Another Clinical Day (of RN Refresher Course)

Another Clinical Day (of RN Refresher Course)

Written by Charlotte E. McCall, September 2014 (published here for safekeeping)

Working all day standing up is hard when you haven’t done it for a while.  Over the last fourteen years, I’ve become rather doughy as I spend most of my time in a recliner or car, and manage my time as I see fit with plenty of breaks between errands or cooking or visiting with friends.  What a shock to the system of loose tender muscles.  Many years ago I was working three twelve hour shifts a week, but then, I was many years younger.  Then, I wasn’t wearing orthotic shoe inserts to prevent plantar fasciitis, and I didn’t have to carry my reading glasses with me to see an IV site or the name of a drug (when did they start printing the names of drugs so TINY??).  By eleven or so, I have to lie down in the locker room and put my feet into the air one at a time and do stretching exercises like they taught me last year when I had physical therapy after that herniated disk.  In the afternoon, sometimes I have to sit down and breathe deeply several times because there are little silver shiny things, shimmering just at the edges of my vision.  During the drive home, I often stop and get a large iced tea because I have been used to drinking ice water all day, and at this hospital they don’t allow any water at the nursing stations.  After a shift, when I get home I generally have a float in the pool while I allow my husband to cook dinner, then after dinner I fall asleep in my chair around 7:30 or so.  During the night, everything hurts.  I talk myself out of taking the leftover Vicodin from my shoulder last spring.  Maybe it will make me too groggy in the morning.


I took care of two patients for each of the last three shifts.  The patients aren’t all the same of course, they all have their own stories.  But on my floor, typically each patient has a long midline incision, several other smaller incisions or punctures somewhere in the abdomen or chest, staples up and down or across their bodies, and at least two drains coming from them with various colors and odors of fluids emanating from them.  Usually two to five lumens of fluids going into them, maybe oxygen going into their noses, and probably things wrapped around their legs like big sheets of bubble wrap inflating and deflating, attached to the bed with tubes. Plastic bracelets around their wrist and bandages covering spots of blood in the inside of their elbows where they’ve been awakened each morning at four a.m. to have a bright light shown on them and blood taken from them. And five super-sticky squares of tape on their chests attached to gray wires, and a red light taped to one of their fingers, with a heavy box monitoring their heart rate that hangs off the pocket in the fashionable hospital gown (no underwear provided).


They get to ‘recover’ in a single bed with a plastic mattress and institutional sheets and a synthetic plastic pillow.  They have one to six family members in their rooms, most of whom will get to see them naked at least once.  They’ll ‘save’ their urine and stool for everyone to view, until someone comes to empty it.  Their door will open and close 3 or 4 times at least every hour, usually with someone coming to poke at them or rip tape off them or take a fluid out of them or put something into them, or show a group of other people their incision or dressing or skin condition.  There are other things you can’t see.  Inside the abdomen, where the doctors have cut out their organs or their intestines and sewed up the remnants, and that hurts.  And their spirit has been delivered a punch in the gut, too.  Many times, they’ll have the dull throbbing knowledge that this is only the beginning, they still have chemotherapy or radiation or something else leading to death, to look forward to. They hurt inside.


So, I’m taking care of a lady last week who was a typical patient as described above.  She was dealing with all the things I mentioned, plus a five-day impaction of stool in her colon.  She was so uncomfortable.  Five times up and down to sit on the pot, with no results.  She can’t strain.  She can’t move it.  I give her a suppository and tell her we’ll check back within the hour and see how that does.  But she has had no luck.  I tell her that drinking more fluids, and moving about more might help her.  And I suggest an enema which has been ordered for her if she needs it.  ‘No,’ she says.  ‘I had an enema before the operation, and it was just horrible.’  So I bring her some coffee.  Up and down she goes, without any results.  I go back to charting and taking care of my other patient who is just like her but without the impaction.


An hour later, I check on her again.  She has two family members with her now and wants to get up again to the bathroom.  She is almost crying in frustration as she sits on the bed after another poopless toilet experience.  I tell her ‘It’s just a small enema.’ I show her the length with my hands.  ‘I have had them myself, after surgery.  It’s not that bad, really.  And such a relief when you finally go.’  She hesitates.  I can see her considering it.  Then she says, ‘I have to rest for awhile.  Just help me back in bed, ok?’  I settle her back in with her son and daughter waiting patiently beside her.  The room is so tiny and there are two large chairs, a wastebin, a laundry basket, a sink and sharps container and the IV pole with its three channels and multiple bags hanging, and drains hanging off her and at the end of the bed, a sequential pressure device machine.  Her walker leans against the wall. With me and the WOW (Workstation on Wheels) and the dynamap (vital signs machine) in the room, there isn’t enough space to spit.  I tell her I’ll check on her again soon.


I go to lunch and come back, and it’s almost shift change and I try to wrap up some charting.  I can’t figure out what I’m supposed to do with the intake and output.  I must remember to ask my preceptor how to clear out the pumps.  Am I supposed to be charting on these Plans of Care?  Why is it asking for a co-signature on the chart check?  I need to hang that tube feed on the other patient down the hall and do some teaching about incision care.  He might be going home later.  Maybe I should be getting ready to take out his IV. My preceptor told me the doctor has written some new orders.  Where the heck would I find them in the computer system?


The lady calls me.  She wants to try walking in the hall. We put another gown on her back to hide her butt.  She is holding her walker.  I am holding on to her.  Her daughter is rolling the IV pole.  Her son is bringing up the rear, with his walking cane.  I feel proud of her and tell her so.  She isn’t shuffling, she is standing up straight, she is using the walker correctly.  She doesn’t look dizzy.   People are going past in all directions: The RN’s with their Workstations-on-Wheels, respiratory therapists in their gray scrubs, care technicians in their forest green scrubs, environmental service people in their blue and black, medical students in their little pods, in the light blue.  This is the time that her bowels begin to awaken.  It starts with a series of long resonant, aromatic farts, for which the patient apologizes.  I praise her and tell her it’s a good thing that she is passing gas.  If I had a gold star, I’d paste it on her.  ‘I’m pooping!’ she suddenly exclaims, and I suggest we head back the other way.  We’ve gotten halfway down the hall despite the unwieldiness of our little group.  Among the current of people streaming down the hall, we start to turn around.  It’s like turning the Titanic to avoid the iceberg.  And like the Titanic, it’s too late.


It seems to take forever to get back to the room.  My mind goes in all directions exploring any other option than to be here, with this very large, sweet, elderly lady who is pooping brown streams down her legs and onto her rubber-soled socks and leaving dots of brown liquid along the waxed hall floor.  Could I pick her up and run with her, like I would a puppy that isn’t yet housebroken?  Could we teleport into the bathroom?  But since this isn’t an episode of Bewitched, I have to settle for moving slowly and safely down the hall into her bedroom and through the narrow opening of the door with her son and daughter and the walker and on to the waiting toilet.


My heart goes out to her as I clean up all the surfaces of her legs and the major expanse of her behind and all around her thighs and yet, she still has not had success at emptying her colon.  The impaction is still there.  This was just leakage around it.  We change sheets and put her back into the bed, and her daughter rubs lotion on her mother’s legs.  I close the door and leave her to recover for a little while until I can somehow convince her to accept the enema.


My preceptor pops in while I am wrapping up my charting.  I offer her the yellow folder which has been already dated for her convenience. She glances at the sheet, quickly scribbles that I need to maintain my focus and manage my time better, and circles a 6 on the evaluation scale.  A SIX.


This failure had me down for several days as I wallowed in the despair of being so incompetent.  Then I would vacillate between feelings of angry indignance (my preceptor doesn’t understand me) to reflections on who really cares anyway, what number she circled?  It’s not going to be projected onto a screen in some courtroom!  Nobody is going to know at my potential, God Willing, place of employment.  The Texas Board of Nursing isn’t going to sit around their board table and say ‘We can’t give this woman back her RN license!  For heaven’s sake!  She has a 6 on one of her evaluation sheets!  WHY, indeed, was I even doing this??  A SIX!


On my next clinical day I made the hour drive in to the hospital in the dark.  It was Labor Day, and traffic was light.  My shift started at 6:30.  I had been awake since 3 a.m., unable to go back to sleep.  I practiced smiling as I drove along.  ‘I am going to make a difference in someone’s life today,’ I stated into the dark car.  My cheeks felt stiff.  I took two deep breaths.  ‘My patients are in the most stressful time of their lives,’ I reminded myself.  ‘I have much to be thankful for.  My day will be spent doing the best I can to help them be comfortable and well.’  Two more breaths.  ‘No matter what kind of day I have, my patients are having a worse day.’  The lights of downtown Dallas shown.  ‘Only two more weeks, and I’ll be done with this class.’


And then what?  said my little voice inside.  But I’ll figure that out later.





Rock, Paper, Scissors

1997 3 Nick in buttercupsSchool children have been playing it for dozens, maybe hundreds of years.  It’s an interesting concept.  Three separate entities, each stronger than one and weaker than one of the remaining two.  In the traditional game, (the one I grew up playing with my siblings), Rock beats Scissors, Scissors cut Paper, and Paper wraps Rock.  In the Math World, if A>B and B>C then A>C.  But not in this game.  One has to think deeper, with more logic and creativity.   Those are the Rules.

Like thousands of children before him, our 7-year-old son was intrigued by the game.  Since sign language is his mode of communication, the handshapes probably struck a resonating chord in his spirit.  The excitement of chance, the equal possibility of beating or being beaten by other players, the satisfaction of bashing, chopping, or enclosing the hand of the opponent—it was thrilling.  Nick had been playing the game for about seven minutes when he started making up his own rules.

Nick preferred to have other handshapes appear unexpectedly.  My Rock was easily overcome by his Ocean (obviously it sank, he explained.)  My Scissors were torn up by his Tyrannosaurus rex, which was hardly fazed by the small pecking motions they made against his leathery skin.  My Paper was burned up in his raging Fire.  When I tried to play by his rules, he still won more often than not.  If the superiority of his handshape was not apparent, he would argue its merits.  I tried to drown his Dragon in my Ocean—but he pointed out that Dragons can fly.  Bears can climb Trees, and if Trees try to fall on them, they can run fast and avoid being hit.  He was a master at the game, and had quite a boorish attitude about it, too.

One day he invited my sister Laura to play.  Laura is quite competitive herself.  Possessing a high level of intelligence and resourcefulness, she is a perfectionist, and used to winning.  I warned my sister that Nick did not play by the traditional rules.  Anything could pop up.  “But, Nick,” she protested.  “There are supposed to be only three choices.”  He was appalled.  “But that’s too boring!”  said my son.  “Other things can appear, too, like wind or animals,” he explained.  Laura thought a moment.  “You mean ANYTHING can happen?”  Nick nodded enthusiastically.  “O.K., then, we’ll play it your way,” agreed Aunt Laura.

For the first round Laura produced a bent two handshape in her palm that she claimed could defeat Nick’s Monster.

“That,” she explained, “is a Bug, and it can eat ANYTHING.”

“But bugs are little, tiny things.”

“Not this one.”  Aunt Laura inched it toward the Monster, making bug-mouth motions.  “It is a HUGE bug that can eat your Monster.”

“Fine.”  Nick was amused and gracious.  “You win that one.”


Next, Laura put a sideways four into her palm that she described as “a Machine that can destroy ANYTHING.  Especially that mountain.”

This is a gigantic mountain.”

“The machine can ruin it.”  The four started moving forward.

“O.K., but it will take it a long time,” he conceded, laughing.


Then Aunt Laura made two fingers stand up in her palm.  “That is Superman, and he is stronger than ANYTHING.”

“But my rocket is very, very, FAST!”

“Your rocket can not hurt Superman.  He is faster than a speeding bullet.”

Nick paused, then brightened.  “I will beat you for sure next time!”


Next round Nick signed Green.  “What is that?” said Laura.

“That green rock that makes Superman feel weak.”

“Well, it can’t do anything to my Hole,” she said smoothly.  “This hole is so big that EVERYTHING falls into it.”   The hole approached the green rock and sucked it in.  Both of them, and me too, were laughing hysterically.  When we regained our composure, Nick looked at Laura with respect.  “You are a very skillful player!”  he said.

“Yes,” said Aunt Laura smugly.  “You have met your equal!”




I tried to incorporate Laura’s creations into my own game.  However, Nick’s mind had been simmering the new handshapes and he had defined them more clearly.  My Machine was too slow to destroy his Cheetah, fastest animal on earth.  His Earth wasn’t affected by falling into the Hole, because the Earth was in space anyway.  A disproportionate amount of times, it seemed to me, the Green rock would somehow show up to weaken my Superman.


One time we were playing a rousing three-way game with Claire, Laura’s 7-year-old daughter.  The rhythmic nature of the game and the uncertainty of our opponents’ options had overwrought us into frenzied, drunken laughter.  Suddenly Nick signed “God.”  Claire and I looked at each other, shocked.  “Well, nothing can beat God.”  We all agreed.  For the next few hands we each selected the Deity simultaneously.  This was uproarious at the time but would be a dull way to play in general.  Finally, we compromised on the acceptance of one guideline.  The Rules for Rock, Paper and Scissors are clear and simple, as we play it: you can only choose God one time in the game. (Unless someone comes up with a better and more interesting way to play…)


Post Note: I wrote this story in 1997, about my seven-year-old son, Nick, and it was one of the stories published in Mark Drolsbaugh’s book, “Deaf Esprit: Inspiration, Humor and Wisdom from the Deaf Community” (edited by M. Dolores Torres Paris, published in 1999).

It was another decade before Sheldon Cooper introduced his RockPaperScissorsLizardSpock variation of the game (although, further investigation reveals that Sam Kass and Karen Bryla were the original inventors.

And, check Wikipedia for the French version which includes a well, and the German version which includes a bull, and other versions including fire and water.)



Why we Sign

I like finding old documents on my computer.  This blog is taken from a letter written to our friend, Peter Paul, in 1997.  He did a presentation on language and deafness, and afterward, we met him and took him out to lunch and talked about language.  He was most interested to find out that we signed with our deaf son, Nick.  But, we didn’t use American Sign Language, or even one of the other sign systems which has rules.  We used more of a contact language, or what was known then as Pidgin Signed English (PSE).

At this time in my life I was reflecting continually on why we did things the way we did.  I was always trying to make sure we was raising our son the “right” way.  It was also about this time that I wrote the story, “Rock, Paper, Scissors” about our son’s changing the rules of the game.

We were continually changing the rules of our game to figure out what worked to communicate with our son and teach him language.  Our philosophy was never engraved in stone.  We were comfortable with a minimum of rules, or maybe we didn’t mind the rules changing from time to time.

It was a little bit of a conundrum  to me  that he questioned the communication methods of people interacting with deaf children based on whether there are rules or not.  The question he asked was, “Since the brown list (ASL, Rochester Method, SEE, SEE II, cues) HAS rules and the green list (Sim-Com, TC, PSE)  doesn’t, why do such a large majority of people use the green list?”

The purpose of this letter (and my story about Rock, Scissors and Paper) is to try to answer that question in detail.   You ask, “Why read?” My answer, “To learn,” (which I signed by symbolically taking knowledge from a printed page held in my hand and putting it in my head). What I really meant is “To gain understanding.”  You may interpret that to mean understanding of others or self, in the cognitive, emotional and spiritual levels.

Why our family signs

The first question is “Why sign?”  The answer, in a nutshell: “We want to have meaningful communication with our child.”


Nick lost his hearing at ten months after bacterial meningitis.  He is profoundly deaf and has a corner audiogram, meaning he does not hear higher frequencies, particularly human speech.  We could devote our lives and his to the pursuit of speech, but we aren’t disciplined enough.   We don’t want to make the sacrifices.  If we had chosen the oral road, our lives would be very different.  The most powerful and expensive hearing aids would be on him every waking moment with the hope that he would hear something.  Or he might have a cochlear implant.  Several days a week, if not every day, there would be intensive speech therapy.  Nick would go to a clinic and sit in front of a computer blowing up balloons on the screen to practice breath control.  He would sit in front of a therapist watching her lips and putting his hand on her throat to try to catch sounds like G and K.  He would try to place his tongue in just the right place to make an S sound.  The therapist would reinforce his efforts by telling him “Great speech!” and she would encourage him to “Work hard!”  At home every day after school, Mom would work on speech with Nick.  They would play matching games to make Nick understand the correlation between saying the word and lip-reading the word.  His parents would always point out environmental sounds like trucks or trains or the phone ringing, and ask if he heard them.  Whenever he looked at Mom or Dad we would always talk to him, treating him as if he were “a normal hearing child.”  We would assume teacher roles, always looking for opportunities to “work with” Nick on developing his speech.  Emphasis would always be placed on Hearing and Speaking, two things for which Nick has no natural aptitude and little chance of success.   Though our family would wish for more time to do things together like ride bikes or play tickling games or just daydream, there would be no time or energy left for those things.

It’s possible Nick would be able to say several words.  Given his level of intelligence, he would even know what some of the words meant.  Most of them would be nouns naming concrete objects used in the speech lessons.  Nick might be able to depend on some speechreading for understanding some situations.  The speech teacher, his parents, and his teacher at school would praise him for his great speech, but likely be the only ones who could understand him.  Eventually Nick would come to realize that he never had “great speech” after all: the teachers were lying to him all along.  He would understand finally that no matter how many years of practice and hard work he invested, he would never be able to truly and comfortably talk.  He would never attain comfortable, easy communication with speech, and the time wasted in its pursuit would have sacrificed other endeavors like sports, art, or developing a literate mind.

He would be isolated in his own world, incapable of communicating thoughts or questions.  He would be frustrated that no one could understand him, although he would not be able to crystallize that feeling into any type of coherent communication.   His spirit would be broken, and slowly dying.  Despite the love of his parents and our desperate wish that things could be different, he would be alone.  After many years of gliding through a fog of life, not knowing or understanding most of it, he would probably meet a manual deaf person and the door of communication would be opened to him.  Later, after gaining much understanding of the world, he would realize he had no relationship with his family and he would grieve over that loss.  He would remember how his parents strictly adhered to the rules of the oralist faith, and he would be very angry and sad.

Maybe the “oralist road” paints a bleak picture, but I have met many people who can attest to its truth.

Sign Language

So we sign.  In the beginning sign language was just another “option” and we took sign language classes just to keep ourselves educated.  We thought that at some point it might come in handy.  We used all our knowledge to communicate with our baby (hence the phrase “Total Communication.”)  No limits would be put on developing any form of relationship with him.  We spoke, we signed, we mimed, we played charades, we drew pictures.  We took turns dropping blocks into a bucket to teach Nick conversational turn-taking.  We played loud music and danced, slinging our baby around in our arms to teach him rhythm.  When he pulled off his hearing aids (50 times a day) we patiently replaced them, over and over again.  We watched to see if he was watching us, and whenever he looked our way, we talked, signed, and tried to interact, to promote development of eye contact.

One day he started signing back to us.  It started out slow, but was so very rewarding.  Daddy.  Eat.  More.  What a wonderful miracle that little children can learn to do that!  We were so excited!  Just three months after the meningitis and loss of his hearing,  I went to get Nick out of his bed when he woke up one morning.  He leaned and pointed toward his door.  So we went out into the hall.  He pointed to the front room.  We went in there, and I was about to put him down to play when he pointed to the kitchen.  We went in and he pointed at the refrigerator.  I opened it and he pointed to his cup of juice on the top shelf.  I got it and he drank it.  I told him how smart he was.  He communicated, using “points,” just exactly what he wanted!  By the time he was 19 months old (nine months after he became deaf) his vocabulary included over 100 signs, plus another 30 or more that he understood but did not use, plus 4 more signs that Nick “created.”  In contrast, our son rarely responded to our voices.  He seemed to enjoy the rhythmic games, but didn’t hear the music.  He could say two words with his voice.   In the years that followed,  Nick’s vocabulary grew.  Before entering kindergarten, he possessed several thousand words including nouns, verbs, adjectives, prepositions, and could manipulate the words to communicate almost any concept he wished to convey.  Some of the questions he asked when he was barely five years old included: “How did God make the earth?  Why does a person grow up for a while, but then they quit growing?  Why don’t I have bones in my belly like I do in my chest?  How would you feel if I died?  How does the dog clean her butt?  How does an airplane see where to go at night?  If a person stands on the bottom of the world, will he fall off?”  This was 9 months before he started kindergarten.  His communication included abstract concepts, feelings, “what if’s”  and “why not’s.”

Nick, now seven years old, signs whatever he wants to us.  He is able to discuss the fairness of parents making all the decisions for a family vs. the child also having input.  He declares that “sometimes the computer just has no respect for me.”  He delights in fingerspelling entire sentences to us as fast as he can.  A talented and gifted student, Nick is able to write stories comparing and contrasting two animals, telling about a sequence of events needed to construct a sandwich, and fantasizing about a magic car.  He even wrote a persuasive letter to the director of the Interpreting for the Deaf program explaining why they should let children who can sign be included in the sign-only “Silent Night” events held at the college.

Could he have had such a rich bank of words had we chosen the oral route?  How would he have been able to think so creatively if we had not given him the opportunity through signing with him?  Even more amazing to me is that we have never really used a language with him.  We have tried to make contact through use of signs (mostly ASL-based signs with a few English signs and some made-up signs and fingerspelling thrown in).  We aren’t fluent enough in ASL to use it as a language.  We can’t hold Nick’s attention (or ours) by using English sign systems.  We have never embraced the use of cueing, mainly because of the method’s dependence on lip-reading ability and the constant practice necessary to develop a reasonable speed of communication.  (Too similar to “oralism”.)  So we use Total Communication, speaking while signing PSE (Pidgin Sign English).  Sometimes we use English signs, sometimes ASL, most of the time only PSE.


It’s controversial whether PSE even exists.  A pidgin is defined as “an auxiliary language resulting from contact between two different languages that is primarily a simplified form of one of the languages, with considerable variation in pronunciation, and is an amalgam of the grammatical features common to both languages.”

Auxiliary:  “subsidiary;  additional; supplementary;  giving support, serving as an aid;  helpful.”  Language:  “a set or system of symbols used in a uniform fashion by a number of people, who are thus enabled to communicate intelligibly with one another…communication of meaning in any way: the language of flowers; the language of art.  

Contact:  “the act or state of touching, as of two things, people, etc…a condition in which two or more individuals or groups are placed in communication with each other…to communicate with (a person.)”

Amalgam:  “a combination.” 

You can see the rich possibilities for discussion on any of the above subsets of the definition of a pidgin.  The one that grabs my attention first is the word CONTACT.  Maybe instead of saying we use “PSE” I should say we use a “contact language.”  That’s my goal.  I want to contact my son.  Secondary to that goal are the objectives of language development and English literacy; yet to attain those objectives would enhance my ultimate goal of contact.

I want to have something interesting to talk about.  I want to talk about it easily.  I want to talk about it deeply and broadly, factually and imaginatively.  I want him to be excited and motivated to talk with me.  That’s how we will get to know one another and ourselves.

Manually Coded English (MCE) systems:

The group of people who thought up MCE had honorable intentions.  Since deaf kids have such a hard time figuring out English, these good people thought, “Why not put English on the hands and thus make it accessible to deaf students?”  A very pure way of doing that is to spell out every word, otherwise known as:

The Rochester Method.

While flawless in theory, this method is extremely cumbersome to use.  The “sender” must fingerspell every word they want to communicate.  The “receiver” must be able to read it.  To reach a comfortable speed of communication, (one that would approximate spoken English), this would imply long hours, perhaps even a lifetime, of practice on both parts.  Two major drawbacks for hearing parents with a deaf child: 1) The parents can’t fingerspell worth a flip when they find out they have a deaf baby,  2) The baby can’t read fingerspelling and is probably not going to watch the laborious efforts of his parents.  What the baby WILL notice is how cranky and frustrated his parents’ facial expressions always seem to be.

Sign Systems

Other types of MCE include SEE, SEE II, MSS,  and probably some others out there that are still being developed and some I never heard of.  I will lump them all into one category, because in my mind they are all points on a continuum that could be described as “less persnickety” to “more persnickety” (with persnickety defined as “requiring painstaking care.”)*

In some of them it’s OK to use two different signs for two different meanings of “duck,” and in others you have to use the animal sign like a beak opening and closing not only for the animal, but also for the concept of “duck–the ball’s going to hit you,” but you have to also crouch down a little and make an anxious facial expression at the same time you do the duckbill to show the slightly different meaning.  (Isn’t that fun?)  In the most persnickety you have to sign stuff like butter + fly to show the meaning of a butterfly (although I’m not sure if you would use the “fly” as in an insect buzzing around, the “fly” like a plane flying, or just kind of wave your hands around at shoulder level, although that might be confused for “wings” or “angel” and then the receiver would think you were trying to say “butterwings” or “butterangel”.)  “I’m going to blow your house down” might get really convoluted once you say you’re going somewhere and then talk about blowing and the house is going down (into the earth?)  “Get on with it” is really hard to understand if you sign it with some of the rules applied, and so are many other common phrases, “Watch out!”  “Keep on,” “I have to get up from this chair and go down to the store.”  Try adding a little poetry to the mix and you really have a challenge.  Ever try signing nursery rhymes or songs with your child?  Heck, they hardly make sense in English, much less in MCE.  And what if you actually find the signs in a dictionary for “Humpty Dumpty”?  Bet you a million dollars you’ll meet six other people who use a different sign for the egg-guy.  A lot of people will laugh at you for signs you learn from an English dictionary.  Example: “flour” (a word I used with my son many times before he was two).  Use an “F” in the sign for bread.  I have gotten laughs, and I’ve also gotten reactions like cringing,  eye-rolling,  and  aghast comments like “Do you really think a Deaf adult would respect that sign?”  Um, no, I was just trying to talk about making brownies with my son.  I’m not trying to oppress the Deaf Community.  Still, we use many English signs in our family.  Nick uses them at school and understands them, especially with reading (in conjunction with other kinds of communication, especially ASL).   But it’s just too hard to use all those English endings like -ing, -ment, -ness, etc. all the time.  By the time you execute (“perform, carry out, accomplish”) the sentence,  you’ve executed the thought (“put to death according to law”).  Nobody even cares what happens to the Big Bear, Middle-sized Bear, and Baby Bear.  It’s boring to watch.  No fun.  Too persnickety.

American Sign Language

So why not use ASL?  We respect the Deaf community and their language.  We are in the time-consuming process of learning ASL now.  However, there are quite a few reasons we have not used ASL in our family up until now.  To enumerate:  1) If we had known beforehand that we would have a deaf child, we could have been fluent when he arrived, but it takes time to learn a new language; 2) ASL classes are few and far between, and expensive; 3) It’s hard to meet native users (deaf adults) for practice; 4) ASL leaves out hearing people not fluent in the language; 5) Deaf people don’t sign ASL with hearing people not already fluent in it;  6) It takes time to go through the grieving process and we are overwhelmed with the process of communicating in a foreign tongue with our child.

Our rules

We only have one, and that’s to have a healthy and happy family.  As parents, our primary aim is a relationship with our child.  Easy, comfortable, enjoyable, and sufficient communication is required for a bond to be made.  We can do this best by being flexible.  When Nick was little, his attention span was not long enough for MCE and our skills weren’t sufficient for MCE or ASL.  It was most rewarding to sign as best we could, in an English word order, leaving out endings and articles.  We supplemented (and still do) with miming, drawing things in the air, or positioning things in space (later we learned that these are ASL skills).  Our child seemed to respond best to that kind of communication.  We were more comfortable with PSE/Total Communication than other methods.  We still think in English word order, though we might be able to understand an ASL sentence.  We can talk at the same time we sign PSE and not leave anyone out of the conversation, though perhaps we are sacrificing a “perfect” language model for our son.  It is still not our Native Tongue but it is the language we use in our family.

Paying the Piper

Are we sacrificing too much by not choosing a language with established rules?  Will Nick’s language suffer as a result?  Should we be working harder to learn ASL so our child can have a true language model?  The answer is…Uh, we dunno.  We are making decisions based on our information, beliefs, feelings, and energy level.  True, Nick’s “grammar” of English is not correct.  He writes just like we sign:  “I go in mall and saw a pet store.”  He has little understanding of contractions, but knows about them and tries to use them: “How many crayons do I’ve?”  Past tense and future tense are problems in reading and writing, especially irregular tenses: “The frog jumping and eagle fly sees the frog.”  If we don’t start adding more fingerspelled words to our  family language diet, he will become deficient in vocabulary which has no signs: slippery, cliff, bungalow, tortoise.  Some people would say we should have been using these years to build a foundation for him to be speaking and talking now (preferably with a cochlear implant) instead of facing this problem of not enough signs.  Some would claim we should be using cues because you can say anything with cues.   Some would say we should have been developing ASL from the beginning, and then Nick would have one complete language to use to learn English in the written form.  Maybe some feel we should have given our child to some nice Deaf family who would have been able to meet all his needs with no “grieving process.”

We believe God gave Nick to us.  And God gave us to Nick.  It is our responsibility and joy to “train up” Nick and to do it with understanding and love.  To do this we must know our son’s weaknesses, help him develop his strengths, and respect his own vision for his life.  At the same time we continue to search for the Truth…what is God’s purpose for our lives, and Nick’s life?  We truly believe (most of the time) that God knew what he was doing when he made us a family. No other parents could love Nick more.

Hopefully, you have gained some understanding of our perspective after reading this.  I have gained some understanding after writing it.

With every good wish,

Charlotte Wilhite


My favorite ukulele player




My favorite ukulele player? That’s a hard one! I don’t know them all, yet!

Jake Shimabukuro is pretty amazing, though! He does all kinds of unusual things with the instrument, and has been playing since he was four! He doesn’t sing, he just plays. So, he has to be one of the best 🙂 My hubby and I went to one of his concerts in Dallas last year.  

Then again, I love the way Iz sounds when he sings and plays.  So mellow and happy.  So sad he died too early.

This girl has unique style and skill. Amazing!!

America’s Got Talent winner, Grace Vanderwaal.  Quirky, cute 🙂 She’s not so much a ukulele player as she is a songwriter…but, it’s all one adorable package.  Oh, I hope she doesn’t get ruined like some other young artists have, by demands of fame and fortune.

So many tutorials on YouTube!! Check out Cynthia Lin

Ukulele Mike



The Ukulele Teacher


I think this kid is pretty cute.  He’s on YouTube teaching ukulele.  This video is pretty old, and his ukulele is out of tune, but I still love it.

YouTube is great to find people who are so much fun to listen to and watch!

James Hill

These girls:


And this is probably the prettiest song I’ve heard on ukulele:


Here’s some of the Kamaka family (of Kamaka Ukuleles) standing around in their ukulele factory, playing some Hawaiian music with Jake Shimabukuro.   I LOVE the ukulele in Hawaii.  Kids, grannies, and everyone puts on colorful clothes, sticks flowers in their hair, and will sing and dance at the merest hint of a suggestion.   It’s so easy to get together with other people, and just play and sing.

There are tons of ukulele players  I love to watch and listen to! So many people, different ages, different styles, all enjoying the ukulele!  See why I like it?  It’s FUN!!!

Happy playing,





This is another post that was written a few years ago.  I’m just saving it here so I can find it again some time when I’m feeling incompetent.

Pretty good day yesterday.  I took one patient and helped do stuff on others.  I felt like I made a difference in my patient’s life.  He started the shift in the fetal position, barely sentient and begging to go back to sleep.  And over the period that I was his nurse, he progressed to walking around in the halls and smilingly pronouncing his lunch ‘Yummy.’ He was happily anticipating discharge later in the day, when he told me I was a wonderful nurse. He had just refused pain medication, telling me he was going to ‘get off it.’

I triumphed over the Medicell computer charting system.  Maneuvering from screen to screen, with deft mouse clicks to ‘SAVE’, I wrapped up my charting just as the second hand snapped to shift change.
It took close to 45 minutes to locate the nurses on next shift and give our reports.  I had to force my patient on the next RN, who somehow seemed in denial that she was actually assigned him.  She argued with no one in particular, “I agree to stay and den dey make me take all dese patients who are to go home.  Dis is not my agreement.  I don’t have to do dis.” She disappeared and a few minutes later, reappeared with an armful of masks, spilling out of her arms.  She sputtered, “Dese tings make de biggest mess when I open the pack.  I am NOT putting dese in order.  Ju can take my license if Ju want.”  She walked away while I was in the middle of reporting.
My preceptor called to postpone an appointment she had made for 4 pm.  She sat down in front of my yellow folder.
Then, the cluster of  Student Doctors appeared.  I saw them, in their light blue scrubs, moving in a herd down to MY PATIENT’s room and then…turning right into it.
Just as my preceptor was about to open my yellow folder, a pimply faced intern rushed up to the station.  “We need a Q-tip,” he announced.
I got up and went to the supply room. My preceptor jumped up and followed, calling, “You’ll never find it, I’ll have to show you where they are,” which was probably an accurate statement.  The young man snatched the cotton swab and raced back to my patient’s room.
Settling back into our chairs, I watched as my preceptor perused my evaluation sheet.  Her pen hovered over the 1 2 3 4 5 6 7 8 9 10…near the 8…and just as she was about to circle a number, a girl of about 19, wearing a light blue scrub outfit, appeared in the doorway.  “Do you have any Iodoform gauze?” she questioned.
My preceptor lost her focus, rose, and headed to the supply room.  Wishing my preceptor believed in my ability to locate the needed gauze, but grateful for the support, I trotted along behind her, with the docky wocky bringing up the rear.
Two sizes of gauze were offered.  The girl doctor selected one, rushed down the hall and disappeared into my patient’s room.  I wished the group of them had been there earlier in the day, for example, NOT at shift change.
Moments later, my preceptor was finishing up her comments and almost ready to sign her name.  I had already dated the form and all she needed was to put her signature on the line.  Suddenly, another blue-scrub clad person’s shadow darkened the room.  “We need you to help us give this patient some pain medication,” he stated authoritatively.  I looked longingly down the hall, where the RN taking my patient for the next shift was shuffling her papers.  Before I could volunteer, my preceptor was already at the Omnicell drug dispensing system, entering information and taking her WorkstationOnWheels down the hall.  I knew with the 8 doctors, the patient, family, and WorkstationOnWheels, I would never fit in there.  Staying at the station, I shuffled masks into orderly stacks.  In a moment, my preceptor was out and back at the desk.
Finally…she signed it.  Finally…we left.
Sigh.  I can’t wait for the next shift.  Hahahahaha


On occasion, the little committee of people in my head has a meeting.  They bring up all my faults and mistakes.  “She’s bitchy, and she’s impatient,” one of them says.  “She’s fat.  She has no energy.” remarks a particularly callus one.  “She’s just lazy.” “She’s getting old,not as bright as she used to be.” “She’s just BORING.”

When I start feeling down and discouraged and unworthy, it always helps to pull out this letter from my friend Nancy.  She wrote it a couple years ago, when I needed a letter of recommendation for a job interview.  I told her it was the mother of all letters of recommendation, like a ten minute standing ovation on paper, and I was going out immediately to get the job of Wonder Woman.

In reality, I’m a mere shadow of the person my friend describes.  The truth is, my friend Nancy is the one made of pure gold, and everyone in this world should have someone like her.  I just don’t know how I got so lucky.  Reading her letter always raises my self-esteem, because I love Nancy, and she believes these things about me, and that means I’m Worthy.  This letter is a treasure, and this is the sandy beach internet X where I’m digging the hole to bury it for safekeeping.

So, here it is:

To Whom It May Concern:

It would be difficult to sum up the many excellent qualities of Charlotte McCall — having known her for over forty years — but I would begin with the word Empathetic.  Her ability to quickly zone in on the person — no matter what age or type — allows her to use her nursing skills and flexibility to give the best care possible.  The very minute she walks into a room, she is prepared, eager, focused, and absolutely competent to handle any patient or task.  Even outside of the profession, Charlotte is a natural care-giver and nurturer.  She has made the journey to my home over the years to care for me and my family post-childbirth, after minor surgeries, even some personal losses, and she has taken joy in being a part of the healing and restoration process.  I can think of no other person better qualified or suitable to have on board in any home or institution when it comes to nursing care.  Charlotte McCall’s boundless energy and enthusiasm translates and transcends through every challenge with compassion and strength.

The next term that describes Charlotte is Creative.  She is literally able to “make a silk purse from a sow’s ear,” because she is undaunted even when there are limited materials.  Her talent for improvisation is remarkable, and she is never rattled when things don’t go according to plan, or because there is a lack of something specific to get a job done.  Her dexterity and intelligence almost make her over-qualified for nursing, but she thrives on using her skills with people in need.  She brings relief and joy with her wherever she goes, and becomes a vital part of any team.  Her confidence and experience allow her to be able to perform on her own without supervision, or to be flexible as a team member, or to lead as example and organizer.  Charlotte McCall does not have an ax to grind, or a fragile ego that needs coddling, or to prove herself to anyone.  Her goal is to be the best nurse for the situation and the patient.  She assumes and respects that others feel the same way, and always assumes the best of others.

For the sake of brevity, I end with the word Qualified.  Charlotte has written published articles related to guidelines for families and children for Deaf Education world-wide.  She has presented at national conferences from San Francisco to Washington, D.C.  She is fluent in American Sign Language.  Charlotte has cared for infants, toddlers, teenagers, adults, and the elderly.  She has worked in hospitals, clinics, and home health.  She is a life-long student, eternally curious, adept at discussing biology, health, mathematics, chemistry, and all topics related to the care, growth, function, and healing of the human body.  Charlotte McCall embodies the spirit of what every health care professional strives for — understanding, creativity, empathy, and implementing her skills for the sake of doing everything she can to be helpful.

Please feel free to contact me if you have questions or want more information about Charlotte McCall.  I am happy to tell you how this remarkable woman as sustained me as a friend and affected my whole life and family.  I am familiar with her origins, her family for three generations.


Nancy (last name withheld)

Soup Mix in a Jar


Soup Mix in a Jar
Your friends and family will love this pretty soup mix in a jar that makes a nice, easy supper!
Use different colored ingredients for a festive look.

Layer in a pint jar, as listed (top ingredient at the top
of the jar):
1/3 cup uncooked pasta (to fill the jar) (we used whole wheat mini-shells)
1/4 cup dry lentils (orange)
1/4 cup split peas (yellow)
1/4 cup uncooked rice
1/4 cup dry split peas (green)
2 T. pearl barley
1/4 cup lentils (dark green or brown)
1 bay leaves
2 T beef, chicken or veggie bouillon granules (or two cubes)
2 T cup dried onion flakes
1/4 t. black pepper
1 t. dried garlic powder or flakes
1/2 t. dried Italian seasoning

In a pint jar, layer the ingredients as listed. Using a jar funnel will help keep messes to a minimum. At the top, wrap the pasta in plastic wrap, and place in the jar. Add enough pasta to completely fill the jar all the way to the top (this will help keep the layers from shifting). Seal tightly. You can cover with decorative cloth and tie with a ribbon or string (Use a rubber band to secure, then remove the rubber band after the ribbon is tied).
Attach an instructions label to the jar.
Include the tomatoes, sauce, and some cornbread mix, if you like!

INSTRUCTIONS (tie this label to your jar)

How to make Soup in a Jar
1 half pound ground beef, turkey, pork, ham, or Italian sausage, or leave out the meat for a vegan version!
8 cups water
1 14 oz. can diced tomatoes, with juice
1 8 oz. can tomato sauce

TO PREPARE SOUP: Remove pasta from top of jar, and set aside. In a 6 qt pot over medium heat, brown beef; drain excess fat. Add soup mix, tomatoes, and water. Bring to a boil, then reduce heat to low. Cover, and simmer 1 hour. Stir in the tomato sauce; bring to a boil, add pasta. Cover and simmer 30 minutes. Serve with fresh cornbread. The person who finds the bay leaf gets to do the dishes! (serves 4-6)

I am making this up and pretending to be an adult.