161) The Meaning of Your Communication is the Response You Get

September 8, 2007

El Milagro: I’m here early today, arriving at 11 and I notice Ron the Nurse in a new light, since he is now the Clinical Director. He was promoted to take Herman’s job when Herman moved to the new S. Austin facility as administrator. Ron seems more attentive to everything that is going on right now… he is in the beginning of his learning curve and hyer-attentive, as he should be. Right now he is talking to one of the older men who always wears burnt orange on UT game days… so I hallucinate the old guy is either a long-ago graduate, or someone that worked at UT. He’s wearing his burnt orange polo shirt today, as I am wearing a burnt orange t-shirt.

Carrie the Tech comes over to stick me and asks my weight. My thoughts of Ron’s new position have erased my short-term memory and I look over at her and say, "Uhhhh; I can’t remember. Sorry.” James the Nurse has just strolled up and he offers to go get my weight from the weighting room. I mumble, “maybe it was 73.9…” and my voice drifts off as I stare back at Carrie, who has sharp eyes and a determined scowl. James returns to break my stare and reports, “He was 73.9” and I nod my head approvingly. Carrie jumps ahead to the business at hand: “So, how much you wanna take off?” I’m not used to them leaving it up to me so completely so I sheepishly say, “Umm… well, my dry weight is usually about 72.0, so…” and she quipped, “So, how much?” with a stare that seems to be getting more icy… “I can’t set it until you tell me.

“Okay. How about 72?” I offer, and James interjects, “Take off 2”, and she goes about her task of setting the machine. When she is done and is done cannulating me she decides to make conversation. “So, where do you live?” she asks. I tell her immediately, comparing her in my mind to Nurse Rached*, and hoping she just walks away and leaves me alone.

I must admit here that I know it takes two to create an image of aversion (that I now have ringing in my brain) and I know I’m stretching it to compare little Carrie to Nurse Rached. It just popped into my head that way so I purged myself of it here. And I do know that I can either add to the aversion or shrink the aversion by my response to it, so how I respond to Carrie actually (probably) fed her squinty eyes and stern nature. In NLP we used to say, “The meaning of your communication is the response you get”. This presupposes that communication and thus relationships are built upon two inputs, not just the “other”. Therefore, we can think of resistance as a constructed action based on both parties input. Either party in a conversation can create resistance in the other by not listening to the other or by simply presenting information that is not agreeable to the other. At any point either party can also decrease resistance by inputting information that is agreeable to the other, or by earnestly asking for the other’s opinions or ideas. When I am teaching counselors, I remind them of Steve de Shazer’s views of resistance: it is created when the counselor attempts to convince a client who is in "denial" (lack of agreement about the "problem") that a problem exists and that the client needs to do something about it. When clients are viewed as having "multiple goals", rather than as "resistant", the counselor has more options for responding to them in useful ways. The key is "to cooperate with the client in respect to each of the client's goals"**. And BTW: later James tells me Carrie’s not so bad.

So, back to football: today I am watching OU whip U of Miami and I’m thinking that even though OU is our big rival, I would still rather see a Big 12 team beat any Atlantic Coast Conference team. And OU is VERY impressive. I am afraid of what they will be like against us on OU Weekend. Yikes!

About 30 minutes before I’m done, and now watching Michigan fall to the Oregon Ducks, there is commotion over to the left of me a number of chairs; and when a commercial comes on, I check with my football-watching neighbor (the one who always wears shorts and boating shoes with ankle socks) about what it’s all about. He reports that this son came in to pick his mother up and noticed she has a badly hanging toenail. He asks Ron to cut it off and Ron explains the rules about toenail cutting (“no way Jose”) and about liability issues, etc. and the guy gets real mad and asks if the center can give him a knife so he can do it himself. I’m getting sorry I missed this drama. After the guy leaves with his mother in her wheelchair, the staff is chuckling about his request and wondering if he’ll take her to an emergency clinic or just home to his garage; sticking her foot in a vise and ripping the toenail off with some pliers.

And, what a Saturday! There’s one more event to report. Just at the end, while Carol was getting ready to de-cannulate me, she gets busied up down the line and then they pull out the medical screen and Ron goes back there to service someone who was just brought in by the transport service. Carol comes back and she sheepishly says, “Sorry. Someone’s colostomy bag just broke.”, with a frown. “Ycch” I say, “Don’t tell me more”. I can tell Carol is just happy that Ron is handling it… so to speak. Carol un-hooks me, (as I hallucinate poopy smells wafting around) bandages me up, and I’m on my way. I’m thankful that I’m one of the healthiest dialysis folks on the block. Yippee! I dance right outa there and drive fast all the way home.

Notes: In at 73.9 and out at 72.5 kgs.
* Green, M.E. (nd) Louise Fletcher in One Flew Over the Cuckoo’s Nest. Retreived online September 2007 from The Little Review’s website: http://www.littlereview.com/goddesslouise/movies/cuckoo.htm
** Tohn, S.L. & Oshlag, J.A. (1996) Solution-focused therapy with mandated clients: Cooperating with the uncooperative. In Miller, S., Hubble, M. & Duncan, B. Handbook of solution-focused brief therapy. San Francisco, Ca: Jossey-Bass Publishers, p. 154
New Readers: For A Welcome Post, click August 2006 on the Sidebar
The Austin Folkies Team Report: We're up to around $1000 dollars of donations for the PKD Walk! WOW! I am amazed at the generosity of my family & friends!


Anonymous said...
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Anonymous said...

Hi Jack,
My husband (who will be 49 next month) was diagnosed last month with PKD. He had a CT scan to diagnose pain he was having caused by kidney stones, and voila, the doctors found PKD. I noticed that you were 50 when you were diagnosed. Was it an incidental finding? Or were you having symptoms? Until now, his creatinine had been within the normal limits, although with an upward trend over the last few years (1.1, 1.2, 1.3). His blood pressure has been normal, and he has had no symptoms other than the stones. I know there is no crystal ball to predict his course, but we would be really appreciative if you could share your experience. Thanks so much! Sincerely, Marlene

Jack Nowicki said...

Marlene ~ I was surprised to find out I have PKD when I went for my physical when I turned 50. I had no symptoms. The doctor found some blood in my stool specimen and my creatinine was somewhat elevated (don't remember the #). So the doc sent me for an ultrasound which showed cysts. I was referred to a Nephrologist, who has followed me since. At 50 my kidney function was about 40% and it went down from there: just a little over the first few years and then more in the last couple years before I started dialysis.
I was taught that the most important things to do to stave off dialysis were to be careful with my diet (low protein) and keep my blood pressure as low as possible. Even though the BP wasn't high, especially, I started BP meds to lower it and then kept watch (wrist monitor) so we could adjust the meds as it went up over the years. Then in the last few years BD (before dialysis) I adjusted my diet to take potassium out (ie french fries). Since I never had weight or heart problems, I was more flexible in my diet and used to boast that I could eat all the fat and sugar I wanted.

My doc never predicted my course of demise and it turns out I lasted pretty long before going on dialysis over a year ago. The good news about dialysis is that even though I was trying to avoid it for years, when I finally started I felt way better than I had in ages. And everyone in my world saw the change, saying things like, you used to really look worn out, etc. So I guess the key is to keep away from dialysis as long as possible, and then when starting, enjoy eating steak and recognize how nice it is to feel better. Good Fortunes to you all as you adjust. JN

Anonymous said...

Thank you so much for sharing your story. I wish you and your family a very Happy and Healthy New year! Shana Tova!