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Self-Care

I sit outside on this fall day. The sun is shining on my face, warming me. A gentle cool breeze blowing. Pups wresting and rooting around. The smell of my remaining flowers fills the air. Mums beg to be pruned.

Today is the first day that I have felt somewhat “normal”.

The last few nights my mind has awaken me with thoughts, details running through. I do not usually wake from thinking. I sleep in order to stop thinking, but these last few days I have stopped sleeping so as to think.

I spoke with my counselor the other day and it was more helpful than I anticipated. She explained the various signs of trauma that I could be experiencing, for which most of them I am or have.

I have felt confused.

I realized, though, that while I have seen a lot of trauma, I have not experienced a lot of trauma and ultimately that is the difference.

There are so many details and truths and facts that are locked away as no one should know them or even see them in their mind.

I am sad.

The last few days have been focused on self-care. Self-care looks different for different people.

 I am a nine on the enneagram, otherwise known as a peacemaker. This means I live in constant tension between the desire to be unbothered by life and a desire to right all the wrongs that I encounter; which inevitably requires action and inconveniencing myself .

Whenever I look at the defined self-care prescription for enneagram nines I cannot help but laugh, but only because I know they are true. They include: sleep, naps, siestas, routines, doing a whole lot of nothing, a fortress of solitude, massages, time to process and to be, mindful breathing, fresh air, and cozy Saturday mornings.

So the last few days I have done just that slept and napped and focused on routine and doing a whole lot of nothing and staying alone in the quiet and taking time to process and to be and to mindfully breath and sit out in the fresh air and sleep in the last few days as if they were cozy Saturday mornings.

I am ok.

 When I got to work this morning, my pen wasn’t working. I went in search for a new one and had a fun ridiculous conversation with the unit secretary about the value and use of 0.7, 0.5, and 0.38 pens. She laughed. We drank our coffee.

I rounded and saw all of my patients. Said hello to everyone who was working. I ate a banana.

I ended up in a patients room later and over the course of the morning she had gotten sicker and was requiring more invasive medications. She went on to become more unstable requiring cardioversion with an appropriate conversion response.

These events resulted in numerous people being gathered around. People I know, people I work with all the time. We went about our jobs enjoying each other’s company. Laughing, joking, going about our work and doing our jobs. As we worked we heard the loud speaker pop on.

Working in Critical Care we are more attune to the loud speaker as there are often announcements of various types of Codes that require the response of various Critical Care teams to respond to other areas of the hospital.

This announcement though was one we had never heard before and one in which we weren’t sure was even real.

Code Active Shooter.

We have talked so much in meetings the past few months about raising our awareness to threats and about various policies to implement, but as of yet we had done nothing of significance.

Code Active Shooter.

Working in a level one trauma center it is not uncommon for us to have assault victims, assaulters, gunshot victims, and other patients who arrive after experiencing some precarious event. We often have police in our ICU. I arrived this morning, in fact, to one such police officer sitting camped out near my desk and asking for coffee, for which I directed her.

Code Active Shooter. Labor and Delivery.

Pagers  and phone calls erupted the unit. This was no joke. There was in fact an active shooter on the premises. We were in a state of lock down. No one was to come or go. We were to stand down and stand by.

As we stood waiting another page echoed our halls.

Code MERT. Labor and Delivery.

A Code MERT is when someone who is not admitted to the hospital needs emergent medical attention. Knowing there was an active shooter we deduced that a Code MERT could only mean that someone had been shot. Later we would find this to be true, but it was two someones, not one.

As we continued to stand down and wait, another page echoed our halls.

Rapid Response. Labor and Delivery.

A Rapid Response or RRT is when someone who is admitted to the hospital needs emergent medical attention.

I often accompany the Rapid Response Team. We looked at each other and geared up to go. We were told to wait until it was all clear. And once it was we went.

As I stepped onto the Labor and Delivery unit, the active shooter, who was no longer active, but was now himself shot, was being rushed to the Emergency Room.

I surveyed the area and there was blood everywhere. Drops trailing down hall ways with pools residing in various places.

Nurses were leaning into walls, sure to fall without the support of them against their shaking bodies.

A handful of new mothers stood in the halls with their newborns cradled in their arms.

Police flooded the halls.

The Rapid Response patient was taken to the emergency room and treated.

I stayed for a time more. Desiring to help but no help was warranted. I headed back to the ICU when I encountered hospital administration who asked me to come back. We debriefed in Labor and Delivery. We continued to evaluate the patient census and the health care workers well being. Statements were made, facts discussed, and needs identified.

After some time I walked back to the ICU. I wondered if I wasn’t tracking blood all the way back with me as I felt covered in it from all I saw. Though, honestly I don’t think there was really any on me.

Once back in the ICU, I called the unit to the front and relayed the information that I knew to them. I tried to say the right things. I wonder though if there are right things.

I went down to the ER to see if they needed anything and to show support of our staff. They were now covered in blood from the trauma we had all experienced. They worked tirelessly despite him.

Again I stood with nothing to offer, nothing to do.

After the dust settled I stood at the front of the ICU. The unit secretary sat there and we did not discuss the trivial value of pen sizes. She asked if I was okay really. She came over and gave me a deep hug.

“You’ve seen a lot of trauma in your young life” she said.

She has seen me on many traumatic days. She has watched me over the years on day shifts and night shifts. She has often given me deep hugs.

Since the events there has been an overwhelming outpouring of concern, love, support, and comfort. I am tremendously thankful and encouraged.

I am okay. Truly.

I have, as my friend said, seen a lot of trauma in my young life. But today what I feel is mostly confused. I feel numb. I feel so very tired.

I’ve come home to my pups and some chips and queso and will retreat in a few hours to my bed for glorious sleep and true rest.

I stopped asking why a long time ago, long before COVID.

Honestly, the why doesn’t really matter. It does not change what happened. It does not change what is.

And so, I will forever find rest and solace in these words and be thankful:

The steadfast love of the Lord never ceases,

His mercies never come to an end;

They are new every morning;

great is thy faithfulness.

“The Lord is my portion,” says my soul,

“therefore I will hope in him.”

What I Always Wanted to Be.

When I was a senior in high school we had a career day where we had to go out into the community and shadow a professional.

It was such a struggle for me to find someone. I did not have a clue what I wanted to do with my life, where I wanted to go to school, what I should study. I took numerous aptitude tests and none of them helped guide me into a complimentary field.

I went on to college and earned an undergraduate degree that I have never used. Upon graduation I went to graduate school and earned a master’s degree in something I only used for a short time. Then, years later, I returned to graduate school and earned a second master’s degree in a completely different field.

So, I spent ten years in college, have three different degrees in three different areas, and have student loans that I will never pay off.

It took me a long time to figure out what I was supposed to do.

But deep down I have always known what I always wanted to be.

From the earliest days of my life, I have always always known that I wanted to be a mom.

As a child I had so many dolls. They all had names and stories. I cared for them and carried them and changed them and loved them. They were mine.

As I grew older I always helped with children at church. I cared for them and carried them and changed them and loved them. They were not mine.

For years, I babysat and nannied so much. I cared for them and carried them and changed them and loved them. They were not mine.

Then the babies came. With time I found myself with eleven beautiful nieces and one amazing nephew. I care for them and love them. As much as they are, they aren’t mine.  

All my life I have wanted to be a mom.

I have dreamed such vivid dreams, of holding my newborn baby in my arms and seeing his sweet little face.

I have had hopes and goals and fantasized and dreamed for and about.

I have named him and loved him and wanted him.

But he, but she, but they, are not mine.  

A few years ago I gave myself permission, and in doing so, I learned how silently unhealthy parts of me were and how too much time had passed. I may have given myself permission but it was too late.

Letting go of a dream is hard. Letting go of a life-long goal is hard. Letting go of an identity is hard.

Letting go is hard.

Two weeks from today, I will wake up on the day after.

The day after my total hysterectomy.

Part of me says, it doesn’t matter because I am too old anyway.

Part of me says, it doesn’t matter because I love sleep too much anyway.

Part of me says, it doesn’t matter because I have my dogs anyway.

Part of me says, it doesn’t matter because I am single and it would be too hard and impossible to figure it all out anyway.

Part of me says, it doesn’t matter because I am a good aunt and they’re partly mine anyway.

Part of me says, it does matter. And I am so sad. and disappointed.

I did not know that I could cause the greatest heartbreak of my life, but here I am.

A friend says that maybe I have other things to birth and give life to. And maybe I do. Maybe there are books to write and a house in the woods to build and more dogs to love.

But for these next few days, I will sit in the presence of now, grieve what wasn’t, count the blessings of what is and go to the one who provides rest.

Food. Weight. Weight loss. Exercise.

I love food.

All food.

I love to try new foods and go to new restaurants and learn about other cultures and try their foods. I love French food and Moroccan food and Afghan food. I love Indian food and Seafood and Tex-Mex. I love food.

I have always loved healthy foods. As a child I would opt for the salad bar over pizza. I love most all fruits and vegetables and especially love the rare occasion when I get to try a new one. I love to cut them and cook them and find different pairings.

Food and the experience of taste is one of the most amazing gifts from God and maybe one of my favorite blessings.

We eat to live, but there are times when I have lived to eat.

I love sugar. I absolutely love sugar. There are times when I am obsessed with sugar. Any form: candy, cake, ice cream, hard candy, chewy candy, sugar, honey, etc. And one is never enough. One turns to two turns to five turns to ten.

As a younger person, I worked out all the time. I was extremely active with sports and running and playing with friends and swimming and with whatever activity the day held. Being active and having built up toned muscles led to having a high metabolism. Eating was a pleasure with no bounds. I ate healthy foods, butI also ate a great deal of non-healthy foods.

Time changes things: life, habits, schedules, metabolism, muscle mass, choices, bodies, eating, health.

Sometimes, life changes some things while other things do not.

So, with time, my schedule slowed down, my eating maintained, my habits became more sedentary, my metabolism slowed down, my muscle mass dwindled, and I slowly began gaining weight.

I realized I was changing, but truthfully, I wasn’t concerned or worried or interested. This had never happened to me before and I was in a bit of a state of denial. Despite having a Bachelor’s degree in Exercise Science and a Master’s degree in Nutrition, I did not really know what to do or how to change.

With time, I realized that I fed my dogs cleaner, healthier food than what I was consuming.

I saw myself in pictures and did not understand what I saw. In my mind’s eye, I was still healthy and fit and trim and the pictures I saw did not represent the me I believed me to be.

Working as I do, I have free access to a significant amount of food at all times. It is not healthy foods: unlimited soft drinks, chocolate, chips, crackers, cookies, etc. It would be nothing for me to go through a 13 hour shift having consumed an excess of free foods and think nothing about it. We even joked at work that I was a trash can and would eat anything.

A coworker mentioned this to me one day. Something in the way she said it sounded different this time. I heard her different. Why would I ever be okay with someone equating my body with a trash can, least of all me? God created me as His beautiful workmanship, a temple, and I was allowing my body to become a trash can.

Concurrently, I found myself neck deep in an ICU filled with dying COVID patients. Nothing we did helped them. No meds we administered made a difference. Week after week, month after month, we watched them die.

The ones who had diabetes, hypertension, and obesity were the ones who did the worst. These were preventable chronic diseases that these patients had simply from making poor choices. 

The same poor choices I was making.

I could not help anyone with COVID; only God can do that. But I can help myself. I can make better choices. I can change my behavior and prevent these chronic diseases from taking root in my body. I can honor God with the temple He made me to be and stop treating my body like a trash can.

Around this same time, a friend posted a book that talked about the psychology and neuroscience of eating. Susan P. Thompson, a PhD in Brain and Cognitive Sciences, wrote, Bright Line Eating. From the moment I began reading, I realized that her writings aligned with many of my core beliefs around eating and food. From an anatomy and pathology standpoint, her writing made sense to me. Almost immediately, I bought into and believed in the psychology behind what she wrote. I knew that this was the key for me beginning my journey out of treating my body like a trash can and into the temple I was called to be.

From the start, I have been adamant about not calling this a diet. When you go on a diet, then you go off a diet. I do not diet. I eat. What I wanted was a new way of eating, thinking, behaving. I wanted to change my habits, my mind set, my lifestyle. While I was hopeful to experience some weight loss, that was not my ultimate goal. My goal was to be healthy, to be happy, and to be free from eating in the manner in which I had been eating with no respect for myself.

So, on June 22, I committed to change my life and eat in a more God honoring, self-honoring way.

I committed to more vegetables, more fruits, eating three meals per day, no sugar, no flour, and no snacking.

There were moments in which this was difficult, but within a very short period of time it became automatic.

I ate my portions and I was satisfied, not painfully gluttonously over full. I found that I wasn’t hungry between meals, but calm and more relaxed. I found that my mind wasn’t obsessed with food and that I was mentally free to think on other things. I contentedly looked forward to the next meal without worry. 

Foods began to taste better than they ever have.

I was not exercising and the weight literally just fell off. I simply stuck to the meal plan. Weighed my foods, planned my meals, and was more filled than I have ever been in all my life.

In just under three months, I lost just under 30 lbs. I feel so good and I am so proud of myself.

I believe in exercise. I believe in moving. I believe in taking care of one’s self in all the ways that one should.

But you cannot do everything at once. It takes work and effort to change habits. It takes willpower. 

To change everything at once is to expect too much of oneself. If I had been trying to incorporate more exercise while also trying to change my eating, I strongly believe I would have failed at both. I am not strong enough to have the willpower to do it all. 

As I said, I believe in exercise. Now that I have lost most of the weight and this new way of eating and treating myself is becoming a lifestyle change, I can begin thinking about incorporating exercise. 

I am not quite ready yet, but I am almost there. I believe in taking one step at a time.

And I am so very glad that I did.

Sabbath

I am off today. I slept in. I am resting.  I am cuddling with my pups.

I have been at the hospital, in the ICU, the last 5 days.

I have been in the room with, talked to, interacted with, and done procedures on patients who are positive for COVID-19.

They are sick, they are not doing well.

We are finding that patients tend to do worse in their second week of illness.

We did not know that. There is so much we do not know.

The increased anxiety has seemed to level out the last few days as we are all settling in to our new normal. People are less panicked and more reasonable. But things are still manageable now, I do not know how it will be when it is not.

We are continuing to try and plan and prepare and learn. We are learning more every day just from simple experience and trial and error.

I am thinking on things differently now. For so long we compared COVID-19 to influenza that I came to assume some things that were not true. I assumed that you get COVID like you get the flu. It comes, you deal with it, it is gone. But I am not sure that is true. We do not know what kind of lasting effects it could have, what kinds of chronic illness it could result in or could be. I dismissed that if I got it I would not die from it, but we do not know that, I do not know that.

I have never been concerned or scared to do my job. But I am becoming more and more aware of how dangerous and deadly this is. I will continue to do my job but not without concern.

People must continue to stay home. People can be contagious for up to 5 days before showing symptoms.

I fear it will be many months before this is over. I believe we need to quarantine for a long time to keep safe and to keep this at bay. I believe we are still only in the beginning stages of this virus in our area.

I have plenty of food and toilet paper and electricity and entertainment.

I have a phenomenal dog walker who caters to my pups and is so incredibly supportive of me.

I have good friends and family who are checking in and offering prayers and encouraging texts and messages and sending love.

I have dear ones who have sewn masks and left them on my door step.

Part of me wants to be at work today. Part of me knows I need time off to rest and recharge. Part of me is confused by the reality of what is happening.

All of me is thankful for a steadfast God above.

HIV, HEP C, PPE, COVID-19

In the fall of last year I suffered a needle stick. I knew as soon as I felt the needle that I was in trouble.

It was early in the morning and I responded to a code blue, a cardiac arrest, as I do on a regular basis. The patient needed an emergent line; this means I needed to access a large vein in his groin. Usually, we place central lines in a sterile fashion wearing a gown, gloves, a mask, and a bouffant and the patient is draped with a sterile cover. But in emergencies, I only don gloves. Sterility is not important when the patient is actively dying.

I knew this patient. They were on my service. I knew they were HIV positive. And when the needle pierced my glove and my finger I knew I would be starting six months of frequent lab draws and prophylactic medications. Fortunately workers comp covered it all, the two meds I needed were each more than $2000 per month.

Time has passed. I am HIV negative. I have completed the meds.

Last week I found myself in a code. A patient was having a cardiac arrest. They needed emergent access. I found the vein I needed. But in the process I sprayed myself with the patient’s blood. I was literally covered in it. I knew the patient. They were on my service. They were positive for hepatitis C.

Fortunately this patient has an undetectable viral load and I do not need to worry. This is good because there is no prophylaxis for Hep C.

PPE is so important. PPE, Personal Protective Equipment. I have never had a time in which this resource has not been available to me. As evidenced above, there have been times in which I have chosen not to don this equipment. And times in which that choice has put me in danger. Most of the time I wear the gown and the mask and the gloves and put on all the things and do all the things.

I have thought a lot about HIV lately. Wondering what it was like for those health care providers in those early days. Caring for patients who had a virus that no one understood, that was killing people, that had no cure. I’ve wondered what the hospitals wards were like, what the anxiety and stress level was. I wondered who the nurses and healthcare providers who volunteered in those days to take those patients were. I’ve wondered what motivated them, what scared them, and how other people treated them.

Years and times and science has passed so that I can now walk into an HIV positive patients room during a code, only wearing gloves, suffer a needle stick, and take meds for six months to find that I am not infected by this devastating virus, to move on, to exist as though nothing happened.

Years and time and science has progressed so that I can now walk into a Hep C positive patients room during a code, only wearing gloves, find myself covered in their blood, and find that because they have an undetectable viral load I need not worry. I can wash myself and move on as if nothing ever happened.

And now we have COVID-19.

I have seen my world change the last few weeks in ways that I have never seen before. Health care workers are full of anxiety and confusion about how to best care for the patients with this virus. We are taking volunteers at the beginning of each shift and they are donning the PPE that we currently have available, making the best decisions that they know how to make, but not knowing if they are the best choices are not. We are watching people die from a virus that we do not understand and that has no proven treatment and no real cure. And more and more people are coming.

More and more health care providers are themselves contracting the virus. We all wonder who will be next. If we will get it.

In time we will run out of PPE, rooms, beds, ventilators, medications. I fear in a shorter time than we know.

I do not know what the days will look like then. I do not know that reality.

HIV.

Hepatitis.

COVID-19.

These are all viruses. Antibiotics do not work on viruses. Time will teach us what does.

I love my job. I have always loved my job. I still love my job.

Moving Forward

I suppose I have been dreading, or maybe grieving, turning 40 for years. Fearing that once it arrived I would be deemed a failure for not having achieved so many of the things I had anticipated. Namely, having children. But it has come and gone and I am doing fine. I have made peace with the things I have not achieved and have embraced the things I have.

Last week, I ventured out with two of my sisters for my 40^th birthday. We took a road trip through Oregon. We explored the city of Portland, ate Moroccan food, ate at Camp 18, toured the Tillamook creamery, sat and watched the sunset over the Pacific ocean, drove the coast, missed the sea lions, went to a disappointing buffet, found the end of the Oregon trail, got lost in Powell’s books, resided on the Salmon river, bought some art, stood in awe of Multnomah falls, shopped at the Goodwill, ate a VooDoo doughnut, drove to the state of Washington, and stopped in at Ikea.

It was a beautiful trip. We drove winding country roads and saw the ocean and the mountains and rivers and streams and brilliant leaves. Beautiful tall trees, blue rocks, stellar jays, We ate ethnic foods, and ice cream, waffles, lots of clam chowder, and a doughnut that was okay. We talked and laughed and rested. We rested. We sat in awe of the beautiful creation that surrounded us everywhere we looked.

I have lived in many different places and climates and landscapes. I have always been so deeply fed by the beauty of this earth and the creation that it is. Sitting outside is often a respite to my soul. Being in Oregon was a feast of beauty that will reside within me for some time and feed my soul for a while. I am not sure how I ended up in the wasteland that is Dallas that boasts significant concrete and limited trees. But even in this wasteland, there is beauty to be found, it just requires intentional looking.

Moving forward, I reflect on the 40 notes to my younger self and I rest in #40. I know that I am loved and I am so very thankful.

Turning 40: Notes to My Younger Self. #40 What I Know to be True

#40. What I Know to Be True

Life is hard.

It has not turned out as I had expected.

Sometimes, I am angry that things have not been different, been better, been more fulfilling.

I do not understand so many many things.

I have been hurt.

I have hurt.

But.

But life is also beautiful.

Some things have been better than I could have ever expected.

I am still learning to work through my anger and disappointment and find fulfillment.

I do not have to understand everything.

I am healing.

I apologize.

What I know to be true is that I am deeply loved.

I have real relationships with real people who love me, I have a job that I love and that I am really good at, I have two amazing dogs, I have good relationships with my 12 nieces and nephew, my parents love me, my sisters love me, and I have a good church family.

I am steadfastly loved by God and have been redeemed by Him. His graces is renewed for me every single day.

My dear dear dear young self, life looks different than we expected, but it is good and you are loved. You are growing and learning and thriving. Life is hard, but it is so beautiful. People are so beautiful. You have good people, good community, and a good good life.

As you arrive today at your 40^th year of life, dwell in these truths and always always always be thankful.

Turning 40: Notes to My Younger Self. #39

#39. . . . 

There were so many things I wanted to write about. Things about relationship and moving and people and pain and healing and death and dying and love and joy and grace and peace and home and friends and self care and honor and wisdom and strength.

So many topics I did not get to. So many things I did not say.

Yet, as I sit here, attempting to write the next to last post and fumbling through the title I had already decided on, I feel that I really have nothing in me to say tonight. The previously assigned topic is lost on a paper full of words that sound empty and trite.

I had an appointment earlier today and then I came home. I had intended to do a lot of things but ended up not doing much of anything. I talked with some friends, watched too much tv, watched my pups play, and made some dinner.

I recently worked quite a bit, so I needed a day of rest. But the day is drawing to a close and I feel tired. I do not feel rested. I think the exhaustion of working nights is catching up to me, it so often does.

My parents sent me flowers a week or so ago. They are beautiful. But they are also dying. Some have wilted and are downcast, others are still strong and tall. I suppose life is like this vase, full of health and death and beauty and wilt and strength and downcast.

Earlier I wrote about hope. Now that feels so foreign to me. Which, in truth, is why I have sat with the concept so much this year. Trying to make hope feel real, feel true, feel hopeful.

My dear young self, there are some days when you find that you do not have much left. You will fill empty and tired and done. Listen to yourself. Rest when you find that you are telling yourself to do so.