Tuesday, July 26, 2011

How to Change a Toddlers Diaper

(This is a piece I wrote for my Freshman Comp class back in 2004. My instructor submitted it for the Freshman Writing Contest that year and it won in the Expository Writing category. I just found it sitting in a drawer and realized I've never posted this, and the paper copy is the only one I have, so I'm putting it up here. Because we all know whatever you post on the interwebs stays there forever.)

How to Change a Toddlers Diaper
1) Assemble the necessary changing supplies: Diaper, wipes, DVD episode of Blues Clues, a sippy cup of juice, toy cars, stuffed animal and a change of clothes (for you)

2) Locate the toddler. If unable to locate the toddler try looking in the following places: the laundry pile, under the bed or inside the refrigerator.

3) Once the toddler is located, transfer him to the designated changing area, preferably someplace with a television. This may take several attempts.

4)Turn on the television, and place the DVD in the player.

5) Remove the DVD as the toddler screams "WANT A DIFFERENT BLUES CLUES!!!"

6) Locate the desired DVD and place it in the DVD player.

7)Remove the DVD as the toddler screams "NO BLUES CLUES, WANT ELMO!!!"

8) Locate the Elmo DVD, scrape the crusted up Gummy Bear off it and place it in the DVD player.

9) Place the toddler on his back and remove the old diaper.

10) Get up, chase the half naked toddler, pick him up and return him to the designated changing area.

11) Repeat step 10

12) Repeat step 10

13) Repeat step 10

14)Hand the toddler a bag of Gummi Bears and the juice cup.

15) Wipe the toddlers bottom from front to back with the baby wipes and begin to apply the clean diaper placing the tabs in the back so that the toddler cannot remove the diaper without assistance.

16) Remove the Gummi Bears from your hair that the toddler placed there during step 15.

17) Now that the Gummi Bears are gone, hand the toddler the toy car.

18) Remind yourself to apply ice to the toy car induced lump on your head.

19) Repeat step 10

20) Finish applying the clean diaper to the toddler. (Reminder - be sure to place the tabs facing the toddlers back to prevent the toddler from removing the diaper without assistance)

21) Allow the toddler to return to playing.

22) Look down at your clothing - note the juice stains and Gummi Bear smudges. Silently pray that the smear on your blouse is chocolate.

23) Realize that the smear is not chocolate.

24) Change your clothing

25) Attempt to locate the toddler again.

26) While attempting to locate the toddler, pick up the clean diaper that the toddler has removed without assistance.

27) Repeat steps 1-26.

Wednesday, July 13, 2011

Whose rights come first?

A while back I had blogged about the Arizona shooting. Because I work in behavioral health nursing I've got a pretty keen interest in how the story unfolds, and so I've been following the case pretty closely. I'm excited for Senator Gifford, her progress in her recovery is nothing short of amazing, as is the recovery of all of the people wounded that day.

I've been very curious to see how the legal system would handle the case against Jared Loughner. He's been declared mentally incompetent, and is now being held in federal custody, in a secure psychiatric facility. He continues to be violent, has attempted to assault both his doctors and his attorneys on several occasions (which I can guarantee means he's also assaulted the nursing staff, but of course nurses are far less news worthy than doctors so that never even gets mentioned), and was refusing all medication. So, his psychiatrists, being trained medical professionals who have years of experience dealing with potentially violent delusional paranoid patients who have no insight into their illness, took the appropriate action, which was to order that Loughner be forcibly medicated.

For those of you who don't know how this works, this means that Loughner would be offered the option of taking his medication voluntarily, most likely in pill form. If he refused, he would be restrained for his and the staffs safety, and the medication would be given in the form of an injection.

I've had to administer medication this way on several occasions, and it's not something that anyone working with the mentally ill looks forward to. It's frightening for the patient and dangerous for the staff. I've been punched, kicked pinched and bitten administering medication to patients who were being restrained and managed to get loose. Forcible medicating is not something that's done lightly, and is always a last resort. It's only used when the patient is clearly a danger to themselves and others, has no insight into or understanding of their illness, and is unable to determine reality from delusion. Jared Loughner would have had to meet all of these standards before an order to forcibly medicate him would have been written.

Unfortunately, Loughners lawyers did what lawyers tend to do, and filed an appeal to stop the forced medication administration on the grounds that it was a violation of Loughners rights. At the initial hearing a judge upheld the doctors orders on the grounds that Loghner was not legally competent to stand trial for the murder of 6 people and the attempted murder of 13 others, due to his mental illness, and therefore was also not competent to make medical decisions for himself.

And here's where things start to piss me off.

Loghners lawyers appealed the decision, and a 3 judge panel agreed that he has the right to refuse his meds.

This is one of the stupidest things I've ever heard. Loughner is SO delusional that he murdered 6 people, including a 9 year old girl and a federal judge, shot a US congresswoman in the head, and wounded 12 other people. He is so disconnected from reality that he is not competent to be held legally responsible for his actions, yet he has the right to make decisions regarding which medications he will or will not take?! He has the right to refuse medication that can treat his delusional state, thereby making him less of a danger to the other patients in this facility and the staff that has to work with him?

This is where the lack of understanding about mental illness by the legal system becomes glaringly apparent. Loghner is a newly diagnosed paranoid schizophrenic in his first psychotic break. There's no telling how long he's been in a delusional state, although based on stories from family and former friends and classmates it's probably been building for several years. Loghner has no understanding of what is real, he sees plots and conspiracy everywhere he turns, and he tried to KILL A CROWD OF INNOCENT PEOPLE. What more information does anyone need to prove that this man is in NO condition to make health decisions for himself?

If Loughners attorneys are so concerned about protecting his rights, then what about his right to participate in his own defense? He won't be able to do that if he's in a delusional state. Then again, that may be the goal - to keep him in a state of mental incompetence, so he's not able to understand the consequences of his actions, and therefore cannot be held legally accountable for them. It's actually a clever criminal defense strategy - if he's never brought back to reality, then he can never be held responsible. So what if he's a danger to the people who are attempting to care for him? So what if some staff member who has a family to support ends up being injured or killed bacause Loghner can't separate reality from his paranoid delusions? Isn't it more important that he be given the right to refuse to be treated, even though he's incapable of understanding the danger of that refusal?

I'm sure that his attorneys will be able to explain that to the next nurse or doctor that he assaults.

Saturday, July 2, 2011

Ow, Ow, Frigging OW!!!!!

"If you had been trying to damn your man by the Romantic method--by making him...submerged in self-pity for imaginary distresses--you would try to protect him at all costs from any real pain; because, of course, five minutes' genuine toothache would reveal the romantic sorrows for the nonsense they were and unmask your whole stratagem." --Screwtape
From The Screwtape Letters, by C.S.Lewis

Yes - I've had a toothache this week - I'm sure that if you missed my UMPTEEN postings on Facebook about it, this is a complete shock to you, but Yes, I've had a FREAKIN toothache this week.

For those of you that have never experienced the unique form of agony that is a dental abscess, first of all let me say Lucky You. Then let me conclude by saying Fuck off and Die.

Don't tell me about the time you stubbed your toe and ask me if this is as bad at that was, because it's a BAJILLION TIMES WORSE!!!! Imagine having your eyeballs pulled out with a dull, rusty pair of tweezers dipped in vinegar, while a 700lb man stomps on your fingers in spike heeled pumps. Then take all that pain, and put it in the space occupied by one tooth, and have it pulse to the same rhythm as your heartbeat.

Fun, right?

Normally I try to head these things off before they get to the Oh God Kill Me Now stage of agony. I've been dealing with dental issues ever since I was a kid,thanks to the crappy genetic dice roll I got in the tooth department. It comes from my Mom's side of the family, along with my freckles and turned up nose.

So, it's been a sucky week, what with the wanting to pry out my aching tooth with an ice pick and all. But silly me, ever determined to find an up side to things, I did realize that having pain like this really does put things in perspective, hence the opening quote. (And a special thanks to Scott Robinson for posting it to my FB page).

This week I haven't given a single turd about what my lawn looks like, or if the dishes are done, or what's going on with any of my neighbors. I haven't cared a bit about the Casey Anthony trial, what Charlie Sheen is up to, or what idiotic nonsense Michelle Bachman or Sara Palin have spouted. No celebrity gossip, no headline news, none of that garbage was anywhere on my radar, all I cared about was getting through the day so I could come home, medicate myself into a stupor and hopefully get some sleep.

I've been in full on, just let me make it through the next 5 minutes mode for 6 days now, and it has SUCKED like you would NOT believe. It's also got me thinking about what it must be like to have to live with chronic pain.

I've cared for a sizable number of patients with chronic pain issues over the years. I like to think that I've treated them with compassion, even though most have been pretty unpleasant people. After spending a week with a tiny little taste of what life is like for them on a daily basis, I hope that the next time I'm caring for someone with chronic pain, I'll have more patience for their temperament.

I'm going to curl up with wee glass of Jamesons and some bad TV now - until this toothache is completely gone that's all the silver lining I'm capable of seeing right now!