NanoWriMo – 2nd instalment

Here is the second instalment of my story – enjoy!

Sarah sat in the waiting room outside the hospital’s employee counsellor’s office.  It was hospital policy for anyone who missed a certain amount of work due to illness or personal circumstances to see the counsellor.  Everyone knew it was often just a front, the truth of the matter was the counsellor was not really a counsellor at all; she was there to give warnings to employees who’s performance had been below par and in some cases to assess whether her ‘client’ was really able to continue to be a valuable part of the ‘Northside Health’ family.  Those who were assessed as being such would often be gotten rid of with the least amount of fuss possible under the guise of being assessed as being unfit for work on non-medical grounds (ie incompetent, dangerous or unreliable).  This practice allowed them to avoid that inconvenient return to work policy that enabled employees to gradually return to work or work more manageable hours in their period of recuperation. For an industry focussed on helping people the health care industry was notoriously unsympathetic towards its own workers when they became ill for whatever reason and Northside was no exception.

Occasionally, when the employee was too valuable to let go or too hard to replace the counsellor would arrange a return to work program for them – Sarah was hoping that her training in the area of nursing she was currently working in meant that she would fall into that category but her long record of sick leave and only being capable of part-time work made her nervous.  She hoped the appointment would just be a slap on the wrist; there was no way she could look for a new job right now.  She was sick more days than well, some days she could hardly get out of bed or would only move as far as the couch.

The ringing of the receptionist’s telephone shook Sarah out of her reverie
‘Miss Jones will see you now’ the young woman looked gave Sarah a sympathetic smile over the desk.  Sarah’s stomach dropped like a stone.

Miss Jones, the counsellor, was a horror of a woman with a minor in psychology, a six-figure salary and friends in high places.  As she opened the door Sarah was struck by a tidal wave of perfume – sickly sweet and cloying.  Then she saw the woman herself.  Miss Jones’ obviously bleached blonde locks curled stiffly around her shoulders – they looked so stripped and treated, so full of product that Sarah wondered if they would crackle like straw if you touched them.  The hair framed a face that could have been almost pretty if it hadn’t been covered in so much makeup; foundation so thick you could see it, eyebrows tweezed to within an inch of their lives and pencilled in, overly-bronzed cheekbones, thick, black eyeliner and bright, bright red lipstick.  Maybe the makeup was a last-ditch effort to preserve or give the illusion of youth, whatever the goal it was impossible to tell her age through the paint.  Her nails were fake, red talons – long and rounded, their colour matched her lipstick.  In a workplace where the majority of employees were required to wear a uniform Miss Jones had clearly wanted to stand out as much as possible and her clothes certainly did that from what Sarah could see over the desk.  She was wearing a scarlet shirt with tight sleeves that went to the elbow and a wide, low neck exposing skin that said she was either older than she appeared or spent a considerable amount of time sunbathing in her youth.  The top was set off by copious amounts of sparkly, gold-hued jewellery, black stockings and high leopard print pumps – her skirt was hidden by the desk which she did not get up from as Sarah entered the room.

‘Miss Henderson, please sit’ she indicated a small chair on the opposite side of the desk.  Sarah felt like she had been sent to the principal’s office at school and couldn’t help feeling guilty for some unknown offence she was to be reprimanded for.
‘Sarah, please’ Sarah replied ‘It’s nice to meet you miss Jones’ and extended her hand for the other woman to shake.  Miss Jones looked at her hand a moment and then took it and shook briefly before letting go hurriedly and dropping her hands to her lap.
‘Sarah, I’ve asked you here today so we could have a little chat.  You see, it has been brought to my attention that you may not be coping so well with the difficult hours associated with shift work and the demands of working on the oncology ward.  Is there anything that has changed recently that could be affecting your performance?’  Miss Jones asked, pen poised over a sheet of paper.
‘Well I have been unwell for a while but that is why I am now working part time instead of full-time as I was when I began working here.’ The pen scribbled quickly as Sarah spoke, it was a little distracting but she tried to ignore it and answer the question.  ‘It has been harder for me in recent months because I seem to keep catching things and every time I do it’s harder for me to get back on my feet again.  That is why I have put in a request to my ward manager to further reduce my rostered hours.’  Miss Jones paused and looked up, eyebrows slightly raised.
‘Right, ok then, and you’ve been with us how long now?’
‘Nearly two years’
‘Two years, really?  And how long have you been unwell for?’  It was a question Sarah always dreaded, it had been a long time and it was a long story.  A story that often provoked sympathetic or pitying looks and a change in people’s attitude, almost like she had to be treated more delicately because she might break at any moment.  And the look that Miss Jones had pinned her with was a common one too: a veneer of sympathy barely covering her slightly sneering and sceptical eyes.

‘Actually I have been unwell off and on for around seven years.  It started about half way through my first university degree and at the time I was diagnosed with Chronic Fatigue Syndrome.  Since then it has persisted but there were some symptoms and things that were inconsistent with the CFS diagnosis.  When I began my nursing degree I was improving steadily to the point where last year, the year after I completed my study, I was well enough to work full time.  This year, however, I seem to be catching everything that is going around and for the last six months I haven’t been able to get on top of it, that is why I dropped my hours back to part time.’  Sarah looked up and found Miss Jones watching her closely, her expression more intent than before and no less unsettling.
‘Well that’s a long time to be sick, what exactly is being done about that?’
‘I had some tests recently to determine if I had an immune deficiency but the results, although low, were not significant enough to qualify for the diagnosis.  I am seeing my GP soon and hopefully he will have some news for me, some new avenues to explore but at the moment I’ve had so many tests and seen so many specialists that they’re all running out of ideas’.
‘It must all be very difficult for you, how are you feeling about it?’
‘Well, to be honest it makes things a bit frustrating and all that but I believe I’m coping quite well under the circumstances.  I have a group of very supportive friends and family and of course Peter is great – he’s my partner’
‘Ah yes, of course.  And how do you feel about work? Do you feel like you are coping with it all?’  Sarah looked at her hands
‘Miss Jones, the reason why I want to cut my hours down a bit further is because I can not currently commit to the number of hours I am rostered on for.  At the moment my health is too unpredictable and I have found myself calling in to cancel a shift maybe once or twice a fortnight not only because sometimes I can’t get in to work but because my brain isn’t working so well and I wouldn’t want to make a mistake.  I would never come in to work if I thought I was not capable of giving my patients the care they need and deserve but then that can leave the ward needing to call in bank or agency staff.’  She sighed and looked back up at Miss Jones who was again scribbling on her sheet of paper.

After a few minutes that seemed an eternity, Miss Jones looked up.  She had a small smile on her face that filled Sarah with unease.
‘Well, I know if I were in your position I would be very annoyed with all of this, am I right?’
‘I am a little annoyed, it’s hard not to be really but probably more disappointed that annoyed’
‘So what you’re feeling then is a real sense of fed-uppedness with everything.  Fed up with life, fed up with work, fed up with being sick and fed up with everything, right?’
‘Um…’ Sarah started but Miss Jones just ploughed right on
‘Yes, of course you are.  Now Sarah what I suggest is this: go home, have a nice early night and a good rest, put your feet up, make sure you get enough sleep (you nurses, I know how you all like to burn the candle a both ends!), make sure that partner of yours cooks you a good, healthy meal because you’re probably lacking a bit in some essential vitamins and minerals – lets face it this canteen food isn’t amazing and we never get enough sun working indoors!  Get out there and get some exercise and sunshine and I guarantee you’ll start to feel better and less fed-up with everything.  You’re not the only one around here with a sense of fed-uppedness you know, even I get it from time to time but the important thing is how you cope with it, what you do.  Have a think about that and if you ever need a chat or anything my door is always open’.  Miss Jones smiled at her and then looked back down at the paper on which she had been so furiously scribbling moments before

Sarah left the room feeling stunned.  ‘A sense of ‘fed-uppedness?’ what, is that a medical term?  A term she learned in all of her semester of studying psychology?  The woman is a painted moron’  She grumbled to herself as she angrily strode down the hallway in the direction of her ward.  ‘Sleep?  Vitamins?  Exercise?  Did she listen to ANYTHING I just said?’

Nanowrimo/50k for awareness – first instalment

Today – November 1st 2011, is the first day of Nanowrimo which, you may recall from previous blogs, is short for ‘National November Writing Month.  The idea is this; you write a work of fiction of 50,000 words during the month of November.  I have decided to take on this challenge but under the concept of 50k for awareness – writing about dysautonomia for Nanowrimo.

In order to satisfy the requirements of both challenges at the same time I have decided to write a partly fictional piece largely based on my own experiences with dysautonomia (with the addition of a few fictional scenarios) altered slightly and explored through a fictional character named Sarah Henderson.  I hope to have enough words and time to add in the Camino along with all the other stuff so fingers crossed.  The idea is that the piece that is produced from this month of writing is not perfect which is why it is possible to produce it in a month – no going over and editing, no reading and re-reading parts and no writers block because it doesn’t matter how good (or bad) it is in the end, only the final word count matters!

In the spirit of writing from personal experience with dysautonomia the first excerpt of my story is about what it feels like (for me) to faint from postural hypotension (aka vasovagal syncope) and an interesting visit to the doctor.

She felt like a robot that was being powered down from the head first.  Dizziness and nausea swept over her accompanied by a hot prickly feeling as she felt the blood quickly draining from her head down to her lower limbs.  Her body began to feel heavy, so heavy it took all her strength of will to remain upright, and movement of any kind was out of the question.  Her arms and legs were too heavy to move anyway and she lacked the strength to even twitch a finger.  Her world started to shrink in on itself; blackness crowding her vision from the periphery until all that was left was a central tunnel of light.  She tried to speak but even that was beyond her.  Finally her knees gave way, she still had enough measure of control to ensure she did not harm herself as she fell to the ground and used all her strength to lie flat.  The blackness closed in as her body shut down and her sight disappeared completely.  The last thing to go was her hearing, she heard him call her name before sound was completely blanked out by the rushing noise in her ears and she finally fell into the darkness.

This whole episode took no more than a few seconds yet felt like a lifetime.  Her hearing returned first, his calm, reassuring voice murmuring words her brain could not yet understand.  Someone had elevated her feet onto a pillow.  She tried to speak but lacked the capacity for more than a wordless groan.  She felt like she had been wrapped in cotton wool.  Slowly her faculties returned in the reverse order from which they had left.  Hearing and comprehension first, followed by speech, and finally movement.  Slowly, so slowly that she felt like she was moving through quicksand she was able to move her arms and legs, to sit up with his assistance and drink the glass of water he offered.  Her arms were so weak she could hardly hold the glass but she managed through sheer determination.
‘I might just sit here for a minute’ she told him, ‘besides; I don’t really think standing is such a good idea right now.  Can’t believe I missed the couch, I never seem to fall where I want to!’
‘So what do you think it was?’ he asked concernedly ‘did you not have enough to drink today?  Not enough sleep?  Did you stand up too quickly?’
‘I dunno Peter, it could have been any or all of those things’ she sighed ‘I wish I had some answers but at the moment I have no idea, nobody seems to know why this keeps happening to me’
‘Well what did the doctor say last time you saw him?  I mean honestly Sarah, people don’t just faint and feel exhausted and dizzy all the time for no reason.’
‘I told you, I’m seeing the GP tomorrow, it’s a different guy cause Dr Caldwell was booked up but hopefully he can give me some ideas about what’s going on now and a medical certificate so I can reduce my hours at work.  Work are making me see the counsellor on Thursday for some reason, dunno what they think she can do for me!  Can you help me up please?  The floor is kinda hard.’  He helped her to the couch and she curled up on her side on the soft cushions.  ‘I hope I can get to work on Thursday I’ve missed too many days recently and they’re starting to be less than sympathetic.  Urgh, I wish they could see, I can’t help it!’
‘I know honey, but from their point of view it looks different, when you do get to work you look fine’
‘Yeah but that’s because I go to work, use up all the energy and everything I have and then come home and crash.  I can’t get anything else done!  I don’t have a life outside work and this house.  I hate it Pete, it’s driving me crazy.’
‘Tell me about it’ he replied ‘we never go out anymore.  We used to be fun but now we’re like a boring old couple.  I’d suggest we move into a retirement village next week but we might find the lifestyle a bit too fast-paced.’

‘Sarah Henderson, here to see Doctor Harman’ Sarah said to the girl behind the desk at the doctor’s office.
‘Sure thing miss Henderson’ the girl replied brightly ‘Have you seen Dr Harman before?’
‘No, I usually see Dr Caldwell but he’s booked out at the moment and I needed a last minute appointment’
‘Ah ok then, Dr Harman is just with a patient at the moment but should be about 5 minutes – he’s not very busy today.  Take a seat please’.  Sarah sat on a spare seat in the waiting room and looked around at her fellow occupants.  There was a mother with her young son, another mother with an infant in a pram, an elderly man with a walking stick and a pair of elderly women chatting away in the centre of the room.
‘Well I always see Dr Caldwell, she’s a lovely lass, I wont see anyone else.  I know she’s always running a bit behind but bless her she’s always so charming and helpful.’ One of the ladies was saying.
‘Same with Dr Norris’ the other replied.  ‘I’ve been seeing him since he started here.  He’s always running behind too, the dear, but he’s always up for a bit of a chat and always listens to what I have to say.  It’s worth it when you find a good one’.  Sarah smiled to herself and wondered what Dr Harman would be like.

She didn’t have to wait long.
‘Sarah Henderson’ a voice said.  She looked up to see a middle-aged man with brown hair and a moustache.  He was average height and build, not skinny or overweight.  He smiled at her and shook her hand with a firm, reassuring grasp.
‘Come this way please’ he said and led her to his room.

He sat down behind the desk and opened her rather sizeable medical file.
‘Now Sarah, what can I do for you today?’ he asked, folding his hands together and using them to support his chin
‘I need a medical certificate for work, I have to cut my hours down and to do that my work requires medical support’
‘You usually see Dr Caldwell is that correct?’
‘Yes I do, but he’s booked up and I needed this as soon as possible for work’
‘Of course’ he replied, looking over his hands ‘now, I’ve been looking over your file, I do that for all my new patients, would you like to tell me in your own words what has been going on for you.’

Sarah took a deep breath and began.  She went over all her medical history from the recurrent infections she experienced as a child to the acute viral illness that lead to the development of her current ongoing symptoms and eventual diagnosis of Chronic Fatigue Syndrome.  He nodded and smiled throughout, prompting and asking questions at appropriate intervals.  She felt reassured that he was listening and when she finished she waited for him to say something profound.  What he did say was not quite what she expected.

‘Now Sarah I feel it is only fair to warn you that I believe in evidence based practice and as such do not believe in Chronic Fatigue Syndrome.  I believe saying someone has CFS is like putting them in the ‘too hard basket’, there has to be a simple explanation for all of it, an underlying medical or psychological condition or some such but up till now there is insufficient evidence to support that this condition really does exist as many health professionals think it does’.  Sarah’s heart sank.  She hardly heard anything he said past ‘do not believe in Chronic Fatigue Syndrome’ and she knew she would be lucky to get what she needed from him.  She was stunned and furious.
‘But I’ve had it for nearly 7 years now, I’ve had so many different tests that have shown nothing.  I was diagnosed by a Chronic Fatigue specialist – what do you believe is going on if all of that is incorrect?’
‘I can’t say right now, but usually these things rectify themselves after time, after the underlying medical condition has resolved.  Now what was it you were saying about your blood pressure?  It’s a bit high is it? Well that can be expected with the anxiety you are no doubt experiencing as a result of all this…’
‘No!’ she interjected sharply ‘it is low, too low, and I sometimes get dizzy and faint when I stand up’ his eyebrows rose in surprise.
‘Ah ok then, that is also common in persistent infection.  You are a nurse so you know some of the physiological responses the body has to disease, can you tell me what you think is going on?’
‘Um,’ Sarah thought for a second.  ‘My body is so busy fighting the infection or whatever that is forgets about my blood pressure, there’s too much for it to do’
‘Exactly’ he agreed cheerfully ‘now lets check this blood pressure of yours’.

He checked her blood pressure sitting and then standing.
‘You do have a bit of a postural drop, it goes from 110/70 to 85/55 but that’s quite normal in someone with an infection, a quite normal response for someone who is unwell so nothing to worry about.  Your heart rate rose a bit too from 85 -120bpm but that is also completely normal as the heart rate rises to increase blood pressure ’.  She looked at him incredulously but said nothing.  At work when one of the patients had a blood pressure below 90 that was cause for alarm and often resulted in a medical emergency being called if they showed any ill effects from it like fainting or had other complications at the same time.  And a rise in heart rate from 85-120 just on standing up was not normal.  She decided to say nothing and get out of there as soon as possible so she could make an appointment to see Dr Caldwell even if she had to wait a month.

‘Sarah, I’ll give you your medical certificate for work.  These are my own stock certificates, not the clinic’s, I have done the wording myself.  Good luck and if you ever need anything, even just a friendly ear, my books are always open.’
‘Thank you Dr Harman’ she replied, shaking the man’s hand again, even though she felt nothing but revulsion, and walked out.
The next appointment Dr Caldwell had available was in two weeks, hopefully she could hold out till then.

As Sarah waited for the bus she remembered the letter in her handbag and, out of curiosity, took it out to read it.  It ran;

To whom it may concern,
__Sarah Henderson__  has described a medical condition which he/she states makes him/her unfit to work during the period of __/__/__ to __/__/__

Dr Anthony Harman

‘Bastard’, Sarah spat disgustedly and crumpled the letter up into her bag.

 

Hope you enjoyed the first instalment!!