Around the world and back again

Wednesday was my last day at UT Southwestern.

I’m moving on Monday. Starting a new job the following Monday.

It has been an interesting year. I learned a lot. I saw a lot. I’m grateful for the opportunities I was afforded, the people I worked with.

Cardiothoracic Surgery was interesting. Being on a surgery service was interesting. On day 3 of employment I realized how extremely different it was from critical care. People have a problem, we meet with them, make a plan to fix their problem, they come to the hospital, we fix their problem, they go home. Most of the time it was very cut and dry; in and out.  Challenges are found in schedules, insurance, and discharge plans.

I feel in the last few years that I have been around the world and back again. I have had some of the highest highs and some of the lowest lows. I have been filled with community and lonelier than I could imagine. I’ve learned about days and nights. I’ve been well rested and beyond exhausted.  I’ve lived on the prairie, in the mountains, in the big city. I’ve been to small churches and large churches, conservative churches and liberal churches. I’ve come to understand the value of organized religion but to deeply appreciate my own spirituality.

I’ve come to know who I am in a way that I never had before and to appreciate and love that more than I ever could have before.

I’ve come to value my family and true friends so very very much.

I’m going to work at Vanderbilt. I’ll be working nights in the Surgical Intensive Care Unit as an Acute Care Nurse Practitioner. It’s a faculty appointment for the school of Medicine.

I’m moving to Nashville. I’m starting over; I’m going home.

Every new beginning starts from some other beginning’s end.

All the Difference

Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;

Then took the other, as just as fair,
And having perhaps the better claim
Because it was grassy and wanted wear,
Though as for that the passing there
Had worn them really about the same,

And both that morning equally lay
In leaves no step had trodden black.
Oh, I marked the first for another day!
Yet knowing how way leads on to way
I doubted if I should ever come back.

I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I,
I took the one less traveled by,
And that has made all the difference. 

............................

So much to say in the coming days.

8 times in 4 years.

My Brother Mike

I recently lost a friend. Truth be known I hadn’t really known him long. But he was a true friend, a brother.

He was a sweet, gentle man. An old soul. A little boy. Without knowing him it is really hard to understand that, knowing him it’s hard not to.  

He was from a small town in Arkansas, yet he had traveled the world. He was planning to lead a group to the summit of Mt. Kilimanjaro next summer. He invited me to go and I was so excited.

He raised hundreds of thousands of dollars for non-profit religious organizations, but had trouble keeping his electricity on.

He needed family, so he created it. He called and invested and loved, so deeply loved. Everyone became his family and he was a true brother.

He was a true servant of God and had the most redemptive of stories. He desired to live life to the fullest, but to live it in the way that God called him to. And so he did.

We spent some time together this past spring and talked and laughed and dreamed. We stayed up late into the night; it was sweet time. We tentatively began a conversation of future dreams and I think we both fearfully and secretly hoped they would come to pass. I’m deeply grieved they didn’t. I’m not sure they would have.

We had some hard good talks about things in our lives that we shared: our faith, our paths, our struggles. Talking with him and discussing some truths with him gave me some of the greatest peace. Peace I had so desperately needed. Peace that only someone like him could give to someone like me. His words filled me and eased fears that I didn’t realize I was holding on to so tightly.

He knew God. He lived his life with God. And now he’s with God.

There will be many people to meet me the day I go home to be with our Father. I will be excited to see so many. But I’ll especially be excited to see my brother Mike Woodall.

I’m so thankful for my time with you, thankful for the memory of you. When I miss you I find myself reaching for the book and turning to Isaiah the 53^rd chapter and I hear you. I hear your voice and it is there that I find you reading to me about our Lord, about our Father.
 

Every blessing You pour out
I'll turn back to praise
When the darkness closes in, Lord
Still I will say

Blessed be the name of the Lord
Blessed be Your name
Blessed be the name of the Lord
Blessed be Your glorious name

You give and take away
You give and take away
My heart will choose to say
Lord, blessed be Your name

Hearts, Lungs, and LVADs

When I think back on the past few years I know that I am beyond blessed.

I have had experiences and opportunities that are outstandingly phenomenal. I've done and seen things that most people never get the opportunity to do or see.

A few months ago I got a phone call and was invited to go on a procurement. We frequently use the term "harvest" but it's really not politically correct and is thought to be disrespectful. I think the term harvest is much more encouraging and sincere than procurement, but nobody asked me, and I don't work for UNOS.

A person had died. We were going to procure the heart and the lungs. We went to the local airport, got on a jet, and flew out to get the organs. When I got there I had to change scrubs and met the Liver team and the Pancreas team in the locker room. We chatted. We changed. We procured.

I minimally assisted in opening the chest and assisting with the removal of the heart and lungs. The heart comes out first, then the lungs, then the other organs. I was very proud that our organs were first, as though we were the most important team. Truthfully, though, it was amazing to observe the whole process. There were so many people in that OR. We were stepping on each other. I never looked at the donor. I did not need to see, to know.

We quickly left with our organs in coolers, boarded an ambulance that was waiting for us. They turned the sirens on and we swiftly went back to the airport. We boarded our jet and had a fantastic meal waiting for us. We landed just as we finished eating. The coolers were grabbed. Placed in the surgeons cars and they were off to graft them into the recipients. I was invited to go, but I declined. I'd seen the surgeries before.

Boarding the jet with the organs.

I never saw the donor, I never saw the recipients. I saw the process. I saw the heart. I saw the lungs. It was amazing.

The day after that, I went in on my day off and observed the placement of an LVAD. A Left Ventricular Assistive Device is a battery operated pump that is implanted into the apex of the patients heart and the out flow cannula is sutured to the aorta. This device helps the heart with contractility and helps perfuse the body in a efficient manner. (Essentially, it's a mechanical heart.)  It is frequently used as a destination therapy device or bridge to transplant. So, most of the patients who get an LVAD are waiting for heart transplants.

LVAD

We frequently have LVAD patients and since it wasn't a surgery that I was completely familiar with, I felt like it would be beneficial to observe it. The resident who was assisting got called away. There I was with the Attending Surgeon. "Hold this", he said. "Pull that", he said. "Cut here", he said. And the next thing I knew I was assisting with surgery. I was doing heart surgery. The resident eventually came back and I stepped back and regained my position watching.

I read over the Operative Report the next day and the Attending of record placed me as the assistant. I assisted with surgery. I assisted with open heart surgery. I did that.

For the most part I have found that the surgical arena doesn't quite compliment me. We know what's wrong with the patient. They come to the hospital. We fix them. We get them ready for discharge. They go home. It's pretty cut and dry (no pun intended). But even in the midst of the most mundane of experiences, there are some pretty exciting and phenomenal experiences too.

Living a blessed life.

Here and There

I went to a conference last week. It was a boot camp for Acute Care Nurse Practitioner’s.  The focus was on critical care, on really sick patients, on working in the ICU.  It was at Vanderbilt.

It was good to be there: to hear those lectures, sit in those chairs, walk those grounds, be among those people. I felt professionally revived in so many ways. I felt the passion for my work returning to me. I felt excited again to be who I am and do what I do.  It definitely started some wheels turning.

I was able to attend church while I was there, able to see so many people who are so very dear to me, to receive hugs and kisses and blessings. It was so very good to be there: to sit in those pews, sing those songs, walk those halls, be among those people. I felt spiritually revived in so many ways.

I talked with so many dear friends. I talked with so many sweet people that I love so dearly; countless people who have so deeply enriched my life. I talked with my dear friend Harold, it took me some time to get to him, but when I did, oh how he filled my heart. He said the sweetest words to me: “you know you just belong here”. His words struck me, moved me. I smiled, squeezed his shoulder, walked away.

Belong here.

You know you just belong here.

Belong.

Here.

Isn’t that what we all desperately long for? A place to belong, to fit, to feel at peace. Having moved 7 times in the last few years I know the power of that in a way that I didn’t understand before. Belonging has the ability to give one value, to validate their life.

I have changed in exponential ways the past few years. The person I was in the fall of 2007 is not the person that I am today. I am better for the changes, I am a differnt person. There was a time when I wasn’t sure who I was, what I was, what I wanted, where I wanted to go. I have a resolute understanding of those things now. Life at times gives you difficult challenges, tasks, and bends in the road for the purpose of molding you. I once said that I felt like life was just happening to me and I was just a participant, but I realize it was during those times that I was allowing God to work in my life to mold me. Those were times when I didn’t have the energy to participate and so I yielded and was molded by Him for Him.

The room that I sat in at the conference had a big mirror in the back. A Vanderbilt logo was on it and it had a slogan. I read it multiple times every day. “It’s who we are.” Funny how marketing propaganda can work to encourage and excite you.

Fulfillment, Church, and Chest Tubes

I’ve thought an awful lot about fulfillment lately: what it means to be fulfilled; the difference between fulfillment and contentment – if there is a difference.

Fulfillment is:
• “the state or quality of being fulfilled”
• “the act or state of fulfilling”

Fulfill is:
• “to carry out, or bring to realization”
• “to perform or do”
• “to satisfy”
• “to develop full potential of”

I realized not too long ago that I’m not currently fulfilled in what I’m doing. I’m not satisfied, don’t feel like I’m living up to my full potential. I’m bored. I feel that God demands more from me. I have learned a great deal in cardiothoracic surgery, but I don’t feel used, don’t feel I’m living up to my full potential, don’t feel fulfilled.

Texas has been good to me in many ways, but it hasn’t been all that I had expected it to be. Different truths than my previous expectations don’t mean it has been bad or not good, just different than what I had expected.

Church has been hard. Very very hard. I’m not sure what I’m looking for, not sure where I belong. I believe that American churches aren’t really designed for single people. It’s not intentional or purposeful, but church compliments families and single people sometimes just don’t fit. You’re supposed to grow up, get married, have children. When you don’t people unconsciously wonder what’s wrong with you, wonder why you’re different. Married women my age with children are busy raising a family. Married men my age are hesitant to talk to me, because, of course, I’m looking for a husband and may attack them. Older people want to send me to the college class because that’s where the single people are (even though we are in very very different places in life). Older women want to think of every single man in church and begin planning a meal where they can invite both of us for a “friendly” dinner. Or worse than that, people just simply don’t talk to me. I become invisible and don’t matter. It’s no wonder so many people stop going to church when they move or get divorced or grow up different (single, not married).

I’ve been to 12 churches since I moved to Dallas. I will eventually find my place. It just takes time.

I had to work a few weekends ago on a Sunday. I stepped into a patient’s room to remove chest tubes. These are large bore tubes that reside in the mediastinal area and they are uncomfortable and removing them is painful. The patient spoke the Spanish. I speak very bad Spanish. I really only speak the English. The patient was blind and hard of hearing. I did my best to explain what I was going to do. A family member stood by the bed; they were bilingual. The patient gazed in my eyes and began talking. I asked the family member what they were saying. I was told that the patient was praying for me. Praying for my hands, for my family, for my future. The patient continued to mumble in the Spanish and the cadence of those words deeply touched my heart. I removed the chest tubes. The act pained the patient, they cried out. Then the patient took my hand, and with tear filled eyes the cadence started again. The family member was crying. I was told that the patient was thanking God for me, was again praying for my hands, prayed that I would have family by my bed if I was ever in the hospital. The family member began to cry as they told me these words. My heart was deeply moved.

There are moments of fulfillment, of joy; even at the most unexpected times and during the most unexpected activity (like when I’m inflicting pain).

It was a Sunday. I was not at church. I did not speak the Spanish. I was more fulfilled though and more spiritually moved in that moment than I had been in quite some time. Sometimes church is found outside of walls and in small rooms with people who speak the same language as you, the one of love, of hope, of thanksgiving.

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…

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.

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

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.