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.

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.

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.

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.

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.

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.

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.

And so goes 2011! http://crossinthebridge.blogspot.com/2007/09/birthday-curse.html

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.

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.