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


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.