Nurse Sean (dot) com

My first thought was, “I have been incredibly jinxed with urine output lately!” It was getting to the point where I was more surprised if my patients actually peed an appropriate amount. The doctors were getting used to my frequent pages begging for boluses for my dry patients.

Yes, my patient’s urine output was only 200cc for the entire shift. I resigned myself to this fact after about ten minutes of manipulating and milking the tube, and falling short only of pushing on my patient’s bladder and begging. I had no choice, it was time to call the doctor for another bolus.

What luck! The doctor was standing by the nursing station flirting with the young nurses. Granted, he his young and devastatingly handsome, but do the girls really need to giggle like that?

I hesitantly walked over to him, taking deep breaths, attempting to overcome my absolute fear and intimidation of talking to doctors. Causing the most trepidation was having to interrupt his “professional” conferencing with the nurses.

“errr…hi….I…ahhh…have a question.” I hate the way I sound so nervous when I talk to doctors.

“What is it?” He went from flirtatious to serious, bored, and bordering on annoyed. Sometimes it just doesn’t pay to be a male nurse!

“My patient has a low urine output. Mr. Smith that is, no! Sorry! Mr. Elliott!” I’m stammering. I’m getting more nervous. Why can’t I just be confident like everyone else?

“Tell me his story.” He said, not looking at me.

This is approximately the moment I panicked. I just expected him to ask about cardiac history, and order a bolus of Normal Saline.

“Errr…well….unresectable tumor of the panc…no liver….geeze…” I point to my abdomen and the doctor gives me a look that most definitely accuses me of being a complete idiot. His eyes ask who the hell let me take care of his patients. “His pelvis, it was in his pelvis.”

“I can see you don’t know anything about this patient, just get me his chart.” He sighed. I gave him the chart and ran away embarrassed. The truth was that I had been caring for this patient for days and knew him inside and out. I had read his chart front to back and knew his entire medical history. I had assessed him numerous times and knew every wheeze and bowel sound.

The patient got his bolus, but I had completely failed at my report to his doctor. As I lay in bed at night reliving the moments of the day (we all know this is a nurse’s favorite past time, and is potentially what leads us to insanity), I asked myself, “tell yourself honestly, did you know this patient.”

The answer was a definite yes. Where I had failed was in my preparation in giving report to the doctor. I didn’t organize my thoughts and the patient’s situation/needs into an organized presentation for the doctor. I failed to use my communication skills properly, and I failed to project confidence in my patient’s needs.

My hospital has begun teaching the SBAR method of reporting a situation to a doctor. Never until this moment have I fully understood exactly why it was necessary. SBAR stands for Situation Background Assessment Recommendation.

I had a Eureka moment as I lay there in bed desperately trying to find a way to improve myself. When I need to talk to a doctor, I just need to stop, organize my thoughts using SBAR, and then proceed. If I had done this, my side of the conversation would have looked more like this:

“Mr. Elliott had an output of 200cc concentrated urine for my shift. He had a laparotomy on Wednesday for an unresectable tumor with a colostomy creation. He has had a low output for the past 72 hours and has received two 500cc Normal Saline boluses, the last one at 23:00 yesterday evening. He has a history of hypertension and a MI in 2004. His vital signs are all stable and unremarkable. I think he would benefit from another bolus.”

I couldn’t help but wish I were the type of person that could just roll words off of my tongue with no effort at all. While earning my degree, I had more than one professor tell me that I sounded very confident and intelligent in my writing, but verbally I struggled. It’s true!

The next morning during report I was told that Mr. Elliott had been causing problems overnight. His lungs sounding worse, his Sats were dipping low occasionally, and he felt short of breath.

Not a problem, I gave him some ventolin for the wheezing, lasix for the crackles, ordered a physiotherapy chest assessment, taught him breathing/coughing exercises, and kicked him out of bed for some walking. He had none of the problems night shift experienced.

During morning rounds, one of the doctors (the same one that caused me to stutter my words in nervousness) had a hunch that Mr. Elliott was having cardiac problems and ordered an ECG and Troponins.

Oh what joy! The ECG shows a block, and the Troponins were sky high!

Moments later, a severe looking women entered the room. She was definitely high on intimidation factor! She introduced herself as a cardiologist here for a consult.

“Can you tell me about your patient?” She said, in a way that told me she was completely bored with the situation. You could tell she would rather be elsewhere. And seriously, how did she get here so fast. And OH CRAP, I need to talk to a doctor again!

“84 year old male for unsuccessful laparotomy to remove abdominal tumor, diverting colostomy created. Low urine output times four days, chest has wheezes and course crackles, at 05:00 this morning he experienced episode of decreased Sats and shortness-of-breath, oxygen delivery was increased, and Lasix and Ventolin were given. All vital signs have been stable since. His ECG showed a block, and Troponis were 0.28” I rattled off with definite confidence. I liked the way it all sounded! I forgot to use SBAR, but I think my bedtime talk with myself had worked a little bit.

“OK” she said, and went to assess the patient. I didn’t receive one condescending look from her!

Nursing is a reflective practice. We learn how to do our jobs by examining our performance, and critically thinking in order to find ways to improve. In nursing school we called them “Reflective Journals,” and we all dreaded them. But I really do understand why the practice is important.

My conversation with Doctor McFlirty kept me up late at night because I knew that I could do better. I knew that I was not happy with my performance. I laid there in the dark, picking apart my performance until I discovered a method to improve the way I communicate with doctors.

Sure, my performance the next day was not perfect, but it was a vast improvement. With practice and reflection, I will develop the confidence I feel my patients deserve from me.

I was never popular throughout school. I was always the guy that was simply “just there”. Everyone knew me, and knew of my existence, but nobody generally paid attention to it. The first group of people I associated myself with was in grade nine. They were a group of outsiders whom in the year 1992 listened to anything except for what was popular. The hit bands of the time were New Kids on the Block, Snow, Vanilla Ice, Boyz to men, and other such cheesy pop, teen idol type bands. These guys and girls listened to heavy metal. Megadeath, Iron Maiden, and anyone that everyone else hated. It was through these people that I was introduced to Nirvana, and became a “grunge” long before it was popular. I was never truly part of the group though. I was never their friend. I was never accepted. I was “just there”

High school started, and I become the “norm” with my grunge look, and the music I listened to was all the rage. The bangers I spent my time with went to a different school and I was left alone without a group of people to be with. The first place I looked was church. The youth group at one particular church was the most incredible experience. The youth group leader could suck in the most hard core atheist. Though, not in a negative way, but because he was such a caring, beautiful person, and the light that shone from him appeared as God shining through him. I spent everyday at the church playing pool, hanging out with friends, and through bible studies and church services I became the most devout bible thumper anyone could possibly be. I felt welcome in a world that accepted everyone, and everyone was loved as a brother. It was a progressive church with hard rock instead of hymns, and youth group movies that discussed sex in an open minded fashion, rather than the hand of God simply telling you “NO”. There was one youth group bible study that started as usual. We all hung out, played some pool, discussed the latest gossip, and just enjoyed each other’s company. Finally, Phil, the leader, sat us down for a bible study session. The topic was homosexuality. I was in shock. The entire bible study focused on bible passages that proved that being gay was wrong and it was not allowed in God’s eyes. I never went back to youth group, or that church. I rarely spoke to my friends. In a place where I felt part of a group, I had suddenly become an outsider. I was 16 and still in the closet, but I still knew I was gay. In the eyes of the Christian God, who preached acceptance of all and love of everyone, I was hated. I rejected Christianity and full out refused to follow that path again. I loved my friends, but I was too intelligent to not be myself. I was alone, searching for friendship, a group of companions.

Now, I was in the concert band during high school, and being a small group we became fairly close to one another. In fact, after I left the church, these were the only people I ever associated with. Even then, however, they all knew that something was “different” about me. I wasn’t the same as anyone. I didn’t seem to have any beliefs, or cares, or morals in common. The only thing that attached me to this group was our absolute love of music. Our common knowledge that the beauty of music was not in the sounds, but the emotions it brought us. Anyone I tell that I spent all my time as a “band geek” laughs at me and tells me that only losers ever take band. They have no idea, or understanding of the feelings involved in playing a piece of music as part of a concert band. No matter what you look like, what you are, who you have sex with, what your marks are, how much money you make, how different you are, when the conductor waves his magick wand and the first note plays, every difference disappears. The beauty that is reached by each and every person working as a whole, and you just being a small, but vital part, is more entrancing than even the most powerful ritual. It was the true definition of ecstasy: divine madness. It was primal, and at times brought tears to my eyes. Anyone who can be brought to tears by listening to classical music should become a part of this process. In true personal style, I graduated, went to university, and egotistical because I was the only person in band smart enough to enter post secondary school, I left my friends behind, all but ignoring their existence. Interestingly enough though, I have now watched several of those friends from band that I held myself high above graduate from university and start successful careers while I failed out. Even the hard core drug addict of the band has a good job and just bought a condo. I live with my parents.

One of the best groups I was ever a part of was in my first couple years of university. We were the smart ones, the intellectuals, we were incredibly introspective. To me it seemed as though we could run the world. All the intellectual thought I learned at university, was not learned through classes or writing papers. It came from the conversations with these individuals. My mind was fully open to new learning and deep, powerful thoughts. I was still the outsider though. I was a first year student, and these were all fourth year students. They were just another group that didn’t “want” to hang out with me, but instead “let” me hang out with them. My greatest influence of that group, and the only person I still converse with is Jason. He was gay, and the smartest human being that ever graced my presence. He was the first to tell me that I was too smart to be earning the marks I do. He claimed that I was an out and out genius and should follow my dreams of taking on a PhD. For him I tried. He was the one true role model I ever had in life, and I miss him now that he lives in Montreal while doing his PhD. This group was disbanded though. Most of the group graduated, and moved on in life. I was left alone, without a group.

I have traced the blooming of my personality to one day while I was bussing tables at Boston Pizza. I had been eighteen for a few months and I finally pounded on my manager’s door, and demanded I be made a waiter, or I’ll quit. He said simply “you’re too shy, you don’t talk to coworkers much, let alone customers. You work hard, and do a good job, but in order to be a waiter, you need to be extremely outgoing. I’ll give you a month to change.” This is back when I was ambitious, and had the energy to take on new challenges, I wasn’t jaded as of yet. I thought to myself, “if I have to change my entire personality, I will”. So, I did. I became wild and outgoing, crazy and attention starved. I was overly happy, and bubbly. I got the job. Although, I truly don’t think I changed my personality. Instead, I believe I awakened my true repressed personality that was hidden all my life, because I was different…gay. I was being myself finally, and I was amazed at how quickly I started to make friends. Socially I was becoming welcome. I loved, and still do, walking down the street and being stopped by someone who cries out, “HEY! You’re the guy from Boston Pizza that serves us all the time.” I was practically famous. Even today, I’ll be out and about and hear “hey, it’s the guy from the university coffee shop” or “look, it’s the waiter from Denny’s” I’m recognized a lot and everywhere. People finally liked me. I wasn’t the quiet, shy guy that everyone ignored. My latest manager said something quiet interesting, and opposite from that first manager. He said “You have a skill. You can make people WANT to see you. You know how to get people to come for coffee just to see you, not for the coffee. It’s a skill that is rare, and I wish I could teach people, but I can’t.”

It was at this time that I was introduced to one of the most accepting groups I’ve ever been with. I wasn’t just the guy who people “let” hang out. I was one of the group, and people in the group enjoyed my company. This group was the Southern Alberta Pagan Society. For years I had been studying witchcraft, and paganism, and through the internet I was led to this group. I remember how scared I was during my first meeting. My heart was racing so hard with excitement and fear that I almost threw up several times. The first person to greet me was Tamatha, then Jill, Feith, Dot, and Mark. I was at peace. The energy in that room amazed me. The feeling of “being home” was a trance that only making music could compete with. I had found my place in life. For months SAPS was my home and family, the people I spent all my thoughts and time on. I loved everyone, and hopefully they all loved me. Unfortunately after about a year, as is usual with any group, people began going their own way. Tamatha moved to Texas, and Feith to Halifax. Jill left the group mysteriously and Colleen left for a life in Edmonton. Dot and Mark Split up. The energy was gone from the group, the passion that could be felt at our meetings as if every Thursday was a ritual was gone. Our time was meaningless. We desperately tried to hang onto SAPS, and still are today, but it will never be the same. Probably the worst occurrence was that a few in the group became close and the rest of us became outsiders. I was once again just someone who people “let” hang out with them. It was uncomfortable to go to the meetings, so I just stopped. I’m still a part of SAPS, but only from a huge distance. I’ve lost respect for many of the people of SAPS and rarely let myself be associated with them. The past is still my dream for the future.

I was on a new path though, it wasn’t just the rest of SAPS. Perhaps the magick created in SAPS was for all of us to find our newest place in life. I came out of the closet and began associated with the gay community in Calgary. I was that bubbly person that learned his social skills from serving tables. I was also the person everyone laughed at cause I was so lonely and constantly depressed. I had found and lost love, and could no longer live without it. I was making friends faster than I ever thought possible, and became a well known individual in the Calgary gay community. I never really have found a group though. I keep wondering from group to group trying to find the one group that will accept me as part of the group rather than someone that just happens to be there. I bring entertainment to a lot of people, but it seems that that’s all I am anymore. I’m not a person with feelings, or needs, or love to give. I’m just entertainment. I’m popular though, Very popular. I’ve had days where I’ve had 10 people call me asking me to do something with them. I’ve had days where there are so many people I know and want to chat with at the bar, that I just have to leave because I didn’t know who to talk to. I had a day last week, where in a supposed group of friends, we were planning a trip to Red Deer for a big gay dance. Everyone was staying together at Dan’s house. Jason, my best friend turned to me and said, “by the way, you can still get a cheap room rate at the holiday Inn.” I’m on the outside of that group too. I’m the guy that just happens to be there, but isn’t welcome to exist withing that circle of people. I’m depressed.

Its been said that the devil lives in Hollywood. People move to Hollywood and would do anything to become famous. Perhaps even sell their soul to the devil. They don’t care about the money. They want fame. They want to be recognized as a person who is worth something. Them want people to look up to them for a change, instead of the opposite. People want to be loved by people. Its as strong of emotion as wanting to be loved by a spouse. So desperate for this feeling, that eternal torture sounds like a fair trade. For most of my life, I wasn’t popular. I was just the guy who happened to be there. I’m never accepted as a human being or someone worth spending time with. I’m good enough to say “hi” to and be entertained by, However while those same people are out watching movies or having dinner, or spending time with their friends, I sit alone at home wishing someone would call me and invite me to a movie. I have no friends, I’m lonely. I go to the bar and spend time with hundreds of people I know well, but I have no real friends. I am popular, and so lonely it hurts. I think the reason I so desperately desire that one true love is that I’ve given up on having a group of friends and receiving any love from them. I’m sick of being the outsider, the one nobody truly cares about. I’m sick of being left out, and rejected, and ditched. I’ve finally experienced popularity in life, and let me tell you, Its truly lonely. I would never sell my soul to the devil for this.

The truth…I push anyone that cares for me away. I won’t let them get close. They give up on me. They stop caring. I reject myself.

Leo’s Rain

I seek a man who is masculine, not week. Protective and strong, charasmatic and beautiful. He does not ooze femininity, or wreak of weekness. He fulfills the archetype of manly energy. I seek a man who is like a father to me.

My father was always the man who was a travelling salesman. he was the man who spent almost all his time in front of the computer, or with his nose in his book. He was the man who could not come within twenty feet of me without one of us starting a fight. He was, and still is happily married to my mother, but he was never my father, or my daddy.

My mother embodies the characteristics of the strongest goddess. She spent her childhood in excruciating pain, confined to a hospital. As a result she is handicapped and can’t walk without crutches. Her father was an alcoholic genius of a musician, and her mother was as stubborn as her. My mother in life became a lifeforce to reckon with. She is curageous and powerful, brilliant and strong. She is a light in the dark, and a social leader. She works so hard that her body can’t keep up to her drive. However, no hurdle ever has or will stop her from acheiving her dreams, or potential. She is commanding and convincing. She wears the pants in the family. She’s purly female. She’s my mommy.

With such a weak masculine influence and such a strong female influence, I could be a poster child for those who believe that being gay is soley a factor of environmental influences while growning up. Even my sister was powerful, quite obviously takes the path of my mother in her views towards life, personality and strength. If my mother and sister were witches, I would never mess with their power. I rarely do now. Perhaps, because I only ever had a strong feminine influence, I seek only a father type figure and influence in my relationships. It is the part of myself that is missing.

I once told a friend my theories on why I seeked out older, masculine men for my relationships, and asked him why he only seeked out young, teenage, feminine boys. He answered “I always dreamed of having a younger brother. Perhaps I still do. So, perhaps all I really want is an older brother type in my relationships. I always dreamed of having an older brother. Especially when being tormenting all through school for being different, in ways none of us understood at the time. I dreamed he would tell the other kids to leave me alone. They would scream, running away afraid of my superhero older brother. The person I looked up to and wanted to be like. Its obvious that I crave a strong masculine influence in my life.

I dream of coming home from a horrible day at work and sit on the couch, alone and on the verge of tears. He walks into the room, the man I’m in love with. He’s tall and strong, his energy is overwhelmingly powerful. His eyes so deep and dark they could scare away the devil. He sits down beside me and wraps his protective arm around me. His grip tight on my soul. His colonge wrapping me in comfort. His sweater warming my heart and is aura mixing with mine to become one. He wipes away a tear, and gives me a gentle kiss. He proclaims “Its alright, I’m here, everything will be ok.” and just lets me fall asleep in his arms. I feel complete and at home. I’m fearful that he’ll leave me for the computer. I’m terrified that he won’t always be there to protect me.

Perhaps this is why none of my relationships worked. One only wanted cold, meaningles sex, even though he was as masculing and powerful as any man imaginable. Another was masculine on the outside, but all women on the inside. Rudy was MY little brother. Or perhaps I was his father figure. I could never be happy with these styles.

I don’t believe that being gay is a result from your upbringing. I think its more like cancer. Cancer isn’t hereditary, but the potential for cancer is. If your mother has breast cancer, there is a great chance that you will be diagnosed with cancer eventually, if some condition turns on the cancer gene. So, like cancer, the potential to be gay is passed on, and if a situation causes this gene to be turned on, you will become gay. I think a stong feminine influence in your upbringing is only one potential way to turn this gene on.

All in all….I just want to be loved. So badly it brings me to tears to see happy people. I have so much love to give, that it brings me to tears when someone won’t take it.

I’m lonely…I seek a man.

Leo’Rain