How do I communicate "moron"?

I recently dicussed communication styles with friends over Postino's bruchetta and wine. The managers in the group have taken classes on identifying how different employees communicate. Apparently this ensures that everything runs smoothly by providing every employee with an effective voice. BUT, my question was, "How do I communicate moron"? I understand that some people are assertive while others are passive. Some people like to analyze data and some like to create. But what about the rest of the population (I'd say about 98% of adults) who do not have the brain capacity to even entertain such high level communicaton skills? It is possible that I have a skewed sample, thus believe that most people are idiots. It scares me. IS America becoming dumber? Less able to interact in the real-life, non-virtual world? I am impressed at the number of blank stares I get in the course of one day. At times I feel self-conscious and doubtful of my abilities to effectively communicate. How can so many people have difficulty understanding simple instructions and/or explanations. Why do I walk around with the same song in my head everyday? "Only stupid people are breeding..." Is the stupidy a result of poor education, language barriers, apathy or legitimately low IQs? Whatever the cause, I need to develop a better coping mechanism to deal with the morons of the world. It is stupid that stupid people have enough power to make me so angry in my day to day life.

Entitlement and the Decline of America

Entitlement is to blame for the rapid decline of the Great US of A. Entitled people expect and demand privileges. The have a delusional belief that they are superior to others. They enjoy manipulation and controlling people and situations. We are a nation where narcissism extends far beyond the DSM and into the core of our infrastructure. What happened to reciprocity? The Golden Rule? If you come to my aid I will repay you in some way or at a minimum I will thank you over and over. With entitlement there is demise of reciprocity. There is no sense of repayment, rather entitled people simply expect others to meet their needs. In health care, it is evident that entitlement and narcissism control the system.

"I am very busy. I am in the emergency department because I am very sick. I demand to be treated immediately. And I expect the Cadillac of all work-ups. Yes, I want a stat MRI of my back. Yes, my pain has been present for 2 years, that's why I must have a stat MRI. You won't order an MRI? I need to speak to the hospital manager. The hospital president. I will call my lawyer. I will absolutely not wait overnight for the MRI. I am leaving. You will be sorry."

This is not a far-fetched situation. It happens every day. In health care alone, Americans are demanding more and more. The health care industry enables this behavior. Heaven forbid a patient leave unhappy. Enter in the customer service push in emergency medicine. You wonder why the use of percocet and other opioid pain killers has increased exponentially over the past 10 years. Everyone wants them and providers dare not say no, because management will be notified that the patient is not adequately being treated. It's a losing battle. We have developed a system that cannot sustain itself, which is obvious.

There are so many social realms in which entitlement has taken the throne. It is all the same. Without reciprocity our society will crumble. We will lose.

Anarchy

I loathe the word "commentary". The definition can be either positive or negative, but I almost always associate this word with the negative. Criticism or Critique. My patients typically do not enjoy the "running commentary" on their thoughts provided by exasperating auditory hallucinations. I do not appreciate commentary regarding my commentary.

I also do not take well to being told, "You shouldn't..." First, and most obvious is the fact that I do not like being told what to or not to do. Ask my parents! They will confirm this. I don't view this as a completely faulty personality trait. I think it has actually gotten me to where I am now, both personally and professionally. I also just find it condescending. It's not really worth your breathe to tell me that I shouldn't do something because I can probably rattle on forever about everything I do that I shouldn't.

I shouldn't:
1. Cuss: I do. A lot. I try to censor when necessary.
2. Sleep In: I hate mornings. I hate my alarm clock. I am not naturally set to rise early. I like the night.
3. Hate Myself: I don't actually hate myself, but I certainly find it hard to love myself. I am "should" love my body, but I don't. I am embarrassed by the shape it has taken.
4. Eat Processed Sugar: I try not to, but I do. I can justify it by mixing sugary goods like peanut butter cups with frozen yogurt. The yogurt is "healthy".
5. Judge: I silently judge everyone. It's not always bad.
6. Lie: Sometimes I do. I'm not a good "big" liar, but a little white lie here and there doesn't seem problematic to me.
7. Break Rules: I LOVE to break rules! I believe in the philosophy that one should not ask for permission, rather ask for forgiveness. Rule breakers make history and create revolutions.
8. Be Late: No matter how hard I try to be on time I am usually a few minutes late. Unless my life or some other life depends on my timeliness I will likely be a bit late.
9. Hold Grudges: I have a hard time forgetting. I might bring up prior lapses in judgment, stupidity, or thoughtlessness from years ago, if we fight again.
10. Put "Real" Trash in the Recycle Bin: I'm sorry! Sometimes, I don't want to exert the energy to mentally sort out what can and cannot go in the blue bin.

I could go on, but I should stop.

Paisley

She is breathing noisily on my arm. I can feel her breathe; hot and wet. It is faster than it has been in the prior 7 years. It keeps me awake. Worried. On edge. But when it slows and becomes more quiet I am also awake. I have joked in the past that I must have some form of autism, because I really do like my dogs better than most people! I'm pretty sure I have always been a bit extreme on dog spoiling...she has a car seat! But, I always assumed that Paisley Star would live her full life span of 18+ years. I have gained acceptance of the fact that I will never have a rug in my home until I am approximately 40 something years old. That is just one of many sacrifices I have made out of love for my dog. Now, I am just hoping for one day more and then another and another etc. I come home each day with a slight pang in my chest for fear that she won't be alive. She has this way of looking at me that makes me believe that I am the most important person in the world. She depends on me entirely and in return she gives me all the love that her 11 pound body can give. I have to credit her with getting me through some of the toughest times in my life. She listens without passing judgment. She never gives advise when advise is not needed (well, actually she never does). She never interrupts and never interjects her opinions. She just cuddles and gives a few licks here and there. I can't stand the thought of losing her to a terrible disease. I have done everything to give her the absolute best chance at survival and nothing seems to be working. I'm not giving up hope!! But, I'm also not naive to the facts. If love itself can cure, Paisley should be making a full recovery soon. I love love love this dog. (some of you may think I am crazy, but that is OK)

jej-men-t-l

Judgmental: [jej-men-t-l] adjective: characterized by a tendency to judge harshly. My name is Dawn, and I am sometimes judgmental. I am powerless over this trait and have come to realize that there is a higher power who can restore my compassion. I will turn my life over to that power, admit that I am wrong and make amends etc etc. I am kidding...kind-of. I do judge people, I believe it is natural. There are so many times that I consciously tell myself, "Dawn, do not judge this person". At least not until I have gathered adequate evidence to support my judgment. :) There is a purpose to my rambling.

For all who read this blog...anyone other than my mom? I have an exercise to share. Imagine you are 25 years old (I know it's been a while mother) You grew up in a dysfunctional family, like many people do. Your dad was gone or drunk and your mom stayed in bed much of the time. Somehow you made it through high school and went to college. You moved across the country to do better for yourself and got a job. Not a great job, but a steady Ok paying job. You lose contact with your family back home. Your mom calls but she burdens you with her problems. You begin to notice a decrease in your energy and you realize that you have called in to work over 5 times last year. You get a written warning about your attendance. Your friends aren't calling much and it occurs to you that you have been pretty flaky about spending time with them. It must have been at least a month since you last attended a happy hour...no wait! It's been 3 months and 2 weeks since you last went to happy hour. You remember the exact night, because you left early, you were tired and frankly you just wanted to be home. Alone. Time passes, your apartment is disorganized with a curious odor. You've lost weight. Your reflection is not you, rather it is a diminutive version of you clothed in crumpled pieces of fabric with a despondent expression worn across your sallow face. You don't go to work that day. Or the next or the next. You actually do nothing. Until, with one final iota of hope you call your old friend for help. She doesn't answer. You compile a collection of every pill you can find in your now dilapidated apartment, grab a bottle of wine, and swallow swallow swallow.

You momentarily gain awareness and hear the laughing, mocking voices of who you believe to be the ambulance crew. You are restrained. It doesn't matter. You have no desire to move. You drift away again...until you are being stripped naked by at least 4 or 5 different people. They are kind of rough and laughing. In the distance you hear somebody say in a disgusted voice "We have another psych in 216." Somebody else "Too bad they didn't succeed" "Should've done a better job" "Probably another druggie" Your tears begin to cascade down your pale, slightly emaciated face. Then you realize everyone can see you. You realize that you are being displayed in the middle of a busy nursing zone hallway, wearing only a gown and with your new security buddy at your side. Then you hear..."I'm with psychiatry, why are you in the ER?"

Judgment. My patients are always being judged. They are seen as less than deserving of care in the health care arena. The are relegated to hallways and denied their dignity. It must be their faults for getting so "messed up". "If only they wanted to get better". I fight constantly for just a morsel of respect from staff. And I am met with resistance as if my patients have no right receiving health care. I am challenged by people who think it is perfectly acceptable for me to ask a person extremely personal questions in the hallway, because "psych patients aren't really sick and rooms are only for sick people". They are frequently disregarded as "just psych". They are ignored for hours. I recently found a patient who had been in the ER for over 15 hours waiting for me to clear him/her. I walked in and saw a critically ill person, frothing at the mouth. Hello! Somebody pay attention to this! This "psych" patient went to ICU.

They are judged every day of their lives. Judged by people who have no idea what their life story is. Judged by people who might also be just shy of an all-consuming mental illness that will wreak havoc in their lives. So, yes I judge too, but I make a concerted effort every day to hold my judgment, at least until I can gather the facts. Even then, I remind myself that a mentally healthy person does not self harm for attention. Not all drug addicts come from bad families. Not all felons are dangerous. Mostly, I try to remember that most people deserve respectful care when in the hospital. I said most, not all, because there are some people that really are just bad people and have provided me with enough evidence to justify judgment!

Lastly, to anyone out there who is quick to judge the mentally ill, remember the average age of onset for severe mental illness (bipolar disorder, schizophrenia, major depressive disorder etc.) is up to age 35. And major depressive disorder spikes again later in life. You never know when it might be you lying in that hallway.

Okayyyy????

I was in the grocery store today and was hit in the calf by a cart. A young sounding voice said, "I'm sorry hun". I turned around and saw a very young, probably teen, mom standing there with her young son. In my head I thought, "Why is this really young girl calling me hun?" It did not seem appropriate since I was clearly her elder. Then, I thought about how patients must feel to constantly be called hun, sweetie, sweetheart, hunny, etc. by nurses who are often much younger. Okayyyy hun? Do you see what I am saying? Nurses are taught NOT to be paternalistic. They are taught to value their patients' autonomy, but it is not long after graduation where "I need you to take your medication sweetheart, Okayyyyy?" is ingrained in their daily dialogue. If I am ever a patient and my 22 year-old nurse calls me hun, I will likely bite her, and pretend I am delirious!

Changes

My little brother is gone. Ok, that sounds very dramatic. He's actually in Baltimore, where he has relocated for a job. I didn't think I would miss him...that much. And, I don't even miss him yet; He's only been gone a day. But, I am sad, more than I thought I would be. It seems like the first step in the scattering of my family, that I always knew would occur. Except, I always thought I would be the one to leave. Instead, it is my baby brother and his wife, who I adore. And, it seems so far...the other side of the country. 4 1/2 hours by plane plus the 2 or 3 hour time difference (depending on the time of year). Not the easiest weekend jaunt. It's actually the same distance in hours as it is to my parents' place in Alpine, and I know how hard it is to do a weekend trip up there even with no time change. I think more than anything, I realize that I have taken the close vicinity of my family for granted. My siblings and I have lived within 5 miles of each other for years, and I rarely saw them outside of holiday functions. And now it is too late and that makes me sad. Dan and Gio are also trying to get out of Phoenix, as far as I know anyway. They have been tossing around the idea of leaving the country. What happened to the days when families stayed near each other? Even with minimal face to face visits it is nice to know my entire family is a short drive away. I'm grieving the loss of that...it hurts more than I imagined.