The Time Machine

I used to facilitate a lots of groups back when I was a psych nurse. Just in cases you didn’t know this, there are two types of psych nurses: those that love to lead groups, and those that don’t. There’s no middle ground.

That’s the truth. You can ask around if you like.

I loved doing groups. Probably not a big surprise there. I did groups on mental illness, medications, Cognitive Behavioral Therapy, cardiac health, whatever. I did groups on stuff no one had ever heard of before, like, the Ghost Dance of the 1890’s.

Maggie, did not like groups. She hated them. I worked with Maggie at the MVAMC. She wasn’t one of the best nurses I ever worked with. In fact, she was probably one of the worst.

Maggie would come to work early and check out her patient assignment, and then she started charting. Before her shift started, and before she even assessed any of her patients. She wrote the same two sentences on all of her patients:

Met with pt. Says he’s okay.  XOXO, Maggie.

Something like unto that. Everyone knew she did that, even her patients knew she did it. She spent most of her shift sitting behind the nursing station drinking coffee and taking cigarette breaks. Marj, my horrible boss, knew Maggie’s charting routine. And this is what she did about it.

Nothing.

Marj was an horrible boss in more ways than one.

* * * *

Want to hear a funny Maggie story? She had come in early and had done all of her charting before her shift started, as usual, and one of her patients had a seizure around the end of our shift. We called a code and ran down to his room to take care of him. And Maggie said this, “Goddammit! I just finished charting on this guy! I’m not writing another note on him!”

And everyone in the room stopped what they were doing, and turned to look at her. Even the guy having a seizure…

Another Maggie story. One of her patients had a condom cath, and she was supposed to remove it. A condom cath is pretty much what it sounds like. It’s an urinary catheter in the form of a condom. You unroll it you apply it, and it sticks to a penis like glue if it’s applied correctly. There’s actually an adhesive on the inside of a condom cath.

I probably put that catheter on that guy, so it was properly applied. Maggie had never removed one, so she asked me to come along. She told the guy what she was going to do, grabbed the tip of the catheter, braced one foot on the frame of his bed and started pulling, like she was trying to land a blue marlin or something.

I just about died to death. And you should’ve seen the look in that guy’s eyes. I made Maggie stop, and took it off myself. That guy thanked me every time he saw me.

And, one last Maggie story. Patient assignments were done by the charge nurse. I decided to have a little fun with Maggie one day, and assigned her to lead groups. Maggie just about had a fucking seizure.

“Are you kidding me!” she confronted me when I walked onto the unit that day. “I’m going to walk in there and look like an idiot for the first time!”

“Oh, it won’t be the first time.” was my response.

* * * *

One of our patients at the MVAMC was a guy we called Forrest Gump’s Smarter Brother. He kind of looked like Forrest, and although he was smarter than Forrest, it wasn’t by much. I can’t remember his real name, but he wanted us to let him use our time machine so he could go back in time to undo some horrendous mistake he had made years earlier.

I can’t remember what he’d done, but wasn’t something of all that much consequence, as least as far as the staff was concerned. I think most of the people involved in the care of FG’sSB all thought the same thing: Hell, I’ve done worse stuff than that! That wouldn’t even be in my Top Ten!

It probably wouldn’t have been in my Top Twenty-five. Or Top Fifty.

The Time Machine is the classic novel written by H.G. Wells in 1895. It’s been adopted into several movies and TV shows. My personal favorite is Time After Time, 1979, starring Malcolm McDowell and Mary Steenburgen. It’s a romantic thriller where H.G. Wells travels to the future chasing Jack the Ripper.

I thought it was a great movie.

At any rate, a lots of staff members at the MVAMC talked to FG’sSB, and they all told him the same thing. We don’t have a time machine, but he refused to believe it. He was probably a little delusional, that guy.

Psychosis and delusions generally go hand in hand, like anxiety and depression. But I don’t remember him being that psychotic. He just wanted to use our time machine, and he was convinced we had one, probably somewhere in the basement. Where else would you store a time machine?

Delusions are incredibly difficult to treat. A delusion is a fixed false belief, and once a delusion is born, it never really dies. You know, like that one guy who wants to be a prophet someday.

According to some psychologists, all religious beliefs are delusions. And, the popular response to that would probably be something like unto, Um, not mine. Those other guys, maybe. But my God, is real!

I wasn’t FG’sSB’s nurse, but I had heard about him in report. One day, one of the docs had just spent about half an hour trying to convince FG’sSB we didn’t have a time machine, and I started laughing.

The doctor was one of our residents, and he walked over to me. He said something like unto he didn’t think this was funny, and added if I thought I could do a better job, I was more than welcome to take my best shot.

So, I did.

“Yo, FG’sSB. Let’s talk. You’re right. We do have a time machine.”

“What!?!” the resident doc shouted.

“I knew it!!!” FG’sSB exclaimed.

“But let me explain how time travel works. Have you ever heard of the Law of Equilibrium and Balance?”

“N-No…”

“It’s the primary principal of time travel. In essence, you can’t go back in time to undo a mistake. The only thing you can do is replace the mistake you made with a different mistake. Do you understand what I’m saying?”

“Yeah, I think so…”

“That’s why the Federal government won’t let anyone use the time machine anymore. They tried it a couple of times. The Feds have made a lots of mistakes over the years, right?” I said, and FG’sSB nodded his head in agreement.

“Look. I’m not supposed to tell anyone about this, but I used to be a data analyst for the CIA, and I had access to all kinds of super top secret files. The Feds have a base somewhere in Greenland, and that’s where they did their tests with the time machine. The first time they tried to change something in the past, the Nazis ended up winning World War II.”

“No way!”

“Way! The Nazis ended up developing the atomic bomb before we did, and they nuked America off the face of the planet.”

“Wow!”

“So the Feds learned something from their experiments. You can’t actually fix anything by going back in time. You can only make things worse. They ended up having to go back and repeating their first mistake again to fix the shit they tried to fix! There has to be balance, get it?”

“Oh. I didn’t know that. So, if I went back in time…”

“You’ll only make everything worse. Do you still want to use our time machine?”

“Um, probably not. I don’t want to make things worse…”

Home run.

The best part of that, the resident doc came up to me and said this: “That, was the most incredible thing I’ve ever seen.”

* * * *

I have no idea if there’s an actual Law of Equilibrium and Balance. And while time travel is theoretically possible, I’m not sure it’s actually possible. But it sounded convincing enough to FG’sSB that he abandoned his quest to travel back in time, and he was discharged shortly afterwards.

And I probably wouldn’t have tried that intervention on everyone, but I knew it would work with FG’sSB. You can’t talk someone out of a delusional belief, but maybe you can use their delusion against them, so to speak.

There was a guy named Steve that was a frequent flyer at the MVAMC, and every time he came in he accused the nursing staff of trying to kill him, and there would be an investigation. So I said this to him, “How many times have you been here? The nurses here are highly trained professionals. If we really wanted to kill you, you would’ve been dead years ago.”

He never accused another nurse of trying to kill him to death.

* * * *

I’ve met more than one person that wished they could go back in time and undo some of the things they had done. I’m sure I’ve wished I could do that myself.

One of my desperately seeking time travel patients was Kathleen. She was at Aurora, and the first time I met her she was laying in bed, crying. I checked on her several times, and that’s what she did all morning.

At noon, I went into her room and said, “Hey, Kathleen. If you want something new to cry about, your lunch is here.” She got up to eat, and eventually stopped crying. And then we talked. Kathleen didn’t want to go back in time to change one thing in her life. She wanted to change all of it.

“Let’s say you could do that. Do you really think you wouldn’t make any mistakes if you could live your life over? As near as I can tell, everyone makes mistakes. I know I have. But those are the things that taught me my most important lessons. I might have had to repeat some of those lessons a few hundred times before the lights came on, but I wouldn’t be who and what I am now if not for those lessons learned.”

And then I told her about FG’sSB. And I told her some of the stories about my crazy life.

“And he believed your story about the time machine?”

“I’m evidently quite a convincing liar.”

“You must be. I can’t tell if you’re telling the truth or not.”

See? I told you.

“And you look pretty well put together now.”

“Years of putting together the pieces of my life. And now it’s your turn. Time to get your head out of your ass and get moving. Go take a shower. You’ll feel better.”

* * * *

My lovely supermodel wife and I went for a walk down the Malacon in Ajijic yesterday. We’re planning to go for a walk down the Malacon in Chapala tomorrow. It’s supposed to prettier than the one in Ajijic, and the Malacon in Jocotopec is supposed to be the prettiest of them all.

I’ll bring my camera, and take a lots of pictures. I’ll post them on my Facebook page. This place is incredibly beautiful.

That should help me achieve better balance and equilibrium in my new life. I had no idea transitioning into retirement would be such a tricksy thing. If I had known that, I would’ve planned a little better, maybe. I might not have believed it.

There’s a couple of football games today to determine which teams will meet in the Super Bowl. I think Jim and Veronica are hosting a Super Bowl party. I’m going to make chili. It’s the only thing I cook anymore, but it’s the best damn chili you’ll ever have.

It takes a couple days to make the World’s Best Chili. If you want the recipe, let me know…

Let’s see if I’m any closer to being a prophet. Falcons over the Packers. Patriots beat the Steelers.

If I’m right about that, I’ll make a Super Bowl prediction.

Diagram of a Defense System

Back when I was a psych nurse at the MVAMC, I worked with a lots of Vietnam vets. They were struggling to find their way through the morass of PTSD symptoms they were suffering from, mostly unsuccessfully.

PTSD is a complicated disease. It’s symptoms are legion, and stealthy. They’re like unto an army of ninjas, and just like ninjas, they attack without warning.

In an attempt to help my brother veterans gain some insight into what they were fighting, I came up with this presentation to help them see what they were up against.

Imagine your life as a game of chess. I actually used chess pieces in the group. I arranged them on a table and moved them around as I explained my idea.

Your opponent attacks. You go on the defensive to protect your position, and the pieces you employ are defense mechanisms. These are tools we use every day of our lives. There’s nothing inherently wrong with this. Defense mechanisms help us survive. But, do you have any idea what kind of weapons you’re using. Or why?

What I’m talking about is something I call a defense system. Anytime you have more than one component, you have a system. Think of it like unto an home theater stereo system. Multiple components working together to produce an integrated effect.

That’s what your defense system does. By utilizing a series of connected mechanisms, you create a buffer zone to keep you safe from the world around you. There are hundreds, maybe thousands of defense mechanisms, but let’s start with the basics. There are three fundamental building blocks that every defense system is built upon.

Repression. Suppression. And Denial. After that, the sky is pretty much the limit, but let’s start here.

Repression. If you’re confronted with a traumatic memory, your brain will automatically repress it. This reaction is hardwired into your brain. You don’t even have to think about it, it just happens.

Suppression. When repression doesn’t work, this kicks in. This takes some conscious effort, but these two mechanisms work together, and they’re pretty damn effective. But life can be complicated, and sometimes you need a lots of tools to get a job done, right?

Denial. When repression and suppression don’t work, you have to start bringing in the big guns. With denial, you can make stuff disappear. Denial is a total negation.

It did not happen.

Defense mechanisms are powerful weapons. And they are mobile! They can be deployed wherever they’re needed, and there are ga-zillion of them. You can lock and load and secure the perimeter, and blow shit up with a thousand different kinds of armament.

Minimization. Take a big problem, and make it small.

Maximization. Take a small problem, and make it big.

Rationalization. Logically analyze anything to pieces until it dies of boredom.

Intellectualization. Logically analyze something to pieces until it commits suicide to get away from you.

Shuffle the deck and play them when and where you need them. You can do this shit all day! And there’s a lots more where those came from. Deflection. Projection. Sublimation. Humor. Drug and alcohol use. Do a Google search. There’s a list of defense mechanisms a mile long.

But any effective system needs a fuel supply to keep it up and functioning. And we have that, too.

Anger!

Anger is almost always a secondary response. The precursor might be fear, or shame, or guilt–and it might only be present for the blink of an eye. None of us like feeling that way, but anger. Yeah, were good with that.

Anger, is a powerful fuel. And I’ve seen you guys. Anger is where all y’all have been living. Anger can also be a defense mechanism. No one wants to be around an angry person. Anger is like an electric fence. Only an idiot pisses on that, right?  Anger is like one of those multi-tools. It can do a lots of stuffs.

There’s one major downside to anger. It’s exhausting! I can stay angry for a couple weeks about something my wife or daughters do, and then I have to let it go. It wears me out. You guys have been pissed off for what–twenty or thirty years? How’s that going?

And what happens when you run out of fuel? Everything shuts down! The walls come crashing down, and then what?

Your defense is breached. You have to fall back. You bunker up. You run!

Yeah, you do all those things, but then you have to find a way to get your system back up and running, and that’s not easy to do when the enemy is looking over your shoulder watching you. That’s what brings you guys here. This is the place you come to when your defense system crashes, and you can’t do it on your own any more.

I mentioned drug and alcohol use earlier, but it’s such a pervasive problem I want to take a moment and talk about it. Eighty percent of the people that come here for treatment have a secondary diagnosis of drug or alcohol abuse.

Only eighty?

Well, it could be higher, but that’s the statistic the administration here likes to throw around. I know I’ve tried these methods myself, and while they might be effective in the short term, they are completely ineffective in the long term.

Alcohol is a depressant. If you’re not already depressed, you’ll end up that way if you abuse alcohol long enough. Also, mass consumption of alcohol tends to short circuit the wiring of your defense system.

Yeah. That’d be true for me. That’s why I quit drinking.

I had not quit drinking, so it’s more than a little ironic that I was telling someone else to take a look at their drinking habits when that’s what I needed to do myself.

Well, there you have it. I’m not telling you guys to quit drinking. I’m just throwing this out there to give you something to think about. But even if alcohol isn’t an issue, look at all this other stuff. We all have these invisible walls that protect us from stuff we don’t want bombarding us. But it probably works in reverse, too. We’re expending all this energy to keep stuff from getting to us. How easy is it to let our emotions out?

Is it easy for us to let someone know we love them? These walls we have constructed are well built, and they are strong! But in the end, we have essentially created a state of siege mentality–nothing gets in, nothing gets out, and we have stopped living, in exchange for simply…existing. And I know what you’re all thinking, What the fuck am I supposed to do?

I don’t have any answers for your questions. I don’t have any solutions to your problems. Hell, I don’t have any answers or solutions for mine. But we have to start somewhere if we’re ever going to get our lives back.

Awareness is the first step. Once you’re aware of a problem, you can start to do something about it. What you do, well, that’s up to you. You’re gonna have to figure this out for yourself.

I been watching you, Mark. I see you up at the nursing station. Sometimes you just sit there, and stare. You have PTSD, don’t you. You’re one of us, ain’t you.

That was a guy named George. He diagnosed me in that group. I have to admit, I was a little freaked out to hear that. But I couldn’t argue with what he said.

The Nam vets called it the Thousand Yard Stare. Someone could be standing right in front of you, and you’d never see them. You were seeing shit in your head ten thousand miles away.

But however freaked out I might have been, it was nothing compared to what the guys in my group were feeling. They came up and analyzed the chess pieces as if they were going back into combat.

When that guy tried flanking you here–it opened a breach when you redeployed there. Your back is to the river…  You have no drop back position, no place to regroup. You’re about to be overrun.

We all are!

The guys in my group practically ran out of the room.

* * * *

About ten years later, I presented this to concept to my AA group, Squad 46, the bestest squad in all the land. And when I finished, I was met with

Silence.

My group members finally came out from the tables they had been hiding under, and discussed my presentation. I’ve discussed bits and pieces of it with a lots of people over the years, but I’ve only presented it in its entirety twice. This makes three.

Sometimes I think it’s the most significant idea I’ve ever imagined, mostly based on the reactions of the people I presented it to, not because it’s actually been proven to be an effective therapy or educational tool.

Oh, and I do make the World’s Best Chili.

Most of the time I don’t think about my concept of an organized defense system at all. But I did this morning. Maybe someone will find it useful. And that’d be cool.

Fear, Phobias, Hypochondria and More

If you’ve never experienced any of these sensations, become a nurse. That’ll do it. Let’s start with fear. The only student nurses that don’t feel fear are serial killers, or potential serial killers.

Let’s face it, if you want to kill people, you’re given ample opportunity to do so as a nurse. And as a non-serial killing student nurse, your deepest fear is that you will accidentally kill one of your patients. Or in a worst case scenario, all of them.

And it is real.

Honestly, it’s almost impossible to kill your patient as a nursing student. Any medication you give is verified by yourself and your clinical instructor, probably twice. And then you verify it again, like, a thousand times before you actually give it. After you do this a few times and you don’t kill anyone, you relax and move on to your next fear. There will always be another. However, if fear continues or persists after your first year of employment, you are in the wrong profession.

Some of the things nurses do are incredibly unglamorous, and even gross. All nurses will tell you there’s that one thing they have to do that makes their skin crawl. We develop phobias.

For some, it’s suctioning a trach patient. Wound care on decubitus ulcers. Cleaning dentures. Removing or placing contact lenses in your patient’s eyes. C-diff. Vomit. Borderline Personality Disorder. Seriously, it can be anything, but whatever it is for you, you would almost rather die than have to deal with it.

For me, it was clocking in at the beginning of my shift.

You are exposed to all sorts of illnesses and diseases as a nursing student that you had no idea even existed before you decided to do something this foolish. But the moment you walk into the room to care for your first patient, you’re pretty sure you just came down with whatever it is they’ve got.

Nowadays you can Google stuff, or go to WebMD. In my day, it meant a lot of painstaking research, and flipping through piles of textbooks to verify all the symptoms you just came down with, or are about to come down with, now that you know what to be looking for. Like you had time for such frivolous ventures such as that. Or having a social life. Or anything that resembled a life.

Even things that aren’t contagious, like diabetes, are suddenly and inexplicably at work inside you, destroying your body. And the next thing you know, you’re calling all your friends at 2:00 AM, asking if any of them have a glucometer.

I can’t explain how this phenomena happens, I can only tell you that it does. When I was going through my OB/GYN rotation, I was pretty sure I was pregnant. Man, I wonder how Sister Mary Hitler would’ve reacted to that! And you have never seen a happier guy than I was when I got my period the following week.

More Stuff: Bedbugs. All my nurse friends just stopped reading and went to take a shower. Lice. And, they just went to take another. That’s all it takes! The Joint Commission. That’ll pucker a lots of buttholes for months.

Well, that’s about it from here. FYI, for those of you that have become avid readers of this series, I’d like to extend my sincere gratitude to each of you. I’d even give you a hug, as long as you don’t have diabetes or anything like that. It means more to me than I can say. Thank you from the depths of my heart. In addition, I’m starting a two day trek deep into the wilds of Mexico, and I have no idea if I’ll have Wifi access anywhere on the road. Now that I think about it, I don’t know when that stuff will be set up in my house.

Fear not, and be of good faith. I have a lots of stories to tell, and I have every intention of telling them all.