People tell me things. They always have even when I was a kid. Maybe it was because my face on the playground had no history with the other kids. Maybe it was my sister Betsy. She had a seatbelt installed on the bus especially for her. This was before short buses and calling kids with Down’s Syndrome; retarded was rude. There were no programs for my sister 40 years ago in many of the places that my military engineer family was assigned. We got on the bus together that first day of Betsy’s education and belted into what would become a lifetime of redefining labels until they became blessedly pase’.
My Mother knew there was something wrong during the pregnancy she told me later, but she certainly knew something was wrong with her birth. Betsy did not develop on target, and she never cried. When she did, it didn’t sound right. Mom went to the Doctor, and at the tender age of 20, she was told she was failing to care for her infant properly. We two girls in matching clothes she had sewn. The misdiagnosis was a failure to thrive. I am too young to remember this moment.
I was only 18 months old, but I can imagine the change in my Mother’s posture, the set of her jaw shifting into a veiled look of sadness, confusion, and defiance. The expression of a Searcher I believe was born at that moment and the death of the girl for there would be many more white coats to come and I would see this posture and expression of my Mother’s perfected over time.
Betsy was two years old when she received her proper diagnosis of Down’s Syndrome Epilepsy and Autism. It took her first grand mal seizure to finally tip the scales. Betsy has consumed a lifetime of anti-convulsants, endured blood draws and side effects but still managed to win medals at Special Olympics and develop a small vocabulary of words in sign and speech.
Among her favorites are No and Mine which she says quite clearly. Her favorite sign is hamburger which can double for a coloring book but can sometimes be slurred into All Gone, much like a magician’s slight of hand. She laughs when people fall and she never loses a staring contest.
Advocacy is my birthright.
My Mom showed me you could never accept the opinions of others no matter how learned especially when it grates on every truth you own. My Sister trained me that there is more to communication than words. Being a Cannabis Nurse is a dedication to their tenacity.
The class bully in my new 4th-grade school was diabetic. She had a seizure on the playground and peed herself. My sister had already seized herself to death twice by then, and I’d seen both my parents perform CPR on her, but her seizure was different. The playground was utter pandemonium. It is a terrifying thing to witness mortality in our peers at such a young age. The shunning began. That bully and I ended up being best friends for the very thing that put us at odds is what drew us together. At every school, I attended I had to teach everyone you couldn’t catch Down’s Syndrome. Usually, it is the class bully who requires this dissertation first. My new Bully Buddy and I had to teach everyone you can’t catch Diabetes, and by the way, we’ll have no more talk of peeing either. An inaccurate perception turned this bully, the most popular girl in school, into a non-person. A virulent non-person worthy of militant fear and mistrust all organized inside a single incident. Almost like birds wheeling in flight.
Why all this back story? I see a parallel to our clinical lives. It has been my great accidental pleasure to own a dispensary in Washington state. After hanging up my stethoscope from ER nursing, I fully believed I would never call myself a nurse again. Our business partner had the good grace to have a seizure in front of us where his wife stepped forward and used cannabis oil as a rescue. Despite the fact that I was a medical patient for insomnia after failing on Ambien, sleep driving broke us up forever; I still believed that Cannabis as medicine was a hippy pipe dream. Until I saw that.
It shook me to the core. My eyes opened for the first time as I realized that all my IV skills and 1st line seizure protocol meds were looking pretty cheap. Like all my king’s horses and men had been plastic all along and now here, at last, was the real thing. My business partner came out of this seizure with a minimal transient post-ictal state that cleared itself further as his wife walked him through cross body exercises that use both hemispheres of his brain. Lights are back on, shall we continue? Would you like to be Nurse Wendy again he asks…
As patients come in for counseling on how to begin this relationship with Cannabis I am relieved that I have the experience I do. The acuity and panorama of the challenges people face with their health are on par with what I saw in the Emergency Department. Every age and every issue, from the mundane to the grave. Ultimately in the dispensary, we listen. Before all else, we listen. Our patients are here to heal. They are here to change, and they have already done an enormous amount of change to walk through the front door. Perhaps like me they took time to shed their ‘Just Say No’ upbringing, get over the fear of disappointing conservative parents or relatives and loved ones, stop being fearful of losing their livelihood and reframe their entire understanding of the human body and their soul’s interaction with it.
After all are you a good person if you use Pot? Are you still the same reliable person you have always been if you use Pot? Will my body be healthy if I use pot? Will someone judge me if I use pot? Yes, people, the answer is yes.
Unfortunately, it is likely that judgment will come via a medical professional. In the ER we use words like seeker or drug seeker, or he’s just seeking when people come in claiming to be in pain. Things that make an ER nurse or Docs radar go up is coming in asking for specific medication at specific dosages for specific problems. Namely headache, back pain, and dental pain. It is estimated that 20% of all ER visits are drug seeking behavior. Pain is the number one reason people visit our ER’s nationwide every day. Through Cannabis use into the history and things can interesting.1
A brain cancer patient continues to inspire me. The ER triage nurse saw her as an overweight, anxious woman with a migraine. The RN did not dig further into her chart to see the documentation of a brain tumor or the seizure activity, expressive aphasia and debilitating migraines that is a side effect of her surgery.
Instead, this nurse chose to judge the package based on the patient admitting her use of cannabis for seizure and pain control, documented her as a drug seeker and allowed her to languish in the waiting room. This drug seeker is 15 credits away from her Ph.D. in Special Education with a focus on Autism. My patient bravely told her physician later after asking her what she was doing differently to reduce her tumor size that she was using cannabis.
He replied I don’t believe in it. She replied, it is not a religion asking us to suspend belief but a science asking for the study. She is the quintessential Cannabis patient who went through a great deal of spiritual and moral gymnastics to walk through our front door much less take on learning a new skill like titration of Cannabis, but she did. Then she discovered she is a good person and she is dependable, and she is healthier, and she became her advocate. She had to stand up to the ignorant and bullies using the only light we have. Reality. We have an Endocannabinoid system she says proudly. You should look it up!
Are you a bully? Have you allowed yourself to believe that medications are healthcare? Have you allowed your opinions of your patients and what kind of time and investment they get from you to become colored by the substances that they use? Is this compassion fatigue? Have you wheeled in flight with the rest of your colleagues eager to escape peer pressure? Is the responsibility of solving another patient’s impossible battle with pain by merely labeling their methods of dealing with it as verboten, disgusting and unacceptable like this removing them from our to-do list going to be a framework that can ethically hold in the healing arts? An alarming culture of dismissing our patient’s pain while painting them as failures are developing as I see reflected in the tears of many frustrated patients including this Brain Cancer patient as she tearfully recounted one of the most humiliating days of her life at the hands of a nurse. Did this breadwinner, Master level degree educator, student, mother and professional ever think anyone would honestly look her in the face and have the stones to call her a drug abuser?
Here is the humbling part. I have been that ER nurse.
This isn’t responsible healthcare. The opiate crisis was created by healthcare and labeling people in chronic pain who have a Failure to Heal as seekers are refusing to take responsibility for it. This is negligent. This is damaging. This is a bully’s mindset allowing supposition to take the day and us with it. While I agree with the CDC that opiates should be used for acute pain crisis, I do not agree with the knee jerk reaction of pulling people off their meds without proper titration or education. The culture of abuser and seeker I feel act as unhealthy justifications for withholding proper treatment and is a sure road to increased morbidity and mortality from plan ole negligence dressed as diagnosis or shall I say misdiagnosis.
I beg you not to fall for it. Consider we have all been educated this way. The pharmaceutical industry spends more money on media marketing than research and development. We are educated as consumers to ask for specific drugs for specific problems, and as healthcare providers, we are educated to judge you for asking for what you know you need.
Consider Cannabis as a correct drug. It can work in tandem with opiate receptors to potentiate the effects of opiate pain medications making them feel stronger and last longer hence using fewer opiates. (Abrams et al. 2011) It’s incredibly low LD-50 rating make it impossible to overdose on, and the CDC reports say that yet again, there are no overdose deaths from Cannabis in 2016. It has been my experience that Cannabis has been an Off-Ramp medication for our patients resulting in a gateway to healing.
It’s ability to mitigate anxiety and nausea make it a useful harm reduction medication for tapering off a myriad of narcotics and psycho-tropics.
2This scenario is backed up the CDC’s finding that Opiate overdose is down by as high 25% in states where cannabis is a legal option.
3Quite a different scenario than the one we’ve been brought up to believe.
Being a Cannabis Nurse is a tall order. The first order is Believe Thy Patient. They tell me it works. I see that it works. Administer, Observe, Titrate, Appreciate. If this were any other med I was pulling out of the Pyxis, I’d be in love it with it because it works. This is the real question facing us now, in our current social epidemic of medicating America. Does how a person elects to treat their pain negate the fact that they are in pain? Cannabis Nursing is more than teaching how to use the plant for its healing properties and educating about the Endocannabinoid System (eCS).
It is the shift in the healthcare paradigm that attracts me. It is not about applying Band-Aids any longer but about teaching how to institute real and lasting change in people’s lives with brutal honesty. Watching patients elect to take this path is the most rewarding of all especially when we as Cannabis Nurses are no longer needed, and they have been able to set aside all substances for the new self-care tools they have cultivated. To me, this is the ultimate in achievement. I am naive enough to believe that there are enough sick people to go around for all of us to make a comfortable living.
No need to create clients. We have plenty. Empowering our patients to graduate from the healthcare system in entirety should be every nurse’s end game. Cannabis Nurses not only know that is possible, but we also make it possible. We are redefining the future of healthcare one “seeker” at a time until the use of certain words become blessedly passé.
Resources:
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556950/
2. https://www.cdc.gov/drugoverdose/prescribing/guideline.html
3. Melameade 2005 https://harmreductionjournal.biomedcentral.com/articles 10.1186/1477-7517-2-17
4. Bachhuber et al. 2014 http://jamanetwork.com/journals/jamain ternalmedicine/fullarticle/1898878
