Sunday, December 20, 2009

I suppose it was a right of passage, though definitely one I could have done without.

I got splashed at work tonight - It's not even a good story. I was taking care of my patient and some of his blood splashed in my eye. So I had to go down to the Emergency Room, fill out some paperwork, pee in a cup, have some blood drawn, and have some of my patients blood drawn. An hour later (I was shocked it wasn't longer), I was back on the unit working.

I got a call later that everything was negative.

There are lots of risks we encounter everyday: HIV, Hep B, Hep C, MRSA, VRE, Nec Fasc, etc. The risks are low though. They were tonight anyway.

Thursday, December 17, 2009

Night Shift

So as I've said before I'm working the night shift.

For those of you who don't know me well, I am NOT a night person. I've always been a 10 o'clock bed time observer and have always adhered to that. In high school, if I went to a youth group lock-in I would always go home around 11. It was beyond me to think that people would stay up late "just for fun". Why is that fun? Why would one stay up late when they could be sleeping? The few times I have stayed up late, I try and sleep in the next day and then just feel like crap for the next few days. So why would one do that?

I don't even stay out late when I go on exciting vacations. In fact, I have left my group early to go back to the hotel and "crash" while vacationing in New York City, Chicago, Las Vegas, and London, England (just to name a few).

I studied a lot in all my years of college, but I never once pulled an all-nighter.

That's not to say that I've never stayed up past 10; I have even stayed up til midnight talking with friends at times, or watching a movie, or being involved with some other nonsense. But as a whole I am not a night owl, not a late nighter, not a night person.
So, I'm working the night shift.

I realized, when I got off from my first shift, that that was the first time, in my 30 years of life, that I had stayed up all night long. I quickly came home and completely crashed, only to wake up at 12 noon. It took me a few weeks to actually sleep a full nights worth during the day. I had bags under my eyes and found myself yawning all the time. Things are better now, I usually go to bed at 8 am and wake up around 4 pm. I don't always get out of bed till 5, but that's okay. So I'm doing a lot better on days that I'm working, but on days that I'm off I'm completely screwed up.

I've never been one to lay in bed all day. I suppose I have felt like that was lazy and that isn't a characteristic I ever cared to possess. Previously, the latest I've slept in was 9:00. Now, on any given non-working day, I don't wake up til around 10:00. I'm not able to go to sleep though until midnight or 2 in the morning. I never thought that I would have trouble sleeping or that I would stay in bed so late, but that's where it's at.

But overall, the night shift hasn't been too bad. I like the people I work with. I'm able to go to church on Sundays (at least once) when I work and if I worked the day shift I wouldn't be able to do that. I don't have to get up early. People are telling me I'm losing weight.

I'm committed to schedules. I love them, I always have. They give me structure, security, and expectations. I like that. So, I'll journey on with the night shift, but as soon as day shift is available, I'm jumping ship. After all, I'm a life long commited day person.

Monday, December 7, 2009


I sit, as I type this, on an airplane flying between my home in Nashville and my life in Oklahoma.

Over the past 24 months my life has been made up of some of the most significant changes I have ever experienced. I quit my job, returned to school, moved, had 2 nieces and a nephew with 2 more on the way, moved again, I have turned my friends over to time and marriage and distance and slowly began making new ones, graduated, moved again and bought a home, started a new job, began making new friends again, and now find myself in the aftermath. The steady stream of constant significant changes are now beginning to subside and I’m finally beginning to find a new “normal”, a new routine, and a new way.

We associate grief only with death, but in truth, we all experience grief from various situations and circumstances throughout life. I know that the experiences over the last two years have resulted in times of grief for me. I wonder now as I am settling into my new “normal” and finding my way if my grief is beginning to subside and I am beginning to resurface as the strong-willed, independent, and powerful self I have always been. Yet, I know that as I resurface I am not the same person I have always been. These past months have changed me in ways that I am still learning and understanding and growing from.

In what ways have I changed?
  • I now acknowledge the uncertainty of life, relationships, earthly truths, and time. We never have stability no matter how stable we feel.
  • I would say that in some ways I am much more appreciative and needy of my family, though I would say they probably have not seen or know that. Despite death, I suppose family is the one stable aspect of life that cannot be taken away; there is an overwhelmingly significant comfort in that.
  • I am beginning to understand, in ways I never did before, the substantial value to friends. I would not say that I didn’t appreciate or value previous friends and friendships that I’ve had, I would just say that their impact on my life was not as underscored as it is now. Now I comprehend the value of friends in a different way than before. I also see those “casual” friendships I’ve always had to be much more significant than I had initially valued them and I am repentant of my lack of value. I suppose those casual friendships, those people that you may not divulge your deepest thoughts to, but those people who just know you; I suppose it is those people that help to make up the idea, the concept, and the feeling of home.
  • I am, for the first time, understanding what it means to be from somewhere and to have a place to call home. Maybe for the first time I am learning what it also means to be homesick.
  • As I discussed in my previous post, I have also become calloused. The past 12 months have afforded me the opportunity to see things that I had previously never dreamed of or could have imagined. And every day those visions are more prevalent and more normal. You do not see these things and walk away unaffected. I don’t dislike the person I’m becoming because of it, but I am very aware and try very dutifully to monitor the change these opportunities are having on me.
  • I now have a significant amount of self pride. I have always been proud of who I was and what I was, but the events of the past months have called me out. They demanded I show myself and prove myself in ways I had always feared and desired all at the same time. In the end I met every challenge and proved me to myself. These events demanded I respect myself and I am thankful for that. I always have, but now I do in a way that will always give me significant internal strength and resilience.
  • I have learned that suffering produces growth.
I frequently find myself feeling so very passionate about these past 24 months of my life. They have truly been a monumental time and cornerstone that has so deeply grounded me and proved so much to me. Yet when I really think about them, my challenges, my struggles, my time, it is not so much.

Every person goes on a journey, not that mine is anywhere close to finished, but that has just been a part of mine. Other people encounter such greater challenges and struggles than I have. I have not lost a parent or a sibling. I have not overcome disability or physical limitations. I have not encountered material disaster and had to start from nothing. I have not encountered financial insecurity or done without. I have had everything I have needed from the beginning of my time until now. I have been surrounded by an encouraging family, strong friendships, important casual friends, a healthy body, financial stability, a good car, shelter, and all the amenities that one needs to succeed in life. I was not born speaking a different language or to parents who had no education. I was born into a family that gave me every opportunity that I could have needed. I was given love, encouragement, food, an elite spiritual training, comfort, and steadfast familial friendships that have conquered all things. My parents and sisters have always championed my causes. There were no disadvantages enrooted in my journey, there was never a reason why I shouldn’t or wouldn’t succeed.

I suppose the only struggles I have encountered over time have been the internal ones: confidence, diligence, endurance, determination, passion, etc. However, the innate resources given to me by my family and friends strengthened me to succeed on my journey and surpass the doubts within.

So as I travel on this plane, suspended in the air between home and my new life, I look to continue on my journey. I look to resiliently continue on as life demands. I look to continue building new friendships and casual friendships and look to maybe call this new foreign place home.

Saturday, December 5, 2009

The value and quality of life.

I have given so much thought to the value and the quality of life as of late. What is it that makes life worth holding on to, worth living, worth sharing?

I came on shift the other day and walked into my patient’s room to immediately begin chest compressions. We shocked him 3 times and finally regained that life sustaining rhythm that we were seeking. I proceeded to work harder than I ever have over the next 12 hours to maintain that life, and at the end of my shift the heart was still beating, the vent was still forcing oxygen into the lungs, and the four overly maxed out pressors were maintaining the blood pressure. It had been touch and go all night but we maintained the patient, the patient was alive.

The truth of the matter though is that that patient will die within the near future, hours if not days. The patient will die when the family finally stops their heroic fight and lets the patient go. I question their motives. Well, maybe not their motives, maybe their understanding. The patient will never regain the quality of life that was previously employed. The patient will never be the person they were prior to these events. Maybe it is the idea of the person, the memory, and the fear of loss that continues pushing the family forward to fight so hard. I see this situation often, I know the end of this story, they don’t. I know and have seen things that are worse than death. I have seen times when it would have been much better for one to die than to continue living in the state of physical torture, pain, disfigurement, and chaos that one’s body encounters in times and places of critical care. This patient’s family has not seen these things, they do not know, they do not understand, and so they hang on to this shell of a person who once was their companion, their parent, their partner, their friend. They keep fighting for an idea that by all reasonable standards is already lost.

So what is it that gives life value? What gives life quality? Is it found in our physical beings, in our bodies ability to move about and experience life and feel and know, to walk, to live independently of aid and physical support? Is it found in our relationships, in our family and friends, in our emotional experiences and encounters? Is value found in our spirituality in knowing that we are valuable and worthy and loved because of a higher being? Is value found from within, from the pride and love we have for ourselves and our abilities, our talents, the achievement of our goals, and the amount of our successes, in the way that one feels about himself/herself?

And what is the difference in the value and the quality of life? Does one trump the other? And how can one define the value and quality of life for another? How can a family know when to keep fighting or when to quit and give up?

I don’t know all the answers to these questions. I do know my thoughts and feelings and beliefs about such matters. I also know that over time I have become calloused. I am quick to give up the fight for human life. I suppose when you watch people day after day, in extremely critical situations, lose their fight, despite insanely heroic efforts employed, you become calloused. It is rare that one will triumph, it is rare that one will overcome their stay in a critical care unit. It is even rarer that a person will live a full 12 months if they should escape their stay. And yet, in the past 3 months I have encountered 2 individuals who had critical care stays >180 days who have lived more than 2 years after their event. They were not patients of mine, they were random people I encountered who thanked me for my work, who thanked me for doing my job.

My job. My job. My job is to save lives, to work to maintain lives, to keep families together. So why do I do what I do when so rarely the outcome is the one we are fighting for, the one we are seeking?

I encounter a great deal of disgusting things: suffocating smells, grotesque sites, nightmarish situations, perpetual alarming sounds, contagious bacteria, the constant feeling of my own dirtiness absorbed from those patients. Most of the really sick ones die. No matter that I worked harder than I ever have for 12 hours, they die. They will code again and we won’t be able to again find that life sustaining rhythm. The family will come in and we will watch time and again as they crowd around the bed with wet faces and weep and cry and comfort one another, only to walk away in the end without their loved one, without my patient.

So why do I do what I do?

Because there are times, though few and far between that the patient doesn’t die. Times when that patient does walk away in the end hand in hand with the family.

Because there is great value to helping one die in peace, in comfort. It is a beautiful thing to give someone a quality death.

Because someone has to talk to the family. Someone has to explain the step by step processes and actions we are performing for their loved one. I like to be that someone. I can talk to the family and help to bridge their previous state of reality to the new one.

Because I enjoy the critical situation, I handle it well. I enjoy the adrenaline rush of the code.

Because I enjoy the critical thinking, I enjoy the troubleshooting and the employment of algorithms to treat and “heal”.

Because that is what I was made for. Because God created me to be there and do what I’m doing. I know that more than I know any other thing. I feel most alive when I am there, amid those smells and sounds and situations.

Sometimes life isn’t so cut and dry. Sometimes we work to save only to lose days later. We wonder what was the point of our efforts only to lose in the end. The point was the knowledge that we did everything we could. Despite not always understanding what gives life value or quality, we still know that it does have value and quality. We fight to maintain that. We fight to honor life. We fight to honor our patients, their families, and ourselves. There is a great deal of personal validation in fighting such a noble fight day in and day out. It is a war that will never be lost just because a battle is not won. It is a war that is reaffirmed to each of us when we each go home to our own families, when we feel little arms around our necks, when we feel old eyes look at us with pride, when we acknowledge those we love. I suppose the fight for life in others is the acknowledgement of the value and quality of our own lives. So we fight for ourselves as we fight for the patient, because we are the patient in some twisted full circle way.

Life is all encompassing.

I have given so much thought to the value and quality of life as of late.