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.