Sunday, July 29, 2018

The Radio Flyer Little Red Wagon

The Radio Flyer Little Red Wagon

It was a nice beginning to our day in Surgery at Marin General Hospital.  Because our ancillary staff was very busy this Tuesday morning, I, as the circulating nurse in my assigned operating room, picked up our new Radio Flyer red wagon and proceeded to pull it up to the Fourth floor where the preoperative area was located, to pick up a pediatric patient who was scheduled for a tonsillectomy that morning.  The wagon had been purchased to carry small children to the operating room, an addition to our transport vehicles that we thought would make their introduction to surgery a little more pleasant.  Mom and Dad, or whomever was accompanying the patient, could walk along with us as far as the entrance to the restricted unit of the hospital called Surgical Services.
I stopped at the nurses station in Pre-Op and asked where I might find my patient, Kelly O’Conner (not her real name), aged 4, and was informed by the unit clerk that she and her parents were in Room Three, along with Nurse Jan.  Pulling the spiffy little red wagon behind me I entered the room to be met by one amazingly cute little girl.  She was sitting up in the great big hospital bed and looked  as if she were giving a conference class to her parents and R.N. Jan.  
I said ‘good morning’ to the assemblage and introduced myself to Kelly and her parents, 
“Hi, Kelly, my name is Mary-Pat.  I’m an operating room nurse and I will be with you while you get your sore throat fixed this morning.” 
As Jan handed me Kelly’s chart, I asked if everything was okay and was informed that Kelly was all ready to go.  
To Kelly’s parents I said, “I’ll be happy to answer any questions you may have while we’re walking to the operating room.  
“Do you have any further questions or comments for Jan before we leave?” I asked  the young couple, who appeared a little nervous about turning their precious child over to a complete stranger wearing drab green scrubs with her hair almost completely invisible save for a minute smudge of brunette above her forehead under a colorful operating room hat, and with a surgical face mask hanging from a rubber band around her neck.  Though our garb was de rigueur and oh, so familiar to those of us who spent our days in surgery, I always kept in mind that that same getup was strange indeed to most who didn’t frequent our little corner of the world on a daily basis.
Nurse Jan handed me Kelly’s pink chart as she quickly and efficiently opened it to the pre-op checklist and reported all that she’d determined and documented that everything was in order for the planned surgical procedure to proceed - patient name, age, date of birth, operating surgeon, surgical procedure to be performed, fasting status for general anesthesia, allergies, special considerations, etc.  Pre-op nurses are specially trained and are proficient in picking up what-may-seem-insignificant bits of information that would be exceedingly helpful to the operating room team, thus ensuring a successful outcome for the patient.  As is routine in the checks and balances of medicine, when Jan had completed her verbal report to me, I, too, went over the chart thoroughly, assuring myself that all that I’d heard and read were in accord.
Indicating in the negative when I queried the parents if they had any final words or questions for Jan, I turned to Kelly and said,
“Kelly, would you like to take a ride in my brand new red wagon?”
That adorable little girl happily slipped off the bed and had no compunction whatsoever about settling herself in the little shiny-red transport.  Her parents positioned themselves on either side and each held one of her hands.  I told Kelly it would be a fun ride and we waved ‘good-bye’ to Jan as we exited the unit and went to the elevator that would take us down two floors to the surgical wing of the hospital.
On the second floor, outside the swinging doors leading to the area that is restricted to physicians, authorized personnel and patients, I directed Mom and Dad to the surgery waiting room, where I assured them there would be a volunteer who could answer any questions or concerns they might have while they waited for their precious little girl.  [If the volunteer was unable to allay their concerns, he or she could request that a message be taken to the operating room.  It was rare that we’d receive such, but the fact that the patient’s significant others had that option seemed to alleviate a lot of discomfort.] 
I explained to the parents that it would probably be about an hour and a half before Dr. McGee, Kelly’s surgeon, would look for them in the waiting room to give a full report regarding how the surgery had gone.  And, I assured them that I, personally, would be with Kelly the entire time she was in the operating room and that we would all take very good care of her.
Mom and Dad embraced little sprite, Kelly, who didn’t seem in the least upset or nervous about being taken from her family.  I pushed the button for the automated door and into the O.R. hallway Kelly and I went as Mom and Dad waved from outside.  
Kelly was such a charmingly precocious child, she waved to doctors and nurses as we made our way along the O.R. corridor to Operating Room Two and maintained a lively conversation with me about all matter of things she found interesting or amusing in this strange environment.
Before opening the door to the O.R. suite, as I pulled my own mask up to cover my mouthing nose, I explained to Kelly that she shouldn’t be worried when she noticed that everybody in the room would be wearing a mask to protect her from our germs. As the door opened and she looked around, her eyes grew large, taking in all the activity in the pale-green room.  Several people, all garbed in scrubs and masks, were busy with all sorts of activities: the anesthesiologist and his assistant busily working on anesthesia machinery, an instrument tech opening and handing sterile instruments to the scrub nurse and our surgeon, Dr. McGee.
When she saw us enter, the masked scrub nurse, outfitted in a sterile-blue-paper surgical gown and gloves, turned around and introduced herself, 
“Hi Kelly, I’m Susan and I’m going to help Dr. McGee.  We’re going to make your throat feel better.”
“Hey, Kelly, remember me?  I’m Dr. Benson and I’m going to help you go to sleep for your operation,” added the anesthesiologist, who motioned that I should lift Kelly onto the operating table that he’d told her about when he’d visited her and her parents earlier that morning in the pre-op area.  Kelly seemed perfectly happy about leaving the red wagon and allowing me to lift her up onto the table.  Dr. Benson continued his banter as we helped her lie down  and covered her with a nice warm cotton blanket.
Keeping up our animated conversation, Dr. Benson and I were determined to occupy Kelly in conversation to keep her mind off all the strange aspects of our foreign world.  Picking up from earlier, I again said to the child,
“Kelly, I just think you are so pretty.  Dr. Benson, don’t you think Kelly is the prettiest little girl you’ve ever seen? Maybe the prettiest girl in the whole world.”
“Oh, boy, she sure is!” replied the good doctor.
“Yes, I am,” came an additional comment, this time from Kelly herself.  Hmmm, interesting?!
“How do you know you’re the prettiest girl in the world?” I queried the precocious youngster.
“Oh, of course I know because we have lots of mirrors in our house,” came the confidant reply.  

Out of the mouths of babes!

Wednesday, July 25, 2018

Thinking About Erik Erikson's Stages of Psycho-Social Development

I met my daughter, Kari, for coffee at a local coffee shop after my bicycle workout this morning.  I still often feel like pinching myself  - yes, I really am retired and don't have to stress out about whether I have time for socializing at 10 AM in the middle of the week!  It's a fantastic feeling to have both the time and my daughter available to pass an hour or so in catching up and conversation. Kari's life is much more busy and hectic than mine so when she has a moment to spare and suggests a rendezvous I try to be available.  

When I came into the house after hearing lots about what's happening in their busy lives, I decided to review Erik Erikson's Stages of Psycho-Social Development  - his theories on personality development and ego.

According to Wikipedia, Erikson's research in the twentieth century suggested that each individual must learn how to hold both extremes of each specific life-stage challenge in tension with one another, not rejecting one end of the  tension or the other.  Only when both extremes of the challenge are understood and accepted as both required and useful, can the optimal outcome for that stage surface.

Erikson's Stages of Psycho-Social Development:

1)  Hope, Basic Trust vs. Basic Mistrust:  
-0-18 months
-depends on trustworthiness of the mother to meet all the physiological, emotional,  and intellectual needs of the infant
-if successful, baby develops a sense of trust which in turn forms the basis in the child for a sense of identity
-failure will result in a feeling of fear and a sense that the world is inconsistent and unpredictable.

2)  Will, Autonomy vs. Shame and Doubt:
-early childhood: ~1-3 years old
-child begins to discover beginnings of his or her independence
-parents must facilitate the child's sense of doing basic tasks "all by himself/herself"
-discouragement can lead to child doubting his efficacy - examples:
     -toilet training
     -discovering talents and abilities
-parent should encourage exploration and experimentation, but not punish or reprimand for failing at a task
-shame and doubt occur when the child feels incompetent in ability to complete a task and survive
-children who are successful in this stage will have "self-control without a loss of self-esteem"

3)  Purpose, Initiative vs. Guilt:  Preschool / ~3-5 years
-does the child have the ability to do things on his own (example: dress himself)?
-children are interacting with peers and creating their own games and activities
-if child is allowed to make decisions regarding activities, he will develop confidence in his ability to lead others
-if not allowed to make these decisions a sense of guilt develops - guilt in this stage is characterized by a sense of being a burden to others - this will foster his becoming a follower
-additionally the child is asking many questions to gain knowledge of the world - successful answers will encourage the child to develop purpose which is the normal balance between the two extremes of initiative and guilt.  Some psychologists estimate that the child in this stage of development asks literally HUNDREDS of questions every single day!

4)  Competence, Industry vs. Inferiority:
-school age / ~6-11 years 
-child compares self-worth to others (example:  classroom environment)
-can recognize major disparities in personal abilities relative to other children - teacher plays a big role in ensuring that the child doesn't feel inferior
-child's friend group increases in importance
-often child will try to prove competency with things rewarded in society
-child develops satisfaction with his abilities
-success is accomplished when the child has a achieved a healthy balance between the two extremes

5)  Fidelity, Identity vs. Role Confusion:
-adolescent / ~12-18 years
-questioning of self:  Who am I? Where am I going in life? How do I fit in?
-adolescent explores and seeks his own identity
-looks at personal beliefs, goals and values
-morality is explored and developed
-if parents allow child to explore, he will conclude his own identity - - success
-if parents continually push him to conform to their views the teen will face identity confusion
-teen is looking to the future in terms of employment, relationships and families
-learning these roles is essential since the teen begins to desire to fit in to society
-success is characterized by ability to commit to others and acceptance of others, even with differences
-difficulty with this stage can result in role confusion and can cause adolescent to try out different lifestyles.

6)  Love, Intimacy vs. Isolation - first stage of adult development
-usually happens during early adulthood: ~18-40
-dating, marriage, family and friendships are important
-increase in growth of intimate relationships with others
-when successfully forming loving relationships with others, individuals are able to experience love and intimacy
-they also feel safety, care and commitment in these relationships
-failure to form lasting relationships may cause the adult to feel isolated and alone

7)  Care, Generativity vs. Stagnation - second stage of adulthood: ~40-65 years
-people are normally settled in their life and know what's important to them
- a person is either making progress in their career or is treading lightly in their career, unsure if this is what they want to do for the rest of their working life
-also raising their own children and enjoying activities that give them a sense of purpose
-contributing to society with productivity at work and involvement in community activities and organizations
-if a person is not comfortable with the way their life is progressing, they're usually regretful about the decisions they have made in the past and feel a sense of uselessness.

8) Wisdom, Ego Integrity vs. Despair:  affects the adult from 65 years and on
-the person has reached the last chapter of life - retirement is approaching, or has already taken place
-ego-integrity means the acceptance of life in its fullness:  the victories and defeats, accomplishments and non-accomplishments
-wisdom is the result of having successfully accomplished this final task
-wisdom is defined as: "informed and detached concern for life itself in the face of death itself"
-having a guilty conscience about the past or failing to accomplish important goals will lead to depression and hopelessness
-the feeling of having lived a successful life

After Erikson's death his wife, Joan Erikson, at   the age of 93, developed the theory of a Ninth Stage of development:

9)  The Life Cycle Completed:  Extended Version
-old age - in one's eighties and nineties
-the psycho-social crises of all eight stages are faced again, but with the quotient order reversed:
   - Basic mistrust vs. trust:  hope -person deals with the mistrust of his own capabilities due to body's inevitable weakening
   - Shame and doubt vs. Autonomy:  will - shame and doubt can challenge his own autonomy over his own body
   - Inferiority vs. Industry - Competence -  aging can be belittling and can make elders like unhappy children
   - Identity confusion vs. Identity - Fidelity - elders can experience real uncertainty about their status and role
   - Isolation vs. Intimacy: Love - years of intimacy and love are often replaced with isolation and deprivation - relationships can become overshadowed by new incapacities and dependencies
   - Stagnation vs. Generativity:  Care - in one's eighties and nineties, there is less energy for generativity or care taking, thus a sense of stagnation may take over
   - Despair and Disgust vs. Integrity - Wisdom -
integrity imposes a serious demand on the senses of elders and requires capacities that elders may not any longer have
   -often the retrospection of this stage can evoke a degree of disgust and despair because introspection can be replaced by the attention to one's loss of capabilities and disintegration.

Joan Erikson expressed that the psycho-social crisis of this ninth stage can be met as in the first stage with the "basic trust" with which "we are blessed."

Tuesday, July 24, 2018

Memoir Writing: A Walk on the Beach

I've been participating in a Memoir Writing Group for the past several months.  Here's a vignette that I wrote to file in my post-divorce dating stories:

A Walk on the Beach with Bob

I’d been divorced a couple of years and was beginning to feel I might actually be able to, in the not too distant future, function adequately in this single life.  It took some time after I’d filed the paperwork that would dissolve my 32-year marriage, but about two years later, I’d finally let it be known to friends and colleagues  that I could maybe, just possibly, eventually, be considered available for introduction to potentially interesting replacements for my ex-husband.  It had taken several years to actually go through with the divorce; now I was maybe ready to have a suitor.
It’s funny, I really don’t recall how I came to meet Bob.  It must have been through a friend or colleague, but that part of the story eludes me.  I do remember that our first coffee date was at Starbucks late one Saturday morning in springtime.  As I lived in Marin County, he drove across the Golden Gate Bridge from the City and, as I entered the coffee shop, he was easily recognizable from the self-description he’d given during our introductory telephone conversation a few days earlier.  A pleasantly handsome and sophisticated-looking gentleman I guessed to be in his mid- to late-fifties with a full head of gray-white hair and a clean-shaven face including nice cheekbones and a strong chin line. I remember thinking to myself, “Well, hmmm, so far so good!”  He stood about six feet tall, slender, impeccably attired in clean, pressed and well-fitting khaki slacks and a neatly-ironed polo shirt, no crumpled collar here. 

It seemed the description I’d given of myself during that previous repartee must have been adequate because, as soon as he saw me, he stood, smiled and started walking toward me with his hand extended.

“Bob?” I tentatively asked in the same instant that he inquired, “Mary-Pat?”

“Yes,” both responded in unison as we shook hands in recognition and greeting.

Phew!  We’d made it through the first hurdle!

Bob held out a chair for me to seat myself at the small table he’d chosen and, after asking what I’d like, he sauntered to the counter and placed an order with the barista.  As always, though I try hard to camouflage it with a feigned illusion of confidence,  those first few moments of new acquaintance find me just a little nervous. 

Blind dates are not my favorite way to meet men and I can honestly say I’ve had some some near-disastrous first dates; but  those are topics for another time!  While waiting for Bob to return with our order I busied myself by hanging my purse on the back of my chair, gathering and folding my skirt around me and patting my hair that I’d just finishing arranging before I’d left my car three minutes earlier.  He returned in a few minutes with two paper cups of black coffee and a cookie for each of us.  The date had begun.

We spent the first few minutes with the usual introductory obligations, asking and answering simple questions and offering basic information that we each thought could pave communication pathways for conversation for the next hour, or so.  First dates are uncomfortable, blind first dates, more so.  However, in a relatively short time, this encounter seemed to be going quite smoothly.  

I was impressed when he shared that he was an appellate court judge for the United States Federal Court System and had been in that position for 20 years.  He was also a widower of over 25 years with four children, most of whose rearing had been his sole responsibility.  They were all grown and he indicated that he, too, was a grandparent.  Conversation between us flowed easily, we seemed to have several things in common, including a Catholic family of origin and parochial education.  He’d graduated from St. Ignatius High School and University of San Francisco, I from Notre Dame and Dominican University.

After about two hours of almost non-stop and fairly effortless chatting, we concluded our first date with a plan to get together the following weekend, activity to be determined by telephone during the week.  I remember I almost felt like skipping to my car for the drive home; I was feeling a little excited, so much more comfortable than when I’d arrived and was looking forward to our next encounter.  I didn’t hear from Bob for a couple of days, just pause enough to begin having those niggling doubts creeping into my consciousness - “Oh, no, he’s not going to call.”  Maybe I’d offered too much information.  Maybe he’d thought I was too old.  Maybe he was more attracted to blonds.  Maybe?  Maybe? 

“Ring, ring,” jingled my home phone on the following Wednesday evening about an hour after my long workday had ended.

“Hello,” I answered affecting a soft, not too anticipatory tone of voice.

“Hi, Mary-Pat, it’s Bob.”  Relief, he’d called!

We readily picked up just about where we’d left off at Starbucks several days earlier.  For our upcoming date Bob suggested that we go to the Marin County Farmer’s Market at the Civic Center the next Sunday morning, buy some picnic fare and head to one of Marin County’s numerous beaches for a casual picnic.  His suggestion sounded nice to me - a simple, but fun plan for our second date.

Sunday morning at the appointed time, Bob arrived at my home in San Rafael in a late-model sporty red sedan, attired in Bermuda shorts, an attractive sport shirt with a button-down collar and sandals.  This fellow was definitely making points with me in the grooming and looks department.  I, too, had put some effort into my wardrobe and grooming, hoping to make a favorable impression on this new gentleman friend.  Ushering me into the passenger seat of his spiffy car, the atmosphere was immediately affable, warm, friendly and comfortable.  

We drove to the Marin County Civic Center, parked conveniently and together strolled throughout the lovely farmer’s market, stopping to glance at various crafts and works of art, admiring, then buying some of the fresh, luscious-looking fruits and vegetables, a couple of fresh homemade cheeses, a loaf of freshly-baked sour dough bread, and topping off our planned picnic meal with some hand-held fruit tarts and bottles of sparkling water.  When Bob spotted a vendor selling hand-built and painted garden bird houses, he took a liking to one and bought it - for me.  What a thoughtful gift for a second date!

We left the market after a most agreeable hour or so and headed south on 101 to the Mill Valley turnoff that eventually led to one of Marin County’s many beaches, several of which are great for walking and picnicking even though the weather may not always be exactly toasty warm.  Our day was clear, not overly warm, but comfortable - no fog this morning.  We parked the car in the parking lot about a quarter of a mile’s walk from the shore, gathered our food and libation parcels, packed them into the cooler Bob had thoughtfully stored in the trunk of the car and headed out to a lovely, minimally populated, rocky beach.  Bob laid out a coverlet he’d brought and we deposited the cooler.

Then we took off our shoes and began ambling along the shore, our feet either in or out of the chilly Pacific Ocean on the northern open-water side of the Golden Gate.

Conversation continued to flow easily from one subject to the next, seeming to become almost effortless.  I was feeling more and more at ease and I had an inkling he did, too.  We walked and talked, heading from one end of the beach to the other, and back again.  When we passed the occasional couple or group, we smiled, interrupted our colloquy long enough to mouth ‘hello’ to the passersby, then returned to the subject at hand.

As we were leisurely walking and talking, I noticed two men casually strolling our way; as I’d done several times already, I smiled in their direction and uttered a friendly ‘hello,’ then resumed whatever line of conversation I was involved in.  The couple passed on my right side and continued on their route. 

Suddenly Bob stopped walking and whispered worriedly, 

“Oh, my.  Mary-Pat, I am so sorry!”

I looked at him with, I’m sure, a blank and then inquisitive  expression on my face, 

“What?  Excuse me? . . . You’re sorry. . . Why?”  I didn’t have the slightest notion what he was sorry about.

“I did not know this was a nude beach!” he quickly replied and repeated again, “I am so sorry.”

“What? . . . What did you say, a nude beach?” I asked, totally confused.

Then, suddenly it dawned on me as a picture materialized in my brain. I looked at Bob, then turned around to see the same two men who’d just walked by us, to whom we’d both said ‘hello,’ strolling hand-in-hand, animatedly conversing with one another, totally stark naked!

Bob, of course, thought I’d surely noticed those nude bodies exhibited for all the world to see and was being polite in not mentioning anything to him. For several moments he continually apologized profusely for unknowingly taking me to this nude beach.  

I knew I had to interrupt his zealous contrition, 

“Bob, please, don’t feel badly.  I didn’t even notice!”

You see, I’d been a surgical nurse for so many years and had seen all manner of naked bodies of all shapes, sizes, physical condition, or lack there of.  I remembered that the two friendly men had smiled and greeted us pleasantly.  It just did not register that this was not a likely place to be confronted with what I saw everyday at work!

Sunday, July 22, 2018

More Photos of Everett Dean Heimann

Here are a few more photos of Everett Dean Heimann

 Mom and Everett - one week old - professional photography

 All decked out for his first 4th of July

Holding his head up at seven weeks old!

 At 2 months old it appears that he's ready to join the swim team.  He loves his bath!

 Oh, it's so nice to be cooled off and clean, Mom.

Stay Tuned for More!!!

It's About Time, Don't You Think?!

Hello Everybody!

It’s about time I return to my blog and begin again, don’t you think?  Lots has happened in my life in the last few years, and in yours too!

As you may, or may not, remember, I’m a single, retired Registered Nurse with eight grandchildren and a considerable amount of wanderlust.  

This year I became, for the first time, a great-grandmother when Everett Dean Heimann was born on May 21st, weighing in at 10 pounds, 10 ounces and measuring 22 inches long.  His proud parents are my oldest granddaughter, Quinn Kathleen, and her husband, Jordan Heimann.

Quinn Kathleen, Mimi and Jordan - March 2018

Everett Dean Heimann - May 21, 2018
10 pounds, 10 ounces and 22 inches long

Mom and Everett - one day old