Thursday, December 15, 2011

Be careful what you wish for…

I couldn’t work at one point because my hands were covered in blood. But wasn’t that what I had asked for, what I had wanted.

I wanted a good bloody night, a code, septic shock, something. I wanted to do all the things I do one last time. And that is exactly where I found myself. I intubated, placed an arterial line, placed a central line. I was in that pt’s room for hours, hovering over that body, doing bloody things, giving a lot of orders.

I’m going to miss this. I love this.

It’s extreme stress. To have a life under your direction. Complete responsibility.

It‘s addicting. The adrenaline rush. It’s also exhausting.

My back hurts. I didn’t set the bed at the right height.

I told the family I had little to no hope and most likely they were going to die. Hours later they did. We did everything we could. I did everything I could.

I had wanted so many more experiences like this. There weren’t as many as I had wanted, as I had hoped. But there were enough. They will stay with me forever. This has been an interesting time in my life, an extreme time, a surreal time.

I have a few nights left. As much as I’m ready for them to be over, I’m not.

Be careful what you wish for…

Thursday, December 1, 2011

Awake

I should be sleeping right now, but I’m not. I worked last night and I’m back on tonight and here I am, sitting up, awake.

My pager went off a bit ago and a text from a friend let me know there’s a high probability for a chaotic night at work.

Last night was not so chaotic. It was a slow night. I had 3 patients. Only one of which was somewhat sick. I slept most of the night, not restful sleep, but sleep none the less.

I’ve thought a lot about the ICU the last few days. About the parts I like and the parts I don’t like. I find the parts I like heavily outweigh the parts I don’t. I don’t like the nights; that’s about it.

All I’ve really known is the ICU. And I love it. I will miss it. Sometimes I feel so used by God in working in critical care, I feel like I’m doing what I’m supposed to be doing. I wonder if I’ll still feel that way. I wonder if I’ll still feel used. Maybe I’m partly having second thoughts.

I am excited for a new adventure, to learn new things, to work in a new arena, to experience a new perspective. I suppose there is a part of me though, that is afraid of what I’m losing professionally, fearful that what I’m gaining won’t outweigh that which I’ve lost.

It’s funny how we tend to define ourselves by various things. I’ve grown to define myself by my work, by what I do, by my service in the healthcare profession. But I have lost myself to my work and you can’t really be who you are when you aren’t sure who you are anymore. And how can you know who you are when you’ve lost yourself?

In truth, I’m moving more for personal reasons: to be closer to family, to have a better schedule, to re-engage in life again, to have a life outside of work, to “find” myself. I don’t regret that. But I do wonder how that will affect me professionally.

Due to staffing issues, my schedule has been quite horrific these last 10 weeks. Time is a personal resource we shouldn’t waste, you can’t restore it. Those 10 weeks are gone. They’ve left me feeling exhausted, irritable, and disengaged. Sometimes I fear that I will never feel rested again. Yet here I am, sitting up, awake.

Tuesday, November 29, 2011

Meet People Where They Are

You have to meet people where they are. You just can't make any progress until you do.

Sometimes it’s hard to understand where someone is. Sometimes when you get to that point, we tend to stop listening. We get so focused on trying to get the person to where we are that we can’t hear when they tell us where they are.

When you don’t meet people where they are, they can’t hear you. Walls come up, defenses set in, the conversation becomes a stalemate, or worse, a battle. No progress is made. Both parties walk away frustrated and the original goal of coming to a common understanding is not met.

People truly don’t care how much you know until they know how much you care. You have to listen. You have to hear where they are. You have to be present for the person you’re talking to. In truth, listening gives someone all the power, all the control. When you hear what they are saying, you hear where they are, you hear what they need, what they want; then, and only then can you help them.

Communication is so extremely important; especially with healthcare. It is our responsibility as healthcare providers to educate, to explain, and to equip families and patients with information so that they can make appropriate choices, so that they can do what they need to for themselves, for their patient, for the peace they are so desperately groping for.

When we argue, when we fight, when we don’t listen, when we dismiss, we lose, the pt loses, no one wins.

In truth, it only takes a moment.

Then Jesus said, “Whoever has ears to hear, let them hear.” Mark 4:9

Wednesday, November 23, 2011

Relax

I went to the dentist today. Going to the dentist doesn’t bother me. At times I have even found it to be relaxing. I’ve even almost fallen asleep.

Today was no different, really. I laid there, my mouth wide open. People had their hands and tools in my mouth.

Then I started thinking.

These thoughts were triggered by a patient I had recently who has some mental disabilities. We suctioned his mouth and explained why. “Oh” he had said, “like the dentist”. “Yes”, I smiled, “like the dentist”.

So, there I was, laying in that chair, with peoples hands in my mouth and all of a sudden I realized how little control I had over what was going on to my body, of what people were doing to me.

I started thinking about what it must be like to be intubated. It’s incredibly uncomfortable. When I intubate people I sedate and paralyze them; after all, I am shoving something into their lungs. We then tie their hands down with restraints, keeping them safe, we don’t want them to pull their tube out. Then they wake up. They’re confused, uncomfortable, scared, agitated. They start moving around and “bucking” the vent. They’re trying to take a huge breath of air through a tiny tube. Then we do what we always do, we get right in their face and tell them to “Just relax! Everything’s fine. Just relax!”.

Relax? Everything’s fine? My hands are tied down, there’s a tube in my lungs, I can’t breathe, I’m scared and you want me to relax?

I’ve never really been in the hospital. I’ve never been the patient. I don’t know what it’s like to sleep in a hospital bed or wear that ugly gown. I don’t know what it’s like to have a foley in my urethra or stickers on my chest or a probe on my finger. I don’t know what it’s like to be inubated. I don’t know what it’s like to have an arterial line placed, a central line placed, a PICC line. I don’t know what it’s like to experience the things that I do to people all the time. I don’t know what it’s like to lay in that bed.

But I know what it’s like to lay in that chair. And as I laid there today with those hands and tools in my mouth, swalloing with my mouth wide open, aware of my surooundings but not being involved with them, I started to think about what it must be like to be intubated.

Truth be told, I don’t want to know what it’s like to be intubated, to wear that gown, to lay in that bed. But I do want to relate to those patients, those people whose mouth my hands are in.

Monday, November 21, 2011

Walking In To Work Tonight

Tonight is the 5th of 6 nights in 8 days. I really hate nights. Some people were built for them, but I’m just not. God definitely did not design me for that. I’m so looking forward to having a “normal” schedule, of being awake and alert and alive during the day, of having a life again.

I parked my car and was walking in to work tonight and realized that there aren’t many more nights that I would be walking into this building, to do this job, in this place, at this time in my life. Everything just seemed so surreal and for a moment it was like life was in slow motion. I became acutely aware of the impending changes coming.

Raleigh has been so very good to me. I came here for many reasons and chasing many things and I feel as though I received everything I wanted and so very much more. I will forever and always be thankful for this beautiful time in my life. I have received so much professionally, personally, and spiritually. I have grown, I have healed.

Sometimes life is what we make it. Sometimes life is what we allow it. Most the time it’s a little bit of both. I think part of maturing is realizing this fact to be true.

The other night I came to work and I passed a pt’s family member in the parking garage. I asked them how the pt was. “Not good”, they told me. “Fix them”, they said, “make them better”. I knew there was little to no hope for this pt. And here this family member was looking at me to make it right, to fix them, to give them back what they want. The pt died a few days later. I did not fix them.

I spoke to another family member for a long time. It was a good conversation. We spent a lot of time talking about Nashville. They had lived there in the late 1940’s. They asked a lot of questions about the pt’s future and what the outcome would be. It was sweet. They were sweet. That pt will mostly likely get better. I did not fix them either though.

I wanted to work in critical care so I could save lives, be a hero. I wanted to save people. I know now that it has nothing to do with me. I do not save or fix. I am no hero. I’m just the person that’s here, that’s involved in the decision making, but in reality it has nothing to do with me. Some people die and some people don’t. I love what I do; even more so now that I truly understand how little it really has to do with me.

My niece called me today. She got a shot in her bottom. She told me she cried. We laughed on the phone. She’s funny. I’m glad someone was there with her.

I would love to recap all of my experiences over the past 17 months, to revisit all the ways in which I’ve grown. But it would take forever and the list would still be lacking. All I can say is that I will forever be indebted for my time in Raleigh; it truly has made all the difference. And I am so much better for it.

Thursday, November 17, 2011

Moving On

Our choices are guided by various factors and variables. Some push us in one direction while others push us in another.

I can honestly say that a lot of various factors and variables have been prodding me, poking me, nudging me the last few months. This has resulted in some slow, meticulous actions on my part. I wanted to make the right choice, wait until the right time to act, be confident and sure of myself. I wanted to do what was best for me professionally, what was best for me personally.

So, I took my time. Fancied a lot of options. Engaged in a lot of discussions. Fielded a lot of phone calls.

And then I finally said “yes”.

So, I’m moving.

Yes, again!

The seventh time in 39 months.

I’ve accepted a position with the University of Texas Southwestern Medical Center as an Acute Care Nurse Practitioner on the Cardiovascular and Thoracic Surgery Service. So, I’m moving to Texas, to Dallas. I’m leaving Raleigh.

I move in five weeks.

I’ll once again be at the bottom of the totem pole.

I’m only going to be working days.

I’ll get to sleep at night.

I’ll only be three hours away from family.

I’m excited about a new area, about working in a very different arena. But, I will miss critical care. I have so deeply appreciated the lessons it has given me, the opportunities I have had, the things I have seen, the things I have done, the privilege it has been.

I will miss many of my coworkers, my attendings. Especially my boss; he has invested so much in me and I will forever be grateful for him and for the confidence, the encouragement, and the opportunities he has given me.

I am a blessed person. Life just keeps giving to me.

Friday, November 4, 2011

Killing and Saving

I have been so worried about killing someone; fearful that I would do something that would result in death, fearful that I would inadvertently take someones life.

Last night I had a patient, they were sick, but not in acute distress. The labs didn't match the patients appearance. They were sweet, alert, oriented. They were sick. I treated the problems and they looked better.  But as the night progressed, the labs weren't improving. The patient seemed to be clinically getting worse, despite physically looking better.

What was I missing? What didn't I see? I ordered some tests, ordered more labs. I watched close.

I realized, after all these many months, that I've been afraid of the wrong thing. I am more likely to not save someone than I am to kill someone. Maybe you think that's semantics, but it's not. It's not the same thing; it's very different. One is doing too much and causing something to happen. The other is not doing enough and not causing something to happen.

Ignorance is not bliss; it's a liability.

The patient looks fine tonight. They have much improved. My initial thoughts were right, some numbers just hadn't peaked yet.
 
This has made me think about some things differently, though.

Friday, October 28, 2011

Flying High

The man sitting beside me has good veins. It's funny, the things you notice when you choose to.

I'm on a plane today. Flying cross country; partly for business, partly for pleasure, completely for me.

I worked yesterday. I worked during the day. It was good, really good. I haven't enjoyed a day at work like that in a really really long time. I talked with lots of families: reassured, educated, laughed, hugged, joked, encouraged. I felt like me. I intubated this young patient; I'm really getting good at that.

I wish everyday were like yesterday. It was what I had hoped and dreamed it would be.

Lately, it has mostly been not what I had hoped and dreamed. It has been rough, exhausting, and at times disappointing. I realized the other day that I love what I do, but I hate my job. How does that even make sense?

A lot of it is the hours, okay most of it. I know that will eventually change. Things happened this year that cut our staffing in half and now there are two of us attempting 24/7 coverage. It's not working out too well. Eventually, there will be five of us again. I won't be switching back and forth between nights and days. I might even feel "normal" again.

I suppose that's the fear though, that I'll never feel normal again. That I'll always be tired. That my life will never know stability and consistency again. That I won't ever have a schedule that makes sense and is conducive with the rest of the living world. I miss sleeping at night and waking up early to meet the day. I miss having routine. I miss going to church.

The woman behind me is coughing. I'm wondering why. Does she have a cold, a virus? Is it just the change in weather? Is she covering her mouth? Or is she spraying millions of bacteria molecules into the air?

I need more sleep. I need more days that dreams were made of.

Tuesday, October 25, 2011

Best

Sometimes, even when you do your best, you just don’t do the best job.

Tonight is night 5 in 6 days. I’m exhausted. I haven’t slept very well the last few days. The pt’s have been really really sick. I’ve had a lot on my mind and I’m just not quite “on”.

I needed to call a service for a pt consult. It’s late. I’m waiting and waiting. The doc finally calls in and I give him report. I can honestly say that it was one of the worst pt reports I have ever given. Here is this doctor at home, responding to a phone call in the middle of the night, and I’m the one he gets to talk to. I don’t start at the beginning, he’s confused, I start over, I’m embarrassed and in the end he says he’ll just see the patient in the morning.

Sometimes I just need to let things go. It wasn’t my best. It’s okay.

I’m still watching the pt. They’re okay. It really is fine.

I suppose even now, revisiting the whole situation I realize how silly it is. Is it even worthy of a blog post; talking about my best not being my best.

Stress haunts us in many ways: worry, anxiety, embarrassment, fear, the desire for perfection.

Let it go.

Saturday, October 22, 2011

Thoughts

We’ve had some really sick people the last few weeks.

The ebb and flow of an ICU is a funny thing. Weeks vary so differently and yet they don’t. Sometimes a patient’s fate seems so grim and they pull through, other times they don’t seem that sick and then they die. The truth is you just never know what the outcome will be.

Sometimes working in healthcare is an incredibly satisfying field. I so deeply appreicate those days, those patients. And then sometimes it’s not. Those days are hard.

I’ve wondered a lot about my role lately, the vitality of it. Wondering if what I do really matters. There is an attending doctor above me and a nurse below me. The doctor ultimately rules and the nurse fulfills the rule. I’m in the middle of all that. I’m what’s known as a “midlevel” provider. I wonder sometimes what that really means.

I enjoy doing procedures; putting in central lines and arterial lines and intubating and even a spinal tap most recently. I appreciate the power of physically manipulating the body and seeing a definitive result; especially when it’s a positive one.

I wonder what my future holds. I wonder what plans God has for me. Where I’ll go, what I”ll do, where I’ll be.

I hate working nights. I hate the life it steals from me. I hate the way extreme exhaustion makes me feel. I hate sleeping during the day when the rest of the world is awake and alive and living. I hate the landscape company employed by my apartment complex.

I love off days when Ruthie and I can go to the park. I love to watch her. She runs so fast and loves it when the big dogs chase her. She likes to play this funny game. It makes me smile. She brings such joy to me.

It’s funny, the things that affect us, the things that mold and shape our daily lives and work in forming who we are. It’s funny how we change from year to year. I am not the same person I was a few years ago and yet I am.

Sometimes life forces us to acknowledge things we couldn’t see before, wouldn’t see before. Sometimes we find ourselves wide awake.

I had the death talk with 3 families this week, all on the same day. The next day all 3 patients died. I took Ruthie to the park. I love to watch her play.

Monday, October 3, 2011

The last one.

It’s funny how you just know when it’s the last one.

You take and you take and you take and then you’re forced to take one more and it turns out to just be one too many.

Sometimes it’s the weight of the matter.

Sometimes it’s the point of the matter.

Sometimes it’s the principle of the matter.

And sometimes you just get to the point where it really doesn’t matter.

I’m not sure which category I fall into; maybe all of them, maybe none. It doesn’t really matter though which one it is.

It’s hard. You work and you work and you work and you want so much to be successful and loyal and to grow something and to get to that place where you can look back at what you’ve done and be proud and feel accomplished. But sometimes you don’t get to that place, sometimes that journey wasn’t meant to be taken, sometimes even loyalty costs too much.

I knew the next one would be the last one. I guess I just kept hoping it wouldn’t fall.

Monday, September 5, 2011

Thankful there wasn't a #8.

When I leave this place today, I will have worked more than 75 hours this past week. It has truly been horrendous. Probably the most intense week I have known as a nurse practitioner. Seven patients died. I had so many serious end-of-life discussions with so many families; held so many crying mothers, fathers, daughters, partners. As I sit here with the past week in review I find that it is a blur to me now. I have trouble remembering the patient names, the families’ faces.

I will be off for a mere 48 hours before I must return to this place and reengage in my work. It’s funny though, the ICU that I walked into last Monday morning is not the ICU that I will walk out of this Monday morning; there are less patients, they are less critical. It’s truly amazing how one week can be so horrendous and the next can be so ordinarily common. The ebb and flow of an ICU can be a fascinating thing. One week is hectic and horrendous and intense and the next is common and easy and of no consequence. A different Attending will walk on today and the insanity that was last week will not necessarily touch the normalcy that is this week.

How easy life goes back to normal.

Yet it really doesn’t. There are seven families who went home this past week and are now facing life in a manner in which they hadn’t anticipated. Their lives will never be the same again and their previous state of normalcy will now morph into something else, something that in time will become familiar, but is so strikingly foreign right now. I wonder how long that transition takes. I wonder if that transition really ever does take.

The Attending for this week just called. I reported off to her, told her of the horrendous week we just had, told her of the good place the ICU is currently in. We laughed about simple things in life. She is sweet. I hope that she has a good week.

…and life goes on.

Saturday, September 3, 2011

A Shield About Me

"As long as there is a beat and a breath, do all you can!”

That’s what the family told me. But I knew from the moment that I laid eyes on the patient that they wouldn’t make it through the night. I knew we would code and code and code and that eventually I would have to call it. I knew we would reach a point when there would be no beat, no breath. And in the end we did.

I don’t know that doing all we can is the best thing to do. In the last moments of life I do not want someone pounding on my chest, feeling my ribs break under the force of their arms, having air forced into my lungs, feeling hands in my groin searching for a pulse, having a central line stabbed into my neck, being repeatedly shocked by the defibrillator. I don’t know what the patient felt or knew, but I hope not much.

Doing all we can sometimes means doing harm. We worked so very hard and in the end it profited nothing. I eventually called it. The patient was dead. Had the patient really even been alive since the moment I saw them?

I think I’ve always wanted to be the go to person, the person called to come “save the day” in intense situations. I wanted to be responsible. Now, being in that position, I realize the complete weight of that responsibility; I did not previously understand the stress of that burden. This past week I worked a couple shifts and found the weight of that responsibility almost unbearable. Lives depended on my thinking, my aptitude, my knowledge, my choices. I love what I do, I find joy in my work and in my practice, but it is also a burden. Sometimes the joy outweighs the burden and sometimes it does not.

Sometimes I make inappropriate jokes during extremely stressful moments. I emotionally take myself out of the situation and converse with others in the room about the weather, the smell of vomit, the tattoos found on the patient, anything else. Joking helps. We all laugh.

But sometimes I’m already emotionally invested, there are no jokes. I feel the weight of the world on my shoulders, I crawl deep within myself, I become short with the nurses, I become the burden I feel. In moments like those I often feel all alone. Ultimately I’m the one responsible and there is no one to help me.

I don’t know why, but when I find myself in extremely critical situations at night, I usually find myself partnered with the same nurse. She’s been a nurse a long time. She does her best to help me in whatever situation we find ourselves in. Recently, we were once again in a critical situation, the patient wasn’t fairing well. I was getting frustrated. I was trying to put a central line in and I was having trouble, I couldn’t find the vein, the patient needed it quick. The room was quiet. And there she stood, this nurse, assisting me. And then, during the midst of that extreme stress, she began to pray. It was a short prayer, my eyes never left the site I was working on, but my ears were on her words and my heart soon followed.

The truth is I am the one responsible. But the greater truth is that there is someone to help me.

A dear friend recently sent me a CD. I have listened to those songs over and over lately. As I walked into work tonight, with the weight of last night still dissipating from my mind I found the words to one song filling my soul.

“Thou, O Lord, art a shield about me
You're my glory
You're the lifter of my head
Thou, O Lord, art a shield about me
You're my glory
You're the lifter of my head

Hallelujah
Hallelujah
Hallelujah
You're the lifter of my head

So, tonight I will say to myself, “As long as you have a beat and a breath, do all you can!” And I will, because I’m not alone, never have been.

Tuesday, August 23, 2011

My little BFF

She says, “I’m her BFF”, and then she giggles. It makes my heart smile.

Haydn, is my oldest niece. And I so dearly dearly love her. I’m often asked if she’s my favorite. I find that question mildly offensive; I’m not going to choose any of them over another. So, the answer to that is no. I don’t have a favorite. I love each of the children (Haydn, Louise, Jonah, Ava, June, Sophia, Caroline, Sweet Nicholas, Baby 9, and Baby 10) as much as the other one, just differently.

I have loved Haydn longer. I have played with Haydn more. Life has afforded me an opportunity to invest more of myself, more of my time with her. We are sweet friends.

Haydn struggles. She has dyspraxia. I don’t completely understand that. I don’t really get it. This isn’t something however that’s wrong with her, it just something about her that’s different from most people. It means that she has a motor learning difficulty that can affect planning of movements and co-ordination as a result of brain messages not being accurately transmitted to the body. So, it doesn’t affect overall intelligence or ability, but just affects particular aspects of development; so she’s not stupid, slow, or autistic. She’s dyspraxic.

People see what they want to see. They hear what they want to hear. They conclude and decide what they want to. It is not my responsibility to raise Haydn, to make decisions for her, to train her up in the way she should go. My only responsibility to her is to love her, to support her, to be the BFF she believes me to be. I hope that I always meet her where she is and not demand that she be more than she can.

I stood right outside the hospital door the night she was born. I waited. I heard her first cry. I found tears streaming down my face. I had a niece. I had a little friend.


I hope that as she grows I’m the big friend that she wants and needs me to be.

Monday, August 22, 2011

Responsibility of Choice

Sometimes it’s hard to know what to do.

You debate. Do I chose A or B? Do I or don’t I? You wrestle with uncertainty and find that you are frustrated with your own indecision and insecurity on the matter. Choices can sometimes become so burdensome.

And yet, all the while there is a small voice, a gut feeling, that presides within you, that is telling you what to do, that is attempting to lead you, that wishes to be heard, acknowledged, followed.

Why is it that we sometimes find ourselves shying away from that voice, from that gut feeling? Was it not designed to lead us in the right direction? Was it not telling us the way to go, the choice to make?

Fear is often the dominating voice that directs our choices, that quiets that voice within us. We hold on to fear as if it had the power to save us, when in actually it may be the thing to destroy us.

I don’t always know what the right thing to do is. I don’t always know what is best for me, so how can I know what is best for my patient?

“We all make choices”. I say this all the time. I say this to mean each person is responsible for the consequences they create, each person has the freedom to choose something different. But sometimes we’re wrong, and the choices we make aren’t good, and we’re still responsible. We made the choice.

Placing one’s self in a position of authority results in one bearing a great deal of responsibility. There are times when I have found that responsibility to be quite heavy, scary, and grave. I did not know or understand how heavy a weight it would be until I felt it on my shoulders, until I carried it on my back.

I sent her out. I brought her right back. I shouldn’t have sent her out. I knew that. I did it anyway.

We live. We learn. We grow.

Wednesday, August 17, 2011

Unicorn Spotting

There are some things we hear about all of our lives. We learn about them in school, study them in our history books, imagine them on television. But the reality of seeing such things is rare and unique and invaluable.

I had such an experience today. Something I have heard about all of my life. I studied about it in school, learned about it in history books and novels, and watched many a movie in which it was featured. Today was not a history lesson, a story, or a movie; it was reality that I encountered.

I suppose the experience was surreal. Yet it was beautiful and magnificent and truly a chance of a lifetime. The sight was one of aged beauty of overcoming significant tragedy.

A few years from now this opportunity will definitely be obsolete. Time with result in extinction. Life, therefore, demanded that I soak up this opportunity.

And so I did.

It’s not every day that you encounter something that once seemed mythical. Not so mythical though, once it has a face.


Monday, August 15, 2011

Coming Home

Home has become a common theme in my writings. As things have changed so dramatically in my life over the past 5 years combined with the constant moving I've experienced, the idea of Home has come to mean so much more to me than it ever has before. I could link all the posts I've made concerning this topic, but then there wouldn't be any room for this post.

I’ve often reported that Nashville, Franklin, and more specifically, Concord Rd. is my home. That means that home is found in a place, a geographical destination, a physical ground. I still ascertain that fact to be true, but I realized this past weekend that there are multiple facets of home. Home is comprised not just of a physical place but of the people that give that place the meaning it possesses.

I traveled this past weekend on a whirlwind trip to see one such person. The calendar is only three weeks shy of making it a year since I had seen her. I can attest that 49 weeks is much too long, yet it was like it was yesterday and I know that the next time will simply feel like tomorrow. Time does not pass with true friends.

The Bible speaks of Jonathan and David’s relationship; I Samuel reads, “the soul of Jonathan was knit to the soul of David, and Jonathan loved him as himself.” I suppose there are very few people in life that find their soul knit together with another, with a true friend.

We were not in Nashville or Franklin or at Concord Rd. Yet, my soul was at home.

There is such comfort in being with another who knows you like she knows herself. There is such comfort in being with another who loves you so unconditionally, so purely, so undeniably. There is such comfort in being with a friend who completely understands what it truly means to “get Jesus” and lives her life in such a way, without judgment. There is such comfort in being with another who helps make you stronger, healthier, better, happy. There is such comfort in being with someone who is knit to your soul.

Life and time has afforded me amazing opportunities and experiences with Karen Craun Perkins. We have laughed and cried and shared so much. We have traveled many miles: Hawaii, Las Vegas, Georgia, and many other simple towns. We can shop together and it works. We enjoy eating new foods. We appreciate the ups and downs we independently experience. We share our faith.

Sometimes we find that home isn’t found in a place, but in a person.


Thursday, August 11, 2011

Circadian (out of) Rhythm

I’ve mentioned it before, (night shift, 36 in 48) but it seems that the gross reality of the situation has been staring me in the face lately. I am NOT a night person. I, specifically, was not designed to stay up all night long and sleep during the day. It is against my personal nature, against my circadian rhythm .

Yet every time I work it’s either a 24h shift or a 12h shift and it’s always during the night, always demanding that I sleep the next day. Some people thrive with this type of schedule, some people not so much. Me? Not so much. I hate the way it makes me feel, hate that I spend my “off” time recovering, hate that I’ll just have to do it again in a few days.

I think it may feel worse today because I’ve been off so long and my body and sleep cycle is super out of sync with sleeping during the day. It may be because I slept just enough last night to not sleep very much today, to make me feel exhausted when I go in tonight.

Vacations are always wonderful but it seems I always have to pay for them in some way on the back end. If anything, during a vacation when I finally start to feel “normal” it just makes me realize how exhausted I feel most of the time.

There are two thoughts that I have seemed to adopt as steering themes for my life:
1. There are positives and negatives to everything and
2. We all have choices.

I enjoy critical care, that’s a positive. Critical care is a 24h, 365d job; sometimes that’s a negative. I worked last year on Christmas Eve, Christmas Day, and the day after; that’s just the fact. The hospital and health care arena have different time demands than a lot of other arenas do. I knew that and I chose to adopt that arena for my life, which was my choice.

I fear though, in the very near future, that my paradigm is going to shift the remaining positives to negatives and demand that a choice be made. With every new choice there will still be positives and negatives facets. But it is my responsibility to myself to make choices in which the positives outweigh the negatives. Sometimes that choice is simply in how we view our perspective, sometimes it reaches beyond that.

So what does my future hold? We shall see. But we all have choices…

Wednesday, August 10, 2011

9 days off, 2 nights on

I’ve been off for 9 days.

I’m working the next 2 nights.

It’s nice to have a break sometimes, to get away from the drama that is the ICU. The last shift I worked my patient started crashing. They had been “fine” most of the night and then they weren’t “fine”. I almost lost them.

It’s amazing sometimes how quickly things can change. How swift things can go from okay to bad to worse. When things go worse it usually takes days to recover and that waiting time is difficult, almost unbearable for families because there’s no guarantee that it will go from worse to better.

I had a friend with me that day. A friend that is about to enter her senior year in high school. She flew in from Nashville, TN to spend some time with me. I invited her to spend a weekend learning about the hospital, the ICU, critical care, nursing duties, my responsibilities, and to essentially let her shadow my life.

It was interesting to evaluate my life through someone else’s eyes, to think about things in a completely new way. It’s hard to remember what it’s like not to know something. It’s hard to know what it was like when I was learning things for the first time. I worried all weekend that she would be bored, that she wouldn’t learn anything, that she would feel like it had been a waste of her time. But I was trying to look at her experience through my eyes, it was her eyes I should have been looking through.

She watched when the patient started crashing, when we intubated, placed the central line, the arterial line, and simply worked as a team to emergently save the patient. I’ve seen this situation numerous times; it’s what I do. She had never seen that situation before.

I don’t have her eyes. I don’t know exactly what she saw and how that situation impacted her. But I believe that event had the potential to be a life altering moment in her life. It had the potential to shape her view of health care, critical care, team work, and emergent situations.

I’ve been off for 9 days.

I’m working the next 2 nights. Hopefully, with different eyes.

Tuesday, August 9, 2011

Opportunity

There are times in life when we find ourselves in situations that we never intended to be in. We aren’t always sure how we got there, how to get out of them, or what to do. Change is hard. Life is difficult. Sometimes circumstances make us so incredibly lonely.

It’s hard to do that which is right sometimes. It’s hard to change.

There are also times in life when unique opportunities present themselves; when we find ourselves in amazing situations that bless us in indescribable ways. These situations work to make us stronger, help change come easier, and make us feel less alone.

This weekend, life afforded me such an opportunity. I found myself surrounded by a group of people who enriched my life and initiated lifelong friendships. We shared. We laughed. We cried. We grew.

I do not know what the future holds. I do not know the plans that God has for me. I do not even know the course of tomorrow.

But I do know that I’m loved. I know that I’m not alone. I know that I am blessed beyond measure. I know that there is always someone there to lend a hand, an ear, a hug, a prayer. There is strength in these truths, hope. There is a new found knowledge that I will never be in a circumstance such as this again that will result in incredible loneliness. Thank God for that.

Friday, August 5, 2011

"You're a prize," she said, "you can do anything you want" . And you know what? She's right.

Wednesday, August 3, 2011

Round and Round and Round she goes. Where she stops, nobody knows.

Tuesday, July 26, 2011

A Home for Ruth

When I was in the first grade I had to start reading chapter books. I was afraid to read chapter books. Even at that young of an age, I was deeply afraid of failure. Chapter books were really long and I was afraid if I started a chapter book I wouldn’t be able to finish it. So, I told people I hated to read. But the truth was that I didn’t know if I liked it or not; I was afraid to try.

I had a chapter book though that I carried with me for months and I would stare at the cover all the time. The book was called “A Home for Jesse”. It was a book about a boy who found a little dog. I dreamed about being the one in the story, about Jesse being my dog. I dreamed about that for years. I did eventually finish the book, but the details of the story escape me now.

All of my life I wanted a dog. We were allergic. We didn’t have a fence. We never lived in a house that we owned; it was always the church’s house. Finally, the summer of my 13th year we got Belle. I loved her. I had always wanted her. But Belle was the family dog, more specifically, she was Mom’s dog. I also was young and immature and didn’t truly understand what it meant to love her in the way I should.

Time passed. Years went by. I kept telling myself when I finished school I’d get a dog (this was before I realized I’d be in college for 10 years!!). Then when I was finally done I started working odd hours and didn’t feel like my schedule would be conducive to raising a puppy. It seemed I would never fulfill my wish.

When I moved to Raleigh a lot of things in life began to change for me. Priorities began to be refocused. I started evaluating things from a different perspective. I began to put an emphasis on other things. Mainly me and what I needed. Some things I had neglected for a long time.

I still wasn’t sure about a dog. I knew that within time I would begin working 24h shifts. How in the world can a person get a dog, a puppy, and work for 24h?? I had no clue, but I began to look. I met a lot of people and met a lot of dogs, but none of the dogs were the “one”. I was almost ready to quit looking, but at the same time, I had such an intense desire. I had finally given true hope to a lifelong dream and it wasn’t going to let me give up.

I’d been to the shelter before; hundreds of dogs yelping in a large room. The smells, the sights (and this from a person immune to most smells and sights). My cousin Audrey decided to go with me. We walked around. I was really in a funk while we were there, I was never going to find the perfect dog. There were 4 criteria I was looking for: female, dark colored (I’m a racist), small, and doesn’t shed. Nothing seemed to fit what I wanted.

Audrey and I were laughing at so many of the names. They were funny and ridiculous. We walked and balked and looked and laughed and toured. Then there she was. I don’t know why or how, but I knew it was her, I knew it was my dog. I bent down to pet her through the chain link cage. She licked my hands and was so excited to see me. I was down there with her for awhile. Audrey was standing at my back. “What’s her name?”, I asked. “Um. Tara”. “What I said? Tara’s not a dog name!” I stood up, and there it was in black and white, her name was Tara. I laughed, but truthfully that was the moment I knew it was meant to be. God in his infinite wisdom had pointed her out to me.

I donned a gown and went into her cage. She smelled, she shed, she was going to keep growing, she was at least female and dark colored though. I loved her immediately. But my heart grew hard and after playing with her for a few more moments I left. I left without her.

I have a fear of intimacy, of commitment, of trust. I just couldn’t do it. I couldn’t let myself be vulnerable, even to an animal.

So I went home and took a hot bath and couldn’t stop thinking of my little dog. I got up and went to church the next morning. While there, I named her. The shelter opened at 12 noon. Church got out at 11:45 and I rushed there. I was afraid someone might have gotten my dog.

They hadn’t. I paid for her before I even went back to see her. I spent the rest of the afternoon shopping for her and getting ready to bring her home. Then, on Wednesday, I did. It was touch and go at first. We both had so much to learn about each other. I was afraid I’d never housetrain her.

She has done more for me than I could have ever known. I love this crazy little dog more than anything. I am so proud of her. She has blessed me in so many ways.


As a single person there are a lot of benefits to living alone. I drink out of the milk carton, eat out of the ice cream bucket, leave doors open when I should close them, and nobody cares what I do. But there are some negatives too: no one’s here when I get home from work, nobody ever fixes my dinner, and nobody cares what I do. Ruthie does though, and sometimes that makes all the difference.


My life has been deeply enriched by Ruth. I will forever be thankful for her.

Monday, July 25, 2011

Living the Dream

“Living the Dream”

This is a phrase that is often stated by people who work in health care. There may be other professional arenas that say this too, but this is where I hear it, this is where I know it.

So, what does it mean? This phrase we use.

I think most people who start out on a career path in health care have an idea, a concept, a dream that positions them in such a way to be the hero, the savior. We dream of being in unbelievable situations and coming out heroic after encountering almost unconquerable circumstances. We dream of saving the day, saving the life. Maybe I really mean I, and not we.

After awhile reality overtakes the dream. More often than not, I hear “seasoned” (or jaded) health care workers saying this phrase in a more sarcastic, indifferent, more humorous way. Almost to laugh, as if to say that it’s no dream at all.

Events have occurred in my professional life as of late that makes me stop and think about this phrase.

I went to Duke recently and assisted in the OR on a neurosurgical case (this is brain surgery). As I drove in my car that morning and arrived at that colossal place, I said to myself “I’m living the dream!” and I found a smile in my heart. Assisting with brain surgery, it sounds quite intense, exciting, awing, powerful. But the truth is, I just did some preoperative work and then I left before the actually surgery got underway. I was invited to stay. The neurosurgeon was more than hospitable. But the truth is, I didn’t want to stay; brain surgery is boring, it’s hard to see, OR’s are cold, and I was just plain tired. So I did my part and left.

We idealize something sometimes and when the reality of the situation is fully embraced, it is at times not quite as gratifying as we had imagined. We find that we are left wanting and dissatisfied.

When I work, I respond to Code Blues. A Code Blue is called when a patient becomes unresponsive, their heart stops, they’re no longer breathing. I was in the call room the other night, had my shoes off, my pager on the night stand; a Code Blue was paged from overhead. “I’m living the dream!” I thought as I gathered myself and ran down the hall. The patient was the typical floor patient, a patient that I have seen so many times, not breathing, no heartbeat. We started compressions, we gave life saving drugs, we intubated, we did a lot of things. I knew we would not get them back. You can almost always tell by the eyes. As I stood at the head of the bed, with the laryngoscope in my hand, I stared into those eyes. After multiple rounds of resuscitation, two shocks, and some last resorts, we called it, the Time of Death.

Most the time there is no saving the day, no saving the life. When I walked into the Duke OR there was no cape on my back, I did not fly down the hall to the code. There is nothing heroic about it.

I spent some time tonight with the child of a patient. The patient is very close to death. Decisions need to be made very soon regarding the end of life choices. We talked about different options, different avenues of support, positives and negatives. We talked about how joyful the patient had been the other night after visiting with all the children and grandchildren that day. We talked about how proud the patient was of the family and how encouraged they were.

I don’t know when that patient will die or the avenues they will choose for the end of life treatment.

What I do know though is this, “living the dream” isn’t exactly what I thought it would be. I thought “living the dream” involved intense, exciting experiences, like assisting in the OR and running a Code. But what I’m finding is that this is not the case at all. “Living the dream” is making small differences, taking advantages of obscure opportunities, being real, being true. Finding a family member who has flown in from across the country, sitting in the parent’s ICU room, alone, in the dark, watching as the parent takes deep long breaths and engaging in meaningful conversation at 0130 in the morning, making a small differences to that child, that, that is “living the dream”.

I will have worked 78 hours for the week by the time I go home today. I’m living the dream.

Friday, July 15, 2011

Perception is Reality

Some people are so opposed to change that they inhibit themselves from growth, which in the end results in their own demise.

I’m not a fan of change; there’s no secret there. But I acknowledge the power it has and I am much more agreeable to it now than I have been in times past.

I went to a fancy dinner for work last night. It consisted of 9 courses (yes 9!); which surprisingly did not include dessert.

I was the only nurse practitioner sitting among a crowd of doctors and other hospital administrative staff.

The evening was nice. We ate. It was boring. We ate. There were some controversial discussions. We ate. We listened to a presentation. And then I had my food boxed up and headed out to get my car from the valet.

Those controversial discussions were personal; they are ignorant, they are consistent, and quite frankly, they are not grounded in fact, and yet they continue.

Some people see what they want and the reality which they dwell in is no reality at all. Things change.

A few have an appropriate reality. I thanked them for that. “Nicely done” my Attending said. I shrugged.

Sometimes you fight a fight until you cannot fight anymore. Sometimes you fight a fight until you realize it’s not worth fighting for anymore. Sometimes it’s hard to tell the difference.

Next week is my long work week; 72 hours. I will live in that place and dwell in those halls and work and function and exist.

My patients will get good care. But as for the politics, I wonder how much fight I will have.

Tuesday, July 12, 2011

36 in 48

A few things have changed at work as of late. Most of which I’m not overly excited about. These changes have resulted in significant changes to my schedule.

My previous schedule consisted of working one 24 hour shift for 3 weeks of the month and working one hellacious 72 hour work week for the 4th week of the month. The 72 hour week is rough, but for the most part, that schedule was very doable.

Now, every time I work, I do 36 in 48. That means I’m on 24, off 12, then back on for 12. Having done it for 4 weeks now, I’d have to say it’s killing me.

I spend a lot of time sleeping during the day, and frankly, that’s hard. I spend a lot of nights that I’m off awake, unable to sleep. I have trouble getting personal business taken care of because I’m asleep during the day and awake during the night and the rest of the world does not function on an upside down schedule. I’m finding that I don’t really either.

People often say I’m so lucky because I have so many days off, but the truth is, I spend much of my off time sleeping or staring blankly at the television because I’m so exhausted. Sleeping has become my part time job, only I don’t get paid. It’s hard working a week’s worth of hours in a couple of days. Generally by the time I’m feeling “normal” or recovered, it’s back to work.

Sometimes work feels like water-boarding, only I choose to be here. Hmm?

It’s funny really. I wanted to have a grueling tasking schedule that was awing and daunting and strong. You can only do that for so long though. I would still say it’s grueling but I am not at all awed or feel strong by my schedule anymore. It’s amazing how something can look so enticing at one point and look so horrific at another.

The census has been low and slow lately too. There haven’t been many patients and they haven’t been very sick. This makes for long boring shifts and I find myself wondering what I’m even doing here.

I suppose I’m at a moment of frustration, exhausting, irritation, confusion, and discontent.

It is said that growth comes from chaos. We shall see.

Wednesday, July 6, 2011

Happy Anniversary Raleigh!

Today marks 1 full year that I have been actively employed at Duke.

In so many indescribable ways this past year has been one of the most monumental years of my life. The depth of change that has occurred is almost overwhelming. I have done and seen and learned and have been given so many things since that time. The place I was in compared to the place I’m in now is absolutely worlds apart. I’ve grown so much. Yet things are as they always have been.

Life has a funny way of giving you what you need when you need it, even when you didn’t know you needed it. But maybe that’s not life, it’s God.

My time in Raleigh has been both rewarding and frustrating, encouraging and heartbreaking, uplifting and challenging, amazing and ordinary, pleasing and disappointing, privileged and humbling, shared and lonely. I’ve been forced to grow and reach and develop and mature, to face fears, acknowledge burdens, and to acknowledge life in a way that I had not before.

And I’m not just talking about professionally but personally; maybe the latter even more so.

Life, however it comes, is a blessing. Each day is filled with opportunities to choose either happiness and contentment or misery and gloom. We make that choice. We build our days, our weeks, our life.

I went in an empty hospital room today with a friend. We pulled the ultrasound in the room with us and closed the curtain. We turned it on. She gooped up her belly. We looked at life. We looked at the beautiful 16 week old baby growing within her. We saw the tiny heart beating fast. We saw the arms moving. We saw the baby repetitively hiccup. We watched as the baby brought its little hand to its mouth.
I blinked the tears away, but they were there, they stung. Life is so beautiful.

I do not know what this next year holds for me. Not professionally or personally. I do know that I am blessed. I know that I will forever be thankful for the changes of this past year, for the personal growth, for the opportunities to learn. I’m thankful for the people in my life who have blessed me beyond words, people who have loved me all of my life and people I have never met.

So, Happy Anniversary Raleigh! And from the bottom of my heart, thank you.

Thursday, June 30, 2011

Words

I have never experienced such extreme frustration in all my life as I did this past winter.

A patient was admitted with a severe exacerbation of a chronic illness. She was young, very young.

I was on night shift that week. The patient was admitted during the day and I came in for my first shift that night. She did okay that first night. I was concerned about her, but there were other patients that were sicker and she was not my primary focus.

During the day on hospital day 2, she got worse. So when I came in that night I spent a lot of time with the patient and her family. I did my best to educate them regarding her chronic illness, but this was not an easy task. The patient and her family didn’t speak English. Unfortunately I am monolingual. The nurse had already had some communication issues with the family. There were also legal issues. The patient was living with a man, who we thought was her husband, but turned out to be her boyfriend, so legally he wasn’t the power of attorney and everything had to go through her brother. So the boyfriend couldn’t give consent, he couldn’t sign any papers, he couldn’t help us. The brother was very involved, but he worked and wasn’t a constant presence like the boyfriend.

Throughout the night she continued to get worse. In the early morning she began what we call “crumping”. I needed to explain a lot of very serious medical things to this patient quickly. I needed to place a central line, an arterial line, start her on some heavy medication, and I had very little time before it was going to be too late. The problem though, was that I needed consent. She was wide awake and I can’t do any of these things to her without permission. And I can’t get her permission because I can’t talk to her. Only the boyfriend was there and he can’t legally help me. We tried and miserably failed at using the interpreter phone (I loathe this machine!!).
Anger consumed me. This patient was going to die simply because I did not know the words to save her.

I spent an hour trying to converse with the patient and her boyfriend through that blasted blue phone. Finally, she was so sick that she became delirious and was now mentally incompetent to make a decision and I could do to her what I wanted. But by this time, it was almost too late. I called my Attending doctor for that week, and at 4:00 in the morning he came in to help me.

Not ten minutes after the arrival of my attending the patient coded. We had to emergently intubate her, place a central line, begin pressors, and pray to God it wasn’t too late. She had a little baby.

She stayed with us for over a month. During that time she coded 3 more times, ended up getting a trach, developed many infections, and just didn’t seem to be making the progress we wanted. She transferred to a larger hospital and stayed there for an additional 6 weeks.

I do not believe in miracles, but somehow, this patient beat the odds.

I’ve been on nights this week, so I slept all day. When I came in to work tonight they said she came back today to visit, to say thank you. They said she looked wonderful. She was strong and healthy. She said her baby just had a birthday. The attending doctor who came in that night was on today and he saw her. He said it was amazing. He said the moment he saw her he was sad that I wasn’t here. He said we saved her that night.

Tonight I again find myself without words. But tonight it is not anger that consumes me.

I'd like to take a moment...

One of my favorite books is written by Dr. Seuss. It’s one of his less popular books, but in my opinion, it’s one of his best. It’s called “Did I Ever Tell You How Lucky You Are?” If you haven’t read the book, I’ll loan you my copy, it’s definitely worth the read.

I suppose I’ve been somewhat overwhelmed lately. I don’t always handle stress and change well. I get easily frustrated when things aren’t just so-so. I want everything to be in its place and perfect and right. I’m grounded in structure, routine, consistency. So, despite the fact that I’ve spent the last 29 months in perfecting the art form of moving, it still upsets my balance.

And yet, amid the chaos, amid the turmoil, amid the commotion, there is one consistent presence. A presence so powerful that she can calm inner-emotional storms, so powerful that she can face obstacles that I turn away from, so powerful that a simple apartment can be transformed into my home in less than 12 hours.

I am faced with situations everyday that remind me how lucky I am. Even still, I grow complacent and take for granted the amazing blessings that I’ve been granted.

So, I’d like to take a moment and say that I am blessed beyond words to have Jackie Dodgen Sanders as my mother. From the day I was born until this moment and beyond, I have always been received with love and encouragement and compassion and joy. She has always been there for me and that alone is priceless. She has been a best friend, a confidant, a cheerleader, a champion, a mom.
So thank you.

Thank you for always loving me, always believing in me, always supporting me, always being proud of me, always listening to me and trying to understand me, always encouraging me, always championing my cause. Thank you for building me up and teaching me to be who I am today. Thank you for the life you created for me. Thank you for the warmth you create in the home you’ve always made. Thank you for the confidence you instilled in me. Thank you for the Godly example you’ve always been. Thank you for your strong work ethic, your giving spirit, and your selfless attitude. Thank you for being my mother.

Tuesday, June 28, 2011

Aim High

Ever since I was a small child I have been fascinated, entranced, and captivated by the military. I wanted to serve my country, do my part, be an American.

The older I became, the more paraphernalia I got in the mail: information packets, posters, postcards, t-shirts, key chains, bumper stickers. I kept a lot of that stuff, decorated parts of my room with it. There was one postcard in particular that seemed to stare at me every day. It was simple, it didn't say much, it was just two words: Aim High.

But as life occurred and choices were made, the military was not a part of them.

I went to college, graduate school, an internship, night school at a community college, and then back to graduate school. And with each degree I earned I continued to be haunted by thoughts of the military. I continued to get e-mails, postcards, and letters. I would travel to conferences for work (Los Angeles, St. Louis, and Honolulu), and the haunting would continue. I would see professional peers in uniform and find myself feeling envious and disappointed that it wasn't me.

A year ago I was talking at length with a recruiter. After much study and research of the different branches, the Air Force was most complimentary to me as a person and to my profession. I was very close to signing, to joining up, to being all I could be (except that's the Army). If I hadn't moved to Raleigh last summer, I was going to join the Air Force. So, why didn't I? It wasn't the right time. Various circumstances surrounding my enlistment, pay, rank, etc. weren't quite lining up. My lack of work experience combined with my advanced education made for difficult placement.

So I moved to Raleigh. I'm pursuing my goal. And despite all of that, the haunting continues. It reemerged while I was in Chicago a few weeks ago. While at the conference, I attended a lecture conducted by USAF Colonel Elizabeth Bridges (RN, PhD, CCNS, FCCM, FAAN) and it was absolutely amazing. The work the Air Force is doing in concert with our other military branches on the battlefield is truly outstanding. At the end of the 1 hour and 15 minute presentation I was ready to sign up, ready to go to the front line, ready to Aim High. I left the lecture and walked around in the expo and who did I run right into but Colonel Elizabeth Bridges. We talked. I told her how much I appreciated her service and her lecture and her work. I told her I had wanted to join and time and circumstance just hadn't worked out. She said it was the best decision she'd ever made. She said it with such certainty that I didn't question. I was in awe.

I came home from Chicago and thought about this recent haunt, but as the days turned to weeks and I reengaged in my own work, the haunting subsided. And then I got an e-mail from the Air Force saying they needed Health Care Providers; it was generated from CareerBuilder.com, but still. And then I became aware of a 19 year old man who was serving in Afghanistan. The exact account of the story is unknown to me. He was going to help a fellow soldier and misstepped. This misstep cost him both legs and an arm. They flew him to Germany and then finally to Texas, to the hospital I would be working at had I not come to Raleigh.

I've thought so much about that young man, that boy.

I do not discredit the work that I do. I do not belittle or minimize the importance it has or the families I interact with.

But I am still haunted to serve.

As the 4th of July, my favorite holiday, approaches, I have to ask myself, am I Aiming High?

Rodents

My friend Claire called last night. Claire's a nurse; we work together.

She was calling to see if I was watching the show “Hoarders”. I wasn’t, so I switched over to see the chaos. We both enjoy watching this show, but this particular episode topped all the episodes we had seen before. The man on the show had such a dirty house, that it was infested with rats. The rats lived in the walls of his house. The man knew the rats were there, he said, “they were his friends”. As they cleaned they found ~2000 rats living in his house. 2000 rats!!

Needless to say, we were shocked, horrified, and disgusted. But as with any car wreck, we couldn’t look away; after all, we are nurses.

Our disgust of the rats led us to discuss other topics associated with rodents. We talked about turtles. We talked about snakes. We talked about patients.

Every patient has a story. Every patient found themselves involved with a set of circumstances that resulted in their admission to the hospital. These stories are often intriguing, humorous, and shocking. Claire told me the story of a patient she’d taken care of when she worked at John Hopkins who had an exotic snake in her home and was bitten. It was a poisonous snake which led to a critical care admission to the ICU until the anti-venom could be administered. (http://articles.baltimoresun.com/2010-01-27/news/bal-snake0127_1_snake-antivenom-cobra)

Crazy times!

This made me think of another story I’d heard when I was at Vanderbilt. A nurse who worked in the SICU there told me the story. It was about a snake.

A couple she knew had a pet snake. They loved the snake. It was out in the house, not in a pen, not in a cage, not in an aquarium. In fact, the pet snake slept in their room with them at night. They loved the snake.

One day, they started worrying about the snake. The snake had stopped eating. They tried everything to get the snake to eat and nothing worked. Days turned to weeks, a few weeks turned into a couple months and finally the couple took their beloved snake to the vet. The vet evaluated the snake, assessed the snake, inspected the snake. To the relief of the couple the vet proclaimed that nothing was wrong with their snake.

“Then why”, asked the couple, “is our snake not eating?”

“Well”, said the vet, “your snake is fasting.”

“Fasting!” said the couple. “But why?”

And to the horror of the couple the vet replied, “your snake is fasting so that he can eat you.”

Friday, June 17, 2011

My Short Shift.

I'm laying in bed, Ruthie is softly snoring at my feet. I'm thinking about my day, my short shift at work and the events that occurred.
I now find myself in the position of the patient (minus the snoring dog): laying in the bed. I suppose it is a perspective I don't always think about.

My perspective is generally at the foot of the bed, looking down at the patient.

I stood at the foot of a patient's bed for a long time today. Had lots of conversations with the family.

They asked what the chances are. We him hawed around the question. I finally told them that they would probably die before the weekend was up. I hate that question. Who really knows? They thanked me for my honesty. It was just the facts.

The family talked. We talked with them. They talked with an additional service that was concurrently managing the patients care. The family talked again. And then the talking was all done.

They decided to withdraw.

I hate this term "withdraw". Generally we say we are going to "withdraw care", but this isn't true. If anything we heighten the level of care so that the patient will not suffer. What we withdraw is aggressive intervention, resuscitation, powerful medications; but not care.

We wrote the orders. Discontinued all the interventions. I called the respiratory therapist. We asked the family to briefly step out. The respiratory therapist pulled out the endotracheal tube. The patient coughed and sputtered and we cleaned them up. We made the patient look pretty. The family came back in. The spouse and child flanked the patient, each holding a hand. They kissed the loved one and said sweet words. We provided suctioning, morphine, ativan, and peace. The monitor was turned off. We do that so the family can concentrate on their loved one and not watch the monitor. We can watch the monitor in the hallway. The nurse kept me updated on the blood pressure and heart rate.

It was a typical death. Deep shallow breaths, a fast heart rate, low blood pressure. Then, the heart rate begins to fall and there are long periods of time between each breath. Then the heart stops and there is no more breathing.

I put my stethoscope on. I listened to the silent chest. I took my stethoscope off, nodded my head, and said the words the family had feared all day, "they're gone". There were tears, but they had peace. The patient had fought a long time and didn't want to suffer anymore. Now, there was no more suffering.

I don't know why I stand there, but I always do. The nurse in the room is more than capable of handling the situation without me. All the orders are written and she won't need anything more from me. And there are other things I could be doing. But I almost always stay and observe.

Maybe it's morbid of me to say, but there is something...... I don't know the word. I'm not sure of what the word is. But there is something in that moment when death occurs that is somewhat awing, so extremely surreal yet unmistakably absolute. There is a deafeningly quite peace that falls.

I suppose it is easier to watch death when I don't know the person, when I'm not the one suffering a loss.

So that was my day, my short shift in the unit. The one thing I accomplished today.

I don't know why I always talk and blog about death. Maybe it's simply the avenue I use to release the events of today so that I can encounter the events of tomorrow.

Monday, June 13, 2011

Hair

So, I cut my hair.

For the majority of my life, I’ve had long hair. Long hair is familiar, comfortable, easy, safe. I can wear it down or pull it up and back. It’s what I know, it’s what I do (pun intended).

I’ve always equated long hair with being feminine, with being pretty, with being beautiful. I’m not a girly-girl and I’ve never been overly feminine; so my hair has always been my saving grace, “my crown and glory”, the thing that made me beautiful. Overtime, it’s become a crutch, a hiding place.

My whole life people, sometimes perfect strangers, have made comments to me about my hair, “you have the most beautiful hair”, “you can’t pay for color like that”, "you are so blessed", etc.

Don’t get me wrong, I appreciate the comments, the compliments, and the reactions. But I think I started identifying who I was by my hair. My beauty, my femininity were all dependent on my hair and how it looked.

The reality is, I do have pretty hair, but I also have thick hair. It takes 20 minutes just to dry it with the hair dryer and I still haven’t even “fixed” it yet. Long hair also gets in the way of blood and “stuff” (trust me, you don’t want to know). I don’t want my hair getting in blood and “stuff”. So when it’s long I just end up pulling it back all the time. What’s the point of having long hair when I’m just going to pull it back?

But truthfully, I’m not pretty because of my hair. I’m pretty because of my character, my dry sense of humor, my intelligence, my nurturing way with patients, my amazing self. I’m not feminine because I have long hair, I’m feminine because I’m female, because I’m a girl, because I have a sensitivity and a gentle nature about me.



Today, I’m happy with my short hair. I can’t say I will be tomorrow, but it won't be because I'm not feminine or girly or beautiful.

Cheers

video

Making your way in the world today takes everything you've got
Taking a break from all your worries sure would help a lot
Wouldn't you like to get away?

Sometimes you want to go - where everybody knows your name
and they're always glad you came
You wanna be where you can see - our troubles are all the same
You wanna be where everybody knows your name

You wanna go where people know people are all the same
You wanna go where everybody knows your name

I suppose, in a lot of ways, this adequately describes the feeling of home. I suppose this is what I have missed most about Nashville, about being away from that place. I suppose there are feelings that an environment grants you simply after you have invested yourself and time in that place.

In some ways I suppose it's silly to equate my home, Concord Rd. with a bar, but it is fitting nonetheless

I don't know that I will ever feel as at home anywhere as I did, and still do, there.

But I'm starting to. And I'm so very thankful for that.

Wednesday, June 8, 2011

Life and Times

It's funny really, when I was in school and had such a need to blog I made the time even though I had little to spare. I thought that when I was working, and found myself with more free time than I ever wanted, that I would blog all the time and yet I rarely find myself doing it. I hold on to so many deep thoughts and concepts and before I know it, time has passed, the thought has matured and left me, the concept has been grasped hold of, and the blog post remains unwritten, vacant, invisible. In some ways this saddens me as blogging has been a way for me to displace so many burdens. Often I wouldn't even directly tell a story, as HIPPA prevents me from my own healing, but I would say things in such a way that I would know, I would remember, and I would release the depth of the rawness associated with the story I had just lived, the life I had just observed, the family I watched. But there are funny stories too, hilarious actually, (well, maybe only truly funny to medical people, as we do have such a morbid sense of humor and acknowledgement of life) and those stories too remain untold.

There are so many things that have happened this past year. So many things I meant to write about.

My recent trip to Chicago for a conference, my first MLB experience while I was there (the White Sox won! the Cubs were out of town), eating a phenomenal lobster and crab dinner, hosted by vendors, who paid for the whole outrageous thing.



I could also tell you about the fact that I’m moving…again. The 6th time in 30 months. I’m tired, excited, irritated, and getting really good at this. I’m moving out of my amazing townhome to a really great apartment. It’ll be an adjustment as I haven’t lived in an apartment in over 7 years and I'm really going to miss my garage and running with Ruthie on the 14th green (our backyard). But I'll be closer to work and the dog park, my commute to church will be shorter, I'm just as close to a Wal-Mart and Target; so overall it'll all work out.



Moving again doesn't do very much to make me feel more settled. I have such a deep craving for roots, as I've written about before (why I bought my condo in Oklahoma, why I've done so many silly unprofitable things the last 30 months). I was talking to a friend last night and she laughed at me, "for someone who sure hates change you sure do move a lot". The irony in what she said was not lost on me. This came after a discussion I had with her about my future plans, i.e. where I'll be a year from now (hopefully westward), but who really knows what these next 12 months hold.

Raleigh has been good to me these past 11 months. I have few complaints. There are definitely a lot of things in my life I needed to get sorted out, to tend to, to prune and nurture, to heal. Raleigh has allowed for a great deal of that.


I'm working a 24 today. The ICU is slow tonight. I can faintly hear the pumps beeping and the monitors alarming from my office. I did some extremely minor "surgery" today (fun bloody stuff). Who knows what this night holds for me.

But one thing I know for sure, I am blessed.

Thursday, May 5, 2011

Its amazing how sometimes you feel you have gone so far but then you realize you've hardly moved at all.

Monday, April 11, 2011

Stepping Back, Major Arteries, and X yo’s

Stepping Back

So, I’m 9 months into working as an Acute Care Nurse Practitioner at Duke Raleigh Hospital. Like with any job, there are good days and bad days, good experiences and bad experiences. Overall, I’m very blessed that I have Attending Doctors who care about me and my professional growth and make an effort to make me better. For this I am extremely grateful.

Part of the reason I took this job was to become efficient at procedures. Procedures are skills that I can perform as a Nurse Practitioner that I can’t perform as a Registered Nurse; skills including intubation, central line placement, arterial line placement, suturing, chest tube insertion, etc. Most of it is blood and guts type of stuff, fun stuff.

So, in order to be credentialed, or checked off, I have to be observed performing each of these skills ~10 times. Some skills are rather easy to dominate and others take much more effort. Fortunately I have great Attending’s who have invested a lot of time in making me proficient. Actually, too much.

It was my 10th time, my finally observation. And there He stood. He is my boss, my primary Attending.

Now, you have to understand that when performing these skills I must be sterile. There is a big difference between being sterile and being clean. Being clean means you aren’t dirty. Being sterile means you have no “bugs” on you. So, in order to be sterile, I have to gown and glove up (note picture). This means that my body is completely enshrouded by some type of sterile material, this means I’m hot and sweating.

When one is slightly bent over a patient, breathing down their neck (through a mask of course), for the purpose of placing a central venous intrajugular catheter, while sweat is dripping down your back and between your…, the last thing you need is someone breathing down your own neck. Yet, there He was. As, I said, this was my 10th time. By this time, I know what I’m doing; yet, there He, in my face, breathing down my neck (through his mask of course).

In truth I’m ignoring him, we have an excellent professional relationship and as he’s blabbing I’m listening to my own thoughts, going through the steps in my own mind, disregarding his words. Then he attempted to intervene, attempts to redirect and reorder my steps.

I realize this is the moment, my moment to take control. If I don’t take control I’ll never stop being observed and He will always be there.

So as he is talking I look up and look him square in the eye. He stops talking. “Yes” he asks.

“I need you to step back!” I say. Yes, I said this to my Attending, to my boss.

Fortunately, he smiled, ho bowed his head, he nodded obligatory, and he stepped back. That isn’t to say that he was silently through the remainder of the procedure, but that was my last observation. So, I’m not sure if we so much as have an excellent professional relationship or if I’m just really lucky.

Major Arteries

Since I was “checked off” on central venous intrajugular catheter placement, I’m now allowed to place this line by myself, unattended, without the presence of a Medical Doctor.

Now the thing with procedures it that there are risks involved, that’s why you have to have advanced training to perform them, that’s why you have to be credentialed, that’s why you have to be “checked off”. Fortunately none of those things have happened to me, after all, the chances are small. These things include causing an embolus (or a traveling blood clot), cutting a major artery, infection, losing a wire, and death, just to name a few.

A few shifts after being credentialed I was past ready to put a line in (a central venous intrajugular catheter ) unattended. Now when one places a central venous intrajugular catheter a lot of large needles, scalpels, and other sharp objects are used to shove a large IV into someone’s neck.

The opportunity came.

It was a Saturday night, I’d slept all day and I walked on shift ready to work. I made my normal rounds, did a foot of the bed assessment on all my patients and was ready for the night to start. Then it happened. A patient, who wasn’t mine, started to crump (this means bad things were happening to the individual). They needed me to come in and put in a line. In fact, the patient’s doctor stepped out of the room and asked me to come in and put in the line.

I was needed. I was so excited. I was so nervous.

I acted cool. I got my stuff together, gowned and gloved up, stepped in the room, and within moments had the line in, placed some of my most beautiful stitches to date. Just to top it off I added an arterial line for good measure. I was the stuff, I was unstoppable.

I left the unit, went to my office, closed the door, and silently hooped and hollered, did a little dance and simply patted myself on the back. I was the stuff.

The night was young and I was on fire.

Hours passed. It was 0200, now Sunday, and a different patient across the unit was crumping (remember, bad things are happening). I called my Attending, who was at home in his bed, and after a brief discussion, we decided I would put a line in. After all, I’ve been “checked off”.

So, once again I gather my stuff, gown and glove up, and head into the room, ready to place my line. Ironically, I’m in the same room as I was before with my Attending in which I told him to “step back”. Could life be any better or what???

The patient was a bleeder, this means they have thin blood, the littlest prick results in profuse bleeding. This means I’m going to make a mess. Ok.

I get right to work. I see the vein on ultrasound, make my mark, prep and I’m in. Easy breezy. But I’m having a little trouble, my dilator isn’t quite going in like I want. So I get my scalpel to make my incision a little big bigger. That’s when it happened. I cut my patient’s major artery. I cut the jugular. I cut the jugular artery. I cut the jugular artery. Did I mention the patient was a bleeder?? Blood was spraying everywhere. I cut the jugular artery!

To make matters worse, the patient is waking up. Profanities are flying from the patient’s mouth, which are actually quite hilarious. I had admitted this patient. They knew me. They knew me well. They were threatening to slap me when it was over. Did I mention I cut the jugular artery? Blood is everywhere. So I start to hold pressure. I know that I’m going to have to hold pressure for quite a long time and no one else can help me because I’m the only one who’s sterile. So the next thing I know, a chorus of registered nurses have gathered outside of the patients room and they are all standing there watching the scene. Are they rushing in to help? Are they quickly gowning and gloving up to assist me? No. They’re laughing. The chorus of nurses are standing outside the room laughing.

The bleeding finally stopped. The line was successfully placed in the other side of the patient’s neck. I wasn’t slapped. The patient improved. And in the end, I’d had an experience unlike any I’d had before. I’d been afraid of cutting the artery as I’d never seen it happen before and knew that it was only a matter of time. Now I had. And while messy, I wasn’t so scared anymore. Hopefully, thought, I won’t cut it again.

X yo

I admitted the patient through the ED around 0400 in the morning. They couldn't breath. Good air wasn't getting in, bad air wasn't getting out. They were hypoxic. They were breathing 60x a minute. The heart rate was in the 160's. Just sick.

I told the patient they needed to be intubated. They didn't want it, shook their head. I found out later they were a paramedic. They knew what I was going to do to them, they'd seen it. Sometimes I hate when patients understand. We talked again. I talked with the ED doc. We tubed the patient. We intubated.

After we tubed the patient, they kept looking at me, grabbing my hand and saying around the tube "I can't breathe". We started sedation. Tubing a patient is very uncomfortable. "Just relax" I said.

We brought them up to the ICU. The parents, they were so sweet, so grateful, so understanding, so humble. We needed to get them stable, ship the pateint out to the big house. They were sick.

The patient remained incredibly agitated. They continued to reach for my hand and mouth the words "I can't breath". Huge amounts of sedation wasn't even touching it.

My shift ended at 0730. I dictated my note. I was leaving to go home, go to bed; I would be back in less than 12 hours. I was heading out the door and something tugged at me.

I went back and looked that father straight in the eye. I shook his hand and said words of insignificance to him, "I wish you well", "I'll be praying for you", "Good Luck", "blah, blah, blah". He looked right back at me, "thank you for all you did", "you've been so helpful".....

I went to bed.

I returned at 1900.

"You know that kid, that X yo you admitted".

"Yeah"

"Yeah, sad thing, they died at 1530".

Numb.

People die every week. I have the "death talk" with families all the time ("We've done all we can do....."). Normally, it's no big deal. It rolls off my back and I go on. That's what we do. That's what I do. But this. This one got me.

What could I have done different? More fluid? I should have given more fluid. Maybe I should have put a line in? I had time, I should have put in a line. Increased the PEEP. I should have gone up on the PEEP. Question after agonizing question.

The truth is, nothing would have changed the outcome. Maybe prolonged it, but not chagned it.

I thought about this case for weeks. Then I thought about that Father. I wonder what agonizing questions he's asked himself.

I wish.

I don't know what I wish.

Sometimes things just happen.