patient stories, pop culture

On Miss Colorado, “The View,” and Misdirected Mockery

Browsing the internet this week, I was pleasantly surprised to see Miss Colorado deliver a well-articulated, beautiful, heart-felt speech about nursing during the Miss America pageant. My heart swelled with pride. Kelley Johnson, RN, donned unflattering, shapeless scrubs instead of a flattering nightgown highlighting her shape. Instead of showing off a talent, she humbly talked about her talent of nursing.

Nursing, as Johnson talked about on the Ellen Degeneres show, is a talent. Many people warned her not to do a monologue, but as Johnson explained to Ellen, she wanted to be herself, wanted to give a voice to her fellow nurses who may have not that opportunity, and knew that Joe, her patient struggling with Alzheimer’s, is something that “hits home for a lot of people.” As she said, “It’s not something that’s really easy for people to talk about, and I just thought, “You know, I want to go up there, and I want to be authentic.””

Authentic, she was. That authenticity, that vulnerability, that courage was raw. When Michelle Collins and Joy Behar mocked her the next morning on “The View,” it stung. For once, we nurses had a well-spoken, accurate portrayal of our often thankless job, and it took less than 24 hours for some outsider to try to take that great moment away from us. We nurses did not take the insult lightly. Nurses posted on their stethoscopes all over social media. My roommate, a PA student, and I discussed how incredibly dated it was thinking only a doctor carried a stethoscope. Gomer, a sarcastic medical blog, wasted no time and announced Littmann is making separate doctor and nurse stethoscopes.

But when an acquaintance in a non-medical career asked me what I thought of the whole thing on Friday, I hesitated for a moment. I could have talked about just how much I use a stethoscope in my scope of practice. I could have mocked the women of “The View.” I could have talked about my own Joes, my own patients who have taught me what it means to be “just a nurse” and challenged me to treat every patient as a person with a diagonsis, not the other way around.

But as a surprise to even myself, I answered with something I learned from my talent of nursing: compassion.

Joy Behar, Michelle Collin, ladies of “The View,” and anyone else mocking Miss Colorado’s speech, I understand. I too have used misdirected mockery to ease my unease.

In fact, not that long ago, a fellow nurse posted on her Facebook about the perverse sense of humor we in healthcare can sometimes have. Though I do not agree that it’s acceptable to make fun of dying patients like Alexandra Robbins who wrote an article about it in the Washington Post, I cannot deny that I have.

I remember one morning after a night shift, my fellow nurse and I finished late. We had to record hours worth of work, write notes, and document seemingly menial details in charting. As we worked at our computers, we chatted mindlessly about patient codes. A code is a very serious time where a person has lost the vital function of breathing or circulation. Seconds can cost a person vital organ function if not life itself. We had narrowly avoided such a situation that previous shift.

He and I somehow got to a joke about how codes are slower in the rural South. Various CPR instructors have taught to compress the patient’s chest to the beat of “Staying Alive” by the Bee Gees. We laughed as we said their accent is slow and thick like honey, so instead of pumping the person’s heart to the 100 beats per minute of “Staying Alive,” they pump much more slowly.

To illustrate our perverse sense of humor, the same various CPR instructors have also suggested to perform chest compressions to the beat of “Another One Bites the Dust” by Queen. I’m an optimist by choice, so I perform to the beat of “Staying Alive.”

I remember vividly how I had tears in my eyes from laughter as my co-worker went back and forth, imitating a Southern, much-slower code. My day shift co-worker in the corner did not find it funny. She shuffled in the corner uncomfortably and left the charting room without saying a word.

She did not have to say anything. Our joke was extremely insensitive, and I am ashamed I made it. I’m ashamed to admit I helped create that joke now. And I’m even more embarrassed that my family who lives in the South might read this and think I’m insulting them.

(Dearest Southern branch of my extended family, I did make this joke. I’d offer excuses, but I did it of my own free will. I don’t actually think codes run slower in the South because of your accent. I actually wish I had a bit of a Southern accent so I could use the word ya’ll. Ya’ll is so much better than the Northern Midwestern equivalent of you guys. Too, I’m jealous of your weather in the winter. I’m sorry. I love you.)

I fully admit, I made that insensitive joke because I was uncomfortable. I was scared my patient was “circling the drain,” “crumping,” and all the other slang terms my co-workers and I would use to otherwise indicate that our patient, a person with loved ones we met and had not met, was likely going to die.

Working with the potentially dying is extremely uncomfortable. Health care is uncomfortable. Every day, every shift, every patient is an opportunity to see our own vulnerabilities as a mortal human being. Patients are sometimes like a mirror. We see our friends, our family members, our loved ones, even ourselves, staring back at us, sick, needing our help, sometimes asking unanswerable questions we ask ourselves in the still of the night. It’s enough to scare you into a bowel movement.

Just in the past several weeks, I took care of nurses in my work as an ER nurse. Nurses are infamously horrible patients precisely because of the nature of our job. As nurses, we are used to be the ones taking care of others and not being taken care of ourselves.

My patients were across from all across the nursing spectrum. One was a psych nurse who herself could not shake her own addiction, coming in for a relapse. One was an oncology nurse who in a cruel twist of fate was battling her own form of cancer, coming in after her chemotherapy proved too strong for her weak body. One was a nurse practitioner and the family member of a sick patient who asked me for answers about his parent’s uncertain future that he and I both knew no one could not give.

As much as I wanted to take care of them, fix them, cure them, heal them, I could not. All I could do was be there with them, like how Kelley Johnson beautifully described just being there with Joe. All I could do was offer compassion, which, from the original Latin means “to suffer with.” I took minutes of my precious time, sat in my swivel chair, and just sat with them, even cracking a couple jokes.

I understand, ladies. Here you were, watching Miss America, the epitome of youth, beauty, and life, and a young woman shocked you. You expected a beautiful young lady in an equally gorgeous ballgown. You got a woman in scrubs with a stethoscope. You expected a talent. You got a monologue. You expected to be uplifted. You got a stark reminder that you too are mortal, you too may become old (if you are so fortunate to live that long), you too many experience dependence, and you too may be so scared of what the future might hold.

You – like me, like my co-workers, like every other human being on the earth – made a joke. You don’t have to search Google very hard or long to see that plenty of comics have gotten their starts and material from uncomfortable events in their past. Making jokes to ease tension, to make something uncomfortable suddenly more comfortable, is completely natural.

Unfortunately for you, your joke was insensitive. Jokes do not always have to be appropriate, but laughter is the best medicine in that it has the ability to connect us to one another. Jokes in dark times are meant to connect people, not disconnect them. Jokes in dark times are to say, “I understand, and I laugh at the uncertainties of life with you,” not “I don’t understand, and I laugh at your unfortunate circumstance.”

In our various training, many well-intentioned teachers will tell us health care providers to disconnect for our sanity. They tell us our job is hard, and the only way to survive is to disconnect. Insensitive jokes are an example of a way of disconnecting.

I respectfully disagree with those teachers and those methods of coping. I have become a talented nurse precisely because I choose daily to connect with my patients. Like Kelley Johnson, I choose to connect with them, to see them as a person with a diagnosis, to understand where they are coming from, and what they truly desire.

As I recently told a young patient of mine, though we do not always get to choose our circumstances, we always have a choice in who we want to be. And we always have a choice to connect to one another or disconnect from one another.

Let me tell you about my Joe.

His name, of course, is not Joe. For well-intentioned privacy reasons, I will never disclose his name, but I will always remember his sweet baby face. Joe was chronologically an adult, but with his baby face, he looked to be no older that 14. He was a student with type 1 diabetes, who came into my ER after he was found passed out in class.

Us health care providers knew with a single glance that Joe was going to need to stay at least the night in the hospital. As Emergency Medical Service providers gave me their report, we learned the reason was going to be to safely bring his blood sugar down to a normal level. His blood sugar was too high for the monitor to read. Blood work showed his glucose to be elevated, his kidneys hurting from the abnormal elevation, and he was going to need intensive care.

The problem was Joe did not want to stay.

I warned him of the risks of leaving. My sweet attending physician explained how much we cared about him and why we did not want him to leave. My fellow nurse offered to make some calls.

After all that talk, I came back into the room. Joe still wanted to leave.

I sighed. In that breath, I though of all the patients I had chosen disconnection instead of connection. I thought of the patients who courageously vocalized their fear of dying whose rooms I left. I thought of the patients who I left crying. I thought of the patients who were clearly struggling whose struggles I never asked about. I thought of all the insensitive jokes and comments I’ve made about patients when I just do not want to care anymore. I regret each one of those opportunities where I have chosen to disconnect.

Baby-faced Joe was still in front of me. I wanted to choose connection. I wanted to choose compassion. I couldn’t help but look at his baby face and see Shane, a high schooler who I had met while a student nurse working with a school nurse for my community clinical in nursing school.

Shane was diagnosed with type 1 diabetes months earlier, and he came to the office every day after lunch for his insulin injection. One week, Shane did not come. The school nurse told me he was absent that day. I thought little of it.

The following week, Shane came for his insulin injection. After he left, the school nurse told me he was actually out because he was admitted to a mental hospital. Shane had come home after one particularly tough day of school and refused to take his vital diabetes medications. His parents called the police. The police took him into civil custody. He was deemed eligible for being treated against his will because of his chronic condition and his refusal to take his medications. He was admitted and discharged from a mental hospital for his passive suicide attempt.

Later in that afternoon, he did not feel well in his class and came to the school nurse. I checked his vital signs, and everything looked normal. The school nurse had him lie on the cot. I checked on him 15 minutes later.

I figured he needed someone to talk to him instead of talk at him, so I popped a squat and gringled to the best of my abilities. Gringling is a mixture of greeting and mingling that I learned as an orientation leader for my college university. That summer, I became a professional gringler, which makes me sound like a mixture of the Grinch and a magical fairy. At times, being a nurse is being a mixture of those two things, so this learned talent has been very valuable.

That conversation was one of the most real conversations I’ve ever had with a patient. Shane’s disease came up for maybe two minutes. We talked about his life, his dreams of being a singer, his aspirations to be an inspiration to other kids with this disease, his struggles in high school, his beliefs in God, everything. He taught me how to see a person with a diagnosis, not just a patient.

I knew how hard diabetes was for Shane, and I knew how grateful I was to choose connection, choose compassion that day. Joe was only a few years older, but I did not want to miss the opportunity of connecting with him.

I took a swivel chair, scooted up to his bed, and said, “Joe, tell me about your diabetes.”

He stared at the wall. I waited in the silence, holding back all the things I wanted to say about why he should stay. I sat in silence with him. “It’s the hardest thing,” he finally said.

I did not give a well-articulated monologue to Joe. I struggled and stumbled through an impromptu speech about how we do not always get to pick our circumstances, but we always have to choice to pick our attitude. I remember I said something about how he gets to decide to become the 60-year-old type 1 diabetic who I saw run a marathon or the 40-year-old type 1 diabetic I’ve taken care of who needs dialysis from kidney damage. Joe did not say anything.  I told him I’d leave him to his thoughts and asked what he wanted to do after I checked on my other patients.

I started an IV, drew labs, assessed a new patient (using my stethoscope), gave a medication, and took a phone call before coming back to Joe. Joe said he’d stay. He even offered a couple numbers to let family know he was there for the first time.

As I called and re-called report to the intensive care unit nurse who was going to be taking Joe, I was struck by his compassion. Usually, the ICU wants patients with two IVs, completely naked under a gown, and will give us ER nurses a hard time if one of these two things is not done. This ICU nurse kept telling me, “That’s OK. I’ll take care of it up here. Thanks for the update.”

At any point, we health care providers could have chosen disconnection. I could have not given Joe a speech, saying it was up to the attending physician and the patient to have that discussion as to whether or not he left. My attending physician could have only outlined the risks of leaving and not explained how much we cared. My fellow ER nurse did not have to offer to help me. My fellow ICU nurse did not have to be kind to me when routine transfer items were not complete.

But that day, we all chose connection. Though I do not know where Joe is or how he is doing, I know he had a better experience because we all chose to not just do our job but to do it with compassion.

Ladies of “The View,” when you mocked Kelley Johnson, when you mocked any Miss America contestant, when you gossiped maliciously, you are chose disconnection.

We all choose disconnection and connection everyday, but unfortunately for you, millions of people watch you. Unfortunately for you, we live in a technologically advanced society where we can record, share, and replay the insensitive words you said repeatedly. Unfortunately for you, health care providers rallied all over social media. Unfortunately for you, your apology seemed insincere, sounding like a list of excuses and false flattery. Unfortunately for you, some nurses like Kati Kleber of Nurse Eye Roll have a great presence in the blogosphere and talked about what happened. Unfortunately for you, sponsors are taking away their advertisements. Unfortunately for you, even though now you’re featuring nurses on your show and are seemingly trying to make sincere amends, the damage is done.

I understand. As remorseful as we are, after the damage is done, we sometimes have to pay for it. Health care providers have had to pay, literally, for their insensitive jokes. Recently, a patient was awarded $500,000 in damages after he recorded his colonoscopy on his smart phone and recorded the various medical providers (a gastroenterologist, anesthesiologist, and medical assistant) making fun of him while he was under anesthesia.

I listened to the recording that won that patient $100,000 for defamation.

The fake page? Done it. Have had co-workers do it for me. Offered to do it for co-workers. Needed to do it to sometimes get out of a room and take care of a patient with more critical physical needs. Am I proud of it? No.

Making fun of a grown man who is afraid of needles? Done it. Have joked about it with co-workers. Have a running joke about how it’s always the toughest looking men with lots of tattoos to help other patients feel braver. Have even poked a little fun at the patient in the room, depending on his or her personality. Am I proud of it? No, but that running joke (based on truth) does put others at ease.

I am incredibly grateful my patients have been forgiving of me for my insensitivities. I’m so grateful I haven’t been recorded. I’m grateful I’d had patients, family members, and co-workers call me out for being brusque, rude, and otherwise not the most compassionate person because it has challenged me to become the nurse I am today and provides the foundation for the nurse I want to become.

So, ladies of “The View,” anyone else mocking Miss Colorado’s monologue, I get it. I’ve done it. I continue to do it even though I try day after day to be a compassionate nurse. I make jokes because I too am uncomfortable with my mortality, my weakness, and my potential to one day be the patient instead of the nurse.

These jokes, this misdirected mockery to ease our uneasiness, is an obstacle to compassion. Authentic compassion is dependent on connection.

As University of Houston shame researcher Brené Brown wrote,

“One of the greatest barriers to connection is the cultural importance we place on “going it alone.” Somehow we’ve come to equate success with not needing anyone. Many of us are willing to extend a helping hand, but we’re very reluctant to reach out for help when we need it ourselves. It’s as if we’ve divided the world into “those who offer help” and “those who need help.” The truth is that we are both.”

– Brené Brown, The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are

Looking at life realistically, I will be a patient someday. I will get sick. I will go to the clinic for annual check-ups. I will God-willing bear children. I will need to depend on another health care provider to take care of me, and that’s a good thing. Dependence is natural.

As much as our culture tells us otherwise, dependence is not weakness. A baby is never considered weak for depending on his or her parents for everything from food to shelter, yet we place independence on such a high pedestal that the smallest inkling of dependence is viewed as weakness.

Yet, independence can be more of a weakness than dependence.

I consider the elderly woman who refuses to use a walker and falls frequently out of stubbornness weak. I consider the man who refuses to seek help for his alcohol abuse out of pride weak. I consider a wide variety of my stubborn, prideful, mean, mocking patients weak. These patients are so independent that they are alone, disconnected from everyone, even keeping those who desperately want to help them at bay. Independence can be weakness.

Maybe I won’t get sick. Maybe I’ll refuse to go to my check-ups. Maybe I won’t bear children or use any kind of health care provider to give birth to them.

But guaranteed, I will one day be dead. That scary reality, that frightening unknown, that lingering question, has made me more alive than anything else in this world.

The source of that life, that hope after death, that compassion towards my patients, that urge to connect with those around me, is Jesus Christ. Jesus Christ, who bore more misdirected mockery than anyone else in this world and understands when that mockery is directed at me. Jesus Christ, the Divine Physician, who teaches me by His life how to authentically care for my patients, and just how natural it is for everyone to require a savior.

I can’t suture my own wounds. I can’t diagnosis my own sickness (though I do try). I can’t save myself from drowning. Regardless of personal beliefs and spirituality, everyone has a need for someone outside themselves. Everyone has a need for connection, for dependence, for love. It’s completely natural.

At its core, connection is what spirituality is. Brown defines spirituality as:

“recognizing and celebrating that we are all inextricably connected to each other by a power greater than all of us, and that our connection to that power and to one another is grounded in love and compassion. Practicing spirituality brings a sense of perspective, meaning and purpose to our lives.”

– Brené Brown, The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are

So, ladies of “The View,” I understand your misdirected mockery. It’s scary looking at your own mortality, but I sincerely hope this whole debacle challenges you to more authentic connection in your life. You have a great opportunity in your position to connect us as a country, as a people, and as a culture. I hope in the future you take your opportunities and use them for connection and authenticity like Miss Colorado Kelley Johnson did.

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