the unknown fluid was sent to the lab for identification, and was found to be a combination of dilaudid, benadryl, and phenergan. we didn’t know where she got the dilaudid, because it was not in her list of meds in the hospital. the phenergan and benadryl tablets were her PRN meds.

i’ve always thought that if you crush tablets, dilute and put them in your veins, you will die. i don’t know where i got that stupid idea, but i just did. anyway, she didn’t die, but multiple doses of narcan didn’t wake her up. i had her 2 days after the incident, and only deep sternal rub made her moan a little. i had to pry her eyes open.

of course, we don’t know if she took other narcotic pills PO before she passed out, but we were assuming she did, because a benadryl-dilauid-phenergan tablets pushed through her veins didn’t seem enough to knock her out like that. then again, what do we know? we don’t really see patients melting tablets and shooting them through their veins everyday.

on the third day, she was more awake, but barely. when her eyes were open, they were empty, and stared beyond the empty space. i don’t know exactly what will happen to her. i just know that some people do some sick things, i don’t know now if i will ever be surprised again.

a couple of nights ago, at work, i rode the elevator down to the pharmacy, and a nurse from the third floor joined me. i knew she was working at the birth center, because her badge said so. the lanyard that hung around her neck was probably given to her for free, or she could have bought it to express her personal noble sentiment, i don’t know. i didn’t ask. what i did know was, oblivious to my presence, she didn’t notice i was staring at the words written on her lanyard, and my thoughts brought me somewhere else.

“babies are born to be breastfed babies are born to be breastfed babies are born to be breastfed babies are born to be breastfed”

i remember my aunt telling me “you didn’t try hard enough, you have no patience, and you don’t know how to sacrifice”. words spoken right after she found out i only breastfed (well, technically, breastpumped, since he was in the NICU the first 8 days of his life) my eldest for 15 days. a decision i made then that obviously still haunt me with guilt now that he is already 5 years old. he never had a major illness, except if you count unresolved hydronephrosis, which he was diagnosed with, when he was just 20 weeks in utero.

i got the same kind of remarks from well meaning family members/friends when they found out i breastfed my second son for 15 days only. he is 4 now, never had a major illness, except if you count the fact that he is still being followed up by an ophthalmologist for having delayed visual response, which was noted when he was only a week old. they are both healthy and active, but if they grow up and encounter ANY kind of problem, the possibility of blaming myself for not persevering with breastfeeding them till they were 2 years old will be as predictable as the sunrise.

i never listened to mozart to increase the chance of my kids being musically inclined, or i didn’t read the encyclopedia to prepare them for college entrance tests. i didn’t do any of those things suggested by studies to make a kid’s life predictably successful in the future, yet i am hopeful. hopeful that they will turn out as good citizens, as opposed to being the menace of society

my mom didn’t really know how to read that much. she was only able to sign her name and write numbers, and she barely finished first grade. she probably breastfed all 8 of us for a month or two, then left us to my grandma while she worked her butt off so we can have food on the table. she was physically abusive, and to her defense, didn’t really know any better.

a few years before her death, i started my journey of truly knowing who she was and why she did the things she did. i found out what i wanted to know, and to facilitate healing, forgave and accepted her. to my surprise, on her part, i have never sensed a hint of guilt, not a sense of regret as far as raising her children was concerned.

she was not guilty she didn’t plan all her pregnancies. no guilt in not reading or not singing to us. no guilt in beating some of us till we bled. no guilt in “abandoning” us, leaving us to my grandma so she can work. no guilt. all she knew was, she did what she thought was best, and that was enough.

she passed away without worldly honor and accolades, but one thing she didn’t lack was the genuine love from her children. when we were all mature enough to see beyond the pain, we all chose to accept and understand, and we understood she did her best, and we truly loved her for that.

that’s all i want from my kids. that when they grow up, or even when i’m gone, they would know one certain thing. that their mother loved them. if they returned that love, that would be the bonus.

as far as i know, we all we returned that flawed but sincere love. my mom knew that, and she didn’t flinch in owning that knowledge. no amount of guilt haunted her for the sugary foods she gave us, for the hurting words she threw at us, for her absence from our student life, or for missing out on those well talked about milestones. she didn’t know much about the first few years of our lives, she just knew that whatever it was she chose to do, all those years, she did it knowing it was the best.

why can’t i be like her?

why do i have to be affected by some words written on a some lanyard? why do i have to beat myself up when i’m told home schooling is better? why do i have to beat myself up when i am told private school is the best? why do i have to feel terribly small when i am questioned for not staying at home full time? why do i eat guilt for breakfast, lunch and dinner when it comes to raising my kids?

why can’t i, as a mother, just do what i believe is best, and leave it at that?

i get it. sick people are usually sweet, nice people who only get to show their ugly side when they are in the hospital, because they can’t help it. when they are dependent on others, they lose control of themselves, their lives, and then they snap.

i get it. i am one hundred percent sure i will go through something very similar if i end up being chronically sick with something that requires me to be at the mercy of people i don’t know, who sometimes act like they don’t care, and sadly, sometimes act like it’s my fault i have an autoimmune disease or something.

i get it. sick people are tired of healthcare people poking, touching, asking, ordering, disturbing them like they have no feelings.

this things are not new to me, and are not unexpected.

i understand that illness and the stress that goes with it blur one’s usual reasonable mind. when you are aching all over and are worried sick that you might lose your life and your all very soon, it is natural to think that most, if not all of the people in the hospital are either a threat, or a nagging piece of calloused human being who go through their responsibilities without any hint of empathy. it is easy for patients to generalize and label every hospitalpersonnel to be the villains of their lives, just because they are the ones who are available to be blamed. i get all that.

i realized that my confusion is based on a selfish sense of entitlement. somehow, despite all the things that patients suffer while they are in the hospital i have often assumed that when they see nurses, they will see people who, for once, are their allies, not their enemies.

it’s logical that they don’t like some of their doctors because they feel like they withhold pain meds, they order unnecessary tests, they come at the most unholy hours and ask the same stupid questions, they don’t really listen. it’s logical that they hate the lab people because they cause them pain. it’s logical that the hate the dietitians because they think the food is crappy. it’s logical that they hate the PTs because they think they force them to do physical activities that they’re still too weak to do. it’s logical that they hate….you get the drift.

but nurses? why hate us? in the midst of chaos, of pain, of goos, and blood, we are the ones who keep patients comfortable and happy. we give even when there is no more to give, we listen, we advocate…you get the drift.

i just thought that that fact separates us from all the “annoying” people in the hospital. i just thought i can just say to every rude patient, “i know, they are all uncaring here, you can hate them all, but spare me, i am an angel, don’t you see?”

i just thought that with the things i especially do in attempts to make patients feel comfortable even when they are in a very uncomfortable situation makes me stand out among the rest, and excludes me from patients’ natural responses to illness.

thank you for your comments. it made me realize i was wrong, and that it was arrogant of me to assume that just because i try to do my job well, i will be treated differently.

my burning question: why is it that SOME patients give nurses THE attitude?

it doesn’t make sense.

we are the ones who give patients everything that they need while they are in the hospital. from that little kleenex box, the emesis basin, the commode, the new gown, the extra pillow, the back rub, crackers juice. we change the tv channel, empty the bed pan, empty the urinal, clean dentures, give meds, ask the docs to increase meds, ask the docs to advance diet, ask the docs to talk to their family members, take the vitals to make sure everything is fine, carry out doctors’ orders to facilitate healing and discharge. just as a matter of fact, the list of things we do for the patients is almost endless.

so why the attitude?

i know you cannot call us your friends, but clearly, we are not your enemy. you don’t even have to be nice to us, that is probably asking too much. but is it too much to ask for at least a good amount of civility? just plain and simple.

i just don’t get it. is it because you see us do the dirty job, you automatically think we are lower class professionals and do not deserve the same respect you give your doctors? if you act like you don’t need us and you are better off without us, what made you think that? what?

WHAT IS IT?

_____________________

i apologize for the nonsensical post title.
blame it on my 5 year old’s homework, which has something to do with rhymes.

her voice was tensed and i knew it took a lot to hold those tears. she told me to hold her mother’s right arm, and make sure she won’t reach her foley catheter. i have never seen a tiny, frail looking old lady get so pumped up, that it took four nurses to stop her from getting up and pulling her IV line. i think she didn’t weigh more than a hundred pounds, but as she gripped my arms, she scared me.

she was screaming, her voice hoarse but determined, it scared the patient in the other bed. obsceneties that i have never imagined she knew, she smugly belted out. i’m pretty sure she wasn’t like this. the face of her on-the-verge-of-tears daughter said it all. this wasn’t the same person she called mom, this wasn’t the same person she knew.

while keeping her hand still, i asked if she wanted to sing. she said no, but i started softly humming “amazing grace” anyway. to  my surprise, the other nurse sang a little bit louder than i did, and the next thing we knew, the patient was singing with us, slightly gasping for air.

after a line or two, she started shouting again. the charge nurse decided to transfer the anxious patient in the other bed, we got another nurse to almost pin the patient down, so she can be given a shot. she eventually calmed down, a dressing was placed on a skin tear caused by her kicking the siderails, new blankets replaced the bloody ones that covered her prior to her pulling her IV access out. i wiped her sweaty forehead and stroked her hair, went outside to get her daughter, who, like me, was speechless as we walked what seemed to be an endless hallway from outside, back to the patient’s room.

she started talking to her mom with that controlled but undeniably shaky voice, we all sighed a deep breath, went out of the room, and quietly mulled over our future.

we all had that look that said nothing but meant everything. even when silence seemed enough, i couldn’t stand it. i looked around and begged. ”please, if i ever get alzheimer’s, can somebody go to my house with the insulin, and just give me a thousand units?”

i didn’t say it out loud, but i wanted to add…”so i can call it a day, die in peace, and leave this world without causing so much sadness i didn’t even know, and so much pain i didn’t even intend.”

the past days were spent visiting my dad, who, by the way, has a picture of obama and clinton, kissing. it was posted on his kitchen door. i assumed he hasn’t found something new to amuse his visitors, thus the obviously late political humor conversation piece.

i’ve used up my days off watching stuff about the candidates, because yeah, i want to make that supposed wise decision. due to the fact that even safe programs have what i think are unsafe advertisements for my 4 and 5 year olds, i do not watch tv when they are around. i have watched this parody of the sarah palin interview in abc, on youtube, way before i have watched the real thing on abc. and also, i agree with everyone who said tina fey was dead on when she did sarah palin at SNL. something funny always comes out of politics, why is that?

anyway, as somebody surrounded by pious christians, i will take the liberty here to defend sarah palin’s “the war is a task from God” boo boo. i know this is extremely difficult for others to understand, but a lot of really devoted christians believe everything happens for a reason. in some sense, the line “God’s plan” has always been unconsciously overused and abused. whatever it is that we are facing, it is God’s will. it doesn’t matter if it doesn’t make sense or it is something we do not approve of, there is God’s plan in everything, and we ought to be faithful in following Him, no questions asked. that’s what i think she meant when she said the war is God’s plan.

defending her like this in this specific issue doesn’t mean i will vote for her. for the record, i’m still undecided. yes, i know that is absolutely stupid for some people, but that is the truth. i will not vote for obama just because he is black and promises change; or for mccain just because he is against abortion. there is so much more to know before a decision is made. i am grateful to those took time to comment and expressed their views, and to those who sent me emails/twitter message with links on informations i can read to help me make a decision. THANK YOU, i really appreciate it.

moving on. i also spent most of my days off getting emotional and inspired by this girl’s rise to fame. i may be wrong, but as far as i know, she is the first filipino to enjoy this kind of attention and recognition. she has proven a lot of people wrong. i may be biased because i’m filipino, but ellen degeneres, oprah, david foster, andrea bocelli, and now, celine dion, they can’t be wrong, right?

seriously, her voice is so powerful, it can rock the world. everytime she sings, i feel the pride of her mother’s heart just overflowing and rushing through me like a million tiny needles pricking my senses. everytime she gets a standing ovation, i tear up. she just gives me the chills. the good kind.

charice pempengco, you’ve made every filipino proud!

when we got those chocolate bars you brought back from your vacation in hawaii, and i said, “C is really something else. how can she remember all of us when she is supposed to have a great time with all those gorgeous beaches and her family? when i’m on a holiday, i think of no one but myself.”

you didn’t have to go through all the troubles proving yourself to us. you didn’t have to bother about little things. birthday cards, valentine’s day treats, handmade christmas stuff…the list seems almost endless. you didn’t have to, but you did anyway. you have that gift. that innate gift of desire to make other peole feel special.

touching as that gift maybe, i have to admit that it wasn’t the only reason why you were a great nurse manager. i assume i do not have to elaborate. the tears shed by your satff on your last few days on the unit were probably enough. after all, it is not everyday that people cry their eyes out just because their nurse manager is leaving.

i have worked under your management for over five years. i may have entertained rebellious thoughts about what the management wants from us, but i have never questioned your ability to do your job well. you had plans, and you have what it takes to implement those plans.

i can only imagine how difficult it was to keep the balance between being loyal to your superiors and being dedicated to your staff, but i can say you handled every difficult situation with admirable grace. you knew where to stand, when to be firm, when to listen, when to speak up. that was not easy, but you were that pillar that kept our unit stable despite the problems and the changes.

THANK YOU!

you reminded me that nursing is a calling. a calling that one can do well, even in a manager’s office. the way you put your heart into keeping our unit compliant, and at the same time a warm place to go to not only to earn money but to meet our personal career goals, speaks volume about your personal and professional values. you reminded me that nursing, in any field, done in the right frame of mind, can inspire us to be better human beings. i think that is an unmeasurable accomplishment, whether you acknowledge it or not.

we were lucky to have you. your resignation, although reasonable and understandable, was, on our part, an undeniable great loss. i hope you know that.

they say “imitation is the greatest compliment”. i don’t know about that, but if i may say so, despite the fact that i have no dreams of becoming a nurse manager, if ever that dream changes and i end up wanting to be one in the future, i want to do it the way you did. i want to be a great nurse manager just like you.

i have thought hard about this personally disturbing nonchalance, and the possible reasons why.

is it because i am surrounded by christians who couldn’t care less about politics and the government because  at the end of the day, “God will be in control of everything anyway”?

or is it because i am surrounded by filipinos who came here and became US citizens but couldn’t care less about who will become the next president or VP because at the end of the day, they will “retire in the philippines anyway”?

or is it because i am just surrounded by people, who, in general, simply do not care?

you know you’re not in the right blog if you are expecting some political facts and rants. i know guys who are good and are passionate about that. shrimplate is one, wounded healer is another. but not me. so if you thought you are in here for a good political opinion read, believe me, you are better off checking the right guys.

i’m just here to let you know, that unlike many of those around me, i have registered to vote, and i intend to be heard, no matter how small my voice is. i have nothing against my friends/family/coworkers who will not vote, because i know they have reasons. i may find those reasons questionable, and i may violently/silently question their apathy, but i think they have the right not to vote if that is their decision. also, in some sense, i do know where they’re coming from with their decision not to dive into the chaos that is politics..

for the record, i don’t want you to take this as a declaration that i know way more than everyone around me when it comes to politics. let’s just say that i have the desire to know as much as i can, as opposed to being completely or outwardly uninvolved.

anyway, does this mean i’m already done with the palin-biden, obama-mccain debate in my head? NO.

i know some people who are republicans or democrats find that fact very aggravating. i mean, they all think there is nothing to think about. i can lie to please those people, but i won’t, because even if it is totally stupid, the truth is, i have not decided yet.

i know there are promises being made right now. as candidates are expected to do, they promise the moon, the stars, and even mars as they go on with their campaign. i have nothing against that, but i know for a fact that one can’t really tell if these people will have that so called word of honor. let’s face it, making a promise is easy, and it gets easier each time the applause gets stronger.

let’s put it in perspective that i have only been here for over 6 years, and to be honest, i still have no concrete idea what the real difference between a republican and a democrat is. what i should focus on is what these candidates have done in the past, and what is it that they have that will make them the best leaders in the future? and that, i just do not have time to do yet. i am getting into it, and will eventually make a decision. i have basic concepts, but i think having lived here in the past few years with a republican president is not enough to make me jump to conclusion that all republicans are evil and that it doesn’t make sense to vote anyone who is republican. or that all dmeocrats are heaven sent and it is a no brainer to even think against them.

don’t get me wrong, i do not support the war in iraq. i strongly disagree with it, even though i support those courageous men and women who put their lives in danger for the sake of their country. i am grateful to them, but i want the war to end. i know the democrats claim that the war will defintely be over as soon as obama steps in. and on the other hand, they ask me sarcastically “so YOU want the war in iraq to contnue?” if i tell them i am still undecided. i won’t start a debate, but let’s be realistic here. a war is not ended by mere words. or, taxes and healthcare issues are not addressed my shallow promises.

anyway, this is getting really long. i suppose i should end this by asking you to blatantly sell your candidates to me. by doing that, i get first hand informations that i will never get from the news, and you get to convince one undecided voter.

it’s a win win situation, right?

P has stiff person syndrome.
stiff. that means not relaxed.
person. that means the patient.
syndrome. something that summarizes her symptoms.

i wasn’t that shocked to see her toes and fingers contracted, overlapping and literally so stiff. i kind of expected that. her pain was expected too, but still, her extreme frustration to the point of crying when the meds were not yet due, was difficult to watch.

i do understand the doctors’ inhibitions to follow exactly what the patient said, but sometimes, this line of thinking is questionable to me. i am not saying that it is true all the time, but there are a lot of times when patients come in with a rare illness, and i think it is unfair not to listen to them just because they are asking for meds that resemble the requests of a junkie.

take P for example. she was diagnosed with this rare neurological auto immune disease in 1996. when it is not flaring up, she functions normally just like me. when it flares up however, she is in excruciating pain and her whole body is so sensitive to any stimulus, that she has learned the only way she can cope with it is to be sedated.

so, for the times she had been in the hospital for the flare up, for almost 12 years now, this was how she was managed:

ativan 1 mg IV, dilaudid 2 mg IV, phenergan 25 mg IV. all given at the same time, every 3 hours.

i know. an experienced nurse will turn the light bulb on right away. the judgement will come easy. after all, the said treatment is a very clear picture of a demand every junkie’s dream is made of. i assume that’s how the docotrs feel too. they ordered only phenergan and dilaudid, the requested dose, but every 4 hours.

i don’t know. maybe i’m gullible. but based on her history, this was not a patient who was in and out of the hospital every month, just for the high. i don’t think it was possible for her to fake the whole thing. if she was faking it, well, she might as well grab helen mirren’s oscar. i’m just saying…maybe she knew what she was saying, and after seeing her with lesser doses and farther frequency still crying in pain, maybe it was time to believe her and not let her suffer.

to make the short story long, i believed her, and told her i will talk to the doctor about increasing the frequency of her meds. as expected, my pleas to the on call doctor was in vain. not only that he didn’t want to overrule the attending’s decision, but i also sensed his nonverbal doubts about the patient’s honesty. i felt bad i gave up, but i had no one to blame, i did my part. the whole night, hearing P’s cries for an hour before the meds were due, i was irritated with the fact that doctors decide what they decide, because let’s face it, they don’t deal with the patient face to face for 12 hours. how easy is it for them to say “tell her that’s the most we can give her, and that’s that.” sometimes, i wonder if they will say the exact same words if they were asked to stay at the patients’ bedside and watch/listen to them cry.

i hope i am not making it look like doctors are heartless. i will never make that generalization. what i’m actually saying is, i wish that sometimes, they take the nurse’s assessment and opinions for what the really are and trust that our suggestions are wise and based on good reasons.

another difficult part is, some doctors listen to the patient enumerate their tried and tested treatment plan, but they don’t tell the patient upfront that they will not follow it. the poor patients, convinced that the treatment plan is settled, expect the exact enumerated thing, only to find out from the bearer of bad news (read: the nurse) that “no, the doctor did not order that.” so often, the poor nurse, aware that it is not his/her fault, still stay with the patient to take in all the gripe, blaming how the system sucks the whole time.

we do what we can do most of the times, but sometimes, even THAT, is not enough.

i went home feeling like i lost a battle, but what can i do? the next day, i was off. i talked to the nurse taking care of P just to check on things. i found out the attending eventually followed P’s treatment med request down to the letter. she told me P was asleep most of the day, which was what she wanted, and might be out of the hospital when i go back to work tomorrow.

to make the long story short…at last, a happy ending. i’m glad.

_______________

anyway, you probably noticed. i finally caught the twitter bug. feel free to comment on my senseless musings, or to follow me if you want to. i am following people i know, and i hope you don’t mind. email or tell me in the comment section if you don’t mind being “stalked”.

as always, thanks to shane for setting the twitter thing up, and for hooking me up at healthcare today. and, thanks to beth over at pixel RN, for the help and for “rubbing off” the bug on me. i’ll blame her if i get addicted to twittering. just kidding!

anyway, the supposed intellectualization of nursing.
that sounds like a topic i should not really put my nose into. if you have been dropping by this little blog for awhile, you probably already figured out that i usually just talk about my experiences and how those experiences affect me either in a positive or a negative way.

beth, i completely agree with you that it is a disservice to the future nurses to give them the idea that they will, when they become RNs enter a job that will only involve their autonomy and intellect, just to find out that isn’t the case. after all, when they work at the bedside, they will be expected to look, smell, and eventually clean up vomit and poop just like everybody else.

but if i may disagree, i will point out that i won’t consider what you do in the recovery room as something that does not involve autonomy and intellectual skills. i could be wrong, but i think the reason why you feel that way is because everything has been so routine and common to you. when you think it over, you will realize that a person without your nursing education, training and experience cannot do your work, no matter how simple it is for you, with the same confidence and competence you have, because you practice with that knowledge that backs your actions up.

can you imagine pulling out some random person from the street to watch a patient recovering after a surgery? will that be the same as paying a registered nurse to do it? if you define autonomy as being capable of being left alone to care for recovering patients with the possibility of going bad, and knowing exactly what you were supposed to do even if the doctors are not around, i think you are autonomous. and intelligence? i think you’ll agree with me that it takes more than a set of eyes, a nose, ears, and a pair of hands to assure that the patients are safely recovering.

going back to nursing education of today, i have nothing against pushing students to embrace the idea that a job in nursing requires them to have that certain amount of brain cells, and that they are expected to use them in their future jobs. i think that every profession are gearing that way. it is some kind of a proof that the profession is evolving, and that education is moving forward. it doesn’t bother me that instructors are hyped up about nursing theories and what not, because those theories are important.

what concerns me is the imbalance. if i went to nursing school and was taught that i need to develop ONLY my intellectual skills, i am screwed. there is no such thing, and it will be an ugly scenario for me to dive into bedisde nursing with that expectation.

i have seen new graduates behave like they were on the floor only to question a doctor’s orders and analyze test and lab results like they were expected to change the treatment plan that the attending has in mind. they look the other way when the call light is on and if the patients need bedpans or emesis basin. they don’t say it, but the look on their faces imply that all those gooey “dirty” stuff are not their responsibilities. i could be wrong, but i think nurses with this kind of attitude, whether new or veteran, are misguided.

on the other hand, i have seen nurses, both new and veterans, who act like they are only on the floor to clean up patients’ mess and never question an order or look up test and lab results because it is not their responsibility. they behave like doctors’ blind followers who do not have a mind of their own, and are not confident enough to suggest interventions, afraid that they will not be heard. i could be wrong, but i also think these nurses are dangerous.

where is the balance?

head. hands. heart.
this is the spirit and core of nursing.
this is the definition of nursing.
being an effective nurse is using all three, having all three.
to be effective is to have that balance.
an effective nurse IS a good nurse.

i have mentioned this in a post a long time ago, as i learned it in nursing school, and i will say it again. we cannot work with just our head, overruled by theories and scientific explanations we memorized and understood in universities and act like we do not have hands therefore we are not supposed to clean up poop. it is not enough that we know what a dirty behind can do to a patient. it is not enough that we have the hands to keep them clean. if we are rough and impersonal, not valuing a patient’s privacy because we think keeping them clean is enough, we are wrong.

we have to know what to do, why we are doing it, and how do we do it.
missing one concept is a disadvantage to our patients.
teaching nursing students, who will be nurses of the future, to focus only on one is not right, and it is dangerous.

nursing is head on, hands on, heart on. all together. all at once.
maybe that is enough explanation why there is a nursing shortage.
it is because not a lot of people can be all that, all at once.

smart people who know every pathophysiological explanation for every disease process but can’t be bothered by unimportant nonintellectual things like changing dirty sheets and cleaning gunky teeth or dentures are probably not cut for it. they will be financially compensated but will never be satisfied.

people with a lot of initiative changing gowns, diapers, and keeping the patient’s environment spotless but do not think twice in giving lasix to a patient with a blood pressure of 70/40 are probably not cut for it. they will be very produtive but will never be efficient.

people who are smart and are hands on who make sure the patients are stable and the orders are unquestionable but do not have time to really listen and show compassion are probably not cut for it. they will always be efficient, but will never feel rewarded.

it is hard to be all that all at once.
very hard.

i know that, because to be honest, i cannot say that i am all that, all at once, all the time.
i keep trying, i keep learning. we all keep trying, we all keep learning.

we have to, because beth’s hanging question is universal, straightforward, and clear.
if no one’s going to do it, who will?