Raleigh

So its been 6 months now that I have lived in Raleigh, NC. I moved here July 3rd and I find myself working a 24 hour shift tonight December 8th. So many things have happened, occurred, and challenged me. Everyday is a new opportunity for me to grow, learn, and evolve.

Is it everything I wanted it to be? I'm not sure that I had ever designed a clear idea of what I wanted, so I'm not sure that I can honestly answer that question.

Do I like my job? Yes. It is challenging. Duke Raleigh isn't the busy metropolis of Vanderbilt or even OU. I miss taking care of really really sick patients. I miss working with residents and interns and fellows. I miss having discussions about the most up to date articles and listening in on an impromptu lecture by renowned Attendings about who knows what critical care topic. I miss wearing light blue. But Duke Raleigh is training me, teaching me, and molding me into the Acute Care Nurse Practitioner I've always wanted to be. Not having residents and interns affords me greater opportunities to preform procedures because I don't have to fight for my turn. Duke Raleigh is a small community and reminds me a lot of NHC Place (a place I dearly love and miss). Duke Raleigh allows me some autonomy that would be difficult to achieve at other places. As I've always said there are positives and negatives to everything.

Moving and becoming accommodated to a new environment has been challenging as I knew that it would be. It's always hard to start over. I can't say that I miss Oklahoma as it is not my home, but there are aspects of Oklahoma that I deeply miss. I miss my condo a great deal, it was truly perfect for me. I miss being close to my parents and other family. I miss a couple of friends. At times, I really miss being a nurse, but then I smell poo and that thought leaves me (not that I don't still help clean poo from time to time. but overall, there is not a great deal I miss about my time in Oklahoma. I miss Nashville, Brentwood, Franklin, Concord Rd., my home. I miss the comfort of having 100s of people know me in a way that only time provides. I miss having a place where everybody knows my name. I miss knowing all the roads inside and out, the shortcuts, the best places to eat, I miss home. I miss the people. I so dearly miss the people. I miss the land, the trees, the hills, the smell of the air in that place, the cleanliness of the medians, the manicuredness that is Williamson county. I miss my home. I don't know that that grief of losing Nashville will ever leave me. I don't know that I will ever stop missing my home. Maybe in time. It will forever be my benchmark.

Moving has afforded me Ruthie. That little dog has brought me so much comfort, joy, peace, entertainment, love, and companionship. If I never have children I will forever be thankful for Ruth. Each day with her is a blessing. As silly as it sounds I truly believe that God created her just for me. For that I am forever grateful.

I don't know how long I will sojourn in this town, how long I will live in the place, work at Duke Raleigh. But for now I'm okay with where I am and what I'm doing. I never imagined I would find myself in this place, but I'm sure that it is much better than other places I could have found myself in.

Considering the extreme changes that have occurred in my life the past 4 years, I suppose that when I reflect on just the past 6 months of my life, I would say that for now I'm doing alright. And I'm good with that. I'm good with that.

Ruthie

For years and years and years. I've wanted my very own for a very long time.

Today I adopted her. Looking forward to the coming years.

Living the Dream

I have so much to say. So much has happened these last 5 weeks. I'm not quite there yet, but I'm on my way to living the dream.

I admitted 2 patients from the ED to the ICU today. I wrote all their admit orders and "tucked them in" before I left.

So many many adventures are headed my way. I'm finially getting the the place I was traveling to.

I worked 56.5 hours last week. And it still wasn't enough. Loving life. Love Duke. Loving me.

Happenings

It just happened. I didn't really realize it and then it was. I suppose the last few years this is how I have felt about all of life - that it's just happening to me. I think somewhere along the way life got so stressful and so busy that I removed myself from myself and stopped being an active participant and just simply allowed life to happen to me. I feel as though I'm watching a movie sometimes. I forget that I'm an active participant. Maybe I'm not an active participant but simply a passive player in the movie starring me about me.

I went on a code the other day. Like most of the codes I've been on the patient didn't make it. We coded the patient for half an hour. As I did compressions on his chest to force the blood through his body I felt his ribs cracking underneath my hands. With every compression there was a break, a crunch, an abnormal movement. As I hovered over him thrusting my hands up and down I looked over at his face. I knew he was gone. There was no spirit, no reaction, no spark in his eye - they were glazed over. When the resident finally stopped the code and called the time of death I stopped compressions, he died, whoever he was. I didn't know his name. I didn't know why he was here. I didn't even know what was wrong with him. There were tons of people milling around. I grabbed the cart and went back to my unit. And that was that. Life just happened to him.

I do not want my eyes to be glazed over while I am living. I don't want life to be happening to me. The days happen so fast. It seems like there is never time. I feel sometimes like I am chasing life down instead of leading or going with. I suppose I need to learn to relax, I need to learn to let go.

I remember sometimes what it was like to be. I see that I will be there again. It just takes time to resume one's self.

Moving On

I flew out to North Carolina a few weeks ago. It was my first trip to the state.

I flew into Raleigh and was there less than 48 hours. It was a tiring, intense, trip. I flew in at 12:09 am on Thursday and flew out at 5:30 pm on Friday. I went for a job interview. I had 4 interviews on Thursday, 6 interviews on Friday, and 1 phone interview on the following Tuesday.

If I were to sit down a year ago and create the perfect job despcription for the perfect job, then this is exactly what it would be. Everything I have wanted, worked hard for, and desired lies within this opportunity. The job is for a new critical care service in a 15 bed intensive care unit that is looking to heavily rely on acute care nurse practitioners. In this job I will be responsible for managing the care of critically ill patients in the ICU. I will write the orders, do procedures, collaborate with the medical staff, the neurosurgeon, the cardiologist, the pulmonologist, and the anesthesiologist.

The service is scheduled to go live on September 1. September 1 will be the start of a new beginning. But every new beginning comes from some other beginnings end. What's ending is a 4 year long journey that involved working full-time and night school, two amazingly wonderful nightmarish years at Vanderbilt, and a year working as an ICU nurse. These past 4 years have served the sole purpose of preparing me for this time, for this moment. I suppose I'm overwhelmingly excited. I suppose I'm terrified beyond words. I desperately hope I'm prepared and ready and able. I know that I will have the utmost of support and training. I reflect on a previous post "Living in the Shadow" and realize that what I'm about to do is step out of the shadow and step into my dream, into my goal, and into the reality I have worked so hard to have.

So, I'm moving - again. It'll be the 5th place I've lived in 16 months. It'll be the 6th state I've lived in. It'll be the 2nd time I've moved to a place where I didn't know anyone. Essentially I'm starting all over. Again.

So, on July 5th I will begin working at Duke Raleigh Hospital as their newest ACNP. On July 5th I will step out of the shadow and be in the reality I have worked for years to have.

I flew out to North Carolina a few weeks ago. It was my first trip to the state, but it won't be my last.

Consequence

To every action there is a consequence. Every choice, every decision, every move committed results in a response, a consequence. We tend to think of the word consequence as a negative term, possibly because we associate it with discipline and receiving the "consequence of our actions"; but in reality, the concept and idea of consequence is neither positive or negative, it just is.   I could go into the story of my evening at work the other night, but I won't. I won't because it would simply be me ranting and raving about the nurse I followed and then the nurse that followed me. There is no benefit in my complaining. There is no benefit in my rant. The issue is really centered on actions, attitudes, personal responsibility, and the result of those things, or the consequences.     We never know the rest of the story in life. We do things all the time and have no real way of knowing how they will affect others. Sometimes, unbeknownst to us, we commit actions that will have an effect 20 years from now on someone we may never meet. When we stop to ponder the power, the effect, and the impact our actions, even our most minor actions, have on others, it should cause us to evaluate our motives.   My actions result in consequences that effect other people. If those consequences have a negative effect on others, then they may take actions and make decisions based on those consequences that result in negative consequences for another. Little acts can so easily be like dominoes, effecting everyone in their path. The same can be true for positive consequences though. Understanding this concept and evaluating this paradigm can result in an overwhelming burden of responsibility to chose every action with careful thought; it can also be very empowering to evaluate the potential impact our actions can have on another.   Since first hearing the poem "Invictus" by William Ernest Henley in 2001 I have had a deep admiration for its words. When summing up these ideas of mine focusing on consequence I can think of nothing better to end with than the last two lines of the poem:   "It matters not how straight the gate, how charged with punishments the scroll, I am the master of my fate: I am the captain of my soul."   We truly have complete control over our actions, our attitudes, and our motives. Free will to use in determining our purpose. It is a great gift to be the captain of one's soul. We do not always acknowledge this gift. The consequences of our actions however acknowledge us and leave behind our legacy for others to encounter.

Stat Counter

I often wonder why anyone would read the ramblings and wonderings of my blog that I post for the whole world to read. I frequently monitor the IP addresses who visit my blog from a website called Stat Counter. There are some IP addresses that I am able to identify and know them to be a certain person or persons, then there are tons and tons of other IP addresses and I have no idea who they are. Yet many of you unknown readers continue to frequent my blog on a daily basis and I appreciate your interest in me and my little blog. I have found over the past few years that blogging, while I enjoy it, can often be a burden and just one more thing in my life I have to maintain, but I don't for see quitting anytime in the near future. I write for myself really and for no other reason. But I often feel that my infrequent writing may be a disappointment to my "followers" that will eventually result in their lost of interest. So to those of you who read my blog, thank you for your devotion and I'll try and write more.

If you care to reveal yourselves I am interested in knowing who some of you are:

• Springfield, Missouri - Extended Stay Hotels
• Antioch, TN - comcast cable

and anyone else who wants to come forward. I respect your anonymity.

25 Random Things About Me

I came across a post today that I had written on Facebook over a year ago. Reading over it made me smile and caused me to reflect over the past year. I wondered what changed, what has stayed the same, and how I feel about those things now. 1. I've been completely consumed by graduate school the past 1.5 years and it has made up my everyday life. I really miss feeling like a regular person and fear that I will never feel like a regular person again. Well, in some ways graduate school feels like yestereday and in other ways it feels like a hundred years ago. I miss school, I've said that before, but I'm so glad that it's over. I don't know that I feel like a regular person yet, I'm not really sure what that is, or what that's supposed to feel like. 2. Sometimes I feel like life is happening to me and that I'm not participating in it. I feel like that all the time really. I still feel this way, though not as much as I did this time last year. I suppose in some ways I will always feel that. I feel that I have more "control" over my life now. I don't know that I feel any more secure than I did before with that control though. 3. I love my sisters more than I understand. Their presence in my life has helped define me, helped shape my character, and allowed me to be who I am. Today, I know this to be even more true than I did a year ago. 4. I miss my parents. They have been the greatest, most supportive people in my life. They have encouraged me to be and do and live. They have taught me the meaning of love, commitment, purpose, respect, and diligence. They have always unconditionally loved and accepted and encouraged me. I have been truly blessed by them. I don't miss my parents anymore. They live around the corner. I'm blessed to spend my days with them. 5. I have had some amazingly wonderful friends in my life. I am truly blessed to have known so many wonderfully phenomenal people who have accepted me for me. This is still true. 6. The last 2.5 years I have pulled away from a lot of people and pushed a lot of others away. I don't really know why. We don't always know why we do what we do when we do it. Sometimes life takes a while to understand. Sometimes you never really understand. Sometimes you understand too much. 7. I don't really have a home. I've lived in 5 states, went to 3 different high schools, and just recently changed my address again. Since this post I changed my address 2 more times. Who knows how many more times I will. 8. I really miss having a dog. I suppose one day I'll have one again. 9. I wish I had time to finish my pilot's license. I'm embarrassed that I haven finished that and really wish I had more time to devote to it (and money). I know that I will accomplish this goal one day. Now is still not the time, but when it is, I'll know. I'll finish. 10. I'm in a SIGNIFICANT amount of debt from school loans. I really try to ignore that. I can't ignore it anymore. They are all consolidated; all 147K worth. I get to think about it every month for the next 25 years. 11. I've been enrolled at 5 different colleges. (Somebody needs to make up their mind!) I think I'm good for awhile. I'm sure that bug will bite me again though. Maybe I'll make a dent in #10 before it happens though. 12. I'm not very good at managing people. I demand too much and appreciate too little. This has not changed. 13. I demand too much from myself and even when I excel I'm still not satisfied, sometimes I get tired of being me. Hmmmm. Don't have much to say about that. 14. I can't wait for August the 2nd, but I know when this time in my life is over I will really miss it. The challenge has been exhausting beyond words, but I've enjoyed it. The most rewarding challenge of all my life. 15. When I am older I want to play a lot of golf. 16. I've been on 2 different bowling leagues. Bowling is fun. Bowling is fun. 17. I like to travel. Traveling with friends has been one of the greatest adventures of my life. I really miss traveling. 18. When I was 9 years old I woke up out in the middle of the country. I had sleptwalked out to the middle of nowhere and wondered around in the dark for hours trying to find my way back. Now I just wake up in the shower about to get ready for the day (or night) or wake up walking around my house thinking someone's there (but not in a scary way). 19. I own a gun. Boom. Boom. Pow! 20. I love having little friends and with I had more time to spend with them. (Haydn, Louise, Jonah, Ava, and #5) And now there is June, Sophia, and #7. I really try to be a good aunt. 21. I look forward to buying a house. I really like my house. I'm glad that worked out. 22. I wonder where I will live in six months. Funny, I'm still wondering that. 23. I miss playing basketball. I miss running cross country. I miss being an athlete. One day, I will be an athlete again. I know this to be true. 24. I love myself. I try very hard to do that. Sometimes this is very hard and sometimes not so much. 25. I wish life didn't happen so fast. Yet here it is, a year later. Thoughts to ponder. Words to wonder.

I suppose you could say I've hit the wall. You know, that point where you are done. I never wanted to be a nurse. When I quit my job to go back to school it was to be a nurse practitioner, not a nurse. In fact, when I realized that I had to be a nurse before I could be a nurse practitioner I was a little surprised. Although it makes complete sense. Then when I realized I would need to actually work as a nurse before I worked as a nurse practitioner I was a whole lot surprised. Like I said, I never wanted to be a nurse, I wanted to be a nurse practitioner.   I'm a good Nurse. I have a good repertoire with patients and their families and I do my job. But I'm a better Nurse Practitioner than I am a nurse. I'm only better because I have more passion, more desire, and feel more purpose in that role.   Being a Nurse is one of the most humbling and beautiful experiences I have ever known; caring for people in the most intimate of ways. Touching, healing, giving.   Being a Nurse is one of the most noble professions. I do not regret or resist or dismiss my place here. But this role is temporary.   I am learning and growing and I will be a better nurse practitioner because of my time in this place. But I often feel that I am majoring in minors and sharpening tools that will soon be placed in a toolbox to remain unused. All the while I feel my nurse practitioner skills are dulling and little by little I am becoming less qualified with every day that passes.   I have worked 5 of the last 6 days, so maybe I'm tired. The last 3 days of work have been exceptionally unfruitful and I have used very little of my talents and skills. I have functioned as a glorified babysitter. I did not pay an exorbitant amount of money to wipe bums and be a babysitter, yet here I am.   I resolved to work as a nurse for 1 year. That means by this September I must take a new job in a new place and begin again, only then as an Acute Care Nurse Practitioner. But where to go and what job to choose? Many of my ACNP peers chose not to work as nurses and went straight into ACNP jobs. I question if I should not have just done that. Since August I have been offered a few ACNP jobs with good pay and benefits and I have turned them down. I question that too. But I didn't just want any job. I know the kind of job I want. A critical care ICU job. I know there are few places that job is offered: Nashville,  California, some places up North, some Texas cities. I know that I needed at least a year of critical care nursing experience to get that job. So here I am, getting my year of critical care nursing experience.   I've thought a lot about the various avenues I'm willing to take to get that job. The next 7 months are going to be full of questions, full of choices, and full of decisions.