In Which I Noodle About My Job
Jun. 30th, 2019 07:09 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
Every now and then, I rant about my job. Ranting is kind of my default form of discourse. Usually, my friends push back against some of the details, often pointing out that they do these exact same things, and why they do them. I want to thank everyone who's done that, as it has made me better at my job. Often, there was a new perspective which helped me understand what my patients were trying to say. The rest of the time, it was just useful to put things back in proportion. I/ve learned a lot about how to phrase questions and elicit useful answers and not sound aggressive or judgmental. In particular, I've really improved the way I ask questions about people's normal habits for bedtime and rise time, and have been able to both get better information and set my patients at ease at the same time.
I have now started screening all my female patients for PTSD, anxiety, or depression. If any of those conditions appear in the chart, wherever possible, I take that patient. I have just had one too many female patients express relief that their tech was also female, and mention a history of sexual violence. I always tell them that they can, in the future, request a female tech. I try to assure them that they will not be asked to disclose why they prefer a female tech. From these conversations, it's very clear that a lot of women do not disclose and do not want to disclose past sexual trauma.
There's another thing I've noticed which suggests unpleasant back stories. Occasionally, I get patients who live in supervised environments. The ones who have spent most of their lives in group homes typically have either serious physical or mental challenges which prevent them from independent living. They tend to be extremely friendly, highly cooperative, and painfully eager to please. They are a dream to work with. They do what I ask them to do, they don't complain, they never yell, they are cheerful and friendly. And I have begun to realize how this is a survival strategy. I can see the edges of how they do this because they are dependent upon the grace and kindness of staff, and if they make the people who care for them uncomfortable or unhappy, their quality of life, or possibly even their life, is at risk. And it troubles me, to think of these people who must live in a way that they are never angry, never make anyone else angry. People with serious challenges and limitations who must put a significant portion of their available energy and skill into making people around them happy. The people who have lived most of their lives in a supervised environment contrast with the ones for whom this is a recent occurrence, like rehab from a stroke or drug use. Those patients, too, often have significant cognitive and physical limitations, but are not nearly as focused on people-pleasing, presumably because it was not a major survival strategy.
I think I have also noted, in the past, the way doctors and others tend to assume that social competency translates to physical competency. I had a very nice gentleman who literally could not stand up without aid, who could only walk a very few steps, but was incredibly good at social interactions. His chart noted that he was fully independent and mobile. He was not. But because he was very good at talking and being friendly and socially ept. he was also very capable of convincing people that he was just fine. People with dementia whose social skills remain intact are frequently also assumed to be much more independent and competent than they actually are. My disabled friends tell me the reverse is also true. People in wheelchairs, using a cane, or otherwise visibly physically limited are assumed to not be fully socially competent, are cut out of conversations and decision-making and social gatherings. And it isn't just an accessibility issue, it's actually that they are treated as less socially aware, less capable of interacting with other people.
TL;DR : people are weird, people have bodies, bodies are weird.
I have now started screening all my female patients for PTSD, anxiety, or depression. If any of those conditions appear in the chart, wherever possible, I take that patient. I have just had one too many female patients express relief that their tech was also female, and mention a history of sexual violence. I always tell them that they can, in the future, request a female tech. I try to assure them that they will not be asked to disclose why they prefer a female tech. From these conversations, it's very clear that a lot of women do not disclose and do not want to disclose past sexual trauma.
There's another thing I've noticed which suggests unpleasant back stories. Occasionally, I get patients who live in supervised environments. The ones who have spent most of their lives in group homes typically have either serious physical or mental challenges which prevent them from independent living. They tend to be extremely friendly, highly cooperative, and painfully eager to please. They are a dream to work with. They do what I ask them to do, they don't complain, they never yell, they are cheerful and friendly. And I have begun to realize how this is a survival strategy. I can see the edges of how they do this because they are dependent upon the grace and kindness of staff, and if they make the people who care for them uncomfortable or unhappy, their quality of life, or possibly even their life, is at risk. And it troubles me, to think of these people who must live in a way that they are never angry, never make anyone else angry. People with serious challenges and limitations who must put a significant portion of their available energy and skill into making people around them happy. The people who have lived most of their lives in a supervised environment contrast with the ones for whom this is a recent occurrence, like rehab from a stroke or drug use. Those patients, too, often have significant cognitive and physical limitations, but are not nearly as focused on people-pleasing, presumably because it was not a major survival strategy.
I think I have also noted, in the past, the way doctors and others tend to assume that social competency translates to physical competency. I had a very nice gentleman who literally could not stand up without aid, who could only walk a very few steps, but was incredibly good at social interactions. His chart noted that he was fully independent and mobile. He was not. But because he was very good at talking and being friendly and socially ept. he was also very capable of convincing people that he was just fine. People with dementia whose social skills remain intact are frequently also assumed to be much more independent and competent than they actually are. My disabled friends tell me the reverse is also true. People in wheelchairs, using a cane, or otherwise visibly physically limited are assumed to not be fully socially competent, are cut out of conversations and decision-making and social gatherings. And it isn't just an accessibility issue, it's actually that they are treated as less socially aware, less capable of interacting with other people.
TL;DR : people are weird, people have bodies, bodies are weird.
no subject
Date: 2019-07-01 01:24 pm (UTC)Even not having to live in a group home. Even just having to live with an intermittently visible, intermittently obnoxious disability.
There is literally no range of tone available to me other than "cheerful" about this. If I use any other emotional tone to talk about any disability issues, I am parsed as less MENTALLY COMPETENT. I am parsed as less able to WRITE FICTION, BAKE THINGS, BE A FRIEND. Whether people treat me as a person who does literally anything at all, ever, is dependent on my ability to not, ever, express any frustration with disability in a way that is not wry and witty. Ever. And I can never, ever lose a tone of calm good humor when describing anything my body is doing, or I am the problem.
People do not register that I have told them that I went off to puke in the bathroom in the middle of a nice dinner in a restaurant with friends (some of them right around here), or in the middle of taking my grandmother to a concert or church, or anything like that, because there are only two modes: quiet and competent or hair-on-fire, and hair-on-fire negates any competence about LITERALLY ANY TOPIC. So I can have no sympathy for having to endure any of that, because there is only sympathy for total incompetence and incapacitation, OR there is the ability to go on, but NEVER BOTH.
Relevant to recent conversations: one of the reasons our until-recently-mutual-friend-now-not-so-much made me so very angry is that I had so little range allowed to me to begin with. I was not allowed to scream at him to STOP TELLING ME HOW I AM DOING because then the problem is immediately and completely the screaming irrational cripple, who is then also presumed incompetent at EVERYTHING. I was not allowed to yell that telling me how great I "get around" with a cane shuts off my frustration at not having a spare hand, having to juggle--negates how quickly something like an unexpectedly oversized library book becomes a problem in my day even when I've gotten a ride to the library. So I got to explain politely and request politely. For years. And none of it made a dent. For years. As it never does. Because it doesn't have to be important from the outside, because look how calm she is, obviously we are having a trivial conversation no one need heed.
And if you lose it and start screaming, the conversation is about how irrational and incompetent you are. At everything, your competence points blank out across the board.
You know this from gender stuff. If you start screaming STOP TOUCHING ME WILL YOU STOP FUCKING TOUCHING ME I AM NOT A SCRATCHING POST AND YOU ARE NOT A CAT FUCK OFF FUCK OFF FUCK OFF then you really should have kept control and been polite and you are the problem, but if you say, please don't do that, I would prefer not, then it can't be that important and no one has to pay attention.
The game is rigged.
no subject
Date: 2019-07-01 07:42 pm (UTC)I think the link between sexual harassment and disability is interesting, and while I doubt the link is new, it is to me. In both cases, there's a way in which other people feel that they have rights to make decisions and judgments about other people's bodies. A way in which bodies and their manifestations in the world are considered property of the viewer.
There was a night at work, where an older, heavier woman threw off her bedclothes during the night. Perfectly normal thing to do. Her nightgown had ridden up a bit, so she was a bit exposed. Not actually indecent, and the picture quality is enough to determine body position, but it's not real crisp. There is, quite honestly, nothing to see here. Just a quick note that the patient is now supine. Except...my creepy, possibly psychopathic co-worker said, "Man, I don't want to see that." As if, somehow, a person who was asleep, and in no way there for his pleasure, was somehow intruding upon him by being female, heavy, and having bare legs. It was this gross and entitled view of a woman's body that I hadn't seen on display before. This is the same man who sometimes makes fun of disabled people, and generally considers disabled people to be a particular burden. Weirdly, this same horrible person is incredibly socially ept, and his patients love him. He's personable, funny, charismatic, and appears genuinely interested in them.
People are fucking weird, man.
I am still working on how to better treat people with disabilities. There are fewer good models out there than you might prefer, you know? I have been trying to listen, as well as practice empathy. Where I get it wrong, most of my friends have been generous with telling me I got it wrong. But I still hurt people I in no way want to hurt. Societal structure make it so easy to do the wrong thing, and then fail to notice it.
no subject
Date: 2019-07-02 01:44 am (UTC)no subject
Date: 2019-07-02 06:31 am (UTC)no subject
Date: 2019-07-02 07:22 pm (UTC)no subject
Date: 2019-07-02 11:28 am (UTC)Well. It's a mess we have not even, as a larger or smaller community, started to clean up. We--both large culture we and small subculture we--are still working on "hey can we get seats for people who lipread up front and can you not be an ass when they need you to repeat yourself in personal conversation."
Add to that the way that some people apparently cannot even distinguish that this is the conversation we're having, and well. It's exhausting.
I am not surprised that the person who made that particular gross and entitled remark is otherwise charismatic and personable. I have seen that combination A LOT. What'sa matter, can't you take a joke that you're constantly prey even while literally unconscious in an actual medical situation with medical personnel?
no subject
Date: 2019-07-02 08:39 pm (UTC)It makes me say ohhhhh about some of the lack of respect I get. Not just being a somewhat heavy middle-aged woman who doesn't wear makeup, but having invisible disabilities I need to communicate about makes me "less competent." Right. With the added bonus that communicating with people about not wearing fragrances triggers the shame that they're using the fragrances to cover up, so they get extra mad at me.
no subject
Date: 2019-07-01 02:21 pm (UTC)While I'm there, one of my cousins comes to town. Late one night I'm playing World of Warcraft with my wife who's still in NM, and I overhear my mom and cousin having a kitchen chat, not being able to comprehend why my mom has a granddaughter who's gay (was planning on marrying her GF later that year, but that fell apart) and cousin had a daughter who was gay). Suddenly they came up with the theory that it was sexual assault or abuse that turned them away from men and to women.
I couldn't take it. I went in to the kitchen and told them that almost every girlfriend that I'd had prior to my wife (and including her, but I didn't tell them that) had been the victim of sexual assault of one kind or another. None of them were lesbians. I didn't tell them that one or more of them had bi tendencies as that would lead to speculation. Needless to say I didn't give them any names.
Fortunately none of my exes seemed to have any PTSD from their violations, or if they did they've dealt with it and recovered from it. But it is so damn appalling that there is so much sexual violence!
no subject
Date: 2019-07-01 07:49 pm (UTC)I would like to clarify that I don't assume that every woman who has a mental disorder has sexual trauma in her past, nor do I assume that a woman who requests a female tech has sexual trauma in her past. It's just that I have been made aware of how damn difficult it is to disclose, and how often women choose not to disclose. Given that I can't tell, I am trying to err on the side of kindness. The best possible outcome would be invisible to me: a woman uncomfortable about disclosing, who gets a female tech, and does not need to say anything because there's no issue. I mean, I also hope she is getting whatever help she needs, but I am not a trauma counselor, I'm a sleep tech.
no subject
Date: 2019-07-01 10:22 pm (UTC)No, I understand that you're not making that assumption. Definitely a good thing to suggest that a woman would prefer a female tech. My wife changed her first name to Russet, and when she had the first night of her sleep study, the neurologist report - and she never met him - used male pronouns throughout. So the second night, when they were testing the machine (this was like a decade ago), the tech (a woman) and my wife, whenever they wrote Russet's name in the paperwork, always followed it with ", a woman, ". Still, the neurologist came back with male pronouns. So as far as we can tell, he never read the paperwork in any detail. Therefore, did he read anything?
My wife was not a happy camper.
no subject
Date: 2019-07-02 06:38 am (UTC)no subject
Date: 2019-07-02 01:19 pm (UTC)Do this often enough and that one time that things are not going well and one must become the Very Nice Man Who Is Being Quite Calmly Very Firm Right Now, has amazing returns on getting things fixed.
no subject
Date: 2019-07-02 07:26 pm (UTC)