this life to the next? It was almost too much. That night I actually considered not being a nurse anymore.

I struggle with the thought of death. So I try not to think about it. It sends a cold shiver down my spine. I am dismayed by it. Weakened by it. Heartbroken by the fact that it can come and take my most beloved, irreplaceable things away from me. That it could take me away from those same things.

Maybe that is why I don't bother it, until it bothers me. Maybe that's why, I never consider it as an option for my patients because to be effective, I have to always feel like there is something I can do. The thought of death, you see, renders me powerless and sorrow seems to be my only recourse.

I will think about Nooney (and death) constantly for the next little while. I will wonder if this was God's way of saving him from an earthly fate worse than death or if it was really just his time to go. Either way, I applaud the folks that never gave up on my dude, even though there might have been reasons other people thought they should.  Life and hope go hand in hand. No matter what the situation might be.

Its easy to say that in a perfect world, all of our chains would remain unbroken.

But my guess is that world would also be absent of God's will and our promised salvation.
 
And nothing about that could ever be perfect.

Its like my granddaddy, Buh Norman used to say, "Chile, you need to try to live until its time to die."

That's right Granddaddy.

I don't think we should bother death, until death bothers us.

RIP Cousin Nooney. Imma see you again.

Towanna

Anybody Can Get Slapped...

I figure that since I am home with my 4 year old and her crud today, I'd take some time to write a new post while she naps. Wonderful thing that Benadryl is. I remember once when I gave it to her, she must have rolled out of bed because when I went in to check on her she was on the floor, wedged between the bed and the wall, fast asleep.

She didn't even stir when I picked her up to put her back to bed. And it would have scared the "ESS" out of me...except she was snoring like a grown man. And anyone whose heard my child snore, knows that is all the sign of life you need.

She's gets that from her Mama. I snore like 2 grown men when I am really tired. Gotta get that good chainsaw sounding sleep in every once in a while.

Helps to replenish your sexy. But at 3:00 in the morning, Hubby would probably disagree.

Anywho, its been a good few days at clinic this week. As usual, there is very rarely a dull moment to be had. Between the staff and the patients, I don't think there is a completely normal person in the bunch. Not even AF. I think her "crazy" is a bit more normal than the rest of our "crazy," but she fits right into our collective "crazy" nonetheless. We also have a fairly new member of our team, DP, who at first glance you would think was super quiet. I thought we might scare her off when she first began working with us, but now I plainly see that we definitely don't have to worry about that. She's so efficient and on top of things. And I think, you better not mess with her. Not only because the rest of us will come looking for you, but because I'm almost sure that if you rub her the wrong way, you'll get told off. Her "crazy" is quiet. But she is from off that water like me and KB, so she is probably still "crazy."

But there are 2 characters in the cast that the word "crazy" might not begin to touch.

Let me explain.

CK has some odd ways too. Real odd. When she eats a Snicker Bar, she eats the chocolate off of the top of the candy bar and then saves the rest for later. I guess it might be more odd that it bothers me so much. We asked her about it one time, but I don't remember what her reasoning was. And I probably don't remember because it didn't make sense to me. Another thing I find odd about her is that she eats Nilla Wafers like they are regular cookies. Again, I might be the odd one, but the only time I think that people should eat Nilla Wafers is if they are in banana pudding. Otherwise, it just doesn't make sense.  And then there's the story about the drug test she took before she was hired on with us. It bothered me. But I am still investigating the situation because I think she was taken advantage of. I can't go into detail for REALLY FUNNY reasons, but just know that I'm going to get to the bottom of that foolishness on her behalf. Last week I asked her to stop responding to me with "ma'am." So when I called her name, instead of saying "ma'am" she said what I think I heard to be "Yurp!" Uh, no. I told her that if that was the alternative, "ma'am" would do just fine. If you ever meet her, ask her about "baby hair," taking "baby" sand to the beach, and why she doesn't think that people should have dogs as pets. No. For real. Ask her. Then tell me something isn't loose somewhere. (I am sure she has her eyes stretched wiiiiide open as she is reading this).

And then there is HL. Dear sweet, HL. Bless her heart. She is too funny. Almost to a fault. And usually without meaning to be. Last week, at one of the clinic sites where we share a really small office and one desk, she and I were sitting beside each other on one side of the desk. We were nowhere near close enough that we had to be touching at all, but every few seconds, she would step on my toe. The first couple of times, I didn't pay it much mind. But after the 4th or 5th time, my pinky toe couldn't take it anymore and I threatened to punch her if she did it again. I thought maybe she was doing it deliberately, but I actually think she has so much energy that she couldn't be still if she wanted to. And then there was last Friday when we were sitting in our makeshift office. She and AF were behind their partition on one side of the room and CK and I were behind our partition on the other side of the room. I called out to HL and asked her if she could come over for a second. All I heard was her voice from behind the partition saying, "Sorry honey, but I'm sitting down right now." (O_o) Ok. But I think that was the point of asking her to come over. She got a pass for being a smart butt, because she wasn't feeling well that day. I wish I had time and space to tell you about her and her friends using Blue Magic hair grease as tanning lotion when they were in 7th grade. Or the fact that its her fault that "Bands A Make Her Dance" is currently our unofficial theme song. But I don't. So I will just say that I hope her lost rottweiler finds his way back to her in good health with the help of that dog whisperer that contacted them. Being sad doesn't suit her.

KB is going to escape unscathed this go round. But threatening your pretty little dog with a shock collar and breaking out in the "Cupid Shuffle" (or was it the "Wobble") in the middle of the street doesn't leave much question about where she falls in all this.

And yeah, yeah, yeah. I know its like the pot calling the kettle black.

But dis here is my blog.

Where anybody can get slapped.

But, duuuhh!!! Why would I slap myself???

Love you guys. I would not be here without you.

Towanna

Blown Away...

Good Morning, Folks....

Its such a peaceful Saturday morning here in the Met. I think that we are going to the zoo today, so I got up early to clean and do some laundry. But I hate that part of my life, so I take frequent breaks while I'm doing it. And I thought that maybe this would be a good time for my weekly blog entry.

There's a movie called "Life as House" about a man named George who has cancer and all sorts of other problems, who simply decides to build a house before he dies. He's divorced and has a teenage son with his ex-wife. The son is a drug addict who can't stand him and steals his Percocets to get high with his equally strung out girlfriend. So yaddah-yaddah-yaddah and blah-blah-blah, by the end of the movie, this huge dysfunctional group becomes a distorted picture of happiness and they all become a part of the construction of the house. The man dies, but his ex-wife and his son, in the traditional movie cliche', find the strength to move on and decide to finish the house for him.

Ok. So what's the point of all that you ask?

Well, there is a line at the end of the movie where George, the main character talks about change:

"You know the great thing, though, is that change can be so constant you don't even feel the difference until there is one. It can be so slow that you don't even notice that your life is better or worse, until it is. Or it can just blow you away, make you something different in an instant. It happened to me."

I think that I am going to have new business cards and t-shirts made up for our clinic with this as our mantra. The clinic staff and I started this journey back on April 11th of this year. I remember that first day, it was just me and KB, in one cramped room with no admin staff at all. We saw 17 patients that day. All of them new patients. I know that won't mean a lot to many of you reading this, but those of you who do know, will appreciate what kind of feat it really is to have see 17 brand new patients, using one exam room and no admin staff. We worked from 8 that morning until 8 that evening. And that went on for quite sometime before a new shelter director came in and offered us a larger space to work from.

I was under so much stress at that time, that I actually ended up with a flare of my TMJ, which I had not had a problem with since undergrad nursing school at MUSC.

We have to also remember that I had only been a nurse practitioner for  5 months when this all started. I was terrified enough at the thought of independently taking care of patients on my own, but at least in the regular office, I had several other providers at my immediate disposal should I need help. Out here at the clinic, it was just me. And if I had a concern about the care of a patient, a phone call was my only lifeline to the outside.

But looking back on it, as hard as getting those clinics up and running seemed to be at the time, I never flinched, never second-guessed what I was doing. Mainly because I knew in my heart, I had not chosen to be there. But I had been chosen to be there. On top of that, I knew that in the form of KB, God had sent me something that I had never had: a completely like-minded spirit with the same motivations, desires, and  ego-absent work ethic that you need to endure what we were tasked to do.

Now, almost exactly 5 months to the day that we opened those clinic doors, I can tell you that I completely understand what George must of felt like as he noticed the transformation that his life had taken. Because we were so busy all the time, not only did I not notice the awesome evolution of the clinic while it was happening, but when I finally did take notice just a few days ago, I was completely blown away what it had become and even more flabbergasted by some of the changes I noticed in myself.

When I was going through NP school at Duke, one of my last rotations was with. Dr. S., an OB/GYN in Conway and an absolutely brilliant lady with high expectations for the people whom work with her. And sometimes, in my experience with her, that combination could translate into a milder form of tyranny. I went into that office with her everyday, always worried about getting my hand slapped. There were not many days that I didn't get my hand slapped and in my mind, that mean that I had an uphill battle getting to where I needed to be as far as she was concerned. But on the last day of my rotation, after seeing the last patient, Dr. S. gave me a great big hug....and offered me a job. 

I did not realize it then, but her constant correction of me was her way of showing me that she knew my potential and she fully expected me to work to fulfill it. I always keep that experience with her in the back of my mind, because when I worked as a floor nurse at the hospital, I had some really nasty experiences with some of the doctors. The running joke amongst the nurses was to ask the question, "Are you a doctor because you're nasty? Or are you nasty because you're a doctor?"

I know now that its neither. At some point as a medical provider, you began to totally grasp what it means to work in a profession where there is little room for error. When you are in charge of the direction of ALL the work that goes into a patient's care, you tend to forget your manners and other people's feelings. Its always business. Never personal (although there is still a line of respect to be drawn). So as much as I used to get upset at those rude doctors who acted like I was bothering them when I called them about their patient, I never in a million years would ever think I'd understand where they were coming from.  But I do.

Talk about blown away.

This all makes me think about a post from my cousin, JJ's, Facebook page a while back. (BTW, he has an awesome blog on WordPress. If you need an uplifting (or even just a laugh) you should check it out at http://throwingsalt.wordpress.com/). It said:

God does not call the qualified. He qualifies the called.

Going into this, I was not well-equipped. At all. But I pressed forward, knowing that my Dude's will can never take me where His grace can not protect me.

GLORY!! I can't sit still....

If you need to reach me, call my cell.

Cuz I am about to walk outside in this parking lot so I have enough room to shout and give testimony!!!!!!!!

Towanna

Fo-shingles, my ningles....

All Imma say is that you have to be careful about who you let doctor (or nurse) on ya these days.

Cuz there are some of us that have no idea what we are doing.

I'm not saying I'm the greatest. Not even close to it.

But there are some really fearless idiots practicing medicine out here right now.

I don't know anybody that is going to get it right 100% of the time. But there are some very basic things, in the course of a medical work-up, that even the most amateur of us, should not miss.

You know, like it might make sense that if a 60 year old man comes in with a stroke and elevated blood pressure, before you discharge him, you might want to check a few things to help me out if you expect me to be his primary care provider.

There's no reason why he was was in the hospital with you for 10 days and I had be the one to figure out that he's also diabetic and the reason that you couldn't get his blood pressure down in the hospital is because his kidneys are jacked up. Yeah. Cuz no one in the hospital had a decent enough stethoscope to have heard that massive aortic bruit during his belly exam. You did do a belly exam, right? (O_o)

And let's talk about shingles. Yes. Shingles.

Prior to graduation, I'd only seen a case of shingles once. And it was not even that bad a case.

So when this lady showed up at the clinic looking like the villain, Two Face, from the Batman movies it wasn't rocket science to know that it could only be one thing. That's right. Shingles.

Rule of Thumb: Shingles, derivative of the chicken pox virus, migrates along the pattern of dermatomes. Which means the rash will only appear on one side or the other.

It is viral. So technically there is no "cure," but only anti-viral medications can suppress the virus in the human body to hopefully keep it at bay.

So no, dear ER provider. Giving this lady Bactrim was not a good idea. Especially since she was allergic to it. Following it with Keflex and Benadryl was also not a good plan of care.

By the time she came to me, she looked like the aliens from that TV show "V." But just on the right side of her body. 

Before I go, another piece of advice for the patients who might put too much faith in their provider.

If they give you a new medication, please make sure they tell you what it is for and what side effects might come with it use.

Because if you show up in my office with your lips looking botoxed and your eyes swollen shut and tell me that you didn't stop taking it because you "thought the medicine was supposed to do that," I can't have any sympathy for you. You just need to be glad that it didn't swell your airway and kill your crazy ass.

So, please. Don't walk into these medical offices thinking that everyone with a medical degree was a straight A student. Some of us only made it out by the skin of our teeth.

Be diligent. Find a provider you really trust and stick with them.

Towanna

Don't Save Her...

Yeah, yeah, yeah. I know that it has been a while.

But I have a good excuse.

I almost died.

Ok, ok.

So maybe I didn't almost die. But that migraine that I told you about in the last post made me feel like I'd rather go home to glory.

Ok. Another exaggeration. (Dear Lord, it was just hyperbole).

But, I would have gladly swapped the pain from the migraine for that of giving birth to an almost 9 lb baby again. And I say church.

Preach.

Instead of trying to blog 2-3 times a week, I'm considering going to once a week. Probably every Saturday morning. Just sitting here right now, after not having posted in 10 days, reflection is easier.  With the exception of love, shoes, and potato salad smothered in sweet barbecue sauce, they say that less is more. We'll see.

Anyway, I've never had a migraine that lasted that long. 5 days. And the pain was way different than what I usually feel. The dizziness, the nausea and the total insomnia just made it a million times worse. I think that I had been on auto-pilot for such a long time that I just did not pay attention to what my body was saying. You know? Stuff like, "I'm hungry." And "Close your eyes and take your stupid ass to sleep."  With the schedule and pace of the clinic (like KB staying until well after 7:00 last night to make sure the patients got their meds or us seeing 13 patients a day with just one exam room), eating, sleeping, and toileting (I learned to hold my pee for 12 hours when I worked at the hospital) can sometimes take a back seat. And ordinarily, I'd tell you that ain't nobody got time for that anyway.

Ordinarily.

But when you find your already slightly insane self, hallucinating about being wrapped in a cotton candy cocoon, sealed into a goo-filled hyperbaric tank, put on a spaceship and kidnapped to the far reaches of outer space, to have your body probed by killer clowns with huge, shark-like teeth, while your Grandmother stands in the middle of the yard waving goodbye and saying, "Wha happen? I deef you know," because she can't hear your deafening shrieks for help, you begin to re-evaluate and make a permanent mental note of the things that you really don't have time for.

 A near-psychotic break is now at the top of that list.

So I have committed myself to always make it a point to sit down and take at least 15 minutes to eat something during my lunch break and to get at least 6 straight hours of sleep at night. The eating thing should be easy. But I might need some, (ahem), intervention with that sleep thing when my brain's "pause" button (just like its "edit" button) doesn't always work like it should.

But I definitely want to avoid a repeat of last week's "A Dukie Down" situation. Especially because there is the potential, that instead of killer clowns, the next time it might be flashbacks of my aunt dressed like a deranged Cabbage Patch doll at the family reunion last weekend that might come back to haunt me.

And that is definitely some shit I won't like.

See there?

Edit button malfunction. (But the rest of y'all don't need to act like you weren't thinking the same thing).

But I digress.

For now.

Our undertaking to get these clinics up and running was ambitious to say the least. Its also what I signed up for, but my problem sometimes is that I am my harshest critic. I always feel like I need to do more, even when there might not be any more that can be done. Couple that with the fact that when it comes to the care of my patients, the Type A part of my otherwise easy personality takes over and I get tunnel vision. So if someone or something gets in the way, it/they probably need to be prepared to get run over. Its never personal and its not my habit to look back to check for survivors, but this time, I was forced to look back.  When I did, it was my own reflection I saw in the rear view. With fresh tire tracks down my back and all.

But let's make sure that we don't get this twisted. I don't subscribe to the idea of the "living martyr" because that suggests that on some level, I would have to consider myself a victim and the set I rep doesn't turn out weaklings.

Justice League over here, my damies. (What up, Pootie?)

E.B White, the author of Charlotte's Web, said, " If the world were merely seductive, that would be easy. If it were merely challenging, that would be no problem. But I arise in the morning torn between the desire to save the world and a desire to savor the world. This makes it hard to plan the day."

Seriously.

The good thing is that since I began working as a nurse practitioner, I've never gotten out of bed just not wanting to go to work. Of course, there are days when I feel more up to the task than others. And most definitely, I hope that I will never ever have to unreasonably sacrifice any part of my role as a wife and a mother in order to fulfill my job responsibilities. As much as I love my job, that choice would be way too easy.

My prayer is only for balance. But I'm certain, that sometimes, just like me, even the most heroic among us secretly wish that our proverbial "ho" was willing to "turn tricks" for a more reasonable exchange. And we could just take a day off and go shoe shopping at Bob Ellis.

Obama-Biden 2012

Towanna


 







 

I Will Survive....

Hey, Folks!!

I am home with the craziest migraine today. I get them from time to time. I can mostly muscle through them, but I've had this one for 3 days. Just sitting here looking at this computer screen makes my left eye feel like it wants to explode.

Definitely time for some intervention, so I am going to get a shot of Imitrex in a little bit. Its nice to be able to get seen at the doctor's office on a moment's notice. Membership does have its privileges.

Its funny how we get our inspiration sometimes.  I've been somewhat of an insomniac for the past few years, usually getting by on 4 - 6 hours sleep in a good night. That's 2 - 4 hours on a really bad night. Sleep has never really been a close friend of mine.

Part of managing my migraines is making sure I don't go without enough sleep for too long or it will catch up with me. And since I've probably only slept a total of 10 hours the last 3 nights, the severity of this migraine has come as no surprise to me.

But Sunday night when I found myself imitating a raccoon at 2 am, I started flipping through channels on the TV and landed on channel 72, which is the Oprah Winfrey Network. I was kind of geeked to see that "March of the Penguins" was about to come on. I guess if I was going to sacrifice a good night's sleep, watching these odd little birds and listening to Morgan Freeman's flawless narration was as good a reason as any.

It was the first time I'd seen it since it came out in the IMAX theaters in 2005. If you've never seen it you should. It is one of the most beautiful films I've ever watched. The plot revolves around the migration and mating rituals of penguins in Antartica. Their existence hinges on the thousand year old tradition and for reference, the animated movie "Happy Feet" is loosely based on the premise of "March of the Penguins."
 
After mating, the female penguins leave the mating grounds, with their eggs in the care of the male, to make the long hike back to the water's edge to gather food for their soon to be born chicks. That journey takes nearly 2 months, which means that the male penguins would go without food for that entire time. Many of the male penguins would not survive those two months and in turn, neither would their chicks. For the father penguins that did survive, if their chicks hatched before the females made it back with food, there was a good chance that they would die of hunger.

I was lying in bed, thinking that being a penguin might be the most awful thing to be in the world.  If I was a penguin, I'd pray that some adventurous human caught me in a net and sold me to the zoo. They could put me with a nice, civilized male penguin. Once my egg was laid, the nice zoo people could put it in a warm incubator until it was ready to hatch. See all that hiking back and forth in all that cold, dodging walruses, and scrounging for food when there is a good chance that in the end it might all be for nothing??? Stop playing. Ain't nobody got time for that.

As the scene of the female hike cuts to the mass of male penguins huddled together, plodding slowly about the mating ground, trying to shelter themselves and their unhatched babies from the bitter cold, Morgan Freeman's easy voice interrupted the silence.

"No matter how cold it is or how hungry they are, the fathers must keep moving. If they don't, they will die."

It's easy to forget that "survival" is a relative term.

What we consider necessary to survive is completely based on our own egocentric view of life and what we have gotten used to.

Same for penguins.

Same for my patients.

Last week, I saw a young, female patient who had been living on the street for years. She had been trying to get a bed at the shelter for some time, but she had to kick her drug habit before they would take her in.  She had been given temporary housing at a half-way house but said that she did not feel safe there. So she chose to live and sleep on the streets.

I asked her how she could feel safe sleeping in public bathrooms, in parks and at transit terminals, but not in a secured, supervised place.

She looked at me and said, "Yeah. The house I grew up in was supposed to be a secure, supervised place, too. I expect to find trouble in the streets."

That was lost on me until her case worker let me in on her history. She'd suffered multiple kinds of abuse at the hands of her stepfather, who had actually beaten her to within inches of her life at one point. Her mother would make the excuse to the schools that it was discipline for her rebellious nature. DSS had taken her away for a short time, only to send her back to have the cycle repeat itself. Broken jaw. Bruised lung. Forced abortion under the suspicion that the baby was her stepfather's. She finally left when she 17 and never looked back.

She was kind of like the penguins.

No matter how cold or hungry she got in those streets, she had to keep moving. Her survival depended on it.

On Friday afternoon, as I was leaving to go run an errand, she stopped me and told me that for the last few nights she had been sleeping on the sidewalk. She had used flattened cardboard boxes for padding and a trash bag for cover. She asked me if there was any way I could get a blanket for her.

I told her that I would see what I could do, but I had all intentions of telling her I asked around and could not find one when I came back.

But as I pulled back into the shelter parking lot and pressed my key fob to lock my car doors, I remembered that I had one of my daughter's blankets and pillows that she used for school naps and road trips in my trunk.
It took me a second to decide that I would let my patient have them, because it was my baby's pink velour blanket and her Disney Princess pillow, which I knew were her favorites. Having "favorites," though, meant that she had a variety to choose from.

Even in a matter of life and death, my patient, like the penguins, didn't have as many options.

So I popped my trunk, took out the blanket and pillow and walked back into the shelter courtyard where I saw the patient looking like she had waiting on me.

When she saw the blanket and pillow in my hands, a grin spread across her face and she ran and hugged me to the point that I was embarassed by the attention that it got from the other residents standing outside.

I told her that my child would be very upset if she knew I had given away her favorite blanket and pillow.

The patient apologized and said, "I'm sorry. I hope she's not too sad."

The truth is that it's ok.
She might be sad for a second.
But the important thing is that she'll survive.

Towanna

Jesus & Michael Jackson...and Star Wars

Good morning, All!!!

First, prayers go up to KB and her family as her Mom recovers from a recent heart attack. She is a living witness that what looks impossible to man is so easy for God.

2 Corinthians 5:17. That power right there can heal a broken spirit and the wounded flesh. Better get you some.

I got a call the other day about some health ministry business at the church back home. I am trying to decide how involved I am going to get into that situation at this point. Not because I don't want to get involved, but when I was fully involved, I experienced some of that church politickin' that I've heard so much about. Didn't like it. Not one little bit.

But don't get me started on that. This blog might get shut down.

Its cool, though. I finally realized that God has given me gifts that the people at home needed, but were not ready to accept from me. As much as I wanted to bring better things to my people at home, God had to move me out of that situation to show me that the work that He sent me here to do was not going to get done in that environment.  And I have been judged harshly for that.

The good thing is that harsh judgment is the proof that what I did was right. Otherwise, I'd be still pulling my hair out trying to please people who had already made up their minds that they were not going to be pleased. Especially not by me.

Chile. Boo.

God sent me here to save the world. I don't owe anyone an explanation of my purpose.

Plus, I don't know about you, but ain't nobody over here got time for that.

But I digress. Because only Jesus and Michael Jackson know what I mean.

I was talking to my supervising physician the other day about how I wanted to go into emergency medicine in my next life. That adrenaline rush is something else.

I told him how frustrated I get when a patient comes to me from the hospital or emergency room without complete care, like just enough was done to justify getting them out of there.

Its just seems like we need folks to change the culture of emergency medicine in this area. Especially for the poor and uninsured populations.

I have an elderly, male patient who is diabetic. He'd had a toe amputated a couple of weeks before the first time I say him. He said that he had seen the surgeon just a few days before that and had been released from care.  He had been being seen at a free clinic to have his diabetes managed. Obviously, though, the diabetes had not been under good control as witnessed by the fact that he had to have a toe amputated.

He was coming to see us to establish care and said that he was told by the surgeon to follow-up with a primary care provider for management of the amputation site. I took a complete health history that was only significant for a personal and familial history of diabetes. He had no history of drug, tobacco, or alcohol use. His blood pressure was excellent and his weight was appropriate for his height.

But when I asked him about his medications we hit a bump in the road.

He was wearing an old-school fanny pack. He unzipped it and started pulling out insulin pen after insulin pen after half-empty insulin pen. Lantus. Novolog. Regular and 70/30. Humalog. Levemir.

"Which ones are you supposed to be using?" I asked him.

His reply: "What's the difference?"

Among other things, he told me that he was using the insulin 3 times a day after meals and wasn't really sure what combinations of insulin he was using. What he did tell me was that he usually gave himself  2 - 6 units each time depending on what he ate and that he did not have a meter to check his blood sugar.

His finger stick blood sugar and rapid A1C in the office that day was 174 fasting and >13.0 respectively.We drew a complete metabolic panel to check his kidney and liver function and a lipid panel to assess his cholesterol.

His physical exam was essentially normal.

That is until we got to his feet.

Now I am no surgeon, but I was pretty sure that releasing this man from his care was probably not a good idea.

Where the "pinky" toe of the right foot had been was a open wound, oozing green and yellow pus with a gangrenous flap of skin hanging off. The other four toes were all blistering, bleeding, or oozing pus in some combination. It was obvious that he was going to have to lose at least part of that right foot. The left foot was in better shape, but not by much. If he did not have some intervention immediately, it would suffer the same fate as the right one.

 As I stood there examining his wounds, it suddenly hit me that he had not made a sound the entire time...because he had absolutely no feeling his feet at this point. The out of control diabetes had completely compromised his circulation.  There was no telling how long he had been walking around like that.

We were able to get in touch with the surgeon's office. It was Friday and he had left early, but I did speak to his nurse who gave me an appointment for first thing Monday morning. I told here that I would clean and dress his wounds and put him back on some antibiotics until then.

As I suspected, the surgeon decided to amputate his forefoot. The surgery was scheduled for Wednesday morning. I fully expected that we would not see him back at the shelter until at least late Thursday or Friday morning.

But I should have known better.

That same Wednesday afternoon, one of the shelter's staff came to the clinic area and asked KB and I if we had time to come check on a patient that was bleeding in the day room.

We followed him through the double doors to the day room and our eyes settled on a heavy trail of blood leading to a table near the front desk. When we finally spotted the source of the bloody scene, I realized it was my patient. He'd had his foot amputated that morning and was discharged back to the shelter just hours later.  The patient's story was that he stayed in recovery for about 2 hours before he was discharged. He had walked back to the shelter from the hospital.

No wheelchair. No crutches. Just a gauze dressing and a blue "shoe" with velcro straps.

His leg was propped up on a chair and underneath the chair was a widening pool of blood. His once white bandages were completely red and blood was actively pouring from the wound. The patient was sitting there like nothing had happened and I was actually grateful for the fact that he could not feel anything. I asked the shelter staff to call 911 because there was no way I would be able to stop that bleeding. KB and I gloved up and began to wrap his foot with layer upon layer of gauze. It only took the ambulance a few minutes to get to us, but by the time they did, there was a red spot growing on the wad of gauze we had just put in place.

Not long after the ambulance picked him up, he was back at the shelter. Apparently, on the walk back to the shelter, he'd busted open his stitches. At least this time, the hospital had given him a cab token for the ride back.

I saw him back a few days later. He'd been set up to be seen at a foot clinic for follow-up. We got him a new meter, ordered him some diabetic shoes and started him on Metformin, Lantus and 2.5 mg of Lisinopril for kidney prophylaxis. I thought about adding mealtime insulin, but felt that it would just complicate things for him at that point.

Plus, and I don't know if this can really be described as a good thing, but the good thing about many diabetic homeless patients is that most of the time, they have not been taking their medicine correctly, if at all. That means that even if their A1C is off the chart, there is great potential that you will have a marked improvement in the control of their blood sugar within the first few months of consistent therapy.

All of this happened a couple of months ago.  I've seen the patient back a couple of times. KB and I have taken a lot of time educating him on his diabetes and his treatment regimen. In the process of all this, we found out that he only has a 3rd grade education and can barely read.

He also told us that he actually had a meter at one time, but that he did not know how to use it. No one ever offered to show him how to use it, so he just didn't. We made sure that we got him a one touch meter with visual prompts to make it easier for him.

Sometimes, it just takes us to recognize that a patient's failure to take care of themselves may be based upon our failure to give them all the tools they need to do so. The patient-provider relationship is meant to be both altruistic and symbiotic. Responsibility for success and failure must be equally shared.

That patient is doing very well these days. He came into the clinic for labs earlier this week was ecstatic to show us his blood sugar diary. His fasting that morning was 96. I can't wait to see what his A1C looks like.

I am proud of and excited about the work that we do in the community. AF and HL are doing a great job at planning health education program planning for the residents at the shelter. We have our diabetes class coming up here soon and the turnout should be massive.

My work has got me giddy. Like a Star Wars geek at a Sci-Fi convention.

Towanna

Love & Help Us Columbia

Good Day, Folks!

Did you miss me?

I know you did.

The last 7 days of my life have been so hectic. I am just getting a minute to take a breath. But that is what I love about the road I'm traveling right now. Never a dull moment. Change is constant. Adaptation is a must.

And that's adaptation. Not assimilation.

But there are a few constants in my life that I know I can always count on: God, my family....and drug seekers.

In that order.

Clinic gets busier every day. The busier it gets, the higher it seems some of the patient's want to ramp up their craziness.

I had a female patient who we banned from even stepping foot into the clinic area because every time we saw her she seemed to be looking for a confrontation. Her story was that she broke her wrist 15 years ago and wanted me to give her Percocet, which is a schedule 2 drug that I can't prescribe anyway. I refused her because when I checked her in the SCRIPTS database she was getting narcotics from several sources --- including a doctor in Charlotte who she was traveling back and forth to see. If she was smart, she would have filled the script in North Carolina and then it would not have shown up in SCRIPTS because it only covers South Carolina controlled substances.

We got a report back from an orthopedic surgeon who saw her in consultation that said when he refused to give her pain medication, she requested that he amputate her hand.

Talk about cutting off your nose to spite your face.

But she showed up on Friday and asked us to check her blood sugar. "No" was on the tip of my tongue, but KB, blessed spirit that she is, told her yes and asked her to sign in and have a seat in the waiting room.

Now this was around 3 pm. We were still seeing our regularly, scheduled patients and I was about to start a well-woman exam so she was going to be waiting for a few minutes.

I think 30 seconds passed before she walked back in screaming that we were "playing with [her] life." KB was in the room working up a patient, so I took a deep breath and tried to explain to her that we would be with her shortly, but that she walked in while we were really busy and she just needed to be patient for a few more minutes.

But the more I tried to reason with her, the louder she got. So I got loud, too.

And you can ask my sweet siblings, KB, or my cousin's wife, Keisha, but when I get loud, you might as well shut your operations down for a moment. I'm not going to stop until I know you've heard me.

So I (loudly) explained to her that she had been banned from the clinic for her prior behavior and that we were only seeing her as a courtesy. Not an obligation. I told her to leave or I would call security to remove her.

As I walked towards her, she started to back her way out of the door.

"I'm going to a higher authority to report you."

I thought to myself, "And??? You aren't the first and you won't be the last. What else?"

Then she played her trump card.

"I know you and the rest of these people smoke crack. You old crackhead m*****f*****!"

Now this caught me off guard. I've been called a lot of things in my life.

But never a "crackhead mofo". She get's major props for that one.

I wish all the irate patients had such original thoughts. I can only be called a "b-word" so many times before I get completely bored with it.

The really frustrating thing about this woman is that even after we banned her from our clinic, I made arrangements for her to see a provider at another site. And she behaved in the same way with him and now he has refused to see her.

More frustrating than that is that this lady really has some serious health problems including diabetes, high blood pressure and lung disease. But she never gave me a chance to help her with what I really needed to help her with because she is blinded by her addiction to those pain killers.

I'd like to manage her diabetes, get her blood pressure under control, help her to quit smoking and try to keep her out of the hospital for her frequent COPD flares.

But regardless of your race, religion or socio-economic status:
Help only helps those that help themselves.
And love don't love nobody that don't love themselves.

Be good, y'all.

Towanna




 

Awareness & Lucidity: Miss Cleo I Need You....

Since I have a late start to clinic today, I decided that now might be a good time to put up a new entry.

Remember the patient from my earlier blog who I told you that we rode that rollercoaster with one afternoon? She came back to see me last week. She looked well. I put her back on her blood pressure medication and the level of gratefulness that she showed us was phenomenal.

I mean, we have a lot of lame people in this world with big ugly houses and big ugly American-made cars walking around with their noses turned up in the air acting like someone owes them the privilege. Then you have people like this particular patient who, for all the hard knocks she's had in her life, still retains the simple decency in her heart to be able to smile and say thank you. She may not know it in her current circumstance, but that is part of a supernatural joy from the Lord that will help to sustain her.

I have a lot of interesting patients that come to see. And I mean interesting as people. Completely independent of their current circumstance.

A few weeks ago, a patient came in with a weird Czechoslovakian sounding name. Even weirder was the fact that he was really tall, really thin...and black.

I asked him where he got such a last name. He said that the story was that his Great-Great-Great-Great Grandfather was bought by a Russian businessman and taken back to the Soviet Union where he married one of the mulatto slave women who was rumored to be the slave master's daughter. Just after Emancipation in the United States, they were allowed to return to the States with their freedom. When they were asked their names to enter into the ship travel log, they just gave the slave master's last name. And if rumors were true that his Grandmother was the slave master's daughter, only his "Grandfather would go to Hell for telling that lie."

By my count he was something like 7th generation in this country. He showed me a picture of his father, with his mulatto skin, wavy hair and thin nose, sitting with his mother, a tall, thin black woman, wearing polyester bell bottoms, and a perfectly rounded afro with pick sticking out of it. You know? The black one with the fist on the handle. (Yeah. I know you knew). I guess he "went" to his mother's side of the family because his father had obviously picked up some features from that Russian gene pool. If he had not told me, I would have never thought that he was anything other than black. But while I was doing his ear, nose and throat exam though, I did get close enough to see that his jet black hair, that looked like a brillo pad from a distance, was actually really curly and thick. I guess that if you don't get anything else from the white side of your family, you can always count on "good hair."

At the main homeless clinic site, we have one particular patient who we see EVERYDAY. Several times a day. She is not a bother. More of a pleasant nuisance. But still. On most days, ain't nobody got time for that.

She first came to us for treatment of her high blood pressure, diabetes and bipolar disorder. She was on so many medications that I really didn't know where to start with her. On top of that, she could not give me a really clear medical history.

Most worrisome that day was the fact that while I was talking to her, she was sitting on the exam table unable to hold her head up. I would ask her a question and midway through her unintelligible answer, she would nod off on me. Each time I would wake her up and a few minutes later, we'd repeat the scenario.

I finally got what I thought was a complete enough history from her, ordered some lab work, did a referral back to mental health to manage her bipolar disorder, and put her back on the medications she told me that she was taking that I thought were appropriate.

Two weeks later, she came back. In the same state. Wanting refills on her Seroquel. I knew that she shouldn't need a refill already if she was taking the Seroquel as I prescribed it. I took her to the exam room and for the portion of time that she was awake and I was able to make out what she said, I found out that she had been self-medicating and taking way more Seroquel than what I had prescribed.

We established that she was not trying to harm herself. I did a urine drug test on her and she was completely clean for any street drugs, narcotics or benzos.

I decided to take a different approach with her at that point.

We discussed that she should only take the medication I gave her as they were prescribed and that if I was unable to trust her to do that, I would no longer see her. She agreed and I agreed to refill the Seroquel. But I had no intention of doing so. She was also on a couple of other medications to manage her bipolar disorder that did not have the sedating effect on her.  I decided that I would give her some time off of the Seroquel and see what happened.

A few days later she came in to ask about her Seroquel. Of course, we did not have it because I had not authorized it to be refilled.

What we did have was a completely different woman standing in front of us.

The usually matted wig that she wore had been replaced by a new, slick, jet black version of a chin length bob. Her weird outfit choices had become a simple pair of blue jeans, a t-shirt and flip flops. Hoops in her ears. Rings on her fingers. A pretty crucifix around her neck. Lip gloss on her lips. Mascara on her lashes. And a look of awareness and lucidity in her eyes that we had never had the privilege of seeing.

She said that she was sorry that she did not come back to check on her medication earlier. But in the last few days she had been out looking for jobs and working on the goals that the shelter staff had set for her in her program plan. She'd gone back to the cosmetology school where she got her degree to see what she needed to do to get her license reinstated.

The more she spoke, the more in awe we became of the difference in her from those first visits.

Who was this well-spoken, intelligent woman?

And what was she doing here?

Since those days in April, we have found out a lot about her story. There has been violence and heartbreak in life. She's had to overcome many things just to be in the place where she is now. What is really amazing is that she has been great at teaching the clinic staff important lessons about ourselves and our interactions with our homeless patients.

I remember one day I had a disagreement with a another female patient who had been diagnosed with schizophrenia and a personality disorder,

That day, I think I'd forgotten my Rules for Mental Health 101. 

1. Never try to reason with a schizophrenic 
2. There is no treatment for a personality disorder. 

The patient was upset that I refused to feed her habit. I explained to her that I was a primary care medical provider. Not a mental health provider. Her diagnoses were of a sort that I did not feel were in my scope of practice, but I would be glad to refer her to the appropriate care.

Homegirl looked at me and said, (and I quote):

"That's cool and all. But are you going to give me my valium, flexeril, lithium and adderall?"

Funny thing is, she'd started off asking me for Effexor and Lortab.

I refused and she left very upset.

Later I found out that the personality disorder she'd been diagnosed with was of the "multiple" kind. I guess "Brenda" had asked for the Effexor and the Lortab. But by the time the request for the valium, flexeril, lithium and adderall had been made, "Jackie" had taken over.

Apparently, she was upset enough that she'd gone outside and went into a full on rant about how she could not stand me. I was a B-word and I did not like female patients. (I'm not sure if it was "Brenda" or "Jackie" who was responsible for that, though).

I'd already been accused of not liking "people like" them.

Not long before that, I had also been accused of not liking white patients.

Yeah. Biggest chauvinist, elitist, racist in the world.

What the EFF ever. Is that all you got? Chile, puh-lease.

Anyway, my patient who I'd taken off of the Seroquel came in for her daily drive-by and asked me if I was ok.

I explained to her that things like that didn't bother me, so much as it reminded me how careful that I need to be about not allowing my personal feelings to overcome me in a situation like that.

This is my job that we are talking about. Not my family life or my social circle. There was no need to fight fire with fire.

We stood and talked about a few others things. And while we talked I noticed that she was kind of giving me the "up/down." You know, like she was sizing me up.

I asked her what was wrong and she said, "Can I tell you something?"

I said yes and she made me promise that I would not be offended.

I promised.

But I didn't really mean it.

She said to me, "You have a sweet spirit, but there is an edge to it. Like you got your guard up and if someone rubs you the wrong way, the sweet is gone and the edge will cut them like a knife."

She was right. The sweetness was planted there by nature. The edge had been cultivated by nurture. 

I wanted her to keep talking.

"You have a hard time dealing with people because most people can only see clearly enough to see the edge."

Bingo.

But then she caught me off guard.

"But you need to take responsibility for that."

Ok. So its my fault?

Now I'm a little offended.

But (and in my Kanye voice) Imma let you finish.

I asked her to explain that to me.

She continued, "Look at how you are standing. The whole time that we stood here talking, you had your arms folded. It doesn't bother me, but other folks might take it as you not being open to what they are saying to you. You lead with that edge and you got better things to lead with."

Anyone who knows me, knows that I fold my arms when I am thinking really hard. I also frown and purse my lips together for the same reason, which I inherited from my Mama. The problem is that I think that I just assumed that people will know those things without them knowing me, me actually telling them...or them being psychic. (SN: Where is Miss Cleo?)

When I realized that she was right, that I had stood there with my arms tightly folded and my face in my concentration grimace, it hit me.

Its like the moment I realized that not everyone has (or appreciates) my brand of humor.  There have been plenty of occasions when things that I find hilarious have made Facebook folks "feel some type of way" and I ended up with my status hijacked by someone who misinterprets my intent.

Nobody knows who I am until I show them. If I always led with that "edge" that she had just talked about,  that is who people will think I am and I will never have the opportunity to present myself as a complete package.

Wow.

And all this time,  I was thinking that she was the one lacking in awareness and lucidity.


Towanna

I Dun Fixed That Mailbox...

Today we got an e-mail from our grant administrator notifying us that our little homeless program scored an "A-" rating from the federal oversight office.

I'm a bit offended by that minus sign. Why bother giving us an "A" if you are just gonna toss a minus behind it? I would almost prefer a "B." Almost.

See, my contract is up for renewal in November. That "A-" gives me the leverage to go in and ask for a 20% raise.  They'll probably offer me 10. I'll push the issue for 15. I'd settle for 12. But don't tell them I said that.

More good news came last week when I got word from the Nursing Education Loan Repayment Program that they are going to pay back the majority of my outstanding student loans. Hands together in prayer that the contract gets finalized. Even if its not, thank the Lord anyhow.

I've been struggling to write this blog entry for the past  3 days. Its not for lack of material. But sometimes its difficult to frame all I want to say in the way that I want to say it. Like I said before, I have a million stories. I want to include the ups, the downs, the joys, and the sorrows of what I do, but I don't want to lose focus on my purpose here.

Yesterday, CK came to give me report on a new patient that had been added to the schedule. Not unusual. But here is the kicker.

She was pregnant. And HIV positive.

I have a rule.

I don't touch pregnant women.

I have seen pregnant women on the rare occasion for colds, and rashes and bladder infections and all that good stuff. In most cases, I will treat them with medication if the drug I am going to prescribe is Category A or B. Anything else and I send them to see their OB provider. The crazy thing is that I've also had OB providers send their pregnant patients to me to manage things like blood pressure or diabetes. But if they don't know, why do they think I do???? I know a little something about birthing babies. But I also don't like what I know. So I don't touch them. Creates the potential to kill 2 people at once. And ain't nobody got time for that.

And HIV patients?

I also have a rule.

If they are already seeing an HIV specialist, that means that they are covered under the Ryan White Grant. Technically, I am not allowed to see them and they must see their HIV provider. In that case, we'll call and get them an appointment to be seen. If they do not have an HIV provider, I will see them, do the initial work-up and HIV panel and refer them to an HIV provider. In either case, if they are sick that day, I will see them and treat them if I can and have them follow-up with their HIV provider immediately. As with any patient, I try to avoid having too many cooks in the kitchen.

Especially if an HIV patient in on anti-retroviral therapy (ART), I am cautious about providing care. Those type of medications interact with EVERYTHING. For example, if an HIV patient is on ART and they come to me to be treated for reflux, it would be simple enough to put them on Prilosec. Except that Prilosec is a proton-pump inhibitor and interferes with how ART works. That doesn't mean they can't take it. Just means that someone more schooled in that arena should make that call. Not me. I know my limits. And that is one of them.

So anyway, this patient is pregnant and HIV positive. She did have and OB as well as an HIV provider who she saw regularly. I tell CK that if she has a minor issue, I will see her. But if she was here for anything related to the HIV or her pregnancy, we'd have to send her somewhere else.

CK tells me that she has a "rash" on her leg and thinks something may have bitten her.

Sounds simple enough. I agree to see her and  CK brings her back to the exam room.

The patient tells me that she noticed a quarter sized red spot on her left lower leg the day before. It was painful, but she thought nothing of it. When she woke up that morning, her entire leg was red, swollen and painful.

I started to exam her leg and noticed that not only was the leg red and swollen, but the patient jumped off of the table at the slightest touch of my fingertip and her leg felt like the top of a warm stove.

Immediately, two things came to mind:

A blood clot or an infection.

I did not see any vector wounds or anything that looks like she might have been bitten. The redness in her leg was diffuse, but streaky and looked to be moving upwards. It had progressed quickly over 24 hours. The swelling was only mild and I'd felt much warmer extremities in the presence of clot. She did not have any calf pain. Her pedal pulse was normal. Her Homan's sign, although neither very sensitive or specific for a blood clot, was negative. She could bear weight, had no chest pain or shortness of breath. She did have a low grade fever. Other than the specific complaint about her leg, she seemed to be fine.


My money was on the infection. I could hit her with Category B Keflex four times a day for a week. But the fact that the cellulitis developed without a point of entry meant that her immune system was compromised. And doubly so by the HIV and the pregnancy. The oral antibiotics might not make up enough ground for her weakened immune system. Even if it would, with the way our pharmacy services worked, it would be 24 hours before she would get the medicine.

And what if it was a clot? Although the presentation wasn't classic, stranger things have happened. If I let it go unchecked for a week, with her risk factors, that was asking for trouble.

I may have been over thinking it all. But the best thing was to send her to the hospital. They could decide whether to treat with oral vs. IV antibiotics and rule out a clot immediately.

So I asked CK to call 911.

Not a big deal in the grand scheme of things. But I remember when I worked as a floor nurse, a physician told me that calling the MD after 11:00 pm was the sign of weakness in a nurse.

Not that I believed him. If I had patient going bad at 3:00 in the morning, getting cussed out by the doctor for waking him up was the least of my worries. But just like most people, I have an ego. Especially when it comes to my competency as a provider. And calling 911 felt like a weakness in that moment.

See, I'm not used to asking for help. I never really learned to, because I've never really had to.  Maybe because in most places I've gone, I ended up being the smartest person in the room. Maybe. Or maybe I just need to find better places to go.

Even in school, I hated group work because the pace in which a task got finished was dictated by the slowest person in the group. When I took Microbiology, I had the worst lab partner....ever. Its wrong for me to say, but when she withdraw because she was flunking the lecture portion of the class, I went out and had a drink after class to celebrate.  This meant, I could finish the course by my lonesome.

You see, my preference is to take full responsibility for anything I do. No matter the outcome. I hate sending patients to the emergency room when I know that I know what's wrong with them and I could potentially fix it.

But I've learned, that as it relates to many things in my life, its just really not about me.

I could not compromise this woman or her unborn child for the sake of my ego. The chance just wasn't worth taking.

So off she went in the ambulance. With me sitting at my desk second guessing myself.

As I was leaving work that day, I ran into this patient on her way back into the shelter. She walked up to me and said, "You were right. They said its an infection. But they did do an ultrasound to rule out a clot because I'm pregnant."

They gave her a weeks worth of four times a day Keflex and told her to follow-up with her regular provider if she did not improve or got worse. I half-nodded at her offer of thanks and went on my way.

It will sound crazy, but it gave me no satisfaction that I was right. 

I want to be the one to "fix" my patients.

Just like Mister fixed that mailbox.

So's I know when theys been messed wit.

Towanna

Excuse me. People Like Who?

Good Morning, Saints!

And only a few people should think that refers to them. The rest of you? Y'all are sinners just like me. So, stop fooling yourselves.

Just kidding. But seriously.

Yesterday's blog was a killer, huh? I'm really interested in seeing how her situation plays out. I promise to keep you posted.

In the meantime, let's lighten the mood. (And I get really pissed every time I think about this situation, so I will do my best to keep the profanity to a minimum. But my best might not be good enough. So, um, sorry in advance).

Most of you who might be reading this grew up where I grew up. If we were poor back then, I didn't know it because everyone around us lived the same way for the most part. I never wanted for a thing, so in my mind it was all good.

It wasn't until I went off to college that I realized that "rich" people really existed. That there were people not on scholarship, who could afford to pay cash for college and didn't need financial aid was AMAZING to me. It was a sign of the sheltered life that I had led in my small community and at my 100% black, working class high school.

But the advantage that I did have was that my parents had instilled in my brothers, my sister and me that once you became an adult, what Mama and Daddy have no longer applies to you. That means that a wo/man who is not willing to work just does not want to eat.

Now I might be the most bleeding heart liberal in the world when it comes to certain things. I am sympathetic to the suffering of the sick, the poor, the homeless, children, and the elderly. I might be delusional, but I truly believe that my ordained purpose in this life is to change something big in this world through the work that I am doing. Sometimes it feels like a suicide mission, but hey, they are much worse fates than martyrdom.

What I am NOT sympathetic to is grown, able-bodied fools trying to get over on the system for a check that they don't deserve.

Case in point...

I have, or I should say had, a 30-something year old, 6'2", 210 lb., male patient (wearing a wife beater, basketball shorts, a doo-rag, and a huge CZ earring in his right ear --yes, I judged him. As I should have) come to me for the first time complaining about numbness, tingling and pain in his left foot. If you read Drug Seeking 101, you know that this raised an eyebrow for me immediately. But I gave him the benefit of the doubt because he said that a car had run over his foot a few months ago and it had "not been right since."

He'd gone to the emergency room and all the x-rays were negative according to him, but he felt that he needed to see an orthopedist for a second opinion. In the meantime, and of course, he wanted something for pain.

I examined his foot. And the exam was completely normal. He had full range of motion. His plantar and achilles reflex were normal. His pedal pulse was normal. I had him close his eyes and he easily distinguished between light touch and pin prick sensations. Hell. I even did the monofilament test on him which was also completely normal. So either nothing was wrong with his foot or he was doing a really bad job of trying to fake it.

He said that the problem was mostly when he did a lot of walking, which was most days. My best guess at that point was that when his foot was run over, there was some damage to the lower portion of the nerve responsible for feeling in the top of the foot. And when  he did a lot of walking, the tissue surrounding the nerve became inflamed causing a bit of compression of the nerve and the resulting pain and numbness that he felt.

I explained to him that we could send him to ortho, but because it was not an emergency, the provider who was contracted to see our uninsured patients was swamped and it would be January before he was able to see anyone. In the meantime, I prescribed him ibuprofen, strengthening exercises, rest, and ice or heat to his comfort. I also suggested that he go to one of the local drug stores and get an inexpensive brace for support, but he said that he had no way of paying for one. So I gave him one of our stretchy ace wraps and showed him how to wrap his foot for support.

I guess I really looked like Boo Boo the Fool that day. Or this guy took my kindness for weakness. Either way, I think that he thought he had found a professional pawn in his scheme to work the system.

For the next couple of months, I saw this fella every week. Sometimes twice a week. One day it was his foot. Then it was food poisoning from the new Hibachi restaurant from across the street, which was funny because 50 other people from the shelter ate there. And he was the only one that got sick.

Once, he came in with an empty pill bottle asking for refills. The medication was acyclovir and had been originally given to him at the ER. (I'll let you google it to see what its used for). I explained to him how the medication was usually taken and that it was only taken on a daily basis when frequent re-occurrence was an issue. He said that wasn't an issue, but that he had read on Wikipedia that the virus can migrate to your nerves and spinal cord and cause brain damage. He said that he felt like he was running a fever and he was worried that the condition had moved from his genitals to his spinal cord. (O_o). Yeah, folks. That is why you need to refrain from the internet medicine.

After that particular visit, I figured that it would be in my best interest to get his records from the hospital. I had him sign a release and in quick turn around, the hospital had faxed his complete ER record to our office.

And when I sat down and began to read, I thought that someone was playing a really funny joke on me.

Multiple visits over the past few months for:

1. A "spider" bite. With absolutely no signs of a vector wound, swelling, rash or anything at the site where he said he was bitten. The ER provider commented that there may have been "some delusional thought" present and "patient may need referral to mental health services." 

2. The feeling that someone had "messed with" him while he slept. Turns out that he was constipated.

3. Several visits in relation to having unprotected sex. I won't explain further.

4. Food poisoning. Multiple visits. And it turns out that he had already been seen in the ER when he came and saw me for the same episode of food poisoning.

5. Foot pain. 6 times in 4 months. Always with the same outcome. Completely negative work-up.

These, among other things, are for what this man kept abusing the use of the emergency room. The more I read, the more I thought that maybe there was some legitimacy to the idea that he may suffer from a type of hypochondria or obsessive compulsive disorder. But other than the frequent medical visits for seemingly ridiculous reasons at times, I had no real justification for that.

And then, a few days later, I got my answer.

I stopped by the main office to check my mailbox. I had gotten near the bottom of the stack of paper that I had pulled out of my cubby when I saw his name in the RE: line of a letter from the disability determination division of Vocational Rehabilitation.

You mean to tell me that all this time, he really wasn't crazy? That he was actually trying to build a disability case?

Chile, puh-lease. Cuz he was NOT doing a very good job of it.

And then I began to have flashbacks.

On several occasions when he'd come to see me, he'd asked me about contacting lawyers to pursue the person that had run his foot over in order to have them pay him medical bills. I told him that seemed reasonable. He'd also asked about getting a copy of the note from his food poisoning visit so that he could take it back to the Hibachi place and see if they would pay for his medication. I told him that didn't make sense...because the visit with me didn't cost him anything and our program was going to pay for his medication.

What was this kid really playing at?

Was he going to get a lawyer to sue the spider that bit him?
Or have the person that "messed" with him in his sleep brought up on charges and slapped with a civil suit?
And whoever made it necessary for him to take acyclovir? They better lawyer up. Right now.

It would be a few weeks before I saw him again. Apparently, he had been banned from the shelter for something he had done. I never found out what. That might be because I didn't ask.

Then one day, on my way home from work, and I actually saw him walking a few blocks down from the shelter. With a pimp in his stride. I watched him as he hot-footed it, jay-walking across a couple of intersections trying to beat traffic. I had to chuckle to myself. Obviously, that foot was doing alright today.

Two days later, he shows up wanting to be seen. KB asked him what he wanted and he said that he needed a refill on his ibuprofen. I stood on the other side of the partition and listened to her explain to him that according to the computer, he still had 4 refills on his ibuprofen. He could call in a refill request and just go down to our pharmacy and pick it up.

His explanation was that he did not have the number to the pharmacy because the label on his pill bottle was "messed" up and he did not have transportation to get there. He felt that it was our responsibility to get him his medicine.

So this is where I had to step in.

I tried to politely explain to him that in the real world, he could not walk into a provider's office and get the staff to go pick up prescriptions for him. It was his responsibility to do so and on occasions when KB has done so, she has done it as a courtesy. Not as an obligation.

I also explained to him that ibuprofen is also sold over the counter and that he could get some from the drug store at the next block.

The gentleman looks at me and says, "Every time I come in here, you get in my face."

My reply was, "Every time you come in here, you whine like a child."

Ok. Maybe not the best thing to have said. Cuz that set it off.

"I'm a man. That is why you don't like me. I'm a man. Plus, I know you don't like people like us."

I think my head spun around 10 times on my neck when I heard him say that.

"Excuse me. People like who?" I asked him.

At that point I noticed that the look in his eyes had changed, like he realized from the look on my face that maybe he should choose his words carefully. His lips parted. But no words came out. So I pressed him.

"Say what you mean? People like who?"

And then my rant began. For the next 60 seconds, I went off on him. I wish I could remember verbatim what I said, but the jist of it was to explain to this fool that he had no idea who I was or where I was from. That I could work anywhere in the world that I wanted to, but being there was my choice. That he was a lazy, able-bodied, description fitting, clown trying to get over on the system. That I have a 85 year old grandmother who would still get up and go to work everyday if she could. That his suffering was self-inflicted and that he, unlike most of the other folks there, had made a choice to be in his situation.

KB finally got up, put her hand on my shoulder, and said to me, "Its not even worth it."

And she was right. But it dang sure felt good to tell him off.

He sat there looking dumbfounded for a second and then he said to me, "I didn't want to come here anyway. My case manager told me to come here."

KB looked at him and said, "Well aren't you a man? A man wouldn't let anyone make him do something he doesn't want to do. Matter of fact, you don't ever have to come back."

I don't think he was expecting that. But he got up and left. And, miracles of miracles,  his limp was gone.

You see sometimes the cure for what ails you is a good old fashioned telling off.

Some of the best medicine in the world.

Towanna