Sunday, January 21, 2018

You Almost Made It, Frankie

By Fred Owens
The Montecito Mudslide claimed 21 lives and two people are still missing. Over 100 homes were destroyed, including great damage to roads, bridges and utilities. The freeway has been closed for 12 days but it will open tomorrow.
A little California history, especially geologic history, shows that destructive mudslides occur from time to time. It would be better if we knew when they were coming. As it was, authorities gave very strong and clear warning to the residents involved, but having evacuated for two and three weeks because of the Thomas fire, many folks decided to shelter in place when the flood came.
Santa Barbara folks are recovering. Big storm waves are filling the waters with ardent surfers. The Santa Barbara Film Festival will open as planned on January 31, for ten days of movie magic.  Plenty of oranges and avocadoes continue to grow in the back yard. People like living in Santa Barbara and no one wants to leave.

I got this story from a friend who works as a nursing aide at the hospital here in Santa Barbara..... slightly edited, but his words.
By Philip Deutsch
You Almost Made It, Frankie
I’m telling this story to get it off my mind. Patients don’t usually stay with me. I put my heart into the work when I’m on the unit, but I forget the whole thing by the time I get to the parking lot when I’m going home at 11 p.m.
It’s a good rhythm. You go home, read a book, have a glass of wine, and sleep without troubles. The next day you do it again
But Frankie stayed with me. He was 78, in assisted living. His wife had just died and he was in pain from hip surgery. He overdosed on his pain medication and the medics found him on the floor with seven Fentanyl patches pressed to his skin.
Fentanyl is a powerful narcotic and widely used in the form of dermal patches to relieve pain. The patch releases the medication in a careful slow way and -- sometimes with unpleasant side effects -- it works.
But seven patches all at once will send you down the river and on your way to the next life. Such a patient will not be left alone in the hospital, lest they try to harm themselves again. Standard procedure. Suicide watch.
Frankie was deeply asleep when I got there at 4:30 in the afternoon. Comatose? I don’t know the medical term. But past danger, I think.
Kelly was the nurse. She’s one of the angels. They make you feel good just walking in the room. I don’t know about the patients, but I know I feel good when Kelly is around.
Frankie had a heart monitor, just in case. These are four wire leads pressed to the chest, connected to a monitor room where someone could watch his pulse and breathing rate. The monitor, besides being watched by a live person, is set with ding-ding-dings if the patient’s heart rate exceeds the parameters. They have ding-ding-dings all over the hospital. You can’t relax for a minute.
So there’s Frankie, on his back, sleeping peacefully, with thick white hair closely cropped, a trim spade beard, round face, and good skin color. He looked healthy, if you asked me, and he was resting well. I was sitting beside the bed and I turned on the TV to watch the baseball game -- kept the volume low. It makes good background noise -- the sound of a murmuring crowd. No ding-ding-dings at the baseball game.
Maybe that’s what’s bothering me. How can anybody get any rest at this hospital? It’s a process of continuous interruption.
Kelly floats in and out of the room. She gives Frankie a bladder catheter. He barely wakes during the procedure. The urine bag fills up promptly. He needed a good pee, but he was too out of it to use the urinal, and the narcotic relaxed his muscles over much, so he wouldn’t just go without help.
If there’s one thing that matters around here, it’s urination. They get really worried if you’re not peeing, and they get happy if you do. It’s all about moving the fluids -- things you’ve been managing by yourself since you were two-years-old, but when you’re sick you need help.
Kelly leaves. Frankie sleeps, I watch the game -- Dodgers and Phillies. That’s it. Six hours and I go home. Only this time, when I get to the parking lot, I keep seeing Frankie’s peaceful face. I keep thinking -- Frankie, you almost made it.
Depression and Suicide.  Everybody gets the blues now and then. But real depression is much worse than having a bad day -- real depression is staying in bed all day, being unable to leave the house, no appetite, insomnia, suicidal thoughts and suicide attempts. One of the things I do at the hospital is suicide watch. Obviously, I don’t see those who have made a successful effort to end their lives. But I see the attempts and the failures. These are some mighty unhappy people -- everything’s going so wrong and they can’t even kill themselves.
Usually it’s an overdose -- a cocktail of legal and illegal drugs. The doctors would sure like to know just what it is you took when you get to ER -- perhaps if you pinned a note to your shirt before you passed out.
Either way, when you get to the ER, they give you the charcoal syrup which soaks up the poison. The charcoal looks awful, but it has no taste.
Don’t try suicide with Tylenol. A sufficient amount of Tylenol will kill you, but a less than sufficient amount will merely damage your liver, resulting in prolonged hospitalization and enormous medical expense. The opiates are actually better, because recovery can be fairly quick after a less than fatal dose. Wrist slashing requires determination, and a failed attempt will leave scars that might embarrass you later in life.
As I said, I deal with the failures, and my medical knowledge is strictly anecdotal -- I only see the patients after they have been medically cleared -- when they just need to be watched.
The patients are almost always quite young, 20 to 35, and two thirds female. They are very withdrawn. They seem to be terribly embarrassed. They just lie in bed and I make no attempt at conversation.
I don’t think they want to die.
I don’t have much faith in therapy and social work, but that’s what happens after the attempt. You have to talk to somebody. This somebody comes into the patient’s room and an earnest conversation ensues -- as in, let’s find out what’s going on, and let’s see what we can do about it. This is just my bias, but I don’t see the point of “doing anything” about it. I’m quite glad to be alive myself, and I would recommend that status to anyone who asked.
But it’s your life, not mine. The social compact requires us to live until we die, so I would not help you if you wanted to kill yourself. Having said that, I think the highest respect and kindness for someone is to let them be the way they are. Are you depressed? Yes, that happens. Do you want my help? Ask for it. Do you want my attention? Then do or say something that interests me.
I just don’t want to treat a patient as if they were pathetic. I stay in the room with them and we’re going to get through the day together. I can promise that -- we’ll get through the day. And we’ll see about tomorrow.
Now Frankie was different than the others, in my own limited experience. He was much older, for one. And he made a fairly serious attempt to die, taking seven Fentanyl patches. As I said, he almost made it. If they hadn’t checked his room for another hour, he would have been gone for good.
So what happened to him after I left him at the hospital? I don’t know. I suspect they won’t let him have his own supply of Fentanyl anymore, but will give it to him one dose at a time. He’ll get counseling, but I hope it comes with respect.
There’s a time when you might tell a younger person that she’s a fool and that she’s throwing her life away. That can be a good thing to say.
But the old folks -- you really shouldn’t tell them anything. They are way past the rest of us. A doctor or a nurse, no matter how experienced or how well trained, will have no idea what it takes to be 78 until they get there themselves.
Adoption

Now, I’ve finished writing about Frankie. I’ve done patient care for five years -- at a hospital, a psychiatric hospital, and a nursing home -- five years.. In those five years, I have adopted about 12 patients. It just happens. These are the ones that get into my psyche, make themselves at home and just stay. That’s why I call it adoption. I see their faces, and I mean going back years and I still see their faces. It looks like Frankie has joined the roster, along with Rachel, James, Eddie, and the others.
Twelve patients are enough. You don’t want to encourage this adoption. You want to shake them off by the time you get to the parking lot, but it happens anyway.
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Fred Owens
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