In Which I Noodle About My Job

[lydy]

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.

Comments

[mrissa]

Oh hell yes.

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.

[lydy]

I have also noticed that you are not allowed to whine about disability, and if you whine, people assume that you don't really have said disability, you're just faking it. This is especially true for invisible things, like fibromyalgia, depression, or asthma. And I am, as I am sure all my friends know, an inveterate whiner. I whine about a lot of things. It makes me feel better. I whine about cleaning up cat vomit, I whine about hating to do my PT exercises, I whine about cleaning the bathroom, I whine ... well, a lot of things. But not about my asthma. And not about my depression. Neither have been particularly debilitating, of late, but when they are...I really can't whine about them. And removing that pressure relief valve is not helpful. Not at all.

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.

[quadong]

You really hadn't heard anyone say something like "Man, I don't want to see that" when they saw someone else's body? I must have observed this awful aspect of our culture thousands of times. Or do you just mean this one co-worker of yours?

[lydy]

I have certainly been told by Mr. Rando Stranger that the way I dressed grossed him out. And at one memorable Minicon post-mort, a man said, to great applause, "Spandex is a privilege, not a right." So, in that sense, yes, I am painfully aware that strange men's sad-boners are a thing that they like to share with women. But I had not, until that point, heard a medical professional comment about the lack of sexual desirability about a person in his care. That did shock me. Now, I dunno, maybe there are a lot of medical professionals who, out of the hearing of their patients, make gross comments about the hotness of their charges. But that was the first, and only time, where I was exposed to that particular variety. And I did find it striking, especially since it was a view and a behavior which is very common in the sleep lab, and no one had ever commented on it in such a demeaning way, before. I suspect there was a performative aspect, in that there were two men working with me, and the comment was really from the possible psychopath to the other man in the room, in a way that suggested an attempt at male bonding. I dunno. I do hope most men in healthcare are more professional than that.

[lydy]

I want to expand on my answer, a little bit. I have swum in the misogynist stew of our culture all my life. I'm pretty sure I laughed at the cleverly misogynistic comment at the 90s era postmortem. It can be hard to focus on the water we swim in. What made my co-workers comment so shocking was that it recontextualized shit I had been seeing all my life. I had bought in, a little bit, to the idea that being a girl in public was to also to be a public utility. The idea that the clothes I wore were not for me, but for strange men, was a concept I had completely internalized. The thing that my co-worker's comment brought home was that there was literally no time or place in which I was not possible prey. There was literally no point of my existence that this man thought belonged to me. It was shocking to me because I had not realized how incredibly offended this man was by a woman who was not fuckable, even in situations where fucking was never a possibility. The existence of a non-fuckable human female was an affront to him. While I had certainly seen this kind of behavior in the past, this was the moment at which I saw it clearly, the moment where I understood how deeply embedded it was in every interaction some men have with women.

[mrissa]

Yeah, the sexual harassment/disability conversation is one we have not even started having in science fiction. Have not even started. It is complicated. Because there is a lot of stuff about being in a vulnerable position and sexualized inappropriately--as above--and there is also stuff about being in an ordinary social position but disabled and having that used against you--and then having prejudice against disability used to cast doubt on your word, and--

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?

[sonia]

I appreciate this post and mrissa's reply and your reply! mrissa, nodding about the game being rigged, and the huge frustration and unfairness around that. lydy, wondering if some of the folks in long-term residential situations who aren't super-accommodating get less access to care like sleep studies.


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.

[thewayne]

Three years ago my dad had a seizure (yes, this is relevant to your post) in the middle of the night, and while trying to figure that out, it was discovered that he had cancer (he's now fine and clear). As I'd just been told that my contract was not going to be renewed and I'd be out of a job in 3-4 weeks plus that the project that I was working on was being shit-canned when this news hit, I requested that I push this remaining time so I could go to Phoenix and take care of my parents while my dad couldn't drive.

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!

[lydy]

Wow. What a terrible conversation to overhear. I'm glad you stepped forward and said something.

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.

[thewayne]

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.

[lydy]

For most sleep stuff, gender is pretty unimportant. If this had happened contemporaneously, I could be pretty certain that the misgendering was most likely the result of the way computer dictations are done. One error causes the entire report to use the incorrect gender. The doctor may not have reviewed the final dictation, and so not seen the error. If they did see it, it may still have been difficult to get it run back through secretarial to have corrected what was, to the doctor's eye, an unimportant detail. Ten years ago, this is still possible, but less certain. As for whether he read anything....man is that a crap shoot. My experience with being secretarial staff to doctors and now working in a sleep lab does not lead me to believe that most doctors spend a lot of time reading the documentation that they have available. I am not a doctor, so maybe I don't understand how these things are done. But I remember handing a four inch thick chart to an oncology doctor five minutes before he saw a patient in the Blood and Bone Marrow Clinic. He could not have possibly gotten through any amount of that chart before the patient walked into his office. I don't know how often he had seen that patient, or how familiar he was with the patient's history, but it didn't seem like he was well-prepared, to me.

[jbru]

From my experience on the patient-advocate side of things: it turns out to be really very helpful to be nice to the people taking care of your loved ones. A batch of cookies for the nurses turns into extra time with a patient, which results in a marked improvement in the patient's comfort and typically in recovery time as well.

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.

[lydy]

I am a big fan of being kind to people. I am a huge proponent of supporting people doing difficult jobs, and medicine can be emotionally, intellectually, and physically taxing. And you noticing their work and effort, and acknowledging it and being kind is a good thing. It speaks well of you, though I didn't need to know that detail to speak well of you. But I do worry about people for whom this kind of kindness is compulsory. And that care that Erica received should not have been contingent upon your emotional work. But, yay you. As a medical professional, thank you for noticing and being kind.