Crossing the Bridge

Be careful what you wish for…

2011-12-15T22:27:00.001-06:00

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

2011-12-01T14:24:00.001-06:00

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

2011-11-29T18:20:00.000-06:00

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

2011-11-23T22:53:00.008-06:00

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.

Walking In To Work Tonight

2011-11-21T23:44:00.001-06:00

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

2011-11-17T00:45:00.004-06:00

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

2011-11-04T05:25:00.001-05:00

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

2011-10-28T13:58:00.001-05:00

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

2011-10-25T00:04:00.002-05:00

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

2011-10-22T01:14:00.001-05:00

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.

2011-10-03T01:16:00.002-05:00

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.

2011-09-19T14:48:00.001-05:00

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

Thankful there wasn't a #8.

2011-09-05T05:24:00.001-05:00

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

2011-09-03T20:34:00.002-05:00

"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.

My little BFF

2011-08-23T14:54:00.029-05:00

She says, “I’m her BFF”, and then she giggles. It makes my heart smile.

Haydn, is my oldest niece. And I so dearly dearly love her. I’m often asked if she’s my favorite. I find that question mildly offensive; I’m not going to choose any of them over another. So, the answer to that is no. I don’t have a favorite. I love each of the children (Haydn, Louise, Jonah, Ava, June, Sophia, Caroline, Sweet Nicholas, Baby 9, and Baby 10) as much as the other one, just differently.

I have loved Haydn longer. I have played with Haydn more. Life has afforded me an opportunity to invest more of myself, more of my time with her. We are sweet friends.

Haydn struggles. She has dyspraxia. I don’t completely understand that. I don’t really get it. This isn’t something however that’s wrong with her, it just something about her that’s different from most people. It means that she has a motor learning difficulty that can affect planning of movements and co-ordination as a result of brain messages not being accurately transmitted to the body. So, it doesn’t affect overall intelligence or ability, but just affects particular aspects of development; so she’s not stupid, slow, or autistic. She’s dyspraxic.

People see what they want to see. They hear what they want to hear. They conclude and decide what they want to. It is not my responsibility to raise Haydn, to make decisions for her, to train her up in the way she should go. My only responsibility to her is to love her, to support her, to be the BFF she believes me to be. I hope that I always meet her where she is and not demand that she be more than she can.

I stood right outside the hospital door the night she was born. I waited. I heard her first cry. I found tears streaming down my face. I had a niece. I had a little friend.

I hope that as she grows I’m the big friend that she wants and needs me to be.

Responsibility of Choice

2011-08-22T02:38:00.000-05:00

Sometimes it’s hard to know what to do.

You debate. Do I chose A or B? Do I or don’t I? You wrestle with uncertainty and find that you are frustrated with your own indecision and insecurity on the matter. Choices can sometimes become so burdensome.

And yet, all the while there is a small voice, a gut feeling, that presides within you, that is telling you what to do, that is attempting to lead you, that wishes to be heard, acknowledged, followed.

Why is it that we sometimes find ourselves shying away from that voice, from that gut feeling? Was it not designed to lead us in the right direction? Was it not telling us the way to go, the choice to make?

Fear is often the dominating voice that directs our choices, that quiets that voice within us. We hold on to fear as if it had the power to save us, when in actually it may be the thing to destroy us.

I don’t always know what the right thing to do is. I don’t always know what is best for me, so how can I know what is best for my patient?

“We all make choices”. I say this all the time. I say this to mean each person is responsible for the consequences they create, each person has the freedom to choose something different. But sometimes we’re wrong, and the choices we make aren’t good, and we’re still responsible. We made the choice.

Placing one’s self in a position of authority results in one bearing a great deal of responsibility. There are times when I have found that responsibility to be quite heavy, scary, and grave. I did not know or understand how heavy a weight it would be until I felt it on my shoulders, until I carried it on my back.

I sent her out. I brought her right back. I shouldn’t have sent her out. I knew that. I did it anyway.

We live. We learn. We grow.

Unicorn Spotting

2011-08-17T20:21:00.003-05:00

There are some things we hear about all of our lives. We learn about them in school, study them in our history books, imagine them on television. But the reality of seeing such things is rare and unique and invaluable.

I had such an experience today. Something I have heard about all of my life. I studied about it in school, learned about it in history books and novels, and watched many a movie in which it was featured. Today was not a history lesson, a story, or a movie; it was reality that I encountered.

I suppose the experience was surreal. Yet it was beautiful and magnificent and truly a chance of a lifetime. The sight was one of aged beauty of overcoming significant tragedy.

A few years from now this opportunity will definitely be obsolete. Time with result in extinction. Life, therefore, demanded that I soak up this opportunity.

And so I did.

It’s not every day that you encounter something that once seemed mythical. Not so mythical though, once it has a face.

Coming Home

2011-08-15T11:23:00.033-05:00

Home has become a common theme in my writings. As things have changed so dramatically in my life over the past 5 years combined with the constant moving I've experienced, the idea of Home has come to mean so much more to me than it ever has before. I could link all the posts I've made concerning this topic, but then there wouldn't be any room for this post.

I’ve often reported that Nashville, Franklin, and more specifically, Concord Rd. is my home. That means that home is found in a place, a geographical destination, a physical ground. I still ascertain that fact to be true, but I realized this past weekend that there are multiple facets of home. Home is comprised not just of a physical place but of the people that give that place the meaning it possesses.

I traveled this past weekend on a whirlwind trip to see one such person. The calendar is only three weeks shy of making it a year since I had seen her. I can attest that 49 weeks is much too long, yet it was like it was yesterday and I know that the next time will simply feel like tomorrow. Time does not pass with true friends.

The Bible speaks of Jonathan and David’s relationship; I Samuel reads, “the soul of Jonathan was knit to the soul of David, and Jonathan loved him as himself.” I suppose there are very few people in life that find their soul knit together with another, with a true friend.

We were not in Nashville or Franklin or at Concord Rd. Yet, my soul was at home.

There is such comfort in being with another who knows you like she knows herself. There is such comfort in being with another who loves you so unconditionally, so purely, so undeniably. There is such comfort in being with a friend who completely understands what it truly means to “get Jesus” and lives her life in such a way, without judgment. There is such comfort in being with another who helps make you stronger, healthier, better, happy. There is such comfort in being with someone who is knit to your soul.

Life and time has afforded me amazing opportunities and experiences with Karen Craun Perkins. We have laughed and cried and shared so much. We have traveled many miles: Hawaii, Las Vegas, Georgia, and many other simple towns. We can shop together and it works. We enjoy eating new foods. We appreciate the ups and downs we independently experience. We share our faith.

Sometimes we find that home isn’t found in a place, but in a person.

Circadian (out of) Rhythm

2011-08-11T15:59:00.007-05:00

I’ve mentioned it before, (night shift, 36 in 48) but it seems that the gross reality of the situation has been staring me in the face lately. I am NOT a night person. I, specifically, was not designed to stay up all night long and sleep during the day. It is against my personal nature, against my circadian rhythm .

Yet every time I work it’s either a 24h shift or a 12h shift and it’s always during the night, always demanding that I sleep the next day. Some people thrive with this type of schedule, some people not so much. Me? Not so much. I hate the way it makes me feel, hate that I spend my “off” time recovering, hate that I’ll just have to do it again in a few days.

I think it may feel worse today because I’ve been off so long and my body and sleep cycle is super out of sync with sleeping during the day. It may be because I slept just enough last night to not sleep very much today, to make me feel exhausted when I go in tonight.

Vacations are always wonderful but it seems I always have to pay for them in some way on the back end. If anything, during a vacation when I finally start to feel “normal” it just makes me realize how exhausted I feel most of the time.

There are two thoughts that I have seemed to adopt as steering themes for my life:
1. There are positives and negatives to everything and
2. We all have choices.

I enjoy critical care, that’s a positive. Critical care is a 24h, 365d job; sometimes that’s a negative. I worked last year on Christmas Eve, Christmas Day, and the day after; that’s just the fact. The hospital and health care arena have different time demands than a lot of other arenas do. I knew that and I chose to adopt that arena for my life, which was my choice.

I fear though, in the very near future, that my paradigm is going to shift the remaining positives to negatives and demand that a choice be made. With every new choice there will still be positives and negatives facets. But it is my responsibility to myself to make choices in which the positives outweigh the negatives. Sometimes that choice is simply in how we view our perspective, sometimes it reaches beyond that.

So what does my future hold? We shall see. But we all have choices…

9 days off, 2 nights on

2011-08-10T16:26:00.002-05:00

I’ve been off for 9 days.

I’m working the next 2 nights.

It’s nice to have a break sometimes, to get away from the drama that is the ICU. The last shift I worked my patient started crashing. They had been “fine” most of the night and then they weren’t “fine”. I almost lost them.

It’s amazing sometimes how quickly things can change. How swift things can go from okay to bad to worse. When things go worse it usually takes days to recover and that waiting time is difficult, almost unbearable for families because there’s no guarantee that it will go from worse to better.

I had a friend with me that day. A friend that is about to enter her senior year in high school. She flew in from Nashville, TN to spend some time with me. I invited her to spend a weekend learning about the hospital, the ICU, critical care, nursing duties, my responsibilities, and to essentially let her shadow my life.

It was interesting to evaluate my life through someone else’s eyes, to think about things in a completely new way. It’s hard to remember what it’s like not to know something. It’s hard to know what it was like when I was learning things for the first time. I worried all weekend that she would be bored, that she wouldn’t learn anything, that she would feel like it had been a waste of her time. But I was trying to look at her experience through my eyes, it was her eyes I should have been looking through.

She watched when the patient started crashing, when we intubated, placed the central line, the arterial line, and simply worked as a team to emergently save the patient. I’ve seen this situation numerous times; it’s what I do. She had never seen that situation before.

I don’t have her eyes. I don’t know exactly what she saw and how that situation impacted her. But I believe that event had the potential to be a life altering moment in her life. It had the potential to shape her view of health care, critical care, team work, and emergent situations.

I’ve been off for 9 days.

I’m working the next 2 nights. Hopefully, with different eyes.

Opportunity

2011-08-09T18:37:00.002-05:00

There are times in life when we find ourselves in situations that we never intended to be in. We aren’t always sure how we got there, how to get out of them, or what to do. Change is hard. Life is difficult. Sometimes circumstances make us so incredibly lonely.

It’s hard to do that which is right sometimes. It’s hard to change.

There are also times in life when unique opportunities present themselves; when we find ourselves in amazing situations that bless us in indescribable ways. These situations work to make us stronger, help change come easier, and make us feel less alone.

This weekend, life afforded me such an opportunity. I found myself surrounded by a group of people who enriched my life and initiated lifelong friendships. We shared. We laughed. We cried. We grew.

I do not know what the future holds. I do not know the plans that God has for me. I do not even know the course of tomorrow.

But I do know that I’m loved. I know that I’m not alone. I know that I am blessed beyond measure. I know that there is always someone there to lend a hand, an ear, a hug, a prayer. There is strength in these truths, hope. There is a new found knowledge that I will never be in a circumstance such as this again that will result in incredible loneliness. Thank God for that.

2011-08-05T12:15:00.001-05:00

"You're a prize," she said, "you can do anything you want" . And you know what? She's right.

2011-08-03T07:32:00.001-05:00

Round and Round and Round she goes. Where she stops, nobody knows.

A Home for Ruth

2011-07-26T15:35:00.009-05:00

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.

Living the Dream

2011-07-25T03:46:00.000-05:00

“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.