Appreciation (42) …The sound of living by ECG

Appreciation (42) …The sound of living by ECG
Torrey Orton
Feb 17, 2011


I had an echocardiographic stress test today and turned out fine…which was nice and not unexpected by me. No clogged arteries to be found. The really nice bit was the sound of my heart at work, which struck me as something a musician would use to background a piece…examples of which you can find at "heart sounds music" in Google, I later discovered (not my heart of course!). I listened then to a bunch of normal heart sounds (Google 'heart sounds', without music) for teaching auscultation (look that up and wonder couldn't they have done better; there's no escape from our Latin heritage!) and none had the richness of that produced by the echocardiograph technology.


I could catch the different valves because they were separated out from each other by the at-rest examination …but best was that I heard myself in a wholly different way from my voice, gut bubbles, joint clicks and such. I was hearing my life pulsing away interminably without my willing it to do so as I must will my muscles to get me up in the morning or to pluck these keys in writing about it all. Gave 'persistence' a new depth.


In addition, I gained a sudden appreciation for my heart itself – just perking along in there without a break (except that one day when my sick sinus captured my attention 9 years ago)…wondering that there must be medical researchers trying to reproduce that muscle for other purposes – generating electricity, perchance??


I hadn't thought about my heart, except for moments seeing if I could catch the pacemaker defending me from an unpredictable burst of slow heart rate. "Burst" you may wonder at? Well the pacemaker's task - for those of us with loose organic electrics, the counter-intuitively named 'sick sinus' – is to pre-empt a dropped beat, failure to do which can lead to passing out and its aftermaths.


Actually running – that is walking faster and faster – on the treadmill was a challenge… couldn't get my pace and stride right. Very strange feel of walking slightly uphill out the window …ah, it was the lack of leg lift required to stay with its demands. Climbing a hill is climbing; running treadmill is milling. Two quite incompatible things. So I tired more quickly than I should have given that I'd done 3ks uphill with a 150 meter climb three days before the milling.


I think the milling movement is less integrated, less whole of body by comparison with climbing, which is done with the whole body in synch leaning slightly forward, selectively placing each step around rock and root protrusions …so balancing all the time, too. Climbing is as much arms and shoulders as it is legs. The ECG testers prompted me to do the wrong thing: not look at my feet, which is exactly what I do climbing for reasons of the roots and rocks above! They said I'd be likely to loose my balance. At least one of them may not have recently climbed a serious hill on an unpaved path.


The sounds of different livings.

Learner therapist (14)……Distorted, not disordered, selves

Learner therapist (14)……Distorted, not disordered, selves
Torrey Orton
Feb 5, 2012

Most everyday therapy is work on distorted capabilities, not mental disorders.

I think of my patients as learners with a wheel off their practice vehicle(s). A few of them think of themselves as "having" ADHD, Asperger's, OCD, BPD (used to be Bi-Polar Disorder, or is that another?), PTSD… an array of afflictions which have a grip on them like the flu, cancer, and such. These self-perceptions are encouraged by the medicalization of mental health issues. Such issues are, in fact, uniformly multi-modal, multi-dimensional – in brief, multi-causal, if we dare to speak of their precipitating, predisposing and maintaining conditions.


We in the mental health sector, and some in the medical, uses the concept of biopsychosocial (often with additives like spiritual and cultural) to describe the domain of the afflictions we engage professionally. In other words, they are not simply "mental" issues, nor physical. They involve a life world – a life style, if that feels more comfortably you – not just loose cogs or a rusted neural joints. And, as is increasingly recognised in various high profile specialisations (addictions, particularly), successful treatment is a social as much as a personal event (think weight, depression, anxiety, eating 'disorders' and so on, too).


The Diagnostic and Statistical Manual delight
So, how did we get here? Here is Gary Greenberg on the DSM, diagnosis and disorders:

… "And as any psychiatrist involved in the making of the D.S.M. will freely tell
you, the disorders listed in the book are not "real diseases," at least not like measles or hepatitis. Instead, they are useful constructs that capture the ways that people commonly suffer. The manual, they go on, was primarily written to give physicians, schooled in the language of disease, a way to recognize similarities and differences among their patients and to talk to one another about them. And it has been fairly successful at that." …

That is, the constructs (PTSD, BPD, OCD…) attempt to describe symptoms systematically, not their sources, causes, underlying structures, etc. For instance, chronic panic is reasonably visible and audible; we feel the other's panic immediately as a reverberation or resonance in our own bodies. This is the leading edge of empathy in action.

 Deep traumas are not so accessible. They are implied by the panic if you know that they must be there, which you should if you know that panic is an appropriate response to a perceived death threat which the patient cannot easily report as the trigger of the most recent episode. That is, it is personal historical material, etc. The trigger is the form of our experience of that historical material – it is a symptom with an anchor in the chronic damage. We (pretty much all of us; not just therapists!), of course, have a sense of others who are damaged deeply, usually from non-verbal markers (the "symptoms") which we do not usually engage directly with those others.


Medicalization by bookkeeping
Symptoms define a 'disease' entity, which then can be subject to micro-analysis for costing purposes so that expenses can be managed, forecast and so on. Psychological services for mental health are increasingly being brought under the medical umbrella which distorts them in three directions: first, medical style item number servicing; second, manualised treatments (CBT); and, third, specialised treatment providers (clinical psychologists).


We can much more usefully think of mental health issues as distortions of the person, of the normal functioning of a person…with patterns arrayed around the emotion system which provides our daily self-regulatory input and output. These centre on expressions of pain (fear, sadness, etc.) and pleasure (happiness, joy, etc.) in a more or less discrete bi-polarity derived from their approximations to perceived life or death challenges of our presents and pasts…


That we have six to eight discrete core emotions (anger, sadness, joy, despair, love, confusion, etc. ) underpinned by a smaller number of organic status indicators (hunger, pain, desire, pleasure, numbness, , etc.) makes seeking an issue's source a viable enterprise. Patients' issues are all emotionally tagged. They show up for therapy because feelings tell them to. Their passage to a more viable personal world will be marked by changes in their actions and feelings about them, or letting feelings direct their actions for the first time – in other words, a reduction in perceived and actual (incongruence) self-distortion.


For a patient's global self-appreciation the thought that they have distorted life processes rather than an affliction, a disorder, is often helpful. It brings normalcy into the diagnostic picture from early on and helps them identify the necessary and useful functionalities they have, even though distorted. 'Disorder' sounds like a permanent injury, a lost limb. Distortion is a reparable injury; disorder a potential life sentence.


PS – it's funny how things come in bunches. Today I sighted a Guardian article on just this subject – distortion by disorders.- five months before the Greenberg article above. Like abortion/euthanasia spikes, they seem to come in waves, maybe annually? Anyone have a feel for the patterns???

Non-violent counter-protest training and practicum

Non-violent counter-protest training and practicum
January 14, 2012
Help: Professional / Personal Development Opportunity

Non-violent counter-protest training and practicum

Our need: Nine or ten counter-protestors to support constraining the harassment behaviours of Helpers of God's Precious Infants 6 mornings a week at The Fertility Control Clinic from 7:30 – 9:30am on Wellington Parade, East Melbourne, Vic

The task: to document harassment of arriving patients, while also inhibiting it in a non-harassing way.

The context: see here for detailed description. In brief:

The Fertility Control Clinic's front gate is a frontline of the struggle over life and death rights in Melbourne. There a group of Catholic protestors meet six days a week at 7:30am to protest patients' moral rights to a legal service authorised by elected representatives of the people of Victoria three years ago. Their protest expresses their unflagging commitment to expunging this parliamentary offence against the revealed word of gods.

The challenge: to engage with the protestors at a personal level to understand their perspectives and establish relationships, and at a social level as legally misbehaving harassers of vulnerable patients; to increase your understanding and competence at dealing with your own embarrassment / shame about taking personal action in public; the protestors have been provided a rationale and action focus for our work.

Benefits for you: increased awareness of own anger triggers, control over your automatic responses and directing them into appropriate, non-violent action to reduce patient harassment; knowing you are providing a support service much appreciated by patients and clinic staff clarification of own views of life and death issues.

The commitment: one session a week for about three months in the first instance

Even if in doubt, but interested, follow Torrey up by phone or comment on this letter at the blog below. Contact is not a commitment, either way.

Hopefully,

Torrey Orton and Charles Brass
Friends of the Fertility Control Clinic
11 Wertheim St
Richmond, Vic., 3121
Australia
Mob. +61 (0) 419 362 349
Skype - torreyo
http://www.diarybyamadman.blogspot.com/

The patient experience…one’s evidence

The patient experience…one's evidence
Torrey Orton
Jan. 12, 2012

A bit more than 21 grams…??¹

 

From another frontline much like the Fertility Control Clinic one, but more common – the medical frontline where the vast bulk of the patient experience is provided by body movers (orderlies, …) and nurses and food service staff and cleaners…with registered medical practitioners ranging from interns thru registrars to fully fledged doctors and the pack leading consultants far in the distance, and often hard to see even when present (they're moving so fast) and smiling so hard …


…it seemed they all went to the same faux intimacy training programs down to the modulation of lips and expression brightness with smoothly patterned discourses of their respective domains. 'Hi, I'm X and I'll be doing Y for you for the next …hours…minutes"… I was rendered "Torrey" by fiat and minded the presumption, since I know my barber better than I will ever know any of them.


Sure the dependency's different: my barber might on a bad day nick an ear (which he hasn't in 36 years), while the more present life vs. deathness of a faulty organ creates an intimacy which is too close and at the same time massively distant, especially when the actors in the hospital drama had almost no time to know me in any other than the piece of meat sense I had experienced with my first hospitalisation 10 years ago (a pacemaker precipitating one).


"Occluded" IVs
Actually every one moved fast all the time, leaving me with a sense of being in the hands of a system with somewhat less than the optimum capacity to function safely…it felt like it wouldn't be hard for an error to arise. For example, I was on a drip from 4 hours after arrival until an hour before departure five days later…sometimes two different intravenous infusions in tandem… especially post-operative². The drip monitor signalled persistently under two conditions: one, I had "occluded" the flow at the point of its entry to my body – the cannula – by moving the arm which held it (this time in the crook of my left elbow which meant occlusions abounded for days and nights due to spontaneous arm movements).


In the process of trying to rearrange my troublesome cannulations three efforts by three different nurses failed, largely due, it seemed to me, being overtired, stressed or both. One stopped after three tries saying she'd lost her "mojo". One pretender to the role arrived saying he'd try but call another if he failed. He never started because I told him to go away if he wasn't sure of himself. I guess he was offended; I was already irritated. My release from the irritation (not anger nor pain nor anything like that; I'm relatively impervious to the pricks that presage a cannulation) came from a 60 year old who did it in 32 seconds (the others were under 35, years that is, at a guess). My reverse ageism?


The second condition
But cannulations were more than an irritant. The possibility of a mix up in the drip lines were another matter. Heavy antibiotics prefaced the op by one day and succeeded it for three days. These were sent by IV, in tandem with the permanent fluid input. BUT, the two were chemically incompatible, requiring the shared mainline to be "flushed" with a chemically neutral solution preventing contamination of the one by the other, both before the antibiotic and after. In the flashlight reduced darkness of middle night I had the impression that shift nurses were not always on top of these delicacies, though the fact I'm writing this three weeks after the fact suggests I needn't have worried, but how was I to know then?


Memorables
These sorts of things are the memorables of my "patient experience" because they occupied my waking and sleeping days for the duration, interrupted by workable, and better, nurse and supporters efforts to minimise their effects. They happened in one of the best private hospitals in Melbourne which I've used before for related matters. My impression of contextual stress was not an artefact of my degraded physical defences.


I spent 4 hours waiting for a first assessment in emergency after entry triage, followed by nearly a whole day on an emergency gurney before transfer to a regular bed. This was not special treatment for me; they were full to the eyebrows. As a full fee private patient I did not get a sole occupancy private room until after the operation, another day plus later. These are system redundancy problems – ones which preoccupations with profit and profitability have removed from the vocabulary and practice of organisational competence in many of our core systems, hospitals among the most important (shortage of retail service staff really doesn't matter in the bigger scheme; it's an irritant without a serious consequence).


Such things do not matter to me a great deal; the double I shared for a day before the op worked fine, though the other guy was having a hard time in recovery from a knee reconstruction. He and I passed on my way out of Intensive Care: he arriving for more serious pain management I guessed and I departing with infection controlled and pacemaker³ unimpeded by the op electricals.


I think there was another move in there but my recollections of the pre-post op period are a little fuzzy. These are, of course, my perceptions. I am a reasonably skilled observer of behaviour, with allowances for memory fudges arising from the tiredness of the gallbladder infection I was carrying and being treated for pre-operatively. I am agile at talking to all kinds of people in all sorts of personal states about how they are finding their life at the moment. Some staff were self-immunized from that level of communication but many were accessible to observations about their apparent pressured work, explicitly confirming my impressions above.




1-As the first major loss of a body part (teeth excluded) in my medical history, my gallbladder excision on Dec. 16^th, '11 roused a wonder as to how much I'd lost, prompted a bit by the notion that a soul was a measurable 21 grams of something. Chasing down the bladder weight query went nowhere, though bilious content volume and dimension, on the average, were readily available. Midst the mild disappointment I realised that I'd already compromised the materiality of my spiritual equation by acquiring a pacemaker 9 years ago after a similarly unprovoked attack by nature on my being.
Three weeks later I got the lab assessment of the offending organ. It was rated as "gangrenous" and a day or so off bursting when the op was done.


2- The op itself was a marvel of keyhole work which, among other things, left me fully operational 10 days later and almost undetectably unwounded at three weeks post-op, plus nil internal wound pain. It took about 1.5 hours, extenuated some by the offending bladder having been "the worst we've seen in years" – made their day, so to speak, the backup surgeon opined the morning after. This led to additional infusions focussed on killing possible bugs which might have escaped from the ravaged bladder before the heavy hitters got to it with their extraction tools.


3- One risk associated with the keyhole surgery was that the electrical aspects of the process might disorient the pacemaker's little brain (it didn't). Had it done so, no worries anyway, perhaps. The techy at my most recent end of pacemaker battery life check-up said in reply to my wonder about a power down, "If it stopped now, it wouldn't make any difference to your life." How was I to know?

Learning to act right (25)… What’s harassment and why it must stop.

Learning to act right (25)… What's harassment and why it must stop.

Torrey Orton
Jan. 4, 2012

A message to HGPI* "helpers"

The Fertility Control Clinic is the everyday frontline of the lifer-choicer confrontation in Melbourne. We sit clearly on the choicer side for a number of reasons, and with a view that it's easier to inflame than it is to understand. So far we have succeeded in not inflaming a volatile setting.


We both retain a strong belief that clinic clients are being unreasonably accosted, and still want to see whether some sort of intervention might be created to address this situation. The objective in general will be to reduce perceived harassment to zero.


You are seen as harassing by many patients and by us. We know you act better when we're around, so the harassment must be even more than we see. We think the Bible encourages supporting the weak and you are harassing the very vulnerable. We also think you as a group do not understand why you are seen as harassing, and not only by us. Here's why, in two parts:

Part 1 - The idea that patients arrive already stressed so you are not aggravating it reflects a basic misunderstanding of stress. It is VERY clear that stress is cumulative, both through multiple stressors at one time and/or sustained stressor(s) over longer periods. A highly stressed person requires slight additional stress to push them over their personal limit. Anything anyone does which increases the stress of already stressed people who cannot defend themselves is understood in law as harassment. Patients are understood in anyone's church to be unusually vulnerable.

 

Part 2 - Harassing behaviour in the FCC context is any continued offering to patients and their families who have refused an initial offer by HGPI members. Continued offering means following the patients beyond the point of first contact and refusal towards the FCC gate and saying things like "You'll be a good mother / father." "Don't harm your beautiful baby", etc.

We would like you to understand this, and here's how we propose to try:

1- This document specifies a publically understood meaning of harassment (Part 2 above)

2- It also assumes a standard conception of stress as cumulative (Part 1 above)

3- We will present it to you and discuss the meanings of 1 and 2 for clarity

4- Then, we will begin to document violations of those 2 understandings and confront you in various ways with the evidence

5- In the process of step 4, our way of confronting you may elicit feelings of guilt and shame and anger from you, which is what harassment elicits from some patients.

6- We will do all of this in ways which do not add to patient stress.

Regards
Your pro-life pro-choicers,
Torrey Orton and Charles Brass
Friends of the Fertility Control Clinic


*HGPI = Helping God's Precious Infants

Appreciation (41) … I thought this was beyond me

Appreciation (41) … I thought this was beyond me
Torrey Orton
Dec. 7, 2011

Ungloved, two-handed catch

The waitress leaned across the small three-seater to recover a finished starters plate. On the way back she tipped my half full, long-stemmed glass of fine Hunter rose towards me from the middle of the table. I can't remember how my hands got to catching it in mid-fall as if it were a cricket ball being gloved by a wicket keeper. I didn't drop the catch but a few drops splashed the table between Jane and me without threatening cuffs or shirt fronts in their flight to the table cloth.


I was, till that moment, mostly renowned for doing the glass tipping myself and having to sop up large wine puddles across tables and floors at home, not counting those glasses – short stemmed and long - smashed irretrievably in the sink : around 1 every two months or so. There's something invigorating about finding a natural skill that had seemed lost forever, though I can't actually remember how my hands got from where they were on the table to the appropriate catching position. Reflexes improve momentarily; short term memory slides even further?? Compensation before capitulation.

Appreciation (40) …Old man’s prayer

Appreciation (40) …Old man's prayer*
Torrey Orton
Nov. 28, 2011

In sight and out of mind at the FCC

Saturday was the monthly prayer vigil against abortion day at the clinic. On our side were a measly 8 or so holding a large banner and chanting moderate offenses at the 100+ followers of Helpers of God's Precious Infants massed across Wellington Parade. I was there to show support (until sunk by a persistent downpour which left me swimming in my shoes) and collect potential players for an enlarged weekday presence in the face of the Helpers.


I was involved in collecting the last name and email when an old guy approached from the back seeking my attention. I turned enough to say I'd come talk to him when I finished. And so I did 3 minutes later, noting that I was approaching a guy short of my height and even shorter of my weight, but longer in days. He was clothed in an almost twin of one of my sports jackets (Germanic hounds-toothy sort of thing to compliment tans and such), trilby hat and wire-rimmed glasses of faintly 80's and a hand hold on a string of rosary beads.


As I came up he started to ask if it was OK for him to pray here. I said fine with me but I couldn't authorise him; he'd have to ask the others…and he volunteered to pray for me, too, as well as the souls in the clinic. I thanked him for the offer. Probably it was my fairly lurid red waterproof, relative towering over the herd on our side and my fairly clear age advance on the rest, too, which drew him to me.


Anyway, he started up walking back and forth in the neutral zone between the roadside white line and the clinic gate soundlessly working through the beads. Of our side, holding the banner and chanting, no one noticed and no one interrupted him. And there we were, infiltrated in broad daylight. As far as I know, prayer doesn't gain or lose power as a function of distance from its objects.


The real story here is power: that there's this power vacuum just waiting for users to appear with enough daring to claim it for themselves, as Charles and I originally did. The proof of its opportunity walked up and down until I left 15 minutes later – in sight and out of mind. The unsqueaky wheel needs no foil.


* A 'prayer' in Fertility Control Clinic security-speak is a pro-life protestor who only prays, as distinguished from protestors who pray and harass patients in moments of prayerful lapses.